ICYMI: HHS and OPM Underscore Commitment to Reproductive Health Care

In statements released yesterday, the Department of Health & Human Services (HHS) and Office of Personnel Management (OPM) acted on the positions the President announced last week in response to the Supreme Court's ruling on reproductive health care, which breaks with almost 50 years of precedent upheld by Justices appointed by Republican and Democratic Presidents.

A joint letter signed by Secretaries Xavier Becerra, Marty Walsh, and Janet L. Yellen of the U.S. Departments of Health & Human Services, Labor, and Treasury, respectively, underscored their commitment to enforcing the Affordable Care Act (ACA) requirement that health insurance issuers and group health plans provide contraceptive services at no cost. In all 50 states, the ACA guarantees free birth control, contraceptive counseling, and other women's preventative services, and the letter affirms the agencies' commitment to ensuring that these services are covered.

In separate FAQs issued yesterday, OPM reaffirmed its commitment to allow employees to use Sick Leave to cover travel time for medical examination or treatment, including for reproductive health services.

Read more below:

HHS: Secretaries Becerra, Walsh and Yellen Underscore Contraceptive Coverage Requirements for Private Insurance
CONTACT: media@hhs.gov

Secretaries Call on Health Insurance Industry to Ensure Access to Contraceptives

Today, Secretaries Xavier Becerra, Marty Walsh, and Janet L. Yellen of the U.S. Departments of Health & Human Services, Labor and Treasury (Departments), respectively, issued a letter to group health plans and health insurance issuers reminding them of their obligations under the Affordable Care Act (ACA) to provide coverage for contraceptive services at no cost.

In all fifty states, the ACA guarantees coverage of women's preventive services, including free birth control and contraceptive counseling, for individuals and covered dependents. Recent reports have shown that some issuers and plans may not be appropriately providing this coverage. The letter is another step for the Departments to put the industry on notice for the required coverage and demand prompt action to ensure that people can rightfully access the birth control they need.

"The Biden-Harris Administration is committed to strengthening access to care and coverage. We are calling on the industry to remove impermissible barriers and ensure individuals have access to the contraceptive coverage they need, as required under the law," wrote the Secretaries in the letter. "It is more important than ever to ensure access to contraceptive coverage with no out-of-pocket costs under the Affordable Care Act."

"Preventive reproductive health care is critical health care. The contraceptive coverage requirements under the Affordable Care Act have been in place for over a decade, and we expect plans and issuers to meet these obligations," said CMS Administrator Chiquita Brooks-LaSure. "The Biden-Harris Administration is committed to ensuring access to health care for all, including access to contraceptive coverage at no cost."

Plans and issuers are required to cover, at no cost, at least one form of contraception within each of the contraceptive categories identified by the U.S. Food and Drug Administration (FDA). This includes instances when an FDA-approved, -cleared, or -granted contraceptive product that is recommended by the individual's medical provider does not fall within one of the identified categories. Specifically, plans and issuers are required to have an easily accessible, transparent, and sufficiently expedient exceptions process in place that ensures individuals can receive coverage without cost sharing for the FDA-approved, -cleared, or -granted contraceptive product that is medically appropriate for them. This coverage must also include the clinical services, including patient education and counseling, needed for provision of the selected contraception.

The Departments are concerned about complaints received regarding the industry's failure to provide coverage of contraceptive services, without cost sharing, in a manner consistent with the standards set forth by the Departments. The Departments expect plans and issuers to immediately take steps to ensure that they are complying, and they may take enforcement or other corrective actions as appropriate.

Today, the Departments also convened a meeting with national leaders where the health insurance industry are expected to commit to promptly correcting all areas of potential non-compliance and to take specific actions to ensure that their members have access to contraceptive services at no cost.

Find more information here: https://www.cms.gov/files/document/letter-plans-and-issuers-access-contraceptive-coverage.pdf - PDF.

OPM: Availability of Sick Leave for Travel to Access Medical Care

The purpose of these FAQs is to make clear that Federal employees may use sick leave for travel time associated with accessing medical care.

1. May sick leave be used to cover travel time to a location where a Federal employee will receive medical examination or treatment?

A: Yes. An agency must grant sick leave to an employee for the employee to receive medical examination or treatment. 5 CFR 630.401. Accessing that medical examination or treatment typically involves travel, and that travel can be covered by sick leave to the extent that the travel time occurs during the employee's tour of duty established for leave-charging purposes. While such travel will generally be short distances—for example, to and from a local doctor's office or hospital—an employee may find it necessary to travel longer distances, including out of state, to obtain medical care. In such instances, sick leave may be used to cover necessary travel time.

2. May sick leave be used to cover travel time for a Federal employee who accompanies a family member to a location where the family member will receive medical examination or treatment?

A: Yes. An agency must grant sick leave to an employee for the employee to provide care to a "family member" (as defined in 5 CFR 630.201(b)) receiving medical examination or treatment, subject to applicable annual limits. 5 CFR 630.401(a)(3). An employee's travel time in connection with a family member's medical care would be covered by sick leave on the same basis as described in Question 1.

OPM has explained this previously in a FAQ: "May I use sick leave to take a family member to a medical appointment? The intent of OPM's regulations governing the use of sick leave for family care is to allow an employee to provide physical care and other assistance to a family member, as appropriate. This may include, for example, providing transportation and/or accompanying a family member to a health care provider's office or to a hospital or other health care facility."

3. When should an agency advance sick leave to a Federal employee?

A: When an employee has not accrued sufficient sick leave to meet the employee's needs, an agency may grant advanced sick leave. This sick leave can be used for the employee to receive medical examination or treatment or for the employee to provide care for a family member receiving medical examination or treatment, subject to applicable annual limits. 5 CFR 630.402. An employee's travel time in connection with accessing this medical care would be covered by advanced sick leave on the same basis as described in Question 1.

4. How should a Federal employee request sick leave?

A: An employee should request sick leave within such time limits as the agency may require. 5 CFR 630.404. An agency may require employees to request advanced approval of sick leave for medical examination or treatment. If the employee complies with the agency's notification and certification requirements (see Question 5 below), the agency must grant sick leave.

5. What type of supporting evidence must a Federal employee submit for the use of sick leave?

A: An employee should provide administratively acceptable evidence for the use of sick leave. 5 CFR 630.405. An agency may consider an employee's self-certification as to the reason for the employee's absence as administratively acceptable evidence, regardless of the duration of the absence. For an absence in excess of three workdays (or a lesser period when determined necessary by the agency), an agency may require the employee to provide a medical certificate or other administratively acceptable evidence. A medical certificate simply means a written statement signed by a physician or other practitioner certifying that the employee received an examination or treatment; it need not contain details regarding the medical examination or treatment.
5 CFR 630.201(b).

6. In addition to sick leave and advanced sick leave, what other options are available to a Federal employee who needs to receive medical examination or treatment?

A: An employee may be able to receive donated leave through an agency's Voluntary Leave Transfer Program (VLTP) or Voluntary Leave Bank Program (VLBP). Under VLTP (which agencies must administer), an employee may receive donated annual leave directly from another employee. Under VLBP (which agencies are not required to administer), an employee may receive donated annual leave if they are a leave bank member.

To qualify for leave under these programs, an employee must be experiencing a "medical emergency," which means the employee or a family member has a medical condition that will require the employee to be absent from duty for a prolonged period that will result in a substantial loss of income due to the unavailability of paid leave. 5 CFR 630.902, 5 CFR 630.909, 5 CFR 630.1009, 5 CFR 630.1002. The employee
must exhaust their available paid leave and be in leave without pay status for at least 24 hours before receiving leave under VLBP / VLTP. An employee may use leave under VLBP / VLTP for necessary travel to access medical care on the same basis as described in Question 1.

In addition, an employee is entitled to 12 weeks of FMLA leave during any 12-month period for certain qualifying circumstances, including the existence of a serious health condition that makes the employee unable to perform any one or more of the essential functions of the employee's position, or to care for a family member who has a serious health condition. 5 CFR 630.1203(a). An employee may use FMLA leave for necessary travel to access medical care for an employee or an employee's family member on the same basis as described in Question 1.

For more information concerning sick leave and other forms of leave available for the healthcare needs of a federal employee or an employee's family member, please see OPM's website.