The Coalition has worked closely with the Department of Treasury and the Department of Health and Human Services to amend IRS guidance and Safe Harbor rules to allow health plans the flexibility to cover chronic disease management medications pre-deductible in HSA-HDHPs. In 2019, the Coalition reached a significant milestone: the IRS released Notice 2019-45, allowing a specified list of services connected to specific conditions to be covered pre-deductible. The Coalition has long supported and called for updated guidance to expand the preventive service safe harbor, and the 2019 guidance aligns with our mission to advance value-based insurance design (V-BID).

The Coalition continues to advocate for broader flexibility, to best meet the needs of individual consumers, including the introduction of the Chronic Disease Management Act of 2020.

The Coalition has supported both administrative and legislative paths, including:

• The introduction of the Chronic Disease Management Act of 2020 by champions in Congress to codify broad flexibility to include chronic disease management drugs and services pre-deductible in HSA-HDHPs.

• Working closely with the Treasury Department to expand preventive care safe harbor rules for HSA-HDHPs.

Recent Updates

Letter to Congressional Leadership in Support of Enacting the Chronic Disease Flexible Coverage Act

On November 28, 2023, the Coalition sent a letter to Congressional leadership expressing strong support for the passage of the Chronic Disease Flexible Coverage Act, introduced by Senators Thune and Carper as S. 3224, a Senate companion bill to H.R. 3800. The Coalition continues to advocate for ensuring additional high-value items and services may be provided pre-deductible so the 6 our of 10 Americans with chronic conditions have access to the care they need to stay healthy.

Letter to Senate Leadership in Support of Amendment Advancing Chronic Disease Management Act

On July 26, 2023, the Coalition sent a letter to Senate Finance Committee leadership expressing strong support for the amendment advancing the Chronic Disease Management Act and urging its unanimous adoption. The Coalition continues to advocate for ensuring additional high-value items and services may be provided pre-deductible so the 6 our of 10 Americans with chronic conditions have access to the care they need to stay healthy.

Letter to Treasury and IRS Urges Protecting Flexibility of Pre-Deductible Coverage of USPSTF High-Value Services

On March 30, 2023, the Coalition sent a letter to Treasury Secretary Yellen and IRS Commissioner Werfel, urging Treasury and IRS to issue guidance that confirms a plan will not fail to be an HDHP solely because it covers, pre-deductible, items and services that have a recommendation of the USPSTF with an A or B rating. This is an extremely important issue given the proven benefits of preventive services for patients.

Letter to the Administration Raising Awareness about the Overwhelming, Positive Response to Notice 2019-45

On November 29, 2021, the Coalition sent a letter to the Administration to provide very encouraging data about the number of health plans and employers that have changed their plan benefit designs in response to the IRS Notice 2019-45 guidance. As a result of this overwhelming, positive response, the Coalition urges the Administration to expand the list of items and services that may be covered under the preventive care safe harbor to include additional high-value, low-cost drugs and services used to prevent complications of other chronic conditions, especially those that would prevent exacerbation of mental and behavioral health conditions, helping millions of Americans improve their mental and physical health.

HSA-Eligible Health Plans Embrace Changes to Better Serve Americans With Chronic Health Conditions
A new survey conducted by AHIP and the Smarter Health Care Coalition (SHCC) found that most health insurance providers and many large employers have taken advantage of new regulatory flexibility to cover more chronic disease prevention services on a pre-deductible basis. The survey, which assessed health insurance provider uptake and changes in the benefit design for Health Savings Account (HSA)-eligible high-deductible health plans (HDHPs), also noted that diabetes and heart disease are the two most commonly targeted conditions for reducing or eliminating cost sharing.

Letter in Support of the Chronic Disease Management Act of 2021

On April 28, 2021, the Coalition sent a letter to Senators Thune and Carper in support of the Chronic Disease Management Act, urging congressional leadership to take up the bill as part of any next moving legislation to address health care.

Senators Thune and Carper re-introduce Chronic Disease Management Act of 2021

On April 28, 2021, Senators Thune and Carper re-introduced the Chronic Disease Management Act of 2021 which builds on IRS Notice 2019-45 to expand pre-deductible access to drugs and services to better manage chronic conditions. The Coalition also distributed a press release and Inside Health Policy published the following article.

Letter in Support of the Chronic Disease Management Act of 2020
On April 23, 2020, the Coalition sent a letter to U.S. Senate and House leadership in support of the Chronic Disease Management Act being included in the next COVID-19 legislative package.

Letter in Support of the Telehealth Expansion Act (S. 3539)
On March 20, 2020, the Coalition sent a letter to U.S. Senate and House leadership in support of the Telehealth Expansion Act (S. 3539).

The IRS Released Guidance for High Deductible Health Plans and Expenses Related to COVID-19
On March 11, The Internal Revenue Service released Notice 2020-15, High Deductible Health Plans and Expenses related to COVID-19, that confirms employers and health plans may waive out-of-pocket costs for coronavirus testing and treatment for individuals enrolled in high deductible health plans coupled with Health Savings Accounts. Read our press release on the guidance here.

IRS Releases Notice 2019-45
Treasury Secretary Steven Mnuchin issued guidance to expand the scope of the preventive services safe harbor for health savings account-eligible (HSA-eligible) high-deductible health plans (HDHPs) to cover certain chronic disease services and drugs on a pre-deductible basis. “We commend the Administration, with the support of bipartisan, bicameral champions in Congress, for continuing to pursue policies that get more health out of every health care dollar our country spends” — Read the Coalition’s full press release on the guidance here.