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CCIIO releases EHB document providing information on benchmark plans

Posted on July 2, 2012 | No Comments

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The Centers for Medicare & Medicaid Services’ (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) released a document today which provides information to facilitate States’ selection of the benchmark plans that would serve as the reference plans for the essential health benefits (EHB). This document complements the bulletin on the EHB released on December 16, 2011. Using data from HealthCare.gov, this document provides below an updated list of the three largest small group insurance products ranked by enrollment for each State. In addition, lists of the three largest nationally available Federal Employee Health Benefit Program (FEHBP) plans are also provided.

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A report recently published by Georgetown University's Health Policy Institute, funded by the Robert Wood Johnson Foundation (RWJF), describes how states and health insurers are adopting the Affordable Care Act's (ACA) essential health benefits (EHB) requirements. Pursuant to the ACA, insurers offering plans in the individual and small group health insurance Marketplaces are required to offer benefits within the 10 specified EHB categories. RWJF found that for most Americans, benefit coverage will not drastically change. If anything, most individuals will now have access to services previously not covered by insurance, such as maternity health, mental health, and prescription drugs.
The Commonwealth Fund published a study today describing how 24 states and the District of Columbia selected the benchmark plans to offer in their respective state insurance marketplaces. The Affordable Care Act (ACA) calls for a set of essential health benefits that state insurers must offer to ensure comprehensive and adequate coverage. The federal government permitted states to choose their own benchmark plans, pursuant to ACA requirements, that serve as a reference point for the essential health benefits package. All but five states have selected a small-group plan. This study analyzes the methodology used to select state benchmark plans, which included approaches such as intergovernmental collaboration, research, and stakeholder engagement.
A proposed rule released by the Department of Health and Human Services (HHS) would establish data collection standards necessary to implement aspects of Essential Health Benefits (EHBs), a provision of the Affordable Care Act (ACA). The rule outlines the data on applicable plans to be collected from issuers to support the definition of essential health benefits and establishes a process for the recognition of accrediting entities as qualified health plans (QHPs). HHS, the states, Exchanges, and health insurance issuers would use the collected information to better define and evaluate EHBs. Section 1302 of the Affordable Care Act (ACA) establishes EHBs...
On December 16, 2011, the Department of Health and Human Services (HHS) released a Bulletin describing the approach it intends to take in future rulemaking to define the essential health benefits (EHB) under the Affordable Care Act. This document of frequently asked questions (FAQs) is intended to provide additional guidance on HHS’s intended approach to defining EHB. This bulletin describes a comprehensive, affordable and flexible proposal and informs the public about the approach that HHS intends to pursue in rulemaking to define EHB.  HHS intends to propose that EHB are defined using a benchmark approach. Under the department’s intended approach, states would have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” This approach would give states the flexibility to select a plan that would best meet the needs of their citizens.
The Affordable Care Act (ACA) identified ten categories of services and items to be included in essential health benefits (EHBs), and specified that the scope of EHBs must be equal to the scope of benefits provided under a typical employer plan. The ten categories include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. A white paper issued in December by the Department of Health and Human Services's Office of the Assistant Secretary for Planning and Evaluation (ASPE) found...
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
The U.S. Department of Health and Human Services (HHS) has issued a pre-rule informational Bulletin which lays out its proposed approach for determining the Essential Benefits package required of all qualified health plans (QHPs) under the Affordable Care Act (ACA). HHS deferred to States' judgment by allowing a State to create a benchmark essential benefits package from a currently-available plan within the State, as long as the package includes benefits from the ten benefit categories laid out in the ACA. HHS proposes that States choose the benchmark plan from a list of plan types:
  • One of the three largest small group plans in the State by enrollment
  • One of the three largest State employee health plans by enrollment
  • One of the three largest federal employee health plan options by enrollment
  • The largest HMO plan offered in the State’s commercial market by enrollment
If a State does not select a benchmark plan, HHS intends to propose that the default benchmark be the benefits package from the largest small group plan within the State. For more information on Essential Benefits, click here.
In February 2012, CMS issued a supplemental document entitled Frequently Asked Questions on Essential Health Benefits Bulletin. This supplement to the December 16th Bulletin provides answers to 22 questions arising from the December 16th Bulletin itself. Highlights are as follows:
Approximately 49 million nonelderly Americans are uninsured. Of those, approximately 20 percent have the financial means to buy health insurance but decide not to and instead rely on emergency care when necessary; the rest desire insurance but are denied coverage or cannot afford it. Even though uninsured, some individuals in the latter group receive medical services, resulting in approximately $43 billion worth of uncompensated care costs. These costs are recouped through higher charges for health care services, thereby producing a cost-shifting effect that results in higher premiums for those who are insured. This cost shift is...
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
Under the Affordable Care Act (ACA) beginning January 1, 2014, state insurance Exchanges become operational and comprehensive insurance market reforms take effect. One of the most significant market reforms is the requirement that all health insurance plans sold in the individual and small group (100 employees or fewer) markets – whether sold outside or inside state insurance Exchanges – cover “essential health benefits” (EHBs). The definition of EHBs also will apply to Medicaid “benchmark” plans, the specified coverage standard for individuals made newly eligible by the ACA’s Medicaid expansions.