HHS will al­low states to de­fine ben­e­fit pack­ages

Modern Healthcare - - LATE NEWS -

HHS will al­low states to de­fine their own “es­sen­tial ben­e­fit” pack­ages of cer­tain ser­vices that cer­tain in­sur­ers must cover un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act. In guid­ance is­sued in a bul­letin in­tended to gen­er­ate pub­lic feed­back, HHS wrote in its com­ing rules im­ple­ment­ing re­quire­ments that it will al­low states to se­lect from among plans al­ready op­er­at­ing within their bor­ders. The law re­quires all non-grand­fa­thered small­group and in­di­vid­ual in­sur­ance mar­ket plans na­tion­wide to cover a core group of ser­vices, known as an es­sen­tial ben­e­fits pack­age, start­ing in 2014. “We’re propos­ing an ap­proach that al­lows states to tai­lor the es­sen­tial ben­e­fit pack­ages to the needs of their own res­i­dents,” HHS Sec­re­tary Kath­leen Se­be­lius said in a call with re­porters. The state-level flex­i­bil­ity will come with strict lim­its. The only ex­ist­ing plans that could serve as a bench­mark for a state’s pack­age are: one of the state’s three largest small-group plans; one of its three largest state em­ployee health plans; one of its three largest fed­eral em­ployee health plans; or the largest HMO plan of­fered in the state’s com­mer­cial mar­ket. How­ever, any plan se­lected by a state must cover all 10 re­quired cat­e­gories of care or the state will have to se­lect cov­er­age of the un­cov­ered cat­e­gories from other bench­mark in­sur­ance plans, such as the Fed­eral Em­ployee Health Ben­e­fits Plan. The 10 cat­e­gories of care in­clude pre­ven­tive care, emer­gency ser­vices, ma­ter­nity care, hos­pi­tal and physi­cian ser­vices, and pre­scrip­tion drugs. The cost-shar­ing aspects will be ad­dressed in fu­ture bul­letins. HHS of­fi­cials de­clined to pro­vide a time­line for ei­ther the pro­posed or fi­nal rules for es­sen­tial ben­e­fits pack­ages.

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