In a follow-up to a blog I posted last month, I thought I’d look into whether allowing states to define essential health benefits themselves, rather than having the feds create a national standard, could inspire some states to move forward on the development of an insurance exchange.
A 13-page “bulletin,” issued by CMS’s Center for Consumer Information and Insurance Oversight on Dec. 16, proposed that states use an existing health plan to define the benefits that must be included in individual and small-group plans beginning in 2014. In a telephone interview, Rhode Island Lt. Gov. Elizabeth Roberts (D) told me she was surprised that the feds didn’t take a more prescriptive approach.
Some states might have decided against launching an exchange if HHS had required all qualified health plans to include a very broad level of essential benefit levels. Giving that control to the states gets HHS out of what could have become a political problem as consumer groups pushed HHS to deem certain coverage as essential, according to Bryce Williams, CEO of Extend Health, a Medicare insurance exchange.
The bulletin calls on states to select an existing and popular plan to set the “benchmark” for items and services to include in the essential benefits package. For 2014 and 2015, states can choose among four benchmark plans: (1) one of the three largest small-group plans in the state, (2) one of the three largest state employee health plans, (3) one of the three largest federal employee health plan options, or (4) the largest HMO offered in the state’s commercial market. HHS said it would assess the benchmark for 2016 and beyond based on evaluation and feedback.
Do you think that allowing states to determine their essential health benefits will encourage them to move forward on the development of state insurance exchanges?
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