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.
Late News: HHS will allow states to define benefit packages
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 small-group 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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