CMS outlines Basic Health Program standards

The CMS on Friday laid out the standards for the healthcare reform law's Basic Health Program, which gives states the option to establish a health benefits program for low-income individuals who otherwise would be eligible to buy coverage in the health insurance exchanges.

Effective after Jan. 1, 2015, this program would affect individuals whose incomes are between 133% and 200% of the federal poverty level.

Under a proposed rule (PDF), the CMS would give states the choice of using an annual open-enrollment model—which the health insurance exchanges will use—or the continuous enrollment model that is used in Medicaid and most Children's Health Insurance Plan programs. In addition, it defines the types of entities that can contract with the state to provide a standard health plan for Basic Health Program enrollees, and proposes a minimum standard of benefits, or "essential health benefits," and makes provisions for other benefits.

Consistent with the Patient Protection and Affordable Care Act, the rule provides that monthly premiums can't exceed the monthly premium an individual would have paid if she or he had enrolled in the second-lowest cost exchange silver plan. And it establishes the same cost-sharing standards used in the insurance exchanges and prohibits cost-sharing for preventive services.

The rule outlines the procedures for a state-submitted Basic Health Plan blueprint that states need to become certified to implement the program. It also includes the eligibility and enrollment requirements for standard health plan coverage, information about federal funding for state-certified Basic Health Program plans, purposes for which states can apply for federal funding, and details about federal oversight of the funds.

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