Milestone: Compare current state benefit mandates with the essential health benefit package and identify any needed changes
States will need to analyze how their benefit mandates compare with federal minimum requirements established by the ACA and decide whether to continue, add to or eliminate any state-mandated benefits.
*Milestone details:
*Full name: Compare current state benefit mandates with federal laws, regulations, and the essential health benefit packages and identify any needed updates.
*Relevance to the ACA:
The ACA establishes federal benefit mandates that all states must follow. The ACA also permits states to establish their own benefit mandates.
§1302 – Establishes the essential benefit package levels that define qualified health plans.
§1311 – Allows states to add additional benefit requirements to qualified health plans; costs would be borne by states rather than the federal government.
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District of Columbia
The California Health Benefits Review Program (CHBRP) has released an issue brief on the interaction between the essential health benefits requirements, as described by the recent HHS regulatory bulletin, and California's existing state benefit mandates. This document may provide a useful framework for similar analyses in other states.
District of Columbia
Othman Ouenes at Manatt, has posted California's comments on essential health benefits, submitted by the California Health Benefit Exchange. You can read more about the comments here:
http://www.statereforum.org/node/143#comment-9251
You can also download a copy of the comment here:
http://www.statereforum.org/sites/default/files/joint_ca_comment_letter_...
California
The California Health Benefits Review Program provides evidence-based analysis to the California Legislature. We do not take positions. We did however, just submit a set of questions (roughly 2 dozen) to CMS’ CCIIO regarding the recently released bulletin on Essential health Benefits. While we did not provide comments or any opinion on the overall approach, we’ll need clarity on these topics to do our analysis work in the future. Since many of our questions may be common ones, we thought we'd post them for colleagues in California and in other states.
District of Columbia
On January 26th, the California Health Benefit Exchange Board convened to discuss essential health benefits. In preparation for the meeting, various stakeholder groups in California submitted comments to the Board on essential health benefits. You can find the comments attached here.
District of Columbia
During the NASHP conference October, John Lewis of the California Health Benefits Review Program presented on California's health benefit review process and offered some suggestions for other states as they prepare to analyze their own benefits in advance of the essential health benefit package requirements in the ACA.
California
Just to provide some context, for states that may be considering how to model potential health insurance mandate repeals. In the spring of 2010, The California Health Benefits Review Program (CHBRP) conducted an evidence-based assessment of the medical effectiveness, and financial and public health impacts of Assembly Bill (AB) 1904, a health benefits mandate repeal bill. This bill proposed to repeal all existing state health benefit mandates for carriers domiciled in another state which would be allowed to offer, sell, or renew a health plan or insurance policy in California without holding a license issued either of California’s two health insurance regulators. The bill would have exempted the carrier from requirements otherwise applicable to insurers providing health care coverage in this state if the plan complied with the domiciliary state’s requirements, and the carrier was lawfully authorized to issue the plan contract or policy in that state and to transact business there.
CHBRP faculty and researchers developed three hypothetical scenarios presenting a potential maximum, low-impact, and very low-impact cost estimates, because of the uncertainty of how insurers might respond were the bill enacted, and the impact of price sensitivity to purchasers of health insurance by different income levels. Other states may find this approach of interest, as some states may be considering benefit mandate repeals due to the potential interaction between essential health benefits and state-level benefit mandates. While Essential Health Benefits will be defined by the Secretary of Health & Human Services before January 1, 2014, states may incur fiscal costs if their mandated benefits exceed federal definitions of essential health benefits in state-based exchanges. CHBRP’s scenario-based approach and review of the existing literature and expert opinion on the premium savings associated with limited-mandate plans sold across state lines may be helpful to those considering these issues.
Hope the background helps!
District of Columbia
This issue brief, developed by the California Health Benefit Review Program, provides an overview of the provisions in the ACA which require “essential health benefits.” The brief also discusses the potential interaction between the federal requirements in the ACA and existing state benefit mandate laws.
Access the issue brief here:
http://www.statereforum.org/sites/default/files/aca-ehb-issue-brief-0112...
District of Columbia
This report analyzes the impacts of proposed repeals of health insurance benefit mandates in AB 1904.
Access the report here:
http://www.statereforum.org/sites/default/files/final_ab_1904_041610_fin...