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NEJM article addresses federalism and EHB

Posted on February 14, 2012 | No Comments

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Alan Weil, Executive Director of the National Academy for State Health Policy (NASHP) recently authored “The Value of Federalism in Defining Essential Health Benefits” in the New England Journal of Medicine (NEJM).  The perspective piece addresses Human Services Secretary Kathleen Sebelius’s December 2011 announcement, stating that there would not be one single national definition of Essential Health Benefits.  Rather, each state will have 10 options to choose from in defining the EHBs, 7 of which are tied to existing coverage in that state’s small-group, state-employee, and health maintenance organization markets.  Weil then relates Sebelius’s announcement to the principles of federalism.  He argues that there are three potential benefits associated with permitting states to make these decisions with respect to the EHBs. These three advantages relate to learning what works, tailoring policies to local conditions, and reflecting citizens’ values.

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Update: Essential Health Benefits FAQs
May 9, 2012
In February 2012, CMS issued a supplemental document entitled Frequently Asked Questions on Essential Health Benefits Bulletin. This supplement to the December 16th Bulletin provides answers to 22 questions arising from the December 16th Bulletin itself. Highlights are as follows:
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HHS releases FAQs on EHB
February 17, 2012
On December 16, 2011, the Department of Health and Human Services (HHS) released a Bulletin describing the approach it intends to take in future rulemaking to define the essential health benefits (EHB) under the Affordable Care Act. This document of frequently asked questions (FAQs) is intended to provide additional guidance on HHS’s intended approach to defining EHB. This bulletin describes a comprehensive, affordable and flexible proposal and informs the public about the approach that HHS intends to pursue in rulemaking to define EHB.  HHS intends to propose that EHB are defined using a benchmark approach. Under the department’s intended approach, states would have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” This approach would give states the flexibility to select a plan that would best meet the needs of their citizens.
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On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
HHS releases bulletin on essential benefits, allows for state flexibility
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The U.S. Department of Health and Human Services (HHS) has issued a pre-rule informational Bulletin which lays out its proposed approach for determining the Essential Benefits package required of all qualified health plans (QHPs) under the Affordable Care Act (ACA). HHS deferred to States' judgment by allowing a State to create a benchmark essential benefits package from a currently-available plan within the State, as long as the package includes benefits from the ten benefit categories laid out in the ACA. HHS proposes that States choose the benchmark plan from a list of plan types:
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  • One of the three largest State employee health plans by enrollment
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If a State does not select a benchmark plan, HHS intends to propose that the default benchmark be the benefits package from the largest small group plan within the State. For more information on Essential Benefits, click here.
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October 7, 2011
The Institute of Medicine (IOM) of the National Academy of Sciences (NAS) has released their highly-anticipated essential benefits report. The report, "Essential Benefits: Balancing Coverage and Cost," recommends that the U.S. Department of Health and Human Services (HHS) consider cost of services as factor when determining the specific benefits qualified health plans (QHPs) must include. The Affordable Care Act (ACA) requires the Secretary of HHS to come up with a minimum essential benefits package that all health plans must offer by January 1, 2014, and HHS tasked the IOM with making recommendations on how HHS should determine which benefits to include. For more information on essential benefits, click here.
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