Administration Releases final rule on essential health benefits for health insurance marketplace (exchanges)
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a final rule that will make purchasing health coverage easier for consumers. The policies outlined today will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act.
“The Affordable Care Act helps people get the health insurance they need,” said Secretary Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”
Today’s rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule released today also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.
A new report by HHS, also released today, details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans.
In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services. The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways:
- By including mental health and substance use disorder benefits as Essential Health Benefits
- By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets
- By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services
To give states the flexibility to define essential health benefits in a way that would best meet the needs of their residents, this rule also finalizes a benchmark-based approach. This approach allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan. Twenty-six states selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest.
The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage. Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors. In addition, the health care law limits the annual amount of cost sharing that individuals will pay across all health plans – preventing insured Americans from facing catastrophic costs associated with an illness or injury.
Policies in today’s rule also provide more information on accreditation standards for qualified health plans (QHPs) that will be offered through the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices.
Together, these provisions will help consumers compare and select health plans in the individual and small group markets based on what is important to them and their families. People can make these choices knowing these health plans will cover a core set of critical benefits and can more easily compare the level of coverage based on a uniform standard. Further, these provisions help expand choices and competition on the Marketplaces.
For more information on today’s rule, visit: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html
To view the rule, visit: http://www.ofr.gov/inspection.aspx
For more information on how today’s rule helps those in need of mental health and substance use disorder services, visit: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm
February 20, 2013
The Final Decision for States to Choose State Partnership Exchange
Last Friday was the final deadline for states to announce whether they want to be a state partnership on the health insurance marketplaces or exchanges. The following states have expressed that they want to establish a state partnership: Iowa, Michigan, New Hampshire, and West Virginia.They are joining conditionally approved states for state partnership: Arkansas, Delaware, and Idaho.
February 7, 2013
Alaska Native Tribal Health Consortium Releases Final Report: “Healthier Alaskans Create a Healthier State Economy Alaska,”
The Alaska Native Tribal Health Consortium (ANTHC,) released a new report “Healthier Alaskans Create a Healthier State Economy Alaska.” The ANTHC Medicaid Expansion Report_Feb 2013 from ANTHC provides a summarized version of information from a recently released report from the Urban Institute and a revised report from Northern Economics.
This report contains new information that is complimentary to the earlier report on fiscal and economic impacts of Medicaid Expansion in Alaska.
To view the reports from the Urban Institute and Northern Economics in their entirety, please visit: http://www.anthctoday.org/news/medicaid.html
February 7, 2013
Medicaid Affordable Care Act FAQs
The Centers for Medicare & Medicaid Services (CMS) posted a set of frequently asked questions to the Center for Medicaid and CHIP Services (CMCS) Medicaid.gov website discussing a range of issues including the Basic Health Program, the new FMAPs and how states qualify, MAGI issues, and the coverage of pregnant women and children.
Click here to view the FAQs: http://www.medicaid.gov/State-Resource-Center/Frequently-Asked-Questions/CMCS-Ask-Questions.html
February 5, 2013
NEW ITEM ADDED: Dear Tribal Letter for Tribal Consultation with CMS & IRS
Click here to learn about an upcoming Tribal consultation with CMS & IRS regarding proposed Rules for Minimum Essential Coverage and Individual Shared.