The health reform law required the Dept. of Health and Human Services (HHS) to set minimum benefit limits for plans in health exchanges. But now the HHS wants to relinquish that responsibility to the states.
Insurance plans participating in state health exchanges will be required to offer a minimum amount of benefits, known as essential health benefits. Their plans must cover services in at least 10 categories, which include preventive care, emergency services, maternity care, prescription drugs, mental health and substance abuse.
But now, instead of the HHS determining what those limits will be, it looks like it’ll be left up to the states to decide for themselves.
The HHS said it has proposed leaving the decisions up to the states so they can create coverage requirements similar to typical employer plans already in their respective state, according to the HHS. The idea is that states can tailor coverage limits based upon what individuals in that state need or have come to expect.
“The coverage that works in Florida may not work in Nebraska,” said HHS Secretary Kathleen Sebelius.
Under the proposal, each state can chose a health plan that’ll serve as a benchmark for local minimum coverage standards. The plans they can chose are:
- one of the three largest small-group plans in the state
- one of the three largest state employee health plans
- one of the three largest federal employee health plans, or
- the largest HMO plan offered in the state’s commercial market.
The proposal allows states to only set limits for services covered by a health plan — not cost-sharing requirements. The HHS says it’ll address those cost requirements in a future announcement.
The HHS is taking comments on the initial proposal until Jan. 31, 2012.