Essential Health Benefits for 2017

NADP posted a new thread
in Dental Interact for all updates related to state selection of
essential health benefit (EHB) benchmarks. Members are encouraged to
post news updates and articles, webinar notices, discussion points and
thoughts.

The Exchange
Policy and Government Relations Workgroups have begun tracking state EHB
selections and discussions. The following updates are noted in the EHB Grid, in a spreadsheet titled “EHB News & Resources.”

• Maryland
  (3/17/15): The Maryland Exchange is considering a legislative approach
  that would grant the Maryland Health Benefit Exchange (MHBE) Board
  authority to select the EHB benchmark plan for 2017. More on the
  Maryland discussion is included in this presentation. (http://tinyurl.com/mzzbzn8)

• Michigan
  (5/20/15): The DIFS is seeking public comment on the selection of the
  state’s EHB benchmark plan for 2017. Comments are due June 5. DIFS
  provided a summary and comparison of health benchmark options. All but
  one option (BCBSM, self-insured state employee plan) do not include
  coverage for pediatric oral services and would thus have to be
  supplemented with either FEDVIP or Children’s Health Insurance Program
  (CHIP). CHIP and FEDVIP plans are also compared in the document. (http://1.usa.gov/1BcuJdy).
  The BCBSM self-insured state employee plan option is described in the
  chart as including coverage for basic and major child dental care and
  ortho. However, the plan document linked appears to only show coverage for some dental surgery and accidental dental. This may need to be clarified.

• Oregon
  (5/13/15): The Essential Health Benefits Rulemaking Advisory Committee
  has recommended that the PacificSource Codeduct Value 3000 plan be the
  state’s base benchmark plan. The public is encouraged to provide comment
  to the committee regarding its base benchmark plan recommendation by
  May 25 at 5 p.m. The pediatric dental supplement has been discussed and
  may be again in a June 2 meeting. (http://1.usa.gov/1LbVGTV)

• Washington (5/22/15): The Officer of the Insurance Commissioner (OIC) has published an emergency rule and a proposed rule on the designation of an EHB benchmark as well as any necessary supplementation. The emergency rule
  would designate the Regence Group Direct (PPO) plan as the benchmark
  and appears to have been issued to meet a June 1 deadline from HHS.
  Further discussion is anticipated regarding the benchmark and the proposed rule
  at a stakeholder meeting, which is tentatively scheduled for Tuesday,
  June 30 at 1pm pacific. The OIC will issue a stakeholder draft prior to
  the meeting.

Other
spreadsheets in the EHB Grid track benchmarks in effect for 2014-15 and
will be updated as more state deliberations begin for Plan Year 2017.
Members can also refer to the Advocacy Resources webpage where staff will post updated copies of the Grid.

As background, the Final Benefit and Payment Parameters
allows states to choose a new benchmark for the 2017 plan year by
choosing a Qualified Health Plan offered in 2014 which meets EHB
requirements. The final rule confirms the states’ ability to supplement
base benchmark plans as codified in §156.110(b)(1), which for dental
allows FEDVIP or the state’s separate CHIP plan to be selected if the
base-benchmark does not cover pediatric oral services. According to HHS
in the rule’s preamble, it’s important to have “a more complete sense of
how EHB policy is working before proposing changes to the benchmark
approach” (page 10813).

Center for
Consumer Information and Insurance Oversight (CCIIO) has gathered
information from issuers and states to compile data on the three largest
health insurance products into small group markets by enrollment in
2014. These are used to establish potential health benchmark plans,
which states would select (in summer and fall of 2015) and issuers would
offer for the 2017 plan year. A list of the three largest small group insurance products
ranked by enrollment in the first quarter of 2014 for each state was
updated online May 19. States can also choose from any of the largest
three state employee health benefit plans by enrollment, any of the
largest three national FEHBP plan options by enrollment or the largest
insured commercial non-Medicaid HMO in the state. CCIIO explained more
on the benchmark approach in a 2011 EHB Bulletin.

For dental,
states can select a supplemental benchmark when the medical EHB does not
include coverage for pediatric oral services. CCIIO has provided the largest FEDVIP dental plan option
as of March 2014 for use in state benchmark decisions this year. For
2014, the plan has been changed in several ways as described on page 4
of the plan document,
including the elimination of a waiting period for orthodontia. It is
unclear how this change could impact the policy that allows issuers
(standalone and embedded) to include a 24-month waiting period for ortho
as it was part of the FEDVIP benchmark.

The Commission
on Advocacy Policy (CAP) will continue discussions on NADP EHB policy
and how the Association can educate state policy makers on EHB options
related to dental. In 2012, NADP and the then-HCR Task Force developed
an Issue Brief
with background and cost information for states when selecting the
benchmarks that included projected costs and AV levels of the benchmark
options. NADP made the Brief available to policymakers and distributed
it in comments, such as this letter to the South Carolina DOI. With volunteers, we also tracked and made available state EHB selections and later, a map of those selections.

• EHB list of Largest Three Small Group Products by State 2014: http://go.cms.gov/1Fx1IhY
• Largest FEDVIP dental plan option 2014: http://1.usa.gov/1K2ijdn
• Final Benefit and Payment Parameters for 2016: http://1.usa.gov/1PxoY6f
• CCIIO EHB Bulletin, 2011: http://go.cms.gov/1AmqkcM