News Release
FOR IMMEDIATE RELEASE
December 16, 2011
Contact: HHS Press Office
(202) 690-6343
HHS to give states more flexibility to implement health reform
Approach will help ensure consumers have quality, affordable coverage
starting in 2014
The Department of Health and Human Services today released a bulletin
outlining proposed policies that will give states more flexibility and
freedom to implement the Affordable Care Act.
The Affordable Care Act ensures all Americans have access to quality,
affordable health insurance. To achieve this goal, the law ensures
that health insurance plans offered in the individual and small group
markets, both inside and outside of the Affordable Insurance Exchanges
(Exchanges), offer a comprehensive package of items and services,
known as “essential health benefits.”
The bulletin released today describes an inclusive, affordable and
flexible proposal and informs stakeholders about the approach that HHS
intends to pursue in rulemaking to define essential health benefits.
HHS is releasing this intended approach to give consumers, states,
employers and issuers timely information as they work toward
establishing Exchanges and making decisions for 2014. This approach
was developed with significant input from the public, as well as
reports from the Department of Labor, the Institute of Medicine, and
research conducted by HHS.
“Under the Affordable Care Act, consumers and small businesses can be
confident that the insurance plans they choose and purchase will cover
a comprehensive and affordable set of health services,” said HHS
Secretary Kathleen Sebelius. “Our approach will protect consumers and
give states the flexibility to design coverage options that meet their
unique needs.”
Under the Department’s intended approach announced today, states would
have the flexibility to select an existing health plan to set the
“benchmark” for the items and services included in the essential
health benefits package. States would choose one of the following
health insurance plans as a benchmark:
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 plan options;
The largest HMO plan offered in the state’s commercial market.
The benefits and services included in the health insurance plan
selected by the state would be the essential health benefits package.
Plans could modify coverage within a benefit category so long as they
do not reduce the value of coverage. Consistent with the law, states
must ensure the essential health benefits package covers items and
services in at least ten categories of care, including preventive
care, emergency services, maternity care, hospital and physician
services, and prescription drugs. If a state selects a plan that does
not cover all ten categories of care, the state will have the option
to examine other benchmark insurance plans, including the Federal
Employee Health Benefits Plan, to determine the type of benefits that
will be included in the essential health benefits package.
The policy proposed today by HHS would give states the flexibility to
select a plan that would be equal in scope to the services covered by
a typical employer plan in their state. States and insurers would
retain the flexibility to evolve the benefits package with the market
as innovative plan designs are developed and advancements in care
become available, and meet the needs of their citizens.
“More than 30 million Americans who newly have insurance coverage in
2014 will have a comprehensive benefit package,” said Sherry Glied,
PhD, assistant secretary for planning and evaluation. “In addition to
assuring comprehensive coverage for the newly insured, many millions
of Americans buying their own insurance today will gain valuable new
coverage, including more than 8 million Americans who currently do not
have maternity coverage, and more than 1 million who will gain
prescription drug coverage.”
The bulletin issued today addresses only the services and items
covered by a health plan, not the cost sharing, such as deductibles,
copayments, and coinsurance. The cost-sharing features will be
addressed in future bulletins and cost-sharing rules will determine
the actuarial value of the plan.
Public input on this proposal is encouraged. Comments are due by Jan
31, 2012 and can be sent to: EssentialHealthBenefits@cms.
For the essential health benefits bulletin, visit:
http://cciio.cms.gov/
For a fact sheet on the essential health benefits bulletin, visit:
http://www.healthcare.gov/
For a summary of individual market coverage as it relates to essential
health benefits, visit: http://aspe.hhs.gov/health/
For information comparing benefits in small group products and state
and Federal employee plans, visit: http://aspe.hhs.gov/health/
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Note: All HHS press releases, fact sheets and other press materials
are available at http://www.hhs.gov/news.
Last revised: December 16, 2011
