States Examine Essential Health Benefits Options

Although the Supreme Court has yet to rule on the ACA, many states are continuing to move forward on implementation. One important implementation area states are working on is selecting a benchmark plan—a plan whose benefits will help define “essential health benefits” or EHB for the state. As we highlighted before, states will be required to establish benchmark plans based on one of four options outlined in a bulletin on essential health benefits. A recent FAQdocument clarified many of the questions that states had on the bulletin. States will need to select a benchmark plan by the fourth quarter of this year, and right now, some states are taking steps to examine and define a plan.
Below are a few highlights from several states that are at different stages in the process. What is your state doing to set its EHB benchmark plan? Let us know here.
Oregon Develops New Decision-Making Tool
In Oregon, Governor Kitzhaber recently formed a workgroup tasked with recommending a benchmark plan. Workgroup members include representatives from county health departments, provider associations, health plans, advocates, and state government. The workgroup convened its first meeting on April 16^th, where members discussed the essential health benefits requirements and proposed decision-making criteria to help assess benchmark plan options. The criteria will be used by the workgroup as it develops recommendations for the state. Key considerations include:

• If any supplements will be needed for the selected benchmark plan to meet EHB standards
• An analysis of costs if Oregon’s mandates satisfy or exceed the EHB requirements
• How different possible benchmark plans meet the health care needs of diverse populations
• Whether individual and small group plans have the ability and capacity to provide the benefits spelled out in a potential benchmark plan
• The potential impact of individuals moving to and from Medicaid

In addition to developing the decision-making criteria, the state has also contracted with Wakely Consulting Group to conduct an analysis of potential benchmark plans. The forthcoming analysiswill inform the state’s selection of a benchmark plan for EHB.
Virginia is for (Public Comment) Lovers
Virginia’s Health Reform Initiative Advisory Council developed task forces in six strategic health reform areas, with memberships consisting of representatives from the legislature, insurance industry, businesses, provider communities, and consumers. The council was formed in 2010 and will convene three times over the coming summer, including a meeting on May 3^rd that will focus on essential health benefits. The state also contracted with Pricewaterhouse Coopers to conductpreliminary analysis of benchmark plan options in Virginia. Released in February, the report discussed interaction between potential benchmark plans and the state’s existing benefit mandates. The analysis also included a brief description of the implications for specific benefits, such as alternative medicine services, and the potential effects of benchmark plan options on premium rates. Cindi Jones, director of the council and of the Virginia Department of Medical Assistance Services, said the written public comments the state received on the analysis were extremely thoughtful and detailed, and have been crucial to their thinking on this issue.
Moving forward, the council will meet on additional exchange issues and submit recommendations to Governor McDonnell and the General Assembly on options for establishing an exchange.
California’s Legislature Nears the Finish Line
Earlier this year, the California legislature requested a study of the potential interaction between the essential health benefits’ requirements and the state’s existing benefit mandates. Published in March, the analysis examined whether California’s existing mandates would fall within or outside of the federal EHB requirements. Last week, the California Assembly and Senate health committees approved bills (AB 1453 and SB 951) that establish a benchmark plan modeled after the set of benefits provided in the Kaiser small group HMO plan. Both committees heard from stakeholder panels that included representatives from consumer advocacy organizations, small businesses, and health plans. While representatives of health plans that spoke at the Assembly hearing noted some concerns about AB 1453, they were pleased with how open the decision process had been. Although the bills will continue through the state legislature’s committee process, initial reports suggest they haven’t incurred any significant opposition from stakeholder groups.
Signed, Sealed, and Delivered in Washington
In Washington, the state worked with Milliman to conduct an actuarial analysis of the benchmark plans outlined in federal guidance. The published report recommended that the state select the small group plan for the benchmark plan. These recommendations were submitted to the state legislature earlier this year, and informed the drafting of HB 2319. The enacted legislation directs the Office of the Insurance Commissioner (OIC) to select the largest small group plan in the state by enrollment as the benchmark plan for the individual and small group market for purposes of establishing essential health benefits. The OIC plans to continue work in this area moving forward, while also coordinating with staff from the state’s exchange.
What is your state doing to set its EHB benchmark plan? Has it already been selected? Let us know on the EHB discussion page or in the comments below.