The Week in Review from the Catalyst Center featured several articles regarding The Affordable Care Act. You can sign up for their updates here. As a reminder, we are seeking family stories about how the Affordable Care Act has helped your family. You can email them to firstname.lastname@example.org or call 317 944 8982 and leave your story on our voice mail; we will transcribe it to feature on our blog in March. We look forward to hearing from you......
By Cindy Mann, Director, Center for Medicare and Medicaid Services
Department of Health and Human Services
February 17, 2012
On December 16, 2011, the U.S. Department of Health and Human Services (HHS) issued an Essential Health Benefits Bulletin that gave each state the responsibility for determining its essential health benefits package. As follow up, HHS has responded to 22 frequently asked questions (FAQ) and provided additional guidance about the development of the essential health benefits package. Key points include:
- States have to choose a single benchmark plan to determine the essential health benefits for both the individual and small group markets, both in and out of the state exchange;
- State mandated benefits passed after December 31, 2011, cannot be added to the benchmark plan. Clarification regarding the cost to states for mandated benefits they may want to provide that are not currently included in the benchmark plan is provided in the FAQ document;
- With the exception of individual grandfathered plans, plans cannot impose annual or lifetime dollar limits on services. Some state-mandated services have dollar limits. If these services are included in the benchmark plan, the essential health benefits must include these services without a monetary limit. However, if the benchmark plan provides equivalent services within the 10 required categories of health services, they may substitute those services, again, without a dollar limit. Plans may impose limits on the scope and duration of services.
With regard to services for children, HHS research confirmed that many health plans do not cover habilitative or pediatric oral health and vision services, which are required as part of the essential health benefits under the Affordable Care Act (ACA). The FAQ document outlines two options that HHS is considering for bridging the gap for habilitative therapies:
- Habilitative services must match what the plan offers for rehabilitative services (also known as parity), or
- Plans can design a habilitative service package, which HHS will then evaluate.
For oral health services, states can use the Federal Employees' Dental and Vision Insurance Program (FEDVIP) with the largest enrollment nationally or use the benefit package provided by its separate Children's Health Insurance Program (CHIP). For vision care, states can use the benefits provided by the largest FEDVIP plan.
The Kaiser Family Foundation
February 3, 2012
On February 3, 2012, the Alliance for Health Reform and The Commonwealth Fund hosted a briefing where panelists representing state, consumer, insurance, and provider perspectives spoke about the issues states will have to address as they develop their essential health benefits packages. The challenge for each state will be to find a balance between the 10 categories of health services they must cover as required under the Affordable Care Act (ACA) and the cost of those services. Watch the video or listen to the podcast of this event, or read the transcript and download the speakers' slides.
Kaiser Health News
February 15, 2012
On March 26, 2012, two years and three days after the passage of the national health reform law known as the Affordable Care Act (ACA), the U.S. Supreme Court will hear oral arguments about the constitutionality of two provisions of the health reform law: 1) the mandate that everyone must have health insurance and 2) the Medicaid expansion that raises the income limit so more people will qualify for this public health program. Kaiser Health News's Jackie Judd and attorney Stuart Taylor discuss the significance of the number of hours (6) and days (3) that the Court has allotted to hear oral arguments. The lawsuits, filed by 26 states, are about more than just these two elements of the ACA. Taylor states this is also an issue of individual rights and state sovereignty and whether or not the federal government can make individuals buy a particular commercial product and insist that states increase eligibility for Medicaid. Watch the interview or read the transcript.
SCOTUS Preview Part 2: Analyzing The Likely High Court Arguments On The Health Law
Kaiser Health News
February 16, 2012
Jackie Judd and Stuart Taylor continue their conversation about the challenges to the Affordable Care Act (ACA) that the U.S. Supreme Court will hear. They also discuss the arguments the federal government will make in favor of the individual mandate and the Medicaid expansion, and the legal tenets states will use to make their case against these provisions of the ACA. Watch the video or read the transcript of this interview.
The Henry J. Kaiser Family Foundation
February 7, 2012
Kaiser State Health Facts has updated information on each state's progress towards creating a Health Insurance Exchange. Use the interactive map to see the status of each state's Exchange; if the exchange was created, or is being created, by executive order, or by executive or legislative action; if the exchange is, or will be, operated by an existing state agency, a non-profit, or an independent public agency; and if the exchange will be a clearinghouse or an active purchaser that contracts with select plans and negotiates the premiums. This resource allows users to compare a state to the nation or to another state.