Comments on Essential Health Benefits Data Collection Proposed Rule
Health insurers objected to a number of parts of a proposed rule that would require each state's largest small group plans to report benefit information in comments filed July 5.
The proposed rule exceeds what is needed to establish coverage requirements under the health care reform law, the Blue Cross and Blue Shield Association said in its letter, signed by Justine Handelman, vice president, legislative and regulatory policy. “The data requested for identifying and defining [essential health benefits (EHBs)] go far beyond information on benefits/covered services and include information that is not relevant for a state in defining its EHB package,” BCBSA said.
Under a proposed rule published in the June 5 Federal Register, the Department of Health and Human Services said the three largest small group health insurance plans in each state would have to report enrollment and benefit information to HHS (see previous article). The proposed rule also outlines how data would be collected from stand-alone dental plans, and the accreditation process for issuers of “qualified health plans” that will be offered in the online exchange markets that begin operation in 2014.
In December 2011, HHS issued a guidance bulletin giving states the option to choose among plans that would be benchmarks for EHB requirements in each state. If a state does not choose a benchmark plan on which to base EHBs, HHS said it would choose as a default the largest small group plan in the state, based on enrollment, for plan years 2014 and 2015. HHS said it intends to pursue a rulemaking at an unspecified later time.
BCBSA said in its letter that it is concerned that HHS is requesting comments on the EHB data collection process without issuing final guidance on the EHB bulletin. “Issuers should not be expected to implement multi-million dollar changes and conduct laborious data collection efforts based on informal guidance that can be subject to changes in a final rule,” it said.
“There are literally thousands of variations of coverage for any single insurer and the administrative burden of reporting all of the situations under which prior authorizations, referrals or non-quantitative limits are required would be significant.”--Justine Handelman, Blue Cross and Blue Shield Association
BCBSA suggested that HHS omit requirements that issuers submit information on referral requirements, prior authorizations, treatment limitations, and prescription drug formularies that are used to determine coverage, and ambiguous “catch-all” categories. “There are literally thousands of variations of coverage for any single insurer and the administrative burden of reporting all of the situations under which prior authorizations, referrals or non-quantitative limits are required would be significant,” it said.
In America's Health Insurance Plans' letter, signed by Jeanette Thornton, vice president, health IT strategies, AHIP said the proposed rule duplicates information already submitted to states and collected by HHS for its Healthcare.gov Plan Finder website, which lists health insurance plans and their features.
No information should be collected by HHS from issuers at this time unless it is needed by states to determine whether all of the 10 general EHB benefit categories are covered as required under PPACA, AHIP said. Once a state selects an EHB benchmark plan, only that plan should have to report the data in the proposed rule, AHIP suggested.
Data collection on benefit limits should be used to prohibit discriminatory and overly restrictive treatment limitations from being incorporated into the EHB package, Families USA said. HHS also should collect data on “rider” policies--provisions purchased separately that cover additional benefits--included in potential benchmark plans as well, it said.
Wellness programs with incentives based on achieving health outcomes can be a backdoor form of medical underwriting, the group said at a conference in January (see previous article). Wellness programs should not be included in EHBs, it said.
Families USA recommended that HHS require more data be collected on quantitative and nonquantitative plan coverage limits, including the number of people reaching each limit.
“Until now it appeared that HHS envisioned two paths that a state could take when selecting an EHB benchmark”--choosing its own benchmark plan or allowing HHS to designate the largest small group plan in a state as the “default” benchmark, CBPP said. Required benefit categories missing from the benchmark plans would be filled in from other available benchmark plan options, it said.
Appendix G of the Health Insurance Web Portal, a template HHS included with the proposed rule for plans to use to submit the data, “suggests that HHS is developing a third path by which a state could designate one of the small group plans as its benchmark and then leave it to HHS to ensure coverage in all 10 required EHB categories,” CBPP said. HHS should provide more information on how the new option would work, it said.
By Sara Hansard
The Blue Cross and Blue Shield Association's letter is athttp://op.bna.com/hl.nsf/r?Open=shad-8vxmcw. The Center for Consumer Information and Insurance Oversight's Essential Health Benefits: List of the Largest Three Small Group Products by State is athttp://cciio.cms.gov/resources/files/largest-smgroup-products-7-2-2012.pdf.pdf. AHIP's letter is at http://op.bna.com/hl.nsf/r?Open=shad-8vxnj9. Families USA's letter is at http://op.bna.com/hl.nsf/r?Open=shad-8vxnwz. CBPP's letter is at http://op.bna.com/hl.nsf/r?Open=shad-8vxpdw. The Health Care Reform Insurance Web Portal Requirements template is at http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS1247405.html.
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