Essential Health Benefits Benchmark Plan Review Process
Review the Essential Health Benefits requirement under Virginia legislation, the EHB Benchmark Plan application update, and the process for selecting and updating the benchmark plan. Understand the ACA requirements, state mandates, and the role of the Health Insurance Reform Commission and Bureau of Insurance in reviewing and updating the Essential Health Benefits Benchmark Plan.
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Presentation Transcript
Presentation to Health Insurance Reform Commission Essential Health Benefits Benchmark Plan Julie Blauvelt Deputy Commissioner Bureau of Insurance September 20, 2023 Confidential
A review of the Essential Health Benefits requirement Virginia legislation related to this requirement EHB Benchmark Plan Application Update HIRC s updated review process The next EHB Benchmark Plan review process Presentation Overview Confidential
The ACA requires states to select a set of Essential Health Benefits (EHB Benchmark Plan) The ACA set default EHB Benchmark Plans- not updated since 2017 Updating the EHB Benchmark Plan is the only way a state can require new benefits as EHB. State mandates after 12/31/11 cannot become EHB unless removed as a mandate and added to EHB through an application process. HB 2198/SB 1399, which went into effect on March 22, 2023 required BOI to select a new EHB Benchmark Plan for 2025. HB 2199/SB 1397 requires HIRC and BOI to review the EHB Benchmark Plan again in 2025 and every 5 years thereafter. Essential Health Benefits Benchmark Plan Confidential
Required by HB 2198/SB 1399 BOI created EHB Benchmark Plan website at: https://scc.virginia.gov/pages/Essential-Health-Benefits- Benchmark-Plan Application approved by CMS Changes to current EHB package: Expanded coverage for prosthetic devices and components Formula and enteral nutrition products as medicine Revised benefits to comply with: Updated federal and state requirements (i.e., MHPAEA, non-discrimination rules, new preventive care services) Mandated providers Revisions for 2025 EHB Benchmark Plan Confidential
HIRC Review Process for Proposed Mandated Benefit or Provider (Section 30-343) Chair of House Commerce & Energy or Senate Commerce & Labor sends letter to HIRC (copy to BOI) requesting assessment of proposed mandate. BOI prepares a Step 1 analysis upon receipt of request received from the Committee Chairs. HIRC determines if the proposed mandate shall be: (i) Part of EHB review (ii) Assessed through Step 2 analysis; or Does the proposal exceed the scope of EHB? (iii) other. Confidential
In 2024, BOI will convene a workgroup to recommend potential changes to the EHB Benchmark Plan. BOI will assess mandates referred by HIRC for EHB consideration and estimate effects of including the benefit in the Benchmark Plan. By March 31, 2025, BOI will report to HIRC on the findings and recommendations of workgroup and assessments of referred mandates. HIRC will need to conduct two public hearings before June 30, 2025 to solicit feedback on potential changes to the EHB Benchmark Plan. By June 30, 2025, HIRC will determine if Virginia will seek changes to the EHB Benchmark Plan and identify potential benefit changes for BOI to analyze for inclusion in the revised EHB Benchmark plan. If HIRC decides to submit an application for a new EHB Benchmark Plan, HIRC must hold two additional public hearings prior to December 31, 2025. By September 30, 2025, BOI will conduct an actuarial analysis of potential new EHBs proposed by HIRC. By December 31, 2025, HIRC will determine the changes, if any, that will be recommended by legislation for inclusion in the 2028 EHB Benchmark Plan application. Next EHB Benchmark Plan Review and Potential Update (Section 30-343.1) Confidential
BOI received approval of the 2025 EHB Benchmark Plan Application. HIRC will operate under a new process for reviewing proposed mandates (additional options for proposed mandates). During 2024, BOI will assemble a workgroup to provide recommendations as well as a summary of benefits HIRC chose to be assessed for the March 31, 2025 report regarding a potential 2028 updated EHB Benchmark Plan. In Summary Confidential
Questions? Confidential
