Department of Health and Human Services release critical guidance on health care law

On Friday, the Administration released guidance to states on establishing the essential benefits package that will be offered in the health insurance exchanges that will be established in 2014. The Department of Health and Human Services (HHS) intends to develop regulations based on this guidance which is open for public comment until January 30. HHS is offering the states considerable flexibility in designing the benefit package. The state must choose a benchmark plan from among several options including the largest small group insurance plan in the state, the state employees’ health insurance plan, the federal employees’ health insurance plan, or the largest HMO in the state. If a service such as habilitation or children’s dental services which are required by the Affordable Care Act are not included in the benchmark plan, the state must develop a plan to cover that service. The issue of cost sharing in the plans is not addressed by this guidance. HHS is responding to the pressure from states who wanted information on the essential benefits in order to develop their state exchanges. The lack of specificity in the guidance will likely mean that the benefits included will vary by state.  The Arc is reviewing the guidance and will be submitting comments to HHS in January.

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