The Selection
On September 27, 2012 The Maryland health Care Reform Coordinating Council voted to select the State Employee Health Plan as its benchmark for the Essential Health Benefit Plan. Of course, because nothing can be simple, the HCRCC included in their motion a support for flexibility around the in vitro fertilization benefit. There was much discussion around this benefit as it is considered a difficult mandate to price effectively in the plans. There is likely more to come on this flexibility issue; advocates and consumers will need to stay aware and engaged on this particular topic.
What It Means for Behavioral Health Consumers
The Maryland State Employee Plan includes a richer benefit package for mental health and substance use disorders than the small group plan, which was the default option if Maryland did not make a selection by September 30th. Also important is that the small group benefit was most definitely not compliant with the Mental Health Parity and Addiction Equity Act, which is required by the ACA. The State Employee Plan is much more likely to be parity compliant and includes fewer limits on mental health and addiction treatment.
Next Steps
Maryland will submit the selection to HHS who will then publish a list of all 50 states benchmark options. HHS will take public comment on this list for 30 days after publication before Secretary Sebelius gives final approval for each state’s benchmark. Once the benchmark has been approved, insurers will begin designing individual and small group plans for sale inside and outside the Health Benefit Exchange. At that time they will also be applying for some of the plans to be certified as qualified health plans,which are the only plans that those individuals who qualify for federal subsidies may purchase.
Ways to Engage
- Provide comment to HHS on Maryland’s EHB selection
- Become involved in the continuity of care discussions, beginning October 3, 2012 1-4 p.m. at the UMBC Tech Center; this committee will be charged with offering comment on how the Exchange and Medicaid should work together to ensure quality care for individuals transitioning from Medicaid to Exchange or vice versa.
- Sign up for Alerts