HHS proposal would allow states to scale back Essential Health Benefits requirements
Prevent Blindness has issued a response in opposition to a proposal by the U.S. Department of Health and Human Services (HHS) that would allow states to scale back the essential health benefits (EHBs) that insurers must offer on insurance plans. Currently, the Patient Protection and Affordable Care Act (ACA) requires that insurance plans cover benefits and services that are considered to be “essential,” including preventive and wellness care, chronic disease management, and pediatric vision care. Under its 2019 Notice of Benefit and Payment Parameters, HHS proposed to grant states with broad flexibility to opt out of providing these basic medical services through the process of selecting an annual benchmark plan to serve as the state’s standard of benefits provided on plans within their state.
In its response to HHS, Prevent Blindness voiced concern that these proposals would lead to a lower standard of care, higher patient costs, and enormous uncertainty for patients with chronic conditions, and ultimately hinder access to needed vision care services for aging Americans and children. We urged HHS to maintain the current process for states to select the EHBs offered on plans within their states and to keep intact the requirement that insurers must provide basic medical care under the current EHB definition. As well, we voiced our concern to HHS’s consideration of a future federal default definition of EHBs and a national prescription drug benefit standard. In the coming weeks, HHS will release a final rule outlining its policies for the 2019 plan year.