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September 26, 2012 at 11:30 PM
A Kansas regulator is suggesting that her state take a generous approach to covering pediatric oral and vision benefits but wait on making a decision about services for children with autism and other developmental problems.
Kansas Insurance Commissioner Sandy Praeger has included those thoughts in a package of recommendations for the Kansas essential health benefits (EHB) benchmark plan.
Praeger has suggested that Kansas should use the Blue Cross Blue Shield of Kansas Comprehensive Plan — the Kansas small group plan with the largest enrollment — as the foundation for its EHB benchmark.
“This plan represents a good balance of cost and benefits,” and adopting a version of the plan as the state benchmark plan “should cause the least disruption in the marketplace,” Praeger said.
One challenge, however, is that the Blue Cross Blue Shield plan lacks the pediatric dental, pediatric vision and “habilitative” development support services required by the Patient Protection and Affordable Care Act (PPACA) EHB provisions.
The EHB package
PPACA opponents continue to fight the law in the courts, in Congress, in state legislatures and at the polls.
If the law takes effect on schedule and works as drafters expect, it will require all individual and small group major medical plans to offer the standardized EHB package by 2014, in an effort to help consumers compare plans on an apples-to-apples basis.
HHS has asked each state to design its own EHB package.
A state is supposed to start by looking at the benefits offered by the three largest Federal Employee Health Benefits Program plans offered in the state, the three largest state employee benefit plans, the three largest small group commercial health plans, and the largest commercial health maintenance organization (HMO) plan.
The EHB benchmark plan chosen must provide benefits in 10 different areas, including ambulatory patient services, emergency services, hospitalization services and pediatric oral and vision health services.
HHS has been telling states to keep solid, affordable small group plans in mind, rather than deluxe benefit plans, when developing the EHB benchmarks.
