Affordable Care Act, Essential Health Benefits, Health Policy

The time is now for final rules re: mental health parity

The time is now for final rules re: mental health parity

This NY Times article illustrates the need for final rulemaking from the federal government on the issue of mental health parity.  While the Affordable Care Act strengthens existing parity laws by mandating substance use and mental health services be covered under the Essential Health Benefits provision, defining and enforcing parity has proven to be a challenge.

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Regulations posted today on Federal Register

title=”Regulations posted today on Federal Register”>Regulations posted today on Federal Register

Today regulations have been posted by the Health and Human Services Department providing guidance on the Essential Health Benefits, Health Insurance Exchange and other provisions of the the Affordable Care Act. 

Affordable Care Act, Essential Health Benefits, Health Reform, Pennsylvania

Pennsylvania’s Essential Health Benefits Package Progress (or lack thereof)

Previously, I provided information about the progress of Pennsylvania’s Health Insurance Exchange (HIX) implementation.  Today I received an email from Pennsylvania Insurance Department (PID) Commissioner, Michael Consedine, providing an update on the Commonwealth’s developments with the Essential Health Benefits (EHB) package and other health reform issues.

In his email, sent out through PAHealthOptions.com, the Insurance Commissioner provided links to three documents that should inform the reader of the “most recent activities of the department.”  The links included: 1. A report conducted by Deloitte on the EHB in Pennsylvania; 2. A letter to the HHS Secretary regarding the EHB; and 3. A letter to the HHS Secretary requesting more information about HIX implementation.  Following the links Commissioner Consedine assured the reader that, “We continue to be committed to pursuing health care reform solutions that work best for Pennsylvanians – but we are similarly committed to making sound, informed decisions – not just fast ones.”

The Deloitte study analyzed the Commonwealth’s choices of existing plans within the state to operate as the EHB as provided by HHS.  These include: 1. The largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market; 2. One of the three largest State employee health benefit plans by enrollment; 3. One of the three largest federal employee insurer options; or 4. The largest HMO plan offered in the State’s commercial market.

Deloitte found that there was only a one percent difference between the total value or cost between the highest and lowest options; however coverage differences did exist among the plans, most notably for dental and specialized services including behavioral health. The study also found that all ten of the existing plans analyzed would need to be supplemented in order to meet requirements under the Affordable Care Act (ACA).

So, the question is: Which health plan will Pennsylvania choose as its Essential Health Benefits package? Like the letter to HHS about the Health Insurance Exchange, Commissioner Consedine, provides a similar answer. The Commissioner states, “Given what we believe to be the clear statutory obligation on HHS to define EHBs and the lack of any rulemaking that would allow Pennsylvania to make an informed and consequential decision by September 30th, we are simply providing the study conducted by the Commonwealth at this time.”  Commissioner Consedine also stated in his letter that he will be “directing interested parties to submit their comments and recommendations to you [HHS] for your consideration. . . ..”

In an ironic attempt to subvert a “one-sized fits all” Washington D.C. policy on the State of Pennsylvania, the Insurance Department has chosen to defer to Washington D.C. to craft the EHB package and will most likely default to a Federally-Facilitated Exchange (FFE) or a Partnership FFE.