{"id":3100,"date":"2023-03-14T22:17:53","date_gmt":"2023-03-14T22:17:53","guid":{"rendered":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/?p=3100"},"modified":"2024-07-01T07:43:46","modified_gmt":"2024-07-01T11:43:46","slug":"national-association-of-insurance-commissioners-addressing-essential-health-benefits-process","status":"publish","type":"post","link":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/national-association-of-insurance-commissioners-addressing-essential-health-benefits-process\/","title":{"rendered":"National Association of Insurance Commissioners Addressing Essential Health Benefits Process"},"content":{"rendered":"<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-content\/uploads\/sites\/3\/2023\/03\/essential-health-benefits-1024x683.jpg\" alt=\"A Call for Improvements in the EHB Process\" class=\"wp-image-3101\" srcset=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-content\/uploads\/sites\/3\/2023\/03\/essential-health-benefits-1024x683.jpg 1024w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-content\/uploads\/sites\/3\/2023\/03\/essential-health-benefits-300x200.jpg 300w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-content\/uploads\/sites\/3\/2023\/03\/essential-health-benefits-768x512.jpg 768w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-content\/uploads\/sites\/3\/2023\/03\/essential-health-benefits.jpg 1124w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<p class=\"leading\">On January 27, 2023, the National Association of Insurance Commissioners (NAIC) sent a letter to the Centers for Medicare &amp; Medicaid Services (CMS) and Department of Health and Human Services (HHS) to express its views on the process for establishing Essential Health Benefits (EHBs). While the NAIC applauded the CMS\u2019 interest in gathering information on the EHBs and stated its support for efforts to update them, it did express concern over the failure to consider a \u201cwholesale change to the process of establishing EHBs through state choices.\u201d The NAIC did, however, confirm that it supported the states\u2019 lead role in selecting EHBs, \u201cwhile adding additional clarity and flexibility to the process.\u201d The NAIC then noted areas which it believes need improvement.<\/p>\n<h2 class=\"wp-block-heading\">A Call for Improvements in the EHB Process<\/h2>\n<p>Two areas cited by the NAIC that require improvements were:<\/p>\n<ul>\n<li>The use of existing benefits and carrying them forward each year leading to a failure to capture advances in medical treatments and local standards of care, as well as the divergence from typical employer plans, and in some instances, a process that is out-of-date; and<\/li>\n<li>In their efforts to comply with federal law, regulations and guidelines, the failure of the federal officials to provide consistent guidance to the states, leading to states uncertainty and concern with exercising their authority to define EHBs for fear they could \u201ctrigger the defrayal requirement\u201d if a state\u2019s EHB determination is different than the federal government\u2019s interpretation.<\/li>\n<\/ul>\n<p>The NAIC noted that state regulators do support the federal government\u2019s development of more detailed and standardized EHB descriptions, while also confirming its support for the states\u2019 maintaining their primary role for selecting and defining these benefits. It also noted the need for the EHB process to take into consideration changes in medical care, advancements in medical technologies and standards of care, and to make certain that EHBs include these new developments into the EHB determinations and descriptions.<\/p>\n<h3 class=\"wp-block-heading h2\">Urging CMS to Consider Broader Benefit Delivery Method Elements<\/h3>\n<p>Another matter pointed out by the NAIC related to the EHB process was the CMS\u2019 interpretation of cost-sharing, provider type, benefit delivery method and reimbursements. The NAIC is asking that the CMS consider an issuer\u2019s medical management of a covered benefit, along with state rules governing this management, to be part of the benefit delivery method. It called for EHBs <em>not <\/em>limiting the delivery of medical advances and legislation which directly addresses benefit delivery methods (e.g., medical necessity criteria for diagnostic imaging), adding that this would facilitate more adaptability and state flexibility in EHBs and enable states to cover up-to-date services.<\/p>\n<h4 class=\"wp-block-heading h3\">Majority of States Not Using&nbsp; Burdensome EHBs Update Process<\/h4>\n<p>In its letter to the CMS and HHS, the NAIC also pointed out the burdensome EHBs update process under 45 CFR 156.111.&nbsp; This rule requires actuaries to access a wide range of comparable plans and then measure a state\u2019s proposed updated EHBs against them. The process, which the NAIC noted also raises defrayal concerns under 83 FR at 16977, is being used only by a few states, with the majority of states not updating their EHBs. To make the process more flexible, the NAIC recommended the CMS consider eliminating the \u201cgenerosity test\u201d required under 156.111(b)(2)(ii), noting that \u201cAs long as a state demonstrates that its proposed EHB update is consistent with a typical employer plan in the state (or another state as provided in 156.111(a)(1) and (2)) it should be permitted to adopt the EHB update.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On January 27, 2023, the National Association of Insurance Commissioners (NAIC) sent a letter to the Centers for Medicare &amp; Medicaid Services (CMS) and Department of Health and Human Services (HHS) to express its views on the process for establishing Essential Health Benefits (EHBs). While the NAIC applauded the CMS\u2019 interest in gathering information on&#8230;  <a class=\"excerpt-read-more\" href=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/national-association-of-insurance-commissioners-addressing-essential-health-benefits-process\/\" title=\"Read National Association of Insurance Commissioners Addressing Essential Health Benefits Process\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/posts\/3100"}],"collection":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/comments?post=3100"}],"version-history":[{"count":4,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/posts\/3100\/revisions"}],"predecessor-version":[{"id":4143,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/posts\/3100\/revisions\/4143"}],"wp:attachment":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/media?parent=3100"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/categories?post=3100"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/tags?post=3100"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}