Deadline for 2017 EHB state benchmarks approaching

The deadline for states to determine, or make changes to, their Essential Health Benefit (EHB) benchmarks for plan year 2017 is June 1, 2015. This deadline applies to both small employer and individual market plans.

Even if state regulators do not intend to make significant changes to their existing EHBs, they may choose to make subtle changes to strengthen consumer protection, according to JoAnn, Volk, author of the Georgetown University Health Policy Institute blog.  Volk gives the following examples of potential benchmark changes by state regulators:

  • Prohibit substitution of benefits within categories
  • Adopt a more comprehensive definition of habilitative services
  • Adopt a strong standard for pediatric vision and dental services
  • Extend pediatric services to children up to age 21
  • Set stronger standards for prescription drug benefits

Here are how some of the states in the West Coast market stacked up in their 2014-16 selection of  EHB benchmarks.

State Number of EHBs required by State Benchmark Plan Supplemental Categories Habilitative Services
Washington 15 Regence BlueShield Innova Pediatric Vision
Pediatric Dental
Oregon 23 Pacific Source Health Plans PPO Preferred Pediatric Vision
Pediatric Dental
California 45 Kaiser Permanente HMO 30 Plan Pediatric Vision
Pediatric Dental

Oregon has already begun its stakeholder feedback process with the Department of Business and Consumer Services (DCBS) setting public meetings on May 18, June 2, and June 18.

Meanwhile, the Department of Health and Human Services (HHS) has announced that it will begin collecting new benchmark data and documents for the second quarter of 2015 to get a better sense of how the EHB benchmark policy is working and whether or not there needs to be a change to federal guidelines, according

CMS has also published tools to help states as they finalize their decisions, including a list of the top three small employer plans by state.