The Department of Health and Human Services (HHS) in December issued an information bulletin outlining how it intends to approach its task of creating an Essential Health Benefits (EHB) package under health reform. When finalized, this policy will have a significant impact on the services available through both public and private health insurance plans because it establishes the minimum benefits that health plans must cover beginning in 2014.
Rather than define one package at the federal level, the HHS bulletin proposes to leave considerable discretion to the states in crafting their own EHB packages. This week, the National Council submitted its comments on the HHS proposed approach. Our comments express our concern that the December bulletin does not include sufficient protections to ensure adequate access to mental health and substance use disorder treatment services. We offer recommendations to HHS on strengthening its EHB guidance by: developing and enforce safeguards to ensure that affording state flexibility for development of EHB plans does not undermine access to care; establishing stronger oversight for Parity implementation and adherence; ensuring adequate health insurance coverage for children by requiring states to mirror Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefits when they establish the EHB plans; defining rehabilitation and habilitation benefits so as to explicitly include services to maintain, as well as improve, daily functioning; and more.
HHS has said it intends to engage in formal rulemaking to further clarify its guidance on EHBs but has not announced a timeframe when advocates can expect to see a regulation issued. For additional information on the December bulletin and its impact on behavioral health, see our Essential Health Benefits FAQ.