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 Legislative Corner

FY 2012 Title V Funding Level Set
In case you missed it, on Saturday, Dec. 17, Congress approved an Omnibus Appropriations Bill that provides funding for a number of federal agencies including the U.S. Department of Health and Human Services (HHS) through Sept. 30. Included in this bill is approximately $646 million for the Title V Maternal and Child Health (MCH) Services Block Grant – a $10 million decrease from the fiscal year 2011 level of $656 million. However, a subsequent provision applies a 0.189 percent across the board cut bringing the Title V MCH Block Grant total closer to $645 million. AMCHP is preparing a detailed chart of related MCH program funding levels. In the mean time, additional details are available in our most recent Legislative Alert, available here.

Once again your collective advocacy helped reverse and minimize a larger $50 million proposed cut to Title V. Thank you! We will no doubt be calling on you to help sustain funding in the next budget cycle, which begins in earnest with the expected release of the Obama Administration FY 2013 budget proposal on Monday, Feb. 6.

Save the Date – AMCHP National Policy Call Jan. 18 at 3 p.m. EST
Mark your calendar! We will convene our next AMCHP all-member National Policy teleconference on Wednesday Jan. 18 at 3 p.m. EST. We will discuss budget details, take a look at the year in review and the outlook ahead. To register, click here.

Essential Health Benefits Guidance Released
On Dec. 16, HHS issued a bulletin outlining proposed policies that will give states guidance on how to implement the provision related to essential health benefits included in the Affordable Care Act. HHS intends to propose that essential health benefits are defined using a benchmark approach. Plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as “essential health benefits.” Essential health benefits (EHB) must include items and services within at least the following 10 categories:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

According to the guidance released, states would have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” This approach would give states the flexibility to select a plan.

States would choose one of the following benchmark health insurance plans:

  • One of the three largest small group plans in the state by enrollment
  • One of the three largest state employee health plans by enrollment
  • One of the three largest federal employee health plan options by enrollment
  • The largest HMO plan offered in the state’s commercial market by enrollment

If a state selects a benchmark plan that does not cover all 10 categories of care, the state will have the option to examine other insurance plans, including the Federal Employee Health Benefits Plan, to determine the type of benefits that must be included in the essential health benefits package.

If states choose not to select a benchmark, HHS intends to propose that the default benchmark will be the small group plan with the largest enrollment in the state.

The benefits and services included in the benchmark health insurance plan selected by the state would be the essential health benefits package. Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage.

It is important to note that to prevent federal dollars going to state benefit mandates, the health reform law requires states to defray the cost of benefits required by state law in excess of essential health benefits for individuals enrolled in any plan offered through an Exchange. However, as a transition in 2014 and 2015, some of the benchmark options will include health plans in the state’s small group market and state employee health benefit plans. These benchmarks are generally regulated by the state and would be subject to state mandates applicable to the small group market. Thus, those mandates would be included in the state essential health benefits package if the state elected one of the three largest small group plans in that state as its benchmark. This means that if a state chooses a benchmark plan as the EHB that includes their state mandates they do not have to cover the cost of the mandates. However, if they choose an option not required to offer state mandates, a state does have to cover the cost of those mandates. This will potentially have an impact on a host of state mandated benefits, which may include those related to autism for example. 

Finally, HHS intends to propose that benchmarks will be updated in the future, and that state mandates outside the definition of essential health benefits may not be included in future years. Click here to read the entire bulletin.

School-Based Health Centers Receive Funding
On Dec. 8, HHS announced $14 million in funding for 45 school-based health centers, allowing the number of children served to increase by nearly 50 percent. This funding will enable clinics to expand their capacity and modernize their facilities, which will allow them to treat an estimated additional 53,000 children in 29 states. Click here to view the full list of grantees.

RFA: Medicaid-Safety Net Learning Collaborative - Deadline: Feb. 16
The National Academy for State Health Policy (NASHP) released a Request for Applications for interested state teams to join the Medicaid-Safety Net Learning Collaborative. With support from the Health Resources and Services Administration (HRSA), The Medicaid-Safety Net Learning Collaborative will provide assistance to seven states through access to expert consultation, implementation resources, and a forum for state-to-state exchange. A webinar for prospective applicants will be held on Tuesday, Jan. 17, at 3 p.m. EST. (Obtain the RFA and register for the webinar on www.nashp.org).