By Getahn Ward | The Tennessean
A decision by Gov. Bill Haslam against setting minimum benefits that
health insurers would have to offer for individual and small-group
coverage here starting in 2014 could make a plan from BlueCross
BlueShield of Tennessee the benchmark for the state.
guidance to implement health care reform, if a state chooses not to
select a so-called essential health benefits package, the federal
fallback option would be the largest small-group plan available as of
March 31. In Tennessee, that's a BlueCross preferred provider
organization plan that had 92,836 people enrolled as of that date. But
the U.S. Department of Health and Human Services could still require
modifications to that default plan after gathering feedback from the
HHS encouraged states to submit their essential health
benefits benchmark by Monday, but it is expected to continue to accept
benchmark plans throughout this month. The essential benefit
requirements would apply to individual and small-group plans sold within
and outside new online, state-based exchanges where individuals and
small businesses can shop for coverage.
In a letter to HHS
Commissioner Kathleen Sebelius on Sunday, Haslam cited three reasons for
his decision not to select a benchmark plan. He cited states' options
being extremely limited because the federal government defined health
plans from which they must choose; individual states' decisions would
only stand for two years before the feds dictate the essential health
benefits for all states; and a lack of guidance, clarity and information
needed for states to make responsible and informed decisions.
of Monday, 24 states, including Arkansas, California, Kentucky,
Mississippi and Nebraska, had selected and submitted benchmark plans,
according to Avalere Health, a consulting firm in Washington, D.C. So
far, Tennessee and Alabama are among states that decided not to choose
one. Several other states have yet to make their intentions known as
they wait for additional HHS guidance.
In many cases, states that
have selected a benchmark plan chose the same plan that would have been
the default option or federal fallback option, said Caroline Pearson,
director in the health reform practice at Avalere. "Certainly, the
default is a reasonable benchmark," Pearson said.
The reform law
required coverage under 10 main categories, such as preventive care,
emergency services, maternity care, prescription drugs and hospital and
doctors' services, but left it to the states to determine specific
benefits offered within those general categories by selecting a
benchmark plan from which benefits must be based.
At first glance,
Pearson said the major differences across the benchmark plans that
Tennessee could choose from centered on coverage for mental
health/substance abuse services and autism therapy. The default
BlueCross PPO plan includes some service limits the other benchmark
plans don't, she said. She noted that was consistent with what Avalere
is seeing in other states, where the key differences across the possible
benchmarks are in coverage for autism, mental health and rehabilitative
In Haslam's letter to Sebelius, he mentioned public
forums and requesting insurance companies to compile data on their
potential benchmark as part of the due diligence performed by state
officials before he reached a decision.
Tennessee officials face a separate Nov. 16 deadline to let the federal agency know whether they plan to run a health exchange.