Comments on Essential Health Benefits rulemaking

Urges HHS to maintain strong federal role and limit benefit design flexibility at the state level

By Government Relations staff

February 9, 2012—The American Psychological Association (APA) Practice Organization co-authored a January 31, 2012 comment letter (PDF, 65KB) from the Mental Health Liaison Group (MHLG) to the Department of Health and Human Services (HHS) regarding the federal agency’s proposed approach for health benefits rulemaking under the Patient Protection and Affordable Care Act (ACA).

The focus of the letter was a December 2011 bulletin from HHS related to defining Essential Health Benefits (EHB) in state level insurance plans. An ACA provision mandates the creation of state level health insurance exchanges through which health plans will be made available to individuals and small businesses. 

The leading coalition on mental health advocacy in Washington, DC, MHLG comprises many national organizations, including APA. APAPO Director of Congressional & Political Affairs Peter Newbould has co-chaired its health policy committee for the past decade.

The coalition’s comment letter showed strong and broad support for upholding mandates embodied in the federal parity law. APA and its 57 co-signers thanked HHS for following through on the intent of the ACA that all exchange plans must include mental health and substance use disorder benefits and that they be provided at parity with medical/surgical benefits.

But the letter took issue with other HHS decisions. The national advocacy organizations seek one national standard benefit in the process of building these exchanges, while states and insurers want maximum flexibility to devise health plans as they see fit.

The co-signers of the January 31 letter lamented the decision by HHS not to develop a national standard and addressed several concerns seeking further definitions that would shore up the consumer protections believed necessary. For example, the coalition recommends HHS protect against restrictive access to services and reject insurance guidelines that fail to consider the individual needs of a beneficiary. The letter also urges the department to limit benefit design flexibility in the states so as not to lose the protection of existing state laws governing mental health coverage.

Projections are that some 16 million previously uninsured people will gain coverage in health insurance exchanges. Another 16 million are expected to be enrolled in state Medicaid plans that in 2014 will be required to cover people up to 133 percent of the federal poverty level. Regulatory details of that expansion have yet to be released by HHS.

The public had six weeks to comment on the HHS bulletin. The agency will take comments into account as it writes a proposed rule on the benefit package. State legislatures are expected to decide this year how to tailor their exchanges to meet the needs of their state’s residents beginning in 2014.

For more information contact the APAPO Government Relations office by email or by phone at (202) 336-5889.