- On Friday, the Centers for Medicare and Medicaid Services (CMS) published a fact sheet that deals with questions that have been raised by states, patient groups and others about how states should develop their essential health benefits packages.
- States must establish a plan that covers ten categories of care as defined in the health care law. They may select among four options: from the three largest small-group plans by enrollment, from the three largest state employee health plans, from the largest federal employee plans or from the largest commercial non-Medicaid HMO.
- States have had many questions around implementation of the exchanges, such as could they adopt one benchmark plan for the individual market and a different one for the small-group market.
- According to the new fact sheet, the answer is no. CMS believes only one plan should be selected, so that the options are more consistent and consumer-oriented, and so they simplify administration of the plans, CMS says.
- The fact sheet also addresses the timeline, stating that states will need to choose their benchmark plans by the third quarter of 2012.
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