What Will DC Consider To Be “Essential Health Benefits?” And a DC Council Legislative Update!
Implementation of the Affordable Care Act—otherwise known as Obamacare—is fully underway in the District, which means there are a lot of important decisions to be made. One of those is what to include as “Essential Health Benefits,” the minimum floor of services that will be provided by almost all health insurance plans sold within the District. The committee charged with coming up with a proposal is considering the issue right now, and the deadline for the public to comment on the proposed plan is this Friday.
Time is of the essence, because federal health reform will take full effect starting in January 2014. While the speed and breadth of changes may be overwhelming, the importance of deciding what will be considered essential health benefits cannot be understated.
Basically, the District can model or benchmark its essential health benefits coverage with a health plan of its choice, but that plan must cover ten categories of service as outlined in the Affordable Care Act.
After comparing ten typical plans already offered by employers in the city, the District has proposed to use the CareFirst Blue Preferred Option One as its benchmark. However, he plan does not cover pediatric oral/vision care and adult habilitative services, which are mandated by the Affordable Care Act. To address this, the District is proposing to use the Federal Employee Dental and Vision Insurance Plan as the benchmark for oral/vision services. As it stands right now, it is unclear how DC will set a benchmark for adult habilitative services – which includes speech therapy and other services for adults who lack basic motor skills and functions.
The full proposal is currently available for public comment. To comment on the essential health benefits proposal, submit comments and questions to Brendan Rose at email@example.com. The public comment period ends this Friday, September 28th at 5:00 PM.
There are various issues to consider. One big concern is whether any gaps exist in services covered by the benchmark, such as whether the plan would cover medical equipment, devices, and prescription drugs. Another issue might revolve around possible restrictions in the benchmark plan. For example, CareFirst benchmark plan includes limits on duration for certain services –caps on visits or days receiving care – and the ages at which some services are available. Such limits are allowable so long as they are not discriminatory in any way and comply with mental health parity law.
Again, the deadline to comment is Friday at 5 p.m.
Now for the legislative update: The DC Council made two good decisions last week.
By an 11 to 1 vote, the Council removed a controversial provision from the “Technology Sector Enhancement Act,” which would have made the tax rate for tech investors the lowest income tax rate in the city. Instead, the Council decided to send the issue to the Tax Revision Commission for review. DCFPI thanks the many residents who contacted the Council on the issue, Ward 4 Councilmember Muriel Bowser for speaking against the provision in committee and helping persuade her colleagues to remove it from the bill, and Ward 2 Councilmember Jack Evans for introducing the amendment to strike the tax cut from the bill.
Also, the Council made the right move in passing a bill last week to delay for six months looming benefit cuts for more than 6,000 families who receive Temporary Assistance for Needy Families (TANF). Without action, these families would have seen a 25 percent benefit reduction next month, before they had a chance to access the District’s new, improved TANF employment services. Unfortunately, however, the newly identified funding is not enough to protect particularly vulnerable families who need more time to deal with serious issues that interfere with their ability to work, such as domestic violence or the care for an ill child.
Committee on Human Services Chairman Jim Graham and At-Large Councilmember Michael Brown worked with the mayor’s office to find funding to forestall the cuts. We urge Mayor Gray and the Council to work together to identify the additional $5.8 million to forestall benefit cuts for one full year and to maintain benefits for particularly vulnerable families. By working together, we can keep families on a path of progress and independence.