Skip to content

Essential Health Benefits Activity to Date

March 23, 2010

Affordable Care Act which was signed into law, which included requirements for Essential Health Benefits (EHB).

October 31, 2011

Governor Dayton issues Executive Order 11-30, Establishing a Vision for Health Care in Minnesota, creating the Health Reform Task Force.

December 5, 2011

Governor Dayton’s Health Reform Task Force created Work Groups, including:

  • The Access Work Group. This group was charged by the Governor’s Health Care Reform Task Force with identifying opportunities to encourage consumer choices based on quality and cost of care, including evaluating options for the Essential Health Benefit set.

January 5, 2012

Health Reform Task Force – introduction of the EHB Bulletin

January 9, 2012

Access Work Group and Health Insurance Exchange interested members meeting – Preliminary Explanation of EHB

February 6, 2012

Health Reform Task Force meeting – includes a presentation on EHB, Access Work Group Update, State Mandates, and the Minnesota Benefit Chart

February 9, 2012

Access Work Group meeting – draft recommendations  were proposed and discussed:  Of note, the lack of significant differences between the benchmark plans available to serve as a reference plan for Minnesota’s Essential Health Benefits:

  • All of the Minnesota-based plans cover all of the Minnesota benefit mandates;
  • The federal plans appear to cover most or all of Minnesota benefit mandates; and
  • The bulletin states that a health insurance issuer will have flexibility to adjust benefits, including both the specific services covered and any quantitative limits, so the specific covered benefits in a benchmark plan may not be significant

The Health Care Reform Task Force should re-examine the EHB after HHS provides additional guidance and/or promulgates regulations to determine if that guidance creates/clarifies significant differences between benchmark plan options.

The Health Care Reform Task Force should urge HHS to provide additional guidance or regulations to allow Minnesota to make fully informed choices about the EHB as soon as possible.

February 23, 2012 

Access Work Group meeting – revised EHB recommendations were discussed including the similarity of the plans available in Minnesota.

Reviewed the CMS Frequently Asked Questions on Essential Health Benefits Bulletin, (.pdf) which includes recommendations for choosing the EHB Benchmark Plan 

March 1, 2012 

Health Reform Task Force meeting – presentation and discussion on the Draft Recommendations on Essential Health Benefits, feedback and recommendations on the EHB, and the CMS FAQs on Essential Health Benefits.

Adopted recommendations (.pdf) from the Access Work Group, including:

  • Task Force should urge HHS to provide additional guidance so Minnesota can make fully informed choices about the EHB
  • Task Force should re-examine the EHB after more guidance/regulations are provided
  • There should be an ongoing mechanism for stakeholder feedback on the EHB as it evolves and for reviewing existing and future benefit mandates
  • Insurers should use flexibility in the EHB to ensure products to meet changing needs
  • Insurers should make it easier and more transparent to identify covered benefits
  • DHS should work with insurers and the Exchange to have plans that support transitions between public and private coverage.

June 14, 2012

Access Work Group meeting – received an update on proposed regulations on EHB and Minnesota’s request for comments. HHS released the proposed rule on June 1, 2012, stating that the benchmark plan is to be determined based on information that the plans submitted to them. 

July 12, 2012

Health Reform Task Force received the Access Work Group Preliminary Recommendations

The Presentation (.pdf) included:

  • Slide 5- Essential Health Benefits: Need more guidance from HHS
  • Slide 6- Background about EHB
  • Slide 7- EHB Recommendations from March 1, 2012 (see above)
  • Slide 8 – May 2012 Proposed HHS Regulations on Essential Health Benefits
    • HHS determines each state’s default plans based on data received by HHS from insurers
    • More details still needed from HHS to determine which small group plan would be MN’s default EHB

At the Task Force meeting, it was noted that since the Task Force adopted preliminary recommendations regarding EHB in March 2012, HHS had released additional guidance but not a final rule on EHB.  Further, the Access Work Group stated that more details are needed to determine which small group plan would be the default for 2014-2016.

Discussion followed – explaining that if we don’t select a plan, Minnesota’s essential health benefits for 2014-2016 will be based on the default plan.  HHS regulations have stated that the default will be the largest plan in the small group market. The default plan would be augmented with other services to ensure that all ten coverage categories required by the ACA are included in the plan.  There is an option to select a different plan later (after 2016).  Minnesota Health Care Reform Task Force Minutes - July 12, 2012 (.pdf)

July 23, 2012

Access Work Group meeting – discussed Recommendations to the Task Force, the Essential Health Benefits Chart, and the HealthPartners Small Employer Plan

During the meeting, the Access Work Group discussed EHB in Minnesota, in particular the similarity of plans.

The Work Group reviewed the presentation and comments from the 7/12/12 Task Force meeting (above).

The work group was briefed on EHB updates: HHS released its final rule on metrics to determine the state’s default plan (the largest plan in the small group market).  Based on these guidelines, a HealthPartners’ Plan would become the state’s default for EHB if no action is taken to select a different plan.  The Work Group received a chart detailing the comparison of EHB benchmark options including the HealthPartners product.  The deadline for health plan data reporting to HHS was set between August 20 – September 4, 2012.

Additional Key Discussion points:

  • Clarity about the implications for mental health services – under mental health parity, non-quantitative limits are permitted
  • Default EHB plan is only in effect for 2 years – from 2014-2016
  • HHS will assess and supplement the default plan if there are benefits missing from the 10 required categories under the ACA.
  • The Certificate of Coverage for the default plan will be posted online as soon as it is available.
  • Noted that Minnesota’s three largest plans are very similar.

Minnesota Health Care Reform Task Force Minutes - July 23, 2012 (.pdf)

August 16, 2012

Access Work Group discussed the EHB Fact Sheet and FAQs

Minnesota Health Care Reform Task Force Minutes - August 16, 2012 (.pdf)

September 2012

HHS gave states a “soft deadline” of September 30, 2012 to provide a choice of EHB and information on state mandates. 

As part of the data reporting deadline, the state submitted information regarding Minnesota’s state mandated benefits but did not make an EHB choice.  The state communicated to HHS that although the default would be indicated for Minnesota in the HHS Notice of Proposed Rulemaking (NPRM) process, that the state is awaiting additional guidance from HHS on EHB and may elect to indicate a different choice during the rulemaking period.

September 30, 2012

The Department of Commerce submitted information regarding Minnesota state mandates to HHS and indicated that an EHB plan choice may still be forthcoming.

November 26, 2012 

HHS used the information reported by September 30 to prepare a Notice of Proposed Rulemaking (NPRM) where they reported the following:

  1. What states have chosen as EHBs to date;
  2. States’ default EHB for those who elect not to choose; and 
  3. Additional guidance on EHB

The NRPM was released on November 26, 2012. The HealthPartners Small Group Product (HealthPartners 500 25 Open Access PPO) was indicated as Minnesota’s default EHB plan.

December 13, 2012

The Governor’s Health Care Reform Task Force released recommendations in the report, Roadmap to a Healthier Minnesota .

Strategy Element #29: Consider that Minnesota benchmark options for the Essential Health Benefits (EHB) based on Minnesota plans would provide generally similar benefits and that an ongoing mechanism for review and stakeholder feedback on the EHB is needed.  The Task Force reviewed the Minnesota-based benchmark options under federal guidance and found that the differences between the options did not appear to be materially significant.  Given this, the Task Force did not have significant concern with the default benchmark, the largest plan in the small group market.  In addition, recognizing that the benefit needs of a community and the costs associated with such benefits change over time, the Task Force recommends that a body be appointed to conduct a periodic review of the EHB to ensure that it maintains an appropriate balance of coverage and cost.  This review should include an ongoing mechanism for community and stakeholder discussion and feedback on the EHB as it evolves over the next few years, especially as the federal government modifies its methodologies and requirements for 2016 and beyond.

December 26, 2012 

The NPRM is open for comment for 30 days starting on November 26.

During the comment period, states may still indicate their choice of EHB.

If a state does not choose an EHB by December 26, 2012, the default will apply.