Title of Rule and Other Identifying Information: Default
benchmark plan for essential health benefits.
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Meg Jones, Office of the Insurance Commissioner, P.O. Box 40258, Olympia, WA 98504-0255 [98504-0258] , AND RECEIVED BY September 18, 2012.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule designates the default benchmark plan for Washington state pursuant to section 13, chapter 87, Laws of 2012 (E2SHB 2319). The proposed rule does not change any existing rules. The commissioner anticipates that the designated default benchmark plan will establish services included as essential health benefits in all not grandfathered individual and small group plans that are offered, issued, renewed or amended on or after January 1, 2014, pursuant to section 1302 of the Affordable Care Act (P.L. 111-148, 2010, as amended). Because the default benchmark plan does not include all required essential health benefits categories or services under those categories, the commissioner anticipates that designation of supplemental benefits and additional scope and limitation requirements to implement the essential health benefits requirements may be required, and has initiated rule making under the agency matter number R 2012-18 (WSR 12-12-064).
Reasons Supporting Proposal: In 2012, the state legislature directed the commissioner to designate the benchmark plan consistent with the Affordable Care Act requirements. This expedited rule proposes to do so within the time frame in the Center for Medicare and Medicaid Services, December 16, 2011, Bulletin on the Essential Health Benefits. The commissioner identified the small group plan with the largest enrollment based on information requested and received from carriers, on plan enrollment information filed with the agency by carriers, and the July 3, 2012, CCIIO publication of state small group plan enrollment.
Statutory Authority for Adoption: RCW 48.02.060, chapter 87, Laws of 2012.
Statute Being Implemented: Chapter 87, Laws of 2012.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Mike Kreidler, insurance commissioner, governmental.
Name of Agency Personnel Responsible for Drafting: Meg Jones, P.O. Box 40258, Olympia, WA 98504-0258, (360) 725-7170; Implementation: Beth Berendt, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7117; and Enforcement: Carol Sureau, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7050.
July 18, 2012
(1) The benefits and services covered by health care service contractor Regence Blue Cross Blue Shield as the Innova small group plan policy form, Policy Form number WW0711CCONMS, and certificate form number WW0112BINNS, offered during the first quarter of 2012. The SERFF filing number is RGWA-127372701.
(2) The services and items covered by a health benefit plan that are within the categories identified in Section 1302(b) of PPACA, including, but not limited to, ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care, and as supplemented by the commissioner or required by the secretary of the U.S. department of health and human services.
(3) Mandated benefits pursuant to title 48 RCW enacted before December 31, 2011.