On Thursday, October 20, 2011, Michelle Rice, NHF Regional Director of Chapter Services, was invited to testify at a meeting hosted by the US Department of Health and Human Services (HHS) on patient community perspectives on essential health benefits. Essential health benefits are the services that qualified health insurance plans that are offered in the Exchanges must cover. Rice discussed the needs of the bleeding disorders community with respect to essential health benefits and emphasized the importance of access to all therapies and specialists, and a cap on out-of-pocket expenses. In addition, she relayed NHF’s concerns regarding “network adequacy,” which will be decided at the state level, and requested that HHS provide stricter guidance on the term’s definition.
NHF also submitted a letter to HHS regarding its proposed rule to implement several aspects of the Affordable Care Act (ACA) regarding Exchanges, qualified health plans (QHPs) and essential community providers. The ACA created Exchanges, new insurance marketplaces where individuals and small businesses can purchase health insurance after 2014. Qualified health plans are the insurance plans offered in the Exchanges that will meet benefit and cost requirements. The ACA also designates several types of healthcare providers, including hemophilia treatment centers, as essential community providers that must be included in plan networks. In its letter, NHF emphasized the need for health plan networks to include HTCs and expressed strong support for their inclusion as essential community providers.
