CMS has published a notice requesting comments on implementation of section 1331 of the ACA, which allows states to establish a Basic Health Program instead of offering coverage through an Affordable Insurance Exchange. Under this option, states may enter into contracts to offer one or more “standard health plans” providing at least the “essential health benefits” established under the ACA to eligible individuals. CMS is requesting information on a number of specific issues to aid in the development of standards for the Basic Health Program including, among many others:

  • To what extent have states begun to assess whether to establish a Basic Health Program?
  • What factors would encourage a state to establish a Basic Health Program?
  • What health plan standards should be considered, including the advantages and disadvantages of an expanded benefit package for standard health plans compared to qualified health plans?
  • What is the expected impact of standard health plans on provider payments and consumer access?
  • What options are states considering relating to premiums and cost-sharing? What factors, other than those listed in the statute, should be considered in the methodology for determining the amount of Basic Health Program funding to states?
  • What standards should be adopted related to health plan offers, the contracting process with standard health plans, and coordination with other state programs?

CMS is accepting comments on the notice until October 31, 2011.