![]() ![]() Option 1: Select another State's EHB-benchmark Plan The below chart describes State documentation requirements for each selection option. The Formulary Drug List Template is generally only required for Option 3. To select a new EHB-benchmark plan, the State must submit: In accordance with 45 CFR 156.111(a), States may choose to select a new EHB-benchmark plan to be applicable starting in plan year 2020. Template and Documentation Requirements for Plan Year 2020 and Beyond Under each of these three options, the new EHB-benchmark also must comply with additional requirements, including scope of benefits requirements, under 45 CFR 156.111(b). Option 3: Otherwise selecting a set of benefits that would become the State’s EHB-benchmark plan. ![]() ![]() Option 2: Replacing one or more categories of EHBs under its EHB-benchmark plan used for the 2017 plan year with the same category or categories of EHB from the EHB-benchmark plan that another State used for the 2017 plan year.Option 1: Selecting the EHB-benchmark plan that another State used for the 2017 plan year.Plan Year 2020 and Beyond EHB-Benchmark Plans EHB-Benchmark Plan Selection Process for Plan Year 2020 and BeyondĬMS provided States with greater flexibility to select its EHB-benchmark plan by providing three new options for selection in plan year 2020 and beyond, including: FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19) (PDF).Current EHB-Benchmark Plan Documents by State.Overview of Current Essential Health Benefits (EHB) Benchmark Plans.Template and Documentation Requirements for Plan Year 2020 and Beyond.EHB-Benchmark Plan Selection Process for Plan Year 2020 and Beyond.States that opted not to exercise this flexibility continue to use the same EHB-benchmark plan from plan years 2017-2019.States that opted not to exercise this flexibility continue to use the same EHB-benchmark plan from plan years 2017-2019. For the 2024 plan year, CMS approved changes to the Vermont EHB-benchmark plan (ZIP). For the 2025 plan year, CMS approved changes to the North Dakota EHB-benchmark plan (ZIP), and the Virginia EHB-benchmark plan (ZIP). For the 2023 plan year, CMS approved changes to the Colorado EHB-benchmark plan (ZIP). For the 2022 plan year, CMS approved changes to the Michigan EHB-benchmark plan (ZIP), to the New Mexico EHB-benchmark plan (ZIP), and to the Oregon EHB-benchmark plan (ZIP). For the 2021 plan year, CMS approved changes to the South Dakota EHB-benchmark plan (ZIP). For the 2020 plan year, CMS approved changes to the Illinois EHB-benchmark plan (ZIP). For plan year 2020 and after, the Final 2019 HHS Notice of Benefits and Payment Parameters promulgated 45 CFR 156.111, which provides States with greater flexibility by establishing new standards for States to update their EHB-benchmark plans, if they so choose. For plan years 2017, 2018, and 2019, each State’s EHB-benchmark plan is based on a plan that was sold in 2014. Those 2014-2016 EHB-benchmark plans and associated materials can be found here. In plan years 2014 through 2016, the EHB-benchmark plan is a plan that was sold in 2012. Below are the EHB-benchmark plans for each of the 50 states and the District of Columbia (D.C.). HHS regulations (45 CFR 156.100, et seq.) define EHB based on State-specific EHB-benchmark plans. The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services (2) emergency services (3) hospitalization (4) maternity and newborn care (5) mental health and substance use disorder services including behavioral health treatment (6) prescription drugs (7) rehabilitative and habilitative services and devices (8) laboratory services (9) preventive and wellness services and chronic disease management and (10) pediatric services, including oral and vision care. Medicare Provider Cost Report Public Use Files.Provider statistical & reimbursement report.Medicare fee for service for Parts A & B.Medicare Claims Synthetic Public Use Files (SynPUFs).Health Care Information System (HCIS) data file.Medicare Provider Utilization and Payment Data.Basic Stand Alone (BSA) Medicare Claims Public Use Files (PUFs).Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for Download.Next Generation ACO Model (NGACO) Public Use Files.Medicare Advantage/Part D Contract and Enrollment Data.Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model Public Use Files. ![]()
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