Confederate and Union forces once fought in Kansas over the laws governing slavery and the nature of the relationship between U.S. states.
Now, commenters are battling in Kansas over just what pediatric oral health benefits ought to go into the “essential health benefits” (EHB) package required by the Patient Protection and Affordable Care Act of 2010 (PPACA).
The Kansas Insurance Department held a hearing on the PPACA EHB requirements earlier this month. The department has posted a hearing transcript and written comments on the Web.
Employers and insurers are arguing that Kansas should make any EHB pediatric oral health requirements as narrow and inexpensive as PPACA allows.
William Tracy, chief executive officer of UnitedHealth’s UnitedHealthcare plan, said in a written comment that the Kansas EHB pediatric dental benefits and vision benefits should consist primarily of preventive services and screening services.
“Any additional pediatric dental or vision benefits should utilize treatment limitations based on current industry standards, such as a maximum number of cleanings per year, to maintain affordability for these services,” Tracy wrote.
Tonya Dorf Brunner, executive director of Oral Health Kansas, a group that represents dentists and nonprofit dental plans, said at the hearing that her group wants the EHB package to include “all pediatric dental services necessary to prevent disease and to promote oral health, to restore oral structures to health and function and to treat emergency conditions for the attainment and maintenance of oral health.”
Kansas Insurance Commissioner Sandy Praeger is developing a package of EHB recommendations for the state’s governor, Sam Brownback. PPACA gives the U.S. Department of Health and Human Services (HHS) the authority to develop an EHB package for a state does not develop its own package.
HHS officials have indicated that, in states that fail to choose their EHB packages, HHS will use the small group plan with the highest enrollment as the basis for creating the state’s package, Praeger said at the EHB hearing.
The EHB Program
If the law takes effect on schedule and works as drafters expect, it will require all individual and small group major medical plans to offer the standardized EHB package by 2014.
PPACA supporters say the EHB package system help consumers compare plans on an apples-to-apples basis.
HHS has asked each state to design its own EHB package.
A state is supposed to start by looking at the benefits offered by the three largest Federal Employee Health Benefits Program plans offered in the state, the three largest state employee benefit plans, the three largest small group commercial health plans, and the largest commercial health maintenance organization (HMO) plan.
The EHB benchmark plan chosen is supposed to provide benefits in 10 different areas, including ambulatory patient services, emergency services, hospitalization services and pediatric services.
The pediatric services provisions must include oral health and vision health services for children.
Commenters in many states are going through the same kind of debate that’s now taking place in Kansas.