September 19, 2012
R. Kevin Clinton
Commissioner, Office of Financial and Insurance Regulation
RE: ESSENTIAL HEALTH BENEFITS BENCHMARK PLAN PUBLIC COMMENTS
Dear Commissioner Clinton:
Thank you for allowing us the opportunity to comment on Michigan’s Essential Health Benefits Benchmark Plan: Executive Report. We understand the difficulty of this task and the effort that OFIR has put forward. We hope that our comments are helpful as this process continues.
The Michigan Universal Health Care Access Network (MICHUHCAN) is a statewide consumer advocacy organization that is dedicated to improving Michigan’s health care system and making it affordable, accessible, and safe for all Michiganders. More information about MICHUHCAN is available online at http://www.michuhcan.org/.
We appreciate the discussion of habilitative services in your final report. Out of the two options offered by the Department of Health and Human Services (HHS) (Michigan’s Essential Health Benefits Benchmark Plan: Executive Report, p. 6.), we recommend that Michigan advocates for making plans offer habilitative services on parity with rehabilitative services. The option where carriers decide which habilitative services to cover, report to HHS, and then let HHS evaluate and define services is a recipe for disaster. The variation in carriers’ coverage decisions and the likely reluctance of HHS to clearly define habilitative services, especially given their reluctance to clearly define Essential Health Benefits generally, will undermine patients’ access to these services that this new scheme is designed to promote.
Prescription Drug Coverage
All of the potential benchmark plans offer prescription drug coverage through formularies. Under these formularies, plans have to cover the categories and classes of drugs set in the benchmark but have discretion in choosing the specific drugs within those classes and categories.2 While we recognize that HHS has yet to provide final guidance regarding formulary requirements, we want to point out that Michigan law allows for exceptions to formulary restrictions when medically necessary and an appropriate alternative. 3 We urge OFIR to ensure that this state law continues to be followed when the benchmarks are finalized.
Thank you again for allowing us to comment on this report. If you would like to follow up with us on any aspect of these comments, please contact Marjorie Mitchell at mjmitchell (at) ameritech (dot) net or (248) 880-2526.
Marjorie J. Mitchell
Executive Director, Michigan Universal Health Care Access Network