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Utah moves ahead with federal health reform mandates

Published: Tuesday, June 19 2012 9:36 p.m. MDT

SALT LAKE CITY — Utah is taking action on federal health care reform regardless of an upcoming decision expected from the U.S. Supreme Court.

"The timeline is marching on, but we don't have all the rules of the game yet," said Rep. Jim Dunnigan, R-Taylorsville.

A federal directive requires states to select a single essential health benefits package, or guidelines for a minimum coverage plan, by this fall or one will be selected for them. Dunnigan said the deadlines loom even without a final decision on health care reform.

As chairman of the state's Health System Reform Task Force, Dunnigan led a statewide public hearing Tuesday to gather opinions on health insurance coverage under the federal Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, which will take effect Jan. 1, 2014.

Defining a baseline for coverage is an important step toward compliance for the state's Health Exchange, which began enrolling employees of small businesses in Utah during a test phase in 2009. It currently provides more than 140 health care coverage options to more than 7,000 individuals and their dependents.

Exchange director Patty Conner said the state will move ahead with its exchange with or without federal health reform, as it has served as "a good value to the state." She said 30 percent of the population benefiting from the exchange did not previously have coverage from an employer.

An extensive marketing campaign to increase awareness of the exchange and draw in additional small businesses will begin next month. The service may also be expanded to include individuals and larger employers who have up to 100 employees, Conner said.

As part of compliance, the state must choose from 10 potential benchmark plans designated by the U.S. Department of Health and Human Services. They include top performers in the private and public sectors, as well as plans offered to federal and state employees.

"Affordability is the key to allowing access," said Kelly Atkinson, executive director of the Utah Health Insurance Association, who spoke at the hearing. "The more expensive insurance is, the less people will avail themselves to be insured."

Dr. Ray Ward, a local family physician, said he can easily learn what is covered within one system, but dealing with the intricacies of 200 is difficult, requiring higher overhead costs at his practice.

A variety of health care provisions are on the table as the state mulls through federal mandates, which require benefits within 10 categories to be addressed in a potential benchmark or reference plan. Affordable Care Act requirements include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventive services and chronic disease management and pediatric services, including oral and vision care.

Rules on how each is implemented have yet to be proposed.

Public comment can be submitted by emailing LRammell@le.utah.gov until July 3. Comments already collected run the gamut of health care, from pleas to include existing benefits to adding new ones, such as acupuncture services. Coverage for treatment of autism is also at stake, as well as for Alzheimer's disease, diabetes and obesity, among other conditions.

Whatever is included in the benchmark plan will be required for all insurers to cover under the Affordable Care Act, Dunnigan said.

He emphasized that Utah law already provides a safety net, the comprehensive Health Insurance Pool, for anyone with serious medical conditions who can't qualify for coverage through an employer or various individual programs. It comes at a cost, but provides health insurance for eligible individuals who may not have it otherwise.

Tuesday's hearing was the first of four working groups the task force will undertake, resulting from health reform legislation. Comments will be compiled and presented to the task force during a July 10 meeting.

Once a benchmark plan is identified, the task force will recommend it to the Utah insurance commissioner, who will enact an administrative rule to designate the required benefits for individual or small employer group plans.

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