AHIP Pushes Back on HHS Efforts To Ensure Non-Discrimination in Plan Design


In its 2023 Notice of Benefit and Payment Parameters Proposed Rule (2023 NBPP), the U.S. Department of Health and Human Services (HHS) proposed to refine the essential health benefit (EHB) nondiscrimination policy to ensure consistent application of the policy and better protect against discriminatory practices. Current CMS rules state that an issuer does not provide an EHB “if its benefit design, or the implementation of its benefit design, discriminates based on an individual’s age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions.” The HHS proposal would refine the rule to ensure that plan designs are based on clinical evidence and also add examples to illustrate practices that are presumptively discriminatory. In response, Advancing Health Insurance Providers (AHIP), a health insurance trade association, has argued that the proposed EHB non-discrimination framework is overly broad and would prohibit plans from placing benefit limits “that are based on clinical evidence, support value-based care and ensure affordable premiums.” Other groups disagreed. The Leadership Conference on Civil and Human Rights applauded HHS’s proposal, asserting that the rule would merely prohibit plans from imposing discriminatory utilization management policies that are arbitrary and not based on clinical guidelines. Read Aimed Alliance’s comment on the 2023 NBPP here 


Comments are closed.