AHA urges CMS, Treasury to protect consumers from skinny benefit plans

The AHA yesterday asked the Centers for Medicare & Medicaid Services and Department of the Treasury to “take swift and decisive action” to protect consumers from limited-benefit plans. The association “has been distressed to learn that some emerging employer-sponsored health plans do not cover outpatient surgeries, including those performed in hospital outpatient departments,” wrote AHA Executive Vice President Tom Nickels. Noting that federal policy requires large employer plans to cover inpatient and physician benefits effective March 1, the letter adds, “We are deeply concerned that some plans have interpreted the new policy to mean that they may exclude critical outpatient surgeries as long as they meet the 60% [minimum value] threshold.” To protect consumers from critical benefit exclusions, AHA urged the agencies to immediately issue guidance mandating employer-sponsored coverage of hospital outpatient surgeries, and that CMS ensure coverage meets the minimum value threshold within a comprehensive set of benefits.