Nevada updating its Essential Health Benefits plan
Under the Affordable Care Act, all health insurers covering individuals and small groups are required to provide what are termed “essential health benefits” and though there are set parameters to follow, the specifics of what these benefits include are up to each state.
In Nevada, the current Essential Health Benefits (EHB) plan encompasses an array of medical services and procedures but there are a few key areas that have not been included, addressing opioid use disorder, HIV and hepatitis B and C.
According to the Nevada Dept. of Health and Human Services HIV Fast Facts Report, there were more than 13,000 residents living with HIV in the state in 2023. In 2022, the latest data available from the U.S. Centers of Disease Control, more than 1,000 Nevadans died from opioid overdose, a figure that has continued to steadily increase in recent years. And though not as prevalent, hepatitis B and C, like HIV, can be spread through contact with bodily fluids, blood or through sex and can lead to serious health complications of the liver.
Under the state’s EHB plan update, the Nevada Division of Insurance is aiming to make coverage of testing, treatment and prevention services for these diseases a requirement of local health insurance providers.
“The Nevada Division of Insurance is seeking public input on revisions to Nevada’s Essential Health Benefits (EHB) plan,” stated an announcement from the state agency issued last week. “Under federal law, states seeking to update their EHB benchmark plan must conduct actuarial analysis, solicit public comments on proposed changes and submit an application to CMS (Centers for Medicare and Medicaid Services).”
Nevada has three options to consider as it moves forward in the process, as defined by CMS. These include: Option 1, which calls for selecting another state’s EHB benchmark plan in its entirety; Option 2, which would replace a category of benefits in the current benchmark with the same category of benefits from another state’s EHB plan; and Option 3, selecting a set of benefits to become Nevada’s new EHB plan.
Silver State officials are leaning toward the third option, with the division remarking that this option would, “… better reflect changes in the insurance market…” Under the changes, Nevada’s EHB plan would be amended to add all Federal Drug Administration-approved drugs to treat opioid use disorder; those for testing, treating and preventing HIV; and those for testing, treating and preventing hepatitis B and C to the must-haves list for health insurance companies serving its residents.
“Ensuring that Nevada’s Essential Health Benefits align with the evolving needs of consumers is a top priority,” Nevada insurance commissioner Scott Kipper stated. “Public participation in this process is crucial and we encourage all stakeholders to share their insights so we can make informed decisions that promote access to necessary health care services.”
“Public comment has historically played a key role in refining health benefit requirements in Nevada, ensuring access to comprehensive health care,” the division noted. “The division urges consumers, health care providers, insurers and other stakeholders to participate in this opportunity to help shape the future of Nevada’s health insurance landscape.”
There are both in-person and virtual meetings slated for next week, giving residents and health care experts the chance to weigh in, ask questions and learn more about the update. Scheduled for Wednesday, Feb. 26 from 10 a.m. to 11 a.m., the meetings will take place at 3300 W. Sahara Ave., Suite 275 in Las Vegas; 1818 E. College Pkwy., Suite 103 in Carson City; and online at tinyurl.com/5aeuwk8w
The meeting access code is 2865 088 8463 and the password is txJfjKE343
Interested parties can also join via phone by calling 844-621-3956 and using the aforementioned meeting access code.
Comments can be submitted as well through the Nevada Division of Insurance’s website, mailed to Commissioner of Insurance, 1818 E. College Pkwy., Suite 103, Carson City, NV, 89706 or emailed to Adam Plain at APlain@doi.nv.gov
All comments must be received by Wednesday, March 19.
Contact reporter Robin Hebrock at rhebrock@pvtimes.com
