A proposed federal rule affecting implementation of the Patient Protection and Affordable Care Act (ACA) provisions establishing health benefit plans within the insurance exchanges does not address a number of critical oral health issues, according to the ADA.
The rule, "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation," sets forth the U.S. Department of Health and Human Services (HHS) guidelines for the states as they move forward in implementing their health insurance exchanges and developing the benefit plans those exchanges will offer to individuals and small businesses.
In official comments filed this week with HHS, the ADA identified four main goals that it believes the agency should stress with state officials:
- The federal and state officials involved in establishing exchanges must ensure that consumers know the full value of what they will be paying for.
- Standalone dental plans and medical plans with dental benefits must be able to compete on an equal footing both inside and outside the exchanges to ensure consumers have a wide selection of dental plans.
- The pediatric dental essential health benefit should be a required purchase for all families with children who buy their coverage in the individual or small group market.
- Children up to age 21 should be covered by a dental benefit, and there should be adult dental coverage for emergencies as part of state essential health benefit packages.
