📋 Tender Overview
The Michigan Department of Insurance and Financial Services DIFS is seeking public comment on proposed updates to Michigans Essential Health Benefits EHB benchmark plan for the 2022 plan year. Pursuant to greater flexibility offered to states by the Centers for Medicare and Medicaid Services CMS DIFS has elected to modify the EHB-benchmark plan for the 2022 plan year to add two new benefits to assist in reducing opioid addiction and overdose.The Patient Protection and Affordable Care Act requires non-grandfathered plans in the individual and small group markets both on and off the Exchange to cover EHBs in ten categories based on the states EHB-benchmark plan. DIFS first selected a benchmark plan in 2012 for use in the 2014 to 2016 plan years and re-assessed its selection for plan year 2017 opting to retain a substantially similar benchmark plan to promote continuity in the individual and small group markets. For plan year 2020 and after CMS provides states three new options for modifying their EHB-benchmark planSelecting another states 2017 EHB-benchmark planReplacing one or more categories of EHBs in the states EHB-benchmark plan used for plan year 2017 with the same category or categories of EHB from another states EHB Benchmark Plan used for plan year 2017 orOtherwise selecting a set of benefits that would become the states EHB-benchmark plan.For plan year 2022 DIFS proposes utilizing option three by adding the following benefits to Michigans current EHB-benchmark planCoverage of at least one intranasal spray opioid reversal agent when prescriptions of opioids are dosages of 50MME or higher.Removal of barriers to prescribing Buprenorphine or generic equivalent products for medication-assisted treatment of opioid use disorder.Additional information regarding the proposed updates to Michigans EHB-benchmark plan for the 2022 plan year are available online at the DIFS EHB Information webpage. This information includes materials regarding Michigans current EHB-benchmark plan an Actuarial Report and Certification affirming that Michigans EHB-benchmark plan proposed for plan year 2022 meets certain federal requirements Michigans EHB-benchmark Plans Benefits and Limitations Summary Formulary Drug List containing applicable RxNorm Concept Unique Identifiers and State Confirmations that the proposed EHB-benchmark plan for the 2022 plan year satisfies applicable federal regulations.
