Comment and response document

#	Commenter	Category of Commenter	Overview of Comments	Response
131	Endocrine Society	Providers/provider groups/provider associations	While it is unclear how many states would set their benchmarks with less comprehensive EHBs, CMS estimates that 10 states would choose to change their EHB-benchmarks in each year and has acknowledged it is more likely that the changes the states will make will reduce benefits and premiums, rather than expanding them. For patients with endocrine disorders, care could become unaffordable. We urge CMS not to finalize this policy as proposed and retain the current policy that governs how states define and select their benchmark plans.	10 States is estimated per a year based on prior experience.
213	American Academy of Actuaries	Other	The proposed information collection (CMS-10448) includes an actuarial certification that appears to note the required regulatory and statutory requirements. We appreciate that actuaries would not be required to certify EHB balance or diverse population segment requirements given the current lack of definition around these concepts. The PDF version of the actuarial certification required form may not provide sufficient space for appropriate responses, especially on the second page of the certificate where short responses are requested. This may lead actuaries to reply “Please see the accompanying report for the methods used” to maintain a readable response.	Added space to the pdf file for responses.
213	American Academy of Actuaries	Other	Further, the second and fourth response boxes on page two of the PDF form appear to be linked, requiring the same response for both. While the methodologies used to determine compliance with each requirement are likely to be similar, they may not be identical and the certifying actuary should be able to document the methodologies of each.	Clarified in a footnote that the Question 4 and 8 do not need to use the same methodology
313	National Association of Dental Plans	Health insurance issuers	In PRA 10448 related to this NBPP, CMS provides a draft form for State submission of EHB- benchmark changes. Several benefit categories are prefilled in the column labeled “EHB” with “No” (e.g. Routine Dental Services (Adult)). This column includes “No” for “Orthodontia – Child,” which we believe may be an error or an area for clarification. Medically-necessary orthodontia, when included in a State’s benchmark plan, is considered an EHB and is provided by many SADPs on the public Marketplaces. Non-medically- necessary orthodontia or cosmetic orthodontia is not considered an EHB for children or adults and may be a better category for this row.	Removed the "no" for “Orthodontia – Child,”
14	American Speech-Language-Hearing Association	Advocacy Group	CMS maintains that these proposed options will afford additional flexibility to states in adopting their own EHB benchmark plan; however, this approach appears burdensome and could actually deter states from even selecting a benchmark. For the 2017 benchmark selection process, only 29 states selected an EHB benchmark plan. Under the 2019 NBPP proposed rule, states would be given the option to modify their EHB benchmark annually, and CMS estimates that 10 states would choose to change their EHB benchmark in any given year. States would have the burden of submitting (a) an actuarial certification and report of the methods and assumptions used when selecting proposed options, (b) its new EHB benchmark plan documents accurately reflecting benefits and limitations, including a schedule of benefits, and (c) documentation operationalizing the state’s EHB benchmark plan. The purported additional flexibility provided to states does not justify or outweigh the potential loss of coverage for consumers or the added administrative and financial burdens on states.	The burden estimate reflects the increased level of effort on behalf of States to select a new benchmark plan.