93.679: EHB-Benchmark Plan Modernization Grant for States with a Federally-facilitated Exchange

93.679

Active

Centers for Medicare and Medicaid Services (CMS) [HHS]

Oct. 1, 2024

Oct. 1, 2024

EHB-Benchmark Plan Modernization Grant for States with a Federally-facilitated Exchange (FFE EHB Mod) will provide a funding source to States on the Federally-facilitated Exchanges (FFEs) for activities related to submitting an application to update EHB-benchmark plans under 45 CFR 156.111. Health insurance that provides the EHB must generally provide benefits that are substantially equal to the benefits provided in the relevant state’s EHB-benchmark plan. Each year, states may make updates to the benefits covered in EHB-benchmark plans by submitting an application to CMS by the first Wednesday in May of the year that is 2 years before the effective date of the new EHB-benchmark plan. States with an FFE must use grant funds for the planning, implementation, and submission of applications to improve or update coverage of, and access to the Essential Health Benefits (EHBs) provided in state EHB-benchmark plans. States that decide to update EHB-benchmark plans with grant funds should endeavor to submit an application by May 5, 2027 for effectiveness in plan year 2029. States that do not submit an application by May, 2027, are encouraged to submit an application to update their EHB-benchmark plan after the end of the award period, but the grant will not be extended to provide states with support. These improvements or updates may include, but are not limited to, items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

This Funding Opportunity is open to states with a Federally-facilitated Exchange (FFE). Grant eligibility is for the 28 states anticipated to have an FFE as of January 1, 2026; specifically, Alabama, Alaska, Arizona, Delaware, Florida, Hawaii, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming. Only one application per State is permitted. For a list of State-based Exchanges (SBEs) and State-based Exchanges on the Federal Platform (SBE-FPs) that would not be eligible to receive funding from this grant, please visit, https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/state-marketplaces. Because Illinois intends to operate an SBE by January 1, 2026, it is not listed as an eligible state.

Applicants must use grant funds for the planning, implementation, and submission of applications to improve or update coverage of, and access to the EHB provided in state EHB-benchmark plans. These improvements or updates may include, but are not limited to, items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

https://sam.gov/fal/0195e5aca2ea41d98917ee21adf9963f/view