1. (a) In selecting the benchmark plan for establishing EHB for nongrandfathered individual and small group health plans, the Insurance Commissioner shall take into consideration the following factors:

   1. (1) The federal requirement that the EHB package covers each of the following ten (10) statutory categories of EHB set out in Section 1302(b)(1) of the Affordable Care Act:

      1. (A) Ambulatory patient services;
      2. (B) Emergency services;
      3. (C) Hospitalization;
      4. (D) Maternity and newborn care;
      5. (E) Mental health and substance abuse disorder services, including behavioral health treatment;
      6. (F) Prescription drugs;
      7. (G) Rehabilitative and habilitative services and devices;
      8. (H) Laboratory services;
      9. (I) Preventive and wellness services and chronic disease management; and
      10. (J) Pediatric services, including oral and vision care;
   2. (2) The balance between comprehensiveness of benefits with plan affordability to promote optimal access to care for all residents of the state;
   3. (3) The extent to which supplements to the potential EHB benchmark must be made to be inclusive of the ten (10) statutory categories above;
   4. (4) The cost to the state of a potential EHB benchmark plan which may require the state to defray the costs of benefits mandated by state law in excess of the essential health benefits;
   5. (5) The appropriate balance of benefits among the ten (10) statutory categories so that benefits are not unduly weighted toward any category;

   6. (6) The health care needs of diverse segments of the Arkansas population, including:

      1. (A) Women;
      2. (B) Children;
      3. (C) Persons with disabilities; and
      4. (D) Other groups;

   7. (7)

      1. (A) The capacity of both individual and small group health plans in their ability to provide the potential EHB benchmark plan.
      2. (B) Capacity should be assessed by considering:

2. (i) Network adequacy in terms of the ability of plans to deliver the EHBs; and

   1. (ii) Whether the EHB package is too rich for plan sustainability and premium affordability in Arkansas’s marketplace;
   2. (8) The advisory committee, public and healthcare industry comments and recommendations, and actuarial studies for EHB benchmark plan options;
   3. (9) The extent to which the selection of a potential EHB benchmark plan may impact participation in the exchange by consumers and health insurers in the market; and
   4. (10) The extent to which the selection of the potential EHB benchmark plan provides and advances consumer protection interests to Arkansas participants in the health insurance marketplace.

3. (b) The commissioner shall maintain that the state benchmark plan shall be selected through an open, transparent, and inclusive process.

   1. (c) The commissioner shall evaluate the above considerations and select an initial EHB benchmark plan for coverage years 2014 and 2015 on or before September 30, 2012.

      1. (d) After selection of the EHB benchmark plan, the commissioner shall issue his or her decision as to the EHB benchmark plan and the reasons therefore, through a publicly issued directive or bulletin within ten (10) days following submission of a report to the commissioner from the Arkansas Health Benefits Exchange Partnership Division, which shall include the data and recommendations related to the factors set out in subdivisions (a)(1) – (10) of this section.

Codification Notes: “EHB” means essential health benefits. Section 1302(b)(1) of the Affordable Care Act is codified at 42 U.S.C. § 18022(b)(1).