Illinois changes its health benefit benchmark plan

Illinois changes its health benefit benchmark plan

In Illinois healthcare news, Illinois became the first state to change its essential health benefit-benchmark plan.

The new plan approved Monday, August 27th, includes measures to fight the opioid crisis and expand mental health services access  in Illinois.

“This isn’t just about rules and regulations, it’s about not giving up on people,” said Jennifer Hammer, director of the Illinois Department of Insurance (IDOI).

After consulting with clinicians and researchers, the institution led by Hammer decided that five revisions need to be made in order manage the state’s biggest health issues: the opioid crisis and access to mental health services.

Under the new plan, for instance, insurance companies are prevented from imposing prior authorization or dispense limits for Buprenorphine products. Patients under medically assisted treatment (MAT) of opioid use disorder will have easier access to this drug, which helps prevent withdrawal symptoms. Buprenorphine creates  feelings of euphoria a similar to those instilled by an opioid, but it has a ‘ceiling effect’ so people can’t overuse it.

More importantly, the IDOI’s new plan includes one modification that primes the state for the digital healthcare era: tele-psychiatry care by both a prescriber and a licensed therapist.

Video-based psychiatric services can bring fast relief to patients who might not otherwise be able to see a therapist a special concern for those who live in rural areas or are homebound.

Beginning in 2020, private health insurance companies in Illinois offering plans on the individual and small group market will also be required to:

• Cover alternative therapies for pain;
• Limit opioid prescriptions for acute pain;
• Cover prescriptions for at least one intranasal spray opioid reversal agent when initial prescriptions of opioids are dosages of 50MME or higher

“These changes to the EHB-benchmark will give many people who carry private insurance access to alternatives to help them deal with the pain from injury and reduce the number of Illinoisans becoming addicted to dangerous medications,” said Illinois Gov. Bruce Rauner.

Overall, the health tech industry is booming and healthcare startups are turning a new leaf in attracting new funds in 2018. According to Healthcare Weekly, the top ten healthcare technology startups have received a staggering $1.7 billion dollars in funding over the last year.

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