Source: hr3590.com
How the U.S. Department of Health and Human Services will identify benchmark plans that would set the standard for essential health benefits under health reform was described in a final rule issued July 23.
This is important because policies sold on health insurance exchanges — for individuals and for small groups — must cover the EHB package.
Larger and self-funded employer plans are watching closely because (while observers say such plans already cover most EHB benefits) they’ll be under market pressure to meet whatever is required to be offered on exchanges that they are not offering now.
The HHS rule (1) addresses the collection of data from potential benchmark plans to define EHBs and (2) establishes a process for recognizing accrediting entities to certify qualified health plans for health insurance exchanges under health reform. The final rules reflect 80 public comments received on the proposed rules, which came out June 5 with a 30-day comment period.
Non-qualitative Limits Excluded
HHS will collect data from prospective benchmark plans on:
- quantitative treatment limits (number-of-visit limits on physical therapy, for example), including time limits;
- drug coverage; and
- plan enrollment data.
The agency rejected calls to collect data on qualitative treatment limits, including exclusions, medical necessity, habilitative services and cost-sharing (including premiums) from benchmark plans.
On July 7, HHS issued a list of the plans eligible to become benchmark plans, which therefore they may be surveying.
The Essential Health Benefits Bulletin of last Dec. 16 determined that the benefits models would be based on the leading health insurance products in each state.
The final goal for HHS is to publish final rules describing which benefits will be essential under the health reform law. More guidance also will be targeted at accrediting agencies. Click here to see more information about health reform from Thompson Publishing.