HHS issues final rule on EHB information reporting

Posted on July 19, 2012 | No Comments

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The U.S. Department of Health and Human Services (HHS) issued a final rule yesterday denoting what data will be collected from health insurance plans regarding essential health benefits (EHB) under the Affordable Care Act (ACA). The rule requires that the three largest small group health insurance plans in each state report on covered benefits to HHS. In the rule, HHS said the information reported by health plans will be used by states and health plan issuers to define, evaluate, and provide EHBs in the new health insurance exchanges.

HHS published a proposed rule June 5.

According to the final rule, the information to be reported includes information regarding health benefits in the plan, treatment limitations, drug coverage, and enrollment.

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A report recently published by Georgetown University's Health Policy Institute, funded by the Robert Wood Johnson Foundation (RWJF), describes how states and health insurers are adopting the Affordable Care Act's (ACA) essential health benefits (EHB) requirements. Pursuant to the ACA, insurers offering plans in the individual and small group health insurance Marketplaces are required to offer benefits within the 10 specified EHB categories. RWJF found that for most Americans, benefit coverage will not drastically change. If anything, most individuals will now have access to services previously not covered by insurance, such as maternity health, mental health, and prescription drugs.
A proposed rule released by the Department of Health and Human Services (HHS) would establish data collection standards necessary to implement aspects of Essential Health Benefits (EHBs), a provision of the Affordable Care Act (ACA). The rule outlines the data on applicable plans to be collected from issuers to support the definition of essential health benefits and establishes a process for the recognition of accrediting entities as qualified health plans (QHPs). HHS, the states, Exchanges, and health insurance issuers would use the collected information to better define and evaluate EHBs. Section 1302 of the Affordable Care Act (ACA) establishes EHBs...
The Affordable Care Act (ACA) identified ten categories of services and items to be included in essential health benefits (EHBs), and specified that the scope of EHBs must be equal to the scope of benefits provided under a typical employer plan. The ten categories include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. A white paper issued in December by the Department of Health and Human Services's Office of the Assistant Secretary for Planning and Evaluation (ASPE) found...
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
In February 2012, CMS issued a supplemental document entitled Frequently Asked Questions on Essential Health Benefits Bulletin. This supplement to the December 16th Bulletin provides answers to 22 questions arising from the December 16th Bulletin itself. Highlights are as follows:
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
Under the Affordable Care Act (ACA) beginning January 1, 2014, state insurance Exchanges become operational and comprehensive insurance market reforms take effect. One of the most significant market reforms is the requirement that all health insurance plans sold in the individual and small group (100 employees or fewer) markets – whether sold outside or inside state insurance Exchanges – cover “essential health benefits” (EHBs). The definition of EHBs also will apply to Medicaid “benchmark” plans, the specified coverage standard for individuals made newly eligible by the ACA’s Medicaid expansions.