A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

HHS releases FAQs on EHB

Posted on February 17, 2012 | No Comments

PDF Version
Details
Library
Implementation Briefs
Key Developments

On December 16, 2011, the Department of Health and Human Services (HHS) released a Bulletin describing the approach it intends to take in future rulemaking to define the essential health benefits (EHB) under the Affordable Care Act. This document of frequently asked questions (FAQs) is intended to provide additional guidance on HHS’s intended approach to defining EHB. This bulletin describes a comprehensive, affordable and flexible proposal and informs the public about the approach that HHS intends to pursue in rulemaking to define EHB.  HHS intends to propose that EHB are defined using a benchmark approach. Under the department’s intended approach, states would have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” This approach would give states the flexibility to select a plan that would best meet the needs of their citizens.

No Comments

Public comments are closed.

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 new analysis from George Washington University's Sara Rosenbaum found that habilitative services will be uncertain during the initial implementation of the Affordable Care Act (ACA). The analysis, commissioned by the The Lucile Packard Foundation for Children’s Health, discusses the implications of the federal government in permitting health plans to both define the parameters of coverage and also, to potentially scale back coverage for habilitative services in favor of broader coverage for rehabilitation services. Many parents of children with developmental disabilities have trouble getting insurance coverage for habilitative services which can help their children keep, learn or improve their skills and daily functioning. The discretion given to health plans to both define the habilitative services benefit and pursue substitution practices in the absence of state requirements to the contrary raises important issues for individuals and families, as well as for providers of critically important services related to the treatment and management of developmental disabilities.
According to an article recently published in Health Affairs, if the Affordable Care Act (ACA) had been in place in 2001-2008, people in the individual insurance market would have saved about $280 per year on out-of-pocket costs. These savings would have been even more significant for people aged 55-64, as this age group racks up higher medical bills, but is still ineligible for Medicare. The root of the savings under the ACA is in the creation of the new health insurance exchanges, which make coverage more accessible for consumers in the individual market. Plans distributed through exchanges must cover essential health benefits, which include benefits such as prescription drugs and certain preventive services without copayments. The essential health benefit requirement in the exchanges will make the individual policies more generous and will create significant annual out-of-pocket savings for consumers. In addition, the study reports that the ACA reduces the risk of incurring high out-of-pocket costs. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.
On February 25th, 2013, final regulations implementing the essential health benefit (EHB) provisions of the Affordable Care Act were published in the Federal Register (78 Fed. Reg. 12834-12872). The EHB rules, which amend 45 C.F.R., apply to all non-grandfathered individual and small group health plans sold after January 1, 2014, as well as Medicaid benchmark and benchmark-equivalent health plans. The EHB rules also apply to...
On November 26, 2012, the Obama Administration published a series of proposed rules implementing many of the Affordable Care Act’s (ACA) most important insurance reforms, including Health Insurance Market Rules and Rate Review (77 Fed. Reg. 70584), Nondiscriminatory Wellness Programs in Group Health Plans (77 Fed. Reg. 70620), and Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation (77 Fed. Reg. 70644). In addition, the Administration issued informal guidance that add to and amplify on the provisions of the proposed rules. This Implementation Brief Update examines the proposed rule implementing the Act’s essential health benefits...
On June 5, 2012 the United States Department of Health and Human Services (HHS) published a proposed rule (77 FR 33133-33142) that would establish data collection standards for health insurance issuers as part of the Department’s implementation of the Affordable Care Act’s (ACA) essential health benefit provisions. Comments will be accepted until 5:00 p.m. on July 5, 2012. Under the ACA, as of January 1, 2014 all health insurers selling policies in the individual and small group...
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:
The Centers for Medicare & Medicaid Services' (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) released a document today which provides information to facilitate States’ selection of the benchmark plans that would serve as the reference plans for the essential health benefits (EHB). This document complements the bulletin on the EHB released on December 16, 2011. Using data from HealthCare.gov, this document provides below an updated list of the three largest small group insurance products ranked by enrollment for each State. In addition, lists of the three largest nationally available Federal Employee Health Benefit Program (FEHBP) plans are also provided.
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...