The Centers for Medicare & Medicaid Services (CMS) has released the long-awaited final rule on the Affordable Care Act's (ACA's) essential health benefits (EHB), actuarial value, and accreditation requirements. In the rule, the Obama administration finalizes the state benchmark approach to defining mandated benefits through 2014 and 2015. As previously proposed, insurers may substitute benefits within the 10 services mandated to be covered under the ACA's EHB package. The final rule also finalized a 2 percentage point leeway regarding the ACA's cost-sharing metal tiers. With regards to drug coverage, the final rule requires plans in the Exchanges to cover one drug in each class, or as many medications as are covered in the state’s benchmark plan. In establishing Exchange drug coverage rules, States must choose the option that provides consumers with greater drug coverage. For a fact sheet on the rule, click here.

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.

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.

On February 24, The Department of Health and Human Services (HHS) outlined the proposal it plans to use to define actuarial value for individual and small group health plans. The bulletin also outlines the plans for cost-sharing requirements for benefits that insurers must cover for moderate-income people purchasing policies through insurance exchanges. Actuarial value (AV), a measure of the percentage of expected health care costs a health plan will cover...

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.

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...