DHHS Solicits Comments on Essential Health Benefits Regulation (Not Applicable to Self-Funded Group Health Plans)
www.myhealthguide.com
MyHealthGuide Source: Department of Health and Human Services (HHS), 12/16/2011,
http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf
Editor’s Note: According to the Bulletin, self-insured group health plans, health insurance coverage offered in the large group market, and grandfathered health plans are not required to cover the essential health benefits. Nevertheless, this Newsletter is reporting Bulletin’s existence and purpose since many readers have inquired about Essential Health Benefits.The U.S. Department of Health & Humans Services (DHHS) solicits comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits (EHB) under section 1302 of the Affordable Care Act.
This bulletin begins with an overview of the relevant statutory provisions and other background information, reviews research on health care services covered by employers today, and then describes the approach HHS plans to propose.
- This bulletin only relates to covered services.
- Plan cost sharing and the calculation of actuarial value are not addressed in this bulletin.
DHHS plans to release guidance on calculating actuarial value and the provision of minimum value by employer-sponsored coverage in the near future.
The intended regulatory approach utilizes a reference plan based on employer-sponsored coverage in the marketplace today, supplemented as necessary to ensure that plans cover each of the 10 statutory categories of EHB. In developing this intended approach, HHS sought to balance comprehensiveness, affordability, and State flexibility and to reflect public input received to date.
Table of Contents of the bulletin:
- Defining Essential Health Benefits
- A. Introduction and Background
- Statutory Provisions
- Public and Other Input
- B. Summary of Research on Employer Sponsored Plan Benefits and State Benefit Mandates
- Similarities and Differences in Benefit Coverage Across Markets
- Mental Health and Substance Use Disorder Services
- Pediatric Oral and Vision Care
- Habilitative Services
- Comparison to Other Employer Plan Surveys
- State Benefit Mandates
- C. Intended Regulatory Approach
- Four Benchmark Plan Types
- Defraying the Cost of Additional Benefits
- Benchmark Plan Approach and the 10 Benefit Categories
- Habilitation
- Pediatric Oral and Vision
- Mental Health and Substance Use Disorder Services and Parity
- Benefit Design Flexibility
- Updating Essential Health Benefits
CMS requests comments on the bulletin by January 31, 2012 be sent to: EssentialHealthBenefits@cms.hhs.gov
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