HHS proposes rule to help define essential health benefits

The Health and Human Services Department on Friday detailed its proposed options for states to use in selecting the "essential health benefits'' they are required to offer individuals and small groups by 2014 under the 2010 Affordable Care Act.

As described in a bulletin released for public comment, states preparing to implement health insurance exchanges are to select the benchmark for their plans -- all of which must include 10 categories of basic care set out in the law. States will choose among typical plans offered by either the three largest small group plans in the state, one of the three largest state employee health plans, one of the three largest federal employee health plan options, or the largest health maintenance organization plan offered in the state's commercial market.

"Under the Affordable Care Act, consumers and small businesses can be confident that the insurance plans they choose and purchase will cover a comprehensive and affordable set of health services," said HHS Secretary Kathleen Sebelius. "Our approach will protect consumers and give states the flexibility to design coverage options that meet their unique needs."

In a conference call with reporters, she added that "what works in Florida may not work in Nebraska."

States can modify the plans as long as they don't reduce the overall value, and they must offer preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs. Since states will be required to finance any benefits over and above the essentials, they will be given a transition period during which HHS can monitor progress.

Sherry Glied, assistant HHS secretary for planning and evaluation, said more than 30 million Americans who are newly insured in 2014 will have a comprehensive benefit.

"Many millions of Americans buying their own insurance today will gain valuable new coverage," she added, "including more than 8 million Americans who currently do not have maternity coverage and more than 1 million who will gain prescription drug coverage."

Glied said the benchmark approach is similar to that featured in the State Children's Health Insurance Program and parts of Medicaid. Most employer packages are similar, she said, the differences falling mostly in coverage of areas such as pediatric vision and dental care.

Steven Larsen, deputy administrator and director of the HHS Center for Consumer Information and Insurance Oversight, told reporters the release was made this month because "states are interested in knowing how we approach this as they come into their legislative seasons."

The proposed rules deal only with benefits being offered to individuals and small groups, not with cost sharing policies such as deductibles and co-payments, which will be addressed separately. Comments are due Jan. 31, 2012.

Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
Close [ x ] More from GovExec

Thank you for subscribing to newsletters from GovExec.com.
We think these reports might interest you:

  • Sponsored by G Suite

    Cross-Agency Teamwork, Anytime and Anywhere

    Dan McCrae, director of IT service delivery division, National Oceanic and Atmospheric Administration (NOAA)

  • Data-Centric Security vs. Database-Level Security

    Database-level encryption had its origins in the 1990s and early 2000s in response to very basic risks which largely revolved around the theft of servers, backup tapes and other physical-layer assets. As noted in Verizon’s 2014, Data Breach Investigations Report (DBIR)1, threats today are far more advanced and dangerous.

  • Federal IT Applications: Assessing Government's Core Drivers

    In order to better understand the current state of external and internal-facing agency workplace applications, Government Business Council (GBC) and Riverbed undertook an in-depth research study of federal employees. Overall, survey findings indicate that federal IT applications still face a gamut of challenges with regard to quality, reliability, and performance management.

  • PIV- I And Multifactor Authentication: The Best Defense for Federal Government Contractors

    This white paper explores NIST SP 800-171 and why compliance is critical to federal government contractors, especially those that work with the Department of Defense, as well as how leveraging PIV-I credentialing with multifactor authentication can be used as a defense against cyberattacks

  • Toward A More Innovative Government

    This research study aims to understand how state and local leaders regard their agency’s innovation efforts and what they are doing to overcome the challenges they face in successfully implementing these efforts.

  • From Volume to Value: UK’s NHS Digital Provides U.S. Healthcare Agencies A Roadmap For Value-Based Payment Models

    The U.S. healthcare industry is rapidly moving away from traditional fee-for-service models and towards value-based purchasing that reimburses physicians for quality of care in place of frequency of care.

  • GBC Flash Poll: Is Your Agency Safe?

    Federal leaders weigh in on the state of information security


When you download a report, your information may be shared with the underwriters of that document.