CCA Statement on the Essential Health Benefits Final Rule

On February 20, 2013, the Department of Health and Human Services issued a final rule covering the essential health benefits, actuarial value, and accreditation requirements of the Affordable Care Act.

View an Overview of the rule: Essential Health Benefits Standards: Ensuring Quality, Affordable Coverage (CMS)

This regulation outlines health insurance issuer standards for coverage of essential health benefits (EHB). Under the Affordable Care Act, health plans offered in the individual and small group markets must offer the EHBs which include ‘preventive and wellness services and chronic disease management’ among others.

“Throughout the regulatory process, Care Continuum Alliance met with officials from the Center for Consumer Information and Insurance Oversight and filed comments on the initial proposed rule outlining the EHBs. In our December 2012 formal comments, CCA strongly supported the proposed regulation’s latitude for flexible program design within the EHBs category of ‘preventive and wellness services and chronic disease management.’

The Institute of Medicine’s Workgroup on Essential Health Benefits emphasized the importance of balancing comprehensiveness with affordability for both beneficiaries and health plans. Flexible standards around program design are fundamental to this balance. They are crucial to insurance issuers’ ability to create options for health care beneficiaries to access a variety of evidence-based services.

Flexible program design standards are also necessary for insurance issuers to tailor services to the health care needs of different beneficiary populations. As long as healthcare services are evidence-based, the specific program design and delivery mode standards should remain adjustable to encourage innovative and patient-centered options in the EHBs. This flexibility was maintained in the final version of the EHB rule.”

Read the rule.

Read CCA Letter to CMS from January 31, 2012.

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