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HHS Issues Final Rule on Benchmarking EHBs for Insurance Exchanges

Margaret Dick Tocknell, for HealthLeaders Media, July 20, 2012

The final rule for identifying potential benchmark plans to support the definition of essential health benefits as well the process for recognizing accrediting entities to certify qualified health plans for state health insurance exchanges, was quietly released earlier this week by the Department of Health and Human Services.

While this rule puts many of the components of EHBs in place, full implementation will require some additional rulemaking. HHS indicates within this rule that it will issue future rules to set criteria for health plan accreditation, as well as to "to align with the timeframe of other quality reporting requirements, including establishing a quality rating system."

The timeline for these additional rules is unknown at this time, although it’s clear that HHS is on a fast track to provide EHB details. This final rule was released only 11 days after the end of its comment period. HHS is committed to having EHBs in place in time for insurance issuers to use the information for plan design and rate setting for initial enrollment in Fall 2013.

According to this rule, data from insurers that offer the three largest small group products will be used to identify the benchmark plan for each state for establishing EHBs that must be offered beginning in 2014 by health plans in the online exchange marketplace as well as in individual and small group health insurance policies.  Insurer size is gauged by total enrollment as of March 31, 2012.

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