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HHS Takes Another Step Toward Defining Essential Health Benefits

Margaret Dick Tocknell, for HealthLeaders Media, June 7, 2012

The Department of Health and Human Services continues to parse out potential requirements for essential health benefits A proposed rule released Tuesday reveals that HHS wants to use the small group market plan and product with the largest enrollment as the default benchmark plan, but only if a state doesn’t select its own benchmark.

HHS also proposes that the National Committee for Quality Assurance and the non-profit URAC serve as the interim accrediting organizations for health plans seeking to be part of the state health insurance exchanges.

The Patient Protection and Affordable Care Act requires HHS to define the EHBs. These are 10 categories of service that must be offered beginning in 2014 by HIEs and individual and small group health insurance policies. The ACA charges HHS with making the final EHB call after getting input from the Department of Labor and the independent Institute of Medicine.

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