The pillars of an essential health benefits package are medical effectiveness, safety, and their relative value compared with alternatives, the Institute of Medicine suggested last week. Working out the details, however, is up to the Department of Health and Human Services, which has announced that it will seek public opinion on what health insurance exchanges must offer.
The Institute of Medicine unveiled last week the processes and procedures it recommends that HHS follow in the development of the health benefits package that will be offered by health insurance exchanges (HIX). That effort involved an 18-member committee comprised primarily of representatives from organized stakeholder groups.
Keith Maley, an HHS spokesperson, said in an interview that the agency will focus for the time being on getting public input on the development of essential health benefits. The IOM has recommended a public process for both defining and updating the EHB package.
In its report, Essential Health Benefits: Balancing Coverage and Cost, the IOMsaid the public deliberation process "would enable individuals? working in small group meetings around the country?to participate in a prioritization process, where different elements of coverage?specific services, types of cost-sharing, degree of provider choice, approval requirements, etc.?are discussed and debated."
In a press statement Secretary Kathleen Sebelius stressed the importance of the "listening sessions where Americans from across the country will have the chance to share their thoughts on these issues but offered no commitment to the structure of the sessions themselves or their locations.
Maley said the department faces "no statutory deadline" for creating the list of essential benefits. However, the Affordable Care Act requires that HIX be up and running in 2014. Health plans have already expressed concern that they will face a tight timeline to develop, test and market a health insurance product that can be ready for HIX. Off the record, insurers have suggested that a six- to 18-month timeline is not out of question.
IOM has recommended that the list be developed by May 1, 2012.
Walt Cherniak, a spokesperson for Aetna, noted that the rollout for an essential health benefits product could be different from how the large insurer usually introduces a new product. "We usually work from customer demand. This time we'll be putting together mandated benefits and mandated design."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
