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HHS Issues Final Rule on Benchmarking EHBs for Insurance Exchanges

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

The rule also establishes the two-phase approach to be used in the quality health plan accreditation process. Phase one identifies the National Committee for Quality Assurance and the URAC as interim accrediting agencies. The two are already responsible for most health plan accreditations.

Phase two, which will be detailed in another rule, will establish the criteria-based review process to be used.

The Patient Protection and Affordable Care Act requires HHS to define EHBs, which are 10 general categories of service that must be offered beginning in 2014 by health insurance exchanges, as well as individual and small group health insurance policies. In December, 2011,  HHS announced that it would leave that job up to the individual states.

HHS, however, reserved the right to establish the process that states must use to identify their EHBs. According to the final rule, "HHS will also publish the state-specific benchmarks for notice and comment" and make final approval of the EHBs.

The EHB categories are

  • ambulatory patient services,
  • emergency services,
  • hospitalization,
  • maternity and newborn care,
  • mental health and substance use disorder services (including behavioral health treatment), prescription drugs,
  • rehabilitative and habilitative services and devices,
  • lab services,
  • preventive and wellness services and chronic disease management, and
  • pediatric services (including oral and vision care
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