The group's final report stressed medical effectiveness, safety, and costs. It provided recommendations in five areas:
Reaction to the IOM report was generally favorable although there was grumbling from consumer groups that wanted the IOM to endorse robust benefits and to not worry so much about costs.
HHS faces a tight timeline for establishing EHB. Health insurance exchanges have already been a tough sell in many states where the political powers that be view healthcare reform as yet another federal mandate that will be costly for states to implement.
HHS took IOM's advice and conducted three listening sessions in Washington, DC for provider groups and consumer advocates, as well as one session for health plans and employers. The department also held a conference call with state government representatives to hear their thoughts on the EHB policy. HHS also held 10 sessions across the country that drew more than 1,000 participants.
HHS identified these key themes:
For now it seems that employers, health plans and government officials have won the latest battle of the benefits. HHS has announced that each state will have the flexibility to select an existing health plan to set the benchmark for the items and services included in an essential health benefits package.
States will still have to make sure that their health insurance plans cover the 10 categories of care mandated in the PPACA, but this decision provides states with flexibility in how the categories will be covered.
But remember, this was all released as a bulletin. That means HHS is testing the waters and probably expects the give and take to continue. Comments are welcome at EssentialHealthBenefits@cms.hhs.gov until Jan. 31, 2012. The final rule is expected in May.