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Proposed EHB Rule Draws Few Comments

Margaret Dick Tocknell, for HealthLeaders Media, July 9, 2012

The Federation of American Hospitals which represents more than 1,000 investor-owned or managed community hospitals and health systems, wants the Centers for Medicare & Medicaid Services to clarify "the specific language related to measures that are developed or adopted by a voluntary consensus standards setting body." FAH notes that the National Quality Forum is the designated consensus-based entity under contract with HHS to endorse clinical quality measures and wants to specify that measure sets used for quality health plan accreditation include measures that are endorsed by the NQF.

Cigna, a provider of health insurance and related services, wants a consistent definition of habilitative services to be applied across all health plans. "We do not support the option of allowing plans to decide which habilitative services to cover." Cigna proposes that habilitative services be "covered in parity with rehabilitative services." It want coverage for both to be limited to care with "quantifiable, measureable, and attainable treatment goals."

It doesn't support the inclusion of block or association products in defining benchmark plans. "Closed blocks are intended to be retired and no longer offered to new purchasers."

Bayer Healthcare, a specialty pharmaceutical and medical device company, expressed concern that some state policymakers could try to limit coverage for contraceptives by selecting benchmark plans that offer less favorable coverage. Bayer wants health plans to be required to provide information about how contraceptive drugs are covered under preventive services benefits, including any required cost sharing.


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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