The purpose of the Essential Health Benefits Bulletin is to provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits (EHB) under section 1302 of the Affordable Care Act. The bulletin begins with an overview of the relevant statutory provisions and other background information, reviews research on health care services covered by employers today, and then describes the approach HHS plans to propose. The bulletin only relates to covered services. Plan cost sharing and the calculation of actuarial value are not addressed in this bulletin. HHS plans to release guidance on calculating actuarial value and the provision of minimum value by employer-sponsored coverage in the near future. In addition, HHS plans to issue future guidance on essential health benefit implementation in the Medicaid program. Please use the following link the access the full bulletin: http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf
The intended regulatory approach utilizes a reference plan based on employer-sponsored coverage in the marketplace today, supplemented as necessary to ensure that plans cover each of the 10 statutory categories of EHB. In developing this intended approach, HHS sought to balance comprehensiveness, affordability, and State flexibility and to reflect public input received to date.
Essential Health Benefits (EHB) include items and services within the following 10 benefit categories:
(1) ambulatory patient services;
(2) emergency services;
(3) hospitalization;
(4) maternity and newborn care;
(5) mental health and substance use disorder services, including behavioral health treatment;
(6) prescription drugs;
(7) rehabilitative and habilitative services and devices;
(8) laboratory services;
(9) preventive and wellness services and chronic disease management; and
(10) pediatric services, including oral and vision care.
Public input is welcome on this intended approach. Please send comments on the bulletin by January 31, 2012 to: EssentialHealthBenefits@cms.hhs.gov.
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