Institute of Medicine To Advise HHS on 'Essential Health Benefits' Rules

TOPIC ALERT:

On Wednesday, the Institute of Medicine will hold a closed-door meeting, followed by a two-day public briefing, to determine what are considered "essential health benefits" under the federal health reform law, CQ HealthBeat reports.

The process aims to help HHS decide which medical services and equipment HHS will require insurers to cover by 2014.

The law specifies several general categories that insurers must cover, including:

  • Emergency services;
  • Mental health care;
  • Outpatient and inpatient care;
  • Pediatric dental and vision care;
  • Rehab therapy; and
  • Wellness services.

HHS must determine whether to be specific or give insurers flexibility in regard to requiring specific treatments. HHS is required to ensure that the scope of essential health benefits "is equal to the scope of benefits provided under a typical employer plan."

According to CQ HealthBeat, it is unclear if officials will seek a specific list of treatments or ask insurers to mirror benefits in particular plans, such as the Federal Employee Health Benefits Program. The rules might enable insurers to design plans differently, as long as they provide a certain value of coverage overall.

Next Steps

IOM will publish recommendations for HHS by September, and HHS will issue its proposed rules by the end of the year, giving insurance companies time to adjust plans before the provisions take effect.

HHS' final decision on which products and services must be covered has wide implications for drug and device manufacturers, physicians, insurers and other health care providers, according to CQ HealthBeat (Adams, CQ HealthBeat, 1/10).


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