Health ben­e­fits feed­back

Sug­ges­tions to HHS in­clude flex­i­bil­ity, clar­ity

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

Flex­i­bil­ity for em­ploy­ers, a min­i­mum fed­eral com­pli­ance stan­dard for states, and a clear def­i­ni­tion of “med­i­cal ne­ces­sity” were among the es­sen­tial health ben­e­fit rec­om­men­da­tions that provider groups, busi­ness as­so­ci­a­tions and health plans sent to HHS.

The sug­ges­tions came as the ini­tial com­ment pe­riod ended last week on the es­sen­tial health ben­e­fits “bul­letin” that HHS re­leased in De­cem­ber to gen­er­ate feed­back from those who have a stake in the ben­e­fits that health plans must in­clude in 2014. Hhs—which will still ac­cept sug­ges­tions—re­ceived just more than 7,000 com­ments.

HHS said the ap­proach was in­tended to give states more flex­i­bil­ity in im­ple­ment­ing pro­vi­sions of the Pa­tient Pro­tec­tion and Af­ford­able Care Act. The law re­quires that health plans of­fered in the in­di­vid­ual and small group mar­kets—both in­side and out­side of the in­sur­ance ex­changes—of­fer a pack­age of ser­vices known as es­sen­tial health ben­e­fits. Those ben­e­fits must in­clude items and ser­vices that fall into 10 cat­e­gories, in­clud­ing am­bu­la­tory care, hos­pi­tal­iza­tion, emer­gency ser­vices, men­tal health, and pre­ven­tive and well­ness ser­vices.

HHS pro­posed that each state be al­lowed to model its es­sen­tial ben­e­fit pack­age on the largest HMO plan of­fer­ing its com­mer­cial mar­ket or one of the three largest small group plans, state em­ployee health plans or fed­eral em­ployee health plan op­tions.

In a six-page let­ter to CMS act­ing Ad­min­is­tra­tor and COO Marilyn Taven­ner, the Fed­er­a­tion of Amer­i­can Hos­pi­tals strongly en­cour­aged HHS to fol­low the bul­letin with a

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