Health benefits feedback

Suggestions to HHS include flexibility, clarity

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