Friday, December 2, 2022

HHS Revisits Essential Health Benefits; Comment til January 31, 2023

On December 2, 2022, HHS published a notice that it is revisiting the definition(s) of Essential Health Benefits under the Affordable Care Act.   By law (ACA 1302), Exchange plans must have ten "categories" of service - defined as "emergency services, hospital services, pediatric services..." etc.   There's a benefit for "laboratory services," but what do those two words mean in this legal context?   The concept is further defined by "benchmark plans" but that can be vague, too.   

HHS doesn't have any answers, but is seeking public comment - til January 31, 2023.  See the full 6-page publication (87 FR 74097) here:

The fact the RFI is 6 pages long indicates that CMS has quite a few topics and questions, including some about access to new technologies.

The topic is also interesting in light of hit-and-miss efforts to add "biomarker mandates" to insurance laws in various - some fizzle, some pass, but even the ones that pass may be slow in implementation.  Some entry points at a blog here.

If a state does not name a benchmark plan, it is the largest plan serving small groups (e.g. small employers). See PDF.