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HHS Issues Final Essential Health Benefits, Other ACA Rules



This week in Washington—HHS releases final essential health benefits and other ACA-related rules. You are tuning in to the National Association of Public Hospitals and Health Systems health policy update for the week of Feb. 25, 2013.

On Feb. 20, the U.S. Department of Health & Human Services (HHS) released final guidance on what essential health benefits packages need to include. HHS’ approach would allow states to select from existing health plan items and services to be included in an essential health benefits package. The package must cover items and services in at least 10 categories of care. Coverage in a particular category could be modified as long as the value of coverage is not reduced.

The rule also provides a timeline for qualified health plans to be accredited in federally facilitated health benefit exchanges. Additionally, HHS released a report that further details how this rule affects mental health and substance abuse disorder benefits.

Last week, HHS also released additional final rules implementing provisions in the Affordable Care Act (ACA). On Feb. 22, HHS issued the final rule regarding insurance market reforms that would prohibit health plans from denying coverage due to preexisting conditions or charging higher premiums based on gender or age. The provisions in the final rule apply to plans or policies beginning in 2014.

HHS also released a proposed rule implementing medical loss ratio requirements for Medicare Advantage and Medicare prescription drug plans under the ACA. This proposed rule addresses the ACA requirement that Medicare health and drug plans spend at least 85 percent of revenue on clinical services, prescription drugs, quality improvements or direct benefits, or face financial and other penalties. The comment period for the proposed rule is 60 days. HHS also issued for public comment an advance notice of proposed Medicare Advantage payment and policy updates for 2014.

Thanks for listening to another edition of This Week in Washington. I’m Zina Gontscharow; join us next week for another update.



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