Institute of Medicine Issues Recommendations on Essential Health Benefits

News from the Blues reports:

“The Institute of Medicine (IOM) today publicly released its final report titled “Essential Health Benefits: Balancing Coverage and Cost.” This report details the findings and recommendations of the IOM regarding the benefits that most new insurance plans for individuals and small businesses will need to include by 2014, as described by the Affordable Care Act (ACA).

Under ACA, beginning in 2014 a package of minimum “essential benefits” falling into 10 general categories ranging from hospitalization to prescription drugs, rehabilitative and habilitative services — must be included in most plans offered on the insurance exchanges established by ACA. Congress largely left it to Health and Human Services to define the essential benefits package and decide what should be included in it.

In 2010, the Department of Health and Human Services (HHS) tasked the IOM, one of the national academies of science that advises U.S. policymakers, with researching essential benefits and recommending how HHS should determine the basic health benefits package. IOM had until this fall to provide their report.

IOM said their report only recommends criteria and methods that HHS can use to develop an essential health benefits package; it does not recommend specific medical services that should be part of the package.

HHS may or may not adopt IOM’s recommendations, but it is expected that the findings will guide HHS in drafting its final rules. We do not anticipate HHS issuing regulations before mid-2012; IOM itself recommended that HHS release its initial design by May 2012. We will keep you informed as more information becomes available about the definition of essential health benefits and how it might impact health insurance coverage.”