Lessons from California on essential benefits…

In 2014 under the Affordable Care Act, health plans will need to include essential health benefits (EHB), which fall under 10 general categories including emergency services, behavioral health treatment, and preventive services and chronic disease management.

The Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) recommend the criteria and methods for determining and regularly updating the EHB package. Today, the IOM released a report summarizing the workgroups that they held around the country.

To be clear, the IOM will release a final report with recommendations on these processes in the early fall of 2011–that’s what everybody is waiting for with some suspense.

Until then, it’s interesting to see what came out of the public workshops held in Washington, DC (January 13-14, 2011), and here in California in Costa Mesa, CA (March 2, 2011). The workshops brought together experts from federal and state governments, employers, insurers, healthcare providers, consumers, and healthcare researchers. Speakers discussed topics such as the need to balance the generosity of EHB with affordability of insurance products, in consideration of how insurers design benefits, and incorporating evidence into benefit priority decisions, among other issues. This document summarizes the workshops.

In particular, one chapter focuses on “Lessons from California Benefit Review Processes,” which features testimony from the CA Department of Managed Health Care, the California Health Benefit Review Program, and from us at Health Access California. We hope the final consensus report is informed by California’s experience.

Health Access California promotes quality, affordable health care for all Californians.
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