QHPs will be the benchmark plans within health insurance exchanges, instituted by the Patient Protection and Affordable Care Act. EHBs are the scope of benefits covered by a typical employer plan and cover at least the following 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse, prescription drugs, rehab services, laboratory services, preventive and wellness care such as chronic disease management, and pediatrics.
HHS will collect data from the three largest health plans within each state’s small group market, as was proposed in the June 5 rule.
In addition, HHS finalized interim accreditation bodies for each state’s proposed EHB package: the National Committee for Quality Assurance and URAC, a non-profit group that accredits quality measures in healthcare organizations. NCQA and URAC would approve health plans for state health insurance exchanges.
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