The rule outlines the data to be collected from issuers to support establishing essential benefits, including treatment limitations, drug coverage and plan enrollment.
Additionally, HHS proposes that the National Committee for Quality Assurance and URAC, a non-profit group that accredits quality measures in healthcare organizations, function as accreditation bodies for each state’s proposed essential health benefits package. NCQA and URAC would approve health plans for a state health insurance exchanges.
HHS issued a bulletin in December discussing the benchmark approach it would take to defining essential health benefits.
Under HHS’ proposal, an individual state is free to select an existing health plan to set a benchmark for items and services included in its essential health benefits package.
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