New rule published on essential health benefits

The Department of Health and Human Services (HHS) published a final rule on Feb. 25 outlining essential health benefits that must be covered by all insurers wishing to participate in the new health insurance marketplaces. The rule, first released to the public the week of Feb. 18, had been long awaited by insurance companies and states looking for guidance while preparing for the marketplaces to go live in October, according to the National Association of Healthcare Access Management (NAHM), quoting “Kaiser Health News.”

Within the rule, there are 10 categories of care that must be covered, including emergency services, maternity care, hospital and doctor services, mental health and substance abuse care, and prescription drugs. “Kaiser Health News” reports that these requirements apply to individual and small group plans, including plans offered in the marketplaces, and to those newly eligible for Medicaid coverage.

HHS published the rule partly to standardize plans for ease of comparisons by consumers, and partly to prohibit discrimination based on age or pre-existing conditions, as stated in the Affordable Care Act. The final version of the rule is also similar to the earlier draft version, which received about 11,000 comments when it was published in November. One change, according to “USA Today,” was a shift to focus more on mental health. Some organizations are concerned that the focus may have come out of the shooting in Newtown, CT, and could prove pricey.

HHS Secretary Kathleen Sebelius fought back against this claim, however. In a written statement, she cited that the new regulations close a major gap in coverage for people suffering from mental health or drug problems. Prior to the rule, almost 20% of people purchasing insurance did not have access to mental health services, and nearly one-third had no substance abuse disorder benefits. According to “The Hill,” the expansion of mental health and substance abuse benefits could benefit 62 million people.

Policies specified in the rule will go into effect in January 2014. The rule can be accessed at