IOM Releases Report on Essential Health Benefits - October 12, 2011

On Oct. 6, the Institute of Medicine (IOM) released its long-awaited report on essential health benefits (EHB) to be included in certain health insurance plans for individuals and small businesses beginning in 2014. In this report, the IOM recommended the process and criteria for determining and updating the EHB package. The report noted that the task of the IOM committee was not to decide what is covered in the EHB package, but rather to recommend a set of methods and criteria that the U.S. Department of Health and Human Services (HHS) should use in deciding what should be covered. Of particular interest to NAPH members, the IOM committee acknowledged the lack of consensus around whether Congress intended the EHB package to be a minimum or comprehensive set of benefits and interpreted the term to mean a minimum set of benefits. Accordingly, the IOM committee recommended that the HHS secretary, who will use the IOM report to promulgate regulations on EHB, focus only on medical benefits and make decisions about which ones should be covered with a target premium amount in mind. NAPH will be closely following this and other exchange-related implementation updates from HHS. If you have questions, please feel free to contact Xiaoyi Huang, assistant vice president for policy, at 202-585-0127 or xhuang@naph.org.