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Essential benefits rules go to OMB for review


By Rich Daly
Posted: November 9, 2012 - 2:15 pm ET
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The CMS submitted rules on essential health benefits two days after the presidential election for the final stage of review before publication.

The widely anticipated rules continuing to outline essential health benefits, or the specific coverage requirements, of insurance plans in coming health insurance exchanges were submitted to the Office of Management and Budget on Nov. 8, according to its website. The proposed rules also will lay out the exchanges' “actuarial value, quality, and accreditation” standards.

Little detail was provided on what aspects of essential benefits the coming rules will address. Policy experts variously expect federal rules to provide states with more guidance about the minimum coverage that plans in state-run exchanges will need to offer their residents; offer approval or tweaks to minimum coverage requirements that some states have submitted to the CMS; and set minimum coverage levels of private plans included in federal exchanges.

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The law established 10 essential benefit categories in which exchange plans will have to provide coverage, including preventive care, emergency services, maternity care and prescription drugs. But states can decide what benefits are included under those categories, and about half of the states submitted an essential health benefits plan to the CMS by a Sept. 30 deadline. The coming rules may provide federal approval of those states' benefit packages or provide another chance to change them, according to policy experts.

The OMB review is a mandatory economic analysis of whether any proposed regulation will have an annual economic impact of at least $100 million. OMB may take weeks or months to complete its review and allow publication of the rule in the Federal Register.

“It can take a while, but my guess is that there have been a lot of preliminary conversations so it can move quickly at this point,” Heather Howard, a lecturer at the Woodrow Wilson School of Public and International Affairs at Princeton University, said about OMB's review of the essential benefits rules.

The essential benefits rules will impact millions of people who are likely to receive coverage when either state-run, federal or hybrid “partnership” exchanges begin operations in 2014 in each state.

Some health policy experts said this week that about half the states are expected to have federally operated health insurance exchanges, at least initially.


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