The insurers targeted by the reporting requirements of the proposed rule are considered to offer the plans that will provide the benchmarks for EHBs in their state. The rule would require those plans to submit data on treatment limitations, drug coverage and plan enrollment.
A December 16 bulletin said states could develop their own essential health benefits packages of certain services that insurers must cover—as long as any plan chosen by a state was from certain benchmark categories and covered 10 required categories of care. The only existing plans that could serve as a benchmark for a state's package are: one of the state's three largest small-group plans; one of its three largest state employee health plans; one of its three largest federal employee health plans; or the largest HMO plan offered in the state's commercial market.
Additionally, the proposed rule would name the National Committee for Quality Assurance and URAC—two Washington-based quality organizations—as the only groups to decide whether plans meet each state's EHB standards. That credentialing process is expected to start early next year. Additional credentialing groups could qualify under a future selection process, according to the proposed rule.
No indication was given in the proposed rule about when HHS officials will issue highly anticipated rules outlining the essential health benefits, but the proposed rule stated that the department will follow the direction outlined in the December bulletin.