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IOM's Essential Health Benefits Recommendations Leave More Questions Than Answers

The IOM recommended that HHS develop an EHB package by May 2012. The high-level recommendations are as follows:

1. The EHB package should be adjusted so that the expected national average premium for a “silver” (second-lowest-price) plan is actuarially equivalent to the average premium small employers would have paid in 2014 for a typical plan.

2. The HHS Secretary should establish a framework for monitoring EHB implementation and updating that accounts for changes in provider payment rates, financial incentives, practice organizations, and other relevant matters. (IOM recommends that this be done by January 2013)

3. The Secretary should update the EHB package to make it more fully evidence-based, specific, and value-promoting — explicitly incorporating costs and a public process to gain input on the updates.  (IOM recommends that this begin in January 2016)

4. State should have flexibility in adopting variants of the federal EHB package, provided that modifications are consistent with the federal package, not significantly more or less generous, and are subject to public input.

5. Establish a National Benefits Advisory Council, with members appointed through a nonpartisan process, which should make recommendations annually stemming from its oversight of the EHB package.

For details on these high-level recommendations and more on the EHB, read Kavita Patel's Health Affairs blog post..

Posted by Cristie Travis at 8:20 AM

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