A proposed rule released Friday by the Department of Health and Human Services (HHS) would establish data reporting standards for states necessary to implement parts of the Affordable Care Act related to essential health benefits (EHB) that must be part of most qualified health plans (QHPs) offered in states' affordable health insurance exchanges (Exchanges). This proposal provides guidance on the type of data certain health plans participating in the Exchanges will need to provide to states; the issuers of the 3 largest small group products in each state must report information regarding covered benefits. Additionally, the proposed rule establishes a process for recognizing entities that will be accredited to certify QHPs that will be offered in states' affordable health insurance exchanges. It is important to note that this proposed rule does not provide comprehensive information regarding EHBs, other than data reporting and the accreditation process. That information will be forthcoming in future rulemaking.
Specifically, the purpose of proposed rule is to gather enough information on each states' benchmark plans' benefits to allow any plans that wish to offer coverage in the Exchanges to know what benefits will be included in the EHB benchmark. It also proposes that certain issuers of applicable plans submit benefit and enrollment information to HHS, such as data on all health benefits in the plan, any treatment limitations imposed on health care coverage and drug type coverage. This information would be used by HHS and eventually states, exchanges, and issuers to define, evaluate, and provide EHB.
Until accrediting entities are established to certify qualified health plans, the National Committee for Quality Assurance (NCQA) and URAC will be recognized by HHS on an interim basis for the purpose of accreditation of qualified health plans.