Manatt Professional Discusses EHB Key Issue to Watch
"Essential Health Benefits Rule Puts Pressure on Insurers"
February 20, 2013 - Manatt's Ian Spatz, a senior advisor with Manatt Health Solutions, discussed with Law360 the key issue to watch when states determine essential health benefits coverage, since the final rule was recently released by the U.S. Department of Health and Human Services.
As reported by Law360, the 10 essential health benefits categories will apply starting in 2014 and are fairly broad. They require coverage for ambulatory services, emergencies, hospitalization, maternity and newborn care, mental health and substance addiction, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management. Though there were a number of comments urging HHS to better clarify the 10 broad categories, the agency says that it wants to achieve health reform's goal of improved individual and small-employer coverage while not treading too roughly on the turf of state regulators.
Spatz told Law360 that the key issue to watch will be how states sort out ancillary benefits.
"What is important is at the margins," Spatz said. "There are certain types of benefits that some health plans cover and some don't. The decisions the states will make will have a significant impact."
Read the article here.