HHS Proposed Rule: June 1, 2012

HHS Issues Proposed Rule

The Department of Health & Human Services issued the proposed rule, “Patient Protection and Affordable Care Act; Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans,” on June 1, 2012. As some background, while HHS issued a Dec. 16 Bulletin laying out the proposed benchmark approach to determining essential health benefits there remained important questions as to what actual plans qualified as benchmarks and under those benchmark plans what benefits were covered and to what extent. AOPA, in an effort to answer those concerns AOPA partnered with McGuireWoods to develop a report of the state benchmark plans identified by HHS in the EHB Bulletin. Additionally, AOPA submitted comments to HHS requesting that HHS provide further details on the qualifying benchmark plans to allow for meaningful stakeholder input. HHS received 11,000 comments on the Dec. 16 Bulletin, where, in addition to AOPA, many commenters requested additional information on the potential benchmark plans and urged HHS to publish the benefit designs of the selected benchmark plans as soon as possible.

HHS stated that HHS considered the comments received when developing the policies in this proposed rule. The proposed rule would establish data collection standards needed to implement parts of the Affordable Care Act as it relates to defining essential health benefits. The proposed rule outlines the types of data to be collected from certain issuers on applicable plans to support the definition of essential health benefits. HHS proposes to collect this information from the issuers in each state that offer the three largest health insurance products, by enrollment, in that State’s small group market. Additionally, HHS’ intends to make information on the final State selections of benchmarks publicly available as soon as possible such that issuers are able to utilize the benchmark for benefit design and rate setting for 2014.

The proposed rule also establishes a process for the recognition of accrediting entities for certification of qualified health plans. This is important as qualified health plans are eligible to participate in the Affordable Insurance Exchanges and participating plans are required to cover essential health benefits. HHS proposed a two-phase recognition process. In the first phase, HHS recommends two entities (National Committee for Quality Assurances (NCQA), and URAC) to serve as interim accreditation entities due to time constraints for implementation. For Phase two, HHS plans to adopt, via future rulemaking, a recognition process that includes an application procedure, standards for recognition, a criteria-based review of applications, public participation and public notice of recognition. HHS also stated in the proposed rule the intention to pursue further comprehensive rulemaking on essential health benefits in the future.

Click here to review the proposed rule.