"Essential Health Benefits: Balancing Coverage and Costs" ed. by Cheryl Ulmer, John Ball, Elizabeth McGlynn, and Shadia Bel Hamdounia

ISBN: 0309219140

Category: Uncategorized


Posted on 2011-10-19. By anonymous.

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"Essential Health Benefits: Balancing Coverage and Costs" ed. by  Cheryl Ulmer, John Ball, Elizabeth McGlynn, and Shadia Bel Hamdounia

"Essential Health Benefits: Balancing Coverage and Costs" ed. by Cheryl Ulmer, John Ball, Elizabeth McGlynn, and Shadia Bel Hamdounia
Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans; Institute of Medicine
NAS Press | 2011 | ISBN: 0309219140 0309220971 9780309220972 | 314 pages | PDF | 2 MB


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This book recommends a process that would help HHS define the benefits that should be included in the EHB, and update the benefits to take into account advances in science, gaps in access, and the effect of any benefit changes on cost. This book does not decide what is covered in the EHB, but rather proposes a set of criteria and methods that should be used in deciding what benefits are most important for coverage.

An estimated 50 million people in 2010 were uninsured in the United States. The benefits included in the EHB must be sufficiently inclusive to enable access to essential services but must also be affordable so that as many as possible can purchase the coverage.
This report is of value to ASPE and other HHS agencies, state insurance agencies, congress and state governors, health care providers, consumer advocates.

Contents
ABSTRACT
SUMMARY
1. INTRODUCTION
Committee Charge
Major Issues
Status of Current Health Insurance
Impact of EHB Across Insurance Programs
Stakeholder Decisions Will Reshape Health Insurance Markets
Organization of the Report
2. APPROACHES TO DETERMINING COVERED BENEFITS AND BENEFIT DESIGN
Understanding Terms
Understanding Contributors to Costs
Illustrative Approaches to Coverage Decisions
3. POLICY FOUNDATIONS AND CRITERIA FOR THE EHB
Policy Foundations
Criteria
4. RESOLVING ACA INTENT
Finding the Meaning of Essential
10 Categories of Care Versus Typical
Essential Versus Nonessential
Boundaries or Not
Understanding Typical Specificity in Scope of Benefits
Typical Employer: Small Versus Large
State Mandates
Medical Versus Nonmedical
5. DEFINING THE EHB
Step 1: Develop the Starting Point
Step 2: Incorporate Cost into the Development of the Initial EHB
Step 3: Reconcile Initial List to the Premium Target
Step 4: Issue Guidance on Inclusions and Permissible Exclusions
Committee Recommendation on Defining the EHB
Other Considerations Areas for the Secretarial Guidance Related to EHB
6. PUBLIC DELIBERATION
The Public Voice
Components of Public Deliberation Processes
Examples of Public Participation and Deliberative Processes.
Summary of Guidelines for Public Participation
7. PROGRAM MONITORING AND RESEARCH
Setting a Research Framework for Data Collection and Analysis
Program Monitoring and Research
Broad Areas of Research
8. ALLOWANCE FOR STATE INNOVATION
Authority for State Variation
Flexibility in Determining EHB
Criteria for Approving a State-Specific EHB Definition
Political Implications
9. UPDATING THE EHB
ACA Direction to the Secretary on Updating the EHB
Goals for Updating
Considering Typical Employer in the Future
Methods for Incorporating Costs into Updates to the Essential Health Benefits
National Benefits Advisory Council
Conclusion
10. APPENDIXES
A Patient Protection and Affordable Care Act Section 1302 and Web Questions for Public Input on
Determination of Essential Health Benefits
B Stakeholder Decisions on Health Insurance
C Examples of Degrees of Specificity on Inclusions
D Models of Benefit Package Statutory Guidance and Resulting Designs
E Description of Small Group Market Benefits, provided by WellPoint
F General Exclusions
G Medical Necessity G Comparison of Existing Advisory Groups

"Essential Health Benefits: Balancing Coverage and Costs" ed. by  Cheryl Ulmer, John Ball, Elizabeth McGlynn, and Shadia Bel Hamdounia

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