"Perspectives on Essential Health Benefits: Workshop Report" ed. by Cheryl Ulmer, Bernadette McFadden, and Cassandra Cacace

ISBN: 0309215439

Category: Uncategorized


Posted on 2011-10-25. By anonymous.

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"Perspectives on Essential Health Benefits: Workshop Report" ed. by Cheryl Ulmer, Bernadette McFadden, and Cassandra Cacace

"Perspectives on Essential Health Benefits: Workshop Report" ed. by Cheryl Ulmer, Bernadette McFadden, and Cassandra Cacace
Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans; Institute of Medicine
NAS Press | 2011 | ISBN: 0309215439 9780309215435 | 213 pages | PDF | 2 MB


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This issue summarizes the presentations in two workshops in 2011. The committee's recommendations will be released in a subsequent report.

Contents
SUMMARY
Charge to the Committee
Key Issues
Balancing Generosity and Affordability
Defining a "Typical" Employer Plan
Evaluating State Mandates for Inclusion
Considering Specificity and Flexibility in Guidance
Determining Medical Necessity
Promoting Value in Insurance Benefit Design
Applying Evidence to Benefit Coverage
Monitoring Required Elements for Consideration
Instituting an Appeals Process
Ensuring Fair Processes
Organization of Workshop Report
1. INTRODUCTION. Exchanges and Essential Health Benefits Study Charge and Approach
2 The Policy Context for Essential Health Benefits
3 Purchaser Perspectives on the EHB
4 State Experiences with Defining a Minimum Benefit Standard
5 Medical Necessity and Use of Evidence
6 Insurer Decisions of Benefit Coverage and Medical Necessity
7 Examining Two Categories of Care in Section 1302
8 Non-Discrimination in the Required Elements for Consideration
9 Additional Stakeholder Perspectives
10 Two Private Sector Approaches to Benefit Coverage and Design
11 Deciding What Is Essential and Evidence-Based in Two States for Public Insurance Programs
12 Lessons from California Benefit Review Processes
13 Priority-Setting and Value-Based Insurance Design
14 Assessing Affordability and the Potential for Underinsurance
Appendix A: Patient Protection and Affordable Care Act, Section 1302
Appendix B: Web Questions for Public Input on Determination of Essential Health Benefits
Appendix C: Stanford Model Contractual Language for Medical Necessity

"Perspectives on Essential Health Benefits: Workshop Report" ed. by Cheryl Ulmer, Bernadette McFadden, and Cassandra Cacace

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