May 22, 2015


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May 19, 2015

Health and Human Services (HHS) - Essential Health Benefits Rule Finalized

Today, HHS released its final rule outlining the essential health benefits insurers must provide for health plans operating in the health insurance exchanges.  A copy of the final rule is available here.

Why are these rules important?  Under the Affordable Care Act (ACA), beginning in 2014 every state will have a health insurance exchange – a marketplace in which individuals and employers will be able to purchase comprehensive health insurance.  Plans participating in the exchanges must provide certain benefit (“essential health benefits”) within 10 specific categories:  prescription drugs; ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; rehabilitative and habilitative services; laboratory services; preventive and wellness services; and pediatric services, including dental and vision care.  The final rules issued today provide additional guidance on standards related to these essential health benefits.

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About this Author

Medicare Reimbursement and Health Policy Director

Anna Schwamlein Howard is the Medicare Reimbursement & Health Policy Director in the firm’s Health Government Relations team.

A nationally recognized authority on health care reform issues, Anna has considerable experience in government relations and regulatory affairs. Specifically, she has extensive knowledge with the Medicare Modernization Act, medical privacy and prescription drug issues, Medicare physician payment legislation, the Affordable Care Act, and other federal health issues impacting the lives of older Americans.

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