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HHS Solicits Stakeholder Opinions on Essential Health Benefits

By Jane Norman, CQ HealthBeat Associate Editor

October 18, 2011 -- The Department of Health and Human Services (HHS) held a closed-door meeting involving dozens of provider groups airing their views on what should be included in an essential health benefits package.

The stakeholders in attendance were told that meetings with consumer advocates and insurers are expected to follow soon, as HHS seeks input on how to structure benefits.

The meeting, which was not open to the press and reportedly was organized just late last week, follows the release of recommendations on essential health benefits by the Institute of Medicine (IOM).

It is now up to HHS to develop more specific proposals on benefits for plans that will be offered to individuals and small businesses obtaining their care through the state-based exchanges in 2014. HHS officials said when the IOM recommendation was released that they would be seeking input in that process.

An HHS proposed rule on essential health benefits is expected soon. The IOM said that HHS should develop its package by May 2012.

HHS officials did not respond to a request for a list of those asked to testify. But among them was the American Academy of Pediatrics.

Patience White, who represented the academy at the meeting, said in an interview that she stressed a section of the health care law (PL 111-148, PL 111-152) that says benefits should “take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities and other groups.” White said the academy is concerned that kids will be lost in the shuffle and would not benefit from a benefit plan tied to the average small employer plan, as recommended by the IOM.

“Kids often lose out in these small employer packages,” she said, because much of what they need is preventive care that’s not covered. The academy would like to see the essential benefits package modeled on the package of benefits extended to children in the Medicaid program.

“I think we got their ear,” she said of the session with HHS officials.

White also said in prepared testimony that the health needs of infants, children and adolescents are distinct enough from those of adults that a health care system designed for adults won’t meet children’s needs.

The academy urged that HHS “build in purposeful consideration of the unique characteristics of children in establishing and updating” the essential health benefits.

Jane Norman can be reached at [email protected].  

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