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The Public Will Have Multiple Chances to Comment on Essential Health Care Benefit Policies

By Rebecca Adams, CQ HealthBeat Associate Editor

April 26, 2011 -- The Department of Health and Human Services is expecting a barrage of comments after its recent announcement that it wants public input into the essential benefits that insurance plans in the new exchange markets will have to cover in 2014.

HHS Secretary Kathleen A. Sebelius said that she will solicit feedback this fall on the types of benefits that plans must cover. The Institute of Medicine also will make recommendations later this year.

"I look forward to hearing from the American people, doctors, nurses, members of Congress and all interested stakeholders," Sebelius said earlier this month. "Beginning this fall, HHS will launch an effort informed by the IOM's recommendations to collect public comment and hear directly from all Americans who are interested in sharing their thoughts on this important issue. I'm confident that this process will ensure all Americans have a seat at the table and strengthen our health care system."

The additional opportunity for public input comes after the release of a Department of Labor survey on April 15. Some lobbyists criticized the effort as minimalist, while advocates for health insurance plans said its findings were not relevant to the types of plans that will operate in the new exchanges.

The survey was required by the 2010 health care overhaul (PL 111-48, PL 111-52). It gave HHS officials a sense of the types of benefits that are typically covered by health insurance plans. While HHS officials had been expected to rely on the information to help them craft the essential benefit package rules, the limited nature of the DOL data makes it less useful in determining a final benefit package.

The 62-page report summarized previous reports and included new information for 12 specific benefits. DOL officials had considered providing details for a wider range of services but concluded that "it is not possible to produce reliable data for many of the services due to the lack of detail that characterizes many plan documents." The dozen benefits that the department had enough data to describe included emergency room visits; ambulance services; diabetes care management; kidney dialysis; physical therapy; durable medical equipment; prosthetics; maternity care; infertility treatment; sterilization; gynecological exams and services; and organ and tissue transplantation.

"It is difficult to see how the DOL report, with its limited information, will be very helpful to HHS," said Ian D. Spatz, senior adviser at Manatt Phelps and Phillips.

"HHS is going to have a lot of different inputs and opportunity for public comment," said Families USA deputy executive director Kathleen Stoll. "They'll take this study as one piece of information. This survey is not an end-all or be-all study, by any means. It's an additional input."

The trade association for health insurers, America's Health Insurance Plans (AHIP), argued that the limitations of the survey could lead to misleading conclusions because the report reflects the types of benefits offered by big companies, rather than plans in the small business and individual markets.

"The coverage data in the new survey are more consistent with coverage offered by large employers which tends to be much broader than what most small businesses choose to purchase today," said AHIP spokesman Robert Zirkelbach. "The essential benefits requirement needs to take into account coverage offered by both large employers and small businesses to avoid forcing many small employers to 'buy up' and purchase significantly more coverage than they can afford. In addition, small businesses will also be hit hard by a new health insurance sales tax that will further drive up the cost of coverage and make it even harder for them to offer coverage to their employees."

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