Institute of Medicine to Release Recommendations on Determining Essential Health Benefits

by Rebecca Farley on October 6, 2011

On Friday morning, the Institute of Medicine (IOM) will release the results of its study on the criteria and methods that should be used in determining what benefits are included in the essential health benefits package enacted under health reform. The IOM study took place at the request of the Secretary of Health and Human Services; it will not include a specific list of benefits, but instead will outline the procedures and process by which such benefits should be selected by HHS.

The essential health benefits package is the minimum coverage requirement for all insurance products that will be offered on the state-based health insurance exchanges beginning in 2014, along with the Medicaid expansion plans. The Affordable Care Act designates certain categories of coverage that must be included among essential benefits (including mental health and substance use disorder treatment), but it did not identify specific services among each category.

No details are yet available on tomorrow’s release of the IOM recommendations. In late 2010, the IOM requested public feedback on how the word “essential” should be interpreted, how “medical necessity” should be defined, and the advantages or disadvantages of current methods for determining the details of benefits packages. The National Council submitted comments to the IOM stressing the importance of including a broad range of substance use disorder and mental health benefits in any calculation of essential benefits.

Friday’s highly anticipated press conference, which will take place on Capitol Hill, can also be viewed via webcast. Click to learn more and register for the webcast. The IOM is the health arm of the National Academy of Sciences; it carries out a range of studies on health and the U.S. healthcare system designed to offer evidence on which lawmakers can rely as they make decisions about health policy.


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{ 2 comments… read them below or add one }

chirag patel October 8, 2011 at 4:45 am

Is there any declaration of the essential health benefits package for all insurance products?


r.m. October 19, 2011 at 1:46 pm

Thank you for this important news. it seems like the more we, the general public learn about the new health care laws, the more it seems like the devil will literally be in the details- first how these important yet broad terms like “medical necessity” will be defined, and second what exactly will be included under those terms, as decided by outside groups such as the IOM. I think little attention is paid in the media to how this aspect of the actual implementation of the law is going to almost be more important than the language of the law itself, while important studies like this one which will guide policy get barely any mainstream coverage besides on targeted blogs such as this one.


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