Activity

Activity Description

The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, will allow individuals and businesses to purchase health insurance directly through exchanges—competitive marketplaces where buyers can compare coverage. These exchanges will offer a choice of qualified health plans (QHPs) that vary in coverage levels but meet certain standards in categories of care and limits on patient cost sharing. The PPACA stipulates that these QHPs will cover the general categories of: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care. Further details of an “essential health benefit” package are to be defined by the Secretary of Health and Human Services (HHS) based on the scope of benefits offered by a typical employer plan.

At the request of the Secretary of Health and Human Services (HHS), the IOM undertook a study to make recommendations on the criteria and methods for determining and updating the essential health benefits package. The committee was not to specify the details of the package.

A summary of the committee’s two public workshops was released in August—Perspectives on Essential Health Benefits: Workshop Report. This summary presents the views expressed by workshop participants, and these views are not necessarily those of the committee.

The committee will release its consensus report, with recommendations to the Secretary, on October 7, 2011. The committee chair, John Ball, will be joined by committee members Marjorie Ginsburg, Sam Ho, Christopher Koller, Elizabeth McGlynn, John Santa, and Paul Fronstin to discuss the committee's findings and recommendations. The report will recommend criteria and methods that HHS can use to develop an essential health benefits package; it will not recommend specific medical services that should be part of the package.