ASAP
HHS Issues Final Rule on Data Collection to Help Define Essential Health Benefits
To this end, the final rule “establishes that issuers of the largest three small group market products in each state report information on covered benefits” in order for the HHS to better define the EHB’s scope, and outlines the first of two phases that will be used to recognize accrediting entities for purposes of certification of qualified health plans (QHPs). The rule states that in the first phase, the National Committee for Quality Assurance (NCQA) and URAC will be recognized as the accrediting entities on an interim basis. For phase two, the HHS will adopt via rulemaking a criteria-based review process.
According to the HHS, the final rule “incorporates the provisions of the proposed rule with some substantive modifications, along with additional non-substantive changes to improve clarity.” The more substantive changes include the following:
- The definition of treatment limitations is modified to include only quantitative limits.
- The rule establishes a submission deadline of September 4, 2012 for applicable issuers. The rule directs issuers to use the Health Insurance Oversight system to make these submissions.
- The rule eliminates the inclusion of essential community providers under the network adequacy standards for accreditation.
- The final rule stipulates that network adequacy standards for accreditation be, at a minimum, consistent with general requirements for network adequacy for QHP issuers outlined in other sections of the rule.
- The final rule establishes that an accrediting entity must provide current accreditation standards and requirements, processes, and measure specifications for performance measures to the HHS within 60 days of the rule’s July 20, 2012 publication in the Federal Register. According to the HHS, “60 days is a reasonable time for accrediting entities to submit their current accreditation processes, standards, and requirements.” The HHS also finalized the timeline for these entities to submit any proposed changes or updates to the accreditation and measurement process. Such changes must be submitted to the HHS 60 days prior to public notice.
- The rule includes an exception to protect personally identifiable information.
Finally, the agency noted also that it intends to publish state-specific benchmarks for notice and comment.
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