Institute of Medicine Releases Report on Essential Benefit Coverage
The Patient Protection and Affordable Care Act (ACA) mandated the establishment of state-based “purchasing exchanges” to help improve access to better private health insurance coverage. The ACA requires that insurance plans participating in these exchanges cover, at a minimum, a package of “essential benefits.” This package includes rehabilitation and habilitation services (ACA §1302), due in part to the advocacy efforts of AOTA and our coalition partners.
The Department of Health and Human Services (HHS), the federal agency tasked with defining and fine tuning the essential benefits package, sought recommendations from the Institute of Medicine (IOM). On October 7, 2011, the IOM released its report, Essential Health Benefits: Balancing Coverage and Cost, which proposes a set of criteria and methods to determine what types of services and care constitute essential benefits. The report is expected to greatly influence the regulations issued by HHS and ultimately the types of care available to the public under the exchanges, which will take effect in 2014.
AOTA Director of Federal Affairs Tim Nanof attended the public release, which was hosted by the IOM Committee on Defining and Revising an Essential Benefits Package for Qualified Health Plans. Committee members John Ball Marjorie Ginsburg, Sam Ho, Christopher Koller, Elizabeth McGlynn, John Santa, and Paul Fronstin discussed the findings and recommendations contained in the report at the event, which was held in Washington, DC, on October 7, 2011.
AOTA staff are closely reviewing the report. Please send comments and questions to the Reimbursement and Regulatory Policy Department at rrpd@aota.org.
References:
IOM Report: Essential Health Benefits: Balancing Coverage and Cost (October 7, 2011)
IOM Report Brief
IOM Report Criteria
Audio from the IOM Public Release Briefing
About the IOM
