The Centers for Medicare & Medicaid Services released a request for information to solicit public comment on issues related to the Essential Health Benefits (EHB) under the Patient Protection and Affordable Care Act (ACA). CMS is gathering input from the public on a variety of topics related to the coverage of benefits in health plans subject to the EHB requirements of the ACA, including the description of the EHB, the scope of benefits covered in typical employer plans, the review of EHB, coverage of prescription drugs, and substitution of EHB.
USBC Insight: The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. Coverage of breastfeeding support and counseling is required under the women’s preventive services.