Last week HHS released the final rule regulating the Essential Health Benefit Plans that will be sold in the large and small group markets in 2014. See entire rule
Of note in the final rule:
- requires that plan designs are non-discriminatory
- clarifies that the EHB must include mental health/substance use disorder benefits at parity for plans inside and outside the health benefit exchanges
- plans are allowed to only cover one drug in a class, but the states must create a process where individuals can request access to a nonformulary drug
- allows the states to define habilitative benefits
- allows states to define and determine substitution standards for benefits
To see the National Council’s of Community Behavioral Health fact sheet on the EHB Rule
For more information on how the rule helps those in need of mental health and substance use disorder services
CCIIO fact sheet on EHB rule
Also released on last week were a new set of FAQ on ACA implementation