The Obama administration on Thursday released the framework for a basic health care benefits package — what insurance companies will be required to provide, at minimum, if they wish to sell through state exchanges in 2014.
The report, authored by independent experts from the Institute of Medicine, recommends that the package be built on mid-tier health plans currently offered by small employers, with expansions to include certain services such as mental health. They did not name specific services to cover but recommended that the government require evidence of cost effectiveness. Workplace plans won’t be required to adopt the federal model, but many predict it will eventually become the national benchmark for health insurance coverage.
Kathleen Sebelius, secretary of Health and Human Services, has said officials will hold “listening sessions” around the country before a formal framework proposal is put forth. While the health care law requires that essential benefits include outpatient, hospital, emergency, maternal, newborn and children’s care, prescription drugs, mental health and substance abuse treatment, rehabilitation, labs, prevention and wellness, the administration has lots of leeway to determine the specifics.