On February 20, 2013, the Department of Health and Human Services (HHS) released the standards for the core package of health benefits that must be offered by the insurance plans available in the health insurance exchanges established under the Affordable Care Act. These standards will also apply to insurance plans in the individual and small group market.
The final rule is consistent with the proposed rule, which permitted the states flexibility in defining essential health benefits. An HHS fact sheet describes the rule.
The final rule requires “parity” of mental health and substance abuse benefits, which means that those benefits must be on a par with other health benefits. At the same time HHS released the final rule, it published a report describing the mental health and substance abuse benefit standards, which will benefit 62 million Americans.
The final rule also clarifies the cost-sharing standards in cases where a polyp is discovered and removed during a colonoscopy. Some insurers had argued that removal of a polyp should trigger a cost-sharing requirement. HHS rejected this suggestion, instead concluding that polyp removal is part of the screening colonoscopy process and no cost-sharing should be imposed.