CMS Issues Final Rule on Essential Health Benefits

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The rule gives teeth to nondiscriminatory provisions in the Affordable Care Act but falls short in other areas.

APA is encouraged by several modifications and clarifications included in the final rule issued last month on the “essential health benefits” (EHB) that must be offered in the federal and state health insurance exchanges mandated by the Affordable Care Act. The rule was issued by the Department of Health and Human Services.

But other areas—especially around requirements for prescription drug coverage, definition of habilitative services, and agency requirements for “network adequacy”—either fall short of APA recommendations or remain to be clarified.

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