A new Institute of Medicine report recommends criteria and methods to guide the Department of Health and Human Services in developing a package of essential benefits for qualified health plans under the Patient Protection and Affordable Care Act. The ACA requires HHS to define the minimum package of benefits that certain health plans must cover, including those participating in health insurance exchanges.
The report recommends that the cost of the average premium for the initial package not exceed the national average premium for the typical small employer plan. It says HHS should gauge potential services and products against a set of criteria, including medical effectiveness, safety and relative value compared with alternative options, and evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective, and addresses the medical concerns of greatest importance to the public.
The report also recommends creating an independent National Benefits Advisory Council to advise the HHS secretary on annual updates to the benefits package.