PPACA allows individuals and businesses to purchase health insurance directly through exchanges that will offer qualified health plans (QHP) that consumers can compare starting in 2014. QHPs vary in standardized coverage levels and have limits to patient cost-sharing. PPACA Section 1302 stipulates that QHPs will cover general categories of care including: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care.
Last week, HHS announced that the Institute of Medicine (IOM) was commissioned to make recommendations on the criteria and methods for determining and updating the essential health benefits. It will review how insurers determine covered benefits and medical necessity and recommend policies and procedures to HHS on how to evaluate QHPs based on the health care needs of diverse segments of the population (including nondiscrimination based on age, disability, or expected length of life).
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