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Focus on Regulation

CMS Releases Final Rule on Essential Health Benefits

On February 20, 2013, the Centers for Medicare and Medicaid Services (CMS) released a final rule providing detailed standards for the essential health benefits (EHB) package as well as actuarial value requirements for plans that must offer EHB. The final rule also addresses the process for entities to become recognized accrediting entities for issuers of Qualified Health Plans. CMS also released a fact sheet summarizing key parts of the final rule.

The final rule largely finalizes, with a few changes, the approach set forth in the proposed rule for EHB standards applicable in the individual and small group market. This approach gave states the flexibility to define EHB by selecting a benchmark plan from options offered in the market.

Appendix A of the final rule includes the final list of EHB-benchmark plans that will apply in years 2014 and 2015.