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  • Washington Highlights

    CMS Seeks Feedback on Essential Health Benefits

    Mary Mullaney, Director, Hospital Payment Policies
    For Media Inquiries

    The Centers for Medicare & Medicaid Services (CMS) released a Nov. 29 request for information (RFI) related to coverage of benefits in health plans subject to the Essential Health Benefits (EHB) requirements of the Affordable Care Act (ACA).  

    Under the requirements, qualified health plans must include coverage for at least 10 general categories and items and services 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 and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. 

     The RFI seeks feedback on a variety of areas including description of benefits in EHB-benchmark plan documents, barriers to accessing services due to coverage or cost, and addressing gaps in coverage.  

     Comments on the RFI will be accepted through Jan. 29, 2023.