December 7, 2010
NAMI has submitted comments to the Institute of Medicine (IOM) on the federally defined “essential benefits package” that all “benchmark” health plans and health plans offered through the state-based health insurance “exchanges” must comply with. This is part of an IOM study being prepared for the Secretary of Health and Human Services (HHS) examining the issue of covered benefits and medical necessity within the essential benefits package. This is also referred to as the benefits that all “Qualified Health Plans” (QHPs) must meet in order to compete in the new "Exchanges” or qualify as “benchmark” plans.
The essential benefits package already includes mental health and substance abuse benefits. It also includes a separate requirement for plans to comply with the federal Wellstone-Domenici mental illness insurance parity law (as part of separate non-discrimination protections). What IOM is undertaking (and making recommendations to the Secretary on) is a review of how insurers determine covered benefits and medical necessity. The IOM will then provide guidance on the policy principles and criteria for the HHS Secretary to take into account when examining QHPs for appropriate balance among categories of care; the health care needs of diverse segments of the population; and nondiscrimination based on age, disability, or expected length of life. The IOM is also planning to offer advice on criteria and a process for periodically reviewing and updating the benefits package.
Please see below to view NAMI’s comments to the IOM on the Essential Benefits package.