California Healthline Daily Edition

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IOM Could Miss Target for Recommendations on Essential Benefits

Recommendations from the Institute of Medicine on how HHS should determine basic coverage standards to be provided through the state health insurance exchanges under the federal health reform law could come later than the current September deadline, Reuters reports (Morgan/Selyukh, Reuters, 8/17).


Under the reform law, states by January 2014 must create insurance exchanges that provide coverage options for individuals and small businesses.

States can choose to administer their own exchanges -- for which they must have some infrastructure in place by January 2013 -- or ask the federal government to run the exchanges for them (California Healthline, 6/10).

HHS will use the IOM recommendations on the essential health benefits package to inform its regulations for the exchanges.

Recommendations Could Come Later Than Target Date

IOM spokesperson Christine Stencel said, "The committee has stated its target to issue a report by the end of September." She added, "But there is a chance that the report could slip a little later."

An 18-member IOM committee recently signed off on its report, which now is being reviewed by experts who will advise IOM before the final recommendations are sent to HHS.

Stencel said the report will not outline specific benefits standards for the exchanges, but will recommend criteria and methods for HHS to use in determining and updating the essential health benefits package.

Possible Effects of Delay

States, health providers and insurers are waiting for the HHS regulations to plan their exchanges. Any delay in the regulations would reduce the time allowed for them to develop the marketplaces, Reuters reports.

Justine Handelman -- vice president of legislative and regulatory policy for the Blue Cross and Blue Shield Association -- said, "It's hard to (begin planning) ... until you see what's going to be required." She added, "Plans really need to know what's in all of these rules, because when you think about the timeline to develop these products, [and] price them, there's a lot of uncertainty" (Reuters, 8/17).

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