1. The ACA and the Essential Benefits Package Sabrina Corlette Georgetown University Health Policy Institute From Vision to Reality: State Strategies for Health Reform Implementation November 12, 2010 Scope of Coverage: What Benefits will Plans Provide Under Reform?

2. Insurance reforms Individual mandate Subsidies Getting to Accessible, Adequate, Affordable Coverage

3. Essential Benefits Package: Critical to Adequate Coverage

4. Essential Benefits Package: Categories of Coverage under the ACA Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care

5. Essential Benefits Package: Who Has to Offer it? For Plan Years Beginning January 1, 2014 or LaterMust Provide Essential Health Benefits Must Limit Cost Sharing and Deductibles Exchange Plans Small GroupYes Non-GroupYes Non-Exchange Plans New Plans Self-insuredNo Large GroupNoYes Small GroupYes Non-GroupYes Basic HealthYes Grandfath ered Plans Self-insuredNo Large GroupNo Small GroupNo Non-GroupNo

6. Essential Benefits Package: Whats next Department of Labor survey IOM study HHS regulation defining items and services within each category Whats left for health plans to decide?

7. Essential Benefits Package: Impact on State Mandates 23 states have autism mandates 25 states have cancer-related mandates 46 states have diabetes-related mandates 14 states have infertility-related treatment mandates 51 unanswered questions!

8. Scope of Coverage: What Benefits will Plans Provide Under Reform? Thank you! Sabrina Corlette Research Professor Georgetown University Health Policy Institute