Defining the Essential Health Benefits Package, in Law360

Lynn Shapiro Snyder, Clayton Nix, and Lesley Yeung, attorneys in the Health Care and Life Sciences practice in the Washington, DC, office, cowrote an op-ed titled "Defining the Essential Health Benefits Package."

Following is an excerpt:

With the assistance of the Institute of Medicine (IOM) in helping the U.S. Department of Health and Human Services define the "essential health benefits package," stakeholders are taking increased notice of the significance of this key provision of the national health reform law.

The benefits to be included ultimately will have great consequence to all relevant participants in health reform — including consumers, providers, payers and manufacturers. It is imperative that the HHS's procedural process of defining this benefit package be inclusive, transparent and efficient.

The approach of the Patient Protection and Affordable Care Act (PPACA) to defining benefits through a minimum essential health benefits package differs significantly from the approach taken in the Medicare and Medicaid programs. However, through the use of umbrella terms that don't carry prior statutory history, HHS has more discretion to determine the scope of benefits included in the benefit package.