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Essential Benefits - Implementation Update

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On June 1, 2012, the U.S. Department of Health and Human Services (HHS) released a proposed rule to establish data collection standards for essential health benefits (EHBs) of health plans and the process for state exchanges to certify qualified health plans (QHPs). The rule proposes that issuers of the three largest small group market products in each state (Kaiser Permanente and Anthem in California) be required to report information on covered benefits.

HHS also proposes that implementation of accreditation standards occur in two phases—in phase one, the National Committee for Quality Assurance (NCQA) and URAC, an independent nonprofit organization, would be recognized as accrediting entities on an interim basis. In phase two, a criteria-based review process would be adopted through future rule making.

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