Patient Protection and Affordable Care Act - Essential Health Benefits

HHS issued a bulletin on essential health benefits in December outlining proposed policies that will give states more flexibility and freedom to implement the Affordable Care Act. The bulletin describes a comprehensive, affordable and flexible proposal and informs the public about the approach that HHS intends to pursue in rulemaking to define essential health benefits.  Today, HHS is issuing a list of FAQs to provide additional guidance on the intended approach to defining essential health benefits.  Among other things, the document contains further information about the process of selecting and updating the benchmark plans, States’ responsibility with respect to State-mandated benefits, and the application of benchmarks to plans that have enrollees in multiple states.  The EHB FAQ is live at the following link: http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf

States should provide access to PrEP as a critical prevention service and prescription medication under the Essential Health Benefits provision of the Affordable Care Act. For highly vulnerable populations such as MSM and people in serodiscordant relationships, PrEP represents a cost-saving measure that will improve public health and save money in the medium and long term.

We need full implementation of the Affordable Care Act –- including a robust Essential Health Benefits (EHB) package -- as well as price concessions from the Pharmaceutical Industry. There is concern that there is not a national EHB package so we have to fight state by state to ensure adequate coverage for all people living with the virus.