HHS details overhaul rules and required benefits

Associated Press Modified: November 20, 2012 at 3:47 pm •  Published: November 20, 2012
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The Obama administration has strengthened the prescription drug coverage that will be available to the millions of people who will get insurance through the nation's new health care overhaul starting late next year.

The increase in prescription benefits was part of a long-awaited package of rules to implement the law formally announced on Tuesday by the Health and Human Services Department. The government laid out minimum requirements for health insurance coverage and banned denying coverage to people with pre-existing health problems.

The new rules, once made final, will govern the operation of new health insurance marketplaces, called exchanges, that will debut in 2014.

Having the federal government set minimum standards for what health insurance must cover is a departure from normal practice. Usually, insurance companies, their state regulators and employers play that role. But the Affordable Care Act requires that Washington establish a baseline for minimum coverage in areas that include inpatient and outpatient care, emergency services, maternity and childhood care, prescription drugs, preventive screenings and lab work.

It must also cover mental health and substance abuse treatment, as well as rehabilitation for physical and cognitive disorders, and dental and vision care for children. Such additional benefits are often not fully covered by frugal plans that are now the best that many small businesses can afford.

Many of the details the administration released on Tuesday had been previously announced, but Dan Mendelson, CEO of the market analysis firm Avalere Health, saw one key change: Health insurance plans will now have to cover the same number of prescription drugs as the benchmark plan in their states. That basically means there will be a higher number of prescription drugs covered in each class, such as antipsychotics or antidepressants, than had previously been required.

"It's going to dramatically increase access to pharmaceuticals in the exchanges," Mendelson said. "It's a big deal. This makes the exchange offerings more consistent with what employers offer."

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