Patient Community "Asks" Are Answered in Essential Health Benefits Proposed Rule

National Health Council: It's a Great Day for the Patient Advocacy Community

WASHINGTON, Nov. 20, 2012 /PRNewswire-USNewswire/ -- The National Health Council (NHC) applauded the Department of Health and Human Services (HHS) for including several of the NHC's recommendations in the proposed rule on essential health benefits (EHB) issued today.

"The federal government heard the concerns of the patient community, and the result is an exchange benefit package that will help people living with chronic diseases and disabilities get the health care they desperately need," said NHC President Myrl Weinberg. "This is a great day for the patient advocacy community. We will continue to work with the department as it refines the proposed rule, in particular the need to strengthen the sections addressing patient protections and federal and state oversight, and to clarify exactly how various provisions will be implemented."

Included in the EHB proposed rule are the following provisions previously proposed by the NHC to HHS:

  • Drug plans can follow the state benchmark's formulary, as the NHC recommended. The proposed rule states in part, "A plan would cover at least the greater of: 1) one drug in every category and class; or 2) the same number of drugs in each category and class as the EHB-benchmark plan." The proposed rule goes on to say, "A health plan providing essential health benefits must have procedures in place that allow an enrollee to request clinically appropriate drugs not covered by the health plan."
  • The proposed rule includes language to assure non-discrimination, a major issue for people with chronic conditions and one that the NHC addressed in its EHB recommendations released nearly a year ago. . The proposed rule mandates that states monitor and identify discriminatory benefit designs, but the federal government will have the authority to step in if necessary.
  • The NHC's recommendation to limit the ability of qualified health plans to substitute benefits is addressed. According to the proposed rule, substitutions could only occur within benefit categories, not between different benefit categories.


Founded in 1920, the National Health Council (NHC) is the only organization of its kind that brings together all segments of the health community to provide a united voice for people living with chronic diseases and disabilities and their family caregivers. Made up of more than 100 national health-related organizations and businesses, its core membership includes the nation's leading patient advocacy organizations, which control its governance.

SOURCE National Health Council