Institute of Medicine Releases Report on Benefits Design under Health Care Reform


The Institute of Medicine (IOM) released a report on October 6 offering recommendations to the U.S. Department of Health and Human Services (HHS) on developing the definitions of “essential health benefits” that qualified health plans will offer through Exchanges under section 1302 of the Affordable Care Act (ACA). The ACA requires such plans to cover at least ten categories of diagnostic, preventive, and therapeutic services. HHS must further define each of those ten categories and periodically update its definitions. The HHS Assistant Secretary for Planning and Evaluation commissioned the IOM to recommend criteria for determining specific services and products that are most important to patients, to outline a process that would help HHS to define the minimum set of benefits that should be covered, and to set forth methods for updating those benefits to take into account on-going advances in science, gaps in access to certain types of providers in some communities, and the impact of benefit design on costs. The IOM’s recommendations relate to such matters as defining relevant data needs and research objectives, encouraging appropriate public input, and acknowledging the importance of state-based innovation to produce benefit packages of equivalent value within ACA parameters. The IOM is an independent, non-profit organization within the National Academy of Sciences. The IOM report, entitled “Essential Health Benefits – Balancing Coverage and Cost”, is available at

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Categories:Health and Human Services


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