Prof. Monahan Named to IOM Committee on Essential Health Benefits
DECEMBER 8, 2010—Professor Amy Monahan has been appointed to serve on the Determination of Essential Health Benefits committee of the Institute of Medicine (IOM), which will issue a report to guide the Department of Health & Human Services (HHS) in determining which medical treatments and services must be covered by new policies when health care reform changes take effect. She was selected for the committee because of her prior scholarly work on regulating the content of health insurance.
While the Patient Protection and Affordable Care Act specifies certain broad categories of treatments that must be covered, the Secretary of HHS is responsible for defining the “essential health benefits” that all individual and small-group policies must cover. The Secretary asked the IOM to make recommendations to help guide the process by which HHS will determine which benefits are considered essential health benefits.
The Determination of Essential Health Benefits committee will review, among other things, how insurers determine covered benefits and medical necessity, health care needs of various segments of the population, and potential discrimination by age, disability, or expected life span. The committee will not make specific recommendations on benefits to include in the package. Rather, it will offer guidance on policy principles and criteria to achieve balance among categories of care. It will also offer recommendations on periodic review and updating of the benefits package.
The 18-member committee is chaired by John R. Ball, M.D., J.D., and is made up of professors, physicians, employee benefits professionals, chief medical officers, hospital administrators, consumer and insurance experts, and others.
The IOM is the health arm of the National Academy of Sciences, which along with the National Academy of Engineering and the National Research Council are collectively known as the National Academies.