April 13, 2016

Improvements Made in ACA Documents for Consumers


Improvements Made in ACA Documents for Consumers

On April 6, the Centers for Medicare and Medicaid Services (CMS) issued a new version of the "Summary of Benefits and Coverage" (SBC) template and the Uniform Glossary of health insurance terms, which must be used by health plans and issuers with respect to plan or policy years beginning on or after April 1, 2017. The SBC template is a 5-page form intended to help people select a health plan. During the public comment period on the draft documents, the Habilitation Benefits (HAB) Coalition, of which Family Voices is a member, along with two other groups, sent a comment letter urging several changes to the draft documents. Some of these suggested changes were adopted in the final versions. With respect to the SBC, the comment letter suggested that the template reflect the recently issued rule requiring that insurers have separate limitations for habilitation and rehabilitation services. The administration made this change, so that the two services will have separate lines in the SBC template (on page 3). While not requested in the comment letter, the final Uniform Glossary (on page 3) includes an improvement in the definition of "medical necessity." That definition now includes a reference to "habilitation services." ("Medically Necessary - Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms, including habilitation, and that meet accepted standards of medicine.") For the associated documents and additional information, click here