CMS has released an “Essential Health Benefits Bulletin,” which provides information and solicits comments on the regulatory approach that HHS plans to propose to define essential health benefits (EHB) under the ACA.  Section 1302 of the ACA mandates that EHBs include items and services within at least 10 broad benefit categories: (1) ambulatory patient services, (2) emergency services (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care. To meet this mandate, HHS plans to give states the flexibility to select one of four types of benchmark plans that HHS believes reflects the scope of services offered by a typical employer plan: (1) one of the three largest small group plans in the state by enrollment; (2) one of the three largest state employee health plans by enrollment; (3) one of the three largest federal employee health plan options by enrollment; or (4) the largest HMO plan offered in the state’s commercial market by enrollment. While a plan could modify coverage within a benefit category, it could not reduce the value of coverage. CMS believes that these benchmarks will cover most of the EHBs mandated by the ACA; however, if a state selects a benchmark plan that does not cover all 10 categories, the state may examine other insurance plans to determine the type of benefits that must be included in the EHB package. If a state does not select a benchmark, HHS suggests that the default benchmark will be the small group plan with the largest enrollment in the state. Comments on the bulletin will be accepted until January 31, 2012. CMS notes that cost-sharing for covered services will be addressed in separate rules.