Payers, providers clash over scope of CMS review of ACA’s essential health benefits

Providers and patient groups, on the other hand, argued more enforcement needs to be done to remove barriers to care caused by plans such as prior authorization and inappropriate denials of coverage.

Several groups and companies gave comments earlier this week on a request for information from the Centers for Medicare & Medicaid Services (CMS) on the ACA’s essential health benefits. The law requires payers to cover 10 essential services, ranging from inpatient hospital care to prescription drug coverage.

Provider groups such as the American Hospital Association (AHA) warned that CMS should look to combat unnecessary...