By NextBestFitTask 1.5.2 of 7
List statutory exclusions: over-the-counter products, cosmetic procedures, premium eyewear and hearing-aid upgrades, nursing-home room and board, and services the HTA Institute finds ineffective.
Who does it
Congress
When
Drafting
Trade-off
Explicit exclusions keep costs predictable but leave real out-of-pocket costs for things like nursing-home room and board.
Part of: Define the benefit package & cost sharing
Write down exactly what UHP covers, what it excludes, and what patients pay at the point of care: nothing for covered services. Out-of-pocket spending falls from $556.6B to $197.3B; what remains is for excluded items.
This step changes 14 existing laws, programs, or institutions. See the list.