P&T
Our
Other
Journal
MediMedia Managed Markets
Managed Care

 

HHS Regulations Identify MLR Provisions for Direct Care

MANAGED CARE December 2010. © MediMedia USA
News and Commentary

HHS Regulations Identify MLR Provisions for Direct Care

MANAGED CARE December 2010. ©MediMedia USA

Insurers must spend at least 80 to 85 percent of premiums on direct care for patients, as well as on efforts to improve quality of care, according to new regulations from the Department of Health and Human Services (HHS). The regulation, the medical loss ratio (MLR) provision of the Patient Protection and Affordable Care Act, outlines disclosure and reporting requirements, how insurers will calculate their MLR and provide rebates, and how adjustments could be made to the MLR standard to guard against market destabilization.

A substantial portion of premiums is spent on administrative costs, executive salaries, overhead, and marketing, says HHS. If insurers fail to reach the 80 percent requirement, they will have to provide a rebate to their customers starting in 2012.

Insurers in the individual and small group markets will be required to spend at least 80 percent of what they collect on medical care; large group plans must spend at least 85 percent.

Karen Ignagni, CEO and president of America’s Health Insurance Plans, says, “HHS’s regulations track closely with the recommendations state insurance commissioners offered after a substantive, collaborative process.”

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014