The Centers for Medicare & Medicaid Services on Dec. 2 issued a final rule implementing changes to the Patient Protection and Affordable Care Act’s medical loss ratio requirements for health insurers effective Jan. 1. According to CMS, the changes from the interim final rule largely address technical issues involved in the way insurers calculate and report their MLR and the mechanism for distributing rebates to enrollees in group health plans.
For example, the rule requires insurers to provide notice of rebates to group policy holders and enrollees, and to provide the rebates through lower premiums or in other ways that are not taxable. Among other changes, the rule allows part of a health plan’s ICD-10 conversion costs to be considered as quality improvement activities, and addresses MLR adjustments for “mini-med” and expatriate policies.
CMS will accept comments through Jan. 6 regarding the rule’s treatment of ICD-10 conversion costs and the process for providing and reporting rebates to group enrollees. In a recent report, the Government Accountability Office said at least 64% of insurers in 2010 would have met or exceeded the 2011 ACA MLR standards.
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