Health insurers and consumer advocacy groups are escalating the war of position papers over the new federal minimum medical loss ratio requirements.
The new Affordable Care Act (ACA), the legislative package that includes the Patient Protection and Affordable Care Act, will require large group plans to spend at least 85% of premium revenue on health care and quality improvement efforts, and individual and small group plans to spend 80% of premiums on health care and quality improvement efforts.
The federal agencies in charge of implementing the ACA minimum medical loss ratio (MLR) provisions could release MLR regulations any day now, PPACA watchers say.
The National Association of Insurance Commissioners (NAIC), Kansas City, Mo., is supposed to help the federal government help the states implement the MLR standards, and the NAIC is going through a model-crafting process of its own.
America’s Health Insurance Plans (AHIP), Washington, today put out a paper listing its 4 goals for the MLR effort.
AHIP says the rules adopted should:
- Ensure that existing efforts to improve quality are allowed to continue and new initiatives to support the goals of PPACA are not discouraged.
- Recognize that quality improvement efforts will be advanced by ICD-10 implementation.
- Include fraud prevention and detection activities in the definition of activities that improve health care quality.
- Implement a plan for transitioning from the existing state system to the new federal standards to maximize consumer choice.
Health Care for America Now (HCAN), Washington, a group that is highly critical of health insurers, says the 6 largest for-profit health insurers would have had to rebate $1.9 billion to customers in 2009 if the minimum MLR rules and new limits on executive compensation had been in effect that year.
AHIP and the Blue Cross and Blue Shield Association, Chicago, are fighting vigorously to undermine the law, by seeking to “expand the definition of allowable medical expenses to include costs that are not directly related to the delivery of care and have not historically been classified as medical,” HCAN says.
“Insurers have used virtually unlimited resources to hire law firms, lobbyists and consultants to drown the NAIC in paperwork,” HCAN says.