The Centers for Medicare & Medicaid Services (CMS) is updating the federal clearance it needs to keep asking mini-med health plans and expatriate plans about their operations.
CMS, an arm the U.S. Department of Health and Human Services (HHS), talks about its plans for the quarterly mini-med and expat plan reports in a notice seeking comments on the reports.
The federal Paperwork Reduction Act of 1995 requires CMS to get permission from the Office of Management and Budget before collecting information from the public.
The Patient Protection and Affordable Care Act of 2010 (PPACA) now requires most non-grandfathered plans to spend at least 85% of large group revenue and 80% of individual and small group revenue on health care and quality improvement efforts.
Issuers and sponsors of mini-med plans – medical plans that typically offer less than $100,000 in annual benefits – argued that applying the medical loss ratio (MLR) requirements to the plans would eliminate the plans.
The plans are not major medical insurance, but they are the best plans that many individuals and employers can afford between now and 2014, when new PPACA subsidies and plan marketing rules are supposed to kick in, mini-med plans defenders said.
Managers of expat plans argued that those plans ought to be exempted from the MLR rules because the cost of developing provider networks, paying claims overseas, and helping insureds with tasks such as translation increases the percentage of revenue that an expat plan must spend on administration.
CMS and its parent, the U.S. Department of Health and Human Services (HHS), is requiring major medical plans to file reports describing spending on claims, quality improvement expenses, non-claims costs, and federal and state taxes and licensing or regulatory fees. Each issuer also must report on earned premium revenue.
CMS has created an MLR waiver program for the mini-med and expat plans, to help them stay in business while adapting to PPACA, but, in exchange, CMS is requiring those plans to file their operating performance reports on a quarterly basis.
For purposes of applying the MLR rules, CMS is classifying plans with total annual benefits limits of $250,000 or less as mini-med plans.
When CMS proposed continuing the data collection on its own website, it received just two comments letter, CMS officials say.
Comments on the OMB clearance request are due Dec. 19.