Podcast Center
Video Center
Webcasts
Resource Center
Events
December 14, 2011 at 09:45 AM
States are winning some and losing some in the effort to gain flexibility in administering the new federal minimum medical loss ratio (MLR) rules.
Congress added the MLR rules to the Patient Protection and Affordable Care Act of 2010 (PPACA) in an effort to press health insurers to control health care costs. The rules require insurers to spend 85% of large group revenue and 80% of individual and small group revenue on health care and quality improvement programs.
A state can ask the U.S. Department of Health and Human Services (HHS) to let it ease the rules for individual health insurance business if it presents evidence that applying the PPACA MLR rules exactly as recommended by HHS would destabilize its individual health insurance market.
Analysts at Avalere Health L.L.C., Washington, a health policy firm, have waded through minimum medical loss ratio (MLR) waiver application documents and found that 17 jurisdictions have filed MLR waiver requests and 34 have not.
Maine asked for permission to set its individual market minimum MLR at 65%, and HHS officials approved that request without asking for changes.
