Keep it simple, CMS.
Daniel Durham, an executive vice president at America’s Health Insurance Plans (AHIP), Washington, and Colleen Gallaher, a senior vice president at AHIP, make that case in a comment letter submitted to the Centers for Medicare & Medicaid Services (CMS).
CMS recently published a Federal Register notice seeking comments on the guidelines the agency ought to set for insurers and health plans that are sending notices regarding the rebates required by the minimum medical loss ratio (MLR) provisions created by Section 2718 of the Patient Protection and Affordable Care Act of 2010 (PPACA).
Durham and Gallaher write on behalf of AHIP that CMS officials ought to avoid any rules that could make complying with the MLR rebate notice requirements any more expensive or complicated than the statute requires.
“Imposing an additional, unnecessary administrative cost is flatly inconsistent with the purpose of the MLR provision,” Durham and Gallaher say.
The PPACA MLR provisions require insurers to spend at least 85% of large group plan revenue and 80% of individual and small group plan revenue on health care and quality improvement efforts. Insurers that find health care and quality expenses fall below the minimum must provide rebates.
One way to simplify the rebate notice process is to drop a CMS proposal that calls for requiring notices to go to individuals who will not be receiving rebates, the AHIP executives say.
PPACA Section 2718 does not require health plans to distribute notices to enrollees in plans that have met the MLR threshold, the AHIP executives say.
Requiring plans to send notices to those enrollees would be duplicative, unnecessary, costly and confusing, and the costs would cleary outweigh any benefit, the AHIP executives say.