HEY, BIG SPENDER /
Provider groups weigh in on how insurers should be able to spend premium dollars under the reform law.
In public comments to HHS, powerful provider groups have weighed in on how insurers should be able to spend member premium dollars under the health reform law. Under the law, starting in 2011, health insurers must spend at least 85% of subscriber premiums on medical costs in group coverage plans, and at least 80% in individual plans. Quality-improvement activities can be included in this calculation. The American Hospital Association wrote that only payments to licensed medical professionals or healthcare services organizations should be classified as “reimbursement for medical services,” under the forthcoming rules. The Medical Group Management Association wrote in its comments that HHS should include administrative costs incurred by providers as a component of insurers’ administrative costs in defining medical-loss ratios. The Federation of American Hospitals said some wellness and physician pay-for-performance programs should not be counted as quality-improvement initiatives. Public comment on the medical-loss ratio rule closed May 14.