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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.

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