HHS finalizes medical-loss ratio regs, rejects insurer requests
HHS issued final regulations requiring insurance plans to spend minimum percentages of premium dollars on paying for healthcare services this year or refund the difference to their customers next year. Under the medical-loss ratio prescribed by the Patient Protection and Affordable Care Act, new individual and small group plans must spend 80% of premium dollars on medical care and healthcare quality improvement, with the remainder allowed for administrative costs. The ratio for largegroup plans is 85%. Karen Ignagni, president and CEO of America’s Health Insurance Plans, hailed changes to the proposed rule issued in December 2010 for recognizing some of the costs associated with modernizing the medical claims coding system “as activities that improve healthcare quality.” The final rule, however, rejected insurer requests that the health expenditures side of the equation include all costs associated with implementing ICD-10 codes, as well as anti-fraud efforts. The rule also will wind down a “special circumstances adjustment for mini-med plans,” giving the catastrophic insurance plans some leeway in calculating their ratio until 2014. Consumers Union praised several components of the rule but blasted that compromise. “Today’s announcement by HHS recognizes the need for mini-med plans to start increasing value for policyholders by requiring them to phase-in the new MLR standard,” Sondra Roberto, staff attorney for the consumer advocacy group, said in a statement. “But as long as these plans continue, policyholders may be left with unexpected medical debt in the event of a major illness.” including improved services for chronicdisease management. “In this new era of healthcare, none of us can stand alone anymore,” Dr. James Keeton, University of Mississippi Medical Center’s vice chancellor for health affairs and dean of the school of medicine, said in the release. Although the details of affiliation have not been decided on, one scenario would allow UMMC and Health Management Associates to work together to boost in-hospital educational and training opportunities for physicians in the face of a looming statewide shortage. “Doing so would enhance UMMC’S ability to grow the number of physicians in Mississippi, which lags behind nearly every other state in its per-capita supply and distribution of doctors,” according to the release.