CMS de­nies Florida’s re­quest for ex­cep­tion to MLR rule

Modern Healthcare - - LATE NEWS -

Florida is the lat­est state to be de­nied an ex­cep­tion to the med­i­cal-loss-ra­tio stan­dard that re­quires in­di­vid­ual and small­group plans to spend at least 80% of premium dol­lars on med­i­cal care, a CMS of­fi­cial said. In its ap­pli­ca­tion, Florida’s Of­fice of In­sur­ance Reg­u­la­tion had re­quested an ad­just­ment of the stan­dard so the state would have to meet lower thresh­olds: 68% in 2011; 72% in 2012; and 76% in 2013. The de­ci­sion to not grant Florida’s re­quest is for the cur­rent cal­en­dar year, but “the im­pact of our de­ci­sion is to en­sure con­sumers get the ben­e­fits this year and through 2014,” Steve Larsen, di­rec­tor of CMS’ Cen­ter for Consumer In­sur­ance & In­for­ma­tion Over­sight, said dur­ing a call with re­porters. Larsen also noted that his of­fice re­ceived “an un­prece­dented level of pub­lic com­ment on this par­tic­u­lar ap­pli­ca­tion,” but did not spec­u­late on the rea­sons why the cor­re­spon­dence was greater for this re­quest. Larsen’s 16-page let­ter to Kevin Mc­carty, com­mis­sioner of the Florida Of­fice of In­sur­ance Reg­u­la­tion, noted that CCIIO had re­ceived a pe­ti­tion signed by more than 3,000 Florida con­sumers who said im­ple­men­ta­tion of the MLR is “long over­due” in the state. The let­ter also stated that eight is­suers in the state have MLRS of 80% or higher, while one other is­suer is close to meet­ing that stan­dard and two oth­ers are ex­pected to meet it in 2012.

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