HHS pre­views sam­ple no­tices for in­surer spend­ing, re­bates

Modern Healthcare - - LATE NEWS -

HHS un­veiled sam­ple no­tices that health plans must send pol­i­cy­hold­ers be­gin­ning this sum­mer to ex­plain how their pre­mi­ums are spent and in­form­ing them when re­bates are owed be­cause too lit­tle was spent on health­care ser­vices. The no­ti­fi­ca­tions—re­quired by the Pa­tient Pro­tec­tion and Af­ford­able Care Act—will de­tail what per­cent­ages of pre­mi­ums go to­ward var­i­ous ac­tiv­i­ties, such as un­der­writ­ing. HHS is adding a re­quire­ment that the no­ti­fi­ca­tion in­clude whether the plan met fed­eral stan­dards on the min­i­mum per­cent­age that those plans must de­vote to de­liv­er­ing health­care ser­vices or ac­tiv­i­ties that qual­ify as “qual­ity im­prove­ment.” The law re­quires in­sur­ance com­pa­nies in the in­di­vid­ual and small-group mar­kets to spend at least 80% of pre­mium dol­lars—be­gin­ning in 2011—on med­i­cal care and qual­ity im­prove­ment. In­sur­ance com­pa­nies in the large-group mar­ket must spend at least 85% on such ac­tiv­i­ties. Plans must pro­vide re­bates be­gin­ning Aug. 1 if they do not meet those min­i­mums. Sep­a­rately, the to­tal num­ber of re­jected state waivers from the med­i­cal-loss ra­tio stan­dard rose to 10, and the num­ber ap­proved or par­tially ap­proved rose to seven. HHS de­nied a waiver sought by Wis­con­sin and ap­proved a nar­rower ver­sion of North Carolina’s re­quest.

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