BNA’s Health Care Daily Report™ sets the standard for reliable, high-intensity coverage of breaking health care news, covering all major legal, policy, industry, and consumer developments in a...
By Sara Hansard
Sept. 23 — Some health insurers will have until Oct. 30 to distribute medical loss ratio (MLR) rebates for 2014, the Centers for Medicare & Medicare Services said in guidance posted Sept. 18.
Issuers that had to revise MLR and risk corridors data may not be able to distribute the MLR rebates by the Sept. 30 deadline, the CMS said in the guidance. Issuers won't be out of compliance with the MLR deadline for 2014 if the rebates are disbursed by Oct. 30, it said. Citing “discrepancies” in data submitted for the MLR and the ACA's risk corridors program, the CMS required some insurers to resubmit the data in August and September.
Under the Affordable Care Act's MLR requirement, health insurers must spend a minimum amount of premiums on medical claims or quality improvements; if they don't meet the ratio, they must refund the difference to consumers. The risk corridors program is one of three risk adjustment programs set up under the ACA to help protect some insurers that attracted sicker-than-average enrollees. The risk corridors calculation and the MLR use the same formula.
The CMS said in an Aug. 7 notice that while conducting quality assurance of the risk corridors data it identified a “significant number of discrepancies in the data, which makes it necessary to conduct additional data validation”.
Health insurers submitted data for the first time July 31 in connection with the ACA's temporary risk corridors program, which is in effect from 2014 through 2016.
The CMS released a report June 30 on payments made for the transitional reinsurance program and the permanent risk adjustment program for 2014, which didn't include the risk corridors program. The CMS released an updated version of the report Sept. 17.
New consumer-directed “co-op” health insurers created under the ACA and small, low-cost insurers with narrow provider networks are among the plans hardest hit by the risk adjustment program, which was set up under the law to stabilize premiums and ensure that plans that cover a high share of sick people aren't put at a disadvantage.
To contact the reporter on this story: Sara Hansard in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Janey Cohen at email@example.com
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)