MLR Waiver Bill Would Shift Power to States
A key waiver provision of the Patient Protection and Affordable Care Act would be amended under a medical loss ratio (MLR) bill scheduled for mark-up Thursday before the House Energy and Commerce Committee.
That provision of HR 1206 would give states the final say on MLR waiver requests. MLR waiver authority now rests with the Centers for Medicare & Medicaid Services.
The ACA requires insurers to spend no more than 20% of premium payments collected for the individual and small group market on administrative expenses such as salaries, overhead, and markets. The remainder, up to 80% of premium dollars, must be spent on direct patient care and efforts to improve care quality.
Insurers that fail to meet that standard are required to make financial rebates to their members.
This year insurers rebated $1.1 billion to 12.8 million members.
- 1 in 5 Eligible Hospitals Penalized for HACs
- 'Mega Boards' Could be Rural Healthcare Disruptor
- Two-Midnight Rule Will Cost Hospitals Big
- The Hospital of the Future is Not a Hospital
- Meaningful Use Payment Adjustments Begin
- HL20: Rebecca Katz—Cooking Up Sustainable Nourishment
- PA hospital to pay $662,000 to settle Medicare fraud case
- Supreme Court to hear Obamacare subsidy challenge in March
- HL20: Peter Semczuk, DDS, MPH—Taking on the Big Challenges
- 12 Hires to Keep Your Hospital Out of Trouble