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.
- CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services
- FDA hopes hospitals will switch to newly regulated pharmacies
- The 5 Biggest Healthcare Finance Trouble Spots
- Not-for-Profit Hospitals Find Opportunity Amid Uncertainty
- Nonprofit Hospital Outlook 'Negative' in 2014
- The Most Polarizing Topics in Healthcare IT
- Are ACOs Really Different from HMOs?
- How CPOE Will Make Healthcare Smarter
- Why You Should Involve Patients in Nursing Handoffs
- Rise of the Chief Strategy Officer