4 Simmering Crises Congress Must Face in 2012
The Centers for Medicaid & Medicare is awash in demonstration projects that reward efficient and effective care. How about developing a system wide approach to reimbursement that employs lessons learned from the demonstration projects?
What Congress might really do
It's an election year so don't expect to see any new trails blazed on this issue. Looks like we're in for another one-year extension, which means a lame-duck Congress will take up the issue (again) at the end of 2012.
2.Don't mess with the new MLR rules
Health insurance agents and brokers are angry about the medical loss ratio and worried that new requirements in the federal Patient Protection and Affordable Care Act will hit them where it hurts—their bank accounts.
The National Association of Health Underwriters lobbied hard to get the Department of Health and Human Services to exclude broker and agent fees from MLR administrative cost calculations, but HHS declined to make the change in the final rule.
Now there's talk that Congress may step in and try to reverse that decision. But consider this General Accounting Office report, which concludes that 64% of all healthcare insurers in 2010 would have met or exceeded the 2011 MLR requirements contained in PPACA. And the PPACA itself expands the MLR definition to include programs like case management for chronic diseases, care coordination, quality initiatives, and the IT needed to support the programs.
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