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TX Strikes Out on MLR Waiver Request

Margaret Dick Tocknell, for HealthLeaders Media, January 30, 2012

Only 17 states and Guam filed MLR waiver requests for 2011 and CMS has acted on all but two: North Carolina and Wisconsin. Those decisions are expected by February 8 unless CMS extends the deadline by 30 days.

CMS has granted six waivers: Georgia, Iowa, Kentucky, Maine, New Hampshire, and Nevada. It denied a waiver for Guam and eight states: Delaware, Florida, Indiana, Kansas, Louisiana, Michigan, Oklahoma, North Dakota, and Texas.

Three states have appealed the denial of their MLR waiver requests. The appeals of Indiana, Louisiana, and most recently Florida were also denied. In a January 19 letter to Kevin McCarty, the Florida insurance commissioner, CMS's Steve Larsen said "we have found no basis to modify our previous determination."

Florida hinged its appeal efforts on three standard arguments:

  1. The implementation of the new MLR requirement creates a barrier to entry
  2. New MLR ratios would hurt the agent and broker workforce
  3. Some insurers would potentially depart if the 80% MLR rate were upheld

In making the appeal McCarty contended that "failure to obtain the requested adjustment will cause permanent, irreparable harm to our market and the distribution channel for health products and services."

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1 comments on "TX Strikes Out on MLR Waiver Request"


Robert Luedecke, MD (2/3/2012 at 10:32 AM)
It is no secret that Governor Perry is opposed to any idea introduced by Democrats. The Texas Medical Association has been trying for many years to get exactly this sort of transparency in the insurance industry. This legislation is a major good for all the people of Texas in giving them more information to help the free enterprise system work more efficiently and should be implemented without delay.