Last Thursday and Friday, the National Association of Insurance Commissioners committee working on Affordable Care Act implementation issues met in Washington, DC. National Underwriter reports that the battle of the minimum medical loss ratio (“MLR”) definitions was a hot topic at the meetings. Under the Affordable Care Act, health insurers, including those sponsoring or underwriting FEHB plans, must spend at least 85% of premiums on medical expenses and health care quality efforts. FEHB plans generally meet this requirement. The tricky part will be how the regulators will treat plan efforts to build or re-build reserves. This requirement takes effect with the 2011 plan year.
According to National Underwriter, “America’s Health Insurance Plans (AHIP) put out a paper listing its goals for the MLR effort. AHIP says the rules adopted should:
Ensure that existing efforts to improve quality are allowed to continue and new initiatives to support the goals of PPACA are not discouraged.
Recognize that quality improvement efforts will be advanced by ICD-10 implementation.
Include fraud prevention and detection activities in the definition of activities that improve health care quality.
Implement a plan for transitioning from the existing state system to the new federal standards to maximize consumer choice.”
California Healthline reports that the NAIC may complete its work next month. The NAIC will be making recommendations to the Health and Human Services Department.
Congress is now hurtling toward its August recess. The Senate Homeland Security and Governmental Affairs Committee will be holding a business meeting on Thursday. No FEHBP issues are on the agenda.