As we ended the summer of 2012, the Obama administration touted one of the more popular aspects of the Affordable Care Act – the requirement that health insurers spend at least 80 cents of every premium dollar on medical care and health care quality (85 cents for large employer groups purchasing health insurance), and if
Alternative Provider Reimbursement Models – How Are They Treated Under MLR Rules?
by Joseph J. Kempf, Jr., and Jackie Selby
Evolving reimbursement models for health care providers (away from “fee for service” and toward “pay for performance” and risk sharing) raise interesting questions as to how such payments will be treated under the new medical loss ratio rules under the Patient Protection and Affordable Care Act. Some…
New Rules Issued on Medical Loss Ratio Requirements
by Gretchen Harders, Daly D.E. Temchine, and Joseph J. Kempf, Jr.
On December 7, 2011, final rules on the medical loss ratio (“MLR”) requirements for insured health plans (and an interim final rule for non-federal governmental plans) were issued by the U.S. Department of Health and Human Services and the Centers for Medicare…