Insurance Firms Seek To Clarify Medical Spending Rules Under Reform Law
Insurance companies have begun arguing that spending on health information technology and programs that reduce unnecessary medical care should qualify as "improving quality of care" and thus count toward the minimum medical loss ratio provision in the new health reform law, CQ HealthBeat reports.
The overhaul requires insurers to spend at least 85% of large group market premiums and 80% of individual non-group market premiums on medical care.
Insurers contend that certain types of spending -- including spending on health risk assessments, wellness programs and nurse advice lines -- should fall under the medical care category. According to CQ HealthBeat, it will be easier for insurers to reach the minimum MLR if more benefits are considered medical care.
The National Association of Insurance Commissioners by June 1 is expected to recommend to federal officials how insurance companies' spending and programs should be classified. HHS has set a May 14 deadline for comments by insurers and other stakeholders regarding the MLR criteria.
Groups Weigh In
An internal America's Health Insurance Plans memo said that regulators could jeopardize certain health insurance benefits if they do not designate them as medical, CQ HealthBeat reports.
However, consumer activists contend that awarding the designation to some programs could lead to inappropriate denials of care and would prevent insurers from increasing spending on actual medical care (Reichard, CQ HealthBeat, 5/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.