MLR program reviewed

By Allison Bell

February 14, 2014 at 10:50 AM

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The Centers for Medicare & Medicaid Services is wrapping up work on the medical loss ratio reporting form and rebate program for the 2013 reporting year.

Carriers will have to use form CMS-10418 later this year to see if they have to send enrollees MLR rebates.

The Patient Protection and Affordable Care Act forces carriers to spend at least 85 percent of large group revenue and 80 percent of individual policy and small-group revenue on health care and quality improvement efforts.

Carriers that miss the MLR targets are supposed to use rebates or other forms of compensation to make up for the gap.

The 2013 plan year reports are due June 1.

Brokers want the government to exclude broker compensation from the calculations. CMS continues to classify producer comp as a "non-claims cost."

One change is that five companies that specialize in writing student health insurance will have to fill out the form. A year ago, student health-only insurers were exempt.

Officials estimate that 522 issuers will file 3,394 annual reports with CMS' parent, the U.S. Department of Health and Human Services.

Preparing the reports, sending rebate notices and sending rebates will take carriers an average of about "70 person-days of effort," officials estimate.

HHS needs one MLR form reviewer who earns about $75,888 per year, including fringe benefits, to analyze the forms, officials say.

Because carriers are getting used to the MLR rules, they're probably getting better at meeting targets, and that could help reduce the burden of the requirements on them, officials say.

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