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Medical Loss Ratio Requirements Under The Patient Protection And Affordable Care Act Aca Issues For Congress
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Book Synopsis Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care ACT (ACA) by : Suzanne M. Kirchhoff
Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care ACT (ACA) written by Suzanne M. Kirchhoff and published by CreateSpace. This book was released on 2015-06-26 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) requires certain health insurers to provide consumer rebates if they do not meet a set financial target known as a medical loss ratio (MLR). At its most basic, a MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans. Congress imposed the MLR to provide "greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care."
Book Synopsis Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress by : Suzanne M. Kirchhoff
Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress written by Suzanne M. Kirchhoff and published by Createspace Independent Pub. This book was released on 2012-10-20 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, a MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” Insurers that fail to meet these minimum standards must provide rebates to policyholders. The Department of Health and Human Services (HHS), with input from state insurance commissioners who are the main regulators of health insurance, issued rules for implementing the provisions. These rules provided greater details for calculating the MLR and issuing rebate payments. ACA allows companies to include quality improvements along with medical benefits when calculating the MLR. In addition, state and local taxes and some licensing fees are subtracted (i.e., disregarded) from expenses in the MLR formula. ACA's requirements are different from those imposed by state laws, which generally compare only medical claims to premiums. Though a number of states have their own MLRs, the ACA is now the minimum standard that must be met nationwide by certain health insurers. About 12.8 million U.S. consumers were due more than $1.1 billion in ACA MLR rebate payments in August 2012, for an average award of $151 per qualifying household. Employers or insurers can provide the rebates, which are based on activity in 2011, via a check, an electronic deposit in a bank account, a reduction in future insurance premiums in the amount of the rebate, or by spending the funds for the benefit of employees. About 66.7 million people were insured by covered companies that met or exceeded MLR standards for 2011, and will not receive rebates. The MLR is based on the aggregate performance of a health plan, not individual policy history. Even if a beneficiary had no medical claims during a given year, he or she would not receive a rebate if the broader plan met the MLR requirements. In addition, many Americans were enrolled in health plans that were not covered by the ACA MLR provisions in 2011. The ACA MLR provisions cover only fully funded health plans, which are plans where insurance companies assume the full risk for medical expenses incurred. The requirements do not extend to self-funded plans, which are health care plans offered by businesses in which the employer assumes the risk for, and pays for, medical care. Non-profit insurers and some Medicare Advantage plans were not covered by the ACA MLR standards in 2012, though the MLR provisions will be phased in during 2013 and 2014, respectively. In addition, some states won special exceptions for individual insurance policies, based on a HHS determination that meeting the MLR requirement would harm a state's insurance market. Several issues have been raised about the MLR provisions since the ACA was enacted. These include considerations regarding the treatment of insurance agent and broker bonuses and commissions, the impact of the MLR on insurers that provide high deductible plans, and special rules for non-profit health insurers.
Book Synopsis Affordable Care Act by : Sean R. Abernathy
Download or read book Affordable Care Act written by Sean R. Abernathy and published by Nova Science Publishers. This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medical loss ratio requirements under the patient protection and ACA.
Author :United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health Publisher : ISBN 13 : Total Pages :128 pages Book Rating :4.F/5 ( download)
Book Synopsis The President's Health Care Law Does Not Equal Health Care Access by : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health
Download or read book The President's Health Care Law Does Not Equal Health Care Access written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2015 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The Affordable Care Act by : Sean R. Abernathy
Download or read book The Affordable Care Act written by Sean R. Abernathy and published by . This book was released on 2014 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medial loss ratio requirements under the patient protection and ACA. (Imprint: Nova)
Book Synopsis Private Health Insurance by : U.s. Government Accountability Office
Download or read book Private Health Insurance written by U.s. Government Accountability Office and published by . This book was released on 2017-08-17 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: "To help ensure that Americans receivevalue for their premium dollars, thePatient Protection and Affordable CareAct (PPACA) established minimum"medical loss ratio" (MLR) standardsfor health insurers. The MLR is a basicfinancial indicator, traditionally referringto the percentage of premiums spenton medical claims. The PPACA MLR isdefined differently from the traditionalMLR (see fig.). Beginning in 2011,insurers must meet minimum MLRrequirements or pay rebates toenrollees. While insurers' first set ofdata subject to the MLR requirementswill be for 2011, and is not due untilJune 2012, insurers preparedpreliminary PPACA MLR data for 2010.GAO examined: (1) what can belearned from the traditional MLR datareported by health insurers prior toPPACA; (2) what factors might affectthe MLRs that insurers will reportunder PPACA; and (3) what changesin business practices, if any, haveinsurers made or planned to make inresponse to the PPACA MLRrequirements. GAO analyzedpremiums, claims, and traditional MLRdata for nearly all insurers for 2006-2009 and interviewed a judgmentalsample of seven insurers-selected toprovide a range based on their size,profit status, and the number of statesin which they operated-about theirexperiences using the PPACA MLRdefinition.In commenting on a draft of this report,the Department of Health and HumanServices (HHS) said that the MLRprovision will increase transparency..."
Book Synopsis US Healthcare Sector - Organization, Management and Payment Systems Handbook Volume 1 Strategic Information, Developments, Reforms by : IBP, Inc.
Download or read book US Healthcare Sector - Organization, Management and Payment Systems Handbook Volume 1 Strategic Information, Developments, Reforms written by IBP, Inc. and published by Lulu.com. This book was released on 2015-09-30 with total page 278 pages. Available in PDF, EPUB and Kindle. Book excerpt: United States Healthcare Sector Organization, Management and Payment Systems Handbook - Strategic Information, Programs and Regulations
Book Synopsis The Affordable Care Act by : Tamara Thompson
Download or read book The Affordable Care Act written by Tamara Thompson and published by Greenhaven Publishing LLC. This book was released on 2014-12-02 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
Book Synopsis Patient Protection and Affordable Care Act by : Otis Cronin
Download or read book Patient Protection and Affordable Care Act written by Otis Cronin and published by Nova Science Publishers. This book was released on 2012 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: In March 2010, the 111th Congress passed health reform legislation, the Patient Protection and Affordable Care Act. Jointly referred to as the PPACA, the law increases access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide individuals and small employers with access to insurance. This book provides an overview of major PPACA provisions, implementation and oversight activities, and current legal challenges.
Book Synopsis Congressional Record by : United States. Congress
Download or read book Congressional Record written by United States. Congress and published by . This book was released on 2012 with total page 1498 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Private Health Insurance by : John E. Dicken
Download or read book Private Health Insurance written by John E. Dicken and published by . This book was released on 2014-08-16 with total page 47 pages. Available in PDF, EPUB and Kindle. Book excerpt: Private insurers are required to meet minimum Patient Protection and Affordable Care Act (PPACA) medical loss ratio (MLR) standards -- expressed as the percent of premium dollars spent on patient care and related activities -- and beginning in 2011 they must pay rebates back to enrollees and policyholders who paid premiums if they do not meet these standards. This report reviewed the effects of the PPACA MLR requirements on insurers and enrollees and how rebates would change if agent and broker payments were excluded from the MLR formula. It examines (1) the extent to which insurers met the PPACA MLR standards, and how much they spent on the MLR components of claims, quality improvement activities, and non-claims costs; (2) the amount of rebates insurers paid and how this amount would have changed with agents' and brokers' commissions and fees excluded from the MLR; and (3) the perspectives of insurers on the effects of the MLR requirements on their business practices. Tables and figures. This is a print on demand report.
Book Synopsis Essentials of Health Policy and Law by : Joel B. Teitelbaum
Download or read book Essentials of Health Policy and Law written by Joel B. Teitelbaum and published by Jones & Bartlett Publishers. This book was released on 2016-02-21 with total page 399 pages. Available in PDF, EPUB and Kindle. Book excerpt: Essentials of Health Policy and Law helps readers understand the broad context of health policy and law, the essential policy and legal issues impacting and flowing out of the health care and public health systems, and the way health policies and laws are formulated. Important Notice: The digital edition of this book is missing some of the images or content found in the physical edition.
Book Synopsis Essentials of Health Policy and Law by : Sara E. Wilensky
Download or read book Essentials of Health Policy and Law written by Sara E. Wilensky and published by Jones & Bartlett Learning. This book was released on 2022-03-25 with total page 412 pages. Available in PDF, EPUB and Kindle. Book excerpt: Essentials of Health Policy and Law, Fifth Edition provides students of public health, medicine, nursing, public policy, and health administration with an introduction to a broad range of seminal issues in U.S. health policy and law, analytic frameworks for studying these complex issues, and an understanding of the ways in which health policies and laws are formulated, implemented, and applied. Thoroughly revised, the Fifth Edition explores the key health policy and legal changes brought about by the Biden Administration and the presently Democrat-controlled Congress. It also addresses the Covid-19 pandemic, and its many devastating and intertwined health, economic, and social consequences.
Download or read book 50 Vetoes written by Michael F. Cannon and published by Cato Institute. This book was released on 2013-03-27 with total page 65 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (PPACA) remains vulnerable to repeal, largely because Congress and the Supreme Court have granted each state the power to veto major provisions of the law before they take effect in 2014. The PPACA itself empowers states to block the employer mandate, to exempt many of their low- and middle-income taxpayers from the individual mandate, and to reduce federal deficit spending, simply by not establishing a health insurance "exchange." To date, 34 states have refused to create Exchanges and some 16 states have announced they would not expand their Medicaid programs. Yet the Obama administration is trying to coerce states into implementing parts of the expansion that the Court rendered optional. This special White Paper provides a comprehensive review of the process now occurring between states and the Obama Administration, underscoring how a critical mass of states exercising their vetoes over Exchanges and the Medicaid expansion can force Congress to reconsider, and hopefully repeal, the rest of the PPACA.
Book Synopsis Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA) by : Annie L. Mach
Download or read book Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA) written by Annie L. Mach and published by Createspace Independent Pub. This book was released on 2012-07-28 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: The private health insurance provisions in the Patient Protection and Affordable Care Act (P.L. 111-148, ACA, as amended) include market reforms that impose requirements on private health insurance plans. Such reforms relate to the offer, issuance, generosity, and pricing of health plans, among other requirements. ACA's market reforms largely focus on the individual and small group health insurance markets, and in this report the reforms have been grouped by effective dates: “immediate” market reforms that become effective prior to the full implementation date of ACA, and reforms that become effective on the full implementation date (January 1, 2014). ACA requires implementation of a number of reforms prior to its full implementation date (i.e., prior to plan years beginning on or after January 1, 2014). “Immediate” reforms include a process to review unreasonable rate increases; an Internet portal to assist consumers in identifying coverage options; prohibition on lifetime limits and restriction of annual limits; the prohibition on rescissions; coverage of preventive health services with no cost-sharing; extension of dependent coverage; prohibition of discrimination based on salary; standards related to medical loss ratios and rebates to plan participants; appeals process; coverage of preexisting health conditions for children; patient protections; uniform explanation of coverage documents; and reporting requirements regarding quality of care. Market reforms effective beginning in 2014 include nondiscrimination based on health status; guaranteed issue and guaranteed renewability; coverage of preexisting health conditions (regardless of age); nondiscrimination regarding clinical trial participation; rating restrictions; waiting period limitation; and nondiscrimination regarding health care providers. This report provides background information about the private health insurance market, including market segments and regulation. It describes each ACA market reform and notes any major implementation activity that has occurred (e.g., issuance of final rule from a department such as Health and Human Services). The appendices of the report provide additional information about the status of regulations relating to each reform and how the reforms apply to the different market segments and health plans.
Book Synopsis Health Care in the United States by : Leone Giangiulio
Download or read book Health Care in the United States written by Leone Giangiulio and published by Nova Science Publishers. This book was released on 2013-02 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The health care reform debate in the United States, raises many complex issues including those of coverage, accessibility, cost, accountability, and quality of health care. Underlying these policy considerations are issues regarding the status of health care as a constitutional or legal right. This book series analyses the constitutional and legal issues pertaining to the right of health care and the power of Congress to enact and fund health care programs. Other topics discussed in this volume include the constitutionality of the individual mandate; health insurance exchanges under the Patient Protection and Affordable Care Act (ACA); health care flexible spending accounts; tax-advantaged accounts for health care expenses; medical loss ratio requirements under the ACA; and an overview of health savings account rules.
Book Synopsis Tax Expenditures by : Library of Congress. Congressional Research Service
Download or read book Tax Expenditures written by Library of Congress. Congressional Research Service and published by . This book was released on 2014 with total page 1060 pages. Available in PDF, EPUB and Kindle. Book excerpt:
