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Patient Protection And Affordable Care Act Benefit And Payment Parameters Us Department Of Health And Human Services Regulation Hhs 2018 Edition
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Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781729722404 Total Pages :260 pages Book Rating :4.7/5 (224 download)
Book Synopsis Patient Protection and Affordable Care ACT - Benefit and Payment Parameters (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Benefit and Payment Parameters (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Benefit and Payment Parameters (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781729722640 Total Pages :268 pages Book Rating :4.7/5 (226 download)
Book Synopsis Patient Protection and Affordable Care ACT - HHS Notice of Benefit and Payment Parameters for 2014 (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - HHS Notice of Benefit and Payment Parameters for 2014 (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 268 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs-risk adjustment, reinsurance, and risk corridors-to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance. This book contains: - The complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781722602680 Total Pages :268 pages Book Rating :4.6/5 (26 download)
Book Synopsis Patient Protection and Affordable Care ACT - HHS Notice of Benefit and Payment Parameters for 2014 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - HHS Notice of Benefit and Payment Parameters for 2014 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 268 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs-risk adjustment, reinsurance, and risk corridors-to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance. This book contains: - The complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781722499907 Total Pages :28 pages Book Rating :4.4/5 (999 download)
Book Synopsis Patient Protection and Affordable Care ACT - Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This interim final rule with comment builds upon standards set forth in the HHS Notice of Benefit and Payment Parameters for 2014, published elsewhere in this issue of the Federal Register. This document will adjust risk corridors calculations that would align the calculations with the single risk pool provision, and set standards permitting issuers of qualified health plans the option of using an alternate methodology for calculating the value of cost-sharing reductions provided for the purpose of reconciliation of advance payments of cost-sharing reductions. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781722602017 Total Pages :198 pages Book Rating :4.6/5 (2 download)
Book Synopsis Patient Protection and Affordable Care ACT - Benefit and Payment Parameters for 2015 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Benefit and Payment Parameters for 2015 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 198 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2015 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2015 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional standards with respect to composite premiums, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2015 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781722602178 Total Pages :282 pages Book Rating :4.6/5 (21 download)
Book Synopsis Patient Protection and Affordable Care ACT - Benefit and Payment Parameters for 2019 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Benefit and Payment Parameters for 2019 (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 282 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2019 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2019 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally-facilitated Exchanges and State Exchanges on the Federal platform. It finalizes changes that provide additional flexibility to States to apply the definition of essential health benefits (EHB) to their markets, enhance the role of States regarding the certification of qualified health plans (QHPs); and provide States with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. It includes changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2019 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781729722381 Total Pages :28 pages Book Rating :4.7/5 (223 download)
Book Synopsis Patient Protection and Affordable Care ACT - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This interim final rule with comment establishes provisions that alter the parameters of select special enrollment periods and that revise certain rules governing consumer operated and oriented plans (CO-OPs). This book contains: - The complete text of the Patient Protection and Affordable Care Act - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section
Author :United States. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research Publisher : ISBN 13 : Total Pages :614 pages Book Rating :4.:/5 (318 download)
Book Synopsis The Belmont Report by : United States. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
Download or read book The Belmont Report written by United States. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and published by . This book was released on 1978 with total page 614 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781729722398 Total Pages :36 pages Book Rating :4.7/5 (223 download)
Book Synopsis Patient Protection and Affordable Care ACT - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of their state, while streamlining the consumer experience. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781729722572 Total Pages :242 pages Book Rating :4.7/5 (225 download)
Book Synopsis Patient Protection and Affordable Care ACT - Exchange and Insurance Market Standards for 2015 and Beyond (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Exchange and Insurance Market Standards for 2015 and Beyond (Us Department of Health and Human Services Regulation) (Hhs) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 242 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Exchange and Insurance Market Standards for 2015 and Beyond (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Exchange and Insurance Market Standards for 2015 and Beyond (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges ("Exchanges"), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non-formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio (MLR) program. The majority of the provisions in this rule are being finalized as proposed. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Exchange and Insurance Market Standards for 2015 and Beyond (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section
Book Synopsis Section 1557 of the Affordable Care Act by : American Dental Association
Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 10 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
Book Synopsis Better Regulation Practices across the European Union 2022 by : OECD
Download or read book Better Regulation Practices across the European Union 2022 written by OECD and published by OECD Publishing. This book was released on 2022-06-28 with total page 202 pages. Available in PDF, EPUB and Kindle. Book excerpt: Laws and regulations affect the daily lives of businesses and citizens. It is important that they are designed in a way that takes account of their social, environmental and business impacts and ensures they remain relevant in today’s fast-changing context. The second edition of the Better Regulation Practices across the European Union report analyses recent developments and current practices for improving the quality of laws and regulations across all 27 EU Member States and the European Union.
Book Synopsis Conditions of Participation for Hospitals by : United States. Social Security Administration
Download or read book Conditions of Participation for Hospitals written by United States. Social Security Administration and published by . This book was released on 1966 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :The Law The Law Library Publisher :Createspace Independent Publishing Platform ISBN 13 :9781722603083 Total Pages :138 pages Book Rating :4.6/5 (3 download)
Book Synopsis Patient Protection and Affordable Care ACT - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) by : The Law The Law Library
Download or read book Patient Protection and Affordable Care ACT - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards (Us Centers for Medicare and Medicaid Services Regulation) (Cms) (2018 Edition) written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section
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 PHS Grants Policy Statement by : United States. Public Health Service
Download or read book PHS Grants Policy Statement written by United States. Public Health Service and published by . This book was released on 1994 with total page 134 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets by : Thomas G. McGuire
Download or read book Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets written by Thomas G. McGuire and published by Academic Press. This book was released on 2018-08-06 with total page 648 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness