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Starting 2014, requires 85% medical loss ratio (MLR) for MA plans, with plans effectively required to return to CMS the portion of their revenue attributable to the difference between their MLR and 85%. After three consecutive years failing to meet the MLR requirement, plans may not enroll new beneficiaries. After five years of violation, plans will be terminated.
On February 15, 2013, CMS issued a proposed rule implementing medical loss ratio (MLR) requirements under which both Medicare Advantage and Part D plans must meet a minimum MLR, beginning in 2014, of at least 85%. Comments were due April 16, 2013.
On May 17, 2013, CMS released a final rule implementing the ACA requirement that, beginning in 2014, Medicare Advantage and Part D Plans meet a minimum medical loss ratio
(MLR) of at least 85 percent. Among other provisions, the final rule affirmed, as the agency stated in the preamble, that “the statute requires us to apply the Medicare MLR requirement to the Part D program.”
On July 5, CMS released a proposed information collection and comment request on a new collection it submitted to OMB, “Medical Loss Ratio (MLR) Report for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)” (see #3 on p. 2 of the hyperlinked source). The agency estimated burden hours associated with plan sponsors’ recordkeeping for yearly reporting for MLR reporting-related requirements. Comments are due on August 5, 2013.
SEC. 1103 ø42 U.S.C. 18003¿. IMMEDIATE INFORMATION THAT ALLOWS CONSUMERS TO IDENTIFY AFFORDABLE COVERAGE OPTIONS. (a) INTERNET PORTAL TO AFFORDABLE COVERAGE OPTIONS.— (1) IMMEDIATE ESTABLISHMENT.—øAs revised by section 10102(b)(1)¿ Not later than July 1, 2010, the Secretary, in consultation with the States, shall establish a mechanism, including an Internet website, through which a resident of any, or small business in, State may identify affordable health insurance coverage options in that State. (2) CONNECTING TO AFFORDABLE COVERAGE.—øReplaced by section 10102(b)(2)¿ An Internet website established under paragraph (1) shall, to the extent practicable, provide ways for residents of, and small businesses in, any State to receive information on at least the following coverage options: (A) Health insurance coverage offered by health insurance issuers, other than coverage that provides reimbursement only for the treatment or mitigation of— (i) a single disease or condition; or (ii) an unreasonably limited set of diseases or conditions (as determined by the Secretary). (B) Medicaid coverage under title XIX of the Social Security Act. (C) Coverage under title XXI of the Social Security Act. (D) A State health benefits high risk pool, to the extent that such high risk pool is offered in such State; and (E) Coverage under a high risk pool under section 1101. (F) Coverage within the small group market for small businesses and their employees, including reinsurance for early retirees under section 1102, tax credits available under section 45R of the Internal Revenue Code of 1986 (as added by section 1421), and other information specifically for small businesses regarding affordable health care options. (b) ENHANCING COMPARATIVE PURCHASING OPTIONS.— (1) IN GENERAL.—Not later than 60 days after the date of enactment of this Act, the Secretary shall develop a standardized format to be used for the presentation of information relating to the coverage options described in subsection (a)(2). Such format shall, at a minimum, require the inclusion of information on the percentage of total premium revenue expended on nonclinical costs (as reported under section 2718(a) of the Public Health Service Act), eligibility, availability, premium rates, and cost sharing with respect to such coverage options and be consistent with the standards adopted for the uniform explanation of coverage as provided for in section 2715 of the Public Health Service Act. (2) USE OF FORMAT.—The Secretary shall utilize the format developed under paragraph (1) in compiling information concerning coverage options on the Internet website established under subsection (a). (c) AUTHORITY TO CONTRACT.—The Secretary may carry out this section through contracts entered into with qualified entities.
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