Insurance Market Reform
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- 05/30/2013
The IRS released proposed regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other health care organizations, on computing and applying the medical loss ratio as detailed in the Affordable Care Act (ACA). That provision requires carriers to apply at least 80 percent of paid premiums to health care services and up to 20 percent to administrative costs.
- 05/30/2013
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on DSH payments. The proposed rule specifies the methodology for the annual reductions in DSH payments from fiscal year 2014 through fiscal year 2020, as required by the ACA. The rule also outlines some additional proposed DSH reporting requirements. A fact sheet is also available.
- 05/30/2013CMS released a third cycle of Rate Review Grants - Grants to States to Support Health Insurance Rate Review and Increase Transparency in Health Care Pricing, Cycle III of the Rate Review Grant Program. This cycle of funding continues to support rate review efforts in states and bolsters state’s ability to establish or enhance data centers which collect, analyze, and publish reimbursement and health pricing data.
- 05/06/2013
This proposed rule released by the IRS provides further detail on the minimum value that employer-sponsored coverage must provide in order to comply with the ACA and not be subject to the employer mandate penalty. It also provides additional guidance on premium tax credits.
- 03/28/2013
This interim rule builds on the standards set forth in the Notice of Benefit and Payment Parameters for 2014. This document adjusts risk corridors calculations that would align the calculations with the single risk pool provision, and sets standards permitting QHP issuers to use an alternate methodology for calculating the value of cost-sharing reductions.
