Relaxing the medical loss ratio was among the Obamacare changes the Centers for Medicare & Medicaid Services announced in a news release at 7:15 p.m. Friday.
“We propose to raise the ceiling on allowable administrative costs and raise the floor on profits by 2 percentage points in the risk corridors formula,” the release said. “This adjustment would be applied uniformly in all States for 2015 to help with additional transition costs and uncertainty.”
The core requirements of the MLR program, which require that insurers spend 80 or 85 percent of premiums on health care and quality improvement, are generally not affected by the proposals, CMS said. CMS also said the adjustments would modify the timeframe for which issuers can include their ICD-10 conversion costs in their calculations “and account for the special circumstances of issuers during the changes taking place in 2014 (e.g., unanticipated costs due to high call center volume in January 2014).”
Other highlights of the proposal:
• Requiring insurers to offer plans on the Obamacare Marketplace to submit data for quality ratings. The goal would be to empower consumers, and “HHS would specify the form, manner, reporting level, and timeline in future technical guidance.” Marketplaces would be directed to display the quality ratings and enrollee satisfaction survey results.
• Strengthing standards for navigators and other assisters by codifying many of the standards already in practice, such as prohibiting cold calls to provide application assistance and offering cash or non-nominal gifts as an inducement to apply or enroll. The rules would also ensure that assisters cannot charge for the services and must be recertified annually, and specify which types of state laws would conflict with federal law.
• Aligning the start of annual employer election periods in all Small Business Health Options Programs with the start of open enrollment in the individual marketplace, “to minimize confusion and maximize efficiency.” It would also let employers allow employees to choose any health plan within a metal tier rather than just one plan, which is what generally happens today.
• Providing additional guidance for insurers participating in the federally facilitated Marketplace, and encouraging “improved consumer protections regarding essential community providers, network adequacy, access to needed prescription drugs, and coverage of care during transitions.”