New Guide to Federal Medical Loss Ratio Requirements Addresses MLR Implementation and Compliance

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The Guide offers critical guidance on the big-dollar questions stemming from the medical loss ratio (MLR) provisions in the health reform law. And it provides valuable insights into their possible ramifications for everyone in the health insurance business.

Atlantic Information Services, Inc. (AIS) -- AIS, publisher of the industry-leading newsletters AIS's Health Reform Week, Health Plan Week and Medicare Advantage News, is pleased to announce its newest publication, A Practical Guide to Federal Medical Loss Ratio Requirements. The Guide offers critical guidance on the big-dollar questions stemming from the medical loss ratio (MLR) provisions in the health reform law. And it provides valuable insights into their possible ramifications for everyone in the health insurance business -- on benefit design, broker commissions, technology investments, medical utilization review and more. Visit http://aishealth.com/node/11629 for publication details.

Few health reform provisions have greater potential to impact Medicare and commercial health plans than those that set MLRs … and Medicare Advantage plans that don't comply could possibly face enrollment suspension or the loss of their MA contracts.

In order to help health plans understand and comply with these new rules, AIS has tapped six of the nation's leading authorities on different angles of MLR implementation to provide insights into these and other big-dollar questions:

-- How has HHS defined quality improvement activities that may be included in MLR calculations? How will that affect the actuarial value of insurers' benefit designs?

-- Without a "pass-through" for broker commissions, how will insurers adjust broker pay while maintaining that distribution channel?

-- What is likely to be the impact of MLR provisions on commercial and Medicare insurers' earnings?

-- What steps are insurers likely to take to ratchet down other administrative spending, without jeopardizing important areas such as technology investment, and fraud and abuse prevention?

-- What are the hidden compliance hurdles in complying with the reporting and rebate requirements?

-- What steps will Medicare Advantage plans take to adjust benefit designs and distribution channels to meet their 85% minimum MLR requirement?

Inside A Practical Guide to Federal Medical Loss Ratio Requirements, readers will find answers to these questions and many more from the team of expert authors that includes: Henry Loubet, chief strategy officer at Keenan; William MacBain, senior vice president, finance, at Gorman Health Group; Carl McDonald, director and senior analyst at Citi Investment Research; Kenneth B. Schnoll, partner at SNR Denton; David Tuomala, director of actuarial services at Ingenix Consulting; and Brian Weible, president of Wakely Consulting Group.

Ramifications of the new MLR provisions are potentially staggering for everyone in the health insurance business. So it's critical that health plans, brokers, employers, benefits consultants and others with a vested interest have a resource that can help them implement these complex regulations.

Visit http://aishealth.com/node/11629 for more information and to view a detailed Table of Contents.

About AIS

AIS develops highly targeted news, data and strategies for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. Learn more at http://www.AISHealth.com.

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