Health Reform + Related Health Policy News - June 2013


In This Issue:

- Top News

..CMS Finalizes MLR Rule for Plans, Maintaining Application to Part D Sponsors

..Early State Filings Show Premium Reductions under ACA

..HHS Received More Than 830 Letters of Intent for Navigator Program

..Hearing Highlights Divergent Positions on ACA’s Impact on Rates, Consumers

..House Subcommittee Chair Says New Draft of Physician Pay Fix Week of May 27

..Federal Prosecutors Get Guilty Pleas from Three Clinical Laboratory Executives in Anti-Kickback Cases

- State News

..Ninth Circuit Declares Arizona Abortion Law Unconstitutional

..States Face Technical Challenges Developing Health Insurance Exchanges

..Patient Record Breach at Idaho University Clinics Leads to Settlement, Corrective Action

..California Exchange Unveils Plans with Moderate Premium Rates

..Minnesota Ranked Best State For Seniors

..Mississippi Governor Gives $1M to Health Law Call Center

- Medicare

..Senators Ask GAO to Investigate Online Information From Medicare Rx Plans

- Regulatory News

..HHS Reduces Medicare Payment Rates for Pre-Existing Condition Insurance Program

..CMS Offers Options to State to Aid Enrollment Under Medicaid Expansion

..Medicare Benefit Package Should Only Be Altered Within Larger Reform Context

..Final Rule Upholds Increased Rewards, Penalties For Wellness Participation

..Medicare Costs May Keep Declining

..Health Law Is Fostering Competition, US Says

- Additional Reading

- Federal Register

- For More Information

- Excerpt from CMS Finalizes MLR Rule for Plans, Maintaining Application to Part D Sponsors:

On May 23, the Centers for Medicare and Medicaid Services (CMS) finalized the requirement under the Affordable Care Act (ACA) that Medicare Advantage and Part D drug sponsors devote 85% of their revenue to clinical services, prescription drugs, and other enrollee benefits. This percentage, known as the medical loss ratio (MLR), represents the percentage of revenue that must be used for patient care, rather than administrative expenses or profits. The final rule (CMS-4173- F) can be found here. Although industry representatives urged CMS not to apply the MLR rule to the Part D drug program, citing a lack of clear Congressional intent to do so, CMS maintained that the ACA requires application of the MLR rule to the Part D program.

Please see full Newsletter below for more information.

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