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AHA comments on medical loss ratio provisions

May 14, 2010
The AHA today expressed support  for Patient Protection and Affordable Care Act provisions that impose reporting obligations and a medical loss ratio on health insurers to ensure that a minimum percentage of health insurance premiums are used to pay for health care services or activities that improve health care quality for enrollees. Responding to a request for comment from the Department of Health and Human Services, AHA says regulations implementing the MLR provision should ensure that the allocation of costs adheres to three principles: only payments to licensed professionals and entities for health care services should be classified as health care services; costs and expenses that are classified as activities that improve health care quality need to meet specific criteria; and loss adjustment activities should be counted as administrative costs, because they do not provide health care services or improve quality. AHA further notes that the MLR rule “must clearly define which activities do and do not improve health care quality and restrict the ability of health insurers to subjectively make such a determination.”