(June 7, 2024) – 2024 MLR Rebate Analysis Available
The KFF estimates insurers will issue $1.1 billion in medical loss ratio rebates across all commercial markets in 2024. The Affordable Care Act limits the amount of premium income insurers can keep for administration, marketing and profits. The MLR for individual and small group markets is 20 persent and is 15 percent for large group insurers. If an insurer fails to meet the MLR threshold, they are required to pay back the excess profits or margins in the form of rebates to individuals and employers. KFF published findings based on preliminary data reported by insurers to state regulators and compiled by Mark Farrah Associates.
CMS Publishes Revised ICR for IRA Rebate Reduction Requests
The Centers for Medicare & Medicaid Services released a revised information collection request for rebate reduction requests under Sections 11101 and 11102 of the Inflation Reduction Act. The IRA requires drug manufacturers that raise the prices of certain drugs covered under Medicare Part B and D faster than the rate of inflation to pay a Medicare rebate. Drug companies seek a reduction to the rebate when severe supply chain disruptions occur or when a rebatable generic drug is likely to be in short supply. CMS previously proposed a rule in February that included the process to receive a rebate reduction, and now has released a revised ICR seeking comments by Wednesday, July 3.
GAO Issues Recommendations on Medicaid Managed Care Prior Authorization Oversight
The Government Accountability Office issued a report recommending the Centers for Medicare & Medicaid Services set expectations for how states should monitor managed care plans’ prior authorization decisions and take steps to confirm whether states are meeting those expectations. The report also recommends CMS take action to determine whether managed care prior authorization processes inappropriately limit access to Early and Periodic Screening, Diagnostic and Treatment services for children. The GAO found no consistency among plans concerning the services that require prior authorization, the medical necessity criteria used and the entities involved in the processes.
The GAO reviewed five states. Generally speaking, although states receive data on prior authorization approvals and denials, meaningful use of the data is lacking. In addition, the state's oversight of prior authorization practices focused primarily on processes instead of whether the plans’ prior authorization decisions were appropriate.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews:
Before You Go ...
- An Advanced Hazmat Life Support class, offered as a partnership between the SSM Health Training and Simulation Center and Region VII Disaster Health Response Ecosystem, will be held Wednesday, Aug. 14, through Friday, Aug. 16, in Fenton, MO. This class will be offered free to those living and working in Missouri, Iowa, Kansas and Nebraska. Registration is required.