NAIC approves proposed MLR financial template

SEATTLE—The National Assn. of Insurance Commissioners voted unanimously Tuesday to approve a proposed financial template, called a “blank,” specifying the types of services, fees and other spending that health insurers may be able to count as medical expenses under the new minimum medical-loss ratio requirements set by the Patient Protection and Affordable Care Act.

However, the instructions might change depending on the definition of medical loss ratio that the NAIC eventually adopts and has certified by the secretary of the Department of Health and Human Services, an NAIC spokeswoman said.

The NAIC also did not include fraud prevention and detection, drawing criticism from America’s Health Insurance Plans, the Washington-based trade group representing the vast majority of U.S. health insurers.

“The current proposal could have the unintended consequence of turning back the clock on efforts to improve patient safety, enhance the quality of care and fight fraud,” said AHIP President and CEO Karen Ignagni in a statement released after Tuesday’s vote at the NAIC’s annual meeting in Seattle.

However, DMAA: The Care Continuum Alliance, the Washington-based trade group representing wellness and disease management program vendors, praised the NAIC for doing “an exemplary job in an open and transparent way to ensure the MLR calculation recognizes the important services and products our members provide.”

“These recommendations are well-aligned with PPACA’s overall emphasis on the importance of prevention, wellness and care coordination,” DMAA President and CEO Tracey Moorhead said in a statement.

Under PPACA, insurers operating in the large group market must spend at least 85% of premiums on medical services and quality improvement, rather than on administrative costs or profits. The MLR for individual and small group plans must be at least 80%.

The NAIC’s medical loss ratio blanks proposal is posted on the NAIC website.