Medical Loss Ratio Reporting Procedures For 2012 Reporting Year Announced

On March 29, the Center for Consumer Information and Insurance Oversight (CCIIO) issued a memorandum that outlines the process by which health insurance issuers will submit their medical loss ratio (MLR) data to fulfill reporting obligations under the MLR provisions of the Patient Protection and Affordable Care Act (ACA). The report for the 2012 MLR reporting year must be filed by June 1, 2013.

Background. Effective 2011, Public Health Service Act (PHSA) Sec. 2718 establishes minimum MLR standards for health insurance issuers, and requires issuers to provide rebates when the issuers’ MLRs are lower than the applicable MLR standard. PHSA Sec. 2718 also requires issuers to submit to the Department of Health and Human Services data on issuers’ use of premium dollars within major categories, including data required to calculate issuers’ MLRs and rebates.

The regulation implementing PHSA Sec. 2718 details the data that issuers must submit and sets forth the MLR and rebate calculation methodology. The MLR data will be collected by the CCIIO within the Centers for Medicare and Medicaid Services (CMS).

Who must file report. The MLR data must be reported by issuers providing health insurance coverage subject to PHSA Sec. 2718 and the MLR implementing regulations. This generally includes life; accident and health; property and casualty; and fraternal issuers providing group or individual health insurance coverage in the (1) individual market, (2) small group market, and (3) large group market, including issuers providing “mini-med” policies (policies with total annual benefit limits of $250,000 or less).

For the 2012 MLR reporting year, expatriate lines of business are exempt from the MLR rebate requirements.

How to file. Issuers will file MLR data reports using the MLR module of CMS’ online Health Insurance Oversight System (HIOS). To access the HIOS MLR module, all users will first need to register with CMS’ Enterprise Portal. Once user access requests are processed, the authorized individuals will receive user account information and instructions for accessing the MLR module in HIOS.

Format of report. A complete MLR filing will require:

• a data submission using an Excel template, and

• attestations to the accuracy of the data by both the Chief Executive Officer (CEO) and the Chief Financial Officer (CFO) of the organization.

Organizations will need to register six HIOS MLR module users as follows:

• an “Upload” user and a back-up “Upload” user authorized to submit MLR data through HIOS, and

• two “Attester” users and two back-up “Attester” users authorized to review and attest to the accuracy and completeness of the MLR data uploaded to HIOS.

The two primary “Attester” users should be the CEO and the CFO of the legal entity required to file an MLR data report. The two back-up “Attester” users should be qualified officers of the filing entity as listed on the state annual filing documents.

Timeline for filing report. CCIIO provides the following timeline for filing the annual MLR data report:

• April 1, 2013: HIOS MLR module registration window opens.

• May 1, 2013: MLR data report submission window opens.

• June 1, 2013: MLR data report filing deadline. MLR data must be uploaded and both designated officials must attest to the accuracy of the data before this deadline.

For questions regarding the HIOS MLR module, contact the Exchange Operation Support Center at CMS_FEPS@cms.hhs.gov or (855) 267-1515. For questions regarding the MLR annual report, please contact the MLR Division at MLRQuestions@cms.hhs.gov. The memo is available at http://cciio.cms.gov/resources/files/Issuer_2012_MLR_Memo.pdf.

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