United States:
CMS Finalizes Medicare Advantage/Part D Plan Medical Loss Ratio Rules
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CMS published a final rule on May 23, 2013 that implements new
medical loss ratio (MLR) requirements for the
Medicare Advantage (MA) program and the Part D prescription drug
program. Under the new requirements, which were mandated by the
ACA, MA organizations and Part D plan sponsors are required to
report their MLR (percentage of revenue used for patient care), and
are subject to financial and other penalties for a failure to meet
a new statutory requirement that they have an MLR of at least 85%.
The rule is generally effective for contract years beginning on or
after January 1, 2014.
This article is presented for informational purposes only
and is not intended to constitute legal advice.
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