By Victoria Moran, J.D., M.H.A.
Health insurance issuers can now access the instructions for filing 2018 MLR Annual Reporting Forms.
On June 25, 2019, the Center for Consumer Information and Insurance Oversight (CCIIO) issued the filing instructions for the 2018 medical loss ratio (MLR) reporting form. Data included in the MLR Form will be used to calculate health insurance issuers’ MLR and rebates pursuant to the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The MLR Form has been updated to incorporate any provisions in 45 C.F.R. Part 158 effective for the 2018 MLR reporting year (CCIIO Filing Instructions, June 25, 2019).
The ACA requires health insurance issuers to report data on premium revenues spent on clinical services and quality improvement and to issue rebates if the percentage (MLR) does not meet certain standards. Section 2718 of the Public Health Service Act (PHSA) requires the filing of a report to the HHS Secretary. An issuer must submit an MLR Form for each state in which the issuer has written direct health insurance coverage or directed payments for the provision of health care services. Issuers must also submit a Grand Total (GT) template listing the total of its business in all states. Issuers must complete a one-time registration through the secured CMS Enterprise Portal for the Health Insurance Oversight System (HIOS) to file reports; issuers that have registered for a previous year do not need to reregister but will need to confirm or update issuer associations.
The instructions recommend completing Part 2 first, followed by Part 1, Part 3, and then Parts 4 through 6.
While the instructions reference the National Association of Insurance Commissioners (NAIC) Statements of Statutory Accounting Principles (SSAP) and Supplemental Health Care Exhibit (SHCE), the instructions note that the MLR Form and Filing Instructions implement requirements of 45 C.F.R. Part 158 and may not be identical to the information of the NAIC’s SHCE.
Issuers with questions regarding the MLR Form are encouraged to email HHS at [email protected].
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