The Centers for Medicare and Medicaid Services has sent a final rule establishing health insurers' "medical loss ratios" to the Office of Management and Budget for review. OMB review is one of the last steps before publication of a rule in the Federal Register.
Implementation of medical loss ratio requirements is mandated under the Affordable Care Act. To reduce excessive costs, the reform law mandates that insurers spend a minimum amount of revenue from premiums on payment for clinical care. This is the "medical loss ratio" and the minimum level is set at 85 percent for the large group market and 80 percent for the small group market.
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