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Rule Imposes Medical Loss Ratio on Medicare Advantage and Drug Programs

Published
  • February 19 2013, 11:59am EST

The Centers for Medicare and Medicaid Services has issued a proposed rule to implement medical loss ratio requirements for the Medicare Advantage Program (Part C) and the Medicare Prescription Drug Benefit Program (Part D).

The rule is available here and scheduled for publication on Feb. 22. The Affordable Care Act mandates insurers comply with a medical loss ratio, or MLR, under which a certain percentage of revenue is used for patient care--including quality initiatives--rather than administrative and marketing expenses, profit, and other such items.

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