HHS Rejects Two MLR Waiver Requests

The Department of Health and Human Services on Monday delivered the news that health law waiver requests from Indiana and Louisiana had been given the thumbs down, making these two states the third and fourth to have their applications for relief denied outright.

Politico: Health Care Waivers Denied For Indiana, Louisiana
The Department of Health and Human Services has denied Indiana's and Louisiana's requests for temporary relief from health reform's medical loss ratio requirements, making them the third and fourth states to have their applications rejected outright (Millman, 11/28).

CQ HealthBeat: Thumbs Down For Indiana And Louisiana On Medical Loss Ratio Requests
Indiana and Louisiana received the news Monday on their applications to phase in new medical payout rules in their states. The answer was no. That means four states among the 17 that have applied to the federal government for temporary "adjustments" in medical loss ratio (MLR) rules under the health care overhaul have been turned down. The other states that had previously been denied waivers were North Dakota and Delaware (Norman, 11/28).

The Hill: Obama Administration Rejects Republican States' Health Law Waiver Requests
The decision could rekindle the controversy over the waiver process, as the two states that were turned down, Indiana and Louisiana, have Republican governors. GOP leaders at the state level have been extremely critical of the health care law and the requirements that it imposes on states. The Department of Health and Human Services said Indiana and Louisiana do not need an adjustment from the health law's medical loss ratio. That provision requires insurers to spend at least 80 percent of premiums on medical care or offer rebates to their customers starting next year. HHS can grant a temporary waiver if regulators determine that the requirement looks likely to destabilize a state's individual health insurance market (Pecquet, 11/28).

Modern Healthcare: Feds Reject MLR Waivers For Ind., La.
The Obama administration rejected waivers on Monday sought by Indiana and Louisiana to the 2010 federal health care law's medical-loss ratio requirement that insurance plans devote a minimum percentage of their budgets to pay for the care of enrollees. The two states' requests sought permanent or temporary waivers of requirements in the Patient Protection and Affordable Care Act that insurance companies spend between 80 percent and 85 percent of premium dollars on medical care or health care quality improvement, rather than on overhead costs (Daly, 11/28).

New Orleans Times-Picayune: Louisiana Won't Get Waiver On Health Care Law Requirement
The Obama administration Monday rejected a waiver request from Louisiana that would have given the state two extra years to meet the 2010 health overhaul law's requirement for health insurance carriers to spend at least 80 percent of premiums for medical care and quality control efforts. ... In a letter to Louisiana Insurance Commissioner James Donelon, Steven Larsen, a Health and Human Services deputy administrator, said his agency found no evidence the 80 percent requirement would force insurers to drop out of the individual health insurance markets (Alpert, 11/28).

Meanwhile, Politico Pro reports on Aetna's Office of Management and Budget meeting —

Politico Pro: Aetna Meets With OMB On MLR Rule
Days after CMS sent a final rule on health reform's medical loss ratio requirements to the Office of Management and Budget, Aetna had the ear of Obama administration budget officials in a closed-door meeting, new records show. The Nov. 16 OMB meeting with the Connecticut-based insurance giant comes as the office is reviewing the final MLR rule, one of health reform's toughest provisions, which requires insurers to spend at least 80 percent of premium dollars on providing medical care or pay a rebate to consumers. CMS sent the rule to OMB for final review on Nov. 9 (Millman, 11/28).

In other news, Michael Dukakis offers his views on accountable care organizations and the AMA president terms the health law a "mixed bag" for physicians —

Boston Globe: Michael Dukakis On ACOs: 'We Tried That, Folks. It Didn't Work.'
The creation of accountable care organizations or a global payment structure won't fix the health care system in Massachusetts and make it more affordable, former governor Michael Dukakis told an audience at Harvard last week. Speaking during the Harvard School of Public Health Voices from the Field series, Dukakis said urging the health care market to fix itself is "a colossal waste of time" (Conaboy, 11/28).

Modern Healthcare: Reform Law A Mixed Bag For Docs, AMA President Says
The Patient Protection and Affordable Care Act has delivered good news to patients, but it's been a mixed bag for physicians, Dr. Peter Carmel, president of the American Medical Association, said Monday to attendees of the Radiological Society of North America's 97th Scientific Assembly and Annual Meeting in Chicago. ... Among its faults, Carmel said, were the lack of medical liability reforms, the continued use of the sustainable growth-rate formula — or SGR — to calculate physician Medicare payments, and its call for an Independent Payment Advisory Board that could further lower payments to doctors (Robeznieks, 11/28).