American Hospital Association May 16, 2019
The Centers for Medicare & Medicaid Services’ yesterday issued guidance regarding the calculation of a plan’s Medical Loss Ratio, which represents the percent of premium revenue that goes toward claims and activities that improve health care quality. CMS regulations require Medicaid and CHIP managed care plans to use an MLR target of 85 percent in developing rates, and to exclude prescription drug rebates from the claims costs used to calculate an MLR. CMS said the guidance clarifies that a prescription drug rebate means any price concession or discount...
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