Federal agencies are starting to lay the groundwork for enforcing compliance with the Patient Protection and Affordable Care Act of 2010 (PPACA).
Staff members from the National Association of Insurance Commissioners (NAIC) gave the Florida Health Insurance Advisory Board a briefing on federal PPACA enforcement efforts Tuesday at a hearing.
Federal teams already are auditing compliance with the PPACA minimum medical loss ratio (MLR) provisions, according to a written version of the briefing. The MLR provisions require carriers to spend at least 85 percent of large group revenue and 80 percent of individual and small group revenue on what officials classify as health care and quality improvement efforts. Carriers that miss the target must use rebate payments or other methods to make up for the gap.
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In states in which the U.S. Department of Health and Human Services (HHS) is running the PPACA public exchanges, federal teams will look at the adequacy of exchange plan networks. Teams will also conduct general PPACA compliance reviews, the staffers said.
Although federal regulators can enforce many PPACA provisions, the "federal government may not prohibit the sale of a policy or use of a rate in a state," the staffers said.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
