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Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.

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Medical Loss Ratio Data and System Resources

The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. MLR requires insurance companies to spend at least 80 percent or 85 percent of premium dollars on medical care, with the review provisions imposing tighter limits on health insurance rate increases. If they fail to meet these standards, the insurance companies will be required to provide a rebate to their customers starting in 2012.

Source: dnav.cms.gov

Data and Resources

FieldValue
Publisher
Modified
2016-04-07
Release Date
2016-04-07
Homepage URL
Identifier
295
License
Contact Name
Health Data Initiative
Contact Email
Public Access Level
Public
Bureau Code
009:38 - Centers for Medicare and Medicaid Services
Program Code
009:000 - Department of Health and Human Services - (Primary Program Not Available)
Data Quality
True
Harvested from dnav.cms.gov
Harvest Source Titlednav.cms.gov
Harvest Source URIhttps://dnav.cms.gov/api/healthdata
Last Harvest PerformedTue, 10/22/2019 - 02:41
Medicare