President Obama appointed Dr. Donald Berwick as the administrator of the Centers for Medicare and Medicaid Services (CMS) on July 7. Berwick is a pediatrician, a professor at Harvard University, and president/CEO of the Institute for Healthcare Improvement. He was nominated for the position in April, but no Senate confirmation hearings had been scheduled. As a result, President Obama made the appointment during a Senate recess, which allows Berwick to serve in the post through 2011 without Senate confirmation.
The Department of Labor's Employee Benefits Security Administration, in conjunction with the IRS and CMS, released on July 1 guidance related to the interpretation of the Mental Health Parity and Addiction Equity Act. In January, the agencies released interim final regulations to implement the law. In response to comments received from plans and issuers that it is common to require a copayment for outpatient office visits but to require coinsurance for other outpatient services, the agencies released new guidance that provides for an "enforcement safe harbor." The new guidance allows a plan or issuer to divide outpatient benefits into two sub-classifications for the purposes of determining parity: office visits and other outpatient services. The interim final regulations allow for similar treatment for multi-tier prescription drug formularies. For more information, visit http://www.dol.gov/ebsa/faqs/faq-mhpaea.html.
In the News
Academy Senior Health Fellow Cori Uccello was quoted in a July 7 article from the Bureau of National Affair's Health Insurance Report regarding new medical loss ratio (MLR) requirements. Uccello discussed the Academy MLR Work Group's related May 14 letter to the U.S. Department of Health and Human Services. The article also quoted Rowen Bell, chairperson of the work group, as the author of the letter. "The fundamental issue with the claims-over-premiums MLR definition," Bell wrote "… is the difficulty of arriving at a definition of claims that applies consistently across different types of business models."
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