U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Endnotes

09/01/2013

1 § 2794(c) of the Public Health Service Act, as added by § 1003 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010).

2 45 C.F.R. 154.200

3 Beginning in 2014, regulations require states to report all rate increases, even though only increases of 10 percent or more are reviewed for “reasonableness.”

4 Medical Loss Ratio Data and System Resources, Public Use File for 2012, Centers for Consumer Information and Insurance Oversight, 2013. (Accessed at http://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html.)

5 Five other states submitted limited RRG data about their individual market; these data were not included in the analysis due to data limitations.  See appendix for further discussion of methodology.  

6 This estimate uses information submitted by 34 states through the RRG Program plus Florida (a non-grant state) and is based on the average difference between rate changes requested and rate changes implemented, weighted by the number of covered lives. Two more states submitted limited RRG data in the small group market that were not included in the analysis. As with the individual market analysis, the small group savings estimates includes data from the reporting states on all rate increases, even those below 10 percent, in the small group market and assumes that the difference will be similar in the states that did not report data. Some additional data from several state websites were used to revise the RRG data. 

7 Medical Loss Ratio Data and System Resources, Public Use File for 2012, Centers for Consumer Information and Insurance Oversight, 2013. (Accessed at http://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html.)

8 42 C.F. R 154.200

9 Chu, Rose and Kronick, Richard, “Health Insurance Premium Increases in the Individual Market since the Passage of the Affordable Care Act,” ASPE Research Brief, Department of Health and Human Services,  February 22, 2013.  (Accessed at http://aspe.hhs.gov/health/reports/2013/rateincreaseindvmkt/rb.cfm

10 “State Statutory Authority to Review Health Insurance Rates, Small Group Plans,” The Kaiser Family Foundation, 2010 and 2012. (Accessed at http://kff.org/other/state-indicator/rate-review-small-group/#.)

11 “State Statutory Authority to Review Health Insurance Rates, Individual Plans” The Kaiser Family Foundation, 2010 and 2012. (Accessed at http://kff.org/other/state-indicator/rate-review-individual/.)

12 Savings estimates from the Annual Reports published in 2012 and 2013 are not cumulative because there is some overlap in the data.

13 For instance, if a rate filing contained documentation of an approved rate increase, but the submission did not indicate the amount of the requested increase, it was assumed that the missing rate change was the same as the rate change listed.

 

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