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Jon R. Kammerzelt quoted in article “Obama Seeks to Add Teeth to MLR in Managed Medicaid Overhaul”

Modern Healthcare

Below is an excerpt:

Days before the Obama administration sent a sweeping managed Medicaid finalized rule that included the MLR to the Office of Management and Budget for review, it released a legislative proposal deep down in its fiscal 2017 budget that would give the CMS explicit authority to mandate that states recoup funds when a Medicaid managed-care organization, or MCO, fails to meet the MLR threshold.

“By forcing Medicaid managed-care plans to return amounts spent in excess of the medical loss ratio, the CMS will have better leverage to ensure that these plans are operating efficiently and using money to provide and improve health services,” said Jon Kammerzelt, a health law attorney at Quarles & Brady. “In other words, the president's legislative proposal gives the medical loss ratio some 'teeth.' "


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