The Department of Health and Human Services announced in a letter it has granted a waiver to the Maine Bureau of Insurance, which delays the implementation of the federal medical loss ratio requirement by three years.

With this waiver, Maine's 65 percent MLR standard for the individual market will remain in effect through 2013.

According to the HHS letter, "After a careful examination of the application and consideration of the criteria set forth in the statute and implementing regulation, we agree with the reasoning that led to the MBI's conclusion that application of the 80 percent MLR standard in Maine has a reasonable likelihood of destabilizing the Maine individual health insurance market."

"We have determined that an adjustment of the MLR to 65 percent is warranted under the particular circumstances presented in the MBI application. While we conclude that such an adjustment is appropriate for three years, the adjustment to 65 percent for the third year is granted on the condition that the MBI provide CCIIO with updated data in 2012 that indicate a continued need for such an adjustment."

The HHS letter contains a review of the Maine waiver application, the regulatory criteria used to examine the application and an overview of Maine's individual health insurance market as well as a summary of public comments.

The HHS and the Department of Treasury also proposed a rule that outlines framework for submitting and reviewing applications regarding state innovation waivers authorized under the Affordable Care Act.

These waivers would exempt states from certain ACA provisions if alternative health reform approaches are implemented, beginning in 2017. The alternative approaches must be at least as comprehensive as the health reform law and include a 10-year budget neutral plan for the federal government. Legislation, which was endorsed by the president, has been introduced in Congress and would allow these state innovation waivers to be granted as early as 2014.

Instant Insights /

HHS grants MLR waiver to Maine

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