Medical Loss Ratio (MLR. The proportion of premium revenues spent on clinical services and quality improvement by the Contractor as calculated in accordance with the requirements of 42 C.F.R. § 438.8.
Medical Loss Ratio (MLR. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the Contractor shall calculate, attest to the accuracy, and submit to FSSA its Medical Loss Ratio (MLR). The MLR submission must fully comply with 42 CFR 438.8(d)-(n) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)). In accordance with 42 CFR 438.604(a)(3), 42 CFR 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications:
Medical Loss Ratio (MLR. The proportion of premium revenues spent on clinical services and quality improvement by the CCO.
Medical Loss Ratio (MLR. A basic financial measurement used to calculate and categorize costs, profits, and losses of a health insurance plan. Calculation of the MLR is defined at 42 C.F.R. § 438.8.
Medical Loss Ratio (MLR. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the Contractor shall calculate, attest to the accuracy of, and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8(d)-(f) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)) as required. In accordance with 42 CFR 438.604(a)(3), 42 CFR EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications:
Medical Loss Ratio (MLR. An adjusted metric for measuring the ratio of (i) incurred claims plus expenditures for activities that improve health care quality plus expenditures on activities to comply with certain program integrity requirements divided by (ii) adjusted premium revenue, as defined in [42 C.F.R. § 438.8].
Medical Loss Ratio (MLR. 12.2.1 The DMO shall track and report to DHS actual medical expenditures against an MLR of eighty-five percent (85%). The report shall be made in accordance with Section 9.3 of this Amendment.
Medical Loss Ratio (MLR. A. Medical Loss Ratio: Beginning in calendar year 2014, Demonstration Plans will be required each year to meet a Target Medical Loss Ratio (TMLR) threshold of 85 percent, which regulates the minimum amount of revenue that must be used for expenses either directly related to medical claims or care coordination.
Medical Loss Ratio (MLR. The percentage of capitation payment received from the State related to this Contract that is used to pay dental expenses as defined by 42 CFR 438.8. The MLR calculation for each MCO in an MLR reporting year is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)).
Medical Loss Ratio (MLR. The percentage of capitation payment received from TENNCARE that is used to pay medical expenses.
