Bob Atlas Quoted in “Insurers See Pluses in Proposed Medicaid Managed Care Rule but Voice MLR Worries”

Medicare Advantage News

Bob Atlas, a Strategic Advisor and President of EBG Advisors, Inc., was quoted in Medicare Advantage News, in “Insurers See Pluses in Proposed Medicaid Managed Care Rule but Voice MLR Worries.”

Following is an excerpt:

Bob Atlas, CEO of the EBG Advisors consulting arm of law firm Epstein Becker Green and a longtime Medicaid managed care consulting executive, tells MAN he doesn’t see much that’s controversial in the rule. Its key goal of seeking “to harmonize” the various federally backed health care programs is a “good thing, he asserts, and while some states with well-developed Medicaid managed care programs don’t need this harmonization, the proposed rule does offer flexibility albeit with some uncertainties about aspects such as quality measures. …

However, he adds that the Medicaid population is less homogeneous than is the case in MA, with costs varying dramatically among the kinds of populations states cover in managed care programs. So “a standardized MLR percentage may not make sense here,” Atlas contends. One way to deal with this, he says, would be for CMS to establish a “floor” MLR level and let states go higher than this if they think it’s warranted. He points out that several states have had MLR requirements for some populations of 90% or above. …

The provisions on actuarially sound rates are “not surprising” and reflect to some degree how bids are submitted now, although there are differences in such areas as data platforms and beneficiary eligibility that could pose challenges, says Atlas. CMS, he notes, now is asking for 90 days of notice before implementation on rate changes and for the actual chosen rates to be actuarially sound instead of allowing ranges of payment rates to meet that criterion.