For months, a National Association of Insurance Commissioners working group has been busily drafting regulations to implement a key provision of the health law — its medical loss ratio requirement. This provision requires insurers in the individual and small group market to spend at least a minimum proportion of their premium revenues on health care services and activities that improve health care quality. Beginning in 2011, insurers who fail to meet these targets must rebate to enrollees the difference between their actual expenditures and the target amount.

The law specifically charged the NAIC with creating the definitions and methodologies for implementing this requirement, subject to certification by the Department of Health and Human Services (HHS).

When the long-awaited regs were released Sept. 23, news reports proclaimed that there were "few surprises." Indeed, there were none for those of us who have followed the seemingly endless conference calls that led to the document's development. And this general lack of surprise was the working group's intent. The draft regulations simply codify the definitions adopted unanimously by the insurance commissioners at the NAIC's August plenary meeting in Seattle, and the final decisions already reached by the subgroup through its transparent and participatory process.