On Monday, the FEHBlog discussed an OPM proposed rule which would change the annual Open Season period to the month of November. I expressed my surprise that according to the rule’s preamble, OPM intended to make this change effective this year. I now understand that in the final rule OPM will implement this change next year 2011.
OPM issued a final rule concerning the Federal Employees Dental and Vision Insurance Program on Tuesday. The new regulations, which is effective on May 20, 2010, permit (1) retroactive FEDVIP enrollment changes when an enrollee has lost his or her spouse through death or divorce or the enrollee’s last eligible child dies, marries, or reaches age 22 and (2) the enrollment of an individual up to 31 days before, as well as up to 60 days after, the enrollee or an eligible family member loses other dental and/ or vision coverage.
The FEHBlog recently discussed a Congressional Research Service report concerning a flawed provision of the health care reform act (PPACA) which called into question the availability of FEHB Program coverage for Members of Congress and their official staffs. The Washington Post reports today that
the Office of Personnel Management has concluded that the section of the law forcing them into the exchanges doesn’t take effect until the exchanges become operational and that no one will lose his or her insurance. “The provision . . . has no current effect upon the eligibility of Members of Congress or their staffs to participate in the Federal Employees Health Benefits Program,” OPM Director John Berry wrote in the letter, dated Friday and sent to House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry M. Reid. (D-Nev.).
On Monday, the Centers for Medicare and Medicaid Services announced a proposed rule on Medicare Part payments to hospitals for the federal fiscal year 2011 that begins on October 1, 2010. “CMS is proposing to update acute care hospital rates by 2.4 percent for inflation, a slight increase over the FY 2010 inflation rate, and apply an adjustment of -2.9 percentage points to recoup one-half of the estimated excess spending in FY 2008 and 2009 aggregate payments, due to changes in hospital coding practices that did not reflect increases in patients severity of illness.” CMS expects to make a further proposal that addresses PPACA required changes to Medicare Part A’s hospital payment rules.
AIS recently released reports on PPACA’s provisions authorizing the Food and Drug Administration to create a regulatory pathway for approval of biosimilar drugs and a new Comparative Effectiveness Research Institute which AIS expects to study biosimilars. Biosimilars bear the same relationship to expensive speciality or biologic drugs as generic drugs bear to brand name prescription drugs. Biosimilars are expected to generate large cost savings over time.
NCAQ President Mary E. O’Kane recently opined on tiered PPO network which “allow consumers to choose physicians in a higher performing tier while encouraging those in lower performing ones to improve their performance.”NCQA points out that
A recent study in the American Journal of Managed Care analyzed consumer awareness, use and trust of a tiered provider network. The study showed that using tiered networks to help consumers choose physicians requires increased consumer education.