Weekend update

Welcome to FEHBlog post number 1,000 counting from the time when I started this blog in April 2006.

The Senate returns to work on HR 4213 tomorrow. Yesterday President Obama and the minority leadership in Congress sparred over the Medicare “doc fix” according to Politico. From a practical standpoint, the ten business day hold that the Centers for Medicare and Medicaid Services placed on the processing of Medicare Part B claims incurred this month ends tomorrow. That means that unless CMS extends the hold (because work on HR 4213 will not be completed tomorrow), Medicare claims administrators on Tuesday June 15 will start processing Part B claims with the statutorily scheduled 21.3% cut in physician reimbursements. Medscape Medical News describes the impact on doctors. This dispute affects the FEHB Program because of the large number of annuitants over 65 who are FEHB Plan members. If the annuitant is enrolled in Medicare Part B, FEHB plan reimburements as secondary carrier will increase. If the annuitant is not enrolled in Medicare, FEHB plan reimbursemetns as primary carrier will increase because non-HMO FEHB plans are entitled by law to Medicare reimbursement rates on annuitants over 65 without Medicare Part B (5 U.S.C. Section 8904(b).

On Friday June 11, the Office of Management and Budget approved HHS’s interim final grandfathered plan regulation for publication in the Federal Register.  The Associated Press, among others, reports, that “an early version” of the regulation has been floating around lobbying firms unofficially. According to the AP,

The main issue in the 83-page regulation is how to deal with what the government calls “grandfathered” health plans.

Those are plans that predated the health care law and are exempt from many, but not all, of its consumer protections. Lawmakers created the special category to deliver on Obama’s promise that people can keep the coverage they have if they like it.

But health plans change frequently. Premiums and copayments keep rising. Coverage is expanded for some services and restricted for others. Lawmakers asked regulators to spell out how much an employer can change a plan and still claim it to be grandfathered, exempting it from closer federal regulation.
[James] Gelfand, the Chamber of Commerce expert, said the draft rules are too inflexible. Generally plans can lose their protected status by increasing copayments and deductibles above certain limits, and Gelfand said they’re too narrow.

But Maria Ghazal, health policy director for the Business Roundtable, said she saw signs that the administration is trying to be responsive to employers. For example, plans that only cover retirees would be exempt from the new regulatory requirements — an important clarification. “We think there is some recognition of the challenges ahead for employers,” she said.

We shall see.

Finally, the New York Times started a series of the ten anniversary of the successful mapping of the human genome.