Weekend update

Congress returns to work this week following the Fourth of July recess during which Donald Berwick MD was appointed administrator of the Centers for Medicare and Medicaid Services.

The FEHBlog is anxiously awaiting the next Affordable Care Act implementing regulation, the preventive care mandate (new Public Health Service Act (“PHSA” Section 2713), which was submitted to the Office of Management and Budget for final review on June 29. The FEHBlog hears that the regulation implementing the disputed claim review procedures mandate is in the on deck circle (new PHSA Section 2719). Neither of these mandates is applicable to grandfathered group health plans.

The Politico Pulse presented an interesting Affordable Care Act tidbits last Friday:

NEXT REG BATTLE – [The National Association of Insurance Commissioners] NAIC is wading into another hazardous regulatory task: writing the form that health insurers will provide in March, 2012 to subscribers and applicants to outline benefits and costs [pursuant to new PHSA Section 2715]. Regulators must boil down complex benefit information into brief, intelligible summaries [maximum of 4 pages 12 point font]. Regulators, administration officials and insurers began the task Thursday in the first of what will be biweekly, 90-minute conference calls. NAIC has four prototype documents, obtained by PULSE, being used as a baseline. Three are from a FTC study and one drawn up by the Oregon Insurance Division (Miller’s home state): http://politi.co/dzIJ6T , http://politi.co/cViAHG , http://politi.co/dffqcx , http://politi.co/9XmNsJ

MLR REDUX? PPACA gives NAIC until March 2011 to write the consumer-focused forms but HHS has asked the group to deliver early, sometime in the fall. NAIC plans to comply, but recall the last time something similar happened… [Plans must begin to use one year later — grandfathered plans also are subject to this mandate.]

ABOUT THOSE MLR [medical loss ratio] DEFINITIONS – The head of the NAIC subcommittee working on the definitions says that, while the group makes progress, the end is not in sight. “We still have the December 31 deadline, which we anticipate meeting,” Steve Ostlund, chair of the NAIC’s Accident & Health Working Group said on a call Thursday. He expects to meet the deadline well ahead of time, but won’t put a new estimate on the group wrapping up its work. “It’s not going to go on forever.” [The group is implementing the minimum medical loss ratio requirements stated in new PHSA Section 2718, which applies to insured plans whether or not grandfathered.]

I enjoy reading the Pulse every weekday morning.

HHS has upgraded the www.healthcare.gov website and it has created a health information privacy website which according to an HHS press release will “help visitors easily access information about existing HHS privacy efforts and the policies supporting them. The site emphasizes HHS’ deep commitment to privacy in the collection, use, and exchange of personally identifiable information. This new resource provides Americans with confidence that their personal information is secure and underscores HHS’ goal of greater openness and transparency in government.” 

Although it’s not an FEHB decision, the FEHBlog did note with interest a Business Insurance article reporting that “A 2004 District of Columbia law that would have made pharmacy benefit managers “fiduciaries” was ruled invalid Friday by a three-judge panel of a federal appeals court.” The court concluded that the FEHBA’s private sector analog ERISA preempted the DC law. Here’s a link to the opinion.