Tuesday Tidbits

David Ermer–Uncategorized–

OPM has posted a new page on its website announcing that

Beginning this Open Season [which starts in November 2011], paper copies of health plan brochures will not be automatically mailed to Federal Employees Health Benefits (FEHB) Program members.

You can quickly and easily view your health plan’s brochure online, anytime by visiting the FEHB website, or visit your health plan’s website. During the next several months, your FEHB health plan will contact you to offer you the option of obtaining your benefit brochure online or requesting a paper copy of the benefit brochure. If you want your health plan to mail a paper copy of your brochure to you for the next Open Season (November 14 through December 12, 2011), follow the instructions your health plan provides you. (For those of you who change plans this Open Season, your new health plan will mail you a paper copy of its brochure.)

You will continue to receive the Open Season package your plan normally mails to you, and this package will include an explanation of benefit changes for the next year and your new premium rate, but will exclude the health plan brochure.

The brochure is the FEHB plan’s contract statement of benefits so it’s a good idea for Plan members to download a copy for reference.

The National Institute of Medicine released today a report recommending that the Department of Health and Human Services treat the following services provided to women as preventive care that non-grandfathered health plans must cover in-network at no cost to the plan member under the Affordable Care Act:

  • screening for gestational diabetes
  • human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
  • counseling on sexually transmitted infections
  • counseling and screening for HIV
  • contraceptive methods and counseling to prevent unintended pregnancies
  • lactation counseling and equipment to promote breast-feeding
  • screening and counseling to detect and prevent interpersonal and domestic violence
  • yearly well-woman preventive care visits to obtain recommended preventive services
HHS, which requested this report, can implement these new requirements pursuant to its regulatory authority to update the list of preventive services. The FEHB Program generally covers these services, including contraception (but not lactation equipment as far as the FEHBlog knows); however, enrollee cost sharing requirements vary. 

HHS issued new Affordable Care Act rules governing the CO-OP plans which are to be offered in the state health insurance exchanges under the Affordable Care Act. This is one of the few Affordable Care Act provisions that offers funding to a health plan instead of a health care provider. The FEHBlog finds this to be another odd Affordable Care Act provision as there already are both for profit and not-for-profit health plans in the marketplace.

The AMA News offers an interesting story about the impact of the CMS proposed rule changing Medicare Part B payment practices for 2012. In addition to the 29.5% reduction in physician reimbursement mandated by law (which Congress has been urged to change), CMS will be slashing radiologist compensation for reviewing multiple MRI or CT scans taken on one patient on the same day (a patient safety measure??) and penalizing doctors for failure to use electronic prescription technology.