TGIF

Mark the tape! Yesterday, the Affordable Care Act regulators issued a final rule on the law’s maximum 90 day waiting period for initial health insurance coverage. Compliance with this rule is not an FEHBP concern because FEHBP coverage begins on the first day of the first pay period after the employee’s SF 2809 enrollment form is received by the employing agency.  What’s remarkable is that this rule eliminates at the end of this year the long standing obligation imposed on health plans to providing terminating members with a HIPAA certificate of creditable coverage that could be used to reduce or eliminate a successor group health plan’s pre-existing condition limitation period. In the new ACA world, there are no pre-existing condition limitations. You have to wonder why the agencies did not terminate this burden as of the end of last year, but no one should look a gift horse in the mouth.  For once, the ACA reduces an administrative burden on health plans.

Yesterday evening, HHS’s Office for Civil Rights issued lengthy informal guidance on the HIPAA Privacy Rule and sharing information related to mental health. The FEHBlog found the information to be accurate and believes that OCR’s heart is in the right place. But the advice includes so many qualifications that he doubts that simply issuing the advice will open the information spigot to family members and friends. It’s always easier for the provider to clam up.

The Advisory Board reports on an AHRQ study that identifies the five costliest surgical procedures in 2011

•Heart valve procedures ($53,400 per hospital stay)
•Coronary artery bypass graft ($38,700);
•Small bowel resection ($34,500);
•Procedures related to cardiac pacemakers or cardioverters ($33,200); and
•Spinal fusion ($27,600).

According to the AHRQ study, “the average hospital stay with an OR procedure costs $3,300 per day and lasts about five days. By comparison, a hospital stay with no OR procedure costs an average of $1,700 per day and lasts about 4.4 days.”  Over 15.6 million surgeries were performed in U.S. hospitals in 2011. Cost curve up.

USA Today reports that the flu is hitting younger adults harder than seniors and children this year due to a lower vaccination rate for that group. “The good news was that this season’s flu vaccine did a good job. Being vaccinated reduced the chance of having to go to the doctor for the flu by about 60%, the CDC reported. That effectiveness rate is comparable with previous years. The CDC recommends that everyone 6 months and older get an annual flu vaccine.”  Of course, there is no enrollee cost sharing for a flu vaccination administered in-network under the ACA.

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