Mid-week update

Today, OPM’s final rule implementing the self plus one enrollment type was posted on the Federal Register’s public inspection list.  The self plus one enrollment type takes effect for 2016.  FEHBP enrollees who want to enroll for self plus one will have to make an affirmative change using the SF 2809, Employee Express, etc., during the upcoming Open Season.  The change will not happen automatically if you currently have only two people covered under a Self and Family enrollment type. The rule also explains how folks can switch from self and family to self plus one outside of Open Season. You can find those answers in a pithier format at OPM’s self plus one website too.

OPM should be announcing the 2016 premiums in the next week or so.  Then federal and postal employees and annuitants will have the final piece of the self plus one puzzle.

The Altarum Institute reported last Friday that

Health care prices in July 2015 were 1.1% higher than in July 2014, for the 4th consecutive month, and only a 10th above the decade-plus low of 1.0% growth registered in August 2013. Year-over-year hospital prices rose 0.9% in July, the highest since September 2014. Physician and clinical services prices fell 1.1%, only a 10th above the multi-decade low recorded in June. Prescription drug prices rose 4.4%, down from 4.8% in June and 6.4% in December 2014.

Business Insurance reports that the ACA regulators are sticking to their position, discussed from time to time in the FEHBlog that group health plans must embed a self only in-network out-of-pocket maximum in the self and family in-network out-of-pocket maximum.  OPM has insisted that all FEHB plans include this feature for 2016.  These administrative mandates simply push premiums closer to the 40% excise tax thresholds.

Fierce Healthcare reports on a JAMA published study finding that half of readmission disparities are outside the hospitals’ control.

Under the standard Medicare formula [created by the Affordable Care Act], which only controls for patient age, sex and certain conditions, the top hospitals have 4.4 percent fewer readmissions than the worst performers. However, when researchers from Harvard Medical School applied a set of 29 more specific variables such as cognition, functional status, income, education and self-reported health, the difference fell to 2.3 percent.

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