Weekend update

Congress is in session again this week on Capitol Hill. Here’s link to the Week in Congress’s account of last week’s actions there. The Week in Congress included a link that the FEHBlog has been trying to find – a Senate Budget Committee summary of the Better Care Reconciliation Act.

Tomorrow is the closing day of the U.S. Supreme Court’s curent term. Six decisions are anticipated. The Court already gave the FEHBP its victory in the Nevils case earluer this year.

On Friday, plaintiffs’ counsel in the massive multi-district class action arising out of Anthem’s 2015  data breach, which impacted FEHBP members, announced a proposed settlement of the lawsuits.  (Multi-district means that an assortment of related lawsuits filed across the country were consolidated before one court — here the U.S. District Court for the Northern District of California.)

The proposed settlement provides [among other things]for Anthem to establish a $115 million settlement fund, which will be used to 1) provide victims of the data breach at least two years of credit monitoring; 2) cover out-of-pocket expenses incurred by consumers as a result of the data breach; and 3) provide cash compensation for those consumers who are already enrolled in credit monitoring.

U.S. District Judge Lucy Koh will hold a hearing on the fairness of the settlement on August 17. More details are available here.

A similar multi-district case arising out of OPM’s 2015 data breach is pending in the U.S. District Court for the District of Columbia. The court heard several dispositive motions late last year. Here’s a link to the lead plaintiffs’ counsel website for that case.

Also last week, the Centers for Medicare and Medicaid Services issued a proposed 2018 rule for the Medicare Part D MACRA quality payment program for clinicians. The fact sheet is available here. Healthcare Dive explains that

MACRA will eliminate the sustainable growth formula and replace it with a .5% annual rate increase through 2019, after which physicians are encouraged to shift to one of two Quality Payment Programs: 1) Merit-Based Incentive Payment System (MIPS) or 2): Alternative Payment Model (APM). It is believed most physicians will enter into the MIPS program in the first year.

The article further notes that

The proposal allows for the exemption of small providers participating in the program by increasing the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or less Medicare patients annually. The original threshold was $30,000 in Medicare Part B charges or 100 Medicare patients. The agency believes the move will exclude about 134,000 clinicians from MIPS.