Midweek update

OPM should be wrapping up 2018 benefit and rate negotiations with carriers by now. The Washington Post reminds us that the 2018 Federal Benefits Open Season is set to occur from November 13 to December 11, 2017. The Post notes that “Premiums typically are announced earlier, in September. Increases have averaged about 7 percent the past several years — but remember, those are averages, and a given plan’s numbers can be much higher or lower.” The government contribution toward FEHBP coverage is 72% of the enrollment weighted average premium capped at 75% of the selected plan’s premium.  As a general rule of thumb, if your selected plan is under that cap, then the lion’s share of that year’s rate changes usually are shielded from the enrollee.  If your plan is over that cap, premium increases and decreases are quite visible. As the FEHBlog has noted, the wild card affecting this year’s premiums is whether Congress will continue to suspend or repeal the onerous and really senseless health insurer tax.

In a bit of good news, Senator Charles Grassley (R Iowa) announced that

The Over-the-Counter Hearing Aid Act became law as part of the Food and Drug Administration (FDA) Reauthorization Act.  The bicameral measure requires the FDA to write regulations ensuring that the new category of over-the-counter hearing aids meets the same high standards for safety, consumer labeling and manufacturing protections as all medical devices, providing consumers the option of an FDA-regulated device at lower cost.

This new category once implemented will bring down the cost of hearing aids for consumers.

In other good news, Healthcare Dive reports that the large Blues-licensed health insurer Anthem announced that

It reached its goal of reducing filled opioid prescriptions by 30% earlier than it initially planned. 

The company had originally set the goal among its affiliated health plans with a target of achieving it by 2019. The idea was to limit the quantity of opioid prescriptions in order to prevent accidental addiction and opioid use disorder. 

Anthem had already taken steps such as limiting coverage for newly prescribed short-acting opioids to seven days. That policy, rolled out in October 2016, applied to all individual, employer-sponsored and Medicaid plan members—with the exception of those receiving palliative care or who have sickle cell anemia or cancer. 

It also implemented a prior authorization policy for long-acting opioids starting in September 2016, and has set up a system that alerts providers about members who may be at risk for an opioid use disorder.

In other news,

  • Healthcare Dive also tells us that healthcare provider groups generally were pleased by CMS’s proposed Medicare Part B / MACRA payments to doctor rule. Hopefully, CMS’s efforts to relieve regulatory pressure on providers will encourage doctors to stay in or even rejoin Medicare Part B.
  • Also on the Medicare front, the Chicago Sun Times reports that nearly 575,000 Medicare beneficiaries used the new end of life counselling benefit in 2016.

Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled.

Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year.

That’s good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives. Patients and, often, their families discuss with a doctor or other provider what kind of care they want if they’re unable to make decisions themselves.

  • One of the few provisions in the ACA that expressly references the FEHBP permits employers to raise premiums by up to 30% for non-compliance with wellness programs and up to 50% for non-compliance with smoking cessation programs.  The Equal Employment Opportunity Committee (EEOC) issued rules implementing this provision.  Fierce Healthcare reports that a federal district judge in DC ruled earlier this week that 

The EEOC has “failed to provide a reasoned explanation” for its decision to adopt the 30% incentive levels in the two rules. “Neither the final rules nor the administrative record contain any concrete data, studies or analysis that would support any particular incentive level as the threshold past which an incentive becomes involuntary in violation of the ADA and GINA,” he added.  

But because vacating the rules would “have significant disruptive consequences” for employers that have already adopted wellness programs that offer participation incentives, Bates ordered the rules remanded to the EEOC for reconsideration.

OPM believes that the government contribution calculation rule in the FEHBA (5 USC Sec. 8909) effectively preempts the agency from allowing carriers to use these brickbat incentives.