Congress remains in session on Capitol Hill this week. We are less than three weeks away from the November 21 continuing resolution deadline. The Senate has passed passed a consolidated domestic appropriations bill (HR 3055) last week  It needs to pass two other consolidated bills, including defense and then the two Houses can hold a conference committee. That’s unlikely to happen within two weeks and it’s therefore likely that Congress will punt the issue down the road into early 2020 as noted in this space recently. Why o why hasn’t the Senate approved the House passed bill repealing the ACA’s high cost health plan excise tax a/k/a the Cadillac tax?

The federal benefits open season begins on November 11, one week from tomorrow. The FEHBllog was pleased to see that OPM already already has launched the 2020 version of its online plan comparison tool. The FEHBlog is puzzled why CMS has not released the 2020 Medicare Parts A and B premium and  cost sharing information yet.

Health Payer Intelligence offers an article explaining why health savings accounts are useful for all employees, including the younger generations. .

The Centers for Medicare and Medicaid Services has had a very busy week:

• Monday, the agency finalized the repeal of the national health plan identifier and other entity designation rule under HIPAA.  The notice explains that 

This final rule eliminates the regulatory requirement for health plans to obtain and use an HPID and eliminates the voluntary acquisition and use of the OEID. The final rule also simplifies the process for deactivating the existing identifiers to minimize operational costs for covered entities. On or after the effective date of this final rule, any active HPID or OEID will be automatically deactivated in the Health Plan and Other Entity Enumeration System (HPOES). If your organization has an HPID or OEID, please take action now to save any necessary information from those records. This rule will become effective 60 days after its publication date.

• Yesterday and today, the agency released final rules for Medicare’s calendar year 2020 payment systems for hospital outpatient payment care, physician care, and durable medical equipment / end stage renal disease care.  Healthcare Dive adds that 

[In these rulemakings] President Donald Trump’s administration is pushing back a proposal that would have required hospitals to make public the secret rates it negotiates with insurers. 

CMS said it received more than 1,400 comments on revealing rates and will respond to those comments in an upcoming rule. 

The proposal first put forward in July went one step beyond a CMS move from last year, which required hospitals to post the list price, or the initial price before insurance negotiations, online in a machine-readable format. Many criticized the move and said the data was useless for consumers with insurance coverage.

In other news Healthcare Dive

•  offers its take the the HLTH conference;

Therapy for Peanut Allergies  –It’s a terrifying reality for 2.5 percent of parents – the possibility that at any moment, their child might be unable to breathe due to an allergic reaction. Though emergency epinephrine has reduced the severity and risk of accidental exposure, these innovations are not enough to quell the ever-present anxiety. But development of a new oral immunotherapy medication to gradually build tolerance to peanut exposure holds the opportunity to lend protection against attack.

Bravo for the innovators.

Fierce Healthcare brings us up to date on the HLTH Conference held in Las Vegas earlier this week.

Axios reports that New York State’s surprise billing law which relies on payer-provider arbitration raising health care costs. Told you so.

Yesterday, the Department of Health and Human Services launched “FindTreatment.gov, a newly designed website that will help connect Americans looking for substance abuse treatment with approximately 13,000 locations across the United States.”

“Visitors can access information on location, treatment options, payment and insurance information, and over 13,000 state-licensed facilities, based on data compiled by SAMHSA

Examples of treatment include:

    Residential treatment – Live-in care, lasting for a month up to one year
    Outpatient treatment – Treatment at a program site while the patient continues to live on their own
    Detoxification – Supervised withdrawal from substance use
    Interim care – When immediate admission to other care isn’t available”

Earlier this week, the U.S. Food and Drug Administration released a report on prescription drug shortages.

The report identifies three root causes for drug shortages:

1. Lack of incentives for manufacturers to produce less profitable drugs;
2. The market does not recognize and reward manufacturers for “mature quality systems” that focus on continuous improvement and early detection of supply chain issues; and
3. Logistical and regulatory challenges make it difficult for the market to recover from a disruption.

The report also recommends enduring solutions to address drug shortages. These solutions include

1. Creating a shared understanding of the impact of drug shortages on patients and the contracting practices that may contribute to shortages;
2. Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities; and
3. Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs.  

Telehealth providers are looking to move beyond urgent care services   For example,

• American Well announced a new venture with the Cleveland Clinic called the Clinic. “The Clinic will offer convenient online access to expert care across a wide array of specialties without requiring individuals to leave their homes. Through a secure digital platform powered by American Well, people from around the world will be able to connect with Cleveland Clinic’s leading specialists and receive insights, opinions, recommendations, and assistance for a variety of conditions.”  The American Hospital Association delves into the deal here.

Walgreens’s roughly 400 walk-in clinics and CVS’s 1,000 Minute Clinic locations have at best barely broken even for the companies. The goal now for both is to shift away from treating minor or acute issues and focus instead on people with chronic conditions such as diabetes, heart disease and hypertension.

The news is that Walgreens “said Monday it will close the roughly 160 in-store health clinics the company runs itself in the U.S., while keeping 220 clinics that are run by local health systems. It didn’t provide an estimate for the financial impact.”

Last but not least, Health Payer Intelligence reports that

To counteract the high-cost, high-risk potential of using opioids to treat back pain, UnitedHealthCare (“UHC”) created a benefit that does not rely on medication or technology but rather on physical therapy and chiropractic care.

The benefit allows eligible employers to offer physical therapist and chiropractor visits with no out-of-pocket costs. Members who already receive physical therapist and chiropractic care benefits under UHC’s employer-sponsored health plans and who have maxed out their visits will not receive additional visits under this benefit.

However, for those who still have visits to use and who choose physical therapy or chiropractic care over other forms of treatment, the copay or deductible for those visits will be waived and they will receive three visits at no cost.  UHC has high expectations for the fiscal and physical impacts of this benefit.

Congress remains in session on Capitol Hill this week.

Healthcare Dive informs us that

Amazon has bought tech startup Health Navigator in its first major health-related acquisition since the Seattle-based retailer purchased PillPack last year, the company confirmed to Healthcare Dive.  Health Navigator, which provides online symptom checking, clinical documentation support and triage tools to route patients to the correct site of care, will be folded into Amazon’s virtual medical clinic Amazon Care.

Amazon Care currently (at least for now) is an employee benefits program for Seattle area based Amazon employees. Amazon’s HQ is in located that fair city.

Speaking of virtual care, Health Data Management reports on CVS’s Health’s Minute Clinic’s Video Visit option.  A Video Visit “costs $59 and is for patients ages two years and up who are seeking treatment for a minor illness, injury or skin conditions.” It’s available in most States and accepts FSA and HSA payments (and credit cards generally), not not insurance coverage “at this time.” Here is a link to the Video Visit FAQs.

Kaiser Health News discusses a new pharma payment model nicknamed Netflix pricing. The model “mimic[s] that media-streaming service ― call for capped costs or flat-rate subscriptions for cheap access to the drugs [particularly drugs that cure major illnesses such as Hepatitis C].”  Washington State is using such a contract to purchase from “AbbVie buys a package of services that includes outreach and testing to identify patients as well as the drugs to treat them.”  Patient advocates are objecting to the fact that the State is refusing to release details on the pricing model.

The FEHBlog head about this model at the HCP=LAN conference last week. Drug pricing is complicated by the fact that the price that Medicaid pays for a prescription drug sets the floor for other deals with the exception of Medicare Part D plans.

Yesterday, the FEHBlog attended the Health Care Payment Learning and Action Network’s (HCP LAN) summit in Washington, DC. The HCP LAN issued its annual its annual alternative payment method measurement report, which found progress in replacing fee for service payments with value based payments. Here are links to Healthcare Dive and Health Payer Intelligence articles on the summit and this report.

Defense News reports on the Senate’s efforts this week to pass necessary fiscal year 2020 appropriations bills. The upshot is the Congress is “mulling” an extension of the current continuing resolution from November 21 until February or March 2020. Federal News Network reports that the Senate appropriators do not plan to provide any fund for an OPM-GSA merger without authorizing legislation being in place. The House of Representatives is refusing to pass such authorizing legislation.

The Office of Personnel Management has announced “a new Federal Long Term Care Insurance Program (FLTCIP) plan offering: FLTCIP 3.0. The new plan and rate structure is available to applicants who apply for coverage on or after October 21, 2019. It does not impact current FLTCIP enrollee plans or premiums.  Tammy Flanagan explains the new offering here.

Govexec.com brings us up to date on the lawsuit against OPM and its contractor over the massive 2015 data breach.

The Justice Department sought to have the entire U.S. Court of Appeals for the D.C. Circuit rehear the case after a panel of the court in June largely sided with two federal employee unions in granting them standing to sue the Office of Personnel Management and a federal contractor for their roles in the hacks that led to mass disclosures of personal records. The court denied the en banc hearing request on Monday, however, meaning the lawsuit can likely now proceed at the district court level.

The Department of Health and Human Services’s Office for Civil Rights (“OCR”) announced another HIPAA security and breach notification rule breach settlement today.

OCR’s investigation revealed a HIPAA compliance program that had been in disarray for a number of years,” said OCR Director Roger Severino. “This hospital system’s [Jackson Health System of Miami. FL] compliance program failed to detect and stop an employee who stole and sold thousands of patient records; lost patient files without notifying OCR as required by law; and failed to properly secure PHI that was leaked to the media.” 

Not good.

Healthcare Dive offers an interesting interview with CVS Health’s CEO Larry Merlo.

CVS Health CEO Larry Merlo, who’s been with the company for almost three decades, chatted with Healthcare Dive about its main competitors, the prolonged Aetna acquisition, taking on Amazon and opportunities in the chronic care market.

Check it out.

The FEHBlog will be attending the Health Care Payment Learning and Action Network annual summit here in our Nation’s Capitol tomorrow. The plenary events at the free event will be streamed live.

Today, OPM released its much anticipated (at least from the FEHBlog’s perspective) benefit administration letter on significant plan changes to the FEHBP and FEDVIP for 2020. The agency also released its FEHB Fast Facts for use with upcoming Open Season. Enjoy.

Congress remains in session on Capitol Hill this week. The Hill reports that Senate leadership will be bringing up Fiscal Year 2020 appropriations bills up for a vote. “The first, as an olive branch to Democrats, will include domestic priorities. The second package will include a mammoth defense bill, which is considered a top priority for Republicans.” The current continuing resolution funding the federal government in the 2020 FY that began on October 1 expires a month from tomorrow November 21 (absent a further extension).

NPR Shots offers an interesting article on the use of genetic tests to identify the preferable drug to be dispensed to the tested individual.

Companies that make [these] genetic tests * * *say they can save patients and doctors from prolonged searching for the right medication and save insurance companies from paying for ineffective drugs. But many researchers say the tests don’t have enough evidence backing them up. The Food and Drug Administration has warned that the tests could potentially steer patients towards the wrong medications. Nonetheless, UnitedHealthcare, the nation’s largest insurer, began covering them October 1 for its 27 million individual and group plans.

The Wall Street Journal reports that

Vaping-related illnesses and deaths have spurred more young people to seek help to quit, physicians and psychologists treating teenage users of e-cigarettes say, but few treatment options exist and there is rising concern that the public-health response for cessation programs is inadequate. * * *

Dr. Melodi Pirzada, chief of pediatric pulmonology at NYU Winthrop Hospital on Long Island * * * said the hospital has long offered smoking-cessation sessions for adults. But given the vaping epidemic among teens, “we’re considering implementing similar teen-only programs to help teens stop vaping,” she said. The hospital is also looking to do increased screening of teens.

Another tool, she said, is a law change that would permit physicians to prescribe nicotine patches or gum to teens. It is now illegal in New York for anyone under 18 years of age to buy such over-the-counter products.

Rep. Elijah Cummings, the City of Baltimore’s Congressman and Chair of the House Oversight and Reform Committee passed away this week. That Committee has oversight over OPM and the FEHBP. The FEHBlog admired Congressman Cummings for his strong endorsement of public health centers to care for lower income people. Here’s a link to a Federal News Network article and a link to OPM Director Cabaniss’s statement on Rep. Cummings’ passing.  This article adds that Rep. Carolyn Maloney, a veteran Democrat from New York, will for now take over leadership of the House oversight committee, according to a senior Democratic leadership aide who spoke on condition of anonymity to discuss the decision publicly. Here’s a link to Congresswoman Maloney’s bio.

Speaking of Congress, Fierce Healthcare reports on the status of Speaker Pelosi’s bill to lower prescription drug costs. The House plans to vote on the bill which will be renamed in honor of Congressman Cummings, soon. Likelihood of its Senate passage is uncertain at best.

On the public health front:

• Here’s a CNBC article on the latest Centers for Disease Control report on the vaping crisis.

The number of fatalities continues to rise as a deadly vaping illness sweeps across the country, taking 33 lives and making 1,479 people sick so far, the Centers for Disease Control and Prevention said Thursday. 

The new cases — up from 26 deaths and 1,299 illnesses a week ago — show that U.S. officials are no where closer to getting the outbreak under control since it emerged as a public health threat in July. 

“This is extremely complicated and difficult. It’s fatal or potentially fatal with half of the cases requiring intensive care,” CDC Principal Deputy

•  The Wall Street Journal reports also regrettably 

The suicide rate among people ages 10 to 24 years old climbed 56% between 2007 and 2017, according to the report from the Centers for Disease Control and Prevention. The rate of homicide deaths decreased by 23% from 2007 to 2014 but then increased by 18% through 2017.

Violent death, including homicide and suicide, is a major cause of premature death for the age group. Around 2010, the death rate of suicides among adolescents and young adults surpassed the rate of homicide deaths, according to the report.

“The chances of a person in this age range dying by suicide is greater than homicide, when it used to be the reverse,” said Sally Curtin, a statistician at the CDC and an author of the report. “When a leading cause of death among our youth is increasing, it behooves all of us to pay attention and figure out what’s going on.”

 On the survey front

• The TransAmerica Center for Health Studies presents its annual consumer survey on health insurance.