The current continuing resolution funding the federal government’s operations expires a week from today. The AP (via Federal New Radio) reports that Congress is on track to timely pass the necessary appropriations bills under the framework created by last month’s budget deal. Another deadlock could occur over the debt ceiling. The continuing resolution suspended the debt ceiling until February 7, 2014, and the Treasury Secretary has predicted that extraordinary measures will only be effective for another month due to the need to pay tax refunds. Fierce Government predicts, and the FEHBlog agrees, that Congress will settle this issue too without another partial federal government shutdown.

The FEHBlog has clients (outside the FEHBP) that offer employee assistance programs. The federal government also offers EAPs to their employees. OPM explains that

An EAP is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems. EAPs address a broad and complex body of issues affecting mental and emotional well-being, such as alcohol and other substance abuse, stress, grief, family problems, and psychological disorders. EAP counselors also work in a consultative role with managers and supervisors to address employee and organizational challenges and needs. Many EAPs are active in helping organizations prevent and cope with workplace violence, trauma, and other emergency response situations.

In the FEHBlog’s experience, employees don’t tend to use EAPs. Business Insurance has an interesting article on why EAPs are underutilized, e.g.  privacy concerns, failure to communicate the broad range of EAP services, etc. “If you build it they will come” proved to be true in the Field of Dreams movie, but it doesn’t always work out in real life.  

The House and Senate return for the second session of the current Congress this week according to the Hill’ Floor Action blog. The January 15 deadline for finalizing appropriations bills is about ten days away. Congress is expected to hit this deadline thereby avoiding another partial government shutdown.

Speaking of Congress, the Hill also reports that Sen. Ron Johnson (R WI) plans to announce today a lawsuit challenging the legality of OPM’s decision to fund exchange plans for members of Congress and their official staffs through the FEHBP.

Federal News Radio reports on two recently proposed OPM regulations that would align the Federal Employees Dental and Vision Program enrollment change rules with the FEHBP’s and restore a Federal Employees Group Life Insurance Program enrollment opportunity that was deleted in 2010 — the ability to elect FEGLI Options B and C upon reaching age 65.

Finally, Kaiser Health News reports on CMS’s release of all cause readmission rates for U.S. hospitals. Since 2008, CMS has been releasing readmission rate data on a three common diagnoses or causes — heart failure, heart attack, and pneumonia.  The article explains that

The all-cause readmission rates are particularly significant because the
Medicare Payment Advisory Commission (MedPAC), which advises Congress, has encouraged lawmakers
to use this measure when determining financial penalties for hospitals
in the Hospital Readmission Reduction Program. Medicare is currently fining 2,225 hospitals for excess readmissions for heart failure, heart attack and pneumonia patients. 

OPM also has expressed concern about the need to reduce hospital readmissions in the FEHBP.   The hsopital industry argues that the readmission rates are not adequately nuanced, and a quick review of the hospitals with relatively high readmission rates indicates that many well known, big city hospitals serving low income populations are listed there.

HIPAA was enacted in 1996 to stimulate the use of electronic health plan claims transactions. That’s a worthy objective but unfortunately Congress chose to the path of bogging down technology by embedding technical standards in law. Technology moves faster than the law. Plus the banking industry did not need the government to mandate electronic banking standards. The banking industry developed those standards because there is a financial incentive in lowering administrative costs.

Almost twenty years after HIPAA was enacted, HHS which administers the law still has not fully implemented all of the standards, and Congress put the kibosh on implementing a key requirement — the patient identifier.

Nevertheless, in the Affordable Care Act, Congress and the President doubled down on HIPAA by hijacking an industry initiative to create common operating rules for the HIPAA transactions. The ACA required HHS to promulgate those operating rules as federal regulations. Mission accomplished there.

The ACA also required HHS for 2013 to issue regulations requiring health plans to certify their compliance with the HIPAA standards subject to a significant civil monetary penalty for non-compliance.  HHS issued a proposed rule implementing this requirement yesterday.  Fierce Health Payer reports on the proposed rule here. Interestingly, the proposed rule requires health plans to obtain compliance certification from the industry resource CAQH CORE that was developing the standards that Congress hijacked (that’s not the only alternative). Also the anticipated deadline for the initial certification submission will be the end of 2015. Fierce Health Payer notes that

That will give health plans enough time for planning, evaluating, designing, and internal and external testing. The new date also better aligns with the requirement for CHPs to obtain a unique health plan identifier on or before Nov. 5, 2015, according to HHS.

Of course, the big HIPAA compliance date for this year is October 1, 2014, when the massive ICD-10 code set becomes the standard for all healthcare transactions.

HHS’s Office for Civil Rights is responsible for enforcing the HIPAA Security and Privacy Rules. The FEHBlog has no problem with the government regulating these areas. Fierce Healthcare reports that OCR’s Director Leon Rodriguez (who spoke at the 2013 OPM AHIP FEHBP carrier conference) may be leaving his post to become director of U.S. Citizenship and Immigration Services. The article discusses a contretemps between OCR and the HHS Inspector General over whether OCR is doing an effective enforcement job. In support of OCR, the FEHBlog notes that OCR recently negotiated a $150,000 penalty with a small dermatology practice that was not minding its HIPAA Ps & Qs. These HIPAA penalties for non-compliance with Privacy and Security Rules are no joke. Cybersecurity insurance is a good buy for health plans.

We have reached the end of another year. The FEHB Program has sailed along smoothly with a reasonable premium increase for 2014 and an uneventful open season.

Beginning tomorrow, the children of same sex domestic partners (living in states that don’t recognize same sex marriage) will be eligible for FEHBP coverage as stepchildren under a recent OPM rule.

The biggest FEHBP kerfuffle of the year involved the rocky transfer of member of Congress and their official staffs from the FEHBP to the DC SHOP exchange. (Indeed the kerfuffle gave rise to the FEHBlog being quoted in the New York Times. Unfortunately the FEHBlog’s prediction proved to be wrong.)  The FEHBlog was pleased that in its final rule OPM decided that members of Congress and their official staffs could return to the FEHBP upon retirement (if they are eligible for federal retirement).  This means that Capitol Hill will continue to have a vested interest in the FEHBP.

Going forward, the ACA’s employer shared responsibility mandate will apply to the federal government in 2015. In 2012, OPM promulgated regulations to the extend the FEHBP to seasonal firefighters and national disaster workers. For 2015, OPM will have to issue rules extending FEHBP coverage to all employees who meets the ACA’s 30 hour per week definition of a full time employee. Also for 2015, in accordance with an ACA amendment to the Fair Labor Standards Act, the federal government and all large employers (200 or more employees) will have to enroll new employees into their health benefits program. The ACA is the gift that keeps on giving to lawyers, etc.

Finally, we creep one year closer to the ACA’s Cadillac plan tax which takes effect in 2018. The Cadillac plan tax imposes 40% excise tax on employer sponsored plans (FEHBP and FEDFlex in the federal government) to the extent that the combined premiums exceed a statutory threshold — $10,200 for self only coverage and $27,500 for self and family coverage subject to certain adjustments. This Idaho Business Review article discusses how employers are preparing for this new assessment. The defect in this assessment is that high premiums typically are based on high costs and poor demographics not necessarily generous benefits.

Happy New Year!

Congress remains in recess this week. FEHBP Open Season changes for annuitants take effect on January 1, while those changes for active employees take effect at the beginning of the first pay period in 2014 which according to this GSA calendar is January 13.  According to OPM regulations, if a person who has made an Open Season change is hospitalized on the day that coverage change would take effect, the losing plan (if it is continuing to participate in the FEHBP) will retain responsibility for covering the hospitalization until discharge (or 90 days which is unheard of in this day and age). 

The FEHBlog hopes that all of readers are enjoying Christmas week. The President signed the budget deal into law yesterday which means that FEHB plans will offer self only, self plus one and self and family coverage options for 2015.

The FEHBlog has read Federal News Radio and Washington Times articles about this development which seem to miss the point. For years creating a self plus option in the FEHBP was meaningless because the average family size was close to two people. In other words there would have been very little difference between the self plus one and the self and family premiums. Then along comes the Affordable Care Act which blew up the average family size by upping the child coverage age limit from 22 to 26 and removing all financial dependency requirements for child coverage under that new age limit. More adult children, more stepchildren, larger family size. So now that there is a meaningful gap between a self plus one and a self and family rate, Congress came along and implemented it.

Annuitants will be the major beneficiaries of the self plus one option. (Couples without children also could benefit but in those families both spouses often have their own employer sponsored coverage.)  Annuitant coverage is on budget which explains why Congress made this move as part of the budget deal. Federal employees who need family coverage will pay more but that’s the way our economy tends to work.

I did pick up from reading the Washington Times article that the Congressional Research Service had released a report on health benefits options available under the FEHBP. Here’s a link to that November 2013 report. The report reminds me that we recently observed the 10th anniversary of the Medicare Modernization Act of 2003 which created the high deductible plan with health savings account option that is available in the FEHBP.

The FEHBlog also ran across this Unitedhealth Foundation funded annual report on America’s Health Rankings. The report provides a state by state snapshot of U.S. healthcare. The report, for example, ranks each state based on obesity, diabetes, smoking and physical inactivity. The report includes a special section on seniors Very cool.

Finally, the Federal Times confirms that “Most federal employees are now officially assured of their first
across-the-board pay raise in four years following an executive order by
President Obama to implement the 1 percent increase next month.” Here’s a link to the Executive Order.

The FEHBlog missed the weekend update because yesterday was the FEHBlog’s birthday. Yesterday, he received the following birthday message from ESPN — may your favorite team not suffer a humiliating defeat today. And the Redskins just lost — it wasn’t a humiliating defeat like the loss to the Kansas City Chiefs a couple of week ago. In any event, the FEHBlog had a nice weekend.

Congress is in recess for the rest of the year after the Senate passed and sent to the President a national defense authorization act for the current fiscal year. The Federal Times reports that the new law includes “prohibitions against any fee increases for Tricare or new user fees for the military health program by more than 1.7 percent next October.”

The Centers for Disease Control and Prevention (“CDC”) listed their top five 2013 accomplishments and their top fve 2014 concerns. The CDCs credits its Tips from Former Smokers Campaign for exceeding the agency’s goals for reducing tobacco use. The CDC also touted its Million Hearts campaign. OPM encourages FEHBP carriers to support these initiatives.

Finally, Kaiser Health News reports that the Centers for Medicare and Medicaid Services (“CMS”) has started publishing how well patients fared after hip and knee replacement surgeries. CMS identified 95 stars and 97 laggards.

Well, we really are hurtling toward the holidays now. Congress has completed its work for this year, according to the Hill’s Floor Action blog. The Hill also reports that yesterday the Treasury Secretary sent a letter to Congress warning that extraordinary measures to extend the debt ceiling will be exhausted only a month or so after the current suspension of the debt ceiling ends on February 7, 2014.

Speaking of finances, OPM has posted its audited financial statements for the fiscal year ended September 30, 2013.  This report also includes OPM’s discussion of its strategic goals. its annual improper payments report, and the Inspector General’s recommendations to management. In a spot of good news, the Inspector General notes in his portion of the report (p. 106) that  “The rate of improper payments in the FEHBP [which the FEHBlog notes already was low] trended down in FY 2013.”

Federal News Radio reports that the new OPM Director Katherine Archuleta has been making appointments at her agency.  Of interest from an FEHBP perspective,

Chuck Grimes, the former COO, will shift to the Healthcare and Insurance
operation, where he’ll serve as deputy director, a role that was previously
vacant. In addition, OPM has hired Donna Seymour, former deputy chief human capital officer for the Defense Department, to serve as the agency’s chief information officer.  Kamala Vasagam, who previously served as special assistant to the president for
presidential personnel, takes over as OPM’s general counsel. The Senate confirmed
Elaine Kaplan, the agency’s former chief lawyer, to a spot on the U.S .Court of
Federal Claims last month. 

The Government Accountability Office released a report on OPM’s oversight of FEHBP plan carrier anti-fraud and abuse programs. Carriers have plenty of incentive to maintain sound programs because they hold the insurance risk. In any event, GAO had no recommendations on how to improve OPM’s processes which are described in the report.

The Drug Channels blog  pointed the FEHBlog to the Pharmacy Benefit Management Institutes’s 2013-14 Prescription Drug Cosr and Plan Design Report, which is available here by registering for access.  Dug Channels explains that

the PBMI report offers the only public benchmarking data on manufacturer rebates to pharmacy benefit managers (PBMs). A few highlights:
    Employers use a wide variety of rebate structures, including per-prescription guarantees and percentage shares. Nearly one-third of smaller employers get no rebates.
    Rebates average $17 per 30-day brand-name retail prescriptions. Surprisingly, rebates were comparable for both large and small employers.

OPM requires that PBMs credit all such manufacturers rebates to experienced rated FEHB plans.

According to the Hill. The Senate just passed the budget deal and the President is willing to sign it into law so the self plus one option for the FEHBP is a go for 2015.

The Federal Times and Govexec.com report on the Federal Workplace Survey which places NASA as the top ranked federal government employer. Govexec.com reports that

The study found that just one-quarter of agencies improved or held steady on their scores from 2012, while an overwhelming 75 percent declined. Last year, only two-thirds of agencies dipped from their 2011 scores. A major driver of the falling ratings was traced back to decreasing pay satisfaction, the study found. 

The Senate is still working on approving the budget deal. Mike Causey has a column criticizing the budget’s deal’s provision to add a self plus one option to the FEHBP. As the FEHBlog pointed out a week or so ago, there will be a price difference between self and one and self and family because the ACA’s increase in the age limit for covered children from 22 to 26 increased the FEHBP’s average family size. CBO expects that the self and one rate will benefit annuitants and the annuitant costs are on budget. The change will increase costs for active employees with the larger families whose costs are in general appropriations. It works for FEDVIP, and it should not work for the FEHBP.

Government HIT reports that the WEDI trade association is concerned that

approximately 80 percent of participants will not even have
completed their business changes or begun [ICD-10] testing prior to 2014. Whereas
only 40 percent of payers, formerly seen as the first movers of ICD-10,
have yet to conduct an impact assessment. And about half of providers
have completed that impact assessment, among the initial steps on
recommended timelines.

The ICD-10 compliance date is just less than 10 months away. The FEHBlog bought a copy of the ICD-10 recently and certainly agrees with the American Medical Association that switching from the ICD-9 to the ICD-10 with it ginormous increase in diagnosis codes is nuts, but it’s just another impending ACA train wreck.  The transaction and code set requirements of HIPAA should be repealed in favor of letting the industry handle it. But that’s not going to happen before October 1, 2014.