[T]he package includes language directing ONC [the Health IT Czar] to decertify electronic health record systems that prevent the electronic exchange of health information. The new law states, “ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in (certified EHR technology) and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”

The law also includes a coupe of provisions requiring reports to Congress.  My money is riding on the private sector to fix this pressing problem. Ihealthbeat further notes that 257,000 eligible healthcare professionals will get smacked with meaningful use penalties starting January 1, 2015. Of course, the cost of those penalties ultimately will be shifted onto private sector payers.

The Christian Science Monitor reports that Congress also passed the ABLE Act which will allow for the creation of tax free savings accounts for disabled people.

The ABLE Act helps people with disabilities save for health-care costs, housing, lifelong education, and other needs. Under current law, a child diagnosed with a disability can’t have assets worth more than $2,000 or earn more than $680 per month without forfeiting eligibility for government programs like Medicaid. The ABLE Act would allow a tax-free savings account up to $100,000 to pay for disability-related expenses.

In Monday’s Federal Register OPM announced a proposed rule for a new performance assessment system for FEHBP carriers.  Federal News Radio provides an overview of the proposed rule. The comment period for the proposed rule ends on January 14, 2015.  When contemplating carrier performance, the important facts to bear in mind are that the FEHB Act requires carriers to compete and also bear the insurance risk. That’s plenty of motivation for good performance and as the FEHBlog noted earlier this month a recent Morning Consult survey of 500 federal employees found that federal employees genuinely appreciate their plans.

The Drug Channels blog offers highlights of CVS Health’s latest specialty market forecasts here. Reuters reports that a new specialty infusion drug from Amgen that treats a rare leukemia called acute lyphoblastic leukemia. Price tag — $178,000 per treatment.

Because it’s the holiday season, let’s wrap things up with this day brightener article from Fierce Health Payer about how Aetna is using technology “to connect members who have recently been diagnosed with breast cancer to members who have already survived the disease. The insurer aims to help its members address the emotional impacts of cancer in addition to all the physical issues.”

The Hosue has adjourned for the holidays, and the Senate has one more day of sessions to handle nominations.  Before leaving town, Congress passed several bills blurbed in this Week in Congress, most significantly the CRomnibus bill and the National Defense Authorization Act. As the FEHBlog has noted, the CRomnibus keeps most of the federal government funded through the end of the current fiscal year. Hopefully, both the Senate and House next year will address appropriations in regular order rather than using an omnibus.

The Federal Times calls to our attention the fact that the NDAA includes a few provisions affecting federal employees, most significantly, a “section [that] allows retired employees to return to the federal workforce without taking a cut to their salaries.” Congress extended this pilot program for another five year period. “Before the authority [first] was granted in 2009 an agency rehiring a retiree
had to offset their salary by the amount of the annuity unless it got a
waiver from the Office of Personnel Management.”

Last Friday, the FEHBlog noted that the Republican Senate Conference last week voted to require all of their staff to be covered under the DC Health Link rather than the FEHBA. Newsmax points out that the Republican House Conference rejected a similar motion. The Washington Post reported last winter that 88% or over 12,000 of the enrollees in the DC Health Link’s small business option are members of Congress and their official staff members. The Democrat Conferenes in Congress like the House Republicans permit legislators to designate their staff members who have to leave the FEHBA for the DC Health Link.

Following Congress’s brief extension of the continuing resolution funding the federal government,. the Senate is on track to join the House of Representatives in passing  the CRonnibus bill (HR 83) which will continue to fund the federal government through September 30, 2015, with the exception of the Department of Homeland Security whose funding will end on February 27. 2015.  Interestingly, the CRomnibus does include a few amendments tot the Affordable Care Act, but none of those changes significantly effects the FEHBP.  The President has promised to sign this bill.

The FEHBlog has complained about Gilead’s pricing of its Hepatitis  C drugs. The Washington Post reports that the health plan for Philadelphia’s public transportation system has sued Gilead for unjust enrichment, violating federal antitrust law,  and violating the ACA’s broad anti-discrimination law. PHSA Sec. 1557 as a result of that pricing decision.  The FEHBlog will be following this lawsuit.

The Washington Post also reports that the Senate’s Republican conference has agreed to require all of its staff members to receive health benefits coverage from the DC marketplace rather than the FEHBP. This change will take effect in 2015.

House leaders posted the omnibus FY appropriations bill colloquially known as the “Cromnibus” (H.R. 83) last night.  The bill would fund the federal government generally through September 30, 2015 and the Department of Homeland Security through February 2015.  The FEHBlog found no FEHBP surprises in the bill. The bill does include the now standard FEHBP-related appropriations provisions — an abortion coverage restriction, a contraception coverage mandate, and a prohibition against apply full Cost Accounting Standards coverage to FEHBP carriers. The Washington Post notes that  “The bill authorizes a 1 percent pay raise for military service members and allows a 1 percent pay raise for federal employees, ordered by [President] Obama, to begin in January.”  This Federal News Radio article provides more details on the end game, e.g., a brief extension of the continuing resolution to allow the House and then the Senate to approve the bill later this week. 

Well, it was a rough day to be a fan of DC’s NFC franchise, but life goes on. Tomorrow is the last day of the Federal Benefits Open Season.  Here’s a link to This Week in Congress’s one page update on last week’s activities on Capitol Hill. 

Congress is expected this coming week to pass an omnibus appropriations bill for all of the federal government except for the Department of Homeland Services. That department which is responsible for implementing the President’s executive order on immigration will be placed on a short leash so that its appropriations can be addressed early in the next Congress which the Republicans will fully control. As a result of Louisiana’s final election on Saturday, the Republicans have 54 seats in the Senate (out of 100) and 246 seats in the House (out of 435 with one election still undecided).  The next Congress will convene in early January.

The House leadership plans to post these appropriations bills on the internet tomorrow according to the Hill.  This could be interesting for FEHBlog readers because last year’s omnibus appropriations bill included the self plus one option.  The FEHBlog will be keeping an eye out for this important post.

By the way the FEHBlog has noticed a couple of articles, such as this one from Fedsmith, highlighting some regulatory impact language in the self plus one rule. Federal agencies prefer to avoid triggering scrutiny for expensive / major regulations (economic impact of $100 million or more). Therefore, the language expressed the agency’s view that OPM is unsure about the financial impact of the self plus one option.  The rule could cause premiums to spike but likely it will be revenue neutral.

In the words of Green Bay’s quarterback, Aaron Rogers, R-E-L-A-X. Because of the choices that the FEHBP offers federal employees, if, assuming strictly for the sake of argument, self plus one causes your plan’s family coverage premium to spike there are bound to be other available plans that will be in your price range. That’s the beauty of the FEHBP. Plus any spike likely will be a one  or two year phenomenon. 

The FEHBlog had a routine doctor’s visit yesterday. His doctor, an internist, railed against the fact that Medicare Part B has not given internists a raise in 12 years. Point taken. His comment illustrates the fact the Medicare’s low reimbursement rates force doctors to jack up prices to me and other patients under age 65.  He also complained about the lack of interoperability of electronic medical records systems. He explained that unrelated EMRs currently rely on faxes to communicate between providers, 1980s style. That’s sad. The federal government has spent almost $30 billion on these systems. You can’t solve a problem by throwing money at it. The FEHBlog hopes that the private sector can resolve this very serious lack of interoperability problem without a new law.

The Hill reports on a biosimilars conference held on Capitol Hill yesterday.  The FEHBlog got a kick out of this exchange:

Though healthcare professionals are hailing biosimilars for their potential to cut patient costs, the head of the National Association of Medicaid Directors raised concerns about whether the nation’s biggest healthcare provider will be able to afford the biological copycat drug.
Medicaid as a payer is not equipped to pay the types of prices we’re seeing out there,” Matt Salo said. “Not just with the drugs to treat hepatitis C or cystic fibrosis, I’m talking about what’s in the pipeline.”
But Lori Reilly, executive vice president for policy and research at Pharmaceutical Research and Manufacturers of America (PhRMA), said the notion that Medicaid prescription drug costs break the budget is misleading.
“Medicaid gets the best price in the market minus a 23 percent statutory discount and in most cases a supplemental rebate on top of that,” she said. 

If Medicaid is complaining out the prices, the root cause is that the prices are just too dam* high.

But it’s Friday so let’s end on a bit of good news. The New Hampshire Business Review reports on a new plan called ElevateHealth that was formed by two large health care providers and an insurer. The Review interviewed ElevateHealth’s CEO

Q. What makes ElevateHealth different?
A. ElevateHealth is a joint venture between two hospital systems and a payer. It’s sort of the first in the country to have a model like this. By sharing data, by integrating and having each entity doing what they are best at, instead of often duplicating efforts, there is an opportunity to reduce costs and improve care.
A lot of health care is struggling because of misaligned incentives, and that is one thing we address immediately by jointly owning ElevateHealth.
Q. How does that address it?
A. Typically in health care, the incentives are for a provider to do a lot of tests, to really increase their revenues through volume. The goal of a payer is to try to reduce their rate of patients. We are trying to address that volume incentive by having the providers be joint owners.

This is not the only such consortium, The number is bound to grow.

According to the Wall Street Journal and other press reports, Congress is working on a omnibus appropriations bill that would fund the federal government though the end of the current fiscal year (9-30-2015) with the exception of the Homeland Security Department which is responsible for implementing the President’s executive orders on immigration. The current continuing resolution funding the federal government expires next Thursday December 11. The FEHBlog is confident that there will not be a full or partial federal government shutdown this go around.

According to the Hill, the House of Representatives by a wide bi-partisan margin passed a bill today that will allow the creation of tax free savings accounts for disabled people to use for health care and vocational expenses similar to IRAs.

In a troubling report from highroads.com a benefits consult predicts that the ACA regulators will make significant complicated changes, such as adding new coverage examples, to the ACA’s summary of benefits and coverage for 2016. The format of the SBCs which the NAIC designed has been left alone by and large since its introduction for the 2012 benefit year. The FEHBlog is not sure how much they are used by consumers. The FEHBlog recommends that Congress require doctors and hospitals to disclose to consumers such important factors as the provider networks to which they belong. It drives the FEHBlog nuts that insurers get shellacked for unreliable provider directories when the most current information should come from the provider of care.

In a bit of good news, Health Data Management reports a big drop in hospital acquired conditions / never events over the period 2010 through 2013 according to an ARQH study. It is good to see the provider community pull together and start correcting this problem.

OPM’s proposed self plus one enrollment rule was posted on the public inspection list today in advance of its publication later this week in the Federal Register. OPM has taken a simple approach to the issue. Beginning in 2016 (the Open Season that will be held next year), enrollees will be able to choose self only, self plus one eligible family member or self plus all eligible family members. OPM will set the government contribution for self plus one enrollments for the first year.

Self plus one enrollment is expected to have a lower premium than self and family enrollment because the ACA’s expansion of coverage for adult children has boosted the average family size for a current self and family enrollment.

Federal News Radio and the Washington Post have reported on this development. OPM will be accepting public comment on this proposed rule until Groundhog Day by the FEHBlog’s calculations.

Not much as gone over the long weekend. Congress resumes its lame duck session tomorrow. The hope has been to adjourn the lame duck session next week after working out an extension to the continuing resolution funding the federal government through December 11.  In view of the President’s executive order on immigration and other pending issues, the Hill suggests that the lame duck may continue beyond December 11. A full or partial government shutdown is not expected.

This will be the last full week of the Federal Benefits Open Season which ends on December 8. OPM recently adjusted the rules under which Indian tribes can participate in the FEHBP effective November 20, 2014.

• A tribal employer may enroll one or more business units carrying out programs or activities under ISDEAA or IHCIA.
• Once a tribal employer has enrolled at least one business unit carrying out programs or activities under ISDEAA or IHCIA in the FEHB Program, the tribal employer may enroll one or more business units that are not carrying out these programs or activities.
• A business unit that is part of a tribe, tribal organization, or urban Indian organization and that has its own ISDEAA or IHCIA contract may participate in the FEHB Program in its own right and enroll the tribal employees of the business unit in the FEHB Program, whether or not its parent tribe, tribal organization, or urban Indian organization participates in the FEHB Program. A business unit with its own ISDEEA or IHCIA contract may not enroll any other business units of the tribe, tribal organization, or urban Indian organization in the FEHB Program.
• A participating tribal employer must offer FEHB coverage to all tribal employees of each business unit the tribal employer chooses to enroll in the FEHB Program.

Before this change, tribal employee participation in the FEHBP was all or nothing.

The FEHBlog added a question mark to TGIF today because he had the day off. Double weekend!! So this blog entry principally will follow up on some other recent entries.

Last Friday and Sunday, the FEHBlog noted the issuance of several new ACA rules.  Timothy Jost in the Health Affairs Blog wrote two lengthy entries on the ACA rules issued last Friday  — a view of the 2016 benefit and payment parameters notice from an insurer’s perspective and a discussion of the IRS’s final minimum value rule and OPM’s proposed revised multi state program rule.

Last Friday the Obama Administration issued the Fall 2014 semi annual regulatory agenda. Here are OPM’s FEHBP regulatory priorities according to that agenda:

OPM will make several amendments to the Federal Employees Health Benefits (FEHB) regulations to adhere to the provisions of the Affordable Care Act of 2010. These amendments include enrollments for eligible employees of Tribes and Tribal organizations, changes to resolutions of disputed health claims and external reviews, rate settings for community-rated plans, enrollment options following the termination of a plan or plan option, and the expansion of eligibility to certain employees on temporary appointments and certain employees on seasonal and intermittent schedules.

Among the many items under the HHS entry in the semi annual agenda are a proposed Section 1557 non-discrimination rule scheduled for next June, the final HIPAA certification rule, scheduled for next July, and a pre-rule rule making solicitation of comments on giving complainants a cut of the penalties imposed on covered entities and business associates for HIPAA privacy and security rule violations, also scheduled for next Spring. The Section 1557 non-discrimination rule will impose new benefit mandates on FEHB plans so it’s worth following. The HIPAA certification rule is a silly but onerous ACA requirement on health plans. The mid 2015 timing final HIPAA rule suggests that HHS may give health plans another year (under the end of 2016) to obtain CORE certification or HIPAA accreditation.  The penalty sharing rule making must have my brother and sisters at the bar slobbering at the bit as they say.

Here are a couple of tidbits to add to these “leftovers?”:

• Modern Healthcare examines the difference of opinions over the efficacy of employee wellness program.  It’s too bad that you can’t inject people with common sense. 
• Fierce Healthcare, based on a Forbes article, looks ten of the 10 most expensive U.S. cities for healthcare. It’s noteworthy that the cities are spread all of the continental U.S.