Senator Jim Bunning (R Ky) agreed tonight to permit the Senate to consider H.R. 4691 by unanimous consent. H.R. 4691 is the bill in addition to extending unemployment compensation benefits, will prolong the COBRA/TCC premium subsidy program and will avoid the 21% Medicare reimbursement cut to doctors until March 31, 2010. Sen. Bunning was allowed to offer a pay-go amendment to the bill. USA Today reports that the Senate may pass the bill tonight.

Update: H.R. 4691 was enacted last night.

The House Energy and Commerce Committee “sent letters to the four largest for-profit health insurance companies [Welllpoint, United Healthcare, Aetna, and Humana] asking for information about claim denials related to pre-existing conditions and company policies related to coverage of maternity care in the individual health insurance market. [The Committee} also requested that the CEOs of the companies testify on these issues at a Subcommittee on Oversight and Investigations hearing on March 23, 2010.

Dow Jones reports that “Health and Human Services Secretary Kathleen Sebelius plans to meet Thursday with health-insurance chief executives she recently invited to discuss premium rates.”  

The President is expected to update his strategy for enacting general health care reform tomorrow. The Associated Press reports tonight that 

In remarks at the White House on Wednesday, the president will describe the final elements of his proposal and then ask Congress to enact it, aides said. Obama was expected to reiterate why changing the system is so important and again explain what his plans would mean to families and businesses. The aides also expected Obama to talk about the Republican ideas he wants woven into the Democrats’ plans. [The President released a letter that he issued to Congressional leaders today outlining four acceptable Republican ideas. The letter is reprinted in the Politico ]

He is expected to leave no doubt that, barring an unexpected change in Republican tactics, he wants Congress to pass the legislation using budget reconciliation rules, which prohibit Senate filibusters.

Modern Healthcare reports that the President will announce the path forward on health care reform later this week.

The Senate, to my surprise, failed last week to pass a bill already approved by the House that temporarily would extend the COBRA/TCC subsidy and avoid a 21% cut in Medicare Part B payments to doctors. The AMA News reports that the Senate will takes up these “extender” issues this coming week. According to the article,

The Centers for Medicare & Medicaid Services started informing physicians on Feb. 26 that contractors will hold Medicare physician claims for 10 business days, starting March 1, to give lawmakers more time to act. That means if Congress and the White House enact a delay before the end of the two weeks and make it retroactive to March 1, then doctors shouldn’t expect to see any Medicare checks come back with a 21% cut applied.

Last week, Health Grades “[f]or the fourth consecutive year, identified 50 hospitals that have provided outstanding clinical quality year after year and recognizes these hospitals as America’s 50 Best Hospitals.” Inova Fairfax Hospital is the only facility in the Washington, D.C., metropolitan area to receive this accolade.

The AHIP News Wire reports that “An insurer is upping the ante for doctors to meet quality standards. Blue Cross and Blue Shield of North Carolina (BCBSNC) has invited 4,000 primary care physicians to apply for the “substantially higher payments” of a reimbursement structure intended to improve the quality of patient care.” Good luck to them.

The President held his bipartisan healthcare summit at the Blair House today. The Politico reflects the general consensus as far as I can tell that there was no clear winner from the lengthy meeting. It further reports that “After a brief period of consultation following the White House health reform summit, congressional Democrats plan to begin making the case next week for a massive, Democrats-only health care plan, party strategists told POLITICO.”

“In attempting to solve a problem that doesn’t exist, this legislation is the triumph of sound bites over substance. The Congressional Budget Office has said that passage of this legislation will do nothing to reduce health care costs. Moreover, according to the National Association of Insurance Commissioners, anti-competitive ‘activities are not permitted under the McCarran-Ferguson Act and are not tolerated under state law.’ Real reform means containing costs to ensure that health care is affordable for working families and small businesses. It’s time to clear the political hurdles that stand in the way of real cost containment.”

The House Federal Workforce Committee held a hearing today on the Chairman’s bill (HR 4489) to regulate prescription drug pricing in the FEHB Program. The testimony is available here. Preceding the hearing, the Office of Personnel Management issued a letter “to provide fee-for-service carriers with new FEHB pharmacy benefit management (PBM) transparency principles.”  

Govexec.com, Joe Davidson of the Washington Post, and Federal News Radio have reported on the hearing.

The President released a summary of his health care reform proposal yesterday. The proposal drives off of the bill that the Senate passed on Christmas Eve. It does not include a public option, but it does include a new federal commission to keep health insurance premiums “affordable.”  Interestingly, the Washington Post joined the Wall Street Journal in editorializing against this commission.

Modern Healthcare reports that “At a news briefing [today], House Speaker Nancy Pelosi (D-Calif.) said the White House’s new reform blueprint was “getting a good reception” among members of the House Democratic Caucus. “We have a lot more work to do” to get all Democrats onboard with the legislation, she acknowledged.

The Politico has posted the agenda for Thursday’s healthcare reform summit.

The Republican proposal is posted here.

Well this week will feature several big events — The President is expected to release his proposal to merge the Senate and House healthcare reform bills tomorrow according to the New York Times; the House Federal Workforce Subcommittee will hold a hearing Tuesday afternoon about its Chairman’s bill (HR 4489) to regulate prescription drug pricing in the FEHBP, and the President’s healthcare reform summit will take place on Thursday.

As prescription benefit managers (“PBMs”) will be under scrutiny at Tuesday’s hearing, let me point out a worthy endeavor of those companies — promoting personalized medicine.  Business Insurance reports about Medco’s effort to use genetic testing to accurately dose the blood thinner wayfarin and tamoxifin, a drug used to treat cancer. What’s more

Woonsocket, R.I.-based CVS Caremark Corp. is preparing to introduce a similar program in May after acquiring a majority stake in Generation Health Inc., a genetic benefit management company in Upper Saddle River, N.J. The companies last fall formed a strategic partnership to expand pharmacogenomic clinical and testing services for CVS Caremark PBM clients to improve care for patients who either don’t respond to their medications or have adverse reactions.

It’s also worth noting a Federal Times column by Reg Jones which discusses how different types of federal annuities affect eligibility for annuitant coverage under the FEHBP.

Last month, OPM announced a reorganization, and this month the Centers for Medicare and Medicaid Services is doing the same. The Hill has an interesting report about the changes, which were announced on Wednesday by internal CMS email, a copy of which is included in the Hill article. The article points out that CMS has not had a Senate confirmed Administrator since October 2006 when Mark McClellan left that post.  President Obama has not nominated an Administrator. Since he took office, CMS’s chief operating officer Charlene M. Frizzera has been acting administrator.

Today is the first birthday of the HITECH Act. President Obama signed this bill into law on February 17, 2009, as part of the Recovery Act. This first birthday is significant because the HITECH Act’s business associate provisions took effect today. Business associates are billing services, claims administrators, and other parties who handle protected health information for HIPAA covered entities, such as health plans, health claims clearinghouses, and health care providers who use electronic claim transactions. The business associate concept which the Department of Health and Human Services (“HHS”) created in the HIPAA Privacy and Security Rules is now enshrined in statute, and business associates are now subject to HIPAA’s enhanced civil and criminal penalties. AIS Health Business Daily recently offered a useful perspective on these new liabilities.

BNA is reporting that HHS is developing regulations to provide guidance on the changes that the HITECH Act made to the HIPAA Privacy and Security Rules. HHS has not indicated when the regulations will be published.

Finally, Government HIT News reports that HHS “named Joy Pritts, an assistant research professor at Georgetown University’s Health Policy Institute, as chief privacy officer in the Office of the National Coordinator for Health IT.”

Happy President’s Day.  President Obama’s health care reform summit is ten days away. Here’s a link to the invitation (not mine). The invitation explains that

The President will offer opening remarks at the beginning of the meeting, followed by remarks from a Republican leader chosen by the Republican leadership and a Democratic leader chosen by the Democratic leadership. The President will then open and moderate discussion on four critical topics: insurance reforms, cost containment, expanding coverage, and the impact health reform legislation will have on deficit reduction.

There are rumblings that Speaker Pelosi is contemplating the use of the budget reconciliation process to ram through the Senate bill with the House modifications as the reconciliation “sidecar.”  However, the unexpected resignation of former Congressman W.J. “Billy” Tauzin as CEO of the prescription drug manufacturer association, PhRMA,  late last week “presents another complication for Democratic leaders as they struggle to keep the effort from falling apart amid a tide of political setbacks” according to the Washington Post.

AHIP and the Blue Cross Blue Shield Association announced late last week that a large group of health insurers and health care provider organizations have teamed up in New Jersey (similar to the ongoing project in Ohio) that creates

opportunities to simplify the work associated with patient visits and achieve savings, including providing physicians and hospitals with information in “real-time” that:

• Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network), minimizing time and expense needed for such purposes;
• Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers.  This will minimize the need for follow up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
• Tests real-time referrals and timely pre-authorization of services; and
• Provides for the online submission of healthcare claims.

Very cool. It’s nice to see the industry cooperating to create uniform technology standards.

Meanwhile, on Friday, HHS Secretary Sibelius announced that the federal government is doling out about one billion Recovery Act dollars to health care providers in order to allow them to adopt and make meaningful use of electronic health records. 

Modern Healthcare reports that the narrowly focused Senate jobs bill that the Majority Leader unveiled today does not include the Medicare Part B doctor pay fix or the COBRA / TCC subsidy extension discussed in previous FEHBlog entries. Politico portrayed this move as a rebuke at Senate Finance Committee Chairman Max Baucus who had negotiated a broader bill with Republican Senator Chuck Grassley. Instead these two time sensitive provisions will be included in a tax extenders bill which also will be considered during the week of February 21 after the Senate returns from its recess.

Govexec.com reports that the House Federal Workforce subcommittee hearing on its Chairman’s bill (HR 4489) regulating FEHBP prescription drug pricing has been rescheduled for Tuesday February 23. According to the Committee’s website, the hearing will be held in Room 2154 of the Rayburn House Office Building beginning at 2 pm. Roll Call published an opinion piece by Mark Merritt, the Pharmaceutical Care Management Association‘s CEO, criticizing the bill as unnecessary.