Weekend update / Miscellany

David Ermer

I am an attorney who practices law in Washington DC. My practice has involved the Federal Employees Health Benefits Program since 1983.

Weekend update / Miscellany

David Ermer–Uncategorized–
  • Last week, according to Business Insurance, the Internal Revenue Service issued guidance to employers (IRS Notice 2008-82) that interprets a new law permitting employers to allow reservist employees called to active duty for 180 days or more to withdraw their health care flexible spending account balances as taxable cash distributions. Prior to enactment of this law, such employees often forfeited their balances because they became eligible for Tricare with no premium contribution obligation. The IRS Notice explains that

    Notwithstanding the general rule that amendments to cafeteria plans and health FSAs may only be effective prospectively from the date of the plan amendment and that a QRD may not be made before the cafeteria plan is first amended to provide for QRDs, a plan may be amended retroactively to permit QRDs requested on or before December 31, 2009, provided that the QRD satisfies the other requirements in this notice. The retroactive amendment must be made by December 31, 2009, and be effective retroactively to the date of the first QRD paid under the plan, but not prior to June 18, 2008.

  • CMS announced on Friday that Medicare beneficiaries, their caregivers, and family members can begin to review 2009 Medicare prescription drug plan and health plan information online through the Medicare Prescription Drug Plan Finder and Medicare Options Compare at www.medicare.gov.
  • HHS’s Office of the National HIT Coordinator is holding a Medical Identify Theft Townhall this coming week. The all day meeting will be held on October 15th at the FTC Conference Center at 601 New Jersey Ave., NW, Washington, DC. RSVP: MedIDTheftTownHall@hhs.gov and indicate that you are planning to attend in person or by webcast.
  • In an interesting development, Healthcare IT News reports that

    Microsoft, Scripps Health, Affymetrix and Navigenics will launch what the companies say is ground-breaking research to evaluate the impact of personal genetic testing on the health and psyche of a patient. The study will offer genetic scans to up to 10,000 employees, family and friends of Scripps Health system and will measure changes in participants’ behaviors over a 20-year period. Researchers will use healthcare IT to study genetic variations linked to many diseases.

Mid-week Miscellany

David Ermer–Uncategorized–
  • The Pacific Business News reports that earlier today Walgreen’s dropped its bid for the Long’s Drug Store chains which means that the chain falls into the waiting arms of Caremark CVS.
  • Congress has recessed for the November 4 election. AHIP’s Washington Bulletin explains that

    Lawmakers will return to Washington during the week of November 17-21 to conduct leadership elections and handle other organizational matters in preparation for the 2009 session. The Senate will consider a very brief legislative agenda that week, including a package of public lands bills, although there are no “must pass” bills awaiting congressional action at this time. For the remainder of the year, both the Senate and the House – instead of adjourning – will continue to hold “pro forma” sessions so lawmakers will be able to reconvene on short notice if turmoil in the financial markets and the broader economy requires Congress to take further legislative action this year.

  • Healthcare IT News reports that HHS Secretary Mike Leavitt hosted an e-prescribing conference in Boston this week to kick off the first phase of Medicare‘s mandate for e-prescribing which rolls out in January 2009.
  • Speaking of IT, the AHIP Newswire reports that “nine research teams from across the country have unveiled innovative prototypes of personal health record (PHR) applications that provide a glimpse of the “next generation” of PHRs.” The effort is part of the Robert Wood Johnson Foundation’s Project Healthdesign. The prototypes focus on patients with different chronic illnesses and diseases, e.g., diabetes.
  • The Washington Post reports that

    Healthfinder.gov, the government’s consumer health site, has just undergone its first overhaul since its debut 11 years ago, and the updates are worth a look. In addition to health news and links to government health agencies and vetted consumer groups, Healthfinder.gov now offers calculators, videos and interactive tools, many of them as good as or better than applications you’d buy for your computer or your iPhone, BlackBerry or similar mobile device.

  • The Wall Street Journal reports that “Online health-information companies Waterfront Media and Revolution LLC’s Revolution Health Network agreed to merge in a deal that could potentially threaten WebMD Health Corp.’s No. 1 spot.”

Monday Miscellany

David Ermer–Uncategorized–
  • Recently, the Senate Homeland Security and Governmental Operations Committee held a hearing on a bill (S. 2521) that would expand FEHB Program eligibility to cover domestic partners. OPM opposes the bill on the ground, among others, that the expansion would be costly. Govexec.com reports on a Center for American Progress report finding that based on state and local government experience, the cost of such expansion, at least to same sex domestic partners, would be low.
  • NCQA published a study on 2008 HEDIS reports submitted by private and public health plans. The upshot of the “State of Health Care Quality” report is that “while quality improved for most people in private health insurance plans [including FEHB plans], there was little improvement in the care delivered to those enrolled in Medicare and Medicaid, the nation’s two largest public health care programs.”
  • The Centers for Medicare & Medicaid Services announced that, beginning October 1, 2008, it will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments. Those MUEs are available here.

Mental Health Parity and the Bailout — Update

David Ermer–Uncategorized–

The Senate passed its “Emergency Economic Stabilization Act of 2008” by a 75-24 vote tonight. The mental health parity bill is Section 512 of the Act. The House will consider the bill on Friday. I expected the mental health parity bill to be enacted this year but not this way.

The major difference between FEHBP mental health parity and this new legislation is that FEHBP mental health parity requires in-network parity only while the new legislation requires both in and out of network parity. The new legislation, if adopted on Friday, will become applicable to the FEHBP for the 2010 contract year. 

Mental Health Parity and the Bailout

David Ermer–Uncategorized–
News reports indicate that the mental health parity bill will be included in the bailout legislation that the Senate will consider this evening.

On a related note, AIS’s Health Business Daily features an article titled “Wall Street Meltdown Could Make Access to Capital More Difficult, Costly for Health Plans.

The Impact of Medicare Cost Shifting

David Ermer–Uncategorized–

It’s a pet theory of mine that employer sponsored health insurance problems can be traced back to Medicare’s adoption of the prospective pricing system back in 1983. I therefore find it interesting that a Milliman principal and consulting actuary Will Fox testified about Medicare and Medicaid price shifting to employer sponsored coverage at a September 16 hearing before the House Energy and Commerce Health Subcommittee. A copy of Mr. Fox’s presentation is here.

Among the findings, which are based on West Coast studies, are the following:
  • Hospitals make 15.9% from Private Insurers to make up losses on Medicare and Medicaid.
  • Cost shifting recently increased private health insurance premiums by 12.2% in California.
  • Cost shifting grows each year.
Medicare cost shifting impacts FEHB plans just like private insurance.

State of the stalled mental health parity bill

David Ermer–Uncategorized–
Here’s an interesting Minnesota Post article about Rep. Jim Ramstad who is sponsoring the House mental health parity bill. The article explains that

Even though the House and Senate both passed Ramstad’s so-called mental health parity bill last week, the two chambers are still squabbling over how to pay for the program. House members want to subsidize the $3.9 billion measure, which would require health insurers to cover treatment for mental health disorders just as they do physical ailments, by a change to the tax code.

The Senate, however, has passed the parity measure as part of a bill to extend tax revenue, some of which would cover the cost of the new requirements.

Ramstad says he’s still hoping the Senate will ultimately take up the language passed in his chamber, which would effectively end the battle over funding. But on the eve of a long Congressional recess, it’s unclear if the two chambers can come to a consensus or will chose to punt the measure to a post-election lame duck session.

Expectmore.gov

David Ermer–Uncategorized–

Here’s a link to the OMB’s latest assessment of the FEHB Program posted on the expectmore.gov website.

Here’s a link to the OMB’s latest assessment of the OPM Inspector General’s oversight of the FEHB Program from the same site.

The assessments were last updated on September 6 of this year.