FEHBlog

Tuesday Tidbits

David Ermer–COVID-19, COVID-19 vaccine, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Good news. The Wall Street Journal reports

The Trump administration is releasing second doses of coronavirus vaccines that were reserved for booster shots and is urging states to give the vaccine to anyone age 65 and older, as well as to people with pre-existing health conditions, a shift in strategy that vastly expands the pool of those eligible for shots while presenting another hurdle for the logistics of administering the vaccine at state and local levels.

Starting in two weeks, doses will be allocated based on the pace that states say they are administering the vaccine, as well as the size of a state’s population of people age 65 and older. 

Health and Human Services Secretary Alex Azar announced the plan on ABC’s “Good Morning America” on Tuesday. “We now believe that our manufacturing is predictable enough that we can ensure second doses are available to people from ongoing production. So everything is now available to our states and our health-care providers,” he said.

The government had been allocating about half of newly available doses from Pfizer Inc. and Moderna Inc. to states since the vaccine rollout began last month. Federal officials said there is enough supply to ensure booster shots will be available and that they won’t extend the current recommended dosing schedules.

Drug makers expect to be able to produce enough vaccine doses to accommodate the new plans, vaccine manufacturers and supply-chain experts say.

The Journal also explains that while scientists are confident that the COVID-19 vaccines will protect you from contracting the disease, they don’t know yet whether they will prevent you from spreading the disease asymptomatically.

“Most vaccines prevent disease as opposed to preventing infection,” says Anna Durbin, a professor of international health at Johns Hopkins Bloomberg School of Public Health who is working on the AstraZeneca Covid-19 vaccine trial and previously worked on the Pfizer vaccine trial. She believes Covid vaccine studies will eventually show a reduction in asymptomatic transmission but not a complete elimination.

Even if vaccines don’t prevent transmission completely, they can still help populations achieve herd immunity if enough people take them, says Arnold Monto, an epidemiology professor at the University of Michigan School of Public Health who chairs the U.S. Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee. “We can still accomplish a lot even if it is demonstrated that there is still some asymptomatic infection occurring post-vaccination,” says Dr. Monto.

STAT News reports that the Pharmaceutical Care Management Association (“PCMA”) has asked the federal district court in DC to block a Trump Administration rule preventing the use of prescription drug manufacturer rebates in the Medicare Part D program. PCMA contends that the CMS rule impermissibly conflicts with a statutory exemption permitting the use of such rebates in Medicare Part D. Of course.

The Biden administration, which is set to take office on Jan. 20, could also choose not to defend the rebate policy in court, thus mooting the lawsuit.

Biden has not yet taken a position on eliminating drug rebates, but a number of prominent Democrats, including House Speaker Nancy Pelosi have spoken out against the policy as a ndout to the pharmaceutical industry.

Studies —

The death rate from cancer in the U.S. dropped 2.4% from 2017 to 2018, the biggest single-year decline on record and a sign of the impact of new treatments on lung cancer especially, the American Cancer Society said.

It was the second year in a row with a record-setting drop, and the progress continues gains that have been made for more than a quarter-century, the cancer society said in a report published Tuesday. The researchers analyzed cancer mortality data from 1930 to 2018, before the start of the Covid-19 pandemic.

Overall, the cancer mortality rate has fallen 31% since its peak in 1991, according to the report, which was published online in the journal CA: A Cancer Journal for Clinicians. The latest decline left the mortality rate at 149 deaths for every 100,000 people in the general population in 2018, according to the American Cancer Society.

Use of telehealth jumped sharply during the first months of the coronavirus pandemic shutdown, with the approach being used more often for behavioral health services than for medical care, according to a new RAND Corporation study.

Between mid-March and early May 2020, telehealth was used by more than 40% of patients with a chronic physical health condition and by more than 50% of those with a behavioral health condition, according to findings published in the Journal of General Internal Medicine.

Overall, almost half of the people who were undergoing treatment when the pandemic shutdown began reported using some form of telemedicine.

Researchers found that the use of telehealth for behavioral health conditions was lower among women and among people over the age of 60. Use of telehealth also was lower among non-Hispanic whites relative to non-Hispanic Blacks, and was lower among those with less than a high school education relative to those with a college degree.

Monday Roundup

David Ermer–CDC, COVID-19, COVID-19 vaccine, Employee Wellness Programs–
Photo by Sven Read on Unsplash

The Centers for Medicare and Medicaid Services has released a COVID-19 Vaccine Toolkit for health insurance issuers and Medicare Advantage plans. The toolkit’s purpose is as follows:

CMS is committed to ensuring that the private health insurance industry has the necessary tools to respond to the COVID-19 public health emergency (PHE). As safe and effective COVID- 19 vaccines become available, CMS issued this toolkit to help health insurance issuers and Medicare Advantage plans identify the issues that need to be considered and addressed in order to provide coverage and reimbursement for vaccine administration. Because COVID-19 vaccines will be federally purchased, this toolkit primarily focuses on vaccine administration. CMS remains available to provide technical assistance to issuers, Medicare Advantage plans, and other stakeholders. This toolkit:
• Provides a list of operational considerations for issuers and Medicare Advantage plans as they design their approach to promoting COVID-19 vaccinations and information on how issuers and Medicare Advantage plans can communicate with providers and enrollees on vaccinations and coverage;
• Outlines legislative and regulatory provisions applicable to issuers that ensure that enrollees can receive a COVID-19 vaccine in a convenient setting, with no out-of-pocket costs;
• Encourages issuers and Medicare Advantage plans to implement streamlined processes to quickly administer COVID-19 vaccine coverage; and • Describes how issuers and Medicare Advantage plans can maximize the number of their enrollees who get vaccinated once a COVID-19 vaccine becomes available

Meanwhile the Centers for Disease Control have released facts sheets on what to expect after you receive your first dose of COVID-19 vaccine and how to improve ventilation in your house during the great hunkering down.

Benefits Pro reports that the Equal Employment Opportunity Commission is poised to release proposed rules addressing the level of incentives employers may lawfully offer to encourage employee participation in wellness programs that require disclosure of medical information. “

Because the {Americans with Disabilities Act] ADA and [Genetic Information Non-Discrimination Act] GINA do not define “voluntary,” the NPRM proposes that in order to comply with the acts, employers may offer no more than a “de minimis” incentive to encourage participation in wellness programs. The exception would be for “wellness programs that are part of, or qualify as, group health plans and that require employees to satisfy a standard related to a health factor to receive a reward or avoid a penalty,” according to the proposed rule under the ADA.

Under the GINA regulation, the proposed rule makes an exception that would allow incentives for genetic information “when a wellness program offers an employee an incentive in return for his or her family member providing information about the family member’s manifestation of disease or disorder.”

Weekend Update

David Ermer–COVID-19, COVID-19 vaccine, Uncategorized–
Photo by JOSHUA COLEMAN on Unsplash

On January 7, 2021, the Secretary of Health and Human Services extended the COVID-19 public health emergency for another 90 days from January 21 until April 21, 2020. The COVID-19 testing mandate and emergency use authorizations used for the vaccines hinge on the existence of the public health emergency.

Speaking of which NPR reports that people in the U.S. are beginning to receive the booster doses of the COVID-19 vaccines.

Many health care workers and others at high risk who had the Pfizer shots in mid December lined up for their “booster” shot this week, due to be given 21 days after the initial dose. * * * So far, there don’t appear to be widespread problems with people missing their second dose, but experts say it’s still early and the feasibility of a two-shot mass vaccine effort will be tested in the coming weeks, especially as those who received the Moderna vaccine await their follow up shot, which comes 28 days after the first.

A opinion piece in Bloomberg further advises

Take a look at the pipelines of Moderna and BioNTech. They include drug trials for treating cancers of the breast, prostate, skin, pancreas, brain, lung and other tissues, as well as vaccines against everything from influenza to Zika and rabies. The prospects appear good.

Progress, admittedly, has been slow. Part of the explanation [BioNTech founders Drs.] Sahin and Tureci give is that investors in this sector must put up oodles of capital and then wait for more than a decade, first for the trials, then for regulatory approvals. In the past, too few were in the mood.

Covid-19, fingers crossed, may turbo-charge all these processes. The pandemic has led to a grand debut of mRNA vaccines and their definitive proof of concept. Already, there are murmurs about a Nobel Prize for Kariko. Henceforth, mRNA will have no problems getting money, attention or enthusiasm — from investors, regulators and policymakers.

That doesn’t mean the last stretch will be easy. But in this dark hour, it’s permissible to bask in the light that’s dawning

Friday Stats and More

David Ermer–COVID-19, COVID-19 vaccine, Mental health care–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 1st week of this year (beginning April 2, 2020, and ending January 6, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noted that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period April 2, 2020 through January 6, 2021.

Because this week the CDC began to update its COVID-19 vaccinations data on a daily basis the FEHBlog was able to create this vaccines distributed and initially administered over the 51st week of 2020 through the first week of 2021 (December 23, 2020 through January 6, 2021):

Over the past four daily reports, the number of initial COVID vaccines administered increased steadily from 273,209 doses on January 4 to 748,313 doses yesterday. Per the AMA’s Morning Rounds

USA Today (1/6, Weintraub) reports HHS Secretary Alex Azar told governors to vaccinate as many people against SARS-CoV-2 as possible and warned to not let “perfection be the enemy of the good,” referring to priority plans. Azar said that with up to 70% of distributed vaccines still on shelves, states should focus on vaccinating the most people rather than prioritizing certain groups.

Today’s Fluview continues to report that “Seasonal influenza activity in the United States remains lower than usual for this time of year.”

UPI reports today that

At least half of COVID-19 transmission globally may have been caused by symptom-free infected people unknowingly spreading the virus to others, a study published Thursday by JAMA Network Open found.

In addition, nearly one in four cases of virus spread involves infected people who remain asymptomatic, the researchers estimated.

The findings highlight the importance of public health measures such as social distancing, mask-wearing and hand-washing — even for people who don’t feel sick — in preventing the spread of the virus, they said.

Mercer writes about the most pressing requirement of the Consolidated Appropriations Act – preparing and document comparative analyses to document compliance with the non-quantitative treatment limitations requirements under the federal mental health parity law. Mercer notes that

In case plan sponsors need more motivation to step up compliance efforts, we’re also seeing more litigation against plan sponsors and insurers alleging MHPAEA violations and breach of fiduciary duties under ERISA. In late 2020, in Wit v United Behavioral Health (UBH), a class action lawsuit ended with a decision by a federal court granting the plaintiffs the full extent of relief they requested and requiring UBH to reprocess nearly 67,000 mental health and substance use disorder (MH/SUD) benefit claims that were denied between 2011 and 2017. The federal court held that UBH breached its fiduciary duty to plan participants based on its use of overly restrictive medical necessity guidelines that resulted in the improper denial of more than 67,000 MH/SUD claims. This is just one example of the more than 100 lawsuits filed in the past several years alleging various MHPAEA and ERISA claims review violations relating to exclusions for ABA therapy, coverage for residential and other treatment facilities, medical necessity standards, and other items.

Thursday Miscellany

David Ermer–CDC, Medicare, OPM, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

In the wake of the Democrat victories in the Georgia Senate elections, Katie Keith in the Health Affairs blog provides her insightful thoughts on what a Democratic Congress means for the Affordable Care Act.

The Robert Wood Johnson Foundation offers for our consideration five experts reflecting on the health equity implications of the COVID-19 public health emergency.

When Medicare pricing changes the healthcare industry takes notice.

  • The American Hospital Association reports today that ” The Centers for Medicare & Medicaid Services has recalculated the Medicare [Part B] Physician Fee Schedule payment rates and conversion factor for calendar year 2021 to reflect changes effective Dec. 27 under the Consolidated Appropriations Act. The new conversion factor is $34.89, which is 3.3% less than the CY 2020 conversion factor of $36.09 but more than the $32.26 conversion factor finalized in the PFS final rule, which would have represented a 10.2% net decrease in PFS payments for CY 2021. This change affects what FEHB plans pay for Medicare prime annuitants. Also where an annuitant over 65 does not pick up Medicare Part B, fee for service FEHB plans pay for doctors services using Medicare Part B payment rates.
  • Beckers Payer Issues reports that “A change in how Medicare pays laboratories for COVID-19 diagnostic tests took effect Jan. 1 * * * Medicare lowered the base payment for COVID-19 tests that use high-throughput technology to $75. Labs can get an additional $25 if they provide results in two days or less.” Medicare testing rates are sound benchmark for out-of-network COVID-19 labs which fail to comply with internet price post requirements.

The Centers for Disease Control yesterday issued an initial report concerning allergic reactions to the COVID-19 vaccines. Here’s the report’s summary:

What is already known about this topic?

Anaphylaxis is a severe, life-threatening allergic reaction that occurs rarely after vaccination.

What is added by this report?

During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination.

What are the implications for public health practice?

Locations administering COVID-19 vaccines should adhere to CDC guidance for use of COVID-19 vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended postvaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine.

The Department of Health and Human Services announced today

a national plan to address the serious, preventable public health threat caused by viral hepatitis in the United States. The Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination 2021–2025 sets national goals, objectives, and strategies to respond to viral hepatitis epidemics. Building on three prior National Viral Hepatitis Action Plans over the last 10 years, the Viral Hepatitis National Strategic Plan is the first to aim for elimination of viral hepatitis as a public health threat in the United States by 2030.  This plan serves as a roadmap for stakeholders at all levels and across many sectors, both public and private, to guide development of policies, initiatives, and actions for viral hepatitis prevention, screening, care, treatment, and cure.  

Federal News Network reports that

Federal payroll providers and agencies are beginning to detail exactly how and when federal employees and servicemembers will repay the Social Security taxes that were deferred from their paychecks during the last four months of 2020. The latest omnibus spending package, which the president signed into law last week, allows those subject to the president’s payroll tax deferral to repay the deferred taxes — worth 6.2% of their income — throughout the entire year of 2021, rather than the first four months of the year.

The article provides examples but generally the services are collecting in equal installments over the course of 2021.

Midweek Update

David Ermer–ACA, HIPAA Privacy and Security Rules, U.S. Healthcare–
Photo by Michele Orallo on Unsplash

On Monday of this week, the FEHBlog carefully was reading through Division BB of the Consolidated Appropriations Act 2021, Pub. L. No.  116-260, and he discovered to his great surprise that the new law adds a new subsection 8902(p) to the FEHB Act. Division BB, Section 102(d)(1) found at page 1616 of the enrolled bill version of H.R. 133.

The FEHBlog was surprised because Division BB like virtually every federal healthcare mandate for the past 25 to 30 years has taken the shortcut of reaching all health plans and providers by amending the Public Health Service Act (“PHSA”), ERISA, and the Internal Revenue. However, in two laws passed in 2020, the CARES Act and Division BB, Congress expressly has amended the FEHB Act too.

This new FEHBA Section 8902(p) applies the No Surprises Act and a patient rights provision (Public Health Service Act (“PHSA”) Section 2799A-1,-2, -7)) contractually to FEHB plan carriers and statutorily to the health care providers who serve FEHB plan members. This means that several of the Division BB provisions about which the FEHBlog has expressed concern, e.g. the continuity of care provision (PHSA Section 2799A-3) and the provider directory provision (PHSA Section 2799A-5) do not apply to FEHB plans. You may recall that the FEHBlog expressed concern about the continuity of care provision because the FEHBP has offered transitional care to it members for over 20 years. Why upset the apple cart?

In any event, the No Surprises law will be a real bear to implement and administer. What’s more, Becker’s Hospital News reports that “The arbitration system implemented by New Jersey in 2018 to resolve surprise billing disputes between insurers and out-of-network providers is advantageous to hospitals and other providers, according to a study published Jan. 5 in Health Affairs.”

1. The authors found that providers won 59 percent of arbitration decisions, and health plans won in 41 percent of decisions in the study period.

2. The average arbitration awards were considerably higher than typical in-network payment amounts. The average award was $7,222. This payment award is nine times higher than the median in-network price for the rendered service.

The FEHBlog was intrigued to read this morning about Optum’s acquisition of one of the largest healthcare clearinghouses in the country, Change Healthcare. Assuming timely shareholder and regulatory approvals, the deal is expected to close in the second half of this year. Interestingly, “Neil de Crescenzo, President and CEO of Change Healthcare * * * will serve as OptumInsight’s chief executive officer, leading the combined organization.”

Becker’s Hospital Review lists fourteen health systems with strong balance sheets. Becker’s cautions that “This is not an exhaustive list. Hospital and health system names were compiled from credit rating reports and are listed in alphabetical order.” Nevertheless it’s worth a gander.

The Department of Health and Human Services announced today the launch of

the HPV VAX NOW campaign with the long-term goal of increasing human papillomavirus (HPV) vaccination rates among young adults ages 18–26. The campaign will specifically target young adults and healthcare providers in Mississippi, South Carolina, and Texas — states with some of the lowest HPV vaccination rates in the country.

Currently, fewer than half of young adults in the United States have received one or more doses of the HPV vaccine, and only 22% have completed the vaccine series. According to the Centers for Disease Control and Prevention (CDC), HPV causes nearly 36,000 cases of cancer in men and women each year in the U.S.  

HPV VAX NOW aligns with the OASH immunization “Catch-up to Get Ahead” campaign as part of HHS’ efforts to improve vaccination uptake in the United States. “With the increased awareness of vaccination opportunities that HHS has prioritized during the COVID pandemic, now is an important time for young adults to complete their HPV vaccine series.” said Dorothy Fink, M.D., Deputy Assistant Secretary for Women’s Health.

The HPV VAX NOW campaign is launching during Cervical Cancer Awareness Month, bringing attention to one of the six cancers and pre-cancerous cervical lesions that the HPV vaccine prevents.

The federal government’s Cybersecurity and Infrastructure Security Agency released a joint statement yesterday from the FBI, CISA, the Office of the National Intelligence Director and the National Security Agency about the status of their work on investigating and remediating the SolarWinds backdoor hack. The statement explains each agency’s role in this work.

Tuesday Tidbits

David Ermer–ACA, COVID-19, COVID-19 vaccine, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

STAT News reports that “Nancy Messonnier, a top federal health official involved in the distribution of Covid-19 vaccines, predicted on Tuesday [in an interview with STAT] that delays in the administration of the shots would improve soon.” (On the bright side, the CDC has begun to update its COVID-19 vaccinations site daily. Around 275,000 initial doses were administered yesterday.) Furthermore

During the discussion Tuesday, Messonnier said she hoped the supply of vaccine would expand greatly in the spring, a time when the shots could be made more widely available to the general public, not just people with certain jobs or health conditions. But making the vaccine is only one step: successfully inoculating the vast majority of the population will require major efforts to educate the public, to build out accessible sites where people can easily get vaccinated, and to ensure individual people show up when it’s their turn to get the shot.

Health Payer Intelligence updates on how three large payers “extended temporary COVID-19 benefits in 2021.” Technically the COVID-19 public health emergency period expires on January 21, 2021, but unquestionably the federal government will extend that period for another 90 days before then.

Under the Affordable Care Act, effective January 1, U.S. Preventive Services Task Force A and B recommendations made two years earlier become eligible for health plan in-network coverage with no member cost-sharing. If you pick out from the USPSTF list those recommendations that received an A or B grade in 2019, you will find ten recommendations that are eligible for “no additional cost” coverage in 2021. Fierce Healthcare provides insights into how health plan members can take advantage of one of those 2019 recommendations -“The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition.”

On the OPM front, Federal News Network lets us know that

Federal employees who forfeited vacation time in excess of the usual annual leave carryover limit at the end of 2020 may be able to get some of those days back for use later this year, thanks to a policy in the new annual defense authorization law. The Office of Personnel Management on Tuesday issued detailed guidance covering the new annual leave policy and instructed agencies to implement it.

On the mergers and acquisitions front —

  • Fierce Healthcare reports that “Harvard Pilgrim Health Care and Tufts Health Plan officially combined Jan. 1. The deal, announced in August 2019, comes about a decade after the organizations attempted to merge in 2011. * * * The combined Massachusetts organization will serve 2.4 million members. Both the Tufts and Harvard Pilgrim brands will be in the market for a period of time, the organizations said.”
  • Healthcare Dive reports that health insurer “Centene has entered into a definitive agreement to acquire Phoenix, Arizona-based Magellan Health for $2.2 billion, or $95 per share, the payer said Monday. Magellan will operate independently under the Centene umbrella. Executives said the combination will result in one of the nation’s largest behavioral health platforms as the two will provide behavioral services to about 41 million members in the U.S. The deal also boosts Centene’s already established footprint in government sponsored health plans with the addition of 5.5 million lives and another 2.2 million to add to its pharmacy benefit management platform.

Monday Roundup

David Ermer–COVID-19, COVID-19 vaccine, OPM, Rx coverage, U.S. Healthcare, Uncategorized–
Photo by Sven Read on Unsplash

Govexec.com provides an update on COVID-19 vaccine administration by federal agencies to their employees. A friend of the FEHBlog asked him today whether he knew how long it took for a COVID-19 to provide protection following the injection. Good question. The New York Times reported last week that “The protective effects of vaccines are known to take at least a couple of weeks to kick in.” To wit,

Data from Pfizer’s clinical trials suggests the vaccine might start safeguarding its recipients from disease around one or two weeks after the first injection. A second jab of mRNA, delivered three weeks after the first, helps immune cells commit the virus’s most prominent features to memory, clinching the protective process.

Biopharma Dive reports that “AbbVie raised the list prices of many of its drugs on Jan. 1, while Biogen hiked the price tag of its old multiple sclerosis treatment Tysabri, part of broad, sector-wide increases typically taken at the start of a new year. The hikes could feature in calls for drug pricing legislation as a new Congress and new administration begin work.” Timing is everything.

Here a few loose ends that have been tied up.

  • According to Healthcare Dive, “Haven, the high-profile, secretive venture to lower healthcare costs backed by Amazon, J.P. Morgan and Berkshire Hathaway, is suspending operations in February after three years, the company announced Monday. Haven caused waves when launched in 2018, with a lineup of notable hires from within the healthcare industry. However, the nonprofit, independent company is now closing with little concrete to show, hinting at the difficulty of reforming the complex insurance system and curbing rising costs in the deeply entrenched healthcare industry. Haven said in a statement on its website that Amazon, J.P. Morgan and Berkshire Hathaway would use the information it gained moving forward and continue working to create programs addressing the health needs of their combined 1.2 million employees. Shares of major U.S. insurers got a bump in Monday trading following the news, with UnitedHealthcare and Humana each climbing more than 2% since noon.”
  • According to Fierce Healthcare, “New York Life completed its acquisition of Cigna’s group life, accident and disability insurance businesses in a deal valued at $6.3 billion.” Cigna like CVS Health / Aetna has decided to focus its attention on healthcare.
  • Congress.gov reported today that the Senate has returned to the President his nomination of Craig Leen to be OPM Inspector General because the Senate failed to act on the nomination during the 116th Congress. The President may renew the nomination for the 117th Congress.

Thinking about the OPM Inspector General caused the FEHBlog to check to see whether the latest OPM Inspector General semi-annual report to Congress (period ended September 30, 2020) is online and by golly it has been posted right here. The lead article in the report discusses the impact of the COVID-19 public health emergency on the FEHBP. The management response to the Inspector General’s report is available here.

Weekend Update

David Ermer–Uncategorized–

The 117th U.S. Congress convened today, and Rep. Nancy Pelosi (D Calif.) was re-elected Speaker of the House. The Wall Street Journal reports that “Democrats expect to have 222 seats to Republicans’ 211.” Party leadership in the Senate hinges on the two special elections that will be held in Georgia on January 5.

The federal mandate for health plans to cover the Moderna COVID-19 vaccine begins today. According to the CDC as of yesterday at 9 am ET, 13,071,925 doses of the Pfizer-BioNTech and Moderna vaccines have been distributed across the U.S. and 4,225,756 initial doses of those vaccines have been administered.

Turning back to the Affordable Care Act amendments included in Division BB of the Consolidated Appropriations Act, 2021, that require health plan attention in order to implement then for 2022:

  • Section 107 requires health plan identification cards to include the following information:

‘‘(1) Any deductible applicable to such plan or coverage.

‘‘(2) Any out-of-pocket maximum limitation applicable to such plan or coverage.

‘‘(3) A telephone number and Internet website address through which such individual may seek consumer assistance information, such as information related to hospitals and urgent care facilities that have in effect a contractual relationship with such plan or coverage for furnishing items and services under such plan or coverage’’.

  • Section 116 creates new requirements on health plan network provider directories and holds health plans and providers liable to consumers/ patients liable for errors in those directories, although the provider may shift certain aspects of that liability to the health plan in the network contract.

There is one requirement in the new law (relating to mental heath parity) that takes effect on February 9, 2021. The section requires specific comparative analyses to demonstrate health plan compliance with the most complicated provision of the federal mental health parity law, non-quantitative treatment limitations, e.g, medical necessity, pre-authorization. Here is a link to the most recent federal government FAQs on NQTLs.

Section 203 of Division B states

In the case of a group health plan or a health insurance issuer offering group or individual health insurance coverage that provides both medical and surgical benefits and mental health or substance use disorder benefits and that imposes nonquantitative treatment limitations (referred to in this section as ‘NQTLs’) on mental health or substance use disorder benefits, such plan or issuer shall perform and document comparative analyses of the design and application of NQTLs and, beginning 45 days after the date of enactment of the Consolidated Appropriations Act, 2021, make available * * * the Secretary of Health and Human Services [FEHBlog note edited for the FEHBP], upon request, the comparative analyses and the following information:

‘‘(i) The specific plan or coverage terms or other relevant terms regarding the NQTLs and a description of all mental health or substance use disorder and medical or surgical benefits to which each such term applies in each respective benefits classification.

‘‘(ii) The factors used to determine that the NQTLs will apply to mental health or substance use disorder benefits and medical or surgical benefits.

‘‘(iii) The evidentiary standards used for the factors identified in clause (ii), when applicable, provided that every factor shall be defined, and any other source or evidence relied upon to design and apply the NQTLs to mental health or substance use disorder benefits and medical or surgical benefits.

‘‘(iv) The comparative analyses demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to mental health or substance use disorder benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical or surgical benefits in the benefits classification.

‘‘(v) The specific findings and conclusions reached by the group health plan or health insurance issuer with respect to the health insurance coverage, including any results of the analyses described in this subparagraph that indicate that the plan or coverage is or is not in compliance with this section.

The law permits that Secretary of HHS to use the comparative analyses for investigative purposes when a mental health parity compliance complaint has been made against the health plan.

Saturday Stats and More

David Ermer–Congress, COVID-19, COVID-19 vaccine, OPM, U.S. Healthcare–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th through 52nd weeks of this year (beginning April 2 and ending December 30; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noted that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2 through December 30):

The CDC’s COVID-19 Vaccine tracker has not been updated since last Wednesday morning At that time roughly 2.8 million initial doses had been administered. The American Hospital Association and the American Medical Association have posted helpful information about the currently available COVID-19 vaccines. The Food and Drug Administration offers a comprehensive year end report.

The CDC’s FluView continues to report that “Seasonal influenza activity in the United States remains lower than usual for this time of year.”

The FEHBlog took a look at a couple of the hospital chain websites and could not find the price information required by the HHS hospital price transparency rule. However, FEP Blue, the largest FEHB plan, announced the availability of their FEP Cost Advisor Tool.

Today is the last day of the 116th Congress. The Wall Street Journal informs us that among the provisions in the Consolidated Appropriations Act, 2021, is the following

Flexible spending accounts. Many workers with FSAs that allow them to use pretax dollars to pay for unreimbursed health expenses (like glasses) or dependent-care expenses (like summer camp) didn’t use all the money in their 2020 accounts because of the pandemic. The IRS had limited ability to ease FSA rules, but Congress has now done so. 

Participants in such plans can carry over unused funds from 2020 to 2021 and 2021 to 2022, or for up to 12 months for companies with fiscal years. For dependent-care accounts, the law extends the age limit from 12 to 13 for some carried-over funds. For workers to take advantage of these changes, company plans must often opt into the new rules.

OPM typically does adopt such changes for FSAFeds.

Federal News Network reports that yesterday the Senate joined the House of Representatives in overriding the President’s veto of the FY 2021 National Defense Authorization Act. The Senate did not join the House in approving a $2000 direct stipend COVID relief proposal.

Federal News Network also reports that

With hours to spare before the new year, President Donald Trump signed an executive order Thursday night implementing a federal pay raise for civilian employees and military members in 2021. Civilian employees will receive a 1% across-the-board federal pay raise in 2021. There are no additional locality pay adjustments this year.