FEHBlog

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.

The FEHBlog appreciates the fact which he learned from govexec.com that federal and postal employees and annuitants are thankful for their FEHB plans. A recent Morning Consult survey of 500 federal employees and annuitants found that

• FEHB participants are very satisfied with their coverage — the FEHB program has an extremely high satisfaction Respondents who are satisfied with their health care coverage is 99% (39% extremely, 45% very, 14% somewhat satisfied). Merely 1% of all respondents rate themselves as either “not very” or “not at all” satisfied with their coverage.
• FEHB participants are highly satisfied with the broad choices available in their health plans— Overall satisfaction with the number of health plan options is at 97%, with 80% of FEHB participants being extremely or very
• Participants also see high value from their FEHB plans — not a single respondent rates themselves “not at all satisfied” with regard to the value of their plan through Overall, 96% express some level of satisfaction, and 74% rate themselves in the top two categories of “extremely” or “very” satisfied.

Congress will be off this week for Thanksgiving. Here’s a link to what happened last week up on Capitol Hill. The continuing resolution funding the federal government expires on December 11.

We are entering our third week of the Federal Benefits Open Season. Open Season ends on December 8. FedSmith writes at length about the ACA’s Cadillac tax which takes effect in 2018 following the next Presidential election. The Cadillac tax is a 40% excise tax imposed on the sum of health plan premiums, flexible spending account contributions, and a couple other things in excess of a threshold. The only thing predictable about the Cadillac tax is that if it is not repealed (which the FEHBlog expects) then employers will convert health care flexible spending accounts into limited dental and vision flexible spending accounts.

The FEHBlog read on Politico Pulse late last week that

WHAT DEFINES A STATE-BASED EXCHANGE? — That’s a pressing question, now that the Supreme Court could potentially block insurance subsidies to non-state-based exchanges in King v. Burwell. This week, concerned state insurance regulators asked CMS Administrator Marilyn Tavenner how a state-based exchange should be defined, but, according to a spokesman, Tavenner “expressed that there is no need to make changes to the law.” The Obama administration has said it’s confident that the lawsuit before SCOTUS won’t succeed next year and that subsidies will be allowed to continue flowing through both types of exchanges.

Consequently, it appears that the Administration does not play to gracefully avoid the Supreme Court decision by negotiating ACA amendments including one that makes it clear that subsidies can be paid on federal exchanges or marketplaces.

The Health and Human Services Department issued a proposed notice of benefits and payments parameters for 2016. Here is a link to a helpful Health Affairs blog summary of the proposed changes in this massive annual rule. As the Health Affairs blog entry indicates, the Internal Revenue Service not to be outdone issued several rules related to the individual shared responsibility mandate. The fun never stops.

The Federal Benefits Open Season keeps chugging along. The Federal Times offers a lengthy interview with FEHBP Expert Walt Francis. Govexec,com offers a brief interview with the FEHBlog. You choose (or read both).

The Office of Personnel Management today released a proposed rule on its Multi State Program. The MSP offers OPM approved health plans in the ACA marketplaces.

The Mercer consulting firm released the results of its own national survey of large employers regarding health coverage practices. The upshot – even broader use of high deductible, consumer directed plans.

Most employers still offer a CDHP as a choice alongside a traditional PPO or HMO. Just 7% of all large employers, and 11% of jumbo employers, offered a CDHP as the only plan available to employees at their largest worksite in 2014.  While this practice may become more common – 18% of large employers say it’s likely they will offer a CDHP as a full replacement within the next three years – for now it remains the exception 

Of course the status quo is the way the FEHBP operates.

At the recent WEDI conference on privacy and security that the FEHBlog attended last month, speakers emphasized the importance of encrypting computers, particularly mobile devices and PCs used at home. The FEHBlog appreciated the speakers’ common rationale that if an unencrypted computer is stolen from or lost by a HIPAA covered entity or business associate, it’s difficult to prove the negative that no protected health information was contained on the stolen or lost device’s hard drive. The enforcers will assume a breach of unsecured protected health information. Therefore encrypt. Here then is a chilling article from Government Health IT about a the theft of an encrypted cell phone and laptop from a hospital staff member. The thieves demanded and received the passwords from the victim. Ergo, loss of the HIPAA safeguard. Nothing is foolproof.

Finally, here’s a link to a sensible Fierce Healthcare article on how hospitals can avoid unnecessary readmissions. The article illustrates why avoiding readmissions is a hospital management issue. Health plans can help management to reduce premature discharges (which lead to readmissions) with sensible utilization review programs.

Following up on the weekend post, OPM postponed its Google hangout on Open Season topics one week to Monday, November 24th from 11:00 AM to noon EST.

OPM has released its FY 2014 financial report. You can find some interesting FEHB tidbits by searching for FEHB when you open the document in Adobe Acrobat. If there were any earth shattering items, the FEHBlog would have mentioned them.

The Senate Homeland Security and Governmental Affairs Committee held a confirmation hearing yesterday for the President’s nominee for OPM Deputy Director, Retired Navy Read Admiral Earl L. Gay. Here’s a link to the hearing on the Committee’s website.

In other Congressional News, the House of Representatives Republic Caucus named Rep. Jason Chaffetz (R Utah) as chair of the House Oversight & Government Reform Committee which has oversight responsibility over our beloved FEHBP. Mr. Chaffetz succeeds Rep. Darrell Issa (R Calif) who had reached his chairmanship term limit. Federal News Radio highlights this and other House chair changes. The other significant change is that Rep. Paul Ryan (R Wisc.) will take the helm of the powerful Ways and Means Committee.

The FEHBlog was overjoyed to read in Modern Healthcare that the eHealth Initiative, which includes the American Medical Association, BCBSA, and United Healthcare, among others, has developed a private sector roadmap to connect disparate electronic medical record systems.

Efforts to encourage greater IT use would need to include a boost from private health plans, said Dr. Sam Ho, chief medical officer for UnitedHealthcare. New value-based payment models will inevitably encourage sharing and collaboration, Ho said, which will in turn encourage increased technology adoption and interoperability.
The insurers in the eHealth Initiative are specifically considering including extra payments for technology adoption, including electronic data transfer and collaborative care plans. “Really this is about what the private sector can do to take health IT to a new level,” Ho said. “It needs to help doctors help practice more consistent, more evidence-based medicine.”
The group’s road map would reach technologies and healthcare professionals not covered by meaningful use. John Glaser, CEO of health services at Siemens Healthcare, noted that meaningful use did not include many types of professionals, such as behavioral health providers. Nor does it cover many types of technologies, and there should be an increased emphasis on connected devices like sensors, Glaser said. 

Interoperability will solve a lot of problems that health plans — other than integrated plans like Kaiser — currently face in collecting quality information from health care providers.

Speaking of healthcare quality, Healthdata Management reports that

Based on 2013 data, an annual report from the Joint Commission on hospitals’ performance to increase the safety and quality of care finds 1,224 hospitals were top performers in 2014. That is an 11 percent increase from last year

That’s certainly good news.

And here are a few more tidbits:

• NPR explains why reports of a looming national shortage of doctors may be overblown. 
• Drug Channels reports that retail generic drug price inflation “is alive and well.”
• HHS and the National Institutes of Health are taking regulatory steps to improve the transparency of clinical trials results. 

The lame duck session of Congress continues. Here is a link to the Week in Congress that looks a week back and a link to the Hill that looks week forward.

The Federal Benefits Open Season continues this week. OPM is holding a Google hangout tomorrow afternoon. The Federal Times is  holding its own Open Season webcast on Wednesday at noon. Of course, federal agencies have been holding Open Season events for their employees and annuitants since last month.

HHS extended the deadline for contributing entities, including FEHB plans, to submit their headcounts and banking information for ACA transitional reinsurance fee purposes from last Saturday until December 5. The FEHBlog understand that the pay.gov site which processes this information has been a little troublesome to users/

Mark the tape. On October 9, 2014, the FEHBlog noted that an error in the Postal employee contribution chart that significantly overstated 2015 premium increases. Yesterday, Govexec.com caught up with the FEHBlog in this article.

[Postal Service] Bargaining-unit employees will pay an average of just 1 percent more
toward their insurance premiums, according to a USPS spokeswoman, while
non-bargaining workers will typically see a 3 percent increase. The
overall average premium increase will be 3.4 percent.

That;s lower than the average increase for civil service employees. As a side note, the Federal Times reports today that Postmaster General Patrick Donahoe will be retiring on February 1, 2015. USPS Chief Operating Officer Megan Brennan will be his successor.

Earlier this week, OPM announced that it will be increasing the health care flexible spending account limit from $2500 to $2550 for 2015.

Also this month, OPM submitted a couple of proposed FEHBP rules to the Office of Management and Budget for its final review before those rule officially are published in the Federal Register

AGENCY: OPM RIN: 3206-AN08
TITLE: Federal Employees Health Benefits Program Self Plus One Enrollment Type [which takes effect in 2016]
STAGE: Proposed Rule ECONOMICALLY SIGNIFICANT: No
RECEIVED DATE: 11/05/2014 LEGAL DEADLINE: None

AGENCY: OPM RIN: 3206-AN07
TITLE: Federal Employees Health Benefits Program: Enrollment Options Following the Termination of a Plan or Plan Option
STAGE: Proposed Rule ECONOMICALLY SIGNIFICANT: No
RECEIVED DATE: 11/06/2014 LEGAL DEADLINE: None

The FEHBlog still does not find on reginfo.gov an anticipated proposed HHS rule implementing the Affordable Care Acts’ anti-discrimination in coverage rule (PHSA § 1557). Nevertheless HHS’s Office for Civil Rights is accepting consumer complaints under that law. Recently, according to the New York Times, health insurer Cigna  has “agreed to reduce the out-of-pocket costs that patients in Florida must pay for H.I.V. drugs [in Cigna’s health insurance marketplaces plans beginning in 2015], settling a [Section 1557] complaint filed by advocacy groups, who said the drug pricing system in the state’s health care plans was discriminatory.

Finally, the actuarial consulting firm Aon Hewitt released a survey of U.S. employers concluding that health care plan costs will continue on an upward trend in 2015. No surprise there.

Congress started its lame duck session today. Federal News Radio’s article helpfully reviews the list of tasks for the lame duck session which of course leads with addressing the continuing resolution funding the federal government which expires on December 11.  In the lame duck session following the Democrat’s takeover of Congress following the 2006 election, Congress did enact a healthcare law which improved the rules for high deductible health plans with health savings accounts. The FEHBlog thought that in view of the Supreme Court’s decision to hear the ACA subsidy case and this recent precedent, Congress would take a crack at fixing this issue pending before the high court and other problems created by the ACA in the lame duck session. We’ll see but the FEHBlog no longer is holding his breath. This type of legislative activity may occur in the next session of Congress.

On Monday, AHIP released information on the value of provider networks which carriers can share with Plan members.

Finally, Fierce Healthcare offers four reasons to be optimistic about the U.S. healthcare system.

We have a big week ahead of us. The Federal Benefits Open Season starts tomorrow and will end on December 8. It will be interesting to see how many temporary, seasonal, and intermittent employees sign up for FEHBP coverage as a result of OPM’s rule implementing the ACA’s employer shared responsibility mandate.

Congress returns on Wednesday for its lame duck session. The continuing resolution funding the federal government expires on December 11.

The ACA health insurance marketplace open enrollment period begins on November 15 and runs until February 15, 2015. So we should hear alot about ACA premium changes this week. Last week, the ACA regulators issued FAQ XXII which puts the kibosh on tax free employer funding of employee coverage in the ACA marketplaces. Pre-ACA marketplace the IRS condoned the common practice of employers reimbursing their employees for individual health insurance premiums on a pre-tax basis. No more.  

The Wall Street Journal reported last week that the big prescription benefit manager (“PBM”) Express Scripts is considering ripping a page out of its major competitor CVS Health’s playbook by offering a no-sin pharmacy network. Express Scripts is considering creating a network of pharmacies that don’t sell tobacco or alcoholic beverages. The CVS no-sin network consists of pharmacies like CVS Health that don’t sell tobacco. Before long you won’t be able to buy a Twinkie at a pharmacy. But after all most sin product sales occur at the gas and liquor stores.

On a related note, the Motley Fool brings us up to date on the third large PBM Catamaran which is not quite in same league as CVS Health and Express Scripts but presumably it tries harder.

Finally the FEHBlog found good and bad news on efforts to solve the hospital readmission problem. Let’s start with the bad but not surprising news. Fierce Healthcare reported on an American Journal of Managed Care report concluding that hospitals cannot control the problem without primary care provider cooperation.

Researchers, led by Ariel Linden of the University of Michigan School of Public Health, analyzed more than 500 patients in two Oregon community hospitals. They gave half the patients an intervention featuring pre-discharge education and planning, post-discharge follow-up, an available hotline and “bridging” techniques such as daily symptom checks. Linden and his coauthor, Susan W. Butterworth, Ph.D., found no statistical difference in readmissions between the two groups after both 30-day and 90-day periods, although mortality was lower in the intervention group than the control group.

Neither of these hospitals could compel PCP cooperation with the intervention group and very little PCP cooperation with offered. How can a health plan help with this mess? The second Fierce Healthcare article offered some light at the end of this tunnel.

One extra day in the hospital cuts costs and significantly reduces the chance of the need to readmit Medicare patients within 30 days, a new study from Columbia Business School found.  That extra day slashed the risk of death for patients treated for pneumonia by 22 percent. Mortality for heart attack patients was cut by 7 percent, as were readmission rates, according to an announcement detailing the findings