FEHBlog

HHS has proposed requiring HIPAA covered entities to implement the new X12 5010 transaction standards on April 1, 2010 and the ICD-10 code sets on October 1, 2011. The comment period ends next Tuesday April 21. A broad coalition of industry members advocate adoption of the stretched out timeline recommended by two HHS advisors, NCVHS and WEDI.

The ICD-10 Coalition which is composed of the AMA and other health care provider associations has released a Nachimson Advisors report that finds that

• For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $83,290.
• For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $285,195
• For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as more than $2.7 million.

Accelerating the change will only increase the impact of the cost burden on providers and payors and could lead to a systemic meltdown as BCBSA has warned.

Healthcare IT News reports today that the CMS administrator gave Zen-like advice on this major issue:

“Be serious about the date.”
That’s the advice of Centers for Medicare and Medicaid Service Acting Administrator Kerry Weems, when asked Tuesday about how CMS could help drive the conversion of healthcare diagnostic and billing codes from ICD-9 to ICD-10 code sets.

• 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.

Govexec.com provides advice on the upcoming FEHBP Open Season here.

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. 

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.

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.

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.