Monday Roundup

Monday Roundup

Photo by Sven Read on Unsplash

From Capitol Hill, the Wall Street Journal reports that the Senate failed to override a filibuster (requiring 60 votes) on a House of Representatives bill including stop gap federal government funding from October 1, 2021, the beginning of the new federal fiscal year, and December 3, 2021.

While lawmakers in both parties negotiated the short-term government funding, Republicans voted against Monday’s procedural motion in a bid to force Democrats to address the debt limit themselves. With 48 in favor and 50 opposed, the legislation fell short of the 60 votes required to advance in the evenly split chamber. * * *

The failure of the procedural vote Monday could prompt Democrats to decouple the short-term spending measure and the debt-limit vote. House Speaker Nancy Pelosi (D., Calif.) suggested last week that Democrats would do so, saying that Congress would pass a stopgap spending measure before the end of the month to keep the government funded.

We shall see.

From the Delta variant front, the New York Times reports that

At the drugstore, a rapid Covid test usually costs less than $20.

Across the country, over a dozen testing sites owned by the start-up company GS Labs regularly bill $380.

There’s a reason they can. When Congress tried to ensure that Americans wouldn’t have to pay for coronavirus testing, it required insurers to pay certain laboratories whatever “cash price” they listed online for the tests, with no limit on what that might be.

GS Labs’s high prices and growing presence — it has performed a half-million rapid tests since the pandemic’s start, and still runs thousands daily — show how the government’s longstanding reluctance to play a role in health prices has hampered its attempt to protect consumers. As a result, Americans could ultimately pay some of the cost of expensive coronavirus tests in the form of higher insurance premiums.

Many health insurers have refused to pay GS Labs’ fees, some contending that the laboratory is price-gouging during a public health crisis. A Blue Cross plan in Missouri has sued GS Labs over its prices, seeking a ruling that would void $10.9 million in outstanding claims.

The FEHBlog disagrees with the journalist’s statement that the government is reluctant to play a role in healthcare prices, see the No Surprises Act, most recently. The FEHBlog further disagrees that the law forces carriers to pay a facially unreasonable price given the web of laws over fraud, waste, and abuse. Certainly though Congress can and should fix this problem its own.

Also Fierce Healthcare informs us that

As schools and businesses weigh their options for tracking COVID-19 cases, UnitedHealth Group’s researchers have developed an online calculator tool these organizations can use to game out potential testing programs.

The free tool allows users to simulate the financial cost as well as the likely number of false positives for several different testing options and frequencies.

For example, if a school in a low-spread area wants to model the cost associated with administering weekly polymerase chain reaction tests, they can input that information to see an estimated per person expense as well as the likely number of infections in a 100-day window.

Cool. This tool also could be useful to project the cost of the vaccination screen program planned for businesses with 100 or more employees.

From the health savings account front, HR Dive tells us that

  • The average individual contribution to health savings accounts fell between 2019 and 2020, while average annual distributions fell to an “all-time low” last year, according to an Employee Benefit Research Institute report published this month.
  • Both trends may have been driven by the pandemic in some way, EBRI said. HSA owners may have reduced contributions as unemployment increased last year, while the decline in both contributions and distributions may have been due to decreased use of healthcare services.
  • HSA owners primarily appear to use their accounts to cover current expenses instead of making contributions in preparation for retirement healthcare expenses, EBRI said. The organization also noted that the average HSA contribution was less than half the maximum allowable contribution for family coverage.

Monday Roundup

Photo by Sven Read on Unsplash

The Hill provides us with the latest on everything that is currently on Congress’s full plate of issues.

From the Delta variant front, the New York Times reports that

The Pfizer-BioNTech coronavirus vaccine has been shown to be safe and highly effective in young children aged 5 to 11 years, the companies announced early Monday morning.

Pfizer and BioNTech plan to apply to the Food and Drug Administration by the end of September for authorization to use the vaccine in these children. If the regulatory review goes as smoothly as it did for older children and adults — it took roughly a month — millions of elementary school students could begin to receive shots around Halloween.

Trial results for children younger than 5 are not expected till the fourth quarter of this year at the earliest, according to Dr. Bill Gruber, a senior vice president at Pfizer and a pediatrician. Results from Moderna’s vaccine trials in children under 12 are also expected around that time, said Dr. Paul Burton, the company’s chief medical officer.

From the M&A front, HCA Healthcare, one of the largest healthcare systems in the U.S., announced this evening that

the signing of a definitive agreement for HCA Healthcare to acquire the operations of Steward Health Care’s five Utah hospitals. HCA Healthcare also entered into an agreement to lease the related real estate from its owner following the expected closing. The hospitals will become part of HCA Healthcare’s Mountain Division, which includes 11 hospitals in Utah, Idaho and Alaska. * * *

Steward Health Care also operates hospitals in Arizona, Texas, Arkansas, Louisiana, Florida, Ohio, Pennsylvania, and Massachusetts. The sale of these facilities to HCA Healthcare will enhance Steward Health Care’s ability to continue growing and reinvesting in other states and locations served by the health system.

Evidently HCA plans to give Intermountain some competition in Utah.

Employee Benefit News offers expert opinions on the pros and cons of healthcare savings account which can only be funded when the individual is enrolled in a high deductible health plan.

From the human resources front

  • The Federal Times informs us that “‘The Office of Personnel Management will temporarily drop several geographic restrictions associated with special hiring authorities for military spouses, according to a regulation published in the Federal Register Sept. 20. * * * ‘It removes limitations — such as a relocation requirement, geographic restrictions, and arbitrary quotas — which caused this authority to be underused until now,’ wrote Rob Shriver, associate director of employee services at OPM, in a Medium blog post. ‘As a result, this new regulation means more military spouses can find their place in the federal workforce, and federal agencies have a larger talent pool of highly-qualified people to hire from.'” The FEHBlog was not aware that OPM has a Medium website.
  • HR Dive reports on the recent Society for Human Resources Management annual conference. The article focuses on a give and take between EEOC commissioners and attendees about vaccination mandates and EEO-1 reporting among other issues.

President names an OPM Inspector General nominee

OPM Headquarters a/k/a the Theodore Roosevelt Building

The Washington Post reports that

President Biden on Thursday made a nomination to fill the long-vacant position of inspector general at the Office of Personnel Management, a watchdog office that has at times publicly clashed with top management of the federal agency.

Nominee Krista Boyd is chief counsel for oversight and policy on the House Oversight and Reform Committee, which oversees federal workplace matters. Boyd has worked on Capitol Hill for more than two decades with a focus on issues including whistleblower protection, transparency and strengthening the access to agency information for inspectors general and other watchdogs, an announcement said.

Ms. Boyd’s nomination is subject to Senate confirmation.

On the Delta variant front, Govexec.com informs us that

The Biden administration released new guidance on Thursday about implementing the COVID-19 vaccine mandate for federal employees, which says even those on telework or remote work must get vaccinated. 

The guidance implements an executive order President Biden issued on September 9 requiring federal employees to get vaccinated against the novel coronavirus, unless they request an exemption. The Safer Federal Workforce Task Force said on Monday that November 22 is the deadline for employees to get fully vaccinated or possibly be subject to progressive discipline. * * *

Postal Service employees are not covered by the mandate, but they will be subject to the forthcoming emergency temporary standard from the Occupational Safety and Health Administration (OSHA) that will require vaccines for companies with 100 or more employees, the senior administration official pointed out. That was another coronavirus measure the president unveiled last week. 

“Our workplaces are subject to regulations from the Occupational Safety and Health Administration,” USPS said in a statement on Thursday. “Therefore, we are working closely with our union leadership so that once OSHA’s COVID-19 Vaccination Emergency Temporary Standard is issued we can move quickly to determine its applicability to our employees and how best to implement [it].” * * *

Other topics covered in the update are: who is considered fully vaccinated and the timeline for getting fully vaccinated (depending on which vaccine individuals receive); vaccination dates for those who are starting government service after November 22; what protocols employees should follow before becoming fully vaccinated; and how agencies should collect and maintain documentation of vaccination for employees. Agencies must collection documentation even if employees previously attested to being vaccinated. 

The Society for Human Resource Management discusses what to expect from OSHA on the vaccination screening program it is developing for private employers with more than 100 employees.

In mergers and acquisitions news, the Deseret News reports that

Intermountain Healthcare announced Thursday that the organization is merging with SCL Health, a faith-based, nonprofit health care organization based in Colorado.

The two organizations are located in adjacent areas with no geographic overlap, so together they will employ more than 58,000 caregivers, operate 33 hospitals and run 385 clinics across Utah, Idaho, Nevada, Colorado, Montana and Kansas.

SCL Health is a $2.8 billion health network that provides comprehensive, coordinated care in hospitals, clinics, home health, hospice and mental health services across Colorado, Montana and Kansas. It brings eight hospitals and more than 160 physician clinics into the merger. Their hospitals will retain their names and their Catholic identity, directives and values.

The merger, which is subject to regulatory approval, is expected to close early next year.

From the studies front —

  • The Centers for Disease Control released updated adult obesity prevalence maps for the U.S. yesterday.
  • The Employee Benefits Research Institute is offering an issues brief on trends in health savings account balances, contributions, distributions and investments and the impact of COVID-19 thereon.

From the reminders front, Fedweek explains the “five year rule” for continuing FEHB and FEGLI coverage into a civil service retirement.

As a rule, you can only continue your FEHB and/or FEGLI coverage into retirement if you are 1) currently enrolled, 2) have been enrolled for at least five years or from your earliest opportunity to enroll, and 3) are retiring on an immediate annuity (including disability).

Further, if you are a FERS employee who is retiring on an immediate annuity but postponing its receipt to a later date to reduce or eliminate the 5 percent per year penalty for retiring under the MRA+10 provision (minimum retirement age—currently 57—with at least 10 but less than 30 years of service), you’ll be able to reenroll in the FEHB program when your annuity begins. Note: If you leave government before being eligible to retire and later apply for a deferred annuity when you have the right combination of age and service, you can’t reenroll in either program.

While there is an automatic waiver of the FEHB five-year rule if you are accepting an offer of early retirement from your agency, no waiver is possible for FEGLI. Nor are waivers of the “currently enrolled” or “retiring on an immediate annuity” requirements available under current law for either program.

Monday Roundup

Photo by Sven Read on Unsplash

From Capitol Hill, Roll Call reports that

Speaker Nancy Pelosi floated a compromise to moderate holdouts Monday that would advance the budget resolution needed to unlock a $3.5 trillion package of aid to families, students and clean energy subsidies in exchange for a guaranteed vote on a separate, $550 billion infrastructure package.

The plan would “deem” the fiscal 2022 budget resolution adopted when the chamber adopts the combined rule for floor debate on the Senate-passed infrastructure bill and voting rights legislation. Pelosi, D-Calif., also committed to a floor vote on the infrastructure bill before Oct. 1, when current surface transportation program authorizations lapse.

The House of Representatives convened at 5 pm ET this evening and went into a recess at 5:30 pm ET for a Democrat member caucus. The House resumed its session with routine business at 6 pm ET and the House recessed again at 8 pm likely for another Democrat member caucus. [Follow-up — Early Tuesday morning the Wall Street Journal reports that “Plans to hold that vote Monday night were [later] abandoned, though, and Mrs. Pelosi said the chamber would vote on the measure on Tuesday as she left the Capitol after midnight.”

From the Delta variant front, Mondays have tended to be a good day for COVID-19 vaccine news. This morning the Food and Drug Administration “approved [for marketing] the first COVID-19 vaccine. The vaccine has been known as the Pfizer-BioNTech COVID-19 Vaccine, and will now be marketed as Comirnaty (koe-mir’-na-tee), for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals.” This action occurred two weeks before the Labor Day.

The Wall Street Journal reports that

The Food and Drug Administration’s approval was seen by public health officials as a key step to convince hesitant individuals to get the shot and to encourage employers to mandate it. 

“Today I’m calling on more companies in the private sector to step up with vaccine requirements that will reach millions more people,” President Biden said. “I call on you to do that—require it.” * * *

The vaccine is now eligible for off-label prescriptions—or use beyond the approved populations. That could include booster doses, according to the FDA. Prescribing the vaccine off label for children wouldn’t be appropriate as there is no data on proper dosing or safety in youth, said acting FDA Commissioner Janet Woodcock. * * *

Pfizer * * * is now permitted to market the vaccine to doctors, healthcare providers and the general public as it does with other approved products. Pfizer declined to share its marketing and advertising plans but said it seeks to take a thoughtful approach with such communications in hopes of increasing vaccine confidence. 

Pfizer made its FDA marketing approval application last May and Moderna, which produces the other mRNA vaccine, applied for FDA marketing approval in June so Moderna now moves from the on deck circle to at bat.

Federal News Network informs us that “The Pentagon said Monday that it will require service members to receive the COVID-19 vaccine now that the Pfizer vaccine has received full approval. Pentagon spokesman John Kirby said Defense Secretary Lloyd Austin is making good on his vow earlier this month to require the shots once the Food and Drug Administration approved the vaccine. He said guidance is being developed and a timeline will be provided in the coming days.”

Govexec tells us that

During the White House’s daily press briefing, Press Secretary Jen Psaki said that some agencies may roll out requirements that subsets of the federal workforce must be vaccinated, similar to those announced for health care workers at the Veterans Affairs and Health and Human Services departments. Across the federal government, agencies are working to implement President Biden’s requirement that all federal workers and contractors either attest that they have been vaccinated against COVID-19 or submit to a stringent regimen of wearing masks and being tested regularly for the virus.

“I expect there will be more . . . we certainly expect there will be more mandates for factions of federal employees,” Psaki said. “I think you’re looking more at agency-to-agency, or different factions of the government at this point, but expect there will be more on that front.”

In the meantime, federal employee unions have already begun engaging with management at various agencies to negotiate how the Biden administration’s vaccine mandate will be implemented. Matt Biggs, president of the International Federation of Professional and Technical Employees, said that although his union publicly announced its support for the vaccine mandate, it is working to ensure workers’ rights are protected, regardless of whether they elect to be vaccinated.

In other vaccine news, the UPI reports

Most teens and young adults want to get vaccinated against COVID-19, a survey published Friday by JAMA Health Forum found.

About 75% of people ages 14 to 24 years in the United States who responded to the survey, conducted by the University of Michigan’s Institute for Healthcare Policy and Innovation, said they would get the shot, the data showed.

Most agreed with the statement that vaccination was important to “help stop the spread [of the virus], as well as get back to normal as soon as possible,” the researchers said.

Still, about 42% of respondents said they were concerned about COVID-19 vaccine side effects and 12% indicated they worried about the shot’s effectiveness, according to the researchers.

From the health savings account front, Benefits Pro informs us that

Devenir has given another peek into the current state of HSAs with its demographic survey. Among its key findings:

  • As of December 31, 2020, the study estimates there were over 30 million HSAs covering 63 million people in the United States.
  • Nearly 1 in 5 Americans in their 30s had a health savings account by the end of the year.
  • HSAs are just as popular with older Americans: Account holders over 50 years of age held more than $44 billion in their accounts, with an average balance of just over $4300.

The study also found that HSAs are being used in every state in the country, with some states reporting nearly 77% of the privately insured populations being covered by an HSA. See our slideshow above for the states with the highest and lowest numbers of people covered by HSAs, and click here for the full study.” Here’s a link to another interesting Benefits Pro article on HSAs.

From the telehealth front, mHealth Intelligence reports that

The pandemic has proven the value of telehealth to parents, according to a recent survey by Nemours Children’s Health. But it has also highlighted the need to continue emphasizing the value of virtual visits to overcome barriers to care and improve health and wellness.

A survey of more than 2,000 adults conducted earlier this year in conjunction with Amwell found that while 35 percent of parents used telehealth prior to the COVID-19 crisis (based on a 2017 survey), that percentage jumped to 77 percent during the pandemic. In addition, almost 80 percent have accessed pediatric telehealth services, compared to 35 percent before the pandemic.

Overall, the survey reports, more than 60 percent of parents want to continue using connected health services after the pandemic – including almost 30 percent of parents who hadn’t used any telehealth in the past.

“While one might expect that factors such as income or access to technology are barriers to telehealth, this survey underscores how telehealth proved to be a viable solution to expanding access and reducing disparities in providing timely care during COVID-19,” R. Lawrence Moss, MD, president and CEO of Nemours Children’s Health System, said in a press release. “Regulations that were eased during the pandemic need to become permanent to support telehealth access for the long-term. Telehealth can be part of building health equity among people experiencing social, economic and family challenges.”

From the research front, the National Institutes of Health announced the results of a study of pregnant women:

Drinking alcohol and smoking tobacco cigarettes throughout the first trimester of pregnancy is associated with nearly three times the risk of late stillbirth (at 28 or more weeks), compared to women who neither drink or smoke during pregnancy or quit both before the end of the first trimester, according to a study funded by the National Institutes of Health. Although prenatal smoking is known to increase stillbirth risk, the researchers conducted the study to examine how smoking combined with alcohol use might influence the risk. The researchers also confirmed the higher stillbirth risk from alcohol alone, which has been suggested by earlier, less comprehensive studies.

In healthcare business news, Healthcare Dive tells us that

  • “Google is dissolving its health division, Google Health, after three years as the head of the unit, David Feinberg, departs to become CEO of health IT vendor Cerner.
  • “Google is splitting its health projects and teams across several other divisions of the company, according to an Aug. 19 internal memo to employees from Jeff Dean, the head of Google’s research division, obtained by Insider.
  • Alphabet’s Google created the Google Health division in 2018 to bring its health initiatives under a single umbrella. The Mountain View, California-based company remains committed to healthcare and will continue to invest in the space, but the goal of the reshuffling is to put its teams in the areas that make the most sense for its projects, a​ Google spokesperson told Healthcare Dive.”

Finally, the American Medical Association President Gerald E. Harmon, MD, opines on the actions that the medical community needs to take into order for American life expectancy to resume its upward track:

The AMA is committed to vigorous advocacy and broad-based collaboration to help people everywhere live longer, healthier lives. Our longstanding efforts targeting heart disease and type 2 diabetes—two of our country’s most common and most devastating chronic diseases—bring physicians in multiple practice settings and specialties together with patients, community groups, and both public- and private-sector organizations to better treat those struggling with these conditions, and also to prevent at-risk individuals from developing them.

The AMA Opioid Task Force and our Pain Care Task Force work with lawmakers and policymakers to guide their decision-making, to shift the perspective from responding to overdoses to preventing them, and to develop clinical best practices to reverse and eventually end the epidemic of fatal overdoses that worsened once the pandemic began.

Additional AMA efforts target: (1) behavioral health integration and suicide prevention;(2)firearm safety; (3) reducing maternal mortality; (4) eliminating racial and ethnic disparities in health care; (5) ensuring that digital health technology improves patient care and health outcomes, and (6) transforming medical education to ensure physicians are prepared to meet patient needs today and tomorrow.

Monday Roundup

Photo by Sven Read on Unsplash

Happy National Hospital Week.

Per a Food and Drug Administration press release,

Today, the U.S. Food and Drug Administration expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to include adolescents 12 through 15 years of age. The FDA amended the EUA originally issued on Dec. 11, 2020 for administration in individuals 16 years of age and older.

The FDA has updated the Fact Sheets for Healthcare Providers Administering the Vaccine (Vaccination Providers) and for Recipients and Caregivers with information to reflect the use of the vaccine in the adolescent population, including the benefits and risks of the Pfizer-BioNTech COVID-19 Vaccine.

The CDC will take up the matter on Wednesday and assuming that CDC approval is given, then health plans will become obligated to cover the full cost of administering the vaccine to this new age group fifteen days later.

The Wall Street Journal adds FAQs:

Do we need to vaccinate children?

Yes, according to most infectious-disease experts. Children can and do get sick from Covid-19, though research shows they typically experience milder cases and are much less likely than adults and the elderly to be hospitalized or die from the virus. As of late March, more than 3.4 million children had been infected with Covid-19, according to the American Academy of Pediatrics, including nearly 14,000 hospitalizations and 279 deaths. The emergence of more-contagious variants, including the B.1.1.7 variant that was first identified in the U.K. and is now dominant in the U.S., appears to be sending younger patients to the hospital with a higher frequency, making vaccines in young adults and adolescents all the more urgent, some doctors and scientists say. In addition, scientists say children need to be vaccinated to achieve the communitywide, or herd, immunity that renders spread of the virus unlikely. “Vaccines give us the opportunity to really turn the tide on this pandemic, and children and teens really need to be a part of that strategy,” said Lisa Costello, a pediatrician and president of the West Virginia chapter of the American Academy of Pediatrics.

Monday continues to be a good day for COVID-19 vaccine news.

In other news —

  • Healthcare Dive reports that “Kaiser Permanente generated a profit of $2 billion in the first quarter of 2021, the integrated health system reported Friday, bouncing back from a staggering $1.1 billion loss in the first quarter of last year, largely tied to investment losses amid the stock market slide spurred by the COVID-19 pandemic.”
  • The Internal Revenue Service announced 2022 inflation adjustments for (a) minimum deductibles and maximum out of pocket cost sharing in high deductible health plans (“HDHP”) associated with health savings accounts {“HSA”) and (b) maximum health savings account contributions. The Journal of Accountancy explains

The annual limitation on deductions under Sec. 223(b)(2)(A) for an HSA with self-only coverage is $3,650, an increase of $50 over 2021; the corresponding amount for family coverage is $7,300, up $100 from 2021. Sec. 223(b)(3) allows an additional $1,000 annual contribution for individuals age 55 or older before the end of the tax year.

The high-deductible health plan (HDHP) that must accompany an HSA also has inflation adjustments, for its minimum plan deductible amount and its maximum annual out-of-pocket limitation. The deductible for 2022 must be at least $1,400 for self-only and $2,800 for family coverage, both the same as for 2021. The out-of-pocket maximums are $7,050 for self-only coverage and $14,100 for family coverage, increases of $50 and $100, respectively, from 2021.

  • The Department of Health and Human Services overruled the Trump Administration’s narrow interpretation of sex discrimination for purposes of the Affordable Care Act’s individual non-discrimination provision known as Section 1557. “Consistent with the Supreme Court’s decision in Bostock and Title IX, beginning today, [HHS’s Office for Civil Rights] will interpret and enforce Section 1557’s prohibition on discrimination on the basis of sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. This interpretation will guide OCR in processing complaints and conducting investigations, but does not itself determine the outcome in any particular case or set of facts. In enforcing Section 1557, as stated above, OCR will comply with the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb et seq., and all other legal requirements.
  • Federal News Network reports that “Few aspects of federal retirement seem to be trending down more than a year after the pandemic first hit the U.S. According to numbers released by the Office of Personnel Management, new claims, processed claims, processing times and the overall claims backlog were all higher in April 2021 than April 2020.” 
  • Fierce Healthcare informs us that “COVID-19 has only worsened social isolation, but [Blue Cross licensee] Anthem is addressing senior’s loneliness through a “wrap-around” program that encourages them to reach out. Through Member Connect, seniors are assigned a social care partner, who assists with connecting them to community services to address their social needs. They also have a phone pal, a volunteer Anthem associate who reaches out to them weekly. Many members (78%) said they either agreed or strongly agreed that participating in the program led to more meaningful connections with people. In addition, 66% said they are happy or very happy when taking into account all facets of their life in the past seven days.”

Monday Roundup

Photo by Sven Read on Unsplash

Mondays have tended to be good news days for COVID-19 vaccines. As of today, over 50% of Americans over age 18 have received at least one dose of a COVID-19 vaccine.

Fierce Healthcare reports that

“CVS Pharmacy has begun stocking its virtual and in-store shelves nationwide with rapid tests for COVID-19—which can be purchased without a prescription and used by anyone regardless of whether or not they are showing symptoms—including three FDA-authorized diagnostics and sample collection kits produced by LabCorp, Ellume and Abbott.”

“Even as vaccines become more widely available, COVID-19 testing remains a critical tool to keep our communities safe,” Walgreens President John Standley said in a statement. Walgreens currently offers on-site testing at more than 5,500 of its pharmacies and plans to expand to 6,000 drive-thru sites by May, using Abbott’s ID NOW portable testing machines.

In addition, earlier this month CVS began offering COVID-19 antibody testing for $38 at 1,100 in-house clinics, using fingerstick blood samples to determine previous infections.

The U.S. Office of Personnel Management announced today that the agency

will allow [FSAFEDS] flexibilities permitted under the Consolidated Appropriations Act 2021 and the American Rescue Plan Act including allowing full carryover for a health care flexible spending account (HCFSA) and Limited Expense FSA (LEX FSA); extending the grace period for a dependent care flexible spending account (DCFSA); and permitting care for dependents through age 14 for 2020 and 2021 under a DCFSA. In addition, OPM is working with our FSAFEDS contractor, Health Equity, to offer a Special Enrollment/Election Period (SEP) in the near future.  This SEP will allow participants to increase or decrease their current elections for their DCFSA and/or their HCFSA.  In addition, the SEP will allow those who did not re-enroll for 2021 during Open Season in the Fall, the opportunity to enroll in a DCFSA and/or HCFSA for 2021.  Finally, OPM will allow DCFSA participants to increase their election during the Special Election Period to the new IRS maximum of $10,500 for 2021. 

All good news.

What’s more, the Wall Street Journal reported in its Saturday essay about the U.S. airline safety revolution.

Over the past 12 years, U.S. airlines have accomplished an astonishing feat: carrying more than eight billion passengers without a fatal crash.

Such numbers were once unimaginable, even among the most optimistic safety experts. But now, pilots for domestic carriers can expect to go through an entire career without experiencing a single engine malfunction or failure. Official statistics show that in recent years, the riskiest part of any airline trip in the U.S. is when aircraft wheels are on the ground, on runways or taxiways.

The achievements stem from a sweeping safety reassessment—a virtual revolution in thinking—sparked by a small band of senior federal regulators, top industry executives and pilots-union leaders after a series of high-profile fatal crashes in the mid-1990s. To combat common industry hazards, they teamed up to launch voluntary incident reporting programs with carriers sharing data and no punishment for airlines or aviators when mistakes were uncovered.

One wonders whether this successful strategy may be transferable to other pressing safety issues, such as patient safety. In this regard, a friend of the FEHBlog suggested check this Washington Post opinion piece written by a group of psychologists titled “We instinctively add on new features and fixes. Why don’t we subtract instead?
‘Less is more’ is a hard insight to act on, it turns out.” How true.

In other healthcare news —

  • The Kaiser Family Foundation informs us that

a relatively small number and share of drugs accounted for a disproportionate share of Medicare Part B and Part D prescription drug spending in 2019 (Figure 1).

— The 250 top-selling drugs in Medicare Part D with one manufacturer and no generic or biosimilar competition (7% of all Part D covered drugs) accounted for 60% of net total Part D spending.

— The top 50 drugs covered under Medicare Part B (8.5% of all Part B covered drugs) accounted for 80% of total Part B drug spending.

Some recent proposals to lower prescription drug prices have limited the number of drugs subject to price negotiation and international reference pricing. This analysis shows that Medicare Part D and Part B spending is highly concentrated among a relatively small share of covered drugs, mainly those without generic or biosimilar competitors. Focusing drug price negotiation or reference pricing on a subset of drugs that account for a disproportionate share of spending would be an efficient use of administrative resources . . . .

  • Employee Benefits News tells us

New research from Voya shows employees have a bias against HDHPs and the reason for that is as simple as marketing.

“One of the really interesting findings that we saw from the research about why there is that bias comes down to branding, pure and simple,” says Nate Black, vice president of consumer driven health for Voya Financial. “When we replaced the high deductible health plan name and called it something more generic, the share of people choosing high deductible health plans doubled. So just the name itself can have a really significant impact on how people think about what plan they should choose.”

Sixty-three percent of the people surveyed by Voya said they would choose the plan with the lowest deductible. As part of the study Voya designed an experiment asking participants to choose between a PPO and an HDHP. The experiment was set up in a way that the HDHP was always the optimal financial choice, despite this, 65% of those surveyed still chose the PPO plan.

Communicating the long term value of plans connected with health savings accounts is quite important.

  • Here’s a link to the CDC’s website on the Johnson & Johnson vaccine pause which explains

If you received the vaccine more than three weeks ago, the risk of developing a blood clot is likely very low at this time.

If you received the vaccine within the last three weeks, your risk of developing a blood clot is also very low and that risk will decrease over time.

Contact your healthcare provider and seek medical treatment urgently if you develop any of the following symptoms: severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, tiny red spots on the skin (petechiae), or new or easy bruising.

If you experience any adverse events after vaccination, report them to v-safe and the Vaccine Adverse Event Reporting System

The FEHBlog enrolled in v-safe after his first Pfizer vaccination and the CDC has continued to inobtrusively check in weekly. The FEHBlog is happy to help out.

Friday Stats and More

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 12th week of this year (beginning April 2, 2020, and ending March 24, 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 noticed 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 March 24, 2021):

Finally here is a COVID-19 vaccinations chart for the past three months which also uses Thursday as the first day of the week:

The charts continue to look pretty good. As of today 34.6% of the U.S. population over 18 years old has received at least one dose of the COVID-19 vaccine and 46% of the U.S. population over 65 years old is fully vaccinated.

STAT News reports that

Pfizer and BioNTech said Thursday they are beginning a study aimed at showing their Covid-19 vaccine can be used in children as young as 6 months.

The study follows the launch of a separate and ongoing trial in children ages 12 to 15, which was fully enrolled in January. That study could lead to results by the end of the first half of the year, depending on the data, and then to an emergency use authorization. That will depend on the Food and Drug Administration and the Centers for Disease Control and Prevention. The vaccine already has an EUA for people 16 and older.

“The FDA, if it sees fit to do this, could, grant an EUA and get them into children in that age group by the fall, provided the CDC also agrees and that that should be the vaccine they receive,” said William Gruber, Pfizer’s senior vice president of vaccine clinical research and development.

Moderna began a similar study of their vaccine on children from age 6 months to 12 years old on March 16.

STAT News also offers “A user’s guide: How to talk to those hesitant about the Covid-19 vaccine.” Here’s one good idea:

Have a conversation

Don’t lecture your family and friends, and don’t assume you know what their concerns are. Make sure to listen.

“Try to address their concerns, not what you assume are their concerns,” said Jorge Moreno, an internist and assistant professor at the Yale University School of Medicine. While you may be thinking people are ensnared in the darkest of conspiracy theories, many may have concerns that are much simpler to address. For Moreno, who even had to convince his mother the vaccine was safe, many questions he’s received have centered around side effects, and whether they might make people too sick to work. A Carnegie Mellon University survey released this week showed 70% of vaccine-hesitant people were concerned about side effects.

“Let people know it’s OK to have questions and that having concerns is legitimate,” added Reed Tuckson, the former public health commissioner for Washington, D.C., and a founding member of the Black Coalition Against Covid, which co-developed a campaign called “The Conversation” to provide Black families credible vaccine information. “Letting people have a safe space to have this conversation is essential,” he said. “Wagging your finger against someone is not very useful.”

From the tax front:

  • The Internal Revenue Service recently announced that “amounts paid for personal protection equipment, such as masks, hand sanitizer and sanitizing wipes, for the primary purpose of preventing the spread of the Coronavirus Disease 2019 (COVID-19 PPE) are treated as amounts paid for medical care under § 213(d) of the Internal Revenue Code (Code). * * * Group health plans, including health FSAs and HRAs, under the terms of which expenses for COVID-19 PPE may not be reimbursed, may be amended pursuant to this announcement to provide for reimbursements of expenses for COVID-19 PPE incurred for any period beginning on or after January 1, 2020, and such an amendment will not be treated as causing a failure of any reimbursement to be excludable from income under § 105(b) or as causing a § 125 cafeteria plan to fail to meet the requirements of § 125.”
  • What’s more, Spotlight on Benefits explains how the IRS has clarified Pandemic-Related Relief for Dependent Care FSAs.

In healthcare business news, Healthcare Dive explains why being a hospital chief financial officer is a particularly tough job during the pandemic. Also Fierce Healthcare discusses a CIGNA telehealth study finding that

while virtual visits for other types of services declined after the initial COVID-19 spike, virtual visits for behavioral health remained in high demand. In April 2020, virtual visits made up about 50% of claims for non-behavioral health services and declined over the course of the year to account for nearly 25% today.

“Virtual behavioral health care is not only a way to access mental health services in the wake of social distancing, but it also allows us the option to pursue treatment in the privacy and comfort of our own homes,” Lustig said.

By contrast, in April, 66% of office visits for behavioral health were conducted virtually, and it’s remained largely flat since.

Behavioral telehealth users also reported higher productivity at work, according to the survey. These patients reported a 45% decrease in sick days, compared to a 28% decrease in miss workdays among patients who did not use telehealth.

That’s good news for the spoke and hub telehealth companies and for health plans and consumers because the spoke and hub telehealth network therapists are in-network.

Midweek Update

Photo by Manasvita S on Unsplash

Happy St. Patricks Day to all.

Congress in a recent appropriations law sought a report from the National Academy for Public Administration on the Trump Administration’s proposal to break up the Office of Personnel Management. The Federal Times reports that “A better federal workforce policy will require the Office of Personnel Management to become a more independent and authoritative agency, rather than being broken apart into other departments, a long-awaited National Academy for Public Administration study determined March 17. ”

“We strongly recommend that a central personnel agency continue to exist, and that organization is an independent, enterprise-wide human capital agency and a steward of the merit system principles,” said Terry Gerton, president and CEO of NAPA, said at a press briefing on the report. “But that organization, OPM as we know it today, really needs to build its staff capacity, encourage innovation and adopt a more data-driven, accountable and forward-looking capital management approach.”

In other federal agency news, the Federal News Network informs us that

The IRS is moving this year’s April 15 tax filing season deadline back to May 17, citing ongoing challenges from the COVID-19 pandemic. IRS Commissioner Chuck Rettig said in a statement Wednesday that the new deadline would give the public more time to take stock of their finances, while also giving agency employees more time to implement new responsibilities under the American Rescue Plan.

The Department of Health and Human Services announced today that the agency

will invest $10 billion from the American Rescue Plan to ramp up screening testing to help schools reopen, $2.25 billion to scale up testing in underserved populations, and provide new guidance on asymptomatic screening testing in schools, workplaces, and congregate settings. These measures are part of President Biden’s strategy to increase COVID-19 testing nationwide as vaccinations increase.

“COVID-19 testing is critical to saving lives and restoring economic activity,” said HHS Acting Secretary Norris Cochran. “As part of the Biden Administration’s National Strategy, HHS will continue to expand our capacity to get testing to the individuals and the places that need it most, so we can prevent transmission of the virus and defeat the pandemic.”

The U.S. Preventive Services Task Force announced yesterday a proposed B grade recommendation “on screening for prediabetes and type 2 diabetes. The Task Force recommends screening adults between ages 35 to 70 years old who are overweight or obese for prediabetes and diabetes.” The current minimum age for this screening recommendation is 40 years old. NBC News reports that

We know the rates of prediabetes and diabetes are increasing in people who are younger,” said Dr. Chien-Wen Tseng, a task force member and a professor of family medicine at the University of Hawaii’s John A. Burns School of Medicine. “Our main reason for dropping the age is to match the screening with where the problem is: If diabetes and prediabetes are occurring at a younger age, then we should be screening at a younger age.”

The Affordable Care Act requires health plans to cover USPSTF A and B recommended preventive services without member cost sharing when an eligible member receives the service in-network. If the USPSTF finalizes this recommendation later in 2021, then the ACA health plan coverage mandate for this screening would expand to people in the age 35 to 40 age group in 2023. Here is a link to background on the USPSTF’s sixteen members.

In other health industry news —

Healthcare Dive reports that

Amazon is expanding its virtual care pilot program, Amazon Care, to employees and outside companies nationwide beginning this summer in a major evolution of its telehealth initiative, as the COVID-19 pandemic continues to drive unprecedented demand for virtual care.

Amazon will also offer its on-demand primary care service to other Washington state-based companies and plans to expand its in-person service to Washington, D.C., Baltimore and other cities in the following months, the e-commerce behemoth announced Wednesday.

Employee Benefit News offers a Chief Financial Offer’s advice on health savings account funding.

Weekend update

Both Houses of Congress will be engaged in committee work and floor voting this coming week, the last full workweek before Thanksgiving week. CNET provides an update on the likelihood of Congress passing another COVID relief bill during this lame duck session. The most pressing lame duck session legislative action is addressing federal government funding which expires after December 11 absent Congressional action. Currently the last day for House voting in 2020 is December 10.

Following up on Friday’s COVID-19 stats discussion, Govexec.com provides estimates of COVID-19 cases afflicting federal employees and military members.

More than 100,000 federal personnel have now tested positive for COVID-19, nearly triple the total in mid-July. Almost 3% of government workers across the military and civilian agencies have now contracted the virus. About 50,000 civilian workers have tested positive, in addition to more than 62,000 members of the Armed Forces.

Earlier today the Centers for Disease Control reported that just under 10.85 million Americans have contracted COVID-19 this year. The current U.S. population is roughly 331 million people. Consequently, the federal employee COVID-19 contraction rate aligns with the total U.S. rate (3.27%). That’s good news in the FEHBlog’s opinion, considering the fact that a sizable percentage of federal employees and military members have contact with the public as part of their responsibilities.

As we enter the second week of the Federal Benefits Open Season, the FEHBlog deems it appropriate to call attention to this helpful Wall Street Journal article titled “It’s Open-Enrollment Season. Is an HSA Still Right for You?” Helpful tidbit from the article:

Roy Ramthun, a consultant who specializes in high-deductible plans and HSAs, recommends conducting a “worst-case-scenario” analysis. This shows which plan would be most cost-effective in the event an employee spends so much he or she hits the plan’s out-of-pocket spending limit. (After that, the plan becomes responsible for 100% of expenses for the rest of the year.)

Assume Ms. [Employee’s]’s family continues to stick largely with doctors and hospitals that take their insurance on an “in-network” basis. The high-deductible plan could make them responsible for $8,000 in out-of-pocket spending—a number that includes the plan’s $4,000 deductible. Some of the blow would be offset by the $5,500 Ms. [Employee] stands to save in premiums and employer contributions.

In contrast, the annual out-of-pocket maximum with the conventional plan is even higher, at $9,000, providing less protection against high medical bills. As a result, the high-deductible plan is the mathematical winner in this scenario, as well. (Mr. Ramthun recommends repeating this exercise using the two plans’ out-of-network spending limits.)

These numbers by the way are not derived from FEHB plans.

Friday Stats and More

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 20th through 32nd weeks of this year (beginning May 14 and ending August 12; 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:

Beckers Hospital Review reports that

The U.S. government is working with commercial health insurers to make future COVID-19 vaccines free of charge with no copay, an HHS official told The Wall Street Journal.

Paul Mango, deputy chief of staff for policy at HHS, said government health insurance programs such as Medicare and Medicaid will cover the cost of administering COVID-19 vaccines, and a federal fund created by the CARES Act will provide the shots free for uninsured people.

A collaboration between the federal government and the healthcare industry will handle the distribution of the vaccines, and the government will announce distributor contracts soon, Mr. Mango told the Journal.

Indeed, the Wall Street Journal reports this afternoon that

McKesson Corp., MCK 4.26% one of the world’s largest drug wholesalers and the biggest vaccine middleman in the U.S., will be a main distributor of Covid-19 vaccines nationwide should the shots prove to work safely, federal health officials said. The U.S. Centers for Disease Control and Prevention is exercising an option in an existing 2016 contract with McKesson for the distribution of a vaccine in the event of a pandemic, the U.S. Health and Human Services Department said Friday.

A friend of the FEHBlog shared this link to an interesting Harvard Business Review article from July 24 discussing the following three scenarios in which the COVID-19 emergency may play out.

1.A dream case in which everything goes as well as could reasonably be expected.
2.A catastrophic case in which everything goes badly.
3.A middle case in which some things go well, but others don’t.

It strikes that FEHBlog that we have been in the midst of scenario three since March. The FEHBlog does not think it can get worse, while he thinks that it may get better.

The FEHBlog was pleased to run across these DOL Office of Federal Contractor Compliance Program’s FAQs on its recent final rule exempting TRICARE but not FEHBP providers from its affirmative action rules.

If my company participates in the Federal Employees Health Benefits Program (FEHBP), are we covered under the amended regulations?

OFCCP did not adopt any regulatory changes related to FEHBP providers. OFCCP plans to issue sub-regulatory guidance to address concerns regarding FEHBP providers.

That’s a clearer update than what the FEHBlog noticed in the preamble to the final rule. The TRICARE exemption likely will not be useful to providers unless the FEHBP also is exempted, in the FEHBlog’s opinion.

The Congressional Research Service has updated its helpful report on Health Savings Accounts (HSAs). CRS reports that for tax year 2017 the IRS processed 11 million tax returns showing employer or employee contributions to HSAs.