President Bush signed the Tax Relief and Health Care Act of 2006 yesterday (see 12/20 FEHBlog entry) and in response the U.S. Office of Personnel Management is allowing the following actions that are permitted under this law:

• Agencies may accept belated Federal Employees Health Benefits (FEHB) open season enrollments in a [High Deductible Health Plan] HDHP with a [Health Savings Account] HSA through December 31, 2006, for employees who are otherwise eligible for an HSA. [The regular Open Season closed on December 11.] Contact your agency Human Resources office for instructions.
• SHPS, the FSAFEDS administrator, will allow FSAFEDS enrollees to revoke their HCFSA or change their HCFSA to a Limited Expense HCFSA (LEX HCFSA) for 2007, so that they may enroll in an HDHP with an HSA. Anyone enrolling in an HDHP may also elect a LEX HCFSA [an FSA limited to dental and vision expenses]. Enrollees should go to www.fsafeds.gov for instructions. >THIS CHANGE MUST BE MADE ON OR BEFORE DECEMBER 31, 2006.
• Current FEHB Program HDHP enrollees with a [Health Reimbursement Arrangement] HRA may make a one-time transfer of the HRA balance to an HSA if they are otherwise eligible for an HSA in 2007.
• FEHB Program enrollees who choose HDHP coverage for 2007 may make a one-time balance transfer from a 2006 HCFSA [Health Care FSA] to an HSA. Anyone who enrolls now or enrolled in an HDHP during Open Season will have to transfer any remaining HCFSA funds to be eligible to have an HSA.
• For FSAFEDS enrollees wishing to make such a transfer, there may be a small processing fee for the transfer. FSAFEDS will notify participants regarding of any fee. The transfer will be made after the payment is received.

Earlier today, President Bush signed the Tax Relief and Health Care Act of 2006 which makes several improvements to the Health Savings Account (“HSA”) law (Internal Revenue Code § 223). Most significantly, as discussed in an earlier post, the new law, which is effective January 1, 2007, for the HSA changes, increases the maximum annual contribution to the indexed amounts as opposed to the lesser of the associated health plan’s high deductible or the indexed amount, which has been the law.

President Bush signed into law the following three health care bills that were enacted during the recent lame duck session of the 109th Congress:

• The Combating Autism Act of 2006 — significantly increases funding for autism research and treatment and public education about autism
• Pandemic and All-Hazards Preparedness Act of 2006 — “creates a new agency within the Health and Human Services Department to oversee the development of medicine and equipment to respond to a bird flu pandemic or a bioterrorism attack.”
• Ryan White HIV/AIDS Treatment Modernization Act of 2006 — renews law and shifts funding to rural areas and the South.

A study published recently in the New England Journal of Medicine concludes that the diagnostic effectiveness of a colonoscopy depends on the doctor’s techniques. An article in the New York Times today gives advice on how a prospective patient can question a doctor about his or her technique. I have always thought that medicine is as much an art as it is a science, a consideration which complicates quality transparency initiatives in my opinion.

Reuters reports that CVS filed a registration statement today with the Securities and Exchange Commission concerning its proposed acquisition of Caremark (which is available on the SEC’s EDGAR system). According to Reuters, “there is a $675 million breakup fee if either it or Caremark terminates the deal under certain circumstances.”

Meanwhile the stock market continues to respond favorably to Express Script’s higher offer for Caremark, pushing Express Script’s stock price up 3.3% today. According to Businessweek.com analysts predict that the debt load associated with Express Script’s leverage buyout proposal is “manageable.” Time will tell.

Caremark and CVS responded to Express Script’s competing bid for Caremark with measured press releases describing their agreement as “definitive” and stating that Caremark’s board of directors will take the ESI proposal under advisement. The stock market responded by boosting Caremark’s common stock price from $50.30 per share to $55.28 per share as investors expect a bidding war over Caremark.

The Wall Street Journal reported overnight that “Pharmacy benefit manager Express Scripts is preparing to launch a $26 billion cash and stock offer for rival Caremark Rx, in an effort to break up the company’s existing takeover deal with drug chain CVS.” Express Scripts this morning confirmed the bid in a press release. According to Bloomberg.com, “Caremark investors would receive $58.50 in cash and stock for each share, 15 percent more than the Dec. 15 closing price, St. Louis, Missouri-based Express Scripts said in an e-mailed statement. CVS agreed to buy Caremark for $48.53 a share on Nov. 1, offering shareholders no premium.” Caremark shares closed at $50.30 on Friday.

The Daily Mail of London reports that “Oversize clothes should have obesity helpline numbers sewn on them to try and reduce Britain’s fat crisis, a leading professor [Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow] said today.”

HHS maintains a web based Hospital Compare tool which “provides you with information on how well the hospitals in your area care for all their adult patients with certain medical conditions.” The tool is based principally on information provided by the Hospital Quality Alliance (HQA): Improving Care Through Information.

The Associated Press reports that researchers from the University of Pennsylvania have published a study in the AMA Journal that analyzed the death rates at the 3,657 hospitals evaluated by Hospital Compare. “The study examined three conditions that often lead to hospitalization — heart attacks, heart failure and pneumonia — and found that death rates for patients with those diseases were only slightly lower at top-rated hospitals in 2004 than at the lowest-rated hospitals.” The researchers contend that HHS needs to develop better quality measures. An HHS rebuts that “researchers likely would have found bigger differences among hospitals if they’d examined all 22 quality measures used on Hospital Compare.”

In yesterday’s Federal Register, the Labor Department, the Internal Revenue Service, and the Health and Human Services Department published a final regulation on non-discrimination and wellness programs in the group insurance market as required by the Health Insurance Portability and Accountability Act of 1996 (fondly known as HIPAA). The rules replace interim final rules that were published in 2001. The changes will be effective for FEHB plans on January 1, 2008.