The FEHBlog expects that the First Lady, Dr. Jill Biden, and HHS Secretary Sebelius will be releasing the next set of Affordable Care Act implementing regulations tomorrow afternoon. Those regulations will implement the preventive care mandate that applies to non-grandfathered plans beginning with plan years that take effect on or after September 23, 2010. FEHB plans currently provide a wide range of preventive care services with no enrollee cost sharing when the services are performed by a health plan network provider.
AHIP's Hi-Wire ran an interesting piece about how health plans are using Medicare Part B's pricing schedule (known as the resource based relative value schedule (RBRVS)) to price commercial health plan reimbursements to providers.
Elizabeth Curran, Head of National Contracting Policy and Medicare Strategy for Aetna, believes that adopting the Resource-Based Relative Value Scale (RBRVS) used by Medicare makes a lot of things easier because everyone understands it, especially providers.Given Ingenix's exit from this business under a settlement with the NY Attorney General, this trend makes a lot of sense to the FEHBlog.
Mark Austin, Senior Vice President of Network Management at Blue Cross Blue Shield of Tennessee, finds that employers and business groups speak in the language of Medicare rates. He also noted that as more and more payers shift to some form of RBRVS, it becomes a lot easier to compare reimbursement plans.
Jessalyn Greene, Director of Reimbursement Strategy for Scott and White Health Plan, cautioned that geographic differences can force variances to the methodology. She finds that many rural areas will see best use of RBRVS for their Medicare populations.