Wednesday, March 02, 2011

Mid-week update

Following up on last Friday's story about the Golinski case, on Monday, the Government filed a response to the Court's show cause order. Here's the upshot -- "Pursuant to the instructions of the President, OPM will continue to enforce Section 3 of DOMA [the Defense of Marriage Act -- in other words OPM will not extend FEHB Program coverage to same sex spouses] until it is repealed or there is a final judicial finding striking it down." Although the last Congress might have repealed DOMA, this Congress will not. So it's up to the judicial system, and Politico reports that the House of Representatives will take action this week to take up the defense of DOMA in court.

Also last month, the FEHBlog discussed a putative class action in San Francisco federal court challenging the validity of the Medicare Part B doctor reimbursement methodology which also has limited FEHBP application. The FEHBlog looked at the Court docket (thank you PACER) and learned that the Court will hear the Government's motion to dismiss the complaint before considering the class action application. The Court has scheduled oral argument on the motion to dismiss for October 14, 2011.

Earlier today, the Senate joined the House in voting for a two week extension of the continuing resolution funding the federal government. The new CR, will expire on March 18, calls for $4 billion in federal spending cuts identified by the President. The President signed the measure into law, according to the Washington Post. reports that the White House plans to take a more significant role in the next stage of the funding negotiations.

OPM posted on its FY 2012 budget justification on the web today. Its discussion of the FEHBP begins on page 58. Here is OPM's list of FEHBP related accomplishments for the past and current fiscal years:
FY 2010 Accomplishments:
Some of the major activities completed in FY 2010 include:
• Revamped Federal Long Term Care Insurance Program (FLTCIP) materials for greater transparency and to promote a better understanding of the insurance products for prospective applicants
• Expanded communication regarding benefits for internal and external customers through the use of focus group and social media
• Used “go green” strategies in to eliminate mail costs for Audit Resolutions, communications to FEHB plans, make the disputed claims process paper--free, increase telework and workplace flexibilities, and review document retention practices to reducing paper dependency and storage
• Maximized our enrollment clearinghouse to identify problematic practices, and piloting an enrollment verification and premium income data base using EHRI data, to reduce Federal agency and FEHB plan discrepancy rates
• Conducted negotiations with carriers to ensure compliance with OPM’s benefits and rate guidance for contract year 2011
• Administered FEHB contracts to ensure that enrollees have access to well-managed and accredited carriers, with competitive healthcare choices and good healthcare benefits
• Conducted the full range of Insurance Operations functions and governmentwide systems support for Open Season activities, audit functions, contract administration, disputed claims, and oversight
• Enhanced web-based information and tools to support employee and annuitant benefits decision making, and fully utilize self service enrollment services
• Provided consultative services to the Department of Health and Human Services’ (DHHS) in standing up the PCIP program and implemented the Federal plan in 23 states and the District of Columbia which did not set up their own plan
• Began developing the FEHBP data collection and analysis capacity. Selected and brought on board dedicated Project Manager and a contractor to provide Project Management Office support
Anticipated FY 2011 Accomplishments:
OPM will continue to improve the FEHBP services during FY 2011 by evaluating quality service and continuing to offer value choices. OPM will be evaluating quality and guiding principles among participating health plans. FEHBP will continue to provide the new tools so enrollees can compare and make informed decisions about health, dental and vision plans and will further enhance the web-based information and tools to support employee and annuitants benefit decisions.
In FY 2011 the HCDW [Health Care Data Warehouse] project will continue implementation activities for the Program Management Office: establishment of the Earned Value Management System and baseline; procurement of a systems integrator; on-board the systems integrator vendor and initiate requirements documentation; and validation activities with the contractor. The System Integrator will stand-up a proto-type version of the anticipated system to streamline requirements documentation and validation activities utilizing a copy of the health claims records maintained by the Office of the Inspector General.
The  Oversight Subcommittee of the House Ways and Means Committee held a hearing today on health care fraud. Interestingly, AHIP President Karen Ignani and Louis Saccoccio, the Executive Director of the National Healthcare Anti-Fraud Association, testified on private sector initiatives to combat health care fraud. Meanwhile, the Wall Street Journal reports on the efforts of Sen. Ron Wyden (D Oregon) and Sen. Chuck Grassley (R Iowa) to open to public view the Medicare claims database information on payments to doctors. That information has been shielded from public view by a 1979 court order obtained by the American Medical Association.

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