Sunday, June 19, 2011

Weekend Update

Happy Fathers' Day. The FEHBlog is enjoying Fathers' Day on North Carolina's Outer Banks.

The House and Senate are in session this week. On June 22, the Subcommittee on Oversight and Investigations of the House  Energy and Commerce Committee is holding a hearing that is ominously titled "Protecting Medicare with Improvements to the Secondary Payer Regime." In 2007, Congress passed the "Section 111" provision that vastly improved the exchange of coordination of information between private sector carriers and Medicare. The only other shoe that can drop is to shift more Medicare costs onto private carriers, including FEHB plans, by changing the order of benefit payment rules.

The most likely candidate is the rule on coordination of benefits for persons who are eligible for Medicare based on end stage renal disease. Currently, the private sector carrier pays primary to Medicarer for the first 30 months of ESRD care (previously 24 months.) The FEHBlog can see 36 months or longer coming down the pipe.

CMS announced on Friday the implementation of  technology based anti-fraud measures that, as AHIP previously has pointed out, finally catch up to private sector carrier efforts. The new measures check for fraud before payment is made. To its credit, CMS also recognized the private sector's role in this effort:
Northrop Grumman, a global provider of advanced information solutions, has been selected through a competitive procurement to develop CMS’ national predictive model technology format using best practices of both public and private stakeholders. Northrop Grumman has partnered with National Government Services (NGS) and Federal Network Systems, LLC, a Verizon company (FNS), to leverage the wealth of claims data and its information to fight health care fraud.   CMS used industry guidance, innovative ideas from private and provider entities and related data in developing the scope of work for this national fraud prevention program. Given the importance of this contract to CMS’ overall anti-fraud efforts, this contract is being implemented nationally and ahead of schedule.
Speaking of AHIP, the AMA News reports on an AHIP study that finds growing consolidation of hospital systems, which is being driven by the Affordable Care Act.  The AMA retorts that health plans also have been consolidating. Of course, unlawful monopolization typically is alleged against sellers, who are trying to raise prices, not to purchasers, who are trying to bring down prices.

On Thursday, June 16, the Office of Personnel Management issued a request for information related to its Affordable Care Act responsibility to contract for multi-state plans to operate in the State health insurance exchanges. The RFI basically asks interested carriers to identify themselves and explain why they are interested and how they could fulfill the requirements for a multi-state plan carrier . The response deadline is August 2, 2011.

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