Thursday, July 07, 2011

Mid-week update

The Federal Government issued its Spring 2011 semi-annual regulatory agenda today. The semi-annual regulatory agenda gives readers a heads-up on the Government's regulatory plans. The agenda tells us that OPM has two FEHBP regulations in mind -- one to implement the Affordable Care Act's requirement to expand FEHBP coverage to employees of Indian Tribes and the other evidently to conform OPM's disputed regulations (5 C.F.R. Sec. 890.105) to conform with the Affordable Care Act's requirement that governmental plans comply with ERISA's claim and internal appeal rules as enforced by the ACA regulators. This second requirement actually took effect at the beginning of 2011.

OPM requires carriers to report on NCQA's Healthcare Effectiveness Data and Information Set measures. OPM explains that HEDIS is "a set of standardized performance measures designed to ensure that consumers have the information they need to reliably compare the performance of healthcare plans." FEHBP HMOs report on all of the measures while FEHBP fee for service plans report on measure that are strictly based on claims data. This week NCQA announced HEDIS changes for 2012:
New MeasuresThe two new measures in the HEDIS 2012, Volume 2: Technical Specifications publication are:
  • Human Papillomavirus Vaccine for Female Adolescents—This measure assesses the percentage of 13-year-old females who had three doses of the human papillomavirus (HPV) vaccine. The measure evaluates compliance with Centers for Disease Control and Prevention and Advisory Committee on Immunization Practices immunization guidelines.
  • Medication Management for People With Asthma—This measure assesses the percentage of people 5–64 years of age who were identified as having persistent asthma and who received and remained on appropriate medications during their treatment period.
Retired Measure

The obsolete measure, which will be removed from HEDIS 2012, Volume 2, is Relative Resource Use for People With Acute Low Back Pain.
Back pain can be difficult to treat. Medscape reports this week that "Massage therapy may effectively reduce or relieve chronic back pain for 6 months or more, according to the results of a parallel-group, randomized controlled trial reported in the July 5 issue of the Annals of Internal Medicine  and "Spinal manipulative therapy is only minimally effective for chronic low back pain, according to the results of an update of a Cochrane review reported in the June 1 issue of Spine."

The Department of Health and Human Services, in accordance with Congress's desire to ramp up HIPAA privacy and security rule enforcement, has contracted with the Big 4 accounting firm KPMG to perform compliance audits of covered entities (health care providers who engage in electronic transactions, health care clearinghouses, and health plans) and their business associates. Health Data Management reports that "Under the contract, OCR expects KPMG to conduct 150 audits by the end of 2012."  Any violations that KPMG finds could result in heavy penalties under the HITECH Act's revised civil penalty scheme.

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