Exciting Day

The Affordable Care Act regulators released the final summary of benefits and coverage ("SBC") and uniform glossary rule today. FEHB plans will be required to distribute this SBC for the first time during the 2013 Open Season, which begins in November 2013. This four doubled sided page summary is intended to help consumers select a health plan. However, the ACA regulators are not requiring that the SBC display the premium. Of course, the premium information could accompany the SBC.

The ACA regulators did not make substantive changes to the form or the uniform glossary on first glance other than to reduce the number of coverage examples from three to two. Here's a link to the HHS Fact Sheet. All of the SBC templates and instructions can be found on this DOL website.

The ACA regulators also released FAQs for employers concerning several ACA provisions that kick in for 2014 - the automatic enrollment provision for new full time employees of employers with more than 200 employees, such as the U.S. Government, the employer shared responsibility provision, and the waiting period provision. Most of the FAQs focus on the question of defining a full time employee. The ACA regulators are accepting public comments on these issues until April 9, 2012.

The Wall Street Journal reports that UnitedHealth care is switching over to a new system for compensating network doctors that rewards doctors financially for avoiding hospital readmissions and doing a good job managing chronic illnesses.

In the last decade, the American Medical Association attacked the Ingenix usual, reasonable and customary fee schedule which health plans had used for decades as a benchmark for pricing out-of-network benefit payments. Ultimately, the New York State Attorney General joined the crusade. UnitedHealth which owned Ingenix settled the AMA lawsuit and New York investigation by agreeing to pay $300 million dollars and turn over its UCR fee schedules to a new non-profit called Fair Health. Health plans and insurers switched to another benchmark -- the resource based relative value schedule that Medicare uses to reimburse doctors under Medicare Part B. (The dollar factor in this formula is adjusted by the statutory sustainable rate of growth formula that Congress always needs to patch and may now replace).  In the FEHBlog's view, this was a good call because the AMA would be hard pressed to challenge the legality of the RBRVS. This week, the Kaiser Health News is reporting to its chagrin hat the RBRVS approach controls costs.

The AMA News is reporting that Rite Aid's in store medical clinics are allowing customers to speak with a doctor over a video monitor -- combining the retail clinic and telemedicine concepts.