Sunday, November 04, 2012

Weekend update

Well this is election week (finally). Next Monday, November 12, Congress will return to Washington and the Federal Benefits Open Season will begin. Here's the link to OPM's Open Season resources. Fedsmith.com announced that OPM again will be offering a series of Open Season how to webinars that begin on Tuesday November 6.

Earlier this years, President Obama ordered OPM to admit seasonal firefighters into the FEHBP. Typically seasonal employees are not eligible for FEHBP coverage. OPM complied with the President's order in the summer and at this point these seasonal workers no longer are working for the Interior Department and are no longer receiving FEHBP coverage with a government contribution. Instead they generally must pay for temporary continuation of coverage until they are called to duty again. The FEHBlog brings this up now because the Washington Post reports that the folks who are temporarily working for FEMA to assist victims of Superstorm Sandy are complaining that they should receive FEHBP coverage. In the regulation extending coverage to the seasonal firefighter, OPM left the door open for extending FEHBP coverage to other temporary first responders. According to the Post article there are about 9,000 temporary first responders working for FEMA.

The federal government employs a lot of temporary employes who are not first responders but rather work for the IRS. Presumably this problem will resolve itself once the state health insurance exchanges are established.  It's not clear to the FEHBlog whether the Affordable Care Act will require a large employer like the federal government to pay for health insurance for temporary employees who work more than 30 hours per week.  There has been a lot written lately about the fact that the pay or play provisions of the Affordable Care Act are limited to full time employees (30 or more hours per week).   It probably will be a case by case situation for the temporary employees.

Reuters reports that the American Hospital Association and others have sued the Health and Human Services Department challenging the way in which the Recovery Audit Contractor program is being administered.  Under the RAC program, private contractors working for HHS audit health care providers that bill Medicare and Medicaid (not the FEHBP) to identify overpayments by those programs. (FEHB plans undergo a variety of independent audits as well as audits conducted by OPM's Office of Inspector General.)  "The RAC audit program, established under the Bush administration to curtail improper Medicare payments, has collected $1.86 billion in overpayments from October 2009 to March 2012, according to the court filing."

The Wall Street Journal explains that the nub of the lawsuit is that when a RAC contractor concludes that inpatient care should have been provided on an outpatient basis, the hospital must refund Medicare's payments (the RAC contractor receives a percentage of the recoveries), and Medicare refuses to cover the outpatient costs. The suit asks the court to order HHS to reimburse the hospitals for the patient's care as if it were rendered on an outpatient bases.  

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