Weekend Update

Welcome back Congress from your Presidents' Day holiday. It appears, according to a Washington Post report, that Congress will push back the continuing resolution showdown from March 4 to March 14. Govexec.com confirms that in the event of a shutdown

Government workers will not see a break in health or life insurance coverage during a furlough. According to the Office of Personnel Management, Federal Employees Health Benefits Program participants are covered while in nonpay status for up to one year. The government will continue its contributions to the program during a furlough and also is responsible for advancing the employee's share. Participants then can choose between paying the agency directly on a current basis, or having the premiums accumulate and be withheld from their pay upon returning to work. Coverage continues even if agencies do not make premium payments on time.

The FEHBlog discovered last week that a California law firm has filed a lawsuit in the San Francisco federal court against the Department of Health and Human challenging the validity of the Medicare Part B fee schedule used to compensate doctors, which is officially known as the resource based relative value schedule ("RBRVS"). Here's a link to the first amended complaint.

The lawsuit charges that due to a faulty geographic adjustment formula in the RBRVS, Medicare has underpaid doctors in certain U.S. counties for many years to the tune of $3.2 billion. Of course,  if the allegations are true then doctors in other counties have been overpaid by the same amount. What insanity.
This problem should be resolved administratively or legislatively, not in the court.

The lawsuit tangentially could affect the FEHB Program because fee for service FEHB plans use the RBRVS to pay doctor claims for services rendered to FEHBP annuitants without Medicare Part B coverage. The FEHB Act, 5 U.S.C. Section 8904(b), calls for this payment arrangement (just as Congress called for HHS to use the RBRVS for Medicare Part B pricing).

URAC has released new certification standards for HIPAA Privacy and Security Rule compliance. It's good timing on URAC's part because last week HHS Office for Civil Rights imposed its first two HITECH ACT enahanced penalties for HIPAA violations -- $4.3 million against Cignet Healthcare as previously noted in the FEHBlog and $1 million against Massachusetts General Hospital based on an employee's negligent loss of patient records likely on the Boston subway according to a Fierce Healthcare report.

NCQA announced last week that it is seeking public comment until March 22 on changes to its HEDIS quality measures. NCQA is considering to add two new asthma care measures and two new child health measures, plus make changes to five existing measures. FEHB plans report on various HEDIS measures in accordance with OPM's direction.