Tuesday Tidbits

The FEHBlog successfully predicted that the University of Connecticut (my alma mater)/ Team of Destiny would win the NCAA men's basketball championship, but the FEHBlog is in no position to predict whether or not there will be a partial government shutdown on Saturday. The FEHBlog hopes for the best and notes the OPM posted shutdown guidance for federal employees on its website today.

Business Insurance reports that the Senate today joined the House of Representatives in repealing the Affordable Care Act's expanded IRS Form 1099 reporting requirement against which large and small businesses rebelled.

The Washington Post reports on recent Justice Department anti-trust actions against health care providers and insurers. The actions are of interest because the violations arise out of provider network contracting actions in the context of a business with alleged monopoly power.

The FEHBlog moves from provider network contracts to out of network payment arrangements. The FEHBlog has discussed the New York State Attorney General's (now Governor's) settlement with Ingenix which lead to Ingenix handing over its out of network reimbursement databases to a new non-profit company called Fair Health, Inc. Fair Health has launched a new website which will give consumers estimated costs for medical and dental procedures by zip code. The site currently offers dental procedure pricing and in August 2011 it will provide medical procedure pricing.

The American Medical News ran an interesting story about the ongoing development of the essential benefits package which health insurance exchange plans must offer. The following paragraph is noteworthy for its praise of the FEHBP:

The AMA recommends that HHS strike a balance by using an existing model -- the Federal Employees Health Benefits Program -- as a reference when setting essential benefits. FEHBP plans cover hospital, physician, medical and surgical care, even though the program does not specify a standard benefit package, said Gerald E. Harmon, MD, a member of the AMA Council on Medical Service. Participating plans follow evidence-based guidelines for preventive care and are required to cover additional benefits, including childhood immunizations, prescription drugs and mental health services. Dr. Harmon emphasized that the definition of essential benefits must allow for a range of health plan options with a variety of benefits, cost-sharing levels and other features to ensure adequate consumer choice.