Weekend update

The House is holding a constitutent work week this week while the Senate is in session. The FEHBlog cannot find any committee activities of note for the coming week.

The FEHB Act, 5 U.S.C. Sec. 8902(m)(2), requires FEHB fee for service plans to expand their coverage of different types of providers in medically underserved states. Last week, OPM announced in the Federal Register that for 2012 South Carolina will leave, and Alaska will join, the list of medically underserved states. 15 states currently are on the list.

The FEHBlog was reminded last week that there are two OPM websites -- the regular site and the open site.  The open website is soliciting public comments the agency's preliminary plan for retrospective review of its existing regulations. On OPM's review list is the similarly sized subscriber group methodology used to price community rated plans. OPM is developing a new approach based on the Affordable Care Act's minimum loss ratio. The comment deadline is July 1.

Last week the Centers for Medicare and Medicaid Service ("CMS") announced a final rule that 

prohibits States from making payments to providers under the Medicaid program for conditions that are reasonably preventable.  It uses Medicare’s list of preventable conditions in inpatient hospital settings as the base (adjusted for the differences in the Medicare and Medicaid populations) and provides States the flexibility to identify additional preventable conditions and settings for which Medicaid payment will be denied.  The final rule is effective July 1, 2011 but gives States the option to implement between its effective date and July 1, 2012.

Kaiser Health News reports that

Some physician groups have concerns about the new policy. "Simply not paying for complications or conditions, that, while extremely regrettable, are not entirely preventable, is a blunt approach that is not effective or wise for patients or the Medicare or Medicaid program," Dr. Michael Maves, CEO of the American Medical Association, said in written comments to CMS in March.

He said the medical association has "grave concerns" about states extending the non-payment policy beyond the conditions considered by Medicare. The American Hospital Association expressed similar reservations.

Finally, CMS offers excellent websites that provide quality of care data on hospitals. nursing homes, home health agencies, dialysis facilities, and soon doctors. The websites are based on care rendered to both Medicare and non-Medicare patients. CMS announced on Friday "proposed rules that will enable consumers and employers to select higher-quality, lower-cost physicians, hospitals and other health care providers in their area." More specifically,

CMS would provide standardized extracts of Medicare claims data from Parts A, B, and D to qualified entities.  The data can only be used to evaluate provider and supplier performance and to generate public reports detailing the results. ·        The data provided to the qualified entity will cover one or more specified geographic area(s).
·        The qualified entity would pay a fee that covers CMS’ cost of making the data available.
·        To receive the Medicare claims data, qualified entities would need to have claims data from other sources.  Combining claims data from multiple sources creates a more complete and accurate picture about provider and supplier performance.
·        Publicly reporting the results calculated by the qualified entity is important for transparency in health care and consumer empowerment.  To prevent mistakes, qualified entities must share the reports confidentially with providers and suppliers prior to their public release.  This gives providers and suppliers an opportunity to review the reports and provide necessary corrections.
·        Publicly released reports would contain aggregated information only, meaning that no individual patient/beneficiary data would be shared or be available.
·        During the application process, qualified entities would need to demonstrate their capabilities to govern the access, use, and security of Medicare claims data.  Qualified entities would be subject to strict security and privacy processes.
·        CMS would continually monitor qualified entities, and entities that do not follow these procedures risk sanctions, including termination from the program.  

The proposed rules will be published in the June 8 Federal Register and CMS will accept comments for six days from that date.