Weekend Update

Congress is on the campaign trail until November 13, the beginning of the lame duck session. Monday is the beginning of a new federal fiscal year and the FEHBlog has learned from Kaiser Health News that today is the deadline for states to submit their minimum essential benefit packages to HHS. "15 states and the District of Columbia have made their choices and 17 more states are expected to do so in the next few weeks, according to consulting firm Avalere Health."  While FEHB plans and large group plans do not have to offer the minimum essential health benefits package, those plans cannot impose lifetime or annual dollar caps on those benefits to the extent that they are offered. OPM for the FEHBP and the Labor Department for ERISA government plans will have to help employer sponsored plans sort out any confusion created by HHS's state by state approach (which was not dictated by the statute).

The AMA News reports on growing insurer use of the patient centered medical home strategy or primary care on steroids.

Programs supported by commercial and government insurers now exist in nearly every state, according to a report issued Sept. 7 by the Washington-based Patient-Centered Primary Care Collaborative, an organization supportive of the medical home model.
For example:

• Programs run by member organizations of the national BlueCross BlueShield Assn. supply care to 4 million patients in 39 states, the District of Columbia and Puerto Rico.

• Humana offers medical home services in 10 states for 70,000 Medicare Advantage members and 35,000 commercial members.

• The Centers for Medicare & Medicaid Services announced Aug. 22 that 500 practices with more than 2,000 physicians across the country will participate in the comprehensive primary care initiative.

• WellPoint, Aetna and UnitedHealthcare have announced in recent months that their medical home programs are expanding.

The momentum is growing, the report said, because insurers see evidence that medical homes save money and improve care.

Under the Affordable Care Act, States may permit large employers to join their  health insurance exchanges beginning in 2017.  Large employers are defined as an employer who employs at least 101 employees. However, in 2016, States can lower that threshold to 51 employees. (Aside -- To ensure that their exchanges have enough enrollees to be viable, the District of Columbia and Vermont might require small employers to participate in their insurance exchanges. Revenue needed to operate state exchanges likely will come from an assessment or tax on participating health plans, which will be based on the number of enrollees.) Business Insurance reports that Aon Hewitt, a  large benefits consulting firm, has created its own version of a health insurance exchange for its large employers clients this year with coverage beginning in 2013. Sears, Aon, and Darden Restaurants (owner of Red Lobster among others) are participating. Of course, the FEHBP is the granddaddy of health insurance exchanges.