Friday, January 18, 2019

TGIF

Regrettably, tomorrow marks the fourth week of the partial government shutdown. OPM updated its furlough guidance earlier this week. Furthermore, Federal News Network reports that
President Donald Trump has signed a new bill into law guaranteeing back pay for federal employees impacted by the partial government shutdown. The Government Employee Fair Treatment Act covers both furloughed and excepted employees. It ensures they’ll receive retroactive pay whenever this shutdown ends — and appears to guarantee back pay during future lapses in appropriations.
On this past hump day, the FEHBlog cautiously commented about the then rocky contract negotiations between CVS Health and Walmart.  Other reported this news like it was a fact that Walmart had dropped out of the CVS retail pharmacy network. Last month, Tenet, the large healthcare system, was asserting that it planned to leave the Cigna network, which it described as "uninsurance."  Two days later Cigna and Tenet announced a contract. Today, the news broke that CVS and Walmart had agreed to a new contract that keeps Walmart in the CVS retail pharmacy network.  Apparently Chicken Littling the situation to the public is a hot bargaining tactic.

Yesterday, HHS released its proposed 2020 ACA notice of benefit and payment parameters. This notice bears on OPM's 2020 FEHBP benefit and rate proposal as it provides for the 2020 annual limit on cost sharing.  The proposed rule’s preamble states as follows:

We propose that the 2020 maximum annual limitation on cost sharing would be $8,200 for self-only coverage and $16,400 for other than self-only coverage. This represents an approximately 3.8 percent increase above the 2019 parameters of $7,900 for self-only coverage and $15,800 for other than self-only coverage.
The HHS Fact Sheet adds that
These [Rx cost reduction] proposals [described in the Notice’s preamble] include allowing individual market, small group market, and large group market health insurance issuers to adopt mid-year formulary changes to incentivize greater enrollee use of lower-cost generic drugs; and allowing such issuers and self-insured group health plans to except certain cost-sharing from the maximum out-of-pocket limit if a consumer selects a brand drug when a medically appropriate generic drug is available, and to except drug manufacturer coupons for specific prescription brand drugs that have a generic equivalent from the maximum out-of-pocket limit.
The final rule should be out in the Spring.

CMS reported earlier this week that the agency has completed the process of mailing out new Medicare ID cards to beneficiaries. Historically the Medicare ID cards used the beneficiary's Social Security Number as the Medicare ID number. The new Medicare ID cards uses an anonymous ID number. Better late than never.  Back in time, FEHB plans also used the Social Security Number as the Plan ID on the ID cards. OPM squelched that many moons ago.

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