OPM adds autism coverage, new performance standards for FEHB carriers

All Federal Employee Health Benefit program carriers are required to cover applied behavior analysis (ABA) benefits for children on the autism spectrum this yea...

The Office of Personnel Management will begin using 19 measures to evaluate how well carriers in the Federal Employee Health Benefits Program are performing.

The metrics are part of OPM’s Performance Assessment Plan for FEHBP carriers, which the agency is implementing for the first time this year.

“Just as your margins will be affected by how well you perform on these measures, at OPM, we are making the success of these measures part of the criteria by which we measure our success as an agency,” Acting OPM Director Beth Cobert said during her keynote speech at the annual FEHB Carrier Conference in Arlington, Virginia March 31. ”

OPM will report its progress to the Office of Management and Budget, and those results will be available on Performance.gov, Cobert said.

Specifically, the performance metrics focus on three areas: clinical quality, customer service and how well a carrier utilizes its resources. OPM said it’s putting special emphasis on three measures: the timeliness of prenatal care, blood pressure control and reducing hospital re-admissions.

For the first time, all FEHB plans are required to cover applied behavior analysis (ABA) benefits for children on the autism spectrum. Some plans included these benefits in the past, but Cobert said OPM wanted to add them as a requirement  after receiving feedback from FEHB participants.

“We continued to receive letters from federal families desperate, truly desperate, to get this coverage for their children,” she said. “We’ve heard from federal families who had to pay out of pocket for this expensive treatment just because of where they lived.”

It’s unclear whether adding ABA benefits will increase premium costs for FEHB plans.

“Carriers may or may not propose a premium increase to cover this benefit, depending upon their estimates of the costs and likely utilization of the benefit,” OPM wrote in a Q&A on new ABA benefits. “Some plans already provide the benefit and their premiums will be unaffected.”

Making the FEHBP as inclusive as possible for all federal employees is particularly important, Cobert said.

According to the results of the 2015 Federal Employee Viewpoint Survey, 67 percent of respondents said the availability and options in the FEHBP factored into their decision to take a federal job. Nearly 78 percent said FEHB availability impacts their decision to keep a job in the federal workforce.

Keeping FEHB costs down is another priority for OPM this year. The agency is asking its carriers to look more closely at ways they can keep their own expenses low and find solutions “to achieve both short and long term savings for the FEHB Program,” OPM’s annual call letter said.

Cybersecurity is also a focus for the agency and FEHB carriers, particularly in the wake of the two major data breaches OPM suffered last year.

“Our experience to me shows what we can all do when we put our heads together to tackle this issue,” Cobert said. “What can we learn from each other? How can we learn about making the important changes in how we operate? We need to tackle this problem collectively? It’s not an IT problem, it’s a leadership problem. It’s a management problem.”

OPM met with FEHB carriers in September to look more closely at IT security and review secure practices for reporting cyber breaches. The agency will release a letter to carriers soon with updated procedures for information sharing, Cobert said.

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