Federal Old-Age, Survivors, and Disability Insurance; revised medical criteria for the determination of disability--Social Security Administration. Proposed rules

These proposed amendments revise the medical evaluation criteria for both the title II and title XVI disability programs. These criteria were last revised in 1979. The proposed revisions reflect advances in the medical treatment of some conditions and in the methods of evaluating certain impairments. These proposals will provide up-to-date medical criteria for use in the evaluation of disability claims.     

Federal Old-Age, Survivors, and Disability Insurance benefits annual earnings test--Social Security Administration. Proposed rule

These proposed regulations reflect recent statutory amendments which delay for one year (from January 1982 until January 1983), for all except a very small number of individuals who file their tax returns on a fiscal year basis, full-implementation of section 302, Pub. L. 95-216, the Social Security Amendments of 1977. Section 302 reduced from 72 to 70 the age at which social security beneficiaries are no longer subject to an earnings test.     

Federal Old-Age, Survivors, and Disability insurance benefits; limitations on benefit payments to prisoners; restrictions on disability determinations for felony-related and prison-related impairments--Social Security Administration. Proposed rules

These proposed regulations, which are based on Pub. L. 96-473, place certain restrictions on the payment of benefits based on disability and student status to persons who have been convicted of a felony and are imprisoned and restrict the use of certain impairments in determining disability. These proposed rules specify the conditions under which benefits will not be paid to these individuals and how a finding of disability may be affected when an impairment, or the aggravation of a preexisting impairment, arises during the commission of a felony or imprisonment. Before the enactment of Pub. L. 96-473, there were no restrictions upon the payment of benefits or the making of disability determinations for these persons.     

Federal Old-Age, Survivors, and Disability Insurance and Supplemental Security Income for the Aged, Blind and Disabled; representative payment--SSA. Final rule

These final regulations reorganize and restate in simpler language our regulations on representative payment under titles II, Old-Age, Survivors, and Disability Insurance (OASDI), and XVI, Supplemental Security Income for the Aged, Blind, and Disabled (SSI) of the Social Security Act. These regulations (1) explain representative payment; (2) state when title II and title XVI benefits will be paid to a representative payee rather than directly to the entitled person; (3) indicate the procedure we follow in selecting a representative payee; (4) specify the responsibilities of a representative payee; and (5) clarify our responsibilities to the beneficiary when we make payments to a representative payee on his or her behalf.     

Federal old-age, survivors, and disability insurance; listing of impairments--mental disorders--SSA. Proposed rules

These proposed amendments revise the medical evaluation criteria for mental disorders for the disability program in title II and title XVI of the Social Security Act. No substantial revisions have been made to these criteria since 1979. The proposed revisions reflect advances in medical treatment and in methods of evaluating certain mental impairments, and will provide up-to-date medical criteria for use in the evaluation of disability claims based on mental disorders.     

Federal employees health benefits program: effective dates--OPM. Proposed rule

The Office of Personnel Management (OPM) is issuing proposed regulations to change the existing Federal Employees Health Benefits (FEHB) Program regulations concerning the effective date for new enrollments made by employees during the annual open season. These regulations would also change the effective date of open season changes in enrollment made by employees, annuitants, former spouses and individuals enrolled under the temporary continuation of coverage (TCC) provisions of FEHB law. The proposed regulations would standardize the effective date of most of these new enrollments or changes in enrollment. This would make it easier for employing offices and health plan carriers to administer the Program and reduce the potential for error in determining effective dates.     

Federal employees health benefits program; coverage of temporary employees--OPM. Interim rule with request for comments

The Office of Personnel Management (OPM) is issuing interim regulations to clarify the eligibility of temporary employees to continue their Federal Employees Health Benefits (FEHB) coverage when they become compensationers. These regulations are necessary to distinguish between retirement as an employee annuitant and "retirement" as a compensationer. OPM is also issuing regulations to allow temporary employees an opportunity to change health plans if their salary is insufficient to pay the premium withholdings, to show the effective date of such an enrollment change, and to provide for the termination of these employees' enrollment if they do not change health plans.     

Community benefit activities of private, nonprofit hospitals

The definition of hospital community benefits has been intensely debated for many years. Recently, consensus has developed about one group of activities being central to community benefits because of its focus on care for the poor and on needed community services for which any payments received are low relative to costs. Disagreements continue, however, about the treatment of bad debt expense and Medicare shortfalls. A recent revision of the Internal Revenue Service's Form 990 Schedule H, which is required of all nonprofit hospitals, highlights the agreed-on set of activities but does not dismiss the disputed items. Our study is the first to apply definitions used in the new IRS form to assess how conclusions about the adequacy of nonprofit hospital community benefits could be affected if bad debt expenses and Medicare shortfalls are included or excluded. Specifically, we examine 2005 financial data for California and Florida hospitals. Overall, we find that conclusions about community benefit adequacy are very different depending on which definition of community benefits is used. We provide thoughts on new directions for the current policy debate about the treatment of bad debts and Medicare shortfalls in light of these findings.     

Federal universal service support mechanisms--FCC. Proposed rule; request for comments

In this document, the Commission seeks comment on the Report and Proposed Plan of Reorganization (Plan) filed on July 1, 1998 by the Universal Service Administrative Company (USAC), the Schools and Libraries Corporation (SLC), and the Rural Health Care Corporation (RHCC). The Plan proposes a revised adminstrative structure of the federal universal service support mechanisms. RHCC filed a Separate Statement of the Rural Health Care Corporation and Request for Three Changes in the Plan, dissenting from certain provisions of the proposed Plan. In this document, the Commission also seeks comment on other issues regarding the administration of the federal universal service support mechanisms, including processes for Commission review of actions by USAC, SLC, and RHCC.     

Federal employees dental and vision insurance program. Final rule

The Office of Personnel Management (OPM) is issuing final regulations to administer the Federal Employee Dental and Vision Benefits Enhancement Act of 2004, signed into law December 23, 2004. This law establishes dental and vision benefits programs for Federal employees, annuitants, and their eligible family members.     

Federal employees health benefits program; revision of contract cost principles and procedures, and miscellaneous changes. Final rule

The U.S. Office of Personnel Management (OPM) is issuing a final regulation amending the Federal Employees Health Benefits (FEHB) Acquisition Regulation (FEHBAR). This regulation provides additional contract cost principles and procedures for FEHB Program experience-rated contracts and is intended to clarify our requirements and enhance our oversight of FEHB carriers.     

Federal Employees Health Benefits Program improving carrier performance; conforming changes--OPM. Proposed rulemaking

The Office of Personnel Management (OPM) is proposing to issue a regulation that would amend the Federal Employees Health Benefits Acquisition Regulation (FEHBAR) to underscore accountability for customer service and contractual compliance among the Federal Employees Health Benefits (FEHB) Program community-rated carriers. The regulation would enable OPM to better manage carriers' performance over key contract areas, including customer service measures, information and reporting requirements, and significant events that might affect service to enrollees. Accurate and timely performance by carriers will facilitate the Program meeting its customer service standards.     

Medicare program; criteria for Medicare coverage of adult liver transplants--HCFA. Proposed notice

This notice proposes Medicare coverage of liver transplantations in adults under certain circumstances. We would provide coverage for adult liver transplants based on the results of an assessment conducted by the Office of Health Technology Assessment of the Public Health Service and our subsequent determination that liver transplants are a medically reasonable and necessary service when furnished to adult patients with certain conditions and when furnished by participating facilities that meet specific criteria, including patient selection criteria.     

Genetic Testing and the Future of Disability Insurance: Ethics, Law & Policy

Predictive genetic testing poses fundamental questions for disability insurance, a crucial resource funding basic needs when disability prevents income from work. This article, from an NIH-funded project, presents the first indepth analysis of the challenging issues: Should disability insurers be permitted to consider genetics and exclude predicted disability? May disabilities with a recognized genetic basis be excluded from coverage as pre-existing conditions? How can we assure that private insurers writing individual and group policies, employers, and public insurers deal competently and appropriately with genetic testing?     

Life, Health, and Disability Insurance: Understanding the Relationships

Communitarian values are stronger in health insurance than in life or disability insurance. This correlates with increased tolerance for insurers' use of genetic information in disability insurance underwriting, which, in turn, is relevant to the scope and content of proposals to regulate such use.     

Federal employees health benefits program; limitation on inpatient hospital charges and FEHB program payments--OPM. Final rule

The Office of Personnel Management (OPM) is issuing final regulations that implement section 7002(f) of the Omnibus Budget Reconciliation Act of 1990. The law sets a limit on the charges and Federal Employees Health Benefits Program (FEHBP) benefit payments for certain inpatient hospital services received by a retired enrolled individual. These regulations finalize interim regulations that defined a retired enrolled individual and set forth the circumstances under which the limit on charges and FEHBP benefit payments take effect.     

Federal employees health benefits acquisition regulation: large provider agreements, subcontracts, and miscellaneous changes. Final rule

The Office of Personnel Management (OPM) is issuing this final regulation to amend the Federal Employees Health Benefits Acquisition Regulation (FEHBAR). It establishes requirements, including audit, for Federal Employees Health Benefits Program (FEHB) experience-rated carriers' Large Provider Agreements. It also modifies the dollar threshold for review of carriers' subcontract agreements; revises the definitions of Cost or Pricing Data and Experience-rate to reflect mental health parity requirements; updates the contract records retention requirement; updates the FEHB Clause Matrix; and conforms subpart and paragraph references to Federal Acquisition Regulation (FAR) revisions made since we last updated the FEHBAR.     

Designation of medically underserved populations and health professional shortage areas--HRSA. Proposed rules

The rules proposed below would consolidate the processes for designating medically underserved populations (MUPs) and health professional shortage areas (HPSAs), designations that are used in several DHHS programs. The purpose is to improve the way underserved areas are designated by incorporating up-to-date measures of health status and access barriers and eliminating inconsistencies and duplication of effort. The intended effect is to reduce the effort and data burden on States and communities by simplifying and automating the design process as much as possible, while maximizing the use of technology. The proposed rules involve major changes to both the MUP and the primary care HPSA designation criteria, which have the effect of making primary care HPSAs a subset of the MUPs. No changes are proposed with respect to the criteria for designating dental and mental health HPSAs. Podiatric, vision care, pharmacy, and veterinary care HPSA designations would be abolished under the rules proposed below.