Tag Archives: transparency

Public Records Delayed Due To Affordable Care Act

A heavy workload caused by the Affordable Care Act, government technology limits and staff shortages are causing unusually long delays in filling public records requests, federal health officials say.

The waits in some cases could stretch out a decade or more.

The Freedom of Information Act requires federal agencies to respond to records requests in 20 working days, though providing documents often takes much longer. The FBI, for instance, recently reported that complex requests could average more than two years to fill.

The Centers for Medicare and Medicaid Services has a backlog of some 3,000 FOIA requests and says it may need 10 years or more to dig out from under some large cases.

The Justice Department disclosed the bottleneck in court papers filed Friday in a FOIA lawsuit brought by the Center for Public Integrity against the Department of Health and Human Services, the parent agency of CMS.

The suit, filed in May 2014, seeks a broad array of records as part of the Center’s ongoing investigation into overcharges by private Medicare Advantage insurance plans for the elderly. The center filed suit after failing to receive any records as a result of its initial FOIA request in 2013.

In its court filing, the Justice Department argued that CMS resources “have been placed under unusual strain” in the past year due to demands of launching Obamacare.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Increasing Transparency Rules Provide Consumers Informed Choices

Consumer advocates are cheering the Obama administration’s plans to strengthen transparency rules (PDF) for provider networks and drug formularies so that insurance exchange customers will be able to make informed choices.

“There are a lot of good things in here that are increasing transparency and adding to access for people with chronic conditions,” Eric Gascho, assistant vice president of government affairs with the National Health Council, said of the draft regulations issued Friday for enrollment in marketplace plans for 2016 and beyond.

Katherine Hempstead, who directs coverage activities for the Robert Wood Johnson Foundation, said it appears that the “CMS really took to heart a lot of things that people were saying.”

Still, the proposal is not without controversy. Plans to scrap the administration’s current policy of automatic re-enrollments and to stick with a fall sign-up season have received less enthusiastic responses.

The CMS said it planned to change the rules that health plans must follow to establish that their drug formularies provide adequate access to pharmaceuticals. The agency wants to require insurers to establish “pharmacy and therapeutics” committees that would meet at least four times a year to review drug formularies. More than half of the panel would have to be made up of healthcare professionals and at least 20% would need to be free of any financial conflicts with insurers or pharmaceutical companies.

“This is a really major improvement,” said Carl Schmid, deputy executive director of the AIDS Institute, which has filed a complaint with the CMS charging that some exchange plans sold in Florida discriminate against customers with HIV. “The only bad thing is that that they’re not proposing it until 2017.”

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary