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HRD-76-174 1 (1977-01-14)

handle is hein.gao/gaobaabwq0001 and id is 1 raw text is: DOCUMENT RESUSE L q 00502 - [A059,985) more Civil Service Commission Supervision 'eeded to Ccntrol Health Insurance Costs for Federal Employecs. HRD-76-174; B-164562. January 14, 1977. Released January 21, 1977. 419 pp. + appendices (32 pp.). Report to Rep. Richard C. White, Chairman, House Committee on Post Office and Civil Service: Retirement and Employee Benefits Subcomeittee; by Elmer B. Staats, Comptroller General, Issue Area: Health Programs: Reimbursement Policies and Utilization Controls (1208). Con4 ct: Human Resources Div. Budget Function: Health: Health Care Services (551). Organization Concerned: Civil Service Commission: Bureau of Executive manpower; National Association of Blue Shield Plans; Aetaa Life Insurance Co.; Civil Service Commission. Congressional Relevance: House Committee on Post Office and Civil Service: Retirement and Employee Benefits Su icommittee. Authority: Federal Employees Health Benefits Act of 1959 (5 U.S.C. 8901). Representative Richard C. White requested a review to deterrine vhat the two Government-wide carriers (Blue Cross and Blue Shield ani the Aetna Life Insurance Company) and the Civil Service Coazissiop. are doing to control health care costs under the Feoer&l Employees Health Benefits prograv. Findings/conclusions: Benefit payments have teen loada without ccnforming to coatract cr policy requirements and without enough information to determine vhether payments were allowable. The contracts negotiated by the Civil Service Commission provide no incentives for the carriers to control benefit payments, and contain uo provisions under vhich the Commission, either through audit cr other means, can exercise sufficient control over the allowability of benefits paid by the carriers. Recommendations: The Civil Service Commission should revise its h,1alth insurance contracts to ?rovide incentives for compliance with the Comissionts contract requirements; it should include in its contracts specific cost-control programs that the carriers must follow; and should clarify its audit authority, expand its audits, and act more effectively on its audit findings. If the Commission does not adopt these recommendations, the Subcommittee on Retirement and Employee Benefits should consider developing legislation to this end. (Author/SW)

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