California Healthline Highlights Recent Medicare News
California Healthline features articles on recent Medicare news. Summaries appear below.
- Ambulatory surgical centers: CMS on Monday issued an interim final rule that would expand the list of services at ambulatory service centers that Medicare covers. The rule would add 65 new services to the list and delete five others. An interim final rule issued in November 2004 would have added 25 new services to the list and deleted 65 others. However, after a public comment period raised concerns that the elimination of Medicare coverage for 65 services could affect patient safety and access to care, CMS decided to revise the November 2004 rule. "The comments we received provided clear, clinical evidence that deleting the procedures, as we had proposed, could have led to reduced access, or riskier care for patients with more complicated medical conditions if performed in a physician's office rather than an ASC," CMS Administrator Mark McClellan said in a news release. Officials for the Federated Ambulatory Surgery Association said that the new rule still "falls far short of what Medicare should be providing its beneficiaries." The rule will appear in the Federal Register on May 4 and will take effect on July 5. CMS at a later date might issue a final rule in response to public comments, according to the agency (CQ HealthBeat, 5/2).
- Living wills: Future consultations with new Medicare beneficiaries could include advice about living wills, the AP/Las Vegas Sun reports. At a meeting with hospital administrators on Monday, HHS Secretary Mike Leavitt said that a member of Congress recently said that the inclusion of advice about living wills in Medicare consultations could reduce program costs. Although Leavitt did not provide specific details, "presumably, if such a proposal is put in place, the government would not spend money keeping alive terminal patients who had filled out living wills rejecting life-prolonging medical care," the AP/Sun reports. According to the AP/Sun, the case of Terri Schiavo, who died on March 31 at a Florida hospice, has "put new focus on living wills and advanced directives" (Freking, AP/Las Vegas Sun, 5/2).
- Long-term care hospitals: CMS on Friday announced a final rule that will increase Medicare reimbursements for long-term care hospitals by 3.4% on July 1. The rule also will reduce requirements for long-term care hospitals to qualify for Medicare outlier payments, which reimburse facilities that provide seriously ill patients with high-cost treatments. In addition, CMS has awarded a research contract to study recommendations by the Medicare Payment Advisory Commission to specify criteria for facilities and patients eligible for payments under the long-term care hospital system (CQ HealthBeat , 4/30).
- Prescription drug benefit: McClellan on Monday announced that under new Medicare rules, private health plans that offer coverage under the new prescription drug benefit will have to allow beneficiaries to receive a 90-day supply of their medications through mail-order programs or retail pharmacies. Pharmacists had raised concerns that health plans would favor mail-order programs over retail pharmacies to help reduce costs under the prescription drug benefit. McClellan said, "Through our final regulation for the drug benefit, CMS has also addressed concerns about creating a 'level playing field' for retail and mail-order pharmacies" (CongressDaily, 5/3).
- Ultrasound stimulation treatment: Medicare will expand coverage of ultrasound stimulation treatment to include "non-union" bone fractures, CQ HealthBeat reports. Non-union bone fractures occur when healing discontinues and "will not proceed without some type of intervention," CMS said. Most bone fractures heal within eight to 12 weeks; fractures that have not healed after 12 weeks are considered non-union. "Ultrasound stimulation is a form of mechanical energy that is transmitted into tissue as high frequency acoustical pressure waves" and can prompt the release of growth factors and increase blood flow to help improve the healing of bone fractures, CMS said. In the past, Medicare covered ultrasound stimulation treatments only for beneficiaries who had previously undergone unsuccessful surgery to heal the non-union fractures. However, based on the results of several studies, CMS found that "of the 173 non-surgical, non-union fractures that received ultrasound stimulation, 148 healed, for a heal rate of 85%," a rate "similar to that of the non-union fractures with prior surgery that received ultrasound stimulation." CMS will conduct a "post-coverage analysis of claims data to examine the net health benefit of ultrasound stimulation for non-union fractures without prior surgery" (CQ HealthBeat , 4/30).
Additional information on the Medicare drug benefit is available online. This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.