News in brief - June 12, 2000

Supporters urge action on stalled patient protection bill - Government creating local Medicare coverage standards - Federal court supports payments to Christian Science nursing homes - Lawmakers vow bipartisanship on Medicare drug issue

Supporters urge action on stalled patient protection bill

Washington -- Rep. Charles Norwood, DDS (R, Ga.), said he was willing to use "any legal means necessary" to gain passage of patients' rights legislation that he sponsored and the House passed in October 1999.

His sentiments were echoed by Sen. Edward Kennedy (D, Mass.), who serves on the congressional negotiating team that has apparently stalled in its attempt to craft compromise legislation between House and Senate bills to regulate managed care.

Kennedy noted that the House bill could be attached to another legislative vehicle in an attempt to gain its passage. Neither Dr. Norwood nor Kennedy provided details.

Dr. Norwood, who was not named to the negotiating team despite being a lead sponsor of the House legislation, said he would take action on the Norwood-Dingell bill if negotiators didn't have a compromise bill or a tentative agreement in writing soon.

Dr. Norwood also released data from a recent poll by the Patient Access Coalition, a group that supports the House bill, showing that 87% of 800 voters surveyed said they thought it was important for Congress to enact managed care legislation this year.

Negotiators have made little progress in resolving the two major differences between the bills: liability and scope. The House bill permits people with employer-based insurance to sue health plans in state court for malpractice. The Senate bill would not expand the current right of patients to sue in federal court only for the benefit denied. The House bill also would cover all 161 million people who have private insurance. The Senate bill would largely apply only to the 55 million Americans in self-insured plans.

Government creating local Medicare coverage standards

Washington -- The Health Care Financing Administration announced in May that it plans to develop standards to help guide local and national Medicare coverage decisions -- a step that physicians say is long overdue.

Medicare carriers and fiscal intermediaries now make about 90% of the coverage decisions, which are binding only in the contractor's service area. HCFA makes the remaining 10% of coverage decisions, which apply to everyone.

The contractors and the agency make coverage decisions on a case-by-case basis whether an item or service passes the "reasonable and necessary" test required in Medicare law.

Critics say the existing decision-making process is confusing and inconsistent.

"The current system is not a system," said William G. Plested, MD, a member of the AMA Board of Trustees who welcomed the agency's effort. "Coverage decisions are made differently in different states and by different carriers in the same state. There is no standardization."

HCFA hopes to standardize the process by developing criteria that contractors and the agency can follow when deciding what is "reasonable and necessary."

Two proposed criteria include requiring an item or service to be shown to have medical benefit and to demonstrate whether it adds value to Medicare patients.

Federal court supports payments to Christian Science nursing homes

A federal appeals court affirmed the legality of Medicare and Medicaid payments to Christian Science nursing homes and any other religious nonmedical health care facilities, saying the payments do not violate the constitutional separation of church and state, as the AMA and other medical societies alleged.

The 2-1 decision reached by the Eighth Circuit Court of Appeals in Minneapolis was issued May 1 in the case of Children's Healthcare is a Legal Duty Inc. et al. v. The Dept. of Health and Human Services et al. and The First Church of Christ, Scientist (as intervener).

The AMA, the American Academy of Pediatrics, the American Nurses Assn. and the American Civil Liberties Union supported the plaintiff -- an Iowa-based child advocacy group, which argued that the payments to Christian Science healing centers allowed those who rely solely on religion for healing to get paid for custodial care when beneficiaries in traditional long-term-care settings cannot.

The appeals court disagreed, affirming a lower court ruling that the payments are a "permissible accommodation of religion."

"By extending nonmedical health care benefits to individuals who object for reasons of religion to medical treatment, [the Balanced Budget Act of 1997] spares such individuals from being forced to choose between adhering to the tenets of their faith and receiving government aid, and in doing so removes a burden that the law would otherwise impose," wrote Chief Judge Roger L. Wollman.

The group, Children's Healthcare is a Legal Duty Inc., plans to appeal the ruling.

Lawmakers vow bipartisanship on Medicare drug issue

Washington -- The Congressional debate over Medicare prescription drug coverage continued to simmer in May, although Rep. Bill Thomas (R, Calif.) and Sen. Ron Wyden (D, Ore.) attempted to stir things up with an announcement they will work together to develop a benefit.

Wyden, the co-sponsor of pending Medicare drug benefit legislation in the Senate, and Thomas, chair of the House Ways and Means Committee's subcommittee on health, said they had agreed to several key principles that must be in a drug benefit.

Those principles include making the benefit universal and voluntary, requiring drug companies to pay a "return on investment" fee to support the drug benefit when they profit on government-funded research, and directing the Dept. of Health and Human Services to oversee the benefit.

President Clinton, meanwhile, met with congressional Democratic leaders and urged them to remain unified so they can develop a bipartisan prescription drug benefit and improve the chances that such a benefit will pass the GOP-controlled Congress this year.