News in brief - July 3, 2000

Final Medicare managed care rules released - Effort launched to boost Medicare beneficiaries' eye exam rates - Medicare to cover blood processing for rheumatoid arthritis

Final Medicare managed care rules released

Washington -- The Health Care Financing Administration released final regulations governing the Medicare+Choice program that are intended to provide participating plans more flexibility and ease certain administrative burdens.

The rules incorporate suggestions made by managed care plans about the interim final rules, as well as changes dictated by last year's Balanced Budget Refinement Act.

Since the new rules cannot address the funding concerns that many managed care plans have raised -- only Congress can do that -- they are not likely to affect plans' decisions to withdraw from Medicare+Choice.

By July 3, plans must announce intentions to leave the program. Some of the largest plans were expected to withdraw, leaving as many as 1 million beneficiaries to find other managed care plans or return to the fee-for-service program in January 2001.

Effort launched to boost Medicare beneficiaries' eye exam rates

Washington -- The Health Care Financing Administration, American Academy of Ophthalmology and American Optometric Assn. joined forces in June to improve the dilated eye exam rate among Medicare beneficiaries with diabetes. As part of the effort, the ophthalmologists' group will help link seniors to a volunteer ophthalmologist who has agreed to provide a comprehensive medical eye exam and up to one year of follow-up care for any condition diagnosed at the initial exam, with no out-of-pocket expenses to the patient.

The joint initiative seeks to raise public awareness of the connection between diabetes and blindness and to attack barriers, such as payment and transportation, that discourage seniors from getting the exams. About 10% of the Medicare population has diabetes.

Medicare to cover blood processing for rheumatoid arthritis

Washington -- The Health Care Financing Administration in June announced that Medicare may cover a blood processing therapy for some beneficiaries with severe rheumatoid arthritis. The national coverage decision for protein A columns applies to those beneficiaries who fail to respond to conventional drug therapies. It does not affect rheumatoid arthritis patients who benefit from disease-modifying anti-rheumatic drugs, HCFA said.

HCFA said the review was initiated under its new national coverage policy, which bases decisions on the best available scientific evidence.