News in brief - Oct. 27, 2003

Medicare offers mediation for complaints about care - Medicare to cover LVAD therapy - Cash-strapped states shifting Medicaid costs - Health insurance tax credit expansion proposed - Deadline set in drug reimportation case

Medicare offers mediation for complaints about care

Quality-of-care complaints brought against physicians or other health care professionals by Medicare beneficiaries can now be resolved through a voluntary mediation program. The program, sponsored by the Centers for Medicare & Medicaid Services, will provide an impartial mediator in a face-to-face meeting with the physician and a patient or a representative. Currently, beneficiary complaints trigger a review process that can take up to six months to complete.

Beginning this fall, after a complaint is filed, a quality improvement organization will determine its suitability for mediation. Both parties must agree to mediation in order to proceed. Mediation will not be available if a serious quality-of-care issue is involved.

Medicare to cover LVAD therapy

The Centers for Medicare & Medicaid Services said Medicare will cover the implantation of left ventricular assist devices for patients who are too old or too sick to qualify for a heart transplant. Previously LVADs were covered only for temporary implantation for patients awaiting a transplant. CMS also indicated it would boost pay for implantation of the device from $54,000 to $70,000, before geographic adjustments.

Initially, only transplant centers that have performed at least 15 implantations will be able to bill for the procedure. Other centers can petition CMS for approval.

The effective date of the coverage decision is expected to be announced in the near future.

Cash-strapped states shifting Medicaid costs

States have hit on hard times, and some are taking advantage of regulatory loopholes to "effectively shift a larger portion of Medicaid costs to the federal government," Thomas A. Scully, administrator for the Centers for Medicare & Medicaid Services said at a recent hearing of the House Energy and Commerce Committee. Medicaid spending has nearly tripled during the past 10 years. It is expected to hit $304 billion next year. Scully outlined several strategies CMS is taking to ensure Medicaid matching funds are used appropriately.

States are also cutting back on Medicaid spending to help deal with their money woes, according to a report from the Kaiser Commission on Medicaid and the Uninsured. At 9.3%, spending growth in 2003 was down for the first time in seven years. The decrease was achieved with payment cuts for physicians and others, prescription drug cost controls, benefit reductions, eligibility cuts and increased cost sharing.

Health insurance tax credit expansion proposed

A new bill would expand existing health care tax credits to a larger population of the unemployed. Tax credits are currently available to an estimated 200,000 workers displaced by international trade. Established by the Trade Adjustment Assistance Act, the advanceable tax credits cover 65% of the premiums for health insurance purchased through COBRA or state pools. The legislation was introduced by Sens. Chuck Grassley (R, Iowa) and Max Baucus (D, Mont.). The bill would extend the tax credits to all laid-off workers at an estimated cost of $31.6 billion over 10 years.

Deadline set in drug reimportation case

A federal judge has set an Oct. 31 deadline for evidence to be submitted in the government's request for an injunction against two companies that help U.S. citizens obtain prescription drugs from Canadian pharmacies.

The U.S. Dept. of Justice in September filed a lawsuit in a federal court in Oklahoma against Rx Depot Canada LLC and Rx Depot Inc. accusing the two companies of breaking drug reimportation laws. Company executives have said they are not violating any laws and that the medications are safe, sent from legitimate Canadian pharmacies that are under tight scrutiny from the Canadian government.

Rx Depot Canada and Rx Depot Inc. are incorporated as separate businesses but are sister companies whose Web sites list nearly all the same 75 offices in 22 states.