News in brief - April 19, 2004

HIPAA payment delay for noncompliant e-claims under fire - CMA issues legal brief opposing "partial-birth abortion" law - HIPAA lawsuit dismissed - Encouraging high-risk health insurance pools - Medicaid costs less

HIPAA payment delay for noncompliant e-claims under fire

A plan to delay payment for electronic Medicare claims that do not meet Health Insurance Portability and Accountability Act standards unfairly harms physician practices and other small entities that make up the bulk of those currently not in compliance with the transaction and code-set rule, according to testimony by the HIPAA Implementation Working Group, a coalition of medical organizations, including the AMA.

Group members told a Health and Human Services Dept. advisory body that the slowdown would disproportionately affect physicians and others, many of whom are still waiting on payers to comply with the rule and begin testing with them. The group recommended that Medicare maintain the current contingency payment plan for any practice currently following a compliance schedule.

CMA issues legal brief opposing "partial-birth abortion" law

In a friend-of-the-court brief, the California Medical Assn. has joined Planned Parenthood in asking the U.S. District Court for the Northern District of California, San Francisco Division, to declare the Partial-Birth Abortion Ban Act of 2003 unconstitutional.

The act endangers women's health and makes criminals "out of highly trained physicians when they perform the safest and most common procedures available for second-trimester abortions," the CMA wrote.

"The act has no foundation in medical science, disrupts the informed-consent relationship between physicians and their patients, and violates firmly established constitutional principles."

At press time, trials challenging the law's constitutionality were under way in federal courts in San Francisco, New York and Lincoln, Neb.

HIPAA lawsuit dismissed

A lawsuit seeking to overturn federal privacy standards that went into effect last year as part of the Health Insurance Portability and Accountability Act has been dismissed by U.S. District Judge Mary McLaughlin of Philadelphia. The plaintiffs, a group called Citizens for Health in Washington, D.C., alleged that the government overstepped the bounds of the original law when the rule was changed to make informed consent for sharing of medical records voluntary rather than mandatory.

The judge ruled that the Dept. of Health and Human Services did not violate federal rule-making requirements with these changes. "The court's decision supports our authority to protect the privacy of patient health information in a way that does not impede access to quality health care," said HHS Secretary Tommy Thompson. Citizens for Health's attorney, Jim Pyles, said the group has not yet decided whether to pursue an appeal.

Encouraging high-risk health insurance pools

Legislation recently introduced in the Senate would expand on a federal grant program designed to encourage states to set up their own health insurance pools for "uninsurable" residents, those with chronic diseases and other costly preexisting conditions. The State High Risk Pool Funding Extension Act would increase annual funding from $40 million to $75 million from fiscal year 2005 to 2009. That money would be available to help states that are already operating high-risk pools.

The bill would also add $15 million in seed money for states starting pools this year or next. Currently 31 states have high-risk pools that qualify under federal definitions.

Medicaid costs less

Medicaid, while undeniably an expensive program, is actually more efficient than private plans, according to a report from the Kaiser Family Foundation. Medicaid has higher per capita spending, but that is mainly due to the program serving three times as many individuals in poor to fair health and four times as many disabled adults as private health plans.

Once these factors were adjusted for, Medicaid's costs per patient were lower than those for private plans. The report notes, however, that this savings comes from lower reimbursement to physicians and others, and this can affect participation rates and patients' access to care.