News in brief - Sept. 20, 2004

Physician pay increase cited in higher Medicare beneficiary premiums - HHS sued over interpreter rules - Insurers sue Pa. over coverage of addicts' medical care - Medicare plans coverage for new carotid stent

Physician pay increase cited in higher Medicare beneficiary premiums

Medicare Part B premiums will rise to $78.20 a month in 2005 due in part to the increase in physician payments scheduled to take effect next year, the Dept. of Health and Human Services announced.

Under last year's Medicare law, doctors' reimbursement will go up 1.5% in 2005, rather than falling 4.5% as was originally forecast. Other reasons for the $11.60 jump in beneficiaries' premiums include new benefits, such as the "welcome to Medicare" physical, and a shoring up of the program's trust fund reserves.

HHS sued over interpreter rules

Several groups, including a physician organization, are turning to the court to try to stop the Dept. of Health and Human Services from requiring doctors to provide interpreters to patients who don't speak English proficiently.

The Assn. of American Physicians & Surgeons, Pacific Legal Foundation, ProEnglish and several medical professionals sued HHS Aug. 30 in the U.S. District Court for the Southern District of California. The lawsuit says Title VI of the Civil Rights Act -- the law that prohibits denying services based on race and national origin -- says nothing about language.

Physicians say the interpreter rule, implemented by President Clinton, is an unfunded mandate that puts a financial burden on their practices.

"This mandate is a prime example of executive and bureaucratic fiat stretching clear statutory language beyond recognition just to advance a political agenda," Pacific Legal Foundation attorney Arthur B. Mark said in a statement.

Insurers sue Pa. over coverage of addicts' medical care

An association representing most of the large group insurance plans operating in Pennsylvania filed a lawsuit in August asking a judge to permit them to set their own limits on the treatment of drug addicts and alcoholics. Their suit challenges a state agency's determination that payers have no right to apply managed care restrictions to patients with those conditions.

The Philadelphia-based Insurance Federation of Pennsylvania says that the state's insurance department erred when it ruled that Act 6, a minimum mandated benefits law passed in 1993, required that restrictions, such as prior authorization, are not allowed if a doctor determines an addict's care is medically necessary. The act requires group policies to cover seven days of detoxification, 30 days of inpatient care and 30 outpatient visits. Consumer activists have charged that insurers have often ignored the requirements.

Sam Marshall, president of the insurance federation, said the law is unclear and that "there's a lot of confusion out there" among health plans about when to apply it.

Medicare plans coverage for new carotid stent

The Centers for Medicare & Medicaid Services announced that it plans to provide Medicare coverage for participants of a large postapproval study who receive percutaneous transluminal angioplasty of the carotid artery with placement of a Food and Drug Administration-approved carotid stent.

This carotid stenting system is used to treat patients who are at very high risk of stoke and cannot have surgery for their occluded carotid artery. The study is designed to yield information to help doctors target the new device to patients who are most likely to benefit from it and to develop information on clinical practices that offer the best outcomes.