News in brief - Oct. 4, 2004

Medicare expands PET coverage - Woman behind Roe v. Wade loses request to have case reopened - Chronically ill hit by high health costs - HHS extends its own HIPAA deadline

Medicare expands PET coverage

The Centers for Medicare & Medicaid Services will begin paying for positron emission tomography scans that are used to help diagnose some patients who might have Alzheimer's disease.

To qualify, a patient must exhibit atypical Alzheimer's symptoms for which a diagnosis of fronto-temporal dementia remains a clinical possibility. Medicare coverage of PET also includes other patients with suspected Alzheimer's who enroll in an upcoming, large CMS-approved clinical trial.

The agency said in its coverage decision that it is not "reasonable and necessary" to cover PET for seniors with mild cognitive impairment or early dementia outside of the trial. The final memo can be found online (www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=64).

Woman behind Roe v. Wade loses request to have case reopened

The woman at the center of the Roe v. Wade lawsuit that legalized abortion in 1973 cannot have her case re-opened, a panel of judges from the 5th U.S. Circuit Court of Appeals in New Orleans ruled in September.

Norma McCorvey, who was identified as "Jane Roe" when her initial lawsuit went to trial, changed her opinion on abortion and sought to have the court issue a new ruling based on what is now known about how a baby develops, the change in how society views unwed mothers and studies on the long-term effect of abortions on women.

The court said the request by McCorvey, a Texas resident, is moot because the state statute criminalizing abortion, which was at issue in her original lawsuit, has been repealed. In addition, the court said, there is no evidence that Texas plans to pass another law banning abortion.

Chronically ill hit by high health costs

Having health insurance is no guarantee that patients still won't struggle with rising health costs, according to a new report from the Center for Studying Health System Change.

The analysis of HSC's 2003 Household Survey showed that 42% of low-income but privately insured Americans with chronic illness were spending more than 5% of their income on out-of-pocket medical costs, compared with 28% of this group in 2001. One in three also reported living in families that had problems paying medical bills, the survey showed.

"The findings that people with chronic conditions bear higher costs and have more problems paying medical bills aren't surprising, but the extent of the cost burden and the degree to which it impedes timely access to medical care are," said study author Ha T. Tu, an HSC researcher.

HHS extends its own HIPAA deadline

The interim rule laying out civil fines for violations of HIPAA was slated to expire on Sept. 16 but has been extended for another year. This gives the Dept. of Health and Human Services more time to review submissions during the comment period.

While the Justice Dept. succeeded in getting a conviction based on the privacy rule, HHS has yet to impose any civil penalties based on either that regulation or the transaction and code set rule -- the two of three regulations that already have gone into effect.