News in brief - Feb. 7, 2005

Medicare expands ICD coverage - Final Medicare drug rules unveiled - Kerry proposes bill to cover all kids - HHS shifts unspent SCHIP funds

Medicare expands ICD coverage

The Centers for Medicare & Medicaid Services announced plans to lift the delay in its expansion of Medicare coverage for implantable cardioverter defibrillators.

The move will increase the total number of beneficiaries eligible for ICD coverage by about a third, to 500,000. Of the newly eligible seniors, Medicare officials expect at least 25,000 to take advantage of the benefit in the first year. The projected federal cost of outfitting all seniors who are expected to get ICDs is about $3 billion.

Physicians who prescribe the devices for the new class of Medicare patients must enter outcomes data on the recipients in a national registry aimed at determining how well the treatments work.

CMS delayed its decision last December, citing the fact that a National Institutes of Health study on ICDs and sudden cardiac death had not yet been published in a peer-reviewed medical journal. The results of the investigation appeared in the Jan. 20 New England Journal of Medicine.

Final Medicare drug rules unveiled

Federal officials released final rules last month that establish how Medicare drug plans will operate starting in 2006.

At press time, stakeholders were still sifting through the hundreds of pages of regulations to determine what changes the Centers for Medicare & Medicaid Services made to proposed rules, issued last August. Among the modifications are a provision to enroll Medicare-Medicaid dual eligibles in Medicare on an automatic basis this year and an enhanced financial assistance for low-income beneficiaries.

CMS kept the door open for drug plans to use many of the same cost-cutting tactics outlined in the proposed regulations. Insurers insist that measures such as tiered drug formularies, prior authorization and generic substitution are necessary to keep the program affordable. But many physicians worry that the limitations will be too restrictive for adequate patient care.

Kerry proposes bill to cover all kids

Sen. John Kerry (D, Mass.) has introduced legislation designed to ensure that all children have access to health care coverage. His bill, part of a large package of health care measures, would give the states the option of providing coverage for all children up to 300% of poverty, with the federal government paying the full cost for children at or below the federal poverty level.

The states also would have to allow children from higher-income families to buy into the coverage at cost. The measure would require that Medicaid reimbursement rates for pediatricians be in line with the generally higher rates paid by Medicare.

HHS shifts unspent SCHIP funds

The Dept. of Health and Human Services has used its administrative authority to move around $643 million in unspent 2002 funding for the State Children's Health Insurance Program. The money will be made available to 28 states with programs expected to run into shortfalls this year. Funds allocated to the SCHIP program expire at the end of three years if unused and are returned to the treasury.

"I am very pleased that we can take action to prevent any loss or break in coverage because program funds weren't being used by states that need them the most," said Mark McClellan, MD, PhD, administrator of the Centers for Medicare & Medicaid Services.