News in brief - Feb. 21, 2005

New Medicare power wheelchair rules coming doctors' way - Minn. court throws out suits charging hospitals unfairly billed uninsured - Genetic nondiscrimination bill offered - Millions abusing illegal or prescription stimulants, government finds - Medicaid less costly than expected

New Medicare power wheelchair rules coming doctors' way

Physicians prescribing power wheelchairs or scooters to Medicare beneficiaries must follow new clinical guidelines and submit new billing codes under changes announced by federal officials in February.

The Centers for Medicare & Medicaid Services released a proposed national coverage determination that would establish a more comprehensive evaluation process for determining what type of mobility assistance equipment a beneficiary might need. Doctors are currently following an older standard that simply requires patients to be "non-ambulatory" or "bed- or chair-confined."

CMS is also scrapping its current set of five power wheelchair and scooter codes starting next year in favor of a more expansive list of nearly 50 codes. Federal officials anticipate that both changes will ensure more appropriate coverage of the devices and will prevent fraudulent activity.

Physicians can access the national coverage determination online (www.cms.hhs.gov/coverage).

The coding changes also are detailed online (www.cms.hhs.gov/suppliers/dmepos).

Minn. court throws out suits charging hospitals unfairly billed uninsured

A federal judge in Minnesota earlier this month dismissed proposed class-action lawsuits alleging that two nonprofit hospitals used unfair billing and collection practices for uninsured patients. The patients said Fairview Health Services and Allina Health System, both based in Minneapolis, charged them far more than what the hospitals billed Medicare or insured patients. The American Hospital Assn. also was named in one of the dismissed lawsuits.

Judge Ann Montgomery with the U.S. District Court for the District of Minnesota said the patients attempted to build their cases on "a flawed foundation." They argued that because the federal government gave the hospitals a tax-exempt status, the facilities had an obligation to provide charitable care to uninsured patients who cannot pay for hospital services.

"There is no legal support to bolster [the] plaintiffs' theory of liability," the court said.

The proposed class-action lawsuits were two of dozens filed across the country. The Judicial Panel on Multidistrict Litigation -- a federal group of judges that decides whether to place similar lawsuits into one courtroom -- in 2004 rejected a request to transfer all of the cases to a single U.S. district court.

Genetic nondiscrimination bill offered

Sen. Olympia Snowe (R, Maine) has introduced genetic nondiscrimination legislation that could quickly come to the Senate floor for a vote. A similar bill passed the Senate last year with strong support from Majority Leader Bill Frist, MD (R, Tenn.). But there has been strong opposition to this type of measure in the House.

The bill would provide protections designed to ensure that health insurers don't use information gained from genetic testing to deny coverage or set premiums. It also aims to prevent employers from using such information for hiring or firing. Opponents say there is no evidence that insurers or employers do this. But advocates say the fear of genetic discrimination is keeping many people from getting tested in the first place.

Millions abusing illegal or prescription stimulants, government finds

An estimated 1.2 million people 12 or older used methamphetamine or prescription stimulants nonmedically in the month before being surveyed, according to Substance Abuse and Mental Health Services Administration information released earlier this month. The data, extracted from the 2003 National Survey on Drug Use and Health, show that 378,000 Americans met the diagnostic criteria for dependence on or abuse of stimulants in the last year, with the greatest prevalence among people 12 to 25.

Stimulants most often abused are methamphetamine, prescription diet pills, Ritalin (methylphenidate) and Dexedrine (dextroamphetamine), the data say. More than 12 million Americans ages 12 and older (5.2% of the population) have used methamphetamine in their lifetimes.

"Methamphetamine is the most frequently illicitly used stimulant," SAMHSA Administrator Charles Curie noted. "Our task is to prevent youth and young adults from initiating methamphetamine use that can wreck their minds, their bodies and their futures."

The report is available online (www.oas.samhsa.gov).

Medicaid less costly than expected

According to revised numbers from the Centers for Medicare & Medicaid Services, spending for Medicaid was less in 2004 than expected. Spending growth for the program was 9% in 2004, rather than the 11% the agency originally projected. The new number brings down spending projections by $73 billion between 2005 and 2014 or $91 billion between 2006 and 2015. Medicaid spending is expected to continue growing at around 7% a year.

The Bush administration said the revised estimate would not impact its plans to cut $60 billion in federal Medicaid funds over the next 10 years.