News in brief - May 23/30, 2005

Many insurers don't cover vaccines - Medicare sets power chair rules - Florida passes governor's Medicaid reform package

Many insurers don't cover vaccines

An estimated 15% of children and 30% of adults with private health insurance do not have coverage for vaccinations, according to a study published in the May/June Health Affairs. That means that as many as 5 million children and 36 million adults with insurance still have to pay for their immunizations. The study by University of Michigan researchers also found that while more than half of states require coverage of recommended vaccinations for children, none requires equivalent coverage for adults.

"Over the past few years, newly approved vaccines have been increasingly expensive, so insurance plans have been less likely to cover them," said study author Matthew Davis. "This means that new vaccines of the future may be available to many people only if they can pay out of pocket."

Medicare sets power chair rules

Physicians who prescribe mobility assistive equipment, such as power wheelchairs and scooters, to Medicare beneficiaries must follow a new set of guidelines to determine whether patients need the devices, according to rules released by federal regulators.

The national coverage determination, which takes effect immediately, requires doctors to evaluate whether a device is necessary to allow beneficiaries to accomplish daily mobility-related activities such as feeding, grooming, dressing, bathing and toileting. Physicians currently must demonstrate only that the patients are "nonambulatory" or "bed- or chair-confined."

Centers for Medicare & Medicaid Services officials said the move is needed to help stamp out fraud.

The national coverage determination can be found on the CMS Web site (www.cms.hhs.gov/coverage).

Florida passes governor's Medicaid reform package

The Florida Legislature has passed a modified version of Gov. Jeb Bush's reform proposal for the state's Medicaid program, which has a budget of about $15 billion and provides coverage for 2.3 million residents. Under the measure, much of the administration of benefits and services will be turned over to private insurers, which will have some flexibility over the scope of services offered. However, changes were made to the final bill that give the Legislature ultimate say over what services the plans must cover.

The legislation also overruled a provision slipped into Florida's budget bill that would have allowed the state to change what Medicaid pays physicians retroactively with as little as 48 hours' notice.