News in brief - Jan. 30, 2006

Medicare mandates drug backup plan - New Mich. whistle-blower law targets Medicaid fraud - R.I. overrides medical marijuana veto

Medicare mandates drug backup plan

Insurers must cover at least a 30-day supply of any medications that Medicare drug plan enrollees were receiving before the Part D benefit started Jan. 1, the federal government recently clarified.

In a Jan. 13 directive, the Centers for Medicare & Medicaid Services reminded drug plan sponsors that they must provide emergency coverage to ensure that those transitioning from Medicaid or another program will receive needed therapies even if problems arise with their enrollment details. Physicians, pharmacists, seniors and their advocates in dozens of states reported that some beneficiaries were leaving pharmacies empty-handed after computer glitches and system slowdowns resulted in the inaccessibility of individuals' information.

Federal officials urged drug plans to develop more timely authorization processes and urged seniors not to go without filling prescriptions when they are needed. Nevertheless, officials added that the system is working well for the majority of beneficiaries enrolled in the program.

New Mich. whistle-blower law targets Medicaid fraud

Michigan Gov. Jennifer M. Granholm signed legislation Jan. 3 that protects whistle-blowers in Medicaid fraud investigations.

The law provides legal protection to any employee who might be discharged or threatened after stepping forward with knowledge of Medicaid fraud. Any person who brings a legitimate claim would be entitled to get a job back with the same status. Financial compensation would include back pay, attorney fees and 15% to 25% of any settlement award. The attorney general would assume responsibility for prosecuting the case.

Republican Rep. David Law said he had sponsored the law because excessive fraudulent billing was draining Michigan's Medicaid budget. But doctors say the law is not the answer to much-needed Medicaid reform, and the state medical society disputed the budget strain. Fearing legal costs to defend themselves, even in the absence of fraud, doctors say the measure will only exacerbate the shortage Medicaid services.

R.I. overrides medical marijuana veto

Rhode Island on Jan. 3 became the 11th state to legalize medical marijuana, with a House vote overriding a veto by Gov. Donald Carcieri.

Under the legislation, patients and their caregivers who are under a doctor's supervision could grow or acquire a limited quantity of the drug. Although the law took effect immediately, patients are not protected until they register for an identification card from the state Dept. of Health.

The Rhode Island Medical Society supported the bill, but doctors say there are still issues to be worked out. Patients are protected from arrest for possessing and using medical marijuana but are not shielded from federal drug laws in acquiring the substance. Purchasing marijuana would still have to be done through illicit means, which was also the basis for the governor's opposition.