News in brief - Aug. 8, 2011

HHS approves IOM advice on women's preventive care

The Dept. of Health and Human Services on Aug. 1 added eight additional services to the list of evidence-based preventive care that many health plans must provide without co-pays or other cost-sharing under a provision in the health system reform law. The services include the entire list of services recommended on July 19 by the Institute of Medicine, an independent organization.

The additional services include all Food and Drug Administration-approved contraception, wider HIV screening, and domestic violence screening and care. Health plans also must provide accompanying counseling for these and other services.

"We are especially pleased that women will soon be able to access all approved contraceptive methods without co-pays or added cost," said Debra L. Ness, president of the National Partnership for Women & Families.

But health insurers objected to the scope of the covered list, saying patients ultimately would pay a price for the mandates.

"Unfortunately, the preventive care coverage recommendations recently issued by the IOM would increase the number of unnecessary physician office visits and raise the cost of coverage," said Karen Ignagni, president and CEO of America's Health Insurance Plans. "The IOM's recommendations would broaden the scope of mandated preventive services beyond existing evidence-based guidelines, suspend current cost-sharing arrangements for certain services, and encourage consumers to obtain a prescription for routine supplies that are currently purchased over the counter."

HHS also released an amendment to the health reform law's prevention regulation that gives religious institutions offering insurance to their employees the ability to decline to offer contraception services. The department based the provision on laws in most of the 28 states that require health plans to cover contraception. Ness said the amendment was unnecessary and noted that the IOM did not recommend it. HHS is accepting comments on the exemption.

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House panel votes to reauthorize pediatric GME

The House Energy and Commerce Committee on July 28 approved three bills that would reauthorize funding for pediatric residency programs in children's hospitals, reauthorize public health programs that help hospitals and others prepare for terrorist attacks, and classify drugs as illegal if they mimic the effects of marijuana, cocaine, methamphetamines and other illegal drugs.

All of the measures were adopted unanimously by voice vote. "These important bills are critical to our efforts to protect the American people and ensure patients have access to quality health care," said committee Chair Fred Upton (R, Mich.).

The Children's Hospital Graduate Medical Education Support Reauthorization Act of 2011 would extend by five years a program that trains about 40% of pediatricians and pediatric specialists. Congress created the program in 1999 to provide funding to independent children's hospitals to support pediatric GME programs, enhance research capabilities and care for the underserved.

The Pandemic and All-Hazards Preparedness Reauthorization Act supports the development of medical countermeasures to chemical, biological, radiological and nuclear attacks. The Synthetic Drug Control Act amends the Controlled Substances Act to include as schedule I controlled substances more than 29 drugs that imitate the effects of other controlled substances.

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CMS eliminates $3.9 billion overpayment to nursing homes

Medicare rates for nursing homes will drop by 11% in 2012 to correct a spike in payments and to align pay more closely with actual costs, according to a Centers for Medicare & Medicaid Services final rule.

CMS found that the current skilled nursing facility payment system has increased Medicare expenditures in 2011 significantly. The agency pointed to utilization of therapy modes under a new classification system that strayed from projections.

"Additional data analyzed by CMS since publication of the proposed rule confirmed the extent of the overpayments that have occurred since implementation" of the pay system, said Jonathan Blum, CMS deputy administrator. "We are also making several improvements to our payment system to strengthen its integrity."

Changes to the system will produce a $3.9 billion net pay reduction to nursing homes, CMS states in the July 29 rule.

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Combat care for veterans projected to keep growing

Health care for veterans returning from Iraq and Afghanistan could reach $55 billion over the next 10 years, according to estimates from the Congressional Budget Office.

More than 1.3 million of the 2.3 million active-duty and reserve soldiers who have returned from overseas by March 2011 qualified for Dept. of Veterans Administration health services, a July 27 CBO report states. Nearly 685,000 military personnel have sought medical care from the VA since 2002.

In 2010, the Veterans Health Administration spent $1.9 billion to treat 400,000 patients who served in Iraq or Afghanistan. Annual spending is expected to climb to at least $5.5 billion, and could reach $8.4 billion, by 2020.

The report states that traumatic brain injury and mental illnesses, such as posttraumatic stress disorder, are conditions for which treatment could result in substantial future costs for the VA. However, the administration lacks certainty on the number of military personnel diagnosed with PTSD or TBI.

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High court will not consider military medical liability shield

The U.S. Supreme Court has declined to hear a case challenging a decades-old doctrine preventing military members from suing the federal government for medical negligence.

The family of Air Force Staff Sgt. Dean Witt sued the government in 2008, claiming that his death was the result of carelessness by military health center staff. In 2009, a trial court dismissed the family's lawsuit, ruling the court was bound by the so-called Feres Doctrine.

The doctrine stems from the Federal Tort Claims Act of 1946, which allowed claims against the government for certain negligent acts but prevented lawsuits by military members for combat-related injuries. A 1950 Supreme Court decision expanded the exclusion to bar lawsuits over any injuries "incident to military service."

An appellate court affirmed the Witt case's dismissal. The family appealed to the high court. In late June, justices said they would not review the case.

Since the denial, Rep Maurice Hinchey (D, N.Y.) has announced that he will reintroduce legislation to abolish the law. He pushed for similar legislation in 2009.

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