News in brief - Sept. 19, 2011

Beneficiaries in Part D gap likely to see "roller coaster" effect

Seven in 10 Medicare beneficiaries reaching the Part D doughnut hole in 2008 hit the federal coverage gap again in 2009, according to a study published by the Kaiser Family Foundation.

"These beneficiaries experience a 'roller coaster' effect, facing dramatically different costs as they move through the different phases of Part D benefit during the year (deductible, initial coverage, the coverage gap and possibly catastrophic coverage) and starting over again in January of each year," the September study said.

Research suggests 3.4 million patients reached the doughnut hole in 2009. Patients hit the gap when they spent $2,700 out of pocket on medications. Catastrophic coverage would begin only when the patient spent $4,350 in out-of-pocket costs on drugs.

Many patients repeatedly hitting the doughnut hole need medicine for chronic conditions, the study said.

More than half of patients taking drugs to treat breast cancer or Alzheimer's disease spent enough to reach the gap.

The health system reform law gradually will eliminate the doughnut hole. In 2011, patients received a 50% discount on brand-name drugs when they hit the coverage gap. Nearly 1.3 million patients had reached the gap by the end of July, according to the Centers for Medicare & Medicaid Services.

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HHS directs hospital inspectors to review visitation rights

An update to federal health regulations would ensure a patient's right to have a same-sex partner visit him or her while in the hospital, the Dept. of Health and Human Services announced.

HHS updated its health and safety standards for Medicare- and Medicaid-participating hospitals to clarify the rights of patients to choose their visitors. Federal officials sent a Sept. 7 letter outlining the equal visitation rights to state survey agencies, which inspect hospitals. The department had finalized a federal rule regarding visitation in November 2010.

Federal rules allow patients to select who may visit them during an inpatient stay. Visitors can be a family member, spouse, domestic partner or any other person, HHS said. Patients can withdraw consent for visitation at any time.

HHS also directs hospitals to defer to patients' wishes regarding representation. The department instructs surveyors to check that hospital policy clearly explains a patient's rights regarding visitation and any unit-specific restrictions on visiting hours.

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Arizona cannot charge co-pays to needy residents

A federal appeals court has ruled that Arizona's plan to charge 200,000 of its poorest residents mandatory health care co-payments violates federal law.

Arizona lawmakers in 2003 approved charging the co-pays, which ranged from $4 to $30, to certain groups of residents covered under the state's Medicaid program. The measure allowed those providing Medicaid to decline serving patients who could not afford the co-pays.

A group of residents affected by the measure sued the state and the U.S. Dept of Health and Human Services, which had approved the payments.

In its Aug. 24 opinion, the 9th U.S. Circuit Court of Appeals said that although the plan would help balance the state's budget, the measure did not meet the standards of Medicaid law (www.ca9.uscourts.gov/datastore/opinions/2011/08/24/10-16193.pdf).

At this article's deadline, the state had not indicated whether it plans to appeal.

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HHS to grant $700 million to expand health centers

The Dept. of Health and Human Services is granting about $600 million to help expand community health centers, hire more employees and serve a greater number of patients, and an additional $100 million to help health centers with immediate needs, according to a Sept. 9 HHS announcement.

The department anticipates awarding 125 of the long-term grants, each between $500,000 and $5 million, and 250 of the short-term needs grants. The application deadline is Oct. 12.

"These funds will expand our ability to provide high-quality care to millions of people," said HHS Secretary Kathleen Sebelius.

The grants are part of $11 billion authorized by the health system reform law during the next five years to operate, expand and build community health centers.

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