Low-Income Seniors Helped
The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.
Coverage Improves Health
Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.
Grant Funds Medical Home Study
The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President, Dr. Michael Barr, who is directing the study, said in a statement.
Retiree Benefits Can be Cut
A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.
Expanded INR Monitor Coverage
CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage of monitoring to those patients with chronic atrial fibrillation or deep-vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.
Judge Overturns Rx Info Law
A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyse, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.