Despite its quick passage and bipartisan support, the House bill seems doomed in the Senate, where Finance Committee Chairman Max Baucus (D, Mont) has said that he would support elimination of the noninterference clause but not a requirement that the secretary of HHS actually negotiate with the companies. In any case, President Bush has said that he would veto the House bill and Democrats there do not have enough votes to override a veto.
That does not mean that Senate Democrats and Republicans won't look for any alternative means of slicing drug costs for Medicare recipients. Senators Ron Wyden (D, Ore) and Olympia Snowe (R, Me) have introduced a bill, for example, that requires the secretary of HHS to negotiate prices in instances in which there is 1 brand-name drug in a therapeutic category, in which a drug was created with substantial taxpayer funding for its research and development, or in which a private plan asks for help with prices.
CMS Finalizes Rules for Seclusion and Restraints
Medicare has made a couple of changes to its final rules on use of restraints and seclusion in hospitals that will affect psychiatrists. These rules, which the agency has been tinkering with ever since it issued a proposed rule on Conditions of Participation (CoPs) for hospitals in 1997, affect all hospitals, including specialized psychiatric hospitals, that receive money from either Medicare or Medicaid.
In general, facilities must first try less intrusive methods to pacify a patient whose behavior is an immediate threat to himself, other patients, or staff. Only then can seclusion and restraints be used, and even then their use comes with numerous conditions.
Drugs such as sedatives are still considered restraints, as they were in the proposed rule issued in 1997, and cannot be used to pacify unruly patients. The CMS, however, made it clear in the final rule that psychotropic medications that act as sedatives could still be given to calm patients—and not be considered restraints—if the drug used is a "standard treatment or dosage for the patient's condition."
Another change the agency made was to allow a trained registered nurse or physician assistant to conduct the face-to-face evaluation required 1 hour after a patient is restrained or secluded for management of violent or self- destructive behavior. In the CoPs that Medicare initially published in 1997, only physicians or "other licensed independent practitioners" could do that 1-hour evaluation.