The Obama administration is formally proposing to pay hospitals and other medical facilities more if they conduct diagnostic procedures on their Medicare patients using radiological isotopes that were not produced with bomb-grade uranium (see GSN, June 26).
The plan is tucked away in a wide-ranging, 687-page proposed rule issued by the Health and Human Services Department on Monday that makes numerous adjustments to the Medicare payment system. It is the latest move by Washington to wean the United States off medical isotopes produced with highly enriched uranium, which could be used to make a nuclear weapon if it fell into the wrong hands.
The White House last month announced an initiative to preferentially procure medical isotopes derived from non-HEU sources that was short on specifics, although internal documents obtained by Global Security Newswire suggested that a plan involving Medicare was in the works (see GSN, June 11).
Under the new plan, Medicare would pay medical providers an extra $10 for diagnostic radiopharmaceuticals that use technetium 99--a product of the decay of molybdenum 99--that are “produced by non-HEU methods,” according to the proposed rule.
“The administration has established an agenda to eliminate domestic reliance on reactors outside of the United States that produce highly enriched uranium (HEU), and to promote the conversion of all medical isotope production to non-HEU sources,” the proposal says. “We are proposing to exercise our statutory authority to make payment adjustments necessary to ensure equitable payments, to provide an adjustment … to cover the marginal cost of hospital conversion to use of non-HEU sources to obtain radioisotopes used in medical imaging.”
The proposal notes that radioisotopes “are widely used in modern medical imaging, particularly for cardiac imaging and predominantly for the elderly [Medicare] population.”
The Health and Human Services effort adds to those the Energy Department’s National Nuclear Security Administration has undertaken in recent years to support a U.S. bid to develop technology that would enable manufacturing of the isotopes domestically using low-enriched uranium.
The United States, which historically has been a key supplier of weapon-usable highly enriched uranium for other nation’s reactors, also recently joined with a group of western European nations in a pledge to eliminate their own use of medical isotopes produced with HEU material by 2015.
In recent months, however, some lawmakers and issue experts have raised concerns that these efforts will be undercut by a deal under which Russia will expand medical isotope production using highly enriched uranium when a Canadian reactor--currently among the top global suppliers of molybdenum 99--goes offline in 2016.
Since producing medical isotopes with lowly enriched uranium is more expensive, it will be difficult for U.S. companies developing this burgeoning technology to compete on the isotope market, they say.
Miles Pomper, a senior research associate with the James Martin Center for Nonproliferation Studies who has raised such concerns, told GSN on Tuesday that the HHS proposal is “a very good start” toward addressing these concerns.
He added, however, that “Congress still needs to pass legislation to make a real barrier to prevent Russia from producing HEU-based isotopes and selling them here.”
Such measures--such as regulations or taxes on the sale of medical isotopes produced with highly enriched uranium--were listed as options that the administration might pursue in the internal government documents obtained by GSN. However, White House spokeswoman Erin Pelton said last month that while the possibility of regulations or taxes “is not off the table and remains under evaluation,” it “is an option that has a considerably longer time frame.”
Pomper on Tuesday also said that he would like Health and Human Services to provide more information about its method for calculating how much more medical isotopes produced without highly enriched uranium are expected to cost. Such information could show whether the extra Medicare payments the administration is proposing “truly reflect real the real world cost difference,” he said.
The HHS document says that the payment is based “on the best available estimations of the marginal costs associated with non-HEU radioisotope production.” A department spokeswoman was unable able to provide further details by press time.
The department’s Centers for Medicare and Medicaid Services will be accepting public comment on the proposed rule through Sept. 4. Officials will then review any comments before making a decision on a final rule.