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May 11, 2006

Law clinic’s work changes Medicare transplant policy

It’s official. Three years of work by Pitt’s Health Law Clinic on behalf of a diabetic woman in need of a pancreas transplant has resulted in a Medicare policy change with nationwide impact.

Pitt associate professor of law Stella Smetanka, who heads the health law clinic, has led students in a legal fight to change an outdated 1995 Medicare rule that provided pancreas transplants only for patients who also needed a kidney.

The health law clinic’s client, Sharon Reigh of State College, was recommended for a pancreas transplant by her doctor due to the severity of her diabetic condition. But she was denied Medicare coverage for the procedure under the old rule. Fortunately, she was able to have the surgery using secondary insurance and her diabetes has since been cured.

Still, the health law clinic continued to fight for changes in the policy, not only in case Reigh should need a future transplant, but for others who could benefit from the change.

They launched a challenge in July 2005 that resulted in a review of the policy, which had been put into effect before recent advances that have increased the success rate for pancreas transplants.

After hearing testimony, including input from doctors at Pitt’s Thomas E. Starzl Transplantation Institute, the Centers for Medicare and Medicaid Services — the group that sets coverage policy — issued a proposed decision in January.

After a required public comment period, the final decision to cover solitary pancreas transplants took effect April 26.

—Kimberly K. Barlow

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