Washington Highlights: Date
House Appropriators
Approve Labor-HHS Bill; Include Delay of 75 Percent Rule
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The full House Appropriations Committee July 14 approved its version
of the FY 2005 Labor, Health and Human Services, Education and Related
Agencies Appropriations bill, including a 2.8 percent increase for
the National Institutes of Health and an 8.4 percent cut to the
Title VII health professions education programs. Appropriators also
adopted by voice vote an amendment offered by Representatives Nita
Lowey (D-N.Y.) and Zach Wamp (R-Tenn.) to delay implementation of
the so-called "75 percent Rule" that would reduce Medicare
payments for some rehabilitation hospitals.
The bill includes a total program level of $28.4 billion for the
NIH, an increase of $782 million, the same level approved by the
Labor-HHS subcommittee on July 8. The full committee also adopted
the subcommittee's recommended cut of 8.4 percent to the Title VII
health professions education programs, including a 21.9 percent
cut to primary care medicine and dentistry, a 63 percent cut to
rural training, elimination of workforce information and analysis
(funded at $722,000 last year), and a 24 percentut to public health,
preventive medicine and dental public health programs [see Washington
Highlights, July 9].
The 75 percent rule amendment would prohibit the Centers for Medicare
and Medicaid Services (CMS) from implementing the rule until an
Institute of Medicine (IOM) study is completed on the issue. The
provision mandates a study conducted by the Institute of Medicine
to make recommendations to the HHS and Congress by Oct. 1, 2005,
and that no funds be expended to implement the rule until nine months
following the date the report is sent out by IOM.
Information:
Dave Moore, Senior Associate Vice President
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Office of Governmental Relations
jfishburn@aamc.org
(202) 828-0525
Lynne Davis Boyle, Assistant Vice President
AAMC Office of Governmental Relations
ldavisboyle@aamc.org
(202) 828-0526
AAMC Submits Comment Letter on Resident Limit
Redistribution and Other GME Proposals
In a July 12 letter
to the Centers for Medicare and Medicaid Services (CMS), the AAMC
commented extensively on key Medicare Graduate Medical Education
(GME) proposals contained in the May 18 Medicare hospital inpatient
annual proposed rule [69
FR 28196]. The letter encourages CMS to clarify its policy
on Direct Graduate Medical Education (DGME) and Indirect Medical
Education (IME) reimbursement associated with resident training
at non-hospital sites that have volunteer physician supervisors.
It also asks for clarification that the Medicare DGME initial residency
periods for specialty programs requiring a first year general clinical
year should be based on the specialty in which the resident ultimately
trains, not the program that fulfills the general clinical requirement
(the so-called "preliminary year" issue).
A large part of the letter is devoted to the proposed implementation
process for the resident limit redistribution program, mandated
by last year's Medicare Modernization Act (MMA). In brief, under
this program, hospitals that are not fully "using" their
Medicare resident caps will have those caps permanently reduced
and the cap slots will be "redistributed" to those teaching
hospitals that can demonstrate a need for them. The AAMC raised
a number of issues about CMS' proposals, ranging from concerns about
the criteria to determine which hospitals will lose resident cap
slots to concerns about the proposed application process for hospitals
seeking to increase their resident caps. The letter urges CMS to
finalize a process that will be less intrusive and less administratively
burdensome to teaching hospitals.
Information:
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
House Letter on Volunteer Physicians Draws Signatures
A letter
on the importance of volunteer physicians in residency training
programs at non-hospital sites, being circulated for Congressional
signatures, currently has 47 signatures. The letter, led by Representatives
Kenny Hulshof (R-Mo.), Earl Pomeroy (D-N.D.), Greg Walden (R-Ore.),
and John Tanner (D-Tenn.), addressed to Centers for Medicare and
Medicaid Services (CMS) Administrator Mark McClellan, M.D., Ph.D.,
urges CMS to adopt a regulatory solution in the upcoming final FY
2005 hospital inpatient PPS rule to ensure that Medicare Direct
Graduate Medical Education and Indirect Medical Education payments
are not disqualified when teaching hospitals count residents training
in non-hospital sites where supervising physicians are volunteering
their time [see Washington Highlights,
July 9].
In addition to Reps. Hulshof, Pomeroy, Tanner, and Walden, the
following Members of Congress have also signed the letter: Rep.
Thomas Allen (D-Maine), Doug Bereuter (R-Neb.), Judy Biggert (R-Ill.),
Rick Boucher (D-Va.), Kevin Brady (R-Texas), Sherrod Brown (D-Ohio),
Dennis Cardoza (D-Calif.), Donna Christiansen (D-V.I.), Robert Cramer
(D-Ala.), Philip Crane (R-Ill.), Norman Dicks (D-Wash.), Lloyd Doggett
(D-Texas), Calvin Dooley (D-Calif.), Vernon Ehlers (R-Mich.), Eliot
Engel (D-N.Y.), John Phil Gingrey (R-Ga.), Virgil Goode (R-Va.),
Gene Green (D-Texas), Ralph Hall (R-Texas), Robin Hayes (R-N.C.),
Joseph Hoeffel (D-Pa.), Williams Jenkins (R-Tenn.), Christopher
John (D-La.), Walter Jones (R-N.C.), Dale Kildee (D-Mich.), Ron
Kind (D-Wisc.), James Leach (R-Iowa), Ron Lewis (R-Ky.), Jim Marshall
(D-Ga.), Karen McCarthy (D-Mo.), Jim McDermott (D-Wash.), Jim Nussle
(R-Iowa), C.L. Otter (R-Idaho), Collin Peterson (D-Minn.), Timothy
Ryan (D-Ohio), Jim Ryun (R-Kan.), Max Sandlin (D-Texas), David Scott
(D-Ga.), Pete Sessions (R-Texas), John Shimkus (R-Ill.), Bill Shuster
(R-Pa.), Charles Stenholm (D-Texas), and Ted Strickland (D-Ohio).
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Office of Governmental Relations
ldavisboyle@aamc.org
(202) 828-0526
Administration Announces Two Stem Cell Initiatives
The Bush Administration July 14 announced two new initiatives related
to human embryonic stem cell research. In a letter
to House Speaker Dennis Hastert (R-Ill.), Health and Human Services
Secretary Tommy Thompson said that the National Institutes of Health
(NIH) will create a National Embryonic Stem Cell Bank that "will
consolidate many of the cell lines eligible for funding in one location,
reduce the costs researchers pay for the cells, ensure uniform quality
control, and further our knowledge about the cells themselves."
Currently, 19 stem cell lines are in the NIH registry of lines eligible
for federal funding.
The Administration also announced that NIH would create at least
three new Centers of Excellence for Translational Stem Cell Research
"with the goal of exploiting new discoveries in basic embryonic
and stem cell biology." Secretary Thompson said that the program
would be funded through $18 million in grants over four years.
Information:
Tony Mazzaschi, Senior Associate Vice President
AAMC Biomedical Health Sciences Research
tmazzaschi@aamc.org
(202) 828-0059
Baucus Continues to Press CMS for Consistent and
Transparent IGT Evaluation Process
Senator Max Baucus (D-Mont.), the Ranking Minority Member on the
Senate Finance Committee, sent a July 8 letter
to Centers for Medicare and Medicaid Services (CMS) Administrator
Mark McClellan, M.D., Ph.D., to reiterate that he remains "deeply
concerned" about "the appropriateness of CMS' IGT [intergovernmental
transfer] enforcement initiative." The letter was sent as a
follow-up to a June 16 meeting attended by Sen. Baucus, Dr. McClellan,
and Senate Finance Committee Chairman Charles Grassley (R-Iowa).
The Baucus letter expresses appreciation for Dr. McClellan's earlier
claims that CMS is attempting to apply a consistent policy when
evaluating State Plan Amendments (SPA) related to IGT arrangements.
"However," Sen. Baucus wrote, "I am not convinced
that enforcement actions initiated only when states seek SPA approvals
reflect a consistently applied policy."
With regard to eliminating a state's IGT policy, the Baucus letter
states that CMS' IGT transition policy "hardly seems a well-considered
approach. " The letter also asked why Montana was forced to
sunset its IGT arrangement by 2005, when Dr. McClellan had reported
earlier that states "usually" have until 2006.
Sen. Baucus reiterated the need for new legislation, regulations,
"or even written guidance to states" to assure appropriate,
transparent, and consistent policy when evaluating state Medicaid
programs. "I urge you," Sen. Baucus stated to Dr. McClellan,
"to develop rules or a legislative proposal as soon as possible
on this issue."
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Clears Bioshield Bill for President's Signature
The House July 14 approved the Project Bioshield Act (S.
15), readying it to be signed into law by the President. The
bill passed by a vote of 414 to 2, following Senate passage May
19 [see Washington Highlights,
May 21]. The legislation authorizes funds to encourage pharmaceutical
and biotechnology companies to develop bioterrorism countermeasures.
First proposed in the 2003 State of the Union address, Project Bioshield
provides $5.6 billion over ten years. The final bill guarantees
this funding cannot be diverted for other purposes, but Congress
retains discretion over the program's annual appropriations, such
as the $890 million approved for FY 2004.
Senators Judd Gregg (R-N.H.), Joe Lieberman (D-Conn.) and Orrin
Hatch (R-Utah) are said to be working on "Bioshield II,"
a bill that will provide liability protections for firms creating
vaccines or drugs that could cause injuries.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Office of Governmental Relations
efroyd@aamc.org
(202) 828-0525
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