Washington Highlights: October
1, 2004
Congress Approves
Stopgap Funding Through Nov. 20
Contents
Prior Issues
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Congress officially signaled its intent to complete the FY 2005
spending bills after the election by passing a continuing resolution
(CR) to keep non-defense federal programs operating until Nov. 20.
The House passed the measure (H.J.Res.
107) Sept. 29 by a vote of 389 to 32; the Senate approved it
later the same day by voice vote. The CR continues to fund programs
at FY 2004 levels, and is necessary because only the defense appropriations
bill (PL
108-287) has been enacted for FY 2005, which begins Oct. 1.
The CR also includes language extending various authorizations set
to expire. For example, it permits continuation of Medicare cost
sharing for Part B premium assistance. Programs, activities, eligibility
requirements, and advisory committees authorized under the Higher
Education Act of 1965 through FY 2004 also will remain in effect
through Nov. 20.
Appropriators will now begin crafting an omnibus spending package
to be considered when Congress returns for a lame-duck session following
the election. The omnibus will include all of the remaining 12 appropriations
bills not enacted as stand-alone bills. Congress is expected to
complete the homeland security appropriation prior to leaving Washington
on Oct. 8. The two major bills of interest to academic medicine
- the Labor-HHS-Education and VA-HUD-Independent Agencies bills
- have been passed by the House and by the Senate Appropriations
Committee.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Hutchison Introduces American Hospital Preservation
Act
Senator Kay Bailey Hutchison (R-Texas), along with Sens. Evan Bayh
(D-Ind.) and Edward Kennedy (D-Mass.), Sept. 30 introduced S. 2876,
the "American Hospital Preservation Act," to restore reimbursement
for indirect medical education (IME) payments to teaching hospitals.
IME payments give teaching hospitals an additional Medicare reimbursement
due to their higher costs of inpatient care. In her introductory
statement in the Congressional Record, Sen. Hutchison noted
that "[T]he Medicare Modernization Act restored the reimbursement
rate to 6 percent for fiscal year 2004. However this payment update
expires today. Over the next 3 years, reimbursements to teaching
hospitals will decrease, making it more difficult to care for our
sick and to train our future health care providers. The American
Hospital Preservation Act would fix the reimbursement rate at 6.0
and will ensure our hospitals are compensated for the invaluable
care they provide to our patients."
Senator Hutchison continued, "[T]eaching hospitals have higher
costs due to their critical role in educating tomorrow's physicians.
They run more tests, utilize newer technology and require more staff
because they are training our future health professionals. Preserving
this reimbursement rate is vital to continuing this training. Although
only 23 percent of all hospitals are teaching hospitals, they deliver
over two-thirds of charity care." She concluded, "[L]ower
reimbursement rates coupled with bioterrorism risks and a workforce
shortage make our hospitals a time bomb waiting to go off. It is
our responsibility to ensure they have adequate resources."
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Senators Circulate Dear Colleague to Extend GME
Moratorium
Senators Susan Collins (R-Maine) and Dick Durbin (D-Ill.) are circulating
for signatures a "Dear Colleague" letter requesting that
Senate Leadership and Senate Appropriators include in the FY 2005
appropriations bill language to extend and expand a current GME
moratorium put into place by the Medicare Modernization Act (MMA)
last year.
Specifically, for purposes of calculating teaching hospitals' Medicare
DGME and IME payments, Section 713 of MMA allows, through the end
of 2004, hospitals to continue counting residents in family practice
programs who are training in non-hospital settings where physicians
are volunteering their supervisory time. Section 713 also requires
the Inspector General of the Department of Health and Human Services
to conduct a study on the use of volunteer physicians in residency
training in non-hospital sites and issue a report with any potential
recommendations to Congress no later than one year after the law's
enactment.
Because this study is not due until Dec. 8 and the moratorium
is scheduled to expire on Dec. 31, 2004, the AAMC is working with
other provider organizations to extend
the moratorium by one year. This will give Congress sufficient
time to review the study and act upon its recommendations. In addition,
since the study will pertain to all medical specialties, the AAMC
would like the moratorium to be expanded to include all medical
(osteopathic and allopathic) specialties as well.
As of Oct. 1, Sens. Christopher Bond (R-Mo.), Maria Cantwell (D-Wash.),
Lincoln Chafee (R-R.I.), Thad Cochran (R-Miss.), Collins, Jon Corzine
(D-N.J.), Mike DeWine (R-Ohio), Durbin, Jim Jeffords (I-Vt.), Patrick
Leahy (D-Vt.), Edward Kennedy (D-Mass.), Barbara Mikulski (D-Md.),
Frank Lautenberg (D-N.J.), Carl Levin (D-Mich.), Lisa Murkowski
(R-Alaska), Patty Murray (D-Wash.), Paul Sarbanes (D-Md.), Debbie
Stabenow (D-Mich.), Jim Talent (R-Mo.), and Ron Wyden (D-Ore.) have
signed the letter.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
AAMC and AMA Express Support for VA Physician
Pay Bill
In a Sept. 27 letter
to all Senators, the AAMC and the American Medical Association (AMA)
expressed their support for S.
2484, the "Department of Veterans' Affairs Health Care
Personnel Enhancement Act of 2004," also referred to as the
VA physician pay bill. In the letter, AAMC President Jordan Cohen,
M.D., and AMA Executive Vice President and CEO Michael Maves, M.D.,
stated that "passage of this bipartisan legislation will improve
the ability of the VA to recruit and retain the best and brightest
physicians to meet the needs of the nation's veterans through access
to the latest clinical research and cutting-edge technologies, as
well as an enhanced academic environment." The Senate Veterans'
Affairs Committee unanimously approved S. 2484 on July 22 [see Washington
Highlights,
July 23] and filed its report on the bill on Sept. 23.
As approved by the Committee, S. 2484 provides for a three-tier
pay system. The base pay tier provides a predictable base salary,
similar to the General Schedule system used for most federal employees.
VA physicians would receive increases every two years, based solely
on their seniority. The market pay tier would be based on pay survey
data drawn from at least two separate sources. VA would then set
national "pay bands" based on specialty or subspecialty
and the physician's salary within the appropriate band would be
determined by the Professional Standards Board (PSB) at the physician's
local facility. The third tier consists of incentive pay and would
allow individual physicians to receive up to $10,000 annually for
making outstanding contributions.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
Hospital Group Letter Addresses Unspent SCHIP
Funds
The AAMC and nine other hospital associations signed a Sept. 24
letter
to Congress urging support of legislation that would extend the
availability of unspent FY 1998, FY 1999, and FY 2000 funding for
the State Children's Health Insurance Program (SCHIP). The letter
urged "swift enactment" of the "Children's Health
Protection and Improvement Act" (S.
2759/H.R.
4936), a bipartisan bill that would preserve states' access
to the estimated $1.1 billion in unspent funds through FY 2007.
The funds were scheduled to revert to the U.S. Treasury on Sept.
30. In addition to the AAMC, the letter was signed by the American
Hospital Association, Federation of American Hospitals, National
Association of Public Hospitals, National Association of Children's
Hospitals, National Association of Urban Hospitals, Healthcare Leadership
Council, Catholic Health Association, Premier, and VHA.
According to a Sept. 28 letter from Health and Human Service Secretary
Tommy Thompson to Senate Finance Committee Chairman Charles Grassley
(R-Iowa), the Administration plans to redistribute $660 million
in unspent FY 2002 funds "to cover any gaps in state funding
needs" in FY 2005. In the letter, the Secretary assured Sen.
Grassley that there is "a sufficient amount of money in the
[SCHIP] program," and that "any concerns that some states
will run short of money to cover children in FY 2005 are unfounded."
Sec. Thompson added that, in FY 2005, states will likely spend only
$5.3 billion of the $10.8 billion in SCHIP allotments.
Secretary Thompson explained to Sen. Grassley that the Administration
would work with Congress to "aggressively target" the
$1.1 billion to a "Cover the Kids Campaign." The Campaign
will enlist community groups, faith-based organizations, states,
and schools to increase SCHIP enrollment on a local level. By investing
in programs that will reach out to families "during the course
of their everyday lives," Sec. Thompson argued, "we stand
a better chance of getting their children registered for health
coverage."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Comment Deadline on NIH Public Access Policy Set
for Nov. 16
The National Institutes of Health (NIH) Sept. 17 published a Federal
Register notice [69
FR 56074] inviting comments on its proposed policy "to
facilitate enhanced public access to NIH health related research
information." According to the notice, "NIH intends to
request that its grantees and supported Principal Investigators
provide the NIH with electronic copies of all final version manuscripts
upon acceptance for publication if the research was supported in
whole or in part by NIH funding." NIH says it "will archive
these manuscripts and any appropriate supplementary information
in PubMed Central (PMC), NIH's digital repository for biomedical
research." Under the proposal, "Six months after an NIH
supported research study's publication-or sooner if the publisher
agrees-the manuscript will be made available freely to the public
through PMC."
The Sept. 7 House Appropriations Committee report on the FY 2005
Labor-HHS-Education appropriations bill (H.
Rpt. 108-636) contains language essentially endorsing the NIH
proposal. In addition, the Committee requests a report "by
December 1, 2004 about how [NIH] intends to implement this policy,
including how it will ensure the reservation of rights by the NIH
grantee, if required, to permit placement of the article in PMC
[PubMed Central] and to allow appropriate public uses of this literature."
The Senate Appropriations Committee's report on similar legislation
is silent on the issue.
Comments on the NIH proposal are being accepted until Nov. 16.
The notice first appeared in the Sept. 3 NIH Guide to Grants and
Contracts [see Washington
Highlights, Sept. 10].
Information:
Tony Mazzaschi, Interin Chief Scientific Officer, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
House Approves Bill to Allow Non-MDs to Run VA
Health System
The House of Representatives Sept. 30 approved by a vote of 411-1
legislation (H.R.
4231) that would eliminate the requirement that the Under Secretary
for Health at the Department of Veterans Affairs (VA) possess a
medical degree. Included as part of legislation primarily designed
to aid in the recruitment of nurses to the VA, the provision is
intended to increase the pool of applicants for the top health position
at the VA and reduce the time it takes to appoint new leadership
when a vacancy occurs.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
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