Washington Highlights: November
12, 2004
Congress Returns to Act on Debt, Spending Bills
Contents
Prior Issues
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Congress returns to Washington Nov. 16 for what many observers
believe will be an abbreviated lame-duck session. Senate Majority
Whip Mitch McConnell (R-Ky.) predicted shortly after the election
that the session would not extend beyond the end of November.
In addition to various meetings to begin organizing the 109th Congress,
the House and Senate are expected to tackle three legislative tasks:
extending the debt limit, completing the FY 2005 spending bills,
and possibly finishing intelligence reform. On the spending side,
only 4 of the 13 regular appropriations bills for FY 2005 have been
enacted. Programs under the jurisdiction of the remaining bills
have been operating under a continuing resolution (CR) that funds
programs at the FY 2004 levels through Nov. 20.
While the House adhered to the FY 2005 budget limits in crafting
these remaining bills, Senate appropriators used a number of accounting
ploys to bypass the spending ceilings and add an additional $8.1
billion to their versions of the bills. Most of the dditional funding
is in the Labor-HHS and VA-HUD bills.
Prior to the election, it appeared the most likely strategy would
be to bundle the 5 or 6 least contentious bills into an omnibus
package that would be approved during the lame-duck session, leaving
the fate of the difficult Labor-HHS and VA-HUD bills hanging perhaps
into 2005. Reports have emerged during the past several days that
suggest movement toward reaching agreement on the overall funding
levels for Labor-HHS and VA-HUD, which might permit completion of
negotiations between the House and Senate conferees and inclusion
of these bills in the omnibus.
House GOP leaders have been adamant in resisting the additional
funds. However, the Administration wants higher funding levels for
some priority programs than have been approved by Congress. As a
result, the White House and Congress are expected to agree to some
additional spending. But they also are expected to offset the additional
funds with an across-the-board cut of non-defense programs.
Some observers have noted the tough stance President Bush has taken
in calling for quick action and limited spending in completing the
FY 2005 spending bills. The President has gone as far as threatening
year-long continuing resolutions on bills that are not completed,
although the White House and Congress would rather avoid that option
as several GOP priorities, such as education and veterans funding,
would suffer. With Republicans set to take a five-seat majority
in the Senate in January, the lame-duck negotiations may serve as
a prelude to further efforts to restrain domestic spending in the
FY 2006 budget.
The debt limit is the most pressing issue facing Congress during
the extended session. The GOP leadership was reluctant to schedule
a vote on raising the debt ceiling prior to the election for fear
of focusing more attention to record the federal budget deficits.
However, Treasury Secretary John W. Snow told Congress Oct. 14 that
the $7.4 trillion limit had been reached and that failing to act
by mid-November would threaten a first-ever default on U.S. obligations.
Since that time, the Treasury Department has exhausted the accounting
measures at its disposal to forestall default, necessitating Congressional
action by the week of Nov. 22. The simplest approach would be to
pass the debt limit increase as a stand-alone bill. However, the
leadership may opt to fold the debt limit into an omnibus appropriations
bill or another stopgap continuing resolution, should Congress fail
to complete the spending bills by Nov. 20.
Information:
Dave Moore, Senior Associate Vice President
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
CMS Announces CY 2005 Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) Nov. 2 announced
that the 2005 Physician Fee Schedule (CMS-1429-F) will be published
in the Nov. 15 Federal Register. The "Medicare Program;
Revisions to Payment Policies Under the Physician Fee Schedule for
Calendar Year 2005" will become effective Jan. 1, 2005.
The Physician Fee Schedule sets rates for how Medicare pays more
than 875,000 physicians and other health care professionals. CMS
projects that in 2005 aggregate spending under the fee schedule
will increase 4 percent to $55.3 billion, up from $53.1 billion
in 2004. The spending increase is due in part to a Medicare Modernization
Act of 2003 (MMA) provision that increased physician payment rates
(the Conversion Factor) by 1.5 percent, a move that negated a previous
law's planned cut of payment rates by 3.3 percent for 2005.
In addition, the final rule implements a new "Welcome to Medicare
Physical" for all new beneficiaries. This exam gives physicians
the opportunity to make an overall assessment of a patient's health,
and provide counseling on nutrition and other steps to stay healthy.
Medicare also provides new coverage for screening for cardiovascular
disease and for diabetes. The expanded benefits also result from
the MMA and are included in the 2005 Physician Fee Schedule rule.
The final rule adopts 18 new codes to be used for billing for administering
drugs, developed by the American Medical Association's (AMA) CPT
Editorial Board. Because new permanent codes will not be included
in the CPT until 2006, CMS has developed these temporary codes to
allow physicians to be paid for these services beginning Jan. 1,
2005. The rule also accepts the relative values (which are used
to determine payment rates) for these codes that were recommended
by the AMA's Relative Value Update Committee (RUC).
These higher payments are based on American Society for Clinical
Oncology survey data, and include payment for staff time to prepare
pharmaceuticals and physician work for supervising of pharmaceutical
preparation. One of the important changes Medicare is adopting based
on the AMA Workgroup's recommendations is that Medicare will allow
the physician to receive additional payments when a second drug
is infused. As a result of implementing the AMA's recommendations,
Medicare payment rates in 2005 for drug administration services
will be more than 120 percent higher than in 2003, and physicians
will have more opportunities to bill for the administration services
they are providing.
Information:
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
AAMC Voices Support for NIH Proposed Policy on
Public Access to Research Information
The AAMC Nov. 9 wrote to the National Institutes of Health (NIH)
to convey its support of NIH's proposed policy to facilitate enhanced
public access to research findings obtained with NIH funding.
Under the proposal, published in the Sept. 17 Federal Register
[69 FR 56074], NIH intends to request that its grantees provide
the agency 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.
The proposal provides that, six months after an NIH supported research
study's publication - or sooner if the publisher agrees - either
the manuscript or the printed article (depending on the publisher)
will be made available freely to the public through PMC.
While voicing support, AAMC President Jordan Cohen, M.D., wrote,
"[I]n view of the complex and rapidly changing context into
which the NIH's public access proposal is being introduced, the
AAMC urges caution in its implementation and suggests that a well-designed
evaluation methodology be established before the policy is finalized."
The letter
also noted several specific areas of concern.
The AAMC expressed the view that "it is critically important
that the publicly accessible content in the PubMed Central (PMC)
archive be identical to that in the published literature.
The generation over time of two parallel, but different, separately
citable literature streams is a recipe for chaos." Dr. Cohen
called on the NIH "to work aggressively with publishers to
ensure that published articles replace posted manuscripts. If this
proves impossible, PubMed Central should post links to the published
article if it is posted on an alternative electronic archive."
Information:
Tony Mazzaschi, Senior Associate Vice President
AAMC Biomedical Health Sciences Research
tmazzaschi@aamc.org
(202) 828-0059
AHRQ Advisory Committee Discusses Agency Activities
The Agency for Healthcare Research and Quality (AHRQ) National
Advisory Council
met Nov. 5 for its final meeting of the year. AHRQ Director Carolyn
Clancy, M.D., provided an update on recent accomplishments, the
budget and future events. She focused on the new health information
technology program, various research findings, a new bioterrorism
tool, and activities of the Agency's various centers, among other
topics. She also listed a number of projects that the Agency was
not able to fund due to budget constraints.
Other presentations addressed the updated National Healthcare Quality
and Disparities Reports, which are scheduled to be released in early
December. These reports serve as comprehensive studies on health
care quality and the differences in access and use of health care
services by various populations. The first version of these reports
was released last year.
Dr. Clancy also outlined the new health information technology
program, which includes a number of grants to researchers, a state
program, and a National Health Information Technology Resource Center.
Some activities, such as research on e-prescribing, were authorized
in the Medicare Modernization Act, passed into law last year.
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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