Washington Highlights: April 15,
2005
44 House Republicans
Oppose Medicaid Cuts in Budget Resolution
Contents
Prior Issues
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Rep. Heather Wilson (R-N.M.) was joined by 43 of her House Republican
colleagues in sending an April 13 letter
to Budget Committee Chairman Jim Nussle (R-Iowa), opposing the inclusion
of Medicaid cuts and reconciliation instructions in the final FY
2006 budget agreement. The House-passed Budget Resolution (H. Con.
Res. 95) directs the Energy and Commerce Committee to identify $20
billion in savings over the next five years. While the bill does
not specify how the Committee must find the savings, it requires
that the savings come from within programs under their jurisdiction.
Given that Medicaid is under Energy and Commerce jurisdiction, and
given its high level of funding, it is likely savings would be achieved
through program cuts.
The letter expresses concern that the proposed cuts would "negatively
impact people who depend on the program and the providers who deliver
health care to them." It advises Chairman Nussle that "policy
should drive the budget and not the budget drive policy." The
co-signers also support establishment of a Bipartisan Commission
on Medicaid, as outlined in the Senate-passed budget resolution
(S. Con. Res. 18). Such a commission, they write, "would serve
as a credible forum for an honest, open discussion and the development
of comprehensive recommendations on how we can reform the Medicaid
program."
Signers of the letter include: Bob Beauprez (Colo.); Judy Biggert
(Ill.); Sherwood Boehlert (N.Y.); John Boozman (Ark.); Ginny Brown-Waite
(Fla.); Shelly Moore Capito (W.Va.); Mike Castle (Del.); Jo Ann
Davis (Va.); Tom Davis (Va.); Charlie Dent (Pa.); Vern Ehlers (Mich.);
Jo Ann Emerson (Mo.); Phil English (Pa.); Mike Fitzpatrick (Pa.);
Luis Fortuno (P.R.); Jim Gerlach (Pa.); Joel Hefley (Colo.); Tim
Johnson (Ill.); Sue Kelly (N.Y.); Peter King (N.Y.); Randy Kuhl
(N.Y.); Steve LaTourette (Ohio); Jim Leach (Iowa); Frank LoBiondo
(N.J.); Donald Manzullo (Ill.); Kenny Marchant (Texas); John McHugh
(N.Y.); John Peterson (Pa.); Jim Ramstad (Minn.); Rick Renzi (Ariz.);
Ileana Ros-Lehtinen (Fla.); Jim Saxton (N.J.); Joe Schwarz (Mich.);
Chris Shays (Conn.); Don Sherwood (Pa.); Rob Simmons (Conn.); Chris
Smith (N.J.); Mike Sodrel (Ind.); John Sweeney (N.Y.); Jim Walsh
(N.Y.); Curt Weldon (Pa.); Jerry Weller (Ill.); Heather Wilson (N.M.);
and Frank Wolf (Va.).
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Members of Congress Urge Restoration of Health
Professions Funding
In an April 8 letter
co-sponsored by Reps. Diana DeGette (D-Colo.) and Charlie Norwood
(R-Ga.), 102 Members of Congress urged House appropriators to restore
the Title VII health professions funding cut in the Administration's
proposed FY 2006 budget.
Noting that the proposed decreases could "hamper the programs'
ability to train health professionals to care for the neediest populations,"
the letter requests restoration to at least the FY 2005 level of
$300 million. The letter also notes that the Title VII programs
are the only federal programs designed to provide interdisciplinary
training in underserved areas of the country and increase minority
representation in the health care workforce.
Additional signers have been added, and the letter will be sent
again April 15 to the House Labor, Health and Human Services, and
Education Appropriations Subcommittee.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
CMS Issues Document Intended to Clarify Medicare
Regulations on Resident Training in Nonhospital Sites
The Centers for Medicare and Medicaid Services (CMS) April 8 issued
to Congressional staff and posted on its website a Q and A document intended to clarify CMS' Medicare policies for counting residents
in non-hospital settings. Entitled "Medicare Policy Qualifications
on Graduate Medical Education Payments for Residents Training in
Non-Hospital Settings," the document provides CMS' answers
to nine questions relating to Medicare Indirect Medical Education
(IME) and Direct Graduate Medical Education (DGME) payments associated
with resident training in nonhospital sites, including whether physicians
in non-hospital settings can volunteer their supervisory time, and
how teaching hospitals should determine the physician' supervisory
costs and payments to the non-hospital site.
The CMS clarification is not in line with AAMC's
long-standing position that teaching hospitals and nonhospital
sites - not the government - are in the best position to determine
the supervisory costs, if any, of community physicians when they
are supervising residents in nonhospital sites. The AAMC is preparing
a response to the Q and A document.
The Q and A document was developed in response to questions raised
by policymakers concerning Medicare fiscal intermediaries' denials
of teaching hospitals' IME and DGME payments for resident training
in nonhospital sites when a community physician volunteers as a
supervisor. The document describes the circumstances under which
CMS believes there are no costs associated with a physician who
volunteers his/her time to supervise residents in a nonhospital
site, and those instances when there is a cost. If the supervising
physician is a solo practitioner and "compensation is based
solely and directly on number of patients treated and for which
he/she bills," then there is no cost associated with his supervision
time and therefore no payment needed by the hospital. If a community
physician is salaried, according to CMS, the salary includes "implicit"
supervisory costs that must be paid by the hospital to the nonhospital
site if the hospital wishes to claim residents for the time they
train at the nonhospital site. In such cases, the teaching hospital
must determine how much the physician should be paid based on a
certain percentage of the physician's salary.
Also issued with the CMS document was a statement by CMS Administrator Mark McClellan, M.D., Ph.D., that "This
guidance will help providers better understand the documentation
requirements related to counting residents' time in non-hospital
settings, particularly those concerning teaching physician compensation….
We hope that greater clarity will open more opportunities for academic
medical centers to conduct nonhospital training."
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
AAMC Government Relations
CMS Document Identifies States' Misuse of Medicaid
Funds
A list of states' inappropriate use of intergovernmental transfers
(IGTs) for purposes of drawing down additional federal Medicaid
payments has reportedly been released to the House Energy and Commerce
Committee and the Senate Finance Committee by the Centers for Medicare
and Medicaid Services (CMS).
The document identifies states that use IGTs "appropriately;"
states that have revised existing IGTs by removing "recycling;"
and states whose IGTs potentially use "recycling," the
process by which states increase federal Medicaid payments without
increasing state expenditures.
The document also suggests that CMS is questioning mechanisms among
certain states with pending state plan amendments (SPA) or no SPA
on record.
IGTs are transactions that states may use to increase the federal
match for Medicaid expenditures. Many of the "inappropriate"
IGTs listed by the CMS document relate to nursing facility and inpatient
hospital services, but also include outpatient services, physician
services, and clinic services. One state was identified as having
revised an IGT related to graduate medical education payments.
The document does not indicate the federal cost associated with
"inappropriate" IGT use. However, the President's budget
proposal includes $60 billion in Medicaid reductions through FY
2015, including $11.9 billion in savings over 10 years generated
by further restricting states' use of IGTs.
Information:
AAMC Government Relations
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
AHRQ Announces New Preventive Services Task Force
Members
The Agency for Healthcare Research and Quality (AHRQ) March 24
announced a new vice-chair and five new members to the U.S. Preventive
Services Task Force. The Task
Force is an independent panel that reviews scientific evidence
and makes recommendations on a broad range of preventive services,
such as prostate cancer, obesity, and cervical cancer.
Diane Petitti, M.D., M.P.H., senior scientific advisory for Kaiser
Permanente of Southern California, is the new vice chair. The new
members include: Thomas DeWitt, M.D., professor of pediatrics and
director of the Division of General and Community Pediatrics at
Children's Hospital Medical Center in Cincinnati; Kenneth Kizer,
M.D., M.P.H., president and CEO of the National Quality Forum and
former Undersecretary of Health in the Department of Veterans Affairs;
Michael LeFevre, M.D., M.S.P.H., professor of family and community
medicine at the University of Missouri School of Medicine; Lucy
Marion, Ph.D., R.N., dean and professor of the Medical College of
Georgia School of Nursing; and George Sawaya, M.D., associate professor
in the Department of Obstetrics, Gynecology and Reproductive Services
and the Department of Epidemiology and Biostatistics at the University
of California, San Francisco.
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