Washington Highlights: July 22,
2005
House Panel Reviews NIH Reauthorization Plan
Contents
Prior Issues
|
The House Energy and Commerce Subcommittee on Health held a hearing
July 19 on draft legislation to reauthorize the National Institutes
of Health (NIH). NIH Director Elias Zerhouni, M.D., testified on
the draft bill, which was released July 12.
Dr. Zerhouni described the committee's analysis in the draft NIH
bill as "functional." He said NIH needs mechanisms to
analyze and coordinate research on a prospective basis. NIH has
shown it can do strategic planning of trans-NIH initiatives on an
ad hoc basis (e.g., the Roadmap, Strategic Plan for Obesity Research,
and Neuroscience Blueprint), but according to Dr. Zerhouni, there
is a need for a permanent structure, such as the draft bill's proposal
for a new Division of Program Coordination, Planning and Strategic
Initiatives within the Office of the Director. He emphasized this
division would address initiatives that are beyond the purview or
resources of any one institute or center but need to be undertaken
by NIH as a whole. He also said the proposed division would not
supplant or dictate specific research plans or investigator initiated
research within the institutes and centers.
Dr. Zerhouni said the "core proposal" of the bill is
to institutionalize a mechanism for allocating a percentage of the
total NIH budget for greater synergy among all the institutes and
centers for trans-NIH initiatives on a prospective basis with proper
consultation and oversight. He described this mechanism as "a
common fund for common needs."
In a July 19 letter to the chairs and ranking members of the full
Energy and Commerce Committee and Health Subcommittee, AAMC President
Jordan J. Cohen, M.D., stated, "[T]he critical factors underlying
the universally acclaimed success of the NIH are merit-based allocation
of resources and a carefully balanced approach to addressing scientific
opportunity and public health need, as determined by peer investigators
and public health officials, and informed by patient and community
advocates in deliberation within the NIH. Any modification of the
NIH's organization and function must adhere to these foundational
principles." The
letter identifies several areas of concern with the draft legislation
and notes "sufficient time must be afforded for thoughtful
consideration and discussion by all stakeholders in the medical
research community."
In general, the draft legislation addresses the organization and
function of the Office of the Director of NIH and its relationship
to the individual NIH institutes and centers, provides enhanced
authorities (and possibly increased funding) for strategic planning
and support of trans-institute initiatives, and creates a detailed
series of reporting requirements covering research and other activities
supported by NIH. The draft also eliminates a variety of disease-specific
authorizations for appropriations and reporting requirements.
Congress last reauthorized NIH in 1993. Energy and Commerce Chairman
Joe Barton (R-Texas) has made reauthorizing NIH one of his priorities
since taking over as chairman of the committee last summer.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
House Panel Approves HEA Reauthorization Bill
The House Committee on Education and the Workforce July 22 approved
legislation (H.R.
609) to reauthorize the Higher Education Act (HEA). The "College
Access and Opportunity Act" includes several provisions of
interest to medical schools and teaching hospitals, including reduced
origination fees and increased unsubsidized loan limits for graduate
and professional students. The Committee adopted an amendment calling
for a study of medical student indebtedness, but rejected an amendment
to extend the Economic Hardship Deferment.
The Committee approved by voice vote an amendment offered by Rep.
Tom Price (R-Ga.), an orthopedic surgeon, that calls on the Secretary
of Education to conduct a study of the indebtedness of medical students,
asking the question of whether the cost of medical school is becoming
prohibitive and whether the best and brightest individuals are not
choosing careers in medicine because of the potential debt burden.
Rep. Charles Boustany (R-La.), a heart surgeon, also spoke in support
of the amendment. Rep. Boustany also offered an amendment extending
the deferment of student loans for medical resident to 8 years,
but subsequently withdrew the amendment because of the large cost
estimate from the Congressional Budget Office (CBO).
The Committee defeated by a vote of 28-19 with one member passing
an amendment offered by Rep. Rob Andrews (D-N.J.) that would have
extended the Economic Hardship Deferment. Rep. Danny Davis (D-Ill.)
also spoke in favor of the amendment. Specifically, the Andrews
amendment sought to extend the Economic Hardship Deferment from
three to five years for medical and dental residents in residencies
and fellowships. The amendment also would not have required borrowers
to apply for the deferment annually, and would include a greater
population of borrowers by expanding from 220 percent to 230 percent
the ration of borrower's income to the federal poverty level or
minimum wage required for qualification. In a July 20 letter
to all committee members, AAMC President Jordan J. Cohen, M.D.,
wrote "[T]he Andrews amendment would allow future physicians
to defer repayment of their student loans for up to five years of
medical training, allowing them to postpone these significant additional
expenses. Approving this amendment will help the next generation
of the nation's physician workforce complete their education without
worrying about how they are going to repay their debt."
In the area of loan consolidation, the Committee adopted an amendment
sponsored by Rep. Tom Petri (R-Wis.) that would provide borrowers
with a one-time choice of a fixed or variable rate for consolidation
loans. Under the amendment, the variable rate loans would be set
at the 91-day T-bill rate plus 2.3 percent, capped at 8.25 percent;
the fixed rate would be set at the 91-day T-bill rate plus 3.3 percent,
with a 0.5 percent origination fee that could be discounted by the
lender. Committee members rejected a second-degree amendment sponsored
by Ranking Member George Miller (D-Calif.) that would have reduced
the add-on for the fixed rate option to 2.8 percent and eliminated
the 0.5 percent origination fee. Efforts to set a cap on variable
rate Stafford and consolidation loans at 6.8 percent rather than
the 8.25 percent cited in the bill were also defeated.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
CMS Proposes Changes to Outpatient Prospective
Payments in CY 2006
The Centers for Medicare and Medicaid Services (CMS) July 18 posted
on its Web site the Medicare hospital outpatient prospective payment
system (OPPS) proposed rule for calendar year (CY) 2006. It is scheduled
to be published in the Federal Register on July 25.
The proposed
rule would raise the conversion factor used to determine payment
rates under the OPPS by the full increase in the hospital market
basket, currently estimated at 3.2 percent. Sole community hospitals
in rural areas would receive an additional payment adjustment increase
of 6.6 percent.
CMS is also proposing to pay on a competitive market basis for
Part B drugs, biologicals and radiopharmaceuticals administered
in hospital outpatient departments. Hospitals would be reimbursed
at 106 percent of the average purchase price, instead of
at the current rate, 83 percent of the average wholesale
price, but average purchase prices tend to be significantly lower
than wholesale prices. The proposed methodology is intended to better
reflect the cost of drugs administered in physicians' offices. Furthermore,
CMS is proposing to add an additional 2 percent to the payment schedule
to cover hospital pharmacy handling costs - such as pharmacists'
salaries - until such time as a study has been completed to better
identify such costs. Under the current system, acquisition and handling
costs are bundled into the total reimbursement payment for the drug.
The rule proposes several other changes that would:
- Increase payment rates for most screening evaluations;
- Reduce the maximum beneficiary co-payments for any outpatient
services to 40 percent of the total payment to the hospital (down
from 45 percent); and
- Decrease payments for some multiple diagnostic imaging procedures
that are performed in the same session with the patient.
Comments on the proposed rule are due Sept. 16, and a final rule
is scheduled to be published by Nov. 1.
Informaton:
Diana Mayes, Staff Associate
AAMC Division of Health Care Affairs
dmayes@aamc.org
(202) 828-0498
Senate Committee Approves Increases for VA Health
Accounts
The Senate Appropriations Committee July 21 approved its version
of the FY 2006 Military Construction and Veterans Affairs Appropriations
bill, including a $2.977 billion (10.7 percent) increase for VA
medical care, and a $10 million (2.5 percent) increase for the VA
research program. The Military Construction and Veterans Affairs
Appropriations Subcommittee approved the bill on July 19.
The FY 2006 increase provided by Senate appropriators to the VA
medical care account includes the Administration's original budget
request, which called for an increase of approximately $1 billion,
and adds an additional $1.977 billion to counter the projected shortfall
that was reported last month [see Washington
Highlights, July 1]. These
additional funds were designated as "emergency spending,"
and therefore do not count against the discretionary spending caps.
$300 million of the $1.977 billion would be for FY 2005; however
the Senate version of the FY 2006 Interior appropriations bill includes
$1.5 billion in emergency-designated funds for FY 2005, and Military
Construction and Veterans Affairs Chairman Kay Bailey Hutchison
(R-Texas) indicated that if the full amount in the Interior spending
measure is enacted for FY 2005, the FY 2006 funds in the Military
Constriction and Veterans Affairs bill could be reduced. The Senate
Committee also rejected the Administration's proposals for increased
co-payments and enrollment fees.
The Senate version of the bill also includes $412 million for the
VA medical and prosthetics research program, an increase of $10
million (2.5 percent) over FY 2005,and $19 million (4.8 percent)
higher than the amount requested by the Administration.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
HELP Committee Passes Health IT Bill
The Senate Health, Labor, Education and Pensions (HELP) Committee
July 20 unanimously approved by voice vote, S.
1418, the "Wired for Health Care Quality Act." The
bill is sponsored by HELP Committee Chairman Sens. Mike Enzi (R-Wyo.),
Ranking Minority Member Edward Kennedy (D-Mass.), Majority Leader
Bill Frist (R-Tenn.) and Hillary Clinton (D-N.Y.). The bipartisan
legislation blends features of previously introduced bills by Frist-Clinton
(S.
1272) and Enzi-Kennedy (S.
1355).
Specifically, the language of the bill codifies the creation of
the Office of the National Coordinator of Health Information Technology,
establishes a collaborative to adopt health information technology
(IT) standards, authorizes two grant programs for individual providers
to encourage linkage to a broader network and one grant to support
development of IT consortia.
Specifically, the bill authorizes a matching grant program for
not-for-profit hospitals and physician group practices to purchase
and enhance qualified IT systems. Grant preference would be given
to those entities in rural, frontier, or underserved areas.
Providers would also have access to loan funds through a state
health information loan fund that would encourage linkage to a broader
network and matching grants provided to local or regional health
information technology consortia. The bill authorizes $125 million
for the 3 programs in FY 2006, $150 million in FY 2007 and such
sums as necessary in FYs 2008 to 2010.
The bill's provisions also authorize grants to encourage the adoption
of information technology in the medical education system. Preference
would be given to community-based medical education programs as
well as programs that collaborate with two or more disciplines.
The bill authorizes "such sums as necessary" in FY 2006,
$5 million in FY 2007 and "such sums as necessary" in
FYs 2008-2010.
AAMC Government Relations
AAMC Signs Group Letters to Congress Urging Replacement
of SGR
The AAMC July 15 joined over 120 physician organizations in signing
group letters to the House
and Senate,
urging enactment of legislation to replace Medicare's Sustainable
Growth Rate (SGR) methodology. The letters recommend that Congress
halt scheduled reductions in Medicare physician payments for two
years. The letters state that the two-year fix would "provide
an opportunity" for Congress to "design a payment system
that appropriately reflects the costs of practicing medicine."
Specifically, the group letters encourage co-sponsorship of House
(H.R.
2356) and Senate (S.
1081) legislation that addresses the problematic SGR methodology.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate Passes Legislation Removing Physician Group
Limits on Patients Receiving Substance Abuse Treatment
The Senate July 19 passed S.
45, which removes the current statutory limit on physician group
practices that treat substance abuse patients. S. 45 was introduced
in the Senate by Senators Carl Levin (D-Mich.), Orrin Hatch (R-Utah)
and Joseph Biden (D-Del.) on Jan. 24.
The full House has yet to take up companion legislation, but is
expected to do so before the end of July. On June 29 and May 4,
respectively, the House Judiciary Committee and Energy and Commerce
Committee approved H.R.
869, the House version of S. 45. H.R. 869 is sponsored by Rep.
Mark Souder (R-Ind.). In addition to the AAMC, S. 45/H.R. 869 has
been endorsed by over 40 provider and patient groups.
The 106th Congress enacted the Drug Addiction Treatment Act (DATA)
of 2000 to expand treatment options for patients addicted to opiates.
A limit of 30 patients per treating physician was included in the
legislation to address concerns about potential abuse or diversion
of the treatment medications. In addition to the limit per physician,
DATA also contained language that imposed a 30 patient cap on group
practices as well as amending the Controlled Substances Act. H.R.
869 clarifies that group practices would not be limited to 30 patients,
while still limiting each provider within the group to 30 patients
seeking treatment for their drug addictions.
Information:
AAMC Government Relations
|
