Washington Highlights: November
11, 2005
Contents
Prior Issues
|
CMS Issues 2006 Physician Fee Schedule Final Rule
The Centers for Medicare & Medicaid Services (CMS) Nov. 2 announced
the release of the 2006
Physician Fee Schedule final rule (Part B). The physician fee
schedule specifies payment rates to physicians and other providers
for more than 7,000 health care services and procedures. The fee
schedule is updated on an annual basis according to a formula specified
by statute that takes into account the rate of growth in overall
Medicare spending for physicians' services in recent years. The
final rule indicates that, based on the update formula, payment
rates per service for physicians' services will be reduced by 4.4
percent for 2006.
The final rule also expands Medicare coverage of glaucoma screening
and expands access for rural beneficiaries enrolled in Medicare
Advantage plans to services of Federally Qualified Health Centers
(FQHCs). The rule also reforms payment for multiple imaging procedures
performed on a beneficiary at one session and make several revisions
to certain aspects of payment for drugs and drug administration
benefits for drugs covered under Part B.
Information:
Denise Dodero, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
CMS Sends Final Resident Limit Redistribution
Letters
The Centers for Medicare & Medicaid Services (CMS) Oct. 27
sent letters
to teaching hospitals that had applied for additional resident limit
("cap") slots under the Medicare redistribution program
informing them of the number of additional cap slots that they will
be receiving. The program, mandated by section 422 of the Medicare
Modernization Act of 2003 (MMA), redistributed cap slots from hospitals
that had lost slots as a result of having resident counts below
their respective caps in 2002 to hospitals that had demonstrated
a need for the additional slots. The cap reductions and increases
were effective as of July 1. According to CMS, the MMA does not
allow for any appeals of CMS' determinations regarding the reductions
or increases.
While all teaching hospitals located in rural and small urban (less
than 1 million population) received the slots they requested, a
number of large teaching hospitals will receive no increase. The
number of requested cap slots exceeded reductions such that nearly
50 percent of requested cap slots were not able to be granted.
Resident counts associated with the additional slots will be paid
differently than residents associated with hospitals' original caps.
Direct Graduate Medical Education (DGME) payments will be based
on a locality-adjusted per resident amount (PRA), as compared to
a hospital-specific PRA. Indirect Medical Education (IME) payments
will be paid at a 2.7 percent rate compared to the 5.55 percent
rate associated with other resident counts.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
House Fails to Take-Up Budget Bill
The House failed to take-up its budget reconciliation legislation
(H.R.
4241) before it recessed for the Veteran's Day holiday. Despite
earlier agreements to drop Alaska National Wildlife Refuge (ANWAR)-related
provisions and mitigate cuts to certain food stamp programs, the
Republican Leadership reportedly failed to secure support from a
sufficient number of moderate Republicans in time for a scheduled
Nov. 10 vote.
According to floor remarks made by House Majority Leader and Majority
Whip Roy Blunt (R-Mo.), the House could possibly take-up the budget
legislation the week of Nov. 14. He has asked Budget Committee Chairman
Jim Nussle (R-Iowa) to "take another look" at the package
before the bill comes before the House.
The AAMC is working to strip a provision in H.R. 4241, which would
limit hospital payments for emergency services provided to "out-of-network"
Medicaid managed care beneficiaries. Under the provision (Sec. 3147),
a provider "must accept as payment in full the amounts (less
any payments for indirect costs of medical education and direct
costs of graduate medical education) that it could collect if the
beneficiary received medical assistance under [fee-for-service Medicaid]."
The AAMC is concerned that the provision could jeopardize DGME and
IME payments that teaching hospitals have already negotiated with
either Medicaid managed care plans or their state.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Releases 2006 OPPS Final Rule
The Centers for Medicare and Medicaid Services (CMS) Nov. 2 released
on its website the 2006 Medicare Outpatient Prospective Payment
System (OPPS) final
rule, which includes a 3.7 percent inflation update in base
payment rates for hospital outpatient services. After factoring
in expiring payments for certain drugs as well as other changes,
the actual outpatient payments for all hospitals will increase by
only 2.2 percent. Major teaching hospitals will receive only a 1
percent increase in OPPS payments.
In response to a study of rural hospitals' OPPS costs, the final
rule implements a rural sole community hospital adjustment of 7.1
percent. In its comment
letter, the AAMC advocated that CMS conduct a similar study
to determine whether teaching hospitals should receive a similar
adjustment. However, CMS rejected this comment stating that teaching
hospitals were compensated fairly under the OPPS.
The agency also rescinded a proposal to decrease payment for certain
multiple diagnostic imaging procedures performed in the same session
with the patient, but will continue to study the issue. CMS decided
to reduce the reimbursement to hospitals for drugs and biologicals
from 108 percent of the manufacturer's average sales price (ASP)
to 106 percent of ASP. The payment is intended to cover both the
average acquisition cost and associated overhead cost for drugs
furnished in hospital outpatient departments. CMS made its decision
based on more recent Medicare claims data as well as ASP data from
the 2nd quarter of 2005.
In other areas, the final rule:
- Sets the fixed dollar threshold used in determining outlier eligibility
at $1,250, an increase of $75 over last year's threshold, but less
than the amount in the proposed rule ($1,575); and
- Did not implement new codes to collect data on drug overhead costs,
a policy that was viewed as unduly burdensome by hospitals.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
AAMC Supports Proposal To Restore SBIR Eligibility
The AAMC has joined 60 patient, health, and biotechnology groups
in a letter urging Congress to pass legislation to restore the eligibility
for Small Business Innovation Research (SBIR) grants to majority
venture capital-backed biotechnology and medical device companies.
The "Save America's Biotechnology Innovative Research (SABIR)
Act" (H.R.
2943/S.1263),
introduced by Rep. Sam Graves (R-Mo.) and Sen. Christopher Bond
(R-Mo.), would reverse recent changes in the Small Business Administration's
(SBA) interpretation of eligibility standards for SBIR grants that
now disqualify many start-up biotech and medical device companies.
Specifically, SBA regulations require that, to be eligible for a
grant, a small company must be at least 51 percent owned by one
or more "individuals." The SBA has recently re-interpreted
"individuals" to exclude venture capital, thereby disqualifying
many bioscience and device companies from receiving these important
grants.
The letter was released at a Nov. 9 press conference on Capitol
Hill. Howard Dickler, M.D., Director for Clinical Research in the
AAMC's Division of Biomedical and Health Sciences Research, represented
the Association at the press conference. Dr. Dickler noted the AAMC's
concern that SBA's limits on eligibility for NIH SBIR awards "unduly
restrict the ability of the NIH to fund some of the most innovative
research that is conducted in high quality, small companies that
depend for their very existence on such investment. This in turn
undermines the ability of the SBIR program to meet its mandate to
'increase private sector commercialization of innovations derived
from Federal R/R&D, thereby increasing competition, productivity
and economic growth.' Because biomedical research to develop new
drugs and interventions for human diseases is both high risk and
capital intensive, venture capital is often the only means of establishment
and survival for many of these small companies." He added,
"In a time when the budget of the NIH is constrained, it is
particularly important that SBIR funds be used to support the highest
quality and most promising research."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Howard Dickler, M.D., Director
AAMC Division of Biomedical and Health Sciences Research
hdickler@aamc.org
(202) 828-0567
NIH Seeks to Identify New Scientific Information
to Inform Decision Whether to Revise Animal Guide
The National
Institutes of Health (NIH) has announced that it is exploring
whether the laboratory animal welfare standards contained in the
Guide for the Care and Use of Laboratory Animals (Guide)
needs to be updated. As a first step, the Office of Scientific Affairs
of the NIH Office of Extramural Research is seeking to identify
new scientific information that might warrant NIH issuing a contract
for a new or updated edition of the Guide.
The Guide was initially published in 1963 and revised in
1965, 1968, 1972, 1978, 1985, and 1996. The purpose of the Guide
is "to assist institutions in caring for and using animals
in ways judged to be scientifically, technically, and humanely appropriate."
All domestic institutions receiving NIH funds are required by Public
Health Service Policy to use the Guide as a basis for developing
an institutional animal care and use program for activities involving
animals.
The NIH is exploring the need to update the four chapters of the
1996 Guide: Institutional Policies and Responsibilities;
Animal Environment, Housing, and Management; Veterinary Medical
Care; and Physical Plant. In particular, the NIH notice lists the
specific topics, for which they are seeking to identify new information
and knowledge.
Information:
Tony Mazzaschi, Interin Chief Scientific Officer, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
|
