Washington Highlights: November
18, 2005
Contents
Prior Issues
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House Defeats HHS Spending Bill
The House of Representatives Nov. 17 voted 224-209 to reject the
conference agreement of the FY 2006 Labor, Health and Human Services,
and Education appropriations bill (H.R.
3010, H.Rpt.
109-300), sending it back to the conference committee for further
consideration. AAMC President Jordan J. Cohen, M.D, Nov. 17 sent
a letter
to the House and Senate opposing the conference agreement, stating
that the severe cuts to Title VII health professions programs and
the minimal increase for the National Institutes of Health (NIH)
"do not serve the best interests of the health and well-being
of the American people."
Specifically, the conference report, which was filed Nov. 16, cut
the Title VII health professions programs by $205.6 million (69
percent) for total funding of $94 million in FY 2006. This includes:
- $51.8 million for the diversity training programs, a $65.9 million
(56 percent) cut;
- $28.2 million for primary care medicine and dentistry, a $60.6
million (68.3 percent) cut; and
- $2 million for the Area Health Education Centers, a $27 million
(93 percent) cut.
The agreement eliminates funding for the geriatric training programs,
rural health training programs and workforce information and analysis.
Also included in the conference agreement is $28.5 billion for
NIH, an increase of $156 million (0.5 percent) above the FY 2005
level. The Agency for Healthcare Research and Quality receives $318.7
million, the same amount provided in FY 2005. Additionally, the
National Health Service Corps receives $126.8 million, a $4.7 million
(3.5 percent) cut; the bioterrorism hospital preparedness grants
receives $500 million for FY 2006, which is $14.6 million below
last year; and the children's hospital graduate medical education
program is provided $300 million, a $730,000 decrease.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
Congress Approves Funding Extension
The Senate Nov. 18 cleared for the White House a second stopgap
funding measure (H.J.Res.
72) to continue funding for federal programs through Dec. 17.
The House of Representatives Nov. 17 voted 413-16 to approve the
measure. The bill, known as a continuing resolution or CR, provides
funds for those programs supported by appropriations bills not yet
enacted, including the Labor-HHS-Education bill (H.R. 3010). The
CR provides funding for programs at the FY 2005 rate, the House-passed
level for FY 2006, or the Senate-passed level, whichever is lower.
The Title VII health professions education programs, which are funded
in the Senate bill only, are to be funded at the lower of the FY
2005 rate or the Senate level. The current CR (H.J.Res.
68) expires Nov. 18.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
House Approves Budget Reconciliation Bill
The House approved Nov. 17 budget reconciliation legislation (H.R.
4241) by a 217-215 vote after House Republican leaders revised
the bill a second time to appease House Republican moderates. The
bill's previous revisions dropped Alaska National Wildlife Refuge
(ANWR)-related provisions. The new revisions include a softening
of cuts to the Medicaid program.
Specifically, the revisions alter the bill in the following ways:
- Allows seniors to shelter $750,000 in home equity their assets
instead of $500,000, to be eligible for Medicaid coverage for
nursing home care. The revision is reported to cost $350 million
over five years.
- Maintains the current $3 co-payment required of Medicaid recipients
for most medical services, rather than increasing it to $5. Such
a change reduces the proposed savings by $100 million over five
years.
- Allows a delay in planned cuts to Medicaid payments to pharmacies
for prescription drugs if the Government Accountability Office
finds that the average prices pharmacies pay for the drugs they
sell to customers are above the new amounts set in the bill.
- Expands the uses of Medicaid Transformation Grants provided
by the Secretary to encourage the use of generic drugs and reduce
Medicaid drug spending.
The budget bill still includes a provision of concern to the AAMC
that 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 direct graduate medical education
and indirect graduate medical education payments that teaching hospitals
have already negotiated with either Medicaid managed care plans
or their states.
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
AAMC Comments on Accreditation Provisions of
HEA Reauthorization
The AAMC, in coordination with the Liaison Committee on Medical
Education (LCME) and in consultation with the American Medical Association,
sent a comment letter
Nov. 15 to the House Committee on Education and the Workforce and
the Senate Committee on Health, Education, Labor, and Pensions.
The letter expresses concerns regarding the accreditation provisions
of the Higher Education Act (HEA) reauthorization bills (H.R.
609, S.
1614).
The letter focuses on several changes in accrediting bodies' reporting
requirements and recommends that public disclosure of sensitive
findings remain at the discretion of the institution. This stems
from concerns that release of this information or a summarized version
without explanation or context could be easily misinterpreted by
the public.
Additionally, the AAMC recommends the deletion of provisions that
require accrediting associations or agencies to enforce standards
based on the institution's mission. The ambiguity of this mission-related
language could be misconstrued to suggest that the LCME compromise
its standards in deference to a school's mission.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Members of Congress Send Letter to CMS on Residency
Training in Non-Hospital Sites
Reps. Kenny Hulshof (R-Mo.), John Tanner (D-Tenn.) and 65 other
Members of Congress sent a letter
Nov. 9 to Centers for Medicare and Medicaid Services (CMS) Administrator
Mark McClellan, M.D., Ph.D., urging CMS "to act, through its
inherent regulatory authority, to promptly extend and expand the
moratorium established by Section 713 of the [Medicare Modernization
Act] MMA." In addition, the letter urges CMS to suspend their
April 8 question and answer document so Congress and CMS can "further
study and work together toward a clear and appropriate policy that
will define 'all or substantially all' of the costs associated with
training residents in non-hospital settings and encourage this valuable
service."
The letter reviews the legislative and regulatory history of residency
training in non-hospital sites. Specifically, the letter expresses
concern with CMS's actions since 2002 that have denied teaching
hospital payments for resident training in non-hospital sites when
the supervising physician volunteers their time or receives nominal
payments from the hospital.
With the December 2004 expiration of the MMA's one-year moratorium
on payment denials related to family medicine residents training
in non-hospital settings, "CMS has resumed its activities denying
teaching hospitals payments." The letter also states, "Furthermore,
CMS has caused even greater confusion as a result of recent guidance
included in the April 8 frequently asked question (FAQ) document
titled 'Medicare Policy Qualifications on Graduate Medical Education
Payments for Residents Training in Non-Hospital Settings.' While
we appreciate CMS's efforts to try to lend clarity to a difficult
and complicated policy, we are concerned that this new guidance
has raised more questions than it has answered and may impose undue
regulatory burdens."
In addition to Hulshof and Tanner, Reps. Allen (D-Maine), Baldwin
(D-Wisc.), Berry (D-Ark.), Boswell (D-Iowa), Boucher (D-Va.), Brown
(D-Ohio), Capuano (D-Mass.), Cardin (D-Md.), Cardoza (D-Calif.),
Chandler (D-Ky.), Cooper (D-Tenn.), Cramer (D-Ala.), Crowley (D-N.Y.),
Davis (D-Ill.), Davis (D-Tenn.), Dent (R-Pa.), Dicks (D-Wash.),
Doyle (D-Pa.), Ehlers (R-Mich.), Emerson (R-Mo.), Engel (D-N.Y.),
English (R-Pa.), Eshoo (D-Calif.), Hall (R-Texas), Hart (R-Pa.),
Herseth (D-S.D.), Higgins (D-N.Y.), Hinchey (D-N.Y.), Holden (D-Pa.),
Johnson (R-Texas), Kennedy (D-R.I.), Kildee (D-Mich), LaHood (R-Ill.),
Latham (R-Ia.), Lewis (R-Ky.), Marshall (D-Ga.), Matheson (D-Utah),
McCotter (R-Mich.), McDermott (D-Wash.), McHugh (R N.Y.),McIntyre
(D-N.C.), Moore (D-Kan.), Moran (R-Kan.), Murphy (R-Pa.), Nussle
(R-Ia.), Ortiz (D-Texas), Pallone (D-N.J.), Paul (R-Texas), Peterson
(D-Minn.), Platts (R-Pa.), Price (R-Ga.), Rogers (R-Mich.), Ross
(D-Ark.), Schwartz (D-Pa.), Scott (D-Ga.), Sessions (R-Texas), Shaw
(R-Fla.), Shimkus (R-Ill.), Shuster (R-Pa.), Souder (R-Ind.), Strickland
(D-Ohio), Sullivan (R-Okla.),Waxman (D-Calif.), Wilson (R-N.M.),
and Wynn (D-Md.) also signed the letter.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
NRC Urges Reforms on Patent Policies in Genomic
and Proteomic Research
The National Academies' National Research Council (NRC) released
Nov. 17 its recommendations
for U.S. patent policies affecting biomedical research, particularly
in genomic and proteomic research. "The goal is to ensure that
public investments in genomics and proteomics bring about the greatest
public good," said committee co-chair Shirley Tilghman, Ph.D.,
president of Princeton University. "In aiming for that goal,
researchers, policy-makers, and other stakeholders must recognize
that achieving an appropriate balance between protecting research
discoveries and granting access to them is critically important
to fostering scientific progress and enhancing human health."
Roderick R. McKelvie, a former judge and partner in the firm Covington
and Burling, co-chaired the 18-member committee with Dr. Tilghman.
David Korn, M.D., AAMC Senior Vice President for Biomedical and
Health Sciences Research, was also a member of the committee. The
study was supported by the National Institutes of Health (NIH).
Among the NRC committee's recommendations:
- NIH should continue to encourage the free exchange of material
and data among its grantees and contractors, and require these
individuals to comply with NIH guidelines for sharing and disseminating
research materials;
- NIH should also adapt and extend the 1996 "Bermuda Rules"
to protein structure databases that NIH-funded centers generate.
Principal investigators and their institutions should avoid seeking
patents on genes or proteins whose functions are unknown.
The report also recommends several approaches to improving public
access to patented inventions. Congress should consider legislation
that would exempt research on certain aspects of patented technologies
or inventions from patent-infringement liability, with the goal
of promoting scientific discovery. Likewise, owners of the patented
technology behind certain gene-based diagnostic tests should establish
procedures that allow other clinicians to validate test results.
If these patent holders do not take this step voluntarily, Congress
should consider whether work to validate such results should be
shielded from liability in the interest of public health.
Copies of Reaping the Benefits of Genomic and Proteomic Research:
Intellectual Property Rights, Innovation, and Public Health will
be available this fall from the National Academies Press; tel. 202-334-3313
or 1-800-624-6242.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
IRS Issues Exempt Organizations Implementing Guidelines
The Internal Revenue Service (IRS) Tax Exempt and Government Entities
Division released Oct. 25 its "FY 2006 Exempt Organizations
(EO) Implementing Guidelines." A letter
from the director of the division accompanying the guidelines states
that the IRS is "considering a compliance project to determine
how hospitals determine and pay executive compensation as well as
how they meet the community benefit standards for purposes of section
501(c)(3)." The project would involve sending compliance check
letters to a "significant number of hospitals" and requesting
that they answer certain questions regarding these and potentially
other issues. No other information is provided.
The guidance lists "Medical/Dental Resident FICA Claims"
as one of the compliance projects on which the IRS will continue
to work. No indication is given about when to expect a resolution
of remaining issues that include: field examinations; cases fast-tracked
to Appeals; erroneous refund suits; and claims that were suspended
pending the issuance of the final regulations.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
MedPAC Focuses on Physician Issues
At its Nov.15-16 meeting,
the Medicare Payment Advisory Commission (MedPAC) covered a variety
of physician issues including: valuing physician payments, reviewing
beneficiary access and physician supply, and updates on special
projects regarding resource use and coordination of care. The commissioners
highlighted the importance of determining accurate payments for
physician services, citing concern that overvalued services are
not routinely identified or updated. They want to ensure accurate
capture of practice expense information for individual services.
Currently, MedPAC is analyzing both existing and alternative processes
for calculating and updating two main components of the physician
fee schedule-the physician work and practice expense relative value
units (RVUs).
MedPAC staff presented preliminary findings regarding beneficiary
access and physician supply. The analysis indicates that both access
and supply are good; however, there was a slight increase in the
number of beneficiaries having a "big problem" finding
new primary care physicians. Other physician topics covered at the
meeting included updates on evaluating the feasibility of measuring
physician resource use through claims data and of improving coordination
of care for beneficiaries.
On the hospital front, in preparation for its discussion on a hospital
update recommendation at the next meeting, MedPAC staff presented
information to the Commission providing indirect evidence that current
Medicare hospital payments are "adequate." Staff reported
that the number of hospital openings exceeded closures, hospital
construction and access to capital was up, and hospital provisions
of services had increased. They also noted that the number of hospital
discharges is growing and the quality of hospital services is improving.
More discussion about the payment update recommendations including
hospitals' financial performance will occur at subsequent meetings.
MedPAC began discussions examining issues regarding quality of
care and cost associated with efficient hospitals versus average
hospitals. With regard to resource use, MedPAC is going to look
at hospitals' costs per discharge, standardized for factors that
influence costs, but are largely outside the hospitals' control;
volume of care around an inpatient stay; and whether - and to what
extent - the hospital can influence physicians' admissions decisions.
Analyses will also explore the relationship between costs and quality.
In other areas, the Commission discussed draft recommendations
that would be part of a mandated report on the effects of Medicare
payment changes on access and quality of oncology services that
is due Jan. 1, 2006. Commissioners will vote on final recommendations
at the next meeting.
Other topics covered during the meeting included:
- Rural hospitals in the outpatient hospital PPS;
- Part D: plans and benefit designs;
- and Medicare Advantage program overview.
The next meeting will occur on Dec. 8-9, 2005.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
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