Washington Highlights: March 31, 2006

House Panel Approves FY 2007 Budget Plan

Contents House Panel Approves FY 2007 Budget Plan House Passes Higher Education Act Reauthorization Bill GAO Issues Report on Health Professions Programs Proposed Rule Would Expand Scope of NPDB Senate Subcommittee Addresses Medicaid Provider Fraud Senate Panel Examines Global Competitiveness Prior Issues March 24, 2006 March 17, 2006 March 10, 2006 March 3, 2006 February 24, 2006 Archive

The House Budget Committee March 29 passed its $2.8 trillion FY 2007 budget resolution by a party line vote of 22-17. The resolution adopts the President's proposed $873 billion discretionary cap, but rejects his proposal to save $65 billion in mandatory spending. Instead, the resolution would cut mandatory spending by $6.7 billion over five years, instructing the House Ways and Means Committee, which has jurisdiction over Medicare, to come up with $4 billion of the mandatory cuts.

The committee rejected an amendment offered by Rep. Rosa DeLauro (D-Conn.) calling for an additional $7 billion for priority health and education programs. The DeLauro proposal was similar to the amendment by Senators Arlen Specter (R-Pa.) and Tom Harkin (D-Iowa), which the Senate approved on March 16 [see Washington Highlights, March 17].

AAMC President Jordan J. Cohen, M.D., sent March 28 a letter to all members of the House Budget Committee urging them to support the DeLauro amendment. Dr. Cohen's letter stated the amendment was needed "to sustain the research, education, and patient care activities at the nations' medical schools and teaching hospitals as we confront unprecedented health challenges ranging from an aging and increasingly diverse population to the threat of new and re-emerging diseases."

The resolution instructs the House Ways and Means Committee to recommend by May 12 proposals that would save $4 billion over five years. Although the resolution does not specify cuts, the Committee must find savings in programs within in its jurisdiction, including Medicare, the Earned Income Tax Credit, welfare, child care and unemployment insurance. Republican budget committee staff reportedly stated that Medicare is not the target of the Ways and Means Committee instruction. The Energy and Commerce Committee, which has jurisdiction over Medicaid, does not have reconciliation instructions to find mandatory cuts.

The House is expected to consider the budget resolution the week of April 3. At a March 28 rally on Capitol Hill, Rep. Mike Castle (R-Del.) announced that he would attempt to amend the budget resolution on the House floor to include $7 billion the Senate added to domestic discretionary spending. Rep. Castle stated, "My message is clear: I will not vote for a House Budget Resolution that would result in real cuts to critical federal investments in education, health care, housing, veterans' services, social and community block grants and encourage my colleagues who share these priorities to do the same."

Information:

Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525

AAMC Government Relations

House Passes Higher Education Act Reauthorization Bill

Under House Rules H.Res.741 and H.Res.742, only 23 of the 117 submitted amendments were considered for inclusion in the final bill. Rep. Charles Boustany (R-La.), a heart surgeon, and Rep. Robert Andrews (D-N.J.) introduced 2 amendments that were approved by a voice vote. The first amendment requires a study by the Government Accountability Office (GAO) to evaluate and determine reasons for the decline in the number of medical school graduates entering residency programs lasting more than 5 years. The second amendment adds "medical specialists" to a new loan forgiveness program for service in "areas of national need." Eligible medical residents must be enrolled in a residency program that requires more than 5 years of graduate medical education training and has fewer US medical school graduate applicants than the total number of training and fellowship positions available. Participants in the loan forgiveness program will be eligible for $5,000.

The House approved an amendment offered by Rep. Louie Gohmert (R-Texas), which strikes certain provisions of H.R. 609 that would have created additional reporting requirements for colleges and universities and would have allowed states to apply to the Secretary of Education to become recognized accreditors. Also approved was an amendment offered by Rep. Mark Souder (R-Ind.) and Rep. Tim Bishop (D-N.Y.), which removes language in the bill that prohibits schools from denying transfers of credit based solely on the accreditation of the institution where the credit was earned, but requires schools to disclose any such policy.

An amendment offered by Rep. Steve King (R-Iowa) that was rejected would have required institutions that receive any federal funding to submit to the U.S. Department of Education an annual report stating whether race, color, or national origin is considered in the student admissions process, followed by a subsequent analysis of how these factors are considered in the process.

H.R. 609 will also require that accrediting associations or agencies enforce standards that "consider the stated missions of institutions of higher education, including religious missions." The AAMC sent a comment letter Nov. 15, 2005, regarding this provision [see Washington Highlights, Nov. 18, 2005], recommending the deletion of provisions that require accrediting associations or agencies to enforce standards based on the institution's mission.

The bill also includes a provision introduced 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." Though the original bill included a number of provisions related to student financial aid, most of these provisions were later included in the Deficit Reduction Act of 2005, signed by the President Feb. 8 [see Washington Highlights, Feb. 10].

GAO Issues Report on Health Professions Programs

The Government Accountability Office (GAO) March 30 released a report on the Title VII and VIII health professions and nursing programs, entitled "Health Professions Education Programs: Action Still Needed to Measure Impact." The report, requested by the Senate Health, Education, Labor, and Pensions Committee in preparation for the next reauthorization of the programs, addresses changes to Title VII and VIII programs since the 1998 reauthorization; the Health Resources and Services Administration's (HRSA) stated goals for the programs and the agency's efforts to measure progress toward meeting them; and national health professions workforce projections developed by HRSA.

The report notes that HRSA recognizes the need for better measuring of the programs' results and is developing new performance goals for this purpose. However, the report states, HRSA "cannot fully assess the programs' effectiveness because the goals do not apply to all the health professions education programs, and the data for tracking progress are problematic."

The report recommends that to enable Congress and HRSA to appropriately target resources to workforce programs, HRSA needs to regularly update and publish national health professions workforce projections, as these assessments are "key to setting policies as the nation's health care needs change."

Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525

Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525

Proposed Rule Would Expand Scope of NPDB

The Health Resources and Services Administration (HRSA) March 21 issued a proposed rule (71 Federal Register 14135) that would expand the scope of the National Practitioner Data Bank (NPDB). The rule implements statutory provisions that were enacted in the Medicare and Medicaid Patient and Program Protection Act of 1987 and the Omnibus Budget Reconciliation Act of 1990.

HRSA proposes to require states to report any negative action or finding that a state licensing authority, peer review organization, or private accreditation entity concludes against a healthcare practitioner or healthcare entity. A "negative action" would include "receipt of less than full accreditation from a private accreditation entity that indicates a substantial risk to the safety of patient care or quality of health care services and includes, but is not limited to, denial of accreditation or nonaccreditation." A "private accreditation entity" includes organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA).

HRSA requests comments on whether there should be any limitation on such reporting. Among other reporting requirements for states would be the loss of license by a practitioner or entity, including voluntary surrender or non-renewal (other than for reason of nonpayment of licensure fees, retire, or change to inactive status). Comments must be submitted by May 22.

Information:

Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490

Senate Subcommittee Addresses Medicaid Provider Fraud

Medicaid fraud was the topic of a March 28 hearing before the Senate Homeland Security Subcommittee on Federal Financial Management, Government Information, and International Security. The witnesses, including Health and Human Services Inspector General Daniel Levinson and Center for Medicaid Services Director Dennis Smith, discussed ongoing efforts to quantify the type and volume of Medicaid fraud. They also praised the recently enacted "Deficit Reduction Act" [P.L. 109-171] for enhancing Medicaid oversight and assuring additional resources for collaborative state-federal program integrity initiatives.

Believing there is a high level of provider fraud in Medicaid, Subcommittee Chairman Tom Coburn (R-Okla.) called for the development of new systems to track, identify, and prosecute providers who defraud the program. Chairman Coburn, who is a physician, also urged a crack-down on provider taxes, upper payment limits, and other "perverse incentives" for states to inappropriately maximize their programs' federal shares.

Information:

Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526

Senate Panel Examines Global Competitiveness

The Technology, Innovation, and Competitiveness Subcommittee of the Senate Commerce, Science, and Transportation Committee March 29 held a hearing on the relationship between basic research and global competitiveness. Subcommittee Chair John Ensign (R-Nev.), who in December introduced the "National Innovation Act of 2005" (S. 2109) with Senator Joe Lieberman (D-Conn.), presided over the hearing. In his opening remarks, Ensign stated, "I am a fiscal conservative, but federal investment in basic research is vital."

Witnesses included White House Office of Science and Technology Policy Director John Marburger, III, Ph.D., National Science Foundation Director Arden Bement, Ph.D., and National Institute of Standards and Technology Director William Jeffrey, Ph.D., who discussed the research component of the President's American Competitiveness Initiative [see Washington Highlights, Jan. 27]. Another panel of witnesses included Steven Knapp, Ph.D, provost and senior vice president for academic affairs at Johns Hopkins University, who praised the newfound interest in funding physical sciences, but cautioned lawmakers against doing so to the exclusion of support for the National Institutes of Health and the life sciences.

Information:

Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525

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