Washington Highlights: July 7, 2006
Contents
Prior Issues
|
Provider Groups Urge Congress to Address Medicare
Payment Policies for Training in Non-Hospital Settings
The AAMC, along with 79 other hospital and physician groups, sent
a June 27 letter
to all Members of Congress requesting their support for the "Community
and Rural Medical Residency Preservation Act" (S.2071,
H.R.4403).
The bipartisan bills are sponsored by Sen. Olympia Snow (R-Maine)
and Reps. Kenny Hulshof (R-Mo.). The bills would clarify congressional
intent regarding the costs hospitals must incur to count - for purposes
of Medicare indirect medical education and direct graduate medical
education payments - the time resident physicians train in non-hospital
settings. Specifically, the bills would allow hospitals and non-hospital
sites to determine what costs (in addition to the residents' stipends
and benefits) the hospital would be required to pay [see
Washington Highlights, Dec. 9, 2005].
The letter explains that current CMS policies effectively deny
much of the time residents spend in non-hospital settings. Such
policies, with very few exceptions, require that hospitals pay for
physician supervisory time even when the physician is volunteering.
The letter also states that the policy is having a "chilling
effect" on the use of ambulatory sites in residency programs.
The new bills would allow for volunteer physician supervisors.
The provider letter to Congress states that these bills establish
"clear and concise guidelines on the use of ambulatory sites
in teaching programs" which reflect "sound educational
policy and a worthwhile public policy goal that Congress clearly
mandated."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Hospital Group Letter Addresses New Medicaid Documentation
Requirements
The AAMC, with seven other hospital groups, sent a June 28 letter
to HHS Secretary Michael Leavitt, expressing concern about Medicaid's
new citizenship verification equirements. The new requirements,
established under Section 6036 of the "Deficit Reduction Act
of 2005" (P.L.
109-171), became effective July 1, 2006.
The letter states that the new requirements will have a significant
impact on the Medicaid enrollment process. It also identifies particular
concerns related to CMS oversight of the regulations, an inadequate
range of exempt populations, and the limited time allowed to produce
necessary documents. In the letter, the hospital groups offer to
work with the Secretary to achieve Medicaid reforms that are "paired
with equal vigor to preserve the Medicaid safety net."
Also signing the letter were the American Hospital Association,
Federation of American Hospitals, National Association of Public
Hospitals and Health systems, NationalAssociation of Children's
Hospitals, Catholic Health Association of the United States, Premier,
and VHA Inc.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate Letter Opposes Proposed Medicaid Cuts
A bipartisan group of 44 Senators June 29 sent a letter
to HHS Secretary Michael Leavitt, expressing concern about anticipated
administrative changes that reduce Medicaid spending by $12.2 billion
over 5 years. The changes were outlined in President Bush's FY 2007
budget proposal and would directly affect providers by limiting
provider taxes and intergovernmental transfers. According to the
letter, which was circulated by Sen. Gordon Smith (R-Ore.) and Sen.
Max Baucus (D-Mont.), the Senators "do not believe it is appropriate
for the Department...to make these changes."
The letter reminds the Secretary that Congress had rejected such
proposals during debate over the "Deficit Reduction Act of
2005" (P.L.
109-171). It also explains that limiting such financing mechanisms
would "undermine the quality of care" provided by safety
net hospitals.
Stating that "proposed administrative changes that lower provider
reimbursement rates are not the correct approach" to improving
the Medicaid program, the letter encourages the Secretary to focus
on "making Medicaid a smarter and better payer for health care
services."
Earlier this year, the National Governor's Association June 27
and 82 House Republicans May 16 sent similar letters.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
GAO, Grassley Call for Improved Medicaid Oversight
The Government Accountability Office (GAO) July 3 released a new
report, entitled
"Medicaid Financial Management," which examines several
steps CMS has undertaken to improve the financial management of
the Medicaid program. The report credits the agency for enhancing
its ability to identify payment errors and improving its oversight
of state funding practices.
However, the GAO criticizes CMS for neglecting to track whether
these "prevention and mitigation steps" are "adequate
and effective." It also faults the agency for not developing
a strategic plan, not monitoring state activities to improve Medicaid
oversight, and not using available data sets to improve the agency's
claims analysis capabilities.
Additionally, the report recommends that CMS create new, permanent
positions for "funding specialists" who would perform
in-depth reviews of state Medicaid financing.
Senate Finance Committee Chair Charles Grassley (R-Iowa) June 30
issued a press
release, advising CMS to "take the GAO's recommendations
to heart." According to Chairman Grassley's statement, the
GAO will continue to include the Medicaid program among its "high-risk
series"- a compilation of federal programs most vulnerable
to fraud, abuse, and mismanagement. In its 2005 high-risk series
report, GAO found that inadequate fiscal oversight of the Medicaid
program had "led to increased and unnecessary federal spending."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
VA Announces Blue Ribbon Panel on Academic Affiliations
In a July 3 Federal Register notice,
the Department of Veterans Affairs (VA) announced the establishment
of a Blue Ribbon Panel on VA-Medical School Affiliations. According
to the notice, the Panel will "advise the Secretary [of Veterans
Affairs] and the Under Secretary for Health on a comprehensive philosophical
framework to enhance VA's partnerships with medical schools and
affiliated institutions… in light of changes in medical education,
research priorities, and the health care needs of veterans."
Members of the panel will include VA and non-VA personnel appointed
by the Secretary in the coming months. The panel's deliberation
is expected to last approximately 18 months.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
AAMC Comments on NCI Biorepository Guidelines
The AAMC June 29 sent a comment letter
in response to an April 28 Federal Register notice
regarding the National Cancer Institute (NCI) First-Generation Guidelines
for NCI-Supported Biorepositories. Despite a few concerns, the AAMC
believes that the guidelines have the potential to facilitate integration,
resource sharing, and team science while setting high standards
for biorepositories.
The comment letter commended NCI's effort to overcome the heterogeneity
that exists across biorepositories, as biospecimens must meet uniform
standards of the highest quality to attain meaningful data interpretation.
The AAMC also applauded NCI's plan to iteratively revise the guidelines,
require biorepository personnel to disclose financial conflicts
of interest, and provide a sample informed consent that not only
protects research participants, but also facilitates a wide-range
of future research use.
The AAMC voiced concern that, although the guidelines are suitable
for large-scale biorepositories, they impose administrative, regulatory,
and financial burdens too great for smaller biorepositories to bear.
In the letter, the AAMC suggests NCI pilot the guidelines with large-scale
biorepositories, develop best practices, and then select specific
practices that are applicable for smaller biorepositories.
A second concern relates to particular language that is more suggestive
of regulation than guidance. This concern could be remedied by removing
regulatory language in adherence with the Office of Management and
Budget's "Good Guidance Practices."
Information:
Kim Wittenberg, Clinical Research Associate
AAMC Division of Biomedical and Health Research
kwittenberg@aamc.org
(202) 862-6134
|
