Washington Highlights: December
1, 2006
Contents
Prior Issues
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Senators Call For Legislative Action on GME Before
Adjournment
Senators Susan Collins (R-Maine) and Richard Durbin (D-Ill.), with
55 other Senators, sent a letter
Nov. 14 to Senate Majority Leader Bill Frist (R-Tenn.) and Minority
Leader Harry Reid (D-Nev.) regarding Medicare reimbursement and
regulations related to resident training in non-hospital sites.
Concerned with CMS actions that have resulted in the denial of payments
for the time residents spend in non-hospital settings where teaching
physicians were freely volunteering their supervisory time, the
letter urges "that the United States Senate take legislative
action to resolve this issue before the adjournment of the 109th
Congress." The letter requests enactment of legislative language
clarifying the Medicare statute that requires teaching hospitals
to pay "all or substantially all" of the costs of the
non-hospital training.
The letter also refers to a 2005 Senate letter
sent to CMS Administrator Mark McClellan requesting that CMS act
immediately, through its inherent regulatory authority, to rectify
this issue. "While we appreciate CMS's efforts to try to lend
clarity to a difficult and poorly understood policy, we are concerned
that the direction they are taking does little to resolve the underlying
issues and remains, in our opinion, in direct conflict with Congressional
intent."
Sens. Snowe (R-Maine), Murkowski (R-Alaska), Murray (D-Wash.),
G. Smith (R-Ore.), Bingaman (D-N.M.), Santorum (R-Pa.), Warner (R-Va.),
Harkin (D-Iowa), Conrad (D-N.D.), Chafee (R-R.I.), Levin (D-Mich.),
Lugar (R-Ind.), Craig, Cantwell (D-Wash.), Menendez (D-Fla.), Coburn
(R-Okla.), Stabenow (D-Mich.), Specter (R-Pa.), Thune (R- Dayton,
Wyden (D-Ore.), Bennett (R-Utah), Bond (R-Mo.), Clinton (D-N.Y.),
Lautenberg (D-N.J.), Hatch (R-Uah), Cornyn (R-Texas), Kennedy (D-Mass.),
Salazar D-Co.), Ensign, Biden (D-Del.), Roberts (R-Kans.), Pryor
(D-Ark.), Inhofe (R-Okla.), Obama (D-Ill.), Feinstein (D-Calif.),
Lincoln (D-Ark.), Feingold (D-Wisc.), Rockefeller (D-W.Va.), Schumer
(D-N.Y.), Reed (D-R.I.), Johnson, Kohl , Kerry (D-Mass.), Bayh (D-Ind.),
Boxer (D-CAlif.), Dorgan, Brownback (R-Kans.), Graham, McCain (R-Ariz.),
Hutchison (R-Texas), Mikulski (D-Md.), Cochran (R-Miss.), Hagel
(R-Neb.), and Crapo (R-Idaho) also signed the letter.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Medicaid Commission Adopts Final Recommendations
The HHS-chartered Medicaid Commission Nov. 17 adopted a series
of recommendations for assuring the program's long-term sustainability.
The Commission will submit the recommendations
as part of a final report to HHS Secretary Michael Leavitt by Dec.
31.
The commission proposes several reforms regarding long-term care
benefits, benefit design, eligibility, health information technology
(HIT), and quality improvement, including:
- Greater state flexibility in determining benefit and eligibility
standards;
- Rewarding beneficiaries for "prudent purchasing, resource-utilization,
and lifestyle decisions";
- A fast-track waiver process for states that replicate "successful"
Medicaid demonstration programs;
- Developing an electronic health record for every beneficiary
by 2012;
- Establishing quality-based payments for providers; and
- Requiring states to establish coordinated care systems (e.g.,
"medical homes"), but not requiring a waiver to initiate
such programs.
The recommendations also include a study to consider a "scaled
federal match" formula that would enhance match levels for
lower-income Medicaid beneficiaries and scale-back the match levels
for higher-income populations.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senators Differ on SCHIP Reauthorization
The Senate Finance Subcommittee on Health discussed reauthorization
of the State Children's Health Insurance Program (SCHIP) at a Nov.
16 hearing. Despite broad support for continuing the program,
subcommittee members disagreed on whether to restructure the program.
Pointing to anticipated shortfalls in SCHIP funding over the next
few years, outgoing Chair Orrin Hatch (R-Utah) stated that the reauthorization
process should re-examine "what populations should most appropriately
be covered by SCHIP." According to Sen. Hatch, program expansions
are triggering budget shortfalls. Of greater concern, the expansions
are also shifting SCHIP's original focus on children's coverage
to include "other vulnerable and needy" populations. Under
SCHIP's current structure, Sen. Hatch warned, cuts in SCHIP funding
could force some children out of the program, while certain adults
would remain eligible for benefits.
Sen. Hatch also expressed concern about the redistribution of unspent
SCHIP allotments. He questioned why states with surpluses should
cover the "deficits" of programs that have expanded to
include higher income beneficiaries.
In contrast, Ranking Democrat Sen. Jay Rockefeller (W.Va.) urged
his colleagues to allow continued program expansions by increasing
funding for SCHIP. He also stated that states should be allowed
to expand benefits "as long as they have adequate funds to
match federal contributions."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Publishes Hospital Discharges Final Rule
The Centers for Medicare and Medicaid Services Nov. 27 published
in the Federal Register the Notification of Hospital Discharge
Appeal Rights Final
Rule, which will take effect on July 1, 2007.
Under the current regulations, hospitals are required to give beneficiaries
the "Important Message from Medicare" (IM) notice at admission,
which provides an explanation of Medicare discharge appeal rights.
If a beneficiary indicates any disagreement with their planned discharge
date, the hospital must provide a detailed notice called "a
hospital-issued notice of noncoverage" (HINN). The proposed
rule would have required hospitals to provide an additional discharge
notice on the day before the planned discharge.
The AAMC
and others urged CMS to reconsider its proposed rule position, emphasizing
the administrative burden that an additional discharge notice would
impose on hospitals. In response, the agency made some significant
changes to the proposed rule. The agency rescinded its proposal
to implement an additional discharge notice before the planned discharge
and instead decided to require hospitals to use a revised version
of the IM notice to explain the discharge rights. Hospitals must
issue the IM within 2 days of admission, and must obtain the signature
of the beneficiary or his or her representative. In cases where
the IM is delivered more than 2 days before discharge, hospitals
will be required to give the beneficiary a copy of the signed IM
before discharge. For beneficiaries who disagree with the discharge
date, the hospital will deliver a more detailed notice that replaces
the current HINN provided at the end of the hospital stay.
Hospitals will have an opportunity to comment on the wording and
content of the notices through the Office of Management and Budget
Paperwork Reduction Act process prior to July 1, 2007 implementation
process.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
CMS Publishes New Hospital CoPs
CMS Nov. 27 published a final
rule revising hospital conditions of participation (CoPs) for
completion of history and physical examinations, authentication
of verbal orders, securing medications, and completion of post anesthesia
evaluations. The regulation is effective Jan. 26, 2007.
In brief, the new requirements are:
- Medical staff bylaws must include a requirement that medical
history and physical examination be completed no more than 30
days before, or 24 hours after, admission for each patient by
a physician or other qualified individual. The medical history
and physical examination must be placed in the patient's medical
record within 24 hours after admission.
- All orders, including verbal orders, must be dated, timed,
and authenticated by the prescribing practitioner. In the absence
of a state law specifying a timeframe for authentication for
verbal orders, such orders must be authenticated within 48 hours.
- All drugs and biologicals must be kept in secure areas and
locked when appropriate.
- The post anesthesia evaluation for inpatients can be completed
and documented by any individual qualified to administer anesthesia
instead of only the individual who administered the anesthesia.
The post anesthesia evaluation for inpatients can be completed
and documented by any individual qualified to administer anesthesia
instead of only the individual who administered the anesthesia.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
NIH Establishes Policy for Awards to Multiple
Principal Investigators
The National Institutes of Health (NIH) Nov. 20 announced
a new policy to recognize multiple principal investigators (multi-PIs)
when appropriate in research project grants and selected other mechanisms.
The new policy is intended to encourage formation of multidisciplinary
research teams, including across departments and institutions. An
appreciation of the need for such policy has been growing steadily
over several years across many, if not all fields of science. Most
notably, in January 2005, the White House Office of Science and
Technology Policy directed all federal science agencies to begin
modifying their databases and award tracking systems to recognize
multi-PIs
NIH had earlier proposed recognition of multi-PIs,
for example in bioengineering research, and initiated a pilot program
in February 2006. The new notice extends this option broadly to
new research grant applications, including R01s, with receipt dates
beginning February 2007, provided applications are submitted electronically
and meet other specifications (referenced below).
The AAMC commented extensively on the NIH's proposal to develop
a multi-PI policy [see Washington
Highlights, Sept.
23, 2005], which was also a topic for extensive discussion by
the Association's Advisory Panel on Research and NIH leadership
(Oct. 6, 2005). While the AAMC endorsed in principle recognition
of multiple principal investigators, its central concern was that
the critical role served by principal investigators and their accountability
not be diminished or attenuated. The resulting NIH policy positively
addresses this concern with a definition of principal investigator
that closely resembles the AAMC recommendation. The AAMC and its
recent Task
Force II on Clinical Research also strongly recommended that
the NIH include in its databases all investigators who play key
roles on a research project; the NIH notice states that such revisions
are now in process.
Information:
Howard Dickler, Director
AAMC Biomedical Health Sciences Research
hdickler@aamc.org
(202) 828-0567
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