Washington Highlights: March 2,
2007
Contents
Prior Issues
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AAMC, Health Groups Urge Congress to Restore Public
Health Funding
A Feb. 26 letter,
signed by the AAMC and 405 other health organizations, urges Congress
to increase funding for public health programs by an additional
$4 billion (7.8 percent) above the FY 2007 level. The letter states
that this increase in the FY 2008 budget for Function 550 discretionary
health programs will restore cuts enacted in the FY 2006 budget
and "reverse the erosion of support" for the programs
that make up the public health continuum.
Federal agencies that receive funding under Function 550 include
the National Institutes of Health, the Health Resources and Services
Administration (which administers Title VII grants and the National
Health Service Corps), the Agency for Healthcare Research and Quality,
the Centers for Disease Control and Prevention, and the Food and
Drug Administration. The House Budget Committee is expected to mark
up its version of the FY 2008 budget resolution the week of March
12, with floor consideration the following week.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
Hospital Letter Urges Halt to Medicaid Proposed
Rule and GME Budget Proposal
The AAMC joined other members of the hospital community in signing
a Feb. 27 letter that urges
Congress to prevent implementation of a Jan. 18 proposed rule that
narrows the definition of "public providers," limits Medicaid
payments to public providers, restricts sources that may be used
to fund the non-federal Medicaid share, and requires providers to
retain the full amount of their Medicaid payments [see
Washington Highlights, Jan 19]. The letter warns that
the proposed rule "singles out safety-net hospitals for drastic
reductions in reimbursement, thus jeopardizing care for millions
of needy Americans with no other place to turn."
The letter also expresses strong opposition to the President's
FY 2008 budget proposal to prohibit Medicaid as a source of graduate
medical education funds [see Washington
Highlights, Feb 9]. The letter states, "Medicaid has
an important responsibility to support care for patients in the
safety-net institutions that participate in graduate medical education."
It asks Congress to "halt development of the proposal."
Co-signers on the letter include the American Hospital Association,
Catholic Health Association, Federation of American Hospitals, National
Association of Children's Hospitals, National Association of Public
Hospitals, Premier, and VHA Inc.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Bipartisan House Letter Urges Congressional Action
to Stop Medicaid Proposed Rule
A bipartisan group of 226 House members (including 66 Republicans
and 15 members of the Ways and Means Committee) signed a Feb. 26
letter urging the leadership
of the Ways and Means and Energy and Commerce committees to stop
implementation of the Jan. 18 Medicaid proposed rule (see
related article).
Circulated by Reps. Anna Eshoo (D-Calif.) and Peter King (R-N.Y.),
the letter warns that the proposed rule would "likely increase
the number of uninsured Americans" and "tie the hands
of individuals and organizations that serve them." The letter
calls for a "legislative proposal that will prevent CMS from
moving forward with...this dangerous and unfair rule."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
NGA Letters Urge Congressional Action on Medicaid
Proposed Rule, SCHIP Shortfalls
The National Governors Association (NGA) Feb. 23 sent a letter
urging the House and Senate leadership to consider and pass legislation
that would prevent implementation of the Jan. 18 Medicaid proposed
rule (see related article). Concerned
that the Administration "is moving forward ... without any
input from Congress or governors," the NGA believes the proposals
"overstep statutory authority" regarding policies that
have "been left to [the discretion of] state governments since
Medicaid was created in 1965." The NGA also warns that the
proposed rule will impede state initiatives to implement healthcare
reform and expand coverage options.
Signed by NGA Health and Human Services Committee Chair Jon Corzine
(D-N.J.) and Vice Chair Jim Douglas (R-Vt.) on behalf of the NGA,
the letter describes the proposed rule as "a significant Medicaid
policy change that will result in cuts of approximately $5 billion
in federal Medicaid spending over 5 years."
In addition, NGA Chair Janet Napolitano (D-Ariz.) and Vice Chair
Tim Pawlenty (R-Minn.) signed a Feb. 26 letter
to the House and Senate leadership addressing concerns about shortfalls
in State Children's Health Insurance Program (SCHIP) funding for
FY 2007. The letter, which was also signed by Govs. Corzine and
Douglas, urges Congress to "immediately pass legislation that
would provide sufficient funds." It adds that the measure "should
be moved as soon as possible to avoid any shortfall in the program."
In the letter, the NGA also states that Congress should "begin
work now to ensure a timely and successful reauthorization of SCHIP."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
MedPAC Report Includes IME Recommendation
The Medicare Payment Advisory Commission (MedPAC) March 1 released
its 2007
Report to the Congress: Medicare Payment Policy. The report
includes a payment update and other policy recommendations for eight
Medicare payment systems, including inpatient and outpatient hospital
services, physician services, and post acute care. The report also
includes information on the Medicare Advantage program, and the
prescription drug benefit.
The recommendations contained in the March Report have been known
for some time, having been voted on by MedPAC at its January meeting
(see Washington Highlights,
Jan.12). Of particular importance to the academic medical community
is the recommendation for Congress to reduce the Medicare Indirect
Medical Education (IME) payment adjustment by 1 percentage point,
concurrent with the implementation of a system for adjusting diagnosis-related
group (DRG) payments to better reflect patient severity of illness.
Because it generally would result in higher DRG payments for more
complex patients, implementation of a severity system would ameliorate
the IME cut for teaching hospitals, which treat more of these patients
than other hospitals. In addition, under MedPAC's recommendation,
savings from an IME payment reduction would be used to fund a quality
incentive payment pool, rather than returned to the trust fund.
In other areas, MedPAC recommends:
- Raising the base payment rate for hospital inpatient and outpatient
services by the full increase in the hospital market basket
(an inflation measure) implemented concurrently with a quality
incentive program. The current estimate of the market basket
increase is 3.1 percent; and
- Increasing the base payment in the physician fee schedule
by the increase in input prices less an adjustment for expected
productivity growth. MedPAC's current estimate of the update
would be 1.7 percent under its recommendation.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
MedPAC Releases SGR Report
The Medicare Payment Advisory Commission (MedPAC) released the
mandated March
2007 Report to the Congress: Assessing Alternatives to the Sustainable
Growth Rate. The Sustainable Growth Rate (SGR) is the legislated
formula to update physician payments based on a cumulative national
physician expenditure target. Since 2002, the SGR has generated
negative updates, though Congress has overwritten the fee cuts multiple
times.
The report proposes two pathways for Congress:
- Repeal the SGR outright and refine the physician fee-for-service
payment system to promote individual accountability, quality
and efficiency and ultimately improve value; or
- Refine the physician fee-for-service payments (as their first
alternative), but replace the SGR with a new system of expenditure
targets. If the second pathway is selected, the targets should
be expanded to encompass all fee-for-service Medicare (not just
physician payments), be geographically based, and allow savings
for efficient providers.
Information:
Denise Dodero, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Appropriations Subcommittee Questions Leavitt,
Duke about Title VII Cuts
The Appropriations Subcommittee on Labor, Health and Human Services,
and Education Feb. 27 heard testimony from Secretary of Health and
Human Services Michael Leavitt on the Department's proposed budget
for FY 2008. Reps. Lucille Roybal-Allard (D-Calif.) and Mike Honda
(D-Calif.) questioned cuts to two Title VII diversity programs:
the Health Careers Opportunity Program (HCOP) and the Centers of
Excellence (COE). The Secretary was unable to respond to the questions,
saying he was unfamiliar with that portion of the budget, but agreed
to submit a written response to the Members' inquiries.
Title VII was again a topic of interest at the Subcommittee's Feb.
28 hearing on the proposed FY 2008 budget of the Health Resources
and Services Administration (HRSA). In response to questions from
the panel, HRSA Administrator Elizabeth Duke, Ph.D., testified that
the Administration is committed to the mission of the HCOP and COE
programs; further, while the programs have done a "marvelous
job," they are "small programs" that exist elsewhere,
such as in the Departments of Education and Labor. Dr. Duke also
described the Administration's emphasis on providing direct health
services as opposed to developing the pipeline.
In addition to Roybal-Allard's questioning, Rep. Jesse Jackson,
Jr., (D-Ill.) expressed disappointment that HRSA did not work to
increase HCOP and COE funding as recommended in the IOM's 2003 Unequal
Treatment report on health disparities. Reps. Betty McCollum
(D-Minn.) and Tim Ryan (D-Ohio) echoed Rep. Jackson's concerns,
and Rep. McCollum requested that Dr. Duke submit the names of other
federal programs with missions akin to HCOP and COE.
Rep. Honda asked Dr. Duke to clarify whether previous HCOP and
COE grantees would be required to reapply in the case of restored
funding, and the Administrator explained that because the grant
cycle ends this summer, all programs will be required to reapply,
regardless of funding status. Moreover, with respect to no-cost
extensions [see Washington Highlights,
Feb. 23], Dr. Duke cited a "grant-making rule in the executive
branch" that prohibits these sorts of continuations that allows
the programs to retain grantee status and leverage additional sources
of federal, state and institutional funding. She indicated that
HRSA was meeting with the National Institutes of Health (NIH) to
help ensure that the programs would not lose their eligibility to
compete for the endowment program administered by the NIH's National
Center on Minority Health and Health Disparities.
Members also expressed concern about cuts to rural health care
and Title VIII nursing programs. Responding to Rep. Ralph Regula's
(R-Ohio) question about the staffing of community health centers,
Dr. Duke praised a partnership between the centers and medical schools
that allows students to complete internships and residencies at
CHCs. HRSA "applauds these relationships" since the first-hand
experiences helps persuade the graduates to practice at CHCs and
in other similar settings.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Panel Approves Bill Supporting Young Researchers
at NSF
The House Committee on Science and Technology Feb. 28 approved
by voice vote an amended bill intended to improve national competitiveness
through support for young researchers in the physical sciences.
The "Sowing the Seeds Through Science and Engineering Research
Act" (H.R.
363) requires the National Science Foundation (NSF)to allocate
at least 3.5 percent of funds appropriated for Research and Related
Activities (R&RA) to a grants program for early career researchers,
and at least 1.5 percent of the R&RA funds to the existing Integrative
Graduate Education and Research Traineeship Program. Sponsored by
committee Chair Bart Gordon (D-Tenn.), the bill was "slimmed
down" from the more expansive version introduced Jan. 10 through
a manager's amendment offered by Chairman Gordon and Ranking Member
Ralph Hall (R-Texas). The previous version included billions of
dollars worth of authorizations for research at NSF, NASA, and other
science agencies, which the committee stripped to improve the bill's
chance of final passage. A similar bill was approved by the committee
in the previous Congress.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
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