Washington Highlights: March 23,
2007
AAMC Submits Comment Letter on Medicaid Cost Limit
Proposed Rule
Contents
Prior Issues
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The AAMC March 19 submitted a comment letter
to the Centers for Medicare and Medicaid Services (CMS) urging withdrawal
of the Jan. 18 Medicaid Cost Limit proposed rule [see Washington
Highlights, Jan. 19].
The letter points out that CMS offered neither data nor rationales
justifying the new restrictions, and that many of the actions are
not authorized under the current Medicaid statute.
In addition, the letter asks CMS to confirm that graduate medical
education (GME) costs would be included in the determination of
new facility-specific cost limits. It also requests that any regulatory
initiative to reduce or eliminate federal matching payments for
GME costs be issued as a separate and distinct rule, subject to
notice and comment.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
House Budget Panel Approves FY 2008 Resolution
The House Budget Committee March 22 approved its FY 2008 budget
resolution on a 22-17 party line vote. The "Chairman's
Mark" drafted by Committee Chair John Spratt (D-S.C.) fully
funds the President's defense request and calls for $19 billion
more in non-defense discretionary spending than requested by the
Bush Administration.
The House budget rejects the Administration's proposals to reduce
Medicare and Medicaid spending. Like the Senate Democratic plan
approved by the Senate Budget Committee March 15 [see Washington
Highlights, March 16],
the House budget resolution includes a number of deficit-neutral
reserve funds to support a range of initiatives, including up to
$50 billion for reauthorization of the State Children's Health Insurance
Program (SCHIP), provided funds are identified to offset the increased
spending. It also provides for a deficit neutral reserve fund to
improve the Medicare program, including "increasing the reimbursement
rate for physicians while protecting beneficiaries from associated
premium increases."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
NIH Director Testifies on NIH Budget, Stem Cells
National Institutes of Health (NIH) Director Elias Zerhouni, M.D.,
told the Senate Labor-HHS-Education Appropriations Subcommittee
March 19 that "it is clear today that American science would
be better served and the nation would be better served if we let
our scientists have access to more [human embryonic stem] cell lines."
Dr. Zerhouni was responding to a question from Subcommittee Chair
Tom Harkin (D-Iowa) regarding the Administration's current policy
limiting the eligibility of human embryonic stem cell lines for
federal research funding. Dr. Zerhouni lso noted that presentations
about the potential of adult stem cells are "overstated."
He told the subcommittee, " I think we do not know at this
point where the breakthroughs will come from. I think scientists
who work in adult stem cells themselves will tell you that we need
to pursue as vigorously embryonic stem cells."
Dr. Zerhouni also testified
about the potential of medical research. He told the subcommittee,
"I think it is absolutely clear that the 21st century will
be for the life sciences what the 20th century has been for the
physical sciences. Mastery of the biological world will impact not
just health, but also our ability to develop sensitive solutions
to our environmental and energy challenges and will be, in my opinion,
the key determinant of national competitiveness for the 100 years
in front of us."
A panel of four scientists testified on the impact of the stagnant
NIH funding in recent years. The panel included Brent Iverson, Ph.D.,
professor of organic chemistry and biochemistry, University of Texas
at Austin; Joan Brugge, Ph.D., chair of cell biology, Harvard Medical
School; Robert Siliciano, M.D., Ph.D., professor of medicine, Johns
Hopkins School of Medicine; and Stephen Strittmatter, M.D., Ph.D.,
professor of neurology and neurobiology, Yale University School
of Medicine. The scientists noted that flat NIH funding disrupts
ongoing research, delays progress against a range of diseases, jeopardizes
the future of young scientists, and threatens the nation's preeminence
in biomedical science.
The scientists had participated in the development of a report
entitled, "Within Our Grasp - Or Slipping Away? Assuring a
New Era of Scientific and Medical Progress" that describes
how progress has been slowed, and opportunities lost, in a number
of areas of medical research. The report, which was developed by
a coalition of nine major research universities and medical organizations,
was publicly released at a press conference following the hearing.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Senate Supplemental Includes Medicaid, SCHIP,
and Health-Related Provisions
The Senate Appropriations Committee March 22 passed its FY 2007
Iraq and Afghanistan supplemental appropriations bill
that includes Medicaid and State Children's Health Insurance Plan
(SCHIP) provisions of important to medical schools and teaching
hospitals. The House Appropriations Committee March 15 passed its
version of the supplemental bill [see Washington
Highlights, March 16].
Specifically, the bill includes an amendment offered by Sen. Richard
Durbin (D-Ill.) that would delay for 2 years implementation of the
January 18 Medicaid Cost Limit/Unit of Government Proposed Rule.
The amendment also delays for 2 years any proposal to restrict Medicaid
funding for graduate medical education (GME). The amendment passed
18-11 and is paid for by altering an existing Medicaid program that
requires brand name drug makers to provide a 15 percent rebate to
the federal government on any drug it sells through the Medicaid
program. Senator Durbin's amendment raises the rebate to 20 percent,
a move that is estimated to generate $1.35 billion over 5 years.
In addition, the bill also includes $747 million in funding for
the FY 2007 shortfall in the SCHIP.
Overall, the bill provides $121.664 billion for the wars in Iraq
and Afghanistan, improving the health care for returning soldiers
and veterans, continued Hurricane Katrina recovery for the Gulf
Coast, homeland security, and emergency drought relief for farmers.
Other important health provisions include:
- $870 million in emergency funding for pandemic flu activities
at HHS, with $50 million directed to the vaccine compensation
program;
- $30 million for higher education institutions impacted by gulf
hurricanes of 2005;
- $30 million for VA research related to returning Operation Enduring
Freedom and Operation Iraqi Freedom veterans and deployment health;
and
- Transfers some bioterrorism research funds from the National
Institutes of Health to the new created Biomedical Advanced Research
and Development Authority within the Department of Health and
Human Services.
The Senate expects to take up the supplemental appropriations bill
on the floor the week of March 26.
Information:
AAMC Government Relations
Congress, Health Groups Submit Comment Letters
on Medicaid Proposed Rule
In a March 19 bipartisan comment letter to Secretary of Health
and Human Services (HHS) Mike Leavitt, 60 Senators (including 17
Republicans) expressed "strong opposition" to the Jan.
18 Medicaid proposed rule and urged its immediate withdrawal [see
Washington Highlights,
Jan. 19].
The letter,
which was circulated by Senators John Rockefeller (D-W.Va.) and
Gordon Smith (R-Ore.), warned that the proposed rule "would
usurp state flexibility and fundamentally alter the nature of state
funding for the Medicaid program." It added that "the
proposed rule has gone far beyond what is necessary to secure fiscal
integrity," and expressed concern that such action "would
have an adverse impact on system-wide health care needs, such as
trauma care...and medical education."
A bipartisan group of 153 House members also submitted a March
19 comment letter
to Secretary Leavitt. Circulated by Reps. Henry Waxman (D-Calif.),
Jan Schakowsky (D-Ill.), Peter King (R-N.Y.), and James Walsh (R-N.Y.),
the letter states that the Centers for Medicare and Medicaid Services
(CMS) has "neither the authority nor the Congressional support"
to implement the rule. The letter adds that "we question the
wisdom of a policy change that will withdraw large amounts of federal
and state Medicaid funds from institutions that play an essential
part of [sic] the health care systems of our largest and most strategic
cities."
A March 19 letter
from the National Association of State Medicaid Directors (NASMD)
urges Acting CMS Administrator Leslie Norwalk to "not move
forward...without first obtaining and communicating additional information
on the proposed rule's impact... and providing a more comprehensive
regulatory analysis." The NASMD letter also requests "further
clarification on the treatment of graduate medical education (GME)
payments to providers and that such payments be considered outside
of the currently proposed cost limit." According to the letter,
"GME payments are one tool that has allowed states to become
more prudent, farsighted purchasers of care. Many states recognize
that support for GME is a valuable tool for meeting the future health
care provider needs of Medicaid beneficiaries and the public in
general."
In its March 19 comment letter
to Administrator Norwalk, the National Governors Association states
that the proposed rule "would further impede our progress in
implementing reform options and expanding affordable health insurance
coverage."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Announces Rule on Medicaid Documentation for
Newborns
Acting Centers for Medicare and Medicaid Services (CMS) Administrator
Leslie Norwalk March 20 announced the anticipated release of an
interim final rule modifying the Medicaid citizenship documentation
requirements for certain newborns.
According to a press
release from Administrator Norwalk's office, the interim final
rule will assure that any newborn whose mother filed for Medicaid
coverage of her delivery will automatically qualify for one year
of benefits. Currently, this "deemed" status does not
apply to newborns of certain non-citizens who qualify for emergency
Medicaid services, such as labor and delivery.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
House Letter Urges Title VII Restoration
A March 16 letter
to the chair and ranking member of the House Appropriations Subcommittee
on Labor, Health and Human Services, and Education and Related Agencies,
signed by 98 Representatives, called for the restoration of the
Title VII health professions programs to FY 2005 levels. As in years
past, Rep. Diana DeGette (D-Colo.) organized the letter, and was
joined by Rep. Cathy McMorris Rodgers (R-Wash.) and 12 other Republicans.
The late Rep. Charlie Norwood (R-Ga.) had served as the lead Republican
on this letter for the past several years.
The letter, addressed to subcommittee Chair David Obey (D-Wis.)
and Ranking Member Jim Walsh (R-N.Y.), describes how "reducing
this resource has already had devastating effects to the country's
neediest communities," and urges the appropriators to enable
grantees "to continue to improve the distribution, quality,
and diversity of the health professions workforce" by restoring
funding. A companion letter led by Senators Jack Reed (D-R.I.) and
Pat Roberts (R-Kan.) is expected to begin circulating the week of
March 26.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
VA Research Lauded at House Appropriations Hearings
The House Appropriations Subcommittee on Military Construction
and Veterans Affairs held hearings March 14 and 22 that examined
the Department of Veterans Affairs (VA) research program. VA Chief
Research and Development Officer Joel Kupersmith, M.D., testified
at the March 14 hearing and highlighted the historical success of
the program in spite of its modest funding. Chairman Chet Edwards
(D-Texas) stressed the need for an additional $35 million proposed
in the FY 2007 emergency supplemental for research on conditions
prevalent among veterans returning from Iraq and Afghanistan. The
supplemental was later approved by the House Appropriations Committee
March 15 [see Washington Highlights,
March 16].
At the March 22 hearing, public witness provided testimony on FY
2008 funding for the VA. A number of organizations praised the VA
Medical and Prosthetic Research program, but stressed the need for
increased funding to meet the needs of current and future veterans.
Galen Toews, M.D., Associate Dean for Research and Graduate Studies,
University of Michigan Medical School, presented testimony
on behalf of the Friends of VA Medical Care and Health Research
(FOVA). Dr. Toews outlined FOVA's recommendation of $480 million
for VA Research, a $66 million (16 percent) increase, and an additional
$45 million for research facilities improvement under the VA Minor
Construction account. The AAMC is a member of the FOVA Executive
Committee.
Organizations that echoed FOVA's' recommendations include the American
Lung Association, American Psychiatric Association, American Psychological
Association, American Thoracic Society, Fleet Reserve Association,
National Association of Uniformed Services, Society for Investigative
Dermatology, and the Independent Budget organizations. The second
ranking Democrat on the Subcommittee, Rep. Sam Farr (D-Calif.),
who chaired the hearing, commented that he was glad to hear witnesses
supporting the same request and had never seen so many organizations
on message.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
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