Washington Highlights: June
1 , 2007
CMS
Issues Medicaid Final Rule on Cost Limits
Contents
Prior Issues
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The Centers for Medicare and
Medicaid Services (CMS) May 29 finalized the January 18 Medicaid proposed rule
regarding costs limits and "units of government." The FY 2007 supplemental
spending bill [P.L.
110-28] delays implementation of the regulation (72
Fed. Reg. 29747) until May 25, 2008 [see Washington
Highlights, May 25].
Under the
final rule, CMS continues to seek additional public comments until July 13 on
the revised definition of "unit of government." Additionally, the rule
makes a few changes and clarifications to the proposed rule, including several
of potential interest to medical schools and teaching hospitals:
- An expanded
definition of "unit of government" as it relates to state university
teaching hospitals and providers without taxing authority;
- Clarification
that the May 29 final rule does not apply to Medicaid graduate medical education
(GME) payments. However, the May 23 proposed rule seeks to eliminate federal matching
for Medicaid GME (also delayed for one year by P.L. 110-28) [see Washington
Highlights, May 25];
- Clarification
that cost limits apply to all government-operated entities receiving state payments
as healthcare providers (e.g., a faculty practice owned by a governmental entity);
and
- Clarification that the regulation does not apply to a provider's
normal operating expenses (e.g., taxes or fees).
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Appropriators
Gear Up
House Appropriators will face a full workload when Congress returns
to Washington the week of June 4. The full House Appropriations Committee is expected
to begin consideration of several individual FY 2008 spending bills. The committee
also is expected to formally approve the 302(b) allocations, which set spending
limits for each of the subcommittees.
With the passage of the FY 2008 budget
resolution (S.Con.Res.
21) on May 17, several House appropriations subcommittees began marking up
the first of the 12 individual FY 2008 spending bills. The Homeland Security Subcommittee
marked up its bill May 18, followed by Military Construction and Veterans Affairs
subcommittee May 23 and the Energy-Water Development and Interior-Environment
subcommittees May 24.
The House Labor-HHS-Education Appropriations Subcommittee
is tentatively scheduled to consider its FY 2008 spending bill on June 7, with
full committee action the following week and floor action by the end of June.
House Appropriations Chair David Obey (D-Wis.) has said he wants to have all 12
bills passed by the House prior to the July Fourth recess.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Senators Urge Treasury to Improve Nonprofit Transparency
In
a May 25 letter to Treasury Secretary Henry Paulson, Senate Finance Committee Chair Max Baucus
(D-Mont.) and Ranking Member Charles Grassley (R-Iowa) urged the Treasury Department
to update the Form 990, which is used for tax related purposes, as part of an
effort to improve transparency in the nonprofit sector, particularly for universities
and hospitals.
"The Form 990 is not adequate to encompass vital information
regarding major parts of the nonprofit sector-especially hospitals and universities,"
states the letter. Describing hospitals and universities as "large, complex
institutions," the letter urges the Internal Revenue Service (IRS) to require
more detailed information and identifies the following areas in need of greater
reporting and transparency: executive compensation; endowments; related organizations;
joint ventures; governance; dollars raised vs. dollars for charity; and hospitals.
Related
to hospitals, Senators Baucus and Grassley urge the IRS to look to "the supplemental
reporting guidelines of the Catholic Health Association (CHA) regarding charity
care and community benefits as a template. The CHA reporting structure has been
embraced by many hospitals already. In addition, we believe that hospitals and
other charities that engage in billing and debt collection should be required
to outline the procedures they follow. Finally, it is important that the information
provided clearly states in plain language what is the hospital's charity care
policy and how individuals are informed of that policy."
Information:
AAMC Government Relations
Immigration
Bill Includes Physician Visa Reform
Senators Edward Kennedy (D-Mass.) and
Arlen Specter (R-Pa.) May 21 introduced a substitute amendment (S.AMDT.1150)
to the "Comprehensive Immigration Reform Act of 2007" (S.1348),
which had served as a placeholder on the Senate calendar. The new language includes
changes to the laws governing H-1B visas, J-1 visas, and the Conrad 30 waiver
program for physicians. The Senate May 21 voted (69-23) to begin debate on the
bill.
Of particular importance to academic medicine, the new language:
- Excludes "graduate medical education and training" from eligible
specialty occupations under the H-1B visa;
- Increases the H-1B visa
cap from 65,000 in FY 2007 to 115,000 in FY 2008. In future fiscal years, the
cap is adjusted by the Secretary using the previous fiscal year as the base, not
to exceed 180,000;
- Permanently authorizes the Conrad J-1 visa waiver
program; and
- Authorizes through 2011 a pilot program for increasing
state Conrad waivers from 30 to 50 for states that grant all 30 waivers in that
fiscal year and have filled fewer than 20 percent of the state's HPSAs in the
most recent fiscal year. These additional J-1 visa waivers are available on the
condition that all "underserved highly rural States" have received their
guaranteed number of waivers (15 in the first year) or waive their right to this
guarantee.
The Senate is expected to finish consideration of the bill
following the Memorial Day recess.
The House Judiciary Subcommittee on Immigration,
Citizenship, Refugees, Border Security, and International Law May 22 met to adopt
rules of procedure for the pending immigration bills.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Confirms Kussman as VA Under Secretary for Health
The Senate May
25 confirmed the appointment of Brig. Gen. Michael J. Kussman, M.D., as Under
Secretary for Health for the Veterans Health Administration. Dr. Kussman has served
as acting Under Secretary for Health since August 2006 and as Principal Deputy
Under Secretary for Health since May 2005.
Dr. Kussman earned his medical
degree from Boston University School of Medicine and completed his residency training
at the Joslin Clinic in Boston. He is a recipient of the Laureate Award from the
American College of Physicians/American Society of Internal Medicine and serves
on the faculty of the Uniformed Services University of Health Sciences.
AAMC
President Darrell G. Kirch, M.D., May 16 testified before the Senate Committee
on Veterans Affairs in support of Dr. Kussman's nomination [see Washington
Highlights, May 18].
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
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