Washington Highlights: August 3,
2007
Contents
Prior Issues
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House, Senate Pass SCHIP Reauthorization Packages
The House Aug. 1 and the Senate Aug. 2 passed their respective
State Children's Health Insurance Program (SCHIP) reauthorization
bills, largely along party lines. The Senate version (H.R.
976) is nearly identical to the $35 billion, "Children's
Health Insurance Program Reauthorization Act of 2007" (S.
1893), adopted by the Senate Finance Committee on July 19 [see
Washington Highlights,
July 20].
The House-passed "Children's Health and Medicare Protection
Act" (H.R.
3162) is an amended version of the bill passed by the House
Ways and Means Committee on July 27. [see Washington
Highlights, July 27].
Before floor consideration of H.R. 3162, House Democrats reduced
the bill's cost
by limiting the availability of "performance bonus payments"
for certain Medicaid/SCHIP expansions to 5 years (a savings of $20.4
billion over 10 years). They also reduced the 10-year cost of the
Medicare physician payment "fix" from $102.7 billion to
$67 billion, presumably by increasing the level of physician payment
cuts in the out-years. Physicians would still receive a 0.5 percent
update in calendar years 2008 and 2009.
The House and Senate must now reconcile their disparate SCHIP packages.
President Bush has issued Statements
of Administrative Policy reiterating his intention to veto any
SCHIP bill based on either the House-passed or Senate-passed language
because the legislation "clearly favors government-run health
care over private health insurance."
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Announces Payment Reforms for Inpatient Hospital
Services in 2008
The Centers for Medicare and Medicaid Services (CMS) Aug.1 issued
on its web site the FY 2008 Inpatient Prospective Payment System
Final
Rule [see Washington
Highlights,
May 11].
A preliminary review of the final rule reveals that the agency
is implementing the so-called "behavioral offset" that
was included in the proposed rule, but will phase in the reduction
over 3 rather than 2 years, so that there will be a 1.2 percent
reduction in FY 2008, a 1.8 percent in FY 2009, and a 1.8 percent
in 2010 instead of a 2.4 cut for both FY 2008 and FY 2009.
Overall, payments will increase by an average of 3.5 percent for
FY 2008, but teaching hospitals with fewer than 100 residents will
see an increase of 3.7 percent while those with more than 100 residents
will experience a 4.4 percent increase.
CMS did not finalize the proposed policy to remove vacation and
sick leave from the FTE calculation at this time. However, CMS is
continuing to look for a way to finalize the proposed policy in
future rulemakings in a manner that would be less administratively
burdensome. The agency is proposing a few options and is seeking
comments from hospitals.
The final rule also eliminates the large urban add-on payment,
and adopts a policy of discontinuing the teaching adjustments to
capital payments over a 3-year period.
Information:
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Rehab Facilities Receive a 3.2 Percent Update
Under FY 2008 Final Rule
The Centers for Medicare and Medicaid Services (CMS) July 31 issued
its Medicare inpatient rehabilitation facility (IRF) final rule
for FY 2008 on its web site. The rule is expected to be published
in the Federal Register Aug. 7. The final
rule provides for an update to IRF payment rates, equal to the
3.2 percent rehabilitation, psychiatric, and long-term care hospital
(RPL) market basket increase.
Overall, however, the estimated payments per discharge for IRFs
in FY 2008 are projected to increase by 2.4 percent. This is largely
due to a 0.7 percent reduction in the standard payment amount that
CMS is implementing to finance the outlier pool, which accounts
for 3 percent of total payments. Because last year's outlier payments
exceeded 3 percent, the final rule increases the outlier threshold
from $5,534 in FY 2007 to $7,362 in FY 2008, which is less than
the $7,522 in the proposed rule.
To determine whether a facility qualifies as an IRF, thereby qualifying
for higher PPS payments than inpatient hospitals, CMS is implementing
the 75 percent rule. When fully phased in, this standard requires
that at least 75 percent of an IRF's patient population has 1 of
13 designated medical conditions for which intensive inpatient rehabilitation
services are medically necessary.
The 75 percent rule is being phased in over a period that started
in July 2004. For providers with cost reporting periods that start
on or after July 1, 2006, and before July 1, 2007, the compliance
threshold is 60 percent. It is 65 percent for cost reporting periods
starting on or after July 1, 2007, and before July 1, 2008. The
phase-in period ends with cost reporting periods beginning on or
after July 1, 2008, when the 75 percent threshold goes into effect.
Currently, a provision of the 75 percent rule allows comorbidities
that meet certain regulatory criteria to be used in conjunction
with the 13 designated medical conditions to meet the requirements
of the rule. This provision is scheduled to expire with the full
implementation of the rule on July 1, 2008. CMS decided not to extend
the provision, stating that it is the principal diagnosis that most
accurately denotes whether a patient has a medical condition that
requires admission to an IRF.
In other areas the final rule:
- establishes a wage index policy for rural areas without hospital
wage data by which the average wage index from all contiguous
counties can be used to represent a reasonable proxy for the rural
area within that State (this policy does not apply to Puerto Rico);
and
- clarifies short-stay transfer policy to indicate that short-stay
transfer cases that meet the criteria to qualify for outlier payments
are eligible to receive the additional payments.
The policies will become effective Oct. 1, 2007.
Information:
Diana Mayes, Staff Associate
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
Congress Clears Competitiveness Bill for President
Both the House and Senate Aug. 2 approved the conference
agreement (H. Rept. 110-289) for the "America COMPETES
Act" (H.R.
2272), which seeks to improve national competitiveness by enhancing
research and education in math and the physical sciences. The bill
cleared the House, 367-57, and the Senate by unanimous consent.
The House had approved the bill May 21 [see Washington
Highlights, May 25],
while the Senate approved its version (S.
761) on April 25 [see Washington
Highlights, April 27].
The conference agreement authorizes a total of $22 billion in funding
for FYs 2008 - 2010 for the National Science Foundation (NSF), with
the goal of doubling NSF funding within 7 years. The agreement also
seeks to double within 7 years funding for the Department of Energy's
(DOE) Office of Science, while funding for the National Institute
of Standards and Technology is scheduled to double within 10 years.
The increases correspond with the President's American Competitiveness
Initiative (ACI) and the Democratic leadership's Innovation Agenda.
The measure also authorizes increased funding for science, technology,
engineering, and mathematics (STEM) education programs at NSF, DOE,
and the Department of Education; provides support for young investigators
and researchers pursuing innovative, high-risk research in STEM
fields; and directs the President to convene a National Science
and Technology Summit, responsible for identifying key STEM research
and technology challenges. Provisions addressing the role of the
National Aeronautics and Space Administration and the National Oceanic
and Atmospheric Administration in national competitiveness also
are included in the agreement.
Both the House and the Senate passed their respective bills with
broad bipartisan support. In April, the White House issued Statements
of Administration Policy expressing concern with the bills' "excessive
authorization levels" and expansion of overlapping STEM education
programs that "have not been proven effective," despite
general support for the bills.
Information:
Tannaz Rasouli, Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Approves FDA Spending Bill
The House Aug. 2 approved its FY 2008 Agriculture-Rural Development-Food
and Drug Administration Appropriations bill (H.R. 3161). The bill
provides $1.7 billion for the Food and Drug Administration (FDA),
an increase of $128 million (8.2 percent) over FY 2007. The FDA
budget is supplemented by revenue generated from user fees, adding
approximately $500 million to the appropriated levels. The bill
also prohibits FDA advisory committee waivers for conflicts of interest.
The bill passed the House, 237-18, with 13 Members voting "present."
A total of 165 Members, mostly Republicans, did not vote on final
passage. The Appropriations Committee had approved the bill July
19 [see Washington Highlights,
July 27].
In a July 31 Statement
of Administration Policy, the President threatens to veto the
bill because of its "excessive level of spending," and
expresses strong opposition to the bill's proposal to lift a ban
on prescription drug importation, among other provisions.
Information:
Tannaz Rasouli, Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Approves NSF Spending Bill
The House July 26 approved, 281-149, its FY 2008 Commerce-Justice-Science
Appropriations bill (H.R.
3093). The measure provides $6.509 billion for the National
Science Foundation (NSF), an increase of $593.4 million (10 percent)
over FY 2007. The House Appropriations Committee had approved the
bill July 12 [see Washington
Highlights, July 13].
The White House issued a July 24 Statement
of Administration Policy threatening to veto the bill, because
"it includes an irresponsible and excessive level of spending
and includes other objectionable provisions." With respect
to NSF, the statement commends the overall funding increase, as
proposed in the President's American Competitiveness Initiative,
but objects to increases for the NSF education programs.
Information:
Tannaz Rasouli, Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
NIH Examines Peer Review Research System
The AAMC July 30 participated in the first of several town hall
meetings being convened by the Working Group on National Institutes
of Health (NIH) Peer Review of the Advisory Committee to the NIH
Director. The working group is co-chaired by Keith Yamamoto, Ph.D.,
Executive Vice Dean at the UCSF School of Medicine and Lawrence
Tabak, D.D.S., Ph.D., Director of the National Institute of Dental
and Craniofacial Research.
NIH Director Elias Zerhouni, M.D., introduced the meeting by stating
that the NIH is seeking broad input and innovative suggestions to
help the agency enhance its system of research support and peer
review to meet the challenges of science that is increasingly broad,
complex, and interdisciplinary. He said the goal is to design a
system that will fund the best scientists doing the best research
with the least possible burden and bias.
The working group will prepare a report and make suggestions by
the end of 2007 for pilot projects, which are with anticipated to
be implanted in the spring of 2008. AAMC is currently drafting its
suggestions for the working group which, has extended the deadline
for comments until Sept. 7, 2007.
Information:
Howard Dickler, Director
AAMC Division of Biomedical and Health Sciences Research
hdickler@aamc.org
(202) 828-0567
HHS Committee Discusses Informed Consent
The Secretary's Advisory Committee on Human Research Protections
(SACHRP) at the Department of Health and Human Services (HHS) July
31 invited an expert panel to discuss informed consent issues. Howard
Dickler, M.D., AAMC Director for Clinical Research, presented a
review of problematic features of informed consent documents
that have been reported in the literature. These include omission
of elements required by regulation, ever increasing length, and
use of difficult and dense language that exceeds the comprehension
of the majority of U.S. citizens.
Dr. Dickler also reported on the outcome of a strategic planning
meeting, entitled "Universal Use of Short and Readable Informed
Consent Documents: How Do We Get There?" convened by the AAMC
May 30, 2007. Participants included bioethicists, Institutional
Review Board (IRB) chairs, IRB administrators, university counsels,
and research deans/vice presidents, as well as representatives of
various government agencies including the Office of Human Research
Protection, the Food and Drug Administration, the National Institutes
of Health, the Agency for Healthcare Research and Quality, and the
Association of Human Research Protection Programs. The group identified
obstacles that must be overcome and proposed an approach that recognizes
informed consent as a process that requires a "toolkit,"
of which the informed consent document is only a part. This would
allow the document to focus on the research question and the specific
items required by federal regulation; supplemental materials (handbooks,
websites, and appendices) would be used for tasks such as educating
participants on the research project and explaining what constitutes
standard care. The group also identified a series of next steps
and urged AAMC to pursue this approach vigorously.
The SACHRP welcomed Dr. Dickler's report with enthusiasm and added
its plea that the AAMC proceed with implementation strategies.
Information:
Howard Dickler, Director
AAMC Division of Biomedical and Health Sciences Research
hdickler@aamc.org
(202) 828-0567
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