Washington Highlights: October
5 , 2007 President
Signs Legislation Relieving IPPS Cuts, Delaying Medicaid Prescription Regulations
ContentsPrior Issues  |
The President Sept. 29 signed the "TMA, Abstinence Education, and
QI Programs Extension Act of 2007" (H.R.
3668, P.L. 110-90), which would prevent the Centers for Medicare and Medicaid
Services (CMS) from fully implementing $20 billion in prospective payment cuts
to Medicare hospital inpatient services over the next 5 years [see Washington
Highlights, Sept. 28]. As part of
the FY 2008 inpatient prospective payment system (IPPS) final rule, the cuts are
an offset to payment increases associated with coding changes that CMS believes
will occur with the change from the current DRG system to "Medicare-severity"
DRGs (MS-DRGs). The law reduces the prospective payment cuts in FYs 2008
and 2009 by half to 0.6 and 0.9 percent, respectively. The bill also gives CMS
the authority to recoup any further "overpayments" starting in FY 2010.
However, if no coding "creep" occurs, the bill directs CMS to pay back
these amounts starting in FY 2010. According to the American Hospital Association,
the bill will restore $2.5 billion to hospitals over the first 2 years and $7
billion over 5 years, assuming no additional retrospective adjustments are made. The
law also institutes a 6-month delay in Medicaid's tamper-resistant prescription
pad rule. Under the law, all written Medicaid prescriptions must be on tamper-resistant
prescription pads as of April 1, 2008. The requirement applies to all outpatient
drugs, including over-the-counter drugs in states that reimburse for such items. Information:
Atul Grover, Assistant Vice President
AAMC Division of Biomedical and Health
Science Research/Office of Governmental Relations
agrover@aamc.org
(202)
828-06666 Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
AAMC Signs Letter Supporting Medicaid
Moratorium BillThe AAMC Oct. 2 signed a hospital group letter
of support for legislation to extend by one year the moratorium related to the
May 29 Medicaid final rule on cost limits/units of government and the May 23 Medicaid
proposed rule on graduate medical education (GME) payments [see Washington
Highlights, May 25]. The "Public
and Teaching Hospital Preservation Act" (H.R.
3533) was introduced Sept. 14 by Reps. Eliot Engel (D-N.Y.) and Sue Myrick
(R-N.C.). Other signatories on the support letter include the American Hospital
Association, Catholic Health Association of the United States, Federation of American
Hospitals, National Association of Children's Hospitals, National Association
of Public Hospitals and Health Systems, Premier Inc., and VHA Inc. The letter
states that cuts to Medicaid GME would impede the ability of teaching hospitals
"to provide essential services including education of the next generation
of medical professionals despite a shortage of medical professionals around the
country." The letter also advises that the rules "would undermine the
already fragile viability of the nation's healthcare safety net." As of Oct.
4, H.R. 3533 had 83 cosponsors. Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
AAMC, FOVA Urge Research Facility Improvements
at House VA HearingThe House Veteran Affairs Subcommittee on Health Oct.
4 held a hearing
on the U.S. Department of Veterans Affairs (VA) Research Programs. John R. Feussner,
M.D., professor and chair of Medicine, Medical University of South Carolina, testified
on behalf of Friends of VA Medical Care and Health Research (FOVA). The AAMC is
a member of the FOVA executive committee. Dr. Feussner, who was Chief Research
and Development Officer at the VA from 1996 to 2002, thanked the committee for
their $480 million recommendation for the VA Medical and Prosthetic Research program
in FY 2008, but cautioned that this "only provides a starting point when
consideration is given to long-term inflationary pressures." He noted that
"research is a long-term ambition that cannot be fully successful in one
funding cycle but must be sustained if treatments are to be discovered."
FOVA recommends a planned growth of the VA research budget over 3 years to accommodate
the standard 3-year VA research award. Dr. Feussner also cautioned that
"even with sustained growth, VA will be ineffectual in advancing new treatments
if it does not have the appropriate infrastructure in place." Dr. Feussner
pointed out that the current funding system pits VA research facilities against
VA medical facilities. Despite a House VA Committee recommendation to appropriate
$15 million for research facilities, the FY 2008 appropriations bills passed by
the House (H.R.
2642) and the Senate (S.
1645) fail to address this issue [see Washington
Highlights, Sept. 28]. For FY 2008,
FOVA recommends at least $45 million dedicated to VA research facility improvements
under the VA minor construction account. Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116 Senate to Consider HHS Funding
BillSenate Labor-HHS-Education Appropriations Chair Tom Harkin (D-Iowa)
confirmed that the Senate will consider the FY 2008 Labor-HHS-Education appropriations
bill (S. 1710;
S. Rpt.
110-107) during the week of Oct. 15. Speaking at an Oct. 3 meeting of various
health, education, and labor groups, Harkin said the Labor-HHS bill would be the
first of the FY 2008 spending bills to be sent to the President. He predicted
the debate on the Senate floor may last a week, but that the conference between
the House and Senate would be completed quickly and that the final bill could
go to the President by early November. President Bush has threatened to
veto a number of the domestic discretionary spending bills, including the Labor-HHS
bill, because the Democrats want to add $23 billion to the discretionary spending
total the President requested in his FY 2008 budget. Chairman Harkin noted the
Senate Labor-HHS bill is $7.5 billion over the FY 2007 level and $11 billion over
the President's request. All programs funded by appropriations bills are
currently operating under a continuing resolution (H.J.Res.
52; P.L. 110-92) that extends through Nov. 16. Chairman Harkin predicted there
likely will be a second CR, perhaps lasting until Dec. 21, before the FY 2008
spending bills are enacted into law.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
President Vetoes SCHIP Bill President Bush Oct.
3 vetoed legislation (H.R.
976) to reauthorize the State Children's Health Insurance Program (SCHIP).
The President stated
that one in every three children "moving onto government coverage" under
H.R. 976 "would be moving from private coverage." According to the President,
the bill also raises taxes and does not fully offset its "true cost."
Explaining that the reauthorization bill "moves our healthcare system in
the wrong direction," President Bush invited Congress to work with him and
"produce a good bill that puts poorer children first ... moves adults out
of a program meant for children, and ... does not abandon the bipartisan tradition
that marked enactment of SCHIP." In response to the veto, House Majority
Leader Steny Hoyer (D-Md.) stated
that House Democrats will work to encourage "our Republican colleagues who
insist on standing with the President" to "join the bipartisan majorities
in both chambers ... in overriding this veto." A press
release from Senate Majority Leader Harry Reid (D-Nev.) assured that his colleagues
also "will fight hard" to override the "heartless veto." While
the Senate Democrats were successful in securing a veto-proof majority vote on
H.R. 976, House Democrats were not [see Washington
Highlights, Sept. 28]. The House reportedly
plans to attempt the override on Oct. 18. Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
HHS Inspector General Issues FY 2008
Work PlanThe Office of the Inspector General (OIG) at the Department of
Health and Human Services (HHS) Oct. 1 issued the Work
Plan for fiscal year 2008. The Work Plan provides brief descriptions of various
audits and investigations that OIG conducts. Some are ongoing from previous years,
some are new, and some were concluded earlier and are being redone in 2008. Audits
are conducted of selected programs that fall under the oversight of each HHS agency.
Examples of audits from the Work Plan include examinations of: Medicare
hospitals (including a new audit of Medicare disproportionate share payments that
will "determine whether the hospitals' classifications are appropriate, and
examine the total amounts of uncompensated care costs that hospitals incur");
Provider bad debts;
The Centers for Medicare and Medicaid
Services' (CMS) oversight of the JCAHO hospital accreditation process;
Compliance
with Medicare secondary payer rules;
Medicare physicians;
The
Food and Drug Administration's (FDA) adverse-event reporting system for medical
devices;
Compliance with FDA's rules on disclosure of financial interests
of clinical investigators; and
Reviews of compliance with selected
aspects of OMB
Circular A-21, "Cost Principles for Educational Institutions," at
schools selected based on the dollar value of Federal grants received. Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
HRSA Revises Title VII Guidance to Include Research FellowshipsThe
Health Resources and Services Administration (HRSA) revised
its FY 2008 Program Guidance for Title VII Primary Care Medicine and Dentistry
grants this week to include competition for Primary Care Clinician Research Fellowships
for faculty development. The original guidance had discontinued competition for
the research fellowships, which provide training support for physicians who plan
to teach in family medicine (including geriatrics), general internal medicine,
and/or pediatrics training programs. The announcement estimates that $3.7 million
will be designated for an expected 12 awards, pending final appropriations. Applications
are due Dec. 10. Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525 House Subcommittee Examines
Oversight of Biosafety LabsThe House Energy and Commerce Subcommittee
on Oversight and Investigations Oct. 4 convened the first in a series of hearings
examining the rapid expansion of new high-containment biosafety laboratories that
work with infectious disease agents classified as the most dangerous. Keith Rhodes,
Ph.D., and Sushil K. Sharma, Ph.D., Dr.P.H., both of the Government Accountability
Office (GAO), discussed preliminary
findings from a GAO investigation of biosafety level (BSL)-3 and BSL-4 labs.
The investigation was prompted by recent incidents at 3 high-containment labs,
highlighting the potential for accidents and security breaches. According
to Dr. Rhodes, since Sept. 11, 2001, an influx of federal funding for research
and development of biodefense countermeasures has encouraged the construction
of additional BSL-3 and BSL-4 labs, particularly in university settings. Yet,
the federal oversight capacity has not grown at a similar pace. Moreover, while
15 federal agencies have funding authority for the labs, no one agency coordinates
lab operations or is responsible for tracking the number and location of all BSL-3
and BSL-4 labs in the country. Dr. Rhodes testified that due to the highly sensitive
nature of research conducted at the labs, proliferation in the face of such ambiguities
may generate more risk without improved regulation and coordination of information
sharing. GAO expects to release in Feb. 2008 a final report recommending which
agency should fill that role. Other witnesses included Richard Besser, M.D.,
Director of the Coordinating Office for Terrorism Preparedness and Emergency Response
at the Centers for Disease Control and Prevention (CDC), and Hugh Auchincloss,
M.D., Deputy Director of the National Institute of Allergy and Infectious Diseases
(NIAID). Dr. Auchincloss described the establishment of a Trans-Federal Task Force
including the Departments of Health and Human Services, Agriculture, Homeland
Security, and Defense, to recommend improvements to the existing biosafety framework. A
complete list of witnesses and testimony is available on the Energy
and Commerce Committee website. Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525 Letter Urges Implementation of
Patient Safety Organizations
Several health care organizations signed
a Sept. 27 letter
to Secretary of Health and Human Services Michael Leavitt urging publication of
a proposed rule implementing Patient Safety Organizations (PSOs), as established
by the AAMC-supported Patient Safety and Quality Improvement Act (PSQIA) of 2005
(P.L.
109-41). Under the PSQIA, providers may voluntarily and confidentially report
patient safety data to PSOs for analysis and the development of quality improvement
strategies. The letter was signed by the American College of Physicians,
American College of Surgeons, American Dental Association, American Hospital Association,
American Medical Association, and the Joint Commission. The organizations express
concern that a proposed rule is "languishing in the review and clearance
process." They state that improving patient safety is "too important"
to allow further delays in the regulatory process. Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526 NASA Extends National Biomedical Research Institute
The
National and Aeronautics Space Administration (NASA) Oct. 1 announced that it
was extending for another 5 years its cooperative agreement with the National
Space Biomedical Research Institute (NSBRI), a 12-member consortium of medical
schools and other research organizations led by Baylor College of Medicine. The
space agency reported that the extension, valued at $120 million, will continue
biomedical research in support of long-term human presence in space, including
such health concerns as bone and muscle loss, radiation exposure, nutrition, cardiovascular
function, and neurobehavioral and psychosocial factors. With the extension, NASA
reports that total support for the NSBRI, from its inception in 1997 to 2012,
is $362 million. Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
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