Washington Highlights: December
7, 2007
Contents
Prior Issues
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Democrats Try to Break Spending Logjam
Democratic leaders in Congress are finalizing a compromise plan
they hope will break the deadlock over the FY 2008 appropriations
bills. Democrats propose to "split the difference" between
the President's discretionary budget request for the 11 spending
bills that have not been enacted and the higher funding level originally
proposed by the Democrats - a difference of about $21 billion ($23
billion if advance appropriations are included).
The new Democratic proposal is to wrap the 11 bills into an "omnibus"
spending package that would provide $484.2 billion, or $10.6 billion
less than congressional Democrats had originally proposed. The House
is tentatively scheduled to vote Dec. 11 on the omnibus package,
which reportedly will include as much as $30 billion in funding
for the war and up to $7 billion in emergency spending for programs
supported by Republicans.
Much of the federal government currently is operating under a continuing
resolution (CR) that expires Dec. 14. The Defense appropriations
bill (P.L.
110-116) is the only one of the 12 annual spending bills that
has been signed into law. However, Congress might need to pass another
short-term CR if congressional action on the omnibus bill is not
completed by Dec. 14.
The omnibus will face opposition from House GOP leaders and the
White House, who have shown little interest in agreeing to more
spending for the regular appropriations bills. President Bush has
repeatedly vowed to veto spending measures that exceed his overall
request, most recently on Dec. 3, when he stated, "Congressional
leaders are now talking about piling the remaining bills into one
monster piece of legislation, which they will load up with billions
of dollars in earmarks and wasteful spending. Now is not the time
to burden our economy with wasteful Washington spending that will
lead to higher taxes. Congressional leaders need to do their job,
and pass the remaining spending bills in a fiscally responsible
way. If they send me an irresponsible spending bill, I will veto
it."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Baucus to Negotiate Directly with House on Year-End
Medicare Package
Senate Finance Committee Chair Max Baucus (D-Mont.) announced in
a Dec. 5 press
release that he "will speed up efforts to craft Medicare
legislation this year by moving directly to negotiations with the
House of Representatives." Chairman Baucus withdrew his request
for a Finance Committee mark-up (initially scheduled for Dec. 5),
given the importance of moving "as quickly as possible"
toward agreement on a year-end Medicare bill.
According to the press release, Chairman Baucus and Ranking Member
Charles Grassley (R-Iowa) "have already reached agreement on
many provisions." Baucus believes "there's now a good
basis for negotiation with the House."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Updates PPAC on 2008 Payment Regulations and
New Stark Provisions
At the Dec. 3 meeting
of the Practice Physicians Advisory Council (PPAC), Centers for
Medicare and Medicaid Services (CMS) staff updated council members
on the 2008 final payments rules for the physician fee schedule,
outpatient prospective payment system (OPPS), and the ambulatory
surgical center (ASC) payments. After the physician fee schedule
presentation, PPAC recommended that CMS apply the Physicians Assistance
and Quality Improvement (PAQI) fund toward offsetting the negative
10.1 percent update for 2008 payments. The PAQI fund is a $1.35
billion fund authorized by the "Tax Relief and Healthcare Act
of 2006" (P.L.
109-432) to be available for physician payment and quality initiatives.
CMS has chosen to fund the 2008 physician pay-for-reporting program
using the PAQI fund.
In a separate presentation, CMS summarized the new Stark provisions
and the Disclosure of Financial Relationships Report (DFRR). After
hearing concerns from the AAMC and other physician organizations,
CMS has decided to delay for a year the "Stand in the Shoes"
expansion outlined in the Stark III regulations. This delay applies
only to academic medical centers and integrated section 501(c)(3)
not-for-profit health systems. [see Washington
Highlights, Nov. 16].
CMS also discussed the anti-markup provisions for diagnostic tests
documented in the final physician fee schedule rule. This provision
modifies the definition of an office, which in turn, impacts which
services may qualify for the Stark in-office ancillary exemption.
Finally, CMS described the current status of the DFRR, a detailed
financial survey scheduled to be sent to 500 hospitals following
approval of the survey by OMB. In an Oct. 12 letter,
the AAMC urged OMB to deny approval of the CMS DFRR information
collection request as submitted.
Other items discussed at the meeting include an update on current
Medicare Demonstrations, an update by the Physician Regulatory Issues
Team (PRIT), and an overview of the 9th Scope of Work for Quality
Improvement Organizations (QIOs).
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Denise Dodero, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
AAMC Joins Coalition Urging Congress to Refrain
from Adding Privacy Rules to Health IT Bill
The AAMC joined a broad-based group of health and business organizations
in a Dec. 3 letter
urging the Senate to reject an effort to "impose expansive
new privacy regulations on providers, health plans, employers and
others" as part of pending legislation on health information
technology. The Senate may consider the "Wired for Health Care
Quality Act" (S.
1693) before it adjourns later this month. The letter expresses
concern about a possible amendment based on the "Health Information
Privacy and Security Act" (S.
1814), sponsored by Senator Patrick Leahy (D-Vt).
Noting that the confidentiality of patients' medical records is
currently protected by the Health Insurance Portability and Accountability
Act (HIPAA) Privacy and Security Rules, the letter states, "[C]omprehensive
HIPAA regulations strike the appropriate balance between protecting
the privacy of a patient's medical information while, at the same
time, ensuring that necessary information is available for medical
treatment and payment, quality assessment and improvement activities,
disease management and care coordination, as well as medical research."
"By contrast, the Leahy privacy amendment would slow or prevent
many of these activities, seriously affecting those with serious
and chronic illnesses," the letter continues. "The requirement
that patients be allowed to refuse the use of their information
would jeopardize medical treatment, payment, research, chronic disease
management, and other important activities." The letter points
out that this approach was rejected by both the Clinton and Bush
Administrations during promulgation of the HIPAA Privacy Rule because
of its significant potential for negative impact on patient care.
The letter concludes, "Before making any modifications to
the HIPAA Privacy Rule, Congress should be absolutely certain that
additional requirements are necessary as broad and sweeping changes
may dramatically affect patient care."
The letter was prepared under the auspices of the Confidentiality
Coalition, which includes hospitals, health plans, pharmaceutical
companies, medical device manufacturers, vendors of electronic health
records, biotech firms, employers, health product distributors,
and pharmacy benefit manufacturers and pharmacies. The letter was
signed by the American Hospital Association, the Blue Cross and
Blue Shield Association, the Federation of American Hospitals, the
Healthcare Leadership Council, the National Association of Chain
Drug Stores, the National Retail Federation, UnitedHealth Group,
and the U.S. Chamber of Commerce, among other organizations.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Clarification on Value Based Purchasing Report
to Congress
Washington Highlights Nov. 30 reported on CMS' Value Based
Purchasing (VBP) Plan, indicating there had not been a decision
regarding the use of either the base DRG payment or full DRG payment
for the basis of the incentive payment [see Washington
Highlights, Nov. 30].
In fact, CMS has recommended the base DRG payment for use in the
VBP plan.
Information:
Jennifer Faerberg, Director of GME Track/Health Care Quality Liaison
AAMC Division of Health Care Affairs
jfaerberg@aamc.org
(202) 862-6221
On the Hill
Following the Nov. 26 announcement that Minority Whip Trent Lott
(R-Miss.) will retire before the end of the year, Republican Senators
Dec. 6 voted to fill the positions opened by his departure. Sen.
Jon Kyl (R-Ariz.) will succeed Sen. Lott as the Minority Whip. Sen.
Lamar Alexander (R-Tenn.) bested Sen. Richard Burr (R-N.C.) to serve
as Conference Chair, the number-three Republican leadership position
previously held by Sen. Kyl.
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