Washington Highlights: February
29, 2008
Governors Raise Concerns with Medicaid GME Rule
Contents
Prior Issues
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In Feb. 26 testimony before Congress, Govs. Janet Napolitano (D-Ariz.)
Deval Patrick (D-Mass.), Christine Gregoire (D-Wash.), Ted Strickland
(D-Ohio), Haley Barbour (R-Miss.), and Sonny Perdue (R-Ga.) called
upon Congress to prevent implementation of the Administration's
new Medicaid regulations, which include the Medicaid GME proposed
rule and the Medicaid IGT final rule. The testimony was delivered
in conjunction with a Feb. 26 letter from the National Governors
Association (NGA) to House and Senate leadership requesting "immediate
action" to prevent finalization of the rules (see
related story). The current moratorium prohibiting action on
the Medicaid GME and IGT rules expires May 25, 2008.
Gov. Napolitano testified
at a Senate Finance Committee hearing that focused on the states'
fiscal conditions. Govs. Patrick, Gregoire, Strickland, Barbour,
and Perdue testified
before the House Energy and Commerce Health Subcommittee during
a hearing on children's health coverage.
In her testimony, Gov. Napolitano raised significant concerns about
the impact of the GME proposed rule. She reported that Arizona would
lose nearly $30 million dollars in FY 2009 under the rule, thereby
threatening the sustainability of "a program that has been
essential to attracting and training new health care professionals
and extending access to low-income individuals." She added
that Arizona was "a fast-growing state with a physician shortage,"
and "this cut would clearly move Arizona backwards in creating
access to care for our residents."
Gov. Barbour's testimony questioned the Administration's "clarification"
that GME was "outside the scope of Medicaid's role, which is
to provide medical care to low-income populations." Explaining
that the University of Mississippi Medical Center was the state's
largest Medicaid provider, he warned that the rule would eliminate
$15 million in FY 2009 GME payments and threaten the state's "ability
to provide care for our Medicaid beneficiaries." Gov. Barbour
added that the Medical Center's GME program "makes it possible
to train 200 residents a year and it has proved to be an effective
physician retention program." According to the Governor, there
is an 85 percent likelihood that Mississippi-trained residents will
choose to live and practice in the state. "Having doctors in
under-served rural areas," Barbour stated, "is necessary
for there to even be a Medicaid program." Gov. Patrick agreed
GME funding played an important role in assuring an adequate supply
of Medicaid providers and continued healthcare access for Medicaid
beneficiaries.
In his testimony, Gov. Strickland referenced the AAMC's comment
letter on the GME proposed rule, which states that the regulation
"represents a major and abrupt reversal of long standing Medicaid
policy" [see
Washington Highlights, June 29, 2007] He reported that
Ohio teaching hospitals would lose millions of dollars under the
rule "and it will undercut their ability to train the next
generation of physicians who will be called upon to treat our Medicaid
consumers."
During the Finance Committee hearing, Chair Max Baucus (D-Mont.)
did not discuss plans to extend the current Medicaid moratorium.
In his opening remarks, Energy and Commerce Committee Chair John
Dingell (D-Mich.) stated that "This Congress will work to restore
the ability of States to cover uninsured children in need"
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
NGA Letter Urges Congressional Delay of Medicaid
Rules
The National Governors Association (NGA) Feb. 26 sent a letter
to House and Senate leadership urging them to "take immediate
action to delay implementation of the pending Medicaid regulations"
issued by the Bush Administration over the past year.
Signed by NGA Chair Tim Pawlenty (R-Minn.), Vice Chair Edward Rendell
(D-Pa.), Health and Human Services Committee Chair James Douglas
(R-Vt.), and Health and Human Services Committee Vice Chair Jon
Corzine (D-N.J.), the letter states that "Timely action by
the Congress is necessary to divert disruptions in coverage that
may otherwise be unavoidable." Advising that the regulations
"are a departure from past practices and reflect new and unsupported
interpretations in Medicaid law," the Governors write that
Congress should prevent finalization of the rules and "provide
for a more appropriate and thoughtful review...of these important
policy changes."
The letter was sent in conjunction with the 2008 NGA Winter Meeting
and Feb. 26 Medicaid-related testimony by several Governors before
the Senate Finance Committee and House Energy and Commerce Health
Subcommittee (see related story).
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Appropriations Subcommittee Questions Leavitt
about Proposed FY 2009 Budget Cuts
The Appropriations Subcommittee on Labor, Health and Human Services
(HHS), and Education Feb. 27 heard testimony from Secretary of HHS
Michael Leavitt on the President's proposed budget for FY 2009.
Members on both sides of the aisle expressed their concerns about
the cuts to many HHS programs, including the elimination of Title
VII.
Appropriations Committee Chair David Obey (D-Wis.) began the hearing
by stating that the Administration focuses too much on the cost
of programs to help Americans, but does not focus enough on the
cost of not having such programs. He then mentioned that he is willing
to negotiate on all aspects of the budget, but the President must
also be willing to negotiate. If he will not, Congress could choose
to wait until the next Administration. Rep. Obey said, "This
can be a wasted eight months, or we can get something done."
Last year, "the president refused to compromise -- his way
or no way -- and the year was wasted," he said, adding, "This
year we can wait until we have another President."
Reps. Barbara Lee (D-Calif.) and Jesse Jackson, Jr. (D-Ill.) questioned
cuts to Title VII diversity programs: Health Careers Opportunity
Program (HCOP), Centers of Excellence (COE), and Scholarships for
Disadvantaged Students (SDS). They both expressed concern about
the lack of attention to health disparities, which these programs
were designed to help alleviate, and the effect that these disparities
have on underrepresented minorities. Sec. Leavitt responded that
the Administration cut programs which they felt were ineffective,
underperforming or duplicative, and that they were trying to focus
their limited resources on direct services rather than infrastructure.
He commented that what looks like a reduction might not be, because
it may be dealt with in another area of the budget, although he
could not point to any other area with the same goals. Rep. Jackson
informed the committee that at the appropriate time, he will be
proposing amendments to restore Title VII funding.
Reps. Tom Udall (D-N.M.), John Peterson (R-Pa.), and Dennis Rehberg
(R-Mont.) questioned cuts to a multitude of rural health programs.
Rep. Udall pointed out that Title VII training programs often produce
health professionals who are willing to work in rural areas, and
these cuts will negatively impact rural Americans. Sec. Leavitt
responded that other areas of the budget provide for 800 new nurses
and 200 new dentists, many of whom will serve in rural areas, and
the Administration feels these programs are more effective than
Title VII has been.
Members also expressed concern about cuts Title VIII nursing programs.
Responding to Rep. Lucille Roybal-Allard's (D-Calif.) question about
the legitimacy of cutting nursing workforce programs during a nursing
shortage, Sec. Leavitt expressed that the Administration feels as
though Title VIII does not accurately respond to the nursing shortage,
and that there needs to be a refocusing on competencies rather than
infrastructure programs. Rep. Roybal-Allard pointed out that you
cannot have adequate services without infrastructure, and vice versa.
Sec. Leavitt could not respond to a question about the elimination
of the Advanced Practice Nursing programs when there is a shortage
of primary care practitioners, saying he will provide the answer
in writing.
Rep. Obey expressed concern about the overall funding levels for
the National Institutes of Health (NIH), which would result in over
600 grants being cut. Sec. Leavitt responded that not all grants
are successful, and the Administration feels as though there is
too much money for NIH that ends up going toward rising health care
costs instead of prevention research.
Information:
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
Bipartisan House Group Calls for Increased NIH
Funding
A bipartisan group of House Members has sent a letter to the leadership of the House Budget Committee urging them
"to allocate sums necessary to the National Institutes of Health
(NIH) that at a minimum includes an increase relative to the cost
of biomedical inflation" as they finalize the FY 2009 budget
resolution.
The Feb. 28 letter to House Budget Committee Chair John Spratt
(D-S.C.) and Ranking Member Paul Ryan (R-Wis.) was signed by Reps.
Edward Markey (D-Mass), Dave Reichert (R-Wash.), Janice Schakowsky
(D-Ill.), Chris Shays (R-Conn.), Joseph Courtney (D-Conn.), and
Chris Smith (R-N.J.).
The letter states, "Unfortunately, we have already seen the
impact on biomedical research when the NIH budget fails to account
for increases in inflation. In the short term, this amounts to a
reduced number of NIH-funded grants awarded around the country each
year. More broadly, inadequate funding for biomedical research delays
or ends cutting-edge research, making it more difficult to retain
talented researchers in the United States. Even worse, flat funding
further impedes our ability to mitigate or delay the onset of chronic
diseases which are the greatest contributor to spiraling health
care costs."
The House Budget Committee is expected to mark up its FY 2009 budget
resolution the week of March 3, with floor consideration possible
the following week.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Senate Aging Panel Reviews Industry Payments to
Surgeons
A Feb. 27 Senate hearing
on payments to surgeons from the medical device industry prompted
support from both sides of the aisle for legislation to mandate
that drug and device manufacturers disclose their payments to physicians.
The hearing before the Senate Special Committee on Aging, chaired
by Senator Herb Kohl (D-Wis.), featured testimony from the Department
of Health and Human Services Office of Inspector General (OIG),
critics of industry payments to physicians, and industry representatives.
Gregory Demske, Assistant Inspector General for Legal Affairs in
the OIG, testified on the risks associated with industry-physician
financial relationships and described recent investigations and
enforcement actions by the OIG. He noted that "it would be
both inappropriate and impractical to rely solely on Government
enforcement to address an issue of this complexity. The health care
industry, medical community, and the Government must develop and
implement additional approaches to reduce the risks raised by these
arrangements." Mr. Demske also cited recommendations
promulgated by both AAMC and the Association of American Universities
to protect human subjects from the effects of conflicts of interest
on the part of academic investigators and their universities, and
described policies implemented by specific institutions.
Democrat and Republican committee members called for quick passage
of the "Physician Payments Sunshine Act" (S.
2029), introduced in Sept. 2007 by Senators Kohl and Chuck Grassley
(R-Iowa) [see Washington
Highlights, Sept.
14, 2007]. The bill, which applies to companies with $100 million
or more in annual gross revenues, requires manufacturers of drugs,
devices, or medical supplies for which payments are made under Medicare,
Medicaid, or SCHIP to disclose quarterly to the HHS Secretary of
Health and Human Services anything of value given to doctors, such
as payments, gifts, honoraria, or travel. Penalties for failure
to report range from $10,000 to $100,000 for each violation. The
bill also requires the Secretary to make the information available
on the Internet in a form that is searchable, downloadable, and
understandable.
Christopher L. White, executive vice president, general counsel,
and secretary of AdvaMed, urged the committee to modify the legislation
to create an alternative reporting threshold, require disclosures
from physician-owned entities, provide the context of the payments
for patients, and preempt State laws to create a strong Federal
standard for disclosure.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Sen. Conrad Introduces Legislation to Reauthorize
Physician Visa Waiver Program
Sen. Kent Conrad (D-N.D.) Feb. 27 introduced
the "Conrad State 30 Improvement Act" (S. 2672) to reauthorize
and expand the Conrad State 30 visa waiver program, a national initiative
that directs foreign medical graduates to underserved areas. S.
2762 significantly alters the size, eligibility requirements, and
incentives of the current program. Sen. Sam Brownback (R-Kan.) co-sponsored
the legislation.
The Conrad State 30 program allows physicians on J-1 visas to waive
the J-1 requirement to return to their home country for 2 years
if they agree to serve for 3 years in an underserved area in the
U.S. Each state is allowed 30 such waivers. <
- Permanently authorize the Conrad 30 program, which has been
repeatedly reauthorized on a temporary basis since its 1994
inception;
- Allow physicians who come to the U.S. on an H-1B visa to
obtain a Conrad 30 waiver in exchange for exemption from H-1B
caps, the 6-year limit on H-1B visas, and green card caps;
- Incrementally increase the 30 per state allotment by 5 additional
slots per state until the number of positions filled that year
drops below 90 percent of the total positions available nationwide.
The per state cap would reset to 30 at the beginning of each
year;
- Exempt physicians who have completed the Conrad 30 program
from green card caps; and
- Increase from 5 to 10 the number of "flex slots"
states can use for physicians employed at facilities not located
in an underserved area, as long as such facilities serve patients
who live in an underserved area.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House, Senate VA Committees Match FOVA Recommendations
for VA Research
The Senate
and the House Committees on Veterans Affairs released their views
and estimates on the FY 2009 budget for the Department of Veterans
Affairs (VA). Both committees recommend $555 million for the VA
medical and Prosthetic Research program, matching the recommendation
of the Friends of VA Medical care and Health Research (FOVA)coalition.
AAMC is a member of the FOVA Executive Committee.
The Administration's budget proposal for FY 2009 included $442
million for VA research, a $38 million (8 percent) cut from FY 2008.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Study of Administrative Burden on Research Grants
Released
The Federal Demonstration Partnership (FDP) has released the results
of their January 2007 "faculty burden survey." According
to the report,
principal investigators on federal research grants spend on average
42 percent of their time dealing with administrative work related
to their project rather than on science. The report derives its
findings from more than 6,000 survey responses by university faculty.
In a cover letter to the report, the FDP notes that, "the
'creep' toward increasing administrative burden decreases the productivity
of our nation's talented academic researchers and lessens the impact
of the federal dollars invested in research." The burden in
part consists of progress-report submissions, personnel hiring,
project revenue management, IRB protocols and training, and numerous
other requirements. No single burden stands out as the greatest
problem, the report notes.
The FDP, which grew out of a project begun in 1986, is a cooperative
initiative between 10 federal agencies and 98 institutions that
collectively receive more than $15 billion in federal funds, with
a goal to streamline procedures for administration of research grants
and contracts. The report has been circulated to the Office of Management
and Budget and other agencies.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
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