Washington Highlights: June 6, 2008
Contents
Prior Issues
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Congress Adopts FY 2009 Budget Resolution
The House and Senate gave final approval to the FY 2009 budget
plan this week, allowing appropriators to move forward with work
on the 12 annual spending bills.
The House June 5 approved the conference agreement for the FY 2009
Budget Resolution (S.
Con. Res. 70, H.
Rept. 110-659), 214-210,
with 14 Democrats joining all 196 voting Republicans in opposing
the measure.
The Senate had voted, 48-45,
to approve the conference agreement a day earlier. Maine Republican
Senators Olympia Snowe and Susan Collins broke ranks with their
party to support the budget plan, while Senator Evan Bayh (Ind.)
was the lone Democrat to oppose the measure. Due to the absences
of Senators Ted Kennedy (D-Mass.) and Robert Byrd (D-W.Va.), Senators
John Warner (R-Va.) and Pete Domenici (R-N.M.) withheld their opposing
votes.
House and Senate negotiators had released details of the conference
agreement May 20 [see Washington
Highlights, May 23].
The budget plan includes approximately $21 billion more for non-defense
discretionary (appropriated) spending than requested by the President,
an increase of slightly more than 2 percent. The budget resolution
also rejects the Administration's proposed cuts to Medicare and
Medicaid and does not include reconciliation instructions.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC Urges Congress to Block Scheduled Elimination
of Capital IME Payments
AAMC President and CEO Darrell G. Kirch, M.D., sent a May 30 letter
urging Congress to block regulatory action to eliminate the indirect
medical education (IME) adjustment for teaching hospitals made under
the Medicare capital reimbursement system. Medicare's FY 2008 Inpatient
Prospective Payment System (IPPS) final rule establishes a 50 percent
cut to the capital IME adjustment in FY 2009 and completely eliminates
the adjustment in FY 2010. Under this rule, teaching hospitals will
lose an estimated $530 million over 2 years ($176 million in FY
2009 and $354 million in FY 2010). The AAMC had outlined its strong
opposition to these cuts in a Nov. 20, 2007 comment
letter to Acting CMS Administrator Kerry Weems.
The May 30 letter - to House Ways and Means Committee Chair Charles
Rangel (D-N.Y.), Ways and Means Health Subcommittee Chair Pete Stark
(D-Calif.), and Senate Finance Committee Chair Max Baucus (D-Mont.)
- states that the cuts would "directly affect Medicare beneficiaries
by significantly reducing funding for institutions that serve their
unique and often complex needs." According to the letter, "the
elimination of these payments threatens the fiscal viability of
teaching hospitals because they serve a high volume of Medicare
beneficiaries and provide many services unavailable elsewhere in
the community." Additionally, since "CMS has not provided
any analyses of the effect that the cuts may have on critical services
provided to Medicare beneficiaries or others in the community, or
their potential effect on medical education or research ….
at a minimum, CMS must allow for sufficient time to thoroughly study
the impact of such cuts."
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Health Care Affairs/Government Relations
tcrytzer@aamc.org
(202) 828-0418
Supplemental Spending Negotiations Continue
Negotiations on a supplemental spending package to fund military
operations in Iraq and Afghanistan continued this week, as House
Democratic leaders worked to resolve disagreements over the size
and cost of domestic spending provisions in the bill.
The House is considering the measure after the Senate May 22 added
$10 billion in discretionary spending over the President's request
to the version the House had approved May 15 [see Washington
Highlights, May 23].
House Majority Leader Steny Hoyer (D-Md.) reportedly told reporters
June 4 that negotiators may remove some spending added by the Senate,
such as a proposed 13-week extension of unemployment insurance benefits.
Among other provisions, the Senate package includes $1.2 billion
in FY 2008 funding for science programs, with $400 million for the
National Institutes of Health (NIH). AAMC President and CEO Darrell
G. Kirch, M.D., sent a June 2 letter
to all Representatives urging support for the NIH funds included
in the Senate package.
Both the House- and Senate-approved versions of the bill also include
AAMC-supported provisions to prohibit until April 1, 2009, any CMS
action on the Medicaid GME proposed rule and the Medicaid final
rule regarding cost limits/units of government ("IGT final
rule").
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
HHS Provides Second Extension of HPSA Rule Comment
Period
The Department of Health and Human Services (HHS) June 2 announced
a second 30-day extension of the proposed
rule, "Designation of Medically Underserved Populations and
Health Professional Shortage Areas" (73 FR 21300) [see Washington
Highlights, May 2]. AAMC
President and CEO Darrell G. Kirch, M.D., May 15 sent a comment
letter urging HHS to extend the comment period by at least 6 months
and to convene a panel of affected stakeholders and community experts
for a public discussion of the proposed new methodology.
In a May 23 letter
to HHS Secretary Michael O. Leavitt, Senate Democrats urged HHS
to provide an additional 120 days beyond the previous May 29 deadline
for public comment. The letter also requests that the Health Resources
and Services Administration (HRSA) provide states -at least 45 days
prior to the comment period deadline- additional analysis of the
proposed rule, including:
- An up-to-date state by state analysis of the proposed rule's impact
on currently-certified Rural Health Clinics.
- A state by state analysis of the number of people living in and
physicians practicing in, areas that will lose geographic HPSA designations
and areas that will gain new geographic HPSA designations. The letter
notes a particular interest in the impact on the primary care physicians
who currently receive MIP payments.
- An analysis "that allows for identification of currently-designated
HPSAs that shift from the highest to lowest quartiles."
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Rajeev Sabharwal, Senior Research Associate
AAMC Medical School Affairs
rsabharwal@aamc.org
(202) 828-0979
House Panel Discusses HIT, Privacy Legislation
The House Energy and Commerce Health Subcommittee June 4 held a
hearing to discuss an initial draft
of health information technology (HIT) legislation that includes
health information privacy and security provisions.
The draft legislation includes a set of grant programs to promote
widespread adoption of electronic health records, codifies the Department
of Health and Human Services (HHS)'s Office of the National Coordinator
of Health Information Technology (ONCHIT), establishes 2 HIT advisory
committees, and creates a demonstration program to integrate HIT
into the clinical education of health care professionals. The privacy
provisions would extend privacy requirements to business associates,
require additional authorizations before patient information could
be shared, and encourage usage of a "limited data set"
for information sharing, rather than the current "minimum necessary"
standard.
Committee Chair John Dingell (D-Mich.) and Subcommittee Chair Frank
Pallone, Jr. (D-N.J.) emphasized at the hearing that the draft serves
as a starting point for discussions with committee members and stakeholders.
Committee Ranking Member Joe Barton (R-Texas) noted his concern
that the bill does not go far enough in addressing health information
security and suggested that the bill should formally define "privacy."
Two panels of witnesses included privacy advocates and industry
representatives, as well as testimony from Agency for Healthcare
Research and Quality Director Carolyn Clancy, M.D., and Deputy Director
for Health Information Privacy at the HHS Office for Civil Rights
Susan McAndrew, J.D.
A committee-prepared summary
of the discussion draft is available on the Energy and Commerce
website. Additional
information on the hearing, including an archived webcast and
witnesses' written statements, is also available online.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
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