Washington Highlights: February
20, 2009
Hospital Associations Comment on Physician Self-Referral
Exception
Contents
Prior Issues
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The AAMC, the American Hospital Association, and the Federation
of American Hospitals submitted a Feb. 17 letter
to the Center for Medicare and Medicaid Services (CMS) on the proposed
exceptions to the physician self-referral regulation for shared
savings and incentive payment programs.
The exceptions would cover hospital incentives to physicians for
such things as achieving quality improvement goals and pay for performance.
While some of these arrangements may fit into current exceptions,
such as the employment exception, many of them do not. The letter
expresses concerns that the complexity and limitations of the CMS
proposal make it unlikely that most providers would use the exception.
The letter makes specific recommendations for an exception that
balances the requirements of the Medicare program and the needs
for hospitals to retain flexibility when working with physicians
to structure arrangements to meet quality, patient safety and efficiency
goals.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Hospital Associations Submit Letter to the HHS
on Gainsharing Special Bulletin
The AAMC, the American Hospital Association, and the Federation
of American Hospitals Feb. 17 sent a letter
to the Department of Health and Human Services Office of the Inspector
General (OIG) requesting that it withdraw the 1999 Special Advisory
Bulletin concerning "Gainsharing Arrangements and Civil Monetary
Penalties for Hospital Payment to Physicians to Reduce or Limit
Services to Beneficiaries."
The letter further requests that the OIG promulgate a safe harbor
for incentive payment and shared savings arrangements under the
Antikickback statute. The letter states that "the many current
and well-founded practices that foster quality improvement and more
efficient delivery of care should support the OIG's revisiting of
its interpretation of what Congress was trying to achieve [in the
Civil Monetary Penalties statute]."
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Department of Education Appoints COSFA Chair to
Rulemaking Committee
The Department of Education has named Carrie Steere-Salazar to
represent the AAMC and "4-year public institutions" on
the upcoming negotiated rulemaking committee, "Team I--Loans-Lender/General
Loan Issues." Ms. Steere-Salazar is director of Student Financial
Services at the University of California, San Francisco, School
of Medicine and chair of the AAMC Committee on Student Financial
Assistance (COSFA).
The committee is charged with developing regulations for the "Higher
Education Opportunity Act" (P.L.
110-315) [see Washington
Highlights, Aug.
1, 2008], the Higher Education Act reauthorization package signed
by the President Aug. 14, 2008. Among other issues, Negotiating
Team I will address the following:
- Borrower eligibility for deferment;
- Changes to prohibited inducement provisions governing FFEL lenders
and guaranty agencies;
- FEL Consolidation Loan-borrower eligibility;
- Definitions (Education loan, Private education loan, Lender,
Preferred lender arrangement);
- Required borrower notifications and lender disclosures or certifications;
- Financial and economic literacy information for rehabilitated
borrowers; and
- Consumer education information provided by guaranty agencies.
The department tentatively has scheduled three negotiated rulemaking
sessions in Washington, DC, for Feb. 23-26, March 30-April 1, and
May 4-6.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Representatives Introduce Multiple Stem Cell-Related
Bills
Reps. Diane DeGette (R-Colo.) and Mike Castle (D-Del.) Feb. 4 introduced
the "Stem Cell Research Enhancement Act of 2009" (H.R.
873), which would lift the Bush Administration's restriction
on federal funding for research using embryonic stem cells created
after Aug. 9, 2001. The bill would allow in vitro fertilization
clinics to donate embryos for research that otherwise would be discarded.
This legislation is similar to legislation previously vetoed by
President Bush [see Washington
Highlights, June 22, 2007].
A second bill, the "Stem Cell Research Improvement Act of
2009" (H.R.
872), also would allow discarded embryos to be used for research,
regardless of the date of creation. However, the bill also includes
a more explicit ethical framework in the statute as well as a various
reporting requirements [see Washington
Highlights, Oct.
3, 2008].
In addition, Rep. J. Randy Forbes (R-Va.), an opponent of embryonic
stem cell research, introduced the "Patients First Act of 2009"
(H.R.
877), which would prohibit embryonic stem cell research while
encouraging the use of adult stem cells.
Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House, Senate VA Chairs Introduce Bills for Advance
Funding of Medical Care
House Veterans Affairs (VA) Committee Chair Bob Filner (D-Calif.)
and Senate VA Committee Chair Daniel Akaka (D-Hawaii) Feb. 12 reintroduced
legislation (H.R.
1016, S.423)
to provide "advance appropriations" for veterans' health
care. The House bill has 10 cosponsors while the Senate bill carries
18.
The "Veterans Health Care Budget Reform and Transparency Act
of 2009" would authorize Congress to approve VA medical care
appropriations one year in advance of the start of each fiscal year.
The medical care appropriations include Medical Services, Medical
Support and Compliance, and Medical Facilities.
Unlike proposals to convert VA health care to a mandatory funding
program, an advance appropriation would not create PAYGO concerns
since VA health care funding would remain discretionary. In a press
statement, Chairman Filner noted, "an advance appropriation
would provide VA with up to a year in which to plan how to deliver
the most efficient and effective care to an increasing number of
veterans with increasingly complex medical conditions."
The new legislation also would task the Governmental Accountability
Office (GAO) with studying and reporting to Congress for the next
three years on VA's budget forecasting model and estimates.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
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