Washington Highlights: March 6,
2009
Congress Continues Work on FY 2009 Spending Bill
Contents
Prior Issues
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The House and Senate March 6 approved a resolution (H.J.Res. 38)
to extend through March 11 a continuing resolution (P.L.
110-329), buying the Senate additional time to complete work
on an FY 2009 omnibus spending package (H.R.
1105) and preventing a government shutdown. The continuing resolution,
which keeps most of the federal government operating at FY 2008
funding levels, would have expired March 6 without Congressional
action.
Majority Leader Harry Reid (D-Nev.) announced the plan after abruptly
reversing course on a scheduled March 5 Senate vote to limit debate
and vote on final passage of the omnibus spending bill. After acknowledging
that Democrats were "probably a vote short of being able to
invoke cloture on this bill," Reid stated that the Senate would
continue work on the package. Several Senate Republicans had objected
to voting on the omnibus without ample opportunity to consider amendments.
The $410 billion omnibus proposal includes the nine FY 2009 appropriations
bills that were not finished by the 110th Congress. The omnibus
provides $151.8 billion for programs in the Labor-HHS-Education
bill, a $6.7 billion (4.6 percent) over the FY 2008 comparable funding
level. This includes:
- $30.3 billion for NIH, a $938 million (3.2 percent) increase
- $222 million for Title VII health professions programs, a $48
million (14.3 percent) increase;
- $372 million for the Agency for Healthcare Research and Quality,
a $37.5 million (11.2 percent) increase; and
- $135 million for the National Health Service Corps, an $11.5
million (9.3 percent) increase.
During consideration of the omnibus, the Senate rejected a number
of Republican amendments to reduce the overall spending levels or
eliminate specific provisions in the bill.
The House approved the measure on Feb. 25 [see Washington
Highlights, Feb. 27].
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
MedPAC Releases March 2009 Report to Congress
The Medicare Payment Advisory Commission (MedPAC) March 1 published
its 2009 Report
to the Congress, which contains Medicare payment policy recommendations.
Of particular importance to the academic medical community is a
recommendation to cut the Medicare hospital operating indirect medical
education (IME) add-on payment from 5.5 percent to 4.5 percent in
2010, with the savings going to fund a quality incentive payment
program. The recommendation would represent an 18 percent cut in
operating IME payments to teaching hospitals, about $1 billion annually.
Congress must act upon MedPAC's recommendation before the cut can
be implemented. The Commission also made this recommendation in
its 2007 and 2008 March Reports.
In another area of interest to the academic community, the Commission
made a series of recommendations for manufacturers to disclose relationships
to physicians and other health care professionals and for hospitals,
and other healthcare entities billing Medicare, to disclose physician
ownership shares [see Washington
Highlights, Nov. 7, 2008].
The March Report also includes payment update and other policy
recommendations for eight Medicare payment systems, including inpatient
and outpatient hospital services, physician services, and post acute
care [see Washington Highlights,
Jan. 16].
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
Senate Committee Approves FCA Amendments
The Senate Judiciary Committee March 5 unanimously reported by
voice vote the "Fraud Enforcement and Recovery Act of 2009" (S.
386). The bill includes some of the False Claims Act (FCA) amendments
introduced Feb. 24 in the "False Claims Act Clarification Act
of 2009" (S.
458) [see Washington Highlights,
Feb. 27].
The legislation would overturn several Supreme Court decisions
that had narrowed the reach of the FCA. The bill also includes as
a false claim "the retention of any overpayment." This provision
is very troublesome for research institutions and hospitals that
receive Medicare overpayments that are routinely returned during
an audit process, and for federal grant recipients who routinely
use the reconciliation process to return any funds to the government
that should not be retained.
The AAMC March 5 joined the U.S. Chamber of Commerce and 11 others
in a letter
to Senate Judiciary Committee Chair Patrick Leahy (D-Vt.) and Ranking
Member Arlen Specter (R-Pa.) regarding the inclusion of the FCA
amendments. The letter states "we acknowledge and appreciate the
various changes the sponsors have made to some of the provisions
in the legislation … However, we continue to have serious concerns
that the legislation would have many unintended and undesirable
consequences, that it contains many ambiguous provisions that would
cause years of litigation over the meaning of the statute, and that
it would unwisely and unnecessarily expand the scope of liability
under the FCA."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
AAMC, NHSC Stakeholder Associations Urge Increased
FY 2010 Funding
The AAMC and nearly 30 health associations March 4 sent a letter
to Office of Management and Budget (OMB) Director Peter Orzag and
Health Resources and Services Administration (HSRA) Administrator-Designate
Mary Wakefield, Ph.D., R.N., FAAN, urging increased annual appropriations
for the National Health Service Corps (NHSC) in FY 2010.
The AAMC-coordinated letter recommends an FY 2010 appropriation
of $235 million for the NHSC, a $111 million (89.5 percent) increase
over FY 2008. This recommendation follows the amount authorized
for the NHSC under the "Health Care Safety Net Act of 2008"
(P.L.
110-355).
The letter notes that the "American Recovery and Reinvestment
Act" (P.L.
111-5) provides an important boost for the NHSC, but "By
its own calculation, the NHSC falls more than 30,000 short of a
field strength that would begin to meet the needs of the nation's
underserved areas."
The FY 2009 omnibus spending bill includes $135 million for the
NHSC. (see related story)
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
AAMC Congratulates New HRSA Administrator; Outlines
Funding Priorities
AAMC President and CEO Darrell G. Kirch, M.D., sent a March 4 letter
congratulating newly appointed Administrator of the Health Resources
and Services Administration (HRSA) Mary Wakefield, Ph.D., R.N.,
FAAN, and encouraging HRSA to prioritize the agency's health professions
programs, including National Health Service Corps, Title VII, and
the Children's Hospitals Graduate Medical Education (GME) program.
Acknowledging the impact of "staff attrition and administrative
reorganization," the letter also encourages HRSA to bolster
its Bureau of Health Professions, which administers the Title VII
and Children's GME programs.
The letter requests that HRSA provide funding for the Title VII
Primary Care Medicine and Dentistry program, the Health Careers
Opportunity Program, and the Centers of Excellence, when implementing
$200 million provided for the health professions programs in the
American Recovery and Reinvestment Act (P.L.
111-5). Citing the drastically reduced funding levels for these
programs compared to their FY 2005 levels, the letter notes that
they "not only train aspiring professionals to meet a critical
workforce need, but also help improve the health of the country."
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
AAMC Thanks ARRA Conferees
AAMC President and CEO Darrell G. Kirch, M.D., Feb. 27 sent a thank
you letter
to the "American Recovery and Reinvestment Act" (ARRA,
P.L. 111-5) conferees, who include Majority Leader Harry Reid
(D-Nev.); House Appropriations Committee Chair David Obey (D-Wis.)
and Ranking Member Jerry Lewis (R-Calif.); House Energy and Commerce
Committee Chair Henry Waxman (D-Calif.), House Ways and Means Committee
Chair Charles Rangel (D-N.Y.) and Ranking Member Dave Camp (R-Mich.);
Senate Appropriations Committee Chair Daniel Inouye (D-Hawaii) and
Ranking Member Thad Cochran (R-Okla.); Senate Finance Committee
Chair Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa).
Dr. Kirch applauded their "continued leadership and strong
commitment to teaching hospitals and medical schools through the
issues included in the [ARRA] signed into law by President Barack
Obama."
The letter specifically thanks the conferees for the bold and visionary
funding levels provided for the National Institutes of Health (NIH),
language reversing the 50% reduction in the FY 2008 Indirect Medical
Education (IME) adjustment made under Medicare's capital reimbursement
system, increased funding for the National Health Service Corps
(NHSC) and for the Title VII and Title VIII health professions training
programs, and for the significant financial resources intended to
promote widespread Health Information Technology (HIT) adoption.
.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
HHS to Proceed with ICD-10 and Electronic Transaction
Standards Final Rules
The Department of Health and Human Services March 5 announced that
it has made a determination under the White House "Regulatory Review"
that the effective dates of two final rules-one regarding the adoption
of ICD-10 code sets used for reporting diagnoses and procedures
on health care transactions and another updating the standards governing
electronic transactions under HIPAA -will not be extended and the
comment periods will not be reopened. As was determined
previously, the compliance date for the electronic transaction
standards rule is Jan. 1, 2012. The compliance date for the ICD-10
code set is Oct. 1, 2013.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Energy and Commerce Committee Favorably Reports
Health Related Bills
The House Energy and Commerce Committee March 4 favorably reported
to the House a number of health related bills including the "Physician
Workforce Enhancement Act of 2009" (H.R.
914) and the "National Pain Care Policy Act of 2009"
(H.R.
756).
The "Physician Workforce Enhancement Act of 2009" was
introduced by Reps. Michael Burgess (R-Texas), a physician, and
Gene Green (D-Texas). The legislation creates a loan program for
establishing residency training programs in rural areas. H.R. 914
would provide eligible public and non-profit hospitals with up to
$1 million in interest free loans to establish residency training
programs in family medicine, internal medicine, emergency medicine,
obstetrics/gynecology, general surgery, preventive medicine, pediatrics
or behavioral/mental health.
Under H.R. 914, hospitals must commence repayment within 18 months
of receiving the loan, complete repayment within 24 months, and
use the funds "only for costs directly attributable" to
the training program. Recipients terminating the residency programs
before full repayment of the loans would face financial penalties.
The bill authorizes the loan program under Title VII of the Public
Health Service Act at an appropriated amount of $25 million for
the period of fiscal years 2010 through 2020.
The "National Pain Care Policy Act of 2009" was introduced
by Reps. Lois Capps (D-Calif.) and Mike Rogers (R-Mich.). The legislation
creates a program for education and training in pain care, and provides
grants, cooperative agreements, and contracts to health professions
schools and other entities for the creation of these programs. The
programs must provide interdisciplinary approaches to the delivery
of pain care, recognize barriers to care in underserved populations,
such as cultural, linguistic and geographic barriers, and use recognized
means for assessing, diagnosing and treating pain. Programs may
be provided at health professions schools, residency training programs,
or other graduate programs in the health professions field. The
bill authorizes the program under Title VII of the Public Health
Service Act at not less than $5 million for awards of grants, cooperative
agreements, and contracts.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
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