Washington Highlights: May 29, 2009
AAMC Opposes Health Care Reform Options that Reduce
Medicare, Medicaid Support for Teaching Hospitals
Contents
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The AAMC May 28 submitted comments
on the final of three health reform "policy options papers"
issued by the Senate Finance Committee [see Washington
Highlights,
May 22]. The third paper, released
by the Committee May 20, focuses on ways to finance comprehensive
health system reform. Among the options "offered for discussion"
in the paper are reductions in Medicare and Medicaid support for
graduate medical education (GME), as well cuts to Medicare and Medicaid
disproportionate share hospital (DSH) payment levels "as more
individuals become insured as a result of health care reform."
The paper states that "not all the options in this document
have the support of Chairman Baucus or Ranking Member Grassley."
It also reiterates the committee's plan to mark-up health reform
legislation in June.
In its comments, the AAMC agrees with the Finance Committee that
"controlling rising health care costs is one of our nation's
greatest challenges," and is "committed to helping the
SFC tackle that challenge." However, the comments advise that
implementing "new programs and structures will take time,"
and urges that the existing GME and DSH payments "should be
fully supported until we are sure that their replacements are, as
determined by a variety of criteria, better and more rational than
the systems they would be replacing." The comments note the
unique education, research, and patient care missions of major teaching
hospitals, which typically work in close collaboration with medical
school faculty.
Additionally, the AAMC comments urge Congress to lift the current
cap on Medicare-supported residency slots and to "work to prevent
implementation of the Medicaid GME proposed rule." The AAMC
"strongly opposes" a Finance Committee option to codify
IRS regulations regarding the FICA tax exception for students, as
well as an option to codify organizational and operational requirements
for determining whether a hospital is a charitable organization
for purposes of obtaining tax-exempt status.
Information:
Atul Grover, M.D., Ph.D., Chief Advocacy Officer
AAMC Government Relations
agrover@aamc.org
(202) 828-0410
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
AAMC Comments on NIH Proposed Guidelines for Federal
Funding of Embryonic Stem Cell Research
AAMC May 23 wrote
to the National Institutes of Health (NIH) generally supporting
the agency's draft "Guidelines for Human Stem Cell Research."
NIH issued the draft
guidelines April 17 in response to President Obama's March 9 Executive
Order, "Removing Barriers to Responsible Scientific Research
Involving Human Stem Cells" [see Washington
Highlights,
April 17]. President Obama lifted restrictions on the federal
funding of human embryonic stem cell research imposed by President
George Bush in August 2001 and ordered NIH to finalize funding guidelines
by July 7.
Under the new guidelines, institutions receiving funding for stem
cell research will be required to provide an assurance that such
research meets various procedural and donor informed consent requirements.
The AAMC letter notes that the "NIH's proposed assurance system
is appropriate, consistent, and workable. For stem cell lines created
after the effective date of the final NIH guidelines, we believe
the processes and consent requirements are workable and reasonable."
However, AAMC wrote, "The most vexing issue unresolved by
the proposed guidelines is the status of the hundreds of stem cell
lines in existence, but derived before the guidelines become effective."
AAMC urged "that NIH allow federal funding for all human embryonic
stem cell lines in existence before the effective date of the final
guidelines, based on an institutional assurance" that certain
criteria are met.
AAMC suggested that NIH use four criteria used for the past eight
years:
- The stem cells must have been derived from an embryo that was
created for reproductive purposes;
- The embryo was no longer needed for these purposes;
- Informed consent must have been obtained for the donation of
the embryo; and
- No financial inducements were provided for donation of the
embryo.
AAMC also wrote that "an NIH Registry of eligible stem cell
lines would give our community some compliance certainty. However,
we understand NIH's reluctance to manage a registry that may grow
exponentially over time. Alternatively, we suggest NIH consider
maintaining a registry of stem cell lines that are ineligible for
funding, based on the NIH Intramural Program's review of a line's
derivation process or from verified institutional concerns."
The AAMC letter also offers a number of technical suggestions to
the guidelines.
Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
AAMC Thanks Congress for Letters Opposing IME
Adjustment
AAMC President and CEO Darrell G. Kirch, M.D., May 28 sent letters
to Sens. Charles Schumer (D-N.Y.) and Pat Roberts (R-Kan.) and Reps.
Richard Neal (D-Mass.) and Patrick Tiberi (R-Ohio) thanking them
for their leadership as sponsors of bi-partisan sign-on letters
urging rescission of the regulation eliminating (effective Oct.
1) the indirect medical education (IME) adjustment under Medicare's
capital reimbursement system [see Washington
Highlights,
May 15]. The House letter was sent to President Obama, while
the Senate letter was sent to CMS Acting Administrator Charlene
Frizzera. The letter emphasizes the importance of the IME adjustment,
especially as it "helps teaching hospitals maintain several
unique missions, including training the next generation of physicians
and providing the highest level of care available." In the
letter, "The AAMC pledges our continued support of efforts
to prevent the elimination of the capital IME adjustment."
The May 5 Schumer/Roberts letter
was signed by a total of 56 Senators including 15 Republicans. The
May 22 Neal/Tiberi letter
was signed by a total of 220 Representatives including 52 Republicans.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
ONC Publishes Schedule for HIT Standards Committee
Activities
The Office of the National Coordinator for Health Information Technology
(ONC) published in the May 26 Federal Register the Health Information
Technology (HIT) Standards Committee's schedule for assessing policy
recommendations. The "work groups" and deadlines set forth
in the notice were established by the HIT Standards Committee during
its first meeting on May 15, and publication in the Federal Register
was required by provisions of the "American Recovery and Reinvestment
Act of 2009" (ARRA, P.L.
111-5) [see Washington
Highlights,
May 22].
According to the published schedule, the Standards Committee's
work groups will have 90 days after receiving recommendations from
ONC to develop a report for the full Standards Committee. Reports
will include an assessment of current standards, implementation
specifications, and certification criteria; an assessment of where
gaps exist and an identification of organizations with the ability
address those gaps; and a timeline for the Standards Committee to
issue recommendations to the National Coordinator. Upon receipt
of a subcommittee report, the full committee will accept or revise
the proposed timeline, assign subcommittees to conduct research,
where necessary, and make recommendations to the National Coordinator
on standards, implementation specifications, and certification criteria.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
HIT Regional Extension Center Draft Plan Released,
Comments Solicited
The Office of the National Coordinator for Health Information Technology
(ONC) published in the May 28 Federal Register as a "notice
and request for comments" a draft plan for the establishment
of Regional Extension Centers ("regional centers") that
will assist providers in selecting and implementing certified electronic
health records (EHRs). The "American Recovery and Reinvestment
Act of 2009" (ARRA, P.L.
111-5) requires both regional centers and a National Health
Information Technology Research Center (HITRC) and provides for
financial assistance to regional centers as part of the Recovery
Act's $2 billion in discretionary health information technology
(HIT) funding. The draft plan sets forth the services that regional
centers will be expected to provide, the funding that will be available,
and a proposed timeline for making awards.
As required by ARRA, regional centers must be affiliated with a
U.S.-based non-profit organization and will be expected to prioritize
their technical assistance to the following providers in their region:
- Public or not-for-profit hospitals or critical access hospitals;
- Federally qualified health centers;
- Entities in rural and other areas that serve uninsured, underinsured,
and medically underserved individuals; and
- Individual or small group practices (or consortia thereof)
that are primarily focused on primary care.
The draft plan clarifies that on-site assistance will be a "key
service" offered by regional centers, that each defined geographic
area will be served by only one center, and that the average award
value will likely be $1 million to $2 million per center (with a
maximum of $10 million per center).
ONC indicates it intends to exercise the option granted by ARRA
to waive the Act's cost-sharing requirements for FY 2010, although
the plan clarifies that the existence of matching funds (or a plan
to obtain matching funds) will be important in determining whether
an entity qualifies for an extension center grant. Preference will
also be given to plans that incorporate "multi-stakeholder
collaborations that leverage local resources," where stakeholders
include such entities as local universities with health professions,
informatics, and allied health programs, health information exchange
organizations, and government entities. Awards will be made as early
as the first quarter of FY 2010, through the fourth quarter of FY
2010, and the ONC proposes to set a series of proposal deadlines
so that well-prepared applicants can begin work sooner and those
requiring more organization will have more time to prepare a plan.
Comments on the notice are due to ONC by June 11, 2009.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
House, Senate Approve Supplemental Spending Bills
with Flu Funds
The Senate May 21 approved, 86-3, an amended version of a supplemental
appropriations bill (H.R.
2346) that includes $1.5 billion in emergency spending for pandemic
flu preparedness and response, among other spending items such as
funds for military operations and international economic and security
assistance. Within the flu funds, $900 million is directed to the
Department of Health and Human Services (HHS), to be spent by the
end of FY 2010 at the discretion of the HHS Secretary.
The House approved its version of the bill May 14 with $1.85 billion
for HHS preparedness and response activities, including $200 million
for the Centers for Disease Control and Prevention; $350 million
for upgrading state and local preparedness and response capacity;
and, $1.3 billion to augment federal stockpiles, develop and purchase
a vaccine, and support surveillance and public health response activities
[see Washington
Highlights,
May 8]. The House bill directs that the funds are to remain
available until expended.
Conferees are expected to reconcile differences in the two bills
shortly after Congress returns from the Memorial Day recess, before
clearing the final legislation for the President. The President
April 28 requested
$1.5 billion in pandemic preparedness funding to be included in
the supplemental.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
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