Washington Highlights: September
4 , 2009
Contents
Prior Issues
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AAMC Submits Comments on 2010 Medicare Hospital
Out Patient Rule
In its Aug. 31 comment
letter on the 2010 Medicare hospital outpatient proposed rule,
the AAMC urges the Centers for Medicare and Medicaid Services (CMS)
to reconsider its decision regarding enforcement actions related
to the physician supervision requirements for hospital outpatient
therapeutic services provided prior to the 2009 final rule [see
Washington
Highlights,
July 10].
The AAMC letter notes that CMS's definitions of "in the hospital,"
"immediately available," and "direct supervision"
would severely hamper hospitals' ability to provide these therapeutic
services, potentially forcing them to shut down services or severely
restrict hours of operations. The AAMC urges CMS to modify these
definitions to provide hospitals with more flexibility to ensure
continued patient access to care.
The AAMC also urges CMS to pay for separately payable drugs and
biologicals at the average sales price (ASP) plus 6 percent rather
than the proposed payment rate of ASP plus 4 percent until the agency
refines its methodology for determining the acquisition and overhead
costs of these products. The proposed methodology tries to address
the flaws of the current methodology, which would result in an ASP
minus 2 percent payment rate in 2010. However, the proposed methodology
would result in a 2010 payment rate that is less than the ASP plus
6 percent rate used to reimburse for separately payable drugs and
biologicals provided in the physicians' office setting, as well
as the rate used in 2007 when CMS first introduced the ASP methodology.
The AAMC supports CMS's decision not to implement a healthcare
acquired condition program in the outpatient setting at this time
and in the interim to utilize the results of the impact study being
conducted for the inpatient Health Care Associated Conditions (HAC)
program to help guide future decisions. The AAMC also supports CMS's
decision not to add any additional measures for the hospital outpatient
quality reporting program and reiterates that measures selected
for future years should be supported by scientific evidence; sufficiently
tested for reliability and validity; and ultimately endorsed by
the National Quality Forum and approved by the Hospital Quality
Alliance.
As it has in the past, the AAMC urges CMS to conduct a comprehensive
analysis to determine the need for a teaching adjustment for outpatient
payments. Internal analyses of 2004-2007 hospital Medicare cost
reports show a disturbing trend of negative margins that are decreasing
at a much faster pace than the margins of other teaching and nonteaching
hospitals.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Jennifer Faerberg, Director, Health Care Affairs
AAMC Health Care Affairs
jfaerberg@aamc.org
(202) 862-6221
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
AAMC Comments on Proposed Changes to the CMS Medicare
Hospital Cost Report
The AAMC Aug. 31 urged
the Centers for Medicare and Medicaid Services (CMS) to address
concerns regarding the proposed modifications to Worksheet S-10
of the Medicare hospital cost report, which requests significant
data on Medicaid and indigent care costs and payments. CMS solicited
comments on its proposed changes to the entire cost report in a
July 2 Federal Register notice.
The method CMS uses to calculate charity care costs is of particular
concern to AAMC members, who represent just 6 percent of all hospitals
yet account for 41 percent of total hospital charity care costs.
In its letter, the AAMC notes the proposed Worksheet S-10 is a
significant improvement over the prior form but expresses several
concerns regarding the accuracy and clarity of specific lines of
the worksheet. For example, CMS's proposed Medicare cost-to-charge
ratio (used to convert charges to costs) is based only on Medicare
reimbursable costs and would not accurately reflect true charity
care and uncompensated care costs, as many patients that receive
charity care are not necessarily Medicare patients.
The AAMC also submitted several comments on the proposed changes
to Worksheets E Part A, which contains data used to compute IME
payments, and E-4, which contains data used to compute DGME payments.
Information:
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CMS Issues Guidance to States on Medicaid HIT
Incentives
The Centers for Medicare and Medicaid Services (CMS) Sept. 1 issued
a "Dear State Medicaid Director Letter" to provide preliminary
guidance to states on implementing Medicaid health information technology
(HIT) incentive payments. The American Recovery and Reinvestment
Act of 2009 (ARRA, P.L.
111-5) provides states with a 100 percent federal financial
participation (FFP) match for Medicaid incentive payment expenditures
to encourage the "meaningful use" of electronic health
records. ARRA also provides a 90 percent FFP match for state expenses
for administration of these incentive payments. CMS's guidance document
announces that the 90 percent FFP match for administrative planning
is available immediately and explains state requirements for accessing
this funding.
To receive the 90 percent FFP match from CMS, states must receive
prior approval of any initial planning activities and ultimately
must develop a State Medicaid HIT Plan (SMHP). A SMHP should contain
at least the following: a current landscape assessment, a vision
of the state's HIT future, specific actions necessary to implement
the incentive payments program, and a HIT road map. CMS intends
to coordinate approval of SMHPs at the national level to ensure
consistency and explains that the agency will "work with States
to determine when each State is ready to begin making [incentive]
payments" to providers. In the meantime, CMS emphasizes that
states should not begin making incentive payments to providers until
CMS issues future guidance, or states risk not receiving their federal
match payments due to noncompliance.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
PPAC Provides Recommendations to CMS on 2010 Medicare
Physician Fee Schedule
At its Aug. 31 quarterly meeting,
the Department of Health and Human Services (HHS) Practicing Physicians
Advisory Council (PPAC) discussed the proposed 2010 Medicare Physician
Fee Schedule, the Medicare Recovery Audit Contractor (RAC) program,
and updates to the PQRI and e-Prescribing incentive programs. Generally,
PPAC's observations were in line with AAMC's Aug. 26 comment
letter on the proposed 2010 Medicare Physician Fee Schedule.
PPAC recommended that CMS reconsider the proposal from the 2010
Medicare Physician Fee Schedule to eliminate consultation codes
(with the exception of telehealth), noting the provider community
views distinct differences between consult services and evaluation
and management services. Further, PPAC noted that any move by CMS
to reduce or limit consultative visits would adversely affect patient
access and quality of patient care. Additionally, PPAC unanimously
recommended that CMS remove proposed regulatory language that requires
a teaching anesthesiologist to be present during all key or critical
portions of a procedure.
At the meeting, CMS staff charged with directing the RAC program
informed council members that for 2010 there will be no change to
the existing RAC record request limits. CMS officials reported that
RACs are now able to conduct reviews in 24 states, with the remaining
states slated to begin this fall. Additionally, CMS has accepted
73 new RAC-proposed issues that may now be used by RAC contractors
in their review. New issues include: urological bundling, blood
transfusions, IV hydration and bronchoscopy services. The program
requires that all approved issues must be posted to the RAC's website
before they can proceed with widespread review.
Information:
Will Dardani, Constituent Services Specialist
AAMC Health Care Affairs
wdardani@aamc.org
(202) 828-0541
NIH Announces New Reporting Requirements for Doctoral
Training Awards
The National Institutes of Health (NIH) Aug. 28 announced
new reporting and assurance requirements for institutions receiving
awards for training of graduate students seeking doctoral degrees.
Beginning Oct. 1, institutions are required to report annually to
the NIH the percentage of students supported by NIH training awards
admitted for study who successfully attain a doctoral degree and
the average length of time between the beginning of graduate study
and the receipt of a doctoral degree. Institutions must also provide
this information to all applicants to doctoral programs supported
by NIH training awards.
The NIH Reform Act of 2006 (P.L.
109-482) and the Food and Drug Administration Amendments Act
of 2007 (P.L.
110-85) established the new reporting and information disclosure
requirements. Grantees with NIH institutional training grant awards
must provide information on completion rates and time to degree
in a renewal application or non-competing continuation progress
report. NIH also has adopted a new Graduate Student Assurance Requirement
to ensure that institutions provide the required information to
applicants to doctoral programs supported by NIH training awards.
Information:
Jodi Lubetsky, Manager, Science Policy
AAMC Biomedical Health Sciences Research
jlubetsky@aamc.org
(202) 828-0485
NIH to Require eRA Commons User ID for Postdocs
The National Institutes of Health (NIH) Aug. 28 announced
that the newly revised Continuation Progress Report for the Department
of Health and Human Services (HHS) Public Health Service Grant (PHS
2590) will now require an electronic research administration (eRA)
Commons ID for "all individuals with a postdoctoral role who
participate in a research project for at least one person month
or more." The eRA Commons is a web interface system developed
to manage and support the exchange of research grants administration
information. Use of the revised PHS 2590 form is required for all
progress reports due on or after Oct. 1, 2009.
The NIH Reform Act of 2006 (P.L.
109-482) established the requirement to collect and report identifying
and demographic information on postdoctoral trainees or others serving
in a postdoctoral role. Although NIH collects data on postdocs supported
by the Ruth L. Kirschstein National Research Service Award Programs,
to date the agency has collected little information on postdocs
supported directly on NIH research grants. This lack of data has
made the analysis of career outcomes for those individuals difficult.
Information:
Jodi Lubetsky, Manager, Science Policy
AAMC Biomedical Health Sciences Research
jlubetsky@aamc.org
(202) 828-0485
NIH Opens 2010 Loan Repayment Programs Application
Cycle
The National Institutes of Health (NIH) extramural Loan Repayment
Programs (LRP) Sept. 1 opened
its 2010 application cycle. The programs offer to repay up to $70,000
of educational loan debt for young scientists committed to conducting
two years of qualified research at a nonprofit or government institution.
Every year, NIH invests more than $70 million in LRPs for more
than 1,600 research scientists. Since 2001, LRPs made approximately
7,500 awards for a total of more than $347 million in loan repayment
funds. Research in one of five specific areas will qualify: clinical
research, pediatric research, health disparities research, contraception
and infertility research, and clinical research for individuals
from disadvantaged backgrounds. Eligible applicants must:
- possess a doctoral-level degree (with the exception of the
Contraception and Infertility Research LRP);
- devote at least 20 hours per week to qualifying research funded
by a domestic nonprofit organization or federal, state, or local
government entity;
- have qualifying educational loan debt equal to or exceeding
20 percent of their institutional base salary; and
- be a U.S. citizen, national, or permanent resident.
Applications for the 2010 award cycle are due by Dec. 1 and are
available through the NIH LRP Web
site.
On the Agenda in Washington
Sept. 9: National Diabetes and Digestive and Kidney Diseases
Advisory Council Meetings
Open sessions: 8:30 a.m. and 1:00p.m.; NIH Main Campus, Building
31; Conference Rooms 10, 6, and 7; 1 Center Drive, Bethesda, MD.
The National Diabetes and Digestive and Kidney Diseases Advisory
Council will present the director's report and review
the scientific and planning activities; Closed sessions will be
held to review and evaluate grant applications. The meeting announcement
is avilable in the July 30 Federal
Register.
Sept. 9: House Energy and Commerce Subcommittee on Energy
and Environment Hearing on Medical Isotopes
Time: 2 p.m.; 2322 Rayburn House office Building
Energy and Environment Subcommittee of House Energy and Commerce
Committee will hold a hearing titled "Solving The Medical Isotope
Crisis."
Sept 15: National Advisory Research Resources Council (NARRC)
Meeting
Open session: 8:00 a.m. - 12:40 p.m.; NIH Main Campus, Building
31; Conference Room 6, 31 Center Drive, Bethesda, MD
The agenda for the Council meeting is avilable on the NARRC Web
site. The open portion of the meeting will be webcast.
Sept. 21: NIH Advisory Board for Clinical Research Meeting
Open session: 10 a.m. to 1:15 p.m.; NIH Main Campus, Building
10; CRC Medical Board Room 4-2551, 10 Center Drive, Bethesda, MD.
The NIH Advisory Board will review the Clinical Center budget plans
and receive updates on selected organizational initiatives. The
meeting announcement is avilable in the Aug. 10 Federal
Register.
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