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Second Opinion Podcasts
Learn about policy issues important to medical schools and teaching hospitals, with Atul Grover, M.D., Ph.D.
Congress Recesses for July 4 Holiday
The House and Senate will be in recess June 29 through July 6 for the July 4 holiday. Washington Highlights will resume on July 10.
AAMC Applauds Supreme Court Decision in King v. Burwell
June 26, 2015 —The AAMC June 25 released a statement applauding the Supreme Court’s 6-3 decision in King v. Burwell, which preserves access to federal subsidies to increase access to health care through the Affordable Care Act’s (ACA, P.L. 111-148 and P.L. 111-152) federal, state, and state-federal partnership exchanges.
AAMC President and CEO Darrell G. Kirch, M.D., commended the ruling stating, “The ACA is an important step toward an improved health care system with greater access to care. Preserving subsidies for affordable coverage will go a long way to ensuring that all Americans can get the health care they need.”
King v. Burwell called into question whether provisions in the ACA limited the availability of federal tax credits to state-run insurance exchanges (i.e., individuals using federally-facilitated or federal-state partnership exchanges could not receive federal tax credits). In explaining the Court’s decision, Chief Justice John Roberts wrote that Congress intended to have tax credits available to individuals in all states. He called any other interpretation of the language “implausible” because it would “destabilize the individual insurance market in any state with a Federal Exchange, and likely create the very ‘death spiral’ that Congress designed the Act to avoid.”
In January, the AAMC, along with other hospital associations, submitted an amicus brief to the Supreme Court in support of allowing subsidies in all exchanges, to avoid adding millions of Americans to the ranks of the uninsured [see Washington Highlights, Jan. 30].
The AAMC statement also acknowledged that addressing the doctor shortage is another vital step toward ensuring that patients can receive the care they need when they need it. The AAMC called on Congress to address the doctor shortage now, rather than face a shortage of 46,000-90,000 doctors in 2025.
Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Appropriations Panels Approve HHS Spending Bills
June 26, 2015 —The House Appropriations Committee June 24 approved its fiscal year (FY) 2016 Labor-HHS spending bill by a 30-21 vote after rejecting a number of Democratic amendments to restore funding to programs cut by the measure. The Senate Appropriations Committee passed its version of the bill the following day by a 16-14 vote.
The House bill, which the Labor-HHS Appropriations Subcommittee approved June 17 [see Washington Highlights, June 19], includes $153 billion in discretionary funding, 3.7 billion below the FY 2015 enacted level and $14.6 billion below the president’s budget request. The committee released a draft committee report on June 23. The Senate bill, which was approved in subcommittee June 23, is slightly higher at $153.2 billion.
National Institutes of Health: The Senate bill provides $32.1 billion for NIH, $2 billion (6.6 percent) more than the FY 2015 enacted level, and $900 million more than the House bill.
Both bills fully fund the administration’s Precision Medicine Initiative at $200 million. The House bill provides $150 million for the Brain Research through Application of Initiative Neurotechnologies (BRAIN) initiative, an $85 million increase over FY 2015. The Senate bill provides the administration’s requested $135 million.
The House bill provides $886 million for the Alzheimer’s disease research initiative, an increase of $300 million over FY 2015. The Senate bill does not specify a funding level for Alzheimer’s disease, but includes a $350 million increase for the National Institute on Aging, “a significant portion of which the Committee expects to be dedicated to Alzheimer’s disease research.”
The Senate bill retains the extramural salary cap at Executive Level II ($183,300 in 2015). The House bill lowers the cap to Executive Level III ($168,700), an eight percent cut.
For the Clinical and Translational Science Awards (CTSA) program, the Senate bill provides $499.7 million, an increase of $25 million over the FY 2015 enacted level and $19.1 million more than the House bill. The Senate committee report states the increase is to implement the recommendations from the 2013 Institute of Medicine report on CTSAs.
For the Institutional Development Award (IDeA) program, the House bill provides $311.9 million, an increase of $38.5 million (14.1 percent) and $11.9 million more than the Senate bill. The Senate bill also includes legislative language to allow entities eligible for the National Science Foundation’s Experimental Program to Stimulate Competitive Research (EPSCoR) for the past two consecutive years to apply for inclusion in the IDeA’s Networks of Biomedical Research Excellence award.
The House committee defeated, 20-30, an amendment offered by Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-Conn.) to increase NIH funding by $3 billion above the level in the bill by adjusting the spending cap. The proposal is similar to the Accelerating Biomedical Research Act (H.R. 531), introduced Jan. 26 by Rep. DeLauro, Brian Higgins (D-N.Y.), and Peter King (R-N.Y.) [see Washington Highlights, Jan. 30].
While opposing the amendment because it violated the bill’s spending cap, Labor-HHS Subcommittee Chair Tom Cole (R-Okla.) noted that NIH “has been an area where the two parties have been able to find common ground.” He added, “[L]ooking down the road, what we ought to try and do is not just an increase this year… but to get ourselves back in the position of sustaining increases on a somewhat predictable basis….”
The committee rejected, 6-23, an amendment by Sen. Bill Cassidy (R-La.) to shift funds within the NIH’s budget away from certain infectious disease programs toward other areas.
Agency for Healthcare Research and Quality (AHRQ): Unlike the House bill, which terminates funding and authorization for AHRQ, the Senate bill provides $236.0 million for the agency, a $127.7 million (35.1 percent) cut below the comparable FY 2015 level.
Children’s Hospitals Graduate Medical Education (CHGME): Both the House and Senate committees reject the president’s proposal to cut CHGME by $165 million. The House bill continues funding for the CHGME program at the FY 2015 level of $265 million, while the Senate bill boosts funding for the program by $5 million (1.9 percent) to $270 million.
Health Professions: The House bill provides a total of $246.0 million for Title VII health professions programs administered by the Health Resources and Services Administration (HRSA), $9 million (3.5 percent) less funding than in FY 2015. Within the total, the bill cuts funding for the Public Health and Preventive Medicine program, but continues funding for the Area Health Education Centers (AHEC) and Health Careers Opportunity Program (HCOP), which the president had proposed to eliminate. By contrast, the Senate bill provides a total of $230.3 million, a cut of $24.6 million (9.7 percent), including elimination of HCOP and cuts to Primary Care Training, Workforce Information and Analysis, Oral Health Training, and Public Health and Preventive Medicine.
For Title VIII nursing programs, the House bill continues funding at the FY 2015 level of $231.6 million, while the Senate bill provides $220.6 million, an $11 million (4.7 percent) cut. The Senate bill also consolidates the Title VII and Title VIII geriatrics programs into one program, eliminating funding for the Title VIII Comprehensive Geriatric Education program.
Senior Director, Government Relations
Director, Government Relations
AAMC Submits Comment Letter to Finance Committee’s Chronic Care Workgroup
June 26, 2015 —In a June 22 letter to the Senate Finance Committee’s bipartisan chronic care working group, AAMC President and CEO, Darrell Kirch M.D., commended Chairman Senate Orrin Hatch (R-Utah), Ranking Member Ron Wyden (D-Ore.), and Sens. Johnny Isakson (R-Ga.) and Mark Warner (D-Va.) for their “efforts to improve care for Medicare patients with chronic conditions by establishing a bipartisan working group.”
The letter highlights that care for patients with multiple chronic illnesses is often fragmented, and suggests that “maintaining a single locus for as much care as is appropriate is an important goal.” The letter continues, “Incentives aligned across providers are key to achieving this end. It is important to design a system that avoids redundant care, conflicting management advice, and high costs and inconvenience that result from poorly coordinated care.”
To improve coordinated chronic care solutions, the AAMC suggests the committee incorporate policies that focus on: collaboration and communication across different providers and care settings; clarity and accountability across health care teams; aligning incentive and rules across all alternative payment model programs (APMs) that a patient may qualify for; and appropriately risk adjusting for complex patients to ensure accurate measurement.
The letter specifically addresses four of the eight areas sought by the senators regarding:
- Transformative policies that improve outcomes for patients living with chronic diseases either through modifications to the current Medicare Shared Savings Accountable Care Organization (ACO) Program, piloted APMs currently underway at the Centers for Medicare and Medicaid Services (CMS), or by proposing new APM structures;
Reforms to Medicare’s current fee-for-service program that incentivize providers to coordinate care for patients living with chronic conditions;
The effective use, coordination, and cost of prescription drugs; and
Ideas to effectively use or improve the use of telehealth and remote monitoring technology.
Director, Government Relations
AAMC Submits Letter to NIH on the Precision Medicine Cohort
June 26, 2015 —The AAMC June 19 submitted a letter to the National Institutes of Health (NIH) regarding strategies to improve community engagement and address health disparities via President Obama’s proposed Precision Medicine Initiative (PMI). The request for information was published on May 29.
Given extensive inequities in health outcomes experienced across socio-demographic groups, the AAMC supports NIH’s efforts to develop community engagement strategies that create a diverse national research cohort for the PMI. The letter acknowledges that a diverse cohort, coupled with PMI’s intended collection of risk factor, socioeconomic, and genetic data, offers enhanced opportunities to identify multi-level drivers of health inequity and potential intervention points. The AAMC commends NIH for ensuring proper safeguards are in place, including the NIH Genomic Data Sharing Policy, which protects participants’ genomic data.
In its letter, the AAMC recommends NIH continue to work with community groups to develop educational programs about the PMI to increase participation. The association also encourages NIH to include community input during the entire research process, particularly when reporting results of PMI studies to participants. To encourage innovation in patient care, the AAMC also recommends the PMI work to evaluate how genes and gene-environment interactions contribute to health.
The success of the PMI is largely dependent on the diversity of the cohort. The letter encourages NIH to continue to seek new knowledge about how to engage in the PMI individuals from groups historically underrepresented in research and to evaluate these engagement efforts.
Philip M. Alberti, Ph.D.
Senior Director, Health Equity Research and Policy
CBO Issues Cost Estimate for 21st Century Cures Act
June 26, 2105 —The Congressional Budget Office (CBO) June 23 estimated the cost of implementing the 21st Century Cures Act (H.R. 6) would total $106.4 billion for the 2016-2020 period. The estimate assumes full appropriation of the amounts authorized in the bill. Since H.R. 6 authorizes the National Institutes of Health (NIH) for three years, the estimate assumes appropriations at the authorized levels, which total $100 billion.
In addition, the estimate includes the $10 billion, five-year NIH Innovation Fund and the $550 million “Cures Innovation Fund for the Food and Drug Administration.” The version of the bill approved by the House Energy and Commerce Committee May 21 includes offsets to cover the costs of these funds [see Washington Highlights, May 22].
Senior Director, Government Relations
Department of Education Issues Dear Colleague Letter on State Authorization
June 26, 2015 —The Department of Education June 19 issued a Dear Colleague Letter (DCL) reminding postsecondary institutions that regulations on “physical presence” state authorization are effective July 1, 2015. The DCL states, “After that date, postsecondary institutions are expected to demonstrate compliance with the requirements; institutions that are not compliant with the State authorization regulations under 34 CFR 600.9(a) and (b) may lose their eligibility to participate in Title IV programs.”
These regulations will take effect July 1, 2015, despite the vacated Department of Education rule on “distance education” state authorization. Addressing institutions that operate across state lines, the guidance states, “To demonstrate that an institution is legally authorized to operate in another State in which it has a physical presence or is otherwise subject to State approval or licensure, the institution must demonstrate that it is legally authorized by the other State in accordance with § 600.9.”
Of importance to medical school clinical rotations, additional guidance notes, “The Department is continuing its policy that students attending one or more locations of an institution [including internships and externships] where the students cannot complete more than 50 percent of a program are considered to be enrolled at the main campus of the institution and these locations need not be listed on its [Application for Approval to Participate in Federal Student Financial Aid Programs (E-App)] or included on its [Eligibility and Certification Approval Report (ECAR)].”
However, the guidance also cautions that “State requirements may require an institution to obtain approval of such sites, and the Department may take that information into consideration when determining whether the institution meets applicable State requirements.”
The AAMC has prepared a summary resource for medical schools regarding state authorization’s impact on clinical rotations and the State Authorization Reciprocity Agreement (SARA).
Matthew Shick, J.D.
Senior Legislative Analyst, Government Relations
Telephone: 202- 828-0525
On the Hill
June 26, 2015 —The Senate June 23 approved by voice vote David Shulkin, M.D., as Department of Veterans Affairs Undersecretary for Health. Dr. Shulkin, previously Morristown Medical Center President, will succeed Robert Petzel, M.D., who resigned in May 2014.
On The Agenda
July 6: NIH Scientific Management Review Board Meeting
11 a.m.; Teleconference
The National Institutes of Health (NIH) Scientific Management Review Board (SMRB) will meet via teleconference to discuss the SMRB Working Group on the NIH Grant Review, Award, and Management (GRAMP) findings and recommendations on ways to streamline the grant award process.
July 14: HIT Policy Committee Meeting
9:30 a.m.; Webinar
The Office of the National Coordinator (ONC) Health Information Technology (HIT) Policy Committee will meet via webinar to discuss recommendations on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information.
July 14: PCAST Meeting
9 a.m.; 2101 Constitution Ave., N.W., Washington, D.C.
The President’s Council of Advisors on Science and Technology (PCAST) will meet to discuss its review of network and information technology research and development as well as technology for the aging population. An agenda will be posted on the council’s website when available.
Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.
For More Information
Senior Director, Government Relations