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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Health Professions, Higher Education Urge Congress to Pass DACA Legislation

September 15, 2017—The AAMC led more than 70 health professions organizations and joined more than 70 higher education associations in separate letters to Congress urging legislative action on Deferred Action for Childhood Arrivals (DACA). The letters respond to the administration’s Sept. 5 decision to rescind DACA [See Washington Highlights, Sept. 8].

The Sept. 14 health professions letter states, “[W]e urge you to ensure that all members of the health care workforce with [DACA] status are able to continue their employment, education, training, and research, with passage of a permanent legislative remedy, such as the bipartisan, bicameral Dream Act of 2017 (S. 1615, H.R. 3440). By providing a legal pathway to permanent residency for undocumented Americans brought to the U.S. as children, Congress can help our country produce a diverse and culturally responsive health care workforce to meet the needs of underserved populations, improve cultural awareness, and promote health equity.”

The Sept. 12 higher education letter also urged Congress to “pass legislation as soon as possible to permanently protect these individuals,” and continues, “Preserving their status is the humane way to respond to the situation these innocent young people are facing. Children brought to the United States at a young age did not have a choice in the matter. It remains in America’s best interest to enable them to use their knowledge, skills and energy to make the strongest possible contribution to our country.”

Under the administration’s "6-month" wind down process, new DACA applications will not be accepted and individuals currently participating in DACA will lose their benefits when their individual 2-year DACA status expires after March 5, 2018.


Contact:

Matthew Shick, JD
Director, Gov't Relations & Regulatory Affairs
Telephone: 202-862-6116
Email: mshick@aamc.org

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AAMC Submits Comments on CMS Proposed CY2018 OPPS Regulation

September 15, 2017—The AAMC Sept. 11 submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed Hospital Outpatient Prospective Payment Rule, (82 FedReg 33558).  The following are AAMC's major comments:

CMS proposed to cut payments to 340B DSH hospitals for non-pass through outpatient drugs from the current ASP (average sales price) + 6% to ASP minus 22.5% starting in Jan. 2018.  The AAMC strongly opposed this proposal and urged CMS to rescind the proposal. The 340B Program was designed to allow safety-net hospitals, many of which are teaching hospitals, to support programs to help low-income, vulnerable patients have access to needed care at no cost to taxpayers.  The proposal represents a significant payment reduction that will undermine the purpose and benefits of the 340B Program, while crippling the ability of 340B hospitals to provide support and programs to serve vulnerable and low-income patients.  In addition, CMS did no independent analysis to support this proposal, or to understand the financial impact which the law requires. Instead, it relied on a 2015 Medicare Payment Advisory Commission (MedPAC) report. The AAMC also submitted a legal memorandum prepared by attorney Mark D. Polston, King & Spalding, that showed that CMS does not have the statutory authority to make this change in payments to 340B DSH hospitals.

CMS also proposed to remove Total Knee Arthroplasty (TKA) from the Inpatient Only List (IPO).  In making this proposal, CMS has not addressed the ways in which it will adversely affect hospitals participating in Medicare bundled payment models, such as in the Comprehensive Care for Joint Replacement (CJR) and in the Bundled Payments for Care Improvement (BPCI).  The AAMC commented that prior to finalizing the proposal, CMS must establish a methodology to adequately risk-adjust target prices for the shift in populations between surgery setting. As this must occur through notice and comment rulemaking, it is premature for CMS to finalize its proposal. The AAMC provided CMS with a proposed payment methodology to be used during a transition from having TKA on the inpatient only list to removing it from the list.

AAMC also encouraged CMS to account for socio-demographic risk factors in the hospital Outpatient Quality Reporting (OQR) program.

Contact:

Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499
Email: ibaer@aamc.org

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AAMC Responds to CMS Physician Fee Schedule 2018 Proposed Rule

September 15, 2017—The AAMC Sept. 11 submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the physician fee schedule 2018 proposed rule.  The annual physician fee schedule rule updates physician payment rates and policies under the Medicare program. 

Most notably, the AAMC made the following key recommendations: 

  • Do not make a 75% reduction in hospital outpatient department (HOPD) reimbursement for non-excepted services provided at off campus outpatient hospital departments. This proposed reduction in payment is based on insufficient data and would set rates well below hospital cost of providing care
  • Finalize the proposal to delay implementation of the Appropriate Use Criteria (AUC) consultation requirement until Jan. 1, 2018, at the earliest

  • Finalize the proposal to delay the requirement that patient relationship codes and modifiers be reported on the claim form

  • Focus efforts on revising the evaluation and management guidelines, particularly the history and physician examination requirements to reduce burden

  • Expand coverage for telehealth services by changing requirements regarding the originating site and rural location of services

  • Provide coverage and payment for consultations between primary care physicians and specialists

In addition, AAMC applauded the invitation to comment on ideas for regulatory relief to improve the health care system by reducing burden.

A final rule will be issued by Nov. 1, 2017, and many of the provisions in the rule will be implemented Jan. 1, 2018.

Contact:

Gayle Lee
Director, Regulatory Counsel
Telephone: 202-741-6429
Email: galee@aamc.org

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House Advances FY 2018 Spending Package

September 15, 2017—The House of Representatives Sept. 14 passed its fiscal year (FY) 2018 spending package by a vote of 211-198. The House Sept. 6 began consideration of H.R. 3354, the “Make America Secure and Prosperous Appropriations Act,” an “octo-bus”  of the remaining eight FY 2018 appropriations bills reported from the House Appropriations Committee [See Washington Highlights, Sept. 8], which continued due to the extended amount of debate over 224 amendments filed on the bill.

H.R. 3354 contains the FY 2018 Labor-HHS-Education spending bill (H.R. 3358, H.Rept. 115-234) approved by the House Appropriations Committee in July, which provided a $943.4 million increase in funding for the National Institutes of Health (NIH), but made cuts to other HHS agencies, including the Agency for Healthcare Research and Quality and workforce programs administered by the Health Resources and Services Administrations (HRSA) [see Washington Highlights, July 21].

Of the 224 amendments filed, the House adopted two NIH related amendments. Rep. Mark DeSaulnier (D-Calif.) offered an amendment, which was adopted by voice vote en bloc, aimed at increasing National Cancer Institute (NCI) funding by $1 million to execute a study on how to improve doctor-patient communication. Additionally, the House approved by voice vote an amendment offered by Rep. Rick Nolan (D-Minn.) to increase NCI funding by $3,819,000, offset with a reduction to the Department of Health and Human Services Office of the Secretary account.

The House also considered two amendments focused on the Health Resources and Servicces Administration (HRSA)'s Title VII and Title VIII programs. Rep. Michelle Lujan Grisham’s (D-N.M.) Title VII Behavioral Health Workforce Education and Training (BHWET) program amendment, which would have increased the program’s funding by $5 million from the House proposed allocation of $25 million, failed by a vote of 115-297. Rep. Grace Meng's (D-N.Y) amendment to increase funding for Title VII's Geriatrics Workforce Enhancement Program by $4 million, also failed by a vote of 115-297.

Contact:

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org

Tyler Hanson, JD
Legislative Analyst II
Telephone: 202-862-6082
Email: thanson@aamc.org

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House Health Subcommittee Holds Hearing to Consider Workforce Reauthorization Bills

September 15, 2017—The House Energy and Commerce (E&C) Subcommittee on Health Sept. 14 held a hearing to examine expired workforce programs under the Health Resources and Services Administration (HRSA) including the National Health Service Corps (NHSC), Title VII health professions and Title VIII nursing workforce development, and the Teaching Health Center Graduate Medical Education (THCGME) programs. The hearing also focused on House legislative proposals that provide reauthorizations for these programs. The witnesses included Neil S. Calman, MD, FAAFP, from the Icahn School of Medicine at Mount Sinai/Mount Sinai Hospital; Adrian Billings, MD, PhD, FAAFP, from Texas Tech University Health Sciences; Janice A. Knebl, DO, MBA, from the University of North Texas Health Science Center, and Juliann G. Sebastian, PhD, RN, FAAN, from the University of Nebraska Medical Center.

The proposals examined included the Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) Act of 2017 (H.R. 3728), a bill introduced by Health Subcommittee Chair Michael Burgess, MD (R-Texas), and Rep. Jan Schakowsky (D-Ill.) that would reauthorize Title VII programs that are currently expired at FY 2017 levels through 2022. The hearing also focused on a Title VIII reauthorization bill introduced by Reps. David Joyce (R-Ohio), Doris Matsui (D-Calif.), Kathy Castor (D- Fla.), and others, called the Title VIII Nursing Workforce Reauthorization Act of 2017 (H.R. 959). The hearing also touched on a third bill introduced by Congresswoman Cathy McMorris Rodgers (R-Wash.), the THCGME Extension Act of 2017 (H.R. 3394).

Chair Burgess began the hearing with an opening statement expressing support for all four of the workforce programs being examined at the hearing, stating “each of these programs seeks to increase the access to providers in underserved areas and promote the training opportunities for medical students and providers to maintain their skills.” He went on to give specifics on the importance of the workforce programs, “For example programs like the NHSC and the Area Health Education Centers, supported by Title VII grants, and Teaching Health Centers tackle these shortages by connecting young providers with underserved communities. These programs are essential to addressing the nation’s provider shortage by connecting providers to those that are not served.”

The Chair also highlighted important components of the Title VII and VIII programs, “Title VII and Title VIII programs support opportunities for continuing medical education for the health care workforce, which is not only mandatory for many providers to keep their licenses, but it is also essential to providers as they attempt to keep up with evolving issues and treatments. In an age with modern drugs, and the 21st Century Cures Act supporting future innovation, we must ensure that our health care workforce is ready for these breakthroughs and prepared for future challenges.”

The AAMC-led Health Professions and Nursing Education Coalition (HPNEC) submitted a letter to the record thanking Chair Burgess and Ranking Member Gene Green (D-Texas) for supporting HRSA’s Title VII and Title VIII programs. The letter expressed the importance of the workforce programs, “The full spectrum of Title VII and Title VIII programs is essential to prepare our next generation of medical professionals to adapt to the changing health care needs of the nation’s growing and aging population, as well as to respond to critical and emerging public health concerns, including the opioid epidemic.”

Contact:

Tyler Hanson, JD
Legislative Analyst II
Telephone: 202-862-6082
Email: thanson@aamc.org

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Senate Leaders Propose CHIP Extension

September 15, 2017—Senate Finance Committee Chair Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) Sept. 12 announced an agreement to extend funding for the Children’s Health Insurance Program (CHIP) for five years. Under current law, funding for the program will expire on Sept. 30.

Chairman Hatch noted, “Congress needs to act quickly to extend the funding for CHIP. This agreement with Ranking Member Wyden is a good first start. Not only does this proposal provide uninterrupted funding for CHIP, but it also provides certainty and increased flexibility for states to administer the program.” Sen. Hatch sponsored the original legislation that created CHIP in 1997 with Senator Edward M. Kennedy.

According to the statement, “The lawmaker’s proposal would also over time, transition CHIP to its traditional federal-state partnership and provide additional protections for low-income children and flexibility for states.”

While full legislative language detailing the agreement has not yet been released, it is expected that the deal will maintain the 23 percent increase in the federal matching rate to states from the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) for 2018 and 2019. The increase would then decrease to 11.5 percent in 2020 and be eliminated beginning in 2021.

The agreement was announced following the Senate Finance Committee’s Sept. 7 hearing on the future of CHIP [see Washington Highlights, Sept. 8]. Meanwhile, in the House, bipartisan consensus on how to extend CHIP has not yet been achieved.

Contact:

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org

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Senate HELP Committee Continues Hearings on Market Stabilization

September 15, 2017—The Senate Health Education Labor and Pensions (HELP) Committee Sept. 12 and 14 continued its series of hearings examining methods to stabilize the individual insurance market. The hearings, spearheaded by Chair Lamar Alexander (R-Tenn.) are aimed at developing a bipartisan plan to stabilize the insurance markets, following the Senate’s failed attempt to pass legislation to repeal and replace the Affordable Care Act (ACA).

The hearing Sept. 12 examined state flexibility, specifically the ACA's 1332 waiver process. Increasing state flexibility in obtaining a 1332 waiver is popular with the Administration and congressional Republicans, but it has been met with skepticism from Democrats. In her opening statement, Ranking Member Patty Murray (D-Wash.) cautioned, “[t]his has to be a conversation about moving forward, not backward, when it comes to affordability, coverage, and quality of care…Democrats will reject any effort to use this discussion as a way to erode the guardrails and protections that so many patients and families rely on.”

Emotions ran high during the Sept. 14 hearing, which featured various health care stakeholders. Robert Ruiz-Moss, Vice President of Anthem, testified during the hearing and was met with criticism by several of the committee’s Democratic members. Sen. Elizabeth Warren (D-Mass.) accused Anthem of sending Congress a “ransom note” and pulling out of various markets in order to win concessions from Congress. Similarly, Sen. Tim Kaine  (D-Va.) criticized Anthem’s decision to pull out of Virginia markets, saying, “I just want to communicate to all insurance companies: there is no way, none, that Congress is going to tolerate a situation where persistently there are counties in this country where people cannot buy insurance on the individual market. We just won’t tolerate it.”

Chair Alexander had called for the hearings with a goal of reaching an agreement on how best to stabilize the marketplaces by Sept. 15. While it appears that this deadline will pass without an agreement, the Chair has indicated he will continue with this effort.

Contact:

Catie Spivey, JD
Sr. Legislative Analyst, Gov't Relations
Telephone: 202-862-6042
Email: cspivey@aamc.org

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Republican Senators Graham and Cassidy Introduce Bill to Repeal and Replace the ACA

rSeptember 15, 2017—Sens. Lindsay Graham (R-S.C.) and Bill Cassidy (R-La.) Sept. 13 introduced legislation to repeal and replace the Affordable Care Act (ACA). The bill, supported by Sens. Ron Johnson (R-Wis.) and Dean Heller (R-Nev.) may represent the last opportunity for Republicans to pass health care reform legislation under reconciliation instructions, which expire on Sept. 30. Without reconciliation, the Senate will need 60 votes, not 50, to pass legislation to amend the ACA.

The bill is estimated to cost $1.2 trillion and would replace current tax credits and subsidies with block grants to states. Additionally, the bill would repeal several key provisions of the ACA, including the individual mandate, the employer mandate, and the medical device tax.

It is unclear if the bill has sufficient support to pass the Senate even under reconciliation. Other efforts to develop bipartisan legislation to stabilize the markets have been ongoing since the Senate returned from their August district work period, including a series of hearings in the Senate Health Education Labor and Pensions (HELP) Committee, spearheaded by Chair Lamar Alexander (R-Tenn.) [see Washington Highlights, September 8]. The Senate Finance Committee has also been examining various issues surrounding health care costs.

It remains to be seen whether Senate Majority Leader Mitch McConnell (R-Ky.) will bring the Graham-Cassidy bill to the floor for a vote, lend his support to ongoing committee efforts, or both. According to press reports, Sen. McConnell has told the bill's authors they must produce the 50 votes before he would consider taking the bill to debate. Pundits have also suggested the appetite to pursue health care reform may be slim due to the Senate’s three failed attempts to pass legislation in July, and a desire to move on to tax reform.

A section-by-section summary of the bill may be found here.

Contact:

Catie Spivey, JD
Sr. Legislative Analyst, Gov't Relations
Telephone: 202-862-6042
Email: cspivey@aamc.org

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On the Agenda

*The House of Representatives is on a district work period for the week of September 18.

Sept. 19: Senate Finance Committee Hearing on Business Tax Reform
10 a.m.; 215 Dirksen Senate Office Building, Washington D.C.
The Senate Finance Committee will hold a hearing to examine ways to improve the U.S. tax code’s business provisions.

Sept. 20: Senate Special Aging Committee hearing on "Disaster Preparedness and Response
9 a.m.; 562 Dirksen Senate Office Building, Washington, D.C.
The Senate Special Aging Committee will hold a hearing on "Disaster Preparedness and Response: The Special Needs of Older Americans.”

Sept. 26: House Veterans’ Affairs Subcommittee on Health Hearing
10 a.m. 334 Cannon House Office Building, Washington, D.C.
The Health Subcommittee of the House Veterans' Affairs Committee will hold a hearing on: H.R.93, to provide for increased access to Department of Veterans Affairs medical care for women veterans; H.R.501, the "VA Transparency Enhancement Act of 2017;" H.R.1063, the "Veteran Prescription Continuity Act;" H.R.1066, the "VA Management Alignment Act of 2017;" H.R.1943, the "Restoring Maximum Mobility to Our Nation's Veterans Act of 2017;" H.R.1972, the "VA Billing Accountability Act;" H.R.2147, the "Veterans Treatment Court Improvement Act of 2017;" H.R.2225, the "Veterans Dog Training Therapy Act;" H.R.2327, the "Puppies Assisting Wounded Servicemembers (PAWS) Act of 2017;" and legislation to make certain improvements in VA's Health Professionals Educational Assistance Program.

Sept. 27: Meeting of the President’s Commission on Commission on Combating Drug Addiction and the Opioid Crisis
12:30p.m.; Livestream via whitehouse.gov/live
The Office of National Drug Control Policy announced the third meeting of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. According to the notice, the meeting will consist of statements to the Commission from invited government, nonprofit, and business organizations regarding innovative pain management and prevention measures for diversion followed by discussion of the issues raised.

 

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org