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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.
President Signs Funding Extension
October 2, 2015—With time running out before the start of the federal fiscal year (FY), Congress approved a short-term continuing resolution (CR) to continue funding for federal agencies, narrowly averting a government shutdown.
The CR (H.R. 719) provides funding through Dec. 11. Most federal programs will be funded at a rate that is 0.21 percent less than FY 2015 levels to keep the overall bill below the FY 2016 spending caps. The CR also continues funding for Planned Parenthood.
The president signed the CR Sept. 30 just a few hours before current budget authority (P.L. 113-235) expired. Earlier in the day, the House passed the CR, 277-151, after the Senate approved it, 78-20. In the House, only 91 Republicans joined 186 Democrats in supporting the CR, while in the Senate, all 20 ”nays” were from Republicans.
In a Sept. 28 Statement of Administration Policy (SAP) supporting the CR, the Obama administration said it “looks forward to working with the Congress on FY 2016 appropriations legislation for the full year that reverses sequestration, preserves funding for critical national priorities, protects national security, and makes investments to maintain economic growth and job creation for years to come.”
House Appropriations Committee Chair Hal Rogers (R-Ky.) said the CR “ensures Americans continue to have access to government programs and services, it prevents unnecessary economic harm caused by a government shutdown, it maintains the budget cap level, and it is free of controversial riders.” He added, “While this isn’t the best way to budget, it will get us past the current deadline and move us forward in addressing the larger fiscal challenges facing our nation.”
Senate Majority Leader Mitch McConnell (R-Ky.), House Speaker John Boehner (R-Ohio), and President Obama reportedly had at least two telephone conversations to begin discussions on a larger budget deal. McConnell has indicated that he will try to secure a two-year deal.
While the CR avoids a government shutdown for now, it pushes the budget debate later in the year when the need to raise the debt limit and desires to extend expiring tax provisions will provide complications. Conservatives also are expected to make another major push to end federal funding for Planned Parenthood.
Rep. Tim Huelskamp (R-Kan.), a member of the conservative Freedom Caucus, predicted, “This December is probably going to be the worst ever; I think some really bad things could happen.”
Senior Director, Government Relations
AAMC Endorses Bill to Strengthen Health Care Workforce
October 2, 2015—AAMC President and CEO Darrell G. Kirch, M.D., Sept. 30 applauded Senators Jack Reed (D-R.I.) and Roy Blunt (R-Mo.) for reintroducing the Building a Health Care Workforce for the Future Act (S.2107), legislation that would offer incentives for primary and specialty care providers to practice in underserved areas and includes a number of provisions addressing the factors that graduating medical students cite as affecting their specialty choice.
In his letter, Dr. Kirch thanked Sens. Reed and Blunt for introducing this legislation, and noted that the bill “will improve access to care for individuals in health professional shortage areas, medically underserved areas, and other underserved communities.”
Among its provisions, the bill would:
- Create a scholarship program to complement the National Health Service Corps by offering federal matching funds to states that invest in health professional scholarship programs in which scholarship recipients must complete a service requirement in designated shortage areas;
- Establish under Title VII a program to increase longitudinal mentorship opportunities for entering medical students who express an interest in primary care, as well as a program to identify effective mentors in primary care through a nationwide network of primary care mentors and resources; and
- Commission a study to examine less burdensome documentation requirements under Medicare for evaluation and management services.
Sens. Reed and Blunt introduced the bill in the 113th Congress [see Washington Highlights, June 14, 2013]. Reps. Raul Ruiz (D-Calif.), David McKinley (R-W.Va.), and others introduced House companion legislation earlier this year [see Washington Highlights, February 20, 2015].
Director, Government Relations
Ways and Means, Energy and Commerce Committees Pass Reconciliation Recommendations
October 2, 2015—The House Ways and Means Committee Sept. 29 passed (23-14) reconciliation legislation to repeal five parts of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152 ) including the individual mandate, the employer mandate, the Independent Payment Advisory Board (IPAB), the medical device tax, and the excise tax on high-cost health plans, otherwise known as the “Cadillac tax.”
Opening the mark-up, Chairman Paul Ryan (R-Wis.) stated that the repeals would “stop Obamacare in its tracks and start working toward a more affordable, higher-quality, patient-centered system. “
Ranking Member Sander Levin (D-Mich.) called the reconciliation hearing a “waste of time for Members of Congress” and added that “The effect of just one provision in this legislation today – repeal of the individual mandate – would increase premiums in the individual market by 20 percent. Fourteen million would lose insurance coverage.”
Additionally, the House Energy and Commerce Committee Sept. 30 passed (28-23) reconciliation instructions to defund both Planned Parenthood and the Prevention and Public Health Fund.
In his opening statement, Chairman Fred Upton (R-Mich.), called for the repeal of the Prevention and Public Health Fund. Chairman Upton further added that the Prevention and Public Health Fund is a “misguided attempt at increasing funding for preventive services.”
Rep. Lois Capps (D-Calif.) highlighted the importance of the Prevention and Public Health Fund and expressed her support by stating the fund “exists to address the expensive and debilitative chronic conditions that plague far too many in our country. These efforts are based on the best medical science to implement programs that prevent disease before they become more costly for the individual and for our health care system.”
Both the House and Senate fiscal year (FY) 2016 budgets instructed House Ways and Means and Energy and Commerce Committees and the Senate Finance Committee to report $1 billion in deficit reduction recommendations [see Washington Highlights, March 20]. The reconciliation recommendations passed by both committees will now be considered by the House Budget Committee.
CMS Releases RFI for MACRA Implementation
October 2, 2015—The Centers for Medicare and Medicaid Services (CMS) Sept. 28 issued a request for information (RFI) regarding implementation of the Merit-based Incentive Payment System (MIPS), promotion of Alternative Payment Models (APMs), and Incentive Payments for Participation in Eligible Alternative Payment Models with a 30-day comment period.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) replaced the sustainable growth rate (SGR) formula with a program that uses quality components as a driver of reimbursement rates. Beginning Jan. 1, 2019, physician payments will be driven by either transitioning to APM or participating in MIPS, a consolidated pay-for-performance program.
In the RFI, CMS solicited stakeholder feedback on numerous issues, including appropriate identification and exclusions of MIPS eligible professionals (EP). An EP’s composite score will be based on the four performance categories, which include: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology. CMS is also seeking feedback on an appropriate methodology to evaluate and assess these performance categories and whether composite score information should be publicly reported on Physician Compare.
CMS also seeks feedback on how APM eligibility should be defined. Currently, an eligible APM entity is: (1) Use of certified EHR technology, (2) bears a nominal financial risk, (3) specific payment and/or patient threshold requirements. However, CMS believes further criteria needs to be established on how to determine who is eligible for incentive payments for APM participation.
Additionally, CMS requests feedback on the development of Physician-Focused Payment Models (PFPM). This will be an opportunity for providers to submit PFPMs to the newly established “Physician-focused Payment Model Technical Advisory Committee” that will review and provide comments and recommendations to the Secretary of Health and Human Services. CMS is looking to establish specific criteria for the committee to use and assess in order to promote robust and well-developed proposals to facilitate implementation of PFPMs.
Comments are due Nov. 02, 2015. CMS will publish the proposed rule in the spring of 2016 and the final rule is expected in November 2016.
Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
On The Agenda
Oct. 6: Senate VA Committee Hearing on Pending Health Care Legislation
2:30 p.m.; 418 Russell Senate Office Building, Washington, D.C.
The Senate Veterans’ Affairs Committee will hold a hearing on pending health care and benefits legislation.
Oct. 7: Senate Appropriations Subcommittee Hearing on NIH
10 a.m.; 124 Dirksen Senate Office Building, Washington, D.C.
The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold a hearing on the National Institutes of Health (NIH). NIH Director Francis Collins, M.D., Ph.D., will testify.
Oct. 7: House VA Committee Hearing on the Veterans Health Administration
10 a.m.; 334 Cannon House Office Building, Washington, D.C.
The House Veterans’ Affairs Committee will hold a hearing to evaluate the independent assessment of the Veterans Health Administration.
Oct. 8: House Energy and Commerce Subcommittee to Mark-Up Drug Abuse Legislation
10:15 a.m.; 2322 Rayburn House Office Building, Washington, D.C.
The House Energy and Commerce Health Subcommittee will mark-up a series of bills to address the threat of drug abuse.
Oct. 8-9: MedPAC Meeting
Time: TBD; 1300 Pennsylvania Ave. N.W., Washington, D.C.
The Medicare Payment Advisory Commission (MedPAC) will meet on Oct. 8-9. A meeting agenda will be posted on the MedPAC prior to the meeting.
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