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House Energy and Commerce Committee Advances Numerous Bipartisan Health Care Bills

July 19, 2019—The House Energy and Commerce Committee held a July 17 markup to advance legislation regarding several key health care issues, including Medicaid Disproportionate Share Hospital (DSH) payments, the Patient-Centered Outcomes Research Institute (PCORI), and the Title VII health professions workforce development programs. Additionally, the committee passed an amended version of its proposal to address surprise medical bills.

In a July 17 statement following the markup, AAMC Executive Vice President Atul Grover, MD, PhD, characterized the markup as “an important step forward today on numerous bipartisan priorities in support of patients.” Specifically, the AAMC praised the committee for repealing the scheduled Medicaid DSH cuts for fiscal years (FYs) 2020 and 2021, reauthorizing and extending the National Health Service Corps for four years, and investing in the Teaching Health Center Graduate Medical Education program for an additional four years.

The committee also advanced a policy previously approved by the Health Subcommittee to extend PCORI and its funding mechanism for three years through FY 2022 [see Washington Highlights, July 12]. The AAMC expressed appreciation for the committee’s efforts to continue PCORI and noted, “we hope to continue working with lawmakers to secure a full 10-year renewal of the institute’s important work.” The House Ways and Means Committee approved a 7-year reauthorization of the institute (H.R. 3439) June 26 [see Washington Highlights, June 28].

Prior to the markup, AAMC Chief Public Policy Officer Karen Fisher submitted a letter to Chairman Frank Pallone (D-N.J.) and Ranking Member Greg Walden (R-Ore.) expressing support for several of the provisions. However, the letter also highlighted concerns with the No Surprises Act, legislation intended to address surprise billing. While the AAMC strongly supports taking patients out of the middle in surprise billing situations, the letter asks the committee to reconsider the policy passed by the Health Subcommittee to use benchmark rate setting to resolve surprise billing disputes.

The AAMC expressed concern that statutory rate setting will lead to narrow networks, which “stands to potentially limit beneficiary access to academic medical centers due to the higher mission-related costs of care at many of these facilities, without recognizing the higher quality.” Instead, the AAMC urged the committee to explore other options for resolving disputes between payers and providers, including independent dispute resolution or arbitration.

In response to these concerns and others raised by several members of Congress and additional stakeholders, the committee passed a version of the No Surprises Act that was amended by Reps. Raul Ruiz (D-Calif.) and Larry Bucshon, MD (R-Ind.) to include an appeals provision. The amended version allows providers and insurers who are unsatisfied with the benchmark rate to enter into an independent dispute resolution process for claims over $1,250, and for complex cases.

In its statement, the AAMC noted its appreciation to the committee for including an independent dispute resolution option and offered “to continue this dialogue to ensure that the final legislation fully avoids any unintended consequences that could result from setting payment rates in statute.”

The Committee also passed legislation (H.R. 2328) that would reauthorize and extend mandatory funding for the National Health Service Corps, Teaching Health Centers, and Community Health Centers at their current funding levels for four years, and the AAMC-endorsed EMPOWER for Health Act (H.R. 2781) that would reauthorize the Health Resources and Services Administration’s Title VII health professions workforce development programs at increased levels for five years [see Washington Highlights, July 12].

Contact:

Len Marquez
Senior Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

Matthew Shick, JD
Sr. Director, Gov't Relations & Regulatory Affairs
Telephone: 202-828-0525
Email: mshick@aamc.org

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

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Research Community, Members of Congress Address HHS Regarding Fetal Tissue Research

July 19, 2019—The AAMC joined over 90 organizations representing medical and scientific societies and academic and research organizations on a July 11 letter to Health and Human Services (HHS) Secretary Alex Azar, expressing concern over the department’s June 5 policy to limit the use of fetal tissue in research supported by the National Institutes of Health (NIH) [see Washington Highlights, June 7].

The letter reiterates that HHS’s new restrictions on NIH’s intramural research program and new or renewing extramural grant applications could “disrupt important biomedical research and delay the development of new treatments for patients.” The letter continues that the new policies “would impose substantial barriers to and limit the use of an essential biomedical research resource that has led to many advances in human health and remains critical for the development of new treatments for a wide range of serious diseases.”

Chair of the House Committee on Oversight and Reform Elijah Cummings (D-Md.) and Ranking Member of the Senate Health, Education, Labor, and Pensions Committee Patty Murray (D-Wash.) sent a July 17 letter seeking clarification from Sec. Azar regarding the department’s scientific rationale for the new policy. In the letter, the Members request specific information from the secretary by July 31, including documents related to the department’s review of fetal tissue research [see Washington Highlights, Sept. 28, 2018], meeting records that informed development of the policy, and various communications between leadership in the department and the administration. 

In response to the new policy, the House adopted an amendment by Rep. Mark Pocan (D-Wis.) to the House fiscal year (FY) 2020 HHS spending bill to prohibit the use of appropriated funds towards implementation of certain provisions of the new policy [see Washington Highlights, June 14].

 

Contact:

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

Christa Wagner, PhD
Senior Legislative Analyst
Telephone: 202-828-0595
Email: chwagner@aamc.org

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IRS Expands List of Preventive Care Benefits Eligible for Coverage by High Deductible Health Plans

July 19, 2019—The Internal Revenue Service (IRS) July 17 released a notice that expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) without requiring the enrollee to meet the deductible. Specifically, items and medical services to treat certain chronic conditions (noted in the Appendix of the notice) will now be included in the list of preventive care benefits. Previously, preventive care benefits did not include medical services or benefits intended to treat an existing illness, injury, or condition. 

The notice acknowledges that cost barriers have resulted in some individuals diagnosed with chronic conditions failing to seek or utilize effective and necessary care that would prevent exacerbation of the chronic condition. Failure to treat chronic conditions can lead to adverse consequences that require considerably more extensive medical intervention. 

Therefore, the Treasury Department and the IRS have determined that certain medical care services and items purchases, including prescription drugs, for certain chronic conditions should be classified as preventive for someone with that chronic condition. Each medical service or item, when prescribed for an individual with the related chronic condition, should have the following characteristics:

· the service or item is low-cost;

· there is medical evidence supporting high-cost efficiency (a large expected impact) of preventing exacerbation of the chronic condition or the development of a secondary condition; and,

· there is a strong likelihood, documented by clinical evidence, that with respect to the class of individuals prescribed the item or service, the specific service or use of the item will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher cost treatments.

The criteria apply to only those items and services listed in the Appendix. Items and services that meet (or may meet) the criteria but are not on the list are not treated as preventive care.

The notice is effective July 17, 2019.

Contact:

Mary Mullaney
Director, Hospital Payment Policies
Telephone: 202-909-2084
Email: mmullaney@aamc.org

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AAMC Joins Letter Advocating for Graduate and Professional Student Loans

July 19, 2019—The AAMC July 15 joined over 30 higher education organizations in a letter to Senate Health, Education, Labor, and Pensions Committee and House Education and Labor Committee leadership urging the committees to prioritize graduate and professional students in any Higher Education Act (HEA) legislation. 

The community letter emphasizes, “Graduate and professional education are vital elements of the nation’s higher education and innovation ecosystems that empower U.S. economic competitiveness and contribute to our nation’s health and security.”

The letter continues, “As part of HEA, we urge Congress to retain strong graduate student loan options, including the GradPLUS program. We also support strengthening the programs that provide critical aid to students who are pursuing graduate education as well as programs that support expanding diversity, equity, and inclusiveness within graduate education.”

As Congressional leaders continue to negotiate HEA reauthorization, the White House released an HEA proposal that would cap GradPLUS loans [See Washington Highlights, March 22]. The AAMC previously joined a letter noting that capping GradPLUS could force the neediest borrowers and nontraditional students to take out private student loans with less favorable terms to fully finance their education [See Washington Highlights, June 28].

Contact:

Brett Roude
Legislative Analyst
Telephone: 202-753-5726
Email: broude@aamc.org

Matthew Shick, JD
Sr. Director, Gov't Relations & Regulatory Affairs
Telephone: 202-828-0525
Email: mshick@aamc.org

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NIH Issues Guidance on Policies for Reporting “Foreign Activities”

July 19, 2019—The National Institutes of Health (NIH) July 10 issued a guide notice outlining responsibilities for institutions and investigators under the NIH Grants Policy Statement as well as other applicable federal regulations to “report foreign activities through documentation of other support, foreign components, and financial conflict of interest to prevent scientific, budgetary, or commitment overlap.”

This notice was published in the context of foreign activities but applies broadly, to all support and grants. While the NIH states in an accompanying Frequently Asked Questions (FAQ)that this notice serves as a reminder for the extramural community and does not expand the applicability of the existing Other Support policy, the FAQ also indicates that the NIH is expecting applicants to disclose paid or unpaid activities that are not only related to the research: Outside Activities such as teaching or consulting that may be compensated or uncompensated constitute Other Support if they are in any way related to the investigator’s research endeavors or expertise.”

The AAMC, along with higher education associations including the Association of American Universities (AAU), the Association of Public and Land-grant Universities (APLU), and the Council on Government Relations (COGR), expressed concerns to the NIH that these FAQs appear to vastly increase the amount of information included in grant applications, including unpaid consulting or activities unrelated to an investigator’s research. The NIH Office of Extramural Research has been receptive to these issues and agreed that the phrasing of the FAQs could result in the misperception that NIH wanted far more information to be included in grant applications than intended. The agency has confirmed that FAQ question number six, which focuses on when outside activities should be reported as “Other Support,” will be removed from the website and that in the coming days and weeks a number of other changes clarifying NIH’s requirements will be posted.

The issue of foreign government influence at U.S. research institutions has been an increasing area of concern for the NIH and other federal science agencies over the past several years. In August 2018, NIH sent a letter to over 10,000 grantee institutions highlighting threats to research integrity, including failure of grantees to disclose foreign support for NIH-funded projects. A working group of the Advisory Committee to the NIH Director subsequently released a report in December 2018 offering recommendations for institutions to address these issues [see Washington Highlights, Dec. 14, 2018].

As noted in testimony given by the NIH at a recent Senate Finance Committee hearing [see Washington Highlights, June 7], the NIH is currently communicating with over 60 grantee institutions that the agency believes have failed to disclose substantial financial ties to foreign agencies or have failed to uphold the confidentiality of the peer review process. Investigations conducted in collaboration with awardee institutions are ongoing and several institutions have returned grant funds to the NIH and in some cases dismissed researchers for violations of agency and/or institutional policies. In a blog post, NIH Deputy Director for Extramural Research Mike Lauer, MD, notes that noncompliance with agency policy may lead to withholding or termination of awards or a referral for investigator suspension or debarment.

The AAMC is developing a set of issue briefs on this topic, and the first communication focused on NIH policy is now available.

Contact:

Anurupa Dev, Ph.D.
Lead Specialist, Science Policy
Telephone: 202-862-6048
Email: adev@aamc.org

Heather Pierce, JD, MPH
Sr. Director, Science Policy & Regulatory Counsel
Telephone: 202-478-9926
Email: hpierce@aamc.org

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HRSA Awards $20 Million in Grants to Create New Rural Residency Programs

July 19, 2019—The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) July 18 announced awardees for its Rural Residency Planning and Development Program (RRPD) grants. HRSA awarded up to $750,000 to 27 recipients across 21 states, totaling $20 million. The awards will support recipients’ efforts to develop new rural residency programs while achieving Accreditation Council for Graduate Medical Education (ACGME) accreditation.

Grant recipients include a variety of providers, such as rural hospitals, community health centers, and schools of medicine. These institutions will receive funding over three years to develop sustainable residency programs in family medicine, internal medicine, and psychiatry. The complete list of recipients can be found here.

Contact:

Andrew Amari
Hospital Policy and Regulatory Specialist
Telephone: 202-828-0554
Email: aamari@aamc.org

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