Washington Highlights: November
6, 2009
House Poised for
Vote on Health Care Reform
Contents
Prior Issues
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The House of Representatives moved closer to a floor vote on health
care reform when Energy and Commerce Committee Chair Emeritus John
Dingell (D-Mich.) Nov. 3 filed a manager's
amendment to the Affordable Health Care for America Act (H.R.
3962) [see Washington Highlights,
Oct. 30]. House leadership had promised members at least 72
hours to review the amendment before floor consideration of the
bill would begin. Upon release of the amendment, Majority Leader
Steny Hoyer (D-Md.) stated
that the House Leadership was "continuing to discuss this legislation
with our Members" and expected to "bring it to the floor
once we have consensus and in keeping with our 72 hour pledge."
The House Rules Committee was scheduled to meet Nov. 6 to establish
guidelines for floor debate on H.R. 3962, further indicating that
House leadership hoped to schedule a final vote on H.R. 3962 in
the following days.
In anticipation of a floor vote, the AAMC Nov. 2 sent a letter
to House leadership and key committee chairs applauding their progress.
The letter highlights the importance of additional investments in
the physician workforce and a repeal of the sustainable growth rate
(SGR) used to calculate Medicare physician payments. The letter
also praises House leaders for excluding an independent Medicare
commission from their bill, "given the potential for unintended
consequences … if Medicare payment policy is changed without
adequate Congressional review."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Len Marquez, Director
AAMC Government Relations
lmarquez@aamc.org
(202) 862-6281
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Democrats Introduce Physician Payment Legislation
House Energy and Commerce Committee Chair Emeritus John Dingell
(D-Mich.), along with Ways and Means Committee Chair Charles Rangel
(D-N.Y.), Energy and Commerce Chair Henry Waxman (D-Calif.), and
Education and Labor Committee Chair George Miller (D-Calif.), Oct.
29 introduced
legislation to avert the scheduled 21.2 percent reduction in calendar
year (CY) 2010 Medicare physician payments. Health Subcommittee
Chairs Pete Stark (D-Calif.), Frank Pallone (D-N.J.), and Robert
Andrews (D-N.J.), also sponsored the Medicare Physician Payment
Reform Act of 2009 (H.R.
3961).
The stand-alone bill is based on provisions that were approved
as part of the House "tri-committee" bill on health care
reform (H.R.
3200). Estimated to cost $210 billion over 10 years, H.R. 3961
eliminates the accumulated "Sustainable Growth Rate (SGR) deficit"
associated with the CY 2010 cut and "rebases" Medicare
physician payments using 2009 expenditures. In CY 2010, it establishes
a conversion factor update based on the Medicare Economic Index.
In CY 2011 and subsequent years, the bill establishes two distinct
"service categories" that will have separate conversion
factors and target growth rates:
- "Evaluation and Management" services (target growth
rate of GDP per capita, plus 2 percent)
- All other services (target growth rate of GDP per capita,
plus 1 percent)
Before holding a final House vote on the new SGR bill, House leaders
plan to add statutory "PAYGO" provisions to H.R. 3961.
The language would put into law the requirement that Congress must
fully offset any new spending, but the requirement would not apply
to the SGR fix. The House approved legislation (H.R.
2920) that accomplished similar goals in July [see Washington
Highlights, July 24],
but the Senate has not acted on the bill.
Currently, PAYGO is in place as a rule that can be waived by Congress.
While enacting PAYGO is among the House leadership's top priorities,
several key Senate Democrats are likely to oppose a PAYGO bill that
excludes the SGR fix.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Releases 2010 Medicare OPPS Final Rule
The Centers for Medicare and Medicaid Services (CMS) Oct. 30 released
the calendar year (CY) 2010 Medicare outpatient prospective payment
system (OPPS) final rule on the CMS Web site. The final rule
includes a 2.1 percent inflation update in base payments for hospital
outpatient services. The changes will take effect Jan. 1, 2010.
In response to comments and meetings with the AAMC and others,
in the final rule CMS makes changes in the requirements for physician
supervision of hospital therapeutic services that are less restrictive
than what was proposed. CMS now defines "direct supervision"
to mean that the supervising physician or non-physician practitioner
providing hospital outpatient therapeutic services can be present
anywhere on the same campus of the hospital, as long as he or she
is immediately available to furnish assistance and direction throughout
the performance of the procedure. While CMS does not define "immediately
available," the preamble states that this would not include,
"for example, performing another procedure or service that"
could not be interrupted.
CMS finalizes its proposal not to include any additional measures
in the current Hospital Outpatient Quality Data Reporting Program
(HOP QDRP). Hospitals will continue to submit data (where applicable)
on the current eleven required measures. CMS will proceed with its
plans to report publicly the Outpatient Measures on Hospital Compare
in 2010. The agency also will implement a new validation process
designed for the chart-abstracted measures for CY 2011. The results
of the new process will not affect the CY 2011 payment determination.
CMS will not expand the current Hospital Acquired Conditions (HAC)
program to the OPPS at this time. The agency will utilize the results
from the impact study on the inpatient program before making any
determinations about its expansion to the outpatient setting.
CMS finalizes its proposal to continue to pay for separately payable
drugs and biologicals at the current rate. Specifically, payment
for the acquisition and overhead cost of these products will be
equal to the average sales price (ASP) plus 4.0 percent, a rate
that is 2.0 percentage points lower than the payment received when
these drugs are furnished in physicians' offices, currently ASP
plus 6.0 percent. According to CMS, the ASP plus 4.0 percent rate
is based on a new methodology; if it had not applied the new methodology,
separately payable drugs and biologicals would be reimbursed at
ASP minus 3.0 percent.
The final rule will be published in the Federal Register
Nov. 20.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
Jennifer Faerberg, Director, Health Care Affairs
AAMC Health Care Affairs
jfaerberg@aamc.org
(202) 862-6221
CMS Releases Final 2010 Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) Oct. 30 published
the Medicare 2010 Physician Fee Schedule final rule
with comments. CMS revised the expected 2010 update for physician
services from a decrease of 21.5 percent (as listed in the proposed
rule) to a 21.2 percent decrease. Although the update formula has
produced negative updates since 2002, Congress has approved legislation
annually to prevent the cuts from being implemented. Changes in
the rule are effective Jan. 1, 2010.
The agency finalizes its proposal to remove physician administered
drugs from the update calculation. This change affects the 2010
rates, but will reduce the number of years physicians are projected
to receive a negative update.
The rule finalizes several proposals to modify relative value units
(RVUs), which are the base units for physician payments. All RVU
changes must be budget neutral. Among the changes are the elimination
of consultation codes with resulting increases in payments for new
and established office visits and for initial hospital and nursing
facility visits.
CMS also will begin using new practice expense data and finalizes
a proposal to increase the utilization rate for expensive diagnostic
equipment (over $1 million) from 50 percent to 90 percent; the increased
utilization rate does not apply to therapeutic equipment. CMS will
phase in these changes over four years.
The rule modifies the proposed implementation of a Medicare Improvements
for Patients and Providers Act (MIPPA, P.L.
110-275) provision that requires the establishment of a "special
payment rule for teaching anesthesiologists." For services
furnished on or after Jan. 1, 2010, the provision allows payment
under the regular fee schedule for the teaching anesthesiologist's
involvement in training residents in either a single case or in
two concurrent cases, which is similar to the way teaching surgeons
are paid. CMS will allow different anesthesiologists in the same
group practice to be considered "teaching physicians"
for purposes of meeting the requirement that the teaching physician
be present for all key or critical portions of the service.
The rule also finalizes several proposed changes to the Physician
Quality Reporting Initiative (PQRI) and the Electronic Prescribing
Incentive Program, such as including a group reporting option, allowing
data submission from electronic health records, and streamlining
the reporting process for e-prescribing.
The final rule will be published in the Federal Register Nov. 25.
CMS will accept comments on a limited number of sections of the
final rule through Dec. 29.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Department of Education Publishes Final Rules
on Higher Education Reauthorization
The Department of Education Oct. 27-29 published
in the Federal Register four sets of final rules for the federal
student loan programs authorized under Title IV of the Higher Education
Act. The new regulations incorporate many of the changes made under
the Higher Education Opportunity Act (HEOA, P.L.
110-315), and reflect recommendations of the AAMC.
With regard to medical school financial aid, the regulations:
- Amend the calculation of monthly payments under the Income-Based
Repayment (IBR) program to adjust for spouses who both elect
IBR
- Increase graduate student annual and aggregate loan maximums
in the Perkins Loan Program from $6,000 to $8,000, and from $40,000
to $60,000, respectively;
- Describe the required content for "codes of conduct"
and require institutions to develop and adopt such codes;
- Require institutions to report on reimbursements received for
certain service on lender advisory boards;
- Require institutions to describe for prospective and enrolled
students the terms and conditions of the loans students receive
under the Federal Family Education Loan (FFEL), Direct Loan,
and Perkins Loan programs;
- Eliminate the requirement that borrowers make ''written'' requests
to obtain a forbearance on their Perkins Loan;
- Reduce from 12 to nine the number of consecutive on-time, monthly
payments a borrower must make to rehabilitate a defaulted Perkins
Loan; and,
- Modify the entrance and exit counseling requirements.
The regulations are effective July 1, 2010.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
HHS Office of Civil Rights Releases HIPAA Enforcement
Rule
The U.S. Department of Health and Human Services (HHS) Office
for Civil Rights (OCR) Oct. 30 issued an interim final rule
to conform the enforcement of Health Insurance Portability and Accountability
Act (HIPAA) privacy regulations with statutory revisions made in
the American Recovery and Reinvestment Act (ARRA, P.L.
111-5) [see Washington Highlights,
Feb. 13]. The rule becomes effective Nov. 30, and applies to
violations occurring on or after Feb. 18, 2009.
The rule amends HIPAA enforcement regulations to:
- Significantly increase civil monetary penalties for established
HIPAA violations;
- Establish a tiered penalty structure based on categories of violations;
and,
- Revise limitations on the secretary's authority to impose civil
monetary penalties for established violations.
HIPAA covered entities can be penalized for four categories of
HIPAA violations, with minimum individual penalties ranging from
$100 to $50,000:
- The lowest penalty applies to entities that are not aware of or
would not have known about a violation despite "the exercise
of reasonable diligence," and starts from $100 for each violation.
- The minimum penalty for each violation due to reasonable cause (and
not willful neglect) is $1,000.
- In cases where willful neglect is established, but corrected within
the required period of time, the minimum penalty for each violation
is $10,000.
- For a violation due to willful neglect that is not corrected by
a covered entity up to 30 days after discovery of the violation,
the minimum penalty for each violation is $50,000.
For the first three categories of violations, the rule sets the
maximum monetary penalty for each violation at $50,000. For all
categories, the rule also establishes an annual penalty cap for
multiple, identical violations at $1.5 million.
In each case, the secretary will consider the appropriate penalty
category depending on the nature and extent of the violation, the
resulting harm, and other factors such as the covered entity's history
of prior compliance and financial condition.
ARRA also revised HIPAA by striking the affirmative defense for
violations in which the covered entity did not know, or by reasonable
diligence would not have known of the violation. Such violations
are now punishable under the first tier of penalties. Additionally,
the HIPAA subsection that provides an affirmative defense for a
30-day time period of correction now requires the covered entity
to demonstrate that the violation was not due to willful neglect.
A covered entity can minimize or avoid imposition of a civil monetary
penalty if it corrects the violation within 30 days of discovery.
HHS will accept public comments on the new regulations until Dec.
29.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Irena Tartakovsky, Senior Science Policy Analyst
AAMC Biomedical and Health Sciences Research
itartakovsky@aamc.org
(202) 862-6134
President Signs Ryan White HIV/AIDS Program Reauthorization
Bill
President Obama Oct. 30 signed into law legislation extending
the Ryan White HIV/AIDS program through fiscal year (FY) 2013. The
program, which provides health care and other assistance to low-income
AIDS and HIV patients, previously was set to expire that same day.
The Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L.
111-87) authorizes $2.35 billion to fund medications, health
care, and other support services in FY 2010, with increases in funding
each year through FY 2013, when it will reach $2.7 billion. The
legislation, which has had strong bipartisan support from its inception,
removes the previously included "sunset" provision, which
would have repealed the law on Sept. 30, 2009. Other changes include
a requirement that states adopt name-based reporting for patients
by FY 2013 and the inclusion of a national HIV testing goal of 5
million tests per year.
The legislation also contains an additional provision, Part G,
that concerns notifications for emergency responders of possible
exposure to infectious disease. Under Part G, medical facilities
must notify emergency responders if the victim of an emergency transported
to the facility was deemed to have an airborne infectious disease.
The bill requires that the notification take place within 48 hours
after the determination is made and also provides a mechanism for
emergency responders concerned about possible exposure to request
a determination from the treating facility.
The Senate approved the measure by unanimous consent Oct. 19, with
the House voting Oct. 21 to approve the bill under suspension of
the rules, 408-9.
Information:
Shannon Curtis, Legislative Analyst
AAMC Government Relations
scurtis@aamc.org
(202) 828-0558
Senate Panel Approves Biological Weapons Bill
The Senate Homeland Security and Governmental Affairs Committee
Nov. 4 approved, 8-1, a bill that would expand the Department of
Homeland Security's regulatory authority of biomedical research
by directing the department to create a new designation of dangerous
"tier I" select agents, require further registration of
labs and facilities, and require extended background checks.
Committee Chair Joe Lieberman (ID-Conn.) and Ranking Member Susan
Collins (R-Maine) introduced the Weapons of Mass Destruction Prevention
and Preparedness Act of 2009 (S.
1649) Sept. 8 [see Washington
Highlights, Sept. 11].
The committee proceeded with a two-part mark-up of the legislation
that began Oct. 28, despite concerns from committee member and Armed
Services Committee Chair Carl Levin (D-Mich.) that affected agencies
had not had ample opportunity to comment on the bill and that the
bill would diminish the role of the Department of Health and Human
Services in dealing with human pathogens. Sen. Levin cast the lone
dissenting vote against the legislation.
At the mark-up, the committee adopted a substitute amendment sponsored
by Chairman Lieberman that reportedly made mostly technical changes
to the bill.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
On the Hill …
House Democrats boosted their majority to 258-177, after special
elections that allowed them to hold a northern California seat and
take over a traditionally Republican seat in New York.
California voters Nov. 3 elected Lt. Gov. John Garamendi (D) to
fill the seat vacated by former Rep. Ellen Tauscher (D), who was
sworn in as Under Secretary of State for Arms Control and International
Security June 27.
A special election in New York determined Democrat Bill Owens as
the successor to former Rep. John McHugh (R), who was sworn in as
Secretary of the Army Sept. 21.
On the Agenda in Washington
Nov. 10: Genomic Medicine Program Advisory Committee Meeting
8:30 a.m.; Hamilton Crowne Plaza, 1001 14th Street NW
The VA Genomic Medicine Program Advisory Committee will meet
and discuss optimal ways for VA to incorporate genomic information
into its health care program while applying appropriate ethical
oversight and protecting the privacy of Veterans. The committee
also will discuss ways to enhance development of tests and treatments
for diseases particularly relevant to Veterans.
Nov. 12-13: Primary Care Medicine and Dentistry Training
Meeting
8:30 a.m.; Hilton Washington DC/Rockville, Executive Meeting
Center, 1750 Rockville Pike, Rockville, Md.
The HRSA Advisory Committee on Training in Primary Care Medicine
and Dentistry will meet
to hear presentations and work on reports.
Nov. 12-13: NIH Scientific Management Review Board Meeting
Nov. 12: 1 p.m.; Nov. 13: 8:30 a.m.; NIH Campus, Building 31,
6th Floor, Conference Room 6, Bethesda, Md.
The NIH Scientific Management Review Board will meet
to receive a presentation and to discuss updates from SMRB working
groups: Deliberating Organizational Change and Effectiveness; NIH
Intramural Research Program; and Substance Use, Abuse, and Addiction.
Nov. 12-14: NHSC Advisory Committee Meeting
Nov. 12: 3 p.m.; Nov. 13-14: 8:30 a.m.; Hilton Washington DC/Rockville,
Executive Meeting Center, 1750 Rockville Pike, Rockville, Md.
The HRSA National Advisory Council on the National Health Service
Corps will meet
to hear updates from the Agency and the Bureau of Clinician Recruitment
and Service, discuss recruitment strategies for the NHSC, and address
current workforce issues.
Nov. 13: Healthcare Research and Quality Advisory Committee
Meeting
9 a.m.; AHRQ, Eisenberg Conference Center, 540 Gaither Rd., Rockville,
Md.
The AHRQ National Advisory Council for Healthcare Research and Quality
will meet
Nov. 13. The agenda will include report from the subcommittee on
Child Health Insurance Program Reauthorization Act (CHIPRA) Quality
Provisions, and discussion of the Patient Safety and Medical Liability
Reform Demonstration Project.
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