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FEDERAL HEALTH UPDATE

January 18, 2008

Produced by Kate Connelly Theroux in collaboration with the U.S. Medicine Institute for Health Studies (USMI)

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  • On Jan. 16, 2008, the House passed H.R.4986, the National Defense Authorization Act for Fiscal Year 2008 (NDAA 2008).  This legislation provides for the enactment of the NDAA 2008, as previously enrolled, with certain modifications to address the foreign sovereign immunities provisions of title 28, United States Code, with respect to the attachment of property in certain judgments against Iraq, the lapse of statutory authorities for the payment of bonuses, special pays, and similar benefits for members of the uniformed services, and for other purposes. The previous bill for NDAA 2008 (H.R.1585) was vetoed by President Bush on Dec. 28, 2007.
  • On Jan. 16, 2008, TRICARE Management Activity announced that TRICARE covers laparoscopic adjustable gastric banding, also commonly called Lap-Band surgery, for qualified beneficiaries.  Although the TRICARE policy change has only recently been made, coverage is retroactive to February 1, 2007.

    Lap-Band surgery, like gastric bypass, gastric stapling or gastroplasty, is only for those suffering morbid obesity, defined as body weight 100 pounds over ideal weight for the individual’s height and bone structure and weight associated with severe medical conditions known to have higher mortality rates.  Body weight that is more than twice the ideal weight for the person’s height and bone structure may also indicate morbid obesity.

    In addition, TRICARE will cover the surgery if a patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery.

  • TRICARE Management Activity announced that, starting in January 2008, TRICARE for Life (TFL) beneficiaries living in the United States and U.S. territories will receive monthly summaries of their Explanation of Benefits (EOB) instead of individual EOBs. The exception to this is if a claim includes services that are rejected, and those services have appeal rights, or if the EOB is mailed with a payment to the beneficiary. TRICARE overseas beneficiaries will continue to get their EOBs as usual.

    In February, TFL beneficiaries will have the option to receive an electronic notification every time a claim is processed.  Beneficiaries can then log onto the secure Web site at www.TRICARE4U.com, to view and print their EOB. 

    The EOB will be available online and beneficiaries will have the ability to access EOB’s for any claim processed during the past 27 months.  Once a beneficiary signs up for this option, he or she will not receive a monthly paper summary.

  • TriWest Healthcare Alliance received the J.D. Power and Associates Call Center Certification for excellence in serving customers.  J.D. Power and Associates measures call center effectiveness judged by recruiting, training, employee incentives, management roles and responsibilities, performance standards and quality assurance.

    TriWest, a Department of Defense contractor, is the administrator of the military's health care program, TRICARE, serving 2.9 million eligible beneficiaries in 21 western states. Each of TriWest's six call centers, and the call center of TriWest's subcontractor, Wisconsin Physicians Services (WPS), received the certification after audits and surveys of 1,800 TriWest customers conducted by a third party over 15 days.

  • On Jan 11, 2008, a groundbreaking ceremony at Fort Sam Houston, Texas, for the construction of a $92 million center for all Defense Department combat casualty care and trauma research missions was held.

    The 150,000-square-foot Joint Center of Excellence for Battlefield Health and Trauma Research marks the first construction project at Fort Sam Houston under the 2005 Base Realignment and Closure legislation.

    Military leaders from the Army, Navy and Air Force joined community leaders at the ceremony. The new facility, slated for completion in September 2009, signifies a ‘‘new era in military medical research,” said commander of the Army Medical Research and Materiel Command Maj. Gen. George Weightman.

    The research center will enable research and development experts, scattered throughout the nation, to centralize efforts, which will improve efficiency, reduce duplication and enhance the collusion between them, Weightman said.

    The center will be co-located with the Institute of Surgical Research, which falls under Weightman’s command, and adjacent to Brooke Army Medical Center. The Institute will also benefit from the Base Realignment and Closure law with a 5,000-square-foot renovation. In addition, the research center adds 230 people to the 440 already working there.

  • Health Net Federal Services, LLC, announced that it has been re-awarded a contract by the Department of Veterans Affairs Healthcare Network Upstate New York (VAHNUNY) to provide primary and preventive health care services to veterans enrolled in the VA Community-Based Outpatient Clinic (CBOC) located in Troy, New York. The base contract with Health Net is effective from January 1, 2008, through December 31, 2008, with four additional option periods.

    The VA CBOC program was developed by VA to provide health maintenance and preventive health care within 30 miles or 30 minutes of a veteran’s home. CBOCs reduce travel time and shorten waiting times for veterans needing outpatient care.

  • The Centers for Disease Control and Prevention (CDC), in conjunction with Kaiser Permanente’s Northern California Division of Research, launched a 12-month study to learn about an unexplained skin condition known as Morgellons. Persons who suffer from this condition report a range of symptoms including non-healing skin lesions associated with the emergence of fibers or solid material from the skin, abnormal skin sensations (such as stinging and biting or pins and needles) and non-cutaneous symptoms, such as difficulty concentrating and short-term memory loss. Researchers hope to learn more about who might be affected, what symptoms they experience, and factors that may contribute to their illness.

    CDC will identify patients in Kaiser Permanente’s Northern California Health Plan to enroll in the study. The Kaiser Permanente Division of Research was awarded a $338,000 contract to assist CDC in this investigation because of the organization’s location in a geographic area where self-reported cases are concentrated, the size of the patient population to draw from (Kaiser Permanente covers approximately 30 percent of the Northern California population), and its ability to systematically identify Kaiser Permanente patients who may have this unexplained illness. http://www.cdc.gov/od/oc/media/pressrel/2008/r080116.htm

  • The U.S. Food and Drug Administration approved the first clotting solution manufactured using recombinant DNA techniques to help stop small blood vessels from bleeding after surgery.

    The new solution, called Recothrom, is a topical thrombin solution. Thrombin is a protein involved in the production of fibrin, a different protein necessary for blood to clot.

    Recombinant DNA is the result of a genetic modification process that enables scientists to create new DNA strands with specific traits, such as the capacity to produce a specific protein.

    After surgery, bleeding from small blood vessels, such as capillaries, can cause significant blood loss. Physicians can apply Recothrom during surgery when standard surgical techniques for stopping blood loss are ineffective or impractical.

    Recothrom, manufactured by Seattle-based ZymoGenetics, Inc., is made from Chinese Hamster Ovary cells (CHO), which have been genetically modified to produce human thrombin. These CHO cells are free from known infectious agents, and Recothrom undergoes an additional process of viral inactivation. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01779.html

  • On Jan 16, 2008, the U.S. Food and Drug Administration issued a Public Health Advisory for parents and caregivers, recommending that over-the-counter (OTC) cough and cold products not be used to treat infants and children less than 2 years of age because serious and potentially life-threatening side effects can occur. OTC cough and cold products include decongestants, expectorants, antihistamines, and antitussives (cough suppressants) for the treatment of colds.

    There is a wide variety of rare, serious adverse events reported with cough and cold products. They include death, convulsions, rapid heart rates, and decreased levels of consciousness.

    The announcement does not include the FDA's final recommendation about use of OTC cough and cold medicines in children ages 2 to 11 years. The agency's review of data for 2-to-11-year-olds is continuing. The FDA said it is committed to making a timely and comprehensive review of the safety of OTC cough and cold medicines in children. The agency plans to issue its recommendations on use of the products in children ages 2 to 11 years to the public as soon as the review is complete. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01778.html

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) is soliciting applications for fiscal year (FY) 2008 Older American Targeted Capacity Expansion (TCE) grants.  The Older American TCE grants help communities provide mental health services that meet the diverse needs of older persons (aged 60 years and older).

    Grantees can pursue an array of efforts for building and sustaining effective mental health outreach, treatment and recovery services for this age group in their communities.  Under the terms of the Older American TCE program, at least 25 percent of the grant funding should be devoted to providing direct services to older persons and another 25 percent should be applied toward building the mental health infrastructure developed for helping that age group.

    The program promotes the development and use of evidence-based practices – prevention, treatment and recovery approaches that have been shown to be effective through some form of documented scientific evidence.  All grantees are required to collect and report certain data regarding the scope, nature and efficacy of the mental health service they provided.

    It is expected that $4.15 million will be available to fund up to 10 grants. Grant awards may not exceed $415,400 per year for up to three years. The actual award amounts may vary, depending on the availability of funds. The grants will be awarded by SAMHSA’s Center for Mental Health Services. For more information on eligibility and applications, please visit http://www.samhsa.gov/newsroom/advisories/0801160511.aspx

  • According to the Wall Street Journal, the Department of Labor recently issued regulatory guidelines that prohibit employers from charging different health insurance deductibles or co-pays based on the health or habits of its employees.

    In December, the department's Employee Benefits Security Administration issued guidelines to its national and regional offices on "supplemental coverage," a form of health insurance covering co-pays and deductibles in regular insurance. Supplemental coverage is generally used to fill such gaps in either Medicare or TRICARE, the health-care plan for current and retired military members. But in recent years, some employers have incorporated a form of supplemental insurance into their wellness programs.

    Under such programs, workers enroll in an employer-sponsored health plan with a high insurance deductible. They can offset the deductible by earning "wellness credits" for meeting certain health benchmarks -- such as for cholesterol count -- issued under a separate supplemental policy.  This goes against the Health Insurance Portability and Accountability Act, or HIPAA -- requiring all workers covered under the same employer-sponsored plan to pay the same premiums regardless of their health. http://online.wsj.com/article/SB120045083670893315.html?mod=hpp_us_entrepreneur

  • USA Today examined the efforts of several states and communities that are moving to provide universal health coverage for their residents despite the 1974 federal law that bars states from requiring or regulating employer-provided benefits such as health coverage. The law protects private-sector companies from having to meet a patchwork of state and local demands.

    Many of the proposals require employers either to offer health coverage themselves or pay into a public fund to help cover the uninsured.  The dispute has set off a legal battle pitting lawmakers against employers. Its resolution could determine how far state and local lawmakers can go with their plans to cover the uninsured.

    An early legal test of these plans is taking place in San Francisco, the first city to offer universal coverage to its residents. A group of restaurant owners sued the city in 2006, saying the law violates the federal Employee Retirement Income and Security Act (ERISA).

    In December, a lower court judge sided with employers. But last week, the 9th U.S. Circuit Court of Appeals court allowed San Francisco to proceed temporarily with its program and begin charging employers a fee, ruling that the city has a "strong likelihood of prevailing" in its appeal.

    California, Colorado, Michigan and Minnesota have proposals pending that rely on partial funding by employers.

    In January 2007, the 4th U.S. Circuit Court of Appeals reached the opposite conclusion over a Maryland law. That law charged very large employers a fee if they did not spend 8 percent of payroll on health care, essentially affecting only Wal-Mart. The appeals court ruled the measure violated federal law.

    Massachusetts, the only state to require all residents to carry insurance, sets a $295 per worker annual fee on employers who don't offer coverage. The fee's small size and early support from business are credited with preventing a legal challenge. http://www.usatoday.com/news/nation/2008-01-16-health_N.htm

  • The total number of Guard and Reserve currently on active duty has increased by 2,166 from the last report to 94,839. The totals for each service are Army National Guard and Army Reserve, 73,695; Navy Reserve, 5,072; Air National Guard and Air Force Reserve, 7,067; Marine Corps Reserve, 8,672; and the Coast Guard Reserve, 333. www.defenselink.mil
  • No reports were published this week.
  • H.R.4991 (introduced Jan. 16, 2008):  To amend the Social Security Act, the Federal Food, Drug, and Cosmetic Act, and the Public Health Service Act to ensure a sufficient supply of vaccines and for other purposes was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Henry A. Waxman [CA-30]
  • H.R.4993 (introduced Jan. 16, 2008):  To amend the Public Health Service Act to increase the availability of vaccines, and for other purposes was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. 
    Sponsor: Representative Henry A. Waxman [CA-30]
  • H.R.5028 (introduced Jan. 16, 2008): To amend the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code of 1986 to require that group health plans provide coverage for pervasive developmental disorders such as autism was referred to the Committee on Education and Labor, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. 
    Sponsor: Representative Robert Wexler [FL-19]
  • The House Oversight and Government Reform Subcommittee on Government Management, Organization, and Procurement will hold a field hearing on Jan. 22, 2008, to examine why did HHS cancel contracts to manage 9/11 responder heath care.
  • The House Veterans' Affairs Committee will hold a hearing on Feb. 8, 2008, examine proposed budget estimates for fiscal year 2009 for Veterans programs.
  • The House Veterans Affairs Subcommittee on Health will hold a hearing on Feb. 14, 2008, to examine Veterans Affairs fiscal year 2008 health budget.
  • The House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on Feb. 15, 2008, to examine the oversight efforts of the U.S. Department of Veterans Affairs (VA) Inspector General: issues, problems and best practices at the VA.
  • A Joint House and Senate Veterans' Affairs Committee hearing will be held on Feb. 27, 2008, to receive legislative presentation of the Disabled American Veterans.
  • The House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on Feb. 28, 2008, to examine the information security management at the U.S. Department of Veterans Affairs.
  • A Joint House and Senate Veterans' Affairs Committee hearing will be held on March 6, 2008, to receive legislative presentation of the Veterans of Foreign Wars.
  • A Joint House and Senate Veterans' Affairs Committee hearing will be held on March 8, 2008, to receive legislative presentations of PVA, JWV, BVA, VVA, NCOA, and AFSA.
  • The House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on March 8, 2008, to examine the service members’ seamless transition into civilian life.
  • The House Veterans Affairs Subcommittee on Health will hold a hearing on March 15, 2008, to examine Polytrauma Center care and the transition between the U.S. Department of Veterans Affairs and the Department of Defense.
  • A Joint House and Senate Veterans' Affairs Committee hearing will be held on March 29, 2008, to receive legislative presentation of the AMVETS, Ex-POWs, MOPH, Fleet Reserve, TREA,GSW, MOAA, and NASDVA.
  • The House Veterans Affairs Subcommittee on Health will hold a hearing on April 18, 2008, to examine veterans’ access to U.S. Department of Veterans Affairs (VA) health care.
  • The House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on May 8, 2008, to examine the sharing of Electronic Medical Records between the U.S. Department of Defense and the U.S. Department of Veterans Affairs.
  • On March 13 and 15 and April 17, 18, 24 and 26, the House Veterans Affairs Committee will mark up legislation.

If you need further information on any of the items in the Federal Health Update, please contact Kate Connelly Theroux at (703) 447-3257 or by e-mail at kate@usminstitute.org. To subscribe, please visit http://usminstitute.org/subscriber.cfm. To unsubscribe, please send an email to update@usminstitute.org with UNSUBSCRIBE as the subject.

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