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FEDERAL HEALTH UPDATE

April 25, 2008

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

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Congressional Schedule

  • The Senate passed H.R.493 as amended, the Genetic Information Nondiscrimination Act of 2007, on April 24, 2008.  This legislation prohibits discrimination on the basis of genetic information with respect to health insurance and employment.
  • The Senate passed S.1315 as amended, the Veterans' Benefits Enhancement Act of 2007 on April 24, 2008.  This legislation includes improvements to veterans' benefits, including:
    • Establishing a new program of insurance for service-connected disabled veterans;
    • Expanding eligibility for retroactive benefits from traumatic injury protection coverage under Servicemembers' Group Life Insurance;
    • Increasing the maximum amount of Veterans' Mortgage Life Insurance that a service-connected disabled veteran may purchase;
    • Providing individuals with severe burn injuries specially adapted housing benefits; and
    • Extending for two years the monthly educational assistance allowance for apprenticeship or other on-the-job training.

    The bill now moves to the House of Representatives.

  • The Senate Veterans Affairs Committee held an oversight hearing on April 23, 2008, to examine an update to cooperation and collaboration between the Veterans Affairs Department and the Department of Defense. The Committee was primarily interested in the problems service members face as they transition from the DoD to VA.  Deputy Secretary of Defense Gordon England, Deputy Secretary of Veterans Affairs Gordon Mansfield, as well as representatives from veterans service organizations, testified.
  • The Senate Appropriations Subcommittee on Military Construction and Veterans' Affairs, and Related Agencies held a hearing on April 24, 2008, to examine proposed budget estimates for fiscal year 2009 for military construction. 

Military Health Care News

  • According to the Associated Press, the U.S. military's health insurance program, TRICARE, has been swindled out of more than $100 million over the past decade in the Philippines, where doctors, hospitals and clinics have conspired with American veterans to submit bogus claims. 

    Seventeen people have been convicted so far — including at least a dozen U.S. military retirees — in a little-noticed investigation that has been handled by federal prosecutors out of Wisconsin because a Madison company holds the contract to process many of the claims. It has not been accused of any wrongdoing.

    Health care providers in the Philippines filed claims for medical services never delivered, inflated claims by as much as 2,000 percent and shared kickbacks with retirees who played along, court records show.

    TRICARE paid $210.9 million in overseas claims in 2006, the latest year for which figures were available. At the height of the fraud in 2003, Pentagon officials say, two-thirds of the $61.8 million paid to Philippine providers—about $40 million—was fraudulent.

    The fraud was so extensive that the number of claims filed in the Philippines skyrocketed nearly 2,000 percent between 1998 and 2003 even as the number of beneficiaries there—about 9,000 mostly retired military members and dependents—remained constant.

    A Pentagon audit in February 2008 warned that the TRICARE program is still vulnerable to rip-offs because of lax controls and that similar fraud schemes are starting to emerge in Latin America.

    News of the scope of the fraud comes as the Pentagon seeks to raise fees for TRICARE's beneficiaries.  The proposed increases have outraged groups representing servicemen and have been blocked by Congress.

  • UnitedHealth Group announced that Arthur Miller has been appointed chief operating officer of UnitedHealth Military & Veterans Services, a dedicated UnitedHealth Group business focused on providing the nation’s military, veterans and their families with high-quality, affordable health care.

    Prior to this appointment, Mr. Miller was president of Infocrossing Healthcare Services, Inc., a provider of IT outsourcing and business processing solutions.  He also has worked for the Navy Bureau of Medicine and Surgery, the TRICARE Management Activity and the Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS). Mr. Miller served in the U.S. Navy for more than 22 years, retiring with the rank of captain.

    At the Navy Bureau of Medicine and Surgery, Mr. Miller served as the director of business plans for TRICARE operations.  In this capacity, he oversaw the Operation of the Navy Healthcare system, which includes more than 100 hospitals and health facilities throughout the world; was responsible for Navy/Marine Corps health care policy; and served as special advisor to the Navy Surgeon General for TRICARE activity.  http://www.unitedhealthgroup.com/news/rel2008/0424_miller_military.htm

  • Health Net Federal Services, LLC, announced Sue Mandry-Schwartz, DBA, R.N., vice president, Government Relations, has been appointed to serve on the Board of Directors of United Service Organizations (USO) and National Military Family Association (NMFA). ,

    Dr. Schwartz will serve as a collaborative member of the board to promote each organization’s mission and public image, ensure organizational planning, adequate resources and management of resources.

    USO supports troops through morale, welfare and recreational services to military personnel at more than 130 centers worldwide, providing the comforts of home to service men and women. NMFA is dedicated to education of and advocacy for the rights and benefits of military families through legislative action and programs such as its Military Spouse Scholarship Program and Operation Purple Camps for children of deployed service members.

  • The Military Health System (MHS) will hold its second live online town hall discussion on Friday, April 25, from 2:45 – 4:15 p.m.

    Following on the success of February’s Wounded Warrior Webhall event, Assistant Secretary of Defense for Health Affairs S. Ward Casscells, MD, is again inviting wounded service members and their families to share concerns and recommendations and ask questions in a live, online discussion with MHS leadership.

    The MHS’ top priority is providing wounded warriors with quality health care. Over the past year, the MHS has been working diligently on the recommendations of independent review groups, task forces and senior leaders to provide the best health care for wounded warriors and their families. 

    Those interested in participating in the live chat should visit the MHS Webhall page at www.health.mil/WWTBWebhall.aspx for instructions on how to participate in the live program. 

    All questions, concerns and recommendations should be focused on broad issues and lessons learned. Due to privacy concerns, the forum should not be used for sharing personal information. Whenever possible, service members should always use their chain of command. http://www.tricare.mil/pressroom/news.aspx?fid=388

  • TRICARE Management Activity published a news release outlining the behavior health benefits offered to National Guard and Reserve members and their families, even when they’re not activated.

    The April 24 release, TRICARE Covers Behavioral Health for National Guard and Reserve Before, During, and After the Call to Duty, explains how service members become eligible and the timeline for access to health care for members and their families.

    According to the release, National Guard and Reserve members who receive delayed active duty orders for more than 30 consecutive days in support of a contingency operation (during a war or during a national emergency declared by the President or Congress) may be eligible for “early” TRICARE benefits prior to activation.  The eligible Reserve Component member and his or her family can obtain behavioral health services for up to 90 days prior to deployment if needed.  The timeline for access to care depends on when the service member’s orders are issued. 

    During activation, National Guard and Reserve members have access to the same benefits, services and programs as active duty service members and should seek behavioral health services from their operational health asset or at a Military Treatment Facility (MTF).  However, if services are not available at the MTF, the service member can seek treatment from an authorized network provider with a referral from their Primary Care Manager (PCM).

    The Behavioral Health Provider Locator and Appointment Assistance Service is available for activated Guard and Reserve members and their TRICARE Prime enrolled family members who need help locating and making appointments with civilian behavioral health care providers in their area.              

    Prime enrolled family members can receive the first eight outpatient behavioral health care visits per fiscal year (Oct. 1–Sept. 30) from a network provider without a referral from a PCM or prior authorization from their Managed Care Support Contractor. 

    Upon deactivation, National Guard and Reserve members may qualify for Transitional Assistance Management Program (TAMP) coverage.  The 180-day TAMP period begins on the Guard or Reserve member’s separation date.  Those covered under TAMP are eligible for TRICARE Standard/Extra or Prime (where available) and have access to TRICARE's behavioral health care benefits under that plan.

    Deactivated Guard and Reserve members and their families losing TRICARE eligibility and transitioning to civilian care can purchase coverage under the Continued Health Care Benefits Program.  This premium-based program allows members to purchase coverage for up to 18 months after loss of eligibility; certain family members have up to 36 months coverage.  The benefits are similar to TRICARE Standard.

    Members of the Selected Reserve who purchase TRICARE Reserve Select (TRS) coverage are eligible for similar behavioral health benefits to TRICARE Standard or Extra.  TRS beneficiaries can seek outpatient behavioral health services from TRICARE authorized providers without a referral for the first eight visits.  Authorization is required for the ninth outpatient visit to continue treatment.  

Veterans Health Care News  

  • On April 18, 2008, Secretary of Veterans Affairs Dr. James B. Peake participated in a ribbon-cutting ceremony to open a unique vocational counseling center for disabled veterans in St. Paul, Minn.

    The new facility at the Bishop Henry Whipple Federal Building will help active-duty military personnel and veterans with severe disabilities obtain productive employment.  Operated by the Paralyzed Veterans of America (PVA) and staffed by a PVA counselor, it will serve about 100 veterans this year.

    The St. Paul facility is only the second of its kind in the nation.  The first PVA counseling center opened last July in Richmond, Va.  Similar centers are planned for California and Texas.

    The counseling center will work closely with VA’s new Spinal Cord Injury Center, under construction at the Minneapolis VA Medical Center.  That $21 million facility, scheduled to open in early 2009, will provide life-long comprehensive inpatient and outpatient care to veterans with spinal cord injuries and disorders.  http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1491

  • The Department of Veterans Affairs (VA), the University of Colorado - Denver and the University of Colorado Hospital (UCH) have partnered to build a new bed tower and research tower for Denver-area residents and veterans.

    The two structures, to be built on University property at the former Fitzsimons Army Medical Center campus, will accompany a state-of-the-art VA Ambulatory Health Care Center, which will also be constructed at that location.

    The new VA Medical Center will provide primary and specialty care for Rocky Mountain-area veterans, outpatient surgical services, and a nursing home care unit.  VA doctors, nurses and other clinical personnel will serve veterans at the bed tower in what has been called “a hospital within a hospital,” while non-veteran patients will be served by UCH staff.  VA and University of Colorado - Denver researchers will work side by side in the new research tower.  

    This unique partnership will allow the two organizations to share resources, such as laboratory and imaging services.  It will further strengthen the long-standing partnership among the two organizations.

    VA also announced it will improve services for Colorado veterans in two additional ways.  The Department’s Colorado Springs community-based outpatient clinic will expand, adding specialty services and same-day surgeries to the primary care already provided to veterans.  In addition, the surgical program at the Grand Junction VA Medical Center will expand, reducing the need for many Colorado veterans to travel to Denver for surgery.  Joint meetings will be held soon to better describe this relationship.  http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1492

  • The White House announced on April 22, 2008, that President Bush intends to nominate Christine O. Hill, of Georgia, to be assistant secretary of Veterans Affairs (Congressional Affairs). Ms. Hill currently serves as deputy assistant secretary for Congressional and Legislative Affairs at the Department of Veterans Affairs. Prior to this, she served as director of Legislative and Intergovernmental Affairs for the Defense Base Closure and Realignment Commission (BRAC). Earlier in her career, she served as a military legislative assistant to Senator Elizabeth Dole. Ms. Hill received her bachelor's degree from the United States Air Force Academy and her master's degree from Troy State University.
  • Dr. Michael E. DeBakey, a Houston-based cardiac pioneer, received the Congressional Gold Medal during a special ceremony at the U.S. Capitol on April 23, 2008. 

    Considered the father of modern cardiovascular surgery, DeBakey has had a career that spans more than six decades.  By the beginning of World War II, he already had a national reputation in the field of vascular disease.  

    His work after coming on active duty with the Army surgeon general’s staff is credited with developing the mobile army surgical hospitals, or M.A.S.H. units, popularized during the Korean War, upon which modern improvements in battlefield medicine are based.

    In 1949, the medical director of the then Veterans Administration, Dr. Warren Magnuson, asked Dr. DeBakey to organize medical staffing at the VA hospital in Houston, which he did with the help of full-time faculty at the Baylor University College of Medicine.  As chief surgeon at the Houston VA Hospital, DeBakey also created an accredited residency program for the facility.

    VA is dedicating a conference room in VA headquarters in honor of Dr. DeBakey.  The medical pioneer’s name will be inscribed on an eighth floor conference room.

  • The Department of Veterans Affairs (VA) announced it will begin contacting nearly 570,000 recent combat veterans on May 1, to ensure they know about VA’s medical services and other benefits.

    A contractor-operated “Combat Veteran Call Center” will telephone two distinct populations of veterans from Iraq and Afghanistan.  

    In the first phase, calls will go to an estimated 17,000 veterans who were sick or injured while serving in Iraq or Afghanistan.  VA will offer to appoint a care manager to work with them if they don’t have one already.  Care managers ensure veterans receive appropriate care and know about their VA benefits.

    For five years after their discharge from the military, these combat veterans have special access to VA health care.  The Department screens combat veterans for signs of post-traumatic stress disorder and traumatic brain injury.  VA personnel have been deployed to the military’s major medical centers to assist wounded service members and their families during the transition to civilian lives.

Health Care News

  • On April 21, 2008, the Food and Drug Administration (FDA) approved the first heart-assist device that uses a continuous flow pump that constantly moves blood with a single moving part, a spinning rotor.  This allows the device to be slimmed down to a mere three inches in length and a weight of approximately one pound. 

    The Thoratec HeartMate II Left Ventricular Assist System, manufactured by Thoratec Corporation of Pleasanton, Calif., employs a first-of-a-kind design. An electrical cable that powers the blood pump passes through the patient's skin to an external controller that the patient wears on his or her waist. The controller is powered either by batteries or connected to an electrical power outlet. Blood flow is set through the pump based on the patient's need, and the controller monitors pump performance, sounding alarms if it detects dangerous conditions or a possible malfunction. The system can operate on two external batteries, allowing the patient to move freely for up to three hours.

    In a clinical study of 126 patients at 26 transplant centers, 57 percent of patients with the HeartMate II survived to heart transplant, which is comparable to the survival of patients treated with currently approved heart assist devices. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01820.html

  • The U.S. Food and Drug Administration approved Cimzia (certolizumab pegol) for adults with moderate to severe Crohn's disease who have not responded to conventional therapies. This product, manufactured by UCB, Inc., Smyrna, Ga., was approved with a Medication Guide.

    Crohn's disease is a chronic, inflammatory bowel disease that affects more than 1 million men and women worldwide. It has no cure and its cause is unknown. Crohn's can cause diarrhea, fever, rectal bleeding, malnutrition, narrowing of the intestinal tract, obstructions, abscesses, cramping, and abdominal pain. It also can lead to abnormal connections (fistulas) leading from the intestine to the skin or internal organs.

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of its nationwide study, which found that about a 15.1 percent of the nation’s drivers age 18 and older drove under the influence of alcohol at least once in the past year. The report says that in some states the levels are far higher – about one in four drivers.

    Nationwide, an estimated 30.5 million people aged 12 or older drove under the influence of alcohol at least once in the past year according to the first-of-its-kind national report.  Driving under the influence ranged from a low of 9.5 percent in Utah, to highs of 26.4 percent in Wisconsin, 24.9 percent in North Dakota and 23.5 percent in Minnesota.

    State Estimates of Adults Driving under the Influence of Alcohol and Illicit Drugs is based on the combined data from the 2004 to 2006 National Surveys on Drug Use and Health (NSDUH) and provides state-level estimates for the pervasiveness of driving under the influence of alcohol and driving under the influence of illicit drugs. These estimates are annual averages based on combined data collected from 127,283 current drivers surveyed in 2004, 2005 and 2006, the most recent data available.

    The report also shows that nationwide nearly one in 20 adult drivers aged 18 or older drove under the influence of illicit drugs such as marijuana/hashish, cocaine/crack, inhalants, hallucinogens, heroin or prescription drugs used non-medically. 

    According to the National Highway Traffic Safety Administration (NHTSA), there were almost 16,700 deaths in 2004 caused by accidents related to driving under the influence of alcohol.  Overall, driving under the influence of alcohol and illicit drugs is among the leading sources of preventable death by injury in the United States.

Reserve/Guard

  • The total number of Guard and Reserve currently on active duty has increased by 570 from the last report to 102,657. The totals for each service are Army National Guard and Army Reserve, 79,049; Navy Reserve, 5,211; Air National Guard and Air Force Reserve, 9,554; Marine Corps Reserve, 8,496; and the Coast Guard Reserve, 347. www.defenselink.mil

Reports/Policies

  • The GAO published “Drug Safety: Preliminary Findings Suggest Recent FDA Initiatives Have Potential, but Do Not Fully Address Weaknesses in Its Foreign Drug Inspection Program,” (GAO-08-701T) on April 22, 2008.  In this report, the GAO presents preliminary findings on how FDA's initiatives address the weaknesses in FDA's foreign drug inspection program identified by a November 2007 GAO report. http://www.gao.gov/new.items/d08701t.pdf
  • The Institute of Medicine (IOM) published “Standardizing Medication Labels: Confusing Patients Less. Workshop Summary,” on April 22, 2008.  This report is a summary of the workshop, which was organized to examine what is known about how medication container labeling affects patient safety and to discuss approaches to addressing identified problems.  http://www.iom.edu/CMS/3793/31487/53764.aspx
  • The GAO published “Nanotechnology: Accuracy of Data on Federally Funded Environmental, Health, and Safety (EHS) Research Could Be Improved,” (GAO-08-709T) on April 24, 2008.  This report focuses on the extent to which selected agencies conducted EHS research in fiscal year 2006; the reasonableness of the agencies' and the National Nanotechnology Initiative's (NNI) processes to identify and prioritize EHS research; and the effectiveness of the agencies' and the NNI's process to coordinate EHS research.  http://www.gao.gov/new.items/d08709t.pdf
  • The Rand Corporation released “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery,” on April 17, 2008.  The study assessed the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury; examined the treatment capacity of the current health care system, and estimated the costs of providing quality health care to all military members who need it. http://www.rand.org/pubs/monographs/MG720.1/

Legislation

  • H.R.5832 (introduced April 17, 2008): To amend title 10, United States Code, to eliminate the requirement for dependents to reside with members of the Armed Forces to be eligible for TRICARE Prime Remote was referred to the House Committee on Armed Services.  
    Sponsor: Representative Kirstin E. Gillibrand [NY-20].
  • H.R.5835 (introduced April 17, 2008): To provide for increased planning and funding for health promotion programs of the Department of Health and Human Services was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Janice D. Schakowsky[IL-9]
  • H.R.5856 (introduced April 22, 2008): To authorize major medical facility projects and major medical facility leases for the Department of Veterans Affairs for fiscal year 2009 and for other purposes was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Michael H. Michaud [ME-2]
  • H.R.5868 (introduced April 22, 2008): To amend title 10, United States Code, to provide for the retention of members of the Armed Forces on active service or in an active status who would otherwise be retired or separated for a combat-related disability, but who are still medically able to perform noncombat-related military occupational specialties or duties was referred to the House Committee on Armed Services. 
    Sponsor: Representative Stevan Pearce [NM-2]
  • H.R.5874 (introduced April 22, 2008): To amend the Public Health Service Act to provide for the establishment of a permanent Multiple Sclerosis National Surveillance System was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Michael C. Burgess [TX-26]
  • H.R.5881 (introduced April 23, 2008): To direct the President to enter into an arrangement with the National Academy of Sciences to evaluate certain Federal rules and regulations for potentially harmful impacts on public health, air quality, water quality, plant and animal wildlife, global climate, or the environment; and to direct Federal departments and agencies to create plans to reverse those impacts that are determined to be harmful by the National Academy of Sciences was referred to the Committee on Science and Technology, and in addition to the Committees on Transportation and Infrastructure, Natural Resources, Agriculture, and Energy and Commerce, 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 Barbara Lee [CA-9]
  • S.2877 (introduced April 17, 2008): A bill to improve and enhance research and programs on cancer survivorship and for other purposes was referred to the Committee on Health, Education, Labor, and Pensions. 
    Sponsor: Senator Hillary Rodham Clinton [NY]
  • S.2889 (introduced April 17, 2008): A bill to amend title 38, United States Code, to improve veterans' health care benefits, and for other purposes was referred to the Committee on Veterans' Affairs. 
    Sponsor: Senator Daniel K. Akaka [HI]

Hill Hearings

  • The Senate Veterans Affairs Committee will hold a hearing on May 7, 2008, to examine pending benefits legislation. 
  • The Senate Veterans Affairs Committee will hold a hearing on May 21, 2008, to examine pending health care legislation.

Meetings / Conferences


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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