FEDERAL HEALTH UPDATE
Feb 13, 2009

Produced by Kate Connelly Theroux in collaboration with the Institute of Federal Health Care (IFHC)

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Congressional Schedule
  • On Feb. 11, 2009, the Senate confirmed William J. Lynn, III, of Virginia, to be Deputy Secretary of Defense.
  • According to news reports, on Feb. 11, 2009, the House and Senate reached a tentative compromise on a $789.5 billion economic stimulus package.  Among the provisions, the compromise stimulus package would:
    • Provide federal subsidies for health insurance under COBRA that would cover 60 percent of the cost of premiums for as long as nine months and impose income eligibility limits for the subsidies;
    • Provide $19 billion for health care information technology, offering bonuses of $44,000 to $64,000 for physicians and as much as $11 million for hospitals for the implementation of electronic health records; physicians and hospitals must implement EHRs by 2014 or face the loss of Medicare reimbursements;
    • Distribute 65 percent of $87 billion in additional federal funds for state Medicaid programs under the current formula and distribute the remainder based on growth in unemployment rates in states;
    • Provide $10 billion to NIH for biomedical research; and
    • Provide $1.1 billion for research to compare the effectiveness of medications and medical devices.

Military Health Care News

  • TRICARE Management Activity announced a new TRICARE provider fee schedule for medical services and procedures for Panama. TRICARE officials expect the new fee schedule to better reflect actual medical costs. There are no changes in payments for laboratory, radiology, and pathology services and procedures.

    TRICARE Standard deductibles and cost-shares will not change for beneficiaries in Panama under the new fee schedule. Annual out-of-pocket caps for active-duty family members will remain at $1,000 and $3,000 for retirees and their eligible family members.

    The new reimbursement rates, which went into effect Feb. 1, 2009, were implemented as a cost control measure by using a country-specific index factor to account for variations in the cost of living and exchange rates for different countries.

    In November 2008 TRICARE beneficiaries and providers in Panama who filed TRICARE claims during the past two years received letters from TRICARE Management Activity (TMA) notifying them of the fee schedule change.

  • As part of a continuing effort to keep beneficiaries informed, TRICARE has added a news podcast to its Web site at http://www.tricare.mil. The TRICARE Beneficiary Bulletin provides the latest news about benefits every week in a quick, easy-to-read format.  The debut podcast contains updates on TRICARE Reserve Select and directs listeners to other useful online information sources.

    The Beneficiary Bulletin features quick tips to promote a healthy lifestyle, news of other military health programs and news on upcoming changes to the TRICARE benefit. 

  • HMS announced that it has been awarded cost containment contracts from Neighborhood Health Providers and Optima Health, a Sentara service — adding more than 200,000 Medicaid lives to its managed care portfolio. HMS will provide these services to Neighborhood Health Providers, LLC in New York, and to Optima Health Plan in Virginia.

    HMS will identify health insurance coverage not previously known for its Medicaid members, including commercial insurance and TRICARE, and then bill the liable third parties. In addition, HMS will assist Optima in identifying any member of its commercial population who has primary Medicare coverage, and facilitate the recovery of claims from Medicare.

  • TRICARE’s regional offices and managed care contractors were among the exhibitors at the 2009 Autism Conference Feb. 6-8 in Jacksonville, Fla. Their mission was to educate attendees about the TRICARE Autism Demonstration Project.

    Representatives from TRICARE’s managed care support contractors were available to talk about the demonstration project and enroll qualified providers. Eligible beneficiaries attending from across the country also learned how they can participate in the demonstration. 

    Sponsored by the Association for Behavior Analysis International, the 2009 conference was a three-day, single-track event that included expert panel sessions and invited presenters from around the world. 

    The Department of Defense autism services demonstration, which is part of TRICARE’s extended care health option (ECHO) benefit, is designed to increase access to applied behavior analysis (ABA) therapy for eligible TRICARE beneficiaries by allowing reimbursement for ABA therapy delivered by paraprofessional providers (tutors) employed and supervised by board certified behavior analysts and board certified assistant behavior analysts. 

    As of January 2009, there were nearly 1,000 supervisors and tutors nationwide to provide services to beneficiaries enrolled in the autism services demonstration project. Approximately 8,500 TRICARE beneficiaries are currently eligible for services. 

  • The chairman of the Joint Chiefs of Staff emphasized the importance of de-stigmatizing mental-health care for returning war veterans Feb. 9 as he cut the ribbon on a newly renovated facility at Fort Drum, N.Y., designed to improve that care.

    Navy Adm. Mike Mullen, paying his first visit to the home of the 10th Mountain Division, presided at the official opening a new, state-of-the-art, mental health facility.

    Speaking earlier in the day at town hall sessions with junior soldiers and family readiness group leaders, Mullen said the military needs to do a better job of encouraging people who need it to seek mental health care services.

    Mullen cited disturbing suicide rates in the Army, and urged soldiers to “take care of each other” and recognize symptoms of post-traumatic stress and other difficulties. He also urged spouses to be on the lookout for problems. “We have to have every sensor out,” he said.

    Families can experience secondary signs of post-traumatic stress, he said, with accompanying depression, sleeplessness and fear.

    The big hurdle, Mullen said, is getting people who need it to seek care without fear that it will damage their reputation or military career.

    Fort Drum’s new Wilcox Center was renovated to provide such care in a modern, state-of-the-art facility. A two-year renovation added 2,000 square feet to the World War II-era facilities it replaced, increasing its overall size to more than 28,000 square feet.

    The center includes more space for the post’s behavioral health department, offering more than 70 new office spaces, three reception areas and multiple group meeting rooms and video tele-psychiatry offices.

  • On Jan. 16, 2009, the Naval Center for Combat Operational Stress Control (NCCOSC) opened at Naval Medical Center San Diego.  The new Navy program is dedicated to restoring, protecting and building the mental health of sailors, Marines and their families.

    The major focus of the NCCOSC is to promote the best practices in diagnosis and treatment of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), conditions that have become synonymous with the unique demands placed on the armed services fighting in Iraq and Afghanistan.  The center identifies and incorporates into training the psychological resilience factors shown to help prevent stress injuries and to promote force readiness.  Resources to aid families in adjusting to deployments — as well as to assist in coping with problems that might arise after a service member’s return — are also emphasized.

    According to a Rand Study released in April 2008, nearly 20 percent of combat troops who have served in Iraq or Afghanistan have PTSD or a major depressive disorder. About 300,000 have experienced a probable TBI.  http://www.health.mil/Press/Release.aspx?ID=544

  • The Department of Defense announced that Navy Rear Adm. (lower half) Matthew L. Nathan has been nominated for appointment to the rank of rear admiral. Nathan is currently serving as commander, Navy Medicine Capital Area, and commander, National Naval Medical Center, Bethesda, Md.
  • On Feb. 12, 2009, TRICARE Management Activity (TMA) announced that Pradeep G. Gidwani was appointed director of TRICARE Regional Office (TRO) – North.  As the regional director, he is responsible for the management and performance of TRICARE contracts that serve more than 3.1 million beneficiaries across 24 states and the District of Columbia.

    Prior to joining the Senior Executive Service as the Deputy Chief of Business Operations at TMA, Gidwani served as the chief of staff for TMA.  His career also included other key TMA, Army and Department of Defense positions. He retired from the Army after serving more than 20 years as a Medical Service Corps officer.

    Like TRICARE’s other two regional directors, Gidwani is responsible for oversight of all health care delivery activities within his region, including management of the health care support contracts. Directors are also responsible for providing support to the military treatment facility commanders in the region, sustaining quality care and improving customer satisfaction across the TRICARE system.  http://www.tricare.mil/Pressroom/news.aspx?fid=504 

      

Veterans Health Care News  

  • The Department of Veterans Affairs (VA) announced it will implement a special training campaign on safety—called a “Step-Up” – from March 8 to 14 at all medical centers and outpatient clinics to ensure VA staff follow the highest standards for patient safety.

    The nationwide Step-Up is the culmination of a VA education program to implement stronger procedures and better accountability at VA health care facilities.  The training was triggered by VA inspections that found reprocessing of endoscopic equipment did not follow the manufacturer’s exact instructions at two VA medical centers.  The facilities—located in Murfreesboro, Tenn., and Augusta, Ga.—have already taken corrective action.

    VA officials are not aware of any patients’ having been harmed by improperly reprocessed equipment.  Although risks are small, the department is being “very conservative” and notifying patients who might have been treated by the affected equipment.

    Normal activities will continue during the Step-Up at all VA facilities, but with extra emphasis on safety and proper processing protocols.  Specific efforts will include retraining on reprocessing endoscopes, establishment of easily tracked accountability for instrument processing, and training on standard operating procedures by facility leadership.

    Patient appointments should not be affected, but individual facilities will notify patients if schedule changes are necessary.

  • Illinois Gov. Pat Quinn named Dan Grant to head the state's Department of Veterans Affairs.

    Grant, an Iraq War Veteran, replaces the post vacated by Tammy Duckworth who has been nominated by President Obama to be an assistant secretary at the federal Department of Veterans Affairs.  Dan Grant is a West Point graduate and also a former senior adviser to Pat Quinn.

  • The Department of Veterans Affairs (VA) announced it discovered a contractor providing medical transcription services who was not following VA rules for protecting medical information during a routine inspection.  

    Although there is no evidence that any patient information was disclosed as a result of the violation, VA has suspended the contractor from receiving any sensitive information until the contractor guarantees compliance with VA’s standards for information technology (IT) security.  

    The issue involves a contractor whose employees create written transcripts of recordings made by health care professionals while performing physical examinations, reporting on surgeries and taking patients’ histories.  VA officials found the contractor’s employees used computers that do not adhere to government policy on security.  

Health Care News

  • The U.S. Food and Drug Administration (FDA) released data gathered by a consortium focused on the genetics associated with drug-induced serious skin rashes, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, and that can help better predict an individual’s risk of developing these reactions.  This information provides health care professionals a better look into the genetic basis of certain types of adverse drug events.

    Both skin conditions appear as allergic-like skin reactions associated with blistering and peeling, and are considered life-threatening. Medications causing these serious allergic reactions should be discontinued; and if such signs and symptoms are not quickly recognized, these reactions can be fatal.

    The SAEC is a nonprofit partnership of pharmaceutical companies, the Wellcome Trust and academic institutions focused on research relating to the genetics of drug-induced serious adverse events. The samples from the initial serious skin rash cases and matched controls were collected by GlaxoSmithKline plc, London, U.K., and donated to the consortium for this research.

    By pooling these samples, the SAEC has identified numerous genetic associations that may contribute to an individual’s risk of developing serious drug-induced skin reactions. The data was compiled and analyzed just 16 months after the consortium was launched.

    The consortium will publish its initial research results later this year.

    Researchers who agree to a data-use agreement can obtain free access to the data to generate custom data inquiries and obtain immediate results on the genetic basis of adverse drug events.

  • Adults aged 18 to 25 currently using pain relievers for non-medical reasons increased from 4.1 percent in 2002 to 4.6 percent in 2007, according to a report based on a series of nationwide surveys. However, this report shows encouraging findings among youths aged 12 to 17 in that non-medical use of pain relievers in the past month had declined from 3.2 percent in 2002 to 2.7 percent in 2007. 

    The report, released by the Substance Abuse and Mental Health Services Administration (SAMHSA), says 1.5 million of these young adults used prescription pain relievers for non-medical purposes in the past month in 2007.

    Overall, 5.2 million people aged 12 years or older reported using prescription pain relievers non-medically in the past month in 2007.

    Trends in Nonmedical Use of Prescription Pain Relievers: 2002-2007 highlights non-medical use of pain relievers in the past month among persons aged 12 or older.

    Other findings include:

    • Among youths aged 12 to 17, nonmedical use of pain relievers in the past month declined from 3.2 percent in 2002 to 2.7 percent in 2007.
    • Use among adults aged 26 or older increased from 1.3 percent to 1.6 percent; and
    • The rate of use among males aged 12 or older increased from 2.0 percent in 2002 to 2.6 percent in 2007 but did not change significantly for comparably aged females.   

    The report is drawn from SAMHSA’s 2002 through 2007 National Surveys on Drug Use and Health (NSDUH) which collected data from a total sample of approximately 405,000 persons representative of the United States civilian, non-institutionalized population aged 12 or older. 

  • The first U.S. case of Marburg hemorrhagic fever has been confirmed in Colorado, and authorities say the patient — who contracted the rare illness while traveling in Uganda — has since recovered.

    The disease, caused by a virus indigenous to Africa, spreads through contact with infected animals or the bodily fluids of infected humans. According to the Centers for Disease Control and Prevention (CDC), no previous cases have been reported in the United States.

    The patient had traveled to Uganda, visited a python cave in Maramagambo Forest in Queen Elizabeth Park and encountered fruit bats, which can carry the Marburg virus. The Ugandan government closed the cave after a tourist from the Netherlands died from Marburg in July.

    The patient was treated at Lutheran Medical Center in January 2008 and sought follow-up care in July, after learning of the tourist's death. The patient recovered and his or her identity wasn't disclosed.

    Identifying the virus and how a patient contracted it can be difficult. It often depends on the quality of the sample being tested and the timing; samples taken early in the patient's illness makes identification easier.

    Marburg hemorrhagic fever is extremely rare. The CDC's Web site counts fewer than 500 confirmed cases since the virus was first recognized in 1967. More than 80 percent of the known cases are fatal.

    It has an incubation period of 5 to 10 days. The first symptoms are fever, chills and headaches, but symptoms worsen significantly after the fifth day of illness.

  • The U.S. Department of Health and Human Services' Health Resources and Services Administration has launched an online repository of information and resources about the healthcare workforce.

    The Health Workforce Information Center, operated by the University of North Dakota School of Medicine and Health Sciences, provides clinicians, educators, researchers and policymakers with the latest information on: health workforce programs and funding sources; workforce data, research and policy; educational opportunities and models; and news and events.

    The Web site is intended to quickly provide decisionmakers with the tools necessary to make tough choices and allocate resources in the face of a national shortage of physicians and other health care workers.

  • The Office of Special Masters of the U.S. Court of Federal Claims has rejected claims that either the measles/mumps/rubella vaccine or thimerosal in vaccines caused children's autism.

    Known as the vaccine court, it administers a system that has overseen all claims for compensation due to injury from vaccinations since 1988.

    The ruling is a major setback for the more than 5,000 cases in which families claim that the MMR vaccine, either alone or due to the mercury-based thimerosal preservative in the vaccine, caused a child's autism.

    Lawyers for the families and Department of Health and Human Services (the defendant in the suit) agreed to argue three test cases.  In these cases, the vaccine court agreed to decide whether there was sufficient evidence to blame vaccines for autism — and whether to pay damages to the families.

    The decision, in all three cases, is no. The court formally rejected arguments that either the MMR vaccine or thimerosal caused the children's autism.

Reserve/Guard
  • No new information is available this week. As of Feb. 4, 2009, the total number of Guard and Reserve currently on active duty is 123,939.  The totals for each service are Army National Guard and Army Reserve 94,231; Navy Reserve, 6,147; Air National Guard and Air Force Reserve, 15,411; Marine Corps Reserve, 7,413; and the Coast Guard Reserve, 737.  www.defenselink.mil

Reports/Policies

  • The Institute of medicine (IOM) published “Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System. Interim Report,” on Feb. 10, 2009.  This interim report outlines the Committee on Effectiveness of National Biosurveillance Systems efforts to evaluate the Department of Homeland security’s BioWatch program, including a comparison of costs and benefits for the current generation and planned next generation of BioWatch technology; the costs and benefits of an enhanced national surveillance system that relies on U.S. hospitals and the U.S. public health system; and the effectiveness of this approach compared to that of the current BioWatch program. The final report is due in June 2009.  http://www.iom.edu/CMS/3740/58811/62347.aspx
  • The Congressional Budget Office (CBO) published “Expanding Health Insurance Coverage and Controlling Costs for Health Care,” on Feb. 10, 2009.  This is the written testimony of Douglas W. Elmendorf, CBO director, before the Senate Committee on the Budget examining the opportunities and challenges of expanding health insurance coverage to more Americans, and making the health care system more efficient. http://www.cbo.gov/ftpdocs/99xx/doc9982/02-10-HealthVolumes_Testimony.pdf
  • The AAMC published "Report on Medical School Faculty Salaries, 2007-2008." The report presents the total compensation attributable to teaching, patient care or research for more than 85,000 full-time medical school faculty.  http://www.aamc.org/publications

Legislation

  • H.R.914 (introduced Feb. 9, 2009): To amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Michael C. Burgess [TX-26] 
  • H.R.916 (introduced Feb. 9, 2009): To amend the Public Health Service Act to provide grants for the training of graduate medical residents in preventive medicine and public health was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Gene Green [TX-29]
  • H.R.917 (introduced Feb. 9, 2009): To increase the health benefits of dependents of members of the Armed Forces who die because of a combat-related injury was referred to the House Committee on Armed Services. 
    Sponsor: Representative Brett Guthrie [KY-2]
  • H.R.919 (introduced Feb. 9, 2009): To amend title 38, United States Code, to enhance the capacity of the Department of Veterans Affairs to recruit and retain nurses and other critical health-care professionals and for other purposes was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Eddie Bernice Johnson [TX-30].
  • H.R.936 (introduced Feb. 10, 2009): To ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Edolphus Towns [NY-10]
  • H.R.944 (introduced Feb. 10, 2009): To amend title 38, United States Code, to provide improved benefits for veterans who are former prisoners of war was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Gus M. Bilirakis [FL-9]
  • H.R.949 (introduced Feb. 10, 2009): To amend title 38, United States Code, to improve the collective bargaining rights and procedures for review of adverse actions of certain employees of the Department of Veterans Affairs, and for other purposes was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Bob Filner [CA-51]
  • H.R.950 (introduced Feb. 10, 2009): To amend chapter 33 of title 38, United States Code, to increase educational assistance for certain veterans pursuing a program of education offered through distance learning was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Bob Filner [CA-51].
  • H.R.952 (introduced Feb. 10, 2009): To amend title 38, United States Code, to clarify the meaning of "combat with the enemy" for purposes of service-connection of disabilities was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative John J. Hall [NY-19]
  • H.R.953 (introduced Feb. 10, 2009): To amend the Internal Revenue Code of 1986 to provide for a deduction for travel expenses to medical centers of the Department of Veterans Affairs in connection with examinations or treatments relating to service-connected disabilities was referred to the House Committee on Ways and Means. 
    Sponsor: Representative Dean Heller [NV-2]
  • H.R.956 (introduced Feb. 10, 2009): To expand the number of individuals and families with health insurance coverage, and for other purposes was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, and Rules, 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 Marcy Kaptur [OH-9].
  • H.R.972 (introduced Feb. 10, 2009): To amend title 10, United States Code, to eliminate the requirement that certain former members of the reserve components of the Armed Forces be at least 60 years of age in order to be eligible to receive health care benefits was referred to the House Committee on Armed Services. 
    Sponsor: Representative Joe Wilson [SC-2]
  • H.R.978 (introduced Feb. 11, 2009): To recognize and clarify the authority of the States to regulate intrastate helicopter medical services pursuant to their authority over public health planning and protection, patient safety and protection, emergency medical services, the quality and coordination of medical care, and the practice of medicine within their jurisdictions was referred to the Committee on Transportation and Infrastructure, and in addition to the Committee on 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 Jason Altmire [PA-4]
  • H.R.988 (introduced Feb. 11, 2009): To amend the Public Health Service Act to provide for the participation of physical therapists in the National Health Service Corps Loan Repayment Program, and for other purposes was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Marion Berry [AR-1]
  • H.R.995 (introduced Feb. 11, 2009): To amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for annual screening mammography for women 40 years of age or older and for such screening and annual magnetic resonance imaging for women at high risk for breast cancer if the coverage or plans include coverage for diagnostic mammography for women 40 years of age or older was Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, 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 Jerrold Nadler [NY-8]
  • H.R.1004 (introduced Feb.11, 2009): To amend title 38, United States Code, to provide an enhanced funding process to ensure an adequate level of funding for veterans health care programs of the Department of Veterans Affairs, to establish standards of access to care for veterans seeking health care from the Department of Veterans Affairs, and for other purposes was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Christopher H. Smith [NJ-4]
  • S.391 (introduced Feb. 5, 2009): A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away was referred to the Committee on Finance. 
    Sponsor: Senator Ron Wyden [OR]
  • S.402 (introduced Feb. 10, 2009): A bill to improve the lives of our Nation's veterans and their families and provide them with the opportunity to achieve the American dream was referred to the Committee on Veterans' Affairs. 
    Sponsor: Senator Olympia J. Snowe [ME]
  • S.404 (introduced Feb. 10, 2009): A bill to amend title 38, United States Code, to expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility, and for other purposes was referred to the Committee on Veterans' Affairs. 
    Sponsor: Senator Daniel K. Akaka [HI]
  • S.407 (introduced Feb. 10, 2009): A bill to increase, effective as of December 1, 2009, the rates of compensation for veterans with service-connected disabilities and the rates of dependency and indemnity compensation for the survivors of certain disabled veterans, and for other purposes was referred to the Committee on Veterans' Affairs. 
    Sponsor: Senator Daniel K. Akaka [HI]
  • S.408 (introduced Feb. 10, 2009): A bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children was referred to the Committee on Health, Education, Labor, and Pensions. 
    Sponsor: Senator Daniel K. Inouye [HI]

Hill Hearings

  • The House and Senate Veterans Affairs Committees will hold a joint hearing on Feb. 24, 2009, to hear the legislative presentation of the Disabled American Veterans.
  • The House Veterans Affairs Committee will hold a hearing on Feb. 25, 2009, to examine document tampering and mishandling at the U.S. Department of Veterans Affairs.
  • The House Veterans Affairs Committee will hold a hearing on Feb. 26, 2009, to hear VA’s update on short and long-term strategies for implementing new G.I. bill requirements.
  • The House Veterans Affairs Committee will hold a hearing on March 5 and 12, 2009, to hear the legislative presentation of veterans’ service organizations.
  • The House Veterans Affairs Committee will hold a hearing on March 18, 2009, to hear the legislative presentation of the Veterans of Foreign Wars.
Meetings / Conferences

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