FEDERAL HEALTH UPDATE
June 26, 2009Produced by Kate Connelly Theroux in collaboration with the Institute of Federal Health Care (IFHC) To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. Sponsored by
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Executive and Congressional News
For details on this legislation,
please visit http://www.whitehouse.gov/the_
U.S. pharmaceutical companies proposed to forgo $80 billion in revenue over a decade, largely by covering more of the cost of brand-name prescription drugs under the federal government program for seniors. It will extend discounts on prescription drugs to seniors, who fall in Medicare's "doughnut hole." Under the pharmaceutical deal, drug companies would pay half of the cost of a prescription when it isn't covered under a gap in the Medicare Part D prescription benefit. In the current system, Medicare beneficiaries are responsible for paying drugs' full price once they exceed $2,700 and up to $6,154 per year. The agreement is the latest in a
series of cost-cutting deals the government has made with insurance
companies, doctors, hospitals and medical-device manufacturers as it
seeks to find ways to pay for proposed changes to the health-care system,
including expanding insurance coverage to 46 million uninsured Americans. http://www.whitehouse.gov/the_
Leaders of three committees discussed details of the 852-page draft bill, which includes numerous details on how to provide coverage to those currently uninsured but relatively few details on how to pay for the expanded coverage. The panels — which include the House Ways and Means Committee, the House Energy and Commerce Committee and the House Education and Labor Committee — say their unified approach will spur efforts to pass the bill. The plan would provide subsidies on a sliding scale for families up to 400 percent of the poverty level, according to the outline. Under current poverty guidelines, individuals with incomes up to $43,000 would be eligible, and families of four with incomes up to $88,000 would be eligible. Those credits could be used to purchase insurance through a new government-run "exchange" that includes both private insurance and government plans. The House proposal includes a new "public option" as an addition to private plans and it would cap out-of-pocket costs to policy-holders and prohibit insurers from denying coverage due to pre-existing conditions. Employers of all sizes would be affected by the House health-care blueprint. The plan would require firms to offer health insurance to their employees, or pay a fee of 8 percent of payroll, according to the outline. To avoid the fee, employer-sponsored health plans must meet minimum benefit and contribution requirements. House Democrats propose that firms contribute a minimum of 72.5 percent of premiums for individual employees, and 65 percent for family plans. At first, employees of large firms wouldn't be eligible to purchase coverage through the new health-care exchange. But eventually, the option would be available to all employers for covering employees, according to the House draft. The bill also would create a tax credit for small businesses to help them afford health benefits if they provide them. According to an outline of the Democratic proposal, small businesses would also see an exemption from the mandate that employers provide insurance, but the bill itself doesn't state which business would qualify for the exemption. Individuals would be required by law to purchase health coverage, or pay a penalty of two percent of adjusted gross income above an unspecified level. The fee could be waived in cases of hardship. The House plan proposes that the public option be financed only by its premiums — not requiring additional government funding — and would be subject to the same regulatory requirements as private plans. The plan would pay doctors and hospitals using Medicare rates and significantly expand Medicaid to cover individuals and families with incomes up to 133 percent of the poverty level. Another provision would require pharmaceutical
companies to begin paying a rebate to the federal government for drugs
purchased by low-income individuals under the Medicare prescription
drug benefit. A similar rebate already exists under the Medicaid program
and generates billions of dollars each year for states, but drug companies
were exempted from the rebate in the 2003 law creating the Medicare
drug benefit. http://online.wsj.com/article/ Military Health Care News
Eighty-one percent of beneficiaries who participated in the survey said they were likely to use BWE again, and 78 percent said they were likely to recommend the Web site to other TRICARE beneficiaries. BWE allows beneficiaries to enroll or disenroll from TRICARE Prime or TRICARE Prime Remote, request enrollment cards, update personal information, choose or change their primary care manager (PCM) and update information regarding other health insurance online from the convenience of their home or office. Retirees can pay or set up an electronic funds transfer for their first quarter or annual enrollment. The BWE Web site has been available to TRICARE Prime and TRICARE Prime Remote beneficiaries in the United States including Hawaii and Alaska since 2007. The service is available from any computer and makes submitting enrollment actions convenient and easy. Surveyed respondents said the top two reasons for using the BWE portal are to update personal contact information followed closely by selection of a new PCM. Some additional highlights of beneficiary feedback include:
The Beneficiary Web Enrollment Web
portal is hosted by the Defense Manpower Data Center and can be found
using most Web search engines using the term “TRICARE Web Enrollment”
or can be accessed directly at https://www.dmdc.osd.mil/appj/
In its report on the H.R. 2647, the House Armed Services Committee said it shifted $1.1 billion, or 85 percent of the agency's total $1.3 billion IT budget, to the secretary's office because "a higher level of leadership oversight is required to ensure that existing problems with the department's health information management/information technology programs are addressed and to ensure better coordination among other department information technology efforts." The report language amounted to a vote of no confidence in the ability of MHS to manage its own IT affairs, particularly projects to develop a new electronic health record system compatible with a system operated by the Veterans Affairs Department, said a knowledgeable congressional staffer who does not work for the committee. The staffer said Deputy Secretary of Defense William Lynn would oversee MHS technology programs. Moving the money to the secretary's office may be a way for Congress to find specific individuals in the Defense Department to hold accountable for IT development, This April, President Obama called on Defense and the Veterans Affairs departments to develop a "unified lifetime electronic health record for members of our armed services that will contain their administrative and medical information — from the day they first enlist to the day that they are laid to rest." The MHS started work in September 2008 on an enterprise architecture for Defense and VA, which Charles Campbell, chief information officer at MHS, estimated would cost less than $1 billion. In April, top MHS officials, including Tommy Morris, acting director of the Office of Deputy Assistant Secretary of Defense for Force Health Protection and Readiness Programs, presented plans for the new electronic health record system at a joint hearing of two House Armed Services subcommittees. Morris told the hearing that the new electronic health record system would be developed using open standards, which would allow VA and the Indian Health Service to help build components of the system. Lt. Gen. Eric Schoomaker, the Army's surgeon general, told the panel that while MHS may have developed a plan for a new system, it did not have a strategy that involves all three services. MHS was supposed to provide the two
subcommittees with a detailed plan for the electronic health record
system. When it did not, the HASC decided to move control over to the
Office of the Secretary of Defense. http://www.nextgov.com/
eCareConnect is a free service that sends weekly e-mails customized to the stage of the beneficiary’s pregnancy or parenthood. Since 2006 more than 35,000 beneficiaries have signed up for this e-mail-based communication service currently available at 30 military hospitals. Hospital staff members can now communicate “need-to-know” information to all of these patients and connect with them every week. Beneficiaries can sign up to take advantage of the valuable information and military hospital-specific updates included in the weekly e-mails. Beneficiaries whose hospital is not covered can enroll in the Department of Defense Standard Version. For more information about TRICARE’s
maternity care go to http://tricare.mil/mybenefit/
Veterans Health Care News
Thomas C. Smith III, director of the Central Texas Veterans Health Care System and Col. Casper P. Jones III, commander of Carl R. Darnall Army Medical Center at Fort Hood, signed a charter letter to form the Central Texas Executive Council of Central Texas Veterans Health Care System and Carl R. Darnall Army Medical Center. The VA and Darnall Army Medical Center have similar missions but their clients are at different stages in life. Darnall treats the active-duty soldier, while the VA cares for the veteran. In the past, the two have shared and worked on joint ventures, collaborations and referrals. The biggest collaboration will be a VA Community Based Outpatient Clinic in Fort Hood’s new hospital, which received funding earlier this year. In the future, it is hoped the VA and Darnall will have the capabilities to make referrals into each other’s facilities. The Waco VA Center of Excellence for Research on Returning War Veterans will be working with Fort Hood soldiers, including setting up its mobile MRI on the base. These are not the first collaborations between the VA and Darnall. The VA has had a laundry contract for several years with Darnall. The laundry is done in Waco at a significant cost savings to the Army. Several years ago, Darnall and the VA took advantage of the VA/Department of Defense Joint Incentive Fund to renovate space at the Temple VA where sleep studies could be performed. Now, Darnall and the VA are looking at expanding the sleep study program, including increasing the size from 6 beds to 10, Smith said. The VA now performs separation and retirement physicals at Fort Hood, which meets the needs of both the Army and VA. Fort Hood’s blood center can supply the VA with red blood cells when needed, at a reduced cost, he said. In addition, there are mental health
care providers from the VA at Fort Hood’s Resilience and Restoration
Center and VA liaisons working at the Warrior Transition Unit, both
helping transition soldiers into the VA system. http://www.tdtnews.com/story/
Effective immediately, all new IT programs and projects at VA must be implemented using the Project Management Accountability System (PMAS). PMAS is an incremental development approach that ensures frequent delivery of new functionality to customers, coupled with a rigorous management approach that halts programs that fail to meet delivery milestones. This new system will ensure early identification and correction of failing IT programs. With incremental development, a program must establish milestones to deliver new functionality to its customers in short increments of at most every six months. Under PMAS, a third missed customer delivery milestone will cause the program to be halted and re-planned. Before the program can restart, substantial changes must be instituted, including a re-evaluation of the need for the program and the program approach, replacement of the program manager, contractors and a portion of the government staff. An analysis of 282 ongoing development programs at VA has indicated that many of those programs exhibit at least one characteristic that could indicate a failing program — either significantly behind schedule, significantly over budget or showing deteriorating product release quality. To ensure that these programs do not continue on a path to potential failure, they will be paused within the next few weeks and required to create an incremental development plan with milestone commitments. The new program plan must be approved by the CIO, and the program managed under PMAS, before development on the program can restart. Over the next year, all IT development
programs within VA will be required to move to the Project Management
Accountability System. http://www1.va.gov/opa/
VA's "National Health Study for a New Generation of U.S. Veterans" will begin with 30,000 veterans deployed to OEF/OIF and 30,000 comparison veterans who were not deployed. The study will include veterans who served in each branch of service, representing active duty, Reserve, and National Guard members. Women will be over-sampled to make sure they are represented and will comprise 20 percent of the study, or 12,000 women. A combination of mail surveys, online surveys, telephone interviews, and in-person physical evaluations will be used to collect data from the veterans. The study will compare the deployed and non-deployed veterans in terms of chronic medical conditions, traumatic brain injury (TBI), post traumatic stress disorder (PTSD) and other psychological conditions, general health perceptions, reproductive health, pregnancy outcomes, functional status, use of health care, behavioral risk factors (smoking, drinking, seatbelt use, speeding, motorcycle helmet use, and sexual behavior), and VA disability compensation. VA has contracted with an independent veteran-owned research firm, HMS Technologies Inc., to collect the data. Health Care News
The new funds for CHIP were made available by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which was signed into law by President Barack Obama on February 4. CHIPRA provides additional funding that will help states and territories maintain existing CHIP enrollment and expand their programs. Of the $6 billion in new funding under CHIPRA, HHS has released more than $1 billion and expects to allocate the remainder to the states and territories by the end of September. CHIP provides health insurance for children of working families whose incomes are too high for traditional Medicaid, but too low for either employer-sponsored family plans or other private coverage. While CHIP is optional, each state and every territory operates a program. Similar to Medicaid, CHIP is jointly funded by states and the federal government. However, the federal government pays states a higher share of their CHIP costs than for their Medicaid programs. A list of funding by state for CHIP
programs can be viewed at: www.insurekidsnow.gov.
Beginning June12, 2009, nursing home surveys will be conducted with a sharpened focus on resident rights in key areas such as:
Currently, nearly 1.5 million individuals live in approximately 15,800 nursing homes on any given day, and about 3 million people will spend some time in a nursing home each year. The new guidance also calls on nursing homes to de-institutionalize their physical environments. The guidance highlights institutional practices that facilities should strive to eliminate including meals served on institutional trays and noise from overhead paging systems, alarms and large nursing stations. The guidance also makes clear that residents have the right to choices concerning their schedules — consistent with their interests, assessments and plans of care. Choice over schedules includes, but is not limited to, those matters that are important to the resident, such as daily waking, eating, bathing and going to bed at night. The facility should gather this information in order to be proactive in assisting residents to fulfill their choices. CMS inspects nursing homes periodically to ensure they meet the federal regulations requiring that each resident receive good quality care in a home that also provides good quality of life. CMS provides guidance, such as today’s release, to help surveyors interpret those regulations. The new guidance provides a substantial roadmap for environmental and culture change in nursing homes, while noting that some facilities are further along than others. As noted in the guidance: “many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them.” The guidance can be found at http://www.cms.hhs.gov/
The letter, which was coordinated by the AAMC, recommends
an appropriation of $235 million for the NHSC, a $111 million (89.5
percent) increase over FY 2008 and $65 million more than the President’s
proposed budget. In the correspondence, the associations note that while
the American Recovery and Reinvestment Act provided more federal support
for the NHSC, the agency, by its own calculation, “is short more than
30,000 health care professionals in meeting the needs of the nation's
underserved areas.”
Dr. Howard Koh was most recently the Harvey V. Fineberg professor of the Practice of Public Health, Associate Dean for Public Health Practice, and director of the Division of Public Health Practice at the Harvard School of Public Health (HSPH). At HSPH, he served as the principal investigator of multiple research grants related to community-based participatory research, cancer prevention, health disparities, tobacco control and emergency preparedness. He also served as director of the HSPH Center for Public Health Preparedness. Koh previously served as commissioner of Public Health for the Commonwealth of Massachusetts (1997-2003). Koh graduated from Yale College and
Yale University School of Medicine. He completed his postgraduate
training and chief residencies at Boston City Hospital and Massachusetts
General Hospital. He has earned board certification in internal medicine,
hematology, medical oncology and dermatology, as well as a Master of
Public Health degree.
Plan B was first approved in 1999 for prescription use only for women of all ages. Plan B is manufactured by Duramed Pharmaceuticals, Inc., of Cincinnati. In 2006, Plan B was approved for nonprescription use for women ages 18 and older. Plan B remained available as a prescription-only product for women ages 17 and under. The FDA's approval allows marketing of a prescription-only generic product for women ages 17 and under. No generic levonorgestrel product for emergency contraception can be approved for nonprescription use in women ages 18 and older until Aug. 24, 2009, when the marketing exclusivity held by Duramed for the nonprescription use expires. The generic levonorgestrel tablets 0.75 mg are made by Watson Laboratories Inc., based in Corona, Calif. Levonorgestrel can prevent pregnancy
after unprotected intercourse or a known or suspected contraceptive
failure. It is not effective in terminating an existing pregnancy and
does not protect against sexually transmitted diseases, including HIV
infection.
With this new technology for a recombinant influenza vaccine, a gene would be extracted from a flu virus and placed into an insect virus called baculovirus, which does not affect people and can multiply quickly to high levels in insect cells. The cells are purified to become a basic part of a human vaccine. Using this method, vaccine candidates, clinical investigational lots and commercial-scale vaccine production may be available faster than by using traditional vaccine production methods. Because the basic cells can be frozen and stored indefinitely, manufacturing large quantities of a vaccine is also faster using this recombinant technology. The new contract will be administered by the Office of Biomedical Advanced Research and Development Authority (BARDA) within HHS and will support Protein Sciences Corporation, Inc., in advanced development activities needed for potential Food and Drug Administration (FDA) approval to use this new technology for producing flu vaccines. If this new technology is demonstrated to be safe and effective and the FDA licenses the new technology for flu vaccines, the contract requires the company to establish domestic manufacturing capability to provide a finished vaccine within 12 weeks of pandemic onset and to produce at least 50 million doses of pandemic flu vaccine within six months of pandemic onset. The contract could be extended up
to five years at a total cost of approximately $147 million. http://www.hhs.gov/news/press/
The goal of the alliance is to strengthen and expand cooperation in a broad range of mutual interests, emphasizing basic and clinical cancer research, bioinformatics, data systems and informatics and transfer of technology. The countries also hope to develop competencies and training of researchers by sharing technology and expertise. In addition, the partners will work to enhance already existing cancer registries and execution of early phase clinical studies with cultural sensitivity. In 2006, cancer was estimated to be the second leading cause of death in Chile. Each year, 36,500 new cases are diagnosed. Cancer mortality rates for Chilean males are highest in stomach, lung and prostate cancers, while for Chilean females the highest mortality rates are in gallbladder, breast, and stomach cancers. The Republic of Chile joined four other Latin American countries and the United States in this unique collaboration, called the United States-Latin America Cancer Research Network, which will support high-quality cancer research and care in Latin America. This network is responsible for developing a comprehensive understanding of the burden of cancer and the current status of the research and care infrastructures in Latin America. In addition to Chile, the network includes Argentina, Brazil, Mexico, Uruguay, and the United States. The first collaborative pilot project of the United States-Latin America Cancer Research Network will focus on breast cancer because it is among the deadliest cancers in each of the five participating Latin American countries. The alliance will conduct research on those cancers that have the greatest impact on Latin America. For more information about NCI's
Office of Latin American Cancer Program Development, please visit www.cancer.gov/aboutnci/olacpd
The human microbiome is all the microorganisms that reside in or on the human body, as well as all their DNA, or genomes. Launched in 2007 as part of the NIH Common Fund's Roadmap for Medical Research, the Human Microbiome Project is a $140 million, five-year effort that will produce a resource for researchers who are seeking to use information about the microbiome to improve human health. In the new round of funding, the Human Microbiome Project will support the work of the large-scale DNA sequencing centers that participated in the initial phase of the project. These centers will work together to sequence at least 400 microbial genomes. Another approximately 500 microbial genomes are already completed or in sequencing pipelines and supported by individual NIH institutes and internationally funded projects. These data will then be used to characterize the microbial communities found in samples taken from healthy human volunteers. These samples are currently being collected by the Human Microbiome Project from five areas of the body: the digestive tract, the mouth, the skin, the nose and the vagina. In the first phases of the Human Microbiome Project, jumpstart funding was awarded to create a framework and data resources. Funding has also previously been awarded for the development of innovative technologies and computational tools, coordination of data analysis, and an examination of some of the ethical, legal and social implications of human microbiome research. To view the specific awards, please
visit http://www.nih.gov/news/ Reserve/Guard
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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 katetheroux@fedhealthinst.org. To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. To unsubscribe, please send an email to newsletter@fedhealthinst.org with UNSUBSCRIBE as the subject. Back issues availiable at Federal Health Update Archives. |
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