FEDERAL HEALTH UPDATE
July 24, 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
Before he took questions from reporters, President Obama shared stories of Americans who either have no access to health care or cannot afford health care to emphasize the need to reform the current system. He also reiterated his belief that reforming American’s health care system is the essential for the nation’s economic recovery. To view the full press conference,
please visit: http://www.whitehouse.gov/
The legislation includes a surtax of as much as 5.4 percent on the nation’s wealthiest households to pay for it. In addition, the legislation would require companies to provide health insurance or pay an 8 percent payroll tax to help pay for their coverage by the government plan. The bill prohibits insurance companies from establishing any lifetime or annual ceiling on benefits and limits companies from charging higher rates because of health status, gender or other reasons. Premiums would be allowed to vary only based on age, geography and family size. In addition, Medicare would be overhauled to reward the efficiency of health-care services, not the volume, as is the case now. The so-called “doughnut hole,” or coverage gap in the Medicare program that provides drugs to seniors, would be eliminated. The plan would cost about $1 trillion over 10 years and reduce the number of uninsured by roughly 37 million Americans, according to a preliminary analysis by the Congressional Budget Office. The legislation must now be voted on by the Energy and Commerce Committee, which began debate on July 17 but postponed further mark-up of the bill. Military Health Care News
The final rule implements section
701 of the John Warner National Defense Authorization Act for FY 2007,
Public Law 109-364. This legislation amended Title 10 of the United
States Code (U.S.C.), Chapter 55, Section 1079(a) by authorizing coverage
for forensic examinations following a sexual assault or domestic violence
for eligible beneficiaries. This rule is effective Aug. 17, 2009, and
applies to services provided on or after Oct. 17, 2006.
The purpose of the meeting is to
allow the panel to review and comment on recommendations made to the
director, TRICARE Management Activity, by the Pharmacy and Therapeutics
Committee regarding the Uniform Formulary.
The award represents the highest recognition given by the U.S. government to employers for their outstanding support of their employees who serve in the National Guard and Reserve. The 2009 recipients are:
A record 3,200 National Guard and Reserve members or their family members from across the country nominated their employers for the Freedom Award this year. A national selection board comprised of senior Defense officials and business leaders selected the recipients. The Freedom Award will be presented to these employers during a formal ceremony Sept. 17, 2009, at the Ronald Reagan Building and International Trade Center in Washington, D.C. The Freedom Award was instituted in 1996 under the auspices of the National Committee for Employer Support of the Guard and Reserve to recognize exceptional support from the employer community. More information about the Freedom
Award is available at http://www.FreedomAward.mil.
The article, published by Brooke Army Medical Center (BAMC) at Fort Sam Houston, Texas, is based on research evaluating the rate of eye injuries in OIF and OEF. Researchers sought to determine if education on the use of eye protection was related to a decrease in the rate of eye injuries. This study was based on data in the Joint Theater Trauma Registry (JTTR), which was established for the explicit purpose of collecting medical data on injuries in OIF and OEF. 3,276 service members, who were injured during March 2003 to September 2006, were included in the study. 605 service members reported that they had not been wearing eye protection; and 26 percent of them sustained an eye injury. 2,671 service members reported that they had been wearing eye protection; and 17 percent of them sustained an eye injury. After an intense education program
on eye protection, the rate and severity of eye injuries decreased in
service members who were wearing eye protection. This study demonstrates
that the military eye protection currently being used in OIF and OEF
resulted in significantly fewer injuries and less severe injuries. In
addition, it appeared that educational programs were successful in increasing
compliance with eye protection.
This annual survey is conducted by Hospitals and Health Networks magazine, the journal of the American Hospital Association. The survey measures the use of information technology at 1,314 hospitals nationwide for quality, customer service, public health and safety, business processes and workforce issues — the survey’s definition of “wired.” One of Madigan’s most cutting-edge capabilities was the launch of MiCare, the Military Health System’s pilot electronic personal health record. Beneficiaries who opt to join the MiCare program can take personal medical information from the MHS electronic medical record, AHLTA, and put the information into their own personal health record with the ability to control and own it. According to a Madigan official, about 500 patients at Madigan have participated in MiCare. Over the past year, Madigan installed
a wireless infrastructure for staff and health care providers enabling
them network and data access using their laptop and tablet personal
computers.
Munroe is the chief of Madigan’s Nurse Midwifery Service. She received the award primarily for the work she did integrating an evidence-based teamwork system called Team STEPPS (Team Strategies and Tools Enhance Performance and Patient Safety) into many of the medical units deployed to Iraq in 2008. The program optimizes patient outcomes by improving communication and other teamwork skills among health care professionals promoting a culture of safety. Team STEPPS has contributed to providing a better level of care for patients, Munroe said. In addition, Munroe has taken an active role increasing Madigan’s nurse midwifery services. Nurse midwives specialize in low-risk pregnancies and natural childbirth. The Anita Newcomb McGee Award honors the memory of Dr. McGee, who organized the Army Nurse Corps during the Spanish-American War. The award is sponsored yearly by the DAR. It is given to an active duty Army Nurse Corps officer, with the grade of captain or above in a career status and selected by Army Surgeon General as the “U.S. Army Nurse of the Year.” Munroe joins Col. Elizabeth Mittelstaedt,
the chief of Madigan’s Consolidated Education as the only other Anita
Newcomb McGee/“U.S. Army Nurse of the Year” recipient working at
Madigan.
The Web site is described as a one-stop clearinghouse for informative and educational resources related to the DHIMS program office, program operations and current and future initiatives. It employs a "user-friendly interface", which allows visitors to quickly access information about the history of electronic medical records (EHR); the policy that mandates a longitudinal EHR; DHIMS product information; product spotlights; and a press room complete with a DHIMS public briefings, archive photo gallery, news articles and press releases. The DHIMS Program Office is a part
of the Department of Defense, Office of Assistant Secretary of Defense
for Health Affairs. It provides information management and IT
solutions that capture, manage and share health care data for the military’s
electronic health record.
The three-year award calls for General
Dynamics Information Technology to provide instruction and consulting
services to internal organizations for MEDCOM’s director of strategy
and innovation. General Dynamics Information Technology will offer its
organizational capabilities, traditionally used with supply chain management,
to MEDCOM to achieve the mission success of promoting, sustaining and
enhancing soldier health. http://washingtontechnology.
The Department of Defense (DoD) awarded the $2.8 billion annual TRICARE contract for the North Region to Aetna Inc., effective April 1. The almost six-year contract to provide care to more than 3 million military beneficiaries, retirees and dependents in 23 states and the District of Columbia is worth almost $17 billion. Health Net Federal Services, the company’s military health care division, alleges Aetna had an unfair advantage in the bidding process because the DoD posted Health Net’s bid price on the Internet. Health Net complained about the breach but was told following an investigation that federal officials don’t believe it affected the procurement process. The protest was filed Monday because Health Net had 10 days to file a complaint. A meeting on the merits of the decision itself is scheduled between the company and federal officials July 23, 2009. Health Net could file another protest
on those grounds. The deadline is Tuesday.
A news release from Humana Inc. said the protest cites “discrepancies between the award criteria and procedures prescribed in the request for proposals issued by the Department of Defense (DoD) and those that appear to have been used by the DoD in making its contractor selection.” The TRICARE contract was awarded last week to UnitedHealth Military & Veterans Services, a division of Minnetonka, Minn.-based UnitedHealth Group Inc., a new participant in the TRICARE program. The contract is valued at as much as $21.8 billion, according to the DoD. It consists of a 10-month transition period, which was set to begin on Sept. 1, and five one-year options. The amount of the initial award is $3.7 billion, which include the transition period and a one-year option period. Humana Military has served as a TRICARE contractor since 1996. Under its existing TRICARE contract, Humana Military provides managed care services for about 3 million active-duty soldiers, their dependents and retired service members and their families in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. That contract is set to expire March 31, 2010. The GAO has up to 100 days from the date the protest is filed to make a determination regarding the contract award. The agency could recommend that TRICARE rebid the contract because it did not follow statutes and regulations related to the award; it could dismiss Humana’s claim for procedural reasons; or it could determine that TRICARE followed the proper guidelines in awarding the contract to United Military. In rare cases, the agency might recommend that the contract be given to one of the losing bidders. Veterans Health Care News
VA Secretary Eric Shinseki ordered a review of the department’s 300 IT projects and implementation of the Project Management Accountability System (PMAS), designed to increase the department’s accountability for IT projects. Each of the 45 projects identified will be temporarily halted. No further development will occur and expenditures will be minimized. A new project plan that meets the requirements of PMAS must be created by the project manager and approved by VA’s assistant secretary for information and technology before resuming. PMAS is a management protocol that requires projects to establish milestones to deliver new functionality to its customers. Failure to meet set deadlines indicates a problem within the project. Under PMAS, a third missed customer delivery milestone is cause for the project to be halted and re-planned. PMAS, in conjunction with the analytical tools available through the IT Dashboard, will ensure early identification and correction of problematic IT projects. The IT Dashboard, launched last month, is a one-stop clearinghouse of information, allowing the American people to track federal information technology initiatives and hold the government accountable for progress and results. Over the next year, all IT projects at VA will be required to move to PMAS. For a complete list of all projects
temporarily halted under PMAS, please visit http://www1.va.gov/opa/
Before ordering an HIV test, VA clinical providers will no longer be required to have patients sign a form, either in hard copy or via iMed Consent electronic pads. However, clinicians should obtain verbal consent from patients for HIV testing and document consent in their medical record, as outlined in VHA Handbook 1004.1 (Informed Consent for Clinical Treatments and Procedures). Before obtaining verbal consent for HIV testing, clinicians should provide patients with appropriate educational materials geared to their specific needs, rather than the previously required pretest counseling information on VA form 10-0121d. A selection of educational materials is now available on the VA HIV Web site. The VA will provide more details on specific procedures to be followed when considering HIV testing and before the new rule goes into effect, on Aug. 17, 2009. The new policy is in keeping with a wider strategy to conform VA policy and practice to guidelines outlined in the 2006 recommendations of the Centers for Disease Control and Prevention (CDC) on HIV testing in healthcare settings, as well as to other recommended public health practices. The 2006 CDC guidelines recommend offering HIV testing to all patients as part of routine healthcare rather than just to those patients at known risk for HIV infection, without requiring separate written consent for HIV testing. Health Care News
This is the next leg of a tour launched by President Obama, showcasing how communities, states and the federal government can work together to help strengthen rural America. The Secretaries for the Departments of Health and Human Services, Agriculture, Labor and Veterans Affairs listened to local residents give their perspectives and discuss solutions to the challenges facing rural communities during the 90-minute community forum. In June, President Obama announced that top officials from his administration would visit communities across the nation to discuss how to strengthen rural America. The community forums allow the Cabinet Secretaries to hear directly from people living in rural communities and advise the President on best ways to support their needs. The forums provide for direct public input on how to build a more healthy American economy, which depends on a prosperous rural America. Rural America supplies much of our nation’s food, safeguards the environment, cultivates a vibrant small business sector, and plays a growing role in science, innovation and energy independence. Rural Tour events have also been held in Pennsylvania, New Hampshire and Michigan. Future events are currently scheduled in Alaska, Nebraska, New Mexico, North Carolina, Wisconsin and Ohio. All Americans can follow the Rural
Tour’s progress online at www.RuralTour.gov.
The seasonal influenza vaccine will not protect against the 2009 H1N1 influenza virus that resulted in the declaration of a pandemic by the World Health Organization (WHO) on June 11, 2009. The FDA continues to work with manufacturers, international partners and other government agencies to facilitate the availability of a safe and effective vaccine against the 2009 H1N1 influenza virus. Each year, experts from the FDA, WHO, U.S. Centers for Disease Control and Prevention (CDC), DoD and other institutions study virus samples and patterns collected from around the world in an effort to identify strains that may cause the most illness in the upcoming season. Based on those forecasts and on the recommendations of the FDA’s Vaccine and Related Products Advisory Committee, the FDA determines the three strains that manufacturers should include in their vaccines for the U.S. population. The vaccine for the 2009-2010 seasonal influenza contains:
Even if the recommendations fail to produce the optimal match between the virus strains, the vaccine may reduce the severity of the illness or may help prevent influenza-related complications. According to the CDC, between 5 percent
and 20 percent of the U.S. population develops influenza each year.
More than 200,000 are hospitalized from its complications and about
36,000 people die. Older people, young children, and people with chronic
medical conditions are at higher risk for influenza-related complications.
Vaccination of these groups is critical. The National Institute of Allergy and Infectious Diseases (NIAID) is using its vaccine clinical trials infrastructure to launch a study of vaccine for pandemic H1N1 virus. Initial studies will look at whether
one or two 15 microgram doses of H1N1 vaccine are needed to induce
a potentially protective immune response in healthy adult volunteers
(aged 18 to 64 years old) and elderly people (aged 65 and older). Researchers
also will assess whether one or two 30 microgram doses are needed. The
doses will be given 21 days apart, testing two manufacturers’ vaccines
(Sanofi Pasteur and CSL Biotherapies). If early information from those
trials indicates that these vaccines are safe, similar trials in healthy
children (aged 6 months to 17 years old) will begin. A concurrent set of trials will look
at the safety and immune response in healthy adult and elderly volunteers
who are given the seasonal flu vaccine along with a 15 microgram dose
of 2009 H1N1 vaccine. The H1N1 vaccine would be given to different
sets of volunteers either before, after, or at the same time as the
seasonal flu vaccine. If early information from those studies indicates
that these vaccines are safe, similar trials in healthy children (aged
6 months to 17 years old) will start. A panel of outside experts will conduct
a close review of the safety data from these trials to spot any safety
concerns in real time. Information from these studies in healthy people
will help public health officials develop recommendations for immunization
schedules, including the optimal dosage and number of doses for multiple
age groups, including adults, the elderly, and children. Data may also
be used to support decisions about the best recommendations for people
in high risk groups, including pregnant women and people whose immune
systems are weakened or otherwise compromised. The trials are being conducted in
a compressed timeframe in a race against the possible autumn resurgence
of 2009 H1N1 flu infections that may occur at the same time as seasonal
influenza virus strains begin to circulate widely in the Northern Hemisphere.
The Recovery After an Initial Schizophrenia Episode (RAISE) project is being funded by NIMH with additional support from the American Recovery and Reinvestment Act (ARRA). Recovery Act funds will underwrite the initial two phases of the trial. With long-term funds committed by NIMH to complete these phases plus a full-scale clinical trial, funding for the study is $40 million. Despite the availability of moderately effective treatments, such as antipsychotic medications and various psychosocial interventions, people with schizophrenia often do not receive treatment until the disease is already well-established, with recurrent episodes of psychosis, resulting in costly multiple hospitalizations and disabilities that can last for decades. Periods of unemployment, homelessness and incarceration are common, making schizophrenia a costly disease for individuals, their families and the community at large. RAISE will test approaches that involve intervening immediately upon first diagnosis and systematically incorporating the range of options that are now available in a more piecemeal fashion to people with schizophrenia. These options include medications, psychosocial treatments and rehabilitation, including teaching patients and families how to manage the disease. The hope is that such a coordinated approach tailored to each individual and sustained over time may make lasting differences in the acceptability of treatment and overall function. Federal, state and local agencies
and organizations — both private and public — that play a role in
providing health care and other services to people with schizophrenia
will have an opportunity to participate in the design of the interventions
to be evaluated by RAISE. NIMH expects that, if successful, this evidence-based
approach can be disseminated and adopted rapidly, thus significantly
speeding the transition between research findings and their use in real-world
practice. http://www.nih.gov/news/
The report examines the demographic and socioeconomic trends accompanying this phenomenon. It was commissioned by the National Institute on Aging (NIA), part of the National Institutes of Health and produced by the U.S. Census Bureau. Researchers found the number of people worldwide age 65 and older is estimated at 506 million as of midyear 2008; by 2040, that number will hit 1.3 billion. Thus, in just over 30 years, the proportion of older people will double from 7 percent to 14 percent of the total world population. "An Aging World: 2008" examines nine international population trends identified in 2007 by the NIA and the U.S. Department of State. "An Aging World: 2008" contains detailed information on life expectancy, health, disability, gender balance, marital status, living arrangements, education and literacy, labor force participation and retirement, and pensions among older people around the world. Highlights of the report include:
Electronic cigarettes, also called “e-cigarettes,” are battery-operated devices that generally contain cartridges filled with nicotine, flavor and other chemicals. The electronic cigarette turns nicotine, which is highly addictive, and other chemicals into a vapor that is inhaled by the user. These products are marketed and sold to young people and are readily available online and in shopping malls. In addition, these products do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes. They are also available in different flavors, such as chocolate and mint, which may appeal to young people. Because these products have not been submitted to the FDA for evaluation or approval, at this time the agency has no way of knowing, except for the limited testing it has performed, the levels of nicotine or the amounts or kinds of other chemicals that the various brands of these products deliver to the user. The FDA’s Division of Pharmaceutical Analysis analyzed the ingredients in a small sample of cartridges from two leading brands of electronic cigarettes. In one sample, the FDA’s analyses detected diethylene glycol, a chemical used in antifreeze that is toxic to humans, and in several other samples, the FDA analyses detected carcinogens, including nitrosamines. These tests indicate that these products contained detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed. The FDA has been examining and detaining shipments of e-cigarettes at the border and the products it has examined thus far meet the definition of a combination drug-device product under the Federal Food, Drug, and Cosmetic Act. The FDA has been challenged regarding its jurisdiction over certain e-cigarettes in a case currently pending in federal district court. The agency is also planning additional activities to address its concerns about these products. Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of e-cigarettes to the FDA's MedWatch Adverse Event Reporting program online, by regular mail, fax or phone. For more information, visit http://www.fda.gov/Safety/
Substance Abuse Prevention Dollars and Cents: A Cost Benefits Analysis is designed to help policymakers and other stakeholders use the results of cost-benefit analysis as an information tool for decision making and for selecting the substance abuse prevention programs that best apply available resources toward addressing their needs. The report draws on the data and
methods of recent substance abuse costs and cost savings studies and
relies heavily on two systematic evaluations of cost- savings estimates,
adds new analyses. These cost-savings analyses show that savings from
substance abuse prevention generally exceed the costs of prevention
programs.
CMS has also contracted with MAXIMUS Federal Services, Inc. to review requests for expedited review of denials and make recommendations — subject to CMS’s review — on whether individuals are eligible for health insurance premium assistance under the Recovery Act’s expansion of COBRA continuation coverage. Maximus will also answer questions about the premium assistance program and the expedited review process. To help displaced workers maintain health care coverage for themselves and their families, the Recovery Act provides a 65 percent subsidy for health insurance premiums for workers who have elected COBRA after they have been involuntarily terminated from their jobs. “COBRA coverage” generally refers to the continuation of coverage provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), which apply to employers with twenty or more employees. The ARRA-established subsidy is also available to eligible federal, state, and local government employees, and, if state law requires certain continuation coverage, to workers for private sector employers with fewer than twenty employees. The Recovery Act’s premium assistance applies to periods of continuation coverage beginning on or after Feb. 17, 2009 (when ARRA became law), and lasts for up to nine months. To qualify for premium assistance, a worker must be involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009, and elect continuation coverage. The subsidy ends when the worker is offered any new employer-sponsored health care coverage or becomes eligible for Medicare. Workers who were involuntarily terminated between Sept. 1, 2008, and Feb. 16, 2009, but who failed to elect COBRA coverage at that time, most likely because it was unaffordable, or who elected COBRA after Sept. 1, 2008, but let it drop because it was unaffordable, would be given an additional 60 days after employer notifications are released to elect COBRA and receive the subsidy. Depending on actions taken by their states, individuals with state continuation coverage may also be eligible for this additional election period. To ensure that the premium assistance is targeted at workers who are most in need, the subsidy generally will be available only to people whose income does not exceed $125,000 for individuals ($250,000 for families). When an individual’s former group health plan denies access to ARRA’s premium assistance, he or she may request an expedited review of the denial. Under the law, CMS handles requests for review for all federal government employees, employees of state and local governments and those individuals covered by certain state continuation coverage laws (sometimes called “mini-COBRA” programs) that apply to employers with fewer than 20 employees. Decisions on appeals will be made within 15 business days after receipt. For more information, visit www.ContinuationCoverage.net. Reserve/Guard
Reports/Policies
Legislation
Hill Hearings
Meetings / Conferences
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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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