FEDERAL HEALTH UPDATE
Oct 9, 2009

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

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Executive and Congressional News

  • On Oct. 6, 2009, the Senate passed H.R. 3326, as amended; the Department of Defense Appropriations Act, 2010. This bill passed the House on July 29. The bill will now proceed to a conference committee of senators and representatives to work out differences in the versions of the bill each chamber approved.

  • The House Veterans Affairs Disability Assistance & Memorial Affairs subcommittee held a roundtable on Oct. 7, 2009, to examine the implications of the Department of Veterans Affairs’ PTSD Rule-Making.

    On August 24, the Department of Veterans Affairs (VA) published a proposed rule amending the rules governing service connection for post-traumatic stress disorder (PTSD). The new rule lowers the evidentiary standard for establishing service-connection for PTSD. Under the new rules, veterans who claim stressors related to a fear of hostile military or terrorist activity, which is confirmed by a VA or VA-contracted psychiatrist or psychologist are eligible for care.

    Bradley G. Mayes, director, compensation and pension service, Veterans Benefits Administration, as well as representatives from a number of veteran service organizations participated.

  • On Oct. 8, 2009, the Senate agreed to the conference report accompanying H.R. 2997; the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2010. The House agreed to the conference report on Oct. 7, 2009.

  • On Oct. 8, 2009, the House agreed to the conference report accompanying H.R. 2647, the Department of Defense Authorization, 2010. The measure now goes to the Senate for final congressional action and then on to the White House for President Obama's signature.

    Military Health Care News

  • TRICARE Management Activity has suspended referral and authorization requirements for TRICARE Prime beneficiaries allowing them to receive the H1N1 vaccine from any TRICARE-authorized provider without a referral from their primary care manager. The requirement is suspended from Oct. 1, 2009 - April 30, 2010.
  • TRICARE Management Activity published a news release on Oct. 2, 2009, to highlight the services offered through the TRICARE Assistance Program (TRIAP) demonstration project.

    The TRIAP demonstration program, launched Aug. 1, 2009, uses today’s Web-based technologies to bring short-term professional counseling assistance service members and veterans recently returned from overseas and their families. It is available in the United States to active duty service members, those eligible for the Transition Assistance Management Program (TAMP) and members enrolled in TRICARE Reserve Select. It is also available to these beneficiaries’ spouses, no matter their age, and other eligible family members 18 years of age or older.

    Eligible service members and family members can log on to TRIAP an unlimited number of times for supportive counseling or advice when dealing with short-term personal problems impacting their work performance, health and well-being. Services include assessments, short-term counseling and, if the TRIAP counselor determines more specialized care is necessary, a referral to a more comprehensive level of care. A referral or prior authorization is not needed to use TRIAP services. http://www.tricare.mil/pressroom/news.aspx?fid=558

  • The Army Times reports that Congress plans to repeal the recent TRICARE fee increases imposed last week by the Defense Department through a provision of the compromise 2010 defense authorization bill.

    Acting on complaints from a variety of military associations, who accused the Defense Department of reneging on a promise of a one-year moratorium on any increases in out-of-pocket patient costs, negotiators writing the final defense policy bill included a provision, retroactive to Oct. 1, prohibiting any TRICARE fee increases.

    The associations had taken issue with a $110-a-day increase in inpatient hospitalization charges for military retirees and their families using TRICARE Standard and with a $1 a day increase in inpatient charges for active-duty families.

    The fee increases were announced on Sept. 30 and took effect on Oct. 1, but the defense bill, HR 2647, includes a provision barring any fee increases until the start of fiscal 2011.

    The fee repeal included in the 2010 defense bill will not take effect until the bill passes Congress and is signed into law by President Obama, which could take several weeks at the soonest.

  • On Oct. 2, 2009, the Army confirmed that a soldier stationed at Fort Jackson, S.C., who died Sept. 10, was the first H1N1-related death suffered by the U.S. armed forces.

    Spc. Christopher Hogg, 23, of Dayton, Fla., died of pneumonia, but autopsy reports released yesterday confirm his death was the result of complications caused by the H1N1 virus, better known as swine flu.

    Fort Jackson is the largest Army training facility with more than 10,000 Soldiers stationed there at any given time. An H1N1 epidemic there could compromise the Army's ability to effectively produce soldiers to support fighting in Iraq and Afghanistan. Fort Jackson officials expect to receive a supply of the H1N1 vaccine this month.

    Hoggs was a basic training recruit in his fifth week of training when he was taken to the hospital Sept. 1 for a fever and respiratory issues. He was set to graduate Oct. 15.

  • The Army released suicide data for the month of September on Oct. 8, 2009.

    Among active-duty soldiers, there were seven potential suicides. One has been confirmed as a suicide, and six are pending determination of the manner of death. For August, the Army reported 11 potential suicides among active-duty soldiers. Since the release of that report, four have been confirmed as suicides and seven remain under investigation.

    There were 117 reported active-duty Army suicides from January 2009 through September 2009. Of those, 81 have been confirmed, and 36 are pending determination of manner of death. For the same period in 2008, there were 103 suicides among active-duty soldiers.

    During September 2009, among reserve component soldiers who were not on active duty, there were seven potential suicides. Among that same group, from January 2009 through September 2009, there were 35 confirmed suicides. Twenty-five potential suicides are currently under investigation to determine the manner of death. For the same period in 2008, there were 40 suicides among reserve soldiers who were not on active duty.

    Over the past year, the Army has engaged in a sustained effort to reduce the rate of suicide within its ranks. This effort has included an Army-wide suicide prevention stand-down and chain teach for every soldier; the implementation of the Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention; and the establishment of both a Suicide Prevention Task Force and Suicide Prevention Council.

    The Army has also entered into a long-term partnership with the National Institute of Mental Health to carry out the largest ever study of suicide and behavioral health among military personnel. There have been more than 160 specific improvements to Army suicide prevention policies, doctrine, training and resources over the past year.

  • The 2009 Armed Services Blood Program's (ASBP) Lifetime Achievement Award in Military Blood Banking recipients are Capt. (Ret.) C. Robert Valeri, and Col. (Ret.) Anthony J. Polk.

    Established this year, the ASBP Lifetime Achievement Award recognizes outstanding individuals in the field of blood banking whose accomplishments have transformed blood banking in the military. This year’s distinguished honorees exemplify, by their lifelong accomplishments and tireless dedication, the very spirit of this award.

    Valeri pioneered the frozen red blood cell program. The ability to freeze red blood cells is of particular use for the military because large quantities of type-specific blood products can be prepositioned to meet wartime and natural disaster needs. His outstanding accomplishments in this area led to FDA licensure of many frozen blood products. Today, the entire Department of Defense frozen blood program, which is part of contingency and mobilization plans all over the world, is a direct result of Valeri’s work.

    Polk’s lifetime of military blood banking from the Pacific during the Vietnam War to Europe during Desert Storm, developed and shaped the Department of Defense blood program into the Armed Services Blood Program of today. This visionary military blood banker conceptualized and implemented the program name, the titles of blood bank officers throughout the military blood banking system and the standardization of distribution systems. As director in 1984, Polk authored the Military Blood Program 2004 Implementation Plan. This plan’s inclusion in DoD’s Medical Readiness Strategic Plan, approved by the Secretary of Defense, marked the beginning of the military blood program’s routine inclusion in all top-level contingency plans.

Veterans Health Care News

  • On Oct. 5, 2009, Secretary of Veterans Affairs (VA) Eric K. Shinseki announced J.D. Power and Associates has given VA pharmacies some of the highest customer satisfaction scores in a national sampling of pharmacy customers.

    J.D. Power and Associates, a firm specializing in consumer surveys, surveyed about 12,000 pharmacy customers who use pharmacy retailers, including independent and mail-out pharmacies, chain drug stores, mass merchandisers and supermarkets. VA received an “Among the Best” ranking for the mail order category, the same overall ranking as Kaiser Permanente Pharmacy and Prescriptions Solutions.

    Among the factors examined in the J.D. Power and Associates 2009 National Pharmacy Study were pharmacy environment, price and value of prescription drugs, experience with online ordering and mail delivery, and experience with pharmacist and non-pharmacist staff.

    Every veteran enrolled in the VA health care system is eligible to receive prescription medications, over-the-counter medications, and medical and surgical supplies.

    In 2008, VA provided approximately 126 million outpatient prescriptions to more than 4.4 million patients.

    VA operates seven mail-out pharmacies, known officially as consolidated mail outpatient pharmacies. These facilities support VA’s health care mission through advanced automated production technologies to dispense and mail prescriptions to eligible veterans.

    In addition to supporting VA health care facilities, the mail-out pharmacies also support the Civilian Health and Medical Program for VA and the Naval Medical Center in San Diego.

  • Secretary of Veterans Affairs (VA) Eric K. Shinseki announced a new “Green Routine” campaign to kick off Energy Awareness Month at the Department of Veterans Affairs (VA).

    The campaign, which kicked off in October, is designed to increase the awareness among VA employees of their environmental impact as individuals and as members of the federal government. It includes VA's new "Green Routine" Web site devoted to helpful environmental tips (www.va.gov/greenroutine); the release of a video featuring the VA Chief of Staff educating employees on how to "green" their workplace; and a toolkit designed to help VA employees implement the Green Routine in their day-to-day lives.

    Additionally, a reference tool for managers and employees entitled the Greening Action Guide and Toolkit offers recommendations such as selecting a "green champion" in each office to help promote environmentally friendly steps including printing double-sided, holding electronic meetings without paper handouts, turning off cubicle lights when not in use, unplugging cell phone chargers and recycling printer cartridges and other items.

    VA is making strides toward operating more energy efficient facilities, using more renewable energy sources, and "greening" its vehicle fleet. VA has reduced energy consumption in buildings by 11 percent since 2003.

  • On Oct. 5, 2009, the Department of Veterans Affairs (VA) Chief of Staff John Gingrich celebrated veteran-artists at the opening banquet of the National Veterans Creative Arts Festival in San Antonio, Texas.

    The festival is the culmination of a year-long fine arts competition involving nearly 3,500 participants nationwide. It is open to all Veterans receiving care at VA medical facilities.

    More than 120 veteran medal winners in music, dance, drama, creative writing and visual arts contests are participating in the week-long festival. The event will conclude on Oct. 11 with a visual art exhibit and gala variety stage show at the San Antonio Municipal Auditorium.

    VA medical facilities incorporate creative arts into their recreation therapy programs. This annual competition recognizes the progress and recovery made through art therapy and raises visibility of veterans’ creative achievements.

    The festival is presented by VA, Help Hospitalized Veterans (HHV) and the American Legion Auxiliary. It is hosted this year by the South Texas Veterans Health Care System.

Health Care News

  • The National Heart, Lung, and Blood Institute (NHLBI) has awarded $170 million to be paid over seven years to 18 teams of research scientists to develop the high-potential field of stem and progenitor cell tools and therapies.

    The awards create the NHLBI Progenitor Cell Biology Consortium, which will bring together researchers from the heart, lung, blood, and technology research fields. The consortium assembles nine research hubs with multidisciplinary teams of principal investigators and an administrative coordinating center to focus on progenitor cell biology.

    While a stem cell can renew itself indefinitely or differentiate, a progenitor cell can only divide a limited number of times and is often more limited than a stem cell in the kinds of cells it can become. Given the potential of these cells for clinical applications, the goals of the consortium are to identify and characterize progenitor cell lines, direct the differentiation of stem and progenitor cells to desired cell fates, and develop new clinical strategies to address the unique challenges presented by the transplantation of these cells.

    The consortium's administrative coordinating center will be led by Dr. Michael Terrin, M.D. at the University of Maryland, Baltimore. The center will administer funds to support cores, pilot studies and ancillary and collaborative studies.

  • The National Institute of Health (NIH) announced that the 2009 Nobel Prize in physiology or medicine was awarded to three of its grantees.

    Elizabeth H. Blackburn, Ph.D, of University of California, San Francisco; Carol W. Greider, Ph.D, of Johns Hopkins University School of Medicine; and Jack W. Szostak, Ph.D, of Massachusetts General Hospital, Harvard Medical School and Howard Hughes Medical Institute were all recognized for their work on telomeres and their effect on aging

    The three researchers, supported by NIH funding for decades, are honored for discovering how telomeres, through the enzyme telomerase, protect chromosomes against degradation. Their discoveries added a new dimension to the scientific community’s understanding of the cell, shed light on disease mechanisms, and introduced new directions for the development of potential new therapies.

    Cancer and aging research merge in the study of telomeres, the tails at the ends of chromosomes that become shorter as a cell divides. All telomeres have the same short sequence of DNA bases repeated thousands of times. Rather than containing any genetic information, these repetitive snippets help keep chromosomes intact. The enzyme telomerase, which builds telomeres, enables the entire length of the chromosome to be copied without missing the end portion.

    Dr. Blackburn has received more than $13 million in NIH's National Institute of General Medical Sciences (NIGMS) funding since 1978; Dr. Greider has received more than $6 million since 1990; and Dr. Szostak has received more than $3 million since 1980. The NIH has provided a total of more than $32 million to the three researchers for their study of telomeres, telomerase, and the molecular functions of cells.

  • Fewer secondary schools in the United States are selling less nutritious foods and beverages, such as candy and soda, according to a survey from the Centers for Disease Control and Prevention.

    The greatest improvements were seen in states that have adopted strong school nutrition standards and policies for foods and beverages sold outside school meal programs.

    The report shows that among the 34 states that collected data in 2006 and 2008, the median percentage of secondary schools that did not sell soda or fruit drinks that are not 100 percent juice increased from 38 percent to 63 percent. The median percentage of secondary schools in these states that did not sell candy or salty snacks not low in fat increased from 46 percent in 2006 to 64 percent in 2008.

    Mississippi and Tennessee made the greatest progress in improving the nutrition environment in their schools. In Mississippi, the percentage of secondary schools that did not sell soda or fruit drinks that are not 100 percent juice increased from 22 percent in 2006 to 75 percent in 2008, while in Tennessee the percentage increased from 27 percent to 74 percent. These two states are national leaders in implementing strong statewide school nutrition standards.

    The School Health Profiles Survey is conducted among a representative sample of secondary schools in a state, large urban school district, or territory. The data are collected from self-administered questionnaires from the principal and the lead health education teacher at each sampled school. The 2008 report includes data from 47 states, 20 cities, and four territories.

    The 2008 study results varied dramatically across states.

    • In Hawaii, Connecticut, California, and Maine, more than two-thirds of secondary schools did not sell baked goods, salty snacks not low in fat, candy, soda or fruit drinks that were not 100 percent juice.
    • In Utah, Kansas, Idaho, and Nebraska, less than one-third of secondary schools did not sell these items.

    The School Health Profiles Survey is conducted every two years and monitors the current status of school health education requirements and content, physical education requirements, school health policies related to HIV/AIDS, tobacco-use prevention, nutrition, asthma management activities, and family and community involvement in school health programs. The 2008 data are available at http://www.cdc.gov/healthyyouth/profiles/index.htm.

  • On Oct. 5, 2009, the Office of the National Coordinator for Health Information Technology (ONC) released a draft Consumer Preferences Requirements Document for public comment.

    To date, the federal government's initiatives for a national health information technology agenda have not "formally addressed all of the interoperability considerations for the communication of consumer preferences to support the goal of patient/consumer focused healthcare and population health," according to ONC. "Therefore, the purpose of this document is to support the ONC Strategic Plan and the national HIT agenda related to standards development and harmonization process by describing business processes, information exchanges, stakeholders, functional requirements, issues and policy implications involving consumer preferences."

  • The Department of Health and Human Services (HHS) has partnered with the Ad Council to launch a series of national television public service advertisements (PSAs) designed to encourage Americans to take steps to protect themselves from the 2009 H1N1 flu virus.

    The ads are designed specifically to reach children, parents, pregnant women and young adults. The Ad Council is distributing the following PSAs nationwide and the ads will be supported in airtime donated by television stations nationwide. A second series of PSAs, aimed at encouraging high-risk populations to get the H1N1 vaccination, is launching in late October.

    Included in the PSAs being released are new spots featuring characters from the popular Sesame Street and the winning spots from the recent 2009 Flu Prevention PSA Contest sponsored by HHS.

    The H1N1 flu virus is contagious and spreads person-to-person the same way that seasonal influenza does. The virus has quickly spread worldwide and in June 2009 the World Health Organization declared a global H1N1 flu pandemic.

    To date millions of Americans have gotten the H1N1 flu virus and more than 600 have died since the spring from H1N1 flu-related complications; including children and pregnant women.

    The spots will also be available at flu.gov, the government’s one-stop Web site for all the latest information on both seasonal and H1N1 flu.

Reserve/Guard

  • As of Oct. 6, 2009, the total number of Guard and Reserve currently on active duty has decreased by 303 to 140,754. The totals for each service are Army National Guard and Army Reserve 110,971; Navy Reserve, 6,379; Air National Guard and Air Force Reserve, 14,073; Marine Corps Reserve, 8,382; and the Coast Guard Reserve, 649. www.defenselink.mil

Reports/Policies

  • The Congressional Budget Office (CBO) published its analysis of “Preliminary Analysis of the Chairman's Mark for the America's Healthy Future Act, as Amended,” on Oct. 7, 2009. In its report, the CBO found that the bill establishes a mandate for most legal residents of the United States to obtain health insurance and as amended, would cost $829 billion over ten years, resulting in a net reduction in federal budget deficits of $81 billion over the 2010–2019 period. http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdf

Legislation

  • H.R.3719 (introduced Oct. 6, 2009): To amend title 38, United States Code, to establish in the Department of Veterans Affairs a Veterans Economic Opportunity Administration, and for other purposes was referred to the House Committee on Veterans' Affairs.
    Sponsor: Representative Steve Buyer [IN-4]
  • S.1752 (introduced Oct. 5, 2009): A bill to amend title 38, United States Code, to direct the Secretary of Veterans Affairs to provide wartime disability compensation for certain veterans with Parkinson's disease was referred to the Committee on Veterans' Affairs.
    Sponsor: Senator Bernard Sanders [VT]
  • S.1753 (introduced Oct. 5, 2009): A bill to amend title 38, United States Code, to increase assistance for disabled veterans who are temporarily residing in housing owned by a family member, and for other purposes was referred to the Committee on Veterans' Affairs.
    Sponsor: Senator Bernard Sanders [VT]
  • S.1760 (introduced Oct. 7, 2009): A bill to amend the Public Health Service Act with regard to research on asthma, and for other purposes was referred to the Committee on Health, Education, Labor, and Pensions.
    Sponsor: Senator Frank R. Lautenberg [NJ]
  • S.1762 (introduced Oct. 7, 2009): A bill to amend the Public Health Service Act to expand and intensify programs of the National Institutes of Health and the Centers for Disease Control and Prevention with respect to translational research and related activities concerning Down syndrome, and for other purposes was referred to the Committee on Health, Education, Labor, and Pensions.
    Sponsor: Senator Sam Brownback [KS]

Hill Hearings

  • The House Veterans Affairs Committee will hold a hearing on Oct. 14, 2009, to receive an update on the state of the Department of Veterans Affairs.
  • The House Veterans Affairs Committee will hold a hearing on Oct. 15, 2009, to identify the causes of inappropriate billing practices by the Department of Veterans Affairs.
  • The Senate Veterans Affairs Committee will hold a hearing on Oct. 21, 2009, to examine pending legislation.

Meetings / Conferences


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