7/3/2007
O & P Government Relations Update
With the new Democratic control of Congress, there is a renewed focus on healthcare issues that is providing increased opportunities to address healthcare issues. Of late, regarding appropriations, both the House and Senate are moving towards final passage by August, but still have yet to actually do so. Importantly, the Senate bill contains several O&P-related provisions. On Medicare, Congress has indicated it will address the problems with the physician payment system and other provider issues some time this July.
Medicare
To that end, the House Ways & Means Committee initiated a series of hearings in May nominally to seek how Congress can help CMS increase efficiency and quality. Practically speaking, they were investigating nearly all provider payments to see if savings could be found to fund other provider provisions and/or fixes. These hearings continued through the end of June.
Driving consideration of a Medicare bill is both the need to fix the SGR problem with the physician payment system but also the desire to reauthorize the State Children's Health Insurance Program (SCHIP) - set to expire on September 30th. Many would like to see the program expanded to cover higher income children, pregnant women and even childless adults. However, SCHIP-purists want to keep the program focused on health care for low-income children.
This year's (FY 2008) budget resolution created a mostly yet-to-be-funded reserve fund that included up to $50 billion over five years to pay for SCHIP. In addition, cuts to the Medicare Advantage program and increases in federal tobacco taxes are the additional options Congress is expected to use to fund the entire SCHIP/Medicare bill.
The Senate was originally expected to pass SCHIP legislation out of Committee by this week but has delayed until after next week. It is unclear whether they will consider a physician fee fix and other Medicare provisions as a part of that process or separately a couple of weeks later.
In the House it appears both the House Energy & Commerce Committee and the House Ways & Means Committee will pass and merge legislation to cover both SCHIP, a Medicare physician fee fix and other Medicare provisions in July, with mark-up hearings expected the week of July 16th and 22rd and floor consideration the final week before the long August recess. All of this legislative action means that all Medicare providers, including O&P providers, will be at risk of having their annual fee schedule increases cut or reduced to help cover the cost of these bills.
Appropriations
On appropriations, this past week the Senate Appropriations Committee approved its fiscal year (FY) 2008 spending bill for the Departments of Labor, Health and Human Services, and Education (L/HHS). This includes $149.2 billion in discretionary spending ($1.9 billion less than the House bill and about $9 billion more than the President’s budget). In addition, the National Institutes of Health would see a $1 billion increase over last year to $29.9 billion for FY 2008.
The following O&P-specific provisions were included in the Senate bill and the accompanying report language that modifies the bill’s provisions:
- Continued funding at no less than 2007 levels for the CDC Limb Loss Information Center;
- An additional $1 million for FY 2008 to fund another year of the Project Quantum Leap project through the American Academy of Orthotists and Prosthetics;
- Language related to peripheral neuropathy encouraging the NIH to establish a clinical network to design and conduct clinical research protocols of new agents to prevent or treat diabetic nerve damage; and
- Language highlighting concern that the Medicare Modernization Act provision requiring mandatory provider accreditations has not been fully implemented to ensure beneficiary access only to quality providers and equipment.
Importantly, L/HHS Subcommittee Chairman Tom Harkin (D-IA) and Ranking Member Arlen Specter (R-PA) included a provision in the spending bill that would make more embryonic stem cell lines available for government research funding. This came just days after President Bush issued his second veto on embryonic stem cell legislation. Should this bill reach the President's desk with stem cell provisions, he will almost certainly veto it. In addition, the President has also issued veto warnings for any spending bill that exceeds the President' spending request.
NAAOP Fly-Ins
The Association had a number of notable recent visits to Washington, D.C. including NAAOP Past-President, Jan Stokosa, CP, who met with House Ways & Means Health Subcommittee Ranking Member Dave Camp (R-MI) and Senate Finance Committee Member Debbie Stabenow (D-MI) and in which he pressed NAAOP Medicare priorities, the O&P fee schedule and related quality issues. In addition, current NAAOP President Tom Guth, CP, met with House Veterans Affairs Committee Chairman Bob Filner (D-CA) to discuss issues related to the VA’s use of prosthetics. These were critical meetings that should yield significant results.
Compiled by Peter W. Thomas, NAAOP General Counsel and Adam Chrisney, Senior Legislative Director, Powers, Pyles, Sutter and Verville, P.C.
