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WASHINGTON WIRE

October 3, 2008
Issue 183

CONGRESS RECESSES AFTER PASSING BAILOUT AND CONTINUING RESOLUTION
MedPAC Debates Gift Disclosure Recommendations
Congress Passes Mental Health Parity Bill
OIG Releases FY 2009 Work Plan
Senate Finance Leaders Want Review of Medicare Appeals System
Hearings

Top Story

CONGRESS RECESSES AFTER PASSING BAILOUT AND CONTINUING RESOLUTION

Congress will recess this week after passing two financial bills meant to address the current economic crisis and to fund federal programs into the next administration.

On Friday afternoon, the House approved 263-171 a $700 billion bailout for the nation's financial system. 172 Democrats and 91 Republicans voted to pass the Emergency Economic Stabilization Act of 2008, just three days after the House defeated a previous proposal. On Wednesday, the Senate passed the bill 74 to 25 after adding the Tax Extenders and Alternative Minimum Tax Relief Act of 2008 and the Energy Improvement and Extension Act of 2008. The President is expected to quickly sign the bill.

Also this week, President Bush signed a Continuing Resolution set to expire in March of 2009. The CR funds at 2008 levels all federal programs for which a separate appropriations bill was not passed. The package only includes full FY 2009 appropriations bills for Military Construction and Veterans Affairs, Defense and Homeland Security.

The Senate failed to reach cloture on a separate economic stimulus package that included a temporary Medicaid FMAP increase over $19 billion.

Majority Leader Harry Reid announced that the Senate will be in session from November 17-19 for organizational purposes for the new Congress and to provide orientation for newly elected senators. But the House will not be in session again until next year.

Health Care News

MedPAC Debates Gift Disclosure Recommendations

This week, MedPAC debated four draft recommendations on the issue of physician gift disclosure out of concern that financial relationships between drug and device companies

and doctors could inappropriately influence medical decisions.

The first draft recommendation would require manufacturers to report their financial relationships (of a suggested minimum of $100) with doctors and other prescribers, hospitals, medical schools, patient organizations and others. A second recommendation would require the posting of information submitted to HHS on a public web site. The third would require all hospitals and ambulatory surgery centers to annually report physicians owning an interest in the facility. The final recommendation would require HHS to report on the prevalence of financial relationships between hospitals and physicians.

Commissioners were generally supportive of the recommendations but expressed a variety of concerns, including the wisdom of putting Medicare billing numbers on a public Web site due to the potential for fraud. The biggest topic of discussion was how to report the free samples drug companies give to doctors on sales calls. Some commissioners noted this practice could curb the ability to pass along free samples to low-income patients while others noted that it can inappropriately influence prescribing patterns. MedPAC expects to formalize these recommendations in early November.

Congress Passes Mental Health Parity Bill

On Friday, the House voted to pass Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, H.R. 1424, which the day before became the vehicle for Emergency Economic Stabilization Act of 2008. The Senate passed the package Thursday.

The bill mandates that commercial insurers must set mental health insurance co-payments and treatment limits equal to those for coverage of physical conditions. It also bans cost-sharing requirements that only apply to mental health or substance abuse disorder benefits.

The legislation follows a Medicare bill passed earlier this year that guarantees mental health parity for Medicare beneficiaries. The President is expected to quickly sign H.R. 1424.

OIG Releases FY 2009 Work Plan

On Wednesday, the Department of Health and Human Services' Office of Inspector General (OIG) released its Work Plan for federal fiscal year 2009. The plan details areas the OIG intends to audit, evaluate and inspect for the next fiscal year. OIG priorities for the Medicare program include:

Part A:

Hospital Capital Payments

Medicare Capital Payments for Extraordinary Circumstances.

Hospital Ownership of Physician Practices.

Inpatient Prospective Payment System Wage Indices

Payments to Organ Procurement Organizations

Inpatient Hospital Payments for New Technologies

Inpatient Rehabilitation Facility Payments

Critical Access Hospitals

Medicare Secondary Payer

Serious Medical Errors ("Never Events")

Part B:

Medicare Practice Expenses Incurred by Selected Physician Specialties

Outpatient Physical Therapy Services Provided by Independent Therapists

Physicians' Medicare Services Performed by Nonphysicians

Geographic Areas With a High Density of Independent Diagnostic Testing Facilities

Patterns Related to High Utilization of Ultrasound Services

Senate Finance Leaders Want Review of Medicare Appeals System

In a letter to Secretary Michael Leavitt, Senate Finance Committee leaders Max Baucus (D-MT) and Charles Grassley (R-IA) asked HHS to review the Medicare appeals system after a July OIG report found that the department's Office of Medicare Hearings and Appeals (OMHA) has inconsistently offered appellants the option of holding hearings by video teleconference.

HHS said it received the letter and will respond to the senators, who requested a response by Oct. 6. The Senators said they previously requested monthly updates, but noted their last update was just under a year ago.

The OIG found OMHA lacked consistent guidance on how it presented hearing choices and lacked consistent documentation of how a it determined a hearing format.

The report found that OMHA has not fully met a requirement that certain appeals be decided within 90 days. Also, 15 percent of cases with the 90-day requirement that had a decision date in the appeals system were not decided on time, according to the report.

Upcoming Events

Hearings

No hearings are scheduled for the week of October 6.

For More Information

For further information on any topics discussed or publications listed, or to get copies of anything mentioned in this alert, please call 202.466.6550 and ask for the Legislative Practice Group.

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