May 17, 2013

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AACP Advocacy Updates and Alerts

May 17, 2013 

United States Congress

House appropriators get funding totals: On Thursday afternoon, leaders of the House Appropriations subcommittees were presented with the total funding for their subcommittee. Referred to as 302b allocations, this becomes the total funding each subcommittee will have to allocate across the federal agencies under their jurisdiction for FY14. For the Labor, Health and Human Services, and Education subcommittee, which includes most of the programs of interest to academic pharmacy, the FY302b allocation is truly horrendous. At $121.8 billion, this allocation is $28 billion below the best estimate for FY13 funding and $42 billion less than appropriated in FY2010. The complete 302b allocation table for the House is not available on the committee Web site. We will make that available to AACP members as soon as it is posted.

The Senate Appropriations leaders are expected to discuss and present their subcommittee 302b allocations next week. The House and Senate are billions of dollars apart on funding totals. The Senate appropriation leadership is using a total funding number of $1.058 trillion for FY14 compared to the House at $967 billion. The Senate funding total is based on the recommendation of the Senate budget committee proposal which reinstates funds lost through the sequester. The Senate majority budget leaders anticipate (hope springs eternal…) that the there will be legislation reversing the sequester. The House allocation is based on the total funding of its budget resolution that does not assume the sequester is repealed. With this type of difference between the two totals, just like the budget resolutions, it is unlikely that meaningful progress will be seen in reconciling the funding differences and moving appropriations bills in regular order. Expect continuing resolutions to keep the federal government funded and operating at least for the first part of FY14.

Education and Workforce passes bills: On Thursday morning, the House Committee on Education and Workforce marked up and passed two pieces of legislation. One, HR 1911, the "Smarter Solutions for Students Act of 2013," provides an option for having student loans, currently at 3.4% interest from increasing to 6.8% on July 1, 2013. The legislation would establish interest rates for Stafford, PLUS and consolidated loans based on Treasury note rates for loans with a first disbursement on or after July 1, 2013.

The committee also passed HR 1949. The "Improving Postsecondary Education Data for Students Act," would require the Secretary of Education to convene an advisory group to study what information is being collected by the Department, how much information should be collected and how that information should be made available to students and families. A final report from the group would be expected one year after passage of the legislation. This timeframe and the fact that the committee is seeking public input on issues for consideration of the Higher Education Act reauthorization with a deadline of August 2, 2013 it is not expected that HEA reauthorization will take place in 2013.

Senate approves CMS Administrator: This week the United States Senate confirmed the appointment of Marilyn Tavenner as Administrator of the Centers for Medicare and Medicaid Services. Tavenner is the first confirmed administrator of the agency since Mark McClellan in 2006.


CBO estimates reduced deficit: Good news, the Congressional Budget Office in its updated budget projections estimates that the federal deficit- the gap between revenue and spendingwill decrease to a level not seen since 2008. The bad news is that this deficit reduction results from the tax increases authorized in the American Taxpayer Relief Act of 2012 (PL 112-240) and the substantial spending cuts associated with the sequester. This deficit reduction is what our national leaders have been seeking and in a weird way it is the balanced (revenue increases combined with spending cuts) approach that many, including the President, sought all along. With the impact of the spending reductions just now being felt across the country, the reduced deficit may make calls for repealing the sequester fall on deaf ears. It certainly will make it more difficult for proponents of sequester repeal to fend off requests for preferential treatment of certain programs such as the reinstatement of funding to the Federal Aviation Authority so we don’t have to wait in security lines longer than pre-sequester days. Of course your plane may not be sufficiently inspected and the runway may be crumbling beneath the plane’s wheels, but that line will move!

Another concern is that the deficit reduction is a likely a short-term phenomenon unless Congress addresses the coming onslaught of an aging population, increased healthcare costs and increased access to federal insurance programs.

ACA…too big to fail?: It is in your best interest to make the healthcare reform initiatives authorized in the Affordable Care Act (ACA) work effectively and efficiently. Until the expected savings estimated to be forthcoming in the next decade from that reorganization federal funding for programs other than ACA programs will continue to face reductions. A case in point is the Prevention and Public Health Fund. Established in the ACA to provide supplemental funds for new program development and current program enhancements, the Fund is being used by the Administration as funding support for many programs for which there funds authorized but not appropriated within the ACA. Of the $1.5 billion to be authorized to be appropriated for FY14 nearly half will be used to support and sustain existing programs within the Centers for Disease Control and Prevention.

Of greater concern are the Administration’s cuts to existing programs recommended in the FY14 budget recommendation to support ACA implementation efforts. If Congress does not appropriate sufficient funds (and it’s likely that will happen) the Administration can be expected to maximize the use of transfer authority given to the Secretary of HHS to ensure that ACA programs are implemented…even at the cost of current, non-ACA programs. So, it is imperative that each of you work to ensure that these programs are implemented as quickly as possible. The estimated billions in savings are need to sustain some of your favorite programs.

Additional FY13 sequester impact information: In the last update you were provided with links to some federal agency operating plans for FY13. These operating plans take into consideration, at varied levels of detail across agencies, the funding levels for the programs, projects and activities administered through that particular agency. The operating plan for the National Institutes of Health has published a more detailed operating plan that is now available. The Health Resources and Services Administration has now posted its FY13 operating plan to its Web site.

CMMI announces next round of innovation awards: The Centers for Medicare and Medicaid Innovation (CMMI) have announced the next round of innovation awards will seek applications starting June 14 through August 15, 2013. Letters of intent will be accepted from June 1 through June 28, 2013. This round of awards will total $1 billion "for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees."

Applications for awards are to be focused on four priority areas including:

  • Models that test approaches for specific types of providers to transform their financial and clinical models.

Additional bundled payment applicants sought: In a Federal Register notice dated May 17, 2013, the Centers for Medicare and Medicaid Innovation announced it is providing an open period for additional organizations seeking participation in the Model 1 Bundled Payment Care Improvement initiative. The BPCI allows acute care hospitals paid under the inpatient prospective payment system and organizations that wish to convene acute care hospitals in a facilitator convener role are eligible to apply. Authorized by Section 3021 of the Affordable Care Act (PL 111-148), the Bundled Payment Care Initiative Model 1 seeks to test innovative payment and service delivery models that reduce spending under Medicare, Medicaid, or CHIP, while preserving or enhancing the quality of care:

  • Improve care coordination, beneficiary experience, and accountability in a person-centered manner.
  • Support and encourage providers that are interested in continuously reengineering care to deliver better care and better health at lower costs through continuous improvement.
  • Create a cycle that leads to continually decreasing the cost of an acute or chronic episode of care while fostering quality improvement.
  • Develop and test payment models that create extended accountability for better care, better health at lower costs for the full range of health care services.
  • Shorten the cycle time for adoption of evidence-based care.
  • Create environments that stimulate rapid development of new evidence-based knowledge.

Pharm.D. eligible for new NIH program: The National Institutes of Health (NIH) continues to develop programs to meet the current and future demand for clinical research scientists. Its latest development in this area is the Lasker Clinical Research Scholars program. Full-time pharmacy faculty with a Doctor of Pharmacy degree are eligible to apply for to the program provided they are within 10 years of having received their professional degree unless they also have residency training, are licensed to practice pharmacy, and their area of research aligns with the focus areas stated in the RFA. An RFA is currently available for the program. A letter of intent must be submitted by May 24, 2013 and the application deadline is June 24, 2013.

"The program offers the opportunity for a unique bridge between the NIH intramural and extramural research communities and contains two phases. In the first phase, Lasker scholars will receive appointments for up to 5-7 years as tenure-track investigators within the NIH Intramural Research Program with independent research budgets. In the second phase, successful scholars will be eligible to apply for up to 5 years of NIH support for their research at an extramural research facility; or, the scholar can be considered to remain as an investigator within the intramural program."

Physicians and Nurse Practitioners disagree on roles: Even though physicians and nurse practitioners have worked side-by-side for decades they have divergent views on what an appropriate scope of practice comprises for nurse practitioners. In a new report, published in the May 16th edition of the New England Journal of Medicine, it is clear that primary care physicians are reluctant to cede additional control to nurse practitioners. "Expanding the Role of Advanced Nurse Practitioners: Risks and Rewards," brings forward long-standing problems with moving to a healthcare system in which all health professionals are allowed and incentivized to practice at the top of their license.

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