March
27, 2000
Newsletter
Archive
Legislative
Affairs
Federal News
On
March 21, the ACC voiced its concern about the
future of anti-smoking efforts for children in
light of the U.S. Supreme Court ruling on the Food
and Drug Administration's (FDA) Tobacco Rule.
The court ruled 5-4 against the FDA's authority to
regulate tobacco products or cigarette company
marketing practices. The court's ruling
essentially halts the already implemented
provisions of the FDA's 1996 Tobacco Rule,
including the nationwide minimum age and photo
identification requirements. In an ACC news
release, ACC President George Beller, M.D., was
quoted as saying that Congress must now "stand up
to the interests of the tobacco lobby and work to
keep tobacco products out of the hands of
children." A copy of the ACC news release can be
found at http://www.acc.org/advocacy/weekly/archives/stc/tobacco2000.html.
Continued
markup of the Campbell-Conyers bill, (H.R. 1304,
the "Quality Health Care Coalition Act") scheduled
for March 22, was postponed. The House
Judiciary Committee is scheduled to resume final
consideration of H.R. 1304 on March 30. A full
report of the committee's action will be included
in the April 3 edition of Advocacy Weekly.
The
House passed its version of the FY 01 budget
resolution early March 24. The resolution sets
aside $40 billion for a Medicare prescription drug
benefit and calls for the Labor-HHS-Education
funding bill to be considered first among the 13
appropriations bills. Agreement in the Senate
Budget Committee has not been reached on the
budget resolution. If agreement is not reached,
Senate Majority Leader Trent Lott, R-Miss., has
the authority to bring the resolution directly to
the Senate floor for a vote after April 1.
State News
The
ACC Chapter in Ohio
submitted written testimony recently to its
state's House Health, Retirement & Aging
Committee. The bill in question, H.B. 570,
amends the state's criteria for how cardiovascular
technologists are trained and licensed but also
expands their scope of practice. The Chapter
is supportive of the training and licensing
changes but has expressed its concerns that the
scope of practice may allow the technologist to
substitute for a cardiologist in certain
catheterization procedures. The Ohio Chapter has
also pointed out that the ambiguity in how the
legislative language defines the term
"supervision."
Arizona is on the verge of
becoming the nation's fifth state to enact
insurer liability legislation. H.B. 2600 contains
a patient right-to-sue provision that passed
through both chambers by overwhelming margins.
Although Gov. Jane Hull opposes the
liability provision, she said she will allow
the bill to pass without her signature. Other
key provisions include protecting physicians who
advocate for their patients against HMO
retaliation and a stipulation that HMO pay for
prescriptions that are not on their formulary.
The
Virginia House and Senate
have passed bills that allow physicians to refuse
to sign insurer contracts that contain "all
products" clauses. Gov. Gilmore is expected to
sign the bill (H.B. 1366).
A
controversial bill under debate in Maine that would make it the
first state in the nation to control the prices
of prescription drugs has passed the Health
and Human Services Committee on a straight
party-line vote. The bill would create a board
to set maximum wholesale and retail prices for
prescription drugs linked to the prices paid by
the federal government and to prices in Canadian
provinces. Opponents say drug companies could
decide not to do business in Maine if the state
was alone in fixing prices.
Regulatory and Legal
Affairs
HCFA
plans to publish its controversial Medicare
hospital outpatient prospective payment system
final rule in the Federal Register by April
10. Hospital outpatient services, one of the
fastest growing services under Medicare, are now
reimbursed under a cost-based system. The new
payment system will lump services into ambulatory
payment classifications similar to the DRG system
for inpatient services. The ACC continues to have
concerns about outpatient PPS and will recommend a
delay of the scheduled July 1 implementation date.
A copy of the ACC's comments on the proposed rule
is available at http://www.acc.org/advocacy/weekly/archives/stc/outpatient.html.
The
ACC is concerned about the incompleteness of a
list published March 10 by HCFA specifying drugs,
biologicals, and medical devices eligible for
higher payments under Medicare's new hospital
outpatient prospective payment system.
Legislation enacted last year required HCFA to
reimburse hospitals at a higher rate for orphan
drugs, cancer therapy drugs, biologicals and
brachytherapy devices, radiopharmaceutical drugs,
and new drugs, biologicals, or medical devices.
These are temporary payments for a period of two
to three years until actual hospital cost
information can be gathered. The ACC will submit
its recommendations and concerns to HCFA.
The
Department of Health and Human Services' (HHS)
final organ transplant rule took effect March
22. The final rule recognizes ACC concerns
about moving from a regional to a national system
of organ allocation by making it clear there is no
requirement for a "single national list" for organ
allocation and recognizing that "medical factors
affecting the viability of the organ must be
considered in designing allocation policies." (See
October
25, 1999 Advocacy Weekly for more
information about the rule.) The United Network
for Organ Sharing (UNOS), the administrator of the
transplant network under contract to HHS,
announced that its Board of Directors approved a
liver allocation plan in response to the final
rule and will examine all other organ-specific
allocation policies as required by the rule. More
information about the final rule and UNOS are
available on UNOS' Website, http://www.unos.org/.
Some
states have responded to HHS' final rule by
passing laws giving their residents first chance
at donated organs. Wisconsin Gov., Tommy Thompson
(R), announced March 14 that his state will sue
HHS in an attempt to block implementation of the
final rule. Last fall, the U.S. House Commerce
Committee approved legislation that would strip
HHS of most of its authority and give it to UNOS.
Despite
receiving an unqualified or "clean" audit opinion,
HCFA needs further improvements to establish
adequate financial control and accountability for
Medicare finances, according to a General
Accounting Office (GAO) report. The report
states that HCFA's financial management
activities, including evaluation and follow-up on
audit findings, contractor monitoring, and
financial reporting, "are insufficient to resolve
the internal control and financial reporting
weaknesses identified through audits and other
reviews." GAO's report, released March 15, is
available through the GAO Daybook on its Web page,
http://www.gao.gov/.
A
U.S. Court of Appeals upheld a substantial part of
a district court injunction against Food and Drug
Administration (FDA) regulations that severely
restrict drug and device manufacturers' statements
regarding off-label uses. Washington Legal
Foundation v. Henney (D.C. Cir. Feb. 11,
2000). The plaintiff in the case, Washington
Legal Foundation, is reported to be considering
legal action against the FDA based on statements
they made regarding the decision in the Federal
Register.
Practice Organization and
Management
Adding
power to the ACC Pennsylvania Chapter's fight,
the American Medical Association (AMA) and the
Pennsylvania Medical Society (Pa.MS) have formally
requested that the U.S. Department of Justice
launch an investigation into the market power and
anti-competitive practices of two
Pennsylvania-based Blue Cross and Blue Shield
plans. There is concern that Independence Blue
Cross (IBC) and Highmark, Inc. have maintained
their dominance by virtue of a "division of
markets" agreement, through which they have agreed
not to compete in each other's territory.
The
insurers dominate the state's two largest markets,
with Highmark controlling over 60 percent of the
Pittsburgh area market and IBC controlling more
than 50 percent of the Philadelphia area market.
As a result, the AMA and Pa. MS argue that the
plans are: restricting patient choice,
unilaterally dictating contract provisions, and
continuing to realize substantial profits while
raising premiums for patients and employers and
reducing payments to those who provide patient
care. The ACC Pennsylvania Chapter has been
actively seeking relief from the insurer's
unreasonable contracting practices.
Advocacy Weekly is a product of the
Advocacy Division of the American College of
Cardiology. Questions or comments regarding this
publication should be directed to the Advocacy
Division at 800-435-9203 or to advocacydiv@acc.org.
|
