By CQ Staff

May 4, 2007 -- Reps. Tom Allen, D-Maine, and Jo Ann Emerson, R-Mo., plan to introduce legislation Monday that would increase federal investment in research to determine the most effective medicines and medical treatments.

The measure would authorize $3 billion over five years for research conducted by the Agency for Healthcare Research and Quality (AHRQ), the federal agency that has done comparative effectiveness reviews on renal artery stenosis, anemia drugs used by cancer patients, and other items. Comparative effectiveness research compares outcomes associated with different therapies for the same condition, allowing providers and patients to avoid ineffective or costly treatments.

Among its provisions, the legislation would establish a comparative effectiveness advisory board appointed by the Comptroller General at the Government Accountability Office that includes employers, consumers, health care providers, researchers, and others, to provide input on research priorities and methodologies.

Separately on Monday, the Blue Cross and Blue Shield Association is expected to announce its proposal for a public–private entity to explore the effectiveness of new and existing medical procedures, drugs, devices, and biologics.

By Mary Agnes Carey, CQ HealthBeat Associate Editor

May 2, 2007 – Sen. Ron Wyden's plan to provide health insurance to all Americans has attracted new GOP sponsorship in both chambers, a move that may boost the Oregon Democrat's efforts to pass the bill this year.

In the Senate, Robert F. Bennett of Utah has signed as the lead Republican sponsor of the bill (S 334), while Jo Ann Emerson of Missouri will assume that role in the House.

Meanwhile, another Democratic lawmaker lending his support during a Wednesday news conference was Brian Baird, D-Wash., who said he had discussed the legislation with Wyden during their long plane flights back home to the West Coast.

Wyden's proposal aims to provide health insurance to all Americans without increasing the $2.3 trillion spent annually on health care in the United States. Under Wyden's plan, the system of employment-linked health insurance would end.

Bennett said Republicans have resisted the idea of universal coverage due to fears that it would create a government-run single payer system. Democrats, in turn, have feared that individuals would not benefit in a health care system where private market forces dominate.

But since both parties would like the issue of the uninsured to be resolved before the next administration takes office, it's in their best interest to pass the legislation now, Bennett said.

To be sure, Bennett would like to see a few changes Wyden's bill, including how tax incentives in the measure affect states and what is the benefit package and who gets to determine it.

Wyden remains open. "This is not set in stone," he said.

By David Clarke, CQ Staff

May 3, 2007 -- House and Senate negotiators have made enough progress toward a joint budget resolution that they plan to formally meet next week in hopes of reaching a final agreement in time for appropriations bills to start moving on the House floor the week of May 14.

The House will appoint conferees May 7 on the fiscal 2008 budget resolution. Senate Budget Chairman Kent Conrad, D-N.D., said the Senate would soon follow, clearing the way for a formal conference meeting.

The House Rules Committee was expected Thursday to approve a rule for consideration of the Senate budget resolution (S Con Res 21). This step is being taken to overcome potential parliamentary problems and objections to heading to conference by unanimous consent. The House rule will clear the way for House conferees to be appointed.

The key sticking point between the House and Senate budget blueprints has been how to handle a Senate plan that proposes using a projected $132 billion fiscal 2012 surplus to extend some tax cuts and to help offset a $50 billion plan to expand a children's health insurance program.

House Budget Chairman John M. Spratt Jr., D-S.C., and members of the fiscally conservative Blue Dog coalition oppose the idea because it would violate the House's pay-as-you-go rule. Yet the Senate adopted the amendment offered by Finance Chairman Max Baucus, D-Mont., on a 97-to-1 vote and Conrad has said the plan must be in final budget plan. Baucus has said if a final agreement does not include his proposal it may be tough to win adoption of a joint budget resolution in the Senate.

The budget resolution is non-binding and the House Ways and Means and Senate Finance panels would have to write legislation to extend the tax provisions. That is unlikely to occur this year.

Still, House Democrats want to closely follow the pay-as-you-go rules they have championed as evidence of fiscal responsibility and do not want to go on the record as supporting the use of surpluses that have not materialized for tax cuts.

Spratt said final decisions have not been made but an idea being discussed is to include in the joint budget resolution a provision, called a "trigger," which would allow a surplus to be used as an offset for tax cuts only if the Congressional Budget Office projects that surplus will materialize in the next fiscal year or two. The idea is that the trigger would apply only in the House.

Conrad said he did not want to discuss details because "this thing is so delicate I don't want to say anything to put it at risk."

A trigger may work to garner the support of Blue Dog conservatives in the House.

"I think we can find some compromise language," said Allen Boyd, D-Fla., a Blue Dog leader and a member of the Budget Committee. "I suspect a trigger will be part of that."

Regarding how to handle the Baucus amendment, House Ways and Means Chairman Charles B. Rangel, D-N.Y., said, "I don't think these things are resolved on the House side." Yet he added: "I'm satisfied as long as we're not constrained in what we want to do."

The pressure to reach agreement on a joint budget resolution centers on the blueprint's role in the appropriations process; it sets the cap for discretionary spending that the Appropriations committees then divide among their 12 bills.

The House-passed budget resolution (H Con Res 99) would provide appropriators with about $7 billion more in spending than would the Senate budget resolution. Resolving the difference is not expected to be too difficult once conferees meet.

House Majority Leader Steny H. Hoyer, D-Md., wants to begin advancing spending bills on the House floor the week of May 14. That schedule may be pushed back, however, depending on when a final budget agreement is reached and because the war spending bill is a priority for leaders.

To advance a spending bill on the floor the week of May 14, a subcommittee and full committee markup of a spending bill would probably have to occur the week of May 7. That could prove difficult.

Also left unresolved is whether to include in a final budget resolution a reconciliation instruction for the House and Senate education panels to write legislation reauthorizing higher education programs.

The House budget blueprint includes an instruction to the House Education and Labor Committee to produce legislation saving $75 million over five years. Conrad said Senate Health, Education, Labor and Pensions Chairman Edward M. Kennedy, D-Mass., has expressed support for the House plan.

The instruction is more important in the Senate, where it provides procedural protections for legislation to move on a fast-track through that chamber.

Conrad opposes using these protections for legislation that is not primarily focused on reducing the budget deficit. He said earlier this week he will not change his position on the issue but acknowledged he might not get his way in the final resolution.

By John Reichard, CQ HealthBeat Editor

May 4, 2007 -- A study released this week by the Government Accountability Office concludes that a "small but significant share" of nursing homes provides substandard care despite tighter oversight of the industry required by a landmark 1987 law. Federal officials must maintain their focus on quality problems to assure continuing improvement in care, the study found.

Through passage of the Omnibus Budget Reconciliation Act of 1987, Congress shifted the focus of federal oversight of nursing homes from measuring a facility's capacity to provide good care to looking at whether it actually does so.

Federal and state officials have intensified their oversight efforts since then, but widespread reports of poor quality care have continued. For example, in 1998 the Senate Special Committee on Aging held a series of hearings exposing substandard care.

The quality of treatment appears to have improved somewhat since then. The GAO found that the percentage of nursing homes with serious deficiencies—those that caused actual harm or placed residents in immediate jeopardy—fell from 28 percent in fiscal 2000 to 19 percent in fiscal 2006. But serious problems remain at one in five nursing homes, the report says.

But sharp state-to-state variations in the percentage of homes with the deficiencies raise concerns about how consistently states are assessing compliance with quality standards, the study said. For example, the study noted that in fiscal 2006 one state found only 2 percent of facilities to have serious quality deficiencies, compared with a high of almost 51 percent in another state.

The variations may reflect the difficulty of recruiting state surveyors who assess quality, the study said. Surveyors face growing workloads and are paid salaries that aren't competitive with the private sector, creating turnover problems, the GAO noted. "It can take as long as three years for a surveyor to gain sufficient knowledge, experience and confidence to perform the job well," the study said.

Inexperience among surveyors can lead to underreporting of quality deficiencies, the analysis found. In fiscal 2006, 28 percent of federal surveys conducted to check on the adequacy of state surveys found a greater number of serious deficiencies, the GAO said.

The Centers for Medicare and Medicaid Services have beefed up enforcement by adopting new penalties for quality violations, including an "immediate sanctions" policy, government auditors found. But the complex procedure involved in levying those penalties has undermined its effectiveness, according to the study. Aimed at nursing homes that repeatedly harm residents, the policy "appears to have induced only temporary compliance."

Some quality improvement efforts overseen by CMS, such as the "Quality Indicator Survey" (QIS) have languished. The program aims to improve the quality of inspections at facilities, in part by interviewing a larger number of past and current residents about quality of care. The QIS "has been in development for over eight years and resource constraints threaten the planned expansion of this methodology beyond the initial five demonstration states," the GAO said.

"CMS has taken many important steps, but "in order to guarantee that all nursing home residents receive high quality care, it is important to maintain the momentum begun by the reforms of the [1987 budget reconciliation law] and continue to focus national attention on those homes that cause actual harm to vulnerable residents," the report concluded.

At a May 2 hearing to review the report, Aging Committee Chairman Herb Kohl, D-Wis., said that the 1987 law has "without question" improved nursing home care. He said that the law has led to a sharp drop in the practice of tying patients to their beds or chairs or sedating them to keep them from wandering.

But he found the report's finding "unacceptable"—that nearly half of a group of facilities studied in 1998 and 1999 that provided poor care have made no progress since then. Kohl said he would file a request with CMS that it brief the committee every two months on steps it has taken to further improve oversight. He also said he would pursue legislation requiring background checks to better screen out workers who might have a history of criminal abuse.

A patients' advocate told the senators at the hearing that while facilities have made strides under the law, expectations surrounding its passage have gone unfulfilled. "For many residents, the quality of their day-to-day care is minimal because of inadequate nurse staffing," Alice H. Hedt, executive director of the National Citizen's Coalition for Nursing Home Reform. Lawmakers should enact policies that increase staffing levels, she said.

The American Health Care Association, which represents the nursing home industry, said in its testimony that "stable funding" of the industry is "critical" and that its link to quality "has been noted time and time again."

By John Reichard, CQ HealthBeat Editor

May 1, 2007 – A study released Tuesday says that since January 2006, 29 states have either adopted or are seriously considering legislation to cover more children through Medicaid or the State Children's Health Insurance Program (SCHIP).

The study also reports that 15 of the states plan on or have proposed increasing SCHIP income eligibility levels, most of them to above 200 percent of the federal poverty level.

Conducted by Georgetown University's Center on Children and Families, the study also says these state efforts will have a better chance of lasting success if Congress reauthorizes SCHIP legislation by adding $50 billion or more over five years in resources to the program.

The Bush administration has called for revising the program by limiting SCHIP matching funds to coverage of uninsured children at or below 200 percent of the federal poverty level.

By Mary Agnes Carey, CQ HealthBeat Associate Editor

May 3, 2007 – President Bush Thursday nominated Kerry N. Weems to head the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicare and Medicaid.

Weems has held several posts within the Department of Health and Human Services (HHS) during his 24-year tenure, currently serving as the agency's deputy chief of staff. He also has served as the agency's acting assistant secretary for budget, technology, and finance and as chief financial officer. If confirmed, Weems will replace Mark McClellan, who left the agency in October 2006.

Bush also nominated Tevi David Troy to serve as deputy HHS secretary. Troy currently serves as deputy assistant to the president for domestic policy and also has served as special assistant to the president and deputy cabinet secretary.

Acting CMS Administrator Leslie V. Norwalk said Thursday she asked not to be considered as a permanent replacement to McClellan. "It was not easy, but I decided early in the search process that I could not commit to staying for another two years," Norwalk said in a statement sent to CMS staff. "I am ready for the next phase in my life and am hopeful it will be as rewarding as the last six years have been."

Norwalk said she would stay on through the transition period and praised the agency's work on the Medicare drug benefit and giving states more flexibility on Medicaid.

In a statement, HHS Secretary Michael O. Leavitt said that Weems' "wealth of experience" as an advisor to several HHS secretaries and as a manager of large budgets and organizations would help Weems at the helm of CMS. "He understands the large fiscal challenges facing Medicare and Medicaid and what it will take to strengthen and sustain those programs for the future," Leavitt said.

Leavitt said Troy "is a consensus builder on tough public policy issues" who has demonstrated "innovative" thinking on several issues, including health information technology, public health, childhood obesity, and food and drug safety.

Senate Finance Committee Chairman Max Baucus, D-Mont., said Thursday he was pleased the White House has nominated a new leader for CMS.

"Medicare and Medicaid are essential programs for more than 80 million Americans. Having a permanent Administrator will be a big help as we continue to improve these programs and provide the highest quality of care possible. I plan to act quickly and work with my colleagues on the Finance Committee to carefully review this nomination," Baucus said in a statement.