Capitol Hill Report:The Reality in Washington

February 24, 2014

By Michael J. Amery, Esq., Legislative Counsel, (202) 506-7468

Congress Approves Spending Bill
Congress has actually started out 2014 with an agreement on a 1,582-page, $1.1 trillion spending bill, sending it to President Obama for signature after the Senate approved the bill by a landslide on January 16.

This means that the government will be funded at congressionally approved levels rather than by a string of continuing resolutions that were in place for all of 2013, which included significant cuts due to sequestration.

Here are the final 2014 funding results for the following agencies and programs the Academy actively advocated for during 2013: 

  • $29.9 billion for the National Institutes of Health, a $1 billion increase from 2013, but still $700 million less than pre-sequestration levels
  • $2.55 billion for the FDA, which restores spending lost to sequestration, plus adds an additional $91 million
  • An additional $122 million for Alzheimer's disease, the largest-ever increase in federal funding for Alzheimer's research and care programs  
  • $16 million for the Department of Defense's Parkinson's research program
  • Continued funding for key programs within the Congressionally Directed Medical Research Programs (CDMRP), which support research for a variety of service-connected neurologic diseases including $5 million for MS, $7 million for ALS and significant funding for headache
  • Increase from $54 million to $127 million in funding for the Center for Disease Controls Heart Disease and Stroke Prevention program
  • $40 million for the Brain Initiative, including $10 million designated for NINDS
  • $10 million dollar reduction in funding for the Independent Payment Advisory Board (IPAB).

We at the AAN are particularly proud of the funding for Alzheimer's. Derek Brandt of the AAN DC staff put significant time and effort on this issue all year with the members of the Leaders Engaged in Alzheimer's disease (LEAD) Coalition. Brandt participated in meetings with top congressional appropriators including Labor-HHS Subcommittee Chair Sen. Tom Harkin (D-IA) and Ranking Member Sen. Jerry Moran (R-KS) to successfully advocate on behalf of the substantial increase for Alzheimer's research.

Medicaid 'Bump' Endorsed
In a big success for neurology, Rep. Frank Pallone (D-NJ), the lead Democrat on the House Energy & Commerce Health Subcommittee, recently urged the subcommittee to extend the Medicaid "bump" portion of the Affordable Care Act. View Pallone's comments, which begin at the eight-minute mark of the hearing and mention neurology at 8:40. 

Pallone's endorsement is timely, as the expiration of the provision that pays primary care and all internal medicine subspecialists Medicare rates for their Medicaid E/M services-but excludes neurology, psychiatry, and Ob/Gyns-is less than a year away. As expected, we have seen some significant efforts by the primary care specialties to encourage Congress to extend the provision beyond 2014-without neurology.

In DC, we have started meeting with staff of the congressional leadership including the offices of Speaker John Boehner (R-OH), Majority Leader Eric Cantor (R-VA), and both sides of the House Energy & Commerce Committee which has jurisdiction over the issue. For the 200 Academy members coming to Neurology on the Hill in March, we expect the Medicare bump will be a top issue as we continue to fight for AAN members and their patients.

Senate Finance Committee Chair Headed to China
If you want to be successful in getting your health care agenda through the congressional process it has to go through the Senate Finance Committee, which has jurisdiction over any health policy that involves federal funding, like Medicare.

Sen. Max Baucus (D-MT) came to the Senate in 1979 and currently chairs the Finance Committee. Throughout his time on the committee as both a member and as chair when the Democrats controlled the Senate, Baucus has had a profound effect on health care policy, including spearheading the passage of the Affordable Care Act in 2010. President Obama has nominated Baucus to become the US ambassador to China and is expected to be confirmed by the Senate in the near future.

We always have appreciated the willingness of Chairman Baucus and his staff to listen and consider issues impacting neurologists and patients with neurologic conditions and we wish him well.

Sen. Ron Wyden (D-OR) is expected to be named as the new chair of the Senate Finance Committee.  

Regulatory Corner
by Daneen Grooms, MHSA, Regulatory Affairs Manager

AAN, CMS Meet About Chronic Care Management Services
The AAN supports the decision of the Centers for Medicare & Medicaid Services (CMS) to reimburse physicians who perform chronic care management (CCM) services because our members treat and are often the principal care providers for patients with chronic conditions of the brain and nervous system. We also share CMS' goal to improve care for patients with chronic conditions. Given our strong interest in this service, the AAN is part of a stakeholder group that has been working closely with CMS for over a year on their CCM code proposal.

A few weeks ago, AAN Past President Bruce Sigsbee, MD, FAAN, and I met with CMS staff in the Clinical Standards Group to discuss what the practice requirements should look like for CCM. During the meeting, we presented recommendations that we believe will help assure that there will be enough practices, including specialists, to deliver CCM services to the Medicare beneficiaries who are eligible and will ultimately benefit. In particular, Dr. Sigsbee stressed that this service should not be limited to primary care because there are neurologists currently providing this service who should be allowed to bill for CCM. He also said that CMS should not require physicians to hire physician assistants or advanced practice nurses in order to perform CCM.

CMS will release their practice requirements for CCM in the 2015 Medicare Physician Fee Schedule proposed rule later this year and you can count on the AAN to stand up for neurology.

View the New AAN Two-Midnight Inpatient Admission Checklist for TIA and Seizures 
The AAN developed a Two-Midnight Inpatient Admission checklist that members can reference when treating patients with TIA or seizures. Effective October 1, 2013, CMS now applies a two-midnight definition for hospitalizations. Physicians should admit as inpatients, patients they expect will require two or more midnights of hospital services. Otherwise, the physician should treat the patient on an outpatient basis unless and until she or he has received hospital services that span two midnights. The Two-Midnight Inpatient checklist is available on the Practice Management Resources page under Additional Resources.


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