Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
October 24, 2014

October 23, 2014

State Medicaid Directors Respond to Critique of Varying State Standards

Last month, Healthopolis noted a Department of Health and Human Services Inspector General report that surveyed the wide diversity of state approaches to regulating Medicaid managed care programs.

The Inspector General’s analysis prompted the National Association of Medicaid Directors to craft a response to the report, suggesting that the lack of consistency in state supervision of Medicaid programs is not necessarily a failure but rather illustrates different approaches to managed care programs, which are colored by the unique circumstances of each state in managing very complicated factors influencing the Medicaid program.



Health Programs Factor in Upcoming House Committee Leadership Changes

The focus on upcoming November congressional elections understandably centers on possible election results and which party will control the Senate. However, the election of a new Congress, which convenes in January, also starts the process for reconfiguring the leadership of pivotal House committees. Roll Call’s Emma Dumain and Matt Fuller today examine possible GOP leadership changes in 11 different committees.

Health care program funding authority, particularly for the Medicare program, falls under the jurisdiction of the House Ways and Means Committee. The committee’s current chairman, Michigan Republican Rep. Dave Camp is retiring and Wisconsin Republican Rep. Paul D. Ryan has the inside track — but has some competition — to take over the gavel of the powerful tax committee.

Ryan has led a long-running campaign to overhaul the Medicare program as the chief of the House Budget Committee. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.  At the helm of the Ways and Means Committee, Ryan would have the opportunity to craft a Medicare overhaul measure instead of offering budgetary suggestions.

If Ryan departs from the budget panel, the heir apparent is the committee’s current Vice Chairman, Rep. Tom Price, a conservative physician from Georgia. Price is a staunch opponent of the 2010 health care overhaul law and has authored his own proposal on overhauling health insurance coverage options. Price’s plan relies on offering tax breaks to give people the means to buy health insurance instead of the current health insurance exchange plan subsidies.

October 22, 2014

EPA Waste Discharge Rule Targets Dentists

The Environmental Protection Agency periodically weighs in on health care provider regulatory matters, usually addressing pollution concerns about medical waste. Today, the environmental regulatory agency published proposed rules on discharges of mercury from dental offices.

Dentists use an amalgam for dental filings and the metal — mostly silver — is bonded together with mercury. The EPA notes that dentists are the main source of mercury discharges into water treatment facilities. The agency claims that mercury waste diffused into the environment is a global pollution problem. The proposed regulations require dentists to use amalgam separators, which separate the mercury for alternative disposal instead of rinsing excess amalgam into the local waste water treatment system.




By Paul Jenks Posted at 3 p.m.

Annual Spending Waste Report Mocks State Medicaid Provider Taxes and Assorted NIH Grants

Oklahoma Republican Sen. Tom Coburn today unveiled an annual report listing examples of possibly dubious spending on various government programs. The report always offers interesting and sometimes humorous reading and illustrates the often-unusual nature of federal program and grant spending. Sen. Coburn usually highlights examples of unusual health program spending.

This year’s report mocks National Institutes of Health research on human interaction with dogs, the impact of meditating through reading Buddhist texts, and funding for a smart-phone application that helps parents manage the eating habits of fussy children. The eccentric nature of  some NIH grants is a regular target for the annual report. Last year’s waste report blasted a study on marital conflict between husbands and wives.

The 2014 report includes a critique of state Medicaid provider taxes, particularly on nursing homes, which inflates federal Medicaid payments to the state. States collect both the additional tax and the additional Medicaid funding.  In July, Healthopolis highlighted a report that indicates states are increasing relying on Medicaid provider taxes to fund the program.

Other items in this year’s report blast the weighting of sleep apnea as grounds for veterans’ disability benefits and the random assignment of Medicare Part D prescription drug plans to beneficiaries who do not indicate a preference. Roll Call’s Niels Lesniewski reports that this year’s report is presumably the last of the senator’s annual compilation of unusual federal spending. Sen. Coburn is retiring from the Senate at the end of the year.



October 21, 2014

DEA Clarifies Drug Wastage Disposal Rules

The Drug Enforcement Administration last month issued final regulations on the disposal of strictly controlled substances, such as prescription painkillers. The regulatory effort hopes to improve and expand on methods of disposing highly regulated substance and adjusts stringent record keeping requirements. The complex rules and record keeping requirements also seek to strictly control the custody of controlled substances. However, hospital groups complained that the new rules were unclear on accounting for unused portions — or drug wastage — from medicine administered to patients and is left over in syringes and IV solutions.

The DEA, in a memo released on Friday, clarified that the regulations do not consider any remaining leftover products used for patients in the hospital as part of the hospital’s drug inventory and subject to provisions of the new regulations.  The rules were designed to assist in collecting unused drugs in patients’ home medicine cabinets but the DEA did not intend for the disposal regulations to apply to hospital drug wastage.  However, the agency does urge hospitals to be careful and document the destruction of the drugs.

Ebola: CDC Updates Guidance on Protective Gear and Drinking Chlorine

There have been no new confirmed Ebola cases in the U.S since October 15. But the last two cases were health care professionals treating the first – and only U.S. identified patient. The Centers for Disease Control and Prevention on Monday updated its guidance protocols for health care worker protective gear when treating an Ebola patient. The guidance and summary stresses a more thorough coverage of the body with protective equipment and urges rigorous training on donning and doffing protective suits. The new guidance follows some critiques offered last week on agency’s original guidance for protective gear.

The updated instructions are also accompanied by a separate warning to health professionals not to drink chlorine or disinfectant solutions. It is (hopefully) safe to assume that health care professionals know not to drink disinfectants but the CDC hopes to dispel a rumor that drinking chlorine can prevent the Ebola virus. Separately on Wednesday, the Department of Health and Human Services hosts a webinar on health worker protection and a previously released emergency room preparedness checklist.






October 20, 2014

UN Ebola Response Trust Fund Struggles to Turn Pledges into Cash

The United Nations has set up a special trust fund to assist efforts to combat the spread of the Ebola virus in West Africa. However, the response from UN member nations has not overwhelmed the trust fund’s accountants. The UN announced the nearly $1 billion effort in September and Reuters reports that $365 million has been pledged to the fund. However, countries have not been quick to redeem pledges with immediate cash contributions. Colombia led the way with a $100,000 check. On Friday Australia deposited $8.7 million. Even if outstanding current pledges from Venezuela, Chile, Estonia, Finland, India, Kazakhstan, New Zealand, Norway and Romania are received before the end of the month, the fund will still substantially miss its initial $100 million October target.




By Paul Jenks Posted at 3:23 p.m.

This Week: Another Committee Hearing on Ebola; Groups Examine Improvements to the Delivery of Health Care

Congressional committees are quickly mobilizing to examine the response effort to combat the spread of the Ebola virus. This week, the House Oversight and Government Reform Committee on Friday takes its turn in quizzing federal health officials. A House panel started the push for hearings in a session last week. Meanwhile, the Aspen Institute today examines leadership of the effort to combat the Ebola virus in West Africa. On Tuesday, a foreign policy group conference call mulls the international implications of the pandemic in Africa. On Wednesday, the retiring House Democratic dean of health care topics, California Rep. Henry A. Waxman discusses national and global health care challenges in a Georgetown University lecture

Overhauling the Delivery of Care

A forum today examines current training and certification standards, best practices and challenges for community health workers. A video of the session will be posted after the discussion. Also, the Brookings Institution will broadcast a half-day forum examining the latest results of accountable care organizations (ACO) efforts to overhaul the delivery of health care. The ACO’s are empowered by the Affordable Care Act to change the method of care delivery with an eye toward reducing health care costs. Also this week, a Capitol Hill conference features prominent health group leaders addressing how hospitals and health systems can foster improvements in delivering health care services. Meanwhile, IBM hosts a conference this week in Arlington, Virginia exhibiting new approaches to delivering health and social programs and the U.S. Chamber of Commerce weighs in with a conference on Wednesday on how the private sector can drive improvements to the health care delivery system


October 17, 2014

Advocates and Chefs Judge Congress on Food Policy

Celebrity chefs might be more accustomed to judging food dishes, but on Thursday they teamed up with farm advocates and policy makers to offer their ratings on something people haven’t always found palatable – Congress.

“Top Chef” head judge Tom Colicchio and Environmental Working Group President Ken Cook – who spearhead the nonprofit organization Food Policy Action – released their third annual National Food Policy Scorecard, which grades lawmakers based on key food and farm bill votes determined by an advisory board. The event took place at Graffiato restaurant in Washington, D.C., where guests could nosh on pizza and other Italian-inspired bites from fellow “Top Chef” alum Mike Isabella.

“Most people don’t connect the dots between what you put on the table and what goes on in Washington,” Colicchio said.

tom 240x320 Advocates and Chefs Judge Congress on Food Policy

Members were judged on their support for a variety of bills and amendments, ranging from sustainable farming and food subsidizes to labeling requirements and safety regulations.

A total of 71 lawmakers from both the House and Senate received perfect scores. All of them were Democrats, with the exception of Independent Sen. Angus King of Maine and Republican Sen. Lisa Murkowski of Alaska. One of the lowest rated Democrats was Collin C. Peterson of Minnesota, who is ranking member of the House Agriculture Committee and got a grade of 39 percent. Seven other Democrats received scores under 50 percent.

Meanwhile, 35 lawmakers – all Republicans – received scores of zero, which the group labels as “food policy failures.”  But not all from the GOP missed the mark. In addition to Murkowski’s perfect score, Sen. Susan Collins of Maine got a 75 percent rating, followed by Republican Rep. Christopher H. Smith of New Jersey with 61 percent.

fork 240x264 Advocates and Chefs Judge Congress on Food Policy

Colicchio noted that they had already received a range of positive and negative calls from lawmaker’s offices since releasing the scorecard on Capitol Hill that morning. “People are starting to take notice,” Colicchio said, adding “We’re not going away.”

CDC Tallies Vaccination Rates for Children in Kindergarten

The Centers for Disease Control and Prevention today issued its annual assessment of vaccination rates for children in kindergarten programs. The agency reviewed state data and reported that median vaccination coverage for the 2013-2014 school year was 94.7 percent for the measles, mumps, and rubella vaccine and 95.0 percent for the diphtheria, tetanus toxoid, and acellular pertussis vaccine. The overall rates are inline with the 95% national vaccination objective. However, many states allow varying levels of exemptions from vaccination due to religious or personal objections. The report records the median national vaccination exemption rate at 1.8 percent. The CDC noted that a high exemption level and failure to maintain vaccination targets could leave children vulnerable to vaccine-preventable diseases.


This Week: Congress Focuses on a Travel Ban and Ebola Response Funding

Lawmakers this week escalated calls for a travel ban for people coming from Ebola-ravaged West African countries. The pleas for travel restrictions culminated at a special recess House subcommittee hearing on Thursday (view C-SPAN video), where lawmakers grilled federal health and border control officials about their recent actions and missteps in managing the response to the first U.S. Ebola case. Republican members are leading the charge for a travel ban – or imposing restrictions on visas –but some Democrats have also endorsed the idea.

However, Centers for Disease Control and Prevention Director Thomas Frieden continued to insist this week that restrictions would only encourage people to avoid regular travel channels and limit governments’ ability to track those who have been exposed to the virus. The Economist, in an opinion that coincided with its cover article on Ebola published today, echoed the same reasoning for avoiding travel restrictions. President Obama told reporters at the White House on Thursday that he does not have a “philosophical objection” to a travel ban but is relying on advice from infectious disease experts, who say the current screening process is the best approach to managing potentially infected travelers.

Meanwhile, a separate congressional battle is brewing over added Ebola response funding for the CDC and the National Institutes of Health. Roll Call’s David Eldridge reported that Democrats are pressing for a separate hearing on Ebola response funding prior to the end of the recess break and claim the CDC cannot do its job adequately without more congressional appropriations. Roll Call’s Emma Dumain wrote that Republicans countered by noting that the CDC has not yet asked for additional funding. Also, CQ HealthBeat’s John Reichard reported (subscription) that hospital executives are scrambling for grant funding for technical assistance in managing Ebola cases, and CQ Roll Call’s Melanie Zanona noted (subscription) that health provider groups have ramped up calls for a boost in funding for a federal hospital preparedness program.

Other related Healthopolis reports on Ebola this week:

October 16, 2014

Cocoa Companies Stir Up Plan to Fight Ebola

Everyone from chocolate companies to social media sites have lined up to help stop the deadly Ebola virus from spreading in West Africa and beyond.

On Wednesday, the World Cocoa Foundation announced at its annual meeting that it will donate $600,000 to support Ebola prevention and care efforts led by the International Federation of Red Cross and Red Crescent Societies and Caritas. The organization said the donations were collected from a variety of its members, including Nestle, Ghirardelli Chocolate and The Hershey Company.

“The spread of Ebola is a serious concern to WCF and our member companies, given our deep and longstanding support for the well-being of West African cocoa-growing communities,” said World Cocoa Foundation President Bill Guyton in a press release. “This member-led contribution reflects an ongoing strong commitment by our industry to health and humanitarian relief efforts during international crises.”

Although Ghana and Ivory Coast – two of the largest cocoa growers – have not yet experienced an Ebola outbreak, the press release notes that 70 percent of the world’s cocoa supply originates in West Africa, which means it could be severely impacted if the virus continues to spread.

Meanwhile, Facebook founder Mark Zuckerberg announced yesterday that he and his wife would donate $25 million to the Centers for Disease Control Foundation, calling the Ebola epidemic a “critical turning point” in a Facebook post. Zuckerberg added that “grants like this directly help the frontline responders in their heroic work. We are hopeful this will help save lives and get this outbreak under control.”

Before the first case of Ebola was even diagnosed in the U.S., the Bill & Melinda Gates Foundation pledged a whopping $50 million last month to combat the epidemic in West Africa, stepping up the pressure on other tech companies.

Study: Ebola Incubation Period May Exceed 21 Days

Doctors are watching those who had contact with the first domestically confirmed Ebola cases in Dallas using a standard 21-day waiting period to see whether a person exposed to the virus will develop an infection. The medical community came up with the standard for observation after past experiences with Ebola, but a study published on Tuesday in the journal PLOS Currents indicates that the virus’ incubation period could exceed 21 days for up to 12 percent of patients. The new research, authored by Dr. Charles N. Haas of Drexel University in Philadelphia, is based on analysis of past Ebola cases, along with data on the first nine months of the current outbreak.

The study noted in its conclusion:

 While the 21-day quarantine value currently used may have arose from reasonable interpretation of early outbreak data, this work suggests a reconsideration is in order and that 21 days may not be sufficiently protective to public health. Further, outbreaks such as the current West Africa EBOV are presenting an opportunity for careful collection of data sufficient to revise and update (perhaps in an adaptive fashion) such recommendations. It may be that incubation time itself is a function of intensity and nature of contact, which may also need to be considered. The estimate of appropriate incubation time would need to explicitly consider the costs and benefits involved in various alternatives, which would incorporate explicit computations from transmission modeling.

By Paul Jenks Posted at 8:28 a.m.
Disease Control

October 15, 2014

Telemedicine Has an Easier Pathway Outside the U.S.

Healthopolis last month highlighted a new report on varying state regulatory agency acceptance of the use of telemedicine, or remote access to health care services through telecommunications devices. The Economist magazine this week examines the varying range of acceptance of telemedicine around the world.

The report notes that the telemedicine concept, which was touted as far back as 1924, is still not completely accepted worldwide despite new electronic devices. The U.S. lags behind in acceptance due to varying state and federal restrictions, but European regulations are simpler and telemedicine increased in Israel after health authorities relaxed guidelines. However, evidence is limited on the cost-effectiveness of remotely offered health services and some physicians are reluctant to adopt the concept.





Ebola: Reviewing Legal Options to Restrict Travel

A consistent lawmaker concern regarding the U.S. response to the Ebola crisis has focused on the airport screening process and possible restrictions on travel from West Africa.  However, there are no direct commercial flights to the U.S. from Guinea, Sierra Leone and Liberia and suggested travel restrictions largely hinge on halting the issuing of visas.

Florida Republican Rep. Tom Rooney on Tuesday penned the most recent request to federal agencies for action on visa restrictions. The Department of State issues visas, the Department of Homeland Security’s Customs and Border Protection agency inspects all people who enter the country and the Centers for Disease Control and Prevention is tasked with preventing the introduction of communicable diseases.

The Congressional Research Service has prepared a brief summary for lawmakers on the legal authority of federal agencies to restrict travel. Federal travel restriction authority ranges from visa limits, “Do Not Board” listings of people with contagious diseases, plus Department of Transportation regulations on passengers with infectious diseases and pilot requirements to report illness they encounter during a flight. Federal and state agencies also can impose isolation and quarantine measures. The CDC’s quarantine authority is authorized for Ebola by a recently revised White House executive order.



By Paul Jenks Posted at 9:23 a.m.
Disease Control

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