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House Panel Approves HEA Reauthorization Bill

The House Committee on Education and Labor unanimously approved the "College Opportunity and Affordability Act of 2007" (H.R. 4137) to reauthorize the Higher Education Act (HEA, P.L. 105-244).  Authority for the HEA expired on Sept. 30th, 2003; however, several extensions have been enacted, making no policy changes but allowing uninterrupted administration of the programs authorized under the law.  The current extension is set to expire March 30th, 2008.

The bill authorizes a loan forgiveness program for medical specialties with residency training programs that require more than five years of training and have fewer U.S. medical school graduate applicants than the total number of training and fellowship positions available.

Several provisions, pulled from the "Student Loan Sunshine Act" (H.R. 890), would dramatically affect medical education financial aid counseling. The Sunshine Act language would:

• Require institutions to develop and administer a code of conduct for their financial aid offices;
• Require institutions to disclose all relationships with lenders;
• Ban all gifts, opportunity pools, and revenue-sharing between lenders and institutions;
• Prohibit financial aid administrators' participation on lender advisory boards; and
• Require "preferred lender lists" to include at least 3 unaffiliated lenders.

The bill also contains several provisions designed to curtail "unfair and deceptive private educational lending practices."

Several amendments were approved during the marathon ten hour mark-up.  Congressman Tom Price (R-GA), an orthopedic surgeon -- on behalf of Congressman Charles Boustany (R-LA), a heart surgeon, and himself -- offered an amendment to require the Government Accountability Office (GAO) to conduct a study of education-related indebtedness of medical school graduates.  The amendment was approved by a voice-vote.

The bill was referred to multiple House committees and it is unclear when it will reach the House floor.  A final Manager's amendment of the bill with additional changes is expected to be released before the full House consideration.  This past summer the Senate passed the "Higher Education Amendments of 2007" (S. 1642), its version of the HEA reauthorization.

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President Signs Temporary HEA Extension

On October 31st, President Bush signed the "Third Higher Education Extension Act of 2007" (P.L. 110-109) to extend temporarily the Higher Education Act (HEA, P.L. 105-244) through March 31, 2008.  Authority for the HEA expired on Sept. 30, 2003; however, several extensions have been enacted, allowing uninterrupted administration of the programs authorized under the law.  The most recent extension would have expired Oct. 31.  Earlier this summer, the Senate passed the "Higher Education Amendments of 2007" (S. 1642) to reauthorize the HEA for five years.  The House is expected to introduce a final HEA reauthorization bill shortly.

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IRS Issues Draft Good Governance Practices for Charitable Organizations

March 13, 2007 - The Internal Revenue Service (IRS) has issued a preliminary staff discussion draft of possible good governance practices for 501(c)(3) charitable organizations.  In the introduction to the document, the IRS states that "we believe that an organization that adopts some or all of these practices is more likely to be successful in pursing its exempt purposes and earning public support."

Among the topics discussed in the IRS document are:

• the need for a clearly articulated mission statement;
• adopting and regularly evaluating a code of ethics and whistleblower policies;
• due diligence by the directors and their duty of loyalty;
• transparency regarding the organization's mission, activities, and finances;
• policies to ensure that fundraising solicitations meet federal and state law requirements;
• ensuring that the board regularly receives and reads up-to-date financial statements, auditor's letters, and finance and audit committee reports;
• payment of reasonable compensation for services of officers and staff; and
• adoption of a policy that establishes standards for document integrity, retention, and destruction.

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Senate Confirms FDA Head

December 22, 2006 - On December 7th, the Senate voted 80-11 to confirm Andrew C. von Eschenbach, M.D. as Commissioner of the Food and Drug Administration (FDA).  Originally nominated for the position in March, Dr. von Eschenbach has been serving as acting Commissioner since September 2005.  For part of that time, Dr. von Eschenbach also led the National Cancer Institute (NCI) where he has been Director since January 2002, until leaving to head the FDA full time in June.  President George W. Bush appointed John E. Niederhuber, M.D., Director of NCI in August.

Prior to his appointment at NCI, Dr. von Eschenbach was Executive Vice President and Chief Academic Officer of the University of Texas M.D. Anderson Cancer Center in Houston, where he also served as Vice President for Academic Affairs and held the Roy M. and Phyllis Gough Huffington Clinical Research Distinguished Chair in Urologic Oncology.   A graduate of St. Joseph's University in Philadelphia, he received his medical degree from Georgetown University School of Medicine and completed his internship at Philadelphia General Hospital and his residency in urologic surgery at Pennsylvania Hospital in Philadelphia before serving as an instructor in urology at the University of Pennsylvania School of Medicine.

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House Committee Preserves Physician Visa Waiver Programs

October 9, 2006 - On September 27th, the House Judiciary Committee approved the "Physicians for Underserved Areas Act" (H.R. 4997) to reauthorize J-1 visa waiver programs through 2008.  Participating entities include the Department of Health and Human Services, the Mississippi Delta Regional Authority, the Appalachian Regional Commission, and State Departments of Health through the Conrad 30 program.  These waiver programs exempt foreign physicians who receive their graduate medical education in the U.S. from the 2-year home service requirement of the J-1 visa in exchange for practicing in a health professions shortage area.

Authority for the waiver programs expired June 1st, 2006, preventing participating entities from granting new waivers.  H.R. 4997 will retroactively authorize the waiver programs during this lapse.  The bill was included earlier this year in broader immigration reform legislation and was originally written to make J-1 visa waiver programs permanent, but was amended during committee mark-up to a 2-year extension.  It is unclear if the House and Senate will pass H.R. 4997 before they adjourn later this year.

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Senators Frist and Kennedy Introduce Health Disparities Bill

October 9, 2006 - On the last day, September 29th, before the Senate recessed until after the election Majority Leader Bill Frist (R-TN) and Senators Edward Kennedy (D-MA), Jeff Bingaman (D-NM), and Barrack Obama (D-IL) introduced the "Minority Health Improvement and Health Disparity Elimination Act" (S. 4024).  This legislation seeks to improve the health and health care of racial and ethnic minority and other health disparity populations through enhanced cultural competency training for providers, grants to improve health care access and outreach to underserved populations, and increased research to reduce health care disparities, among other provisions.

The bill reauthorizes the Title VII Centers of Excellence, Health Careers Opportunity Program, Scholarships for Disadvantaged Students, and Faculty Loan Repayment programs, which are designed to improve the diversity of the health care workforce through recruitment, training and mentoring.  The legislation also requires health professions schools to collect and report demographic data on applicants, matriculants, and graduates to the Department of Health and Human Services to be stored in a database and analyzed to assess diversity within the health professions.

The bill also creates a new grant program at the Agency for Healthcare Research and Quality for research to improve the health of racial and ethnic minority and other health disparity populations.  It directs the Institute of Medicine to convene a summit to evaluate and report on federal efforts addressing health disparities.  The bill reauthorizes the National Center for Minority Health and Health Disparities and strengthens its role in coordinating disparities research at the National Institutes of Health.

Senator Frist hopes to pass the bill in November before he leaves the Senate.

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House Passes Health IT Bill

August 20, 2006 - On July 27th the House passed (270-148) the "Health Information Technology (HIT) Promotion Act of 2006" (H.R. 4157).  Of interest to teaching hospitals and medical schools, the bill:

• Amends the self-referral ("Stark") and anti-kickback laws to provide exceptions/safe harbors for the provision of HIT and training services.  The exceptions/safe harbors apply to hospitals, group practices, prescription drug plan sponsors, Medicare advantage organizations, or any other such entity specified by the Secretary.  Within three years, the Secretary must complete a study determining the impact of such changes on rate of HIT adoption, types of resources offered to providers, changes in provider relationships, and healthcare quality;
• Provides similar exceptions/safe harbors for consortia of healthcare providers, payers, employers and others to either collectively purchase and donate health information technology or offer a choice of technologies that take into account the varying needs of such providers;
• Directs the President to promote the advancement of healthcare quality and health research by allowing access to "useful categories" of non-identifiable electronic health information;
• Provides $15 million in matching grants in both FY 2007 and FY 2008 to help integrated health systems use HIT to better coordinate the provision of care;
• Directs the HHS Secretary to implement ICD-10 codes by October 1st, 2010.  However, the Secretary can not demand a "level of specificity" that requires documentation of "non-medical information;" and
• Directs the HHS Secretary to study whether there is a need for "greater commonality" in state privacy laws and regulations.

The bill, which contains several other related provisions, must now be reconciled with the Senate's HIT bill (S. 1418).  The Senate bill does not include the AAMC-supported Stark and anti-kickback provisions.  It also provides a higher level of funds for purchasing HIT.

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Higher Ed Commission Comments on Physician Workforce Shortages

July 26, 2006 - The Secretary of Education's Commission on the Future of Higher Education released a second draft of its final report.  The new draft is widely acknowledged as less critical of higher education than the original report.  Among the additions, a findings section outlines concerns that "current and projected shortages in physicians, registered nurses, and other medical specialties may affect the quality of care for the increasingly aging population of Baby Boomers" and the report recommends "increasing federal and state investment in education and research in critical areas such as the STEM fields (science, technology, engineering and mathematics) teaching, nursing, biomedicine, and other knowledge-intensive professions."  Additionally, the draft report broadly calls for increased transparency and accountability; developing - at the institutional level - new and innovative means to control costs and improve productivity; simplifying the financial aid process; and a shift to financial aid awards based on need rather than merit.

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Senate Panel Approves Ryan White Reauthorization Bill

May 26, 2006 - The Senate Health, Education, Labor and Pensions (HELP) Committee approved legislation (S. 2823) to reauthorize the Ryan White CARE Act (P.L. 101-381).  Sponsored by HELP Committee Chairman Michael Enzi (R-WY) and co-sponsored by Ranking Member Edward Kennedy (D-MA), the bill attempts to address changes in the AIDS epidemic since the act's last reauthorization in 2000.

Specifically, the bill includes a provision to include the number of HIV cases in addition to AIDS cases for funding formulas; requires that 75 percent of funds be spent on "core medical services;" and attempts to more evenly distribute funds between rural and urban areas, a contentious issue among lawmakers.  The committee voted 19-1 in favor of the measure, with Sen. Hillary Clinton (D-NY) voting against it on the grounds that New York will lose $20 million under the new formula.

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May 12, 2006 - Senate leaders pulled two Republican-supported medical liability reform bills from consideration on the Senate floor, following two unsuccessful votes to invoke cloture and avert filibusters.  The 48-42 vote to limit debate over the "Medical Care and Access Protection Act of 2006" (S. 22) fell short of the sixty votes needed to invoke cloture.  The cloture vote on the bill, which was introduced by Senator John Ensign (R-NV), was split primarily along party lines, with three Republicans voting against cloture.  A subsequent 49-44 vote to limit debate over the "Healthy Mothers and Healthy Babies Access to Care Act" (S. 23) also fell short of the required sixty votes.  As a member of the Health Coalition on Liability and Access, the Association of American Medical Colleges has endorsed S. 22 and S. 23.

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Education Commission to Hold Open Meeting

(AAMC’s Washington Highlights) The Secretary of Education's Commission on the Future of Higher Education plans to hold its fifth meeting on May 18th and 19th in Washington, DC.  The Commission is charged with initiating a national dialogue about the future of higher education and how best to improve the country's system of higher education to ensure graduates are well prepared to meet future workforce needs.  The agenda for the May meeting includes a discussion of preliminary findings, possible recommendations and a proposed format for the final report, which must be submitted to the Secretary by August 2006.

The meeting will be open to the public, but individuals interested in attending must register in advance by contacting Kristen Vetri at kristen.vetri@ed.gov.  Opportunities for public comment and more information on the Commission are available on the Department of Education's Web site.

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House Subcommittee Holds Fourth HIT Hearing

(AAMC’s Washington Highlights) At an April 6th House Ways and Means Subcommittee on Health hearing, Chair Nancy Johnson (R-CT) expressed concern about the slow adoption of health information technology (HIT).  Stating that "additional actions are needed by both the public and private sectors" to achieve the President's goal of providing most Americans with electronic health records (EHRs) by 2014, Rep. Johnson urged the witnesses to suggest ways to expedite HIT adoption.

Among those testifying was Brent Henry, Vice President and General Counsel for Partners HealthCare System in Boston.  Mr. Henry stated that Congress should craft a Stark law exception and an anti-kickback safe harbor for the provision of HIT and related services.  He commended Chairwoman Johnson for introducing legislation (H.R. 4157) that would assure these exceptions.  According to Lewis Morris of the Health and Human Services (HHS) Office of the Inspector General, his colleagues are exploring whether and how HIT exceptions/safe harbors could assure a "balance between fostering the adoption of beneficial [EHR] systems and preventing fraud and abuse in the Federal health care programs."

Ken Kizer, M.D., M.P.H., Chairman and CEO of Medsphere Communications, suggested that the federal government "support and utilize open source software as the preferred option" whenever possible.  Open source software is non-proprietary, available at no or minimal cost, and is designed to operate in collaboration with multiple systems.  He also testified that the use of EHRs should be a condition of participation for Medicare providers. Ranking Member Pete Stark (D-CA) supported this option, explaining that it would eliminate the need to alter Stark and anti-kickback laws.

Also testifying at the hearing was David Brailer, M.D., Ph.D., HHS National Coordinator for Health Information Technology.  Responding to privacy concerns related to remote monitoring technology, Dr. Brailer announced that HHS plans to initiate a demonstration project evaluating remote monitoring for multiple sites.

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Congress Extends Mental Health Parity

January 3, 2006 - In December the Senate joined the House of Representatives in passing legislation that would extend for one year a mental health parity law under which health insurers are prohibited from placing caps on annual or lifetime mental health benefits unless they place similar caps on medical and surgical benefits. This means that if a health plan provides no lifetime limit on medical benefits, it could not impose one for mental health benefits either. The bill is an extension of the original 1996 law that was scheduled to expire December 31st.

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Higher Education Provisions Included in Budget Reconciliation

January 2, 2006 - The final version of the Budget Reconciliation cuts a net $12.7 billion from student aid programs. The Senate had proposed attaching all of the Higher Education Act reauthorization, but only certain financial provisions were included in the final agreement. A majority of these provisions are designed to decrease mandatory spending, such as reducing lender subsidies. Other provisions recycle savings back into student aid, such as increasing unsubsidized loan limits for graduate borrowers from $10,000 to $12,000.

The conference report accepted the House's proposal to reduce borrower origination fees for both the Federal Family Education Loan (FFEL) and Direct Loan programs. Under this proposal, both types of loans will be incrementally reduced to a total origination fee of 1% in 2010. While the origination fee for Direct Loans is 1% higher during this period, the conference report requires FFEL lenders to charge an additional 1%. The final agreement does not include any changes to consolidation origination fees, thus allowing borrowers to continue to refinance their student loans without initial fees.

Like the Senate proposal, the conference report makes no changes to Stafford Loan interest rates. In July, 2006, interest rates are scheduled to change to a fixed 6.8 % rate, as opposed to the current variable rate formula based on the 90-day T-bill plus 2.3%. The final agreement also does not make any changes to consolidation loan interest rates, which will remain a fixed rate formula based on the weighted average of the loans to be consolidated, not to exceed 8.25%. Additionally, the conference report eliminates a loophole that allowed lenders to charge interest rates of 9.5% and, with the House and Senate in agreement, repeals in-school consolidation.

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AAMC Comments on Accreditation Provisions of HEA Reauthorization

On November 15ththe Association of American Medical Colleges (AAMC), in coordination with the Liaison Committee on Medical Education (LCME) and in consultation with the American Medical Association, sent a comment letter to the House Committee on Education and the Workforce and the Senate Committee on Health, Education, Labor, and Pensions. The letter expresses concerns regarding the accreditation provisions of the Higher Education Act reauthorization bills ( H.R. 609, S. 1614).

The letter focuses on several changes in accrediting bodies' reporting requirements and recommends that public disclosure of sensitive findings remain at the discretion of the institution. This stems from concerns that release of this information or a summarized version without explanation or context could be easily misinterpreted by the public.

Additionally, the AAMC recommends the deletion of provisions that require accrediting associations or agencies to enforce standards based on the institution's mission. The ambiguity of this mission-related language could be misconstrued to suggest that the LCME compromise its standards in deference to a school's mission.

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Congress Passes Student Aid Forgiveness Legislation In Response to Hurricane Katrina

As a result of numerous school closings in the path of Hurricane Katrina, on September 8th, the House moved provide relief to students forced to withdraw from schools closed due to natural disasters. The House unanimously approved the "Student Grant Hurricane and Disaster Relief Act" ( H.R. 3668), proposed by Congressman Bobby Jindal (R-LA), which gives the Secretary of Education the ability to waive the Title IV federal assistance programs' repayment requirements when a natural disaster is recognized by the President. The Senate passed H.R. 3668 without amendment by Unanimous Consent on September 15th.

"This bill fulfills an urgent need to provide flexibility and assistance to students who have been forced to put their higher education on hold as a result of Hurricane Katrina," said Congressman Jindal. "Students in my district are facing hardships on numerous fronts, from the loss of their homes and communities to the damage and closure of college campuses. As students cope with these unprecedented challenges, we should not add to their burden by requiring those who have been forced to withdraw from college to repay student aid." Under current law, students with grants and scholarships offered under Title IV federal assistance programs (including Pell Grants, the Supplemental Educational Opportunity Grant program, Leveraging Educational Assistance Partnerships program, and scholarships offered under the GEAR UP and TRIO programs) must repay the awarded funds if they fail to complete the required academic year or semester.

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House Subcommittee Approves Higher Education Act Reauthorization Bill

On July 14th The House Education and the Workforce 21st Century Competitiveness Subcommittee approved, as amended, H.R. 609, the "College Access and Opportunity Act of 2005," which would reauthorize the Higher Education Act (HEA), by a party line vote of 18-15. Specifically, H.R. 609 contains several provisions of particular interest to medical schools and teaching hospitals. The bill seeks to increase loan limits, but limits increases in subsidized loan limits to freshmen and sophomores, and to a small increase from $10,000 to $12,000 in unsubsidized loans for graduate and professional students. H.R. 609 also includes provisions shifting all Stafford loans, including consolidation loans, to a variable interest rate. Full Committee Chairman John Boehner (R-OH) noted that he is working on compromise legislation that would allow borrowers a choice of consolidating student loans at a fixed or a variable rate, with the rates for each based on different underlying financial instruments. Chairman Boehner stated during the mark-up that he will continue his discussions and may have a compromise to announce at the full committee mark-up. The subcommittee rejected amendments offered by Ranking Member Dale Kildee (D-MI) that would have retained the fixed rate option for consolidation, and capped Stafford Loan interest rates at 6.8% rather than the 8.25% included in the bill.

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Senators Frist and Clinton Introduce Health IT Bill

Senate Majority Leader Bill Frist (R-TN) and Senator Hillary Clinton (D-NY) have introduced S. 1262, "The Health Technology to Enhance Quality Act of 2005." According to the bill's summary, it "will help harness the potential of health information technology (IT) and preserve patient privacy while reducing costs, enhancing efficiency, and improving the overall quality of patient care."

Specifically, S. 1262 would establish in statute the Office of the National Coordinator for Health Information Technology (ONCHIT), created by the Bush administration in 2004. ONCHIT is located within the Department of Health and Human Services (HHS). The bill directs ONCHIT to work with the National Institute for Standards and Technology (NIST) to establish a permanent electronic health information standards development working group to review existing standards, identify deficiencies and omissions working against a national goal of interoperability, and recommend to the HHS Secretary which standards should be adopted.

According to the legislation, ONCHIT would also direct and coordinate federal spending related to health care IT. The bill authorizes $125 million per year in grants to local or regional health care facilities over five years in order to create an interoperable system in which records could be stored electronically. S. 1252 also provides exemptions from "Stark" self-referral and anti-kickback laws to allow hospitals, health plans and other to offer health information technology equipment to physicians as long as its purpose is to "reduce medical errors, improve quality, reduce costs, improve care coordination, streamline administration, and promote competition and transparency." Relief from the physician self-referral and anti-kickback laws would apply only if the physician entity receiving support complies with final data standards for interoperability.

The bill requires the Medicare program to establish a budget neutral "value-based purchasing pilot program to encourage the reporting of health care quality data and facilitate the payment of providers based on performance." The pilot program could be expanded nationwide and implemented after two years. The bill also includes a "Sense of the Senate" that Medicare physician payment modifications should include provisions to encourage the adoption of health IT standards and reporting of quality measures. S. 1252 also directs HHS, the Departments of Defense and Veterans Affairs and other federal agencies to adopt uniform healthcare quality measures to assess "the effectiveness, timeliness, efficiency, patient centeredness and safety of care across federal health care programs" including Medicare, Medicaid and State Children's Health Insurance Program.

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Medical Schools Support Legislation to Expand Liability Protections

On May 10th Association of American Medical Colleges (AAMC) sent a letter in support of the "Community Health Center Volunteer Physician Protection Act of 2005" (H.R. 1313), which would extend liability protections under the Federal Tort Claims Act (FTCA) to physicians who volunteer their services at Community Health Centers. The bill was introduced by Representative Tim Murphy (R-PA). Under H.R. 1313, physicians who volunteer at federally funded health centers would be deemed Public Health Service employees and thereby qualify for liability coverage under the FTCA. The AAMC letter applauds H.R. 1313 for providing "a meaningful incentive for physicians to volunteer their services at Community Health Centers (CHCs)." The letter states that such action "would help mitigate the shortage of CHC physicians and thereby improve healthcare access for many underserved Americans." In the letter, AAMC President Jordan J. Cohen, M.D., explains that CHCs "provide unique learning environments and experiences for many medical students and residents." It praises H.R. 1313 for helping "CHCs maintain these valuable patient care and medical education activities."

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Senate Committee Passes Patient Safety Legislation

On March 9th, the Senate Health, Education, Labor, and Pensions (HELP) Committee passed patient safety legislation that would establish a voluntary and confidential reporting system in support of initiatives to reduce preventable medical errors. The "Patient Safety and Quality Improvement Act of 2005" (S. 544) is based on legislation that was approved by the Senate in the 108th Congress ( S. 720). The House passed similar legislation last year; however, the House and Senate did not reconcile subtle differences between the two bills before the 108th Congress adjourned.

By granting legal protections for reported data, S. 544 would encourage providers to report medical errors or "near misses" to "Patient Safety Organizations" (PSOs). The PSOs would compile and analyze the data with the intent of developing and disseminating "best practices" that could avoid subsequent errors and improve healthcare quality.

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Slow-Down in Healthcare Spending Growth

According to a report in the January/February 2005 issue of Health Affairs, healthcare spending grew by 7.7% in 2003, versus a 9.3% increase the previous year. However, the proportion of national gross domestic product (GDP) related to healthcare spending increased from 14.9% in 2002 to 15.3% in 2003.

Slower growth in Medicaid payments helped moderate spending growth, according to the report. In 2003, Medicaid spending grew by about 7%, versus about 12% in 2002. The report identifies tighter eligibility requirements, reduced benefits, and decreased upper payment limit payments as major factors in the decline. In 2003, Medicaid spending growth for hospital services was 5.3%, about 6% lower than in 2002.

Medicare spending in 2003 grew by 5.7%. By contrast, in 2001 and 2002, program spending increased by 10.8% and 7.6% respectively. According to the report, the "slowdown in growth in 2003 was evident in Medicare spending for hospital services, which increased 5.3% in 2003 compared to a 7.0% growth in 2002."

While the growth in private spending on physician services increased from 8.2% in 2002 to 9.4% in 2003, the growth in public spending on physician services fell from 8.1% in 2002 to 6.7% in 2003. However, the growth in Medicare spending on physician services was higher in 2003 than in 2002 (6.9% vs. 5.7%). The increase reflected a significant difference in the Medicare payment update for CY 2002 (which was negative) and CY 2003 (when a legislative "fix" averted a negative update for CY 2003 Medicare physician payments).

According to the report, health insurance enrollment dropped in 2003, likely due to job losses and a reduction in take-up rates for employer-based coverage.

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Senate Committee Leaders Urge HHS, OMB to Fund Health IT Initiatives

Senate Health, Education, Labor, and Pensions Committee Chairman Michael Enzi (R-WY) and Senate Finance Committee Chairman Charles Grassley (R-IA) joined Ranking Members Edward Kennedy (D-MA) and Max Baucus (D-MT) in signing a January 5 letter to Secretary of Health and Human Services Tommy Thompson encouraging him to "include in the 2006 budget a significant commitment to health information technology." The letter also was sent to Office of Management and Budget Director Joshua Bolton.

In the letter, the Senators praise the "ambitious and commendable agenda" of Dr. David Brailer, National Coordinator for Health Information Technology. They urge Secretary Thompson and Director Bolton to assure that Brailer's office receives "adequate resources…to continue its important work." According to the letter, Dr. Brailer has estimated that an interoperable health information technology system could "generate savings of about…$170 billion annually" and could improve "clinical trials and public health surveillance and response."

The Senators requested a "complete plan of action" to address "issues surrounding the adoption of health information technology," including "targeted financial assistance" for providers, assistance for regional/community health technology organizations, and "financial incentives" for providers who "implement and use" such systems to improve quality. According to the letter, Congress plans to explore pay-for-performance options, "and the use of technology may play a role."

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Congress Approves Extension of J-1 Visa Waiver Program

Congress has approved S. 2302, legislation extending for two years the authority of states to provide up to thirty waivers per year for international medical graduates that complete residency training in the U.S. on J-1 visas to remain in this country in return for providing primary health care services in federally-designated health professional shortage areas. Without such waivers, J-1 visa physicians would be required to return to their home countries for two years before returning to the U.S. The legislation also includes authority for each state to offer up to five waivers to physicians who would not be serving in designated shortage areas. Under the bill, J-1 visa physicians that convert to H-1B visa status during their waiver period would not count against the statutory cap on H-1B visas.

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House Approves One-Year "Clean" Reauthorization of Higher Education Act

On October 6th, the House of Representatives approved by voice vote a "clean" one-year extension of programs authorized under the Higher Education Act (HEA). The legislation, H.R. 5185, makes no policy changes, and allows uninterrupted administration of the programs through FY 2005 while the Congress continues to debate a longer reauthorization. A day later, the House also approved by a vote of 414-0 legislation (H.R. 5186) to close for one year a loophole in lending rules that allows lenders to collect a significant profit on certain types of loans. The savings associated with closing the loophole would be used to increase loan forgiveness for elementary and secondary school teachers of math, science and special education.

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House Approves 2-Year Extension of J-1 Visa Waiver Program

On October 6th, the House of Representatives approved legislation (H.R. 4453) extending for two years the J-1 Visa Waiver Program, which provides each state with authority to sponsor waivers permitting foreign physicians who complete their residency training in this country to avoid the two-year home country requirement associated with the J-1 visa program. In return, the foreign physicians are required to provide health care in underserved areas for a minimum of three years. An amendment offered in the House Judiciary Committee would allow up to five physicians in each state to work in areas that are not designated as underserved. Additionally, the bill, as approved, would clarify that physicians that transfer into the H-1B visa program do not count against the statutory cap on H-1B visas. The program expired on May 31.

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Judge Dismisses Resident Match Litigation

On August 12, U.S. District Court Judge Paul Friedman granted the Association of American Medical Colleges’ (AAMC) motion to dismiss the Jung resident match case, due to the passage of legislation which clarifies that the NRMP does not violate antitrust law. On May 7, 2002, three former resident physicians filed an antitrust lawsuit against the National Resident Matching Program (NRMP) and its five sponsors, the Accreditation Council for Graduate Medical Education, and 29 hospitals that sponsor residency programs. The suit, Paul Jung, M.D., et al. v. Association of American Medical Colleges, et al., was filed in the U.S. District Court for the District of Columbia. The AAMC believed that this lawsuit was without legal merit and contested it vigorously, as it could have had implications for all of graduate medical education.

On April 27, the AAMC filed a motion to dismiss the lawsuit. The motion cited the Pension Funding Equity Act of 2004, which includes language confirming that an entity's sponsorship or use of the NRMP Match does not violate antitrust laws. In early April, both houses of Congress passed legislation to clarify that the NRMP does not violate antitrust law. As Congress has now spoken directly on the issue, Judge Friedman determined that the lawsuit was no longer viable.

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Congress Passes Match Legislation

Legislation clarifying that the National Resident Matching Program (NRMP) does not violate antitrust law was cleared for the President's signature on April 7. Through the leadership of Senator Judd Gregg (R-NH), a provision entitled "Confirmation of Antitrust Status of Graduate Medical Education Resident Matching Programs," was included in the conference report to the Pension Funding Equity Act of 2004 (H.R. 3108). This legislation passed the House on April 2nd and President Bush is expected to sign the bill.

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Last updated 1/11/2008