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January 26, 2005

2005

January 26, 2005

HEADLINE

ATS Comments on Medicare Coverage Proposal for Tobacco Cessation Counseling

This week the ATS, joined by the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR) and the National Association for the Medical Direction of Respiratory Care (NAMDRC), submitted comments to the Centers for Medicare and Medicaid Services (CMS) supporting the draft decision to cover tobacco cessation counseling services for Medicare beneficiaries.

The proposed Medicare coverage policy extends to all Medicare beneficiaries with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA-approved information. The counseling may only be provided by individuals trained in tobacco use cessation counseling.

Medicare is proposing to cover two cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions in a 12 month period. The practitioner and patient have flexibility to choose between intermediate or intensive cessation strategies for each attempt.

While the proposed policy falls short of creating a uniform smoking cessation benefit for all Medicare beneficiaries – only Congress has the authority to create such a broad new benefit – the CMS does extend smoking cessation counseling to significant number of Medicare beneficaires.

In addition to supporting the CMS decision to provide coverage of tobacco cessation counseling services to Medicare beneficiaries, the ATS comments recommended that the cost of expanding tobacco counseling services be included in the Medicare sustainable growth rate formula – essentially asking Medicare to provide new money to cover the service. The ATS also noted that the counseling service should be closely linked with coverage of prescription drugs used to assist tobacco cessation efforts under the new Medicare drug benefit starting January 2006.

CLINICAL PRACTICE

Pulmonary Community Petitions for Permanent Seat on the AMA RUC

The American Thoracic Society and the American College of Chest Physicians sent a letter to the AMA Resource Based Relative Value Up date Committee (AMA RUC) seeking a permanent seat on the committee. The AMA RUC plays an important function by recommending the relative work value for CPT codes to Medicare, which drives the Medicare – and many private insurers - reimbursement CPT codes. The Medicare program accepts over 90% of the recommendations made by the AMA RUC.

The AMA RUC is made of 20 permanent seats held by selected specialties and three rotating seat for specialties that do not hold permanent seat. The pulmonary community is eligible to hold one of the three rotating seats.

The criteria for a permanent seat on the AMA RUC are:

  • The specialty is an American Board of Medical Specialties recognized specialty.
  • The specialty comprises 1% of physicians in practice.
  • The specialty comprises 1% of physician Medicare expenditures.
  • Medicare revenue is at least 10% of mean practice revenue for the specialty.
  • The specialty is not meaningfully represented by an umbrella organization, as determined by the RUC.

The pulmonary community clearly meets criteria 1-4, and in the opinion of the ATS and ACCP leadership, meets criteria 5. The American College of Physicians has sent a letter in support of the pulmonary community request for a permanent seat, strengthening the case for meeting the fifth criteria.

The gastroenterology and oncology/hematology community have submitted similar petitions. The petitions will be discussed at the February meeting of the AMA RUC.

RESEARCH

NIH Delays Release of Open Access Policy

In a surprise move, the National Institutes of Health cancelled last week’s release of the revised “Open Access� publication policy for research articles supported with NIH funds. Several observers speculated that the cancelled release was intended to prevent the controversial policy from becoming an issue at the confirmation hearing of President Bush’s nominee for the Secretary of Health and Human Services, Mike Leavitt. He currently is the Administrator of the Environmental Protection Agency.

As reported earlier in the ATS Washington Letter, the NIH issued draft policy requiring NIH-funded researchers to submit their manuscripts to the NIH after they have been accepted for publication and edited by the accepting journal. Six months after an NIH-supported research study's publication - or sooner if the publisher agrees- the manuscript would be available to the public, at no charge, on the NIH's Web-based database, PubMed Central.

Several sources have reported that NIH has revised its policy to require public access to NIH-funded articles 12 months after publication – as opposed to the 6 months initially proposed.

COPD

COPD Raised in HHS Secretary Confirmation Hearing

In his lead question at the Senate Finance confirmation hearing, Sen. Mike Crapo (R-ID) asked Secretary of Health and Human Services (HHS) nominee Mike Leavitt about the importance of COPD under Medicare and what plans Leavitt had to deal with increasing prevalence of COPD. The HHS nominee agreed about the importance of addressing COPD and committed himself to working with Senator Crapo and Congress to address issues facing the COPD community.



Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator