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January 13, 2006


January 13, 2006


CMS Issues Policy on Dealing with Medicare Update
Last week, Herb Kuhn, Director for Medicare Management at the Centers for Medicare and Medicaid Services (CMS), sent a letter to Congress outlining how CMS anticipates dealing with the Medicare update factor for 2006.
As you know, because Congress failed to enact legislation in 2005 to fix the Medicare update factor for 2006, physician payments were cut by 4.4 percent starting January 1, 2006.
However, it is expected that Congress will pass legislation in early 2006 that will mandate a 0.0 percent update for Medicare in 2006.
In the letter to Congress, Mr. Kuhn indicated that CMS would be able to process claims at the 0.0 percent update starting two business days after enactment of the legislation. Further, Mr. Kuhn indicated that CMS will not require physicians to resubmit claims that have already been processed to receive the revised payment rate. Medicare carriers and fiscal intermediaries will automatically reprocess these claims and make the 4.4 percent adjustment. The letter outlined that, pending swift enactment of the legislation, CMS hopes to have all the claims reprocessed by July 2006 and expects to provide physicians with lump sum payment checks reflecting the revised payment rate.
Additionally, CMS will reopen the Medicare provider participation period for 2006. The enrollment period will run for an additional 45 day after enactment of the legislation. Any physician that elects to change their status to “participating� will have that status made retroactively to January 1, 2006.


NHLBI Set to Make Changes to Deal with FY06 Budget Shortfall
On January 4, ATS staff met with Dr. Elizabeth Nabel, Director of the National Heart, Lung and Blood Institute (NHLBI) as part of the annual meeting arranged by the NHBLI Constituency Group. The NHBLI Constituency Group is a coalition of organizations that support the NHBLI, of which the ATS is a member. Dr. Nabel gave an overview of the research successes and activities that NHLBI did in fiscal year 2005 (FY05), programs in FY06 and research opportunities for FY07.
Dr. Nabel outlined steps the Institute would take to adjust to the cut in the fiscal year 2006 budget, including
  • Non-competing awards cut 2.35% below FY06 Notice of Grant Award amount. Amounts indicated in future budget periods also will be adjusted by the same factor
  • Competing renewals will be capped at a 3% increase over the previous budget
  • Intramural research will be cut by 1% below FY 2006 budget level
  • The amount budgeted for contracts and Centers is being reduced by at least 1%
All NIH Institutes and Centers will be implementing similar measures.
Dr. Nabel discussed how decreasing funding has impacted the research payline at NHLBI. At the conclusion of the NIH doubling effort, the NHLBI payline was at the 21st percentile. Currently the payline is at the 14th percentile and likely to drop in fiscal year 2006.

HHS Release Pandemic Flu Guide
On January 6, the Department of Health and Human Service released a guide to help to inform and prepare Americans for a pandemic flu epidemic. According to HHS Secretary Mike Leavitt, the Pandemic Influenza Planning: A Guide for Individuals and Families is "a new tool to help Americans understand the threat of pandemic influenza and specific actions they can take to protect themselves and their families.�

The handbook includes a "Pandemic Flu Planning Checklist for Individuals and Families" and "Family Emergency Health Information Sheet" to help people gather information and resources they may need.
A copy of the "Pandemic Influenza Planning: A Guide for Individuals and Families," other checklists and pandemic planning information are available online at www.pandemicflu.gov.

Points of Contact

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