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July 11, 2008


July 11, 2008

Senate Passes Medicare Bill, Include Pulmonary Rehabilitation Provision

Legislation to avert a 10.6% cut in Medicare physician reimbursement passed the Senate this week by a veto proof margin of 69-30. The bill also includes a provision to create a pulmonary and cardiac rehabilitation benefit in Medicare. Both these are significant wins for the respiratory community.

The Senate vote was the next step in the legislative drama surrounding the Medicare bill. As you may recall, House passed the Medicare bill in late June. The Senate then failed, by one vote, to pass the same bill just before the July 4th recess. The physician community turned up the grassroots heat over the July 4th recess, in an effort to get at least one more Senator to vote in support of the Medicare bill. Senator Kennedy, who missed the earlier vote due treatment for brain cancer, made a dramatic return to the Senate to cast his vote for the Medicare. After the bill reached the 60 votes needed to ensure its passage a number of Senators who had previously voted against the bill switched their votes to support the bill.

The bill replaces the 10.6% cut in Medicare physician payments that started on July 1, 2008 and replaces it with a 0.5% update for the reminder of 2008 and a 1.1% update for 2009. However the legislation does not fix the underlying payment formula that is causing all cuts in Medicare physician payments. Congress will need to address that issue to avert additional cuts in 2010 and beyond.

The legislation recently passed by Congress creates a benefit category for pulmonary rehabilitation in Medicare statute, starting January 1, 2010. Establishing a pulmonary rehabilitation benefit in the Medicare statute will create a national coverage policy of pulmonary rehabilitation - eliminating the state by state coverage policies that have lead to coverage variations and barriers to pulmonary rehabilitation services for many Medicare beneficiaries.

The legislation also ends the mandatory title transfer of oxygen equipment to Medicare beneficiaries. Prior Medicare legislation required that ownership of oxygen durable medical equipment be transferred Medicare beneficiaries after 3-years of use. The legislation just passed by Congress rescinds this requirement.

But the legislative maneuvering is not over yet. While the Senate passage of the bill is an important victory for the physician community, the status of Medicare physician payments for the remainder of 2008 and 2009 still remain in doubt. The White House has stated that the President will likely veto the legislation. It remains to be seen if the White House will make good on it veto threat. If the President does veto the legislation, the House and Senate will again vote on the Medicare legislation to attempt to override the president's veto.

While it is premature to claim final victory, most observes believe Congress will override the President's threatened veto. Assuming the bill becomes law, pulmonary rehabilitation will now become a defined benefit under Medicare and should lead to enhance access to pulmonary rehabilitation services for Medicare beneficiaries. Inclusion of the pulmonary rehabilitation is a majority victory for the ATS and marks a successful advocacy partnership with sister organizations and patient organizations to bring the advocacy goal to fruition.


Senate Set to Vote on Global HIV/AIDS, TB and Malaria Bill

The Senate is set to take a procedural vote later today on the global HIV/AIDS, TB and malaria bill, known as PEPFAR (President's Emergency Plan for HIV/AIDS Relief), S. 2731, which expands U.S. leadership and funding support of detection, treatment and prevention of these diseases. This vote will be the final procedural step to full Senate consideration of the bill beginning next week. The PEPFAR bill includes the ATS's priority global tuberculosis control legislation, the Stop TB Now Act. This legislation expands the US Agency for International Development's (USAID) global TB control activities and provides $4 billion over 5 years for the program. Senate Conservatives are expected to offer amendments to the PEPFAR bill to reduce the overall funding level of $30 billion over 5 years for global HIV/AIDS, TB and malaria programs and concerning use of funds for reproductive health activities in certain countries. The bill passed the House in April. ACTION: ATS members are asked to contact their Senators in support of the bill. For more information visit the ATS website at:


House Action on Spending Bills Stalls

Further action in the House on FY 2009 Appropriations bills has stalled after Appropriations Committee chairman Rep. Obey (D-WI) announced this week that the committee will not be voting on any of the bills. Obey's decision follows a disagreement between committee Republicans and Democrats over a different bill that resulted in adjournment of the full committee's consideration of the Labor-Health and Human and Education (Labor-HHS-ED) Services Appropriations bill on June 26. Under the House's current proposed Labor-HHS-ED bill, the NIH would receive a 3.8% funding increase for 2009 and CDC is slated for a 2.4% increase.

Although the House Appropriations process is breaking down, the Senate Appropriations Committee, chaired by Sen. Byrd (D-WV), is moving ahead with consideration and passage of its versions of the FY 2009 spending bills. This includes the Labor-HHS-ED bill, which the full committee passed on June 26th. The committee is expected to pass all of its spending bills although it is unlikely that the full Senate will consider any on the floor before adjourning in October. The Senate's proposed FY09 Labor-HHS-ED bill would allocate a 3.4% increase for NIH and a 1.2% increase for the CDC.

If the House Appropriations Committee does not pass any of the spending bills out of the committee, the likely scenario is that a continuing resolution will be passed just before Congress recesses in October funding all programs at FY 2008 levels. The spending bills with the final FY 2009 spending levels will then be finalized by the Congress following the Presidential election and the beginning of the new Congress in January. Another option is passage of an emergency supplemental spending bill before Congress recesses in September that will provide funding for some selected spending priorities, including the NIH.

Points of Contact

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