Presentation by Marsha Simon, Ph.D. Key Health and Human Services Legislation in the First Session of the 111th Congress Presentation by Marsha Simon, Ph.D.

111th Congress Senate Democrats - 58 Seats (50) Republicans - 41 Seats (49) 1 seat still undecided, but likely will be Democrat, Al Franken (D-MN) House of Representatives Democrats - 256 (235) Republicans - 178 (199) 2 Vacancies Rahm Emanuel (D), Illinois 5th District Kirsten Gillibrand (D), New York 20th District

New Leadership Chairman, Senate Health, Education, and Labor Committee Edward Kennedy (D-MA) Tom Harkin (D-IA) or Chris Dodd (D-CT) Chairman, House Energy and Commerce Committee John Dingell (D-MI) Henry Waxman (D-CA)

Legislative Agenda for the 111th Congress Children’s Health Insurance (CHIP) Program Reauthorization Stimulus/Economic Recovery Fiscal Year 2009 Health Appropriations - This Week Health Reform - ??? Medicare Physician Payment Fix - By End of Calendar Year 2009

Committees of Jurisdiction House Appropriations - discretionary funding (annual appropriations) Ways and Means - tax provisions, Medicare, Unemployment Insurance Energy and Commerce - Medicaid, Medicare, CHIP Senate Appropriations - discretionary funding Finance - Ways and Means, and Energy and Commerce mandatory/entitlements programs above

HHS Key Appointments Key Terms HHS- Department of Health and Human Services CDC - Center for Disease Control and Prevention CMS - Center for Medicare & Medicaid Services FDA - Food & Drug Administration HRSA - Health Resources and Services Administration

Stimulus/Economic Recovery Medicaid 4.9 percentage point increase ($87 billion) with other adjustments in federal matching funds for Medicaid in the House $8.6 billion for Medicaid coverage for the unemployed, 100% federal match in the House 5.6 percentage point increase with other adjustments in the Senate (also $87 billion) Conference Agreement: $87 billion, split over two years between 65% across the board increase and 35% targeted unemployment

Health Information Technology (HIT) Discretionary Appropriations for the Office of the National Coordinator for Health Information Technology (ONCHIT) $2 billion in the House $3 billion in the Senate Conference Agreement: $2 billion Discretionary Appropriations for the National Institutes of Health Conference Agreement: $10 billion

Mandatory HIT $17.1 billion net in the House and Senate Medicare bonus payments to hospitals and physicians beginning in 2011 for “meaningful EHR user” Medicare payment reductions beginning in 2016 for non-adopters Medicaid bonus payments, but no penalties, to health providers, 100% federal match Medicaid 90% enhanced match for HIT related administrative costs $19 billion net ($12 billion savings, $31 billion gross spending estimate)

Electronic Health Record (EHR) Meaningful User EHR meaningful users qualifying for incentives must include: Clinical Decision Support Computerized Physician Order Entry Ability to Capture Health Care Quality Data Support the Exchange of Clinical Data with Other Organizations

Comparative Effectiveness Research* $1.1 billion in discretionary appropriations in the House and Senate House: entire amount goes to Agency for Healthcare Research and Quality (AHRQ) Senate: funding goes to AHRQ ($300 million), the National Institutes of Health ($400 million), and the HHS Office of the Secretary ($400 million) Conference Agreement: Follows the Senate * Health services research assessing the comparative outcomes, effectiveness, and appropriateness of health care treatment and strategies

Prevention and Wellness Fund Discretionary Appropriations $3 billion in the House: Including $1 billion for childhood immunizations, $300 million for the preventative health and health services block grant, $545 million for a new program to carry out chronic disease, health promotion and genomics programs, $345 million for HIV/AIDS, Hepatitis, STD and Tuberculosis prevention, $60 million for environmental health programs, $50 million for injury prevention and control, $30 million for public health workforce development, and $40 million for the National Institution for Occupational Safety and Health, $40 million for National Center for Health Statistics, $150 million to implement a national action plan to prevent healthcare associated infections

Prevention and Wellness Fund $5.8 billion in the Senate: Including $750 million for childhood immunizations, $600 million for workforce development, $75 million for smoking cessation, $1 billion for screening and education especially for diabetes, $60 million for evaluation, $400 million for HIV and STD prevention, and $400 million for Healthy Communities Conference Agreement: $1 billion for new Prevention and Wellness Fund, broad discretion - does not include additional funding for biopreparedness and avian flu vaccine development