Summary: Selected Enacted Health Legislation The 110 TH Congress Updated November 20, 2007

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1 National Conference of State Legislatures 444 North Capitol Street, N.W., Suite 515 Washington, D.C Summary: Selected Enacted Health Legislation The 110 TH Congress Updated November 20, 2007 Joy Johnson Wilson, Health Policy Director Rachel Morgan, Senior Health Policy Specialist

2 TABLE OF CONTENTS SUMMARY: SUMMARY: SELECTED ENACTED HEALTH LEGISLATION THE 110 TH CONGRESS APPROPRIATIONS/BUDGET... 3 Department of Defense Appropriations for FY2008 (H.R. 3222)... 3 FY 2008 Continuing Resolution (H J Res. 52)... 3 U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007 (H.R. 2206)... 4 HEALTH PROMOTION/DISEASE PREVENTION... 6 National Breast and Cervical Cancer Early Detection Program Reauthorization Act of 2007 (H.R. 1132)... 6 PHARMACEUTICAL ISSUES... 6 Food and Drug Administration Amendments Act of 2007 (H.R. 3580)... 6 PUBLIC HEALTH... 7 TMA, Abstinence Education, and QI Programs Extension Act of 2007 (HR 3668)... 7 Trauma Care Systems Planning and Development Act of 2007 (H.R. 727)... 8 TRADE... 9 Extend the Trade Adjustment Assistance Act (H.R. 3375)... 9 VETERANS Veterans' Compensation Cost-of-Living Adjustment Act of 2007 (H.R. 1284) Joshua Omvig Veterans Suicide Prevention Act (H.R. 327)... 10

3 SUMMARY: SELECTED ENACTED HEALTH LEGISLATION THE 110 TH CONGRESS APPROPRIATIONS/BUDGET Department of Defense Appropriations for FY2008 (H.R. 3222) Murtha (D-PA) Making appropriations for the Department of Defense for the fiscal year ending September 30, 2008, and for other purposes. Summary of Health Provisions Provides $22.96 billion for the Defense Health Program. President Bush P.L (11/13/07) NCSL supports continuation of federal programs pending final action on FY 2008 appropriations bills. Continuing Appropriations Authorizes funding for the continued operations of the Veterans Health Administration Medical Services. Extends the authorization for spending under the FY 2008 Continuing Resolution from November 16, 2007 to December 14, FY 2008 Continuing Resolution (H J Res. 52) Obey (D- WI) Provides for FY 2008 funding for federal programs pending final action on FY 2008 appropriations bills. Authorizes spending through November 16, President Bush P.L (9/29/07) NCSL supports continuation of federal programs pending final action on FY 2008 appropriations bills.

4 U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007 (H.R. 2206) David Obey (D-WI) Provides for funding for continued operations in Iraq. Provides emergency supplemental appropriations for FY Provides funding for FY 2007 SCHIP shortfall. Imposes a one-year moratorium on two administrative rules regarding Medicaid and SCHIP. Obtains savings in the Medicaid program through requiring the use of tamper-resistant prescription pads. Extends the Wisconsin Pharmacy Plus program through December 31, Summary of Health Provisions State Children s Health Insurance Program Provides for funds as necessary up to $650 million to address the FY 2007 SCHIP shortfall. Medicaid and State Children s Health Insurance Program (SCHIP) Imposes a one-year moratorium on the proposed rule, Cost Limit for Providers Operated by Units of Local Government and Provisions to Ensure the Integrity of Federal-State Financial Partnership, published in the January 18, 2007 Federal Register. The final rule was published in the May 29, 2007 Federal Register, with associated forms and instructions, but is subject to the one-year moratorium because the emergency supplemental appropriations legislation was signed into law on May 25, Medicaid Imposes a one-year moratorium on any rule or provisions restricting payments for graduate medical education (GME). A proposed rule, Graduate Medical Education was published in the May 23, 2007 Federal Register and would P.L (5/25/07) NCSL supported the supplemental funding for the SCHIP program. NCSL supported the moratorium on the final and proposed rules. NCSL Correspondence SCHIP Shortfall Letter to Representatives David Obey and Jerry Lewis, leadership of the House Committee on Appropriations, from NCSL President Senator, Leticia Van de Putte urging their support for inclusion of provisions which appropriate funds to avert the FY2007 shortfall for the State Children s Health Insurance Program (SCHIP) in the supplemental appropriations bill. (4/13/07) Letter to Representatives Nancy Pelosi and John Boehner, and Senators Harry Reid and Mitch McConnell from NCSL President Senator, Leticia Van de Putte, and NCSL President-elect, Representative Donna Stone urging congress to provide sufficient funding to avert the FY 2007 funding shortfall for the State Children s Health Insurance Program (SCHIP). (3/09/07) Intergovernmental Transfer (IGT) Rule Letter to Ms. Leslie Norwalk, Acting Administrator for the Centers for Medicare and Medicaid Services, from Carl Tubbesing NCSL Deputy Executive Director, providing comments on proposed rule, regarding the use of intergovernmental transfers (IGTs) to raise state matching funds for Medicaid. (3/19/07) Graduate Medical Education Letter to Ms. Leslie Norwalk, Acting Administrator for the Centers for Medicare and

5 eliminate federal financial participation for payments and services in Medicaid related to GME. This proposed rule is subject to the moratorium. Restricts Medicaid reimbursement for outpatient prescription drugs for scripts that are not submitted electronically, to scripts written on tamper-resistant prescription pads. Effective October 1, This provides $35 million in federal savings in FY 2008 and $210 million in savings over five years. Extends until December 31, 2009, Wisconsin s Pharmacy Plus program, a Medicaid 1115 waiver that provides prescription drug coverage for seniors. Provides $25 million to compensate individuals injured by the H5NI vaccine. Defense Health Provides $600,000,000 to the Defense Health Program for the treatment of traumatic brain injury and post traumatic stress disorder to remain available until September 30, 2008, of which $118,000,000 will be used for procurement and available until September 30, Veterans Health Provides $466 million to the Veterans Health Administration for veterans medical care inclusive of $30 million to establish at least one new Level I comprehensive polytrauma center, $9.4 million to establish polytrauma residential transitional rehab programs, $25 million for prosthetic, $100 million for enhancements to mental health services, and $229 million for treatment of Operation Enduring Freedom and Operation Iraqi Freedom veterans. Provides additional sums for transitional caseworkers, substance abuse treatment, readjustment counseling, and blind rehab services. Provides $32.5 million for medical and prosthetic research for research related to the unique medical needs of returning veterans Medicaid Services (CMS), from Carl Tubbesing, NCSL Deputy Executive Director, providing comments on the proposed rule regarding the elimination of federal reimbursement under Medicaid for costs associated with Graduate Medical Education (GME). (6/22/07)

6 FDA Office of Women s Health Requires the office to be funded at not less than $4 million. Poison Control Centers HEALTH PROMOTION/DISEASE PREVENTION National Breast and Cervical Cancer Early Detection Program Reauthorization Act of 2007 (H.R. 1132) Baldwin (D-WI) PHARMACEUTICAL ISSUES Food and Drug Administration Amendments Act of 2007 (H.R. 3580) Sponsor: Appropriates $23 million for poison control centers. Amends the Public Health Service Act to provide waivers relating to grants for preventive health measures with respect to breast and cervical cancers. Authorizes grants to states. Provides additional funding flexibility to up to five states. Reauthorizes the Prescription Drug User Fee and the Medical Device User Fee programs; and the Pediatric Research Equity and the Best Pharmaceuticals for Children Acts. Authorizes the Pediatric Medical Device Safety and Improvement Act. Enhances the Food and Drug Administration s ability to improve drug safety. Creates a clinical trial database. Establishes the Reagan-Udall Foundation. P.L (4/20/07) P.L (9/27/07) Public Health Preventive Health Screenings and Check-Ups NCSL urges Congress to increase support for initiatives that promote regularized preventive health screenings and check-ups. NCSL is particularly supportive of efforts that provide information about and promote screening for: cardiovascular disease, dental disease; obesity, asthma, diabetes, cancer. We also support efforts to ensure that children receive age appropriate check-ups and screenings that include recommended childhood immunizations; and dental, vision and hearing screenings; and recommended treatment. Drug Safety Drug Safety. The NCSL supports efforts to improve the safety and quality of our drug supply by: (1) Establishing a publicly available database of clinical trials to help increase patient enrollment in clinical trials, provide a mechanism to track trial progress and to ensure that trial results are made public; (2) Enacting laws and regulations and embracing new technologies to track and trace drugs through the supply chain, to help address concerns about drug diversion and counterfeit drugs; (3) Increasing post market surveillance to monitor drug safety; (4) Requiring a FDA review of its preapproval guidelines with respect to special populations; and (5) Enacting laws and promulgating - 6 -

7 PUBLIC HEALTH TMA, Abstinence Education, and QI Programs Extension Act of 2007 (HR 3668) Dingell (D-MI) Preempts some state laws. Enhances the FDA s ability to monitor and regulate food and drug safety. Extends abstinence education programs, eligibility for transitional medical assistance (TMA) under Medicaid, and authority to pay Medicare Part B premiums for certain qualifying individuals through December 31, Potential impact on state SCHIP programs due to changes in the TMA outlays. Summary P.L (9/29/07) regulations to prevent the sales of misbranded, adulterated, and improperly prescribed drugs from any source including domestic and imported drugs and drugs from both domestic and imported sources sold over the internet or via mail order; and (6) Increasing funding for the Food and Drug Administration to provide support for additional staff and other resources necessary to make substantial and significant improvements in the drug safety system. NCSL supports continuation of federal programs pending final action on FY 2008 appropriations bills. State legislators strongly support continuation of the transitional medical assistance (TMA) program to support parents who move from welfare to work. NCSL strongly opposes efforts to make significant policy and statutory changes to the Medicaid program through regulation. Appropriates $12.5 million for the continuation of abstinence programs for the first quarter of FY Extends through December 31, 2007, the requirement that state Medicaid programs provide TMA to certain beneficiaries who would otherwise lose eligibility bacause of a change in income. Extends the authorization for payment of Medicare part B premiums by State Medicaid programs from September 2007 through to December Delays by six months the requirement through rules that providers use prescription pads that are tamper-resistant for non-electronic, hand written prescriptions executed after September 30, 2007 in order to receive reimbursement under Medicaid

8 Trauma Care Systems Planning and Development Act of 2007 (H.R. 727) Sponsor: Senator Jack Reed (D-RI) Amends the Public Health Service Act to add requirements regarding trauma care. Provides for grants to states. Summary Amends the Public Health Service Act to direct the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration (HRSA), to promote the collection and categorization of trauma data in a consistent and standardized manner. Reauthorizes the program through Removes authorization for the National Clearinghouse on Trauma Care and Emergency Medical Services. P.L (5/03/07) Public Health Federal support through grants and cooperative agreements, research and technical assistance is key to the stabilization and effective operation of the nation s public health system and provides critical support for the state and local public health infrastructure. NCSL urges Congress to continue: (1) to support grants and cooperative agreements to states and local governments for a broad range of public health activities; and (2) to support research and technical assistance, which aides states in the development and implementation of effective programs. In addition, NCSL wishes to foster the development of public and private sector partnerships to increase community accessibility to public health information and public health programs. Allows the Secretary to make grants to entities to carry out demonstration projects to improve emergency medical services in rural areas by increasing communication and coordination with state trauma systems. Revises the matching requirements for states to be eligible for grants to improve emergency medical services in rural areas. Prohibits the Secretary from making trauma care grants to a state unless the state's emergency medical services plan coordinates planning for trauma systems with state disaster emergency planning and bioterrorism hospital preparedness planning. Requires the Secretary to update the model plan for the designation of trauma centers and for triage, transfer, and transportation policies. Directs the Secretary to enter into a contract with the Institute of Medicine or another appropriate entity to conduct a study on trauma care and trauma systems - 8 -

9 TRADE research. Extend the Trade Adjustment Assistance Act (H.R. 3375) Herger (R-CA) Requires the HRSA Administrator and the ADA Commissioner to coordinate data collection on protection and advocacy. Provides that in any year in which at least $6 million is appropriated for the HRSA protection and advocacy services, two percent must be used for grants for training and technical assistance to protection and advocacy programs. Extends the Trade Adjustment Assistance Act for three months. Interest in expanding access to affordable health care coverage P.L (9/28/07) Free Trade and Federalism Adjusting to Free Trade. NCSL acknowledges that trade can bolster economies and increase standards of living. However, there are many who may suffer as states, localities, manufacturing or service industries, small farms, and communities adjust to the new realities of open markets. NCSL supports federal efforts to provide meaningful Trade Adjustment Assistance (TAA) to affected workers. NCSL encourages Congress and the implementing federal agencies: (1) to ensure that the funding for TAA programs is sufficient to meet current and future needs; (2) to expand benefits eligibility to service-sector and agricultural workers impacted by trade; (3) to work with NCSL and state legislatures to ensure that TAA programs are flexible to suit different states needs; (4) to engage in aggressive outreach to ensure that workers, employers, and communities are informed of the benefits of the TAA program and are able to effectively utilize the program; (5) to ensure that adversely affected workers are provided the full income support, training, reemployment services and other services and benefits to which they are entitled, and that claims for such benefits are reviewed expeditiously and objectively; (6) to simplify procedures for determining TAA eligibility; and (7) to refrain from modifying TAA in any way that would jeopardize the program s mandate to help tradeaffected workers who have lost their jobs as a result of increased imports or shifts in production out of the United States.

10 VETERANS Veterans' Compensation Cost-of-Living Adjustment Act of 2007 (H.R. 1284) Akaka (D-HI) Directs the Secretary of Veterans Affairs to increase, as of December 1, 2007, the rates of veterans' disability compensation, additional compensation for dependents, the clothing allowance for certain disabled adult children, and dependency and indemnity compensation for surviving spouses and children. Requires each increase to be the same percentage as the increase in benefits provided under the Social Security Act Old Age, Survivors and Disability Insurance, and on the same effective date. P.L (11/05/07) NCSL supports federal initiatives to improve the accessibility and quality of health care services to U.S. veterans and their families. NCSL is particularly supportive of efforts to: (1) increase access to health care services to veterans and their families; (2) improve and expand mental health services; (3) provide assistance to veterans and their families regarding the range of health care services available to them and the appropriate means of accessing the services; (4) expand and improve services to veterans who are amputees, who have traumatic brain injuries or other conditions or injuries sustained during active duty. NCSL urges the Department of Defense and the Department of Veteran s Affairs to work closely with state and local governments to when they can assist in the implementation of these initiatives, including sharing information with state Veteran s Departments regarding the status of veterans residing in the state.. Joshua Omvig Veterans Suicide Prevention Act (H.R. 327) Boswell (D-IA) Expresses the sense of Congress that: (1) suicide among veterans suffering from post-traumatic stress disorder (PTSD) is a serious problem; and (2) the Secretary of Veterans Affairs, in developing and implementing the comprehensive program outlined in this Act, should take into consideration the special needs of such veterans and of elderly veterans who are at high risk for depression and experience high rates of suicide. Directs the Secretary to develop and carry out a comprehensive program designed to reduce the incidence of suicide among veterans. Requires the program to include: (1) mandatory training for appropriate staff and contractors P.L (11/05/07) NCSL supports federal initiatives to improve the accessibility and quality of health care services to U.S. veterans and their families. NCSL is particularly supportive of efforts to: (1) increase access to health care services to veterans and their families; (2) improve and expand mental health services; (3) provide assistance to veterans and their families regarding the range of health care services available to them and the appropriate means of accessing the services; (4) expand and improve services to veterans who are amputees, who have traumatic brain injuries or other conditions or injuries sustained during active

11 of the Department of Veterans Affairs (VA) who interact with veterans; (2) screening for suicide risk factors veterans who receive medical care at a Department facility; (3) referral of at-risk veterans for counseling and treatment; (4) designation of a suicide prevention counselor at each Department medical facility; (5) research on best practices for suicide prevention; (6) mental health care for veterans who have experienced sexual trauma while in military service; (7) 24-hour veterans' mental health care availability; (8) a toll-free hotline; and (9) outreach and education for veterans and their families. Requires the Secretary to report to Congress on the program. duty. NCSL urges the Department of Defense and the Department of Veteran s Affairs to work closely with state and local governments to when they can assist in the implementation of these initiatives, including sharing information with state Veteran s Departments regarding the status of veterans residing in the state. NCSL Federal Health Policy website at: NCSL Staff Contacts: Joy Johnson Wilson, Health Policy Director (joy.wilson@ncsl.org); Rachel Morgan, R.N., Senior Health Policy Specialist (rachel.morgan@ncsl.org

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