Government Relations Update Council of Osteopathic Student Government Presidents October 23, 2010 Pamela Murphy, MSW Acting Director of Government Relations

Overview Congressional Update Federal Student Financial Aid Update USDE Gainful Employment Rule GME and Primary Care Workforce Pursuant to the ACA Other AACOM Initiatives ACGME Resident Duty Hours Osteopathic Health Policy Internship Program

Congressional Update On 9/29/10, Congress approved a continuing resolution (CR) allowing continued government operations at current levels for most programs through 12/3/10 The Senate approved the measure 69-30, several hours before it passed the House.  The CR was necessary because Congress had not approved the 12 regular appropriations bills for FY 2011, which began on 10/1/10.  Congress failed to address the impending Pell grant shortfall by denying White House requests to add funding in the CR for the Pell grant program, which helps low-income college students pay for school

Congressional Update The Senate Appropriations Committee approved its fiscal year (FY) 2011 Labor-HHS-Education appropriations bill The bill includes funding increases for both Title VII and Title VIII programs, with Title VII receiving $356 million and Title VIII receiving $292 million The bill also provides $32 billion for the National Institutes of Health, $5.1 million to fund a newly authorized Rural Physician Pipeline program to create opportunities for primary care physicians to train in rural areas

Federal Student Financial Aid Update During March 2010, the House included financial aid reform provisions in the reconciliation bill -- the Health Care and Education Reconciliation Act of 2010 -- which was approved by the Senate and signed into law AACOM fact sheet http://publish.aacom.org/advocacy/topics/Documents/StudentLoanReform.pdf

Federal Student Financial Aid Update A scaled-down version of SAFRA, the act makes the federal government the sole originator of federal loans Provides funding to sustain the Pell Grant Program

Federal Student Financial Aid Update Student Financial Aid Resources Department of Education http://studentaid.ed.gov/PORTALSWebApp/students/english/IBRPlan.jsp IBRinfo http://www.ibrinfo.org/what.vp.html FinAid http://www.finaid.org/loans/ibr.phtml Sallie Mae http://www.salliemae.com/after_graduation/manage_your_loans/repaying-student-loans/starting_repayment/income-based-repayment.htm

Federal Student Financial Aid Update U.S. Department of Education Resources Direct Loan Program http://www2.ed.gov/offices/OSFAP/DirectLoan/index.html Direct Loan Servicing https://www.dl.ed.gov/borrower/BorrowerWelcomePage.jsp Direct Loan for Students Page http://www2.ed.gov/offices/OSFAP/DirectLoan/student.html

USDE Program Integrity: Gainful Employment Proposed Rule On 7/26/10, the US Department of ED released a Notice of Proposed Rulemaking (NPRM) in the Federal registrar requiring for-profit career colleges to better prepare students for "gainful employment" or risk losing access to federal student aid The NPRM seeks to protect students from taking on unsustainable debt they cannot repay and to protect taxpayers from high loan default rates The NPRM affects for-profit institutions and non-degree vocational programs at nonprofit institutions

USDE Program Integrity: Gainful Employment Proposed Rule On 9/9/10, AACOM submitted comments on the NPRM To view comments: http://www.aacom.org/advocacy/topics/testimony/Documents/AACOM%20Comments%20on%20NPRM%20Gainful%20Employment.pdf

USDE Program Integrity: Gainful Employment Proposed Rule The NPRM was scheduled to go into effect by July 2012 The USDE plans to delay finalizing NPRM The USDE ‘technically’ has until 11/1/2011 to finalize the regulations for them to take effect by July 2012 

GME Pursuant to ACA Primary Care Workforce Grants Proposed GME Rule Teaching Health Centers

GME Pursuant to ACA: Primary Care Workforce Grants On 9/27/10, HHS Secretary Sebelius announced $320 million in grants under the ACA to strengthen the health care workforce Of those grants, $253 million will go to improve and expand the primary care workforce under the Prevention and Public Health Fund

GME Pursuant to ACA: Primary Care Workforce Grants Under the $253 million for the Prevention and Public Health Fund, $167 million will go to primary care residency training programs to increase the number of residents trained in general pediatrics, general internal medicine, and family medicine By 2015, the program will support training of 889 new primary care residents over the number currently being trained The University of Medicine and Dentistry of New Jersey received award for primary care residency expansion 

GME Pursuant to ACA: Proposed GME Rule On August 30, 2010, AACOM submitted comments on a CMS proposed rule that would implement the direct graduate medical education (DGME) and indirect graduate medical education (IME) provisions of the ACA To view AACOM Comments: http://www.aacom.org/advocacy/topics/Documents/DMB-08302010.pdf The proposed rule implements ACA provisions that permit hospitals to count resident time in clinical nonprovider settings The proposed rule also would allow hospitals to count didactic time in non-hospital settings for DGME payment purposes and didactic time in hospital settings for IME payment purposes

GME Pursuant to Health Reform Act: Proposed GME Rule The proposed rule would implement the resident redistribution provisions of ACA regarding hospitals that have unused residency slots The proposed deadline for hospitals to apply for redistributed slots is Wednesday, December 1, 2010 If any slots are left in the distribution pool after the first round of applications, CMS proposes to initiate a new round of applications after July 1, 2011, using the same redistribution criteria as the first round

GME Pursuant to ACA: THCs AACOM was engaged in the support of the expansion of GME via the Teaching Health Center (THC) initiative in the ACA Under the ACA, the THC Program would establish new residency programs or expand existing ones in Federally Qualified Community Health Centers, Community Mental Health Centers, Rural Health Clinics, Indian Health Service Clinics, and Family Planning Programs funded by Title X of the Public Health Service Act

GME Pursuant to ACA: THCs Specialties include Family Medicine, Internal Medicine, Pediatrics, Internal Medicine-Pediatrics, OB-GYN, Psychiatry, General Dentistry, Pediatric Dentistry, and Geriatrics $230 million appropriated over 5 years and is projected to create approximately 750 new slots HRSA expected to release program guidance in November, which will provide details on eligibility, resident amount, and other criteria AACOM is working closely with HRSA during the implementation of the THC provisions

Other AACOM Initiatives The Congressional Academic Medicine Caucus (CAMC) - an informal, bipartisan group of Members of Congress, established on October 7, 2009 Co-Chairs - Reps. Allyson Schwartz (D-PA-13) and Patrick Tiberi (R-OH-12) Currently 47 members on the Caucus, with two members representing COMs (VCOM-VC and LECOM) To view CAMC page on AACOM website: http://www.aacom.org/advocacy/topics/Pages/camc.aspx AACOM continues to work to increase CAMC membership

Other AACOM Initiatives On June 1, 2010, the U.S. Supreme Court agreed to hear a case next term that would determine the applicability of the student FICA tax exemption for medical residents  The case, Mayo Foundation for Medical Education and Research, et al v. United States, involves a rule change by the Treasury Department in 2005 providing that the student exemption from FICA tax does not apply if the individual works full-time

Other AACOM Initiatives On 8/13/2010, AACOM along with the AOA, AAMC, and others filed an amicus brief with the U.S. Supreme Court. To view amicus brief: http://www.supremecourt.gov/oral_arguments/argument_calendars/MonthlyArgumentCalNovember2010.pdf The Supreme Court will hear oral arguments on the case (Mayo Foundation V. United States) on Monday, November 8, 2010  AACOM continues to closely monitor the case

ACGME Resident Duty Hours Accreditation Council for Graduate Medical Education (ACGME) Board of Directors approved graduated standards for duty hours of resident training in accredited teaching institutions Effective July 1, 2011 To view ACGME approved standards: http://acgme-2010standards.org/pdf/Common_Program_Requirements_07012011.pdf

The 2011 OHPIs were selected: Vi Song Tring (NSU-COM) will be serving as OHPI in November; Michelle Keown, MPH, (UNTHSC/TCOM) will serve in February-March; and Cole Zanetti (UNTHSC/TCOM) will serve in March-April OHPI Program

OHPI Program The OHPI Program is accepting applications for 2012 through 02/28/11 To apply: http://www.aacom.org/events/intern/Pages/default.aspx

Contact Information Pamela Murphy, MSW Acting Director of Government Relations pmurphy@aacom.org 301-968-4151