ASN urges your participation in our advocacy efforts regarding Fiscal Year (FY) 2004 appropriations for the National Institute of Health (NIH).

The U. S. Senate is scheduled to begin consideration of the FY 2004 Labor-HHS-Education appropriation bill (S. 1356) shortly after it returns to Washington on September 2. As reported by the Senate Appropriations Committee, the bill currently provides $27.9 billion, a $1 billion (3.7 percent) increase over the FY 2003 budget. The House of Representatives passed its version of the bill (H.R. 2660) before the summer congressional recess. The House adopted the President’s request for a 2.5 percent increase for NIH. The House bill would bring the NIH FY 04 funding level to $27.7 billion.

The Senate bill provides $1.683 billion for the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) - $13 million more than the House recommended FY04 funding level of $1.670 billion. The NIDDK and kidney disease research programs would presumably receive a proportional funding increase in the range of 8 to 9 percent, if the Specter-Harkin-Feinstein amendment is approved.

Senate Labor-HHS-Education Subcommittee Chair Arlen Specter (R-Pa.), Ranking Member Tom Harkin (D-Iowa) and Senator Dianne Feinstein (D-CA) will offer an amendment during Senate floor consideration of the bill to increase NIH funding by an additional $1.5 billion, for a total increase of $2.5 billion (9.2 percent) over FY 2003.

The funding increase would be achieved by pushing back into FY 2003 $1.5 billion in funding advances that were appropriated in FY 2003, but advanced into FY 2004. By moving advances in this manner, it permits an additional $1.5 billion to be appropriated for the NIH without breaking the (budget) cap for FY 2004. The amendment requires 60 votes to pass.

To achieve the 60 votes needed to pass this amendment, it is imperative that all ASN members contact their Senators and urge them to vote for the Specter-Harkin-Feinstein amendment.

Please take a moment now to contact your two senators. A list of Senators and their contact information can be found here.

Below please find a sample letter. The attached letter was drafted to assist you and make it as easy as possible to contact your senators. It summarizes the issues in a way that should appeal to the senators' interest. We encourage you to cut, paste, and email the letter. (Please note that email is a perfectly acceptable and prefered form of correspondence in Congress.)

Read and send the letter to your Senators!

In a related matter, U. S. Representatives Lois Capps (D-CA), Chris Bell (D-TX), Mark Foley (R-FL) and Jim Leach (R-IA) are circulating a "Dear Colleague" to seek sign-ons for a letter to the House-Senate conferees on the Labor-HHS-Education bill seeking an 8-10 percent increase in the FY 2004 NIH budget.

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The Centers for Medicare & Medicaid Services (CMS) published a proposed rule that will update payment rates under the Medicare physician fee schedule for 2004 including significant changes to reimbursement for medical care for beneficiaries with End Stage Renal Disease (ESRD).

ASN members are concerned that the proposed rule could have negative impacts on patient care, dramatically change the monthly capitation fee for nephrologists and could potentially have a negative (financial) impact on academic institutions with nephrology departments.

ASN is working with its Dialysis Advisory Group and Policy & Public Affairs Committee to formulate talking points and a formal written response on the proposed (ESRD) changes. CMS will accept comments on the proposals until October 7, and publish a final rule later this year.

The press release issued by CMS on Friday, August 8 proposes the creation of new codes to allow Medicare to align its payments for physician oversight of dialysis services to the frequency of physician visits. The press release explains that “Medicare currently pays a composite rate to physicians for medical oversight without regard to the patient’s condition or the number of times the physician sees the patient” and recognizes the variance for patients on dialysis, as well as physician involvement. “The proposed codes are intended to ensure that beneficiaries with ESRD receive the highest quality dialysis care available and that physician involvement in dialysis for ESRD patients is appropriate and consistent with the needs of the patient in any month." Once finalized, these schedules will be effective for calendar year 2004. This proposal was published in the August 15 Federal Register. To learn more, visit the CMS website.

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As always, if you have questions or suggestions related to either of these important issues, please feel free to contact ASN's Director of Policy and Public Affairs, Paul Smedberg by email.