Despite budget pressures, Congress, before adjorning, doubled to $932 million the amount the federal government will spend to combat AIDS in fiscal 1988.
The biggest chunk, $448 million, is for the National Institutes of Health, basically for research. Of that, $223 million is for the National Institute of Allergy and Infectious Diseases and $90 million for the National Cancer Institute.
Another $305 million goes to the Centers for Disease Control for educational and preventive work.
The Alcohol, Drug Abuse and Mental Health Administration will get $112 million, about $76 million of that for drug-abuse programs to combat transmission of acquired immune deficiency syndrome through infected needles.
About $25 million is for the Food and Drug Administration; another $11 million is to train health professionals and $6.7 million for renovation of long-term care facilities for AIDS patients.
On other health issues, Congress increased by $480 million funds for the National Institutes of Health to $6.7 billion, including AIDS money; created a "no-fault" method of compensating children injured by vaccines; strengthened inspection of nursing homes; moved to encourage the states to enlarge Medicaid coverage for pregnant women and children, and improved the Medicare mental health benefit. These provisions were included in the final omnibus appropriations and budget reconciliation bills.
Two other major Medicaid changes sponsored by Rep. Henry A. Waxman (D-Calif.) and others were dropped, but may be revived next year. They are a proposal to prevent the impoverishment of people whose spouses are in nursing homes and a plan to allow welfare mothers who work their way off welfare to remain eligible for Medicaid for up to 24 months.
After a long dispute with the Reagan administration, Congress approved an excise tax of $4.56 per dose on diphtheria-pertussis-tetanus (DPT) vaccine, $4.44 per dose on measles-mumps-rubella vaccine, 29 cents on polio vaccine and 6 cents on diphtheria-tetanus vaccine to compensate children harmed by vaccines. In order to be compensated, the children and their families would not need to prove that the manufacturer had been negligent.
In older cases, involving as many as 3,500 children already hurt by vaccines, the bill authorizes various payments from appropriations to be decided by Congress, with a ceiling of $80 million a year for the next four years.
Congress approved new rules, based on recommendations of the Institute of Medicine, to strengthen the quality of care and inspections in nursing homes, particularly intermediate-care facilities, that receive Medicare or Medicaid funds. Such homes will be required to have a registered nurse on duty eight hours a day, seven days a week, and 24-hour licensed practical nurse care seven days a week, although the staffing requirements could be waived in some cases by the states. Penalties for violations are strengthened.
In another provision of the omnibus bill, which President Reagan has signed into law, states will be allowed to provide Medicaid to pregnant women and infants through age 1 with family incomes up to 185 percent of the poverty level. The income limit had been 100 percent of the poverty level. A premium could be charged if the family income is over 150 percent of the poverty line.
In addition, states are being encouraged to provide Medicaid for children through age 7 by fiscal 1991 if the family income is under the poverty line.
The maximum Medicare benefit for outpatient mental health services will be increased from $250 a year to $1,100 by 1989. And, in another provision, a 36-member National Commission on Children, sponsored by Senate Finance Committee Chairman Lloyd Bentsen (D-Tex.), will study children's needs and issue a report by Sept. 30.
Reductions in Medicare payment rates to doctors and hospitals that were ordered Nov. 20 under the Gramm-Rudman-Hollings budget law will continue until April 1. After that, hospitals in urban areas with populations of more than 1 million will receive a rate increase of 1.5 percent, hospitals in rural areas will get 3 percent and other hospitals will get one percent.
These rate changes are classified as saving Medicare money because they are less than the 4.7 percent increase in the cost of hospital supplies.
Medicare payments to reimburse hospitals for capital outlays will be cut in 1988 to 12 percent less than Medicare's estimated "fair share" of capital costs.
Doctors who agree to accept the Medicare-allowed payment as their full payment for all Medicare cases will be permitted a 3.6 percent increase in rates for primary care services and one percent for other services. Doctors who refuse will get 3.1 percent and 0.5 percent.