The Senate confirmed Michele Leonhart’s nomination to lead the Drug Enforcement Administration Wednesday night, giving the agency an official leader for the first time in more than three years.

Leonhart’s confirmation was in doubt as early as Wednesday morning until Sen. Herb Kohl (D-Wis.) allowed her nomination to go through. Kohl, who heads the Senate’s Aging Committee, released a block on her nomination after receiving assurances from Attorney General Eric Holder that the DEA will work with Congress to ease restrictions on administering painkillers to nursing home patients in emergency situations.

The Senate unanimously confirmed Leonhart before it adjourned for the rest of the year. Leonhart, who had been serving as the acting administrator, was first nominated to the agency’s top spot by President George W. Bush in 2008, but the Senate failed to confirm her before the 110th Congress adjourned.

Obama upset marijuana advocates by renominating her in January. They say Leonhart has taken too tough a stance against states that have legalized marijuana for medicinal purposes.

Sen. Grassley pushed back after Reid said there'd been "too much piddling" on the panel and negotiations were handled "poorly."

Welcome to The Hill's evening roundup of the day's health policy news and advance look at tomorrow's schedule.

Wednesday’s health news:

Congress approve 9/11 benefits: A $4.3 billion bill providing health benefits and compensation to Ground Zero first-responders passed through Congress Wednesday afternoon after Senate Democrats struck a last-minute deal with Sen. Tom Coburn (R-Okla.), who had been blocking the bill. Failure to pass the bill Wednesday would have doomed it in the lame duck, and its chances next year were thought to be slim in a Republican-controlled House. http://bit.ly/gBRRPB

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In the final vote of the 111th Congress, House lawmakers approved legislation Wednesday providing healthcare services for 9/11 workers.

The Medicare agency and Senate Finance Committee leaders are calling for new guidelines on Medicare quality-of-care reviews after a new report said that federal dollars may be going to waste.

The Centers for Medicare and Medicaid Services (CMS) is unable to determine if Medicare quality-of-care budgets are excessive because CMS does not provide specific guidance on how much data should be recorded on quality reviews, according to a Government Accountability Office (GAO) report released Wednesday.

Medicare enters into three-year contracts with Quality Improvement Organizations (QIOs) in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands to review whether Medicare-financed medical services meet professionally recognized standards of care. The CMS QIO budget totals about $1.1 billion through July 31, 2011, with about one-fifth going toward reviews, including quality-of-care reviews.

“Without consistent information on the volume and costs for quality of care reviews, CMS cannot ensure that the budget for these reviews [...] for each QIO is appropriate,” the GAO report said.

A 2006 Institute of Medicine Report and a 2008 CMS report both identified weaknesses in CMS’s ability to compare costs across QIOs. CMS said it would work to implement GAO’s recommendations.

“The money we spend to ensure quality healthcare should make people healthier, and effective budget guidelines from Medicare will certainly contribute to making sure we meet that goal,” said Senate Finance Committee Chairman Max Baucus (D-Mont.)

“CMS has to do a better job of tracking this work so it can pay the appropriate amount and so taxpayers get what they’re paying for, which is better quality of care for Medicare beneficiaries,” said ranking member Chuck Grassley (R-Iowa).

The Susan B. Anthony List is launching a massive e-mail campaign to elect an RNC head who opposes abortion rights.

A Democratic senator announced Wednesday he would release his block on President Obama’s nominee to lead the Drug Enforcement Agency after receiving assurances from the Justice Department it will ease delivery of powerful pain medications to nursing home patients in need.

Sen. Herb Kohl (D-Wis.) had vowed to block Michele Leonhart’s nomination to lead the DEA unless the agency worked with his Aging Committee to develop guidelines providing for faster delivery of powerful painkillers, like morphine and Percocet, to nursing home patients.

Kohl’s announcement Wednesday clears the way for the Senate to confirm Leonhart, who has been the acting DEA head since 2008. Without Senate confirmation, Leonhart would have been forced to go through the nomination process again next year.

Under the Justice Department agreement, Attorney General Eric Holder will send draft legislation to Kohl in January that outlines changes to the Controlled Substances Act, which describes who is authorized to order and administer drugs.

“Attorney General [Eric] Holder assured me that he would be personally responsible for promptly seeing this matter through the review process both at the Justice Department and administration-wide,” Kohl said in a statement. “Based on our agreement, I am releasing the hold on Michele Leonhart’s nomination, and I look forward to introducing a mutually acceptable legislative fix in the opening days of the 112th Congress.  Time is of the essence for nursing home residents who need immediate pain relief.”

Painkiller use in nursing homes received higher scrutiny over the past couple of years after the DEA cracked down against pharmacies that allowed nursing home nurses to administer the drugs without a written prescription.

According to Kohl’s office, the draft legislation allows certain nurses and other licensed healthcare professionals to transmit a physician’s order for powerful Schedule II painkillers over the phone or by fax. Nursing homes, physicians and pharmacies will be required to take steps to verify order's legitimacy.

A Senate aide said it's possible Leonhart will be confirmed with other nominees later Wednesday. If confirmed, it would give the DEA its first Senate-approved leader in more than three years.

"We are working to confirm as many of the president’s nominations as possible before we leave," said a spokeswoman for Senate Majority Leader Harry Reid (D-Nev.).

In early October, the DEA relaxed its rules to allow nurses to call in prescriptions for certain painkillers, but not the Schedule II drugs.

Evvie Munley, senior health policy analyst for the American Association of Homes and Services for the Aging, called the October guidelines “a small step forward.”

Federal regulators will consider applying new health insurance consumer protections that were announced Tuesday to the large group market, a Health and Human Services Department official told The Hill.

The proposed rule unveiled yesterday would require health insurers that increase premiums by more than 10 percent to publicly justify the higher rates, and it empowers HHS to impose its own review if states do not have an effective process in place.

The rule, which implements a healthcare reform law provision, applies only to insurance plans in the individual and small group market, but an HHS official said the department still might choose to apply the regulation to the large group market. If review requirements are extended to large groups, it would provide new oversight to a market that isn’t accustomed to such scrutiny.
 
Most states do not review rates in the large group market because individuals and small groups — lacking the bargaining power of a large pool — are more prone to major rate hikes. Most states do not review rates in the large group market, and insurers don’t typically submit proposed rate increases for this market.

The large group market includes groups with at least 50 employees, though states will be required to use 100 employees as the cut-off in 2016.

HHS specifically asked for feedback on its decision to exclude the large group market from state scrutiny. According to the proposed regulation, only 18 states have some form of rate review for the large group market.

Sandy Praeger, past president of the National Association of Insurance Commissioners, said there is less of a need for the large group market to be monitored as closely.

“The real issue is in the individual or small group,” Praeger said. “That’s where you have more rate volatility.”

A California-based consumer advocacy group said it was unsure about the decision to exclude the large group market.

“I think saying no insurer has even taken advantage of a large employer is a stretch,” said Carmen Balber of Consumer Watchdog.

Under the HHS proposal, the 10 percent threshold for rate review would end after 2011, when HHS will use state-specific benchmarks based on cost trends. 

Julian Pecquet contriubted to this report.

Oklahoma City firefighters are pressuring their senator to drop his opposition to a bill that would provide health benefits and compensation to Ground Zero first responders.

The firefighters association, recalling its own tragic day in 1995 when an Oklahoma City federal building was bombed, urged its senators to support a bill that provides $6.2 billion to workers who got sick at the Ground Zero site in the aftermath of the Sept. 11 terrorist attacks.

With both chambers hoping to wrap up the lame-duck session Wednesday, supporters of the bill are pleading with Sen. Tom Coburn (R-Okla.) to allow the vote to proceed. Coburn said Tuesday that he has concerns with the bill and wants it to go through the committee process next year.

"We're going to have to come back and fix it," Coburn told Fox News on Tuesday, "and we're going to waste a whole bunch more money and not fix the real problem, which is taking care of those people who are so desperately dependent on it."

The Oklahoma City firefighters said the Senate shouldn't delay the bill.

"It has been almost 10 years since that tragic day, and firefighters, police officers and those who worked on the pile remain without adequate health monitoring and care," they said. "It is a national disgrace."

House Majority Leader Steny Hoyer (D-Md.) said Tuesday that members of the lower chamber will stay in Washington on Wednesday to pass the bill if it gets through the Senate.