The Headlines
- The federal government and stakeholders continue to respond to the impact of COVID-19.
- President Trump signs Executive Order suspending certain immigration activities for 60 days.
- HHS delays enforcement of some new data-sharing rules.
The Details
1. Federal COVID-19 virus updates
The House and Senate have announced that they will not return to Washington, D.C. to open regular sessions until May 4 at the earliest.
As the Administration continues to implement the $2 trillion COVID-19 relief package signed into law last month, multiple congressional offices remain in regular contact with Duke Health experts on the health system's supply chain needs, surge planning, and research.
President Trump again invoked the Defense Production Act (DPA) to enter into a priority production agreement with private industry to produce medical supplies. Facing continued shortages of materials for COVID-19 testing kits, the Administration will provide additional funding to Puritan Medical Products to increase production of testing swabs.
Drs. Maggie Sallinger and Katie Pollard, internal medicine residents at Duke University Hospital, published an op-ed in The Hill on April 22, calling for faster COVID-19 testing procedures. The piece highlights the costs, both in terms of resources and patient care, of slow turnaround times for patient testing and urges that more widespread, accurate, and quicker tests be developed and made available to providers throughout the country. Drs. Sallinger and Pollard, along with fellow residents in Duke's ACLT program, were also able to share their testing concerns in a virtual conversation with Rep. David Price (D-NC-04) on April 3.
In an April 16 letter to the Health and Humans Services (HHS) Secretary, several Democratic leaders urged the Administration to “immediately reverse fetal tissue research restrictions on any current or future federally supported COVID-19-related research.” The letter raises concerns regarding the barriers and limitations on COVID-19 research resulting from the Administration’s current policy for fetal tissue research. It also requests a briefing by the end of the month on other issues relating to this policy. Duke Health Government Relations is monitoring this issue closely and has expressed concern about fetal tissue research restrictions to the NC delegation.
This week, Congress approved a $484 billion interim relief and stimulus package to boost support for hospitals and providers, as well as the small business assistance fund that ran out of its initial allotment of CARES Act funding. As part of the new package, $75 billion is being made available to hospitals and medical providers, $25 billion to aid in testing, and $1 billion to cover costs for the uninsured. Duke Health worked closely with the NC congressional delegation and association partners in support for the additional funding for health care systems and providers.
As work on the interim package wrapped up, HHS announced this week that another $20 billion of the $100 billion fund for hospitals provided by the CARES Act will be allocated to providers. The payment made to each provider will take into account what they previously received under the first $30 billion distribution, so that their total allocation under both waves ($50 billion total) is proportional to their share of 2018 total net patient revenue. This methodology is reportedly designed to account for the fact that providers with lower shares of Medicare fee-for-service (FFS) payments, such as hospitals with high Medicaid or Medicare Advantage populations, received proportionally less funds under the first distribution of $30 billion. A portion of providers will automatically be sent a payment based on the revenue data they submit in their Medicare cost reports.
While attention has now turned to what is likely to become a fourth broad stimulus and recovery package, some policymakers, including Senate Majority Leader Mitch McConnell (R-KY) are pressing pause on negotiations. Senator McConnell indicated that it is premature to discuss additional relief without first seeing the impact of Congress' efforts so far, also preferring to engage in more serious talks when lawmakers return to Washington, D.C. Despite this momentary slowdown, policymakers and stakeholders are still advocating for provisions to be included in the next effort. The Association of American Medical Colleges (AAMC) has renewed its call for an additional $26 billion in funding for research, and Reps. GK Butterfield (D-NC-01), George Holding (R-NC-02), David Price (D-NC-04), David Rouzer (R-NC-07), and Alma Adams (D-NC-12) signed on to a House letter led by Reps. Diana DeGette (D-CO) and Fred Upton (R-MI).
Duke Health Government Relations is working to ensure that any additional recovery packages include support for hospitals, research, testing and supplies, and resources to protect and strengthen our medical workforce.
2. Trump signs Executive Order to suspend immigration
President Trump signed an Executive Order on April 22, suspending certain immigration activities for 60 days. The order is limited to those currently outside of the U.S. who are seeking to become lawful permanent residents. It notably provides exemptions for physicians, nurses, other medical professionals, and medical researchers. Those who currently have or who are applying for J-1 or H-1B worker visas are not affected by this order.
However, due to COVID-19, United States Customs and Immigration Services (USCIS) offices remain closed throughout the country, and there are processing delays for new and renewed J-1 and H-1B visas, as well as J-1 to H-1B visa transfers. Duke Health Government Relations, in partnership with AAMC, is supporting outreach and advocacy efforts to expedite the processing of these visas and to temporarily remove location and specialty restrictions that may impede medical professionals from aiding the COVID-19 response.
3. HHS formally delays some data sharing rules
The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) announced that it will delay enforcing certain aspects of new data sharing rules finalized in early March.
ONC, whose rule is the basis for the information-blocking provisions, will give stakeholders an additional three months before enforcing certain measures, including some Application Program Interface requirements and the information blocking certification. CMS will give providers an additional six months before enforcing the admission, discharge, and transfer notification of Conditions of Participation for hospitals included in its data sharing rule. All other provisions in the two rules will take effect as planned on January 1, 2021.