Skip to main content

Federal Health Policy Updates for the Week of August 3, 2020

Duke Government Relations Logo

It's simple, really
Advocate until you can't
Then, do it again

(COVID-19 relief bill haiku)

The Details
Federal health updates from Capitol Hill and the agencies

Negotiations on COVID-19 relief package drag on another week
Despite reports of some progress being made on key issues this week, House Democrats, Senate Republican leadership, and the White House have yet to strike a deal on the next round of COVID-19 relief and stimulus.
 
Among other disagreements, the parties remain at odds over the scope of the package, as well as the issues of liability protections, aid to state and local governments, boosts to unemployment insurance, and relief for individuals and businesses. House Democrats and Senate Republicans have both unveiled their respective proposals with few major similarities between them. The Senate Republican HEALS Act does include $15.5 billion in emergency funding for the National Institutes of Health (NIH), which found support among the research community, including Duke Health.
 
With no deal apparently imminent, President Trump has signaled he may use Executive Orders to provide extensions of federal unemployment insurance and to temporarily suspend the collection of payroll taxes as temporary measures of relief while negotiations continue.
 
As congressional leadership and the White House continue to try to reach a deal, Duke Health Government Relations is engaging with Congress to support at least $26 billion in emergency research funding, including the $15.5 billion in funding for NIH identified in the Senate bill.
 
To support these efforts, this week Duke Health Government Relations reached out to members of the North Carolina congressional delegation to support separate House and Senate “Dear Colleague” letters requesting the $15.5 billion for NIH be included in the next COVID-19 relief package.
 
Duke Health also joined the Ad Hoc Group for Medical Research on a letter to House and Senate leadership, as well as to the Administration, urging that they quickly finalize a relief package with no less than $15.5 billion for NIH. The Ad Hoc Group for Medical Research is a coalition of over 330 patient and voluntary health groups, medical and scientific societies, academic and research organizations, and industry that support enhancing the federal investment in the biomedical, behavioral, and population-based research conducted and supported by the NIH.
 
CMS releases PFS and OPPS proposed rules for CY 2021
The Centers for Medicare & Medicaid Services (CMS) released 2021 proposed rules for the hospital outpatient and ambulatory surgical center prospective payment systems (OPPS/ASC) and the physician fee schedule and quality payment program (PFS/QPP).
 
Of concern, the 2021 OPPS/ASC proposed rule would further reduce the payment rate for certain drugs purchased under the 340B drug savings program, expand the list of outpatient services subject to prior authorization, eliminate the inpatient-only list over three years, make changes to the hospital star ratings methodology, and loosen current restrictions on the physician-owned hospital policy.
 
The proposed reduction in payment rates for the 340B drug savings program follows a U.S. Court of Appeals for the District of Columbia decision announced July 31 that affirmed CMS’s authority to propose such cuts to the 340B drug program.
 
The 2021 PFS/QPP proposed rule includes payment rates for physicians and other health care professionals’ services, evaluation and management (E/M) changes finalized in the 2020 rule, expansion of certain telehealth services, solicitation for feedback on other telehealth waivers and flexibilities provided during the public health emergency, and changes to the Merit-based Incentive Payment System (MIPS) and participation options and reporting requirements for alternative payment models (APMs). The proposed rule also seeks feedback on whether policies enacted as part of the public health emergency (PHE) by CMS for resident supervision should be extended or made permanent.

Duke Health Government Relations is working with Duke Health experts to develop targeted feedback on various proposals in the OPPS and PFS proposed rules. This feedback will help inform CMS’s final decisions about these vital policies, which impact Duke Health and our patients. Comments are due by October 5.
 
Federal telehealth activity continues to ramp up
On August 3, President Trump signed an Executive Order with the stated goal of improving rural and telehealth access. Specific to telehealth, the order directs the Secretary of Health and Human Services to review within 60 days the enhanced and new telehealth services offered to Medicare beneficiaries during the PHE and the services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas. The order further directs the Secretary to propose regulations to permanently extend these services and flexibilities, as appropriate and to the extent allowed under current law, beyond the PHE period.
 
The order follows comments from CMS Administrator Seema Verma that CMS is considering various mechanisms (including the PFS rule noted above) to more permanently expand Medicare telehealth services.
 
Congress is also continuing its new wave of telehealth activity as Senators Chris Murphy (D-CT) and Roy Blunt (R-MO) introduced the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act. The TREAT Act would allow any health care practitioner or professional in good standing with a valid practitioner's license to render services—including telehealth—anywhere for the duration of the COVID-19 emergency. The bill also includes designated protections for patients and providers and would not apply to health professionals already covered by existing compacts. Duke Health joined a letter in support of the legislation that includes health systems and providers from across the country.
 
Duke Health Government Relations has been actively engaged with congressional offices and committees of jurisdiction to share the Duke Health perspective, working in partnership with Duke leadership and the Duke Telehealth Office to ensure that beneficial telehealth policies are strengthened and maintained.