We’ve seen this before
Rote endings need not be trite
If the end’s the point
The Rundown
- Congress passes one-week CR as year-end omnibus takes shape
- Bipartisan group of policymakers push for two-year extension of telehealth flexibilities
- Congress passes the Data Mapping to Save Mom’s Lives Act
- The latest from our desks
- Join Duke Health Advocacy Network
Federal Updates
A deal without (much) detail
It looks like we may get a massive, year-end omnibus legislative package after all – if Congress can wrap it up by next Friday. The breaking news of the week is that congressional appropriations leadership finally reached a top-line agreement on overall spending for FY 2023. The announced deal comes in just the nick of time to give congressional leaders an opportunity to work out final details – but Senate Minority Leader Mitch McConnell (R-KY) made clear that his members would not be returning to wrap up any remaining work after the Christmas holiday. So, it’s now – or likely next year. Here’s what we know at publication time.
FY 2023 federal funding
Congress has passed a one-week continuing resolution (CR) to give leadership a little more time to fill in the details of the above-mentioned deal. The government-funding piece alone of the omnibus is likely to be somewhere around $1.7 trillion, with $858 billion in funding for defense spending. What hasn’t yet been made public is the settled top line number for the non-defense priorities, including biomedical research funding and other non-mandatory programs supporting healthcare access and delivery. There has also been a sticking point about how to categorize funding for Veterans’ Affairs programs, with Democratic leaders and the White House arguing that at least some of the funding should be moved to mandatory status so as to not impact the discretionary spending bottom line.
That’s a lot to work out in seven days, not to mention that there are rules in both chambers with respect to how much time members are required to have to review legislation before voting. These rules can be waived, but there is bound to be some grumbling here and there that certain priorities weren’t addressed to someone’s or some constituency’s satisfaction.
We continue to advocate strongly for Duke Health federal funding priorities and look forward to sharing more detail as it becomes available.
NDAA
The 60+ year “on time” streak will live on. Congress has passed the 2023 National Defense Authorization Act (NDAA) following a little longer than anticipated time on the House and Senate floors. The NDAA formally authorizes broad programmatic and spending initiatives at the Department of Defense (DOD), including the Defense Health Program, which supports and funds DOD medical research, as well as the Defense-supported medical workforce.
What about everything else?
It is common vernacular on the Hill, especially this time of year, to refer to such a large legislative vehicle like the developing omnibus as a “Christmas tree” – with the goal of adding as many ornaments (other priorities) as possible without the “tree” toppling over. We’ve mentioned a lot in recent weeks about the various “ornaments” in play for addition to a year-end package. We know of at least one for now: a year-end omnibus would include the Electoral Reform Act, a bipartisan measure to streamline processes and protections for future presidential elections. The list below is everything else of which we are aware (and certainly not an exhaustive list) that may still be under consideration:
- Waiver of PAYGO rules to avoid a 4% across the board cut (including Medicare)
- Addressing recommended cuts to the Medicare physician fee schedule
- Extending the 5% Alternative Payment Model incentive payments under the Medicare Access and CHIP Reauthorization Act (MACRA)
- Further extension of public health emergency (PHE) related Medicare telehealth flexibilities
- Extension of the Acute Care Hospital at Home program waiver beyond the PHE
- FDA policy riders
- Black Maternal Health Momnibus Act
- PREVENT Pandemics Act to improve pandemic and public health preparedness
- PCHETA to strengthen the palliative care workforce
- TRAIN Act to prevent recoupment of payments to hospital-based nursing schools
- VALID Act to regulate laboratory-developed tests
- VIPER Act to address conflict of interest issues with outside compensation by non-public academic affiliates to VA researchers
- Cybersecurity
- Mental and behavioral health access and care
We should know more about how the tree is filling out in the coming days and are working with the NC congressional delegation and stakeholders around the country to ensure as many of these priorities, particularly the looming Medicare cuts, are addressed before the end of the year.
Going for two: bipartisan, bicameral effort urges extension of telehealth flexibilities in year-end legislation
There’s entrenched ideological differences and lame duck hand wringing – and then there’s telehealth, where the debate is seemingly more centered on “when” rather than “if” Congress will act on the issue. Bipartisan leadership of the House Telehealth Caucus and the Senate Telehealth Working Group, including Senator Thom Tillis (R-NC), as well as over two dozen of their colleagues in both chambers, sent a letter to congressional leadership urging extension of PHE-related expanded coverage of Medicare telehealth services through the end of 2024 to be included in a year-end legislative package.
Under current law, many expanded telehealth flexibilities and waivers under Medicare are set to expire 151 days after the COVID-19 PHE expires. The administration is expected to renew the PHE in January, which would start the clock ticking on expiration sometime in April – assuming that the PHE is not renewed again in the spring.
While there is broad bipartisan support to take steps to make many telehealth flexibilities permanent, policymakers recognize that more time is needed to put those changes in place. According to the letter, a date-certain extension is intended to decouple telehealth expansion from the uncertain PHE environment so that providers aren’t forced to further “delay fully integrating telehealth into their care delivery models to the detriment of patients’ experience.”
Our team continues to work closely with Duke Health experts, stakeholders, and policymakers in support of both an extension of current policy as well as finding a path forward to permanent expansion.
Light up the board: Congress passes Data Mapping to Save Mom’s Lives Act
Congress has now passed the “Data Mapping to Save Mom’s Lives Act,” which includes among its provisions directing the Federal Communications Commission (FCC) to include data on certain maternal health outcomes in its broadband health mapping tool. Retiring NC congressional delegation member Rep. G.K. Butterfield (D-NC-01) is a cosponsor of the House version of the bill that passed the lower chamber last week. It was agreed to by voice vote in the Senate on Tuesday evening and now heads to President Biden for his signature.
From our desk(s): Duke Health GR this week
This week, members of our team participated in the Association of American Medical College’s (AAMC) Government Relations Representatives planning meeting in Washington, DC. The meeting included discussing advocacy strategies for the current lame duck session and in the new Congress.
Members of our team met with representatives of the Robert Graham Center for Policy Studies, an organization dedicated to creating and curating the evidence to support family medicine and primary care. The team at the Robert Graham Center is interested in policy relevant research related to nationwide primary care investment, access to care (particularly for vulnerable populations), graduate medical education, the primary care workforce, and scope of practice for family physicians.
We participated in a Health Policy Forum with Xavier Becerra, Secretary of the U.S. Department of Health and Human Services, hosted by The Johns Hopkins School of Nursing. The discussion focused on topics such as nursing workforce and leadership, in addition to Secretary Becerra’s work to expand access to health care and advance health equity.
We monitored the We Can Do Better: Advancing Maternity Care Together event hosted by the Centers for Medicare & Medicaid Services (CMS).
Members of our team organized and joined a call with Duke Health experts and staff of Senate Health, Education, Labor and Pensions Committee ranking member Richard Burr’s (R-NC) to discuss laboratory-developed tests (LDTs) and the VALID Act.
We are also connecting regularly with offices of the NC congressional delegation on key priorities for year-end legislation, as well as building contacts with new incoming delegation members for the 118th Congress.
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