Federal Health Policy Updates for the Week of December 19, 2022

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Don’t look back unless
Retracing your steps alights
A new path forward

Publication Note: Congress is expected to wrap up its work for the year by the end of this week – so our newsletter will take a brief pause. We plan to resume our regular publication schedule the week of January 2nd as the 118th Congress is officially sworn in.

It’s our privilege to have this space to engage with you – and have a little fun – each week. Thank you for reading – as well as for strengthening, inspiring, and sustaining our work and commitment to serve you, the institution, and our community.
We wish you all a safe and joyous holiday season.


The Rundown

  • 117th Congress takes a bow and moves toward passage of FY 2023 omnibus spending and policy legislative package
  • Join Duke Health Advocacy Network

Federal Updates

It’s all happening (hopefully by midnight)
It looks like we’ll avoid a Dickensian holiday season after all. While a visit by three spirits to congressional leadership was not required, there was still some finessing (and arm twisting) to put together a massive $1.7 trillion FY 2023 omnibus spending package and have it on track to pass ahead of tonight’s expiration of the continuing resolution (CR). 

The omnibus not only provides for greater certainty and continuity in federal funding for the current fiscal year but also includes a number of critical health policy line items important to the missions and work of Duke Health.

Here’s a quick snapshot of some of the key provisions:

  • Delay until 2025 of the 4% Medicare across-the-board cut to providers (PAYGO).  
  • 2-year physician payment relief from pending 4.5% conversion factor cut. 
    • Relief of 2.5% in 2023, followed by 1.25% in 2024 
  • 2-year extension of Medicare PHE-related telehealth waivers and the Acute Care Hospital at Home waiver program (through Dec. 31, 2024).
  • Extension of Alternative Payment Model bonus through 2025, at 3.5% instead of 5%.
  • Inclusion of the VIPER Act to address conflict of interest issues with outside compensation by non-public academic affiliates to VA researchers.
  • Inclusion of the TRAIN Act to prevent recoupment of payments to hospital-based nursing schools, including Watts College of Nursing.
  • Inclusion of the PREVENT Pandemics Act to improve public health preparedness, including a provision to provide loan repayment to the infectious disease workforce.
  • Inclusion of mental health provisions, e.g., coverage of marriage and family therapists in Part B, 200 GME slots (with one-half of the total number of positions dedicated to psychiatry or psychiatry subspecialty residencies), coverage of intensive outpatient services policy (partial hospitalization / community mental health center), and out-year refinement of the inpatient psychiatric hospital PPS.
  • $47.5 billion for NIH, an increase of $2.5 billion (5.6%) above the current level, as well as $1.5 billion for the new Advanced Research Projects Agency for Health (ARPA-H).
  • $52 million for the 12 Regional Biocontainment Labs, including at Duke, to assist national, state, and local public health efforts in the event of a bioterrorism or infectious disease emergency.
  • $39 billion for the Defense Health Program, a $3 billion increase, including funding for medical research programs.
  • $916 million for VA Medical and Prosthetic Research, a $34 million increase above the current level.
  • $880 million for Title VII health professions programs and Title VIII Nursing Workforce Development programs at the Health Resources and Services Administration (HRSA), an increase of $80.6 million above the current level.
  • Provisions focused on improving maternal mental and behavioral health, including a maternal mental health hotline and grants to support maternal mental health programs.
  • Reauthorization of several mental health programs at the Substance Abuse and Mental Health Services Administration and HRSA).
  • Medication Assisted Treatment (MAT) & Medication Access and Training Expansion (MATE).
  • Maintains the prohibition against establishing a national patient identifier (NPI).

Starting in 2024, the bill requires children to be provided with 12 months of continuous coverage in Medicaid and CHIP.

There were also a number of other priorities that did not quite make the cut for inclusion and will likely be revisited in the 118th Congress, including:

  • Legislation to streamline Medicare Advantage prior authorization was not included due to its high price tag from the Congressional Budget Office. Our team has sent Katie Flanagan and others information about a recent proposed rule from CMS that would impose many of the same improvements that are contained in the bill.   
  • Legislation to improve maternal health.
  • Legislation to overhaul how laboratory-developed tests are regulated.

Our team is continuing to update multiple leaders across Duke Health about individual funding and policy issues, and we will keep you posted in this space as provisions of the legislation are implemented in 2023.

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