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Federal Health Policy Updates for the Week of February 27, 2023

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Like an ink blot test
The budget process can mean
Whatever you see

 

The Rundown

  • Congress returns to clear a path for the FY 2024 appropriations process and other priorities
  • House Energy & Commerce, House VA, and Senate HELP Committees hold hearings with healthcare implications
  • DEA issues rules for tele-prescribing of controlled substances post-PHE
  • HHS Office of Civil Rights announces expansion
  • The latest from our desks
  • Join the Duke Health Advocacy Network!


Federal Updates


Lace 'em up: the spring sprint starts now
Congress returned from recess and district/state work periods this week to begin clearing the path ahead for a number of critical priorities, including the FY 2024 federal budget and appropriations process. House Republicans and Democrats will separately spend a few days away from the Hill over the next two weeks for their annual policy retreats, while the Senate is expected to begin work on national railway safety legislation.

Budget and Appropriations
This week, leadership of the House and Senate Appropriations Committees issued official guidance to Members of Congress, which is a key step to starting the FY 2024 funding process. The guidance includes guidelines, as well as deadlines, for Members of their respective chambers to submit funding requests, including specific funding levels for federal agencies and programs funded in the twelve appropriations bills. Our office has begun our internal processes for reviewing and submitting Duke Health funding priorities to Members in the NC congressional delegation for their support and consideration.  

Next week, President Biden will release his administration’s FY 2024 budget request to Congress, which will outline the Administration’s funding and policy priorities. While non-binding and certain to meet some resistance from the House Republican majority, the budget is the most comprehensive look at the administration’s agenda and may serve as a baseline in some areas for the Senate Democratic majority to consider its own funding and policy priorities for the coming fiscal year.

Debt limit
When will the federal government exhaust all of the extraordinary measures put in place to avoid catastrophic default on its financial obligations as a result of reaching the debt limit earlier this year? It depends on who you ask and a host of other factors, but the general wisdom suggests sometime between June and September. No matter where the actual “X” date falls, that’s an alarmingly close timeline, and no “official” negotiations between the White House and Congress have begun.

The dividing lines remain the same as they did a few weeks ago: the administration would prefer a clean debt limit increase with a separate conversation on fiscal policy while the House Republican majority would prefer that a commitment to spending cuts be tied directly to a debt limit increase vote.

While it’s unclear when and how an agreement will be reached, the debt limit debate will absolute color and cast a shadow over the appropriations process and any other major deficit-impacting legislation for the remainder of this year, if not longer.

Federal COVID response oversight
The House Select Subcommittee on the Coronavirus Pandemic is set to hold its first hearing on the origins of COVID-19 next Wednesday, March 8th, where a recent “low confidence” report by the Energy Department that suggests that the virus originated from an accidental lab leak in China rather from zoonotic origin is expected to be among the topics of conversation.

New Subcommittee Chair Brad Wenstrup, DPM (R-OH) has pledged to further investigate the federal government’s response and policies related to the COVID public health emergency. Rep. Deborah Ross (D-NC-02) serves on the minority side of the Subcommittee.

Heard on the Hill: Hearings recap
Fine tuning and moving forward with a comprehensive policy agenda is a lot like preparing for a big dinner party– no matter what, you’ll need to set the table before you can eat. Congressional hearings are often how the House and Senate fill this place setting role, with the invited “guests” serving to bring support and legitimacy to specific policy objectives. And like any memorable dinner party, there is sometimes a little theater involved.
 
House Energy and Commerce Subcommittee on Innovation, Data, and Commerce – Data Privacy
This week, the House Energy and Commerce Innovation, Data, and Commerce Subcommittee held a hearing on “Promoting U.S. Innovation and Individual Liberty through a National Standard for Data Privacy.” The conversation featured witnesses from the public and private sectors and a reiteration of bipartisan cooperation to revisit a stalled effort to create a national data privacy standard. In the 117th Congress, the full Energy and Commerce Committee approved the American Data Privacy and Protection Act, which would have created federal data privacy and security standards, with some exceptions, including for non-HIPAA covered entities that collect, store, and transfer health data.
 
Subcommittee Chair Gus Bilirakis (R-FL) noted the continued bipartisan efforts of committee members to redevelop and reintroduce comprehensive data privacy legislation this year. He received support from Ranking Member Jan Schakowsky (D-IL) on the need for a legislative proposal that addresses the complexity of the nation’s data privacy and security challenges so that consumers have greater control over their personal data.
 
House Veterans' Affairs (VA) Committee – VA Oversight
The House Veterans’ Affairs (VA) Committee held its first oversight hearing of the 118th Congress on “Building an Accountable VA: Applying Lesson’s Learned to Drive Future Success.” The hearing featured witnesses from the non-partisan Government Accountability Office and the Department of Veterans’ Affairs, including VA Undersecretary for Health Shereef Elnahal. In his testimony, Undersecretary Elnahal focused on three major areas for the Veterans’ Health Administration: increasing access to critical services, including mental health services; investing in VA medical, research, and support staff; and transforming systems, processes, and infrastructure.
 
VA Committee Chair Mike Bost (R-IL) noted in his opening remarks that his “number one priority” is modernizing the VA for the 21st Century and commented on a number of areas, including denial of medical claims, compliance with community services opportunities under the MISSION Act, and pension services.
 
Senate Health, Education, Labor, and Pensions (HELP) Committee – Community Health Centers
This week the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing entitled, “Community Health Centers: Saving Lives, Saving Money.” The Community Health Center Fund (CHCF) expires on September 30th and this hearing sets the stage for reauthorization.

In his remarks, Ranking Member Bill Cassidy, MD (R-LA) discussed how the landscape for community health centers has changed since the Affordable Care Act was passed and the mandatory Community Health Center Fund was created. Earlier in the week he sent a letter to the Government Accountability Office (GAO) requesting an update to the report entitled, “Health Centers: Trends in Revenue and Grants Supported by the Community Health Center Fund,” with up-to-date data. 

HELP Committee Chairman Bernie Sanders (I-VT) discussed that millions of people do not have access to healthcare, which he said is unfair to working and lower income individuals and noted his belief that healthcare is a human right and should be guaranteed to all people. He further stated that it’s critical to “do the right thing” for the American people and guarantee that a medical home is ready when they are sick and that investing in primary healthcare saves the system money.

Witnesses for the hearing included leadership from community health centers, as well as a representative from academia and from the GAO.
 
DEA issues post-PHE rules for tele-prescription of controlled substances
On February 24, the Drug Enforcement Agency (DEA) announced two proposed rules for prescribing controlled substances via telemedicine after the COVID-19 Public Health Emergency expires on May 11, 2023. The proposed rules are intended to bridge between the DEA’s current PHE waivers of Ryan Haight Act requirements that an in-person exam be conducted before tele-prescribing a controlled substance and a post-PHE environment.

Under the proposed rules, after the expiration of the PHE, telehealth providers would no longer be able to prescribe Schedule II controlled substances or narcotics without an in-person evaluation. Telehealth providers would be able to prescribe a 30-day supply of Schedule III–V controlled substances or buprenorphine as medication for opioid use disorder without an in-person evaluation, but an in-person evaluation would be required for any renewal of such prescriptions. An exception for provider-patient relationships formed via telehealth during the COVID-19 PHE would allow telehealth providers to continue prescribing Schedule II–V controlled medications for a wind down period through November 7, 2023 – but after that date, an in-person evaluation would be required to continue prescribing.

Not included in the proposed rules is an anticipated telehealth special registration regulation, which would be designed to allow certain clinicians the ability to prescribe controlled substances through telehealth without conducting an in-person exam of the patient. 

In its announcement, the DEA provided a number of resources for providers and patients.

There is a 30-day public comment period for the two proposed rules that runs through March 31, 2023. Our team is working closely with Duke Health leaders on any potential health system response.

HHS Office of Civil Rights opens new divisions
In case you missed it, this week the U.S. Department of Health and Human services, through the Office for Civil Rights (OCR), announced the formation of a new Enforcement Division, Policy Division, and Strategic Planning Division. The announcement follows a significant increase in caseload. According to OCR’s Director Melanie Fontes Rainer, “OCR’s caseload has multiplied in recent years, increasing to over 51,000 complaints in 2022– an increase of 69 percent between 2017 and 2022 – with 27 percent alleged violations of civil rights, 7 percent alleged violations of conscience/religious freedom, and 66 percent alleged violations of health information privacy and security laws.” She said that the reorganization improves OCR’s ability to effectively respond to complaints, puts OCR in line with its peers’ structure and moves OCR into the future.”
 
One Stop Shop for all Your Government Relations Needs
With the new Congress now in full swing, we wanted to remind you about some of the ways our office can assist you in your work and your interactions with the federal government.
 
Hill Days
Professional association Hill days are wonderful opportunities to connect with your elected officials, showcase your work, and make connections on key federal policy issues for your field. If you’re planning to join or even considering joining an association lobby day this year, we’d love to hear from you!

We know your associations provide great training opportunities and materials to prepare you for the big day, but please know that we’re your in-house resource every day of the year for consultation and to help you continue to build those relationships with staff and Members of Congress.

Visits from Federal Government Employees and Elected Officials
As a reminder, please contact our office before extending invitations for elected or other federal officials to attend events at Duke Health. Duke Health is required to follow a series of federal lobbying and ethics laws and is prohibited from providing anything of value to designated individuals, with certain exceptions in place.

Contact Brian Lee in our office at brian.lee887@duke.edu to share your information or if you have additional questions.
 
From our desk(s): Duke Health GR this week
This week, our team coordinated a meeting for Duke Health experts to meet with staff of Senate Finance Committee Ranking Member Mike Crapo (R-IL) to discuss Medicare Advantage (MA) challenges and the impact on patient care and access, including those associated with increased lengths of stay as a result of MA policies.
 
We met with new legislative staff of Rep. Alma Adams (D-NC-12) to re-introduce Duke Health policy priorities, including reconnecting on shared goals to advance Black Maternal Health issues and the broader Momnibus legislation.
 
We joined with a colleague from the Duke University Office of Government Relations to meet with staff of the NC congressional delegation to discuss university and health system-wide immigration policies and priorities, including visa and green card processing and professional and educational international recruitment.
 
We coordinated Duke Health joining members of the Ad Hoc Group for Medical Research, which includes organizations representing patients, scientists, health professionals, research and academic institutions, educators, and industry to endorse a recommended FY 2024 funding level of at least $50.924 billion for NIH’s foundational work, which is a $3.465 billion increase over the comparable FY 2023 program level. This recommendation would allow NIH’s base budget to keep pace with the biomedical research and development price index and allow meaningful growth of 5 percent. Duke Health also joined a letter to members of Congress requesting no less than $500 million in funding for the Agency for Healthcare and Research and Quality (AHRQ) in FY 2024.

A member of our team joined the inaugural national coalition working group meeting on data privacy, cybersecurity, and artificial intelligence in healthcare and telehealth, as Congress prepares to ramp up legislative and committee work on these issues over the next few months.
 
Our team followed the release of two new Medicaid DSH rules, a request for information from HELP Committee leadership to inform the development of healthcare workforce legislation, and a request from Rep. Richard Hudson (R-NC-03) to inform the reauthorization of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. We are coordinating with Duke Health leaders to coordinate potential health system responses.
 
Members of our team also virtually joined the 4th Annual Gun Violence Prevention Forum. This forum serves to mobilize the collective efforts of leading executives, clinicians, researchers, and policymakers around gun violence as a public health emergency.
 

Join the Duke Health Advocacy Network!
Looking for more opportunities to connect with fellow advocates and professionals interested in public policy across the health system? Join the Duke Health Advocacy Teams Channel!

Managed and moderated by Duke Health Government Relations and Duke State Relations, the purpose of the platform is for you to connect with your colleagues throughout the health system who are engaged and/or interested in public policy advocacy. We hope the channel will be used as a space for sharing ideas, collaboration, and engaging with the government relations teams on the issues most important to your work.
 
We encourage you to explore the channel, as we will post relevant news items, policy updates, questions, advocacy resources, and opportunities for engagement. As importantly, this is your space to do the same and to help grow the community.
 
Click to Join
 
(Note: This is only open to Duke Health employees. By joining this teams channel, you acknowledge that the platform and your participation are intended for information sharing and connections/relationship building and is not an inducement by Duke Health Government Relations and Duke State Relations, or the channel’s participants, to act as an unauthorized advocacy and/or lobbying representative of Duke Health or Duke University).