An impasse broken?
Not by neon moonlight - but
A beltway love song
The Rundown
- There’s another CR and potential framework for FY 2022 spending
- The congressional to-do list is only growing in the first half of 2022
- Senate telehealth bill seizes on growing urgency for extension of PHE flexibilities
- Momentum building for mental health policy in D.C.
- Committee round up: ARPA-H and healthcare workforce
- The latest from our desks
- Challenge: Post your own Health Policy Valentines
Federal Updates
A CR and a deal?
The latest episode of the ongoing FY 2022 funding saga began the week with a “to be continued,” but it’s ending with a possible preview of a series finale wrapping up a number of loose ends.
Early Monday morning, the only thing that seemed certain this week is that Congress would need to pass another continuing resolution (CR) to keep the federal government funded beyond the February 18 expiration date of the current CR passed in December 2021. Some progress had been reported in negotiations among the “four corners” Democratic and Republican House and Senate appropriations leadership, but a deal didn’t seem close enough – and even with some sort of an agreement, staff would still need time to write the actual legislative text. The House responded by passing another CR on Tuesday that would extend level funding through March 11, with the Senate expected to follow suit before next Friday. It is necessary breathing room to avoid a government shutdown, but the long-term future of FY 2022 spending remained uncertain.
That is, until the very next day.
On Wednesday, appropriations leadership announced that they had agreed to a bipartisan framework to complete the FY 2022 appropriations process, allowing subcommittee staff to begin finalizing an omnibus spending bill for consideration in the next few weeks. Granted, the hard work remains in the details – and individual line items will still need to be determined under the framework – but the announcement is a significant step forward in a process that seemed stuck in neutral. Longer-term CRs offer virtually no opportunity for program growth, wipe out innovation, and delay new initiatives.
There is growing optimism that a final omnibus package will come together relatively quickly – and then we get to do it all over again… from the beginning… for FY 2023.
Our team continues to advocate for Duke Health federal spending priorities and will stay closely engaged with the NC congressional delegation.
Running down the rest of the schedule
A reported FY 2022 spending framework agreement does take some pressure off a rapidly expanding to-do list that will get tougher to manage the closer the calendar approaches the midterm election season. Here’s an update on a few items we’re following:
- FY 2023 federal appropriations – As far as we know today, President Biden is still expected to release his administration’s budget blueprint for FY 2023 in early March. The congressional budget season will officially begin soon thereafter. Expect a flurry of activity to begin piecing together House and Senate budget resolutions, and then the appropriations process will likely be off to the races by early summer.
- COVID-19 response – We don’t talk about the CDC, oh no no… With a framework in place for FY 2022 spending, negotiations on a possible COVID-19 and disaster relief supplemental package that would attach to a FY 2022 omnibus bill will likely pick up in the coming weeks. The size and scope of the supplemental are unclear, but in addition to further provider relief, advocates are pushing for a number of other priorities to be included, from an extension of the Medicare sequester moratorium to a multi-year extension of Medicare telehealth flexibilities currently tied to the COVID-19 public health emergency (more on that below). The potential omnibus may be the last major legislative vehicle to have a chance of passing Congress for a while, so there will be a frenzied effort to attach as much as possible.
- Build Back Better Act (BBBA) – Practically, there has been no change on this priority, and even behind the scenes talks have taken a back seat to other issues. Until Senator Ben Ray Lujan (D-NM) is healthy enough to return to the Senate, there likely won’t be much to report publicly.
- Senate and SCOTUS – President Biden is scheduled to meet with Democrats on the Senate Judiciary Committee next week to begin discussing the process for his eventual nominee to replace the retiring Justice Stephen Breyer. This is another issue where the final steps on the confirmation process may not take place until Senator Lujan returns, but we may know more about the initial steps, as well as the nominee, in the coming weeks.
- Califf nomination to lead FDA – Senate Majority Leader Chuck Schumer (D-NY) has filed a motion to limit floor debate on a final Senate confirmation vote for Robert Califf, MD to be the next commissioner of the Food and Drug and Administration (FDA). The motion is a signal that Democratic leadership has enough votes to ensure Califf’s confirmation. The vote could take place as early as next week.
Urgency grows for telehealth flexibilities extension as new bill is introduced in the Senate
In follow up to a national community letter signed by Duke Health and a separate House and Senate telehealth working group letter signed by Senator Thom Tillis (R-NC), legislation has been introduced in the Senate to extend for two years (through 2024) the current Medicare telehealth flexibilities tied to the COVID-19 public health emergency (PHE).
The Telehealth Extension and Evaluation Act (S.3593), sponsored by Senate Finance Committee members Senators Catherine Cortez Masto (D-NV) and Todd Young (R-IN), is similar to legislation introduced in the House by Rep. Lloyd Doggett (D-TX), who chairs the House Ways and Means Subcommittee on Health. The Senate Finance and House Ways and Means Committees are the primary committees of jurisdiction for Medicare coverage in Congress.
In addition to extensions of currently enhanced telehealth services under Medicare, which would also include rural health centers, federally qualified health centers, critical access hospitals, and treatments for substance abuse disorders, the bill would provide “guardrails” for the order of certain DME and lab tests and authorize a Department of Health and Human Services-led evaluation of telehealth growth during the PHE. A section-by-section analysis of the legislation is available here.
With uncertainty about the duration of the PHE for the remainder of the year, there is growing momentum to get at least a two-year extension passed this spring with, as noted above, a potential FY 2022 omnibus package eyed as a potential vehicle. Decoupling telehealth expansion from the PHE will give Congress more room to make final decisions on permanent expansion and more time for our team and other stakeholders across the country to make the case for permanence.
Mental health policy grabs focus and momentum in D.C.
This week, the Senate Finance Committee held a hearing entitled “Protecting Youth Mental Health: Part I - An Advisory and Call to Action. The hearing featured Surgeon General Dr. Vivek Murthy. The conversation follows months of Committee efforts to examine major challenges impacting mental health and stakeholder feedback, including input provided by Duke Health. Senate Finance Committee Chairman Ron Wyden (D-OR) has indicated that the the full committee will remain engaged on mental health issues with hearings featuring experts and advocates, as well as families who can share their own experiences with mental health challenges – all part of a bipartisan effort to find a legislative path to address “shortfalls in America’s mental healthcare system.” The Part II hearing will be held on February 15.
Chairman Wyden also announced that several Committee members have agreed to bipartisan partnerships to lead efforts on specific policy challenges with a goal of producing comprehensive mental health legislation this summer. Finance Committee member Senator Richard Burr (R-NC) has agreed to co-lead a focus area on behavioral and mental health parity with Senator Michael Bennett (D-CO).
The Senate Health, Education, Labor and Pensions Committee (HELP) and the House Energy and Commerce (E&C) Committee are also examining mental health-related issues within their jurisdiction, which includes oversight and authorization of Substance Abuse and Mental Health Services Administration (SAMHSA). This week, HELP Committee Chairwoman Patty Murray (D-WA) and Ranking Member Burr issued a press release to announce bipartisan efforts to strengthen mental health and substance use disorder programs through reauthorization. The Energy and Commerce Subcommittee on Oversight has announced an upcoming hearing on the nation’s response to the mental health crisis on February 17.
Also this week, the White House held a livestreamed discussion on the importance of mental health and wellness in the Black community. The discussion was hosted by Domestic Policy Council Senior Advisor Susan Rice and SAMHSA Administrator Miriam Delphin-Rittmon, and included actress Taraji P. Henson, professional tennis champion Sloane Stephens, and WNBA star Nneka Ogwumike who shared their personal stories around mental health and wellness, as well as administration policies to address mental health issues.
With increased momentum and attention, the time may be ripe for a number of mental health legislative priorities to move forward. Our office will continue to work with Duke Health stakeholders and these Committees as initiatives are developed.
Additional committee focus: ARPA-H and the healthcare workforce
It wasn’t all mental health this week as the Energy and Commerce and HELP Committees also spent some time on ARPA-H and support for the healthcare workforce, respectively.
House Energy and Commerce Committee examines ARPA-H proposal
This week, the House Energy and Commerce Health Subcommittee held a hearing entitled "ARPA-H: The Next Frontier of Biomedical Research." The hearing examined the president’s proposal for the creation of a new entity, the Advanced Research Projects Agency for Health (ARPA-H), which is modeled on the Defense Advanced Research Projects Agency (DARPA), “to make pivotal investments in breakthrough technologies and broadly applicable platforms, capabilities, resources, and solutions that have the potential to transform important areas of medicine and health for the benefit of all patients and that cannot readily be accomplished through traditional research or commercial activity.”
Among the issues discussed is where this new agency should be housed, either within the National Institutes of Health or as an entity within the broader Department of HHS. Subcommittee Chair Anna Eshoo (D-CA) is now working with Reps. Diana DeGette (D-CO) and Fred Upton (R-MI), who have included the creation of ARPA-H in their Cures 2.0 legislation, to negotiate and advance a final ARPA-H authorization proposal. Chair Eshoo said in her remarks at the hearing that creating ARPA-H is her top legislative priority in this Congress.
Senate HELP Committee discusses workforce shortages
This week, the Senate HELP Subcommittee on Employment and Workplace Safety held a hearing on “Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage,” an issue that our office has actively been engaging in with the NC congressional delegation and other congressional leaders. In his opening remarks, Subcommittee chair John Hickenlooper (D-CO) discussed the “daunting estimates” of shortages of healthcare providers facing the U.S. and the need to prioritize workforce support at every level and entry point into healthcare professions.
From our desk(s): Duke Health GR this week
This week, leadership from the Duke Cancer Institute met virtually with Senator Burr’s HELP Committee staff to share updates on cancer research and care and to reaffirm DCI as a resource for some of the major policy initiatives in Congress.
Our office met with Dr. Marla Wald, Associate Professor of Psychiatry and Behavioral Sciences, to learn more about her work and programs at Duke Health focused on maternal mental health to inform congressional efforts.
We monitored the release of The Access to Life-Saving Trauma Care for All Americans Act (S. 3566) by Senators Jack Reed (D-RI) and Jerry Moran (R-KS). The bill would reauthorize and modernize federal trauma center and system support grants. Language from the bill is also included in the Senate HELP Committee’s PREVENT Pandemics Act discussion draft. A member of our team serves on the policy advisory committee for the Trauma Centers Association of America and has been working with advisory committee colleagues on the bill’s introduction.
Our office urged support for a bipartisan letter being led by Reps. Suzan DelBene (D-WA), Markwayne Mullin (R-OK), Ami Bera, M.D. (D-CA), Mike Kelly (R-PA), Peter Welch (D-VT), Darin LaHood (R-IL), and Brad Wenstrup (R-OH) asking the Biden administration to adopt policies to increase participation in accountable care organizations (ACOs) and alternative payment models (APMs). Rep. Kathy Manning (D-NC-06) and G.K. Butterfield (D-NC-01) have signed the letter. Our efforts are coordinated with leadership for Duke Connected Care.
Finally, our team also continued engaging experts and allies on a range of legislative issues, including the regulation of laboratory-developed tests, correct dosing of prescription drugs for children, cancer research funding, and strengthening the 340B Program, among other topics. We also presented to a cohort of Duke University School of Nursing Doctor of Nursing Practice students about effective advocacy.
Social Media Challenge: Health Policy Valentines
It’s that time again – Health Policy Valentines are popping up all over social media and we encourage you to post your own! Here’s one from our team that we’ve posted on social media this week.
Roses are red, violets are blue, the budget is around the corner so please finish funding for FY 2022 #HealthPolicyValentines #FundNIH
If you’d like to give it a try, head to Twitter and use #HealthPolicyValentines