Imagine a world
Where I don’t know what to do
Was let’s get it done
The Rundown
- Congress is back for appropriations, defense policy, and major reauthorization efforts
- Congressional hearings focus on healthcare transparency, antimicrobial resistance, and Veterans
- CMS releases CY 2024 Physician Fee Schedule and OPPS proposed rules
- AHRQ shares Strategic Framework for the PCOR Trust Fund and Plan for Investments
- The latest from our desks
- Virtual office hours – July 31
- Join the Duke Health Advocacy Network!
Federal Updates
Congress is back, and the going looks tough
Stop us if you’ve heard this before. Congress returned from its two-week summer recess on Monday with a number of high-priority items on its to-do list, many of which are must-pass legislation with deadlines quickly approaching. Oh, and there are only seven legislative days scheduled until the next congressional break. Awesome!
Priorities include legislation authorizing military programs, updating agriculture and food-aid policy, and keeping the country’s airports running, all of which must also be enacted by the new fiscal year, although Congress can also agree to temporarily extend current programs. Screaming for attention on the to-do list are the annual spending bills to keep the federal government open, which must be enacted by the time the new fiscal year starts on October 1.
FY 2024 Appropriations
On Thursday, House Republicans unveiled the last of their 12 proposed FY 2024 spending bills, including the Labor-Health and Human Services (HHS)-Education package, which includes funding recommendations for key medical research and public health programs, such as the National Institutes of Health (NIH). The proposed Labor-HHS spending bill would cut $3.8 billion from NIH and $500 million from ARPA-H as compared to current funding levels. The proposed funding bill also includes several policies that try to restrict funding for certain research, including grain of function research, and policies to limit federal support of and access to abortion. House Democrats shared their response to the proposed bill by highlighting the harmful impacts cuts could have.
This proposed bill will be met with resistance from House Democrats, and in the Senate where Democrats hold a slim majority. However, Congress must pass its appropriations bills to keep the government functioning and tough negotiations are expected. Our office will continue to advocate for vital investments in biomedical research and our healthcare workforce and oppose deep cuts to these programs.
House Appropriations Committee Chair Kay Granger (R-TX) has scheduled full committee markups for eight of the appropriations bills ahead of the August recess. The Senate is not expected to move forward with any appropriations bills prior to the August recess, although the Senate Appropriations Committee is working to finish markups on all of its 12 spending bills by July 27.
NDAA
The House and Senate are working on their respective versions of the National Defense Authorization Act (NDAA), which 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. The House began debate on its NDAA legislation on Wednesday with the goal of passing the bill by today, but the timeline is in flux as Speaker Kevin McCarthy (R-CA) and a small group of Republican conservatives are working to make a deal that may involve votes on several controversial social amendments in order to allow the legislation to proceed to a final vote. The Senate Armed Services Committee approved the Senate version of the NDAA in June, and committee leadership is working with Members on potential amendments to be considered on the Senate floor.
After both chambers have passed their respective bills, they will have to come together in conference to reconcile differences and develop a final bill that has the best opportunity to maneuver around obstacles among their respective Members.
Other issues
What’s left? Congress must revamp the nation’s pandemic and emergency preparedness law before many of its programs expire on September 30. The House Energy and Commerce Committee marked-up of its version of the bill, which would reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA), on Thursday despite lingering differences between Republicans and Democrats over its scope. Democrats are pushing to include policies meant to address shortages that have impacted antibiotics, ADHD medication, and cancer drugs. The Senate released its draft bill text last week and just announced plans for its own markup next Thursday. The August recess looms. It’s possible that efforts to pass House and Senate negotiated PAHPA reauthorization will slip past the deadline.
Congress must also reauthorize the Community Health Center Fund, which represents about 70 percent of the federal funding for community health centers, by September 30. While a House panel advanced a package that included a community health center reauthorization in May, Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Bernie Sanders (I-VT) is requesting a massive increase in the fund that has stalled action on the Senate side.
Our team is also actively engaged with House and Senate staff to reauthorize the National Child Traumatic Stress Network (NCTSN), which is coordinated and managed by the Duke-UCLA National Center for Child Traumatic Stress.
Senate Majority Leader Chuck Schumer (D-NY) has vowed to move forward on several other health related efforts, including advancing bills that would lower the cost of insulin and prescription drugs. Leader Schumer is also taking an increased leadership role on developing legislation to address the expansion of artificial intelligence technologies and capabilities, which will directly impact A.I. innovation in healthcare.
Heard on the Hill
They're back - which means so are the hearings and legislative markups. Below is a snapshot of some of the committee activity we followed this week.
House Committee on Education and the Workforce Focus on Healthcare
On Wednesday, the House Education and the Workforce Committee advanced several bills focused on “transparency” in the healthcare sector as part of its authority under the Employee Retirement Income Security Act.
Among the bills advanced at the markup include the ‘‘Transparency in Billing Act,’’ which would place hugely burdensome and costly requirements on hospitals for the care provided in hospital outpatient departments by requiring a unique health identifier for the department where care was provided in order to be reimbursed under a commercial health plan. Duke Health opposes these burdensome and costly regulations. In addition, the bill, as amended, also takes aim at hospital facility fees.
These provisions are similar to site-neutrality provisions included in the House Energy and Commerce markup in June. In a statement following the markup, the American Hospital Association (AHA) emphasized its commitment to strengthening the U.S. health care system and willingness to work with policymakers. The AHA also pushed back on the notion of dishonest billing, stressing that “hospitals and health systems bill according to federal regulations, which require them to bill all payers using codes that indicate the location of where the service is provided. All hospital outpatient departments currently bill using a code that identifies them as a hospital outpatient department, regardless of location.”
House Energy and Commerce Subcommittee on Health
On Thursday the House Energy and Commerce Subcommittee on Health held a markup of 17 healthcare bills, several of which focused on reauthorizing programs set to expire this year. A full list of the bills can be viewed here. Many of the programs support activities at Duke Health including the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), which is being led by Rep. Richard Hudson (R-NC-09).
Senate Health, Education, Labor, and Pensions (HELP) Committee
On Tuesday, the Senate HELP Subcommittee on Primary Health and Retirement Security held a hearing on “Superbugs: The iImpact of Antimicrobial Resistance on Modern Medicine.” Witnesses included representatives from colleges of veterinary medicine and traditional medicine, a small therapeutics company, and a healthcare advocate. The largely bipartisan conversation focused on the challenges of antimicrobial resistance (AMR) on the future of public health, as well as the need to address the threat of AMR within the context of any future emergency preparedness planning. Witnesses discussed reimbursement issues related to AMR testing that has limited use and innovation, and market-related access issues that have prevented new therapies from being available to providers and patients.
The hearing comes as a bipartisan group of Senators is working to have major AMR innovation legislation added to the HELP Committee’s emerging legislative proposal to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA).
Senate Veterans’ Affairs Committee
On Wednesday, the Senate Veterans’ Affairs Committee held a legislative hearing of 19 pieces of legislation. Witnesses included representatives from the Veterans Health Administration’s Office of Integrated Care and leadership from Veterans’ service organizations. Among the bills examined was one introduced by Committee ranking member Jerry Moran (R-KS), the Veterans' Health Empowerment, Access, Leadership, and Transparency for our Heroes (HEALTH) Act of 2023 (S.1315), which has the intent of increasing transparency and accountability within the VA Community Care program, as well as potentially expand access to more Veterans. Additional legislation focused on VA electronic health record modernization, Veterans’ patient access, homecare, and a bill from Senator Thom Tillis (R-NC) that would award grants to nonprofit organizations to support programs that provide service dogs to eligible Veterans.
Our team is closely monitoring legislation related to VA integrated care and community choice as Congress considers any potential expansion or changes to the current community health access program.
Double the fun: CMS releases CY 2024 Physician Fee Schedule and CY 2024 Outpatient Prospective Payment System (OPPS) proposed rule
The Centers for Medicare and Medicaid Services (CMS) late on Thursday released the calendar year (CY) 2024 Physician Fee Schedule and Quality Payment proposed rule. Overall, the proposed rule, in accordance with current statutory requirements, would cut physician reimbursement by 3.34 percent in 2024.
The proposed rule also seeks to advance health equity and caregiver support, supports the Biden administration’s Cancer Moonshot, and increases support for expanded telehealth services, among other provisions.
A CMS fact sheet on the PFS proposed rule may be found here – and the full proposed rule may be found here.
Separately, CMS also released the CY 2024 Outpatient Prospective Payment System (OPPS) proposed rule on Thursday evening. The proposed rule would increase payment rates under the OPPS by 2.8 percent. The proposed increase is based on inpatient hospital market basket increase of 3.0 percent, reduced by a productivity adjustment of 0.2 percentage point. Hospitals must meet the hospitals outpatient quality reporting requirements to be eligible for the full update.
The proposed OPPS rule also seeks to expand access to behavioral health services through coverage of intensive outpatient services to better streamline policies to enhance hospital price transparency rules.
CMS has released a fact sheet on the proposed rule and updated resources on hospital price transparency.
The full OPPS proposed rule may be found here.
Our team is beginning our review of the two proposed rules and will be connecting with health system leadership and experts to inform potential comments and recommendations as part of the open public comment period that runs through September 11, 2023.
ICYMI: AHRQ Shares Strategic Framework for the Patient-Centered Outcomes Research Trust Fund and Plans for Big Investments
In case you missed it, this week the Agency for Healthcare Research and Quality (AHRQ) has been discussing its new strategy for patient-centered outcomes research. In an AHRQ blog post, AHRQ Director Robert Otto Valdez and AHRQ Chief Implementation Officer Karin Verlaine Rhodes said that the agency is preparing to make new and historic investments to disseminate and implement evidence-based innovations to improve patient and provider experience and advance healthcare delivery with the goal of achieving better health outcomes, with a focus on underserved populations. Specifically, AHRQ plans to invest about $100 million per year on high-impact initiatives to move local healthcare systems closer to providing more equitable, whole-person care across the lifespan.
From our desk(s): Duke Health GR this week
On behalf of Duke Health, our office responded to the opportunity to comment on the Senate HELP Committee’s legislative draft to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA). Specifically, we expressed support for language that would codify the 12 Regional Biocontainment Laboratories (RBLs), which include Duke, and offered suggestions to the proposed language. Our office also expressed support for the reauthorization of the Military and Civilian Partnership for the Readiness Trauma Grant program in the draft bill.
While on recess, our office met with staff for Reps. Alma Adams (D-NC-12) and David Rouzer (R-NC-07) to discuss Duke Health priorities. Our office also organized a meeting with staff for Senator Thom Tillis (R-NC) and Senator Ted Budd (R-NC) for Dr. Moira Rynn, Chair of the Department of Psychiatry and Behavioral Sciences, and Dr. Gary Maslow, Associate Professor of Psychiatry and Behavioral Sciences, Associate Professor of Pediatrics, and Co-Division Director of Child and Family Mental Health and Community Psychiatry. During the meeting, Dr. Rynn and Dr. Maslow shared their insights to help inform work happening in the Senate to improve mental and behavioral health.
Our office met with staff from the office of Rep. Danny Davis (D-IL) to discuss reauthorization of the National Child Traumatic Stress Initiative, which supports the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS). Our team also conducted outreach to our NC congressional members on the House Agriculture Committee regarding Duke Raleigh Hospital’s engagement in the community on reducing food insecurity.
Save the Date – Virtual “Office Hours” on July 31st
Duke Health (federal) Government Relations is once again partnering with our Duke State Relations colleagues to hold our second open, virtual "office hours." Open to members of the Duke Health Advocacy Network, these “office hours” are not formal presentations but instead an opportunity to talk about some of things on deck for us to learn more about the issues that are at the forefront for you and your work.
Date: Monday, July 31. 2023
Time: 12:00pm
More information on how to access the office hours will be available soon.
Not yet a member of the Duke Health Advocacy Network? No problem! Learn more about how to join below.
Join the Duke Health Advocacy Network!
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