It’s all fuel, really
The things we carry – and those
We wish to put down
The Rundown
- Medicare issues proposed CY 2023 Medicare Physician Fee Schedule rule
- Administration to extend COVID-19 PHE
- A tight congressional schedule, including work on appropriations, gets more complicated
- Congress holds hearings on healthcare legislation and VA healthcare access
- White House issues Maternal Health Blueprint
- White House announces Executive Order on abortion access
- The latest from our desks
- Join Duke Health Advocacy Network
Federal Updates
CMS issues CY 2023 Physician Fee Schedule and Quality Payment Program proposed rule
Last week, the Centers for Medicare and Medicaid Services issued its calendar year (CY) 2023 proposed rule for the Physician Fee Schedule and Quality Payment Program. According to the CMS news release and fact sheet, the proposed rule would expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care, particularly in rural and underserved areas, and make additional policy changes for evaluation and management (E/M) visits and to the Medicare Shared Savings Program.
The CY 2023 PFS proposed rule also adds new telehealth services to be covered under Category III through the end of 2023, implements the current 151-day post-public health emergency (PHE) extension of PHE-related telehealth flexibilities, and clarifies which services will no longer be covered by Medicare once the post-PHE extension ends. For the Quality Payment Program, CMS proposes five new, optional Merit-based Incentive Payment System (MIPS) Value Pathways (MVP) that would be available beginning in 2023. These MVPs align the reporting requirements of the four MIPS performance categories around specific clinical specialties, medical conditions, or episodes of care. It does not address the Advanced APM incentive payment, but our office continues to work with Congress on this issue.
Among the more controversial provisions in the proposed rule would cut the conversion factor $33.08 in CY 2023, as compared to $34.61 in CY 2022, a reflection of certain statutory requirements, including the expiration of a 3 percent statutory payment increase, a 0 percent conversion factor update for 2023, and a budget neutrality adjustment. The conversion factor proposal has drawn wide criticism from stakeholders around the country, especially as a 2 percent Medicare payment cut was allowed to fully phase in on July 1.
Our team is working closely with Duke Health leadership and experts to coordinate a formal response. Comments are due to CMS on September 7, 2022.
Administration set to extend COVID-19 PHE
The Biden administration is reportedly preparing to once again extend the COVID-19 PHE through at least mid-October, meaning that a number of pandemic-related flexibilities will remain in place, as well as the federal government’s expanded authority to respond broadly to ongoing COVID-related challenges. Could this be the final extension? It’s unclear, particularly given the new rapidly spreading variant and timing of the extension’s expiration being close to the November midterm elections. Yet, the administration continues to face political pressure from some state leaders and national policymakers to formally end the emergency declaration.
The White House has promised governors at least 60 days-notice before winding down the PHE, and the eventual, gradual drawdown comes with it the disentanglement of temporary regulatory changes and would also start the clock on the current five-month extension of Medicare telehealth waivers and flexibilities.
We will continue to monitor this issue closely and report any new developments from the administration, and actions by Congress to make some of the PHE provisions permanent.
Stop us if you’ve heard this before – D.C. schedule update
We’re running out of new ways to say that time and scheduling are not exactly on Congress’s side with respect to any number of pre-midterm election agenda items – but a stall in metaphors and creative banter doesn’t make the sentiment any less true. August recess is on the horizon and the number of legislative days until the first major fall deadline – the September 30th end to the current fiscal year – are few. Here’s a quick update on a few key priorities.
FY 2023 Appropriations
On June 30, the House Appropriations Committee advanced its FY 2023 funding bill for the Department of Health and Human Services (HHS) by a vote of 32-24. The bill provides funding for a number of Duke Health priorities, including:
- $47.5 billion for the NIH base budget, which would represent a $2.5 billion increase above the current level. This also includes funding for the Regional Biocontainment Laboratories, of which Duke is one, and other NIH priorities including the Clinical and Translational Science Awards (CTSA) Program.
- $10.5 billion for the CDC, an increase of $2 billion above the FY 2022 level. This funding also includes support for firearm injury and mortality prevention research, as well as funding for Sickle Cell Disease data collection activities at Duke Health.
- $385 million for AHRQ, an increase of $35 million above the current level.
- $150 million for the National Child Traumatic Stress Initiative co-led by Duke and UCLA.
- $678 million for Title VII health professions training programs at the Health Resources and Services Administration (HRSA).
- $324 million for Title VIII nursing workforce development programs at HRSA.
- $10 million for the MISSION Zero Military-Civilian Trauma for the Readiness grant program.
The House has advanced all of its spending bills out of committee and plans to move six of the bills to the full House floor next week for consideration; however, the bill funding HHS is not among the six on the current schedule. What now? There is still no agreement on top-line spending totals for defense and non-defense discretionary funding, so Democrats are forging ahead to put markers in place before final FY 2023 negotiations.
The House intends to hold a vote on all of its versions of the twelve annual appropriations bills before the August recess. The Senate Appropriations Committee is not expected to release any of its bills until the end of this month, at the earliest.
Build Back (Manchin)
Senate Majority Leader Chuck Schumer (D-NY) has spent the last several weeks negotiating a scaled-down, $1 trillion reconciliation package with Senator Joe Manchin (D-WV). As of publication, it seemed as if the two reached an agreement on several aspects of the reconciliation package, including a proposal to allow Medicare to negotiate drug prices and a proposal to raise taxes on certain high-income individuals in order to boost Medicare’s solvency. Then came the most recent report on inflation and Senator Manchin is once again tapping the brakes. The next few weeks are realistically Democrats’ last shot to move forward on a second reconciliation measure, and whether or not a deal comes together, the process may take up a lot of valuable time.
NDAA
The House has wrapped work on its version of the FY 2023 National Defense Authorization Act (NDAA). 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. Both House and Senate leaders are hoping to resolve any differences between their respective NDAA bills ahead of the midterm elections and preserve an over 60-year streak of the legislation being enacted in the same calendar year in which it was introduced.
User fees
Let the “pre-conferencing” begin. House and Senate committee staff are reportedly meeting to begin the process of blending and negotiating certain provisions on a comprehensive user fee package before legislation is brought to the Senate floor. The Senate’s initial version of user fee legislation was passed by the Senate Health, Education, Labor and Pensions (HELP) Committee before the July 4th recess and included the VALID Act of 2022, which would allow for the FDA to regulate laboratory developed tests (LDTs). Unexpectedly, on July 14, Senator Richard Burr (R-NC) introduced a clean user fee reauthorization bill that does not include any other FDA-related policy changes. The House passed its version of a user fee reauthorization bill, which does not include any provisions to regulate LDTs, on June 8, 2022. The current FDA user fee authorization expires September 30.
Data privacy
June’s bicameral discussion draft of comprehensive data privacy legislation is now fully introduced legislation. With some exceptions, the American Data and Privacy Act (H.R. 8152) would cover all entities subject to the Federal Trade Commission’s jurisdiction, supersede most state privacy laws (exceptions include those for health data), and create a federal private right of action for consumers. House Energy and Commerce Committee leaders have announced that the bill will be marked up by the full committee next week.
Our team will continue to advocate for Duke Health priorities and provide updates on these issues as they become available.
Congressional hearings focus on critical healthcare legislation and policies
Last week, the House Energy and Commerce Committee held a hearing entitled, “Investing in Public Health: Legislation to Support Patients, Workers, and Research.” The hearing focused on several bills that can be viewed at the link above and covered a range of topics, including health equity, access to services, NIH support for early-career pediatric researchers, and foreign influence and research. One of the bills on the docket included the “NIH Clinical Trial Diversity Act,” which was introduced by several members including Rep. G.K. Butterfield (D-NC-01).
The Committee has successfully advanced several bipartisan healthcare bills dealing with a range of topics impacting delivery of care and research, but a robust congressional agenda leaves the fate of healthcare legislation unclear.
This week, the House Veterans’ Affairs (VA) Health Subcommittee held a hearing entitled, “Examining VA Community Care Access, Utilization and Expenditures.” The first panel of witnesses included leaders from the VA’s Veterans Health Administration, who discussed strategies for optimizing VA healthcare and access, and the second panel featured testimony on improving mental healthcare for veterans by the co-founders of Forge Health, which focuses on the treatment of mental health and substance abuse.
White House releases blueprint to improve maternal health
In late June, the White House released its Blueprint for Addressing the Maternal Health Crisis. This effort is characterized as a whole-of-government approach to combatting maternal mortality and morbidity. The Blueprint outlines specific actions to improve maternal health under five priority goals, including:
- Increasing access to and coverage of comprehensive high-quality maternal health services, including behavioral health services.
- Ensuring those giving birth are heard and are decision makers in accountable systems of care.
- Advancing data collection, standardization, harmonization, transparency, and research.
- Expanding and diversifying the perinatal workforce.
- Strengthening economic and social supports for people before, during, and after pregnancy.
Some of the outlined activities and goals in the blueprint are already pending in Congress, such as extending Medicaid postpartum coverage for 12 months and efforts to strengthen the perinatal workforce. However, more comprehensive supporting legislation, including the Black Maternal Health Momnibus, has yet to advance. Improving maternal health and closing the health equity gaps remain a priority for our office and we continue to engage with policy makers on strategies to help support these efforts.
White House issues Executive Order on abortion access
On July 8, 2022, President Biden signed an executive order directing HHS to expand access to abortion pills, strengthen enforcement of Obamacare’s birth control coverage mandate, and stand up an army of pro bono lawyers to help defend people criminally charged for seeking or providing the procedure.
The order instructs the administration to consider several additional actions to shore up privacy rights for patients using digital apps such as period trackers and those who are now at risk of being reported to law enforcement by a medical provider. The administration will also consider strengthening protections for doctors performing abortions in medical emergencies by updating the Emergency Medical Treatment and Labor Act, and plan to create another interagency task force that includes Attorney General Merrick Garland.
Following the signing of the executive order, the Justice Department created a “Reproductive Rights Task Force” that will take “proactive and defensive legal action” to help women seeking abortions in states where it’s legal, prevent states from banning Mifepristone, or try to “impose criminal or civil liability” on healthcare workers who provide abortions in cases of medical emergency.
This week, the Biden administration, through the HHS Office of Civil Rights, issued clarifying guidance that federal law does not permit pharmacies to turn away people who have a prescription for a drug that could be used to terminate a pregnancy.
From our desk(s): Duke Health GR this week
We have some catching up to do!
At the end of June, a representative from our team attended the American Hospital Association’s Government Relations Officers Network meeting and a roundtable organized by the North Carolina Healthcare Association with staff from the NC congressional delegation. Our office also organized and attended meetings with Vincent Guilamo-Ramos, Dean of the Duke University School of Nursing, with Rep. Deborah Ross (D-NC-02) and Marco Davis, President and CEO of the Congressional Hispanic Caucus Institute (CHCI), to discuss policy impacting nursing education and workforce, serve as a resource, and identify opportunities to coordinate.
This week, we followed Dean Guilamo-Ramos’ discussion as part of the NINR Director's Lecture Series: Social Determinants of Health and joined him at the monthly meeting of the Deans’ Nursing Policy Coalition.
Members of our team participated in the Association of American Medical Colleges’ (AAMC) Government Relations Representatives working groups on health equity, rural health, and hospital at home to discuss pending legislative and regulatory opportunities. We also met with the government relations team for the American Nurses Association (ANA) to discuss coordination on policy issues and participated in the monthly Trauma Centers Association of America (TCAA) policy committee meeting.
We joined coalition and stakeholder engagement calls on telehealth expansion, veterans’ healthcare access, surprise medical billing, and supporting federal medical research.
Finally, Duke Health Government Relations joined colleagues from other health systems and the business and life sciences communities for a virtual meeting with Senator Richard Burr (R-NC). Hosted by the Healthcare Leadership Council, participants shared appreciation for his service in light of his retirement later this year, as well as updates on the COVID and monkeypox responses, telehealth, the infectious disease workforce, and reauthorization of FDA user fees.
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