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Federal Health Policy Updates for the Week of July 13, 2020

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To catch us all up
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The Details
Federal health updates from Congress and the Administration
While resuming a more regular schedule, new precautions are being put into place to protect Members and staff. The Office of the Attending Physician, which serves Congress and the U.S. Supreme Court, has warned that pre-COVID-19 normal operations will not be back in place for quite some time.
 
ICE rescinds controversial SEVP rule change
Following a week of intense backlash from the higher education community, businesses, policymakers, and a lawsuit filed by MIT and Harvard University, on July 14 Immigration and Customs Enforcement (ICE) rescinded revised SEVP guidance for the Fall 2020 semester that would have jeopardized the visa status of international students in the U.S. whose programs of study were online only due to COVID-19.
 
The initial guidance for Fall 2020 released by ICE on July 6 modified expanded flexibilities provided to international students in the spring whose programs transitioned entirely to remote instruction. The modifications would have forced international students in the U.S. — in programs that decided to remain online only for the fall due to ongoing safety concerns — to either leave the country or find a program at another institution offering both in-person and online instruction.
 
Duke joined an amicus brief in support of the MIT-Harvard case, and Duke Health Government Relations, in partnership with our counterparts on the campus side, professional associations, and Duke faculty, staff, and leadership, mobilized to engage with policymakers. These efforts were strengthened by the response of Duke’s international students, who have proactively shared their stories and concerns about this and other immigration related proposals.
 
The flexibilities allowed for the Spring 2020 semester will now continue through at least the end of the year.

Duke resources on the ICE rules and other immigration policies may be found here.
 
House Appropriations Committee passes 12 spending bills, including funding for Duke Health priorities
Retiring House Appropriations Committee Chairwoman Nita Lowey (D-NY-17) set an ambitious schedule to move all twelve of its annual appropriations bills before the August recess – and now she is halfway there. The House Appropriations Committee wrapped up its work this week, setting the stage for funding measures to be considered by the full House beginning next week.
 
The Labor, Health and Human Services, Education (Labor-HHS) appropriations bill, which provides discretionary funding for federal healthcare programs, passed out of full Committee on Monday by a vote of 30-22.  Provisions in the FY 2021 Labor-HHS spending bill encompassed increased funding for several of Duke Health’s priorities, including $47 billion for the National Institutes of Health, which would be an increase of over $5 billion above the FY 2020 enacted level. $5 billion of the increase would be one-time emergency funding. The bill would continue to invest in Title VII health professions programs at the Health Resources and Services Administration (HRSA) by providing $512.5 million, a $38 million increase above the FY 2020 enacted level. The bill would increase funding for Nursing Workforce Development programs at HRSA by $10 million in FY 2021, for approximately $270 million in total funding.  The bill would also provide $342 million for the Agency for Healthcare Research and Quality (AHRQ), which would be a $5 million increase above the FY 2020 enacted level.
 
The Committee also passed separate appropriations bills to fund the Congressionally Directed Medical Research Program (CDMRP) at the Department of Defense (DoD) and medical research at the Department of Veterans Affairs (VA). Among the priorities funded through CDMRP include $12 million in level spending for the Reconstructive Transplant program and $110 million for prostate cancer research. Total medical research funding at the VA would be set at $840 million, representing a $21 million increase above current funding levels.
 
Next week the House is expected to consider the first four of the appropriations bills passed out of Committee as part of a broader “minibus” package. The House is expected to bring the Labor-HHS bill to the floor the week of July 27. It is unclear when the Senate Appropriations Committee will take up its versions of the appropriations legislation and increasingly likely that a continuing resolution will be needed to keep the government funded beyond September 30.
 
Senators Introduce Bipartisan Legislation to 340B Status
To address challenges facing hospitals during the COVID-19 pandemic, a bipartisan group of Senators introduced S. 4160 to enable certain hospitals already participating in, or that that have applied for, the 340B Drug Pricing program prior to the COVID-19 pandemic to temporarily maintain eligibility.  The legislation was introduced by Senators Rob Portman (R-OH), Debbie Stabenow (D-MI), John Thune (R-SD), Tammy Baldwin (D-WI), Shelley Moore Capito (R-WV), and Ben Cardin (D-MD).
 
This bill is especially important since the case mix for most hospitals changed due to COVID-19, thus leaving a hospital’s eligibility for this program negatively and unintentionally impacted.
 
HHS to take over COVID-19 data collection
The Trump Administration announced July 10 that it is changing the way health care providers report daily coronavirus data. As of July 15, hospitals and states will no longer submit daily COVID-19 data through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network and instead report through two HHS systems. Duke Health Government Relations has contacted our congressional offices to express concerns about the change.

The abrupt change has raised questions from some policymakers about maintaining the integrity of the data, as well as from health systems adapting quickly to new reporting requirements. CDC Director Robert Redfield said that he supports the change as a means of streamlining data and easing reporting burdens, but questions persist with respect to how the data is utilized and ultimately reported to the public. 
 
Next COVID-19 relief package in sight but details are unresolved
Senate Republican leaders have indicated that they may release their version of a “Phase IV” COVID-19 relief and stimulus package as soon as next week after returning from a two week recess. While the final details are still coming together, the legislation is expected to include liability protections for employers, aid to schools (reportedly tied to reopening for in-person instruction), tax incentives, and potentially another round of stimulus checks with a much narrower threshold to qualify. Further extending enhanced unemployment benefits remains an issue of contention between House Democratic and Senate Republican leaders, with no agreement on the appropriate level of funding.
 
House Democrats passed their version of “Phase IV” relief in May. The HEROES Act (H.R. 6800), among other provisions, would provide funding to support the research infrastructure, schools, state and local governments, as well as continued relief for individuals and small businesses.
 
Duke Health Government Relations is advocating for at least $26 billion to be included in a “Phase IV” package to protect the research enterprise, including $10 billion for the NIH and $3 billion for the DoD Medical Research Program, as well as additional relief for providers.
 
Stakeholders intensify efforts to include important priorities in the next COVID-19 relief package
The North Carolina Healthcare Association joined a letter, led by associations representing states, territories, counties, cities and towns, to House and Senate leadership requesting support for an enhanced federal medical assistance percentage (FMAP) for the Medicaid program in the next bipartisan COVID relief bill. The letter also urged that the proposed Medicaid Fiscal Accountability Rule (MFAR) be rescinded. Rescinding this rule has been a priority for Duke Health, which would jeopardize over 40 percent of Medicaid reimbursement at Duke Health and other health systems across North Carolina.

You can learn more about support for these topics on the Duke Health Government Relations’ Issue Page.
 
In addition, on July 9, over 60 healthcare stakeholders led by the Association of American Medical Colleges sent a letter to Congressional leadership in the House and Senate urging action to better prepare the nation for its next health care crisis by including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) in the next comprehensive COVID-19 supplemental. The letter noted that the demand for physicians continues to grow faster than supply, leading to a projected shortfall between 54,100 and 139,000 physicians by 2033. This bill, which Duke Health supports and is currently cosponsored by Reps. David Price (D-NC-4) and G.K. Butterfield (D-NC-1), would increase the number of Medicare-funded residency slots by 3,000 a year for five years.