Skip to main content

Federal Health Policy Updates for the Week of July 19, 2021

Duke Government Relations Logo

Federal Health Policy Updates for the
Week of July 19 - July 23, 2021

To build as you fly
Is to govern as you sell
Both take leaps of faith

The Rundown

  • CMS releases CY 2022 outpatient proposed rule
  • House moves forward on FY 2022 appropriations as debt ceiling fight awaits
  • Infrastructure deal may be imminent – and we really think so this time
  • Rep. Butterfield joins colleagues to form House Social Determinants of Health Caucus
  • Read more about our office’s work in the latest “From Our Desks”

Federal Updates

Hot reg summer: CMS releases CY 2022 OPPS proposed rule
One week after dropping the 2022 Medicare Physician Fee Schedule like the latest track on the summer 2021 regulatory playlist, the Centers for Medicare and Medicaid Services (CMS) this week released its calendar year (CY) 2022 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) proposed rule.

In addition to standard updates and increases in OPPS rates for 2022, the rule, among other provisions, would: reverse two policies finalized in CY 2021 related to the inpatient only list and the ASC covered procedures list; significantly increase civil monetary penalties for noncompliance with the hospital price transparency rule; continue cuts in OPPS payments to 340B hospitals; solicit comments on establishing a new provider type called the Rural Emergency Hospital; and formally begin implementation of the Radiation Oncology Model on January 1, 2022.

With respect to hospital transparency rules, CMS is also seeking to prohibit specific barriers to accessing machine-readable files and to clarify the expected output of price estimator tools for those hospitals that chose to use them to fulfill the shoppable service requirement. CMS further requests comment on related issues for future rulemaking, including best practices for online cost estimator tools, methods for identifying and highlighting exemplar hospitals, and opportunities to improve the standardization of the machine-readable files.

Our team is reviewing the provisions in the proposed rule and will work in coordination with our professional associations and internal stakeholders to develop feedback. The public comment period for the OPPS proposed rule closes September 17 at 5:00pm ET.

House to proceed on FY 2022 appropriations; debt limit debate looms
The House is expected to vote next week on a seven-bill minibus appropriations package to approve all but five of its versions of the twelve annual appropriations bills for FY 2022. The minibus will contain the Labor-Health and Human Services-Education (Labor-HHS) spending bill approved by the House Appropriations Committee last week. The House Labor-HHS bill recommends increased investments in key federal healthcare and biomedical research agencies, including the National Institutes of Health and Centers for Disease Control and Prevention. House Democratic leaders are hoping to pass as many of the appropriations bills as possible ahead of the upcoming August recess and before the current fiscal year expires September 30.

Further success of the FY 2022 appropriations cycle will depend on efforts in the Senate, and Senate Appropriations Chair Patrick Leahy (D-VT) has only recently announced a tentative schedule that would carry the Committee’s work into September. The delay increases the likelihood of at least a short-term continuing resolution to buy more time for House and Senate leaders to reach an agreement on FY 2022 spending and to avoid a government shutdown.

Sounds fairly standard, right? If only. One major complication hanging over all spending related debates in Congress is that the current suspension of the federal debt limit (yes, that thing) is set to expire at the end of next week. While the administration will be able to take some measures to stave off fiscal catastrophe for a short while, the Treasury has indicated that without congressional action it could run out of money as soon as October. Adding to this potential scenario is that Senate Minority Leader Mitch McConnell (R-KY) has said that if Democrats want to raise the debt limit, they’ll have to include a patch in their stand-alone infrastructure reconciliation package (more on that below), as no Senate Republican will vote to support an increase over disagreements on the scope of Democratic spending priorities.

Oh yeah, and that reconciliation work will likely take a few more weeks and may find itself intersecting with tough appropriations negotiations in the fall.

It’s a mess – and the clock is ticking.

Infrastructure talks going somewhere…again
Hold up… wasn’t this supposed to be done by now? In what continues to be a wild summer in Washington, the ongoing infrastructure negotiations are seemingly stuck on a roller coaster of ups-and-downs, twists-and-turns, and the train cars have overshot the platform. Keep your hands and feet inside the ride, because here we go again.

Negotiators did not meet Senate Majority Leader Chuck Schumer’s (D-NY) self-imposed mid-week deadline to produce details of a nearly $1.2 trillion bipartisan infrastructure package, leading to the failure of a key procedural test vote.

However, soon after the failed vote, a group of 22 senators from both parties, including Senators Richard Burr (R-NC) and Thom Tillis (R-NC), released a statement suggesting a final proposal will be available soon with debate potentially beginning as soon as early next week.

Democratic leaders are also continuing to press forward on a separate $3.5 trillion infrastructure package through the budget reconciliation process. Details are still coming together, but many congressional Democrats are insisting that proposals to expand Medicare coverage and to reform drug pricing be included in the final draft.

Work on the two-pronged infrastructure strategy is threatening to carry over into the August recess and perhaps even the early fall, where a number of other priorities (highlighted above) will also demand congressional attention.

We continue to monitor the release of proposals, legislation, and negotiations. We are also working with our partners, associations, other stakeholders, and Duke leadership to advocate for robust infrastructure investment in academic medical and research institutions, hospitals, clinical and research laboratories, and technological investments supporting the delivery of and greater access to healthcare.

Rep. Butterfield joins bipartisan group to launch congressional caucus on social determinants of health
This week, Rep. G.K. Butterfield (D-NC-01) joined Reps. Cheri Bustos (D-IL), Tom Cole (R-OK), and Markwayne Mullin (R-OK) to launch the bipartisan Congressional Social Determinants of Health Caucus, which will highlight opportunities to coordinate federal investments in health and social drivers of health such as food, housing, and transportation.

Specifically, the caucus will spotlight the disparate impact of the COVID-19 pandemic on certain populations and communities; convene thought leaders to educate members on the evidence around social determinants; collect stakeholder input on how best to facilitate effective social determinant interventions; discuss bipartisan legislative efforts to address social determinant challenges; and highlight priorities to external stakeholders and the Executive branch.

The caucus is soliciting feedback from stakeholders through September 21 on challenges and opportunities related to social determinants of health.

Our office will monitor activities of the new caucus and coordinate with Duke Health experts to inform its policy priorities and engage with its leadership.

From our desk(s): Duke Health GR this week
Duke Health Government Relations continues to urge support for the “Resident Physician Shortage Reduction Act of 2021.” Currently, there is a cap on the number of residency slots in the Medicare Graduate Medical Education (GME) program. This bill would help efforts to address the projected shortage of physicians by increasing the number of residency slots available through the Medicare GME program. To date, the following members of the NC Congressional Delegation have cosponsored the bill: Rep Deborah Ross (D-NC-02), David Price (D-NC-04), Kathy Manning (D-NC-06), and G.K. Butterfield (D-NC-01). Learn more on our website about this issue and specific legislation.

This week, Duke Health continued meetings in support of the 340B Health Hill Day to share updates and concerns with the office of Rep. Richard Hudson (R-NC-08) and Rep. Price about the 340B Drug Discount Program. As reported last week, several drug manufacturers have been taking actions that appear to fall outside the scope of the program, possibly jeopardizing patient access to drugs provided at a discount. Specifically, some manufacturers are refusing to offer drugs to safety-net providers at the discounted prices that federal law requires, while others are demanding claims data that go beyond the scope of the 340B statute. Duke Health Government Relations continues to urge our representatives to support giving HRSA, which oversees the program, more authority to enforce the law.

In continued advocacy and follow up on Duke Health’s concerns about an organ transplantation proposal in the FY 2022 Inpatient Prospective Payment System (IPPS) proposed rule, we connected our transplant experts with the office of Rep. Price. The conversation reflected Duke Health’s public comments submitted to CMS, noting that the proposed rule would have widespread and unintended consequences for patients, as “undermining the financial viability of organ procurement efforts is likely to reduce organ availability and lead to increased wait times for transplantation, resulting in greater acuity and possibly death.” 

Our office monitored the Health, Education, Labor, and Pensions (HELP) Committee hearing entitled “The Path Forward: A Federal Perspective on the COVID-19 Response.” During the hearing, members of the Committee heard testimony from leadership in the Biden Administration about the response to COVID-19, including vaccines and the need for a potential booster. In his remarks, Ranking Member Richard Burr (R-NC) stated that cases are significantly down from their peaks but the Delta variant is surging, and vaccines have slowed because of hesitancy or resistance. He stated that “COVID-19 won’t just go away. We need all Americans who can get the vaccine to get the vaccine. If you won’t do it for yourself, do it for your friends and family, for your neighbors and your local community.”

We connected with staff in the offices Senators Burr and Tillis in support of passage of the Equality Act (H.R.5/S.393), which would formally codify federal protections for members of the LGBTQ+ community, including in workplace and healthcare settings.

Our team also coordinated with Duke telehealth leadership to add Duke Health to a broad telehealth community stakeholder letter urging congressional action to continue current expanded telehealth services and reimbursement under Medicare beyond the COVID-19 public health emergency.

Want to Join Team Advocacy?
Thanks to the PDC and our partners in the Duke State Relations office, Duke Health physicians and providers can engage with policymakers through the PDC Provider Advocacy Network.

By enrolling in the Phone2Action advocacy tool, individuals can join a powerful, collective voice on priority healthcare issues debated in Raleigh and Washington, D.C., including telehealth, workforce, drug pricing, and many more.

Learn more here. (NOTE: You must register and use a non-Duke email address to receive action alerts.