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Federal Health Policy Updates for the Week of June 5, 2023

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The Rundown

  • With the debt ceiling done, Congress turns to FY 2024 and other annual priorities
  • Congressional hearings focus on children’s mental health, CDC oversight, consolidation and corporate control of healthcare 
  • Legislation introduced to permanently expand Medicare coverage for telehealth therapy services 
  • The latest from our desks 
  • Save the Date! June virtual office hours
  • Join the Duke Health Advocacy Network! 


Federal Updates

What do we talk about now? 
We probably won’t have to talk about the debt ceiling again until late next year, just after a hotly contested presidential and congressional election cycle (GREAT) - but at least not this week, right? Given all of the hand wringing and tension in D.C. over the past couple of months around the possibility of default, it would be tempting to think we’ve just worked through the toughest policy item of the year. Not likely. 

So, what does that leave us with? Everything else. 

What the debt limit deal passed by Congress last week did provide was a little more guidance around certain priorities, including the process for moving forward on the federal appropriations process for FY 2024.  

FY 2024 
And…end scene. Now that the debt ceiling drama has come to its conclusion (for now), Congress can turn its attention to the appropriations process. Remember, there is a new incentive for Congress to complete its work on FY 2024 appropriations. The debt ceiling agreement included a one percent cut to all spending if all twelve appropriations bills are not enacted by January 1 of the following year. 

So what's the deal? In exchange for the debt limit suspension, the Fiscal Responsibility Act effectively capped non-defense spending at current levels for FY 2024, with modest increases allowed for Veterans and defense spending. These levels will increase by 1% in FY 2025. With the overall discretionary funding capped, House and Senate appropriators have some idea of what they are working with, but now comes the harder part of figuring out how much each subcommittee will be given to fund programs and agencies within their jurisdiction. Once this framework is figured out, House and Senate appropriations committees will work to get their bills through the process. 

House Appropriations Committee Chair Kay Granger (R-TX) has indicated that her committee will resume markups of its remaining versions of the twelve annual appropriations bills as soon as next week. 

Our team continues to work with Duke Health leadership and the NC congressional delegation to emphasize the critical importance of federal support for health systems, the healthcare workforce, research, and other Duke Health federal funding priorities as part of the FY 2024 appropriations process. 

NDAA 
It’s time again to talk about the National Defense Authorization Act (NDAA). Why does it matter to Duke Health? 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, as well as the Defense-supported medical workforce. Over the next few months, the NDAA will also occupy a fair amount of press, committee, and floor time in each chamber. Congress has managed to pass a version of the NDAA on time (before January 1) every year for the past sixty-plus years. The 118th Congress is not aiming to be the one to break that streak. This year will not be without complications outside of the norm, in part because the debt limit deal places some caps on defense spending, which impacts the authorization top line.  

The NDAA has also become a vehicle, although more limited, to address policy changes addressing Veterans’ health and healthcare access. 

What else? 
Where do we start? We anticipate that congressional committees will continue examining healthcare reimbursement policies, prescription drugs, access, transparency, hospital and health system operations in a post-public health emergency environment, and potentially greater scrutiny of tax-exempt healthcare providers and the community benefit standard. 

There’s also ongoing efforts to reauthorize the Pandemic All-Hazards and Preparedness Act, the National Child Traumatic Stress Network, which is coordinated by the Duke-UCLA-led National Center for Child Traumatic Stress, the MISSION Zero Military-Civilian Trauma grant program that supports embedding and cross-training military trauma providers in civilian trauma center settings, as well as other programs supporting opioid treatment and addiction. 

We also can’t forget permanent telehealth expansion, data privacy, healthcare cybersecurity, the role of artificial intelligence in healthcare, maternal health, mental and behavioral healthcare access, strengthening the healthcare workforce, and protecting resources supporting research. 

And the above isn’t even all-inclusive. It’s a snapshot of just this week in time. We have a lot to do together, and we’re looking forward to the work ahead. 
 

Heard on the Hill: committee activity turns focus back to healthcare and public health 
Federal and public healthcare systems, institutions, and issues were once again squarely in the sights of congressional committees this week, and it’s likely going to be an active summer session. Here’s a quick rundown of a few that we were following this week. 

(And no, there’s nothing we can do about the length of the hearing titles)  

House Energy and Commerce Subcommittee on Oversight and Investigations  
On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing entitled, “Looking Back Before Moving Forward: Assessing CDC's Failures in Fulfilling its Mission.” 

In his opening remarks, Subcommittee Chairman Morgan Griffith (R-VA) was critical of the Centers for Disease Control and Prevention (CDC), as well as its response during the pandemic, expressing his frustration that “when you look at all of the talent, all of the scientific knowledge, technical resources, and immense funding we have put into the agency, the end product is somehow less than the sum of its parts.”  

Ranking Member Kathy Castor (D-FL) cautioned that the committee must be constructive in its oversight of the CDC and not undermine our public health. She stressed the need to take an honest and holistic look at the responses to public health challenges from agencies. Both leaders acknowledged the CDC’s internal review and reorganization plans, but Republican members of the Committee stressed that further evaluation of the reorganization plan is needed before they will consider the request from the CDC for new and extensive legal authorities.

Witnesses for the hearing included representatives of the public health industry, the Government Accountability Office, healthcare association leadership, and an epidemiologist. 

There was some contention among committee members that CDC leadership was not invited to testify at the hearing. Chair Griffith signaled his intent to hold a separate hearing with CDC but that the agency must first comply with written requests for documents and background information ahead of that discussion. 

Senate Health, Education, Labor and Pensions (HELP) Committee 
On Thursday, the Senate Health, Education, Labor and Pensions Committee held a hearing entitled, “Why Are So Many American Youth in a Mental Health Crisis? Exploring Causes and Solutions.” 

Two panels of witnesses provided insights at the hearing, the first featuring federal government officials and the second consisting of state and local government officials and mental healthcare practitioners. 

The conversation covered a variety of issues contributing to the more broadly identified youth mental health crisis, including social media and the resulting isolation from the COVID-19 public health emergency. The discussion focused on the importance of education and resources for children, as well as parents, local leaders, and institutions, to be better informed and prepared for challenges. 

Ahead of the hearing, our team reached out to the office of Senator Ted Budd (R-NC), who serves on the Committee, to offer Duke Health experts and leaders as resources in preparation. 

Senate Finance Committee 
On Thursday, the Senate Finance Committee held a hearing on “Consolidation and Corporate Ownership in Healthcare: Trends and Impacts on Access, Quality, and Costs.” Witnesses included healthcare professionals, a healthcare economist, physician association representation, and the leader of a community hospital. 

While hospital consolidation and mergers were themes discussed during the hearing, particularly the potential impacts for rural patients already struggling with access issues, a variety of perspectives and issues were raised as part of the broader conversation on quality and cost.  

Finance Committee Chair Ron Wyden (D-OR) noted that there is no singular solution to addressing rising costs and he raised concerns about the use of artificial intelligence to aid insurance claim denials, including those for Medicare Advantage. Ranking member Mike Crapo (R-ID) remarked that better alignment of payment policies may serve to preserve competition and stabilize the healthcare marketplace, particularly for rural communities, but cautioned against “heavy-handed” solutions that might otherwise unintentionally hurt hospitals and further limit access. 

The hearing discussion also included efforts to strengthen hospital price transparency enforcement, Pharmacy Benefit Manager (PBM) practices, hospital facility fees, the implementation of the federal ban on surprise billing, and prescription drug access, among other issues. 

Our team has been closely engaged on many of the topics highlighted by the Finance Committee and continues to share Duke Health priorities and positions with committee staff and the office of our own committee representative, Senator Thom Tillis (R-NC). 
 

Legislation introduced to permanently expand access to PT, OT, and other services via telehealth under Medicare 
This week, Reps. Diana Harshbarger (R-TN) and Mikie Sherrill (D-NJ) introduced legislation, the Expanded Telehealth Access Act (H.R. 3875), to allow physical therapists (PT), occupational therapists (OT), speech language pathologists, audiologists, PT- and OT-assistant therapy providers in private practice, and facility-based outpatient therapy providers who bill under Medicare Part B to offer telehealth services permanently.  

The introduction of the legislation follows some controversy near the end of the public health emergency in May as the Centers for Medicare and Medicaid Services (CMS) was unclear whether certain therapy services would be covered as intended through the end of calendar year 2024. CMS later confirmed that therapy services would benefit from the same two-year extension as other PHE-tied telehealth flexibilities. 

The Expanded Telehealth Access Act was also introduced in the 117th Congress, receiving bipartisan support but not a separate vote. Our team is connected with the bill sponsors and members of the NC congressional delegation to increase support for this legislation for committee and floor consideration. 
 

From our desk(s): Duke Health GR this week  
This week our team helped coordinate a visit with leadership from the School of Medicine, the Duke Human Vaccine Institute, and the Duke Global Health Institute with officials from the African Union. The visit was part of the U.S. Department of State’s International Visitor Leadership Program, and the discussion was focused on best practices in coordinating medical regulatory bodies. 

Our team also coordinated a meeting for Duke Health leaders with the office of Rep. Deborah Ross (D-NC-02), who serves on both the House Judiciary and House Space, Science, and Technology Committees, to discuss Duke’s leadership of the Health A.I. Partnership (HAIP) and ongoing work to successfully integrate and model healthcare A.I. solutions. 

We advocated to the NC congressional delegation in support of a bipartisan letter to CMS urging the agency to reevaluate its FY 2024 inpatient prospective payment system (IPPS) proposed rule and consider using its special exceptions and adjustments authority to revise the IPPS final rule and increase the payment update, ensuring that hospitals have the resources they need to deliver high quality care. To date, Reps. Deborah Ross (D-NC-02), Don Davis (D-NC-01), and Kathy Manning (D-NC-06) have signed the letter.  

We organized and participated in a meeting with Duke leadership in the Regional Biocontainment Laboratory to meet with staff for Rep. Richard Hudson (R-NC-09) to discuss the Pandemic All-Hazards and Preparedness Act. 

We participated in an American Hospital Association briefing with government and public policy leaders on the current congressional landscape and to hear key messages that hospital and health system leaders can develop to support advocacy efforts. 

We joined colleagues from the business and life sciences communities for a virtual meeting with Rep. Valerie Foushee (D-NC-04). Hosted by the Healthcare Leadership Council, participants shared updates on legislation related to telehealth, behavioral health, workforce, and Black maternal health. 

Members of our team also joined advocacy committee and coalition meetings to discuss strategy in support of expanded telehealth, trauma care and coordination, cancer centers, and 340B. 
 

Save the Date – Virtual “Office Hours” on June 26th 
Duke Health (federal) Government Relations is once again partnering with our Duke State Relations colleagues to hold our second open, virtual "office hours" in May. 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, June 26, 2023   

Time: 12:00pm   

A link to access the event will be published in the Duke Health Advocacy Network Teams Channel   

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!
Looking for more opportunities to connect with fellow advocates and professionals interested in public policy across the health system? Join the Duke Health Advocacy Teams Channel!

Managed and moderated by Duke Health Government Relations and Duke State Relations, the purpose of the platform is for you to connect with your colleagues throughout the health system who are engaged and/or interested in public policy advocacy. We hope the channel will be used as a space for sharing ideas, collaboration, and engaging with the government relations teams on the issues most important to your work.

We encourage you to explore the channel, as we will post relevant news items, policy updates, questions, advocacy resources, and opportunities for engagement. As importantly, this is your space to do the same and to help grow the community.

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(Note: This is only open to Duke Health employees. By joining this teams channel, you acknowledge that the platform and your participation are intended for information sharing and connections/relationship building and is not an inducement by Duke Health Government Relations and Duke State Relations, or the channel’s participants, to act as an unauthorized advocacy and/or lobbying representative of Duke Health or Duke University).