Hurry up and wait.
Negotiations drag on.
Chance of a budget?
(Katie Stanley Lipe, Communications and Outreach Coordinator, Duke State Relations)
We want to feature you - 3 opportunities left!
Our thanks to Katie for her excellent haiku! As first announced in our May 21 newsletter, we want your poetry to replace our haikus for the month of June. Get creative and tell us a little more about your work.
Entering your submission is easy – just email it to dukegovrelations@dm.duke.edu – and we look forward to hearing from you!
Federal Updates
Keep it above 50 to avoid the darkest timeline
Let’s talk about the summer session. We’ve referenced, alluded to, and highlighted a number of priorities that Congress either must or hope to address before the August recess (listed below). We’ve also discussed how the realities of narrow congressional majorities and procedural tools may either open the window or shut the door on any one of them. To borrow (rip off) from the folks at Marvel, there is an entire multiverse of possibilities that lie ahead, and we’re just about to reach that fork in the journey where the next step may very well determine the endgame.
- Infrastructure
- Immigration system reform
- Health care access
- Debt ceiling
- Tax reform
- Voting rights and social engagement
- FY 2022 appropriations
The last one on the list is undoubtedly important to any number of Duke Health priorities as the appropriations process directly determines support for federal agencies, federal medical research opportunities, and federal support for the health care and research enterprise. It may also be the most sensitive to choices made with respect to others on the list. All will take a considerable amount of time, energy, and the right procedural pathway – and despite indications that the House may fast track its appropriations process, the Senate is far less bullish on its process.
The current fiscal year ends on September 30 and without House and Senate agreement on individual appropriations bills, we are likely to enter another cycle of continuing resolutions (CRs). The good news is that prior budget caps limiting discretionary spending are no longer in place; there is room for appropriate and robust levels of investment. But, CRs are notoriously sticky, require a lot of compromise, and the cycle would be hard to break heading into an election year.
To invoke a separate cinematic classic: pop quiz, what do you do? These are the considerations of the White House and Democratic majority. Focusing too much on any single priority and the others may suffer.
There may be nearly infinite possibilities but not infinite time.
Becerra offers assurances on telehealth, provider relief at budget hearings
Testifying this week at a hearing before the House Ways and Means Committee on President Biden’s FY 2022 budget proposal, Health and Human Services Secretary Xavier Becerra sought to quell concerns that the president’s budget did not adequately address telehealth expansion under Medicare beyond the current public health emergency (PHE). Becerra acknowledged that the administration had no intention of reverting back fully to more limited telehealth access before COVID-19 but also conceded that the agency may need some help from Congress to make some statutory changes to ensure certain Medicare flexibilities remain in place once the PHE ends. Becerra further spoke to the need of investments in expanded broadband services and technologies so that underserved and rural communities are not left behind.
Becerra was also asked to comment on the status of the COVID-19 provider relief fund (PRF) given the current June 30 spend down deadline for those who have previously received funding. While he would not commit to a deadline extension, Becerra suggested that there will be some flexibility and additional guidance coming soon on how hospitals can expend any remaining funds. In a separate hearing with the Senate Labor-Health and Human Services-Education Appropriations Subcommittee the following day, Becerra also clarified that there is around $24 billion remaining in the PRF and that those currently undistributed funds would not be subject to the June 30 deadline.
Don’t hate the game; change the players - infrastructure talks continue
The Biden administration broke off on-again, off-again infrastructure negotiations this week with a group of Senate Republicans led by Senator Shelley Moore Capito (R-WV) after the two sides were unable to overcome an impasse on new spending and offsets.
While some Democratic leaders are viewing the recent breakdown as a signal to begin exploring options on how to move an infrastructure package through another round of reconciliation, the White House is not quite ready to abandon hope for a bipartisan agreement. President Biden has now turned his attention to an evenly spilt group of 20 bipartisan Senators to develop an infrastructure package framework. Can we get there? Despite some reports that a deal may be close, it remains to be seen just how far this new round of talks may go and whether enough rank and file members will support a final compromise product.
In the meantime, other proposals are beginning to surface. The House Transportation and Infrastructure Committee began a markup of its $547 billion, five-year, surface transportation reauthorization bill this week, and the measure is expected to be modified to feature a number of the administration’s infrastructure priorities. The House Problem Solver’s Caucus, whose bipartisan efforts helped bridge the divide during last year’s budget negotiations, is also readying a reported $1.2 trillion infrastructure framework to share with the White House. And of course, there are increased calls from stakeholders and lawmakers for a final infrastructure package to include investments in hospital and clinical laboratory infrastructure and drug pricing reform.
Whatever happens next, expect a few more twists and some new faces before the path forward becomes clear.
We continue to monitor the release of proposals, legislation, and negotiations. We are 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 health care.
Now? OHSA sets COVID-19 standards for healthcare settings
On Thursday, the Occupational Health and Safety Administration (OSHA) within the Department of Labor (DOL) issued a long-awaited COVID-19 Emergency Temporary Standard (ETS) to put in place mandatory safety standards in workplaces. While the ETS fulfills an early objective of the Biden administration, its timing at this point in the pandemic in the United States and its limited application to only health care settings has been met with some bewilderment.
Among other provisions, the ETS includes requirements for protective equipment and barriers, social distancing, employee screening, and providing resources and opportunities for employees to become vaccinated. In many cases, the new rules may not require much adjustment from health care providers, who have imposed strict safety protocols throughout the PHE to protect patients and practitioners – and the rationale from the administration to limit the safety requirements to health care settings is to apparently ensure such vigilance remains in place.
The ETS is effective as of today with implementation of some provisions required within the next 14 days while others must be in place in the next 30 days. OSHA also issued updated voluntary safety guidance for other industries as the country continues to reopen amid increased vaccinations in what is becoming a more controlled phase of the pandemic.
OSHA resources and the full text of the COVID-19 ETS may be found here.
Our office will continue to monitor this issue and share any updated guidance from OSHA and DOL.
Surprise! With pun intended, the first new surprise billing rules expected soon
Despite some indications that the Biden administration may miss an early July 1 statutory deadline to issue new federal surprise medical billing rules, the first of a set of regulations may be public within the next couple of weeks. The new rules are the product of legislative language included in the December 2020 Consolidated Appropriations and Omnibus Act that, among other provisions, establishes a baseball-like arbitration process to settle billing disputes between providers and payers. Providers will no longer be allowed to charge patients more than the in-network rates for services done in an out-of-network setting, or for treatment done by an out-of-network doctor in an in-network setting. Disagreements between providers and payers that cannot be settled after 30 days will be subject to the arbitration process.
The initial interim final rule (IFR) released by the Centers for Medicare and Medicaid Services (CMS) is expected to be related to the structure and application of the qualifying payment amount, which will be used to help determine patient cost-sharing responsibility.
There will be a notice and comment period once the IFR is issued, and there are early indications that CMS will heavily consider stakeholder and industry feedback before finalizing a formal rule.
Our office will continue to monitor the development of surprise medical billing regulations and work with Duke Health leadership to provide response and comment when appropriate.
From our desk(s): Duke Health GR this week
This week, our office coordinated a meeting for Jacquelyn McMillian-Bohler, PhD, CNM, CNE, Assistant Professor in the Division of Health for Women, Children and Families in the School of Nursing, and her colleagues from UNC-Chapel Hill and Vanderbilt University with the office of Rep. Lauren Underwood (D-IL) to discuss Black maternal health issues. They described their work in increasing birthing persons’ access to social, emotional, and educational support from trained Black doulas and certified nurse midwives. Rep. Underwood co-chairs the Black Maternal Health Caucus with Rep. Alma Adams (D-NC-12), and they recently reintroduced the Black Maternal Health Momnibus Act that aims to address every dimension of the maternal mortality crisis in our country.
We connected with Duke Health experts on critical federal funding priorities to inform our appropriations advocacy efforts. Members of our team also discussed advocacy and policy influence with a group of medical students and joined the Trauma Center Association of America policy advisory council meeting to chart strategies in support of the development of legislation to address gun violence and to modernize federal trauma and emergency services grants.
Our team also monitored this month’s meetings for the National Institutes of Health Advisory Committee to the Director and the National Center for Advancing Translational Sciences (NCATS) Advisory Council. Additionally, our office met with the office of Senator Richard Burr (R-NC) about the infectious disease workforce and about vaccine hesitancy.
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.)