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Federal Health Policy Updates for the Week of March 7, 2022

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A deal is a deal
Unless not. The difference?
Consideration

 

The Rundown

  • FY 2022 omnibus clears Congress
  • Medicare telehealth flexibilities get five month, post-PHE extension
  • OSHA announces new COVID-19 enforcement effort
  • The latest from our desks
     

Federal Updates

FY 2022 omnibus makes it to the finish line
There’s a lot happening in the world right now, and just this week the timeline added the possibility of hand-sized, parachuting spiders colonizing the East Coast and a FY 2022 omnibus bill that almost imploded before its official launch. If your “what in the world is happening today?” bingo card wasn’t already full from the past couple of years, we’re not sure how many open spaces could be left (and it’s probably better not to ask).

Congress has completed work on federal funding for FY 2022, as the House and Senate have passed a $1.5 trillion omnibus spending package to fund the government through the end of the fiscal year on September 30.  The massive legislation, which also includes relief for Ukraine and a package of healthcare policy provisions, was painstakingly crafted by bipartisan leadership. So, naturally, there was some last minute drama.

The omnibus also originally included nearly $15 billion in additional COVD-19 emergency response funding that had to be stripped at the last minute over objections to a provision that would have paid for the new measures with currently unspent COVID-relief funding. Democratic leaders will now try to move a standalone COVID bill next week.

Omnibus Highlights
Now, let’s talk about what’s in the bill.

The omnibus provides increased funding for several of Duke Health’s priorities, including:

  • $45 billion for the National Institutes of Health (an increase of $2.25 billion above the FY 2021 enacted level).
    • Includes support for the 12 Regional Biocontainment Laboratories (RBLs), including Duke’s RBL.
    • $6.9 billion for the National Cancer Institute – including $194 million for the Cancer Moonshot (an increase of $353 million above the FY 2021 enacted level).
  • $1 billion for the new Advanced Research Projects Agency for Health (ARPA-H). While congressional legislation establishing the new ARPA-H is pending, this bill would put funding into the HHS Office of the Secretary with mechanisms in place to allow the office to be transferred within 30 days of enactment.
  • $350.4 million for the Agency for Healthcare Research and Quality (AHRQ), a slight increase of $12.4 million above the FY 2021 enacted level.
  • $8.5 billion for the Centers for Disease Control and Prevention (CDC), an increase of $582 million above the FY 2021 enacted level.
  • $6.5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), an increase of $530 million above the FY 2021 enacted level.
  • $280.47 million for Nursing Workforce Development Programs at the Health Resources and Services Administration (HRSA), an increase of $16 million above the FY 2021 enacted level.
  • $2 million for the MISSION Zero Trauma Grant program, the first time the program has been funded since it was authorized.
  • $81.9 million for the National Child Traumatic Stress Network, an increase of nearly $10 million above the FY 2021 enacted level.
  • Robust funding for congressionally directed medical research program (CDMRP) initiatives at the Department of Defense, including $12 million for the DoD’s Reconstructive Transplant program.
  • $882 million for the Department of Veterans’ Affairs Medical and Prosthetic Research program.

The healthcare policy provisions in the omnibus include almost $1 billion to support maternal health initiatives focused on reducing maternal mortality, morbidity, and disparities. More details on these provisions can be viewed here.

The bill also extends all current public health emergency-related Medicare telehealth flexibilities for five months beyond the end of the public health emergency (More details in the next article below).

What now? You’re going to start hearing a lot more from us about FY 2023 relatively soon, and our team is already working across Duke Health to prepare funding requests for the next fiscal year.

Resources
If you’d like further details, here are a few helpful resources on the FY 2022 omnibus. If you have any questions about specific funding, please contact our office.

 
Medicare telehealth flexibilities get brief reprieve – for now
As referenced above, the FY 2022 omnibus brings a little more certainty for the future of telehealth under Medicare – but there is still work to do.

A provision in the legislation extends all current Medicare telehealth flexibilities for 151 days (roughly five months) beyond the end of the COVID-19 public health emergency (PHE). The extension includes no additional guardrails or restrictions and directs HHS to issue a report on data collected about telehealth utilization and outcomes during the PHE.

With the PHE expected to be extended at least once more through mid-July, this provision would likely mean an extension through at least December of this year.

For stakeholders and advocates, including Duke Health, seeking a longer-term extension and permanence for many of the PHE-related telehealth flexibilities, the five month extension can feel a little disappointing. But, there is still bipartisan enthusiasm and desire among congressional leaders to find a longer-term solution. They just simply ran out of time to negotiate within the context of the omnibus.

Our team will continue our advocacy work to promote and protect expanded telehealth policies under Medicare and engage Duke Health experts and leadership as opportunities to share our experiences with policymakers arise in the coming months.
 
OSHA steps up targeted COVID-19 safety enforcement with final rule in development
This week, the Department of Labor’s Occupational Safety and Health Administration (OSHA) announced the start of a short-term increase in focused inspections directed at hospitals and skilled nursing care facilities that treat or handle COVID-19 patients.

Under the new initiative, OSHA will expand its presence in targeted “high-hazard” healthcare facilities during a three-month period from March 9 to June 9, 2022. These facilities include general medical and surgical hospitals, psychiatric and substance abuse hospitals, skilled nursing facilities, and assisted living facilities for the elderly.

OSHA will conduct focused follow-up and monitoring inspections of previously inspected or investigated healthcare facilities and assess employers’ compliance actions. Among the criteria that may lead to an inspection include: facilities that have received a COVID-19-related citation or hazard alert letter as a result of a prior inspection; facilities that were the subject of a now-closed COVID-19 case involving unannounced surveys or investigations, such as complaint surveys or rapid response investigations conducted in response to an employer’s report of a severe injury; or facilities that  previously received a COVID-19-related citation as a result of a remote-only COVID-19 inspection.
 
The new focused initiative comes as OSHA is reportedly working to finalize a permanent COVID-19 healthcare worker safety standard over the next few months. OSHA withdrew its previous time-limited Emergency Temporary Standard (ETS) for COVID-19 healthcare workplace safety on December 27, 2021, but pledged to supplement its safety enforcement efforts while a final rule is being developed.
 
From our desk(s): Duke Health GR this week
This week our office participated in the American Hospital Association’s Government Relations Officers Network (GRON) meeting. During the meeting, we heard from AHA leadership, key Hill staff, and others on policy issues impacting hospitals.

We coordinated meetings for Duke Health leadership with the offices of Senator Richard Burr (R-NC), Senator Thom Tillis (R-NC), who is a member of the Senate Veterans’ Affairs Committee, and Rep. Greg Murphy, MD (R-NC-03), who is a member of the House Veterans’ Affairs Committee, to discuss Duke’s relationship with the Durham VA Medical Center ahead of next week’s scheduled release of a Department of Veterans’ Affairs asset and infrastructure report on VA medical facilities.

We continued our advocacy in support of the recently introduced Hospital Inpatient Services Modernization Act (H.R. 7053/S.3792), which would extend the Centers for Medicare and Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) waiver through the end of 2024. As a result of initial outreach, we have learned that Senator Tillis plans to join the legislation as a cosponsor.

We joined our colleagues in Duke State Relations and Duke University Office of Government Relations to present an overview of our work and policy outlook to the Duke Office of Counsel. Our office also met with Dr. Moira Rynn, Chair of the Department of Psychiatry and Behavioral Sciences, to discuss mental and behavioral health and the latest federal policy developments.

Finally, members of our team participated in the Government Relations Representatives Preparedness Working Group for the AAMC and joined meetings of other stakeholders in support of trauma centers, telehealth, and academic medicine. We continue to engage experts and allies on a range of pending regulatory and legislative issues.