Skip to main content

Federal Health Policy Updates for the Week of March 8, 2021

Duke Government Relations Logo

When clouds blow away
What else to do with the light
Except let it shine


Federal Updates
 
Can I get a witness? Duke Health leaders featured (virtually) on Capitol Hill
The winter thaw is upon us, and the bright light shining on Durham, NC this week wasn’t just because of the return of that elusive warm, yellow orb in the sky. Not one but two Duke Health leaders played prominent roles in congressional hearings examining the nation’s COVID-19 response and ongoing mental health and substance abuse crises, respectively. We have more details below, and to say that this team has immense pride in the efforts of these two standouts, not to mention all of our colleagues across the health system, is an understatement.

Oh, Congress also got around to passing the COVID-19 relief package.

What a week. Testify.

Duke Health’s Chief Nurse testifies before Senate HELP
Mary Ann Fuchs, DNP, RN, NEA-BC, FAAN, Vice President of Patient Care, System Chief Nurse Executive for the Duke University Health System, and Associate Dean of Clinical Affairs for the Duke University School of Nursing, testified before the Senate Health, Education, Labor and Pensions (HELP) Committee on Tuesday for a hearing entitled, “Examining Our COVID-19 Response: An Update from the Frontlines.”

In her testimony, Dr. Fuchs, who is also the current president of the American Organization of Nursing Leadership (AONL), discussed Duke Health’s COVID-19 response and her point of view from the frontlines, including how teams at Duke Health quickly pivoted during changing circumstances to meet new public health challenges and noting that Duke became the “hub of the COVID-19 response in our community.” She highlighted the dedication and commitment of her Duke Health colleagues while sharing a perspective of lessons learned over the last year and highlighting the need to recognize and respond to the mental health needs of the frontline workforce. Dr. Fuchs offered support for legislative efforts to strengthen the nursing workforce though increased funding for Title VIII Nursing Workforce Development Programs.

Dr. Fuchs has been a trusted resource to congressional staff and members throughout the current public health emergency, especially to our broader North Carolina congressional delegation and Senator Richard Burr (R-NC), who serves as ranking member of the HELP Committee.

We will continue to engage on the issues highlighted above, as well as all of those prioritized in Dr. Fuch’s full testimony, both inside and beyond the public health emergency (PHE).

Duke Health leader speaks on child mental health issues at House Appropriations Subcommittee hearing
Dr. Lisa Amaya-Jackson, Co-Director of the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS), Professor in Psychiatry and Behavioral Sciences in the Duke University School of Medicine, and a child and adolescent psychiatrist, testified on Thursday before a House appropriations subcommittee about COVID-19 and the mental health and substance abuse crises. NCCTS provides leadership, organizational structure, and coordination to the current grantees, affiliates, and partners of the National Child Traumatic Stress Network (NCTSN). Working closely with the Substance Abuse and Mental Health Services Administration (SAMHSA), NCCTS leads NCTSN in its efforts to increase access to services and raise the standard of care for children and their families who have experienced trauma.

In her testimony for the hearing, Dr. Amaya-Jackson noted several pandemic-related stressors being observing around the country, highlighted some of NCTSN’s efforts to mitigate these issues, and suggested increasing access to evidence-based, trauma-informed services for children and families experiencing mental health and substance use challenges. She also recommended prioritizing the needs of at-risk and vulnerable communities of children and families, including racial and ethnic minorities; individuals with disabilities; immigrants, refugees, and English Learners; LGBTQ persons; and those living in poverty.

House Appropriations Committee and Labor-HHS-Education Appropriations Subcommittee Chair Rosa DeLauro (D-CT-03) noted with pride that the Subcommittee has increased funding for NCTSN by $25 million over the last five years, and that additional investment by Congress in childhood trauma has been directed to provide counseling and trauma services to unaccompanied immigrant children.

Reconciled: Congress clears next round of COVID-19 relief
Congress has now passed through budget reconciliation the $1.9 trillion American Rescue Plan, directing additional resources for COVID-19 relief and economic stimulus. The reconciliation process allowed Democratic leaders to pass the legislation to get around procedural obstacles in the Senate and without Republican support, if necessary – which turned out to be the case. While congressional Republicans were not opposed to another round of COVID-19 relief, there were concerns that the package was too large and not targeted enough. The Democratic caucus ultimately held together to pass the measure despite some late changes during the Senate debate.

In addition to more stimulus payments for individuals and support for businesses, highlights of the American Rescue Plan include:

  • Increasing a state’s base Federal Medical Assistance Percentage (FMAP) by 5% for states that newly expand Medicaid services.
  • Expanding Affordable Care Act subsidies for insurance purchased through federal and state exchanges by fully removing the current income cap for eligibility for two years.
    • Capping the amount paid in premiums by any exchange purchaser to 8.5% of income.
  • Providing a 100% COBRA subsidy through September 30, 2021, for those who have lost their jobs to remain on their employer-sponsored healthcare plan.
  • Eliminating cost sharing for individuals utilizing Medicaid and the Children’s Health Insurance Program (CHIP) to receive the vaccine for up to one year of the end of the PHE.
  • Allowing states for 5 years to extend Medicaid eligibility to postpartum women (up to 12 months after birth) and incarcerated individuals.
  • Providing a temporary, one year 7.35% Medicaid FMAP increase for states to make improvements to Medicaid supported home and community based services.
  • Providing an enhanced FMAP to incentivize state Medicaid programs to cover mobile crisis intervention services for people in mental health or substance abuse crises.
  • Eliminating the cap on Medicaid drug rebates beginning in 2023.
  • (Selected) funding:
    • $7.5 billion to the CDC for vaccine distribution.
    • $5.2 billion to HHS for research and development, manufacturing, production, and purchase of vaccines, treatments, and supplies.
    • $46 billion for national testing and contact tracing strategies.
    • $7.5 billion for HHS to provide public health workforce grants to the states to aid in the hiring and training of healthcare staff.
    • $7.6 billion for community health centers.
    • $40 million in grants for health care providers to promote mental health among their health professional workforce.
    • $80 million for mental health and substance use disorder training for health care professionals, paraprofessionals, and public safety officers. Eligible grantees include health professions schools and academic health centers.

Despite a strong advocacy push by the provider community to attach a provision to the final bill to boost the Provider Relief Fund (PRF) by $35 billion, only $8.5 billion was included for the PRF to be dedicated exclusively for rural hospitals. The Government Accountability Office estimates $40 billion of the current PRF remains unallocated by HHS. The legislation also does not address the Medicare sequester cut moratorium that is set to expire on March 31 or proposals to convert Medicare Accelerated Payments from loans to grants. Efforts will continue to address these issues, including a bill that will reportedly be introduced in the House on the Medicare sequester, over the next few weeks.

President Biden signed the legislation on Thursday afternoon.

Although the push for the latest round of relief is over, there is still much work ahead. Duke Health Government Relations will continue to advocate for support for the research enterprise, provider relief, telehealth expansion, and other key Duke Health priorities as part of broad public health and infrastructure measures expected to be debated in Congress throughout 2021.
 
It’s Senate floor official: Becerra confirmed as next HHS Secretary
California Attorney General Xavier Becerra was confirmed by the Senate 51-48 this afternoon to be the next Secretary of the Department of Health and Human Services. Throughout his confirmation process, Becerra pledged support for the public health infrastructure, telehealth expansion in Medicare, and for the 340B Program. He will take over leadership at HHS during a critical point in the nation’s fight against COVID-19, as increased vaccinations combined with public health measures have led to declines in cases and deaths from earlier in the winter.

With hearings expected to be scheduled soon for Centers for Medicare and Medicaid Services (CMS) Administrator nominee Chiquita Brooks-LaSure, attention is now turned to who President Biden will nominate as Commissioner of the Food and Drug Administration (FDA). Janet Woodcock, MD, current acting Commissioner and longtime director of the FDA’s Center for Drug Evaluation and Research, is reportedly among the candidates under consideration.

Public charge rule changes appear to be on the way out
The Supreme Court has dismissed cases challenging the Trump administration’s changes to the public charge rule – and the decision is a welcome one for child health and immigration advocates. In 2019, the Trump administration adjusted the public charge rule to make it easier for the government to deny green cards based on an immigrant’s likely use of public benefits including Medicaid. How could the dismissal of these cases be good news? The Court dropped the cases at the request of advocates and the Biden administration, which has indicated that it will not defend current public charge rule policy.

While the Biden administration will not enforce the current rule, it is unclear when it will pursue a formal revocation of the Trump-era changes, which will require a formal notice and comment rulemaking process.

From our desk(s): Duke Health GR this week
The Duke Health Government Relations team worked closely with Duke University Health System Vice President of Patient Care & System Chief Nurse Executive Mary Ann Fuchs, as well as health system leaders and partners, in preparation for her testimony and appearance at the Senate HELP Committee’s March 9 hearing.

We also met in follow up with key HELP Committee staff to reinforce Dr. Fuch’s testimony, discuss Duke Health health policy and research priorities, and to learn more about the Committee’s plans over the next few months.

In addition, our team is making connections in support of permanent telehealth expansion for Medicare beneficiaries beyond the current PHE and are scheduling meetings with congressional staff to include Duke Health experts to discuss the impact of federal funding on their clinical work and fields of research.

Finally, we continue to connect our leadership, clinicians, and researchers with policymakers engaged in COVID-19 response efforts, protecting the research enterprise, and health equity.