It’s incremental
Progress is frustratingly slow
But the lights stay on
Publication Note: Congress has departed for the Thanksgiving recess, and so will our newsletter! We will return to our regular publication schedule the week of November 27th.
For breaking news in the meantime, please follow us on Twitter @DukeGovRel or join the Duke Health Advocacy Teams channel (more information below).
The Rundown
- Shutdown averted – Congress passes two-step continuing resolution
- House puts pause on HHS spending bill until after Thanksgiving
- Senate Finance Committee examines permanent telehealth expansion
- E&C Health Subcommittee advances health legislation
- The latest from our desks
- Virtual office hours – come see us on November 28!
- Join the Duke Health Advocacy Network!
Federal Updates
They did it – and will have to do it again twice more
Well, color us surprised. Congress actually passed another continuing resolution (CR) before today’s deadline. Technically they kicked the can down the road and now have two cans to deal with early next year, but hey, a shutdown was still averted.
On Tuesday, most Democrats joined some House Republicans to pass Speaker Mike Johnson’s (R-LA) two-step CR. We say “some” because 93 Republicans voted against the CR. This CR is considered “clean,” in that it continues government funding at current levels and does not include any additional controversial policies. Without any spending cuts or contentious amendments, the White House and Senate Majority Leader Chuck Schumer (D-NY) threw their support behind the CR, all but guaranteeing its final passage.
The CR funds the government on an interim basis with two separate deadlines: one on January 19 and another on February 2, the latter of which includes the Labor and Health and Human Services (HHS) funding bill. Speaker Johnson has publicly stated that he does not plan to pass another short-term CR, setting up a difficult next few months as House Republicans seek to pass their remaining fiscal year (FY) 2024 appropriations bills.
As a reminder, included in May’s debt ceiling deal was a provision that automatically imposes an across-the-board 1 percent spending cut if FY 2024 appropriation bills haven’t been passed by January 1. The cuts, however, don’t go into effect right away, so the real deadline to avert these cuts is April 1, 2024.
House hits pause until after Thanksgiving on its bill that includes funding for HHS
This week the House began consideration of its FY 2024 spending bill for the Departments of Health and Human Services (HHS), Education, and Labor. Drafted by the Republican majority in the House, and previously reported on by our office, this bill would impose significant cuts to several programs important to Duke Health, including a $2.8 billion cut to the base of funding for the National Institutes of Health (NIH). Over 300 amendments, several of concern, were filed as the bill went through the Rules Committee process, with several making it to the House floor for consideration, including an amendment to limit NIH facilities and administrative costs to 30% of the total grant. Our office worked to oppose this amendment, outlining the significant impact it would have on research. Ultimately, the amendment was withdrawn. However, other concerning amendments were agreed to, including amendments that would limit funding for certain Institutes at NIH and specific research.
In response to the bill, the Ad Hoc Group for Medical Research, which represents over 400 patient and voluntary health groups, medical and scientific societies, academic and research organizations, and industry dedicated to enhancing the federal investment in biomedical, behavioral, social, and population-based research supported by the NIH, expressed extreme concern about the impact this bill would have on patients, families, and communities that rely on medical research supported by the NIH. The community urged lawmakers to reverse these damaging cuts and reject any amendments that would impose further harm and arbitrary restrictions on the nation’s medical research enterprise.
The House left without voting on the bill, leaving action until after Thanksgiving. The Senate has introduced a more favorable and bipartisan bill to support NIH. Our office will continue to urge support for Duke Health’s federal priorities, including more favorable funding for NIH.
The future is now: Senate Finance looks at telehealth expansion
This week, the Senate Finance Subcommittee on Primary Health and Retirement Security held a hearing entitled, “Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency”. Witnesses included representatives from academic medicine, telehealth researchers, and a leader of a telehealth resource center serving rural populations. There was broad bipartisan agreement among subcommittee members that expanded telehealth under Medicare has increased access and that data suggests efficacy and the potential for long-term savings. While there were some concerns about the presence of bad actors and waste, fraud, and abuse, the invited panel countered with evidence demonstrating that utilization has remained steady in a post-public health emergency environment. They also noted the benefits of provider discretion for determining the clinical appropriateness of a telehealth service.
Congress has extended CMS’s authority to keep pandemic-era telehealth flexibilities in place through the end of calendar year 2024. Members suggested that perhaps another multi-year extension is coming to give Congress more time to evaluate post-PHE data on which services should be made permanent.
Ahead of the hearing, our team worked with Duke Health telehealth experts and the Digital Strategy Office to share high-level data on Duke’s telehealth experience, including evaluation data from both patients and providers. We will continue to work internally and with national partners and coalitions in support of permanently expanded telehealth under Medicare.
E&C Health subcommittee advances health legislation
On Wednesday, the House Energy and Commerce Subcommittee on Health held a markup of 21 bills and approved several proposals, including one that would extend incentive payments for participation in eligible alternative payment models (APM) for one year, but would tier the size of the bonus according to how long a provider has participated in an APM. Our office has been advocating for an extension of the APM bonus payment since January. Ahead of the markup, our office reached out to the office of Rep. Richard Hudson (R-NC-09), who serves on the Subcommittee, expressing support for extending the APM incentives and asking that the issue be included in the markup.
The Subcommittee also advanced several other bills of interest, including the “Medicare Telehealth Privacy Act of 2023,” which would prohibit HHS from making a physician's or practitioner’s address of residence publicly available if they elect to provide telehealth services from that address; a bill from Rep. Hudson to create a new pilot program to evaluate the benefits of providing additional shared savings payments to providers of biosimilars under Medicare; and legislation supported by the American Hospital Association (AHA) to extend the Geographic Practice Cost Index floor for physician work under the Medicare Physician Fee Schedule and to delay payment reductions of up to 15% under the Medicare Clinical Laboratory Fee Schedule.
The legislation now moves to the full Committee for consideration. A list of the bills can be found here.
From our desk(s): Duke Health GR this week
This week our office participated in sessions for the Biomedical Advanced Research and Development Authority’s (BARDA) industry day. BARDA’s industry day is an opportunity for the agency to foster relationships and for participants to hear updates about the agency’s work. Rep. Richard Hudson (R-NC-09) spoke about the Pandemic and All Hazards Preparedness Act reauthorization.
We contacted the NC congressional delegation to defeat concerning amendments to the FY 2024 Labor, Health and Humans Services, and Education funding bill. We also coordinated outreach to Senator Thom Tillis (R-NC), thanking him for his support of the nomination for Dr. Monica Bertagnolli for NIH director.
We joined coalition and legislative strategy meetings focused on telehealth, data privacy, artificial intelligence in healthcare, and trauma centers and trauma care.
Our office also had the pleasure to meet internally with the PRMO administration fellows.
See You Soon – Virtual “Office Hours” on November 28th
Duke Health (federal) Government Relations is once again partnering with our Duke State Relations colleagues to hold virtual "office hours.” Open to members of the Duke Health Advocacy Network, these “office hours” are not formal presentations but instead an opportunity to talk about health-related issues before Congress and for us to learn more about the issues that are at the forefront for you and your work.
Date: Tuesday, November 28, 2023
Time: 12:00pm
A meeting invite will be distributed soon. If you would like to be added to meeting invite, click here.
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).