In an effort to be more diverse
Our message this week is less terse
Now that in-person voting’s a task
Please, oh please wear a mask
So that fewer COVID droplets disperse
Early voting is now open in NC (October 15-31)!
Learn more at https://vote.duke.edu/.
Federal Updates
You keep on knocking, but you can’t come in
COVID relief and stimulus
As of newsletter circulation time this morning, there is still no announced deal between House Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steven Mnuchin on the next round of COVID-19 relief and stimulus. Are we getting closer? Maybe. Depends on who you ask and often in which hour of the day you’re asking.
Despite missing a self-imposed deadline of October 20 to reach an agreement in time for votes before the November elections, Pelosi and Mnuchin have pressed forward with negotiations. The Speaker has sounded more optimistic in recent days that a negotiated package was imminent, and President Trump has signaled that he is willing to sign off on a higher price tag than the $1.8 trillion top line he suggested last week.
In addition to a few remaining policy hurdles, including assistance to states and localities, relief for health care providers, COVID testing, and liability protections, the Senate is the biggest hurdle to a vote on a comprehensive package before November 3rd. Senate Republican leaders again held procedural votes on two much smaller measures that did and were expected to fail, in part to provide cover for vulnerable incumbents in tight races.
In a tone-shift from recent weeks, Senate Majority Leader Mitch McConnell (R-KY) said he would be willing to bring a House and White House negotiated package to the Senate floor for a vote but would not commit to doing so before the elections.
Duke Health Government Relations continues to advocate for $26 billion to support the research enterprise, support for hospitals and providers, and greater certainty for the future of expanded telehealth policies in any COVID-19 relief and stimulus agreement.
Senate Judiciary Committee advances Barrett nomination
Senate Judiciary Committee Republicans voted to advance the nomination of Judge Amy Coney Barrett to fill the vacant Supreme Court seat of the late Justice Ruth Bader Ginsburg. Committee Democrats boycotted the vote in protest of the confirmation process taking place before the potential inauguration of a new president. The full Senate is scheduled to vote on Barrett’s confirmation on October 26, with only a simple majority of 51 votes required to secure her appointment.
The timing of the Senate vote makes it likely that Judge Barrett will participate in the November 10th opening arguments of a case challenging the legality of the Affordable Care Act.
RAD! CMS to delay Radiation Oncology Model
On October 22, the Centers for Medicare and Medicaid Services (CMS) announced that it would delay the start date for its Radiation Oncology (RO) Payment Model until July 1, 2021 through upcoming rule-making. In a release, CMS Administrator Seema Verma stated that the agency is responding to feedback from the radiation oncology community and understands more time is needed but added that the model is an important part of CMS’s strategy to strengthen Medicare and improve cancer care for patients across the country. The American Hospital Association (AHA) sent a letter the day before the announcement requesting a delay on behalf of its members, and our office has been working with Duke Health leadership to convey our concerns to congressional offices.
Visa changes make it harder to be everywhere you want to be
AAMC strikes back on proposed F and J visa rules
The Association of American Medical Colleges joined with several medical education and health care organizations in a letter to the Department of Homeland Security (DHS) expressing concerns over a proposed rule that would change certification and extension policies for F and J visa holders. The letter asks specifically for an exemption for J-1 physician visas should the proposed rule move forward.
On September 25, DHS issued a notice of proposed rulemaking to change the “duration of status” policy for F and J visas to a “fixed duration,” meaning that these visa holders would be required to petition for extensions after certain periods of time.
Duke Health Government Relations is supporting our colleagues on the campus-side government relations team and leadership who are preparing formal comments to oppose the F and J visa proposed rule and is communicating our concerns with the NC Congressional delegation. We will continue to monitor this issue closely.
H-1B rule changes meet fierce opposition
Our office is also closely monitoring an interim final rule (IFR) issued in early October to overhaul the specialty occupation criteria for H-1B visas. The IFR calls for updating minimum qualifications for certain positions, fee increases for premium, or expedited, processing of H-1B visas, and a provision from the Department of Labor that immediately raises the “prevailing wage” for new H-1B hires in certain occupations, including “medical scientists.”
The H-1B IFR faces stiff opposition from private companies and academic institutions across the country, with several lawsuits intended to block any further implementation filed over the past week. We are working with the Duke Visa Services office, the campus-side government relations team, and the Duke Administration office to determine the impact on Duke while communicating our opposition to the IFR with policymakers.
Senate VA Committee examines MISSION Act implementation
The Senate Veterans’ Affairs (VA) Committee held a hearing October 21 to examine the implementation of Title I of the MISSION Act, which, among other provisions, authorized the development of a consolidated VA community care program and more robust benefits for Veterans’ caregivers. Witnesses included Lt. Gen. Patricia Horoho, CEO, OptumServe; David McIntyre, President and CEO, TriWest Health Alliance; David Schwab, CEO of the Elizabeth Dole Foundation; and Jennie Beller, a pre-9/11 Veteran caregiver. Representatives from the VA were also invited to participate in the hearing but declined, drawing the ire of both Republican and Democratic committee members.
The MISSION Act has opened new opportunities for Duke Health to provide community care to Veterans, and our office will continue to monitor its implementation and other related VA issues into the new Congress.
Bipartisan – yes, bipartisan – pushback leads to PRF reporting requirement changes
Ask, and ye shall receive. Sometimes.
In September, the Department of Health and Human Services (HHS) released updated reporting requirements that would have required providers that received more than $10,000 from the PRF authorized by the CARES Act to submit their COVID-19 related expenses for which they have not been reimbursed. In addition, the new guidelines changed the definition of lost revenue such that funding was only accessible for COVID-19-related expenses and lost revenue up to the amount of a provider’s 2019 net patient operating income. This change could have forced many hospitals to return funding.
Congress pushed back on the changes at the highest levels, including by Senate Majority Leader Mitch McConnell (R-KY). Senators Richard Burr (R-NC) and Thom Tillis (R-NC) signed onto a Senate letter to HHS, at the request of Duke Health Government Relations and other NC hospitals, requesting a reexamination of policies that define lost revenue and that could negatively impact small, rural, and safety net hospitals. Rep. G.K. Butterfield (D-NC-01) and Rep. David Price (D-NC-04) signed onto a similar House letter at our request, urging HHS to revert to its previous guidance that defined lost revenue as any revenue lost due to COVID-19 and allowed the “use of any reasonable method of estimating the revenue during March and April 2020 compared to the same period had COVID-19 not appeared.”
On October 22, HHS updated the reporting requirements again to clarify that providers may use remaining PRF funds to cover any lost revenue, measured as a negative change in year-over-year actual revenue from patient care related sources.
The portal for providers to begin reporting their relief fund spending is expected to open on January 15, 2021.
We’re No Five Thirty-Eight, but a Special Edition is coming next week from the 919
Next week we plan to use this space to share some of what to expect when the calendar turns to November 4 – and how the potential outcomes of the 2020 elections might shape the order and magnitude of certain priorities for the rest of this year and into 2021 with the 117th Congress.
No crystal balls, electoral math, made up analytics, Ouija boards, or voter algorithms – just what we see and how we’re preparing for what’s next.