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Federal Updates
Live from D.C., it’s OMG
Where to start? The political winds in Washington, D.C. seem to shift on an hourly basis in what is shaping up to be an unusually busy October before a major election.
COVID relief and stimulus
House Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steve Mnuchin reportedly remain in negotiations on a broader COVID-19 relief and stimulus agreement, despite some confusion whether the White House supports a COVID package before the elections. While recovering from his own COVID-19 infection, President Trump initially signaled that he was walking away from talks until November only to reverse course a few hours later.
The House passed a scaled-back version of its HEROES Act last week. The $2.2 trillion proposal retains many elements from the original HEROES Act, including $4.7 billion for the National Institutes of Health, as well as $2.9 billion for the National Science Foundation, a temporary increase in Federal Medical Assistance Percentage (FMAP) payments to state Medicaid programs, and additional support for small businesses and the airline industry. The White House has indicated that it has a top-line of $1.6 trillion for any relief and stimulus package, and it remains unclear how the two sides will bridge the gap.
The wild card, of course, is the Senate. Senate Republican leaders have been lukewarm to advancing any COVID relief measure this month and have thus far shown no willingness as a unified caucus to support a deal in excess of $1 trillion.
Duke Health Government Relations continues to advocate for $26 billion to support the research enterprise and greater certainty for the future of expanded telehealth policies in any COVID-19 relief and stimulus agreement.
Senate focuses on Supreme Court confirmation
Senate Republican leaders may be undecided on how and when to proceed with the next round of COVID relief, but they are firm in their decision to move forward with confirmation proceedings for Judge Amy Coney Barrett to replace the late Justice Ruth Bader Ginsburg on the Supreme Court. Despite several Republican members of the Senate Judiciary Committee testing positive for COVID-19, including Sen. Thom Tillis (R-NC), the panel still expects to begin confirmation hearings virtually next week, with Senate Majority Leader Mitch McConnell (R-KY) eyeing a final confirmation vote by the end of October.
PHE extended through early 2021
Health and Human Services (HHS) Secretary Alex Azar recently announced that he has signed an extension of the COVID-19 public health emergency (PHE), effective October 23. The 90-day extension will run through mid-January and keeps in place a number of emergency public health protections, including Centers for Medicare and Medicaid Services (CMS) waiver authority to continue flexibilities for telehealth services for Medicare patients.
Public comments on CY 2021 Medicare Physician Fee Schedule
Duke Health and the Private Diagnostic Clinic (PDC) submitted comments to CMS in response to the proposed CY 2021 Medicare Physician Fee Schedule (PFS). The PDC comments focused on proposed changes in Evaluation and Management (E/M) coding within CMS’s environment of “budget neutrality” that could have variable impacts on providers depending on specialty. The PDC urged CMS “not to implement any payment policy changes that will exacerbate the financial instability of health care providers’ practices, particularly in the middle of a global pandemic.”
Duke Health’s comments were focused on CMS proposals related to telehealth and digital medicine expansion. Duke Health called on CMS to make a number of proposed telehealth flexibilities permanent within its authority while keeping the current expanded regime in place to allow Congress time to make any necessary additional statutory changes.
HHS, what are you doing? (HHS provider-relief reporting requirements update)
Opposition continues to mount against recently released HHS provider relief payment reporting requirements. The new requirements ask providers that received more than $10,000 from the COVID-19 provider relief fund authorized by the CARES Act to send the department their COVID-19 related expenses for which they have not been reimbursed. Providers who do not spend all their relief before January 2021 will have to send HHS another expenditure report by July 31, 2021 for those funds.
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 could negatively impact rural and safety net hospitals. The American Hospital Association and other associations have also expressed concern that changes in how HHS defines lost revenue may disproportionately impact small and rural hospitals. The portal for providers to report their relief spending is expected to open on January 15.
New Research Insights: Dr. Rosa Gonzalez-Guarda from the Duke University School of Nursing
Duke Health Government Relations has added a new “Research Insight” story on our homepage to illustrate the intersection of research and federal policy. The story highlights Dr. Rosa Gonzalez-Guarda in the Duke University School of Nursing and her important work to improve health in Latinx Communities. Learn more here about the project she leads — SER (Salud, Estrés y Resiliencia/Health, Stress and Resilience) Hispano Project, which examines the effects of acculturation stress and resilience on the health and wellbeing of Latinx immigrants in the Research Triangle — and how she can be an expert resource for policymakers.