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Federal Health Policy Updates for the Week of September 19, 2022

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We judge actions, but
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The Rundown

  • September schedule update with details on federal funding and other priorities
  • Senator Tillis introduces National Nursing Workforce Center Act
  • Committee updates on health-related legislation and policy
  • The latest from our desks
  • Information on 2022 Voter Registration
  • Join Duke Health Advocacy Network


Federal Updates

Why put off until tomorrow what you can put off until September 30?
The title, of course, is a tongue-in-cheek reference to Congress’ rote reputation for finding an extra gear of productivity when faced with a deadline. In fairness, it not always a result of partisanship or procedure – sometimes things just happen, and the calendar gets a little more crowded. Here’s a quick snapshot of a few priorities we’re following.

  • FY 2023 appropriations – The current fiscal year ends a week from today. No one in party leadership in either chamber on both sides of the aisle – nor the White House – wants even a hint of a government shutdown. There will be a continuing resolution (CR) that will likely run through mid-December to keep the government funded. That’s a succinct enough update, but, surprise, it’s much more complicated. As we’ve mentioned in prior newsletters, the CR is probably the last big moving legislative vehicle for a while, at least until after the midterm elections, and there is no shortage near and long-term issues awaiting congressional response. The CR is expected to be relatively clean, meaning free of contentious policies, but debates continue over additional resources for potential COVID-related funding, monkeypox, the Ukraine war, the water crisis in Jackson, MS, and emergency support for Puerto Rico in the wake of Hurricane Fiona. There is also the matter of a side deal on permitting reform between Senator Joe Manchin (D-WV) and Senate Majority Leader Chuck Schumer (D-NY) that is also unsettled. At the moment, the Senate has kicked things off procedurally while the House works on additional details. There’s optimism this gets done ahead of next Friday evening, but members have been cautioned to be prepared to hang around for the weekend just in case.
     
  • FDA user fees – The current Food and Drug Administration (FDA) user fee agreement also expires on September 30th. A relatively straightforward user fee extension is still among the items in discussion for attachment to the CR. Unless negotiators can reach a deal on a more comprehensive package in the coming days, the extension will be the only way to avoid potential temporary disruption in FDA activities.
     
  • Electoral reform – Electoral reform legislation gaining momentum in an election year? Maybe so. A bipartisan effort in the Senate has gained new supporters over the past week as the House passed its own reform legislation this week. The bills, while different in their approaches, are focused mostly on safeguards for future presidential elections – and believe it or not, 2024 is just around the corner. Expect to see more debate on this issue in the lame duck session.
     
  • NDAA – As noted last week, the Senate version of the National Defense Authorization Act (NDAA) is almost certainly not receiving a vote along with the CR in the next week. It seemed that any potential vote would have to wait until after the midterms – but in a surprise announcement this week, Senate Armed Services Committee Chair Jack Reed (D-RI) indicated he was considering opening debate on the measure in October when quite a few members are expected to be back home campaigning. Whether or not a Senate vote happens next month, expect informal conference negotiations to begin taking place between House and Senate leaders. The House passed its version of the NDAA over the summer. The NDAA formally authorizes broad programmatic and spending initiatives at the Department of Defense (DOD), including the Defense Health Program, which supports and funds DOD medical research, as well as the Defense-supported medical workforce. The legislation has been passed by Congress “on time” every year for over 60 years.

Our team will continue to advocate for Duke Health federal funding and policy priorities as the legislative session moves forward.

Senator Tillis leads effort on National Nursing Workforce Center Act
Senator Thom Tillis (R-NC) joined Senator Jeff Merkley (D-OR) and Reps. Lisa Blunt Rochester (D-DE) and Young Kim (R-CA) in introducing the National Nursing Workforce Center Act (H.R. 8817/S.4844), which would implement a three-year pilot program to establish new or enhance existing State-based nursing workforce centers, evaluate the impact of State-based nursing workforce centers on outcomes, and assess the feasibility of nursing workforce public-private partnerships.

Our office shared feedback with Senator Tillis on behalf of Duke Health. North Carolina is currently one of the states that does not have a Nursing Workforce center and could benefit from this vital resource. In a press release introducing the bill, Senator Tillis said, “nurses play a crucial role in providing accessible, high-quality care to Americans. Resolving existing nursing workforce challenges, which have been compounded by the pandemic, the increased demand for health care services, and the aging workforce, requires innovative approaches that support and strengthen every aspect of the nursing workforce pipeline…I’m proud to co-introduce the bipartisan National Nursing Workforce Center Act that will enhance collaboration and coordination, enabling state and local experts to identify and address unique challenges to increase the resiliency of the nursing workforce.”

Heard on the Hill: Committees advance health policy - but what's the endgame?
This week several committees advanced important pieces of bipartisan healthcare legislation, adding to the growing list of stalled healthcare priorities. With only a few working days left before Congress departs for election-related activities, it’s all about the CR we discussed above. Legislation that does not get attached to the CR will either be taken up after the election, likely in an end-of-the year package, or face the fate of so many well-meaning priorities that have not made it past the end of Congress finish line: reintroduction next Congress.

Ways and Means advances health bills-- including bipartisan mental and behavioral health provisions
On Wednesday, the House Ways and Means Committee advanced several healthcare bills, including coverage of forensic medical exams at no cost, and reauthorization of the Maternal, Infant, and Early Childhood Home Visiting Program. The Committee also approved mental and behavioral health legislation that would, among other goals, seek to improve Medicare’s inpatient psychiatric facility payment system and add a benefit category for intensive outpatient services under Medicare Part B; provide outreach on opioid use disorder treatment services furnished by opioid treatment programs and certain behavioral health integration services; and expand Medicare coverage to include licensed marriage and family therapists (MFTs) and mental health counselors (MHCs).  The committee also passed H.R. 8890, the Physician Wellness Program Act, co-led by Rep. Greg Murphy, MD (R-NC-03), to help physicians who are part of a hospital’s staff, but not employed by the hospital, to access mental health programs without limitations imposed under the Physician Self-Referral Law and the Federal Anti-Kickback Statute. A full list of considered legislation can be viewed here.

Next steps for the committee-approved legislation are unclear, but inclusion in a year-end package is possible if none of the bills are attached to the CR. The House Energy and Commerce Committee has approved a separate package of mental health bills, including a bill to reauthorize programs at the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration.

E&C advances health bills
This week the House Energy and Commerce Committee also held a full Committee markup of several bills, including the Maximizing Outcomes through Better Investments in Lifesaving Equipment for (MOBILE) Health Care Act to expand and modify the allowable uses of New Access Point grant funds, which help health centers establish new delivery sites to provide comprehensive primary care to medically underserved populations. Under the bill, which is co-led by Rep. Richard Hudson (R-NC-08), a mobile clinic could qualify for grant funding as a new delivery site regardless of whether it is associated with a permanent, full-time site.

The full Committee also advanced the Duke Health-supported “Improving Trauma Systems and Emergency Care Act” (H.R. 8163), which would reauthorize federal grant programs to support national trauma care, readiness, and coordination and improve trauma care in rural areas, including resources to create research and demonstration projects that improve emergency medical services and trauma care through development of innovative technology and training, education, transportation, prehospital care and other priorities. 

A full list of considered items at the hearing is available here.

Senate VA Committee takes on Veterans’ healthcare
The Senate Veterans’ Affairs (VA) Committee held a hearing on “Ensuring Veterans’ Timely Access to Care in VA and the Community”. VA Secretary Denis McDonough was the sole witness on the first panel with a second comprised of representatives from the research community, Veterans’ advocacy groups, and a former adviser from the Trump administration. The conversation focused heavily on the implementation of the VA Mission Act and evaluation of the VA Choice program, which allows Veterans’ to seek comparable care outside of the VA if certain criteria are met by the non-VA medical facilities. Of note, Secretary McDonough indicated that telehealth will become a more prominent option for VA care and is set to be added to the evaluative criteria for VA Choice partners in a future proposed rulemaking.

From our desk(s): Duke Health GR this week
This week, a member of our team participated in the American Hospital Association's (AHA) Government Relations Officers Network Meeting to hear updates from congressional staff and the AHA about federal priorities and strategy. We also participated in the Association of American Medical Colleges' (AAMC) Government Relations Representatives (GRR) meeting to discuss legislation affecting teaching hospitals and medical schools and to connect with congressional staff on key policy issues. Julie Rose, a Director of Government Relations on our team, was nominated and approved to serve a three-year term on the GRR steering committee.

We coordinated meetings for Duke University School of Nursing Dean Vincent Guilamo-Ramos with leadership for the Congressional LGBTQ+ Equality Caucus to discuss the federal government’s response to monkeypox and to share his perspectives on community engagement and the importance of strengthening the nursing workforce.

Our office continues to prioritize policies impacting the safety and wellness of Duke Health team members, including the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961). As a result of our outreach, Rep. David Rouzer (R-NC-07) signed on as a cosponsor of this important bill to provide healthcare workers the same legal protections against assault and intimidation that flight crews and airline employees are provided under federal law. Rep. Alma Adams (D-NC-12) was also added as a cosponsor last week, joining Rep. Deborah Ross (D-NC-02), who was among the first House members to cosponsor the bill. Our office also conducted some follow-up outreach in support of the bill to one of its sponsors, Rep. Larry Bucshon (R-IN-07).

We met with health policy staff for Senator Thom Tillis (R-NC) in follow up to his visit to Duke University Hospital on September 9th to discuss health system priorities.

Finally, our team supported a meeting between U.S. Department of Health and Human Services Assistant Secretary for Health Admiral Rachel Levine, MD, and medical students, residents, and faculty regarding Duke Health’s programs in gender affirming care and reproductive health.

Voter Registration Information
DUHS is offering several opportunities for team members to register to vote in the November 8th, 2022 election. Voter registration events will take place at Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital on Thursday, September 29th from 11:00am-2:00pm. A voter registration table will also be available at the Duke Farmer’s Market on Thursday, October 6th from 11:00am-2:00pm. The events are hosted in coordination with You Can Vote, a nonpartisan voter mobilization organization. For additional information about registering to vote in North Carolina, visit the State Board of Elections website or vote.duke.edu.

 Thursday, September 29th

  • Duke University Hospital: Duke North outside of the Atrium Café from 11am-2pm
  • Duke Regional Hospital: Hospital Cafeteria (1st floor) from 11am-2pm
  • Duke Raleigh Hospital: North Pavilion Lobby (1st floor) from 11am-2pm

Thursday, October 6th

  • Duke Farmer’s Market: Duke Medicine Pavilion Greenway outside of Trent Semans Center for Health Education from 11am-2pm

Duke Health team members and Duke University School of Medicine students are also partnering with other national academic medical centers in a nonpartisan, online voter registration initiative called Vot-ER. The Vot-ER program is completely voluntary and will not impact or interrupt clinical care. Team members who participate can wear lanyards and badge backers with a QR code that individuals can use to register to vote on their own device. In our clinical environments, volunteers are not allowed to proactively approach patients, visitors, or team members for voter registration efforts or impede privacy guidelines. They may serve as a resource for people who are interested in learning about the voter registration process. To obtain a Vot-ER badge backer, please fill out this Qualtrics form. For questions about Vot-ER, contact Kreager Taber (kreager.taber@duke.edu).

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).