Swing. You might miss - but
Your pitch is coming. Eyes up.
Dig in. Grip tight. Swing.
Publication Note: Congress is soon scheduled to begin recess ahead of the midterm elections. Due to the expected break in major congressional activity, our office will also pause the newsletter. Absent breaking news, we will resume our normal publication schedule in November.
For the latest news in the meantime, please follow us on Twitter @DukeGovRel or join the Duke Health Advocacy Network Teams channel (more information below).
The Rundown
- CR on track to pass with user fees extension; Congress sets up year-end priorities
- FY 2023 appropriations/CR
- FDA user fees
- Electoral reform
- Annual Defense policy
- Public Health Emergency
- White House holds conference on nutrition, hunger, and health
- Senate Finance Committee release mental health draft
- The latest from our desks
- Information on 2022 Voter Registration
- Join Duke Health Advocacy Network
Federal Updates
Continuing resolution (CR) on track to pass with user fees extension; Congress sets up year-end priorities
Perhaps the kindest thing we can say about September in D.C. is that it’s almost over. Then again, it has been a productive few weeks. Here’s the latest on a few key priorities, including efforts to keep the federal government running past midnight tonight.
FY 2023 appropriations – Congress is on course to pass a stopgap measure to keep the government funded beyond today’s final day of the current fiscal year. Senate Democrats introduced a Continuing Resolution (CR) to fund the government at current FY 2022 spending levels through December 16, 2022. To date, Congress has not passed any of the 12 spending bills for federal agencies for FY 2023.
The CR would extend two soon-to-expire rural hospital programs through December 16, including the Medicare-Dependent and Low Volume Hospital programs. It would also temporarily reauthorize the Best Pharmaceuticals for Children Program (BPCA), provide $12 billion in aid for the Ukraine, and $20 million in disaster assistance for Jackson, Mississippi. Additional funding requested by the White House for COVID and monkeypox vaccines, testing, and response was not included.
As in years past, we expect NIH Institutes and Centers to monitor expenditures carefully and follow the same previous guidance with discretion to issue non-competing research grant awards.
The outcome of the midterm elections will determine how quickly and in what form Congress will approve a final FY 2023 omnibus spending bill in mid-December. In addition, only extending expiring provisions such as the Medicare provisions, is likely a tactic to leave the door open for negotiating on other end-of the year policies. Our office continues to advocate for Duke Health priorities in a final package, and we will urge swift passage post-election.
FDA user fees – In addition to the short term-extensions for healthcare programs, the CR includes a five-year authorization for the FDA User Fee programs. Both parties agreed to move forward on a clean five-year extension, meaning additional policies or reforms to the programs were not included. Following the agreement, Senate Health, Education, Labor and Pensions Committee Chairwoman Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC) noted that they intend to include bipartisan legislation on mental health and pandemic preparedness efforts, among other issues, in a year-end package.
Electoral reform – The bipartisan Electoral Count Act now includes among its supporters Senate Minority Leader Mitch McConnell (R-KY), which may smooth the way for Senate passage of legislation that aims to revise the process of casting and counting electoral votes for presidential elections. The House has passed its version of presidential election reform legislation. More to come in December.
NDAA – Until Thursday evening, Senate Majority Leader Chuck Schumer had planned to bring the Senate back into session for at least a week in mid-October to consider the Senate version of the National Defense Authorization Act (NDAA) and potentially address other lingering business - but the realities of election season got in the way. The Senate is now expected back in mid-November, after the election, to take up its NDAA bill. 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.
PHE – The current COVID-19 federal public health emergency (PHE) is set to expire in the next two weeks, but the administration has signaled that another 90-day extension is expected. Could this be the last one? The Department of Health and Human Services has promised to give state officials at least 60-day notice before winding down the PHE, so if the October extension occurs as anticipated, we’ll be looking to early November for communication from the administration about a potential end date.
White House holds conference on nutrition, hunger, and health
This week, for the first time in over 50 years, the Biden administration convened the White House Conference on Nutrition, Hunger, and Health. The conference comes at a time of rising food inflation, the end of pandemic benefits that helped to reduce rates of hunger, particularly among children, and natural disasters currently threatening the food security of millions of people in the United States. In his opening address, President Biden pushed for Congress to permanently extend the child tax credit, raise the minimum wage, and expand nutrition assistance programs to help reduce hunger rates, while also proposing new nutrition programs to cover medically tailored meals as part of an $8 billion commitment to end hunger by 2030. Several Duke Health leaders participated in the conversation remotely and provided recommendations ahead of the conference.
Just ahead of the conference, the administration released its national strategy on hunger, nutrition, and health, which consists of five pillars: improving food access and affordability, integrating nutrition and health, empowering all consumers to make and have access to health choices, supporting physical activity for all, and enhancing food security research. The broader national strategy may face some roadblocks in Congress, as well as in the rulemaking process, but the administration views the effort as a major policy and practical domestic priority.
Our team will engage with the Biden administration and Congress as implementation of the national strategy moves forward and coordinate with Duke Health leadership in support of the health system’s similar commitment to addressing these issues in our communities.
Senate Finance Committee releases mental health workforce draft
Last week, the Senate Finance Committee released a discussion draft of legislation aimed at expanding the mental health workforce. Under the direction of Committee leadership, senators have partnered in a bipartisan fashion to serve as co-chairs on five specific policy area working groups, with the goal of producing recommendations for a larger mental health bill. Senators Debbie Stabenow (D-MI) and Steve Daines (R-MT) serve as the co-chairs for the working group on strengthening the workforce.
Among its provisions, the draft bill would:
- Increase new Medicare physician residency positions by 400;
- Update Medicare coverage for clinical social worker services;
- Expand Medicare's Health Professional Shortage Area bonus program to attract more mental health care providers;
- Require Medicare to provide education and outreach to providers and other interested parties about the ability of occupational therapists to furnish occupational therapy behavioral health;
- Create a demonstration project to increase behavioral health provider capacity under the Medicaid program; and,
- Provide flexibility in Medicare’s direct supervision requirements by allowing psychologist trainees to provide mental health therapy services under the general supervision of a licensed clinical psychologist.
The draft includes provisions similar to those advanced by the House Ways and Means Committee last week to expand Medicare coverage to include licensed marriage and family therapists and licensed professional counselors and to help physicians access mental health programs without limitations imposed under the Physician Self-Referral Law and the Federal Anti-kickback Statute.
This marks the third draft of recommendations to come from the working groups after prior efforts focused on telehealth and youth mental health.
From our desk(s): Duke Health GR this week
This week, our team worked closely with congressional staff, the Association of American Medical Colleges (AAMC), and other stakeholders to further raise awareness and advance legislative solutions to address recent VA guidance on conflict of interest policy applied to VA researcher outside compensation impacting non-public VA-affiliated institutions.
We monitored passage in the House of the “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. Our team engaged with the NC congressional delegation to build support for the bill ahead of recent committee activity and the final House vote.
Our office coordinated outreach on behalf of the Duke Human Vaccine Institute to offer insights to key leaders in the NC congressional delegation on their efforts to improve future pandemic preparedness efforts. Our team also connected with staff of members of the NC congressional delegation in support of legislation to extend Medicare-PHE related telehealth flexibilities beyond for at least two years beyond the expiration of the PHE.
Voter Registration Information
DUHS is offering opportunities for team members to register to vote in the November 8th, 2022 election. A voter registration table will be available at the Duke Farmer’s Market on Thursday, October 6th from 11:00am-2:00pm. The event is 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, 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!
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