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The Rundown
- Work on government funding inches forward
- Biden administration releases broad Executive Order on artificial intelligence
- HHS issues proposed rule to enhance penalties for information blocking rules
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
Appropriations work slowly continues
When it comes to government spending, most of the focus right now is on the Biden Administration’s $105 billion supplemental funding request related to aid for Israel and Ukraine, federal disaster relief, and border funding. But no matter how much everyone wants to ignore it, the current continuing resolution (CR) keeping the government open expires on November 17.
With limited time between now and then, it is clear that another CR will be necessary. In a meeting with Senate Republicans this week, new House Speaker Mike Johnson (R-LA) suggested he is open to another short-term CR that would fund the government through January 15 and force 1% discretionary spending cuts across the board. This automatic spending cut is opposed by President Biden, Democrats, and some Republicans in both the Senate and the House. Some sort of agreement will have to be worked out before November 17 in order to prevent a government shutdown.
Congress continues to work on FY 2024 spending bills. On Wednesday, the Senate overwhelmingly approved the first three of its FY 2024 appropriations bills in a “minibus,” which combines funding for Military Construction-Veterans Affairs, Agriculture, and Transportation-Housing and Urban Development. The House has passed 6 of its 12 spending bills. Speaker Johnson has laid out an aggressive schedule for consideration of the remaining spending bills with plans to bring to the floor the Financial Services and Commerce-Justice-Science bills next week, and the Labor-HHS-Education and Agriculture bills the week of November 13. Unlike the bipartisan approach in the Senate, House Republicans are taking a party-line approach that would cut spending and advance their preferred policy measures that are opposed by Senate Democrats and the White House.
The administration has a plan: AI EO... oh, we’ve got work to do
On Monday, President Biden signed a broad and ambitious Executive Order on artificial intelligence (AI) that seeks to balance encouraging innovation while also protecting safety, national security, and consumer rights. Executive orders are designed to direct the activity of executive branch departments, agencies, and officials – and the 111-page document has implications across every entity under the purview of the White House.
It is intended as an initial step to promoting a trustworthy and safe AI framework for the federal government to coordinate with and regulate AI technological development. Every federal agency will designate a Chief AI Officer within 60 days, and an interagency AI Council will coordinate federal action.
The EO has specific requirements for the Department of Health and Human Services (HHS) to meet in the next 90 days and within a year. Response to the EO has been largely positive in principle, but there is also recognition that some congressional augmentation will be necessary to make its goals achievable, including the development of more comprehensive data privacy rules.
In the days following its release, the Biden administration has already announced the creation of a new AI Safety Institute in the Department of Commerce, with more announcements of new policy changes expected in the coming days.
Congress has also been in on the AI action this week. The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on the impact of AI and the workforce, and Senate Majority Leader Chuck Schumer (D-NY) held his third, closed-door AI insight forum to discuss workforce development for AI.
Our team is continuing to evaluate the impact of the EO on healthcare policy and clinical and research operations along with our health system experts and leadership in Duke AI Health. We continue to position Duke Health as a national leader in healthcare AI and resource to policymakers as legislative and regulatory conversations move forward.
Open up or pay up – HHS proposes new penalties for violations of information blocking rules
This week, the Department of Health and Human Services issued a proposed rule to create new penalties and financial disincentives for entities that are found to have committed information blocking. Under the 21st Century Cures Act, information blocking is defined as the act of knowingly interfering with the access and exchange of electronic health information, although there are some allowable exceptions.
The proposed rule would establish disincentives for health care providers through existing Medicare programs including:
- Medicare Promoting Interoperability Program - Information blocking by an eligible hospital or critical access hospital would result in the facility being marked as not a meaningful electronic health record (EHR) user in an applicable reporting period. Eligible hospitals would lose 75% of the annual market basket increase. Critical access hospitals would see payment reduced to 100% of reasonable costs.
- Merit-based Incentive Payment System (MIPS) - Under the promoting interoperability category, an eligible provider or health group found to be information blocking would not be deemed a meaningful user of certified EHR technology in a performance period and would score zero on the MIPS interoperability performance category. This category can be up to a quarter of the total MIPS score for a provider in a year.
- Medicare Shared Savings Program - A health care provider that is part of an Accountable Care Organization would be deemed ineligible to participate in the program for a period of at least one year following a determination of information blocking. This could also prevent a provider from working at an ACO in the future. Estimates suggest the median individual disincentive amount could be a loss of $686 for an eligible clinician.
A public comment period is open through January 2, 2024, and our team is coordinating with Duke Health experts and leadership to develop any health system response.
From our desk(s): Duke Health GR this week
This week, Senator Ted Budd (R-NC) signed on as a cosponsor of S. 2372, the Accelerating Kids’ Access to Care Act. Our office has been urging support for this important bill, which would require state Medicaid programs to establish a process through which qualifying out-of-state providers may enroll as participating providers for five years without undergoing additional screening requirements. Reps. Deborah Ross (D-NC-02) and Richard Hudson (R-NC-09) have cosponsored a similar bill in the House.
Our team monitored a hearing of the Senate Veterans Affairs Committee on “Foundation of Care: Examining Research at the Department of Veterans Affairs” and connected with the office of committee member Senator Thom Tillis (R-NC) to reinforce Duke’s longstanding research partnership with the Durham VA Medical Center. The hearing focused on the development of a broader VA research enterprise, the need for additional investment, and prioritizing more outcomes-based research initiatives.
We coordinated a meeting for Duke nursing international recruitment leadership with the office of Rep. Deborah Ross (D-NC-02) to discuss immigration and visa challenges. Rep. Ross sits on the House Judiciary Committee, which has jurisdiction over immigration policy issues.
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