Health Policy Report (6/8)

June 8, 2020

Capitol Hill Update

Senators will pick up legislative business this afternoon to begin consideration of a sweeping public lands bill. Senate Majority Leader Mitch McConnell (R-KY) has queued up votes on a bipartisan measure that would permanently fund the Land and Water Conservation Fund (LWCF), while also addressing billions of dollars in deferred maintenance backlogs on existing public lands and national parks. While the bill currently enjoys strong bipartisan support in the upper chamber, it remains to be seen whether the Senate will consider amendments to the underlying bill. A bipartisan group of House lawmakers introduced companion legislation to the Senate’s bill last week.

Meanwhile, House leadership has started to flesh out its appropriations schedule and strategy for July. In a “Dear Colleague” letter to Members on the House Appropriations Committee last week, Chairwoman Nita Lowey (D-NY) provided an overview of the Committee’s plan of attack for addressing fiscal year (FY) 2021 spending bills next month. Appropriators will hold subcommittee and full committee markups on funding bills during the weeks of Jul. 6 and Jul. 13, with floor consideration likely occurring the weeks of Jul. 20 and Jul. 27, according to Chairwoman Lowey. She also plans to offer additional details on the schedule — as well as the specific order in which the bills will be considered — later this month. There are no votes currently scheduled in the lower chamber for this week, but members will receive 72-hour notice of any changes to the House schedule moving forward.

Medicaid Provider Relief Delays Scrutinized by Bipartisan Committee Leaders

Following reports that the Trump administration has been slow to distribute COVID-19 response aid for Medicaid-dependent health care providers, the Chairs and Ranking Members of the House Energy & Commerce and Senate Finance Committees wrote to Department of Health and Human Services (HHS) Secretary Alex Azar last week demanding a timeline for paying out the remainder of the $175 billion in COVID-19 funds that Congress appropriated months ago. Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR) and Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR) expressed “serious concerns” that the delay in funding could result in the closure of safety net hospitals and clinics nationwide facing “strained scarce resources” during the pandemic, and requested that the administration provide an explanation for the delay impacting primarily safety net providers that care for low-income and vulnerable populations. The foursome, who lead the Committees in each chamber with jurisdiction over Medicaid, joined forces on the letter, noting that “while HHS has made public statements regarding a commitment to develop a distribution for Medicaid providers who may not have Medicare claims, we have not yet seen public progress on such a commitment.”

The lawmakers are seeking transparency on several issues related to the delay in funding, including: a timeline for which HHS plans to distribute funds to Medicaid-dependent providers; how HHS plans to release the funding; the level of funding the administration plans to dedicate to Medicaid-dependent providers; why the administration waited until May 1 to request state-level data on Medicaid-dependent providers; and what factors contributed the delays in distributing funding and how HHS plans to resolve the issues. The letter to HHS Secretary Azar can be read here.

Congress has allocated more than $175 billion in relief funding for hospitals and physicians in previous COVID-19 response legislation, but HHS has yet to distribute most of the aid, according to reporting from Politico last Tuesday. HHS’ own website details just over $77 billion in distributions, plus a program to reimburse providers for care for uninsured individuals. Lengthy deliberations over how best to distribute the funding, as well as challenges obtaining the state-level data need to identify providers appropriate for funding, has reportedly delayed the funding distribution. Additionally, the letter criticized the administration for distributing aid in a manner that favored providers with Medicare-heavy or wealthier patient populations and financially healthy hospital groups. Providers with large Medicaid patient bases have largely been ignored by aid distribution methodologies, including home and community-based health care organizations, mental health and addiction clinics, and services for those with disabilities.

HHS Asks for Input on Health Care System Resilience

Last Thursday, the Department of Health and Human Services (HHS) issued a request for information (RFI) relating to the resilience of the health care system. As the COVID-19 pandemic goes on, HHS says that responses to public health crises require a “highly resilient, adaptable health care delivery system.” The RFI seeks to gain a greater understanding of how health care system stakeholders have defined resilience in their organizations and how they use data and analytic approaches to bolster resilience. The agency is looking for opportunities to strengthen the U.S. health care system over the long term. Stakeholders in the health care system, which HHS defines broadly, are encouraged to submit comments by midnight on July 8, 2020.

This RFI could mark a turning point as HHS looks beyond urgent immediate needs relating to the public health information and towards implementing lessons learned on the ground. It is an opportunity to begin to reshape certain parts of the health care system to better deal with emergencies in the future. HHS asks stakeholders to comment on a range of topics, including: 1) public-private partnerships to continually assess and monitor health system resilience and health outcomes; 2) health conditions that should be used as indicators of healthcare availability, access, timeliness, and quality, in terms of treatment and preventive services; 3) barriers and improvements to policies and programs to mitigate the risk of COVID-19 and avoid negative impacts on patient outcomes as well as to strengthen health system resilience; 4) data and approaches being used to assess and monitor health system resilience; and 5) scientific advances needed to address vulnerabilities in the U.S. health care system during the COVID-19 response and during future crises.

HHS to Require Labs to Report Racial, Gender Information with COVID-19 Testing Data

The Department of Health and Human Services (HHS) announced last Thursday that it will require new data be reported by labs alongside COVID-19 test results, including information on race, ethnicity, age, and sex. The new guidance mandates standardizing reporting to ensure public health officials have access to “comprehensive and nearly real-time data to inform decision making in their response to COVID-19.” HHS Secretary Alex Azar acknowledged that the public health emergency has had a disproportionate impact on certain demographics, including racial minorities and older Americans, and Assistant Secretary for Health ADM Brett Giroir explained the additional information will allow the administration to ensure all groups have equitable access to testing. The administration noted the new reporting requirements will help better monitor disease incidence and trends by initiating epidemiologic case investigations, assisting with contact tracing, assessing availability and use of testing resources, and anticipating potential supply chain issues.

White House Coronavirus Task Force Reportedly Winding Down 

Although the White House walked back comments in early May that the Coronavirus Task Force would be disbanded by Memorial Day, its work appears to have been scaled back significantly. Director of the National Institute for Allergy and Infectious Diseases Anthony Fauci reported in an interview with STAT News last week that his meetings with the president have “dramatically decreased,” and noted the Coronavirus Task Force meetings have “not occurred as often” as the daily meetings they were previously holding. Adm. Brett Giroir, the Assistant Secretary of Health, also announced last Monday that he would be returning to his regular duties next month after spending the past several weeks working with FEMA to increase COVID-19 testing capacity. It was reported that the day-to-day management and operation of testing would instead be taken over by the HHS operating divisions directly under the leadership of Office of the Secretary.

Stakeholders criticized the signs the Task Force was winding down last week, and Ashish Jha, Director of the Harvard Global Health institute, declared it felt like the administration “was just throwing in the towel” after failing to meet adequate testing needed. The last public briefing from the task force was over a month ago, although White House counselor Kellyanne Conway stated last week that the Coronavirus Task Force would soon hold additional press briefings to update the public on the pandemic. Last Friday, Dr. Fauci clarified that although the Task Force is less visible, it is still doing “substantial” work.