Policy Updates: Hill Happenings and Administration Activities

By Julio Contreras January 19, 2021

Hill Happenings

Legislative Priorities and Financial Relief Discussions Under a Biden Administration

With the 2020 election cycle now squarely in the rearview, the 117th Congress is readying for the incoming Biden-Harris Administration. Early legislative priorities for the new Democratic majority include confirming President-elect Biden’s cabinet appointees and passing a new round of financial relief amid the ongoing pandemic. President-elect  Biden urged senators not to neglect Cabinet confirmations and other legislative priorities as they prepare to consider the House’s article of impeachment in the trial of President Donald Trump.

As the new chair of the Senate Budget Committee, Senator Bernie Sanders (I-VT) is expected to pursue an ambitious spending agenda, including an early COVID-19 financial relief package that is expected to go farther than previous legislation. Democrats are prepared to leverage a procedural tactic, known as budget reconciliation, to bypass the Senate filibuster and pass policy priorities with a simple majority vote. The budget reconciliation process was recently used by Democrats to pass the majority of the Affordable Care Act (ACA) in 2010, and then again by Republicans to push through changes to tax law in 2017. However, President-elect Biden has indicated that he is interested in negotiating a bipartisan relief package, which may complicate financial relief discussions on Capitol Hill.

On Thursday, January 14, President-elect Biden unveiled a $1.9 trillion emergency legislative package for Congress to take up after the inauguration. The relief package addresses the public health and economic crises by scaling up a robust vaccination program and directing economic relief, including $1,400 in direct stimulus payments, $350 billion in emergency state and local funding, extending unemployment benefits, and funding for vaccine programs and schools to safely reopen. Despite the new Democratic majority in Congress, the relief package is expected to be met with some resistance on Capitol Hill due to key provisions in the bill text and the sheer size of the relief amount.

NASTAD will continue to monitor stimulus negotiations in the 117th Congress and the appropriations process under a Biden Administration to advocate for the highest funding levels on behalf of HIV and hepatitis programs.

FY2022 Appropriations

The House Republican Steering Committee submitted nominations for key appointments to the House Appropriations Subcommittees. The nominations must be approved by the full Republican Caucus. Committees with jurisdiction of concern include:

  • Vice Ranking Member of the Full Committee – Rep. Tom Cole (OK-4)
  • Labor, Health and Human Services, Education – Rep. Tom Cole (OK-4)
  • Transportation, Housing and Urban Development – Rep. Mario Diaz-Balart (FL-25)

NASTAD will continue to provide updates as additional appointments and nominations are announced.

NASTAD Joins Coalition Calling on Democratic Leadership to Prioritize State and Local Financial Relief

NASTAD signed onto a coalition letter urging the new Democratic congressional majority to pass legislation allocating $1 trillion in emergency funding for states, cities, towns, and schools. With state and local governments facing devastating revenue shortfalls, this funding is essential to maintaining the services that sustain our communities – public education, public health, public safety and much more. The coalition calls for $1 trillion in unrestricted funding -- free of any poison pills, conditions or limitations that undermine working people -- and an increase in the Federal Medical Assistance Percentage (FMAP).

Administrative Activity

HHS Releases HIV National Strategic Plan

On January 15, the U.S. Department of Health and Human Services (HHS) released the HIV National Strategic Plan for the United States: A Roadmap to End the Epidemic 2021-2025 (HIV Plan). The HIV Plan was developed collaboratively by federal partners from six federal departments and 12 HHS agencies and offices through a process led by the HHS Office of the Assistant Secretary for Health and its Office of Infectious Disease and HIV/AIDS Policy (OIDP). The HIV Plan and the Ending the HIV Epidemic: A Plan for America (EHE) initiative are closely aligned and complementary, sharing the overarching goal of reducing new HIV infections in the United States by 90% by 2030. EHE is an HHS initiative that is geographically focused on the jurisdictions with the highest number of new HIV diagnoses and will be a leading component of the work by the Department to implement the HIV Plan. The HIV Plan covers the entire country, has a broader focus across federal departments and agencies beyond HHS, seeks to engage all sectors of society, and addresses the integration of several key elements that are vital to our collective work to end the HIV epidemic, including stigma and discrimination, social determinants of health, and the syndemic of HIV, viral hepatitis, sexually transmitted infections, and substance use disorders. NASTAD submitted comments on the draft plan in December in 2020.

President-elect Joe Biden Announces Key Healthcare Appointments

President-elect Joe Biden is appointing key healthcare staff in the final days before the Biden-Harris administration readies for office. In addition to naming a group of scientists and experts to the White House Science Team, the Biden-Harris transition team announced the following key appointments:

  • Andrea Palm – Deputy Secretary of Health and Human Services
  • Dr. Rachel Levine – Assistant Secretary for Health

Andrea Palm is a veteran of the Obama administration and is currently leads the Wisconsin Department of Health Services. Dr. Rachel Levine currently serves as the Secretary of Health for the Commonwealth of Pennsylvania and is poised to become the first openly transgender federal official to be confirmed by the U.S. Senate. The Biden-Harris transition team is expected to announce the remaining key healthcare nominations and appointments in the coming weeks, such as the Administrator for Centers for Medicare and Medicaid Services (CMS).

NASTAD Joins Coalition Calling on the Biden Administration to End the Overdose Crisis and the War on Drugs

NASTAD and a coalition of 212 organizations signed onto a letter urging the Biden Administration and the Office of National Drug Control Policy (ONDCP) to take bold, decisive, evidence-based action that shifts the government’s response to substance use. The coalition calls for the administration to abandon criminalization as a means to address substance use, and instead ensure universal access to equitable evidence-based solutions rooted in racial and economic justice, and compassion. ​The war on drugs has a legacy in white supremacy and classism and has interfered with interventions proven to turn the tide on the overdose crisis and heal the traumas of criminalization.

NASTAD Joins Coalition Urging the Biden Administration to Repair the Title X Family Planning Program

NASTAD joined a coalition of 60 organizations to endorse a strategic approach for the Biden Administration to undo the harms leveraged against the Title X family planning program by the Trump Administration. The coalition calls for the incoming administration to undo the Title X “Gag Rule” and strengthen the Title X program by aligning programmatic requirements with evidence-based quality of care standards and reissuing grant awards to family planning providers that are committed to providing the highest quality of care.

HHS OASH and Office for Civil Rights Issue Letter Urging Medical Professional Schools to End Discriminatory Practices Against Students Living with HBV

In October of 2020, the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) and the Office for Civil Rights (OCR) released a Dear Colleague letter urging schools of medicine, dentistry, nursing, and other health professions to give renewed attention to their policies and practices to ensure that they are in compliance with federal civil rights laws and do not discriminate against students and applicants living with hepatitis B virus (HBV). NASTAD applauds the departments for clarifying that discrimination against people living with HBV in medical profession schools is prohibited under federal law.

HRSA HIV/AIDS Bureau Releases AIDS Education and Training Centers Program Report

The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau’s (HAB) Ryan White HIV/AIDS Program (RWHAP) AIDS Education and Training Centers (AETC) Program Annual Data Report, 2019 is now available on the HAB website at http://hab.hrsa.gov/data/data-reports. This publication reflects HRSA HAB’s ongoing commitment to ensuring the availability of timely program information. Through the use of this report, our recipients, stakeholders, and partners can access newly available data in a single publication. The report presents data for training events and event participants reported by the RWHAP AETC Program recipients from July 2014 through June 2019.

340B Administrative Dispute Resolution (ADR) Final Rule and Claim Submission Process

On December 10, 2020, the Health Resources and Services Administration (HRSA) released a long-awaited final rule that sets forth the requirements and procedures for the 340B Drug Pricing Program’s administrative dispute resolution (ADR) process. The ADR has important implications for Ryan White HIV/AIDS Program and Section 318 grantees and subgrantees participating in the 340B Drug Pricing Program, as it formally establishes a process to resolve: 

  • claims by 340B covered entities that they have been overcharged for covered outpatient drugs by manufacturers, and  
  • claims by manufacturers, after a manufacturer has conducted an audit as authorized by section 340B(a)(5)(C) of the Public Health Service Act, that a covered entity has violated the prohibition on diversion or duplicate discounts.  

  A HRSA FAQ reviewing the ADR final rule and claim submission process can be found here.  

Resources

Fact Sheet: Preparing for Long-Acting Antiretroviral Treatment

Following a December 2019 U.S. Food and Drug Administration (FDA) approval delay due to Chemistry Manufacturing and Controls (CMC) issues, the first long-acting antiretroviral product for HIV treatment is expected to be available in the U.S. in the first quarter of 2021. Cabenuva will be a co-packaged product containing cabotegravir and rilpivirine and is manufactured by ViiV Healthcare. Cabenuva will be delivered via monthly intramuscular injections that generally will need to be administered in a clinical setting. This novel maintenance therapy option may help to improve adherence and reduce stigma for some patients, but will require pharmacy and/or clinical delivery system and administrative adjustments for clinics and providers. 

In collaboration with the HIV Medicine Association (HIVMA) and the American Academy of HIV Medicine (AAHIVM), NASTAD developed a fact sheet highlighting delivery system, staffing, and administrative issues for clinics and clinicians to consider in preparing to provide patients access to this novel treatment modality. 

Webinar: Overdose Response Resource Walkthrough w/ Brave Technology Coop

Date and Time: Wednesday, January 27, 2:00-3:15pm ET

Please join NASTAD Drug User Health for a webinar with Brave Technology Coop on Wednesday, January 27, 2:00-3:15pm ET. Brave Technology Coop develops and administers technology-based tools to prevent and facilitate response to drug overdose, including the BeSafe Community remote supervision app. Gordon Casey and Oona Krieg from Brave will provide a walkthrough of existing tools and services and discuss ongoing collaborations to expand harm reduction capacity in local communities. Please click here to register for this webinar. After registering, you will receive a confirmation email containing information about joining the webinar.

Webinar: Virtual Condom Distribution as a Structural Intervention

Dates: February 8 – 9, 2021

Registration is now open for the NASTAD workshop, “Condom Distribution as a Structural Intervention,” being held through our Capacity Building Assistance (CBA) program. The workshop will be hosted through two interactive virtual sessions on February 8-9, 2021. This workshop is designed for HD HIV prevention program staff and CBO staff. Moreover, the workshop is open ONLY to participants from CDC directly-funded HDs and CBOs in the Southern CBA region of the U.S. Registration will be open through February 1, 2021.

Condom distribution programs remain a crucial component of the HIV response. Effective programs can increase condom use, while preventing transmission of HIV and other STIs. Given the focus of Ending the HIV Epidemic by 2030, Health Departments (HDs) and Community Based Organizations (CBOs) are in a unique position to promote innovative strategies and address persisting gaps in condom distribution programs.

Job Postings

HIV/STD Epidemiologist – Augusta, ME

The University of Southern Maine seeks applicants for a full-time, soft-money funded scientific professional position for statewide epidemiological support, program coordination, and leadership focusing on for HIV and sexually transmitted diseases (STD). Responsibilities include statewide surveillance for HIV and other STDs, education and outreach activities focused on prevention of HIV and STD transmission, and participation in routine and outbreak infectious disease monitoring and response activities. Candidates must develop and maintain technical expertise in the subject area, and coordinate, design, develop, evaluate, implement, and oversee programmatic interventions. Strong written and oral communication skills are needed along with knowledge of epidemiology, statistics, outbreak response, and data management. Work is performed under administrative direction. Work location will be Augusta, Maine Center for Disease Control and Prevention with travel to remote work sites around the state.

Senior Associate, Health Equity – Washington, DC

NASTAD is seeking a Senior Associate for the Health Equity team. The Senior Associate, Health Equity plays an essential role in supporting the implementation and dissemination of evidence-based interventions identified by NASTAD's Center for Innovation and Engagement (CIE). CIE is leading a collaborative partnership with Northwestern University's Center for Prevention Implementation Methodology and Howard Brown Health Center to identify, catalog, disseminate, and support the replication of evidence-informed approaches and interventions to engage people living with HIV (PLWH) who are not receiving HIV care or who are at risk of not continuing to receive HIV care. The project's end goal is to support the replication of identified interventions into real-world implementation by Ryan White HIV/AIDS Program (RWHAP) and HIV care providers.

STD Epidemiology and Surveillance Team Lead – Texas

The Texas Department of Health Services is seeking a STD Epidemiology and Surveillance Team Lead in the STD/Hepatitis C Epidemiology and Surveillance Group of the HIV/STD/HCV Epidemiology and Disease Surveillance Branch. Under the supervision of the group manager the Epidemiologist III performs highly advanced senior-level research and epidemiological work requiring specialized knowledge of STD surveillance. Designs and conducts advanced epidemiological research, evaluating populations and their risk factors for STDs using data from the STD reporting systems and other large data sets in the Epidemiology and Surveillance Branch. Prepares and presents research findings on STD issues in reports, professional journals, national conferences, and state meetings. Plan, assign, and/or supervise the work of others. Works under minimum supervision with extensive latitude for the use of initiative and independent judgment. This posting closes on April 20, 2021.

  Ending the HIV Epidemic Treatment Coordinator – Tarrant County, TX

The Ending the HIV Epidemic Treatment Coordinator oversees implementation of the Ending the HIV Epidemic grant activities for the Tarrant County HIV Administrative Agency. This position focuses on operational functions while working with community partners and sub-recipients to drive changes impacting the lives of more than 6,000 clients living with HIV. The Coordinator will assist with preparing the grant application, developing the workplan, overseeing grant-related reporting, monitoring the budget, and supervising Ending the HIV Epidemic staff. The posting may close at any time.

Open Positions – New York State

The New York State Department of Health, in partnership with Health Research, Inc, has various job openings, including some within the AIDS Institute. Please visit this link to learn about their current opportunities.

News Bulletin

Combination of two drugs can help treat methamphetamine addiction for some, new clinical trial data shows

“…in a new study, researchers found that a combination of two existing drugs — one, a treatment for opioid addiction, and the other, an antidepressant — can help some people who use methamphetamine regularly cut back. In a clinical trial, the researchers reported Wednesday, 13.6% of participants treated with the two drugs had repeated urine tests free of methamphetamine, compared to just 2.5% of those who were given placebos.”

Drug makers sue HHS over a discount program serving low-income populations

“In a clutch of lawsuits, three drug makers argue the federal government is wrong to insist they must provide discounts on medicines to pharmacies that work with hospitals and clinics that serve primarily low-income populations. The claims made by AstraZeneca (AZN), Sanofi, (SNY), and Eli Lilly (LLY) follow a recent advisory opinion issued by the Department of Health and Human Services, which maintained drug companies were wrong to curtail price breaks required as part of the 340B drug discount program.”

Trump administration to let more doctors prescribe drug to fight opioid addiction

“The Trump administration introduced new addiction treatment guidelines Thursday that give physicians more flexibility to prescribe a drug to patients struggling with opioid addiction. The Department of Health and Human Services is eliminating the requirement that physicians obtain a special federal waiver in order to prescribe buprenorphine, a medication to treat opioid use disorder. Previously, doctors had to take an eight-hour course to receive the license, called the "X-waiver." The obstacle discouraged doctors from pursuing buprenorphine as an addiction treatment for patients, despite evidence it was highly effective in preventing a relapse, advocates for the change have long said.”