Policy Updates: Hill Happenings and Administration Activities

By Julio Contreras July 12, 2021

Hill Happenings

FY2022 Appropriations 

Congressional Appropriators are working quickly to draft and markup federal spending bills for fiscal year 2022 (FY2022). Appropriators are aiming to allocate funding for federal agencies and programs ahead of a September 30 funding deadline, but some lawmakers are anticipating that a protracted appropriations negotiations process in the Senate may necessitate the adoption of a continuing resolution to keep the government open as lawmakers work out an agreement. 

House Appropriators released the text of FY2022 spending bills on Sunday, July 11, ahead of a packed week of subcommittee and full committee markups. On July 12, the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies (L-HHS) passed the FY22 L-HHS funding bill during a markup by a voice vote with no amendments taken. The House Appropriations Committee will now hold a full committee vote for the bill on July 15.

For FY2022, the subcommittee is proposing to fund the Department of Health and Human Services (HHS) at $119.8 billion, an increase of $22.9 billion above FY2021 and $129 million below the President’s budget request. The bill funds the Centers for Disease Control and Prevention (CDC) at $10.6 billion, an increase of $2.7 billion above the FY 2021 enacted level and $1 billion above the President’s budget request. Notably, the L-HHS funding bill did not include any restrictions on the use of federal dollars to purchase syringes and sterile injection equipment. Other priority funding areas include:  

  • CDC National Center for HIV, Hepatitis, STDs, and TB Prevention
    • Funded at $1.5 billion, an increase of $187.6 million  
      • CDC Ending the Epidemic Initiative (EHE) funded at $275 million, an increase of $100 million  
  • Health Resources and Services Administration (HRSA)  
    • Ryan White Program 
      • Funded at $2.7 billion, an increase of $231 million
      • Ryan White EHE programs are funded at $190 million, or an $85 million increase
    • Health Centers EHE
      • Health Centers are funded at $152 million, an increase of $50 million 
  • Minority AIDS Initiative
    • Funded at $58.4 million, a $3 million increase
  • Housing Opportunities for Persons with AIDS (HOPWA)
    • Funded at $600 million, an increase of $170 million 

Senate Appropriators have yet to release any FY2022 funding bills. NASTAD will continue to monitor the FY2022 appropriations process to advocate for the highest funding levels on behalf of HIV and hepatitis programs. 

Senate Confirms Delphin-Rittmon, Ph.D. to Serve as SAMHSA Administrator  

On June 24, the Senate confirmed the nomination of Dr. Miriam Delphin-Rittmon, Ph.D., to serve as the Assistant Secretary for Mental Health and Substance Use at HHS and the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). Delphin-Rittmon will play a key role in the Biden Administration’s response to the worsening mental health and substance use crisis. Delphin-Rittmon was formerly the Commissioner of the Connecticut Department of Mental Health and Addiction Services.

Administrative Activities

Biden Administration Moves to Strengthen ACA and Boost Enrollment 

On July 1, the Biden Administration proposed rulemaking that would expand annual enrollment for Marketplace coverage, bolster the Navigator program, and reverses Trump-era changes to the 1332 waiver process. The proposed rule would expand the open enrollment period for an additional 30 days and removes limitations on sign-up periods for Americans who earn under 150% of the federal poverty level. Additionally, the proposed rule would reinstate requirements for health plan Navigators to provide detailed information on coverage and patient protections, including post-enrollment assistance. Finally, the rule limits changes to Section 1332 of the Affordable Care Act, which the Trump administration leveraged to allow states to opt out of the marketplace and sell health plans through private brokers. Comments are due July 28. The proposal marks one of the Biden Administration’s efforts to strengthen the ACA after the Supreme Court upheld the health law’s legality in June of 2021. 

Additionally, on July 1, Centers for Medicare & Medicaid Services (CMS) announced that consumers who received or have been approved for unemployment compensation in 2021 are now eligible for lower cost health plans. CMS also announced that Special Enrollment Period for the COVID-19 health emergency has been extended through August 15. The changes were financed through the American Rescue Plan, the Biden Administration’s COVID-19 relief package that passed earlier this year.

Biden Administration Finalizes Rule Expanding Mobile Methadone Delivery 

On June 28, the Biden Administration published a final rule that revises restrictions on narcotic treatment programs that prevented the use of mobile vehicle delivery to dispense methadone. The rule is designed to increase access to maintenance or detoxification treatments for people living with addiction, particularly for people who use drugs that live in rural areas. Under the updated guidelines, all narcotic treatment programs may operate mobile units to prescribe and dispense treatment if a licensed physician is on board.

White House Announces New Transgender Equity Initiatives and Resources 

On June 30, the White House highlighted actions that the Biden Administration is taking to advance equality for Transgender Americans. The Biden Administration announced the creation of a new White House-led Interagency Working Group on Safety, Inclusion, and Opportunity for Transgender Americans under the White House Domestic Policy Council and Gender Policy Council. The Working Group will review policies that perpetuate violence and poverty for transgender individuals, including homelessness, employment discrimination, violence and abuse, and bullying and rejection at school.  

Additionally, the Administration released a White House Toolkit on Transgender Equality. The toolkit compiles recent announcements across federal agencies that uphold the rights of Transgender individuals, including an explainer on how to file discrimination complaints. The toolkit also includes best practices for advancing health equity for Transgender individuals, which includes guidance for collecting, analyzing, and reporting on data on sexual orientation, gender identity, gender expression, and intersex status to identify the needs and experiences of diverse communities.

Biden Administration Moves to Stop Surprise Billing 

On July 1, the Biden Administration issued an interim final rule with comment period that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. The interim final rule bans surprise billing for emergency services, bans high out-of-network cost-sharing for emergency and non-emergency services, and modifies other patient notification requirements to safeguard patients from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses. Comments are due by September 11, 2021. The interim final rule is the first of several regulatory requirements promulgated by the “No Surprises Act” of the 2021 Consolidated Appropriations Bill.  

Resources

NASTAD Resource: Recommendations for Federal Partners and Health Departments Navigating Naloxone Supply 

This resource provides recommendations and strategies for how federal partners and health departments can best support SSPs and harm reduction programs that may be experiencing naloxone supply disruptions, such as assessing naloxone distribution needs among SSPs, coordinating jurisdictional naloxone supply sharing, prioritizing SSPs for naloxone supply, and ensuring flexibility with funds used to purchase naloxone.  This resource was developed by NASTAD’s Drug User Health Team, in consultation with harm reduction consultants that have been instrumental in creating access to low-cost naloxone for syringe services programs (SSPs) and people who use drugs (PWUD) across the country. 

NASTAD Webinar: Scaling Up HIV Workforce Capacity for Ending the HIV Epidemic 

Date & Time: Wednesday, July 21 from 2:00 – 3:00 pm ET 

Summary: In this final webinar, presenters will emphasize the importance of community representation in the workforce. Black AIDS Institute will offer strategies on how to develop the skills of community members for long term involvement and contribution as illustrated through their pilot HIV Certificate Program. They will also share how their Health Department Initiative provides training and capacity building assistance to support health department efforts to provide culturally appropriate HIV services within Black communities. The Arkansas Department of Health, an Ending the HIV Epidemic (EHE) Phase 1 Jurisdiction, will discuss their approach to navigating challenges related to health department hiring policies and practices through their Community Connector Project and a Community Connector will share their experience of working with the program.

CAP Webinar: Beyond Medication – Humanizing the National HIV Response 

Date & Time: July 14 from 2:00 – 3:00 pm ET 

Summary: For decades, networks of people living with HIV have advocated for an HIV national strategy that goes beyond a biomedical response to the epidemic—one that incorporates quality of life and care for people living with HIV and meaningfully involves the leadership and expertise of people living with HIV in its planning and implementation. Please join us for a discussion with the Positive Women’s Network-USA, U.S. People Living with HIV Caucus, New York Transgender Advocacy Group, and the National Working Positive Coalition on the People Living with HIV Networks Federal Policy Agenda.

HCMSG Webinar: Eliminating Hepatitis C: From the Clinic to the Streets 

Date & Time: Wednesday, July 28 at 4:00 – 5:00 PM ET 

Summary: HCMSG is hosting a webinar addressing the impact of Hepatitis C in underserved and overlooked populations. Hear directly from our medical providers at HCMSG about some of the real world challenges we face in order to reach elimination. We invite patients, providers, peers, and community based organizations to join us. 

2021 Midwest LGBTQ Health Symposium 

Date: September 29-30 

As part of the HRSA-funded Special Project of National Significance (SPNS): Evidence-Informed Approaches to Improving Health Outcomes for People Living with HIV, Howard Brown Health will host the virtual 2021 Midwest LGBTQ Health Symposium taking place on September 29-30. This year's theme is Community Informed Care is a Radical Act. The goal of the conference is to provide a space for healthcare professionals, educators, researchers, and advocates from across the country to disseminate evidence-based practices and engage in rigorous discussion around issues relating to the health of the lesbian, gay, bisexual, transgender, and queer communities. 

CDC MMWR: Unexpected Hepatitis B Virus Infection After Liver Transplantation 

Job Postings

Assistant, Program and Policy – Remote/Washington, DC 

The Assistant, Program and Policy will support NASTAD’s program and policy teams by providing administrative and logistical support for the Senior Directors/Directors. The ideal candidate will be motivated, highly organized, and able to follow through on tasks with minimal prompting. Demonstrated ability to execute projects in a timely manner and precise attention to detail are required.  

NASTAD Senior Associate, Prevention – Remote/Washington, DC 

The Senior Associate, Prevention, as part of NASTAD’s Prevention team, supports the organization’s capacity to support health departments’ (HDs) implementation of Ending the HIV Epidemic plans. The position works primarily on NASTAD’s CDC-funded “Strategic Partnerships and Planning to Support Ending the HIV Epidemic in the United States” (PS19-1906 Component A) project to provide technical assistance to HDs implementing CDC PS20-2010 Component A.

NASTAD Senior Director, Public Health Systems – Remote/Washington, DC 

The Senior Director, Public Health Systems, provides leadership and direction to NASTAD’s health care access (HCA) and health systems integration (HSI) efforts. This position leads the HCA and HSI teams providing direct supervision to these teams’ directors and the overarching work of the teams regarding programmatic, technical assistance, and capacity building activities. 

New Hampshire Bureau of Infectious Disease Control 

  • ID Care Services Program Manager (Public Health Program Manager #43569, Job ID 20909): This full-time position leads the dynamic NH Ryan White CARE Program and NH TB Financial Assistance Program teams. 

  • HIV Surveillance Coordinator (Program Specialist III #18990, Job ID 21123): This full-time epidemiologist position is responsible for HIV/AIDS case and cluster/outbreak surveillance activities, develops routine and ad hoc reports and data analysis projects, and supports related health equity initiatives.  

  • STD Surveillance Statistical Assistant (Statistical Assistant #19623, Job ID 21093): This full-time position is responsible for supporting STD case surveillance activities, communicating with healthcare providers, and conducting preliminary data analyses. 

  • Viral Hepatitis Coordinator (Health Promotion Advisor #42860 , Job ID 20743): This full-time position is responsible  for coordinating state-wide viral hepatitis activities including prevention, testing, treatment and linkage to care activities.  

  • ID Care Services Quality Management Specialist (Program Specialist IV #9T2810, Job ID: 19231). This full-time position plans and evaluates the quality management areas of the NH Ryan White CARE Program. Provides subject matter expertise with regard to quality improvement methodology and HIV specific performance measures, to demonstrate measured improvements in HIV care across NH.  

  • COVID-19 Public Health Nurse Specialist (Public Health Nurse Specialist #9T2809, Job ID 20592). This full-time registered nurse position will join a multi-disciplinary team responsible for COVID-19 case investigation, contact tracing and outbreak response. 

Statewide Deputy Medical Director, HIV/STD/Vi ral Hepatitis -- Nashville, Tennessee 

Primary responsibilities include leadership and oversight of programs related to HIV prevention and treatment in Tennessee. This position will supervise and provide mentorship to the directors of HIV Prevention and Surveillance and the Ryan White Part B program. Utilize data to guide program and policy development and will provide clinical and programmatic oversight for the implementation of all related prevention and treatment activities. Requires management and leadership skills. 

Assistant Commissioner - Health Department – Baltimore, Maryland 

The Baltimore City Health Department (BCHD) is seeking an Assistant Commissioner to lead the Bureau of Communicable Disease and Outbreak Control. This senior management position will lead a talented team responsible for communicable disease investigation, outbreak control and emergency preparedness programming. The incumbent will also be responsible for developing and implementing agency wide policies related to health department readiness to respond to public health emergencies. The incumbent will report directly to the Deputy Commissioner for BCHD’s Division of Population Health & Disease Prevention. 

Communicable Disease Epidemiologist – Cheyenne, Wyoming 

This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program.  Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, analyzing exposure data utilizing epidemiological and statistical methods. 

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

'This will shut us down': HIV prevention clinics brace for Gilead reimbursement cuts 

“But now clinics like this that provide vital HIV prevention services to disadvantaged populations are facing a dire — and for some of these nonprofit groups, even existential — financial crisis driven by the vagaries of an arcane federal law governing prescription drug discounts. These safety net clinics are set to lose well over $100 million in annual HIV prevention funds due in part to a recent decision by the pharmaceutical giant Gilead Sciences to cut off what has become an increasingly valuable revenue stream supporting these organizations in their grassroots efforts to prevent the virus’s spread. The consequences are expected to be most devastating to clinics in the South, due to the region’s disproportionately large uninsured population and the fact that half of HIV transmissions in the United States occur in those states.”  

A CDC Investigation Says West Virginia Needs Needle Exchanges — Which The State Outlawed — To Stop Its HIV Outbreak 

“A dangerous HIV outbreak in Charleston, West Virginia, will require “low-barrier” needle exchanges to stop the disease from spreading, according to a preliminary CDC investigation obtained by BuzzFeed News. The only problem is that new state and city laws banned those needle exchanges in April. The CDC’s investigation into the HIV outbreak in Charleston comes as the city of 48,000 has emerged as the fiercest battleground in a nationwide reckoning over syringe exchanges, long shown to stop HIV outbreaks among people who use drugs. Needle exchange locations have recently faced shut down efforts in Indiana, California, and New Jersey, despite fears of more HIV outbreaks amid a nationwide epidemic of injection drug use.” 

Plugging Obamacare’s biggest hole poses dilemma for Democrats 

“Democratic lawmakers are grappling with how to extend health insurance to millions of poor Americans in states that have refused Obamacare’s Medicaid expansion, believing their upcoming party-line “human infrastructure” package represents the best chance to plug the health law’s biggest gap. After months of behind-the-scenes discussions, Democrats are coalescing around three options for closing the coverage gap in the Medicaid expansion holdout states, according to nine sources on and off the Hill. These approaches, which would leverage the existing Obamacare insurance marketplaces or require the Biden administration to create a new coverage program, each carry risks. And lawmakers still don’t see a clear path forward as they face a narrowing window to assemble a massive package of Democratic priorities.” 

Giving blood has been off limits for many gay men. A new study could help change that 

“Men who have sex with men have long faced restrictions on giving blood in the United States, amid concerns about the disproportionate toll of HIV/AIDS on gay and bisexual men. Decades ago, as AIDS began devastating gay communities, the Food and Drug Administration advised blood centers to prohibit any man who had had sex with another man since 1977 — even once — from donating.”