Policy Updates: Hill Happenings and Administration Activities

By Julio Contreras November 1, 2021

Hill Happenings

Build Back Better Act and Budget Reconciliation

Democrats are working to resolve lingering internal disagreements and advance the Build Back Better Act through budget reconciliation. On October 28, the White House released a $1.75 trillion framework for the Build Back Better Act ahead of a House Rules Committee hearing on the bill, when House Democrats released draft legislative language. The White House negotiated the scaled-down legislative framework with centrist Democrats who blocked key policies, such as empowering the Department of Health and Human Services (HHS) to negotiate the price of certain prescription drugs. 

The new Build Back Better Act framework would expand access to affordable coverage by bolstering Marketplace plans. The bill includes provisions that would:

  • Temporarily close the Medicaid coverage gap until 2025 by providing Affordable Care Act (ACA) premium tax credit eligibility and cost-sharing reductions to people with low incomes in states that did not expand Medicaid. Earlier provisions that would have permanently closed the Medicaid coverage gap by launching a federal Medicaid program in 2025 were removed in negotiations.
  • Extend the ACA premium tax credits that were authorized by the American Rescue Plan Act through 2025, increasing access to coverage and lower premiums for current enrollees.
  • $75 million for the Ryan White HIV/AIDS Program

Despite the reduced scope of the healthcare provisions in the Build Back Better Act, the legislation would mark the most significant health care expansion since the Affordable Care Act.

FY2022 Appropriations

Fiscal Year 2022 (FY2022) spending discussions are temporarily on hold as Democrats work to quickly finalize the Build Back Better Act. Lawmakers must pass a bipartisan appropriations package by the December 3 funding deadline afforded by the current continuing resolution. On October 27, Acting Director of the Office of Management and Budget sent a letter to House of Representatives Appropriations Committee Chair Rosa DeLauro (D-CT-03), urging lawmakers to avoid issuing another continuing resolution and enact spending levels for the full fiscal year. NASTAD will continue to monitor the FY2022 appropriations process to advocate for the highest funding levels on behalf of HIV and hepatitis programs.

Administrative Activities

HHS Releases New Opioid Overdose Prevention Strategy

On October 27, HHS released the Biden Administration’s Overdose Prevention Strategy. The new strategy takes a polysubstance approach to the overdose crisis and prioritizes four key target areas: primary prevention, harm reduction, evidence-based treatment, and recovery support. Notably, the plan provides coordinated, federal support for harm reduction and seeks to expand sustainable funding strategies for harm reduction services. Additionally, the plan aims to maximize health equity for underserved populations and reduce stigma around drug use.

Resources

CDC NOFO: Enhanced Surveillance of Persons with Early and Late HIV Diagnosis

The Centers for Disease Control and Prevention (CDC) has issued a notice of funding opportunity (NOFO) for supplemental HIV surveillance activities that will improve understanding of barriers and gaps in HIV prevention services that may lead to continued HIV transmission or delayed diagnosis in the era of multiple testing modalities and prevention options such as PrEP. This NOFO will support health departments in conducting enhanced public health surveillance of people diagnosed with HIV during the earliest and latest stages of infection (stages 0 and 3, respectively). It is an effort to understand their recent experiences with HIV prevention and testing services and the system- and individual-level barriers that led to failures in early diagnosis and prevention.

CDC DHP Success Stories: HIV Cluster Detection and Response in Action: Stories from the Field

“Using new tools and strategies, public health departments can detect and respond to “clusters” and “outbreaks” of HIV infections faster than ever before. These techniques allow public health officials to bring services and support to affected communities and prevent new infections. HIV cluster detection and response (CDR) represents a key pillar in the federal government’s initiative, Ending the HIV Epidemic in the U.S. The level of response can be scaled up or down to address the needs of a particular cluster or outbreak. With the help of communities across the country, CDC has produced three stories from the field that demonstrate the benefits of CDR work, including how the different outbreak investigations have catalyzed positive, long-lasting change and improved local HIV prevention services. The stories come from Lawrence and Lowell, Mass., San Antonio, Tex., and Minneapolis, Minn.”

HRSA Releases Three Funding Opportunities that Focus on HIV and Aging

On October 26, 2021, the Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) released three notices of funding opportunities (NOFOs) related to HIV and aging. While utilizing HRSA HAB Special Projects of National Significance and implementation science frameworks, the funded organizations will identify, refine, evaluate, and disseminate emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial concerns of people 50 years and older with HIV within the context of the RWHAP. 

SAMHSA 2020 National Survey on Drug Use and Health

On October 26, the Substance Abuse and Mental Health Services Administration (SAMHSA) released findings from the 2020 National Survey on Drug Use and Health (NSDUH). Survey respondents reported that the COVID-19 pandemic adversely impacted their mental health, including exacerbating use of alcohol or drugs among people who had used drugs in the past year.

USPSTF JAMA Article: USPSTF Approach to Addressing Sex and Gender When Making Recommendations for Clinical Preventive Services

“Authored by members of the Task Force, this article asserts that research studies of clinical preventive services often do not fully consider biological sex and gender identity, leaving the Task Force without the data necessary to offer more nuanced recommendations. The article calls for all clinical research to adopt a more inclusive approach to considering and reporting the sex and gender of study participants and outlines the steps the Task Force is taking now to update the way it addresses sex and gender in its recommendations.”

AIDS United NOFO: Syringe Access Fund

The Syringe Access Fund is a collaborative grant-making initiative that seeks to reduce the health, psychosocial and socioeconomic disparities experienced by people who use drugs. The Syringe Access Fund invests in evidence-based and community-driven approaches to prevent the transmission of both HIV and viral hepatitis, reduce injection-related injuries, increase overdose prevention and reversal efforts, and connect people who use drugs to comprehensive prevention, treatment, and support services. The application process for begins with the submission of a Letter of Inquiry, due on Nov. 5, 2021, at 5 p.m. EDT. Please find more information, including details on eligibility, process and key dates, in the Request for Letters of Inquiry linked here.

HRSA NOFO: Ending the HIV Epidemic - Primary Care HIV Prevention

Application Deadline: Tuesday, December 14

TA Webinar: Thursday, October 28 at 2 pm ET

HRSA released the fiscal year (FY) 2022 Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP) Notice of Funding Opportunity (HRSA-22-104). HRSA will invest approximately $50 million in health centers located in the targeted geographic locations where a majority of new HIV infections occur, as identified by the Ending the HIV Epidemic in the U.S. initiative. FY 2022 PCHP will support expanding HIV prevention services that decrease the risk of HIV transmission in underserved communities, focusing on supporting access to and use of pre-exposure prophylaxis (PrEP). Health centers with service delivery sites in the targeted geographic locations that did not receive FY 2020 PCHP or FY 2021 PCHP funding will be eligible to apply. Technical assistance (TA) resources are available on the PCHP TA webpage.

Job Postings

Senior Project Manager, HIV, Gender Affirming, and Integrated Care – New York City, New York

Primary Care Development Corporation (PCDC), a nationally recognized 501(c)(3) community development financial institution (CDFI), catalyzes excellence in primary care through strategic community investment, capacity building, and policy initiatives to achieve health equity. The Senior Project Manager will be a member of the High Impact Prevention (HIP) project team and will work across the broader CQP practice.

PCDC’s CDC-funded High Impact Prevention (HIP) program provides support to communities greatly impacted by HIV. With CDC and other national partners, the HIP Program enhances the expertise of the HIV prevention workforce – including health care providers and staff in local and state health departments and community-based organizations (CBOs) – to achieve the United States’ goal of substantially reducing the number of new HIV infections. The PCDC HIP Program serves the Northeast region of the US and the territories of Puerto Rico and US Virgin Islands.

Public Health Investigator Manager – Houston, Texas

This position will report to the Bureau Chief and will oversee the HIV prevention program primarily funded through a cooperative agreement with the US HHS Centers for Disease Control and Prevention (CDC).  The successful applicant will manage a variety of projects/programs in specialized public health area(s) to enhance prevention, care and support services as well as collaborating with stakeholders including people living with HIV, state and local health departments, HIV service providers, subject matter experts and others to evaluate and improve HIV prevention, care, and treatment provision within the City of Houston and Harris County. Applications close November 6.

Public Health Specialist 2 – Anchorage, Alaska

Working as a Public Health Specialist 2 (PHS II) HIV Prevention Coordinator in the HIV/STD Program offers you a rare opportunity to help develop and implement policies, protocols, procedures, and services around HIV prevention activities in the State. You will help assure that services are based on scientific findings and best practices that are adaptable to Alaska’s specific needs. You will provide expertise on HIV Prevention practices, including helping individuals to enter and stay in care, to both improve their health and reduce the likelihood of HIV transmission. Applications close November 22.

New Hampshire, Department of Health and Human Services, Division of Public Health Services

  • Public Health Program Manager/Ryan White Care Program Manager
    • #43569 (search Job ID 22642)
    • Supervises and monitors the NH Ryan White Human Immunodeficiency Virus (HIV) CARE Program (NH CARE Program) and the NH Tuberculosis Financial Assistance (TBFA) Programs with responsibility for coordinating all aspects of program services and developing goals, objectives and performance improvement measures for a statewide continuum of TB and HIV care.
  • Program Specialist IV/Ryan White Care Program Quality Management Specialist
    • #9T2810 (search Job ID 22333)
    • 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.  
  • Infectious Disease Care Coordinator
    • #9T3153(search Job ID 22634)
    • Reviews, modifies and implements program policies and procedures related to prevention of transmission of human immunodeficiency virus (HIV) and sexually transmitted diseases (STD), hepatitis C (HCV), COVID-19, and other infectious diseases among high-risk populations.
  • Infectious Disease Care Coordinator
    • #9T3152 (search Job ID 22631)
    • Reviews, modifies and implements program policies and procedures related to prevention of transmission of human immunodeficiency virus (HIV) and sexually transmitted diseases (STD), hepatitis C (HCV), COVID-19, and other infectious diseases among high-risk populations.

Wyoming Department of Health, Public Health Division, Communicable Disease Unit

  • Communicable Disease Unit Surveillance Program Manager – Cheyenne, Wyoming
  • The Wyoming Department of Health, Public Health Division, Communicable Disease Unit is seeking a Communicable Disease Surveillance Program Manager for Cheyenne. This position will serve as the Communicable Disease (CD) Surveillance Program Manager and senior epidemiologist for the Communicable Disease Unit. This position oversees public health surveillance of four disease areas (HIV, STD, TB, and Viral Hepatitis).  This position will monitor disease trends and utilize surveillance data to coordinate public health activities.  
  • 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.

Public Health Informaticist, California Department of Public Health – Richmond, CA

The Public Health Informaticist position is assigned to the California Department of Public Health (CDPH), Sexually Transmitted Disease (STD) Control Branch, and is located at the CDPH campus in Richmond, CA, with consideration for a telework schedule. Under the general supervision of the STD Control Branch, Surveillance and Data Management Unit Chief, the Informaticist supports the design and implementation of disease prevention and control activities related to HIV, STDs, and viral hepatitis (especially hepatitis C virus (HCV)). 

Hepatitis Surveillance Data Analyst – New Orleans, Louisiana

This position is responsible for the data analysis activities for the Louisiana Office of Public Health STD/HIV/Hepatitis Program (SHHP), in the Hepatitis Surveillance unit. Data utilized for Hepatitis Surveillance activities include Hepatitis laboratory data, Case Report Forms, Provider Report Forms, Linkage to Cure data, investigation data, Medicaid data, and data from related sources and programs. This position will implement and coordinate data analysis activities to monitor and evaluate progress toward meeting hepatitis elimination within the state. All activities must be completed in accordance with the security and confidentiality guidelines required by the Centers for Disease Control and Prevention (CDC) and SHHP.

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.   

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

De Blasio administration pushes to approve supervised injection sites

“The New York City health department is “moving aggressively” to green-light a long-stalled pilot program to open at least two supervised injection facilities aimed at reducing overdose deaths, according to four people with knowledge of the plan.

The pilot to approve and fund the facilities is seen by some as controversial because of the stigma of drug users openly injecting illegal substances and fears of federal prosecution. It failed to get off the ground since the City Council funded a feasibility study in 2016 and the latest push comes as Mayor Bill de Blasio eyes a gubernatorial run…Now, de Blasio is using his last 10 weeks in office to direct his health department to coordinate with the state and the federal government to implement the pilot, the sources said, requesting anonymity to speak on the matter ahead of an official announcement.”

How Harm Reduction Can Help Win the Fight Against Opioids

“Last year, nearly 70,000 people in the United States died of opioid-related overdoses, up from 49,860 in 2019—a rise driven by synthetic opioids. Despite three years of aggressive enforcement-based attempts to target the trafficking of these drugs, opioids increasingly dominate illicit markets across the country. The current approach is failing both to reduce supply and to prevent deaths. Furthermore, it has health and criminal justice consequences of its own, especially in communities of color. It’s time for a different response.”

The Persistence of PrEP: Essential for Ending HIV

“…It is well known that PrEP adherence is directly related to efficacy. Thus, a barrier that should be addressed is the ability to remain on PrEP after initiation, referred to as PrEP persistence. PrEP persistence is also defined as the length of time a person continues to refill PrEP prescriptions without an interruption of more than 30 days.”