Policy Updates: Hill Happenings and Administration Activities

By Julio Contreras November 8, 2021

Hill Happenings

Build Back Better Act and Budget Reconciliation 

Democrats are working to quickly advance the Build Back Better Act (BBB) after months of internal negotiations. The broad-reaching social spending package is being advanced through budget reconciliation, requiring consensus within the Democratic caucus to advance the BBB. On November 3, House Democrats released revised bill text, updating the BBB with provisions that were newly negotiated. 

Notably, the updated House version of the BBB includes a provision to lower the cost of pharmaceutical drugs in Medicare Part D by empowering the Secretary of the Department of Health and Human Services (HHS) to directly negotiate prices with drug manufacturers. The drug price negotiation plan was reintroduced after Democratic leadership negotiated a compromise with centrist holdouts that that were opposed to the original provision. Additionally, the BBB 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 subsidizing private coverage for people with low incomes living in states that did not expand their Medicaid programs. 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 lowering premiums for current enrollees.  
  • $75 million for the Ryan White HIV/AIDS Program. 

However, it is unclear whether the House version of the BBB will receive enough votes in the Senate to pass. Despite the uncertainty, House Democrats are forging ahead in an effort to end the protracted negotiations and pressure the upper chamber to advance the BBB on the heels of Democrat’s successful bipartisan infrastructure package.   

FY2022 Appropriations 

Fiscal Year 2022 (FY2022) spending discussions are sidelined as Democrats work to quickly finalize the BBB. Lawmakers must pass a bipartisan appropriations package by the December 3 funding deadline afforded by the current continuing resolution (CR). On November 2, the House and Senate Appropriations Committee chairs and ranking members convened to establish a bipartisan framework for the FY2022 spending package. However, the appropriators did not reach an agreement, complicating Democrats’ strategy to promptly fund the government for the full fiscal year and avoid having to issue another CR. 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 

ACIP Issues Recommendation on Adult HBV Vaccination  

On November 3, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) convened to vote on the proposal to recommend universal hepatitis b (HBV) vaccination for adults. ACIP unanimously voted to recommend the preventive vaccination for all adults ages 19-59, but maintained the current risk-based guidelines for vaccinating adults aged 60 and older. The ACIP vote will facilitate greater vaccine uptake among adults, helping to prevent disease transmission and outbreaks. Advocates applauded the decision, highlighting that ACIP’s vote will reduce health disparities by increasing affordable or cost-free access to the vaccine and accelerate efforts to eliminate viral hepatitis by 2030. NASTAD supported the universal adult HBV vaccination recommendation and submitted comments in favor of the recommendation.  

Senate Confirms Dr. Rahul Gupta to lead the Office of National Drug Control Policy 

On October 28, the United States Senate confirmed the nomination of Dr. Rahul Gupta to lead the White House Office of National Drug Control Policy (ONDCP). He will be the first primary care physician to lead ONDCP. In this role, Dr. Gupta will oversee the development of the Biden Administration’s upcoming National Drug Control Strategy and play a significant role in responding to the opioid and overdose crisis. Prior to joining ONDCP, Dr. Gupta was the senior vice president and chief medical and health officer at the March of Dimes and served under two Governors as the Health Commissioner of West Virginia, where he led the state’s opioid crisis response efforts. 

USPSTF Releases Draft Research Plan to Update PrEP Recommendation 

On November 4, the United States Preventive Services Task Force (USPSTF) posted a Draft Research Plan on pre-exposure prophylaxis (PrEP) for the prevention of HIV infection. The Draft Research Plan is available for review and public comment from  
November 4, 2021 through December 8, 2021. The draft research plan initiates the process for updating the current USPSTF recommendation for PrEP, which was designated an A grade in 2019.  

Resources 

NOFO: Expanding Syringe Services Programs Capacity to Respond to COVID-19 

Webinar: Friday, November 12 from 3:30 – 5 PM EST 

In 2021, as part of the COVID-19 response under the American Rescue Plan Act and in partnership with the collaborative centers within the CDC, resources to support SSPs and expand their overall capacity to provide COVID-19 vaccination, education testing, and expanded services for additional adult vaccination were awarded to NASTAD and AIDS United. This one-year demonstration project, with expanded authority to extend its impact beyond the first year, aims to strengthen the capacity of SSPs to serve as critically essential access points for COVID-19 vaccination services, general COVID-19 response interventions and expanded adult vaccination services for people who use drugs.  These applications will go live on Nov. 5, 2021, on NASTAD and AIDS United’s websites and a centralized landing page describing the project with links to all three RFPs is available here. The webinar will include a discussion of the rationale and intention behind this SSPs and COVID-19 special projects funding opportunity, a walkthrough of the application elements and process for each funding tier, project timeline, eligibility criteria, and time for Q&A.

NASTAD Webinar: Positively Safe: Addressing the Intersection of HIV and Domestic Violence 

Date & Time: Thursday, November 18, 2021, 3:30 PM – 5:00 PM ET 

Please join NASTAD and the National Network to End Domestic Violence (NNEDV) for a webinar presentation exploring the intersections of domestic violence (DV) and HIV, specifically in the context of health department service delivery and Ending the HIV Epidemic (EHE) goals. Ashley Slye (NNEDV) will share an overview on DV, trauma, and how perpetrators of violence may use HIV status to exert power and control. Attendees will also discuss trauma-informed promising practices to implement when working with individuals who disclose DV, as well as and tips and resources to assist in building partnerships with local DV programs.     

NASTAD Webinar: Introducing PrEP Coverage Check—A PrEP Verification Tool 

Date & Time: Thursday, November 18, 3:00-4:00 PM EST 

Please join NASTAD for a webinar introducing and walking through the forthcoming resource, PrEP Coverage Check—A PrEP Verification Tool. As a reminder, The Patient Protection and Affordable Care Act (ACA) requires qualified health plans to cover PrEP as a preventive service without cost-sharing. This tool aims to assist PrEP navigators and enrollment assisters in quickly verifying whether PrEP medications are covered in select health plans throughout the 2022 Open Enrollment Period.  

CDC MMWR: Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics 

“During 2010–2018, changes occurred in the demographic composition of patients attending STD … Overall, fewer females, especially those aged 15–24 years, accessed care in these STD clinics during the study period… Increases in the number of MSM attending STD clinics present a unique opportunity to reach this population with STD and HIV prevention services. Although a large percentage of STD cases are diagnosed outside of STD clinics, publicly funded STD clinics are an important safety-net provider of STD-related health services and provide vital STD-related health services for patient populations at risk for the consequences of STDs and HIV infection… Ensuring that all persons receive quality HIV and STD prevention and treatment services is vital for an effective public health approach to reducing STDs.”  

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 

Manager, Legal Research (NASTAD) – Remote/Washington, DC 

The Manager, Legal Research provides legal and policy research and analysis as part of NASTAD’s technical assistance and capacity building assistance. This position works closely with the Prevention, Policy & Legislative Affairs, and Health Systems Integration teams to support programmatic activities. This role works with the Director of Policy & Legislative Affairs and Senior Manager of Health Systems Integration, to implement key activities under NASTAD’s health systems legal and policy portfolio, including conducting public health legal research, synthesizing complex policy material, and supporting development of webinars, peer learning opportunities, and deliverables to support health department efforts to navigate federal, state, and local laws and policies 

Program Analyst: HIV, STI, & Viral Hepatitis Program - Harm Reduction (NACCHO)  

The Program Analyst will support projects and activities across NACCHO’s HIV, STI, and Viral Hepatitis program portfolio. In particular, the Program Analyst will support the implementation of projects designed to build local capacity and partnerships for harm reduction and the prevention and elimination of viral hepatitis. The ideal candidate will possess interest and experience in harm reduction and/or the prevention and elimination of viral hepatitis, as well as health department and harm reduction programming, public health policy, the provision of technical and capacity building assistance, monitoring and evaluation, partnership building, and project management. 

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. 

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

Syphilis is resurging in the U.S., a sign of public health's funding crisis 

“In May 2021, President Joe Biden's administration announced it would set aside $7.4 billion over the next five years to hire and train public health workers, including $1.1 billion for more disease intervention specialists like Yang. Public health officials are thrilled to have the chance to expand their workforce, but some worry the time horizon may be too short. ‘We've seen this movie before, right?’ Frieden said. ‘Everyone gets concerned when there's an outbreak, and when that outbreak stops, the headlines stop, and an economic downturn happens, the budget gets cut.’” 

Are Health Centers Needlessly Prescribing Pricey Descovy for PrEP Because They Get a Government Kickback? 

“What seems to be happening is that doctors are being encouraged to switch patients to Descovy based on the surface impression that it has a better safety profile,” said Kenyon Farrow, the managing director of Advocacy and Organizing of the group PrEP4All, which advocates for greater expansion of PrEP access, primarily by lowering the drug’s price. “But for most of us, generic Truvada is perfectly safe. The switch to Descovy has more to do with Gilead trying to hold onto its market share of PrEP users in the face of the generics.” 

Biden administration doubling down on ACA open enrollment outreach campaigns with health equity in mind 

“The Biden administration has extended the Affordable Care Act (ACA) open enrollment period by one month and invested in a more robust outreach campaign as part of its efforts to bolster the legislation. The Centers for Medicare & Medicaid Services (CMS) kicked off Monday the start of the HealthCare.gov open enrollment period, which has been extended to Jan. 15, 2022. CMS Administrator Chiquita Brooks-LaSure said the American Rescue Plan greatly improved the financial assistance available during the open enrollment period, significantly lowering people’s premiums.”