Policy Updates: Hill Happenings and Administration Activities

By Mike Weir November 19, 2018

Hill Happenings 

Congressional Leadership 

Senators Mitch McConnell (R-KY) and Chuck Schumer (D-NY) were reelected to serve as their respective party leaders in the Senate for the 116th Congress. Congressman Kevin McCarthy (R-CA-23) was elected to serve as House minority leader in the next Congress. Democrats will vote on their nominee for speaker on November 28. The full House will vote January 3 to elect a new speaker. 

The Senate Leadership for the 116th Congress by party: 

Democrats: Democratic Whip: Senator Dick Durbin (IL); Assistant Democratic Leader: Senator Patty Murray (WA); Chair of the Democratic Policy and Communications Committee: Senator Debbie Stabenow (MI); Vice Chair of the Conference: Senator Elizabeth Warren (MA); Vice Chair of the Conference: Senator Mark Warner (VA); Chair of Steering Committee: Senator Amy Klobuchar (MN); Chair of Outreach: Senator Bernie Sanders (VT): Vice Chair of the Democratic Policy and Communications Committee: Senator Joe Manchin (WV); and Senate Democratic Conference Secretary: Senator Tammy Baldwin (WI) 

Republicans: Republican Whip: Senator John Thune (SD); Conference Chair: Senator John Barrasso (WY); Vice Chair: Senator Joni Ernst (IA); Campaign Committee Chair: Senator Todd Young (IN); Policy Committee Chair: Senator Roy Blunt (MO) 

The House Leadership for the 116th Congress by party: 

Democrats: Democrats will hold their leadership elections on November 28. 

Republicans: Republican Whip: Steve Scalise (R-LA-1); Conference Chair: Liz Cheney (R-WY-At Large); Policy Committee Chair Gary Palmer (R-AL-6); Conference Vice Chair Mark Walker (R-NC-6); Conference Secretary Jason Smith (R-MO-8) 

Election Results 

As a result of the 2018 elections, Democrats now control the House and Republicans have expanded their Senate majority. Currently in the House, Democrats have 232 seats to Republicans 198; there are still five undecided races. In the Senate, Republicans gained two seats, bringing their majority to have 52 seats to Democrats 47. Mississippi will hold their Senate runoff election on November 27 between incumbent Republican Cindy Hyde-Smith, who was appointed to replace retired Senator Thad Cochran earlier this year, and Democratic challenger Mike Espy.

PEPFAR 

The House passed the PEPFAR Stewardship and Oversight Act, H.R. 6651— PEPFAR reauthorization legislation. The legislation reauthorizes the program for five years. On October 3, the Senate Foreign Relations Committee passed the Senate’s PEPFAR reauthorization bill, S. 3476

PEPFAR and other global health programs are funded through the State-Foreign Operations spending bill which is currently funded through December 7. 

Health Care after the Midterm Elections 

NASTAD signed on to a letter urging “Congress to listen to the American people and pursue an agenda that ensures the best health and health care are equally accessible and affordable to all.”

Administration Activities  

IMD Exclusion 

The Center for Medicare & Medicaid Services (CMS) announced that states can soon apply for waivers to expand their treatment capacity for serious mental health issues. In a letter to state Medicaid directors, CMS outlines how states can use 1115 waivers to lift the institution for mental diseases “IMD” exclusion — a ban on federal Medicaid funding for residential treatment facilities with more than 16 beds.   

2017 HIV Surveillance Report 

The Centers for Disease Control and Prevention (CDC) published the 2017 HIV Surveillance Report. The report presents data on numbers and rates of diagnoses of HIV infection that occurred through December 31, 2017. All data were reported to CDC through June 2018. 

Social Determinants Reimbursement 

Health and Human Services (HHS) Secretary Azar announced that CMS is looking into new care models that could allow organizations to pay for patients' social needs, like housing and nutrition.

National HIV/AIDS Strategy and National Viral Hepatitis Action Plan Update 

The HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) announced it will begin engaging with community partners to update the National HIV/AIDS Strategy (NHAS) and National Viral Hepatitis Action Plan. As part of their community engagement, OHAIDP anticipates to host listening sessions in the Spring of 2019. OHAIDP expects the updates to be released in Spring/Summer 2020.  

Wildfire Public Health Emergency 

Secretary Azar declared a public health emergency in California due to the wildfires. The declaration gives CMS “beneficiaries and their healthcare providers and suppliers greater flexibility in meeting emergency health needs created by the wildfires.” 

2019 Open Enrollment 

Open enrollment is now open throughout the country. The Centers for Medicare and Medicaid Services (CMS) announced Healthcare.gov now has 2019 plan data available for window shopping which allows consumers to look at plans without logging in, creating an account, or filling out the official application.  

Upcoming Conferences 

2019 National HIV Prevention Conference 

The 2019 National HIV Prevention Conference will be held March 18-21, 2019 in Atlanta, Georgia. Check out the updated website for more information about tracks and to view the tentative conference schedule. Late Breaker abstract submissions are being accepted now through November 30, 2018. 

2019 HIV Diagnostics Conference 

The 2019 HIV Diagnostics Conference will be held in Atlanta on March 25-28, 2019. The conference will address advances in diagnostic testing, and strategies for using test technologies in public health programs and clinical practice.  The conference program this year expands beyond HIV testing, and incorporates STI and HCV testing technologies and strategies, with an emphasis on integrating testing programmatically.  As with past conferences, there will be a mix of oral presentations, panel discussions, and poster sessions. We strongly encourage health department HIV, HCV, and STI testing program managers and other staff consider submitting an abstract, attending the conference.   

Resources

NASTAD released a map detailing jurisdictions who have developed Ending the Epidemic plans. These plans are dynamic and will be updated as progress continues. 

NASTAD released a Private Insurance State Policy Tracker. The tool tracks state action in the following areas: 1332 waivers, individual mandates, short-term limited duration insurance protections, bans on transitional policies, extended Open Enrollment period, and Essential Health Benefits modifications. In addition to this new Private Insurance State Policy Tracker, NASTAD continues to update our Medicaid Waiver Map and two Medicaid fact sheets: Medicaid 1115 Waivers: Considerations for HIV and Hepatitis Programs and Medicaid 1115 Waivers: Exemptions for People Living with HIV and Hepatitis

NASTAD recently released PrEPcost.org. PrEPcost.org is an online tool that will help PrEP navigators and their clients evaluate the cost and coverage for PrEP across on- and off-Marketplace health plans. 

Year 2 of Affordable Care Act Qualified Health Plans (QHPs) in a Medicaid Non-expansion State: QHPs Associated with Viral Suppression for Virginia AIDS Drug Assistance Program Clients: “For year 2 of the Affordable Care Act in Virginia (Medicaid non-expansion state), AIDS Drug Assistance Program clients’ Qualified Health Plan enrollment differed based on demographic and healthcare delivery factors, and it was associated with higher rates of viral suppression.” 

The Center for Health Law and Policy Innovation released a fact-sheet highlighting new limited coverage options available on the ACA Marketplace often called “term health insurance,” “short-term medical insurance,” or a “limited duration plan”: Short-term Health Insurance: Is It Right For Me? The Access, Care, and Engagement (ACE) TA Center also released resources on short-term, limited duration plans.  

The Act Now End AIDS coalition, in concert with AIDS United, has developed a policy paper – "Ending the HIV Epidemic in the United States: A Roadmap for Federal Action."  The coalition also released an Executive Summary which be used as the basis of Hill advocacy for the Roadmap. Please fill out this form by close of business (8pm EST) on Wednesday, November 28 to be listed as a signer of this document on its World AIDS Day launch.  NASTAD is an original signer of the document and has been involved in its development. 

Investing in STD Prevention: Making the Case for Your Jurisdiction: These customizable factsheets from ASTHO and the National Coalition of STD Directors (NCSD) are designed to show the impact of STD program funding on disease burden and associated medical costs. 

News Bulletin 

SMAIF at 20: Continuing the Federal Response to a “Severe and Ongoing Health Care Crisis”
“As we mark the 20th anniversary of the Minority AIDS Initiative (MAI) this fall, I am pleased to announce the FY 2018 “Promoting Innovation to Eliminate HIV-Related Health Disparities for Racial and Ethnic Minorities” awards funded under the Secretary’s Minority AIDS Initiative Fund (SMAIF). For FY 2018, more than $50.2 million has been awarded to support 27 programs and activities led by eight HHS Operating Divisions and Staff offices. These projects reflect current epidemiological data, apply evidence-based HIV prevention and care strategies, and help us advance toward the goals of the National HIV/AIDS Strategy.” 

An Underused Strategy For Surge In STDs: Treat Patients’ Partners Without A Doctor Visit 
“That’s when Bowe, who practices on both sides of the North and South Carolina border, does something doctors are often reluctant to do: She prescribes the partners antibiotics without meeting them. Federal health officials have recommended this practice, known as expedited partner therapy, for chlamydia and gonorrhea since 2006. It allows doctors to prescribe medication to their patients’ partners without examining them. The idea is to prevent the kind of reinfections described by Bowe — and stop the transmission of STDs to others.” 

Incoming Dem chairman: Medicare negotiating drug prices is a priority 
“Rep. Frank Pallone Jr. (D-N.J.), who is slated to be the next chairman of a House committee overseeing drug prices, said Wednesday that his top priorities on the issue are allowing Medicare to negotiate prices and speeding the approval of cheaper generic drugs.” 

Some pharmacies thwart efforts to improve access to the opioid overdose reversal drug 
“Whether this is saving lives is just beginning to be evaluated, but one obstacle is clear: Many pharmacies haven't gotten with the program. In California, three out of four pharmacies still required a doctor's prescription for naloxone early this year — two years after the law changed, according to a new study by the University of California, San Francisco. Only half the stores had the easy-to-administer nasal spray in stock.” 

Recent incarceration increases HIV and hepatitis C risk for people who inject drugs 
“People who inject drugs (PWID) recently released from prison or jail have a substantially increased risk of acquiring infection with HIV or hepatitis C virus (HCV), according to the results of a systematic review and meta-analysis published in The Lancet Infectious Diseases. Recent incarceration was associated with an 81% increase in the risk of HIV and 62% increase in the risk of hepatitis C.”