Policy Updates: Hill Happenings and Administration Activities

By Garrett Eberhardt February 11, 2020

Administration Activities

Fiscal Year 2021 Presidential Budget Released

Yesterday afternoon, the President Trump released his Fiscal Year (FY) 2021 Budget Request, A Budget for America's Future and the Department of Health and Human Services (HHS) Budget in Brief, proposing a nine percent cut to the agency along with numerous other austere cuts at odds with the previous budget agreement struck with the Bipartisan Budget Act of 2019. While the Ending the HIV Epidemic (EtHE) Initiative, Division of Viral Hepatitis, STD Prevention, and non-EtHE Ryan White programs avoided decreases to their funding, the Medicaid program, and other safety-net programs. The Centers for Disease Control and Prevention’s National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP) received a proposed increase of $279 million while domestic HIV/AIDS prevention and research programs at CDC requests an increase of $231 million under the EtHE initiative while the Ryan White program received a proposed $95 million increase under EtHE in order to provide treatment to more people living with HIV in the EtHE jurisdictions. $48 million in increases for Eliminating the Infectious Disease Consequences of the Opioid Epidemic were proposed in support of quality harm reduction programs, building state and local capacity, and improving testing and linkage to care.

Presidential budget requests are typically not adopted by Congress, which solely possesses the authority to appropriate funding, and it is unlikely that President Trump’s FY2021 budget will break this trend. NASTAD will continue to advocate on behalf of health departments and people living with or at risk of HIV and/or hepatitis and provide updates on the FY2021 appropriations process. 

Experimental HIV Vaccination Clinical Trial Ended for Ineffectiveness

The National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) announced last week that it has ceased investigational HIV vaccinations in its HVTN 702 clinical trial. The trail was ended because the independent Data and Safety Monitoring Board (DSMB) found that the regimen did not prevent HIV. The Phase 2b/3 study began in 2016 in South Africa and was testing an investigational prime-boost vaccine regimen based on the regimen tested in the RV144 clinical trial in Thailand. Despite the trial’s ineffectiveness, DSMB did not find any threat of potential safety issues for participants.

CMS Publishes Rules Outlining Changes to Medicare Advantage and Part D Prescription Drug Programs

Late last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule and its Advance Notice Part II that proposed changes to the Medicare Advantage and Part D prescription drug programs. The proposed changes focused on lowering beneficiary cost sharing on some of the most expensive prescription drugs by allowing plans to use a second specialty tier, greater promotion of the use of generic drugs, and advanced notice for beneficiaries of out-of- pocket payments for prescription drugs along with the ability to compare price differences starting January 1, 2022. The proposed changes described in the Advance Notice are expected to increase plan revenue by 0.93%.

CMS Releases 2021 Notice of Benefit and Payment Parameters Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) recently issued its 2021 proposed Notice of Benefit and Payment Parameters rule. This rule is released every year and governs rules and operating procedures for the ACA-compliant private insurance market. Of note to the HIV and hepatitis communities, the proposed rule explicitly allows issuers to refuse to count manufacturer copay cards towards a patient’s deductible and out-of-pocket maximum. The proposed rule reverses previous compromise guidance from CMS, which had prohibited issuers from refusing to count co-pay cards toward a deductible or out-of-pocket maximum when there was no generic equivalent. NASTAD will be commenting on the rule with coalition partners.

White House Releases National Treatment Plan and National Drug Control Strategy

One week ago, the White House’s Office of National Drug Control Policy (ONDCP) unveiled the President’s National Drug Control Strategy and the National Treatment Plan outlining an evidence-based framework to increase Americans’ access to substance use disorder (SUD) treatment and support those in long-term recovery. The Treatment Plan outlines strategies to encourage healthcare providers to screen for SUD to address the treatment gap. Alleviating financial barriers for patients by working with health insurers in the private and public sectors to pay for treatment, supporting telemedicine and an expansion of the addiction workforce, combating stigma toward addiction, affordable housing, and employment were all offered as potential solutions for both SUD and eventual long-term recovery.

Hill Happenings

President Trump Addresses the Nation During State of the Union

President Donald Trump gave his State of the Union address last week before both chambers of Congress where he outlined policy priorities and highlighted the Ending the HIV Epidemic: A Plan for America. NASTAD, as part of the Partnership to End HIV, STDs & Hepatitis, released a statement saying that it echoes the President’s “commitment to this issue and stand ready to work with the administration to end the HIV epidemic in the United States by 2030.” and that “we have the tools to end HIV once and for all, but we must back it up with sound and sensible policies that expand access to stigma-free care, lift up vulnerable populations like our Black and Latinx communities, protect LGBTQ individuals from discrimination and address rising STD and viral hepatitis rates.” Despite the President’s stated support for ending the epidemic, critics have cited numerous policies of the Trump Administration that work to undercut the goals of the initiative such as cuts to Title X-funded providers, its public charge rule covering immigration, religious discrimination law reforms that all could lead to undocumented immigrants delaying healthcare or healthcare workers being allowed to object to providing care to the most vulnerable populations.

House of Representatives Passes Resolution Disapproving Trump Administration’s Medicaid Block Grant Plan

Late last week, the House of Representatives passed a non-binding resolution by a 223-190 vote condemning the Trump administration’s Medicaid block grant plan that will allow states to apply for a waiver allowing them to cap federal Medicaid payments. The resolution condemns the plan’s potential to covertly make cuts to the Medicaid program and challenges the legality of the application of the Medicaid waiver authority despite the administration’s argument that block grants will allow states to tailor the program specifically to their residents and better control spending. NASTAD has released a public statement decrying the effect of the plan on people living with HIV and hepatitis and plans to end the HIV and hepatitis epidemics.

Rep. John Lewis Introduces Loan Repayment Legislation for Healthcare Workforce

On Friday, Representative John Lewis (D-GA) introduced a bill creating a new loan repayment program for healthcare professionals. H.R. 5806, the HIV Epidemic Loan-Repayment Program (HELP) Act would offer up to $250,000 over five years to physicians, nurse practitioners, physician assistants and dentists who provide HIV treatment in areas with health professional shortages or at Ryan White-funded clinical sites, in an effort to support those already working to combat HIV/AIDS and encourage further growth of the workforce. During the bill’s introduction, Rep. Lewis stated We need to support all our brothers and sisters who are living with HIV/ AIDS.  Their lives are precious, and policy makers must ensure that there are enough qualified, dedicated health professionals to care, support, and guidance for them.”

House Appropriators Expected to Decide on Earmarks Soon

House Committee on Appropriations Chair Nita Lowey (D-NY) has met with freshman Democrats and those in highly competitive districts to discuss the potential framework of a process for earmarking. The news comes as Senate Committee on Appropriations Chair Richard Shelby (R-AL) appears to have softened his previous stance of the return of earmarks. Senator Shelby changed his position to defer the decision to President Trump, who stated that he was open to bringing back the earmarking process in 2018.

Ending the Epidemic

Ready, Set, PrEP Spanish Language Materials Published

Last week, the Department for Health and Human Services released Ready, Set, PrEP fact sheets, information cards, and posters in Spanish. Ready, Set, PrEP is a part of the Ending the HIV Epidemic: A Plan for America initiative and provides pre-exposure prophylaxis (PrEP) medications at no cost to thousands of individuals who qualify.

Resources

NASTAD’s Senior Director of Prevention/Care Program & Policy Natalie Cramer was recently published as a co-author of a manuscript for Sage Publications on Research Methods Cases. The research manuscript studies the process and lessons learned from an academic-public health collaboration between HIV program directors and a multidisciplinary research team that sought to identify potential applications of social media data and its contribution toward enhancing health department HIV prevention and care services.

Tim Horn, NASTAD’s Director of Medication Access and Pricing, recently co-authored a research letter in Jama Internal Medicine entitled HIV Antiretroviral Therapy Costs in the United States, 2012-2018. The letter seeks to characterize the costs of recommended initial antiretroviral treatment (ART) regimens in the United States from 2012 to 2018 and the magnitude of cost changes over time. The United States has the highest ART prices yet the lowest rate of HIV viral suppression (54%) compared with all other well-resourced countries.

CDC will be holding an informational webinar on February 12 on at 2:00 pm (EDT) on the Evaluation and Performance Measurement Plan (EPMP) for Component A of the notice of funding opportunity (NOFO) for Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic in the United States.

Job Opportunities

Program Specialists IV – Texas

The Texas Department of State Health Services (DSHS) is seeing applicants for two Program Specialist IV positions. The positions will be responsible for ensuring that organizations who enter into written agreements with DSHS to provide HIV, STD, and hepatitis C (HCV) programs deliver services that are consistent with the needs of the population to be served and are in accordance with State and Federal mandates and program requirements. The positions will also administer and oversee HIV/STD/HCV prevention activities (which may include focused or routine testing, linkage to HIV-related medical care, structural interventions, nPEP/PrEP, and varied evidence based interventions) and plans and direct the development, implementation, and evaluation of HIV/STD/HCV programs.

Policy Fellowship – Online

Positive Women’s Network USA is seeking applicants for a year-long fellowship on effective engagement in federal, state and local policy and advocacy. The Fellowship period is April 2020 – March 2021 and fellows will participate in a series of interactive web-based and a possible in-person skills-building session delivered by PWN staff and other policy experts. Fellows will also expand their understanding of the structure of government and how federal policy is developed, implemented and funded, learn key frameworks for advocacy interventions, and learn to analyze policy.

Manager, Prevention – Washington, DC

NASTAD is seeking a Prevention Manager as part of its prevention team to support health departments and community-based organizations implementation of high-impact HIV prevention programs. The position is responsible for providing technical assistance and training related to HIV cluster response, biomedical interventions, and Pre-Exposure Prophylaxis (PrEP). The Manager, Prevention will coordinate training strategies related to HIV policy and health systems; and implement Jurisdictional TA Plans for health departments.

Epidemiology Unit Manager – Michigan

The state of Michigan is seeking an HIV/STD Epidemiologist Manager to direct to a team of epidemiologists in its Lansing and Detroit offices regarding HIV/STD reports and activities. The position would also be responsible for conducting analysis and interpretation of surveillance data, working with other unit managers to set and complete objectives, performing data analyses, helping to resolve database issues and presenting data to groups as requested. This position also provides support and consultation to other units within the HIV and STD Division.
 
Program Director – New York

Whitney M. Young Jr Health Center, located in NY’s Capital District, is a regionally-focused FQHC that provides outreach, screening and treatment to patients with, and at-risk for, HIV/AIDS, STIs and Hepatitis C. The health center is looking to hire a Program Director of Community Prevention & Treatment Services who would oversee multiple federal and State-funded initiatives. The position offers not only the chance to lead program services, but also influence policy through advocacy and interaction with the NYS Department of Health, AIDS Institute.

News Bulletin

Trump Administration’s Domestic Gag Rule Has Slashed the Title X Network’s Capacity by Half

“New data from the Guttmacher Institute show that the Trump administration’s domestic ‘gag rule’ has slashed the Title X national family planning network’s patient capacity in half, jeopardizing care for over 1.6 million female patients nationwide. On the 50th anniversary of the Title X program, a new analysis estimates that roughly one in every four Title X service sites left the network in 2019 because of the domestic gag rule, shorthand for restrictive regulations that prohibit—among other things—referrals for abortion care.

In 2019, an estimated 1,000 U.S. clinics receiving Title X funding—approximately one-quarter of all sites that received Title X funding as of June 2019—likely left the Title X network because of the gag rule.”