Policy Updates: Hill Happenings and Administration Activities

Hill Happenings

FY2024 Appropriations 

Lawmakers adjourned for the August Congressional recess having achieved little bipartisan agreement on a funding proposal for fiscal year 2024 (FY2024). The House and Senate issued competing spending proposals in July that adhere to budgetary caps set by the bipartisan debt limit compromise, but House Republicans are pursuing even steeper cuts in the FY2024 package. On July 14, the House Appropriations Health and Human Services, Education, and Related Agencies (LHHS) Subcommittee approved broad spending cuts that threaten funding for vital health programs, including axing funding for programs like the Department of Health and Human Services (HHS) Ending the HIV Epidemic Initiative and the Minority AIDS Initiative. 

On July 27, the full Senate Appropriations Committee passed the upper chamber’s LHHS Subcommittee bill, approving spending levels that would preserve funding for many programs that were targeted for cuts. The funding disagreements between the two chambers of Congress indicate a lengthy FY2024 negotiations process that will extend beyond the September 30 funding deadline. As a result, lawmakers will need to pass a continuing resolution to temporarily extend funding levels until an agreement is reached or face a government shutdown. Additionally, appropriators must now deliberate on President Biden’s supplementary budget request to Congress issued on August 10. The bulk of the supplemental request calls for additional Ukraine aid and natural disaster support, but it also includes a $350 million request to support the Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response (SOR) Grant program, with $50 million set aside for the Indian Health Service (IHS).  

NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.  

Administration Activities

CMS Prompts State Medicaid Commissioners to Comply with Federal Requirements as they Unwind Expanded Medicaid Eligibility and Coverage  

On August 9, Centers for Medicare and Medicaid Services (CMS) publicly posted correspondence issued to state Medicaid program commissioners in May of 2023 that reminded them of federal program requirements that must be followed as they unwind the Medicaid eligibility and coverage flexibilities that were authorized by the COVID-19 public health emergency (PHE), such as continuous enrollment. The letter serves as a warning to states that are leveraging the first post-PHE Medicaid redetermination process to cull Medicaid enrollment rates, which reached an all-time high during the PHE. HHS guidance issued in 2022 estimated that as many as 15 million people would be disenrolled from the Medicaid program during the unwinding period. The letter could signal an increased focus on program monitoring and enforcement as the Biden Administration works to prevent future enrollment losses, which already total 4 million disenrollments in the past 4 months, with nearly three out of four disenrollments due to procedural challenges, like paperwork. 

Dr. Jeanne Marrazzo to Lead NIH National Institute of Allergy and Infectious Diseases 

On August 2, NIH announced that Dr. Jeanne Marrazzo was selected to lead the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID). Dr. Marrazzo is currently the Director of the University of Alabama at Birmingham Division of Infectious Diseases. At NIAID, Dr. Marrazzo will oversee research to advance the understanding, diagnosis, and treatment of infectious, immunologic, and allergic diseases. Dr. Marrazzo is well-known for her background in discovery and implementation science, especially for STIs and PrEP for HIV. NIAID has been operating under acting leadership since Dr. Fauci stepped down from the role in December of 2022. Additionally, Congress has not yet approved President Biden’s nomination of Dr. Monica Bertagnolli for Director of NIH, who would replace former Director Dr. Francis Collins. 

NASTAD Submits Comments on CMS National Coverage Determination for PrEP 

On August 11, NASTAD joined the HIV Health Care Access Working Group and the HIV Prevention Action Coalition of the Federal AIDS Policy Partnership and submitted comments in support of the CMS proposal to cover PrEP as a preventive service in Medicare Part B without cost-sharing, including oral and injectable PrEP medication and the requisite ancillary services needed to secure an initial prescription or renewal for PrEP. The advocates applauded the proposal for its potential to expand PrEP access, but urged CMS to include all clinical services required to prescribe PrEP in the coverage determination, and to refine risk-based language to ensure PrEP access reaches all who need it.

Resources 

NASTAD Statement: HIV Cluster and Outbreak Detection and Response (CDR) & Molecular HIV Surveillance (MHS) 

This document serves as a resource for both NASTAD and its members for communications, community engagement, and advocacy purposes to reflect common concerns, issues, and priorities held by health departments around the implementation of CDR and MHS strategies. Specific areas of focus in the statement include community engagement, the protection of public health data, assessing and addressing HIV criminalization, supporting flexible implementation of CDR programs, and program utility and evaluation.   

CDC DHP Resource: Success Stories: EHE in Action 

The CDC Division of HIV Prevention (DHP) published two new success stories:

• NASTAD: Expanding TelePrEP in EHE Jurisdictions Through Online Learning and Collaboration 
• Baltimore City Health Department: Dismantling HIV and STI Testing Barriers in Baltimore City, MD with Self- and Mail-In Tests 

GU O’Neill Institute: The Minority AIDS Initiative (MAI) After Affirmative Action 

“The Minority AIDS Initiative (MAI) was established by Congress in 1998 in response to the highly disproportionate impact of HIV in communities of color and the inadequate investment in Black and Latino communities over many years. Since its enactment, however, the HIV epidemic has become even more highly concentrated in communities of color. Some have questioned the ongoing viability of this program following the Supreme Court’s recent decision in Students for Fair Admissions, Inc. v. President and Fellows of Harvard College.” 

New England Journal of Medicine: 

• Free the PrEP — Over-the-Counter Access to HIV Preexposure Prophylaxis
  • “Several barriers to access to preexposure prophylaxis for HIV could be alleviated by making it available over the counter. This step could particularly facilitate access among groups that face stigma.” 
• Racial Inequality in Receipt of Medications for Opioid Use Disorder
  • “Racial and ethnic differences in the receipt of medications to treat OUD after an index event related to this disorder among patients with disability were substantial and did not change over time. The high incidence of ambulatory visits in all groups showed that disparities persisted despite frequent health care contact.” 

Job Postings

NASTAD 

• Senior Manager, Health System Integration

Drug Trends and Technology-Based Drug Checking Analyst – New York City, NY 

NYC DOHMH is looking for an analyst to work on our drug checking initiative. Currently operating in four SSPs across the city, including one of the OPCs, drug checking technicians use Bruker Infrared technology to test samples from SSP participants and provide individualized harm reduction education. This is a great opportunity for someone with strong data skills and an interest in drugs and toxicology. Please send out far and wide and feel free to reach out if you have any questions.

Prevention Coordinator, Boulder County AIDS Project – Boulder, Colorado 

The primary duties of this position are to provide HIV/HCV/STI testing, syringe access, and street outreach services, as well as outreach education at community partner locations and events. This position provides these services in collaboration with other Prevention Department staff and key community partners, as well as enters data into databases and completes monthly reports. This position reports directly to the Prevention Director, and attends staff, department, and community partner meetings. 

Florida Department of Health – Palm Beach County 

To apply, please send resumes to Robert Scott, Robert.Scott@flhealth.gov. These are all $20/hr, in-office roles with possible remote flexibility. 

• EHE Navigator: This position’s work will be actively guided by the Palm Beach County Ending the Epidemic (EHE) Plan, including the four pillars and their goals, objectives, strategies and activities. Incumbent will assist in the planning, coordination, implementation and monitoring of the goals, objectives, strategies and activities set forth in the Palm Beach County Ending the Epidemic (EHE) Plan, in collaboration with other Area 9 EHE funding recipients, to include, but not limited to: Palm Beach County, FoundCare, and Florida Community Health Centers.
• PrEP Navigator: This position’s work will be actively guided by the Palm Beach County Ending the Epidemic (EHE) Plan, including the four pillars and their goals, objectives, strategies and activities. Incumbent will link high-risk negative persons to available Pre-Exposure Prophylaxis (PrEP) and non-occupational Post Exposure Prophylaxis (nPEP) services with the goal of significantly reducing the number of new HIV infections among high-risk populations. Incumbent will assess and increase the knowledge, desirability, accessibility, and adherence of PrEP among referred high-risk individuals.
• Digital Media Manager: This position is responsible for developing and coordinating the area HIV digital media presence through multiple platforms. Developing digital marketing strategies, creating social media content, collaborating with community partner organizations, and creating new ad campaigns to advance Ending the HIV Epidemic (EHE) in Palm Beach County. Tracking data from digital campaigns to assist with EHE goals.

Deputy Medical Director, HIV/STI/Viral Hepatitis/Harm Reduction – Nashville, TN 

This position will serve as the Statewide Deputy Medical Director in the HIV/STI/Viral Hepatitis section. The position has cross-cutting responsibility in all program areas with potential for promotion in succession plans. Primary responsibilities include leadership and oversight of cross-cutting programs related to End the Syndemic Tennessee to tackle HIV, sexually transmitted infections, viral hepatitis and substance use disorder in an integrated manner with an outward-facing, community-engaged process.  

Program Content and Training Specialist, Supporting Harm Reduction Programs (SHaRP) – University of Washington 

This position is part of a cooperative agreement award from the Centers for Disease Control and Prevention to provide technical assistance about monitoring and evaluation to syringe services programs (SSPs) as part of the National Harm Reduction Technical Assistance Center. One of the primary projects of this award is to provide technical assistance (TA) to SSPs for monitoring and evaluation activities. The University of Washington is working in collaboration with the CDC, SAMHSA, NASTAD, the National Harm Reduction Coalition, and other TA partners to provide a suite of technical assistance support to individual programs.  

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

The White House proposes new plan to eliminate hepatitis C 

“CBS News chief medical correspondent Dr. Jon LaPook joins "CBS Mornings" with an inside look at a new White House initiative to eliminate hepatitis C in the U.S., a disease that kills thousands of Americans every year despite being curable with treatments.” 

CDC director overhauls leadership of center that oversaw response to Covid-19 

“The new director of the Centers for Disease Control and Prevention, Mandy Cohen, is overhauling the leadership of the CDC center that led the agency’s Covid-19 response. 

In an announcement to staff issued Tuesday, Cohen said José Romero, who headed the National Center for Immunization and Respiratory Diseases for the past 14 months, would be leaving the CDC at the end of August…Replacing Romero, at least on an acting basis, is Demetre Daskalakis, who has spent the past year in Washington as deputy director of the White House’s national mpox response team. The White House operation is being wound down and will be completed by the end of August.” 

In the Fentanyl Crisis, Lawmakers Are Making the Same Mistakes 

“Hundreds of fentanyl crime bills were introduced in at least 46 states during this past legislative session, according to the National Conference on State Legislatures. Many of those bills impose mandatory minimums for anyone convicted of possessing, distributing, selling, or manufacturing fentanyl or fentanyl analogs, also referred to as fentanyl-related substances. At the federal level, the Halt All Lethal Trafficking of Fentanyl Act (HALT Fentanyl Act), which has passed in the House of Representatives and currently sits in the Senate, would trigger new and increased mandatory minimum sentences for fentanyl-related substances. Essentially, lawmakers are relying on the same stale and ineffective strategies that have led to mass incarceration, more dangerous drugs, and an overdose crisis—and which have done nothing to make our communities safer.”