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Newsletter: Policy

Policy Updates: Hill Happenings and Administration Activities

Julio Contreras,
Mike Weir, M.P.H

Hill Happenings 

Fiscal Year 2023 (FY2023) Appropriations 

On December 23, Congress passed the Fiscal Year 2023 (FY2023) appropriations omnibus bill, ending months of debate over partisan disagreements and completing the must-pass bill in the final days of the 117th Congressional session. Senior Republican appropriators convinced reluctant GOP colleagues, who wanted to leverage their new majority in the House of Representatives before finalizing a FY2023 spending package, to pass the spending bill in the 117th Congress to afford the new Republican majority in the lower chamber a clean slate to legislate their agenda in 2023. President Biden signed the bill into law on December 29.

The FY2023 appropriations omnibus included some increases in funding to health programs, although final levels were not as high as the Democrat-proposed plan released in the summer of 2022. The bill included the following funding levels: 

  • Centers for Disease Control and Prevention (CDC)
    • National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP) Total - $1.391 billion (+$46 million) 
    • Division of HIV Prevention (DHP) 
      • HIV Prevention - $755.6 million (+$0) 
      • EHE – $220.0 million (+$25 million) 
      • School Health - $38.1 million (+$2 million) 
    • Viral Hepatitis - $43 million (+$2 million) 
    • Infectious Diseases and Opioids Program - $23 million (+$5 million) 
    • STD Prevention - $174.3 million (+$10 million) 
  • Health Resources and Services Administration (HRSA) 
    • Ryan White HIV/AIDS Program –
      • Part A - $680.8 million (+$10.3 million) 
      • Part B (Care) - $464.6 million (+$20.6 million) 
      • Part B (ADAP) - $900.3 million (+$0) 
      • Part C - $209 million (+$3.5 million) 
      • Part D – $77.9 million (+$1.1 million)
    • Ending the Epidemic Plan - $165 million (+$40 million) 
    • Community Health Centers - $5.9 billion (+$110.0 million) 
    • EHE Community Health Centers - $157.3 million (+$35 million) 
  • National Institutes of Health (NIH) 
    • AIDS Research - $3.294 billion (+$100 million) 
  • Department of Housing and Urban Development (HUD) 
    • Housing Opportunities for Persons With AIDS (HOPWA) - $499 million (+$49 million) 

The FY2023 package retained the policy rider prohibiting the use of federal funds to purchase syringes and included a new ban on the purchase of pipes in Substance Abuse and Mental Health Administration (SAMHSA) funded programs. However, in a significant win for advocates, lawmakers included the Mainstreaming Addiction Treatment Act (MAT Act) in the appropriations omnibus bill text. The MAT Act removes burdensome administrative requirements that limit the number of providers who are authorized to prescribe medication assisted treatment (MAT), allowing providers nationwide to prescribe buprenorphine as they would any other medication.

NASTAD will continue to monitor the appropriations process and advocate for the highest funding level on behalf of HIV and hepatitis programs.

Lawmakers Commence 118th Congress 

On January 3, Congress reconvened to kick off the 118th Congressional session. As a result of the November 2022 midterm elections, Democrats retained the majority in the Senate, but Republicans flipped the House of Representatives. Senator Chuck Schumer (D-NY) continues to serve as Senate Leader, and Senator McConnell (R-KY) retained his spot as minority leader, becoming the longest-serving party leader in Senate history.

On January 7, Rep. Kevin McCarthy (R-CA-20) was elected to serve as Speaker of the House after protracted internal party negotiations. Following former House Speaker Nancy Pelosi’s (D-CA-11) retirement from the leadership post, Democrats voted for Rep. Hakeem Jeffries (D-NY-08) to serve as minority leader, who became the first Black lawmaker to lead a party in Congress. The split power balance between the two chambers will likely pose further challenges to advancing bipartisan legislation in the final two years of the Biden-Harris administration.

Administration Activities 

Biden Administration Issues Proposed Rule to Protect Patients from Stigma 

On January 5, the Department of Health and Human Services (HHS) issued a proposed rule that restores the balance struck during the passage of the Affordable Care Act (ACA) between safeguarding moral and religious rights in health care while also protecting access to health care. The proposed rule largely rescinds the Trump-era rule that allowed medical workers and providers to refuse care if it conflicted with their religious or moral beliefs. The “conscience” rule, which never went into effect due to legal challenges, posed a major threat to access for stigmatized care like abortion, HIV and PrEP, contraception, and gender affirming care. Comments are due on March 6.

Biden Administration Updates Immigration Policy Manual to Remove Trump-Era Public Charge Rule 

On December 23, a Department of Homeland Security rule rescinding the Trump-era “Public Charge” rule took effect, restoring U.S. Citizenship and Immigration Services (USCIS) agency guidance that was in place since 1999. The Public Charge rule penalized immigrants seeking legal status in the US for using federal assistance programs, such as nutrition, healthcare coverage and care, housing, and education programs. Advocates celebrated the Biden Administration’s new rule, citing the chilling effect that the Trump-era rule had on access to healthcare for immigrants who feared losing eligibility for citizenship for themselves or a loved one.

NCHHSTP Announced Equity Initiative 

On January 9, the CDC National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP) announced a transformational, long-term strategy designed to achieve equity within the Center’s workplace and eliminate health disparities by addressing racism and other systems of oppression. The NCHHSTP Equity Initiative builds on decades of the center’s equity work and features an Implementation Plan that outlines the first steps of a long-term process to place equity squarely at the forefront of all internal and external Center activities, including workplace culture, NCHHSTP practices and policies, and program design and evaluation.

Resources 

University of Washington: Hepatitis B Online

The University of Washington (UW) Infectious Diseases Education & Assessment (IDEA) program recently launched the second edition of the free Hepatitis B Online  curricula which includes six updated lessons on hepatitis B virus epidemiology, immunization, initial treatment regimen, perinatal transmission, reactivation, and hepatocellular carcinoma screening. UW will launch four additional new lessons in early 2023. Healthcare providers and others can earn free CME, CNE and CE.  

HHS/CDC EHE Townhall: HHS Regions 8 & 10 Community Town Hall 

  • Date: Thursday, January 26, 10:00 - 11:30 am PT / 1:00 - 2:30 pm ET 

CDC is convening a number of community engagement events with community leaders and members to discuss community-driven solutions to advance HIV prevention, diagnosis, treatment, and outbreak response. The Division of HIV Prevention (DHP) is hosting regional town hall sessions to collaborate with the community to address barriers and maximize opportunities to reach our shared HIV prevention goals. 

CDC Mpox MMWR:  

NASTAD RFP: Strengthening Syringe Services Programs (SSP) through Direct Program Funding 

  • Deadline: January 20, 2023, at 11:59 PM EST 

NASTAD and project partners, VOCAL-NY and University of Washington (UW), are excited to announce a CDC-supported funding opportunity: Strengthening Syringe Services Programs (SSP) through Direct Program Funding. This five-year project aims to strengthen the capacity of SSPs through direct program funding, provided through NASTAD, to continue serving as critically essential access points for core syringe and safer drug use supplies, overdose prevention information and materials, and a range of services for PWUDs such as adult vaccination services, HIV and viral hepatitis testing and linkage to care services, and referral and navigation efforts. Click here to view the RFP TA webinar recording. 

HRSA NOFO: Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP) 

  • Deadline: January 17, 2023 

HRSA released the fiscal year (FY) 2023 Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP) notice of funding opportunity (NOFO, HRSA-23-025). HRSA will make approximately $50 million available for up to 140 health centers located in the targeted geographic locations where there are a substantial amount of new HIV infections. 

FY 2023 PCHP will support expanding HIV prevention services that decrease the risk of HIV transmission in underserved communities. This funding will focus on increasing HIV testing, PrEP prescriptions, and linkage to HIV care and treatment. It is part of HHS’ Ending the HIV Epidemic in the U.S. initiative, which aims to reduce the number of new HIV infections in the U.S. by 90% by 2030. Health centers with service delivery sites in the targeted geographic locations that did not receive FY 2020, FY 2021, or FY 2022 PCHP funding, are eligible to apply. View the FY 2023 PCHP one-pager (PDF) for applicants. Visit the FY 2023 PCHP technical assistance (TA) webpage to access the NOFO, application aids, and other resources.

CDC NCHHSTP NOFO: PS-23-0009: Advancing Policy as a Public Health Intervention to Reduce Morbidity, Mortality, and Disparities in HIV, Viral Hepatitis, STDs, and Tuberculosis 

  • Deadline: February 1, 2023 

The Center for Disease Control and Prevention’s (CDC) National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) is thrilled to announce a new funding opportunity. This two-component funding opportunity aims to strengthen the ability of leaders who make decisions in public health to identify and implement evidence-based policy interventions. The funding opportunity features two distinct components:

  1. Leverage legal epidemiology methods to examine laws and policies over time and perform critical analyses to understand the effect of laws and policies on health and economic outcomes.  
  2. Provide robust legal and policy technical assistance (TA) to support leaders who make decisions in public health as they navigate complex issues unique to their jurisdiction and proactively create publicly accessible TA tools and resources.  

CDC RFA: Public Health Crisis Response Cooperative Agreement 

  • Deadline: February 12, 2023 

The CDC is activating CDC-RFA-TP22-2201 Public Health Crisis Response Cooperative Agreement to support state and local public health mpox response efforts. CDC will award up to $16 million to select jurisdictions on the approved but unfunded (ABU) list for CDC-RFA-TP22-2201. Funding will be prioritized for jurisdictions reporting the highest numbers of cases during October 2022. Funding is intended to address urgent needs and to implement monkeypox response related activities including efforts to increase vaccine accessibility and uptake, case and cluster investigation, surveillance, testing, communication, education, and outreach. Additional information, including supplemental funding guidance, is forthcoming. 

Job Postings 

Hepatitis Program Manager – Raleigh, NC 

This position serves as the supervisor and manager of the Viral Hepatitis Program, overseeing all viral hepatitis B and C activities (prevention and health education, expanded testing, reportable disease surveillance, epidemiology, healthcare outreach, linkage to care, etc.); Responsible for risk-based hepatitis A response and infrastructure development; Supervise five centralized hepatitis staff and activities of locally placed staff working to link hepatitis C patients to healthcare. Serve as the lead hepatitis epidemiologist and subject matter expert responsible for surveillance, reporting and epidemiologic investigation, and subject matter expert on drug user health. Responsible for implementing comprehensive hepatitis C elimination plan in partnership with others. 

Manage grants and associated budgets and apply for funding opportunities. Apply by January 26. 

HIV Prevention and Syndemics Specialist – Salt Lake City, UT 

You will be a part of the HIV/STD Elimination, Analysis, Response and Treatment (HEART) Program to implement HIV prevention activities statewide. You will work closely with Local Health Departments (LHDs) and Community Based Organizations (CBOs)  to not just concentrate on HIV itself, but the syndemics that lead to new HIV infections (STDs, Hepatitis C, substance use, etc). As our newest team member, your main focus area in HIV prevention would be with Pre Exposure Prophylaxis (PrEP) and expanding its reach around the state of Utah with medical organizations, CBOs and local health departments.  You will be a part of Utah's "Getting to Zero" plan, seeking to eliminate new HIV infections, HIV-related deaths and HIV-related stigma. Apply by January 17.

Manager, Legal Research – NASTAD 

The Manager, Legal Research provides legal and policy research and analysis as part of NASTAD’s technical assistance and capacity building assistance work.  This position will 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.

NASTAD RFP: Consultants for HIV Prevention Billing and Coding Guide 

  • RFP Issue Date: October 7, 2022 
  • RFP Closing Date: January 15 
  • Performance Period: January 1, 2022 – September 29, 2023 

NASTAD is soliciting proposals from professionals with demonstrated expertise and experience in medical coding and billing and creation of HIV-related coding guides. The consultant will lead creation of a billing and coding guide for HIV Prevention, with a special emphasis on pre-exposure prophylaxis (PrEP). This work is funded by a cooperative agreement from the Centers for Disease Prevention and Control (CDC) and builds off of and updates a HIV Prevention billing and coding guide NASTAD created in 2018.

Baltimore City Health Department

  • PrEP Navigator: The PrEP Navigator will work with the clinical care team in the Baltimore City Health Department Sexual Health and Wellness Clinics to support patient access to comprehensive HIV pre-exposure prophylaxis (PrEP). The PrEP Navigator provides psychosocial support, linkage to care and nonmedical case management support including health insurance and medication payment assistance navigation. Apply by December 23. 
  • Disease Reactor Coordinator: The Disease Reactor Coordinator will be part of the HIV/HCV Linkage to Care Team at Baltimore City Health Department, Bureau of Clinical Services and HIV/STI Prevention. This team performs a vital component of HIV and HCV prevention, by assisting individuals in reengaging with HIV and/or Hepatitis C with healthcare providers. The Disease Reactor Coordinator receives notifications of individuals who have fallen out of care for HIV and/or Hepatitis C. They search medical and public health records for contact information and contact medical providers to verify medical history. The Disease Reactor Coordinator assigns cases to additional members of the team. Apply by December 23. 
  • Care Linkage Specialist: The Care Linkage Specialist (CLS) identifies and provides counseling to people with HIV and/or Hepatitis C (HCV) and links them to qualified infectious disease providers for treatment and case management services. The CLS uses disease intervention specialist techniques to contact people and assist them with transportation and registration to their selected provider. Apply by December 23. 
  • Community Health Educator II: The Community Health Educator II will work directly with our HIV/STI Prevention: Outreach Program. The Outreach Program provides community testing throughout Baltimore City engaging with over 10,000 individuals yearly. Services are provided via a mobile health unit that conducts HIV, Syphilis, Gonorrhea, and Chlamydia testing. Other community services provided are PrEP navigation, Linkage to Care for people with HIV or Hepatitis C, free condoms, literature and referral resources. The majority of work duties occur in the field, interacting directly with community members. Apply by December 23. 

Boulder County AIDS Project – Boulder, Colorado 

  • Prevention Coordinator: 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. 
  • Bilingual Medical and Housing Case Manager: The focus of this position will be to ensure efficient delivery of quality medical case management services to clients who are living with HIV through assessment, planning, service procurement, delivery, coordination, and monitoring, ensuring all services are offered in an inclusive, respectful and professional manner. The Bilingual Medical and Housing Case Manager reports directly to the Care Services Director and is required to attend All Staff meetings, Care Services team meetings, Clinical Consultations, Finance Committee meetings and to keep all client data up to date for reporting purposes. Because this position manages confidential information for clients, the Bilingual Medical and Housing Case Manager must demonstrate the highest degree of professionalism. 

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. 

Executive Director, Hepatitis Education Project (HEP) – Seattle, WA (partially remote) 

Reporting to a Board of Directors and in partnership with a staff of 19, the ED will lead the evolution of HEP as the organization reviews its impact to date and plans for the future in the fields of viral hepatitis and drug user health both locally and nationally.  

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, and analyzing exposure data utilizing epidemiological and statistical methods. 

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 

‘The slippery slope is powerful’: Dems believe drug pricing law will pay dividends 

“..this year’s passage of the Inflation Reduction Act will empower Medicare to negotiate drug prices for the first time, paving the way for more government action over the coming years, argued Peter Welch (D-Vt.)… Welch’s confidence about the law’s potential to expand over time underpins Democrats’ strategy on drug pricing next year: defend the law from Republican attacks long enough to give Medicare breathing room to begin negotiating with pharmaceutical companies over some of their most expensive drugs, focus on new ways to cap prices of certain drugs, and bet that, like the Affordable Care Act, the policy pays political dividends down the road.” 

HIV Outbreak Persists as Officials Push Back Against Containment Efforts 

“In August 2021, the Centers for Disease Control and Prevention concluded its investigation of an HIV outbreak in Kanawha County, home to Charleston, where people who inject opioids and methamphetamine are at highest risk. The CDC’s HIV prevention chief had called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg…” Following its probe, the CDC issued recommendations to expand and improve access to sterile syringes, testing, and treatment. It urged officials to co-locate services for easier access. 

But amid this crisis, state and local government officials have enacted laws and ordinances that make clean syringes harder to get. In April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and required that they present an ID. Charleston’s City Council added an ordinance imposing criminal charges for violations. As a result, advocates say, a substantial number of those at highest risk of contracting HIV remain vulnerable and untested.” 

White House sees light at the end of the monkeypox tunnel 

“More than four months later, their efforts have been effective enough that Daskalakis and Fenton are now sketching out a wind-down of the White House-led response, with the goal of returning much of the management to the CDC. The transition would likely begin around the time the mpox public health emergency expires at the end of January, according to people familiar with the planning. Fenton and Daskalakis declined to comment on the specifics of their plans, but agreed that the emergency stage of the outbreak was nearly over.” 

Hepatitis C is a slow-moving killer that can be stopped. What’s getting in the way? 

“’For the past 10 years, the strategy has been, ‘OK, let’s get those people to their doctor,’” said Dr. Jeffrey Klausner, an infectious disease specialist at USC’s Keck School of Medicine. “In reality, we know that many people don’t have a doctor, or it’s too difficult to get access to a doctor. Or then they go to some doctors — and the doctors don’t know how to treat them.”” 

OTC Naloxone Nasal Spray Gains Priority Review 

“The FDA has accepted Harm Reduction Therapeutics’ (HRT) new drug application (NDA) for RiVive, an investigational over-the-counter (OTC) nasal spray containing 3 mg of naloxone, and has granted the compound a priority review. The combination drug-device, which is intended as an emergency treatment for accidental opioid overdose, has the potential to widely expand the availability of naloxone. The NDA is supported by phase 1 data demonstrating that RiVive produces a three-fold higher systemic exposure with comparable early absorption to the reference naloxone product. HRT has entered into a commercial supply agreement with a contract manufacturer in anticipation of FDA approval and U.S. launch in early 2024. The agency is expected to make an approval decision by April 28, 2023.” 

The fight over how to deliver bad news to patients 

“Congress was full of good intentions when it directed the Department of Health and Human Services to make sure patients get their test results as soon as they’re available. 

But the implementation of that directive has set off a battle between doctors on one side and HHS and patient advocates on the other, and raised a fundamental question: How should patients get bad news? The debate underscores how medicine’s digital transformation is changing the doctor-patient relationship and upending ingrained practices. Doctors say that patients are now receiving news about potentially terminal disease, or other, less catastrophic but confusing, test results from patient portals before they have a chance to explain them. The American Medical Association is pressing the department to revise its rules, and the trade group for physicians is finding allies in state legislatures. But patient advocates, and HHS, say patients should, and can, decide when they want their results.” 

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