Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
FY2025 Appropriations
On July 10, the House Appropriations Committee (HAC) approved the Labor, Health and Human Services, Education, and Related Agencies (LHHS) Subcommittee spending bill and released an accompanying report for fiscal year 2025 (FY2025), which begins on October 1, 2024. The LHHS bill proposes major cuts to health programs across the Department of Health and Human Services (HHS), totaling a decrease of 7% compared to FY2024 enacted levels. The cuts include the elimination of the Centers for Disease Control and Prevention (CDC) component of the Ending the HIV Epidemic Initiative (EHE) and a $190 million cut to the Health Resources and Services (HRSA) Ryan White HIV/AIDS Program (RWHAP). Notably, the subcommittee proposed a $10 million increase for the CDC hepatitis program and a $6.1 million increase for the infectious disease and opioids program.
The House spending bills must be reconciled with the Senate before they can become law. On July 11, the Senate Appropriations Committee (SAC) announced the topline spending totals for all twelve spending bills, allowing subcommittee staff to start drafting bill text and programmatic spending proposals. The SAC is proposing higher spending totals than the House, teeing up partisan spending disagreements for FY25.
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 Authorizes Coverage for People Transitioning out of Incarceration
On July 2, the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) announced that five states were approved for Section 1115 demonstration projects to expand coverage for adults and youth transitioning out of incarceration. The first-ever Medicaid Reentry Section 1115 Demonstration Opportunity allows a state to cover certain services not otherwise coverable in Medicaid and CHIP up to 90 days before an eligible person’s expected release from incarceration. CMS approved the waivers in Illinois, Kentucky, Oregon, Utah, and Vermont.
NIH Panel Releases New Recommendations to Prevent Anal Cancer for People with HIV
On July 9, the HHS Panel on the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV has released new recommendations to prevent anal cancer for people with HIV, the first U.S. federal guidelines on the topic. These recommendations include a screening program that uses high resolution anoscopy (HRA) to help detect and treat precancer and prevent anal cancer for people with HIV.
The guidelines recommend that all adults with HIV be assessed at least once per year for anal abnormalities (such as pain, burning, or masses) and undergo digital anorectal examination (DARE).
HUD Awards $26 Million to Address the HIV Epidemic through Housing
On July 9, the Department of Housing and Urban Development (HUD) awarded $26 million in Housing Interventions (HINT) to End the HIV Epidemic program funding, providing 11 grantees with a one-time award to fund housing assistance and supportive services for eligible individuals and families, coordination and planning activities, grants management and administration. The program is part of the Housing Opportunities for Persons with AIDS (HOPWA) program, and at the end of the grant period, each grantee will create a HOPWA Special Projects of National Significance (SPNS) Grant Model.
FTC Report Reveals Concentrated PBM Market Structure
On July 9, the Federal Trade Commission (FTC) released an interim report detailing the impact of pharmacy benefit managers (PBMs) on the accessibility and affordability of prescription drugs. The report is part of an FTC inquiry launched in 2022 to assess PBM market practices and shows how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95 percent of all prescriptions filled in the United States. As a result, PBMs have an outsized impact on patient access and affordability for prescription drugs.
Resources
“Among adults evaluated for substance use treatment and reporting past–30-day IMF or heroin use or IMF or heroin as their primary lifetime substance use problem, those also reporting xylazine use reported more past nonfatal overdoses, and higher percentages of persons who reported xylazine use reported other recent substance use and polysubstance use than did persons who did not report xylazine use. Provision of nonjudgmental care and services and linkage to and retention in effective substance use treatment might reduce harms, including overdose among persons reporting xylazine use.”
CDC MMWR: Treatment for Opioid Use Disorder: Population Estimates Along a Cascade of Care —United States, 2022
“The analysis highlights that in a representative community sample, most adults who needed OUD treatment either did not perceive that they needed it or received treatment without medications for OUD. Based on evidence from the analysis, it is recommended that clinicians and other treatment providers should offer and arrange for evidence-based treatment, including medications for OUD.”
CHLPI Brief: Medicare Coverage of HIV Pre-exposure Prophylaxis (PrEP): Information for Patients, Providers, and Pharmacists
“The federal Centers for Medicare and Medicaid Services (CMS) are considering issuing a final National Coverage Determination (NCD) for PrEP directing Medicare to cover all forms of PrEP (oral and injectable) through Medicare Part B, the portion of Medicare that covers outpatient treatment. If CMS does this, Medicare beneficiaries will be able to get PrEP under Medicare Part B with zero cost-sharing.”
KFF Issue Brief: Supreme Court Decision Limiting the Authority of Federal Agencies Could Have Far-Reaching Impacts for Health Policy
“The US Supreme Court has again overturned longstanding precedent, this time getting rid of a 40-year- old standard for decision making that required federal courts to defer to reasonable agency decisions where federal law is silent or unclear. This “Chevron deference” standard is now gone, ushering in a new era where courts will not have to accept agency expertise in their review of challenged regulations.”
“The Indian Health Service (IHS) is accepting applications for the second round of cooperative agreement for the Ending the Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), and Syphilis Epidemics (known as “the Syndemic”) in Indian Country (ETHIC II) program. The purpose of this program is to support communities to directly increase the diagnoses, treatment, and prevention of HIV, HCV, and syphilis.”
Job Postings
Government Affairs Manager – HIV+Hepatitis Policy Institute
The Government Affairs Manager will be responsible for advocating policy positions before the United States Congress, federal agencies, and state officials. Primary focus will be on securing adequate appropriations for domestic HIV and hepatitis prevention and treatment programs. Additional areas of focus include Congressional and federal agency consideration of issues that impact access and affordability of health care, including prescription medications. On occasion, state legislative and agency communication will also be part of the portfolio. For further details and to apply by July 19, 2024 please click here.
Director, HIV Prevention -- Tennessee Department of Health
This role is responsible for overseeing and administering the entire portfolio of HIV Prevention activities supported by TDH and our community-based organization partners statewide. In addition to leading an internal team of eleven direct and shared staff, this role will also be responsible for maintaining strong relationships with a wide variety of external stakeholders, including our CBO partners, metro Health Department leadership, and the United Way of Middle TN.
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
Biden administration plans major cuts to AIDS relief programs in Africa
“The Biden administration plans to cut funding by more than 6 percent in fiscal 2025 from the President’s Emergency Plan for AIDS Relief, the 21-year-old program credited with saving millions of lives in Africa, a senior PEPFAR official told POLITICO.
The State Department, which oversees the program, confirmed the cuts. The department has gradually spent down a glut in the PEPFAR budget from years in which funding from Congress exceeded State’s ability to spend it, said a department spokesperson who, like the PEPFAR official, was granted anonymity to discuss sensitive program decisions. Now the glut is gone and Congress in March held the program’s $4.4 billion budget flat.”
With mpox cases on the rise, advocates urge vaccinations to avoid potential resurgence
“More than two years since the initial mpox outbreak, cases are trending up again — and the word still hasn't gotten out to everyone at risk. During Pride Month, public health officials came armed with a serious message: Get vaccinated.”
US judge blocks Biden rule adding gender identity protections to healthcare
“A U.S. judge on Wednesday blocked the Biden administration from enforcing a new rule against discrimination on the basis of gender identity in healthcare while he hears a lawsuit challenging it by 15 Republican-led states.
The rule was finalized in May by the U.S. Department of Health and Human Services (HHS) and was set to take effect on Friday. It states that a federal prohibition on sex discrimination, part of the Affordable Care Act health insurance law, extends to discrimination against transgender people.
Stimulant users caught up in fatal 'fourth wave' of opioid epidemic
“The third wave began when powerful synthetic opioids like fentanyl started appearing in the supply around 2015. Now experts are observing a fourth phase of the deadly epidemic. Nationwide, illicit stimulants mixed with fentanyl were the most common drugs found in fentanyl-related overdoses, according to a study published in 2023 in the scientific journal Addiction. The stimulant in the fatal mixture tends to be cocaine in the Northeast, and methamphetamine in the West and much of the Midwest and South.”