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The under-the-radar health provisions in the massive government funding bill

The under-the-radar health provisions in the massive government funding bill

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  • December 21, 2022
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Today’s edition: Nursing homes are at risk of more covid deaths amid lagging uptake of the new booster shot. The Drug Enforcement Administration seized enough fentanyl this year to kill everyone in the U.S. But first … 

Here are the health provisions in the spending bill you might have missed

Capitol Hill’s sweeping spending package is filled with new health measures, from longer-term funding for the Indian Health Service to beefed up dollars for the new 988 mental health crisis hotline.

The massive 4,155-page bill is expected to be sent to President Biden’s desk by the end of the week, where an array of health policy provisions large and small are set to become law. 

Still reading the bill? We’ve got you covered today with some of the under-the-radar provisions — and details on some measures that didn’t make it in. 

More stable IHS funding: Native American groups and their congressional allies mounted perhaps their largest effort to push Congress to provide more funding certainty to the federal health agency that helps serve roughly 2.6 million American Indians and Alaska Natives. 

  • Their efforts paid off. For the first time, the Indian Health Service will now get what’s called an advance appropriation. That means the omnibus package will also include funding for the 2024 fiscal year, so the agency isn’t subjected to a temporary funding measure when Congress almost certainly fails to pass another budget before Sept. 30.

A boost for 988: The nationwide hotline for mental health emergencies is set to get nearly $502 million — which is a nearly $400 million increase. Over the summer, the hotline switched to a new, easy-to-use number, 988, and the ultimate goal is to be able to dispatch mobile crisis teams immediately to anyone in need, no matter where they live.

Nixing the X waiver: The legislation aims to make it easier for providers to prescribe buprenorphine to treat opioid addiction. Providers have had to obtain a separate waiver from the Drug Enforcement Administration to prescribe the drug, a requirement providers argue slows their response to the opioid epidemic. The government spending bill would let DEA-registered providers prescribe or dispense the drug for opioid use disorder without obtaining separate permission.

Cracking down on accelerated approvals: The Food and Drug Administration will have added oversight over drugs approved under an expedited process, such as allowing the agency to require post-approval studies already be underway when a drug gets the greenlight. Other measures include creating an intra-agency council to ensure the pathway is being used appropriately. 

  • The FDA’s fast-tracked process is meant to speed up the availability of drugs that treat serious conditions in need of more treatments. But the accelerated approval program has come under scrutiny in recent years with lawmakers, experts and even top FDA officials saying they want to reform the program.

Covering covid-19 pills: The package appears to plug a major looming hole in coverage for Paxlovid, the pill that has proved effective at preventing hospitalization and death among the elderly. The legislation would allow Medicare’s voluntary prescription drug benefit to cover oral antiviral drugs even if they are under emergency use authorization. This comes as the federal government is poised to stop paying for the medication some time next year, turning over the drugs to the commercial market instead.

A Senate-confirmed CDC director: We mentioned this yesterday, but it’s a pretty big change. The Senate confirms the leaders of prominent health agencies, but not the director of the Centers for Disease Control and Prevention — at least up until now. Bipartisan legislation from Sens. Patty Murray (D-Wash.) and Richard Burr (R-N.C.) aimed at tackling future pandemics included a requirement that the chamber confirm the CDC director, and such a measure was included in the new spending bill. The mandate would start on January 20, 2025, which seems to be around the next presidential inauguration.

  • “NIH [and] all the other major agencies are Senate confirmed, that was something Sen. Burr worked really hard on,” said Murray, who also supported the change.

Hannah Recht, Kaiser Health News:

No increase in Title X funds: The federal family planning program, known as Title X, received flat funding of roughly $286 million this year. The program directs grants for birth control, reproductive health and preventive services for low-income women — and reproductive health and abortion rights groups had argued more funding was needed in the post-Roe era. 

Forget about new pandemic aid: Congress again rebuffed the White House’s request for new dollars to combat the coronavirus. Last month, Biden administration officials urged lawmakers to approve about $9.25 billion in emergency funds to help ensure access to vaccines and treatments while supporting new research into long covid.

The battle over more funds has been ongoing since the spring, and Republicans have refused to budge, with one Senate GOP aide telling The Health 202 that they want further explanations on how the federal government has spent billions previously allocated for its pandemic response. 

Nursing homes at risk of another covid wave amid lagging vaccinations

Fewer than half of all nursing home residents and a quarter of nursing home staff have received the latest coronavirus vaccine booster shot, according to data collected by the CDC

The lagging vaccination rates have renewed fears about a deadly winter for elderly people, with more than 300 nursing home residents recently dying from the coronavirus per week, The Post’s Christopher Rowland reports. The current death rate isn’t close to what it was in 2020, though it comes amid an expected uptick in cases as people gather for the holidays and move indoors during the winter weather.

“We’re certainly expecting to see an increase in deaths in nursing home residents in the coming months because that is what we have historically seen, especially given how low the rate of the latest booster take up is,” Priya Chidambaram, senior policy analyst at the Kaiser Family Foundation, told Christopher.

In total, more than 163,000 nursing home residents and staff have died from the coronavirus. Many of them died during the first year of the pandemic. 

White House response: The Biden administration announced a series of directives last week in anticipation of a potentially deadly winter.

  • Nursing home staff are now eligible to administer coronavirus vaccines.
  • The administration is urging governors to do more to increase the number of vaccinated residents and staff, especially in states with low uptake.
  • It’s also pushing hospitals to offer coronavirus vaccines to patients before they’re discharged to a nursing home. 

On the Senate floor yesterday …

Sen. Tammy Duckworth (D-Ill.) attempted to bring up by unanimous consent her new legislation aimed at codifying access to fertility treatment, such as in vitro fertilization, amid the turbulent landscape of reproductive politics.

The move was swiftly blocked by Sen. Cindy Hyde-Smith (R-Miss.). Unanimous consent requests are often used to send a message on legislation that doesn’t have the votes, and Democrats have utilized the tool to draw attention to legislation to protect reproductive and abortion rights in a post-Roe era. For instance: Over the summer, Democrats attempted to bring up a bill on the freedom to travel across state lines to obtain an abortion, a procedural maneuver Republicans objected to.

DEA seizes enough fentanyl to kill every person in the U.S. in 2022

The Drug Enforcement Administration has seized more than 379 million potentially deadly doses of fentanyl this year, enough to “kill every American,” the agency’s administrator said. 

“These seizures — enough deadly doses of fentanyl to kill every American — reflect DEA’s unwavering commitment to protect Americans and save lives, by tenaciously pursuing those responsible for the trafficking of fentanyl across the United States,” Anne Milgram said in a statement.

More than 107,000 Americans died of drug overdoses in 2021, and fentanyl — a powerful synthetic opioid — is a major driver of deaths nationwide.

But the seizure numbers do not reflect the volume seized by U.S. Customs and Border Protection along the southern border, The Post’s Nick Miroff reports. CBP authorities have seized more than 14,000 pounds of fentanyl during the fiscal year that ended Sept. 30. 

Still, they estimate that they’re only catching 5 to 10 percent of the illegal fentanyl that crosses the border.

Now available: Ownership data for thousands of hospitals

The Biden administration released a massive spreadsheet yesterday with ownership information on the nation’s Medicare-certified hospitals, Stat reports.

The data dump includes details for more than 7,000 hospitals, such as whether an individual or an organization owns the facility. It can be difficult to learn when private equity buys into a hospital. That comes as concerns over private equity ownership of hospitals mount, which can have cost and quality implications, Stat’s Tara Bannow writes.

The details: The Centers for Medicare and Medicaid Services plans to update the ownership data spreadsheet every month. It includes information like the organization’s name, type, address, details about each owner and more. 

The information may be more useful to researchers than consumers — at least at first. One expert, who quickly looked through the spreadsheet, estimated that researchers will need to comb through the information and present it in a way that the average consumer can understand. That means the ownership breakdown of hospitals wasn’t immediately clear. 

First came a viral storm. Now, we have puzzling superinfections. (By Ariana Eunjung Cha l The Washington Post)

Many Hospitals Get Big Drug Discounts. That Doesn’t Mean Markdowns for Patients. (By Anna Wilde Mathews, Paul Overberg, Joseph Walker and Tom McGinty l Wall Street Journal)

Diabetes treatments are improving. Racial disparities are wider than ever. (By Elaine Chen l Stat)

Planned Parenthood starts telemedicine abortions in Kansas (By John Hanna l Associated Press)

Thanks for reading! See y’all tomorrow.

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