Policy Update

February 10, 2021


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Oregon’s 81st Legislative Assembly

State Budget

As with all long legislative sessions, one of the key factors is determining the state's budget for the next biennium. We will have a more solid picture about the revenue and economic outlook at the Office of Economic Analysis' quarterly forecast on February 24. However, a few pieces have started to come into focus, as House Speaker Tina Kotek (D-Portland) and Ways & Means Co-Chair Rep. Dan Rayfield (D-Corvallis) discussed at a press briefing earlier this week.

Because Oregon is constitutionally required to have a balanced budget, unlike the federal government, the most important number for lawmakers is how big the budget gap is between projected revenue and projected expenditures.

In November, legislators heard a fourth-quarter revenue forecast from the Office of Economic Analysis, which stated that the shortfall would be just under $800 million. This was great news to hear at the time, considering the forecast for tax and lottery funds were up by $2 billion from the previous forecast. Since then, the legislature approved an $800 million COVID-19 relief package in the December special session, bringing the budget gap up to $1.6 million.

The Oregonian reports "legislative committees will soon begin working on proposals for how state agencies could absorb budget cuts of 5% to 7% if that turns out to be necessary."

When asked about whether tapping into the Rainy Day Fund would be necessary, Rep. Rayfield responded, "I would most certainly say that it’s raining."

House may take first-ever vote on expulsion of a member in wake of Conduct Committee findings

The internal process for conduct violations are conducted through two processes: first, an external investigation takes place, and then the respective chamber's committee on conduct meets to go through the findings of the investigation and determine whether or not the member violated the rules of the chamber.

As you may have heard, the House Committee on Conduct met for several consecutive days this week to consider the findings of an investigation into allegations against Rep. Diego Hernandez (D-Portland) of sexual harassment and creating a hostile work environment.

The committee members unanimously determined they had sufficient evidence that 18 violations of the conduct standard took place.

Next, the committee was charged with deciding what actions to put before their fellow House members. They were deciding between two actions: to censure or to expel Rep. Hernandez. After a discussion of their rationales for their decisions, the members unanimously voted to move forward with a bill to expel Rep. Hernandez, which requires a two-thirds vote on the House floor.

If the bill is scheduled for a vote, it would be the first time the Oregon House has considered a vote to expel a member. Similar complaints have been made for other members, but the respondents either resigned or did not seek reelection before this kind of action could have been enforced.


The White House and Capitol Hill

American Rescue Plan Act (Reconciliation bill language)

As expected, late last night (Feb. 9) the House Energy and Commerce Committee released its draft language for its section of the COVID Rescue/ Reconciliation bill. The draft includes $7.6 billion for CHCs, as well as $800 million for the NHSC.  There is also a significant funding boost for Teaching Health Centers, an incentive for the 12 remaining states to expand Medicaid, and a provision that could expand CHCs’ 340B savings on Medicaid drugs (assuming they are able to retain these savings.)  An overview of these provisions is below. 

The E&C Committee will be marking up this language on Thursday, February 11. The Chairman has indicated that he is not interested in accepting amendments and plans to vote against all that are offered. However, other committee members have expressed a willingness to consider amendments, as long as offsets are provided.

Funding for CHCS: $7.6 for CHCs. 

  • Look-alikes ARE eligible
  • Funds can be used for expenses incurred starting January 31, 2020 (last year)
  • Allowable uses of funds are broad, and include:
    • standard COVID activities (e.g., testing, tracing, vaccinating, educating),
    • equipment and supplies, including to purchase and maintain mobile vehicles for COVID care
    • workforce – both to address COVID needs and “to carry out other health workforce-related activities”
    • “to modify, enhance, and expand health care services and infrastructure”

Workforce funding

  • $800 million for National Health Service Corps
    • Of this $100 million goes directly to State Loan Repayment programs
  • $200 million for Nurse Corps
  • $330 million for Teaching Health Centers
  • Funds will remain available through Sept. 30, 2023
  • Will fund both existing THC programs and the development of new programs.
  • Increases the per-resident amount by $10,000
  • $7.66 billion for “public health workforce.”
    • Can be used for awards to state and local health departments, to fund a variety of public health positions (e.g., community health workers, contact tracers, lab personnel) and related costs (e.g., PPE, administration.) 
    • Health departments can use their funds to pay for public health workers employed by CHCs and other “nonprofit private or public organization(s) with demonstrated expertise in implementing public health programs and established relationships with… public health departments, particularly in medically underserved areas.” 
    • The language leaves open the possibility that awards can be made directly to organizations other than state and local health departments (e.g., CHCs), but gives no specifics. 

340B:  The language would remove the “cap” on the size of the rebate that drug makers must pay Medicaid for drugs whose price has risen significantly faster than inflation.  Currently, the maximum rebate is 100% of the drug’s cost; for drugs subject to the 100% rebate, manufacturers may charge no more than (or one penny.)  The E&C language proposes to lift the 100% cap so that manufacturers could have to pay Medicaid if a drug’s price rises so fast that the rebate formula exceeds 100%.  (For example, if the formula requires a rebate of 120%, the drugmaker would have to pay Medicaid 20% every time it dispenses that drug.)  Since 340B discounts are equal in dollar value to Medicaid rebates, this provision would require drug makers to pay CHCs for these drugs also, if they are purchased under 340B. 

Medicaid

  • Incentivizes states to expand Medicaid by offering a 5% increase in the FMAP (from 90% to 95%) for two years for states that implement the ACA expansion after this bill is passed. 
  • 100% FMAP for vaccine administration
  • Makes COVID vaccines a mandatory Medicaid service
  • Other coverage and financing expansions, including extending post-partum coverage, increasing FMAP for crisis intervention, temporarily hiking FMAP for home-and-community-based services and extending 100% FMAP into Urban Indian Health Organizations and Native Hawaiian Health Care Systems.
  • A five-year extension of the policy granting Medicaid coverage to women for 12 months after they give birth, as well as to prisoners starting 30 days before their release.
  • Increased funding for Medicaid programs to support mobile crisis intervention care for people with mental illnesses or substance use disorders.

Other provisions of interest

  • $340 billion for state, local, and tribal governments to address the COVID crisis
  • $46 billion for testing, contact tracing, and mitigation
  • $7.5 billion to CDC for general COVID activities
  • $6 billion for Indian health
  • $5.7 billion for vaccine and therapeutics supply chain (e.g., development, review, production, purchase)
  • $1.75 billion for block grants for community mental health services
  • $1.75 billion for block grants for prevention and treatment of substance use disorder
  • $1 billion for vaccine confidence activities
  • $50 million increase for Title X (a 17.5% increase.)

Biden announces Community Health Center Vaccination Program

White House Press Release

You may have heard the breaking news yesterday that health centers will receive vaccines direct from manufacturers. While this is incredibly exciting, it will not come as quickly as we would like. Here is what we know as of today, February 10.

  • Starting the week of February 15, direct allocation to health centers (25), in partnership with CDC
  • Health centers will follow CDC guidelines on sequencing and population prioritization
  • CHCs interested in taking part will need to opt-in (apply)/ this is optional
  • The rollout will start slow to make sure the strategy works, is effective and vaccines are able to be utilized
  • 250 health centers were selected using specific criteria - ensure at least 1 CHC in each jurisdiction/state, focus on hardest to reach/serving the most vulnerable
    • Focus on special populations, limited English proficiency, homeless, migrant, living in public housing, mix of urban and rural
  • Of the 250 selected 25 CHCs were selected to start (allocation week of 2/15)
    • Narrowed from 250 for the 25 selected based on criteria to meet the above, AND:
      • Senior population of 2k or more (65 )
      • Used CHC HRSA survey responses to select and determine which CHCs are not having staffing issues, have storage ability, and are doing ok financially
    • BPHC emailed the 25 CHCs selected and their corresponding PCAs Tuesday - not all states are part of this initial group (OPCA was not contacted)
    • Will ramp up to 1M doses weekly but will take some time, based on availability and success
    • Priority is health equity and reaching the most vulnerable
    • Health centers do not have to opt-in if things are working in a state with current state plans
    • Intent to eventually include Look A Likes but starting small
    • Financing/additional funding to CHCs for COVID-19 response being worked out. Will likely get funding out quickly, similar to other COVID-19 funds, and request information regarding projects and reporting later

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January 2021

February 3, 2021