December 2006

For more information, please contact:
Eli Briggs, Senior Government Affairs Specialist
(ebriggs@naccho.org)

Donna Brown, JD, MPH, Government Affairs Counsel
(dbrown@naccho.org)

109th Congress Concludes; Passes Health Legislation in its Final Hours
Two bills of critical importance to local health departments were passed in December by the 109th Congress.

The Pandemic and All Hazards Preparedness Act (S.3678) was passed on December 9 and would establish an "all-hazards" approach to public health preparedness, rather than focusing exclusively on acts of bioterrorism. Below you will find a summary of the provisions in the bill that are most pertinent to local public health departments.

The bill codifies much that is already existing or planned practice with respect to the CDC cooperative agreement program that provides funds to state and local health departments to support preparedness. In addition, it establishes penalties for states (and the three direct urban grantees) that fail substantially to meet performance benchmarks or that exceed carryover limits that the Secretary of Health and Human Services would establish. There is a strong emphasis on performance measurement and fiscal accountability and a new requirement for a state match beginning in 2009 (which would include in-kind contributions.)

The bill establishes a modest new federal public health workforce program, in the form of grants to states that establish state loan repayment programs for public health professionals who go to work in state or local health departments that provide services to health professional shortage areas or areas at risk of a public health emergency. It is important to note, however, that this new program would not be implemented until Congress appropriated new funds for it and a state established a loan repayment program. The bill also officially authorizes the Medical Reserve Corps in order to provide for an adequate supply of volunteers in the case of a public health emergency.

The bill also opens the hospital preparedness program (which it moves organizationally from the Health Resources and Services Administration to a new Assistant Secretary for Preparedness and Response) to direct funding by HHS of partnerships that could include a group of hospitals and a state or local health department, rather than passing all the funding through the state.

The bill codifies into law the requirement for local concurrence with state spending allocations that has existed for several years in the CDC cooperative agreement guidance. It also requires activities undertaken under both CDC and the hospital preparedness cooperative agreement programs to be consistent with the activities of local health departments and local emergency plans. This reflects NACCHO's consistent advocacy for the proposition that public health response to a disaster takes place in the context of local emergency management plans.

The bill ensures some additional local flexibility in spending preparedness funds by explicitly permitting their use to pay salary and expenses for any health department personnel carrying out preparedness activities, even if that is not their primary assignment. NACCHO proposed and advocated strongly for this provision. The bill also requires states to coordinate with local public health departments, the Cities Readiness Initiative and local emergency plans when determining the activities to be carried out.

The bill creates an Advisory Committee on At-Risk Individuals and Public Health Emergencies and requires that recipients of state and local public health grants include preparedness strategies in their plans to address the medical and public health needs of at-risk individuals in the event of a public health emergency.

The bill requires HHS to establish a "near real-time" electronic nationwide public health situational awareness capability through an interoperable network of systems to share data and information to enhance early detection of, rapid response to, and management of infectious disease outbreaks and other public health emergencies. This network will be built upon systems that are already in place for this purpose.

The bill allows for the creation of a vaccine tracking program to track the distribution of federally purchased influenza vaccine in an influenza pandemic that would be dependent on manufacturers, wholesalers and distributors choosing to participate. The bill also encourages information exchange between public health officials and manufacturers, wholesalers and distributors regarding the distribution of seasonal influenza vaccine. It reflects CDC's current activities in this area.

The bill authorizes Centers for Public Health Preparedness based at accredited schools of public health. Centers for Public Health Preparedness are required to develop a competency-based training program to train public health practitioners. The bill also requires Centers for Public Health Preparedness to collaborate with state, local or tribal public health departments to create materials or trainings on public health preparedness and response for use in educating the general public.

The full text of the bill can be found by searching for S. 3678 at thomas.loc.gov.

The Ryan White Treatment Modernization Act (HR 6143), passed the House and Senate on December 9. The new law's impact on funding will depend on the outcome of the FY 2007 appropriations process. The bill provides a three-year authorization period. After this time period, the bill will again be up for reauthorization.

The major provisions of the bill are as follows:

1. Maintain funding levels of Title 1 and Title 2 at 95 percent of the previous year, but never allow funding to fall below 95 percent of what states and cities received in 2006.
2. Counts all people with HIV for funding no matter where they live or how the data is packaged.
3. Maintains the targeted funding pool for pharmaceuticals and therapeutics, instead of running out of money paying for hold harmless provisions which would happen if we continue with current law
4. Includes an absolute repeal of the law after three years so it forces the issue of restructuring to meet the needs of those living with the disease now.
5. Expects HHS to continue to develop a framework to look at severity of need and to report their progress in 2008.
6. Maintains four years of transition time for code states to switch to names without being penalized.

The Early Diagnosis Grant Program opposed by NACCHO remains in the final bill. It would divert $30 million from HIV/AIDS prevention efforts in the Centers for Disease Control and Prevention and would be targeted toward the states to implement new HIV testing policies, especially mandatory testing for newborns. To redirect prevention dollars for use in prescribed testing activities will limit the flexibility to respond to local prevention needs.

The full text of the bill can be found by searching for HR 6143 at thomas.loc.gov.

Public Health Funding Outlook
Before adjourning for the last time, the 109th Congress failed to complete a bill funding the Department of Health and Human Services for FY 2007, which began October 1, 2006. Funding for programs administered by HHS will remain at the FY 2006 level until February 15. Incoming Appropriations Committee chairmen Sen. Robert Byrd (D-WV) and Rep. David Obey (D-WI) have indicated that they plan to pass a continuing resolution in February that would fund all government programs not funded by the 109th Congress through the end of FY 2007. The continuing resolution to be passed in February will not contain any Congressional earmarks, or funding for special projects identified by individual members of Congress. Working within the constraints of the Republican budget for FY 2007, Byrd and Obey pledged to make "limited adjustments" to address their policy priorities. This is expected to free up approximately $7 billion. It is unclear at this time how this additional funding will be allocated.

The outlook for public health funding with Democrats in the majority in the next Congress is also unclear at this time. Tight budget constraints are expected to continue and Democrats have indicated that they will attempt to enforce stricter fiscal controls in order to reduce deficit spending. This will mean that discretionary spending continues to face an uphill battle as various policy priorities are forced into a competitive situation. NACCHO will continue to advocate for strong funding of public health priorities and will notify you at key decision points when communicating with your Members of Congress is critical.

***Remember to visit http://capwiz.com/naccho/home/ for all the latest legislative news from Washington.***