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April 16, 2019

The latest developments and trends in federal affairs impacting allied health education.

ASAHP Meets with HRSA's Leadership

On April 5th, ASAHP Executive Director John Colbert, along with a select group of leaders from national practice organizations, participated in a day-long meeting at the Health Resources and Services Administration (HRSA) with Administrator George Sigounas and each of HRSA’s Associate Administrators overseeing the agency’s key bureaus, to discuss the agency’s strategic plan, goals, and upcoming areas of focus.

Administrator Sigounas touched upon his overall focus of improving health outcomes and disparities through a skilled health workforce and highlighted HRSA’s ongoing work in addressing opioid abuse, as well as addressing the workforce challenges in rural areas through proven models of practice.

Dr. Luis Padilla, Associate Administrator for the Bureau of Health Workforce (BHW), described how BHW does not view our health workforce in isolation from health care service delivery and how it is trying to improve the health of underserved and vulnerable populations by connecting skilled workers to communities in need.

BHW has three goals: increasing access via telehealth and other modalities in areas where there is not a strong health workforce footprint; reducing health professions shortages; and improving the quality of education and training, as well as quality of care. He cited their geriatric workforce education program as an example of this approach.

John spoke with Dr. Padilla about the challenges our institutions face in finding clinical education sites and inquired about BHW’s work with the Bureau of Primary Care to create more clinical education opportunities. Dr. Padilla is aware of the challenges allied health institutions are facing, as well as other health professions. As part of HRSA’s effort to improve clinical education opportunities, BHW will unveil later this spring a “Health Workforce Connect” portal which students will be able to access to locate available clinical education sites.

In addition, John spoke with Jim Macrae, the Associate Administrator of the Bureau of Primary Care, about the possibility of offering more clinical education at Community Health Centers. Macrae indicated that many Community Health Centers have been stymied to date from offering clinical education due to a lack of funding, a lack of preceptors, and being chronically understaffed. Macrae said that BHW and the Bureau of Primary Care are examining ways to work together to increase clinical opportunities.

ASAHP will continue to work with HRSA on this effort and also explore additional ideas with Congressional Appropriators who can provide the funding and directives necessary to help address such shortages. 

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Members of Congress have left Washington for a two week recess with much work still pending on both the policy and funding fronts impacting higher education and our workforce.

FY 20 Funding

The House Democratic majority spent the bulk of the previous two weeks focused on developing a FY 20 budget resolution that would highlight key Democratic priorities and be in marked contrast to the Administration’s budget request, which proposed a nearly 10% cut to domestic funding.

However, Democrats were unable to pass a standalone House budget resolution due to a divide within their Caucus, as their most liberal Members sought funding increases for domestic programs of a magnitude well beyond what more moderate Democrats were willing to support. Instead, the House leadership was forced to utilize a procedural mechanism to “deem” a 5.7% overall increase, above FY 19 levels, for domestic programs in FY 20.

Now that top line funding has been created, the House leadership is moving forward with the next step of the budgetary process, the development of their FY 20 appropriations bills with a goal of moving these bills through the House floor by end of June. The Labor-HHS-Education (“Labor-HHS”) bill, which provides funding for higher education and health workforce programming, will be the first appropriations bill to be drafted (or “marked up”) in Subcommittee on April 30th.

This 5.7% funding increase will not be shared equally among domestic programs. Appropriators will prioritize how to spend these additional dollars, but key Labor-HHS appropriators indicated to ASAHP their first goal will be to protect funding for programs sought to be cut by the Administration and then provide increases for high priority programming, such as funding for the National Institutes of Health.

The House FY 20 appropriations process will likely be the high water mark for funding this year, as the Senate budget process to date has adhered to the lower overall funding levels proposed by the Administration – which both chambers agree are unworkable low.  

To help bridge this funding gap between the House and Senate, leadership officials in both chambers are already meeting with the goal of reaching a new “top line” agreement to raise overall defense and domestic spending for both FY 20 and FY 21.

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Cabinet Secretaries Testify Before Congress

As part of the FY 20 appropriations process, Education Secretary Betsy DeVos and HHS Secretary Alex Azar have both testified three times before Congress over the past few weeks.

DeVos’ testimony has largely focused on her Department’s budget request and policy priorities and exposed the deep breach between the Secretary and Congressional Democrats over funding for higher education, the role of for profit education, accountability standards, Public Service Loan Forgiveness, and Title IX related campus issues. ASAHP has created and circulated our own summaries of each of these hearings for our members, which can be found here: House Appropriations Committee, Senate Appropriations Committee, and House Education and Labor Committee.   

Secretary Azar has also testified on his budget request and while key Members of Congress have mentioned their skepticism about the Administration’s proposal to eliminate funding for health workforce programs in PHSA Titles VII and VIII. Most of the focus of these hearings has been on broader policy issues, such as funding for NIH, fighting opioid abuse, and Medicaid. ASAHP’s summary of the hearing can be found here.

The good news is there is broad opposition in Congress to the Administration’s proposed elimination of Title VII and VIII, as well as additional cuts to higher education that we outlined in our March 20th memo.

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Higher Education Act Hearings Continue

Both the House and Senate continued their HEA reauthorization hearings, with the Senate HELP Committee holding a hearing last week focused on accountability and highlighting different ideas on the type of accountability measures institutions might be responsible for providing in the future.

Chairman Lamar Alexander (R-TN) would like to narrow reporting requirements to a single measure – student loan default rates – to determine institutional accountability, as well as strengthen the role of regional accreditors. Ranking Member Patty Murray (D-WA) believes a student outcome focused accountability system is needed, noting 60 percent of students graduate or receive a credential in six years, with lower rates for underrepresented students. She prefers a partnership between federal government, states, and accreditors to provide oversight, accountability and quality assurances for students. Our full summary of the hearing can be found here.  

The House Education and Labor Subcommittee on Higher Education also had its own hearing on accountability on April 3rd, the second in a series of hearings on HEA reauthorization. While much of the discussion reflected issues and divisions similar to their counterparts in the Senate, the House hearing had an even more partisan tone regarding for profit education with Democrats wanting stronger scrutiny of this sector, which has lower outcomes and higher default rates than traditional higher education and Republicans urging accountability standards be applied equally across postsecondary institutions. Our summary can be found here

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HEA Negotiated Rulemaking Panel Reaches Consensus

Defying the expectations of most policy insiders, the Department of Education’s negotiated rulemaking panels, focused on accreditation, distance education (including state authorization), and innovation, reached consensus last week.

While the language from the “Neg Reg” panels has yet to be released, it is expected to be published this summer with notice and comment rulemaking closing toward the end of the year. Of specific concern to ASAHP’s members has been the State Authorization rule, which was originally published in 2016 by the Obama Administration, but delayed by the Trump Administration. The Neg Reg panel largely kept in place the state reciprocity agreement “SARA” process. It did make one specific change of note – institutions must meet the requirements of the state where they determine students are located, rather than where students reside. More details about the changes made to each of these areas will be provided when the proposed rules are published. An overview can be found here.

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