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Continuing Resolution and Zika Funding Clears Congress; Government Shutdown Averted (For Now)

Congress on September 28 cleared a Continuing Resolution (CR) to keep the government running after the October 1 start of the new fiscal year (FY 2017). The President signed the measure on September 29.  The bill keeps Federal agencies functioning until Friday, December 9. The measure also includes $1.1 billion in Zika-related funding and $500 million in emergency disaster aid, mostly for the flooding in Louisiana. The bill does not include funding to address the Flint water crisis, but a separate agreement makes such funding a high priority in the lame duck session following the November 8 election. Following passage of the CR, both chambers adjourned until the lame duck session. The date for the start of the lame duck session has been tentatively been set for November 11.

Details on the CR: The Continuing Resolution (H.R. 5325) was approved on September 28th by the House (by a vote of 342-85) and the Senate (by a vote of 72-26). The CR applies a small (0.496 percent) cut to all accounts to maintain the earlier budget agreement levels. Some spending changes are included to adjust for known future expenses (for example, for the inauguration), statutory changes (for example, for the recent changes to the Toxic Substances Control Act), and other minor adjustments. None of the so called “anomalies” impact programs of importance to ASPPH. The bill does include $37 million in new spending to implement some of the new opioid abuse initiatives enacted earlier this year. However, the rate that the new funding could be expended is limited. The CR does not cover the agencies covered by the Military Construction, Veterans Affairs, and Related Agencies Appropriations bill. That funding bill, which had earlier been agreed to but held up due to the Zika funding dispute, was included as a separate title in the CR bill, to allow it to be enacted. It ends up being the only one of the 12 regular appropriations bills to be enacted before the start of the fiscal year.

Details on the Zika Funding: The Zika funding provisions in the bill, which were included as a separate section, total just over $1.1 billion. Gone are poison pills that might impact Planned Parenthood and waive Clean Water Act regulations related to some pesticides. Also gone are most of the funding offsets. The spending includes:

• $394M for a range of Zika-related activities at CDC;
• $152M for vaccine development, diagnostics, and research at NIH;
• $175M for State Department, USAID, and related accounts for Zika-related activities; and
• $387M for the Public Health and Social Services Emergency Fund, of which $245M would go to BARDA for vaccines, therapeutics, diagnostics, etc. and $141M for health care services. The $141M includes $75M for health care services for Zika in general; $40M for Community Health Centers in Puerto Rico and the territories; $20M for Title V Maternal and Child Health Block Grant SPRANS projects in Puerto Rico and the territories; and $6M for National Health Service Corps in Puerto Rico and the territories.

ASPPH Shares Policy Priorities with Presidential Candidates

On September 1, ASPPH released a new white paper, Academic Public Health’s Priorities For America, to the Presidential transition teams. The document focuses on advancing public health education, science, and practice as the basis of improving population health. ASPPH calls on the new Administration to make public health a national priority and advance the research, training, and action necessary to protect and promote health for all our citizens.

The 12-page set of priorities that the Association asks the Presidential candidates to endorse begins by listing a set of prospective accomplishments that the elected President could announce in their second inaugural address and at the end of the 45th President’s first term. The Association asserts that the President can cite all of these proposed accomplishments “by supporting strategic investments that strengthen the Nation’s public health infrastructure and global health security, advance prevention science research, train the next generation, and establish policies and systems built on evidence of what supports the best health and that advances a culture of health.”

The Association’s white paper was written by the ASPPH Legislative Committee, under the leadership of Dr. Howard Frumkin. Input from deans and primary representatives was included in the final document following extensive discussion at the Association’s Leadership Retreat in July. The final white paper was approved by the ASPPH Board. The paper offers four overarching policy priorities and scores of more specific policy recommendations. The four overarching priorities are:

Priority One:

Ensure every American has the opportunity for a healthy life through initiatives that promote health, including mental health, and that:

• Prevent disease, injury, and disability.
• Integrate affordable, quality medical care with public health.
• Eliminate health inequities and promote social justice.

Priority Two:

• Educate the next generation of skilled, highly competent public health professionals.

Priority Three:

Increase investment in public health research by:

• Rebalancing the research portfolio of the National Institutes of Health to address population-wide health threats and to advance prevention research.
• Identifying and expanding the public health research portfolios of the Centers for Disease Control and Prevention and other relevant Federal agencies.

Priority Four:

• Strengthen U.S. leadership and investment in global public health.

The Association plans to release specific funding recommendations related to the recommendations contained in the white paper following the election and when the fiscal year 2017 appropriations levels are finalized.

ASPPH Endorses Cancer Moon Shot Blue Ribbon Panel Report; Highlights Prevention Investment Recommendations

The report of the Cancer Moonshot’s Blue Ribbon Panel was released on September 7. The report highlights research focus areas to help guide the Moon Shot initiative, which aims to accomplish 10 years’ worth of progress fighting cancer in half that time. One section of the report makes recommendations related to cancer prevention and early detection. The recommendations were accepted by the National Cancer Advisory Board, the NCI, and NIH and passed along to the Vice President and the White House Cancer Moonshot Task Force. Several knowledgeable experts in public health and prevention served on the NCI’s Cancer Moonshot Blue Ribbon Panel, and additional, stellar individuals from ASPPH member schools and programs served on the committees that drafted the Panel’s recommendations.

In a letter to Vice President Biden on September 8, ASPPH Chair Dr. Gary Raskob wrote, “ASPPH strongly endorses the report of the Blue Ribbon Panel. In particular, we commend to your attention the recommendations on Prevention and Early Detection: Implementation of Evidence-Based Approaches.” Dr. Raskob also said that the Association was “gratified that the Panel noted, ‘Importantly, primary prevention is ripe for enabling by Cancer Moonshot funds, which can be used to learn how to better implement interventions that we know are effective at reducing cancer risk in the first place.’”

The summary of the prevention and early detection section from the report’s executive summary is:

“Prevention and early detection: implementation of evidence-based approaches. Conduct implementation science research to accelerate development, testing, and broader adoption of proven cancer strategies to significantly reduce cancer risk and health care disparities. Research should focus on identifying effective, sustainable strategies that involve individuals, families, and caregivers; health care providers and systems; and the greater community. High-priority areas for which much is known about effective prevention and screening modalities are HPV vaccination, colorectal cancer screening, tobacco control, and identification of individuals with genetic predisposition to cancer, both in the general population and among medically underserved groups.”

Funding for the Moon Shot is uncertain. However, even if Congress doesn’t provide specific additional funding for the Moon Shot initiatives, the report is likely to influence NCI’s research portfolio going forward. The Blue Ribbon Panel also identified policy recommendations that were not included as part of the report, but are being forwarded to the Vice President and his task force separately. In his letter to Vice President Biden, Dr. Raskob said, “The ASPPH strongly advocates for integrating cancer prevention and health promotion into all policies, in sectors such as housing, transportation, environmental protection and agriculture. To the extent that the Panel’s policy recommendations advance prevention and public health, we hope that you and your colleagues also will give them serious consideration.”

The White House Cancer Moonshot Task Force is expected to issue a set of policy recommendations in October and a final set of policy and research recommendations at the end of the year. Vice President Biden may also issue a separate report.

Department of Education Issues Proposed Rule on State Authorization of Distance Education

The Department of Education published in the July 25 Federal Register (81 FR 48597) a proposed rule concerning state authorization of distance postsecondary education programs. The proposed rule also mandates various institutional disclosures on such programs. The proposal recognizes state authorization reciprocity agreements, “as long as the agreement does not prevent a state from enforcing its own consumer laws.” Comments were accepted on the proposed rule until August 24th.

The federal Higher Education Act requires institutions of higher education to obtain approval from states in which they provide postsecondary educational programs. Compliance with the Act is required in order to qualify for various federally sponsored programs, including all federal financial aid programs. Last year, revised regulations concerning state authorization related to programs with a physical presence went into effect. Those regulations did not cover state authorization for distance education programs or foreign branch campuses. This proposed rule seeks to address both of those gaps.

The State Authorization Reciprocity Agreement (SARA), administered by the National Council for State Authorization Reciprocity Agreements, currently establishes standards for the interstate offering of postsecondary distance-education courses and programs. As of July 2016, 40 states and the District of Columbia participate in the SARA program. However, there are several large states not yet participating in SARA, including California, Florida, New York, Pennsylvania, New Jersey and Massachusetts. Participation in SARA is a state-level decision. Institutions can only participate in SARA if their state formally decides to participate in the program.

The proposed rule would:

• Require an institution offering distance education or correspondence courses to be authorized by each state in which the institution enrolls students, if such authorization is required by the state, in order to qualify for various federal programs, including through a state authorization reciprocity agreement.
• Define the term “state authorization reciprocity agreement” to be an agreement between two or more states that authorizes an institution located and legally authorized in a state covered by the agreement to provide postsecondary education through distance education or correspondence courses to students in other states covered by the agreement.
• Require an institution to document the state process for resolving complaints from students enrolled in programs offered through distance education or correspondence courses.
• Require that an additional location or branch campus located in a foreign location be authorized by an appropriate government agency of the country where the additional location or branch campus is located and, if at least half of an educational program can be completed at the location or branch campus, be approved by the institution’s accrediting agency and be reported to the state where the institution’s main campus is located.
• Require that an institution provide public and individualized disclosures to enrolled and prospective students regarding its programs offered solely through distance education or correspondence courses.

About 120 unique comments were submitted to the Dept. of Education by the comment deadline. Some of the key issues raised in the comments include:

• The NPRM endorses state reciprocity agreements but requires that such agreements do “not prohibit a participating State from enforcing its own consumer protection laws.” The current reciprocity regime allows states to enforce general consumer protection laws applying to all entities in the state, but not education-specific protections. Reciprocity-agreement supporters want clarity on the provision’s scope noting that the entire reciprocity rationale falls if each state’s regulations hold. Some state education officials, including Massachusetts, argue that the provision should be clarified to make it clear that state education regulations do apply.
• University leaders from the nine states not currently members of the state reciprocity agreement compact are calling for the rule to be withdrawn. They argue that conditioning Title IV funding on an institution’s compliance with state authorization laws is beyond the scope of the Department of Education’s interest. They also fear that the regulation will affect MOOCs and courses or programs that do not charge tuition.
• Several commenters asked for clarity about whether hybrid programs (those requiring some on-campus time – including internships and practicums) are subject to the proposed rule. Some commenters also noted that the NPRM is inconsistent in referring to “courses” and “programs” and seek clarity.
• Some commentators urged that the foreign location section of the proposed rule be considered separately. They also argue that getting foreign authorization is impossible in some low resource countries that do not have a centralized educational bureaucracy (and that tend to benefit most from distance course offerings).

The Department of Education says it hopes to issue a final rule by the end of the year.