/ en Sat, 26 Apr 2025 02:28:50 -0500 Fri, 03 May 24 15:07:50 -0500 /news/headline/2024-05-03-white-house-releases-critical-infrastructure-memo-empowering-cisa-strengthen-health-care-security <p>The Biden Administration April 30 released a <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2024/04/30/national-security-memorandum-on-critical-infrastructure-security-and-resilience/">memo</a> announcing updated critical infrastructure protection requirements, which include the Cybersecurity & Infrastructure Security Agency acting as the National Coordinator for Security and Resilience, and heightening the importance of minimum security and resilience requirements within health care and other critical infrastructure sectors, consistent with the National Cybersecurity Strategy.  </p> Fri, 03 May 2024 15:07:50 -0500 Infrastructure /news/headline/2022-11-30-cdc-awards-32b-expand-public-health-workforce-infrastructure <p>The Centers for Disease Control and Prevention yesterday awarded public health departments <a href="https://www.cdc.gov/infrastructure/pdfs/508-OE22.2203-Nov-29th-Total-Funding-Table.pdf">$3.14 billion </a>over five years to recruit, retain and train public health workers and improve their data, systems and processes. The agency also awarded partner organizations $65 million to assist in the efforts. The American Rescue Plan Act provided $3 billion of the funding to expand the public health workforce.</p> Wed, 30 Nov 2022 13:35:41 -0600 Infrastructure /news/headline/2022-09-15-hospitals-testify-house-hearing-environmental-sustainability-and <p>The House Ways and Means Committee today held a <a href="https://waysandmeans.house.gov/legislation/hearings/preparing-america-s-health-care-infrastructure-climate-crisis">hearing</a> on preparing the nation’s health care infrastructure for climate change. Witnesses included Paul Biddinger, M.D., chief preparedness and continuity officer for Mass General Brigham in New England; Parinda Khatri, CEO of Cherokee Health Systems in Tennessee; and Elizabeth Schenk, executive director of environmental stewardship for Providence health system in Renton, Wash. In conjunction with the hearing, the committee released a <a href="https://waysandmeans.house.gov/health-care-and-climate-crisis-preparing-americas-health-care-infrastructure">report</a> based on responses to its March request for information to better understand how climate events have impacted the health sector.<br />  </p> Thu, 15 Sep 2022 16:04:00 -0500 Infrastructure /fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce <div class="container"> <div class="row"> <div class="col-md-8"> <h2>The Issue</h2> <p>A talented, qualified, engaged and diverse workforce is at the heart of America’s health care system. However, hospitals and health systems now face mounting and critical staffing shortages that could jeopardize access to care in the communities they serve. For example, AHA survey data show that between 2019 and 2020, job vacancies for various types of nursing personnel increased by up to 30%, and for respiratory therapists by 31%. These shortages are expected to persist, with an <a href="https://www.mercer.us/content/dam/mercer/assets/content-images/north-america/united-states/us-healthcare-news/us-2021-healthcare-labor-market-whitepaper.pdf">analysis</a> of EMSI data showing there will be a shortage of up to 3.2 million health care workers by 2026.</p> <p>The COVID-19 pandemic has taken a heavy toll on health care teams who have been on the front lines of the pandemic with many suffering from stress, trauma, burnout and increased behavioral health challenges. A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of health care workers are considering leaving their profession altogether, and nearly 60% reported impacts to their mental health stemming from their work during the COVID-19 pandemic.</p> <p>However, the daunting challenge of sustaining the health care workforce predates the COVID-19 pandemic. America will face a shortage of up to 124,000 physicians by 2033, and will need to hire at least 200,000 nurses per year to meet increased demand and to replace retiring nurses. There also are critical shortages of allied health and behavioral health professionals, especially in historically marginalized rural and urban communities. These workforce shortages — combined with an aging population, a rise in chronic diseases and behavioral health conditions, and advancements in the “state-of-the-art” of care delivery — all contribute to the need for supportive policies so that America’s health care workforce can ensure access to care and be adequately prepared for the delivery system of the future.</p> <h2>AHA Take</h2> <p>The AHA urges Congress and the Biden Administration to prioritize funding that supports the health care workforce needs of the country in the wake of the COVID-19 pandemic and into the future. AHA urges Congress to pass the legislative priorities referenced below in any legislation enacted this year.</p> <h2>Why?</h2> <ul> <li><strong>The health care workforce supports American jobs, serves American communities and spurs American economic activity</strong>. Indeed, hospitals and health systems alone employed more than 6 million individuals in full- or part-time positions in 2019; purchased more than $1 trillion in goods and services from other businesses; supported almost 18 million, or one out of nine, jobs; and supported roughly $2.30 of additional business activity in the economy for every dollar they spent. Yet the pandemic is taking its toll on health care jobs. According to the U.S. Bureau of Labor Statistics, employment in the field is still down by over 80,000 jobs since February 2020.</li> <li><strong>Physician shortages are growing, exacerbated by caps on the number of Medicare-funded residency slots.</strong> The Association of American Medical Colleges projects a national shortage of up to 124,000 physicians by 2033, including shortages of primary care physicians and specialists, such as pathologists, neurologists, radiologists and psychiatrists. While the aging of the U.S. population and the physician workforce drives some of the projected shortage, much of it stems from the caps on Medicare-funded residency slots imposed by Congress nearly 25 years ago as a cost-saving measure. While the number of medical school graduates has increased significantly over the past two decades, Medicare-funded training opportunities for these graduates has remained frozen at 1996 levels. As a result, over 3,100 applicants lacked residency slots in 2019. Furthermore, the caps have created imbalances that favor allocation of slots toward lower-cost and higher-reimbursement specialties, rather than more urgently needed primary care and behavioral health. While some hospitals are filling in gaps by self- funding a portion of their residency slots, this model is not sustainable over the long haul, as evidenced by the -8.7% Medicare margins for teaching hospitals in 2019.</li> <li><strong>Lifting the cap on Medicare residency positions would enhance access to care and help America’s hospitals better meet the needs of the communities they serve.</strong> Increasing Medicare-funded residency slots would provide hospitals more flexibility to diversify and maintain more training programs, including both primary care and specialty programs. In addition, an increase in slots would allow health systems to train residents in more diverse types of facilities, such as smaller rural hospitals, which may not be able to operate their own training programs. This would benefit both the quality of physician education and the patients they would serve. <strong>The AHA supports the Resident Physician Shortage Reduction Act of 2021</strong>, which would add 14,000 Medicare-funded residency slots over the next seven years. Additionally, the AHA supports the <strong>Pathway to Practice Training Programs</strong>, which would fund 1,000 post-baccalaureate and medical school scholarships annually, increase physician diversity, promote cultural and structural competency training, improve access to physicians in communities dealing with sustained hardship, and lift the caps on Medicare-funded residency slots by 4,000 over the next two years, dedicating 25% of those slots to primary care and ob/gyn and 15% to psychiatry.</li> <li><strong>The nursing and allied professional workforce also faces critical shortages.</strong> The U.S. needs more than 200,000 new registered nurses (RNs) each year to meet increasing health care needs and to replace nurses entering retirement. In 2017, more than half of all nurses were age 50 or older, and almost 30% were age 60 or older. Workforce pressures also exist across a variety of allied health professions. According to one recent survey, the annual turnover rate of hospital certified nursing assistants (CNAs) was 27.7% (nearly double the turnover rate of nurses and physician assistants). Meanwhile, the Bureau of Labor Statistics projects a need for 11% more CNAs by 2025. The lack of laboratory technicians may be particularly acute — a 2017 survey conducted by the American Society for Clinical Laboratory Science concluded that there were, nationally, 7.2% lab technician positions unfilled.</li> <li><strong>Faculty shortages severely constrain ability to meet future nursing needs.</strong> According to the American Association of Colleges of Nursing, American nursing schools turned away over 80,000 qualified applicants from baccalaureate and graduate programs in nursing in 2019 alone due to an insufficient number of qualified faculty, clinical sites, classroom space, clinical preceptors and budget constraints. The low salaries for nursing faculty also are not commensurate with their level of educational preparation (i.e., master’s degree level, or above), making recruitment a dire challenge. That is why the <strong>AHA supports the Future Advancement of Academic Nursing (FAAN) Act</strong>, which would provide resources to boost student and faculty populations, as well as support educational programming as well as partnerships and research at schools of nursing.</li> <li><strong>Extreme nurse staffing agency prices during the pandemic are unsustainable and deserve heightened regulatory scrutiny.</strong> Hospitals have shared that nurse staffing agencies are often charging up to three times their pre-pandemic rates. Unfortunately, many hospitals have dire needs for nursing staff to care for their patients and have had little choice but to pay these exorbitant rates. The AHA urges the Administration to use its authority to investigate anti-competitive pricing by nurse staffing agencies and to take appropriate action to protect hospitals and the patients whom they treat.</li> <li><strong>America’s behavioral health needs are reaching a crisis point rising amid gaps in the behavioral health workforce.</strong> One in five American adults has a behavioral health condition; before the pandemic, nearly 60% of adults with behavioral health disorders reported not receiving services for their conditions. The stresses of the COVID-19 pandemic have compounded these concerns: one in three adults reported symptoms of an anxiety disorder in 2020, compared with one in 12 in 2019. Yet, over 100 million Americans live in areas that have a shortage of psychiatrists, as designated by the Health Resources and Services Administration (HRSA). HRSA also projects shortages of psychiatrists and addiction counselors to persist through 2030. AHA supports the <strong>Opioid Workforce Act of 2021/Substance Use Disorder Workforce Act of 2021</strong>, which would address shortages of substance use disorder treatment providers by adding 1,000 Medicare-funded training positions in approved residency programs in addiction medicine, addiction psychiatry or pain medicine.</li> <li><strong>Several mechanisms provide good starting points for addressing workforce and faculty shortages.</strong> For example, the AHA supports Congress funding HRSA’s title VII and VIII programs, including, $517 million for the health professions program, continued funding for the National Health Service Corps, and $530 million for the nursing workforce development program, which includes loan programs for nursing faculty. Congress also should consider expanding the loan program to allied professionals and targeting any support for community college education to high priority shortage areas in the health care workforce.</li> <li><strong>Rising clinician burnout — accelerated by the pandemic — calls for national support.</strong> A recent National Academy of Medicine report suggests that between 35% and 54% of U.S. nurses and physicians have symptoms of burnout, which it characterizes as high emotional exhaustion, high depersonalization (i.e. cynicism), and a low sense of personal accomplishment from work. Hospitals and health systems are deploying a range of programs and interventions to assist their workforce, but given the financial pressures posed by the pandemic, Congress should provide additional funding to support national research and demonstration programs related to clinician well-being. <strong>The AHA supported the passage of the Dr. Lorna Breen Health Care Provider Protection Act</strong>, which aims to prevent suicide, burnout and behavioral health disorders among health care professionals.</li> <li><strong>Visa relief — especially during the pandemic — is critical given that many hospitals rely on foreign-born employees to serve their communities.</strong> Recent studies show that 18.2% of U.S. health care workers were born outside of the U.S. For example, 29% of U.S. physicians are born in other countries, and almost 7% are not U.S. citizens. Similarly, foreign-born nurses account for 15% of RNs in the U.S., according to a report by the Institute for Immigration Research at George Mason University. <strong>That is why the AHA supports the bipartisan Healthcare Workforce Resilience Act,</strong> which would expedite the visa authorization process for highly-trained nurses who could support hospitals facing staffing shortages, and provide protections to U.S.-trained, international physicians who are vitally important to patient care in their communities.</li> </ul> </div> <div class="col-md-4"> <div class="external-link spacer"><strong><strong><strong><a class="btn btn-wide btn-primary" href="/action-alert/2021-05-25-urge-your-senators-representatives-include-resources-support-hospitals-and" target="_blank">Action Alert: Urge Your Senators, Representatives to Include Resources to Support Hospitals and Health Systems in Upcoming Infrastructure Legislative Package</a></strong></strong></strong></div> <p><a href="/system/files/media/file/2021/11/strengthening-the-health-care-workforce-II.pdf" target="_blank" title="Click here to download the Fact Sheet: Strengthening the Healthcare Workforce (June 2022) PDF."><img alt="Fact Sheet: Strengthening the Healthcare Workforce (June 2022) page 1." data-entity-type="file" data-entity-uuid="80aaba30-e8b7-45e3-8ebe-1d3e2b368284" src="/sites/default/files/inline-images/Page-1-Fact-Sheet-Strengthening-the-Healthcare-Workforce-June-2022.png" width="1700" height="2200"></a></p> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2021/11/strengthening-the-health-care-workforce-II.pdf" target="_blank" title="Click here to download the Fact Sheet: Strengthening the Healthcare Workforce (June 2022) PDF.">Download the Fact Sheet PDF</a></div> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2022-06-21-strengthening-health-care-workforce-strategies-now-near-and-far" target="_blank" title="Click here to read the AHA report Strengthening the Health Care Workforce: Strategies for Now, Near and Far.">NEW: Strengthening the Health Care Workforce: Strategies for Now, Near and Far</a></div> </div> </div> </div> Fri, 17 Jun 2022 08:32:19 -0500 Infrastructure <div class="container"> <div class="row"> <div class="col-md-8"> <h2>Summary</h2> <p>This joint Cybersecurity Advisory (CSA)—authored by the Cybersecurity and Infrastructure Security Agency (CISA), Federal Bureau of Investigation (FBI), and National Security Agency (NSA)—provides an overview of Russian state-sponsored cyber operations; commonly observed tactics, techniques, and procedures (TTPs); detection actions; incident response guidance; and mitigations. This overview is intended to help the cybersecurity community reduce the risk presented by these threats.</p> <p>CISA, the FBI, and NSA encourage the cybersecurity community—especially critical infrastructure network defenders—to adopt a heightened state of awareness and to conduct proactive threat hunting, as outlined in the Detection section. Additionally, CISA, the FBI, and NSA strongly urge network defenders to implement the recommendations listed below and detailed in the Mitigations section. These mitigations will help organizations improve their functional resilience by reducing the risk of compromise or severe business degradation.</p> <ol> <li><strong>Be prepared.</strong> Confirm reporting processes and minimize personnel gaps in IT/IO security coverage. Create, maintain, and exercise a cyber incident response plan, resilience plan, and continuity of operations plan so that critical functions and operations can be kept running if technology systems are disrupted or need to be taken offline.</li> <li><strong>Enhance your organization’s cyber posture.</strong> Follow best practices for identity and access management, protective controls and architecture, and vulnerability and configuration management.</li> <li><strong>Increase organizational vigilance.</strong> Stay current on reporting on this threat. <a href="https://public.govdelivery.com/accounts/USDHSUSCERT/subscriber/new" target="_blank">Subscribe</a> to CISA’s <a href="https://www.cisa.gov/uscert/mailing-lists-and-feeds" target="_blank">mailing list and feeds</a> to receive notifications when CISA releases information about a security topic or threat.</li> </ol> <p>CISA, the FBI, and NSA encourage critical infrastructure organization leaders to review CISA Insights: <a href="https://www.cisa.gov/sites/default/files/publications/CISA_INSIGHTS-Preparing_For_and_Mitigating_Potential_Cyber_Threats-508C.pdf" target="_blank">Preparing for and Mitigating Cyber Threats</a> for information on reducing cyber threats to their organization.</p> <p><em>Click on the PDF link below to view to complete Advisory.</em></p> </div> <div class="col-md-4"> <div> <p>Actions critical infrastructure organizations should implement to immediately strengthen their cyber posture.</p> <ul> <li>Patch all systems. Prioritize patching <a href="https://www.cisa.gov/known-exploited-vulnerabilities-catalog" target="_blank">known exploited vulnerabilities</a>.</li> <li>Implement multi-factor authentication.</li> <li>Use antivirus software.</li> <li>Develop internal contact lists and surge support.</li> </ul> </div> </div> </div> </div> Fri, 17 Dec 2021 13:25:47 -0600 Infrastructure /special-bulletin/2021-11-18-house-passes-build-back-better-act-significant-health-care-provisions <div class="container"> <div class="row"> <div class="col-md-8"> <p>The House of Representatives today voted 220-213 to pass a modified version of the Build Back Better Act (<a href="https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-117HR5376RH-RCP117-18.pdf" target="_blank">H.R. 5376</a>), a roughly $1.75 trillion social spending package that includes many health care provisions. The bill, which is being considered under reconciliation procedures, is likely to undergo significant changes as it moves through the Senate in the coming weeks.</p> <h2>AHA Take</h2> <p>In a <a href="/press-releases/2021-11-19-aha-statement-house-passage-build-back-better-act" target="_blank" title="AHA Statement on House Passage of Build Back Better Act">statement shared with the media today</a>, AHA President and CEO Rick Pollack said, “The AHA supports many parts of the Build Back Better Act that would advance health in our nation’s communities. These provisions include expanding access to coverage though subsidized health insurance marketplace plans and investing in workforce training. In particular, we appreciate expansion of Medicare-funded physician residency slots and Pathway to Practice, which promotes physician diversity and improves access to physicians in communities dealing with sustained hardship. We also applaud the investments to improve maternal and child health.</p> <p>“However, while we appreciate the goal of increasing coverage to residents in states that did not expand their Medicaid programs, it should not come at the expense of vital funding to hospitals and health systems located in those parts of the country that serve a large number of children, the poor, the disabled and the elderly. These cuts are unacceptable, especially while hospitals remain on the front lines of fighting COVID-19 and the deadly Delta variant.</p> <p>“In addition, we are disappointed the House did not include critical funding for hospital infrastructure improvements through the Hill-Burton Act, as they did in an earlier version of the legislation.</p> <p>“We look forward to working with the Senate to improve this bill.”</p> <p><strong>The following is a summary of key provisions affecting hospitals and health systems.</strong></p> <h2>Health Care Coverage</h2> <h3>Temporary Expansion of Marketplace Subsidies and Cost-Sharing Assistance to Address Coverage Gap in Non-Medicaid Expansion States</h3> <p>The legislation would temporarily close the Medicaid coverage gap by providing subsidized coverage through the federal health insurance marketplace for individuals with income under 138% of the federal poverty level. Beginning in 2023 and continuing through 2025, premium tax credits would be extended to such individuals to purchase marketplace coverage with zero dollar premiums (see section below) and cost-sharing assistance that reduces enrollee cost-sharing to 1%. Plans would be required to include non-emergency transportation and family planning benefits for this population and would be fully reimbursed by the Secretary of Health and Human Services (HHS). Similar to the Medicaid program, enrollment in this Affordable Care Act (ACA) coverage expansion program would be available year round. Outreach and enrollment efforts would be funded during this period at $105 million. In addition, navigators to assist in enrollment would be funded through a combination of health plan user fees and appropriations.</p> <h3>Reductions in Medicaid Disproportionate Share Hospital (DSH) Allotment and Uncompensated Care Pools for Non-Medicaid-Expansion States</h3> <p>States that have not expanded their Medicaid program, including any state that chooses to reverse their Medicaid expansion, would face a reduction in their Medicaid DSH allotment. Beginning in fiscal year (FY) 2023, non-expansion states would be subject to a 12.5% reduction of their DSH allotment. This fixed 12.5% “DSH penalty” would be applied against their DSH allotment (allowing for inflation) each fiscal year the state has not expanded their program and would cease only if the state expands coverage. Note that the penalty also would apply to the state of Tennessee, which has its DSH allotment set in statute through FY 2025. The AHA estimates, based on available data, that the reduction in federal DSH spending for the non-expansion states would be $2.2 billion over five years and $4.7 billion over 10 years. Beginning in FY 2024, when the ACA DSH reduction delay is scheduled to end, the “DSH penalty” would be applied in addition to the ACA reduced DSH allotments for non-expansion states. Expansion states that decide to withdraw their coverage of the expansion population would be subject to DSH allotment reductions, and these reductions would be applied on a pro-rata basis.</p> <p>Funding restrictions also would apply to any state with a Medicaid uncompensated care pool that has not expanded their program. Such restrictions would prevent these states from claiming federal matching dollars for health care services provided to an “expansion individual” through the pool funds. Non-expansion states with uncompensated care pools include Florida, Tennessee, Texas and Kansas.</p> <h3>Expanding Eligibility for and Value of Health Insurance Marketplace Subsidies</h3> <p>The legislation would extend the expanded eligibility for and value of health insurance marketplace subsidies authorized through the American Rescue Plan Act (ARPA) through 2025. The subsidy expansion is currently authorized through 2022. Specifically, the ARPA expanded eligibility for subsidies to individuals above 400% of the federal poverty level (the limit in the ACA) by making eligible anyone for whom the cost of benchmark coverage would exceed 8.5% of income. The ARPA also lowered the premium percentage at every income level, with the effect of increasing the value of the marketplace subsidies and further reducing the cost of coverage. For individuals with income up to 150% of the federal poverty level, the new subsidy amounts result in the availability of plans with zero dollar premiums. This legislation also would expand marketplace cost-sharing assistance for certain low-income individuals and authorize funding for a state-based health insurance affordability fund (discussed below). It would not, however, address several other marketplace coverage issues, including fixing the “family glitch.”</p> <h3>Other, Related Health Insurance Marketplace Provisions</h3> <p>The legislation would establish a new health insurance affordability fund available to all states to provide assistance in reducing health care premiums and out-of-pocket costs through reinsurance programs, which would be funded at $10 billion annually from 2023 through 2025. The Centers for Medicare & Medicaid Services (CMS) also is directed to implement a temporary reinsurance program in non-Medicaid expansion states. In addition, cost-sharing reductions would be extended through 2025 for individuals with income up to 150% of the federal poverty level receiving unemployment.</p> <h3>Children’s Health Insurance Program (CHIP) and Medicaid Coverage Improvements</h3> <p>Federal CHIP funding would be made permanent. In addition, other CHIP-related provisions would be made permanent, such as the pediatric quality measures program and the contingency fund to provide states with assistance in the event their CHIP state allotment is insufficient. States would be provided an option to increase CHIP income eligibility levels above the existing statutory ceiling, which is currently tied to Medicaid income levels. The bill also creates a drug rebate program similar to the Medicaid rebate program in order to lower the cost of prescription drugs for CHIP. The new rebate program strictly prohibits duplicate discounts for any drug purchased through the 340B program. In addition, children under the age of 19 will be provided one-year continuous eligibility for Medicaid and CHIP coverage. There also is Medicaid coverage available to justice-involved individuals 30 days prior to their release.</p> <h3>Ensuring Coverage for Pregnant and Postpartum Individuals</h3> <p>The legislation would require that Medicaid and CHIP provide 12 months of continuous postpartum coverage and provide the full range of Medicaid benefits during this period. Current rules generally permit enrollees to stay on Medicaid or CHIP for up to 60 days, though the ARPA provided states with an option, for five years, to extend Medicaid and CHIP eligibility to pregnant individuals for 12 months postpartum. The legislation also allows for a state option to provide coordinated care through a maternal health home for pregnant and postpartum individuals and provides $5 million in funding.</p> <h3>Expanding Medicare Benefits</h3> <p>The package includes a provision to expand Medicare coverage to include hearing benefits in 2023. The hearing benefits would cover hearing aids and aural rehabilitation, among other services. The traditional Medicare program does not cover such benefits; however, some Medicare Advantage plans do cover hearing services as supplemental benefits.</p> <h2>Other Medicaid Provisions</h2> <h3>Enhanced Federal Medical Assistance Percentages (FMAP) Increase for Expansion States</h3> <p>The federal match for spending on the Medicaid expansion population would be increased by 3 percentage points from the current 90% FMAP to 93% FMAP. This would apply to all states that cover the Medicaid expansion population. The increased FMAP would apply for calendar quarters in 2023 through 2025.</p> <h3>Phase-out of Temporary FMAP Increase from the Families First Coronavirus Response Act (FFCRA)</h3> <p>The temporary FMAP increase of 6.2 percentage points established by the FFCRA to assist states during the COVID-19 public health emergency (PHE) would be phased out beginning March 31, 2022, rather than the end of the quarter in which the PHE ends, as previously established. The FMAP increase would be reduced to 3 percentage points on April 1, 2022, 1.5 percentage points on July 1, 2022 and end entirely on Sept. 30, 2022.</p> <h3>PHE-related Eligibility Maintenance of Effort</h3> <p>States would need to maintain their Medicaid eligibility standards that were in place prior to the PHE. Should a state change eligibility requirements between Sept. 1, 2022, and Dec. 31, 2025, the state would be subject to a penalty that would reduce FMAP by 3.1 percentage points for each calendar quarter they have in place the more restrictive standards, methodologies or procedures, as compared to what was in effect on Oct. 1, 2021.</p> <h3>Medicaid Cap Amounts and the FMAP for the Territories</h3> <p>The legislation would permanently increase federal Medicaid funding for the territories by establishing a set FMAP of 83%.</p> <h3>Medicaid Pharmacy Payments</h3> <p>Requires that the HHS Secretary conduct a survey of retail community pharmacy drug prices in all states and the District of Columbia to determine the national average drug acquisition cost for covered outpatient drugs in the Medicaid program. Information to be collected includes the actual acquisition cost of the covered outpatient drugs, discounts and rebates, average professional dispensing fees paid, and reimbursement received from all sources of payment. Any pharmacy that receives a Medicaid payment must participate in the survey or risk civil monetary penalties not to exceed $10,000 for each day the survey data is not provided. The information collected would be made publicly available.</p> <h2>Other Health Care-related Provisions</h2> <h3>Graduate Medical Education</h3> <p>The bill would increase the existing cap on the number of Medicare-funded residency slots by 4,000, with no more than 2,000 slots distributed each year starting in FY 2025. At least 25% of these slots would be awarded for primary care residencies, including obstetrics and gynecology, and at least 15% would be awarded for psychiatry residencies, including addiction medicine. To be eligible for these slots, hospitals must be training above their Medicare caps, located in a rural area, in states with new medical schools, located in or serving health professional shortage areas, or in states with the lowest quartile of medical resident to population ratio.</p> <p>The bill also would establish the Rural and Underserved Pathway to Practice Program, which would provide 1,000 scholarships annually to students from underrepresented groups to attend post-baccalaureate programs and medical school, starting in FY 2023. Teaching hospitals would be eligible to train graduates of the Pathway to Practice Program, and these positions would be excluded from hospitals’ GME caps. Eligible teaching hospitals must be recognized by the Accreditation Council for Graduate Medical Education as providing mentorship, training in cultural and structural competency, and training in underserved areas.</p> <p>The package also would provide $200 million for the Children’s Hospitals Graduate Medical Education program for FY 2022.</p> <h3>Maternal and Child Health</h3> <p>In addition to the expanded coverage for pregnant and postpartum individuals described above, the legislation would fund numerous maternal and child health initiatives, some of which were part of the AHA-supported Black Maternal Health Momnibus Act. Among the funding allocations are: $100 million to address social determinants of maternal health; $75 million for the Office of Minority Health to award grants to community-based organizations operating in areas with high rates of adverse maternal health outcomes; $170 million to grow and diversify the perinatal nursing workforce; $50 million to support perinatal quality collaboratives; $50 million to help develop and diversify the doula workforce; $175 million to address maternal mental health conditions and substance use disorders; $85 million to support the development and integration of education and training programs for identifying and addressing risks associated with climate change for pregnant, lactating or postpartum individuals; $50 million for minority-serving institutions to study maternal mortality, severe maternal morbidity and maternal health outcomes; $25 million to identify Maternity Care Health Professional Target Areas; $50 million to promote community engagement in maternal mortality review committees and increase the diversity of a committee’s membership; $100 million for conducting surveillance for emerging threats to mothers and babies; $30 million for carrying out the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality program; $15 million for the Pregnancy Risk Assessment Monitoring System; $15 million for the National Institute for Child Health and Human Development; $30 million to evaluate, develop and expand the use of technology-enabled collaborative learning and capacity building models; $30 million to increase access to digital tools related to maternal health care; and $50 million for anti-discrimination and -bias training.</p> <h3>Behavioral Health</h3> <p>The bill includes a number of provisions to increase access to behavioral health services, including $40 million for behavioral health needs of family caregivers and $25 million for initiatives to address the behavioral health needs of individuals with intellectual and developmental disabilities. It also expands the Community Mental Health Services Demonstration Program and makes permanent the option for states to provide mobile crisis intervention services.</p> <h3>Proposals to Lower Drug Costs</h3> <p>The package includes a number of proposals aimed at reducing the cost of prescription drugs. It would direct the HHS to establish a Drug Negotiation Program, which would require the HHS Secretary to identify 100 brand-named, single-source drugs annually. Beginning in 2025, the HHS Secretary must negotiate the price of 10 drugs from that list, followed by 15 drugs in 2026 and 2027, and 20 drugs annually thereafter. In addition, insulin products must be included in negotiations. Certain drugs would be exempt from negotiation requirements based on exclusivity and expenditure criteria. Once a drug is selected for negotiation, it will remain in the program until a competitor product enters the market. The prices resulting from these negotiations would apply to individuals eligible for the program through Medicare Part B and Part D, as well as Medicare Advantage plans.</p> <p>The legislation would establish penalties on manufacturers for certain actions. Failure for a drug manufacturer to negotiate the price of a selected drug would result in an excise tax. The legislation also would penalize drug manufacturers that increase their prices faster than inflation for drugs used by individuals covered by Medicare by requiring that the manufacturer pay a rebate to the federal government and subjecting manufacturers to a civil monetary penalty if they fail to pay the rebate.<.p></p> <p>Other provisions would redesign the Medicare Part D program by capping beneficiary out-of-pocket costs and shifting certain financial responsibilities to insurers and drug manufacturers. The legislation also would repeal a final rule aimed at creating a new safe harbor protection for pharmacy benefit managers. Finally, the bill would establish a $35 cap on cost-sharing for insulin products under Medicare Part D, apply zero coinsurance to vaccines recommended by the Advisory Committee on Immunization Practices under Medicare Part D and revise payment for new biosimilar products under Medicare Part B.</p> <h3>Addressing Disparities</h3> <p>The bill also would provide $75 million to increase research capacity at minority-serving institutions, diversify the national scientific workforce and expand the activities of the National Institutes of Health Scientific Workforce Diversity Office.</p> <h3>Investments in Clean Energy and Sustainability Efforts</h3> <p>The bill includes significant funding for investments in clean energy and sustainability programs that have the potential to benefit hospitals and health systems and the communities they serve. For example, the bill includes $29 billion for a greenhouse gas reduction fund, with 40% of investment going to low-income and underserved communities; a $1 billion investment electric vehicle infrastructure; and $20 billion in clean energy innovation and climate pollution reduction investments.</p> <h3>Home- and Community-Based Services</h3> <p>The legislation includes $150 billion in investments in home- and community-based services, including through increasing provider reimbursement rates, making permanent the Money Follows the Person and the spousal impoverishment programs, and providing additional funding for states for home- and community-based care infrastructure investments.</p> <h2>Public Health Provisions</h2> <h3>Pandemic Preparedness</h3> <p>The package contains a number of provisions to bolster the nation’s pandemic preparedness, including $1.4 billion for Centers for Diseases Control and Prevention (CDC) laboratory activities to support renovation, improvement expansion and modernization of state and local public health laboratories and CDC laboratory infrastructure and enhancement of the CDC’s ability to oversee the biosafety and biosecurity of state and local public health laboratories. It also provides $1.3 billion for the Assistant Secretary for Preparedness and Response (ASPR) public health and preparedness research, development and countermeasure capacity, including improved support for surge capacity for facilities needed to respond to a public health emergency and for drugs, devices, shoring up the Strategic National Stockpile, strengthening the supply chains, supporting domestic and global manufacturing of vaccines, bolstering biosecurity, and investing in therapeutics. Finally it provides $300 million for modernizing the Food and Drug Administration’s (FDA) technological and laboratory infrastructure and innovation and enhancing food and medical product safety.</p> <h3>Public Health Infrastructure</h3> <p>The legislation includes provisions to improve the nation’s public health infrastructure, including $7 billion in funding for state, local and territorial public health infrastructure and programs; $2 billion for capital investments in health centers; and a number of provisions to improve the clinical workforce capacity (many of which are outlined in the following section).</p> <h2>Workforce</h2> <h3>Workforce Capacity</h3> <p>The legislation includes several provisions intended to bolster health care workforce capacity and training in addition to several already noted above. These include:</p> <ul> <li>Reauthorizing the Health Profession Opportunity Grant (HPOG) Program, which provides grants for the purpose of preparing certain low-income individuals to enter into the health care profession.</li> <li>$2 billion for the National Health Service Corps, which provides scholarships and loan repayment to qualified health care providers in exchange for service in underserved parts of the country.</li> <li>$500 million for the Nurse Corps, which provides loan repayment assistance to registered nurses (RNs) and advanced practice registered nurses (APRNs) in exchange for service in critical shortage areas or serving as faculty at eligible nursing schools.</li> <li>$500 million for schools of nursing in underserved areas.</li> <li>$500 million for schools of medicine in underserved areas, with priority given to minority-serving institutions.</li> <li>$85 million across several programs aimed at bolstering training and education for palliative care medicine and nursing.</li> </ul> <h3>Nurse Staffing Ratios for Skilled Nursing Facilities (SNFs)</h3> <p>The legislation would establish staffing-related requirements on SNFs. Specifically, it would establish a requirement for SNFs to use the services of a RN 24 hours a day, seven days a week beginning Oct. 1, 2024, subject to existing statutory waivers. In addition, the legislation directs CMS to establish and enforce minimum ratios of staff-to residents in SNFs. These ratios would be informed by mandatory reports to Congress on the appropriateness of establishing minimum staffing ratios, the first of which must be completed within three years of enactment, and thereafter updated at least every five years. The HHS Secretary would be expected to promulgate regulations establishing minimum staffing ratios within a year of the first report to Congress. The HHS Secretary would have the authority to waive compliance with the minimum staffing ratio for SNFs in rural areas with an insufficient workforce supply.</p> <h3>Paid Family and Medical Leave</h3> <p>The legislation would establish the first permanent, mandatory paid family and medical leave provision in federal law. The provision would require employers to provide up to four weeks of paid family and medical leave to cover a number of situations, including maternity and paternity leave and caring for ill or injured loved ones. The policy would begin in 2024, and would provide most workers, including contract, part-time and self-employed workers, with a minimum wage guarantee based on a portion of their income capped at $2,000 in 2024, and subsequently indexed to the annual Social Security Average Wage Index. This minimum standard benefit would provide funding by the federal government. States with existing programs would be eligible for funding from the federal government to maintain their programs. A similar provision is included to compensate employers that already provide such benefits.</p> <h3>Child Care Investments</h3> <p>The legislation includes a number of provisions to support access to child care. It would extend the child care tax credits provided for in the ARPA, create a tax credit for caregivers, establish new tools to connect parents and caretakers to child care, and create grants to improve safety in child care sites, among other provisions.</p> <h3>Community Violence and Trauma Intervention</h3> <p>The bill funds grants in the amount of $2.5 billion for public health-based interventions to address community violence and trauma. Grants will be awarded through the CDC, and communities with high rates of, and prevalence of risk factors associated with, violence-related injuries and deaths will be prioritized. Hospital-based violence intervention programs and trauma-informed mental health care and counseling are among the programs eligible for these grants.</p> <h3>Civil Monetary Penalties</h3> <p>The legislation dramatically increases certain civil monetary penalties for various violations of labor law. Any employer that commits an unfair labor practice as defined in section 8(a) of the National Labor Relations Act would be subject to civil monetary penalties of up to $50,000 for each violation. Any civil monetary penalties would be in addition to any other remedy the National Labor Relations Board (The Board) orders in the case. Where unfair labor practice is the result of discrimination on the basis of union membership or retaliation against an employee or has resulted in discharge of the employee or serious economic harm to the employee, The Board would double the fine imposed (up to a maximum of $100,000) in any case where within the past five years that employer has committed another unfair labor practice of that same type.</p> <p>In determining the amount of the civil monetary penalty, The Board would need to consider a number of factors: (1) the gravity of the employer’s action that resulted in the penalty, including the impact on the party making the charge or any other person seeking to exercise rights guaranteed by the Act; (2) the size of the employer; (3) the history of previous unfair labor practices or other actions by the employer resulting in a penalty; and (4) the public interest. In addition, if The Board determines, based on the particular facts and circumstance involved, that a director’s or officer’s personal liability is warranted, a civil monetary penalty also may be assessed against the officer or director who directed or committed the violation, established the policy that led to the violation, or had actual or constructive knowledge of and authority to prevent the violation and failed to act.</p> <h2>Provisions Not Included in the Build Back Better Act</h2> <h3>The Protecting the Right to Organize (PRO) Act</h3> <p>The bill does not contain the PRO Act, which would make sweeping changes to the National Labor Relations Act and other labor laws in the United States, including in ways that could have a significant adverse impact on hospitals and health systems as employers.</p> <h3>Hospital Infrastructure Funding under the Hill-Burton Act</h3> <p>The bill does not include the $10 billion in hospital infrastructure investment included in previous versions of the bill.</p> <h2>Further Questions</h2> <p>If you have questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p> </div> <div class="col-md-4"> <div class="panel module-typeC"> <div class="panel-heading"> <h3 class="panel-title">Key Takeaways</h3> </div> <div class="panel-body"> <p>The Build Back Better Act would:</p> <ul> <li>Expand access to coverage, including through a temporary coverage solution for individuals who fall into the Medicaid coverage gap and expansion of subsidized health insurance marketplace coverage;</li> <li>Penalize states that have not expanded Medicaid by reducing their federal Medicaid DSH allotment and limiting their use of uncompensated care pools;</li> <li>Add a hearing benefit to the Medicare program;</li> <li>Authorize a number of programs to improve maternal and child health;</li> <li>Authorize Medicare to negotiate prices on a limited scope of Part B and D drugs;</li> <li>Make additional investments in workforce training, including education and loan repayment and expansion of Medicare-funded residency slots;</li> <li>Require SNFs to meet certain nurse staffing ratios; and</li> <li>Implement additional civil monetary penalties for violations of labor law.</li> </ul> </div> </div> <hr> <a href="/system/files/media/file/2021/11/Special-Bulletin-BBBA-Summary-2021-11-19.pdf" target="_blank" title="Click here to download the Special Bulletin: House Passes Build Back Better Act with Significant Health Care Provisions PDF."><img alt=" Special Bulletin: House Passes Build Back Better Act with Significant Health Care Provisions PDF page 1." data-entity-type="file" data-entity-uuid="fc4ad088-e793-45ac-adc3-83a94eabb67d" src="/sites/default/files/inline-images/Page-1-Special-Bulletin-BBBA-Summary-2021-11-19.png" width="1700" height="2189" class="align-center"></a> </div> </div> </div> Thu, 18 Nov 2021 22:20:42 -0600 Infrastructure <div class="container"> <div class="row"> <div class="col-md-8"> <p><strong>Please contact your representatives today and urge them to make a number of changes to the Build Back Better Act (<a href="https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-117HR5376RH-RCP117-18.pdf" target="_blank">H.R.5376</a>) to support patients and communities and the hospitals and health systems that care for them.</strong></p> <p>Specifically, we are asking House lawmakers to eliminate punitive Medicaid disproportionate share hospital (DSH) and uncompensated care cuts; remove excessive civil monetary penalties for labor violations; and restore hospital infrastructure funding under the Hill-Burton Act.</p> <p>The House as soon as this week could consider the roughly $1.75 trillion package, so it is critical that you contact your representatives, especially House Democrats, today and urge them to make changes to the bill. Please note: The bill, which is being considered under reconciliation procedures, is likely to undergo changes as it moves through the Senate in the coming weeks.</p> <p>More details on the changes we are advocating for in the House bill, as well as resources you can use to engage with your representatives, follow.</p> <h2>Eliminate Punitive Medicaid DSH and Uncompensated Care Cuts</h2> <p>In Section 30608 of the version of the bill that was released Nov. 3, states that have yet to expand their Medicaid program face reductions in federal Medicaid DSH allotments and federal funding for uncompensated care pools. The AHA estimates that the Medicaid DSH cuts would be $4.7 billion over 10 years (2023-2032). In addition, if a state that currently has expanded its Medicaid program chooses to discontinue expansion, its federal DSH allotment also would be reduced. Even if your state is not impacted, these types of cuts set a dangerous precedent for other payment reductions that could be enacted in the future.</p> <p><strong>These provisions should be eliminated from the bill. Proposing cuts to hospitals and health systems that have continuously provided care for uninsured, historically marginalized, medically complex and low-income populations is extremely shortsighted.</strong></p> <p>Further constraining hospital and health system resources in the middle of a pandemic could gravely reduce their ability to continue serving their communities. This policy unnecessarily punishes hospitals and health systems and their communities and weakens a program that protects our neediest patients.</p> <h3>AHA Advocacy Efforts and Talking Points to Push Back Against DSH Cuts</h3> <p>The following are a number of ways we have been pushing back against the Medicaid DSH cuts contained in the Build Back Better Act and resources that you can use and share in your own advocacy efforts.</p> <ul> <li><strong>Talking Points</strong> – Access the following <a href="/fact-sheets/2021-11-15-talking-points-medicaid-dsh-build-back-better-act" target="_blank">talking points</a> that you can use in conversations with your lawmakers.</li> <li><strong>Letter to Hill Leaders with Other Hospital Groups</strong> – The AHA and seven other national organizations representing hospitals and health systems <a href="/lettercomment/2021-11-01-congress-urged-remove-hospital-cuts-social-spending-bill" target="_blank">urged congressional leaders</a> to remove the reductions to the Medicaid DSH program and uncompensated care pools from the social spending bill.</li> <li><strong>Digital Media Ads in Politico</strong> – The AHA and Federation of ����������s this week are running <a href="/issue-landing-page/2021-11-14-protect-patients-dont-cut-hospitals" target="_blank">ads in Politico</a> urging Congress to “Protect Patients: Don’t cut hospitals serving our most vulnerable.”</li> <li><strong>Blog Responding to Brookings White Paper</strong> – The <a href="/news/blog/2021-11-08-brookings-paper-misses-point-medicaid-dsh-cuts-included-bbba" target="_blank">AHA blog</a> responds to a flawed white paper from the USC-Brookings Schaeffer Initiative for Health Policy.</li> </ul> <h2>Remove Excessive CMPs for Labor Violations</h2> <p>The bill would significantly increase certain civil monetary penalties for various violations of the Occupational Safety and Health Act and National Labor Relations Act, provisions originally included as part of the Protecting the Right to Organize Act. <strong>These penalty increases are excessive and unwarranted, and should be eliminated. In addition, provisions included in the bill that subject officers and directors to personal liability should be removed.</strong></p> <h2>Restore Hospital Infrastructure Funding Under the Hill-Burton Act</h2> <p>Please urge your lawmakers to provide direct capital investment through grants to hospitals by updating the Hill-Burton Act. A previous version of the reconciliation bill included $10 billion for this provision and that should be added back into the bill.</p> <h2>Further Questions</h2> <p>If you have questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2021/11/BBAAlert-2021-11-15.pdf" target="_blank" title="Click here to download the Action Alert PDF."><img alt="Urge Your Representatives to Remove Hospital Cuts from House Social Spending Bill page 1." data-entity-type="file" data-entity-uuid="00634a83-baf6-4fe5-8f21-1d5c03a2eb94" src="/sites/default/files/inline-images/Page-1-BBAAlert-2021-11-15.png" width="1700" height="2200"></a></p> </div> </div> </div> Mon, 15 Nov 2021 14:47:41 -0600 Infrastructure <div class="container"> <div class="row"> <div class="col-md-8"> <p>Hospitals and health systems oppose Section 30608 of the Build Back Better Act, (H.R. 5376), which would impose a 12.5% cut in Medicaid Disproportionate Share Hospital (DSH) to states that have not expanded Medicaid. Specifically, in the current version of the bill, the 12 states that failed to expand their Medicaid program face reductions in Medicaid DSH payments and federal funding for uncompensated care pools.</p> <ul> <li>Cutting hospitals is not the solution to expanding coverage. <ul> <li>The legislation includes provisions to expand coverage in non-expansion Medicaid states through permitting enrollment of eligible individuals in the federal marketplace. Unfortunately, the bill seeks to partially offset these costs by imposing harmful DSH cuts to hospitals and health systems.</li> <li>DSH payments are not limited to the uninsured. They are intended to address significant shortfalls for hospitals that disproportionately care for the Medicaid population, as well as preserve the financial stability of safety-net hospitals. The hospitals and health systems serving these historically-marginalized, medically-complex and low-income populations are inarguably under reimbursed.</li> <li>Reducing DSH allotments to either penalize states or offset coverage costs will financially undermine hospitals.</li> <li>Further constraining hospital and health system resources could gravely reduce their ability to continue serving their communities.</li> </ul> </li> <li>Now is not the time to cut hospitals given the COVID-19 pandemic, and most especially not in the states that have been particularly hard hit by the Delta variant. These facilities are already struggling with severe workforce and supply chain issues.</li> <li>Moreover, this provision cuts hospitals and health systems that are committed to treating uninsured patients and have been strong advocates within their states to expand Medicaid.</li> <li>The DSH reductions amount $4.7 billion over 10 years and are permanent for the non-expansion states. This will further unfairly disadvantage hospitals and health systems in these states.</li> <li>It is not at all clear that states will expand Medicaid even with the penalty, yet it will directly harm hospitals and the patients they serve; the payment cuts are certain, but the coverage gains are not. <ul> <li>States did not expand when coverage was fully federally funded (2014-2016).</li> <li>None of the non-expansion states have indicated interest in expanding since Congress added a 5% bump in the American Rescue Plan Act.</li> </ul> </li> </ul> </div> <div class="col-md-4"> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2021/11/DSHTalkingPoints.pdf" target="_blank">Download the Talking Points PDF</a></div> </div> </div> </div> Mon, 15 Nov 2021 11:09:42 -0600 Infrastructure /news/news/2021-11-08-house-sends-infrastructure-package-president-signature <p>The House late Friday voted 228 to 206 to pass the <a href="https://www.govinfo.gov/content/pkg/BILLS-117hr3684eas/pdf/BILLS-117hr3684eas.pdf">Infrastructure Investment and Jobs Act</a> — legislation passed by the Senate in August that includes funding for broadband internet deployment, equity and affordability, as well as investments to improve federal coordination and assistance with response and recovery from significant cybersecurity incidents. The legislation will now go to President Biden for his signature. See the <a href="/system/files/media/file/2021/11/BIFKeyProvisions.pdf">summary</a> for highlights of provisions that may affect hospitals and health systems and the communities they serve. <br />  <br /> In addition, the House early Saturday voted 221-213 on a procedural move that advances a <a href="https://amendments-rules.house.gov/amendments/YARMUT_024_xml211104220514322.pdf">modified version</a>  of the <a href="http://H.R. 5376 https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-117HR5376RH-RCP117-18.pdf">Build Back Better Act</a>, a roughly $1.75 trillion social spending package that includes many health care provisions. Democratic leaders say they expect the House to pass the legislation before the Thanksgiving congressional recess. </p> Mon, 08 Nov 2021 14:41:27 -0600 Infrastructure /fact-sheets/2021-11-05-key-provisions-infrastructure-investment-and-jobs-act <h2>Broadband</h2> <h3>Grants to states for deployment: $42.45 billion</h3> <ul> <li>This funding supports a formula-based grant program to states, territories and the District of Columbia for the purposes of broadband deployment. The program does not favor particular technologies or providers. Projects would have to meet a minimum download/upload build standard of 100/20 megabits per second.</li> <li>The funding includes 10% set-aside for high-cost areas and each state and territory receives an initial minimum allocation, a portion of which could be used for technical assistance and supporting or establishing a state broadband office.</li> <li>To increase affordability, all funding recipients have an obligation to offer a low cost plan as a condition of receiving funding.</li> <li>States would be required to have enforceable plans to address all of their unserved areas before they are able to fund deployment projects in underserved areas. After both unserved and underserved areas are addressed, states may use funds for anchor institution projects.</li> </ul> <h3>Private Activity Bonds (PABs): $600 million</h3> <ul> <li>Based on the Rural Broadband Financing Flexibility Act (S.1676), this provision allows states to issue PABs to finance broadband deployment, specifically for projects in rural areas where a majority of households do not have access to broadband.</li> </ul> <h3>Additional Support for Rural Areas: $2 billion</h3> <ul> <li>The provision includes support for programs administered by the Department of Agriculture, including the ReConnect Program, that provide loans and grants (or a combination of loans and grants) to fund the construction, acquisition or improvement of facilities and equipment that provide broadband service in rural areas.</li> </ul> <h3>“Middle Mile”: $1 billion</h3> <ul> <li>This provision would create a grant program for the construction, improvement or acquisition of middle-mile infrastructure. Eligible entities include telecommunications companies, technology companies, electric utilities, utility cooperative, etc. The “middle mile” refers to the installation of a dedicated line that transmits a signal to and from an internet Point of Presence. Competition of middle-mile routes is necessary to reach unserved areas, reduce capital expenditures and lower operating costs.</li> </ul> <h3>Tribal Grants: $2 billion</h3> <ul> <li>This provision will provide additional funding to the Tribal Broadband Connectivity Program, which was established by the December COVID-19 relief package and is administered by the National Telecommunications and Information Administration (NTIA). Grants from this program will be made available to eligible Native American, Alaska Native and Native Hawaiian entities for broadband deployment as well as for digital inclusion, workforce development, telehealth and distance learning.</li> </ul> <h3>Inclusion: $2.75 billion</h3> <ul> <li>Establishes two NTIA-administered grant programs (formula based and competitive) to promote digital inclusion and equity for communities that lack the skills, technologies and support needed to take advantage of broadband connections. Grants can be used to accelerate the adoption of broadband through digital literacy training, workforce development, devices access programs, and other digital inclusion measures. The legislation also tasks NTIA with evaluating digital inclusion projects and providing policymakers at the local, state and federal levels with detailed information about which projects are most effective.</li> </ul> <h3>Affordability: $14.2 billion</h3> <ul> <li>This provision creates a permanent, sustainable Affordable Connectivity Benefit to ensure low-income families can access the internet. The program provides a $30 per month voucher for low-income families to use toward any internet service plan of their choosing. It builds on the Emergency Broadband Benefit, making the benefit permanent and expanding eligibility to help more low-income households, while also making it more sustainable for taxpayers.</li> </ul> <h2>Cybersecurity</h2> <h3>Cyber Response and Recovery Fund: $100 million</h3> <ul> <li>This provision allows the Secretary of Homeland Security to declare a Significant Incident following a breach of public and private networks and a fund that allows the Cybersecurity and Infrastructure Security Agency to provide direct support to public or private entities as they respond and recover from significant cyberattacks and breaches. Funded at $20 million per year over five years, any unused funds remain available until expended with the program ending Sept. 30, 2028.</li> </ul> <h3>State, Local, Tribal, and Territorial (SLTT) Grant Program: $1 billion</h3> <ul> <li>Allocated over four years, these funds are available until expended and will establish a new grant program to provide federal assistance to SLTT entities. The current grant programs to provide cybersecurity assistance to SLTT entities has inherent flaws that this program will address. The program will be administered by the Federal Emergency Management Agency in consultation with CISA acting as the subject matter expert.</li> </ul> <h3>Department of Homeland Security Science and Technology Directorate for Research and Development - $157.5 million</h3> <ul> <li>These funds will include support for specific areas of research related to risk assessments; cybersecurity vulnerability testing; and positioning, navigation, and timing capabilities over five years.</li> </ul> <h3>CISA Sector Risk Management: $35 million</h3> <ul> <li>This is a one-time investment in fiscal year 2022 for CISA to establish a capability to oversee and execute cross-sector governance to support CISA’s national cross-sector coordination role.</li> </ul> <h3>Office of the National Cyber Director: $21 million</h3> <ul> <li>The National Cyber Director was sworn in to office July 14, 2021. This office does not currently have appropriated funds. This will fully fund the office through FY 2022.</li> </ul> Fri, 05 Nov 2021 14:15:08 -0500 Infrastructure