Tuesday, February 11, 2020

Very Brief Blog: Trump Administration Posts "Budget in Brief" For HHS for FY2021

With much fanfare, the Trump administration released its government-wide budget plans on February 10, 2020, WaPo here.

As part of this, HHS released a 188-page FY2021 budget in brief.   Find it here.  See also the HHS budget home page here.

Example: Kidney Disease

The budget reflects priorities that President Trump launched in July 2019 with a coordinated roll-out of initiates in kidney disease and transplant care. 

The Budget includes $39 million across multiple HHS
agencies and requests new legislative authority in
support of the initiative’s three goals:
   * Reduce the number of Americans developing
End-Stage Renal Disease (ESRD) by 25 percent
by 2030.
   * Have 80 percent of new ESRD patients in 2025
receive dialysis at home or a transplant.
   * Double the number of kidneys available for
transplant by 2030.
Adding, "The Budget invests $31 million in HRSA for the Organ Transplantation program, including $18.3 million for the Organ Procurement Transplantation Network, Scientific Registry of Transplant Recipients, and public and professional education efforts to increase public awareness about the need for organ donation...The Budget also advances legislative proposals to revolutionize the way patients with chronic kidney disease and kidney failure are diagnosed, treated, and supported."  The plan also includes efforts to keep kidney transplant patients on anti-rejection drugs, which currently terminate (along with the rest of their Medicare) 36 months after transplant (unless the patient is otherwise Medicare-eligible.)

I've used renal care as an example; many other proposals are found in the 188-page document.

Example: Medicare Coverage Policy & Processes

In October 2020, President Trump issued an executive order for improving coverage and processes at Medicare.  This was echoed in a pair of December 18, 2019, long blogs in Health Affairs on improving Medicare coverage rules and processes (entry point here).

Several paragraphs in the FY2021 plan also address Medicare:

Provide Price and Quality Transparency -  
Improve Clarity and Transparency of the Medicare
Coverage Process

Many stakeholders find the process and standards for the Medicare coverage determination process lack clarity. This proposal requires CMS to issue additional
guidance around the Medicare coverage process, including sub-regulatory guidance on the evidence standards that CMS utilizes in assessing coverage and the process to appeal coverage determinations, in an effort to improve clarity around Medicare coverage.
[Budget Neutral] 
Strengthen the Parallel Review Process to Streamline Medicare CoverageThe Parallel Review program is a collaborative effort between the Food and Drug Administration (FDA) and CMS that reduces the time between FDA approval of a device and Medicare coverage of that item. This proposal strengthens the existing parallel review process to improve device manufacturer participation and increase transparency. [Budget Neutral]
Thanks to a former senior CMS official who pointed out to me, these FY2021 paragraphs, while echoing the recent October 2019 Executive Order, are also very close to improvements captured in a 2012 Obama "Bioeconomy Blueprint" which is still online - here.


While not directly related to healthcare, Trump also proposes raising spending on AI and quantum computing to $2B per year within 2 years (WSJ here).