Important Issues & Priorities

As one of the largest non-profit, nondenominational health systems in the country, the UnityPoint Health network of Disproportionate Share Hospitals, Sole Community Hospitals, Critical Access Hospitals and Rural Health Clinics provide vital access to health care services. The 340B Drug Pricing Program has served as a critical federal resource for our safety-net providers and the patients we serve in Iowa, Illinois and Wisconsin.

UnityPoint Health SUPPORTS efforts to ensure safety net hospitals and their patients benefit from the 340B program. This includes urging HHS action on drug manufacturers unlawfully restricting access to 340B-priced medications at contract pharmacies and maintaining the program as a discount model.

340B Impact Statements – Spring 2023

• Anamosa
• Cedar Rapids
• Des Moines
• Fort Dodge
• Madison
• Quad Cities – Iowa
• Quad Cities – Illinois
• Sioux City
• Waterloo

340B Impact Statements – Spring 2022

• Anamosa
• Cedar Rapids
• Des Moines
• Fort Dodge
• Madison
• Peoria
• Quad Cities – Iowa
• Quad Cities – Illinois
• Sioux City
• Waterloo

340B Program at UnityPoint Health -2021

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Fort Dodge Region’s 340B Program >>

Rural Health Clinic Telehealth – “At UnityPoint Health, we pride ourselves on being able to serve our patients in a way that puts quality and accessibility at the forefront of their care. Using technology to transform how we reach and treat those who live in our rural communities is critical to our mission to improve access, outcomes and meet the needs of our patients—no matter where they live.” ~ Dave Williams, MD, Senior Vice President & Chief Clinical Officer UnityPoint Health and President & CEO UnityPoint Clinic.

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Telehealth has made a difference for many patients by providing safe access to high-quality care. Since the beginning of the COVID-19 pandemic, telehealth visits at UnityPoint Health have increased by 2,499 percent and include settings such as homes, clinics, hospitals, nursing homes and more. For UnityPoint Clinic, virtual care has demonstrated cost savings by getting patients to the right level of care at the right time. With a 96 percent average patient satisfaction rate, access to telehealth services is evolving from a nicety to a necessity. As a health care delivery tool, telehealth is now an option patients will continue to desire and expect. Telehealth technology maintains the quality of care for patients, makes practicing in urban and rural areas more attractive, and provides added financial sustainability for health systems and the services they provide.

Telehealth Delivers Needed Access with High-Quality Care

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Enhancing Health Care

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Dr. Shriram Lokare, a native of India and a board-certified Rheumatologist serving patients in the Peoria, Illinois and surround communities, shares his personal story of caring for UnityPoint Health patients and the need for Congress to pass S.1024, the Healthcare Workforce Resilience Act.

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Dr. Ratna Priya Gangi, a native of India and a board-certified Cardiologist serving patients in West Des Moines, Iowa shares her personal story of caring for UnityPoint Health patients and the need for Congress to support immigrant workforce resilience.

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Dr. Vijaya Gogineni, a native of India and a board-certified Pulmonary and Critical Care physician for UnityPoint Health – Cedar Rapids, shares his personal story of caring for COVID-19 patients and the need for Congress to support immigrant workforce resilience.

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Dr. Vara Ponnada, a native of India and a board-certified internal medicine physician for UnityPoint Health – Waterloo, shares her personal story of caring for patients in the Cedar Valley and the need for Congress to support immigrant workforce resilience.

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Appropriations Process – The Federal Fiscal Year (FFY) starts on October 1 and ends on September 31. For FFY 2024, this starts on October 1, 2023, and ends on September 31, 2024. The federal budget is comprised of regular 12 appropriations bills:

1. Agriculture-Rural Development-FDA
2. Commerce-Justice-Science
3. Defense
4. Energy & Water Development
5. Financial Services & General Government
6. Homeland Security
7. Interior-Environment
8. Labor-HHS-Education
9. Legislative Branch
10. Military Construction & Veterans Affairs
11. State and Foreign Operations
12. Transportation-Housing & Urban Development

If any appropriations bills that are not passed and signed by September 31, federal agencies may generally not enter into additional financial obligations, although there are exceptions. These exceptions include programs/staff funded through prior year appropriations, mandatory appropriations, and user fees or other reimbursements of non-lapsed appropriations.

Continuing Resolutions – In order to continue federal agency operations in the absence of an appropriations, Congress can pass a continuing resolution. This is a short-term measure to enable continued government funding pending the passage of an appropriations bill.

Agency Contingency Plans – If a budget is not passed prior to the start of a new FFY, federal agencies have contingency plans to identify how they will operate pending passage of a new budget. Contingency plans from federal agencies are being released as we inch closer to a potential government shutdown on October 1, and all are located on the Agency Contingency Plans page of the Office of Management and Budget (OMB).

Department of Health and Human Services – The HHS Contingency Staffing Plan is broken into its operating divisions. These current plans represent initial estimates for HHS activities under a lapse, and that it will continue to review its resources, authorities, and flexibilities during any lapse, in order to minimize impacts on the safety of human life and the protection of property. Highlights include:

Centers for Medicare and Medicaid Services (CMS)

• The Medicare program will continue during a lapse in appropriations.
• Other non-discretionary activities including Health Care Fraud and Abuse Control and Center for Medicare & Medicaid Innovation activities will also continue.
• CMS will have sufficient funding for Medicaid to fund the first quarter of FY 2024, based on the advance appropriation provided for in the FY 2023 appropriation.
• CMS will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP).
• CMS will continue Federal Exchange activities, such as eligibility verification, using Federal Exchange user fee carryover.
• 3,236 (49%) of CMS staff will be retained including 2,928 (45%) who are exempt (their activities or position are already funded or otherwise exempt) and 308 (5%) who are excepted staff (their activities are deemed necessary by implication).

Administration for Community Living (ACL)

• ACL will continue activities funded through carryover funding provided under the Health Care Fraud and Abuse Control (HCFAC) Account and carryover funding from the Medicare Improvements for Patients and Providers Act (MIPPA), including the Senior Medicare Patrol Program and related Medicare program integrity activities as well as Medicare Beneficiary outreach activities.
• Staff will continue to perform reimbursable work related to managed care consumer information and assistance.
• Supplemental funding for ACL programs under the Families First Act and the CARES Act has been distributed to grantees and would not be impacted by a lapse in appropriations.
• 22 (11%) of ACL staff will be retained including 10 (5%) who are exempt (their activities or position are already funded or otherwise exempt) and 12 (6%) who are excepted (their activities are deemed necessary by implication, or for the safely of human life or protection of property).

Health Resources and Services Administration (HRSA)

• HRSA will continue activities funded through mandatory funding, advanced appropriations, prior year carry-over funds, and user fees.
• HRSA will continue to oversee many direct health services and other activities funded through carryover balances, such as the Ryan White HIV/AIDS program – Parts A and B and Ending the HIV Epidemic.
• HRSA will continue to oversee the National Practitioner Databank and Hansen’s Disease Program using existing balances.
• 1,594 (54%) of the HRSA staff will be retained, including 1,365 (46%) who are exempt (their activities or position are already funded or otherwise exempted) and 229 (8%) who are excepted (their activities are deemed necessary by implication, or for the safety of human life and protection of property).

Substance Abuse and Mental Health Services Administration (SAMHSA)

• SAMHSA will continue substance abuse and mental health programs, including those that provide critical behavioral health resources in the event of a natural or human-caused disaster such as Disaster Behavioral Health response teams, the 24/7 365 day-a-year Disaster Distress Helpline that provides crisis counseling to people experiencing emotional distress after a disaster, and the 988/Suicide Lifeline to connect people in crisis with life-saving resources.
• SAMHSA will continue activities supported with Bipartisan Safer Communities Act (BSCA) advanced appropriations and will also continue previously funded operations and utilize available balances to provide important resources to those seeking help for addiction and behavioral health concerns through the Treatment Services Locator program, the Treatment Referral Line, and the Suicide Prevention Lifeline.
• SAMHSA will have staff ready to receive and properly route any letters indicating suicidal ideation to the appropriate local crisis intervention services.
• SAMHSA will review opioid prescription limit waivers.
• Most SAMHSA grants awarded in the prior year will have funds that remain available to be spent by the grantee, including for example the 988 and Behavioral Health Crisis Services program, the State Opioid Response Grant program, and the mental health and substance abuse block grants.
• The retained Commissioned Corps Officers (CCO) will assist with maintaining any required grants programs/activities, including grants funded with COVID-19 and BSCA advanced appropriations.
• SAMHSA does not anticipate that COVID-19, BSCA or grant activities will be impacted during a short-term lapse.
• 127 SAMHSA staff will be retained including 52 exempt staff (their activities or position are already funded or otherwise exempt) and 75 who are excepted (their activities are deemed necessary by implication, or for the safety of human life).

Centers for Disease Control and Prevention (CDC)

• CDC will continue support to protect the health and well-being of US citizens here and abroad through response to outbreaks, maintaining laboratory functions, the President’s Emergency Plan for AIDS Relief (PEPFAR), and the agency’s 24/7 emergency operations center.
• CDC will continue the World Trade Center (WTC) Health Program, the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), and the Vaccines for Children (VFC) program, which are supported through mandatory funding.
• CDC’s immediate response to urgent disease outbreaks and critical investigation needs in areas such as food, healthcare, vectors (mosquitoes and ticks), and high-consequence pathogens would continue.
• CDC will collect data being reported by states, hospitals, and others, and report out critical information needed for state and local health authorities and providers to track, prevent, and treat diseases.
• 6,176 (41%) of CDC staff will be retained including 2,594 (17%) who are exempt (their activities or position are already funded or otherwise exempt) and 3,582 (24%) who are excepted (their activities are deemed necessary by implication, or for the safety of human life or protection of property).

National Institutes of Health (NIH)

• NIH activities that will continue are centered mainly on the ongoing operations at its biomedical research hospital, the NIH Clinical Center, to maintain the safety and continued care of its patients.
• NIH will provide basic care services to protect the health of NIH animals, and retain staff to safeguard ongoing experiments or operations, as well as facilities and infrastructure.
• 4,427 (approximately 22.4%) of NIH staff will be retained.  This total includes 177 exempt staff (slightly less than 0.9%) whose activities or positions are already funded or otherwise exempted, as well as 4,250 (nearly 21.5%) who are excepted given their activities are deemed necessary by implication or for the safety of human life or protection of property.

Food and Drug Administration (FDA)

• FDA activities funded through carryover user fee funding will continue, including certain activities related to the regulation of human and animal drugs, biosimilar biological products, medical devices, and tobacco products.
• Activities that can be carried out with COVID-19 supplemental funding include work on emergency use authorizations to respond to the COVID-19 pandemic, mitigation efforts related to potential drug and medical product shortages and other supply chain disruptions, medical device infection control, work on enforcement actions for fraudulent, counterfeit and misbranded products related to COVID-19, and work on medical countermeasures, therapies, and vaccines and important generic and biosimilar treatment options.
• All vital FDA activities related to imminent threats to the safety of human life will also continue.
• This includes detecting and responding to public health emergencies, continuing to address existing critical public health challenges, and managing recalls, including drug shortages, and outbreaks related to foodborne illness and infectious diseases.
• Other vital activities that will continue are surveillance of adverse event reports for issues that could cause human harm, the review of import entries to determine potential risks to human health, determining and conducting systems for cause and certain surveillance inspections of regulated facilities, and criminal enforcement work and certain civil investigations.
• 15,602 (81%) of FDA staff will be retained including 12,300 (64%) who are exempt (their activities or position are already funded or otherwise exempted) and 3,302 (17%) who are excepted (their activities are deemed necessary by implication, or for the safety of human life or protection of property). Of the staff retained, 998 would be working directly on COVID-19 response activities.

Advanced Research Projects Agency for Health (ARPA-H)

• ARPA-H has been appropriated three-year appropriations in FY 2022 and FY 2023, and the FY2024 carryover balances from these two appropriations are sufficient to support ARPA-H operations during a lapse of appropriations.
• All ARPA-H activities would continue during a lapse.
• All ARPA-H federal staff will be exempt and paid from carryover funding.

Administration for Strategic Preparedness and Response (ASPR)

• ASPR will continue support of COVID-19, hurricane and other emergency responses.
• ASPR is leading the federal government’s response to COVID-19, and a large number of staff are supporting the medical countermeasure program by negotiating, awarding, and managing contracts that are critical to the response effort.
• In addition to COVID-19 response, ASPR staff are also negotiating, awarding, and managing contracts that are critical to the other material threats within ASPR’s mission, including the development of medical countermeasures for CBRN and pandemic influenza preparedness and response efforts, and the overall technical oversight and management of those contracts.
• 498 (47%) of ASPR staff will be retained including 260 (24%) who are exempt (their activities or position are already funded or otherwise exempted) and 238 (22%) who are excepted (their activities are deemed necessary by implication, or for the safety of human life or protection of property).

Office of the Secretary (OS)

• OS reports the contingency staffing numbers for 15 Staff Divisions and the Program Support Center.
• Excepted staff in the immediate Office of the Secretary would continue to provide leadership and key support staff to ensure Department operations and national security related activities continue.
• The Intergovernmental and External Affairs Regional Directors will continue to support working partners in the regions.
• The Assistant Secretary for Financial Resources’ budget and grants staff will continue to support HHS’ funded programs and will assist with orderly phase down of operations.
• 3,383 (59%) of OS staff will be retained, including 2,658 (47%) who are exempt (their activities or position are already funded or otherwise exempted) and 725 (13%) who are excepted (their activities are deemed necessary by implication, or for the safety of human life or protection of property).

Entitlement Program Impact – During a government shutdown, entitlement programs like Medicare and Medicaid will still be fully operational— meaning that beneficiaries can still go to their doctor or visit a hospital and clinicians and facilities are still able to provide and bill for services.  However, the effect of a shutdown on Medicare payments is a little more nuanced:

• Impact of Short Shutdown:  For both Medicare fee-for-service (FFS) and Medicare Advantage, a short shutdown of a month or less will likely not affect the timing of payments to providers or health plans.
• Impact of Long Shutdown:  A shutdown of over a month could delay the timing of payments to providers under Medicare FFS by Medicare Administrative Contractors (MACs).  Payments to health plans who participate in Medicare Advantage will not be affected.
• Background on Medicare FFS Payments to Providers (Clinicians and Facilities): Medicare FFS payments to providers are made by MACs that operate regionally.  Each MAC has a contract with the Centers for Medicare & Medicaid Services (CMS) to handle Medicare FFS claims (Medicare Part A and Part B). The contracts are funded by the CMS discretionary Program Management account that is appropriated by Congress annually through the appropriations process. The contract periods for MACs do not always align with the government fiscal year (October 1- September 30), so MACs can be funded past September 30^th.  However, when a MAC runs out of funding and needs additional funding from the new fiscal year appropriation, it could start to hold back payments until the funding is received (once funding is received, the claims are paid in full).  Therefore, any type of payment delay to providers truly depends on how each MAC’s contract is structured and how long the government shutdown lasts. If the government shutdown lasts longer than 30 days, there is a greater likelihood that at least some of the MACs could run out of funds.
• Background on Medicare Advantage Payments to Health Plans:  Medicare Advantage plans are paid a monthly risk-adjusted capitated payment on around the first of every month.  The payments, which come directly from the Treasury, are mandatory and must always be made.  Therefore, a government shutdown, regardless of its length, will have no impact on Medicare Advantage payments to health plans.