the American Association of Colleges of Osteopathic Medicine

This analysis was prepared by Venable, LLP, on behalf of AACOM.

The House Appropriations Committee is currently developing its budget bill for fiscal year (FY) 2022. Funding for programs and report language relevant to the OME community are below:

Department of Education

Discretionary Spending

The bill provides $102.8 billion in discretionary spending for the Department of Education. This is an increase of $29.3 billion over the FY 2021 level and matches the President’s budget request.

Higher Education Funding- Provides $3.43 billion for higher education programs, an increase of $889 million above the FY 2021 enacted level and $122 million above the President’s budget request.
Pell Grants- Provides $24.7 billion for the Pell Grant program. This is $2.3 billion more than the FY 2021 enacted level, but $750 million less than the President’s budget request.
Expanded Eligibility for Financial Aid- The bill includes new language that allows DREAMERs and students with temporary protected status to be eligible for Pell Grants, Federal student loans, and other student financial assistance.
Temporary Extended Public Service Loan Forgiveness (TEPSLP)- Provides $25 million for the TEPSLF, which is $25 million less than the FY 2021 enacted level and matches the President’s budget request.
- The Committee notes that many physicians are excluded from receiving forgiveness under section 455(m)(3) of the HEA as they are prohibited from direct employment with private, non-physician, corporate entities within their States. As such, the Committee encourages the Secretary to provide full-time borrowers who are engaged in health care practitioner occupations in such States, including California and Texas, with loan cancellations that are consistent with the Department’s ongoing loan cancellations for health care practitioners across the country. Further, the Committee encourages the Department to explore this issue through negotiated rulemaking this year.
Fund for the Improvement of Postsecondary Education- Provides $168 million for the Fund for the Improvement of Postsecondary Education. This is an increase of $127 million over the FY 2021 enacted amount and $92 million above the President’s budget request.
For-profit College Accountability- The 85/15 Rule was first implemented in 1992 as a bipartisan amendment to the Higher Education Act (HEA). It is based on the rationale that if an institution provides a quality education, individuals without access to Federal funding sources should be willing to pay for it. The rule prevented for-profit postsecondary institutions from deriving more than 85 percent of revenues from Title IV of the HEA. It was based on a longstanding principle first enacted in 1952 to protect veterans from for-profit college abuses dating back to the original GI Bill (the Servicemen’s Readjustment Act) in 1944, and was in response to widespread reports that many for-profit colleges were using aggressive, sometimes fraudulent recruiting tactics in order to profit off of students with access to Federal student aid funding. In 1998, the rule was amended to allow for-profits to derive an extra five percent of their revenue from Title IV and became known as the 90/10 Rule. Since that time, thousands of students have been defrauded by schools that have since gone out of business. Students who graduate from these schools can obtain degrees that often offer little value. A 2016 National Bureau of Economic Research study using data from the Department and the Internal Revenue Service found that the earnings of students who attend for-profit colleges or universities are lower than if they had never enrolled at all. Given these deeply disappointing outcomes, the Committee believes that reverting back to the 85/15 ratio is a critical step in holding for-profit colleges accountable and protecting students from predatory practices and taxpayer dollars from being wasted. Therefore, the Committee includes new bill language requiring that for-profit institutions of higher education receive not more than 85 percent of their revenue from Federal sources.

Department of Health and Human Services

Discretionary Spending

The bill provides $119.8 billion for HHS. This is an increase of $22.9 billion over the FY 2021 enacted level and $129 million below the President’s budget request.

Physician Education Programs- Provides $75 million for grants to public institutions of higher education to expand or support graduate education for physicians. Priority is given to public institutions of higher education located in states with a primary care provider shortage in 2026, as determined by the Secretary. The grant to any such institution shall not be less than $1 million per year and not to exceed five years. Institutions receiving a grant would be required to provide a non-Federal funding match of not less 10 percent of the total amount of Federal funds.
National Institutes of Health (NIH)- Provides $49 billion for NIH. This is an increase of $6.5 billion over the FY 2021 enacted level.
Centers for Disease Control and Prevention (CDC)- Provides $10.6 billion for the CDC. This is an increase of $2.7 billion over FY 2021 enacted levels and $1 billion above the President’s budget request.
Centers for Medicare and Medicaid Services (CMS)- Provides $4.3 billion for CMS administrative expenses. This is an increase of $646 million over the FY 2021 enacted level and matches the President’s budget request.
Health Professions Education and Training- Provides $565.4 million for the Health Professions Education and Training Program. This is an increase of $125.9 million over FY 2021 enacted level and $38 million over the President’s budget request.
Health Resources and Services Administration (HRSA)- Provides $7.5 billion for HRSA. This is an increase of $1.6 billion above the FY 2021 enacted level and $910 million over the President’s budget request.
Children’s Hospitals Graduate Medical Education (CHGME)- Provides $400 million for the CHGME program. This is an increase of $50 million over the FY 2021 enacted amount and the President’s budget request.
Rural Health Programs- Provides $400 million for Rural Health Programs. This is an increase of $214 million over the FY 2021 enacted level.
Rural Health Residency Program- Provides $12.7 million for the program, which is an increase of $2.2 million over the FY 2021 enacted amount and matches the President’s budget request.
- Rural Health Residency Program- The COVID–19 pandemic has exacerbated the challenges in access to care faced by Americans in rural areas, particularly when they require specialty care. The Committee commends the Federal Office of Rural Health Policy for its efforts to expand the physician workforce in rural areas and supports continuation and expansion of the program to develop new rural residency programs, or Rural Training Tracks (RTTs). This Committee encourages HRSA to expand the current program to include RTTs in obstetrics and gynecology, as women in rural communities are more likely to begin prenatal care late and are more likely to experience maternal mortality and severe maternal morbidity. The Committee requests a report in the fiscal year 2023 Congressional Budget Justification on the progress made to date and efforts to expand RTTs in obstetrics and gynecology.
National Health Service Corps (NHSC)- Provides $185 million for NHSC. This is an increase of $65 million above the FY 2021 enacted amount and matches the President’s request.
- National Health Service Corps Rural Demonstration Program- The Committee strongly supports the NHSC program for improving access to quality care in rural and underserved areas. The Committee notes that rural communities continue to face acute workforce challenges, with approximately five percent of incoming medical students coming from rural areas and only one-third of NHSC placements in rural communities. The Committee includes $25,000,000 within NHSC for a pilot program to evaluate the benefit to patient access and practitioner recruitment and retention of extending loan repayment for five years and $200,000 for providers serving in rural areas that are part of a Health Professional Shortage Area. The Committee also directs HRSA to include an assessment of program utilization and impact in the annual NHSC report to Congress and to submit a final report after completion of the pilot.
Agency for Healthcare Research and Quality- Provides $380 million for the AHRQ. This is $34.7 million over the FY 2021 enacted level and matches the President’s budget request.
Area Health Education Centers (AHEC)- Provides $50 million for the AHEC program. This is an increase of $6.8 million above the FY 2021 level and the President’s request.
Primary Care Training and Enhancement Programs (PCTE)- Provides $49.9 million for PCTE, which is an increase of $1 million over FY 2021 enacted level and the President’s budget request.
Public Health and Preventive Medicine Training Programs- Provides $23 million for Public Health and Preventive Medicine Training Grant Programs. This is $6 million over the FY 2021 enacted level and $5 million over the President’s request.
Geriatrics Workforce Enhancement Program (GWEP)- Provides $52.7 million for GWEP, which is an increase of $10 million over the FY 2021 level and $6.2 million over the President’s budget request.
Centers of Excellence (COEs)- Provides $31.7 million for COEs. This is an increase of $8 million over the FY 2021 enacted level and $5 million over the President’s request.
National Health Care Workforce Commission- Provides $3 million to establish the National Health Care Workforce Commission, as authorized by the Affordable Care Act. The Commission is intended to serve as a resource on health care workforce policy for Congress, the Administration, States, and localities and is tasked with evaluating health care workforce needs, assessing education and training activities, identifying barriers to improved coordination at the Federal, State, and local levels and recommending changes to address those barriers.
Mental and Substance Use Disorder Workforce Training Demonstration- The Committee includes $34,000,000 for the Mental and Substance Use Disorder Workforce Training Demonstration program, $4,300,000 above the fiscal year 2021 enacted level and the same as the fiscal year 2022 budget request. This program makes grants to institutions, including but not limited to medical schools and Federally-Qualified Health Centers (FQHCs), to support training for medical residents and fellows in psychiatry and addiction medicine, as well as nurse practitioners, physician assistants, and others, to provide SUD treatment in underserved communities.
Physician Shortage Report- The Committee directs the Advisory Committee on Minority Health to issue a report advising HHS on the best efforts to create pipeline programs that start with pre-med students in underserved areas and end in more graduate medical education training programs in those underserved areas. The Committee recognizes the need to build and strengthen the pipeline for physicians who practice in medically underserved areas. The COVID–19 pandemic has exposed how fragile the frontline provider workforce is because of the physician shortage crisis, and it is most pronounced in medically underserved areas.
Pediatric Cancer Expertise- The Committee recognizes that the Childhood Cancer STAR Act (P.L. 115–180) calls on NCI to ensure that all applicable study sections, committees, advisory groups, and panels at NCI include one or more qualified pediatric oncologists, as appropriate. The Committee requests an update in the fiscal year 2023 Congressional Budget Justification on the actions NCI has taken to ensure appropriate pediatric cancer expertise is included in such groups.
Adolescent Addiction Medicine and Addiction Psychiatry Workforce- The Committee applauds HRSA for issuing a funding solicitation for the Addiction Medicine Fellowship (AMF) program and the Mental and Substance Use Disorder Workforce Training Demonstration, as both programs will build the capacity of our nation’s addiction medicine physician workforce. However, the Committee remains concerned by the lack of pediatric and adolescent addiction medicine and addiction psychiatry expertise. Currently, there are insufficient opportunities to effectively train a robust mental health and substance use disorder (SUD) workforce. Only 75 of the nation’s 179 accredited medical schools offer addiction medicine fellowships, and only one program focuses on fellowship opportunities for pediatric and adolescent addiction medicine and addiction psychiatry. The Committee encourages HRSA to support fellowship programs focused on increasing the number of board certified pediatric and adolescent addiction medicine and addiction psychiatry subspecialists.
Black Men and Women Pursuing Medicine and Science- The Committee supports the efforts of the National Academies Roundtable on Black Men and Black Women in Science, Engineering, and Medicine and its efforts to develop specific programs to increase numbers and effectiveness of Black Men and Women pursuing medicine and science. The Committee directs the Director to allocate increased resources from the Common Fund of the diversity program consortium to the National Academies Roundtable on Black Men and Black Women in Science, Engineering, and Medicine to address the increasing underrepresentation of Black men in medical schools and in the biomedical research profession. In addition, the Committee recognizes the need to increase the number of biomedical research professionals as leaders in critical areas of national need. The Committee directs NIH to establish a scholarship program that encourages African American students to pursue a career in medicine, science, and biomedical research to combat the persistent decline of Black male physicians over the last decade.

Department of Veterans Affairs

Discretionary Spending

The bill provides $113.1 billion for the Department of Veterans Affairs. This is an increase of $8.7 billion over FY 2021 enacted levels and $176.4 million over the President’s budget request.

Report Language

The committee raised concerns about staffing shortages affecting care at Veterans Health Administration (VHA) centers and clinics, which has negatively impacted the delivery of services to veterans. The committee specifically highlighted the following as it relates to staffing shortages:

Addressing Mental and Behavioral Health Workforce Shortages.—The Committee remains concerned about the negative effects of VHA workforce shortages on the delivery of care for Veterans at VHA medical centers and clinics across the country, particularly in the areas of mental and behavioral health care. A VA Office of the Inspector General Report published on September 23, 2020 found severe occupational staffing shortages across 277 occupations in VHA medical centers. Some of the most common facility-designated severe occupational staffing shortages were in psychiatry, psychology, and nurse practitioners focusing on mental health and substance use disorders. The Committee continues to direct the Department to prioritize hiring mental health professionals, and encourages VA to prioritize initiatives to recruit and retain mental and behavioral health professionals at VHA medical centers and clinics to ensure Veterans with mental health conditions and substance use disorders have access to high-quality care.
VA/HHS Taskforce on Health Workforce Shortages.—The Committee encourages VA to create a taskforce with HHS to explore ways the agencies can work together to increase the availability of providers, including in the behavioral health workforce and among physicians specializing in cancer, spinal cord, and neuropsychiatric conditions. The taskforce is urged to examine VA’s recruitment challenges, review programs that could enhance recruitment and retainment, and to think creatively on how other federal agencies like HHS can identify and address provider shortages. The taskforce is also encouraged to consult with DOD to explore recruiting those who have left the military.
Medical and Nursing Understaffing.—The Committee recognizes that understaffing, especially in medical and nursing positions, is a principal obstacle to timely access to care for Veterans and encourages the Department to investigate the use of commercially available hospital management information technologies to reduce nursing administrative workloads while simultaneously improving patient flow and access to care.

Department of Defense

Report Language

The Committee expressed concern about the fracturing of the military health system and that not enough attention is being placed on medical capabilities and capacity required for the homeland defense mission. The Committee provides funding and directs the Department of Defense to establish a joint civilian-military pilot program that creates a civilian and military partnership to enhance interoperability and medical surge capability. The committee report says the following:

Section 740 of the National Defense Authorization Act for Fiscal Year 2020, as amended by Section 741 of the National Defense Authorization Act for Fiscal Year 2021, authorized a pilot program on civilian and military partnerships to enhance interoperability and medical surge capability and capacity of the National Disaster Medical System. The Department of Defense Appropriations Act, 2021 included $15,000,000 for the pilot program but the Committee is disappointed that funding was not included as part of the fiscal year 2022 budget request. The Committee recommendation includes $15,000,000 and directs that sufficient funding be included in the budget request for fiscal year 2023.

Additionally, as was observed during the response to the COVID 19 pandemic, the nation lacks medical surge capacity beyond what is currently available. Therefore, the Committee recommendation includes $14,000,000 for the Department of Defense to initiate investment in a joint civilian-military modular surge facility. This type of modular and/or convertible medical surge facility should be adjacent to existing medical facilities and should include laboratories, intensive care units, x-rays, and be able to use the staffing and services available in the medical facility. The initial investment in the Committee recommendation should be used to initiate facility modifications, prepare for construction, and begin development of a training curriculum necessary to activate the surge facility.

Please contact AACOM Government Relations at aacomgr@aacom.org with questions or for further information.

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