the American Association of Colleges of Osteopathic Medicine

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

The Senate Appropriations Committee Chairman Patrick Leahy (D-VT) released the remaining nine Fiscal Year 2022 Appropriations Bills on Monday, October 18. Below is a summary of provisions relevant to the osteopathic medical education community.

EXPLANATORY STATEMENT FOR DEPARTMENTS OF SENATE LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL

Committee Summary

Bill Text

Complete Explanatory Statement

For fiscal year 2022, the Committee recommends total budget authority of $1,352,922,397,000 for the Departments of Labor, Health and Human Services, and Education, and Related Agencies. This amount includes $220,757,000,000 in current year discretionary funding consistent with the subcommittee’s allocation, and $2,124,000,000 in allocation adjustments for healthcare fraud and abuse control, Unemployment Insurance Trust Fund program integrity, and for program integrity at the Social Security Administration, in accordance with the allocation for this bill. Fiscal year 2021 levels cited in this explanatory statement reflect the enacted amounts in Public Law 116–260, the Consolidated Appropriations Act, 2021, adjusted for comparability where noted, and do not include fiscal year 2021 supplemental appropriations.

Osteopathic Medical Schools. The Committee supports access to NIH research funding for osteopathic medical schools. The Committee is concerned by the historical disparity in NIH funding as osteopathic professionals receive only 0.1 percent of NIH grants, yet osteopathic medicine is one of the fastest growing healthcare professions in the country and osteopathic medical schools educate 25 percent of all medical students. The Committee understands that osteopathic medical students receive 200 hours of additional training in the musculoskeletal system and learn the value of osteopathic manipulative treatment as a non-pharmacological alternative to pain management. Over half of osteopathic physicians practice in the primary care specialties of family medicine, internal medicine, and pediatrics, and a disproportionate share of osteopathic medical graduates locate in rural and underserved areas. The Committee recognizes that increased access to research funding for the osteopathic profession will significantly bolster the NIH’s capacity to support robust recovery from the COVID–19 pandemic, address health disparities in rural and medically-underserved populations, and advance research in primary care, prevention, and treatment. The Committee urges NIH to report to the Committee on the current status of NIH funding to colleges of osteopathic medicine and representation of doctors of osteopathic medicine on NIH National Advisory Councils and standing study sections in the fiscal year 2023.

NASEM Study on Implicit Bias Recognition. The Committee provides $1,000,000 for a partnership with the National Academy of Medicine to study and make recommendations for incorporating bias recognition in clinical skills testing for accredited schools of allopathic medicine and accredited schools of osteopathic medicine.
Public Health Workforce Development. The Committee provides $20,000,000, an increase of $3,000,000, for Public Health Workforce Development. This program line, also called Public Health and Preventive Medicine, funds programs that are authorized in titles III and VII of the PHS Act (Public Law 111–148) and support awards to schools of medicine, osteopathic medicine, public health, and integrative medicine programs.
Primary Care Training and Enhancement. The Committee provides $48,924,000 for Primary Care Training and Enhancement [PCTE] programs, which support the expansion of training in internal medicine, family medicine, and pediatrics. Funds may be used for developing training programs or providing direct financial assistance to students and residents.
Medical Student Education. The Committee continues to provide $50,000,000 to support colleges of medicine at public universities located in the top quintile of States projected to have a primary care provider shortage in 2025.
Mental and Substance Use Disorder Workforce Training. Within the total for BHWET, 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 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.
Minority Serving Institutions. Congress recognizes the importance of highly trained physician-scientists to serve diverse communities, decrease health disparities, and enhance the biomedical research workforce. The Committee encourages NIGMS to support medical scientist training at Minority Serving Institutions as defined in law under Title III of the Higher Education Act. Such efforts should support dual degree programs that train students in medicine and biomedical research.
Children’s Hospitals Graduate Medical Education. The Committee provides $375,000,000 for the Children’s Hospitals Graduate Medical Education [CHGME] program, an increase of $25,000,000. The Committee strongly supports the CHGME program, which provides support for graduate medical education training programs in both ambulatory and in-patient settings within freestanding children’s teaching hospitals. CHGME payments are determined by a per-resident formula that includes an amount for direct training costs added to a payment for indirect costs. Payments support training of resident physicians as defined by Medicare in both ambulatory and inpatient settings.
Faculty Loan Repayment. The Committee provides $2,310,000, an increase of $1,120,000 above the fiscal year 2021 enacted level, for the Faculty Loan Repayment Program. This program provides loan repayment to health profession graduates from disadvantaged backgrounds who serve as faculty at eligible health professions academic institutions.
Public Health Scholars Program. The Committee commends CDC for its commitment to health equity and workforce development to ensure a future where an increasingly diverse American public benefits from a more diverse and better trained public health workforce. The Committee applauds CDC on the 10th anniversary of the CDC Undergraduate Public Health Scholars [CUPS] Program and provides increased funding of $5,000,000 to expand the program, including the opportunity for more HBCUs to participate, as well as Tribal Institutes. The CDC CUPS Program is hereby renamed the John R. Lewis CDC Undergraduate Public Health Scholars Program.
Public Health Workforce. The Committee includes an increase of $50,000,000, consistent with the budget request, to help rebuild the public health workforce following its decades-long erosion. The COVID–19 pandemic exacerbated these workforce deficiencies, and revealed a public health system that did not have the people or resources to meet the demands of a pandemic emergency response. Strategic investments in a diverse, robust, well-trained public health workforce are critical to ensuring the nation is able to respond to the current pandemic and build a stronger, more resilient workforce to safeguard the public’s health. The Committee urges CDC to invest in fellowship and training programs to rebuild the public health workforce of epidemiologists, contact tracers, lab scientists, community health workers, data analysts, behavioral scientists, disease intervention specialists, public health nurses, informaticians, program managers, policy experts, and communicators who can help protect the nation’s communities.
Federal Direct Student Loan Program. The Committee recommendation includes $50,000,000 in additional discretionary funding for the Federal Direct Student Loan Program Account to provide student loan borrower forgiveness under the Temporary Expanded Public Service Loan Forgiveness [TEPSLF] program. The Committee established and first-funded TEPSLF in fiscal year 2018 to address eligibility gaps in the Public Service Loan Forgiveness [PSLF] program. The Committee applauds the Department for its recent announcement to address many of these eligibility issues through the PSLF program, and supports the Department’s efforts to continue to expand and simplify access to PSLF during the current negotiated rulemaking. The Committee recommendation continues funding for the TEPSLF program, and modifies existing language to simplify that program, including allowing previously appropriated funds for TEPSLF to be used under these same terms and conditions. The Committee looks forward to working with the Department on improvements to PSLF and to evaluate how those changes effect the continued role of TEPSLF to ensure borrowers do not face unnecessary challenges while pursuing loan forgiveness. The Committee further notes that all federally-held student loan borrowers who have met the required terms of public service but did not previously satisfy the 12-month payment amount requirement, should now qualify for TEPSLF because their payments have been $0 under the CARES Act forbearance for more than 12 months. Accordingly, the Committee expects the Department to approve borrowers who have previously been denied based on this payment amount requirement, and to ensure such requirement does not apply to TEPSLF applicants throughout the remainder of the forbearance period.

EXPLANATORY STATEMENT FOR THE DEPARTMENT OF DEFENSE APPROPRIATIONS BILL

Committee Summary

Bill Text

Complete Explanatory Statement

Chronic Pain Management Research. The Committee recommends $15,000,000 for a chronic pain management research program to research opioid-alternative or non-addictive methods to treat and manage chronic pain. Chronic pain is defined as a pain that occurs on at least half the days for 6 months or more and which can be caused by issues, including but not limited to: combat- and training-related physical or mental stress and trauma, migraines and chronic headaches, traumatic brain injury, arthritis, muscular-skeletal conditions, neurological disease, tick and vector-borne disease, other insect-transmitted or tropical disease, and cancer. The funds provided in the chronic pain management research program shall be used to conduct research on the effects of using prescription opioids to manage chronic pain and for researching alternatives, namely non-opioid or non-addictive methods to treat and manage chronic pain, with a focus on issues related to military populations. The Committee encourages the Department to collabo-rate with non-military research institutions, such as the institutions of the National Institutes of Health Pain Consortium and the institutions represented in the Interagency Pain Research Coordinating Committee, to address the efforts outlined in the 2016 National Pain Strategy.
Peer-Reviewed Medical Research Program. The Committee recommends $370,000,000 for the Peer-Reviewed Medical Research Program. The Committee directs the Secretary of Defense, in conjunction with the Service Surgeons General, to select medical research projects of clear scientific merit and direct relevance to military health. Research areas considered under this funding are restricted to: Alzheimer’s, arthritis, autism, burn pit exposure, cardiomyopathy, congenital heart disease, diabetes, Duchenne muscular dystrophy, dystonia, eating disorders, emerging viral diseases, endometriosis, epidermolysis bullosa, familial hypercholesterolemia, fibrous dysplasia, focal segmental glomerulosclerosis, food allergies, Fragile X, frontotemporal degeneration, Guillain-Barre syndrome, gulf war illness, hemorrhage control, hepatitis B, hydrocephalus, hypercholesterolemia, hypertension, inflammatory bowel diseases, interstitial cystitis, lupus, malaria, metals toxicology, mitochondrial disease, multiple sclerosis, myalgic encephalomyelitis/chronic fatigue syndrome, myeloma, myotonic dystrophy, nephrotic syndrome, neurofibromatosis, non-opioid therapy for pain management, nutrition optimization, Parkinson’s, pathogen-inactivated blood products, peripheral neuropathy, plant-based vaccines, platelet like cell production, polycystic kidney disease, pressure ulcers, pulmonary fibrosis, reconstructive transplantation, respiratory health, Rett syndrome, rheumatoid arthritis, sleep disorders and restriction, suicide prevention, sustained release drug delivery, tick-borne diseases, trauma, tuberous sclerosis complex, vision, vascular malformations, and women’s heart disease. The Committee emphasizes that the additional funding provided under the Peer-Reviewed Medical Research Program shall be devoted only to the purposes listed above.
Advanced Trauma and Public Health Direct Training Services for the National Guard. The Committee recognizes the valuable support universities and hospitals provide by offering civilian-based emergency response trauma and critical care training including public health, bio-environmental, and biomedical instruction to sustain capabilities of the National Guard Enhanced Response Forces Packages, National Guard Homeland Response Forces, National Guard Civil Support Teams, and other National Guard medical conversion/readiness requirements.
Peer-reviewed Amyotrophic Lateral Sclerosis. The committee is aware of research that reports that people who served in the military are twice as likely to develop and die from Amyotrophic Lateral Sclerosis [ALS] as those with no history of military service, and therefore, it is especially important that this research be continued into early phase clinical trials. The Committee encourages the Department of Defense to take a broad approach to the type of research projects it may support through the peer-reviewed approach to help advance potential treatments for people living with ALS. The committee recommends $40,000,000 for a peer-reviewed ALS research program.
Armed Forces Institute of Regenerative Medicine. The Committee is aware of the many emerging breakthrough treatments for severely wounded servicemembers that have resulted from the Army’s leadership in pioneering an institute-led consortium approach to productivity in the field of regenerative medicine. Therefore, based upon the most effective features of the historic successful models of the Armed Forces Institute of Regenerative Medicine [AFIRM] I and II, the Committee provides $10,000,000 to the Department of Defense to establish the AFIRM III. AFIRM is a multi-institutional, interdisciplinary network of universities, military laboratories and investigators that is designed to promote a seamless integration of development, from basic science research through translational and clinical research, as the best means of bringing regenerative medicine therapies to practice. The Committee encourages the Department to resume funding in its fiscal year 2023 budget request for AFIRM III, to sustain and build upon the success of the program.

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL

Committee Summary

Bill Text

Report Language

Clinical Workforce. The Committee appreciates the Department’s efforts to address challenges in recruiting and retaining physicians, physician assistants, nurses, mental health providers, other healthcare professionals, and related support staff. The Committee reminds the Department of the annual requirement for a report on workforce issues outlined in the Joint Explanatory Statement accompanying Public Law 116–260.
- Health Professions. 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.
- Medical School Affiliations with VA Health Care Facilities. The Committee is pleased VA improved its academic affiliation activities with minority medical schools. For the purposes of enhancing training initiatives, improving patient care, and providing educational opportunities for our Nation’s veterans, the Committee urges VHA and the Office of Academic Affiliations to maintain this ongoing commitment to minority health professions schools.
- Rural Health Providers. The Committee notes persistent issues for VA health facilities in rural areas in recruiting and retaining health providers in the face of national provider shortages and a highly competitive environment. The Committee encourages VA to continue to consider expanded use of physician assistants, through both physical facilities and expanded access to telehealth services, to address the rural health provider gap. VA is directed to submit a report, no later than 90 days after enactment of this act, to the Committees on Appropriations of both Houses of Congress, providing an update on VA hiring needs in rural areas and VA plans to address the provider gap in rural areas
Rural Healthcare. Veterans residing in rural and remote areas face unique barriers to receiving high-quality mental health, primary healthcare, and specialty care services. While enhanced community care programs offer veterans increased flexibility to obtain care close to home, there are often gaps in services in rural and remote communities even among private providers. The Office of Rural Health [ORH] and its Rural Health Initiative has played a critical role in assisting VA in its efforts to increase access to care. Therefore the Committee recommendation includes $327,455,000 for ORH and the Rural Health Initiative. This is $27,455,000 greater than fiscal year 2021 enacted and $20,000,000 above the budget request.
Supporting Rural Care Facilities. The Committee is aware of a growing shortage of healthcare and support professionals in rural and highly rural areas. To improve recruitment and retention initiatives for healthcare providers and support personnel in rural and highly rural areas the Committee urges the Department to prioritize the hiring of positions that the Office of Inspector General has designated as having critical occupational staffing shortages, including specialty care providers, human resource professionals, police officers and security personnel, housekeepers, and clinical support personnel. The Committee is also aware of additional challenges identified by the VA Office of Inspector General in offering telehealth consults for specialty care in rural and highly rural CBOCs and urges the Department to address ongoing deficiencies in access to telehealth equipment, training, and adequate bandwidth to operate the equipment at rural and highly rural CBOCs.
Veterans Care Agreements. The Committee is concerned that if the Department does not utilize its authority to enter into Veterans Care Agreements, as established by section 102 of the MISSION Act, veterans may lose access to long-term care services. Therefore, the Committee directs the Secretary to quickly finalize the template for Veterans Care Agreements and to utilize these agreements in conjunction with Community Care Network [CCN] contracts, particularly in areas where local contracts have not worked in the past. The Committee also urges the Department to coordinate with the Departments of Labor and Health and Human Services to streamline to the greatest extent possible Federal requirements as they pertain to veterans and skilled nursing facilities and remove any unnecessary or duplicative requirements.
MISSION Act Reporting. The Department is directed to continue to provide to the Committees on Appropriations of both Houses of Congress quarterly reports on the expenditures related to the MISSION Act for the prior fiscal year and the current fiscal year, and estimates for expenditures related to the MISSION Act for the next five fiscal years. These reports should include costs broken out by account, with categories for costs of MISSION Act affected community care, caregiver expansion, urgent care, and other efforts. These reports should also include: (1) the number of veterans served by each authority for care outlined in section 1703(d) of title 38, United States Code (the Department does not offer the care, the Department does not operate a full-service medical facility in the State in which the covered veteran resides, etc.); (2) the cost of such care broken out by the authorities in section 1703(d); and (3) the timeliness of care, on average.

In addition, the Department is directed to submit monthly reports to the Committees on Appropriations of both Houses of Congress identifying available resources, obligations, authorizations, and anticipated funding needs for the remainder of the fiscal year. This should include detail on the timing of authorization of care and the obligation of funds. The report should also provide data broken out by VISN on the number of referrals and completed appointments in-house and in the community, including timeliness.

Improved Oversight of the Community Care Networks’ Compliance with Access Standards. The Committee requests further information comparing access to VA in-house care and care provided in the private sector based on timeliness. While the Committee recognizes the contractual obligations of the network administrators are different than the requirements placed on the Department, the MISSION Act clearly states VA was to report on compliance with standards established as a result of the law. The Department is reminded of this requirement to report according to the timelines in the MISSION Act, and is further directed to include a breakdown of this data for primary and specialty care in these reports.

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