This analysis was prepared by McDermottPlus on behalf of AACOM.

On March 11, Congress passed the $1.5 trillion omnibus spending bill (H.R. 2471) to fund the government through September 30, 2022. The legislation also includes $13.6 billion in supplemental funding to support Ukraine, as well as several health policy provisions. The funding package would boost non-defense spending by 6.7 percent and defense funds by 5.6 percent. It is also the first omnibus to include congressionally-directed spending, or earmarks, since they were banned in 2011.

A summary of key provisions relevant to the osteopathic medical education (OME) community can be found below.

Department of Health and Human Services

The Joint Explanatory statement for Division H - Labor-HHS-Education can be found HERE and HERE.

The 2022 Labor, Health and Human Services, Education, and Related Agencies funding bill provides $213.6 billion, an increase of $15.3 billion – 7.7 percent – above 2021. 

The bill provides a total of $108.3 billion for the Department of Health and Human Services, an increase of $11.3 billion above the FY 2021 enacted level. 

• National Institutes of Health (NIH) – The bill provides a total of $45 billion for NIH, an increase of $2.25 billion above the FY 2021 enacted level. The bill includes an increase of no less than 3.4 percent for each Institute and Center to support a wide range of biomedical and behavioral research, as well as targeted investments in several high-priority areas.
  • Increased investments in increasing diversity in the biomedical research workforce, including $5 million above the FY 2021 enacted level for Research Centers in Minority Institutions, an increase of $6 million for research workforce programs, and an increase of $10 million to strengthen the Office of the CIO for Scientific Workforce Diversity.

Osteopathic Medical Schools .-The agreement recognizes that increased access to research funding for the osteopathic profession will significantly bolster 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 agreement requests an update 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 Congressional Justification.

• Centers for Disease Control and Prevention (CDC) – The bill includes a total of $8.5 billion for CDC, an increase of $582 million above the FY 2021 enacted level. This includes $903 million in transfers from the Prevention and Public Health Fund.
  • The bill includes significant investments in our nation’s public health infrastructure including $61 million, an increase of $5 million above the FY 2021 enacted level, in public health workforce initiatives.
• Agency for Healthcare Research and Quality (AHRQ) - The bill includes $350 million for AHRQ, an increase of $12 million above the FY 2021 enacted level.
• Substance Abuse and Mental Health Services Administration (SAMHSA): $6.5 billion, an increase of $530 million, to address the mental health crisis.
• Health Resources and Services Administration (HRSA) – The bill includes $8.9 billion for HRSA, an increase of $1.4 billion above the FY 2021 enacted level. 
  • The amount includes $1.3 billion, an increase of $72 million above the FY 2021 enacted level, for HRSA’s Bureau of Health Workforce programs to support health workforce development, including:
    • $799 million for Title VII & VIII Health Professions Workforce Training and Scholarship Programs, an increase of $45 million above the FY 2021 enacted level.
      • $123 million for Behavioral Health Workforce Education and Training, an increase of $11 million above the FY 2021 enacted level.
      • $55 million for Medical Student Education, an increase of $5 million above the FY 2021 enacted level.
    • $121 million in National Health Service Corps discretionary funding, an increase of $1 million above the FY 2021 enacted level.
    • $5 million to establish the Pediatric Subspecialty Loan Repayment Program.
    • $24 million, an increase of $8 million above the FY 2021 enacted level, for the Substance Use Disorder Treatment and Recovery Loan Repayment Program.
    • $375 million, an increase of $25 million above the FY 2021 enacted level, for Children’s Hospitals Graduate Medical Education.

There are also a number of additional healthcare policy provisions included in the omnibus package, including:

• Improving Maternal Health. The bill includes grants for improving and implementing maternal health best practices including: funding to medical schools and other health professional schools to train health care providers to improve care for racial and ethnic minority populations pre- and post-partum;  a new five-year grant program to integrate services for pregnant and post-partum women; and a program to improve maternal vaccine awareness. Additionally, there are provisions relating to rural maternal health that include funding to improve maternal and infant health outcomes, funding for medical schools and other health professionals to operate training to support pregnancy and post-partum care.
• Extending Telehealth Flexibilities Post-Public Health Emergency (PHE). The bill extends telehealth flexibilities for 151 days beyond the end of the PHE—approximately five months. These flexibilities include:
  • Waiving geographic and originating site restrictions
  • Expanding of the list of eligible practitioners
  • Allowing audio-only telecommunications
  • Permitting telehealth as a face-to-face encounter prior to recertification of a patient’s eligibility for hospice care

Department of Education

The bill provides a total of $76.4 billion in discretionary appropriations for the Department of Education, an increase of $2.9 billion above the FY 2021 enacted level. Of this amount, the bill includes:

• Student Financial Assistance— The bill provides $24.6 billion for federal student aid programs, an increase of $35 million above the FY 2021 enacted level. Within this amount, the bill provides:
  • $6,895 for the maximum Pell Grant, an increase of $400 above the FY 2021 enacted level. This is the largest increase in the maximum award in more than a decade.
  • $1.21 billion for Federal Work Study, an increase of $20 million above the FY 2021 enacted level.
• Higher Education— The bill provides $3 billion for higher education programs, an increase of $452 million above the FY 2021 enacted level.

Department of Veterans Affairs

The Joint Explanatory Statement for Division J - Military Construction and Veterans Affairs can be found HERE. 

The 2022 Military Construction, Veterans Affairs, and Related Agencies Appropriations bill provides $284.6 billion, an increase of $32.7 billion – more than 13 percent – above FY 2021. Of this amount, discretionary funding for programs such as veterans’ health care and military construction totals $127.6 billion, an increase of $14.4 billion above FY 2021.

• Department of Veterans Affairs (VA) – The bill provides a total of $112.2 billion in discretionary appropriations for VA, an increase of $7.8 billion above the FY 2021 enacted level and $755 million below the President’s budget request. These resources will serve to expand access to services for veterans and will boost oversight and accountability across the department. Of this amount, the bill includes:
  • $97.5 billion for Veterans Medical Care, an increase of $7.5 billion above the FY 2021 enacted level and equal to the President’s budget request. This will provide care for 7.1 million patients expected to be treated by VA in FY 2022.
    • The bill includes $111.3 billion in advance fiscal year 2023 funding for veterans’ medical care – equal to the President’s budget request. This funding will provide for medical services, medical community care, medical support and compliance, and medical facilities, and ensure that our veterans have continued, full access to their medical care needs.
    • $882 million for VA Medical and Prosthetic Research, an increase of $67 million above the FY 2021 enacted level and equal to the President’s budget request. This funding will allow VA to fund approximately 2,563 total projects, support more than 1,700 researchers, and partner with more than 200 medical schools and other academic institutions.

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.
• Lack of Rural Health Providers.—The Committee is aware of a shortage of medical healthcare providers nationwide, which corresponds to persistent issues for VA health facilities in rural areas in recruiting and retaining health providers in this highly competitive environment. To address the rural health provider gap, the Committee encourages VA to continue to consider expanded use of physician assistants, through both physical facilities and expanded access to telehealth services. The Committee directs VA to submit a report to the Committees on Appropriations of both Houses of Congress, no later than 90 days after enactment of this Act providing an update on VA hiring needs in rural areas and VA plans to address the provider gap in rural areas. The Committee also directs VA to submit an updated report to the Committees on Appropriations of both Houses of Congress providing an analysis of the hardest-to-reach rural Veterans, the barriers to accessing these Veterans, and next steps to address the needs of these Veterans, no later than 120 days after enactment of this Act.
• Shortage of VA Community Care Providers in Rural Areas.—The Committee is aware that certain rural regions of the country are experiencing a shortage in private health care providers electing to participate in VA’s Community Care Program, as authorized by the VA MISSION Act (P.L. 115–182). The Committee encourages the Secretary to continue working with its partners to recruit private health care providers in rural communities to participate in the Community Care Network System to serve veterans in their local communities. The Committee requests a report within 60 days of enactment of this Act regarding the Department’s and its partners’ outreach strategies to private health care providers located in rural areas regarding this program.
• Women Providers.—The Committee is encouraged by the Department’s recognition of the need to hire additional women’s health personnel nationally. The desire for women Veterans to seek care from women providers extends beyond specialties traditionally dominated by women, such as gynecology and mental health. Therefore, the Committee encourages the Department to hire women providers in specialties within the Department with lower rates of such providers, in order to more accurately represent the growing number of women Veterans seeking services. In addition, the Committee is also strongly supportive of efforts by the Department to train and hire Women’s Health Primary Care Providers (WH–PCP). The Department is directed to report to the Committees on Appropriations of both Houses of Congress within 180 days of enactment of this Act on the total number of women providers providing care in the Department, the total number of women providers in each care specialty, and the number of women providers in each specialty as a percentage of total providers within that respective specialty. In addition, the Department is urged to note separately for each reporting requirement the number of women providers hired since September 30, 2020.
• Research Facilities and Academic Affiliates.—The close partnership between the VA and its academic affiliates has led to develop[1]ment of new health care specialties, modern models of delivery and has grown into the most comprehensive academic health system partnership in history. The Department’s academic affiliation network has also provided an effective pathway for VA to recruit highly qualified health care professionals into its health care system. While this partnership has led to a number of clinical innovations and better quality of care for Veterans, there are areas where the affiliation could be better leveraged, including through shared research space. VA is encouraged to consider greater utilization of available research space available at its academic affiliates to support its work, especially given growing capital needs at its own facilities. Leveraging these partnerships to include greater use of research space on a shared basis could prove to be useful, especially for principal investigators who are both VA clinicians and on faculty at the respective affiliate. Therefore, the Committee directs the Secretary to report back no later than 90 days after enactment of this Act, on locations where the Department has, can, or plans to employ arrangements that would allow for sharing agreements between local VA Medical Centers to utilize existing research space at an academic affiliate.

Department of Defense

The Joint Explanatory statement for Division C - Defense can be found HERE and HERE. 

For 2022, the bill provides $728.5 billion in discretionary spending, an increase of $32.5 billion above FY 2021.

Defense Health Programs 

• $37.35 billion for medical and health care programs of the Department of Defense. Within this total, adds $577.5 million for cancer research.
  • $150 million for the breast cancer research program;
  • $110 million for the prostate cancer research program;
  • $50 million for the kidney cancer research program;
  • $45 million for the ovarian cancer research program;
  • $20 million for the lung cancer research program;
  • $40 million for the melanoma research program;
  • $15 million for the pancreatic cancer research program;
  • $17.5 million for the rare cancer research program; and
  • $130 million for the cancer research program.
  • Adds $175 million for the peer-reviewed traumatic brain injury and psychological health research program.
  • Adds $40 million for spinal cord research.
  • Adds $40 million for the joint warfighter medical research program.
  • Adds $30 million for a new toxic exposures research line.
• Chronic Pain Management Research - 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.
• Peer-Reviewed Medical Research Program - The agreement provides $370,000,000 for a peer-reviewed medical research program. The Secretary of Defense, in conjunction with the Service Surgeons General, is directed to select medical research projects of clear scientific merit and direct relevance to military health. Research areas considered under this funding are restricted to: arthritis, cardiomyopathy, congenital heart disease, diabetes, dystonia, eating disorders, viral diseases, endometriosis, epidermolysis bullosa, familial hypercholesterolemia, fibrous dysplasia, focal segmental glomerulosclerosis, food allergies, Fragile X, frontotemporal degeneration, Guillain-Barre syndrome, hemorrhage control, hepatitis B, hydrocephalus, hypercholesterolemia, hypertension, inflammatory bowel diseases, interstitial cystitis, malaria, mitochondrial disease, myalgic encephalomyelitis/chronic fatigue syndrome, myotonic dystrophy, nephrotic syndrome, non-opioid therapy for pain.
• 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.

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

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