This analysis was prepared by Venable, LLP, on behalf of AACOM.
Summary: FY 2023 House Military Construction, Veteran Affairs, and Related Agencies Appropriations Bill
The House passed a package of six spending bills on July 19, 2022 by a vote of 220-207. The Military Construction-VA appropriations bill was included in the minibus of spending bills. Below is a summary and analysis of the various programs in Military Construction, Veterans Affairs, and Related Agencies (MilCon-VA) that may be relevant to the American Association of Colleges of Osteopathic Medicine (AACOM) and its member institutions.
Military Construction, Veterans Affairs, and Related Agencies
On June 23, 2022, the House Appropriations Committee approved the FY 2023 MilCon-VA funding bill on a 32 to 26 vote. The legislation funds agencies and programs in the Department of Veterans Affairs and for military construction. For 2023, the bill provides $314.1 billion overall, an increase of $29.5 billion—more than 10 percent—above 2022. Specifically, the bill provided $135 billion in discretionary spending for the VA, which is an increase of $22.8 billion over the FY 2022 enacted level.
Department of Veterans Affairs (VA)
Osteopathic Manipulative Treatment—The Committee is aware that doctors of osteopathic medicine receive intensive training in osteopathic manipulative treatment (OMT) and play an important role in the treatment of veterans, who experience higher prevalence of pain and more severe pain than nonveterans. To ensure veterans have access to effective non-addictive treatments for back and other pain, the Committee directs VA to provide a report, including outcomes data, to the Committees on Appropriations of both Houses of Congress within 120 days of enactment on the VA’s use of OMT in the treatment of back and other pain in veterans.
Whole Health Initiatives- The bill provides $85.9 million for the Whole Health Initiatives, which is an increase of $2.3 million above the FY 2022 enacted level. This will enable VA to build upon the success of this program that focuses on veterans’ overall health and well-being, which saw 573,940 veterans participating in 2021.
Medical School Affiliations- The Committee continues to be pleased with VA’s implementation of its collaborative agreements with academically affiliated minority medical schools. The Committee encourages VHA and the Office of Academic Affiliations to further align academic partnerships with training opportunities and patient needs of veterans in surrounding communities.
Staffing shortages- The Committee has long recognized the growing shortage of VHA physicians and medical professionals has negatively affected the delivery of care for veterans at VHA medical centers and clinics across the country. VHA facilities have been forced to provide care with fewer staff than are medically necessary to properly care for the nation’s veterans. The Committee looks forward to the annual comprehensive report required by the Joint Explanatory Statement accompanying the Consolidated Appropriations Act, 2022 (P.L. 117–103) on the Department’s plan to address critical workforce issues.
VA/HHS Collaboration on Health Workforces Shortages- The Committee continues to encourage VA to work with HHS to explore ways the agencies can work together, such as by creating a taskforce, to increase the availability of providers, including in the behavioral health workforce and among physicians specializing in cancer, spinal cord, and neuropsychiatric conditions. This collaboration is urged to examine VA’s recruitment challenges, review programs that could enhance recruitment and retention, and to think creatively on how other Federal agencies like HHS can identify and address provider shortages. VA is also encouraged to consult with DOD to explore recruiting those who have left the military.
Enhancing Recruitment- The Committee recognizes the challenge VA has in the recruitment and retention of clinicians. To help VA better keep pace with other providers and continue to train its workforce to improve their service to veterans, the Committee urges VA to explore potential options to enhance recruitment and retention, such as expanding reimbursement to clinicians for Continuing Professional Education.
Academic Collaborations at Community-Based Outpatient Clinics- The Committee encourages VA to expand academic collaborations with CBOCs. CBOCs provide valuable patient care and access to services that can be strengthened by collaboration with educational institutions. Through clinical traineeships and research fellowships, emerging health professionals can gain a better understanding of veterans’ specific healthcare needs, improve patient outcomes, advance specialized research, and increase the talented workforce pipeline. VA should look to include wholly public academic medical centers in CBOC collaborations.
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 healthcare providers electing to participate in VA’s Community Care Program, as authorized by the VA MISSION Act (P.L. 115–182). The Committee notes that a lack of Community Care Providers, specifically in regions with recent facility closures, has the potential to compromise veterans’ access to care. The Committee encourages the Secretary to continue working with its partners to recruit private healthcare providers in rural communities to participate in the Community Care Network System to serve veterans in their local communities. The Committee directs VA to submit a report on the progress of these efforts within 180 days of enactment of this Act. The report should include the number of community care providers brought into the system over the past year, the locations of the providers, and how much funding VA has allocated for provider recruitment efforts in fiscal year 2023 and fiscal year 2024. The report should also detail a three-year plan on how the VA will continue to recruit private healthcare providers in rural communities to participate in the Community Care Network System.
Veteran Awareness of Student Loan Forgiveness- The Committee understands that veterans may have student loans they acquired either prior to enlistment or outside of their GI Bill benefits. The Committee encourages VA to coordinate with other agencies, including the Departments of Education and Defense, and increase efforts to ensure that veterans are aware of all their student loan forgiveness options or repayment programs for which they may be eligible.
Third-Party Payments and Reimbursements- The Committee continues to be concerned about the timeliness of reimbursements by VA to private healthcare/third-party providers. The Committee believes VA must prioritize efficient and prompt payment to community providers to ensure timely access to quality care. Delays in processing of such payments undermine the ability to recruit and retain private healthcare providers to serve the nation’s veterans. The Committee continues to direct VA to provide comprehensive reports on a quarterly basis detailing the amount owed to outside providers for every state, outstanding payments over six months old and the corrective actions being implemented to address these outstanding balances, and average time for repayment.
Please contact AACOM Government Relations at aacomgr@aacom.org with questions or for further information.
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