the American Association of Colleges of Osteopathic Medicine

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

On July 28, 2022, the Senate Appropriations Committee (the Committee) released the text of all 12 appropriations bills. No markups are currently scheduled, or anticipated to be scheduled, in the Committee due to the limited number of legislative days remaining before the end of fiscal year (FY) 2022 on September 30.

Below is a summary and analysis of the various programs that may be relevant to the American Association of Colleges of Osteopathic Medicine (AACOM) and its member institutions in the following appropriations bills:

Labor, Health and Human Services, Education, and Related Agencies (LHHS);
Military Construction, Veterans Affairs, and Related Agencies (MilCon-VA); and
Department of Defense (DOD).

Labor, Health and Human Services, Education, and Related Agencies

The LHHS bill funds agencies and programs in the Departments of Health and Human Services, Education, and Labor. For FY2023, the bill includes $216.1 billion in base non-defense discretionary funding, or 10 percent, over the comparable FY2022 level.

Department of Health and Human Services

National Institutes of Health (NIH)—The Committee recommends nearly $48 billion, an increase of $2 billion above the FY2022 enacted level, for NIH. This $1.1 billion in in budget authority authorized in the 21st Century Cures Act. The total also includes $1,429,313,000 in transfers available under section 241 of the PHS Act. The LHHS bill also includes the following language regarding osteopathic medical schools:

Osteopathic Medical Schools—Osteopathic medicine is one of the fastest growing healthcare professions in the country and osteopathic medical schools educated 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 are located in rural and underserved areas. The Committee believes that increased access to research funding for the osteopathic researchers 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 Committee 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 2024 CJ.

Health Resources and Services Administration (HRSA)—The Committee recommends the following funding for HRSA programs:

$1.92 billion for Community Health Centers, an increase of $170 million above the FY2022 level. The Community Health Centers program includes funding for community health centers, migrant health centers, healthcare for the homeless, school-based, and public housing health service grants. The Committee continues to support the ongoing effort to increase the number of people who have access to medical services at health centers. Health centers play a vital role in ensuring access to primary care in underserved areas of the country, including urban, rural, and frontier areas.
$28.4 million for Centers of Excellence (COEs), an increase of $4 million above the FY2022 level. This program provides grants to health professions schools and other institutions to serve as resource and education centers for the recruitment, training, and retention of underrepresented minority students and faculty. The Committee notes that COEs educate a disproportionate share of health professionals from minority and underserved backgrounds and address the need for a diverse and culturally competent healthcare workforce.
$18.5 million for Health Careers Opportunity Program (HCOP), an increase of $3 million above the FY2022 level. HCOPs assist students from minority and economically disadvantaged backgrounds navigate careers into the health professions.
$2.31 million for Faculty Loan Repayment, an increase of $1.1 million above the FY2022 level. This program provides loan repayment to health profession graduates from disadvantaged backgrounds who serve as faculty at eligible health professions academic institutions.
$55 million for Scholarships for Disadvantaged Students, an increase of $2 million above the FY2022 level. This program provides grants to eligible health professions and nursing schools to award scholarships to students from disadvantaged backgrounds who have financial need.
$54.9 million for Primary Care Training and Enhancement, an increase of $6 million above the FY2022 level. This program supports the expansion of training in internal medicine, family medicine, and pediatrics. Funds may be used to develop training programs or provide direct financial assistance to students and residents.
$55 million for Medical Student Education, the same as the FY2022 enacted level. This program supports colleges of medicine at public universities located in the top quintile of States projected to have a primary care provider shortage in 2025.
$47 million for Area Health Education Centers (AHECS), an increase of $2 million above the FY2022 level. The program links university health science centers with community health service delivery systems to provide training sites for students, faculty, and practitioners. The program supports three types of projects: core grants to plan and implement programs; special initiative funding for schools that have previously received AHEC grants; and model programs to extend AHEC programs with 50 percent Federal funding.
$213 million for Behavioral Health Workforce Education and Training (BHWET), $90 million above the FY2022 enacted level. This program establishes and expands internships or field placement programs in behavioral health serving populations in rural and medically underserved areas.
$47.2 million for Geriatric Workforce Enhancement Program (GWEP), an increase of $2 million over the FY2022 enacted level. This program supports training to integrate geriatrics into primary care delivery and develops academic primary care community-based partnerships to address gaps in healthcare for older adults.
$44.1 million for Mental and Behavioral Health Programs, an increase of $5 million over the FY2022 enacted level.
$25 million for Graduate Psychology Education (GPE), an increase of $5 million above the FY2022 enacted level, to increase the number of health service psychologists trained to provide integrated services to high-need, underserved populations in rural and urban communities. The Committee recognizes the severe impact of COVID–19 on Americans’ mental and behavioral health and urges HRSA to strengthen investments in the training of health service psychologists to help meet these demands.
$18 million for Public Health and Preventive Medicine Training Programs, an increase of $1 million over the FY2022 enacted level. This program funds programs that are authorized in titles III and VII of the Public Health Service (PHS) Act and supports awards to schools of medicine, osteopathic medicine, public health, and integrative medicine programs.
$15 million for the Pediatric Subspecialty Loan Repayment Program, an increase of $10 million over the FY2022 enacted level. The Committee recognizes that significant shortages of pediatric medical subspecialists, pediatric surgical specialists, child and adolescent psychiatrists, and other pediatric mental health professionals is impeding access to care for children and adolescents in underserved areas.
$30 million for Preventing Burnout in the Health Workforce to fund activities authorized in the Dr. Lorna Breen Health Care Provider Protection Act to provide comprehensive and evidence-based support to prevent suicide, burnout, and mental and behavioral health conditions among healthcare providers.
$385 million for Children’s Hospital Graduate Medical Education (CHGME), an increase of $10 million above the FY2022 enacted level. 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.
$135.6 million for National Health Service Corps (NHSC), an increase of $14 million above the FY2022 enacted level. The Committee recognizes the success of the Corps program in building healthy communities in areas with limited access to care. The program has shown increases in retention of healthcare professionals located in underserved areas. The Committee recognizes the importance of the Corps in increasing the number of health providers in Health Provider Shortage Areas (HPSAs). The Committee also recognizes that while 70 percent of all HPSAs were rural or partially rural in 2019, only 36 percent of NHSC providers served in rural areas. The Committee encourages HRSA to increase the number of Corps providers in rural areas and prioritize applicants from rural areas who are more likely to stay beyond their required service commitment. The Committee is also concerned there are Medically Underserved Areas and HPSAs with a high percentage of active physicians who are age 60 or older and nearing retirement. HRSA should consider prioritizing funding for physician workforce development in these areas to avoid extreme shortages.

Advanced Research Projects Agency for Health (ARPA-H)—The Committee recommends $1 billion for ARPA-H, the same as the FY2022 enacted level.

Rural Health—The Committee recommends $392 million, an increase of $26 million above FY2022 enacted levels, for Rural Health programs. This includes the following programs:

Rural Health Flexibility Grants—$62.8 million is provided for Rural Hospital Flexibility grants and the Small Hospital Improvement Program. Under these grant programs, HRSA works with States to provide support and technical assistance to Critical Access Hospitals to focus on quality and performance improvement and to integrate emergency medical services.
Rural Residency Planning and Development—$12.5 million is provided, which includes $ million increase family medicine/ obstetrics training programs in States with high infant morbidity rates.

National Cancer Institute (NCI)—The Committee recommends $7.2 billion for NCI.

Agency for Healthcare Research and Quality (AHRQ)—The Committee provides $385.4 million AHRQ, a $35 million increase over the FY2022 enacted level. This funding is combined with the $111 million in mandatory funding from the Patient-Centered Outcomes Research Trust Fund. AHRQ’s mission is to enhance the quality, appropriateness, and effectiveness of health services, as well as access to such services. AHRQ conducts, supports, and disseminates scientific and policy-relevant research on topics, such as promoting high-quality care and patient safety, eliminating healthcare disparities, using information technology, and evaluating the effectiveness of clinical services.

Centers for Disease Control and Prevention (CDC)—The Committee recommends a program level of $10.5 billion for the CDC, which includes $55 million in mandatory funds under the terms of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), and $903 million in transfers from the Prevention and Public Health (PPH) Fund. The activities of CDC focus on several major priorities: providing core public health infrastructure and functions; detecting and responding to urgent health threats; monitoring the nation’s health using sound scientific methods; preventing the leading causes of illness, injury, and death; assuring the Nation’s preparedness for emerging infectious diseases and potential pandemics; and providing training, support and leadership for the public health workforce.

Department of Education (ED)

Student Financial Assistance—The Committee recommends an appropriation of $24.6 billion for federal student aid programs. This includes the following programs:

$22.5 billion for the Pell Grant Program, to fund a maximum discretionary grant of $6,335, an increase of $500. Combined with mandatory funding, this would provide a total maximum award of $7,395.

Department of Labor (DOL)

Workforce Innovation and Opportunity Act (WIOA)—The Committee recommends nearly $3 billion for Training an Employment Services Grants to States.

Strengthening Community College Training Grants (SCCTG)—The Committee recommends $50 million for SCCTG. This program builds the capacity of community colleges to address workforce development needs in in-demand industries and career pathways leading to quality jobs.

Military Construction, Veterans Affairs, and Related Agencies

The MilCon-VA bill funds agencies and programs in the Department of Veterans Affairs and for military construction. For 2023, the bill provides $317 billion overall, including $152 billion in discretionary spending, which is an increase of $24.5 billion above FY2022. Specifically, the bill provides $135 billion in discretionary spending for Veterans Affairs, which is an increase of $22.8 billion over the FY 2022 enacted level.

Department of Veterans Affairs (VA)

Study on Osteopathic Manipulative Treatment-—The Committee is aware that doctors of osteopathic medicine receive intensive training in osteopathic manipulative treatment (OMT) and could help ensure our veterans have access to effective non-addictive treatments for back and other pain. The Department is directed to track utilization of OMT among veterans seeking care and provide a report of the use of OMT, to the Committees on Appropriations of both Houses of Congress within 120 days of enactment of this act. The Department is further urged to develop a mechanism to track outcomes of this treatment.

Improving the Quality of Life in Tinnitus Management by Veterans-—The Committee encourages the Department to work with academic partners, as appropriate, to address and improve the outcomes for veterans experiencing problematic tinnitus, including research to identify contributing factors associated with tinnitus onset and progression to chronic tinnitus and develop novel interventional therapies and self-management tools. VA is encouraged to consider academic institution factors such as proximity to operational military bases, the presence of Nurse Practitioner/Doctor of Nursing Practice/Doctorate programs, and the presence of Osteopathic Medicine and Engineering programs.

Continued Support and Expansion for Whole Health-—The Committee is pleased by data in the Department’s budget request regarding the Whole Health program, demonstrating its consistent, ongoing ability to provide efficient and effective patient-centered, integrative care to veterans, especially those who are struggling with opioid use disorder and chronic pain. Given evidence of the program’s success, the Committee supports expanding the Whole Health model to all VA health facilities nationwide.

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.

VA Medical Center Staffing-—The Committee recognizes that pay rates for health and human resources professionals at VA continue to be uncompetitive with the private market and could limit access to care. In addition to utilizing new authorities provided by Congress, the Committee encourages the Department to explore ways to introduce new technologies to reduce staff workloads and improve patients’ access to timely care.

Program of Comprehensive Assistance for Family Caregivers (PCAFC) Program Legacy Caregivers Employment Assistance-—The Committee is also concerned about PCAFC changes with regard to legacy caregivers that will need to find employment once no longer eligible for the PCAFC stipend, despite not having been in the workforce for years. The Department is directed to provide a report to the Committees on Appropriations of both Houses of Congress no later than 60 days after enactment of this act detailing what steps have been or could be taken to assist legacy PCAFC caregivers with job-hunting skills and employment placement.

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) 44 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 $337.5 million for ORH and the Rural Health Initiative. This is $10 million more than the FY2022 enacted level and $30 million above the budget request.

Rural Health Continuity of Care-—The Committee encourages the Department to sustain continuity of care for rural veterans through provider agreements, based on previous models, such as the Access Received Closer to Home program, to ensure veterans do not experience a lapse in existing healthcare access during the transition to the Veterans Community Care Program and Community Care Networks. The Committee continues to support enabling the Department to enter into provider agreements, with non-VA long-term care providers, including skilled nursing facilities, as appropriate

Rural Access to Home and Community-Based Services-—Within 1 year of enactment, the Committee directs VA to report to the Committees on Appropriations of both Houses of Congress on the availability of and access to home- and community-based services (HCBS) for rural veterans. Non-institutional long-term services and supports are valuable in helping veterans age in place. The report should include an analysis of rural veterans’ access to HCBS, including programs or care provided directly by VA, as well as HCBS paid for by VA. The report should include any disparities in rural veterans’ access to each type of HCBS, as compared to their urban veteran counterparts. If available, the report should include considerations in access to care for rural veterans who live on Tribal lands, are women veterans, or are disabled veterans.

VA-Academic Telehealth Partnerships-—The Committee recognizes the potential of telehealth to build capacity for VA to provide healthcare services to the increasing number of female veterans, including services that VA has not typically provided. The Committee also recognizes that telehealth partnerships between VA and academic institutions with telehealth and clinical expertise may be beneficial to serve veterans, their families, and communities, particularly in geographically isolated regions with large numbers of veterans. The Committee encourages the Department to support and allocate appropriate funding toward such VA-academic telehealth partnerships, including in communities in non- 41 contiguous areas without university teaching hospitals, and including Maternal Fetal Medicine services.

Department of Defense

The DOD bill provides $791.1 billion for the Department of Defense. This is $63.6 billion above the FY 2022 enacted level, excluding emergency spending.

Department of Defense (DoD)

Peer-Reviewed Medical Research Program-—The Committee recommends $370 million 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; botulinum toxin type A; burn pit exposure; burn outcomes; celiac disease; Duchenne muscular dystrophy, dystonia; eating disorders; Ehlers-Danlos syndrome; eczema; neuroinflammatory responses to emerging viral diseases; endometriosis; epidermolysis bullosa; familial hypercholesterolemia; fibrous dysplasia/McCune-Albright syndrome; focal segmental glomerulosclerosis; food allergies; Fragile X; frontotemporal degeneration; Guillain-Barre syndrome; gulf war illness; hemorrhage control; hepatitis B; hereditary ataxia; hydrocephalus; hypercholesterolemia; inflammatory bowel diseases; interstitial cystitis; lupus; malaria; lymphatic disease; lymphedema; maternal mental health; mitochondrial disease; multiple sclerosis; musculoskeletal disorders related to acute and chronic bone conditions and injuries; myalgic encephalomyelitis/chronic fatigue syndrome; nephrotic syndrome; neuroactive steroids; neurofibromatosis; non-opioid therapy for pain management; orthopedics; pancreatitis; Parkinson’s; peripheral neuropathy; polycystic kidney disease; pressure ulcers; proteomics; pulmonary fibrosis; reconstructive transplantation; respiratory health; rheumatoid arthritis; scleroderma; sickle-cell disease; sleep disorders and restriction; spinal cord; suicide prevention; tickborne diseases; trauma; tuberculosis; tuberous sclerosis complex; vision; and vascular malformations. The Committee emphasizes that the additional funding provided under the Peer-Reviewed Medical Research Program shall be devoted only to the purposes listed above.

Holistic Health and Fitness-—The Army’s Holistic Health and Fitness program represents an investment in performance readiness designed to improve soldier training. The Committee encourages the Secretary of the Army to expand the Holistic Health and Fitness program’s current focus on musculoskeletal injuries and to broaden educational and research partnerships with Institutes of Higher Education in the areas of physical fitness, injury prevention, mental health, cognitive performance, and nutrition.

Chronic Pain Management Research-—The Committee recommends $15 million 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 collaborate 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.

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