This analysis was prepared by McDermott+ Consulting, on behalf of AACOM.

OME Priorities in the FY23 Omnibus

On December 23, 2022, Congress passed the $1.7 trillion omnibus spending bill (Public Law 117-328) to fund the government through September 30, 2023. The legislation also includes $44.9 billion in emergency assistance to Ukraine and NATO allies and $40.6 billion to assist communities across the country recovering from drought, hurricanes, flooding, wildfire, natural disasters and other matters. It also contains numerous other provisions, including health policy changes. 

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.

The 2023 Labor, Health and Human Services, Education, and Related Agencies funding bill provides $226.8 billion, an increase of $15 billion, or 7.1 percent, above 2022. The bill provides a total of $120.7 billion for the Department of Health and Human Services (HHS), an increase of $9.9 billion above the FY 2022 enacted level. Highlights include:

• Advanced Research Projects Agency for Health (ARPA-H) – The bill provides $1.5 billion, an increase of $500 million above the FY 2022 enacted level, for ARPA-H to accelerate the pace of scientific breakthroughs for diseases such as amyotrophic lateral sclerosis (ALS), Alzheimer’s disease, diabetes, and cancer.
• National Institutes of Health (NIH) – The bill provides a total of $47.5 billion for NIH, an increase of $2.5 billion above the FY 2022 enacted level. The bill includes an increase of no less than 3.8 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 $8 million above the FY 2022 enacted level for the John Lewis National Institute on Minority Health and Health Disparities (NIMHD) Research Endowment Program, an increase of $4 million for Research Centers at Minority Institutions, and an increase of $45 million for other health disparities research.
• Centers for Disease Control and Prevention (CDC) – The bill includes a total of $9.2 billion for CDC, an increase of $760 million above the FY 2022 enacted level. This includes $903 million in transfers from the Prevention and Public Health Fund.
  • The bill includes significant investments including $350 million, an increase of $150 million above the FY 2022 enacted level, for public health infrastructure and capacity nationwide, as well as a $71 million, an increase of $10 million above the FY 2022 enacted level, in public health workforce initiatives.
  • The bill provides $5 million to establish an Office of Rural Health (ORH). The ORH will enhance the implementation of CDC's rural health portfolio, coordinate efforts across CDC programs, and develop a strategic plan for rural health at CDC that maps the way forward both administratively and programmatically. The agreement encourages ORH to accelerate innovation, make scientific and communication resources tailored to current rural public health needs, build and improve public health functions and service delivery and provide leadership in matters of public health infrastructure.
• Agency for Healthcare Research and Quality (AHRQ) – The bill includes $373.5 million for AHRQ, an increase of $23.1 million above the FY 2022 enacted level.
• Substance Abuse and Mental Health Services Administration (SAMHSA) – The bill includes $7.5 billion, an increase of $970 million above the FY 2022 enacted level.
• Health Resources and Services Administration (HRSA) – The bill includes $9.7 billion for HRSA, an increase of $852 million above the FY 2022 enacted level. Of this amount:
  • $509 million, an increase of $51 million above the FY 2022 enacted level, for Title VII Health Professions Education and Training, including:
    • $40 million, an increase of $16 million above the FY 2022 enacted level, for the Substance Use Treatment and Recovery Loan Repayment Program and an additional increase of $14 million for other Behavioral Health Workforce Education and Training programs.
  • $385 million, an increase of $10 million, for Children’s Hospitals Graduate Medical Education.
  • $13 million, an increase of $2 million, for Pediatric Mental Health Access.
  • $352 million, an increase of $21 million above the FY 2022 enacted level, for Rural Health Programs, including $145 million, an increase of $10 million, for the Rural Communities Opioid Response Program.

The Committee highlighted the need for additional resources and data around a variety of health policy issues, including:

• Osteopathic Medical Schools – The Committee recognizes that increased access to research funding for the osteopathic profession will bolster NIH’s capacity to support 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 Congressional Justification.
• Bias Recognition in Clinical Skills Testing – The Committee includes $1,000,000, the same as the fiscal year 2023 budget request, to support a National Academies of Sciences, Engineering, and Medicine (NASEM) study authorized under Subtitle D, Sec. 133 of the fiscal year 2022 Consolidated Appropriations Act (P.L. 117– 103) to make recommendations for incorporating bias recognition in clinical skills testing for accredited schools of allopathic medicine and osteopathic medicine.
• Addressing Workforce Shortages – The Committee supports HRSA’s efforts to develop the workforce needed to care for a rapidly aging U.S. population. The Committee encourages HRSA to address the skilled care workforce needs of seniors through existing workforce education and training programs.
• Rural Demonstration Program – 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 $10,000,000 within NHSC to conduct a pilot program to evaluate the benefit to patient access and practitioner recruitment and retention of extending loan repayment for 5 years and $200,000 for providers serving in a rural HPSA. The Committee directs HRSA to submit a report to the Committee within a year of enactment of this Act on program utilization and impact.
• Adolescent Addiction Medicine and Addiction Psychiatry Workforce – 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 strongly encourages HRSA to include an adequate number of funding awards to fellowship programs focused on increasing the number of board certified pediatric and adolescent addiction medicine and addiction psychiatry subspecialists.
• Mental and Substance Use Disorder Workforce Training Demonstration – The Committee includes $34,700,000 for this activity, $3,000,000 above the fiscal year 2022 enacted level and $700,000 above the fiscal year 2023 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.
• Rural Health Residency Program – The Committee includes $12,700,000 for the Rural Health Residency Program, an increase of $2,200,000 above the fiscal year 2022 enacted level and the same as the fiscal year 2023 budget request. This program funds physician residency training programs that support physician workforce expansion in rural areas. The Committee commends the Federal Office of Rural Health Policy for their 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 Programs.
• Graduate Medical Education – The Committee notes that Congress provided an additional 1,000 new graduate medical education (GME) slots eligible for Medicare payment, specifying four categories of hospitals eligible for additional GME slots: hospitals located in rural areas; hospitals currently training over their caps; hospitals located in States with new medical schools; and hospitals serving Health Professional Shortage Areas; however, when CMS released their final plan for the distribution of the 1,000 new slots, a ‘‘super prioritization’’ based on location of resident training was created that is not found in the statute. The Committee urges CMS to prioritize applications in fiscal year 2023 from any hospitals seeking to establish or expand residency training in certain needed specialties, such as primary care, geriatrics, and general surgery, as had been the priority with previous GME slot distribution programs.

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

• Addressing Mental Health and Substance Use Disorders. The bill includes three main sections addressing mental health and substance use disorder (SUD) reforms, including many of the provisions of H.R. 7666, a section addressing Medicare provisions, and a section addressing Medicaid and CHIP provisions.
  • Provisions from H.R. 7666, The Restoring Hope for Mental Health and Well-Being Act – The bill establishes or expands upon more than 30 programs that collectively support mental health care and SUD prevention, care, treatment, peer support and recovery support services. The bill includes workforce provisions to increase capacity and training as well as includes a provision to eliminate the requirement that practitioners apply for a separate waiver through the Drug Enforcement Administration (DEA) to prescribe buprenorphine for SUD treatment, as set forth in the Mainstreaming Addiction Treatment Act (H.R. 1384/S. 445).
  • Medicare Provisions – The bill establishes Medicare coverage of marriage and family therapists and mental health counselors beginning in 2024, and provides for the distribution of 200 additional Medicare-funded graduate medical education (GME) residency positions, specifically dedicating half of the total number of positions to psychiatry or psychiatry subspecialty residencies. With respect to physician wellness, the bill adds new exceptions to the Stark Law to allow for hospitals to provide evidence-based programs for physicians to improve their mental health and increase resiliency, and to prevent suicide among physicians.
  • Medicaid and CHIP Provisions – The bill requires HHS to issue guidance providing recommendations and best practices to states regarding the development of an effective crisis response continuum of care through Medicaid and CHIP, and to establish a technical assistance center to provide support for states in designing and implementing crisis response services.
• Extending Telehealth Flexibilities Post-Public Health Emergency (PHE) – The bill extends pandemic-related Medicare telehealth flexibilities for two years through December 31, 2024. These flexibilities include:
  • Waiving geographic and originating site restrictions
  • Expanding of the list of eligible practitioners
  • Eligibilities for federally qualified health centers and rural health clinics
  • Allowing audio-only telecommunications
  • Permitting telehealth as a face-to-face encounter prior to recertification of a patient’s eligibility for hospice care
  • Delaying the in-person visit requirement before a patient receives tele-mental health services

The bill also requires HHS to conduct a study on telehealth and Medicare program integrity, with an interim report to be submitted to Congress no later than October 1, 2024, and the final report due by April 1, 2026. Finally, the bill extends the safe harbor allowing individuals with health-savings-account eligible high-deductible health plans to receive pre-deductible coverage for certain telehealth services (a provision that was not tied to the PHE and was set to expire on December 31, 2022, without congressional action) for two years, through December 31, 2024. The provision allows for coverage for the entirety of the plan years that begin before January 1, 2025.

Department of Education

The Joint Explanatory Statement for Division H – Departments of Labor, Health and Human Services, and Education can be found HERE. 

The bill provides a total of $79.6 billion in discretionary appropriations for the Department of Education, an increase of $3.2 billion above the FY 2022 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 $34 million above the FY 2022 enacted level. Within this amount, the bill provides:
  • An increase to the maximum Pell Grant award by $500 or 7.2 percent to $7,395 for the 2023-24 school year. This is the largest increase in the maximum Pell grant award since the 2009-10 school year and further builds off the $400 increase provided last year.
  • $910 million for the Federal Supplemental Educational Opportunity Grant program, an increase of $15 million above the fiscal year 2022 enacted level.
  • $1.2 billion for Federal Work Study, an increase of $20 million above the fiscal year 2022 enacted level.
• Higher Education – The bill provides $3.5 billion for higher education programs, an increase of $532 million above the FY 2022 enacted level.

Department of Veterans Affairs

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

The 2023 Military Construction, Veterans Affairs, and Related Agencies Appropriations bill provides $322.7 billion, an increase of 13 percent, above FY 2022. Of this amount, discretionary funding of $128.1 billion was appropriated for Veterans Medical Care.

• Department of Veterans Affairs (VA) – Of the $128.1 billion, the legislation includes $118.7 billion for VA medical care in FY 2023, a $21.7 billion or 22.4 percent increase over FY 2022. This will go towards providing essential health services for more than 7.3 million veterans, including deferred care due to the COVID-19 pandemic. Funding includes:
  • Rural Health – $337 million, $10 million more than FY 2022, to support improved access to care, including expanded access to transportation and telehealth.
  • Women’s Health – $840.5 million, equal to FY 2022, for gender-specific healthcare services, as well as initiatives and improvements to healthcare facilities.
  • Mental Health – $13.9 billion, $744 billion more than in FY 2022. This includes $498 million for suicide prevention outreach.
  • Medical and Prosthetics Research – $916 million, $34 million more than FY 2022, to support ongoing and new research in areas such as toxic exposures, traumatic brain injury, and precision oncology.
  • Telehealth and Connected Care – $5.1 billion for telehealth and connected care, which includes home telehealth, home telehealth prosthetics, and clinic-based telehealth.

The Committees highlighted a variety of issues affecting care at Veterans Health Administration (VHA) centers and clinics, including:

• Pain Management Treatments – The Committees note alternative treatments for pain management have been shown to be effective in reducing pain and reliance on prescription opioids, and continue to encourage VA to expand the use of alternative treatments to pain management in its delivery of healthcare services, as well as integrate treatments such as acupuncture into VA medical centers and clinics through licensed professionals or on a contract basis. Additionally, given the potential of osteopathic manipulative treatment (OMT) to treat back and other pain, the Department is directed to track utilization of OMT among veterans seeking care and provide a report to the Committees within 120 days of enactment of this Act on the use of OMT. The Department is further urged to develop a mechanism to track outcomes of this treatment.
• VA-Academic Telehealth Partnerships – The Department is encouraged to support telehealth partnerships with academic institutions, including in communities in noncontiguous areas without university teaching hospitals, and including Maternal Fetal Medicine services.
• Telehealth Improvements – Telehealth services increase veteran access to care. The Committee directs VA to continue to expand telehealth availability to include additional mental health, primary care, and rehabilitation services as a means to deliver care in rural and underserved communities. The Committee particularly recognizes and appreciates the significant improvements made in Telehealth Service by VA in the past two years. These timely improvements were critical in meeting the healthcare needs of veterans during the COVID–19 pandemic. As the pandemic travel restrictions are relaxed, the Committee urges the Department to evaluate current telehealth services to improve and inform a normalized, sustainable Telehealth Service model and to focus on easing the burdens of rural veterans with limited travel options. Additionally, VA is encouraged to leverage newly gained telehealth capacity to address backlogs for disability exams and healthcare appointments when appropriate. The Committee further directs VA to continue to implement plans to improve veteran and provider satisfaction, increase awareness of the telehealth program, and enhance adoption of telehealth by veterans and providers. The Department’s plans should include efforts to make telehealth more accessible to patients in highly rural areas. The Committee requests a report on these efforts within 90 days of enactment of this Act.
• Improving the Quality of Life in Tinnitus Management by Veterans – The Department is encouraged 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.
• VA/HHS Collaboration on Health Workforce 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.
• 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.
• 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.
• 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.
• 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.

Department of Defense

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

For FY 2023, the bill provides $797.7 billion in discretionary spending, an increase of $69.3 billion above FY 2022, with $39.2 billion going toward medical and health care programs of the Department of Defense including: 

• Defense Health Programs:
• $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.
• $25 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.
• $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 $25 million for the joint warfighter medical research program.
• Adds $30 million for the toxic exposures research line.

Department of the Interior

The Joint Explanatory Statement for Division G - Interior can be found HERE.

The fiscal year 2023 Department of the Interior, Environment, and Related Agencies bill provides a total discretionary funding level of $40.45 billion, which is $2.45 billion more than FY 2022 levels. In an historic first, the bill provides an advance appropriation for the Indian Health Service which totals $5.129 billion for fiscal year 2024.

Hospitals and Health Clinics – The agreement provides $2,503,025,000 for Hospitals and Health Clinics, which includes an additional $10,000,000 for Tribal epidemiology centers, $2,000,000 for village built clinics, and an additional $1,000,000 to improve maternal health. This amount also includes requested reallocation of prior year staffing funds for the Phoenix Indian Medical Center, Cherokee Nation, and United Keetoowah Band. The agreement maintains funding at fiscal year 2022 enacted levels for the Alzheimer's program and Produce Prescription Pilot program. The agreement also continues funding at the fiscal year 2022 enacted levels for the domestic violence prevention program, accreditation emergencies as discussed in the House report, health information technology, healthy lifestyles in youth project, and the National Indian Health Board cooperative agreement.

Indian Health Professions – The agreement provides $80,568,000 for Indian health professions, which includes an additional $5,000,000 for the loan repayment program and a general program funding increase to be allocated for all programs, including among others, the lnMed program, the fourth site expansion, Quentin N. Burdick Indians into Nursing, and the American Indians into Psychology Programs.

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