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

On July 27, 2023, the Senate Appropriations Committee approved the FY24 Labor, Health and Human Services, Education and Related Agencies (LHHSE) appropriations bill, S. 2624, by a vote of 26-2. The bill next moves to the full Senate for consideration.

A summary of key provisions relevant to the osteopathic medical education (OME) community can be found below. Information was gathered from the Senate bill and the Senate Report 118-84. 

Importantly, the LHHSE report (page 129) again recognizes the importance of osteopathic research and representation at the National Institutes of Health (NIH) as follows. This language was sought by AACOM and builds on legislation from past appropriations cycles. AACOM has engaged in a comprehensive strategy to expand osteopathic research and representation at the NIH that began in 2020 and has resulted in language in LHSSE reports over the past three years, as well as a letter to NIH from 27 Members of Congress. 

• Osteopathic Medical Schools — The Committee recognizes that 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. Osteopathic research is needed to enhance primary care and improve healthcare for rural and underserved populations. Over the past 5 years, osteopathic medical school applications have seen similar success rates as seen in NIH overall. The Committee 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 Committee urges NIH to consider how best to incorporate colleges of osteopathic medicine into research activities and involvement of their researchers on NIH National Advisory Councils and study sections to have better representation of the osteopathic medicine field.

Department of Health and Human Services

S. 2624 provides $224.4 billion in total funding.

The bill provides $117.0 billion in discretionary funding for the Department of Health and Human Services.

• Health Resources and Services Administration (HRSA) - The Committee provides $9.1 billion for HRSA.
  • Bureau of Primary Health Care
    • Community Health Centers - The Committee provides $1.85 billion for the Bureau of Primary Health Care. Programs supported by this funding include 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.
    • Ending the HIV Epidemic - The Committee provides $157 million within the health centers program for the Ending the HIV Epidemic initiative.
  • Bureau of Health Workforce
    • National Health Service Corps (NHSC) - The Committee provides $128.6 million for the National Health Service Corps, an increase of $3 million above the fiscal year 2023 enacted level.
    • Maternity Care Target Areas (MCTAs) - Within the total for the NHSC, the Committee includes $8 million, an increase of $3 million above fiscal year 2023, to support loan repayment and scholarships for maternity care health services in health professional shortage areas.
    • Rural Health Equity — The Committee recognizes the importance of the NHSC Scholarship Program, especially in combatting the rural healthcare provider shortage, and recommends that HRSA increase the number of scholarships provided. Providing NHSC scholarships, particularly to students from rural communities, will increase equitable access to medical school and help to solve the rural provider workforce shortages throughout the United States.
    • Public Health Workforce Development- The Committee provides $18 million 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 supports awards to schools of medicine, osteopathic medicine, public health and integrative medicine programs.
    • Children’s Hospitals Graduate Medical Education (CHGME) - The Committee provides $385 million for the Children’s Hospitals Graduate Medical Education program.
    • Faculty Loan Repayment – The Committee provides $2.3 million 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.
    • Pediatric Subspecialty Loan Repayment Program -  The Committee includes $10 million for section 775 of the PHS Act.
    • Primary Care Training and Enhancement (PCTE) - The Committee provides $49.9 million for the Primary Care Training and Enhancement program to support the expansion of training in internal medicine, family medicine and pediatrics. 
      • Administrative Academic Units — Funding of academic administrative units, such as medical school departments and divisions, under the PCTE program has been a critical part of the program both in its role in medical student selection of primary care training programs and in facilitating scholarly activity in departments of family medicine. The Committee directs HRSA to maintain this funding and to continue funding opportunities to support administrative academic units within medical schools.
    • Medical Student Education - The Committee recommends $36 million 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. The Committee notes that this program has significant unspent balances from previous fiscal year appropriations that will continue to be available to public universities that meet the program criteria.
    • Area Health Education Centers(AHECs) - The Committee provides $47 million for Area Health Education Centers.
    • Behavioral Health Workforce Education and Training Program (BHWET) - The Committee provides $172 million for Behavioral Health Workforce Education and Training program, $19 million above the fiscal year 2023 enacted level.
      • Addiction Medicine Fellowship Program (AMF) — Within the total for BHWET, The Committee includes $30 million for AMF to foster robust community-based clinical training of addiction medicine or addiction psychiatry physicians in underserved, community based settings who see patients at various access points of care and provide addiction prevention, treatment and recovery services across healthcare sectors. 
      • Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program — The Committee also includes $52 million for this program within the total for BHWET. 
    • Geriatric Workforce Enhancement Program - The Committee provides $48.2 million for the Geriatric Workforce Enhancement Program.
    • Health Professions Workforce Information and Analysis - The Committee provides $5.6 million for health professions workforce information and analysis.
    • U.S. Healthcare Workforce Analysis - The Committee directs HRSA to submit a report to the Committees of jurisdiction, not later than 12 months from the date of enactment of this act, providing data on: how the training and supply pipeline is matched against health workforce projections; whether any capability gaps exist; how regional conditions impact local and regional supply; what information is needed to implement the use of such data going forward; and if there are existing resources available to access that data more expediently.
    • Mental and Behavioral Health Programs - The Committee includes $44 million for Mental and Behavioral Health programs.
    • Graduate Psychology Education (GPE) — Within the total for Mental and Behavioral Health programs, the Committee includes $25 million for the inter-professional GPE program.
    • Training for Diversity - The Committee supports programs that improve the diversity of the healthcare workforce. HRSA’s diversity pipeline programs help advance patient care and ensure opportunity for all healthcare providers.
  • Rural Health
    • The Committee recommendation for Rural Health programs is $364.4 million, an increase of $12 million above the fiscal year 2023 enacted level. 
    • Rural Communities Opioid Response Program (RCORP) - The Committee provides $155 million for RCORP, an increase of $10 million to expand the program. Within the total provided for the Rural Communities Opioid Response program, the Committee includes $4 million to support career and workforce training services and other needs related to substance use challenges within the Northern Border Regional Commission’s rural regions to assist individuals affected by a substance use disorder.
    • Rural Maternity and Obstetrics Management Strategies (RMOMS) — The Committee provides no less than $8 million for RMOMS to support grants to improve access to and continuity of maternal and obstetrics care in rural communities by increasing the delivery of and access to preconception, pregnancy, labor and delivery and postpartum services, as well as developing sustainable financing models for the provision of maternal and obstetrics care.
    • Rural Residency Planning and Development - The Committee provides $12.5 million for the Rural Residency Planning and Development program. The Committee provides $2 million to support family medicine/obstetrics training programs in States with high infant morbidity rates. The funding will reduce infant mortality and maternal morbidity by improving availability and accessibility of prenatal care through increasing family medicine/obstetrics training programs and graduates, increasing Family Medicine and OB/GYN faculty to train physicians, and by providing equipment, such as ultrasound, electronic fetal monitors and telemedicine equipment with the training and support for this equipment to rural areas.
  • HRSA-Wide Activities and Program Support
    • Telehealth - The Committee provides $38 million for the Office for the Advancement of Telehealth (OAT), which promotes the effective use of technologies to improve access to health services for people who are isolated from healthcare and to provide distance education for health professionals. The Committee strongly supports OAT and their mission to expand high quality medical care to rural communities that do not have adequate access to medical providers including many medical specialties.
  • Maternal and Child Health
    • The bill provides $1.1 billion for maternal and child health programs.
    • Maternal and Child Health (MCH) Block Grant - The Committee provides $603.5 million for the MCH Block Grant, which provides a flexible source of funding that allows States to target their most urgent maternal and child health needs.
    • Pediatric Mental Health Care Access - The Committee provides $13 million for expanding access to behavioral health services in pediatric primary care by supporting the development of pediatric mental healthcare telehealth access programs.
    • Maternal Mental Health Hotline - The Committee provides $7 million to expand support for a maternal mental health hotline.
  • HIV/AIDS Bureau
    • The Committee recommendation includes $2.5 billion for the HIV/AIDS Bureau. The mission of the Bureau is to address the unmet care and treatment needs of persons living with HIV/AIDS.
    • Ending the HIV Epidemic (EHE) - The Committee provides $165 million for the EHE initiative.
  • Health Care Systems
    • The Committee recommendation for the Health Care Systems Bureau is $101 million.
• Agency for Healthcare Research and Quality (AHRQ) - The Committee provides $370.5 million for the Agency for Healthcare Research and Quality (AHRQ). This funding is combined with the $116 million in mandatory funding from the Patient-Centered Outcomes Research Trust Fund.
  • Health Costs, Quality and Outcomes
    • Center for Primary Care Research — The Committee includes no less than $2 million for the Center for Primary Care Research authorized at 42 U.S.C. 299b–4(b). The center supports clinical primary care research as well as strategies to improve primary care delivery and advancing the development of primary care researchers. The Committee supports efforts to coordinate research in areas such as multiple chronic conditions, symptom syndromes such as Long COVID, behavioral and social health integration, telehealth in primary care, shared decision-making and patient experience of care. The areas of focus should include, but not be limited to, expanding research on persons with multiple co-morbid conditions and improving primary care in rural and underserved areas.
    • Improving Maternal Health — The Committee supports AHRQ efforts to address the complex challenges of ensuring safe and healthy pregnancies and childbirth, particularly for underserved women who are at substantially higher risk of complication and death.
    • Opioid Research — The Committee continues to support the research AHRQ has undertaken to better equip practitioners with evidence-based interventions to treat opioid and multi-substance misuse. The Committee expects AHRQ to continue its opioid-related research to include equitable access to treatment, management of substance use disorders with other co-occurring chronic conditions and how changes in service delivery could improve outcomes.
    • Telehealth — The Committee notes that telehealth now represents a significant share of healthcare delivery. The Committee encourages AHRQ to issue guidance on effective strategies to engage individuals with disabilities and individuals with limited English proficiency, and to assess and publish the effectiveness of beneficiary telehealth readiness tools commonly used across the health system, such as digital navigators and provision of technology.
• Centers for Disease Control and Prevention (CDC) - The Committee recommendation provides a program level of $9.19 billion for the Centers for Disease Control and Prevention (CDC), which includes $55.35 million in mandatory funds under the terms of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), and $1.18 million in transfers from the Prevention and Public Health (PPH) Fund.
  • Public Health and Scientific Services
    • Public Health Workforce — The Committee includes $71 million and urges CDC to invest in fellowship and training programs to rebuild the public health workforce that includes, but is not limited to, epidemiologists, contact tracers, lab scientists, community health workers, data scientists, behavioral scientists, disease intervention and prevention specialists, occupational health specialists, public health physicians, veterinarians, nurses, informaticians, program managers, economists, policy and evaluation experts and communicators who can help protect the Nation’s communities.
    • Community Health Workers and Community Health — The Committee recognizes the importance of the community health workforce in reaching underserved communities, preventing illness and reducing related healthcare costs. The Committee urges CDC to encourage the use of community health workers in communities, including Tribal communities, to support the delivery of person-centered care.
  • CDC-Wide Activities
    • Office of Rural Health (ORH) — The Committee is encouraged by efforts from the agency to establish the ORH. The Committee directs the agency to ensure that the established ORH will guide the CDC’s rural health leadership across the entire agency. This includes developing purposeful public health guidance for rural health departments, analyzing and developing initiatives to expand the rural public health workforce, coordinating with the Federal Office of Rural Health Policy under HRSA and otherwise serving as a resource and technical assistance hub for public health in rural communities. The Committee includes $5 million for the continued efforts to establish the ORH.
• National Institutes of Health (NIH) - The Committee provides $49.2 billion, an increase of $943 million for the National Institutes of Health (NIH). 
  • Women’s Health Clinical Research Network — The Committee directs NIH to expand and more formally coordinate its support for women’s health clinical research by leveraging the Clinical and Translational Science Awards (CTSA) program. The Committee urges National Center for Advancing Translational Sciences (NCATS) and CTSA awardees to focus on women’s health within its efforts to modernize the translation of research into health benefits across the full spectrum of medical research. The Committee directs NCATS to collaborate with ORWH to evaluate how to better promote research and collaborations that address the distinctive medical and health needs of women and advance the dissemination and implementation of research results. The Committee requests an update on these activities with 120 days of enactment.
  • National Cancer Institute
    • Clinical Research Workforce Training — The Committee is concerned that a shortage of staff who are qualified to support and administer cancer clinical trials has reached a crisis point and is slowing our Nation’s progress in developing new treatments. In some cases, trials have been delayed or even abandoned because the sponsor or cancer center conducting the trial could not hire enough staff to run them. The shortage is especially acute in trials involving cellular therapies, such as CAR–T, which are customized for each individual patient. Specialized skills are required to run trials that involve extracting a patient’s cells, re-engineering them in the lab and infusing them back into the patient. Therefore, the Committee urges the NCI to address the shortage of clinical research staff by working with the academic community to support the training of highly specialized clinical research staff, including in the area of cellular therapy.
  • National Institute of General Medical Sciences
    • 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 title III of the Higher Education Act. Such efforts should support dual degree programs that train students in medicine and biomedical research.
  • National Institute on Drug Abuse
    • Raising Awareness and Engaging the Medical Community in Drug Use and Addiction Prevention and Treatment — Education is a critical component of any effort to curb drug use and addiction, and it must target every segment of society, including healthcare providers (doctors, nurses, dentists, and pharmacists), patients and families. Medical professionals must be in the forefront of efforts to curb the opioid crisis. The Committee continues to be pleased with the NIDAMED initiative, targeting physicians-in training, including medical students and resident physicians in primary care specialties (e.g., internal medicine, family practice, emergency medicine, and pediatrics). The Committee encourages NIDA to continue to provide clinical resources to providers to help identify and treat patients with substance use disorder.
  • National Center for Advancing Translational Sciences (NCATS)
    • Clinical and Translational Science Awards (CTSA) Program — The Committee provides $629.5 million for the CTSA program. The CTSA program has helped modernize the Nation’s approach to effective and efficient medical research and will continue to be fully supported to facilitate further scientific progress through this critical infrastructure. Finally, the CTSA program is encouraged to catalyze emerging opportunities in AI, big data and other areas, while maintaining the commitment to critical activities, such as training the next generation of cutting-edge physician scientists.
• Substance Abuse and Mental Health Services Administration (SAMHSA) - The Committee recommends $7.5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA).
  • Mental Health
    • Minority Fellowship Program — The Committee includes $11million to support grants that will increase the number of culturally competent behavioral health professionals who teach, administer, conduct services research and provide direct mental illness services for underserved minority populations. The Committee encourages SAMHSA to prioritize and increase the number of pediatric behavioral health treatment providers, including child and adolescent psychiatrists, selected to participate in the minority fellowship program and requests a report within 1 year showing the number and type of primary care, physician specialists and subspecialists and other mental health professionals participating in the program and describing how the program is working to support youth mental health across communities.
    • Primary and Behavioral Health Care Integration Grants and Technical Assistance — The Committee notes that Congress recently enacted changes to the Primary and Behavioral Health Care Integration Grant program, with the goal of improving patient access to bidirectional integrated care services. The Committee provides $55.8 million for the program, and $1.9 million for technical assistance and directs SAMHSA to fund the psychiatric collaborative care model implemented by primary care physician practices as authorized under section 1301(i)(2) of division FF of Public Law 117– 328.
    • Infant and Early Childhood Mental Health — The Committee provides $15 million for grants to entities such as State agencies, Tribal communities, universities or medical centers that are in different stages of developing infant and early childhood mental health services.
• Centers for Medicare and Medicaid Services (CMS) – The Committee provides $1.13 billion for the Centers for Medicare and Medicaid Services (CMS).
  • Program Management
    • Tribal Health Care Reimbursements — The IHS rate does not reimburse Tribal healthcare providers for the cost of chemotherapeutics provided by a physician in the office setting. This makes the provision of cancer treatment on Indian reservations unsustainable for Medicare patients and damages the ability of American Indians to access local cancer treatment. The Committee urges CMS to clarify reimbursement procedures and amounts for Part B oncology drugs dispensed at IHS facilities to ensure parity among IHS and non-IHS facilities.
• Advanced Research Projects Agency for Health (ARPA-H) - The Committee includes $1.5 billion for the Advanced Research Projects Agency for Health (ARPA–H), the same level as fiscal year 2023.
• Administration for Strategic Preparedness and Response (ASPR) - The Committee recommends $3.67 billion for the Administration for Strategic Preparedness and Response (ASPR).
  • Research, Development and Procurement
    • Made in America Strategic National Stockpile — The Committee is concerned about the Nation’s limited infrastructure to produce essential products such as medical devices, medical equipment, pharmaceuticals and Personal Protective Equipment (PPE). The Committee strongly urges ASPR to develop a long-term sustainable procurement plan that gives preference to and results in purchases directly from domestic manufacturers to the maximum extent practicable.
  • Operations, Preparedness and Emergency Response
    • Medical Reserve Corps (MRC) - The Committee recommendation includes $6.2 million for the Medical Reserve Corps program, which is a national network of local volunteer doctors, dentists, nurses, pharmacists and other community members. The Committee appreciates that funding for MRCs has historically been provided to local units quickly and effectively, thereby allowing for grants to help build and sustain local communities’ ability to prepare for and respond to emergencies. The Committee encourages ASPR to continue this locally driven approach and to allocate this funding and any remaining funding from the American Rescue Plan Act via established mechanisms that provide funds directly to local MRC units, which are made up of representatives from their communities.
• Office of the Secretary
  • Public Health and Social Services Emergency Fund (PHSSEF)
    • The Committee recommends $115.9 million for the Public Health and Social Services Emergency Fund (PHSSEF). This appropriation supports the activities to prepare for, respond to and recover from the consequences of a wide range of natural and man-made medical and public health security threats and includes the HHS Office of the Chief Information Officer Cybersecurity Program, the Office of National Security (ONS), the Office of Global Affairs (OGA), pandemic programs and other HHS-wide preparedness activities.

Department of Education

The bill provides $79.6 billion in discretionary funding for the Department of Education.