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

On October 25, 2023, FY24 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) was referred to the House Committee on Appropriations. 

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

Importantly, the LHHSE report (page 102) 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 — Osteopathic medical schools educate 25 percent of all medical students and more research involving doctors of osteopathic medicine is needed to enhance primary care and improve healthcare for rural and underserved populations. The Committee urges NIH, in conjunction with national stakeholders, to consider how to best 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.

The Labor, Health and Human Services, Education, and Related Agencies bill provides $147,096,000,000 in discretionary funding for programs under the jurisdiction of the Subcommittee, which is $60.3 billion (29%) below the FY23 enacted level and $73 billion below the President’s Budget Request. The Committee recommends $195,999,840 in overall programmatic funding, including offsets and adjustments. The fiscal year 2024 recommendation is a decrease of $60,271,000,000 below the fiscal year 2023 enacted level.

Department of Health and Human Services

The bill provides a discretionary total of $103.3 billion to the Department of Health and Human Services (HHS), which is $14 billion (12%) below the FY23 enacted level and $25.9 billion below the President’s Budget Request.

• Substance Abuse and Mental Health Services Administration (SAMHSA) – The bill funds SAMHSA at $7.3 billion, a cut of $234 million below the enacted level. The Committee recommendation for the Substance Abuse and Mental Health Services Administration (SAMHSA) program level includes $6,975,882,000 in discretionary budget authority, $133,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in transfers from the Prevention and Public Health Fund.
  • Mental Health
    • Mental Health Services Block Grant - The Committee provides $1,007,571,000 for the Mental Health Services Block Grant (MHBG) which is the same as the fiscal year 2023 enacted program level.
    • Children’s Mental Health Services - The Committee provides $130,000,000 for Children’s Mental Health Services, which is the same as the fiscal year 2023 enacted program level, to fund grants and technical assistance for community-based services for children and adolescents with serious emotional, behavioral, or mental disorders, and assists States and local jurisdictions in developing integrated systems of community care.
    • Mental Health Awareness Training — The Committee provides $27,963,000, which is the same as the fiscal year 2023 enacted program level, for Mental Health Awareness Training program, to train individuals to recognize the signs and symptoms of mental disorders and provide education on resources available in the community for individuals with mental illness.
    • Primary and Behavioral Health Care Integration — The Committee provides $55,877,000, which is the same as the fiscal year 2023 enacted program level, for the Primary and Behavioral Health Care Integration program to promote full integration and collaboration in clinical practice between behavioral healthcare and primary/physical healthcare.
    • Suicide and Crisis Lifeline (988) Program — The Committee provides $501,618,000, which is the same as the fiscal year 2023 enacted program level, to support the national suicide hotline to continue to support State and local suicide prevention call centers as well as a national network of backup call centers and the national coordination of such centers.
    • Minority Fellowship Program — The Committee supports the Minority Fellowship Program and requests a report within 180 days of enactment of this Act outlining the number and type of health care providers, disaggregated by occupation, participating in the program.
• Administration for Strategic Preparedness and Response (ASPR) – Research Development and Procurement – The Committee recommends $3,620,597,000.
  • Biomedical Advanced Research and Development Authority (BARDA) - The Committee includes $1,100,000,000 for the Biomedical Advanced Research and Development Authority, which is $150,000,000 above the fiscal year 2023 enacted level and $84,868,000 above the fiscal year 2024 budget request.
  • Strategic National Stockpile - The Committee provides $1,000,000,000 for the Strategic National Stockpile, which is $35,000,000 above the fiscal year 2023 enacted level and $5,000,000 above the fiscal year 2024 budget request.
  • Operations and Emergency Response
    • Medical Reserve Corps - The Committee provides $6,240,000 for the Medical Reserve Corps, which is the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
• National Institutes of Health – The bill includes a total of $44.6 billion for NIH, a cut of $2.8 billion below enacted level, excluding funding for the Advanced Research Projects Agency for Health (ARPA–H), including:
  • Office of the Director
    • Osteopathic Medical Schools — Osteopathic medical schools educate 25 percent of all medical students and more research involving doctors of osteopathic medicine is needed to enhance primary care and improve healthcare for rural and underserved populations. The Committee urges NIH, in conjunction with national stakeholders, to consider how to best 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.
    • Clinical Research Workforce — The Committee supports efforts to increase participation of diverse populations in clinical trials and recognizes the importance of a research workforce that reflects the participants. The Committee encourages NIH to support efforts to diversify the clinical research workforce, as doing so may support an increase in the diversity of patients participating in clinical trials and a better understanding of health disparities among these groups.
    • Sexual and Gender Minority Research Office — The Committee does not include funding for this activity.
    • Youth Evidence Review — NIH shall conduct a comprehensive evidence review of all published research regarding the social and medical gender transition of minors.
  • $7.1 billion for the National Cancer Institute (NCI), a cut of $216 million below the enacted level
    • Pediatric Research - The Committee includes $1,500,000 for the National Academies of Science, Engineering, and Medicine to assess the current NIH pediatric research portfolio and structure, including how projects are categorized as pediatrics, how pediatric components have been included or excluded from larger NIH initiatives, structural or process impediments to pediatric applicants, how pediatric research priorities are established, and how pediatric research activity is coordinated across the institutes and centers.
  • National Institute of General Medical Sciences (NIGMS) - The Committee recommendation includes $1,827,197,000 in discretionary appropriations and $1,327,482,000 in PHS Act section 241 evaluation set-aside transfers.
    • Institutional Development Awards (IDeA) — The Committee provides $435,956,000 for IDeA, $10,000,000 above the fiscal year 2023 enacted level.
  • National Institute on Minority Health and Health Disparities (NIMHD) – The Committee recommends $524,395,000.
    • Research Endowment Program — The Committee notes the recent passage of the John Lewis NIMHD Research Endowment Revitalization Act (PL 117–104), which aimed to reinvigorate the NIMHD Research Endowment Program. The Committee includes $12,000,000 for the Research Endowment Program, the same as the fiscal year 2023 enacted level.
  • $2.7 billion for the National Institute of Neurological Disorders and Stroke (NINDS), a cut of $139 million below the enacted level
  • $2.2 billion for the National Institute of Mental Health (NIMH), a cut of $139 million below the enacted level
  • $5.1 billion for the National Institute of Allergy and Infectious Diseases (NIAID), a cut of $1.5 billion below the enacted level
• Advanced Research Projects Agency for Health (ARPA-H) – The bill includes $500 million for ARPA-H, a cut of $1 billion below the enacted level.
• Centers for Disease Control and Prevention (CDC) – The bill includes a total of $7.6 billion for CDC, a cut of 1.6 billion below the enacted level. The Committee recommendation for CDC program level includes $6,350,008,000 in discretionary budget authority, $55,358,000 in mandatory funds under the terms of the Energy Employees Occupational Illness Compensation Program Act, and $1,186,200,000 in transfers from the Prevention and Public Health (PPH) Fund.
  • The bill eliminates funding for Firearm Injury and Mortality Prevention Research, a cut of $12.5 million below the enacted level.
  • The bill eliminates funding for Tobacco Prevention and Control, a cut of $247 million below the enacted level.
  • The bill eliminates funding for the Ending the HIV Epidemic initiative, a cut of $220 million below the enacted level.
  • The bill includes $100 million for Public Health Infrastructure and Capacity, a cut of $250 million below the enacted level.
  • The bill includes $75 million for Public Health Data Modernization, a cut of $100 million below the enacted level.
  • The bill includes $371 million for Global Health, a cut of $322 million below the enacted level.
  • The bill eliminates funding for the Climate and Health program, a cut of $10 million below the enacted level.
  • The bill eliminates funding for the Center for Forecasting and Analytics, a cut of $50 million below the enacted level.
  • Chronic Disease Prevention and Health Promotion – Provides $797,569,000 for carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health promotion.
  • Disabilities and Health - Provides $205,560,000 for carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health.
  • Public Health Scientific Services
    • The Committee recommends $654,497,000. This account supports programs that provide leadership and training for the public health workforce, support infrastructure to modernize public health surveillance, promote and facilitate science standards and policies, and improve access to information on disease outbreaks and other threats.
  • Public Health Preparedness and Response
    • The Committee recommends $735,000,000. This account supports programs that build and strengthen national preparedness for public health emergencies, both naturally occurring and intentional.
  • CDC-Wide Activities and Program Support
    • Office of Rural Health — The Committee is encouraged by efforts from the agency to establish the CDC Office of Rural Health (ORH). The Committee continues $5,000,000 for this activity, the same as the fiscal year 2023 enacted level.
• Health Resources and Services Administration (HRSA) – The bill includes $7,260,141,000 for HRSA, a cut of more than $700 million below the enacted level. The Committee recommends $261,497,000 in mandatory funding.
  • Primary Health Care
    • Health Centers
      • Alcee L. Hastings Program for Advanced Cancer Screening in Underserved Communities — Within the total for health centers, the Committee continues no less than $10,000,000 for this activity.
      • School-Based Health Centers — The Committee continues $55,000,000 for school-based health centers authorized under section 330 of the Public Health Service (PHS) Act.
    • Free Clinics Medical Malpractice - The Committee includes $1,000,000 for carrying out responsibilities under the Federal Tort Claims Act, the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request. The program provides medical malpractice coverage to individuals involved in the operation of free clinics to expand access to health care services to low-income individuals in medically underserved areas.
• Health Workforce – Provides $1,336,348,000 for carrying out titles III, VII, and VIII of the Public Health Service (PHS) Act with respect to the health workforce, sections 1128E and 1921 of the Social Security Act, and the Health Care Quality Improvement Act of 1986
  • Interstate Licensure — The Committee recognizes that almost 100 million Americans live in a primary care health professional shortage area and over 156 million—almost half of the U.S. population— live in a mental health care health professional shortage area. While efforts continue to support the recruitment and retention of the health care workforce, optimizing the existing workforce is critical. The Interstate Medical Licensure Compact, created under the Licensure Portability Grant Program, is a voluntary, expedited pathway to licensure for qualified health care professionals, including psychologists, to practice in multiple states. Since 2015, the compact has grown from 7 member States to 37 member States, as well as Washington, D.C. and Guam. The Committee encourages HRSA to expand public awareness of these compacts to encourage provider participation.
  • National Health Service Corps (NHSC) - The Committee includes $126,000,000, which is $400,000 above the fiscal year 2023 enacted level and $49,600,000 below the fiscal year 2024 budget request, for NHSC to support competitive awards to health care providers dedicated to working in underserved communities in urban, rural, and tribal areas. The Committee also includes $16,000,000, which is $400,000 above the fiscal year 2023 enacted level, within the total to support NHSC awards to participating individuals that provide health services in Indian Health Service facilities, tribally-operated health programs, and Urban Indian Health programs.
  • Health Professions Training
    • Centers of Excellence and Health Careers Opportunity Program - The Committee does not include funding for these programs.
    • Faculty Loan Repayment — The Committee includes $2,310,000 for Faculty Loan Repayment, equal to the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
    • Scholarships for Disadvantaged Students (SDS) — The Committee includes $55,014,000 for SDS, equal to the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
    • Primary Care Training and Enhancement - The Committee includes $49,924,000, equal to the fiscal year 2023 level and $4,000,000 below the fiscal year 2024 budget request, for Primary Care Training and Enhancement programs.
    • Interdisciplinary Community-Based Linkages
      • Area Health Education Centers (AHEC) - The Committee includes $47,000,000 for the AHEC program, equal to the fiscal year 2023 enacted level and equal to the fiscal year 2024 budget request.
      • Geriatrics Workforce Enhancement Program (GWEP) - The Committee includes $47,245,000 for the GWEP program, equal to the fiscal year 2023 level and equal to the fiscal year 2024 budget request.
    • Mental and Behavioral Health Programs - The Committee includes $44,053,000 for Mental and Behavioral Health Programs, equal to the fiscal year 2023 enacted level, a decrease of $5,947,000 from the fiscal year 2024 budget request.
      • Behavioral Health Workforce Education and Training (BHWET) - The Committee includes $113,000,000 for the BHWET Program, the same as the fiscal year 2023 enacted level and $184,374,000 below the fiscal year 2024 budget request.
      • Graduate Psychology Education — The Committee includes $25,000,000 for this activity, the same as the fiscal year 2023 enacted level.
      • Mental and Substance Use Disorder Workforce Training Demonstration — The Committee includes $34,700,000 for this activity, the same as the fiscal year 2023 enacted level. Within the total for the Mental and Substance Use Disorder Workforce Training Demonstration, the Committee includes $25,000,000 for the Addiction Medicine Fellowship program 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 health care sectors.
      • Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program - The Committee includes $40,000,000 for this program, the same as the fiscal year 2023 enacted level.
    • National Center for Health Workforce Analysis - The Committee does not include funding for this program.
    • Public Health and Preventive Medicine Training Programs - The Committee includes $18,000,000 for Public Health and Preventive Medicine Training Grant Programs, the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
    • Nursing Workforce Development - The Committee recommends $281,129,000 for the Nursing Workforce Development programs authorized under title VIII of the PHS Act, $19,343,000 below the fiscal year 2023 enacted level and $68,803,000 below the fiscal year 2024 budget request.
    • Advanced Nursing Education - The Committee includes $89,581,000 for Advanced Nursing Education, equal to the fiscal year 2023 enacted level and $17,000,000 less than the fiscal year 2024 budget request.
    • Nurse Corps Scholarship and Loan Repayment - The Committee includes $92,635,000 for Nurse Corps, equal to the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
    • Children’s Hospitals Graduate Medical Education (CHGME) - The Committee includes $400,000,000 for the CHGME payment program, $15,000,000 above the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
    • Medical Student Education - The Committee includes $60,000,000, the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request, to support colleges of medicine at public universities located in the top quintile of States projected to have a primary care provider shortage.
    • Pediatric Subspecialty Loan Repayment Program - The Committee includes $10,000,000, equal to the fiscal year 2023 enacted level and the fiscal year 2024 budget request, for the Pediatric Subspecialty Loan Repayment Program authorized by section 775 of the PHS Act.
    • National Practitioner Data Bank (NPDB) - The Committee includes $18,814,000 for the NPDB, the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
• Maternal and Child Health
  • The bill includes $781 million for the Maternal and Child Health Block Grant, a cut of $35 million below the enacted level.
  • State Maternal Health Innovation Grants — The Committee includes $55,000,000, the same as the fiscal year 2023 enacted level, for State Maternal Health Innovation Grants to establish demonstrations to implement evidence-based interventions to address critical gaps in maternity care service delivery and reduce maternal mortality.
  • Screening and Treatment for Maternal Mental Health and Substance Use Disorders - The Committee provides $10,000,000, the same as the fiscal year 2023 enacted level, for the Screening and Treatment for Maternal Mental Health and Substance Use Disorder program (MMHSUD).
  • Pediatric Mental Health Care Access - The Committee includes $13,000,000 for Pediatric Mental Health Care Access, equal to the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
  • Maternal Mental Health Hotline - The Committee includes $7,000,000 for the Maternal Mental Health Hotline, which is the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
• Ryan White HIV/AIDS Program - Provides $2,332,535,000 for carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, of which $2,045,630,000 will be available to the Secretary through September 30, 2026, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 will be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act.
  • The bill eliminates funding for the Ending HIV Epidemic initiative, a cut of $220 million below the enacted level.
  • Health Systems - Provides $101,009,000 for carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, of which $122,000 shall be available until expended for facility renovations and other facilities-related expenses of the National Hansen’s Disease Program.
• Rural Health – Provides $402,607,000 for rural health funding activities
  • Rural Health Outreach Programs - The Committee includes $102,975,000 for Rural Health Outreach Programs, an increase of $10,000,000 above the fiscal year 2023 enacted level and $7,600,000 above the fiscal year 2024 budget request.
  • In coordination with the Delta Regional Authority, the Committee provides $3,000,000 for the Delta Region rural health workforce training program.
  • Rural Health Research and Policy Development - The Committee includes $11,076,000 for Rural Health Research and Policy Development, the same as the fiscal year 2023 enacted level and the fiscal year 2024 budget request.
  • Rural Health Flexibility Grants - The Committee includes $74,277,000 for Rural Health Flexibility Grants, $10,000,000 above the fiscal year 2023 enacted level and $10,000,000 above the fiscal year 2024 budget request.
  • Rural Maternity and Obstetrics Management Strategies (RMOMS) — The Committee includes no less than $13,000,000 for RMOMS, an increase of $3,000,000 above the fiscal year 2023 enacted level.
  • Rural Residency Planning and Development - The Committee includes $12,700,000 for the Rural Residency Planning and Development program, an increase of $200,000 above the fiscal year 2023 enacted level and the same as the fiscal year 2024 budget request.
  • The bill eliminates funding for Title X Family Planning, a cut of $286 million below the enacted level.
  • The bill eliminates funding for Healthy Start, a cut of $145 million below the enacted level.
  • HRSA-Wide Activities and Program Support
    • Telehealth - The Committee includes $45,050,000 for Telehealth, an increase of $7,000,000 above the fiscal year 2023 enacted level.
      • Telehealth Centers of Excellence — Within the funds provided for Telehealth, the Committee provides $9,000,000 for Telehealth Centers of Excellence, an increase of $500,000 above the fiscal year 2023 enacted level.
  • Of the amounts made available for the National Institutes of Health (NIH), 1 percent of the amount made available for National Research Service Awards (NRSA) must be made available to the Administrator of HRSA to make NRSA awards for research in primary medical care.
• Agency for Healthcare Research and Quality (AHRQ) – The bill eliminates funding for AHRQ, a cut of $374 million below the enacted level.
• Centers for Medicare & Medicaid Services (CMS) – The bill includes a total of $3.3 billion for CMS administrative expenses, a cut of $798 million below the enacted level.
  • Grants to States for Medicaid – The Committee recommends $406,956,850,000. This amount does not include $197,580,474,000, which was provided as advance funding for the first quarter of fiscal year 2024. In addition, the Committee recommends an advance appropriation of $245,580,414,000 for program costs in the first quarter of fiscal year 2025, to remain available until expended.
  • Payments to the Health Care Trust Funds - The Committee recommends $476,725,000,000.
• Office of the Secretary—General Departmental Management – The Committee recommends $460,369,000. Of the funds provided, $58,028,000 shall be derived from evaluation set-aside funds available under section 241 of the Public Health Service Act, which is $6,800,000 less than fiscal year 2023 enacted level and $35,218,000 below the fiscal year 2024 budget request.
  • The bill eliminates funding for the Teen Pregnancy Prevention Program, a cut of $108 million below the enacted level.
  • The bill includes $26 million for the Office of Minority Health, a cut of $49 million below the enacted level.
  • The bill includes $28 million for the Minority HIV/AIDS Initiative, a cut of $24 million below the enacted level.
  • The bill includes $20 million for the Office on Women’s Health, a cut of $49 million below the enacted level.
• Prohibited Entity - Funds in this Act may not be provided to a “prohibited entity” – this includes community providers primary engaged in family planning services, reproductive health, and related medical care;  and performs, or provides any funds to any other entity that performs abortions, other than an abortion performed in the case of a pregnancy that is rape or incest, or in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life endangering physical condition caused by, or arising from, the pregnancy itself.

Department of Education

The bill provides a discretionary total of $67.4 billion to the Department of Education, which is $12.1 billion (15%) below the FY23 enacted level and $22.6 billion below the President’s Budget Request.

• Student Aid Administration
  • Public Service Loan Forgiveness - Within 90 days of enactment of this Act, the Committee directs the Department to provide a written report detailing its efforts to implement recent changes that allow California and Texas physicians to utilize the Public Service Loan Forgiveness program. The report should include the guidance provided to eligible California and Texas physician applicants and a detailed summary of the number of submitted and approved physician applicants that have utilized the program in 2023.

Department of Labor

This bill provides a discretionary total of $9.8 billion to the Department of Labor, which is $4 billion (29%) below the FY23 enacted level and $5.7 billion below the President’s Budget Request.