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

On March 9, 2024, Congress passed the first package (Public Law No: 118-42) of FY 2024 appropriations bills as part of the Consolidated Appropriations Act, 2024. The $468.7 billion package included funding for the following agencies: Agriculture, Rural Development, Food and Drug Administration, and Related Agencies; Commerce, Justice, Science, and Related Agencies; Energy and Water Development and Related Agencies; Interior, Environment, and Related Agencies; Military Construction, Veterans Affairs, and Related Agencies; and Transportation, and Housing and Urban Development, and Related Agencies.

On March 23, 2024, Congress passed the second package (Public Law No: 118-47) of FY 2024 appropriations bills, or the Further Consolidated Appropriations Act, 2024, totaling $1.2 trillion in funding for: Defense; Financial Services and General Government; Homeland Security; Labor, Health and Human Services, Education, and Related Agencies; Legislative Branch; and State, Foreign Operations and Related Programs.

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

Importantly, the Joint Explanatory Statement (JES) for the Labor, Health and Human Services, Education, and Related Agencies (LHHSE) appropriations bill incorporated by reference report language (page 129) again recognizing the importance of osteopathic research and representation at the National Institutes of Health (NIH). 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 LHHSE 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.

The JES to the Military Construction and Veterans Affairs appropriations bill signed into law by President Biden, on March 9, 2024, incorporated by reference report language (page 35) again recognizing the importance of osteopathic manipulative treatment (OMT) and other therapies for treating veteran pain.

• Opioid Use Disorder/Alternative Treatments.—Alternative treatments for pain management have been shown to be effective in reducing pain and reliance on prescription opioids. The Committee notes the directive language in the Joint Explanatory Statement accompanying Public Law 117–38 requiring the Department to track the use of osteopathic manipulative treatment to treat back and other pain. The Committee continues to encourage VA to expand the use of alternative treatments to pain management, such as acupuncture, in its delivery of healthcare services. The Committee also urges VA to integrate alternative treatments into VA medical centers and clinics through licensed professionals or on a contract basis.

Extensions for the Teaching Health Centers Graduate Medical Education, Community Health Centers and the National Health Service Corps programs were included in the March 9 funding package and run through December 31, 2024.

• Teaching Health Centers Graduate Medical Education received $219 million through the end of the year, an increase  of more than $100 million from FY23.
• Community Health Centers received $4.27 billion, a $270 million increase from FY23.
• The National Health Service Corps received $345 million, a $35 million increase from FY23.

Department of Health and Human Services

The Joint Explanatory Statement for Division D: Labor, Health and Human Services, Education, and Related Agencies can be found HERE.

The 2024 Labor, Health and Human Services, Education and Related Agencies funding bill provides $224.4 billion in total funding, a decrease of $2.4 billion, or about 1%, from the FY 2023 enacted level. The bill provides a total of $117.0 billion in discretionary funding for the Department of Health and Human Services (HHS). Highlights include:

• Advanced Research Projects Agency for Health (ARPA-H) – The bill provides $1.5 billion for ARPA-H, protecting current funding and allowing for the development of novel, breakthrough, and broadly applicable capabilities and technologies to accelerate transformative innovation in biomedical science and medicine. 
• National Institutes of Health (NIH) – The bill provides $48.6 billion in base discretionary funding for NIH, an increase of $300 million in base funding over FY 2023.
  • Excluding ARPA-H, the agreement provides $47 billion for the Institutes and Centers of NIH.
  • The agreement provides $80 million for grants to public and nonprofit entities to expand, remodel, renovate, or alter existing biomedical research facilities or construct new facilities under Section 404I of the Public Health Services Act. 
• Centers for Disease Control and Prevention (CDC) – The bill provides $9.2 billion in total program level funding for the CDC, which includes $7.93 billion in budget authority and $1.18 billion in transfers from the Prevention and Public Health (PPH) Fund. 
  • $350 million to support public health infrastructure and capacity, maintaining the 75% increase secured in FY 2023 to strengthen public health infrastructure and the public health workforce at the state and local level to improve preparedness and respond to emerging public health threats.
  • $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.
  • $5 million for the continued efforts to establish the Office of Rural Health (ORH). 
• Agency for Healthcare Research and Quality (AHRQ) – The bill includes $369 million for AHRQ, a $4.5 million decrease from the FY 2023 enacted amount.
• Substance Abuse and Mental Health Services Administration (SAMHSA) – The bill provides $7.4 billion for SAMHSA, a less than 1% decrease from the FY 2023 enacted amount. 
• Health Resources and Services Administration (HRSA) – The bill includes $8.8 billion for HRSA, a $577 million decrease from the FY 2023 enacted level. Of this amount:
  • $510 million, an increase of $1 million above the FY 2023 enacted level, for Title VII Health Professions Education and Training, including: 
    • $153 million for Behavioral Health Workforce Education and Training, including $40 million for the Substance Use Disorder Treatment and Recovery Loan Repayment Program. The bill also includes $34.7 million for Mental Health and Substance Use Disorder Workforce Training Demonstrations. Within the total, the agreement includes $25 million for the Addiction Medicine Fellowship Program as described in Senate Report 118-84. 
  • $390 million, an increase of $5 million, for Children’s Hospitals Graduate Medical Education. 
  • $13 million for Pediatric Mental Health Care Access, continuing FY 2023 enacted levels.
  • $364 million, an increase of $12 million, for the Rural Health Programs, including a continuing $145 million for the Rural Communities Opioid Response Program. The bill also provides $12.7 million for the Rural Health Residency Program. This program funds physician residency training programs that support physician workforce expansion in rural areas.  
  • $60 million for medical student education to support colleges of medicine at public universities located in the top quintile of States projected to have a primary care provider shortage. The bill directs HRSA to give priority to applications from academic institutions located in States with the greatest number of Federally recognized Tribes. It also directs HRSA to give priority to applications from public universities with a demonstrated public-private partnership.  

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

• Rural Health Equity – The Committee recognizes the importance of the Corps Scholarship Program, especially in combating 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.
• 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. While the final bill supports inclusion of administrative academic units within medical schools, the directive in Senate Report 118-84 is not included.

Additional health care policy provisions included in the FY 2024 spending package include:

• Addressing Mental Health and Substance Use Disorders. The bill includes an increase of $75 million for mental health research as described in Senate Report 118-84. 
  • Mental Health Block Grant – The agreement continues to include a 5% set-aside of the total for evidence-based care programs that address the needs of individuals with serious mental illness, children with serious emotional disturbances, or individuals experiencing a mental health crisis.
  • Outreach in Underserved Communities – The agreement directs SAMHSA to conduct outreach and provide technical assistance to underserved States and communities applying for competitive grants.
  • Adolescent Mental Health – The agreement directs SAMHSA to work across HHS and in consultation with other Departments as appropriate, develop a comprehensive interagency coordinating plan to improve adolescent mental health.
  • Rural Mental and Behavioral Health – The agreement notes that the FY 2023 agreement directed SAMHSA to provide a report on strategies to respond to the challenges of rural individuals and providers in accessing and delivering behavioral health services.
  • Substance Abuse Treatment – The bill maintains key investments made in recent years to address the rising toll of opioid overdoses fueled by fentanyl and to improve access to substance use disorder treatment and prevention by providing more than $4.6 billion to support substance use prevention and treatment efforts. The bill includes $10 million for Opioid Treatment Programs and Regulatory Activities. The bill provides $2 billion for the Substance Use Prevention, Treatment, and Recovery Services Block Grant and $1.575 billion for State Opioid Response grants. It also provides $111 million for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction, as well as $57 million for First Responder Training, with $32 million dedicated to Rural First Responder Training. 
• Essential Health Care Programs – The bill protects essential funding to address public health threats, improve health care access and affordability, and strengthen the health care workforce. This includes:
  • $1.86 billion for Community Health Centers, including $55 million for school-based health centers.
  • $1.2 billion for the core Maternal and Child Health programs.
  • $345 million for the Improving Maternal Health Initiative to combat the unacceptable levels of maternal mortality – a $21 million increase over fiscal year 2023.
  • $4.1 billion for the Centers for Medicare and Medicaid’s (CMS) administrative needs.
  • $613 million for the Ending the HIV Epidemic Initiative. This includes $220 million within the CDC Domestic HIV/AIDS Prevention and Research programs to develop and deploy innovative data management solutions, increase access to PrEP, and better detect and respond to HIV clusters.
  • The bill also protects funding for reproductive health programs, including Title X and the Teen Pregnancy Prevention Program.
• Pandemic Preparedness and Biodefense – The bill includes $3.6 billion for the Administration for Strategic Preparedness and Response (ASPR). This includes a $65 million increase for the Biomedical Advanced Research and Development Authority (BARDA) and $10 million to establish ongoing funding for industrial base manufacturing and supply chain activities to help ensure that critical resources in the public health supply chain – including raw materials, medical countermeasures, and ancillary supplies – are manufactured in the United States.
• Telehealth – The agreement continues $8.5 million for the currently awarded telehealth sites. It includes an increase of $4 million for HRSA to integrate and implement a robust telementoring initiative at an academic medical center with existing Federal support and expertise in the field. This should include technology enabled delivery of evidence-based curricula, offering of practice based, culturally responsive care, and advancing the skill set of health care workers.  
• Congressionally directed spending – The bill provides $6 million to the West Virginia School of Osteopathic Medicine for facilities and equipment (Sens. Shelley Capito and Joe Manchin).

Department of Education

The Joint Explanatory Statement for Division D: Labor, Health and Human Services, Education, and Related Agencies can be found HERE.

The bill provides $79.1 billion in discretionary funding for the Department of Education. Of this amount, the bill includes:

• Student Financial Assistance – $24.6 billion for federal student aid programs. Within this amount, the agreement provides:
  • A maximum Pell Grant award of $7,395 for the 2024-2025 school year, preserving the $900 increase in the maximum award over the last two fiscal years.
  • $910 million for the Federal Supplemental Educational Opportunity Grant program, a continuation of FY 2023 enacted levels.
  • $1.2 billion for Federal Work Study, another continuation of FY 2023 funding levels.
• Higher Education – $3.2 billion for higher education, a $242 million decrease from the FY 2023 enacted level. 

      Department of Veterans Affairs

The Joint Explanatory Statement for Division A: Military Construction, Veterans Affairs, and Related Agencies can be found HERE.

The 2024 Military Construction, Veterans Affairs, and Related Agencies Appropriations bill provides $346.7 billion, an increase of $24 billion or 7 percent above FY 2023. Of this amount, discretionary funding of $138.1 billion was appropriated for Veterans Medical Care, a $10 billion increase from FY 2023.

• Department of Veterans Affairs (VA) - Of the $138.1 billion, the VA estimates to use $17.1 billion from the Toxic Exposures Fund to support medical care. Funding includes:
  • Rural Health – $343.5 million, $5 million above FY 2023, to support improved access to care, including expanded access to transportation and telehealth.
  • Women’s Health – $990.4 million, $149.5 million above FY 2023, to support gender-specific care for women, as well as funding for the program office and initiatives, including the expansion of the childcare initiative.
  • Mental Health – $16.2 billion, $2.3 billion above FY 2023. This includes $558.8 million for suicide prevention outreach, including $300.5 million for the Veterans Crisis Line (VCL).
  • Medical and Prosthetics Research – $943 million, $27 million above FY 2023, to support ongoing and new research in areas such as toxic exposures, animal research, women veterans and access to clinical oncology trials.
  • Telehealth and Connected Care – $5.1 billion, equal to FY 2023, for expand telehealth availability, including mental health, primary care, and rehabilitation services as a means to deliver care, including in rural and underserved communities.

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

• American Indian/ Alaska Native, Native Hawaiian, Pacific Islander and U.S.-Affiliated Pacific Islander Veterans – The Committees note their appreciation for American Indian/ Alaska Native, Native Hawaiian, Pacific Islander and U.S. -Affiliated Pacific Islander military service and recognizes the challenges they have in securing the benefits they have earned. The agreement continues to require reporting on efforts to improve and expand access to benefits, mental health, preventative and wellness programs, telehealth, among other programs, and reduce homelessness, among these veteran populations. The agreement continues to support the establishment of the Center for Native Hawaiians, Pacific Islanders, and U.S.-Affiliated Pacific Islanders Health.
• Child Care Assistance Expansion – The Committees note their disappointment in the VHA’s slower than anticipated progress to expand child care assistance to veterans receiving healthcare at all VA medical facilities by January 5, 2026. The agreement directs the VHA to brief the Committees on 27 Appropriations of both Houses of Congress no later than April 19th on the status of the regulatory process, the new timeline for expansion to the planned number of sites, and progress on completing the information technology systems necessary for this expansion. Further, the agreement directs the VHA to include cost estimates, timelines, and actions taken by the VHA in the justifications accompanying the fiscal year 2025 budget submission. The Committees also encourage the VHA to re-evaluate under which program office the child care program should reside.
• Special Modes of Transportation – The Committees note the VHA’s actions to postpone the final effective date for reimbursement rates for ground and air ambulance services. Before modifying these rates in accordance with the new timeline, the VHS is directed to communicate directly with service providers to fully understand the impact of the proposed rule change on veterans. Further, the Committees note that the VHA should identify staff dedicated to facilitating contracting with providers of these services at fair and appropriate reimbursement rates, to include providing technical assistance on the contracting process, and to provide support for entities who are beginning the contracting process for the first time. The agreement directs the VHA to report back to the Committees on Appropriations of both Houses of Congress no later than June 18th on the feedback received from industry stakeholders and its plan for ensuring zero harm to veterans. 

      Department of Defense

The Joint Explanatory Statement for Division A: Department of Defense can be found HERE.

For FY 2024, the bill provides $39.89 billion, an increase of over $600 million from FY 2023, for medical and health care programs at the Department of Defense.

• $582.5 million, the same funding as FY 2023, for cancer research.
  • $150 million for the breast cancer research program.
  • $130 million for the general cancer research program.
  • $50 million for the kidney cancer research program.
  • $25 million for the lung cancer research program.
  • $40 million for the melanoma cancer research program.
  • $45 million for the ovarian cancer research program.
  • $15 million for the pancreatic cancer research program.
  • $110 million for the prostate cancer research program; and
  • $17.5 million for the rare cancers research program.
• $175 million for the traumatic brain injury and psychological health research program.
• $40 million for the spinal cord research program.
• $20 million for the joint warfighter medical research program

Department of the Interior

The Joint Explanatory Statement for Division D: Department of the Interior, Environment and Related Agencies can be found HERE.

The FY 2024 Interior, Environment and Related Agencies bill provides $41.2 billion in total funding, which is $75 million more than the FY 2023 levels. Continuing from last year, the bill provides $10.88 billion for Tribal programs across the Department of the Interior and the Indian Health Service.

• Hospitals and Health Clinics – $2.5 billion for Hospitals and Health Clinics, which maintains funding at FY 2023 enacted levels for Alzheimer’s activities and the Produce Prescription Pilot program. The agreement also continues funding for the FY 2023 enacted levels for the Tribal Epidemiology Center Program, domestic violence prevention program, village-built clinics, maternal health, accreditation emergencies, health information technology, healthy lifestyles in youth project, and the National Indian Health Board cooperative agreement.
• Indian Health Professions – $80.5 million for Indian health professions, which includes enacted levels for the loan repayment program as well as the InMed program, the Quentin N. Burdick Indians into Nursing, and the American Indians into Psychology Programs. The bill also provides $90 million for the Urban Indian health program.