Summary
The House and the Senate are both on a two-week spring recess after finally passing the last of the fiscal year (FY) 2024 appropriations bills over the weekend. Six months into the fiscal year, Congress passed a minibus package of six appropriations bills, including the Labor-HHS bill that funds the Department of Health and Human Services. President Biden signed the bill into law on Saturday.
Overall, $116.8 billion in funding was provided for the Department of Health and Human Services, an increase of about $955 million over last year. Most programs were flat funded or received modest increases with a couple of programs receiving cuts. Programs that received modest funding boosts include the National Institutes of Health, Biomedical Advanced Research and Development Authority, organ transplant system modernization and the 9-8-8 mental health crisis hotline.
Despite a last-minute push from members and advocates, the bill did not include a separate health care package that would have reformed pharmacy benefit manager and hospital billing practices.
Details on specific programs are below:
National Institutes of Health: The bill provides $48.6 billion in base discretionary funding for the National Institutes of Health (NIH)—an increase of $300 million in base funding over fiscal year 2023. ARPA-H receives a $1.5 billion, the same as last year. Most of the funding increases go towards NIH priority programs, including $120 million increase for the National Cancer Institute for cancer research; a $75 million increase for mental health research; a $100 million increase for Alzheimer’s disease research; a $5 million increase for opioid research; $12.5 million for a new palliative care research program; a $10 million increase for diabetes research; and a $10 million increase for the IMPROVE initiative for research on maternal mortality.
Mental Health: The bill includes $1 billion for the Mental Health Block Grant and $153 million for the Behavioral Health Workforce Education and Training Program to support community-based clinical training and strengthen the mental health workforce. The bill also provides an $18 million increase for the 988 Suicide Prevention Lifeline; continued $385 million for Certified Community Behavioral Health Clinics; and $98.8 million (a $5 million increase) for the National Child Traumatic Stress Initiative. The bill also includes more than $160 million in investments within the Department of Education to address the shortage of school-based mental health professionals in our nation’s K-12 schools.
Healthcare Workforce: The bill includes a $5 million increase for the Children’s Hospital GME program, as well as a $3 million increase for the National Health Service Corps; and a $5 million increase for nursing training programs. HRSA’s Graduate Medical Education program was flat funded.
Organ Transplantation: The bill increases funding for the Organ Procurement and Transplantation Network (OPTN) Modernization Initiative by $23 million to strengthen and reform the nation’s organ donation and transplant system. This funding increase will allow HRSA to recompete the contract to run the nation’s organ allocation system and to potentially break up the current contract into multiple contracts. On a related note, the House Energy & Commerce Committee sent a letter HRSA requesting information on how the OPTN contract solicitation plan will support fair and competitive practices during the contracting process, promote data transparency and patient safety, and ensure system security and operability. A separate letter was sent to the United Network for Organ Sharing (UNOS), the current contractor, regarding the UNOS IT system security and operability, issues with patient safety and equity, and conflict-of-interest concerns.
Pandemic Preparedness and Biodefense: The bill includes $3.6 billion for the Administration for Strategic Preparedness and Response (ASPR), including 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.
Public Health Infrastructure: The bill also includes $350 million (same as FY 2023) to support public health infrastructure and capacity, and the public health workforce at the state and local level to improve preparedness and respond to emerging public health threats.
Agency for Healthcare Quality and Research: AHRQ received a $4.5 million decrease in funding from last year, however it was stated that not less than $13,500,000 is to be used for Long COVID research.
The full explanatory statement can be found here; the House Committee’s summary can be found here; and the Senate Committee’s summary can be found here.
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the FY 2025 inpatient rehabilitation facilities. OMB is also reviewing the following rules:
Medicare
- Alternative Payment Models – The proposed rule would implement a new Medicare payment model titled, Increasing Organ Transplant Access (IOTA) Model (was set for December 2023).
- Payment Update – The proposed rules would make policy payment updates for acute care hospitals inpatient and long-term care hospitals, hospice, inpatient psychiatric facilities, and skilled nursing facilities (April 2024).
- Nursing Homes – The final rule would establish minimum staffing standards for long-term care facilities and establish Medicaid institutional payment transparency reporting requirements (September 2026).
Medicaid
- Disproportionate Share Hospital Program – The final rule would implement requirements under section 203 of the Consolidated Appropriations Act, 2021 (CAA), which relate to Medicaid shortfall and third-party payments (February 2024).
- Eligibility and Enrollment – The final rule would implement changes to align enrollment and renewal requirements for most individuals in Medicaid and promote maintenance of coverage (February 2024).
- Access to Care – A pair of final rule intended to access to care and quality outcomes for Medicaid and CHIP beneficiaries enrolled in managed care delivery systems and fee-for-service Medicaid (April 2024).
- Drug Rebate Program – The final rule would establishes requirements related to manufacturers’ misclassification of covered outpatient drug products under the Medicaid Drug Rebate Program (MDRP). In addition, it finalizes beneficiary protections, as well as MDRP program integrity and administration changes (June 2024).
Commercial Insurance
- ACA Marketplace – The final rule would make changes to regulations governing Affordable Care Act (ACA) Marketplace plans, insurance standards, and the risk adjustment program for plan year 2025 (not specified but likely April 2024).
- Short-Term Plans – The final rule would modify definitions to ensure short-term, limited duration insurance and fixed indemnity benefits coverage do not undermine consumer protections and requirements under the Affordable Care Act (April 2024).
Other Topics:
- Healthcare System Resiliency and Modernization – The proposed rule would revise and update national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers (was set for December 2023).
- Reproductive Health Care Privacy – The final rule would modify the HIPAA Privacy Rule to support reproductive health care privacy (March 20240.
- Health IT – The proposed rule would advance interoperability through proposals for: standards adoption; public health IT certification; expanded uses of certified application programming interfaces (APIs), such as for electronic prior authorization, patient engagement, care management, and care coordination; and information sharing under the information blocking regulations (was set for November 2023).
- Disability – The final rule would revise regulations under section 504 of the Rehabilitation Act of 1973 to address discrimination on the basis of disability in HHS-funded programs and activities (April 2024)