President Signs FY 2022 Funding Bill with Increases for Research, Health Programs

President Joe Biden signed the Consolidated Appropriations Act, 2022 (H.R. 2471) into law on March 15, following House and Senate passage of the measure on March 9 and March 10, respectively. The law completes the annual spending bills nearly six months into the fiscal year by including funding for all federal agencies for the remainder of fiscal year (FY) 2022, and a temporary extension of certain telehealth policies, among other health care provisions.

The omnibus package originally included $15.6 billion in emergency funding to address COVID-19, including $10.6 billion to the Department of Health and Human Services (HHS), but congressional leaders removed the funding before the House vote over concerns that it would be offset in part by rescinding unobligated COVID-19 funding for state and local governments. House Appropriations Chair Rosa DeLauro (D-Conn.) introduced on March 9 the COVID-19 supplemental as a stand-alone bill (H.R. 7007) without the rescission of state and local funding, as the White House warned that testing capacity and the supply of therapeutics will decline by the spring without additional resources.

AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Karen Fisher, JD, issued a statement just before House passage noting, “The AAMC supports the bipartisan, bicameral efforts of congressional negotiators to provide crucial resources for programs that promote the health of patients, communities, and the nation and to preserve gains in telehealth that have improved access to care for people nationwide.” The AAMC statement also indicated, “As the pandemic continues to evolve, it will be essential to ensure that HHS has the targeted resources it needs to address COVID-19, in addition to the foundational investments in the annual spending bills.”

Additional details about the package of note for academic medicine are provided below.

Department of Health and Human Services

Within the Labor-HHS-Education section (Division H) of the bill, the agreement provides a total of $45 billion for the National Institutes of Health (NIH) in FY 2022, including the full $496 million provided in FY 2022 through the Innovation Account established in the 21st Century Cures Act for specific initiatives (P.L. 114–255). This total funding level represents a $2 billion or 4.7% increase over the comparable FY 2021 funding level — the seventh consecutive increase since FY 2016.

The Ad Hoc Group, convened by the AAMC, issued a March 9 press statement expressing appreciation that the bill includes a seventh straight year of bipartisan funding growth in the agency and urging lawmakers to continue this trend of sustained, robust growth “to fully realize the potential of medical discovery.”

The bill retains the salary cap at Executive Level II of the federal pay scale. The bill also includes increases for the NIH’s Clinical and Translational Science Awards program ($606.7 million, an increase of $19.8 million) and the Institutional Development Award program ($410.4 million, an increase of $13.3 million), among other increases.

Like the House-passed bill and the bill introduced in the Senate, the omnibus directs the NIH to require grantee institutions to notify the NIH if a principal investigator or key personnel on a grant are removed from their positions or disciplined over concerns of harassment, bullying, retaliation, or hostile working conditions.

The joint explanatory statements (Part 1 and Part 2) accompanying the package include new report language on several issues including animals used in research, foreign government influence, diversity of the biomedical research workforce, and biomedical research facilities. The joint explanatory statement also states that report language in House Report 117-96 carries the same weight as the updated statement, unless otherwise noted.

For a third year in a row, the legislation includes dedicated funding for firearm injury and mortality prevention research, with $12.5 million for the NIH and $12.5 million for the Centers for Disease Control and Prevention (CDC), the same funding levels as FY 2021.

The omnibus provides $1 billion and some limited authorities within the Office of the HHS Secretary to establish the Advanced Research Projects Agency for Health (ARPA-H). The bill directs the president to appoint an ARPA-H director and allows the secretary to transfer ARPA-H to any HHS agency or office, including the NIH, within 30 days of the omnibus’s enactment.

The omnibus includes $8.4 billion for the CDC, an increase of $582.4 million (7.4%) above the FY 2021 program level. The bill provides $8 million for the CDC Social Determinants of Health Pilot Program in FY 2022, which will provide grants to state, local, territorial, or tribal jurisdictions to support the development of Social Determinants of Health Accelerator Plans. The president, House, and Senate had proposed $150 million for this program in FY 2022.

Within the Office of the Assistant Secretary for Preparedness and Response (ASPR), the legislation increases funding for the National Emerging Special Pathogens Training and Education Center and the Regional Emerging Special Pathogen Treatment Centers (RESPTCs), directing ASPR to expand the RESPTC program to include at least three new centers through a competitive process.

The legislation increases funding for the Agency for Healthcare Research and Quality to $350 million, an increase of $12.4 million above the FY 2021 spending level.

The legislation provides $799 million for the Health Resources and Services Agency (HRSA) Title VII Health Professions and Title VIII Nursing Workforce Development Programs in FY 2022, a $45.1 million (5%) increase above FY 2021 comparable levels, with all the diversity pathway programs receiving 2% increases.

Other HRSA funding includes $375 million for the Children’s Hospitals Graduate Medical Education program (a $25 million or 7.1% increase over FY 2021), $10.5 million for the Rural Residency Program (no increase over FY 2021), and $121 million for the National Health Service Corps (NHSC) discretionary appropriation (a $1 million or 0.8% increase). The NHSC previously received $800 million in mandatory supplemental funding through the American Rescue Plan, to remain available until expended.

Department of Veterans Affairs

The bill provides funding for the Department of Veterans Affairs (VA) within the Military Construction, VA, and Related Agencies section (Division J). This includes $882 million for the VA Medical and Prosthetic Research program in FY 2022, a $67 million (8.2%) increase above the FY 2021 funding level. The joint explanatory statement includes text related to research facilities and academic affiliates and access to oncology clinical trials.

The bill does not provide additional VA Medical Services funds for FY 2022 beyond the $58.9 billion provided as advanced appropriations for FY 2022 in the FY 2021 spending bill. FY 2022 funding for VA Medical Services represents a $5.24 billion (10.2%) increase over the comparable FY 2021 spending level. The bill also provides $70.3 billion in FY 2023 advanced appropriations.

For VA Community Care, the bill provides an additional investment of $3.3 billion in FY 2022 funding, on top of the $20.15 billion provided in the prior year’s appropriation, for a total $4.9 billion (26.5%) increase in FY 2022 over the comparable FY 2021 spending level. The bill also provides $24.2 billion in FY 2023 advanced appropriations.

National Science Foundation

Within the Commerce-Justice-Science section (Division B), the bill provides a total of $8.84 billion for the National Science Foundation, with $7.16 billion (a $250 million or 3.6% increase) dedicated to research and related activities. The funding total would represent an increase of $351 million (4%) over the comparable FY 2021 funding level.

Other Health Care Provisions

The Health Provisions section (Division P) of the legislation temporarily extends flexibilities for Medicare reimbursement of telehealth services established during the COVID-19 public health emergency (PHE). These provisions include the removal of geographic restrictions and the expansion of originating sites for telehealth services, as well as flexibility for providers to continue to provide audio-only telehealth services. In addition, the bill would delay the requirement that a Medicare beneficiary attend an in-person visit with their provider prior to receiving behavioral health services via telehealth. The AAMC previously endorsed these telehealth flexibilities in a Jan. 25 letter to congressional leadership [refer to Washington Highlights, Jan. 28].

In its statement, AAMC applauded the telehealth provisions in the legislation, noting that “temporarily extending these telehealth waivers at the end of the public health emergency will provide policymakers with time to partner with stakeholders to make telehealth access permanent for patients, families, and communities, especially those in rural, urban, and other underserved areas.”

Division P of the legislation also includes authorizations for programs to improve maternal health outcomes and work to ameliorate disparities, particularly for individuals living in rural communities. The legislation authorizes HRSA to establish evidence-based programs to better integrate care for pregnant and post-partum individuals. In addition, the bill authorizes grants to develop rural obstetric networks, invest in telehealth capabilities, and establish training demonstrations for rural maternal and obstetric care. At the end of 2020, the AAMC joined 115 national organizations to call on Congress to take action to improve maternal and perinatal health care quality [refer to Washington Highlights, Dec. 11, 2020].

Division P of the bill also includes several provisions that are salient to Medicaid and safety net providers. The legislation extends the increased Federal Medical Assistance Percentage for U.S. territories and provides Puerto Rico with an additional $200 million in Medicaid funding for fiscal year 2022. For individuals who are dually eligible for both Medicaid and commercial insurance, this bill reaffirms Medicaid’s role as a payer of last resort by requiring that third-party insurers accept prior authorization determinations rendered by the state Medicaid agency. Finally, the bill protects hospitals’ eligibility for the 340B Drug Pricing Program despite transient shifts in their patient mix due to the COVID-19 public health emergency.