On Dec. 29, 2022, President Joe Biden signed the Consolidated Appropriations Act, 2023 (H.R. 2617) into law, which includes $1.7 trillion in fiscal year (FY) 2023 discretionary government funding as well as a number of other health care provisions. After prolonged negotiations to reach an agreement on various procedural issues following the bill’s Dec. 20 introduction, the Senate passed the omnibus on Dec. 22, 2022, by a vote of 68-29 and the House passed the package on Dec. 23, 2022, by a vote of 225-201.
The $1.7 trillion omnibus included provisions relevant to academic medicine including funding for all 12 annual spending bills and a host of other policies, including a number related to pandemic preparedness [refer to related stories on appropriations and preparedness measures.]
AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Danielle Turnipseed, JD, MHSA, MPP, issued a statement upon the release of the legislation, noting, “The AAMC appreciates that House and Senate negotiators have reached a bipartisan agreement on legislation that includes numerous crucial investments that will enable America’s medical schools and teaching hospitals, known collectively as academic medicine, to continue to improve the health of patients, families, and communities nationwide.”
Additional details about the Medicare, Medicaid, and other patient care policies of interest for academic medicine are provided below.
Graduate Medical Education and Other Medicare Policies
The Health and Human Services section (Division FF) of the legislation includes the creation of 200 new AAMC-endorsed Medicare-supported graduate medical education (GME) slots in FY 2026, with 100 of these slots specifically allocated to psychiatry and psychiatry subspecialties, and no restrictions on the remaining positions. Under the proposed distribution framework, the following categories of teaching hospitals will each receive 10% of the slots: rural hospitals, hospitals over their cap, hospitals in states with new medical schools or branch campuses, and hospitals serving Health Professional Shortage Areas.
This text was adapted from a bipartisan discussion draft released by the Senate Finance Committee in September, which proposed to bolster the behavioral health workforce by providing additional Medicare-supported GME slots for psychiatry and psychiatry subspecialties [refer to Washington Highlights, Sept. 23]. The AAMC previously commented on this proposal in an Oct. 21, 2022, letter to committee leadership [refer to Washington Highlights, Oct. 31].
In addition, the legislation provides an extension of certain flexibilities for Medicare reimbursement of telehealth services first established during the COVID-19 public health emergency through Dec. 2024. 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. The bill delays 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 policies in a Sept. 13, 2022, letter urging Senate leadership to pass the Advancing Telehealth Beyond COVID-19 Act of 2021 (H.R. 4040), which passed in the House of Representatives on July 27 [refer to Washington Highlights, July 29, 2022 and Sept. 16, 2022]. The bill also extends the Acute Hospital Care at Home program waiver until Dec. 31, 2024, a policy first introduced in the AAMC-supported Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053), led by Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.) and Reps. Earl Blumenauer (D-Ore.) and Brad Wenstrup, DPM, (R-Ohio) [refer to Washington Highlights, March 11, 2022].
The omnibus provides a two-year delay of statutory Pay-As-You-Go Act (PAYGO) 4% Medicare sequester, avoiding $38 billion in Medicare provider cuts. The AAMC previously joined the American Hospital Association, the Federation of American Hospitals, America’s Essential Hospitals, and other hospital and health system groups in a Nov. 14, 2022, letter urging congressional leadership to avert pending cuts to Medicare payments [refer to Washington Highlights, Nov. 17, 2022].
The bill also partially mitigates payment cuts contained in the 2023 Medicare Physician Fee Schedule, which are due to take effect on Jan. 1, 2023 [refer to Washington Highlights, Nov. 4, 2022]. Under the legislation, the nearly 4.5% cut to the 2023 conversion factor would be reduced by 2.5% in 2023 and 1.5% in the following year. The AAMC previously joined other health care provider groups in a Sept. 30, 2022, letter backing the Supporting Medicare Providers Act of 2022 (H.R. 8800), which would entirely negate the proposed payment cut by providing a 4.42% positive adjustment to the conversion factor [refer to Washington Highlights, Oct. 7, 2022].
Medicaid, Mental Health, and Related Provisions
The package also includes several provisions relevant to Medicaid and the Children’s Health Insurance Program (CHIP). The legislation would extend CHIP funding for two years, through FY 2029. In addition, the bill would sunset the continuous coverage requirement of the Families First Coronavirus Response Act (P.L. 116-127) on April 1, 2023, after which states may begin to redetermine Medicaid beneficiaries continued eligibility for the program. The legislation provides states with enhanced federal Medicaid funding for the remainder of 2023, provided they adopt certain protections during the redetermination process (e.g., using multiple modalities to contact a beneficiary in the case of returned mail). The bill would provide children with continuous coverage under Medicaid or CHIP, effective Jan. 1, 2024, as well as permanently extend the state plan option first established under the American Rescue Plan Act of 2021 (P.L. 117-2), allowing states to provide Medicaid coverage for up to one year postpartum.
In addition, the bill includes the House-passed Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666), which reauthorizes key federal mental health programs. The AAMC previously commented on this legislation in a June 22, 2022, letter to House Energy and Commerce Committee leadership, highlighting the urgent need to expand access to behavioral health care, particularly for children and young people, as well as reduce barriers to evidence-based treatment for substance use disorders [refer to Washington Highlights, June 24, 2022].