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Washington Highlights

Senate Appropriators Release Draft FY15 Labor-HHS Spending Bill

July 25, 2014— The Senate Appropriations Committee Democratic leadership July 24 released the Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations Subcommittee’s fiscal year (FY) 2015 draft spending bill and report language. The subcommittee June 10 approved the bill, but consideration by the full Senate Appropriations Committee was indefinitely postponed shortly after the markup [see Washington Highlights, June 13].

Given the limited time in session before the start of the next fiscal year on Oct. 1, lawmakers are expected to consider a continuing resolution (CR) extending funding for discretionary programs through the November elections.

National Institutes of Health (NIH): The subcommittee provides $30.5 billion for NIH, a $606 million (2 percent) increase over FY 2014. The report notes that this increase combined with the $1 billion increase in FY 2014 fully replaces the sequester cut to NIH. 

The subcommittee retains the level for program evaluation transfers under section 241 of the Public Health Service Act at 2.5 percent. In addition, the subcommittee has reformed the section 241 allocations so that in FY 2015, NIH will contribute $696.3 million to program evaluation activities and will receive $808.2 million for a net gain of $111.9 million. The committee report notes the reform "improves the transparency of NIH's budget, so that the enacted total is truly the amount the Committee expects to be used for biomedical research."

The committee's bill retains the limit on salaries paid by extramural mechanisms at Executive Level II.

The subcommittee provides $275.4 million for the Institutional Development Award (IDeA) program, fully replacing cuts from sequestration. The committee report directs the HHS Secretary to dedicate the increase above the FY 2014-enacted level toward new Centers of Biomedical Research Excellence awards.

The committee report also notes that "many institutions in the Experimental Program to Stimulate Competitive Research (EPSCoR) qualifying states that could benefit from the IDeA program are ineligible for funding." The report instructs the IDeA director to develop a plan, including legislative language, to update eligibility criteria, and specifically evaluate whether EPSCoR participation should be a factor in a state's eligibility for the IDeA program.

The subcommittee's bill includes $651.5 million for the National Center for Advancing Translational Sciences (NCATS), and includes bill language allowing up to $29.8 million to be used by the Cures Acceleration Network (CAN). The report also notes the committee is pleased NCATS is implementing the recommendations of the Institute of Medicine (IOM) report on the Clinical and Translational Science Awards (CTSA) program. NCATS is directed to provide an update on implementation in the FY 2016 congressional justification.

Health Professions: The subcommittee provides $234.2 million for the Health Resources and Services Administration (HRSA)’s Title VII health professions programs, an $11.2 million (4.6 percent) decrease below the FY 2014 level.

Unlike the president’s request, the subcommittee includes funding for the Title VII Area Health Education Centers (AHEC), but does not provide funding for the Title VII Centers of Excellence (COE) program, the Health Careers Opportunity Program (HCOP), or the faculty loan repayment program [see Washington Highlights, March 7].

The subcommittee provides $58 million for the Title VII Scholarships for Disadvantaged Students (SDS) program, a $13 million increase over FY 2014. Regarding the increase, the report states, “The Committee believes that direct aid to students with financial need has the most immediate impact on the production of health professionals from diverse backgrounds…The committee strongly believes that providing financial support to undergraduate, post-baccalaureate, and doctoral students is the most effective way the Federal Government can ensure that the healthcare workforce is of sufficient size and skill to meet the Nation’s growing healthcare needs.” 

Additionally, the subcommittee directs $1 million of the SDS funding to support a national Center of Excellence (COE), which, according to the report text, “will build on the important foundation of best practices and curricula generated” through COE programs and will “support the development and dissemination of evidence-based practices and technical assistance in recruitment and training for diversity.”

The subcommittee also includes a provision that expands eligibility for funding transferred to HRSA from the NIH National Research Service Award (NRSA) for “research in primary medical care” by allowing previous Title VII COE and HCOP grantee institutions to apply.

The subcommittee provides $41 million primary care training and enhancement programs, a $4 million increase over FY 2014. The Title VII workforce information and analysis line receives $5 million, which, according to the report, includes resources to evaluate HRSA’s diversity training efforts.

For the Title VIII nursing workforce programs, the subcommittee provides $236.3 million, a $12.5 million (5.6 percent) increase above the FY 2014 level. In the report, the subcommittee expresses concerns that “waiting lists for admission to nursing school are limiting our Nation’s ability to address the nursing shortage,” notes that the committee “continues to place a strong priority on filling vacant nursing faculty positions, the majority of which require either a Ph.D. or a doctorate of nursing practice,” and encourages HRSA’s Division of Nursing to “prioritize this level of training.”

National Health Service Corps (NHSC): According to the report, the subcommittee does not provide a distortionary appropriation for the NHSC due to budget restraints. However, the NHSC Fund established by the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) provides $310 million in mandatory funding for the program in FY 2015. The report states the subcommittee “strongly supports continued mandatory funding for the Corps,” which is set to expire at the end of FY 2015.

Children’s Hospitals Graduate Medical Education (CHGME): The subcommittee provides $265 million for the CHGME program, rejecting the administration proposal to eliminate the program’s budget in FY 2015 [see Washington Highlights, March 7].

Agency for Healthcare Research and Quality (AHRQ): For AHRQ, the bill provides $373.3 million, $2.3 million more than the FY 2014 funding level and $39.2 million more than the president’s FY 2015 request. Unlike previous years, the bill funds the agency entirely through a direct appropriation instead of the Public Health Service (PHS) evaluation tap. The report notes continued support for “AHRQ’s unique mission within the Department to fund health services research,” acknowledging that though “NIH and CDC also fund health research, only AHRQ provides funding to universities, medical centers and research institutions that produces evidence to improve the delivery of healthcare services and the health outcomes of patients.”

Within the AHRQ total, the spending measure offers $10 million in the agency’s patient safety portfolio for “patient safety learning labs” to “support a systems model approach to patient safety issues in order to identify interrelated threats, generate new ways of thinking about these threats, and establish new environments conducive to brainstorming and rapid prototyping techniques.”

National Healthcare Workforce Commission: The subcommittee provides $3 million for the commission, which was established as an independent advisory body in the ACA. Though the Government Accountability Office appointed commissioners Sept. 30, 2010 [see Washington Highlights, Oct. 1, 2010], to date, Congress has not approved an appropriation to fund the commission’s activities.

Centers for Disease Control and Prevention (CDC): The subcommittee provides $6 billion in base budget authority for CDC. In addition, the subcommittee assumes a transfer of $887 million from the Prevention and Public Health Fund (PPHF) and $112 million from the PHS evaluation tap in FY 2015, bringing the subcommittee’s total for CDC to $7 billion. This funding level represents a $150 million (2.2 percent) increase over the FY 2014 level.

Contact:

Dave Moore
Senior Director, Government Relations
Telephone: 202-828-0559
Email: dbmoore@aamc.org

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org

Alexandra Khalife
Legislative Analyst
Telephone: 202-828-0418
Email: akhalife@aamc.org

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org