Appropriations

Appropriations / en Fri, 25 Apr 2025 20:16:25 -0500 Thu, 26 Sep 24 15:30:53 -0500 Senate passes continuing resolution to fund government through Dec. 20 /news/headline/2024-09-26-senate-passes-continuing-resolution-fund-government-through-dec-20 The Senate Sept. 25 voted 78-18 to pass a <a href="https://www.congress.gov/118/bills/hr9747/BILLS-118hr9747eh.pdf" target="_blank">continuing resolution</a> funding the government through Dec. 20 and avoiding a government shutdown. The House of Representatives passed the CR prior to the Senate by a vote of 341-82. The bill will allow the Federal Emergency Management Agency to access its full-year appropriation beginning Oct. 1. It also extends certain public health authorizations and delays for one-year clinical lab fee schedule cuts and reporting, among other provisions. Thu, 26 Sep 2024 15:30:53 -0500 Appropriations AHA Letter to House Subcommittee Leadership on Appropriations Priorities for FY 2025 /lettercomment/2024-05-13-aha-letter-house-subcommittee-leadership-appropriations-priorities-fy-2025 May 13, 2024<table><tbody><tr><td>The Honorable Robert Aderholt&nbsp; Chairman&nbsp; Subcommittee on Labor, Health and&nbsp; Human Services, Education, and Related Agencies&nbsp; Committee on Appropriations&nbsp; U.S. House of Representatives&nbsp; Washington, D.C. 20515</td><td>The Honorable Rosa DeLauro Ranking Member Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Committee on Appropriations U.S. House of Representatives Washington, D.C. 20515</td></tr></tbody></table>Dear Chairman Aderholt and Ranking Member DeLauro:On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinical partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes regarding funding for health care programs for fiscal year (FY) 2025.&nbsp;America’s hospitals are facing many challenges, and we appreciate you considering the effect your decisions have on hospitals’ ability to provide care to their patients and communities. We ask you to consider funding for health care programs that have proven successful in improving access to quality health care for patients and communities across America. As you prioritize your FY 2025 appropriations measures, we ask that you include the following programs.Strengthening the Health Care Workforce. Long-developing structural changes in the health care workforce have left hospitals and health systems, including post-acute and behavioral health care providers, facing a national staffing emergency that could jeopardize access to high-quality care for patients and the communities they serve.Hospitals face significant challenges making it difficult to sustain, build and retain the health care workforce. The National Council of State Boards of Nursing’s 2022 National Workforce Study reveals 100,000 nurses left the workforce during the pandemic and by 2027, almost 900,000 intend to leave the workforce due to stress, burnout and retirement.1 Hospitals face similar demographic trends for physicians, with data from the Association of American Medical Colleges indicating that one-third of practicing physicians will reach retirement age over the next decade. Hospitals also report significant shortages of allied health and behavioral health professionals. Congress must support efforts to ensure an adequate, sustainable health care workforce.Health Professions Education and Workforce Challenges. The AHA supports $1.51 billion for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs for FY 2025. The workforce crisis facing our nation necessitates bold increases in HRSA discretionary programs that address workforce challenges.<ul><li>Nursing Workforce Development Under Title VIII of the Public Health Service Act. The Nursing Workforce Development programs support nursing education, seek to further diversify the nursing profession, and improve access in rural and underserved communities. Nurses are integral members of the health care team. Each year, nursing schools must deny admission to thousands of potential students because they do not have enough faculty to teach these aspiring professionals. The AHA also supports $210 million for the National Institute of Nursing Research, one of 27 institutes of the National Institutes of Health.</li><li>Primary Care Medicine, Pediatric Subspecialty Loan Repayment, Substance Use Disorder Treatment and Recovery Loan Repayment Program and Oral Health Training programs. These programs improve health care access and quality in underserved areas by training general internists, family medicine practitioners, general pediatricians, pediatric subspecialists, oral health providers, physician assistants and expanding behavioral health services. The AHA supports additional funding over last year’s enacted level for these programs.</li><li>Health Professions Programs. An adequate, diverse and well-distributed supply of health care professionals, including allied health care workers, is indispensable to our nation’s health care infrastructure. Health professions programs support recruitment of individuals into the allied health profession to help address the challenges rural and underserved communities face accessing primary care providers. Our nation must act now to maintain a vibrant workforce by strengthening nursing and medical educational programs. Without decisive intervention, the looming workforce shortages threaten hospitals’ ability to care for patients and communities. Title VII programs help patients and communities by playing an essential role in improving the diversity of the health care workforce and connecting students to health careers by supporting recruitment, education, training and mentorship opportunities. Inclusive and diverse education and training experiences expose providers to backgrounds and perspectives other than their own and heightens cultural awareness in health care, resulting in benefits for all patients. Evidence shows that concordance between patients and providers results in better health outcomes.</li><li>National Health Service Corps (NHSC). The NHSC awards scholarships to health professions students and assists graduates of health professions programs with loan repayment in return for an obligation to provide health care services in underserved rural and urban areas. The AHA supports $210 million in discretionary funding for the NHSC. The AHA also believes substantial mandatory funding is also a necessary investment in this critical program.</li></ul>Centers of Excellence and the Health Careers Opportunity Programs. These programs focus on recruiting and retaining minorities into health professions to build a more diverse health care workforce. The Centers of Excellence grants strengthen the national capacity to train students from minority groups that are underrepresented in allopathic and osteopathic medicine, dentistry and pharmacy, and behavioral or mental health. The Health Careers Opportunity program provides support for increasing the number of individuals from disadvantaged backgrounds in the health and allied health professions. The AHA supports these programs.Preventing Burnout in the Health Workforce Program. For decades, health care professionals have faced greater rates of mental and behavioral health conditions, suicide and burnout than other professions while fearing the stigma and potential career repercussions of seeking care. The COVID-19 pandemic exacerbated the already-present issues of stress, depression, anxiety and other mental health issues experienced by health care providers.The Dr. Lorna Breen Health Care Provider Protection Act addresses this mental health crisis among our nation’s healers. The law is intended to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care providers. The act authorized grants to health care providers to establish programs that offer behavioral health services for front-line workers, requires the Department of Health and Human Services (HHS) to study and develop recommendations on strategies to address provider burnout and facilitate resiliency, and directs the Centers for Disease Control (CDC) to launch a campaign encouraging health care workers to seek assistance when needed. It’s critical this program is fully funded to continue this important work. The AHA supports funding of at least $45 million for the Preventing Burnout in the Health Workforce Program.Children’s Hospitals Graduate Medical Education (CHGME). The CHGME program supports graduate medical education programs at children’s hospitals that train resident physicians. The purpose of the program is to provide 59 independent children’s hospitals in more than 30 states and territories with funds to train pediatricians and pediatric specialists. Freestanding children’s hospitals typically treat very few Medicare patients and, therefore, do not receive Medicare funding to support medical training of residents; the CHGME program helps fill this need. In addition to teaching the next generation of physicians, these hospitals provide lifesaving care to many children with complex medical needs. Currently, CHGME hospitals train 56% of the nation’s pediatricians and 54% of the pediatric specialists who care for children living in all 50 states. Unlike Medicare’s GME program, CHGME is funded through annual appropriations. The AHA supports funding the CHGME program in FY 2025 at $758 million.Rural Health Programs. Rural hospitals provide essential care in local communities. Critical programs such as the Rural Communities Opioids Response Program, Medicare Rural Hospital Flexibility Grant Program, Rural Outreach Grants, State Offices of Rural Health, Rural Telehealth and other health care programs support rural hospitals at-risk of imminent closure, expanding needed service lines at rural hospitals and workforce training in rural communities. They are vital to ensuring that needed services remain available to rural patients. The AHA supports funding these programs at least at the FY 2024 enacted levels of $364.6 million.Disaster/Emergency Preparedness. When disaster strikes, people turn to hospitals for help. Congress recognized that role when it created the Hospital Preparedness Program (HPP), the primary federal funding mechanism for health care emergency preparedness. Since 2002, the HPP has provided critical funding and other resources to states and other jurisdictions to use in aiding hospitals’ response to a wide range of emergencies. The HPP has allowed for enhanced planning and response; improved integration of public and private sector emergency planning to increase the preparedness, response and surge capacity of hospitals; and improved state and local infrastructures to help health systems and hospitals prepare for public health emergencies.However, funding for the HPP has not kept pace with the ever-changing and growing threats faced by hospitals, health systems and their communities. Furthermore, in recent years, hospitals have received only a fraction of the HPP funds. In particular, the vast majority of HPP funds supports the sub-state Health Care Coalitions (HCCs) — regional collaborations between health care organizations, emergency management, public health agencies and other private partners. The AHA urges Congress to provide significantly more funding.Annual appropriations have declined significantly since the program began. Federal HPP appropriations dropped from a high of $515 million in FYs 2003 and 2004, to a low of $255 million for FYs 2014 through 2017. While appropriations for the program have increased slightly over the last four years, with level funding of $305 million in appropriations for FY 2024, overall, HPP appropriations have fallen dramatically.The AHA urges Congress to substantially increase funding over last year’s enacted level for the HPP to ensure that the health care infrastructure is ready to respond to future crises. At a minimum, we ask the committee to double the funding of the program to $610 million for FY 2025. Funding should reflect a more appropriate level of investment in emergency preparedness to ensure sufficient preparedness, response and surge capacity of hospitals as well as improved state and local infrastructures to help health systems and hospitals prepare for public health emergencies.Centers for Disease Control and Prevention. The CDC is a vital partner to hospitals, patients and other health care providers in the prevention and monitoring of disease and emergency preparedness. Much of the research from CDC demonstrates the value of prevention activities in averting health care crises, resulting in savings to Medicare, Medicaid and other health care programs. The AHA supports additional funding for the CDC over last year’s enacted level.Social Determinants Accelerator Plans. The CDC supports Social Determinants of Health Accelerator Plans, which help state and local governments develop strategies to address the health and social needs of targeted populations. The AHA supports funding the program at $6 million in FY 2025 to continue to expand social determinant of health efforts by funding another round of Accelerator Plans to states, tribes, territories and/or localities to develop or enhance existing plans and support sustained funding for program implementation, evaluation, research and data collection efforts.Public Health and Other Health Care Programs. The AHA urges increased funding over current levels for the following programs.<ul><li>Maternal and Child Health Block Grant (MCHBG). The Title V MCHBG is a funding source used to address the most critical, pressing and unique needs of maternal and child health populations in each state, territory and jurisdiction of the United States. The program helps states assure access to quality maternal and child health care services, especially for those with low incomes or who have limited access to care. The MCHBG program supports the State MCHBG program, Special Projects of Regional and National Significance, and Community Integrated Service Systems grants. According to data gathered by HRSA, the State MCHBG Program supports approximately 93% of pregnant women, 99% of infants and 61% of children. Improving maternal and child health is a major priority for the AHA. The AHA supports $1 billion for the Title V MCHBG in FY 2025.</li><li>Healthy Start Program. The Healthy Start program provides support for high-risk pregnant women, infants and families in communities with exceptionally high rates of infant mortality, including health care services, such as those focused on reducing maternal mortality, as well as the socioeconomic factors of poverty, education and access to care. The AHA supports $185 million in funding for FY 2025.</li><li>Emergency Medical Services for Children. This valuable program is designed to provide specialized emergency care for children through improved availability of child appropriate equipment in ambulances and emergency departments. In addition, the program supports training programs to prevent injuries to children and to educate emergency medical technicians, paramedics and other emergency medical care providers. The AHA supports $28 million in funding for FY 2025.</li><li>Substance Use and Mental Health Services Administration (SAMHSA). Providing adequate substance use and mental health services are essential to increasing productivity and economic well-being for individuals, families and communities. The AHA requests $8.1 billion for SAMHSA, in line with the President’s FY 2025 budget proposal.</li><li>Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR). The STAR Program provides for the repayment of education loans for individuals working in a full-time substance use disorder treatment job that involves direct patient care in either a Mental Health Professional Shortage Area or a county where the overdose death rate exceeds the national average. AHA requests $50 million, a $10 million dollar increase over FY 2024 enacted.</li><li>Funding to Support Behavioral Health Providers Health Information Technology (HIT). Behavioral health providers were excluded from the Health Information Technology for Economic and Clinical Health (HITECH) Act back in 2009, a bill that incentivized electronic health record (EHR) adoption with payments for providers who participate in the Medicare and Medicaid Promoting Interoperability Programs. As a result, many behavioral health providers are behind in their ability to incorporate HIT in their workflows. In addition to this financial pressure, the nature of behavioral health records — that is, that they are often narratives or follow different structures than physical health records — as well as conflicting regulatory requirements regarding information sharing has led to far lower adoption of EHRs by providers of behavioral health services and in psychiatric hospitals, as compared to general acute care providers and hospitals. AHA supports$1.0 billion in funding to enhance HIT adoption and engagement for behavioral health providers.</li></ul>Office of Minority Health. The AHA supports $86 million for FY 2025 for the Office of Minority Health within HHS.The National Institute on Minority Health and Health Disparities. Eliminating health disparities and promoting health equity are essential to improving the overall health status of Americans and reducing health care costs. The National Institute on Minority Health and Health Disparities (NIMHD) leads scientific research to improve minority health and eliminate health disparities. Given the role of the institute in coordinating research of the other institutes and centers, and the disproportionate burden of certain diseases, including chronic conditions, on historically marginalized communities, the AHA supports $576 million for NIMHD in FY 2025, a $52 million increase from the FY 2024 enacted level. We urge the committee to invest in efforts to close gaps in health and health care by increasing funding for health disparities research and activities at NIMHD and supporting the training of a more diverse research workforce.Unique Patient Identifier (UPI). The AHA supports adoption of a UPI. Removing the prohibition on the use of federal funds to promulgate or adopt a national UPI would provide HHS the ability to explore solutions that accurately identify patients and link them with their correct medical records. America’s hospitals and health systems are committed to ensuring the highest quality care in a timely manner. Funding for a UPI would promote safe, efficient and timely care for patients while reducing administrative costs. We look forward to working with you to ensure appropriate patient identification methods.The AHA appreciates and is grateful for the support you have provided to vital health care programs, and we hope the committee will continue to support these funding priorities in FY 2025. We look forward to working with you.Sincerely, /s/ Stacey Hughes Executive Vice President&nbsp; Mon, 13 May 2024 14:16:49 -0500 Appropriations AHA Letter to Senate Subcommittee Leadership on Appropriations Priorities for FY 2025 /lettercomment/2024-05-13-aha-letter-senate-subcommittee-leadership-appropriations-priorities-fy-2025 <table><tbody><tr><td>The Honorable Tammy Baldwin Chair United States Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Committee on Appropriations Washington, DC 20510 &nbsp;</td><td>The Honorable Shelley Moore Capito Ranking Member United States Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Committee on Appropriations Washington, DC 20510 &nbsp;</td></tr></tbody></table>Dear Chair Baldwin and Ranking Member Capito:On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinical partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes regarding funding for health care programs for fiscal year (FY) 2025.America’s hospitals are facing many challenges, and we appreciate you considering the effect your decisions have on hospitals’ ability to provide care to their patients and communities. We ask you to consider funding for health care programs that have proven successful in improving access to quality health care for patients and communities across America. As you prioritize your FY 2025 appropriations measures, we ask that you include the following programs.Strengthening the Health Care Workforce. Long-developing structural changes in the health care workforce have left hospitals and health systems, including post-acute and behavioral health care providers, facing a national staffing emergency that could jeopardize access to high-quality care for patients and the communities they serve. Hospitals face significant challenges making it difficult to sustain, build and retain the health care workforce. The National Council of State Boards of Nursing’s 2022 National Workforce Study reveals 100,000 nurses left the workforce during the pandemic and by 2027, almost 900,000 intend to leave the workforce due to stress, burnout and retirement.1&nbsp;Hospitals face similar demographic trends for physicians, with data from the Association of American Medical Colleges indicating that one-third of practicing physicians will reach retirement age over the next decade. Hospitals also report significant shortages of allied health and behavioral health professionals. Congress must support efforts to ensure an adequate, sustainable health care workforce.Health Professions Education and Workforce Challenges. The AHA supports $1.51 billion for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs for FY 2025. The workforce crisis facing our nation necessitates bold increases in HRSA discretionary programs that address workforce challenges.<ul><li>Nursing Workforce Development Under Title VIII of the Public Health Service Act. The Nursing Workforce Development programs support nursing education, seek to further diversify the nursing profession, and improve access in rural and underserved communities. Nurses are integral members of the health care team. Each year, nursing schools must deny admission to thousands of potential students because they do not have enough faculty to teach these aspiring professionals.The AHA also supports $210 million for the National Institute of Nursing Research, one of 27 institutes of the National Institutes of Health.</li><li>Primary Care Medicine, Pediatric Subspecialty Loan Repayment, Substance Use Disorder Treatment and Recovery Loan Repayment Program and Oral Health Training programs. These programs improve health care access and quality in underserved areas by training general internists, family medicine practitioners, general pediatricians, pediatric subspecialists, oral health providers, physician assistants and expanding behavioral health services. The AHA supports additional funding over last year’s enacted level for these programs.</li><li>Health Professions Programs. An adequate, diverse and well-distributed supply of health care professionals, including allied health care workers, is indispensable to our nation’s health care infrastructure. Health professions programs support recruitment of individuals into the allied health profession to help address the challenges rural and underserved communities face accessing primary care providers. Our nation must act now to maintain a vibrant workforce by strengthening nursing and medical educational programs. Without decisive intervention, the looming workforce shortages threaten hospitals’ ability to care for patients and communities. Title VII programs help patients and communities by playing an essential role in improving the diversity of the health care workforce and connecting students to health careers by supporting recruitment, education, training and mentorship opportunities. Inclusive and diverse education and training experiences expose providers to backgrounds and perspectives other than their own and heightens cultural awareness in health care, resulting in benefits for all patients. Evidence shows that concordance between patients and providers results in better health outcomes.</li><li>National Health Service Corps (NHSC). The NHSC awards scholarships to health professions students and assists graduates of health professions programs with loan repayment in return for an obligation to provide health care services in underserved rural and urban areas. The AHA supports $210 million in discretionary funding for the NHSC. The AHA also believes substantial mandatory funding is also a necessary investment in this critical program.</li></ul>Centers of Excellence and the Health Careers Opportunity Programs. These programs focus on recruiting and retaining minorities into health professions to build a more diverse health care workforce. The Centers of Excellence grants strengthen the national capacity to train students from minority groups that are underrepresented in allopathic and osteopathic medicine, dentistry and pharmacy, and behavioral or mental health. The Health Careers Opportunity program provides support for increasing the number of individuals from disadvantaged backgrounds in the health and allied health professions. The AHA supports these programs.Preventing Burnout in the Health Workforce Program. For decades, health care professionals have faced greater rates of mental and behavioral health conditions, suicide and burnout than other professions while fearing the stigma and potential career repercussions of seeking care. The COVID-19 pandemic exacerbated the already-present issues of stress, depression, anxiety and other mental health issues experienced by health care providers.The Dr. Lorna Breen Health Care Provider Protection Act addresses this mental health crisis among our nation’s healers. The law is intended to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care providers. The act authorized grants to health care providers to establish programs that offer behavioral health services for front-line workers, requires the Department of Health and Human Services (HHS) to study and develop recommendations on strategies to address provider burnout and facilitate resiliency, and directs the Centers for Disease Control (CDC) to launch a campaign encouraging health care workers to seek assistance when needed. It’s critical this program is fully funded to continue this important work. The AHA supports funding of at least $45 million for the Preventing Burnout in the Health Workforce Program.Children’s Hospitals Graduate Medical Education (CHGME). The CHGME program supports graduate medical education programs at children’s hospitals that train resident physicians. The purpose of the program is to provide 59 independent children’s hospitals in more than 30 states and territories with funds to train pediatricians and pediatric specialists. Freestanding children’s hospitals typically treat very few Medicare patients and, therefore, do not receive Medicare funding to support medical training of residents; the CHGME program helps fill this need. In addition to teaching the next generation of physicians, these hospitals provide lifesaving care to many children with complex medical needs. Currently, CHGME hospitals train 56% of the nation’s pediatricians and 54% of the pediatric specialists who care for children living in all 50 states. Unlike Medicare’s GME program, CHGME is funded through annual appropriations. The AHA supports funding the CHGME program in FY 2025 at $758 million.Rural Health Programs. Rural hospitals provide essential care in local communities. Critical programs such as the Rural Communities Opioids Response Program, Medicare Rural Hospital Flexibility Grant Program, Rural Outreach Grants, State Offices of Rural Health, Rural Telehealth and other health care programs support rural hospitals at-risk of imminent closure, expanding needed service lines at rural hospitals and workforce training in rural communities. They are vital to ensuring that needed services remain available to rural patients. The AHA supports funding these programs at least at the FY 2024 enacted levels of $364.6 million.Disaster/Emergency Preparedness. When disaster strikes, people turn to hospitals for help. Congress recognized that role when it created the Hospital Preparedness Program (HPP), the primary federal funding mechanism for health care emergency preparedness. Since 2002, the HPP has provided critical funding and other resources to states and other jurisdictions to use in aiding hospitals’ response to a wide range of emergencies. The HPP has allowed for enhanced planning and response; improved integration of public and private sector emergency planning to increase the preparedness, response and surge capacity of hospitals; and improved state and local infrastructures to help health systems and hospitals prepare for public health emergencies.However, funding for the HPP has not kept pace with the ever-changing and growing threats faced by hospitals, health systems and their communities. Furthermore, in recent years, hospitals have received only a fraction of the HPP funds. In particular, the vast majority of HPP funds supports the sub-state Health Care Coalitions (HCCs) — regional collaborations between health care organizations, emergency management, public health agencies and other private partners. The AHA urges Congress to provide significantly more funding.Annual appropriations have declined significantly since the program began. Federal HPP appropriations dropped from a high of $515 million in FYs 2003 and 2004, to a low of $255 million for FYs 2014 through 2017. While appropriations for the program have increased slightly over the last four years, with level funding of $305 million in appropriations for FY 2024, overall, HPP appropriations have fallen dramatically.The AHA urges Congress to substantially increase funding over last year’s enacted level for the HPP to ensure that the health care infrastructure is ready to respond to future crises. At a minimum, we ask the committee to double the funding of the program to $610 million for FY 2025. Funding should reflect a more appropriate level of investment in emergency preparedness to ensure sufficient preparedness, response and surge capacity of hospitals as well as improved state and local infrastructures to help health systems and hospitals prepare for public health emergencies.Centers for Disease Control and Prevention. The CDC is a vital partner to hospitals, patients and other health care providers in the prevention and monitoring of disease and emergency preparedness. Much of the research from CDC demonstrates the value of prevention activities in averting health care crises, resulting in savings to Medicare, Medicaid and other health care programs. The AHA supports additional funding for the CDC over last year’s enacted level.Social Determinants Accelerator Plans. The CDC supports Social Determinants of Health Accelerator Plans, which help state and local governments develop strategies to address the health and social needs of targeted populations. The AHA supports funding the program at $6 million in FY 2025 to continue to expand social determinant of health efforts by funding another round of Accelerator Plans to states, tribes, territories and/or localities to develop or enhance existing plans and support sustained funding for program implementation, evaluation, research and data collection efforts.Public Health and Other Health Care Programs. The AHA urges increased funding over current levels for the following programs.<ul><li>Maternal and Child Health Block Grant (MCHBG). The Title V MCHBG is a funding source used to address the most critical, pressing and unique needs of maternal and child health populations in each state, territory and jurisdiction of the United States. The program helps states assure access to quality maternal and child health care services, especially for those with low incomes or who have limited access to care. The MCHBG program supports the State MCHBG program, Special Projects of Regional and National Significance, and Community Integrated Service Systems grants. According to data gathered by HRSA, the State MCHBG Program supports approximately 93% of pregnant women, 99% of infants and 61% of children. Improving maternal and child health is a major priority for the AHA. The AHA supports $1 billion for the Title V MCHBG in FY 2025.</li><li>Healthy Start Program. The Healthy Start program provides support for high-risk pregnant women, infants and families in communities with exceptionally high rates of infant mortality, including health care services, such as those focused on reducing maternal mortality, as well as the socioeconomic factors of poverty, education and access to care. The AHA supports $185 million in funding for FY 2025.</li><li>Emergency Medical Services for Children. This valuable program is designed to provide specialized emergency care for children through improved availability of child appropriate equipment in ambulances and emergency departments. In addition, the program supports training programs to prevent injuries to children and to educate emergency medical technicians, paramedics and other emergency medical care providers. The AHA supports $28 million in funding for FY 2025.</li><li>Substance Use and Mental Health Services Administration (SAMHSA). Providing adequate substance use and mental health services are essential to increasing productivity and economic well-being for individuals, families and communities. The AHA requests $8.1 billion for SAMHSA, in line with the President’s FY 2025 budget proposal.</li><li>Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR). The STAR Program provides for the repayment of education loans for individuals working in a full-time substance use disorder treatment job that involves direct patient care in either a Mental Health Professional Shortage Area or a county where the overdose death rate exceeds the national average. AHA requests $50 million, a $10 million dollar increase over FY 2024 enacted.</li><li>Funding to Support Behavioral Health Providers Health Information Technology (HIT). Behavioral health providers were excluded from the Health Information Technology for Economic and Clinical Health (HITECH) Act back in 2009, a bill that incentivized electronic health record (EHR) adoption with payments for providers who participate in the Medicare and Medicaid Promoting Interoperability Programs. As a result, many behavioral health providers are behind in their ability to incorporate HIT in their workflows. In addition to this financial pressure, the nature of behavioral health records — that is, that they are often narratives or follow different structures than physical health records — as well as conflicting regulatory requirements regarding information sharing has led to far lower adoption of EHRs by providers of behavioral health services and in psychiatric hospitals, as compared to general acute care providers and hospitals. AHA supports$1.0 billion in funding to enhance HIT adoption and engagement for behavioral health providers.</li></ul>Office of Minority Health. The AHA supports $86 million for FY 2025 for the Office of Minority Health within HHS.The National Institute on Minority Health and Health Disparities. Eliminating health disparities and promoting health equity are essential to improving the overall health status of Americans and reducing health care costs. The National Institute on Minority Health and Health Disparities (NIMHD) leads scientific research to improve minority health and eliminate health disparities. Given the role of the institute in coordinating research of the other institutes and centers, and the disproportionate burden of certain diseases, including chronic conditions, on historically marginalized communities, the AHA supports $576 million for NIMHD in FY 2025, a $52 million increase from the FY 2024 enacted level. We urge the committee to invest in efforts to close gaps in health and health care by increasing funding for health disparities research and activities at NIMHD and supporting the training of a more diverse research workforce.Unique Patient Identifier (UPI). The AHA supports adoption of a UPI. Removing the prohibition on the use of federal funds to promulgate or adopt a national UPI would provide HHS the ability to explore solutions that accurately identify patients and link them with their correct medical records. America’s hospitals and health systems are committed to ensuring the highest quality care in a timely manner. Funding for a UPI would promote safe, efficient and timely care for patients while reducing administrative costs. We look forward to working with you to ensure appropriate patient identification methods.The AHA appreciates and is grateful for the support you have provided to vital health care programs, and we hope the committee will continue to support these funding priorities in FY 2025. We look forward to working with you.Sincerely, /s/ Stacey Hughes Executive Vice President__________1 <a href="https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis" target="_blank" title="NBC Research Project ">https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis</a> Mon, 13 May 2024 13:41:32 -0500 Appropriations House passes omnibus funding HHS and other programs through FY 2024 /news/headline/2024-03-22-house-passes-omnibus-funding-hhs-and-other-programs-through-fy-2024 The House March 22 voted 286-134 to pass the <a href="https://docs.house.gov/billsthisweek/20240318/WDI39597.PDF" target="_blank">Further Consolidated Appropriations Act of 2024</a>, legislation that would fund all remaining federal agencies through Sept. 30. The bipartisan bill includes six appropriations bills, including <a href="/news/headline/2024-03-21-new-omnibus-would-fund-hhs-programs-through-fy-2024" target="_blank">one funding the departments of Labor, Health and Human Services, and Education</a>. The legislation omits other mandatory health extenders previously under discussion, including site-neutral and hospital price transparency provisions. It also would extend through fiscal year 2024 the Conrad 30 waiver program, which waives the foreign residence requirement for physicians holding J-1 visas who agree to stay in the U.S. for three years to practice in federally designated underserved areas; and rescind $4.3 billion in COVID-19 funding from the American Rescue Plan Act that was never obligated. &nbsp; &nbsp; The Senate could consider the legislation as soon as March 22, or passage may occur over the weekend, triggering a short government shutdown. President Biden is expected to sign it into law.&nbsp; Fri, 22 Mar 2024 15:28:35 -0500 Appropriations Appropriations Committees Release Spending Bills and Health Extenders Package <div class="container"><div class="row"><div class="col-md-8">The House and Senate Appropriations Committees March 3 released text of <a href="https://docs.house.gov/billsthisweek/20240304/HMS31169.PDF">six appropriations bills</a> that would fund various agencies of the federal government through the end of the current fiscal year (FY). The House is expected to consider the legislation by March 6, with Senate action following later in the week.&nbsp;The remaining six appropriations bills for fiscal year 2024 — including the Labor, Health and Human Services legislation — are expected to be released in coming weeks and voted on ahead of the March 22 expiration.<div class="panel module-typeC"><div class="panel-heading">Key HighlightsThe health extenders package contains provisions:<ul><li>Preventing cuts in Medicaid Disproportionate Share Hospital payments.</li><li>Extending critical rural Medicare programs.</li><li>Reducing the physician fee schedule cut.</li><li>Providing funding for the National Health Service Corps, Teaching Health Centers Graduate Medical Education (GME) Program and Community Health Centers.</li></ul>The package does not include:<ul><li>Site-neutral hospital cuts.</li><li>Price transparency provisions.</li></ul></div></div><h2>AHA TAKE</h2>The AHA appreciates that Congress’ health care extender package, which was unveiled yesterday, will provide continued relief from Medicaid disproportionate share hospital reductions, extend key programs that support access to care in rural communities, and provide a boost to doctors caring for Medicare patients, among other provisions. We will continue to work with Congress throughout the year to ensure hospitals and health systems have the resources they need to advance health for patients, families and communities.&nbsp;Based on an initial review of the more than 1,000-page package, the following are highlights of provisions that affect hospitals and health systems.<h2>MEDICAID AND MEDICARE</h2>Medicaid DSH Relief. Eliminates the Medicaid DSH cuts for FY 2024 and delays the start of the FY 2025 cuts to Jan. 1, 2025, rather than the current statutory requirement of Oct. 1, 2024. The reductions for FYs 2026 and 2027 remain unchanged.Medicare Rural Extenders.&nbsp;The legislation will extend the Medicare-dependent hospital and enhanced low-volume hospital programs for three months through Dec. 31, 2024. They were set to expire Sept. 30, 2024.Physician Payment.&nbsp;The legislation provides partial relief for Medicare physician reimbursement rates, which under current law and regulatory policy had a 3.4% reduction for this year starting on Jan. 1. Instead, this legislation will increase the statutory conversion factor adjustment from 1.25% — which was passed in the Consolidated Appropriations Act (CAA) of 2023 — to 2.93%, improving the conversion factor by 1.68%. This statutory increase will only be applied for services performed from March 9 to Dec. 31, 2024. Retrospective services from Jan. 1 to March 9 will not be reconciled to the higher adjustment rate, and thus will only have the 1.25% statutory adjustment applied.Extension of the Work Geographic Index Floor under the Medicare Program.&nbsp;The legislation also extends a 1.0 floor on the work Geographic Practice Cost Index (GPCI) through Dec. 31, 2024. This was previously extended in the CAA 2021 and was scheduled to expire at the end of last year.&nbsp;Incentive Payments for Alternative Payment Models.&nbsp;The legislation will extend incentive payments for alternative payment models for an additional year. Specifically, the legislation includes a provision that will extend payments through the calendar year (CY) 2026 payment period, albeit at 1.88%. Last year, incentive payments were reduced to 3% from the historic 5%.&nbsp;<h2>WORKFORCE</h2>Workforce Extenders.&nbsp;The legislation will extend the Community Health Centers, National Health Service Corps, and Teaching Health Centers GME programs through Dec. 31, 2024. They were set to expire March 8, 2024.<h2>BEHAVIORAL HEALTH</h2>The legislation would expand Medicaid coverage for certain types of behavioral health services, particularly for children. It would require state Medicaid plans to cover medication-assisted treatment for opioid use disorder and would add the option for states to cover care in Certified Community Behavioral Health Clinics as well as Institutions of Mental Disease (IMD), regardless of the size of the facility, for up to 30 days per 12-month period. AHA has been a strong&nbsp;<a href="/lettercomment/2023-06-14-aha-comment-letter-reauthorization-support-act">supporter</a> of permanently extending Medicaid coverage for medication assisted treatments and repealing the IMD exclusion.The legislation also calls for states to monitor the prescribing of antipsychotic medications to adults in institutional care settings, home health and community-based settings. Finally, it would require Health and Human Services to issue guidance on integrating behavioral health care services with other medical services under Medicaid and the Children’s Health Insurance Program.<h2>OFFSETS</h2>The health care title includes the following offsets.<ul><li>Medicare Improvement Fund.&nbsp;Reduces balances in the fund by approximately $2.2 billion.&nbsp;</li><li>Medicaid Improvement Fund.&nbsp;Reduces balances in the fund by approximately $5.1 billion.</li><li>Hospice.&nbsp;Extends for one additional year (through 2033), the use of an alternative hospice payment update for the annual update to the hospice aggregate cap. Rather than using the CPI-U for updating the hospice aggregate cap, the alternative methodology uses the inpatient hospital market basket update for that fiscal year, reduced by a productivity factor. This provision saves roughly $930 million.</li><li>Medicare Sequester. Extends the sequester for one month, saving roughly $2.5 billion.</li></ul><h2>OTHER ITEMS OF INTEREST</h2>Site Neutral.&nbsp;The package does not include any site-neutral payment cuts to hospitals.Price Transparency. There are no changes to the current Hospital Price Transparency rule requirements, such as no longer allowing the use of price estimator tools in order to meet the shoppable services portion of the rule, which were part of the Lower Costs, More Transparency Act (H.R. 5378) that passed the House in December.Pandemic and All-Hazards Preparedness Act Provisions. While the Pandemic and All-Hazards Preparedness Act was not reauthorized, the legislation extends through Dec. 31, 2024, funding for certain programs that would otherwise sunset. These include the Assistant Secretary for Preparedness and Response’s direct hire authority for the National Disaster Medical System, the ability for states and tribes to request temporary reassignment of federally funded personnel, three national advisory committees related to preparedness and response and certain authorities related to public-private partnerships under the Biomedical Advanced Research and Development Authority.CMS Quality Measure Endorsement and Pre-rulemaking Input.&nbsp;The legislation provides an additional $9 million through Dec. 31, 2024, to fund CMS’ statutorily-required contract with a consensus-based entity (currently Battelle) that conducts measure endorsement and pre-rulemaking input activities.<h2>APPROPRIATIONS BILLS</h2>The appropriations bills included in this package include the following:<ul><li>Agriculture, Rural Development, Food and Drug Administration and related agencies.</li><li>Commerce, Justice, Science and related agencies.</li><li>Energy and Water Development and related agencies.</li><li>Interior, Environment and related agencies.</li><li>Military Construction, Veterans Affairs and related agencies.</li><li>Transportation and Housing and Urban Development and related agencies.</li></ul><h2>FURTHER QUESTIONS</h2>If you have further questions,&nbsp;please contact AHA at 800-424-4301.&nbsp;</div><div class="col-md-4"> <a href="/system/files/media/file/2024/03/appropriations-committees-release-spending-bills-and-health-extenders-package-bulletin-3-4-2024.pdf" target="_blank" title="Click here to download the Special Bulletin: Appropriations Committees Release Spending Bills and Health Extenders Package"><img src="/sites/default/files/2024-03/cover-appropriations-committees-release-spending-bills-and-health-extenders-package-bulletin-3-4-2024.png" data-entity-uuid data-entity-type="file" alt="Appropriations Committees Release Spending Bills and Health Extenders Package"></a></div></div></div> Mon, 04 Mar 2024 16:11:58 -0600 Appropriations Government Funding Talks Continue, Hospitals and Health Systems Should Monitor Situation <div class="container"> <div class="row"> <div class="col-md-8">There are nine days until the end of the federal fiscal year, and none of the 12 annual appropriations bills necessary to fund the federal government have been enacted. In addition, the House and Senate have been unable to act on a continuing resolution (CR) to temporarily keep the government running, so there is a high probability that the federal government will shut down on Oct. 1. Negotiations are expected to further intensify in the coming weeks. <h2>AHA TAKE</h2> While AHA will continue to monitor the progress of the government funding negotiations, hospital and health systems should know many programs they rely upon will continue operating without interruption. <h2>IMPACT ON HOSPITALS AND HEALTH SYSTEMS</h2> Because Medicare payments to hospitals are mandatory, they are unaffected by a government shutdown. The Centers for Medicare and Medicaid Services (CMS) has indicated Medicare, health care fraud efforts and Center for Medicare &amp; Medicaid Innovation activities will continue during a lapse in federal funding through appropriations. For additional details on the impact on other <a href="https://www.hhs.gov/about/budget/fy-2024-cms-contingency-staffing-plan/index.html" target="_blank">CMS</a> and <a href="https://www.hhs.gov/about/budget/fy-2024-hhs-contingency-staffing-plan/index.html" target="_blank">HHS</a> programs, as well as the impact on CMS and HHS personnel, please refer to the agencies’ contingency plans. <h2>HEALTH EXTENDERS</h2> The authorizations for several important health care programs expire on Sept. 30. These programs include delays of impending Medicaid Disproportionate Share Hospital (DSH) cuts, the authorizations for community health centers, the National Health Service Corps, Children’s Hospitals Graduate Medical Education (GME) and Teaching Health Center GME. Normally, these program authorizations would be extended for the duration of the short-term funding bill. Final legislation addressing these authorizations would be enacted with the last appropriations bill for the fiscal year. In the absence of a CR, these authorizations will have to be extended on a different legislative vehicle, or they will temporarily expire. With respect to the waiver of impending Medicaid DSH payments, many states will not make DSH cuts, if they are not addressed by Congress on Oct. 1 or on a CR, until near the end of 2023. However, this decision is made by each state’s Medicaid agency and some states may impose the cuts on their own schedule. <h2>BACKGROUND AND ADDITIONAL DETAILS</h2> The Federal government has seen three long shutdowns. 2018-2019: A 35-day partial government shutdown occurred from Dec. 22, 2018, to Jan. 25, 2019, because of a dispute over funding for border security. During the shutdown, the Department of Health and Human Services (HHS) continued to operate as its funding had been previously enacted. The government reopened with full-year funding adopted for all remaining departments and agencies in February 2019. 2013: A 17-day full government shutdown unfolded from Oct. 1-17, 2013, because of a dispute over defunding the Affordable Care Act. Congress passed full-year spending for all departments and agencies in January 2014. 1995-1996: A 21-day partial government shutdown occurred from Dec. 15, 1995, through Jan. 6, 1996, during a confrontation over balancing the budget. The partial shutdown affected HHS. Congress and the administration negotiated full-year funding for all affected departments in March 1996. <h2>FURTHER QUESTIONS</h2> If you have further questions, contact Mary Naylor, AHA’s senior director of federal relations and operations, at <a href="http://mailto:mnaylor@aha.org" target="_blank">mnaylor@aha.org</a>. </div> <div class="col-md-4"> <a href="/system/files/media/file/2023/09/government-funding-talks-continue-hospitals-and-health-systems-should-monitor-situation-advisory-9-22-23.pdf" target="_blank"><img alt="Government Funding Talks Continue, Hospitals and Health Systems Should Monitor Situation" data-entity-type="file" data-entity-uuid="0842b648-d26b-41cd-b57d-c25fe0ca469f" src="/sites/default/files/inline-images/cover-government-funding-talks-continue-hospitals-and-health-systems-should-monitor-situation-advisory-9-22-23.png" width="489" height="632"></a> </div> </div> </div> Fri, 22 Sep 2023 08:31:35 -0500 Appropriations Senate committee passes HHS appropriations bill for FY 2024 /news/headline/2023-07-27-senate-committee-passes-hhs-appropriations-bill-fy-2024 The Senate Appropriations Committee today voted 26-2 to approve legislation that would provide $224.4 billion in funding for the departments of Labor, Health and Human Services, and Education in fiscal year 2024, a 7% cut below the prior fiscal year. Most details about the bill were not immediately available. According to a committee <a href="https://www.appropriations.senate.gov/news/majority/bill-summary-labor-health-and-human-services-education-and-related-agencies-fiscal-year-2024-appropriations-bill" target="_blank">summary</a>, the bill would provide $117 billion for HHS, $7.2 billion less than the FY 2023 enacted level. Specific levels include:&nbsp; <ul> <li>$47.8 billion, or $943 million more for the National Institutes of Health, including $100 million more for mental health research; &nbsp;</li> <li>Over $5 billion for opioid treatment and prevention, a more than $125 million increase over FY 2023; and</li> <li>$172 million for the Behavioral Health Workforce Education and Training Program, a $19 million increase over FY 2023, to expand community-based clinical training and for repayment of education loans for individuals working in either a Mental Health Professional Shortage Area or where the overdose death rate exceeds the national average. &nbsp;</li> </ul> It is unclear how this legislation will proceed through the legislative process, given vastly different topline funding levels under consideration in the Senate and House, which has yet to advance its version of this legislation through the full House Appropriations Committee. Thu, 27 Jul 2023 15:24:37 -0500 Appropriations AHA Letter to Senate Leadership Regarding Funding for Health Care Programs for Fiscal Year 2024 /lettercomment/2023-05-09-aha-letter-senate-leadership-regarding-funding-health-care-programs-fiscal-year-2024 May 9, 2023 <table border="0" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>The Honorable Tammy Baldwin Chairman United States Senate Subcommittee on Labor, Health and Human &nbsp;&nbsp;Services, Education, and Related Agencies Committee on Appropriations Washington, DC 20510</td> <td>The Honorable Shelley Moore Capito Ranking Member United States Senate Subcommittee on Labor, Health and Human &nbsp;&nbsp;Services, Education, and Related Agencies Committee on Appropriations Washington, DC 20510</td> </tr> </tbody> </table> Dear Chair Baldwin and Ranking Member Capito: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinical partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes regarding funding for health care programs for fiscal year (FY) 2024. America’s hospitals are facing many challenges and we appreciate you considering the effect your decisions have on hospitals’ ability to provide care to their patients and communities. We ask you to give favorable consideration to funding for health care programs that have proven successful in improving access to quality health care for patients and communities across America. As you prioritize your FY 2024 appropriations measures, we ask that you include the following programs. Strengthening the Health Care Workforce. Long building structural changes in the health care workforce, combined with the profound toll of the COVID-19 pandemic, have left hospitals and health systems, including post-acute and behavioral health care providers, facing a national staffing emergency that could jeopardize access to high-quality care for patients and the communities they serve. Prior to the COVID-19 pandemic, hospitals were already facing significant challenges that were making it difficult to sustain, build and retain the health care workforce. In 2017, the majority of our nursing workforce was close to retirement, with more than half aged 50 and older, and almost 30% aged 60 and older. Yet, nursing schools had to turn away over 90,000 qualified applicants in 2021, according to the American Association of Colleges of Nursing, due to lack of faculty and training sites. The National Council of State Boards of Nursing’s 2022 National Workforce Study reveals 100,000 nurses left the workforce during the pandemic and by 2027, almost 900,000 intend to leave the workforce due to stress, burnout and retirement. 1 Hospitals faced similar demographic trends for physicians, with data from the Association of American Medical Colleges indicating that one-third of practicing physicians will reach retirement age over the next decade. Hospitals also were reporting significant shortages of allied health and behavioral health professionals. Congress must support efforts to ensure an adequate, sustainable health care workforce. Health Professions Education and Workforce Challenges. The AHA supports $1.51 billion for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs for FY 2024. The workforce crisis facing our nation necessitates bold increases in HRSA discretionary programs that address workforce challenges: <ul> <li>Nursing Workforce Development under Title VIII of the Public Health Service Act. The Nursing Workforce Development programs support nursing education, seek to further diversify the nursing profession, and improve access in rural and underserved communities. Nurses are integral members of the health care team. Each year, nursing schools must deny admission to thousands of potential students because they do not have enough faculty to teach these aspiring professionals. The COVID-19 pandemic heightened the nursing shortage our country was already facing. It is imperative that funding for these programs reflects the heightened needs of our communities. The AHA also supports $210 million for the National Institute of Nursing Research, one of 27 institutes of the National Institutes of Health. &nbsp;</li> <li>Primary Care Medicine, Pediatric Subspecialty Loan Repayment, Substance Use Disorder Treatment and Recovery Loan Repayment Program and Oral Health Training programs. These programs improve health care access and quality in underserved areas by training general internists, family medicine practitioners, general pediatricians, pediatric subspecialists, oral health providers, physician assistants and expanding behavioral health services. The AHA supports additional funding over last year’s enacted level for these important programs. &nbsp;</li> <li>Health Professions Programs. An adequate, diverse and well-distributed supply of health care professionals, including allied health care workers, is indispensable to our nation’s health care infrastructure. Health professions programs help address the challenges rural and underserved communities face accessing primary care providers by supporting recruitment of individuals into the allied health professions. Our nation must act now to maintain a vibrant workforce by strengthening nursing and medical educational programs. Without decisive intervention, the looming workforce shortages threaten hospitals’ ability to care for patients and communities. Title VII programs help patients and communities by playing an essential role in improving the diversity of the health care workforce and connecting students to health careers by supporting recruitment, education, training and mentorship opportunities. Inclusive and diverse education and training experiences expose providers to backgrounds and perspectives other than their own and heightens cultural awareness in health care, resulting in benefits for all patients. Evidence shows that concordance between patients and providers results in better health outcomes. &nbsp;</li> <li>National Health Service Corps (NHSC). The NHSC awards scholarships to health professions students and assists graduates of health professions programs with loan repayment in return for an obligation to provide health care services in underserved rural and urban areas. The AHA supports $210 million in discretionary funding for the NHSC. The AHA also believes substantial mandatory funding is also a necessary investment in this critical program.</li> </ul> Centers of Excellence and the Health Careers Opportunity Programs. These programs focus on recruiting and retaining minorities into the health professions to build a more diverse health care workforce. The Centers of Excellence grants strengthen the national capacity to train students from minority groups that are underrepresented in allopathic and osteopathic medicine, dentistry, and pharmacy, and behavioral or mental health. The Health Careers Opportunity program provides support for increasing the number of individuals from disadvantaged backgrounds in the health and allied health professions, and the AHA supports these programs. Preventing Burnout in the Health Workforce Program. For decades, health care professionals have faced greater rates of mental and behavioral health conditions, suicide, and burnout than other professions while fearing the stigma and potential career repercussions of seeking care. The COVID-19 pandemic exacerbated the already-present issues of stress, depression, anxiety, and other mental health issues experienced by health care providers. President Biden signed into law the Dr. Lorna Breen Health Care Provider Protection Act, legislation the AHA supported, which aims to address this mental health crisis among our nation’s healers. Named in honor of Dr. Lorna Breen, a physician from Charlottesville, Va., who worked on the front lines of the pandemic in New York and died by suicide in spring of 2020, the law is intended to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care providers. The legislation authorized grants to health care providers to establish programs that offer behavioral health services for front-line workers, requires the Department of Health and Human Services (HHS) to study and develop recommendations on strategies to address provider burnout and facilitate resiliency, and directs the Centers for Disease Control (CDC) to launch a campaign encouraging health care workers to seek assistance when needed. It’s critical this program is fully funded in order to continue this important work. The AHA supports $45 million for the Preventing Burnout in the Health Workforce Program at HRSA. Children’s Hospitals Graduate Medical Education (CHGME). The CHGME program supports graduate medical education programs at children’s hospitals that train resident physicians. The purpose of the program is to provide 59 independent children’s hospitals in more than 30 states and territories with funds to train pediatricians and pediatric specialists. Freestanding children’s hospitals typically treat very few Medicare patients and, therefore, do not receive Medicare funding to support medical training of residents; the CHGME program helps fill this need. In addition to teaching the next generation of physicians, these hospitals provide lifesaving care to many children with complex medical needs. Currently, CHGME hospitals train 56% of the nation’s pediatricians and 54% of the pediatric specialists who care for children living in all 50 states. Unlike Medicare’s GME program, CHGME is funded through annual appropriations. The program has enjoyed broad congressional support since its inception. Providing increased funding for pediatric workforce training programs is even more important as we respond to the effects of COVID-19 on children. The AHA supports funding the CHGME program in FY 2024 at $738 million. Rural Health Programs. Rural health programs — such as the Rural Communities Opioids Response Program, Medicare Rural Hospital Flexibility Grant Program, Rural Outreach Grants, State Offices of Rural Health, Rural Telehealth, and other health care programs to support rural hospitals at-risk of imminent closure, expanding needed service lines at rural hospitals and workforce training in rural communities — are vital to ensuring that needed services remain available in America’s rural communities. The AHA urges the committee to support funding these programs at $416 million, an increase of $63 million over the FY 2023 enacted levels. We also urge Congress to support funding to continue HRSA’s Rural Emergency Hospital Technical Assistance Program, to support rural hospitals who are making the transition and those who have converted to maintain critical services for their communities. Disaster/Emergency Preparedness. When disaster strikes, people turn to hospitals for help. Congress recognized that role when it created the Hospital Preparedness Program (HPP), the primary federal funding mechanism for health care emergency preparedness. Since 2002, the HPP has provided critical funding and other resources to states and other jurisdictions to use in aiding hospitals’ response to a wide range of emergencies. The HPP has allowed for enhanced planning and response; improved integration of public and private sector emergency planning to increase the preparedness, response, and surge capacity of hospitals; and improved state and local infrastructures to help health systems and hospitals prepare for public health emergencies. However, funding for the HPP has not kept pace with the ever-changing and growing threats faced by hospitals, health systems and their communities. Furthermore, in recent years, hospitals have received only a fraction of the HPP funds. In particular, the vast majority of HPP funds (nearly 80% in FY 2023) supports the sub-state Health Care Coalitions (HCCs) – regional collaborations between health care organizations, emergency management, public health agencies and other private partners. As the COVID-19 pandemic made clear, our health care system needs far more assistance during a national crisis. To address these concerns, the AHA urges Congress to provide significantly more funding. Annual appropriations have declined significantly since the program began. Federal HPP appropriations dropped from a high of $515 million in FYs 2003 and 2004, to a low of $255 million for FYs 2014 through 2017. While appropriations for the program have increased slightly over the last four years, with $305 million in appropriations for FY 2023, overall, HPP appropriations have fallen dramatically. The AHA urges Congress to substantially increase funding over last year’s enacted level for the HPP to ensure that the health care infrastructure is ready to respond to future crises. At a minimum, we ask the Committee to double the funding of the program to $610 million for FY 2024. Funding should reflect a more appropriate level of investment in emergency preparedness, especially in light of the COVID-19 pandemic that has ravaged our hospitals, health systems and communities, as well as the growing threats from natural disasters and other emergencies. Centers for Disease Control and Prevention. The CDC is a vital partner to hospitals, patients and other health care providers in the prevention and monitoring of disease and emergency preparedness. Much of the research from CDC demonstrates the value of prevention activities in averting health care crises, resulting in savings to Medicare, Medicaid, and other health care programs. The AHA supports additional funding for the CDC over last year’s enacted level. Social Determinants Accelerator Plans. The Consolidated Appropriations Act of 2023 provided $8 million in funding for the CDC to support Social Determinants of Health Accelerator Plans, which will help state and local governments develop strategies to address the health and social needs of targeted populations. The AHA supports funding the program at $100 million in FY 2024 to continue to expand social determinant of health (SDOH) efforts by funding another round of Accelerator Plans to states, tribes, territories and/or localities to develop or enhance existing plans and support sustained funding for program implementation, evaluation, research and data collection efforts. Public Health and Other Health Care Programs. The AHA urges increased funding over current levels for the following programs. <ul> <li>Maternal and Child Health Block Grant (MCHBG). The Title V MCHBG is a funding source used to address the most critical, pressing, and unique needs of maternal and child health populations in each state, territory and jurisdiction of the United States. The program helps states assure access to quality maternal and child health care services, especially for those with low incomes or who have limited access to care. The MCH Block Grant program supports the State MCH Block Grant program, Special Projects of Regional and National Significance and Community Integrated Service Systems grants. According to data gathered by HRSA, the State MCH Block Grant Program supports approximately 92% of pregnant women, 98% of infants, and 58% of children. Improving maternal and child health is a major priority for the AHA. The AHA supports $1 billion for the Title V MCHBG in FY 2024. &nbsp;</li> <li>Healthy Start Program. The Healthy Start program provides support for high-risk pregnant women, infants and families in communities with exceptionally high rates of infant mortality, including health care services, such as those focused on reducing maternal mortality, as well as the socioeconomic factors of poverty, education and access to care. The AHA supports $185 million in funding for FY 2024. &nbsp;</li> <li>Emergency Medical Services for Children. This valuable program is designed to provide specialized emergency care for children through improved availability of child appropriate equipment in ambulances and emergency departments. In addition, the program supports training programs to prevent injuries to children and to educate emergency medical technicians, paramedics, and other emergency medical care providers. The AHA supports $28 million in funding for FY 2024. &nbsp;</li> <li>Substance Use and Mental Health Services Administration (SAMHSA). Providing adequate substance use and mental health services are essential to increasing productivity and economic well-being for individuals, families and communities. The AHA supports the $10.8 billion for SAMHSA, an increase of $3.3 billion above FY 2023 enacted.</li> </ul> Office of Minority Health. The AHA supports $86 million for FY 2024 for the Office of Minority Health within HHS. The National Institute on Minority Health and Health Disparities. Eliminating health disparities and promoting health equity are essential to improving the overall health status of Americans and reducing health care costs. The National Institute on Minority Health and Health Disparities (NIMHD) leads scientific research to improve minority health and eliminate health disparities. Given the role of the Institute in coordinating research of the other institutes and centers, and the outsized impact of COVID-19 on historically marginalized communities, the AHA supports $660 million for NIMHD in FY 2024, a $135 million increase from the FY 2023 enacted level. We urge the Committee to invest in efforts to close gaps in health and health care by increasing funding for health disparities research and activities at NIMHD and supporting the training of a more diverse research workforce. Unique Patient Identifier (UPI). The AHA supports adoption of a UPI. Removing the prohibition on the use of federal funds to promulgate or adopt a national UPI would provide HHS the ability to explore solutions that accurately identify patients and link them with their correct medical records. The AHA was pleased with the removal of the ban from initial drafts of previous bills in the House and Senate and encourages the Committee to allow funding for this critical issue. America’s hospitals and health systems are committed to ensuring the highest quality care in a timely manner. Funding for a UPI would promote safe, efficient and timely care for patients while reducing administrative costs. We look forward to working with you to ensure appropriate patient identification methods. The AHA appreciates and is grateful for the support you have provided to vital health care programs, and we hope the Committee will continue to support these funding priorities in FY 2024. We look forward to working with you. Sincerely, /s/ Lisa Kidder Hrobsky Senior Vice President, Advocacy and Political Affairs _________ 1&nbsp;https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis Tue, 09 May 2023 15:35:02 -0500 Appropriations AHA Letter House Leadership Regarding Funding for Health Care Programs for Fiscal Year 2024 /lettercomment/2023-05-09-aha-letter-house-leadership-regarding-funding-health-care-programs-fiscal-year-2024 May 9, 2023 <table border="0" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>The Honorable Robert Aderholt Chairman U.S. House of Representatives Subcommittee on Labor, Health and Human &nbsp;&nbsp;Services, Education, and Related Agencies Committee on Appropriations Washington, DC 20515</td> <td>The Honorable Rosa DeLauro Ranking Member U.S. House of Representatives Subcommittee on Labor, Health and Human &nbsp;&nbsp;Services, Education, and Related Agencies Committee on Appropriations Washington, DC 20515</td> </tr> </tbody> </table> Dear Chairman Aderholt and Ranking Member DeLauro: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinical partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes regarding funding for health care programs for fiscal year (FY) 2024. America’s hospitals are facing many challenges and we appreciate you considering the effect your decisions have on hospitals’ ability to provide care to their patients and communities. We ask you to give favorable consideration to funding for health care programs that have proven successful in improving access to quality health care for patients and communities across America. As you prioritize your FY 2024 appropriations measures, we ask that you include the following programs. Strengthening the Health Care Workforce. Long building structural changes in the health care workforce, combined with the profound toll of the COVID-19 pandemic, have left hospitals and health systems, including post-acute and behavioral health care providers, facing a national staffing emergency that could jeopardize access to high-quality care for patients and the communities they serve. Prior to the COVID-19 pandemic, hospitals were already facing significant challenges that were making it difficult to sustain, build and retain the health care workforce. In 2017, the majority of our nursing workforce was close to retirement, with more than half aged 50 and older, and almost 30% aged 60 and older. Yet, nursing schools had to turn away over 90,000 qualified applicants in 2021, according to the American Association of Colleges of Nursing, due to lack of faculty and training sites. The National Council of State Boards of Nursing’s 2022 National Workforce Study reveals 100,000 nurses left the workforce during the pandemic and by 2027, almost 900,000 intend to leave the workforce due to stress, burnout and retirement.1 Hospitals faced similar demographic trends for physicians, with data from the Association of American Medical Colleges indicating that one-third of practicing physicians will reach retirement age over the next decade. Hospitals also were reporting significant shortages of allied health and behavioral health professionals. Congress must support efforts to ensure an adequate, sustainable health care workforce. Health Professions Education and Workforce Challenges. The AHA supports $1.51 billion for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs for FY 2024. The workforce crisis facing our nation necessitates bold increases in HRSA discretionary programs that address workforce challenges: <ul> <li>Nursing Workforce Development under Title VIII of the Public Health Service Act. The Nursing Workforce Development programs support nursing education, seek to further diversify the nursing profession, and improve access in rural and underserved communities. Nurses are integral members of the health care team. Each year, nursing schools must deny admission to thousands of potential students because they do not have enough faculty to teach these aspiring professionals. The COVID-19 pandemic heightened the nursing shortage our country was already facing. It is imperative that funding for these programs reflects the heightened needs of our communities. The AHA also supports $210 million for the National Institute of Nursing Research, one of 27 institutes of the National Institutes of Health. &nbsp;</li> <li>Primary Care Medicine, Pediatric Subspecialty Loan Repayment, Substance Use Disorder Treatment and Recovery Loan Repayment Program and Oral Health Training programs. These programs improve health care access and quality in underserved areas by training general internists, family medicine practitioners, general pediatricians, pediatric subspecialists, oral health providers, physician assistants and expanding behavioral health services. The AHA supports additional funding over last year’s enacted level for these important programs. &nbsp;</li> <li>Health Professions Programs. An adequate, diverse and well-distributed supply of health care professionals, including allied health care workers, is indispensable to our nation’s health care infrastructure. Health professions programs help address the challenges rural and underserved communities face accessing primary care providers by supporting recruitment of individuals into the allied health professions. Our nation must act now to maintain a vibrant workforce by strengthening nursing and medical educational programs. Without decisive intervention, the looming workforce shortages threaten hospitals’ ability to care for patients and communities. Title VII programs help patients and communities by playing an essential role in improving the diversity of the health care workforce and connecting students to health careers by supporting recruitment, education, training and mentorship opportunities. Inclusive and diverse education and training experiences expose providers to backgrounds and perspectives other than their own and heightens cultural awareness in health care, resulting in benefits for all patients. Evidence shows that concordance between patients and providers results in better health outcomes. &nbsp;</li> <li>National Health Service Corps (NHSC). The NHSC awards scholarships to health professions students and assists graduates of health professions programs with loan repayment in return for an obligation to provide health care services in underserved rural and urban areas. The AHA supports $210 million in discretionary funding for the NHSC. The AHA also believes substantial mandatory funding is also a necessary investment in this critical program.</li> </ul> Centers of Excellence and the Health Careers Opportunity Programs. These programs focus on recruiting and retaining minorities into the health professions to build a more diverse health care workforce. The Centers of Excellence grants strengthen the national capacity to train students from minority groups that are underrepresented in allopathic and osteopathic medicine, dentistry, and pharmacy, and behavioral or mental health. The Health Careers Opportunity program provides support for increasing the number of individuals from disadvantaged backgrounds in the health and allied health professions, and the AHA supports these programs. Preventing Burnout in the Health Workforce Program. For decades, health care professionals have faced greater rates of mental and behavioral health conditions, suicide, and burnout than other professions while fearing the stigma and potential career repercussions of seeking care. The COVID-19 pandemic exacerbated the already-present issues of stress, depression, anxiety, and other mental health issues experienced by health care providers. President Biden signed into law the Dr. Lorna Breen Health Care Provider Protection Act, legislation the AHA supported, which aims to address this mental health crisis among our nation’s healers. Named in honor of Dr. Lorna Breen, a physician from Charlottesville, Va., who worked on the front lines of the pandemic in New York and died by suicide in spring of 2020, the law is intended to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care providers. The legislation authorized grants to health care providers to establish programs that offer behavioral health services for front-line workers, requires the Department of Health and Human Services (HHS) to study and develop recommendations on strategies to address provider burnout and facilitate resiliency, and directs the Centers for Disease Control (CDC) to launch a campaign encouraging health care workers to seek assistance when needed. It’s critical this program is fully funded in order to continue this important work. The AHA supports $45 million for the Preventing Burnout in the Health Workforce Program at HRSA. Children’s Hospitals Graduate Medical Education (CHGME). The CHGME program supports graduate medical education programs at children’s hospitals that train resident physicians. The purpose of the program is to provide 59 independent children’s hospitals in more than 30 states and territories with funds to train pediatricians and pediatric specialists. Freestanding children’s hospitals typically treat very few Medicare patients and, therefore, do not receive Medicare funding to support medical training of residents; the CHGME program helps fill this need. In addition to teaching the next generation of physicians, these hospitals provide lifesaving care to many children with complex medical needs. Currently, CHGME hospitals train 56% of the nation’s pediatricians and 54% of the pediatric specialists who care for children living in all 50 states. Unlike Medicare’s GME program, CHGME is funded through annual appropriations. The program has enjoyed broad congressional support since its inception. Providing increased funding for pediatric workforce training programs is even more important as we respond to the effects of COVID-19 on children. The AHA supports funding the CHGME program in FY 2024 at $738 million. Rural Health Programs. Rural health programs — such as the Rural Communities Opioids Response Program, Medicare Rural Hospital Flexibility Grant Program, Rural Outreach Grants, State Offices of Rural Health, Rural Telehealth, and other health care programs to support rural hospitals at-risk of imminent closure, expanding needed service lines at rural hospitals and workforce training in rural communities — are vital to ensuring that needed services remain available in America’s rural communities. The AHA urges the committee to support funding these programs at $416 million, an increase of $63 million over the FY 2023 enacted levels. We also urge Congress to support funding to continue HRSA’s Rural Emergency Hospital Technical Assistance Program, to support rural hospitals who are making the transition and those who have converted to maintain critical services for their communities. Disaster/Emergency Preparedness. When disaster strikes, people turn to hospitals for help. Congress recognized that role when it created the Hospital Preparedness Program (HPP), the primary federal funding mechanism for health care emergency preparedness. Since 2002, the HPP has provided critical funding and other resources to states and other jurisdictions to use in aiding hospitals’ response to a wide range of emergencies. The HPP has allowed for enhanced planning and response; improved integration of public and private sector emergency planning to increase the preparedness, response, and surge capacity of hospitals; and improved state and local infrastructures to help health systems and hospitals prepare for public health emergencies. However, funding for the HPP has not kept pace with the ever-changing and growing threats faced by hospitals, health systems and their communities. Furthermore, in recent years, hospitals have received only a fraction of the HPP funds. In particular, the vast majority of HPP funds (nearly 80% in FY 2023) supports the sub-state Health Care Coalitions (HCCs) – regional collaborations between health care organizations, emergency management, public health agencies and other private partners. As the COVID-19 pandemic made clear, our health care system needs far more assistance during a national crisis. To address these concerns, the AHA urges Congress to provide significantly more funding. Annual appropriations have declined significantly since the program began. Federal HPP appropriations dropped from a high of $515 million in FYs 2003 and 2004, to a low of $255 million for FYs 2014 through 2017. While appropriations for the program have increased slightly over the last four years, with $305 million in appropriations for FY 2023, overall, HPP appropriations have fallen dramatically. The AHA urges Congress to substantially increase funding over last year’s enacted level for the HPP to ensure that the health care infrastructure is ready to respond to future crises. At a minimum, we ask the Committee to double the funding of the program to $610 million for FY 2024. Funding should reflect a more appropriate level of investment in emergency preparedness, especially in light of the COVID-19 pandemic that has ravaged our hospitals, health systems and communities, as well as the growing threats from natural disasters and other emergencies. Centers for Disease Control and Prevention. The CDC is a vital partner to hospitals, patients and other health care providers in the prevention and monitoring of disease and emergency preparedness. Much of the research from CDC demonstrates the value of prevention activities in averting health care crises, resulting in savings to Medicare, Medicaid, and other health care programs. The AHA supports additional funding for the CDC over last year’s enacted level. Social Determinants Accelerator Plans. The Consolidated Appropriations Act of 2023 provided $8 million in funding for the CDC to support Social Determinants of Health Accelerator Plans, which will help state and local governments develop strategies to address the health and social needs of targeted populations. The AHA supports funding the program at $100 million in FY 2024 to continue to expand social determinant of health (SDOH) efforts by funding another round of Accelerator Plans to states, tribes, territories and/or localities to develop or enhance existing plans and support sustained funding for program implementation, evaluation, research and data collection efforts. Public Health and Other Health Care Programs. The AHA urges increased funding over current levels for the following programs. <ul> <li>Maternal and Child Health Block Grant (MCHBG). The Title V MCHBG is a funding source used to address the most critical, pressing, and unique needs of maternal and child health populations in each state, territory and jurisdiction of the United States. The program helps states assure access to quality maternal and child health care services, especially for those with low incomes or who have limited access to care. The MCH Block Grant program supports the State MCH Block Grant program, Special Projects of Regional and National Significance and Community Integrated Service Systems grants. According to data gathered by HRSA, the State MCH Block Grant Program supports approximately 92% of pregnant women, 98% of infants, and 58% of children. Improving maternal and child health is a major priority for the AHA. The AHA supports $1 billion for the Title V MCHBG in FY 2024. &nbsp;</li> <li>Healthy Start Program. The Healthy Start program provides support for high-risk pregnant women, infants and families in communities with exceptionally high rates of infant mortality, including health care services, such as those focused on reducing maternal mortality, as well as the socioeconomic factors of poverty, education and access to care. The AHA supports $185 million in funding for FY 2024. &nbsp;</li> <li>Emergency Medical Services for Children. This valuable program is designed to provide specialized emergency care for children through improved availability of child appropriate equipment in ambulances and emergency departments. In addition, the program supports training programs to prevent injuries to children and to educate emergency medical technicians, paramedics, and other emergency medical care providers. The AHA supports $28 million in funding for FY 2024. &nbsp;</li> <li>Substance Use and Mental Health Services Administration (SAMHSA). Providing adequate substance use and mental health services are essential to increasing productivity and economic well-being for individuals, families and communities. The AHA supports the $10.8 billion for SAMHSA, an increase of $3.3 billion above FY 2023 enacted.</li> </ul> Office of Minority Health. The AHA supports $86 million for FY 2024 for the Office of Minority Health within HHS. The National Institute on Minority Health and Health Disparities. Eliminating health disparities and promoting health equity are essential to improving the overall health status of Americans and reducing health care costs. The National Institute on Minority Health and Health Disparities (NIMHD) leads scientific research to improve minority health and eliminate health disparities. Given the role of the Institute in coordinating research of the other institutes and centers, and the outsized impact of COVID-19 on historically marginalized communities, the AHA supports $660 million for NIMHD in FY 2024, a $135 million increase from the FY 2023 enacted level. We urge the Committee to invest in efforts to close gaps in health and health care by increasing funding for health disparities research and activities at NIMHD and supporting the training of a more diverse research workforce. Unique Patient Identifier (UPI). The AHA supports adoption of a UPI. Removing the prohibition on the use of federal funds to promulgate or adopt a national UPI would provide HHS the ability to explore solutions that accurately identify patients and link them with their correct medical records. The AHA was pleased with the removal of the ban from initial drafts of previous bills in the House and Senate and encourages the Committee to allow funding for this critical issue. America’s hospitals and health systems are committed to ensuring the highest quality care in a timely manner. Funding for a UPI would promote safe, efficient and timely care for patients while reducing administrative costs. We look forward to working with you to ensure appropriate patient identification methods. The AHA appreciates and is grateful for the support you have provided to vital health care programs, and we hope the Committee will continue to support these funding priorities in FY 2024. We look forward to working with you. Sincerely, /s/ Lisa Kidder Hrobsky Senior Vice President, Advocacy and Political Affairs __________ 1 https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis Tue, 09 May 2023 14:57:39 -0500 Appropriations AHA urges Congress to support health care programs in FY 2023 appropriations /news/headline/2022-05-05-aha-urges-congress-support-health-care-programs-fy-2023-appropriations AHA&nbsp;today urged&nbsp;leaders of the <a href="/lettercomment/2022-05-05-aha-letter-house-regarding-funding-health-care-programs-fy-2023">House</a> and <a href="/lettercomment/2022-05-05-aha-letter-senate-regarding-funding-health-care-programs-fy-2023">Senate</a>&nbsp;Appropriations Subcommittees on Labor, Health and Human Services, and Education to give favorable funding consideration in fiscal year 2023 to health care programs shown to improve access to quality health care for patients and communities. AHA requests funding for a number of workforce programs, including grants for the recently-enacted Dr. Lorna Breen Health Care Provider Protection Act; programs to increase and support pathways for and resilience in the health care workforce; and&nbsp;assistance for children’s hospitals to train resident physicians. In addition, AHA urges funding for programs to retain needed health care services in rural communities; help hospitals respond to emergencies; address the social determinants of health; improve maternal and child health; strengthen substance use and mental health services; eliminate health disparities and promote health equity. Thu, 05 May 2022 15:53:14 -0500 Appropriations