End-of-Year Funding and Policy Package Summary
December 20, 2022
On Dec. 20, Congress released a bipartisan and bicameral spending package and other legislation. The package includes the FY23 Labor, Health and Human Services, Education and Related Agencies appropriations bill, an extension of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, the PREVENT Pandemics Act, Medicaid provisions as it relates to the public health emergency, and maintains the existing federal match and funding allotment for the U.S. territories. This legislation does not include emergency supplemental funding for COVID-19 and does not require Congress to establish a COVID-19 commission.
In addition to the funding and authorizing provisions, the legislation eliminates a requirement for healthcare practitioners registered to dispense controlled substances to apply for a separate waiver through the DEA to dispense buprenorphine for opioid use disorder maintenance or detoxification treatment, known as the X Waiver. It also requires health care providers, as a condition of receiving or renewing a DEA registration to prescribe controlled substances, to meet a one-time eight-hour training requirement on identifying and treating patients with substance use disorders. Finally, the legislation increases the time limit for healthcare providers to hold long-acting injectable (LAI) buprenorphine before administration to a patient, if received through a specialty pharmacy, from 14 to 45 days.
The federal government is currently operating under a continuing resolution through Dec. 23. Given the bipartisan negotiations, ASTHO’s government affairs team believes this bill will be signed into law this week.
Bill Section-by-Section Summaries
The legislation is massive, totaling over 4,000 pages in bill text. Therefore, the legislative alert below should serve as a snapshot of critical provisions in the bill. For additional information, please use the following resources:
Key Public Health Funding Proposal Highlights
ASTHO members' priorities saw proposed increases or level funding in the bill:
- $350 million, an increase of $150 million, for public health infrastructure and capacity nationwide.
- $175 million, an increase of $75 million, to modernize public health data surveillance and analytics at CDC and state and local health departments.
- $8 million or level funding for CDC's social determinants of health programs.
- $735 million, an increase of $20 million, for the CDC Public Health Preparedness Cooperative Agreements.
- $305 million, an increase of $9.5 million for the ASPR Hospital Preparedness Program (HPP).
- $160 million in funding for the Preventive Health and Health Services Block Grant.
The agreement directs ASPR to brief the Committees on the Department's plan to transition COVID-19 vaccines and therapeutics with FDA approval to the commercial market. The briefing shall include a timeline for each product, for products with FDA approval and those with emergency use authorization; costs associated with a transition from federal purchasing to the private market; and details about how non-federal purchasers will compete in the market. The briefing shall be provided within 30 days of enactment of this act and every six months thereafter until the transition to the commercial market is complete.
For information about other funding levels and policy proposals for CDC, HRSA, SAMHSA, and additional public health programs, view the summary provided by the subcommittee.
Medicaid for the Territories
This package averts a funding cliff for the U.S. territories by continuing the current federal medical assistance percentage (FMAP) of 76 for five years for Puerto Rico and permanently at 83 for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. In addition, the bill establishes a new framework for Puerto Rico's enhanced allotments for the next five fiscal years. The bill also makes programmatic improvements to the territories' Medicaid programs, including requiring increased provider payment rates and improving contracting practices for Puerto Rico, and providing 100 percent funding for qualifying data system improvements for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands and do not count against the funding allotments.
Medicaid, Children's Health Insurance Program, and Postpartum Coverage
The bill extends funding for the Children's Health Insurance Program (CHIP) through FY29 and requires that children be provided with 12 months of continuous coverage in Medicaid and CHIP, effective Jan. 1, 2024. It also makes permanent a state option to allow states to continue to provide 12 months of continuous coverage during the postpartum period in Medicaid or CHIP.
Medicaid and Public Health Emergency Declaration
Provides funding and requirements for state Medicaid programs to support the transition from the enhanced Medicaid funding and continuous coverage requirements of the Families First Coronavirus Response Act (FFCRA). This section would sunset FFCRA's continuous coverage requirement as of April 1, 2023 and allow states to initiate redeterminations of eligibility over at least twelve months. States would be able to receive enhanced Medicaid funding from April 1 through Dec. 31, 2023, subject to meeting certain conditions, such as updating beneficiaries' contact information and using more than one modality to contact beneficiaries in the event of returned mail. The section establishes public reporting requirements for all states during this temporary redetermination period. It also provides additional enforcement mechanisms for the Centers for Medicare & Medicaid Services.
The package includes the House-passed Jackie Walorski Maternal and Child Home Visiting Reauthorization Act (H.R. 8876). The bill includes a five-year reauthorization of the program and an increase in base funding to $500 million for FY23 to FY27 with a minimum base grant of $1 million. The bill also doubles the tribal set aside and allows for limited virtual home visits. There are also important changes to the funding formula and a state match. Please read more in ASTHO's legislative alert from Sept. 22, 2022.
PREVENT Pandemics Act
The PREVENT Pandemics act makes reforms to CDC, as well as public health and medical preparedness systems, and authorizes new programs. Key provisions of the bill include:
- CDC Director: Requires Senate confirmation of the director of the CDC beginning on Jan. 20, 2025 and establishes specific functions of the director. It also requires an agency-wide strategic plan to be developed every four years that describes CDC's priorities and objectives, the capabilities that need to be developed to achieve these objectives, and how CDC will leverage strategic communications, external partnerships, and coordination with other agencies.
- Advisory Committee: Requires the CDC director to establish or maintain an advisory committee within CDC to advise the director on policy and strategies that enable the agency to fulfill its mission, which may include informing strategic planning and advising on prioritization and performance metrics. The advisory committee shall consist of up to 15 non-federal members in relevant fields of expertise, of which 12 shall be appointed by the director from relevant health disciplines, and three shall be appointed by the secretary from the general public, such as individuals with expertise in public policy, public relations, or economics.
- Office of Pandemic Preparedness and Response Policy: Establishes an Office of Pandemic Preparedness and Response Policy within the Executive Office of the President, led by a director appointed by the president, to advise on pandemic preparedness and response policy and to support coordination and communication within the federal government related to preparedness and response. It also establishes an Industry Liaison within the office to work with affected industries during responses. The section requires the director to develop a Preparedness Outlook Report every five years on situations and conditions that warrant significant attention related to preparedness and response, including opportunities and challenges related to medical countermeasures. It also requires the director to conduct a review of existing federal policies to identify gaps and inefficiencies related to preparedness and response and submit to Congress a report, which shall be updated every two years, describing the findings of the review, current and emerging threats, federal roles and responsibilities, and any plans and associated barriers to address such findings.
- PHEP Cooperative Agreements: Updates the Public Health Emergency Preparedness (PHEP) cooperative agreements to ensure coordination between health departments and other state agencies to improve preparedness and response planning. It also requires PHEP recipients to provide technical assistance to agencies and other entities with an increased risk of infectious disease outbreaks, such as residential care facilities and group homes, to improve preparedness and response.
- Public Health Data: Improves collaboration among federal departments, implements lessons learned from previous public health emergencies, and identifies steps the secretary will take to further develop and integrate infectious disease detection, support rapid, accurate, and secure sharing of laboratory test results during a public health emergency, and improve coordination with public health officials, clinical laboratories, and other entities with expertise in public health surveillance. Directs the secretary to help states, localities, territories, and tribes better leverage public health data that is deidentified as applicable to support public health responses, such as by improving data use agreements between relevant federal agencies and other public and private entities. It also authorizes a program to develop best practices to improve the quality and completeness of demographic data to support public health responses.
- Public Health Loan Repayment: Reauthorizes the Public Health Workforce Loan Repayment Program to provide loan repayment to individuals in exchange for working in a state, territorial, tribal, or local public health department. It establishes a Bio-Preparedness Workforce Pilot Program to provide loan repayment for health professionals with expertise in infectious diseases and emergency preparedness and response activities to ensure an adequate supply of such professionals. It also requires GAO to conduct an evaluation of the public health workforce in the United States during the COVID-19 pandemic.
- Strategic National Stockpile: Amends the Strategic National Stockpile (SNS) Annual Threat-Based Review to include an assessment of the supply chains and any vulnerabilities for products that SNS plans to purchase during the period covered by the review. Clarifies that, as part of the procedures of the SNS, the secretary should ensure that items in the stockpile are in working condition so they can be readily deployed when needed. Requires the secretary to issue guidance on how states, territories, and tribes can access the SNS and other countermeasures and factors the secretary considers when making decisions related to product distribution. It requires the secretary to convene annual meetings with public health officials, the private sector, and other stakeholders to share information about the maintenance and use of the SNS and future procurement plans.
- State Stockpiles: Authorizes a pilot program to support states in establishing, expanding, or maintaining stockpiles of medical supplies needed to respond to a public health emergency or disaster. It requires HHS to issue guidance to all states within 180 days on best practices and strategies for maintaining stockpiles, such as the types of products that may be appropriate to maintain in a stockpile, use of vendor-managed inventory arrangements, and purchasing products made in America. It also requires a report to Congress and a GAO report assessing the impacts of the pilot program and technical assistance provided by HHS to states on stockpiling
Opioid Crisis Response
The bill requires the development and dissemination of training materials for pharmacists who may decline to fill a prescription under certain circumstances. It allows CDC to prioritize jurisdictions with a high burden of drug overdoses or drug overdose deaths when awarding grants to prevent overdoses of controlled substances. Additionally, it requires HHS to conduct a public education campaign on synthetic opioids (including fentanyl and its analogs) and other emerging drug misuse issues, disseminate information about synthetic opioids to healthcare providers, and develop a training guide and webinar for first responders and other individuals at high risk of exposure to synthetic opioids that details measures to prevent exposure.
The bill authorizes and reauthorizes several programs at SAMHSA to improve crisis care services and 9-8-8 implementation. Specific new provisions include addressing mental health by:
- Establishing a national hotline to provide information and resources for pregnant and postpartum women at risk of, or affected by, maternal mental health and substance use disorders.
- Establishing a task force to make recommendations to coordinate and improve federal activities related to maternal mental health conditions.
- Establishing the Mental Health Crisis Response Partnership pilot program to allow for mobile crisis response teams. It also reauthorizes the Mental Health Awareness Training (MHAT) Grant program and expands access to technical assistance for MHAT grantees. The section also reauthorizes and improves the Adult Suicide Prevention program.
- Requiring a study to determine the true costs of untreated serious mental illness on families, healthcare systems, public housing, and law enforcement in America.
- Authorizes the SAMHSA National Center of Excellence for Eating Disorders to award competitive subgrants or subcontracts for developing and providing training and technical assistance for primary and mental health providers, paraprofessionals, and relevant individuals. It also authorizes the center to collaborate and coordinate with SAMHSA, CDC, and the Health Resources and Services Administration (HRSA) on the identification, treatment, and ongoing support of individuals with eating disorders.
- Authorizing resources to provide services for the prevention of, treatment of, and recovery from mental health and substance use disorders for American Indians, Alaska Natives, and Native Hawaiians.
- Requiring that states' plans describe the recovery support service activities supported by block grant funds, including the number of individuals served, target populations, workforce capacity (including prevention, treatment, and recovery), priority needs, and the amount of funds allocated to recovery support services disaggregated by type of activity.
- Allowing certain Drug Enforcement Administration (DEA) registrants to operate one or more mobile units to dispense medications for opioid use disorder without separate registrations for each mobile unit. It also requires HHS to issue regulations eliminating the requirement that an individual has an opioid use disorder for at least one year before being admitted for treatment by an opioid treatment program.