Omnibus Bill Funds Government

Today both the House and Senate passed legislation to fund the government and various programs through the rest of Fiscal Year 2018 (FY18). This bill funds the government for the remainder of FY18 and follows the two-year bipartisan budget deal that was passed during the Policy Institute in February. That legislation funded critical rural Medicare Extenders and provided additional funding for opioids, while this legislation provides more specific details on how Congress plans to spend the agreed upon money in the budget. We were pleased to see that Congress included funding for some key rural programs, and provided crucial funding for the agencies that house many of these programs.

Funding for the rural health safety net is more important than ever as rural Americans are facing a hospital closure crisis. 83 rural hospitals have closed since 2010. Right now, 673 additional facilities are vulnerable and could close. Rural health programs assist rural communities in maintaining and building a strong health care delivery system into the future. Most importantly, these programs help increase the capacity of the rural health care delivery system and true safety net providers.

The following agencies will be funding for the remainder of FY18:
  • HHS - The bill provides $88.1 billion for the Health and Human Services Department.
  • NIH - The National Institutes of Health receives roughly $37.1 billion for fiscal 2018-- a $3 billion increase over its $34.1 billion enacted in fiscal 2017, including $500 million extra for research into opioid addiction.
  • CDC - The Centers for Disease Control and Prevention receives $8.3 billion in total program level funding compared to its $7.3 billion appropriation for 2017. The amount includes $7.26 billion in discretionary budget authority, $800 million in transfers from the Prevention and Public Health Fund. The bill provides an extra $161.8 million for CDC Preparedness and Response.
  • SAMHSA - The Substance Abuse and Mental Health Services Administration will be given a raise in the total for substance abuse block grants, from approximately $2.9 billion to $3.4 billion, and the amount for mental health block grants from approximately $1.1 billion to $1.4 billion.
  • AHRQ – the Agency for Healthcare Research and Quality is given $334 million.
  • IHS - $5.5 billion for the Indian Health Service.
  • Opioids - $2.6 billion in new funding specifically for HHS. A state block grant program that distributed $500 million to the states in 2017 would be doubled to $1 billion in 2018.

Rural programs included in the Omnibus are:
  • $49,609,000 will be available for the Medicare Rural Hospital Flexibility Grants Program, as requested by NRHA
  • $15,942,000 of the above $49,609,000 are provided for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology
  • $1,000,000 of the above funds will be focused on telehealth services, including pilots and demonstrations on the use of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs.
  • $10 million for the State Offices of Rural Health (SORH), an NRHA goal in our appropriations requests.
  • An additional $15 million is provided for Rural Residency Development Program through September 30, 2020.
  • $100 million is provided through September 30, 2022, for the Rural Communities Opioids Response Program.

One additional key fix that was made in the Omnibus is a correction to allow rural hospitals to be eligible for the Medicare inpatient low volume hospital adjustment regardless of their proximity to an Indian Health Services (IHS) facility since these facilities are not “comparable” hospitals. This has effected hospitals like Neshoba County General Hospital which lost their low volume hospital status because of a nearby IHS facility, that is only able to serve the tribal community according to federal IHS regulations. This is essential for keeping small rural hospitals that support the non-Native communities in tribal-adjacent regions open for the general public. We appreciate the tireless efforts of Lee McCall, Chief Executive Officer of Neshoba County General Hospital, on this legislative fix – none of NRHA’s work is possible without the grassroots efforts of our members.

Programs in the rural health safety net increase access to health care, help communities create new health programs for those in need and train the future health professionals that will care for the 62 million rural Americans. With modest investments, these programs evaluate, study and implement quality improvement programs and health information technology systems.

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