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House Appropriations Committee Releases Labor-HHS Bill

The House Appropriations Committee released the text of its Labor and Health and Human Services (HHS) Appropriations bill this morning. NRHA submitted testimony and requests to both the House and Senate Appropriators requesting robust support for rural health programs. While we understand the current federal budget situation, rural health discretionary spending is relatively small but is vitally important for maintaining access to care for individuals living in rural America. The rural healthy safety net programs outlined below are effective and crucial for the physical and economic health of many rural communities.

NRHA is pleased the House appropriators understood the important of these program funds and appropriated funding in line with the urgency of the needs in rural health care. We will continue to work with the House and Senate to ensure strong support of important rural health programs to solidifying the fragile rural health care infrastructure in the United States. While NRHA requested a modest, across-the-board funding increase of 10 percent (unless another amount has specifically been authorized by law), we are pleased the House Appropriations Committee draft reflects our request for robust funding support.

Further, though NRHA appreciates the support that Congress has for opioid funding, we asked that Congress ensure that this funding is targeted to the communities that need it most. Rural areas have been disproportionately impacted by the opioid epidemic, and we ask that additional funding for programs critical to combatting this crisis be targeted to ensure a robust rural response.

House Bill
In total, the draft bill from the House Appropriations Committee includes $177.1 billion in discretionary funding, almost the same as the 2018 enacted level.

Rural Health Programs
Medicare Rural Hospital Flexibility Grants are used by each state to implement new technologies, strategies and plans in Critical Access Hospitals (CAH). CAHs provide essential services to a community. Their continued viability is critical for access to care and the health of the rural economy. The draft bill provides $59,609,000 dollars for these programs, a recognition of the importance of these grants and the work they allow CAHs to do. NRHA presented details of the work done with these grants, resulting in $9.2 million over our initial request of $50.4 million.

Of the funds made available under Rural Hospital Flexibility Grants, $25,942,000 is specifically provided for the Small Rural Hospital Improvement Grant Program “for quality improvement and adoption of health information technology” and up to $1,000,000 may be used for funds “provided for grants for the purchase and implementation of 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 electronic health record system.”

State Offices of Rural Health (SORH), located in all 50 states, help their individual rural communities build health care delivery systems. They accomplish this mission by collecting and disseminating information, providing technical assistance, helping to coordinate rural health interests state-wide, and by supporting efforts to improve recruitment and retention of health professionals. The Committee has appropriated $11 million to help the SORH improve rural health care across our country.

Further, $10,000,000 will remain available through September 30, 2021, to support the Rural Residency Development Program, and $82,500,000 will remain available through September 30, 2023, for the Rural Communities Opioids Response Program.

$85,000,000 will remain available for the provision of primary health services, assigning National Health Service Corps (NHSC) members to expand the delivery of substance use disorder treatment services, notwithstanding the assignment priorities and limitations under sections and making payments under the NHSC Loan Repayment Program. An additional $20,000,000 will remain available under the NHSC Loan Repayment Program to individuals participating in similar programs who provide primary health services in Indian Health Service facilities and Tribally-Operated Health Programs.

Health Research and Services Administration (HRSA) is funded at $6.5 billion, which is $196 million below the fiscal year 2018 enacted level and $3 billion below the budget request.

Agency for Healthcare Research and Quality (AHRQ) - The recommendation provides $334 million for AHRQ, which is the same as the fiscal year 2018 enacted level. The budget request proposed to merge most of AHRQ's activities into NIH.

Opioids and Substance Use Treatment
In addition to the Rural Communities Opioids Response Program, critical funding for opioid misuse programs are housed at the Substance Abuse and Mental Health Administration (SAMHSA). The bill funds SAMHSA at $5.6 billion, an additional $448 million above the FY18 enacted level.
  • The legislation continues to prohibit the use of federal funds for the purchase of syringes or sterile needles, but does allow communities with rapid increases in cases of HIV and Hepatitis to access funds for substance-use counseling and treatment.
  • The bill includes $3.85 billion to address substance use, including opioid and heroin abuse, which is $36 million above the fiscal year 2018 enacted level. This amount includes $1 billion for State opioid response grants, along with funding for programs authorized in the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act.

The House Appropriations Committee Subcommittee on Labor, HHS, Education, and related agencies will host a markup of the legislation at 9:30 a.m. EST on June 15. We will live tweet from the @NRHA_Advocacy account about any rural health issues discussed during the markup. 

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