Congress passed and the President signed the fiscal year (FY) 2021 omnibus spending bill, which included a COVID-19 stimulus package and health extenders. The massive 5,593-page bill (HR 133) funds federal agencies through September 30, 2021.
On September 22, the U.S. Department of Education (ED) issued its final rule on Religious Liberty and Free Inquiry. The final rule furthers objectives in an Executive Order signed last spring, and implements new requirements on public and private institutions of higher education (IHEs) that receive certain federal grants. These requirements relate to free speech, free inquiry, and religious liberty. An institution’s failure to comply may jeopardize its eligibility to participate in ED’s Direct Grant or State-Administered Formula Grant Programs. It is important to note that these grants are distinct from Title IV Grants and include, for example, funding under the Coronavirus Aid, Relief, and Economic Security Act.
On September 2, the U.S. Department of Education (ED) issued its final rule on distance learning and innovation for higher education, a result of consensus-backed language crafted in 2019. The final rule reflects the Administration’s desire to accommodate non-traditional forms of education by simplifying and liberalizing the regulations surrounding Title IV funding for non-traditional programs.
Application Deadline: Tuesday, June 30, 2020
In a continued effort to combat the dire economic effects of the COVID-19 pandemic, the Senate unanimously passed on Tuesday the Paycheck Protection Program and Health Care Enhancement Act (H.R. 266), a $483.4 billion relief package originally meant to be an “interim” fix to replenish a small-business loan program created by the last coronavirus aid package, the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-134). Dubbed COVID 3.5, the package includes $321 billion for the depleted Paycheck Protection Program to aid small businesses suffering under the COVID-19 pandemic, $75 billion for hospitals and other medical providers to cover increased expenses and lost revenue, and $25 billion for federal, state, and local coronavirus testing. Due to expected objections to a vote by unanimous consent, members of the House are in Washington, DC today to vote on the package. If passed, the President is expected to immediately sign it into law.
Coronavirus Aid, Relief, and Economic Security (CARES) Act
Phase 3: Major economic stimulus package
$2.3 trillion major stimulus package, including loans and support to major industries (e.g. airlines and small businesses) and direct payments to individuals and families. Became law March 27, 2020.
- Bill sponsor: Sen. Mitch McConnell (R-KY)
- Introduced: March 23, 2020
- Signed into law: March 27, 2020
- Direct payments to individuals: $1,200 per adult, with an additional $500 per child
- Hospital investments
- $100 billion for hospitals
- $1 billion to Indian Health Service
- $16 billion for building a stockpile of medical equipment
- Increases reimbursements by 20% for treating Medicare patients with coronavirus
- $350 billion in loans for small businesses
- Loans to small businesses would be forgiven if payrolls are maintained
- Unemployment benefits increased $600/week for four months
- $150 billion for state and local funds, including $8 billion for tribal governments
Institutes of Higher Education
Institutional Refund and Federal Student Loan Flexibility
- For students who dropped out of school as a result of COVID -19, the student is not required to return Pell grants or federal student loans to the Secretary
- Waives the requirement that institutions calculate the amount of grant or loan assistance that the institution must return to the Secretary in the case of students who dropped out of school as a result of COVID-19
- For students who dropped out of school as a result of COVID-19, the student’s grades do not affect a student’s federal academic requirements to continue to receive Pell Grants or student loans
Temporary Relief for Federal Student Loan Borrowers
- Requires the Secretary to defer student loan payments, principal, and interest for 6 months, through September 30, 2020, without penalty to the borrower for all federally owned loans
- This provides relief for over 95 percent of student loan borrowers
- Makes technical edits to the FUTURE Act to improve implementation and aid student loan borrowers
- Excludes loans borrowed from counting towards annual or cumulative limits if a borrower is unable to complete the term due to a qualifying emergency
Education Stabilization Fund
- Flexible funding that will get out the door quickly and go directly to states, local school districts, and institutions of higher education (IHEs) to help schools, students, teachers, and families with immediate needs related to coronavirus, including
- $14.25 billion in funding to IHEs to directly support students facing urgent needs related to coronavirus, and to support institutions as they cope with the immediate effects of coronavirus and school closures
- This provides targeted formula funding to IHEs, as well as funding for minority serving institutions and HBCUs
- $3 billion in state flexibility funding to be allocated by states based on the needs of their elementary and secondary schools and their IHEs
- Includes a special priority for schools who are not receiving at least $500,000 from the $14.25 billion higher education fund
Medical Product Supplies
Requiring the strategic national stockpile to include certain types of medical supplies
- Clarifies that the Strategic National Stockpile can stockpile medical supplies, such as the swabs necessary for diagnostic testing for COVID-19
Treatment of respiratory protective devices as covered countermeasures
- Provides permanent liability protection for manufacturers of personal respiratory protective equipment, such as masks and respirators, in the event of a public health emergency, to incentivize production and distribution
Discontinuance or interruption in the production of medical devices
- Clarifies that during a public health emergency, a medical device manufacturer is required to submit information about a device shortage or device component shortage upon request of the FDA
Public Health and Social Services Emergency Fund: $127 billion
- Reimbursement to Hospitals & Healthcare Providers: $100 billion to ensure healthcare providers continue to receive the support they need for COVID-19 related expenses and lost revenue
Strategic National Stockpile: $16 billion to procure personal protective equipment, ventilators, and other medical supplies for federal and state response efforts
- When combined with the first supplemental, the Committee has provided approximately $17 billion for the Stockpile
- Vaccine, Therapeutics, Diagnostics, and other Medical or Preparedness Needs: $11 billion
- Includes at least $3.5 billion to advance construction, manufacturing, and purchase of vaccines and therapeutic delivery to the American people
- This is in addition to the billions already provided for these activities in the first supplemental
- Hospital Preparedness: Not less than $250 million to improve the capacity of healthcare facilities to respond to medical events
- HRSA: $275 million to expand services and capacity for rural hospitals, telehealth, poison control centers, and the Ryan White HIV/AIDS program
- Language is also included to allow Community Health Centers to use FY2020 funding to maintain or increase staffing and capacity to address the coronavirus
- $4 million for HHS Office of Inspector General for oversight activities
Access to Health Care for COVID-19 Patients
Supplemental awards for health centers
- $1.32 billion in supplemental funding to community health centers on the front lines of testing and treating patients for COVID-19
Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs
- Reauthorizes HRSA grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services
United States Public Health Service Modernization
- Establishes a Ready Reserve Corp to ensure we have enough trained doctors and nurses to respond to COVID-19 and other public health emergencies
Limitation on liability for volunteer health care professionals during COVID-19 emergency response
- Makes clear that doctors who provide volunteer medical services during the public health emergency related to COVID-19 have liability protections
Flexibility for members of National Health Service Corps during emergency period
- Allows the Secretary of HHS to reassign members of the NHSC to sites close to the one to which they were originally assigned, with the member’s agreement, in order to respond to the COVID-19 public health emergency
Allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics to Furnish Telehealth in Medicare
- This section would allow, during the COVID-19 emergency period, FQHCs and Rural Health Clinics to serve as a distant site for telehealth consultations
- A distant site is where the practitioner is located during the time of the telehealth service
- This section would allow FQHCs and RHCs to furnish telehealth services to beneficiaries in their home
- Medicare would reimburse for these telehealth services based on payment rates similar to the national average payment rates for comparable telehealth services under the Medicare Physician Fee Schedule
- It would also exclude the costs associated with these services from both the FQHC prospective payment system and the RHC all-inclusive rate calculation.
Health Care Workforce
Reauthorization of health professions workforce programs through FY 2025, including:
- $23.7 million for Centers of Excellence (decrease from $50 million)
- $51.5 million for Scholarships (increase from $50 million)
- $1.2 million for Loan Repayments and Fellowships (decrease from $5 million)
- $15,000 for educational assistance in health professionals from disadvantaged backgrounds (decrease from $60 million)
- $41.25 million for AHECs (decrease from $125 million)
Extends mandatory funding for CHCs, the NHSC, and THCGME Program at current levels through November 30, 2020
- THCGME Program - $126.5 million total for FY20 and $21,141,096 for October 1, 2020-November 30, 2020
Education and training relating to geriatrics
- Reauthorizes and updates Title VII of the Public Health Service Act (PHSA), which pertains to programs to support clinician training and faculty development, including the training of practitioners in family medicine, general internal medicine, geriatrics, pediatrics, and other medical specialties
Workforce Response Activities
- Allows Governors to utilize reserved workforce funds on rapid response activities in response to COVID-19
Increasing Provider Funding through Immediate Medicare Sequester Relief
- This section would provide prompt economic assistance to health care providers on the front lines fighting the COVID-19 virus, helping them to furnish needed care to affected patients
- Specifically, this section would temporarily lift the Medicare sequester, which reduces payments to providers by 2 percent, from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care
- The Medicare sequester would be extended by one-year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook
Clarification Regarding Uninsured Individuals
- Clarifies a section of the Families First Coronavirus Response Act of 2020 (PL 116-127) by ensuring that uninsured individuals can receive a COVID-19 test and related service with no cost-sharing in any state Medicaid program that elects to offer such enrollment
Clarification Regarding Coverage of Tests
- Clarifies a section of the Families First Coronavirus Response Act of 2020 (PL 116-127) by ensuring that beneficiaries can receive all tests for COVID-19 in Medicare Part B with no cost-sharing
Coronavirus Relief Funds
Coronavirus Relief Fund
- Provides $150 billion to States, Territories, and Tribal governments to use for expenditures incurred due to the public health emergency with respect to COVID- 19 in the face of revenue declines, allocated by population proportions, with a minimum of $1.25 billion for states with relatively small populations
- Centers for Disease Control (CDC) and Prevention: $4.3 billion
- National Institutes of Health (NIH): $94.5 million for vaccine, therapeutic, and diagnostic research
- Increases our understanding of COVID-19, including underlying risks to cardiovascular and pulmonary conditions
- When combined with the first supplemental, the Congress has provided $1.78 billion for NIH research
- Substance Abuse and Mental Health Services Administration: $425 million to address mental health and substance use disorders as a result of the coronavirus pandemic
Emergency paid sick leave limitation
- Creates a limitation stating an employer shall not be required to pay more than $511 per day and $5,110 in the aggregate for sick leave or more than $200 per day and $2,000 in the aggregate to care for a quarantined individual or child for each employee under this section
President Trump recently released his fiscal year (FY) 2021 budget request totaling $4.8 trillion. Overall, the proposal includes deep cuts to research, public health programs, federal student financial aid and loan forgiveness, and graduate medical education (GME), all of which are vital to educating the next generation of osteopathic physicians and improving patient health across the nation.
Highlights from the proposal pertinent to osteopathic medical education include the following:
Department of Education
Requests $66.6 billion, a $5.6 billion or 7.8 percent reduction in funding from FY 2020 enacted levels.
- Proposes institutions participate in student loan risk sharing but does not describe what that plan looks like in depth. Any program must be authorized by Congress.
- Consolidates multiple income-driven repayment (IDR) plans into a single plan.
- Caps borrower’s monthly payment at 12.5 percent of discretionary income.
- For undergraduate borrowers, any balance remaining after 15 years of repayment would be forgiven.
- For borrowers with graduate debt, any balance remaining after 30 years of repayment would be forgiven.
- Proposes to auto-enroll severely delinquent borrowers in IDR.
- Removes standard repayment cap.
- Calculates payments for married borrowers filing separately using their combined household Adjusted Gross Income (AGI).
- Eliminates the Public Service Loan Forgiveness program.
- Eliminates subsidized loans for undergraduate students.
- Proposes to set annual and aggregate limits of $50,000 and $100,000 respectively for graduate students, exclusive of any undergraduate borrowing.
- Graduate student borrowing would be consolidated under one graduate loan program with the same corresponding loan terms and conditions as the current Grad PLUS program.
- Recommends the evaluation of the Office of Federal Student Aid (FSA) as an independent, separate organization.
Department of Health and Human Services
Requests $96.4 billion in discretionary funding, a 9 percent decrease from FY 2020.
- Provides $38 billion for the NIH, a nearly $3 billion (7.2 percent) cut from the FY20 enacted level.
- Combating the Opioid Crisis -- Proposes $5 billion to combat the opioid epidemic, while trimming the overall Substance Abuse and Mental Health Administration’s budget by $142 million.
- Continuation of $1.6 billion, an $85 million increase, in State Opioid Response Grants and $1.85 billion for the Substance Abuse Prevention and Treatment Block Grant.
- Consolidates GME spending in Medicare, Medicaid, and the Children’s Hospital GME Payment Program into a new mandatory GME capped grant program.
- Extends Teaching Health Centers Graduate Medical Education (THCGME) Program, Community Health Centers, and the National Health Service Corps.
- THCGME Program: Includes $126.5 million in mandatory resources for residency training in primary care medicine and dentistry in community-based, ambulatory settings. This is level funding with FY 2020.
- National Health Service Corps: Provides $430 million, including $120 million in flat discretionary funding. Additionally, the budget continues the $310 million mandatory appropriation fund for FY21, which would require congressional reauthorization.
- Health Centers and Free Clinics: Provides a total of $5.7 billion, including $4 billion in mandatory funding.
- Title VII and Title VIII Programs – Eliminates thirteen health professions training and workforce programs, including the Loan Repayment/Faculty Fellowships; Health Professions Training for Diversity (including the Scholarships for Disadvantaged Students and Health Careers Opportunity Program); Primary Care Training and Enhancement; Oral Health Training Programs; Graduate Medical Education for Health Care Professionals; Area Health Education Centers; Geriatric Programs; Public Health/Preventative Medicine; Advanced Nursing Education; Nursing Workforce Diversity; Nurse Education, Practice and Retention; and Nurse Faculty Loan Program.
- Preserves funding for the Centers of Excellence, Behavioral Health Workforce Development Programs, and NURSE Corps Scholarship and Loan Repayment Program with a slight decrease.
- Proposes to eliminate the Agency for Healthcare Research and Quality (AHRQ) as a standalone agency and transfer its authority to a new institute within NIH as the National Institute of Research on Safety and Quality (NIRSQ). This was proposed previously in the past three budget year proposals. The FY21 request for AHRQ/NIRSQ is $257 million, a decrease of $81.3 million or 24 percent below AHRQ’s current funding level.
Department of Veterans Affairs
Requests $105 billion in discretionary funding in 2021, a 14 percent increase from FY 2020, and $94.2 billion in advance appropriations for VA medical care programs in 2022. Additionally, the budget requests:
- Provides $90 billion, a 12.7 percent increase, to fully support veteran medical care.
- $309.4 million to fully support implementation of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018.
- $787 million for VA research in FY21, a $23 million or 1.6 percent decrease from FY20 enacted levels.