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AAP Advocacy Update January 2022

Congress Wrapping up 2021, CMS Finalizes GME Funding



Congressional leaders are slowly taking care of several priority issues that they needed to handle before the end of the year. Among the challenges faced by lawmakers were Fiscal Year 2002 spending, debt-limit increase, Medicare provider cuts and spending for national defense. Congressional Democrats were also hoping to use the budget reconciliation process to pass President Biden’s tax and spending measure known as the Build Back Better Act. While lawmakers were able to make progress on some of these measures, some were only addressed temporarily while others look left behind.


With regard to appropriations and government spending, Congress has yet to pass a majority of the FY 22 appropriations measures to fund government programs in 2022. However, On Dec. 3, President Joe Biden signed the Further Extending Government Funding Act (H.R. 6119), a continuing resolution (CR) that extends funding for federal agencies, including the NIH and other funding agencies, at FY 2021 levels through Feb. 18, 2022. While this does provide temporary relief and prevents a government shutdown, it provides no new money for any government programs. The Ad Hoc Group for Medical Research released a Dec. 3 press statement citing the harms of Continuing Resolutions to medical research supported by the NIH stating “While stopgaps serve an important purpose in maintaining federal operations, prolonged continuing resolutions create uncertainty that is disruptive to the long-term endeavour of medical research and impose unnecessary inefficiencies and delays in harnessing scientific opportunity toward the development of new treatments, diagnostics, preventive measures, and cures for patients.” Congress will need to act again before Fe. 18th or face a government shutdown.


Congress also passed legislation, which President Biden has signed, to avert large cuts that were looming for Medicare providers in 2022. The bill, the Protecting Medicare and American Farmers from Sequester Cuts Act provides delays in the Medicare sequestration cuts for 2022 and increases the rates under the Medicare Physician Fee Schedule (PFS). The bill delays the resumption of the 2% Medicare sequester for three months (Jan. 1–March 31, 2022), followed by a reduction to 1% for three months (April 1–June 30, 2022), while also providing a one-year increase in the Medicare physician payment schedule of 3%.


President Biden and Congressional Democrats have been working for months to garner support for their social tax and spending plan to be passed through the budget reconciliation process, which requires no support from Republicans in the evenly divided Senate. This strategy relied on getting moderate Democrats such as Sen Joe Manchin (D-WV) on board. Manchin has expressed several concerns over the last several months with the size and scope of the package. He was hoping for a smaller bill with a total price tag capped at $1.75 trillion over 10 years. While the package that passed the House of Representatives earlier, this year totalled over $2.2 trillion in spending. The sweeping legislation would have increased taxes by about $1.9 trillion over 10 years and used that revenue for investments in climate change, health care, childcare and family leave. Sen. Manchin recently stated that he will not support the legislation in its current form and has called off further negotiations, leaving President Biden without enough support from Democrats to pass the bill.


On December 17, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period to implement the legislative changes to Medicare direct graduate medical education (DGME) and indirect medical education (IME) payments to teaching hospitals that were contained in sections 126, 127, and 131 of the Consolidated Appropriations Act, 2021. The Consolidated Appropriations Act (CAA), 2021, added an additional 1,000 new Medicare-funded medical residency positions to help train physicians, phased in at no more than 200 slots per year beginning in FY 2023. CMS estimates that this additional funding will total approximately $1.8 billion from FY 2023 through FY 2031. CMS is prioritizing applications from qualifying hospitals that serve geographic areas and underserved populations with the greatest need. In addition, Sen. Tim Kaine (D-VA) re-introduced his Expanding Medical Education Act, legislation to tackle the lack of representation of rural students, underserved students, and students of color in the physician pipeline. The bill would provide grants to colleges and universities to establish or expand medical schools in underserved areas or at minority-serving institutions (MSIs), including Historically Black Colleges and Universities (HBCUs). The legislation would encourage the recruitment, enrollment, and retention of students from disadvantaged backgrounds at the medical schools.

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