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  • Writer's pictureAssociation of Academic Physiatrists

August 2020 Update

House Continues to Push Spending Bills

House Democrats are plowing forward on their attempt to pass all 12 Fiscal Year 2021 spending bills before the August recess. To date, the House has passed funding for the Department of Veterans Affairs (VA), but not the Department of Health and Human Services (HHS). Here’s a look at the relevant funding programs in each of those spending packages.

The House approved a four-bill package of spending bills on July 24th, which included spending for VA and VA research programs. Some items of note within the VA budget include:

  • $840 million for Medical and Prosthetic Research, an increase of $40 million above the 2020 enacted level and $53 million above the President’s budget request.

  • $2.6 billion to continue implementation of the VA Electronic Health Record System, an increase of $1.1 billion above the 2020 enacted level and equal to the President’s budget request.

  • Spinal Cord Research - The Committee encourages the Department to work with outside organizations on spinal cord injury translational research to improve the quality of life of impaired and disabled Veterans, and provides $10,000,000 to do so.

  • Regional Research Networks - The Committee supports the Department’s efforts in continuing to establish regional research networks in areas where existing small VA research programs align with co-located academic partners. The Committee directs the Department to provide a report within 120 days of enactment of this Act on how it is achieving the following objectives and/or steps the Department can take to better meet these objectives: (1) supporting the development and/or enhancement of infrastructure and human resources required to address clinical and translational research needs in small under-resourced VA jurisdictions, (2) fostering and sustaining collaboration and coordination of clinical and translational activities within and across VA jurisdictions, and (3) addressing the broad spectrum of health challenges and concerns faced by populations served by small underfunded VA research programs.

The House is planning action next on the six-bill spending package for Fiscal Year 2021, which includes funding for HHS. If approved by the House, the bill would fund the following programs:

  • National Institutes of Health (NIH) - The bill provides a total of $47 billion for NIH, an increase of $5.5 billion above the FY 2020 enacted level. The bill provides $42 billion in annual appropriations, an increase of $500 million above the 2020 enacted level and $8.6 billion above the President’s budget request, as well as $5 billion in emergency appropriations.

  • National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) - The Committee recommends $111,970,000 for the NIDILRR, which is equal to the FY 2020 enacted level and $21,599,000 above the FY 2021 budget request.

  • Paralysis Resource Center (PRC) - The Committee recommends $9,700,000 for the PRC, and directs not less than $8,700,000 to the National PRC. The PRC offers activities and services aimed at increasing independent living for people with paralysis and related mobility impairments, and supporting integration into the physical and cultural communities in which they live.

  • Limb Loss Resource Center - The Committee recommends $4,000,000 for the Limb Loss Resource Center, which is equal to the FY 2020 enacted level and the FY 2021 budget request. The Limb Loss Resource Center supports a variety of programs and services for those living with limb loss, including a national peer support program, educational events, training for consumers and healthcare professionals, and information and referral services. In addition, the Center supports Veterans and Wounded Warriors through VA and DOD partnerships and volunteer programs, and disseminates over 20,000 patient education materials created by the program to promote recovery and reintegration, improve health and enhance well-being and rehabilitation through a national network of professionals and support groups.

  • Traumatic Brain Injury - The Committee recommends $11,321,000 for the Traumatic Brain Injury program, which is equal to the FY 2020 enacted level and the FY 2021 budget request. The program provides grants to States for the development of a comprehensive, coordinated family and person-centered service system at the State and community level for individuals who sustain a traumatic brain injury.

  • Stroke - Despite remarkable progress to reduce the stroke mortality rate, it is still the most common cause of severe long-term disability. The Committee supports continued research to improve the scientific understanding of stroke and clinical trials that are developing new treatments and improved approaches to stroke recovery and rehabilitation through the NIH-funded clinical trials network StrokeNet. The Committee supports continued stroke-related research conducted through the BRAIN Initiative that seeks to discover how brain circuits rewire themselves to repair damage that occurs during a stroke and that may lead to effective treatments to mitigate this damage in the future.

  • BRAIN Initiative - The Committee directs NIH to transfer $50,000,000 from the NIH Innovation Account to NINDS to support the BRAIN Initiative. These funds were authorized in the 21st Century Cures Act (P.L. 114–255). This collaborative effort is revolutionizing the understanding of how neural components and their dynamic interactions result in complex behaviors, cognition, and disease, while accelerating the development of transformative tools to explore the brain in unprecedented ways, making information previously beyond reach accessible.

  • Traumatic Brain Injury (TBI) Mitigation - The Committee understands that research on regenerative medicine and neuroplasticity, including the use of adult stem cells and neuroplasticity, may play an important role in developing treatments and identifying therapeutic targets for neuroprotection pre/ post TBI. The Committee urges NINDS to work with all relevant Institutes and Centers, including NIA, to support a robust and coordinated portfolio of TBI research that explores all promising avenues to facilitate functional repair of damaged circuitry in TBI.

  • Non-Opioid Pain Management - The Committee believes that providing affordable non-opioid pain management to patients covered by Medicare and Medicaid is critical to combating drug addiction and the opioid crisis. The Committee looks forward to receiving CMS’s upcoming report on non-opioid pain management, as required by section 6086 of the SUPPORT Act.

  • Chronic Pain - The Committee remains concerned about the public health epidemic of acute and chronic pain, including its interrelationship with the opioid crisis. The Committee is pleased with the release of the HHS Pain Management Best Practices Inter-Agency Task Force Report in May 2019, but remains concerned over delayed dissemination and implementation of the Report’s recommendations. A strategic plan to disseminate the report and implement recommendations is needed, and the Committee strongly encourages the Department to widely disseminate the Report to health care providers and other public health stakeholders, and to update relevant pain management policies and educational tools to reflect the Task Force's recommended best practices across all relevant HHS agencies, including the CDC, CMS, SAMHSA and other relevant agencies. The Committee also urges the Department to coordinate with the Department of Defense and VA to launch a public awareness campaign to educate Americans about acute and chronic pain and the evidence based non-opioid treatment options that are available, including non-opioid medications; interventional procedures such as nerve blocks, injections and surgical devices; behavioral health approaches such as cognitive behavioral therapy; and complementary and integrative health therapies such as massage therapy and acupuncture.

While the House moves forward with appropriations bills, the Senate has been slower to take action. It is very likely that the House-passed spending packages will wait until after the November elections for final action.

Update provided by Bryan Cave Leighton Paisner LLP

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