White House Releases Fiscal Year (FY) 2023 Budget Request – Big Proposed Increases for Research
On Monday, March 28, 2022, President Biden released his proposed fiscal year (FY) 2023 budget. The president’s budget request starts the Congressional budget process. The budget presented by the Biden administration provides a roadmap to what the president would like to be implemented. However, it is not a requirement for Congressional authorizers and appropriators, and how much Congress integrates these ideas remains to be seen.
Of note, the budget includes a $9 billion increase in resources for the National Institutes of Health (NIH). That total includes $6.5 billion for a new entity, the Advanced Research Projects Agency-Health (ARPA-H), initially focusing on research into cancer and other diseases such as diabetes and Alzheimer’s. APRA-H aims to “drive transformational innovation in health research and speed application and implementation of health breakthroughs,” the request says. A $10 million NIH office funding research on climate change and human health would increase to $110 million. The National Science Foundation would get a 20%, $1.7 billion boost, to $10.2 billion.
The President’s budget also includes a suite of proposals to address the urgent need for behavioral health care which has grown due to the pandemic. The budget would also strengthen Medicaid mental health provider capacity and expand and make permanent the Certified Community Behavioral Health Clinic demonstration program, which provides enhanced Medicaid funding to behavioral health clinics that meet robust services criteria.
Biden’s request will now go to Congress, which will have the final say on 2022 spending levels.
Upton Plans to Retire – Implications for Cures 2.0
Rep. Fred Upton (R-Mich.) announced his retirement plans last week. Upton, a member of the Congressional Mitochondrial Disease Caucus, was first elected to the House of Representatives in 1986. He is the third most senior Republican in the 117th Congress and the former chair of the Energy and Commerce Committee. He is also the lead Republican sponsor of the Cures 2.0 Act. Cures 2.0, among other provisions, would accelerate medical research, increase patient access to novel therapeutics, remove current barriers to telehealth services, and codify a recent regulation that would accelerate Medicare coverage of breakthrough devices. Given Rep. Upton’s retirement, there will likely be a push to advance elements of Cures 2.0 before he retires. Rep. Upton’s last day in office will be January 3rd, 2023.
Public Health Emergency Extended
The public health emergency (PHE) was extended for another 90 days until July 15. The extension comes amid political pressure to wind down the PHE and its associated flexibilities. States are preparing for the administration to wind down the emergency. CMS has already alerted providers that many nursing home compliance standards will phase out, while still protecting those residents. Congress also extended telehealth coverage of Medicare for 151 days (roughly five months) after the emergency ends in the fiscal 2022 omnibus spending bill. Notably, UMDF members successfully advocated for the inclusion of the telehealth extension. This extension also has Congress requiring the Medicare Payment Advisory Commission (MedPAC) and the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) to report on how well the telehealth flexibilities are working and if more guardrails are needed for fraud and abuse – along with a look at the cost impact of telehealth to the Medicare program in the long run. While the 151-day extension of telehealth coverage beyond the PHE may not provide much long-term clarity regarding telehealth access, the de-linking of telehealth coverage from the PHE is notable and keeps pressure on Congress to pass longer-term extensions of telehealth policy.