Following protracted negotiations, lawmakers on Capitol Hill reached a bipartisan and bicameral deal to finalize the Fiscal Year (FY) 2023 appropriations process. While not as generous toward medical research and public health as prior proposals, the final omnibus package still provides meaningful funding increases for many key agencies and programs. Lawmakers were also working to dispense with critical and timely health policy items and used the omnibus as a comprehensive vehicle to advance legislative provisions, in addition to providing funding. A summary of key items from the FY 2023 omnibus appropriations package is included below.
FY 2023 Funding
- $47.459 billion program level for the National Institutes of Health (NIH), an increase of $2.5 billion over FY 2022.
- $3.24 billion for the National Institute of General Medical Sciences (NIGMS), an increase of $147.31 million over FY 2022.
- $425.96 million for the Institutional Development Awards (IDeA) program, an increase of $15.50 million over FY 2022.
- $524.4 million for the National Institute on Minority Health and Health Disparities (NIMHD), an increase of $65.34 million over FY 2022.
- $88.77 million for Research Centers at Minority Institutions (RCMIs), an increase of $4 million over FY 2022.
- $923.32 million for the National Center for Advancing Translational Sciences (NCATS), an increase of $41.06 million over FY 2022.
- $629.56 million for the Clinical and Translational Science Awards (CTSA) Program, an increase of $22.91 million over FY 2022.
- $1.5 billion for the Advanced Research Projects Agency for Health (ARPA-H), an increase of $500 million over FY 2022.
- $9.218 billion program level for the Centers for Disease Control and Prevention (CDC), an increase of $760 million over FY 2022.
- $373.5 million for the Agency for Health Care Research and Quality (AHRQ), an increase of $23.1 million over FY 2022.
Health Policy Provision
- Authorizes the establishment of the Advanced Research Projects Agency – Health (ARPA-H), that will accelerate innovation in health and medicine by investing in novel, broadly applicable, high-risk, high-reward research projects. ARPA-H will be part of NIH, but physically located away from the NIH campus. ARPA-H will have the authority to collaborate with other federal agencies, including FDA, and have the authority to establish relationships with historically black health professions schools.
- Additional Graduate Medical Education (GME) Residency Positions. Supports physician workforce development by providing for the distribution of 200 additional Medicare-funded graduate medical education (GME) residency positions starting in Fiscal Year 2026. This provision dedicates one-half of the total number of positions to psychiatry or psychiatry subspecialty residencies and provides consideration to teaching hospitals located in health professions shortage areas.
- Requires FDA to take a series of actions intended to modernize and improve clinical trials including increasing the diversity and engagement of trial participants.
- Extends Medicare telehealth flexibilities that were extended in the Consolidated Appropriations Act, 2022, through December 31, 2024.
- Provides additional support for physicians and other health care professionals in adjusting to Medicare payment changes. For services furnished in 2023, increases otherwise applicable Medicare Physician Fee Schedule payments by 2.5 percent. For services furnished in 2024, provides a 1.25 percent payment increase. Extends the mandatory Medicare payment reductions under sequestration for the first 6 months of fiscal year 2032, while revising Medicare sequestration percentages to 2 percent for fiscal year 2030 and fiscal year 2031.
CTSA Program Instructions
Clinical and Translational Science Awards (CTSAs).-The agreement provides $629,560,000, an increase of $22,914,000 above the fiscal year 2022 enacted level. The agreement maintains its strong support for the CTSA program and reaffirms previous language preserving the size, scope, and historic mission of the CTSA program, including the direction that no hub shall receive less than 95 percent of the resources that were provided prior to fiscal year 2022. Last year, the agreement expressed concerns with a new Funding Opportunity Announcement and its potential to divert appropriated resources away from CTSA hubs. The agreement is concerned that NCATS continues to push to disaggregate CTSA activities, which makes the application process burdensome on investigators and resulted in nearly all institutions submitting partial applications. No later than 30 days after enactment of this Act, NCATS is directed to brief the Committees on options to reverse disaggregation, preserve historic CTSA activities and institutional support, including training as many young investigators as possible, and ensure that any hub funded receive not less than 95 percent of the resources that were previously provided. Finally, the agreement reiterates previous direction that NCATS inform the Committees prior to any planned changes to the size of hub awards, scope of the program, or strategic changes to the program, specifically noting that the Committees shall be consulted prior to any new CTSA initiatives being implemented.