House Appropriations Committee Approves Fiscal Year 2023 Labor, Health and Human Services, Education, and Related Agencies Bill

On June 30th, the House Appropriations Committee approved the fiscal year (FY) 2023 Labor, Health and Human Services, Education, and Related Agencies bill. The bill includes $242.1 billion for FY 2023, an increase of $28.5 billion from FY 2022. More specifically, the bill and related report language include $124.2 billion for the Department of Health and Human Services (HHS), an increase of $15.6 billion from FY 2022, including:

• $9.6 billion for the Health Resources and Services Administration (HRSA), an increase of $683 million from FY 2022, including:
  • $34,700,000 for the Mental and Substance Use Disorder Workforce Training Demonstration, $3,000,000 from FY 2022. This program is home of the Addiction Medicine Fellowship program and makes grants to institutions to support training for fellows in addiction medicine and addiction psychiatry, as well as nurse practitioners, physician assistants, and others, to provide addiction treatment in underserved communities.
  • $28,000,000 for the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment program, $4,000,000 from FY 2022. This program addresses shortages in the addiction workforce by providing for the repayment of education loans for individuals working in a full-time addiction treatment job that involves direct patient care in either a Mental Health Professional Shortage Area or a county where the overdose death rate exceeds the national average;
• $47.5 billion for the National Institutes of Health (NIH), an increase of $2.5 billion from FY 2022, including an increase of $100 million for research related to opioids, stimulants, and pain/pain management;
•  $9.2 billion for the Substance Use And Mental Health Services Administration (SAMHSA), an increase of $2.6 billion from FY 2022, including:
  • $2.4 billion for the Substance Use Prevention and Treatment Block Grant (SUBG), an increase of $500 million from FY 2022;
  • $1.8 billion for State Opioid Response Grants, an increase of $250 million from FY 2022;
  • $147.9 million for Targeted Capacity Expansion, including addiction medications; and
  • A new 10 percent set-aside within the SUBG for recovery support services.

Of note to addiction specialists, the following excerpts also appear in the related report:

• Access to Buprenorphine.*—The Committee is concerned by reports of patients not being able to fill buprenorphine prescriptions at pharmacies. The Committee requests a briefing from CMS and OIG within 180 days of the date of enactment of this Act on the results of the current audits examining access to and use of medications for opioid use disorder (MOUD) and CMS’s intended response.
• Utilization Management for MOUD.—The Committee recognizes that frontline medical provider experience and research increasingly indicate that individuals who take oral buprenorphine for opioid use disorder (OUD) may benefit from doses higher than 24mg. The population of individuals who may need higher doses of buprenorphine to prevent cravings is expected to increase as fentanyl continues to proliferate the illicit opioid market. The Committee is aware that State Medicaid programs may have in place utilization management practices, including those that require a prior authorization before prescribing oral buprenorphine above 16mg or 24mg daily. The Committee requests that CMS examine State utilization management requirements related to oral buprenorphine, and whether such requirements unnecessarily delay access to treatment.
• Contingency Management.—The Committee is aware that contingency management, also known as motivational incentives, is an evidence-based treatment method for individuals with SUD, particularly for substances such as stimulants that currently have no FDA-approved pharmacological intervention. Current interpretation of Federal laws and regulations constrain the ability of individuals and entities to use Federal funding for appropriate contingency management program incentives. The Committee urges SAMHSA, in coordination with the Office of Inspector General, to reevaluate the limitations on the use of cash and cash-equivalent payments offered as part of contingency management in the treatment of SUD to better align them with current research.
• Overdose Prevention Centers.—The Committee recognizes that overdose prevention centers, or supervised consumption sites, are part of a larger effort of harm reduction interventions intended to reduce the risk of drug overdose death and reduce the spread of infectious disease. The Committee encourages NIH to discuss in the fiscal year 2024 Congressional Justification significant advances in research on the potential public health impact of overdose prevention centers in the U.S.
• Eliminating Racial Disparities in Overdose Deaths.—The Committee is concerned with the rising rates of overdose deaths in communities of color, specifically among Black people. These racial disparities are made worse by the fact that access to treatment is often dependent on race, income, geography, and insurance status, rather than individual preferences, or medical or psychiatric indicators and needs. The Committee urges SAMHSA to scale programs in communities of color, including increased outreach capacity, to help eliminate racial disparities in overdose deaths and improve access to prevention and treatment services.

Key House Labor-HHS documents can be found below:

• LHHS Appropriations bill
• LHHS Appropriations bill summary
• LHHS Appropriations bill report
• Community Project Funding requests
• Adopted Amendments

*The House Appropriations Committee also passed the FY23 Commerce, Justice, Science, and Related Agencies Appropriations Bill; its related report includes the following excerpt:

• Buprenorphine.—The Committee is concerned by reports of patients not being able to fill buprenorphine prescriptions at pharmacies. Reports indicate that pharmacies are unable or unwilling to stock sufficient buprenorphine products because of unclear regulations on suspicious orders, fear of DEA raids, overly burdensome distributor processes and paperwork requirements, or distributor confusion over whether DEA has caps or quotas on distribution of opioids and/or buprenorphine. The Committee directs the DEA Administrator to clarify the difference between suspicious orders of opioids and suspicious orders of buprenorphine, clarify the difference between suspicious orders and caps or quotas, clarify that the DEA has no quotas or caps on buprenorphine, and clarify how distributor-imposed quotas or caps on opioids or buprenorphine do or do not satisfy suspicious order regulations. Within 180 days of the date of enactment of this Act, the Committee requests DEA report on what actions it has taken to prevent individuals from being inappropriately denied access to medications for opioid use disorder.