March 27, 2018  | 

What is in the New 2018 Omnibus Spending Bill?

March 2018 | A BREAKDOWN OF APPROPRIATIONS

The Senate successfully passed (65 to 32) a $1.3 trillion omnibus spending bill, after the House passed the bill (256 to 167) on Thursday.

While there was some uncertainty initially about whether President Donald Trump would sign the bill, after a tweet saying he was considering a veto, the bill was signed into law, avoiding a government shutdown. The bill provides $177.1 billion in discretionary appropriations for health, education, and labor agencies for the 2018 fiscal year. This is $16 billion more than in fiscal year 2017. *Note: Fiscal year (FY) 2018 goes from October 1, 2017 to September 30, 2018.

The omnibus spending bill allocates roughly $4.65 billion to addressing the opioid epidemic across the federal government — about three-quarters of that comes from the Labor-HHS section – about $3 billion of that amount is “new” money consistent with the budget agreement reached last month. Overall, the Department of Health and Human Services (HHS) is receiving $78 billion in budget authority, an increase of $10 billion from FY17.

Summary of FY18 Omnibus Spending Bill

(NIH) National Institutes of Health

The omnibus provides $37.084 billion for NIH, including the full $496 million from the 21^st Century Cures Act Innovation Account, a $3 billion increase over the 2017 level.  Within NIH, the bill includes $500 million split evenly between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Drug Abuse (NIDA) for research related to opioid addiction, development of opioid alternatives, pain management, and addiction treatment.

INCLUDED PROGRAMS OF INTEREST:

• $37,084,000,000 for the National Institutes of Health, an increase of 8.8% above FY17
  • Including $496,000,000 for the 21^st Century Cures Act, including:
    • $300,000,000 for National Cancer Institute
    • $43,000,000 to NINDS and $43,000,000 to NIMH for the BRAIN Initiative
    • $110,000,000 will be allocated from the NIH Innovation Fund, in the Office of the Director, for the Precision Medicine Initiative cohort ($100,000,000) and regenerative medicine research ($10,000,000)

• Includes $500,000,000 for targeted research on opioid addiction:

  • National Institute of Drug Abuse ($250 million)

  • National Institute on Neurological Disorders and Stroke ($250 million)
• Increases funding for All of Us precision medicine initiative by $60,000,000
• Increases funding for the Brain Research through Advancing Innovative Neuro-technologies (BRAIN) Initiative by $140,000,000
• Increases funding for regenerative medicine by $8,000,000
• Increases funding for antibiotic resistance research by $50,000,000
• Increases funding for the development of a universal influenza vaccine by $40,000,000
• Includes a new initiative to expand research into Down syndrome
• Increases funding for Clinical and Translational Science Awards to $542,771,000, an increase of $26,651,000
• Increases funding for Institutional Development Awards to $350,575,000
• Continues to support the National Children’s Study Follow-on program at $165,000,000
• The Common Fund is supported as a set-aside within the Office of the Director at $588,116,000

INCLUDED NIH POLICY DIRECTIVES:

• The additional opioid funding is made available until September 30, 2019. For-profit recipients of opioid funds shall be subject to a matching requirement of funds or documented in-kind contributions of not less than 50 percent of the total funds awarded to such entity
• For the additional $500 million in opioid funding, the agreement gives the NIH Director authority to transfer funds to other Institutes and Centers for the purpose of conducting research on opioid addiction, opioid alternatives, pain management and addiction treatment.
• Maintains the Salary Cap for NIH-funded extramural researchers to Executive Level II
• Prohibits the Department of Health and Human Services from developing or implementing modifications to Indirect Cost Rates (Facilities and Administration) that were in effect as of the third quarter of 2017

(SAMHSA) Substance Abuse and Mental Health Administration

The bill funds SAMHSA at $5 billion – $1.3 billion above the FY17 level. The legislation maintains a prohibition on federal funds for the purchase of syringes or sterile needles, but allows communities with rapid increases in cases of HIV and Hepatitis to access federal funds for other activities, including substance-use counseling and treatment referrals.

The omnibus includes $1 billion in new State Opioid Response grants under SAMHSA; within these funds, there is a 15% set-aside for states with the highest mortality rates related to opioid use disorders and a $50 million set-aside for Indian tribes and tribal organizations. These funds are in addition to the $500 million for FY 18 from the 21^st Century Cures Act.

INCLUDED PROGRAMS OF INTEREST:

• $1.9 billion for the Substance Abuse Prevention and Treatment Block Grant
• $84 million for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction
• $53.8 million for the National Child Traumatic Stress Network
• $30 million for Screening, Brief Intervention, Referral and Treatment (SBIRT)
• $29.9 million for pregnant and post-partum women
• $8.7 million for Opioid Treatment Programs/Regulatory Activities
• $5 million for Building Communities of Recovery
• $2.4 million for Recovery Community Services Program
• $1.9 million for disaster response
• $1 million for Improving Access to Overdose Treatment

(HRSA) Health Resources Services Administration

• $27 million for mental and behavioral health education training to recruit and train professionals and faculty in the fields of social work, psychology, psychiatry, marriage and family therapy, substance abuse prevention and treatment and other areas of mental health behavioral health
• $105 million to the National Health Service Corps to expand and improve access to opioid and substance use disorder treatment. The omnibus also expands loan repayment through the National Health Service Corps to include substance use disorder counselors

• $130 million for a new Rural Communities Opioids Response program
• $1.63 billion, $135 million above FY17 for Community Health Centers to expand behavioral health and substance use disorder prevention and treatment services, including opioid misuse, and provide access to overdose reversal drugs and recovery support services.

(CDC) Centers for Disease Control and Prevention

The omnibus includes $7.2 billion in discretionary budget authority for CDC, or about a $1.1 billion increase over FY17. It also gives CDC $475 million for prescription overdose prevention activities — an increase of $350 million to help fight the opioid epidemic, with $10 million of those funds dedicated to an opioid misuse awareness campaign.

OTHER HEALTH POLICY PROVISIONS INCLUDED IN SPENDING BILL

• Continues the Hyde Amendment, which bars the use of federal funds to pay for abortion services, with exceptions for rape or incest or when the mother’s life is endangered.
• Continues the Weldon Amendment, which prohibits federal agencies from discriminating against providers that do not perform abortions.
• Continues to prohibit the CDC from advocating for gun control measures, a provision known as the Dickey Amendment, but the report accompanying the bill includes language stating that the agency has the authority to research the causes of gun violence.
• Does not include changes to the Medicare Part D coverage gap.
• Excludes a health insurance market stabilization package.

This Policy Exclusive was provided by Holly Strain & Carol McDaid of Capitol Decisions