Rural Health Policy Update

The fiscal year 2024 (FY ’24) budget process got underway on March 9, when the Biden Administration released its FY 2024 budget request to Congress. Here is a link to the 169-page HHS budget brief. At the top line, the budget proposes $144.7 billion in discretionary budget authority for HHS, a $17 billion (13.3 percent) increase over FY 23. Some of the other healthcare highlights include:

• $13 million requested for the State Offices of Rural Health (SORH) line. This request represents a $500,000 increase over FY 23 if enacted by Congress. 
• $64 million requested for Medicare Rural Hospital Flexibility Program (Flex) – down slightly from $64,277,000 for FY 23.
• $165 million requested for the Rural Communities Opioids Response program – a $20 million increase over FY 23. 
• $13 million requested for the rural residency program – a $500,000 increase over FY 23.

HHS also requested funding for several new rural health-related programs that Congress has not previously funded. 

• $10 million for rural health clinic behavioral health initiative (this program was included in the House and Senate Appropriation bills in FY 23 but not in the final passage). 
• $10 million for the Community Sustainability for At-Risk Hospitals program
• $20 million for the Rural Hospital Stabilization Program. 

Along with the annual budget release comes the annual reminder that the budget is a non-binding document on Congress written mainly for political purposes. The budget request merely establishes the Administration’s spending and policy priorities. In late March, the House and Senate began the process of Congressional hearings, with HHS Secretary Becerra defending the administration’s budget before House and Senate committees of jurisdiction. 

Look for the House and Senate Appropriations Committees to introduce their FY 24 spending bills sometime in May or June. 

Rural Health Bills Recently Introduced: 
Several House and Senate rural health-related bills have been introduced over the past month. 

• Reps. Graves (R-MO) and Huffman (D-CA) introduced H.R. 833, the Saving Rural Hospitals Act. Included in this bill is a section that would reauthorize the Flex Program. NOSORH has been actively meeting with Senate offices over the past two months in hopes of introducing a Senate bill reauthorizing the Flex Program. 
• House E&C Chairwoman Cathy McMorris Rodgers introduced H.R. 1518, which would create a schedule for federal programs that Congress has not reauthorized. The bill gives Congress three years to re-authorize a program after it has expired, or the program will be eliminated. While a bill like this would not pass in the current Congress, it emphasizes how important congress views its role of reauthorization. 
• Rep. Adrian Smith (R-NE) introduced H.R. 1565, which seeks to remove the 96-hour physician certification requirement for inpatient Critical Access Hospital services. 
• Senator Amy Klobuchar (D-MN) reintroduced S. 665, the Conrad 30 bill. If reauthorized, the bill would allow international doctors to remain in the U.S. upon completing their residency under the condition that they practice in areas experiencing doctor shortages. Here is the Klobuchar press release. 
• Senator Jackie Rosen (D-NV) introduced S. 705, which would amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians. Senator Rosen also introduced S. 703, which seeks to make improvements on the redistribution of residency slots under Medicare after a hospital closes. Here is the Rosen press release on the two bills. 

Update Provided by Hall Render, NOSORH’s Legislative Liaison.