Policy Update: Fiscal Year 2023 Draft Funding Bill Supports ASN Policy and Kidney Health Priorities

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The House Appropriations Committee on Labor, Health and Human Services, Education, and Related Agencies released its draft funding bill for fiscal year (FY) 2023 on June 22. The report language in the bill bolsters the nation's public health infrastructure and strengthens biomedical research and innovation. The bill allocates funding for and directions to agencies and programs on policy priorities for which ASN and the broader kidney health community have advocated. Key policies are highlighted here.

Centers for Disease Control and Prevention (CDC)

The committee includes a total of $10.5 billion for the CDC, which is $2 billion more than the FY 2022-enacted level. The bill includes an increase of $5 million for activities to increase awareness, diagnosis, and treatment of kidney diseases as part of the CDC Chronic Disease Prevention and Health Promotion program.

Health Resources and Services Administration

The draft language released by the committee supports efforts to improve transparency, accountability, and accessibility in organ donation. Specifically, the committee includes $31 million for the Organ Transplantation program and $8 million for the Living Organ Donation Reimbursement Program, each $1 million above their respective FY 2022-enacted levels. The bill supports the expansion of income eligibility for the Living Organ Donation Program to allow as many donors as possible to qualify.

The committee also declares its support in the bill for Medicare's efforts to minimize excessive and frivolous expenses reimbursed to organ procurement organizations (OPOs) and the Organ Procurement and Transplantation Network (OPTN) and encourages the Department of Health and Human Services (HHS) to make all efforts to promote competition for the OPTN contract.

The bill also attempts to reduce organ discards to help alleviate the organ shortage that the nation is facing and supports the procurement and transplantation of kidneys with a moderate-to-high Kidney Donor Profile Index. The bill requests a report within 180 days of enactment on the OPTN proposal to remove donor service areas from allocation and the impact of this policy on organ discards.

Finally, the bill includes a $10 million increase for the Pediatric Subspecialty Loan Repayment Program for a total $15 million. ASN, the American Society of Pediatric Nephrology, and the broader kidney and pediatric subspecialty communities have advocated for this program to help address the significant shortages of pediatricians in underserved areas by helping reduce the barrier of high levels of graduate debt among providers who seek to complete additional training.

National Institutes of Health (NIH)

The bill includes a $2.5 billion increase for NIH above FY 2022-enacted levels, for a total of $47.5 billion. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) receives a $79.5 million increase over FY 2022-enacted levels, for a total of $2.28 billion.

The committee positively impacts the kidney community beyond just funding. Built on the work of the National Kidney Foundation-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases, the draft bill includes report language that requests NIDDK to prioritize research of new ways to diagnose kidney diseases that do not include race and for an update on its efforts during the FY 2024 Congressional Justification. The committee also directs the NIH Office of the Director to release a report on kidney disease research, specifically related to health equity concerns.

Centers for Medicare and Medicaid Services (CMS)

The bill acknowledges the committee's support of efforts by CMS to implement the final rule for OPO Conditions for Coverage, including efforts to decertify underperforming OPOs in advance of 2026. Noting that OPO reform is a health equity issue, the committee also encourages CMS to require OPO process data to be publicly available.

The committee indicates its support for CMS efforts to address the unique care needs and services of children with kidney failure in its December 2020 technical expert panel and in the request for information included in the calendar year 2022 End Stage Renal Disease (ESRD) Prospective Payment System proposed rule. The committee requests an update in the FY 2024 Congressional Budget Justification on progress toward establishing adequate bundled payments for pediatric ESRD services.

Office of the Secretary, HHS

The committee continues to include a total of $5 million for Kidney Innovation Accelerator (KidneyX) to enable the program to continue to accelerate innovation in kidney care. KidneyX has been a significant policy priority for ASN and the kidney community since its creation and is frequently highlighted during ASN's advocacy efforts in Congress

Advanced Research Projects Agency for Health (ARPA-H)

Modeled after the Defense Advanced Research Projects Agency, ARPA-H aims to accelerate transformative breakthroughs for many diseases. The committee includes $2.75 billion in funding for ARPA-H and recommends that the agency be established as a separate entity within HHS to ensure its success in driving innovation.

The report language in the bill is non-binding, and the full House and Senate Appropriations Committees may amend this funding legislation moving forward. Although not legally enforceable, report language helps to show the intent of Congress and provides instruction to executive agencies about how to spend their allocated funding. It is particularly useful in advocacy to highlight specific priorities on which executive agencies should take action; agencies typically take the language seriously. As of publication, the Senate has yet to release its report, but typically all of the language in this House report will be carried over to the final enacted conference report and adopted by Congress. ASN will continue to provide updates on the status of the FY 2023 appropriations package. Follow @ASNAdvocacy on Twitter for updates on policy priorities in real time.