Puerto rico government

Congress passes the omnibus fiscal year 2022 spending bill


After months of negotiations in both houses, Congress passed the omnibus fiscal year 2022 spending bill; however, COVID aid was removed from the bill, leaving future action open by lawmakers.


Government funding for fiscal year 2022 passed. With a House vote of (260-171) followed by the Senate vote of (68-31), Congress passed the $1.5 trillion omnibus spending bill (HR 2741) to fund the government until September 30. The legislation also includes $13.6 billion to support Ukraine, as well as a number of health policy provisions.

Passing the bill was not easy. House Democrats had to withdraw $15.6 billion for COVID funding after negotiators agreed that $7 billion in unused COVID aid from states and local governments would be used as payment for new relief funding . This caught the attention of members whose states would lose funding, and with no time to renegotiate a new payment, the COVID relief provision was removed from the bill. The House hopes to pass a stand-alone COVID-19 relief bill next week.

Overall, HHS will receive a total of $108.3 billion (summary here) along with some highlights below, with most areas seeing increased funding from their FY2021 levels:

  • Agency for Advanced Research Projects for Health (ARPA-H): $1 billion to establish ARPA-H within the Office of the Secretary of HHS, or the option of transferring it to another HHS agency, including NIH, to accelerate scientific breakthroughs for diseases such as ALS, Alzheimer’s disease, diabetes and cancer. These funds show a commitment from Congress, but lawmakers must act on separate legislation to authorize ARPA-H to spend the funds.

  • National Institutes of Health (NIH): $45 billion, an increase of $2.25 billion, which will allocate funds to the National Cancer Institute ($6.9 billion), opioid research ($50 million), and health disparities research ($50 million).

  • Centers for Disease Control and Prevention (CDC): $8.5 billion, an increase of $582 million, with a focus on public health infrastructure.

  • Substance Abuse and Mental Health Services Administration (SAMHSA): $6.5 billion, an increase of $530 million, to address the mental health crisis.

  • Health Resources and Services Administration (HRSA): $8.9 billion, an increase of $1.4 billion, including $1 billion for programs to improve maternal and child health.

  • Centers for Medicare and Medicaid Services (CMS): $4 billion, an increase of $50 million.

  • Office of the National Coordinator (ONC): $64 million, a $2 million increase from fiscal year 2021, but $23 million less than the President’s budget request.

The main provisions of the health policy included in the omnibus package are described below:

Additionally, a CARES Act flexibility that allows first-dollar coverage for certain telehealth services for those with Health Savings Account (HSA)-eligible high-deductible health plans (HDHPs) that expired on 31 December 2021 would be reinstated for the period from March 31, 2022 to December 31, 2022.

  • Protecting hospitals’ 340B eligibility during the COVID-19 public health emergency. During the COVID-19 pandemic, some hospitals have experienced changes in disproportionate share adjustment percentages and as a result have lost or are at risk of losing 340B eligibility. This provision would help deal with those particular hospitals.

  • Improve maternal health. Grants for improving and implementing best practices in maternal health, including funding for medical schools and health professionals to train health care providers; a new five-year grant program to integrate services for pregnant and postpartum women; and a program to improve mothers’ awareness of vaccines.

  • Increased Medicaid funding for Puerto Rico and the Territories. The bill extends enhanced Medicaid FMAP funding for Puerto Rico and the territories through December 31, 2022.

It’s important to note that the final bill does not address impending cuts to Medicare sequestration. In the absence of Congressional action, the cuts will roll over this year to 1% from April and 2% from July. Requests to add funds to the Provider Relief Fund to help hospitals overcome labor shortages were also excluded from the final package.

Bill aiming to extend the exemption from hospitalization at home. the Hospital Services Modernization Act (Senate and lodge versions) would extend the Acute Hospital Home Care Waiver (AHCAH) program for two years after the end of the PHE. Senators Tom Carper (D-DE) and Tim Scott (R-SC), along with Representatives Earl Blumenauer (D-OR) and Brad Wenstrup (R-OH), sponsored the bill. The legislation also requires CMS to issue regulations to establish health and safety requirements for AHCAH programs within one year of enactment and requires HHS to conduct waiver research in the hope that CMS will establish a permanent program. The waiver has become a widely used program during the pandemic to help address bed shortages and allow patients to get care at home, with 92 health systems and 203 hospitals in 34 states participating. On the very day the bill was introduced, March 10, more than 110 organizations submitted a letter to the leadership of Congress supporting the legislation.


Biden launches Test-to-Treat initiative. The Biden administration officially spear on March 8, the “Test to Treat” initiative which was announced as a key part of the national COVID preparedness plan during the State of the Union address. Participating pharmacies and federally licensed community health centers (FHQC) can test patients for COVID-19 and then treat those who test positive with antiviral drugs. Pharmacies participating in the initiative will receive Paxlovid from Pfizer and Molnupiravir from Merck by ordering directly from the federal government.


  • Leaders of the House Energy and Commerce Committee in a bipartisan letter at SAMHSA on March 8 requested information on the Biden administration’s efforts to address the mental health crisis in the United States, particularly as it relates to the impacts of the COVID-19 pandemic.

  • On March 8, the FDA and the medical device industry reached a five-year user fee agreement, Medicare Device User Fee Amendment 2023 (MDUFA V) with $1.9 billion in user fees. basis for fiscal years 2023 to 2027. This amount is almost double what is collected. under the current agreement. This means that all user fund agreements are in progress so Congress can move forward to meet the September 30 deadline.

  • Senate Majority Leader Chuck Schumer (D-NY) sent a dear colleague letter on March 7, which announced that the Senate Finance Committee will begin a hearing next week entitled “Prescription Drug Price Inflation: An Urgent Need to Reduce Medicare Drug Prices.” Other committee hearings to tackle drug prices are also expected this month and next.

  • House Energy and Commerce Committee Chairman Frank Pallone (D-NJ) unveiled the Accelerated Approval Integrity Act (HR 6963), on March 7, to reform the FDA’s fast-track approval pathway. The legislation would also require manufacturers to enter into a postmarketing study agreement with the FDA before obtaining expedited approval, as well as the FDA to provide more frequent updates regarding study progress.

  • Senate HELP Committee Announced Full Committee audience for March 15 on the PREVENT Pandemics Act, bipartisan legislation, aimed at strengthening the country’s public health system and medical preparedness for the response to the pandemic.


The House intends to consider the COVID relief legislation that was scuttled this week, sending it to the Senate for consideration.