Consolidated Appropriations Act, 2021, for Healthcare and Health IT

On Dec. 27, 2020, President Donald Trump signed into law a nearly $1.4 trillion legislative package containing FY 2021 appropriations, emergency COVID-19 relief legislation and numerous authorizing matters.

HIMSS Government Relations team members have reviewed and summarized relevant sections of H.R. 133, the Consolidated Appropriations Act, 2021.

Questions can be directed to policy@himss.org.

Jump to Appropriations Sections
Jump to COVID-19 Relief Provisions
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Appropriations Sections

Division A – Agriculture-Rural Development-FDA Appropriations

Rural Development and Infrastructure

What It Is: Funding for the Distance Learning, Telemedicine, and Broadband Program within the US Department of Agriculture.

What Happened: This bill includes provisions that will help develop programs aimed at creating an environment for economic growth by providing business and housing opportunities and building sustainable rural infrastructure for the modern economy.

Funding Amount: The bill provides a total of almost $3.9 billion for rural development programs. The legislation invests more than $730 million to provide economic development opportunities and improved education and healthcare services, including $635 million for the ReConnect program. It also provides $97 million for distance learning and telemedicine grants.

Division C – Department of Defense Appropriations Act

Defense Health Program

What It Is: Funding for the Defense Health Program and various projects within related to the Department of Defense Healthcare Management System Modernization (DHMSM) and the EHR system deployment.

What Happened:  The bill directs the Secretary of Defense to report to Congress on the status of the deployment of the electronic health record system, including the timeline to complete installation, and costs associated if the department accelerated the deployment timeline, and directs the Comptroller General to continue quarterly performance reviews of the deployment of the Department of Defense Military Health System’s Genesis project (MHS GENESIS), specifically around cost, schedule, scope, quality and risk mitigation expectations. It also directs the Director of the Interagency Program Office to submit quarterly reports to Congress on the current status of the deployment of the electronic health record and the progress of interoperability between the Department of Defense and Veterans Affairs

Funding Amount: The bill provides a total of $33.68 billion in funding for the Defense Health Program, including $232 million for DHMSM and $2.4 billion for research, development, testing and evaluation.

Division H – Labor-HHS-Education Appropriations

What It Is and Funding Amount: The bill includes a total of $97 billion for the Department of Health and Human Services (HHS), an increase of $2.1 billion above the 2020 enacted level and $9.9 billion above the president’s budget request.

What Happened: Here are the topline numbers for the key HHS agencies for FY 2021.

• National Institutes of Health – The bill provides a total of $42.9 billion for NIH, an increase of $1.25 billion above the 2020 enacted level.
• Centers for Disease Control and Prevention – The bill includes a total of $7.9 billion for CDC, an increase of $125 million above the 2020 enacted level.
• Health Resources and Services Administration - The bill includes $7.5 billion for HRSA, which is $151 million above the 2020 enacted level.
• Agency for Healthcare Research and Quality – The bill provides $338 million for AHRQ, the same as the 2020 enacted level.
• Office of the National Coordinator for Health IT – The bill provides $62.37 million for ONC, which is $2 million above the 2020 enacted level.
  • The increase in funding will go to support interoperability and information sharing efforts related to the implementation of FHIR standards or associated implementation standards.

Rural Health

What It Is: Funding for programs within HRSA to improve healthcare for people who are geographically isolated and economically or medically vulnerable by advancing healthcare access and delivery.

What Happened: This bill supports HRSA’s rural health outreach initiative by supporting programs that leverage telehealth and other technologies to help those in need of primary healthcare, people with HIV/AIDS, pregnant women and mothers. The bill also supports workforce and health professional training, improvements to healthcare delivery and the distribution of providers to areas where they are needed most. This initiative supports telehealth capacity building, centers of excellence and evaluation in response to the needs of the underserved in rural communities.

Funding Amount: The agreement includes more than $329 million for FY 2021 to support these programs and initiatives, including:

• $1 million for a tele-mentoring training center
• $4.5 million for technology-enabled collaborative learning capacity building models
• $6.5 million for the Telehealth Centers of Excellence, specifically to develop best practices for utilizing telehealth in HIV prevention, care and treatment
• $1 million to support a comprehensive evaluation of nationwide telehealth investments in rural areas

Public Health Scientific Services

What It Is: Continued and expanded support for CDC Public Health Scientific services including public health surveillance, epidemiology, informatics and workforce development.

What Happened: This bill provides ongoing resources for the CDC to support state and local health agencies and strategic partners in efforts to improve US public health infrastructure, informatics, surveillance and data modernization services. Specifically, this bill continues funding for the foundational investments necessary to upgrade the nation's public health data infrastructure through the Data Modernization Initiative. With the additional $50 million included in this bill for FY 2021, the CDC Data Modernization Initiative has been appropriated $600 million of the initial $1 billion requested by the Data: Elemental to Health Campaign HIMSS helped form in 2019.

Funding Amount: The agreement includes a total of $591,997,000 for Public Health Scientific Services, including $361 million to strengthen epidemiologic and laboratory capacity. Within this total, the agreement encompasses the following amounts for FY 2021:

• Health Statistics - $175,397,000
• BioSense - $23,000,000
• Public Health Data Modernization - $50,000,000
• Public Health Workforce - $56,000,000

Patient Identification

What It Is: Accurate patient identification is a key component of secure, interoperable information sharing that advances patient safety and improves patient access to advanced healthcare solutions.  For more than 20 years, Section 510 of Labor HHS Appropriations has been interpreted as precluding HHS from promulgating a patient identity strategy, to include a unique patient identifier, as required by HIPAA.

What Happened: Congress provided report language to encourage HHS and ONC to continue supporting industry initiatives to improve patient identification but stopped short of removing the current appropriations language.

Funding Amount: No funding identified

Additional Requirements: Congress reminded HHS and the ONC that a report analyzing industry-led patient identification solutions is due to Congress.

Division J - Department of Veterans Affairs:

VA Electronic Health Record Modernization

What It Is: Establishes the next phase of funding for the VA EHR Modernization Project to accelerate the rollout of the Cerner solution to VA medical centers and clinics across the United States. The EHR Modernization Program was announced in 2018 and began implementation at the Initial Operating Capacity sites in October 2020. The expectation is that the VA EHR Modernization Program will coincide with MHS GENESIS and associated modernization effort at the U.S. Coast Guard.  The overall intent is for the modernized EHR to create a digital health environment that fosters greater interoperability between VA, DoD, Coast Guard and civilian healthcare systems.

What Happened: Congress recognized that the initial steps have been completed on the EHR Modernization Program and has appropriated funding to begin the formal rollout.

Funding Amount: $2.6 billion for the next round of implementations. Funds are available through Sept. 30, 2023.

Additional Requirements: Congress wants to ensure the program moves forward and has made 25 percent of the funding available, however, the funding is contingent on Congress receiving a letter from the VA Secretary certifying any changes to the deployment schedule by July 1, 2021.  The VA Secretary is required to provide quarterly updates on implementation rollout and progress toward completion. Congress has also tasked the Government Accountability Office with continuing its multi-year oversight project.

VA Rural Health

What Happened: Congress recognized the important roles the VA Office of Rural Health and the Rural Health Initiative play in improving veteran access to care.

Funding Amount: $300 million to support the Office of Rural Health and the Rural Health Initiative.

Additional Requirements: Congress expects the Office of Rural Health to complete its work on rural health that was required in previous VA appropriations and fulfill a Senate requirement (115^th Congress) to provide analysis and recommendations on the Veterans Transportation Services program.

VA Telehealth

What It Is: Expands the VA telehealth program that has pioneered innovative approaches to increasing access for veterans for more than a decade.

What Happened: Congressional approval to expand the VA Telehealth program to expand access for veterans, particularly in rural and medically underserved areas.

Funding Amount: $1.33 billion to expand the program and cover costs of providing telehealth services during the COVID-19 pandemic.

Additional Requirements: The VA is required to present a report to the Appropriations Committees within 180 days on telehealth services that were expanded during 2020 and recommendations on which services should be made permanent. The VA is also required to provide analysis and recommendations to Congress on expected long-term telehealth needs, and efforts to expand telehealth services to veterans living in communities with limited access to broadband technology.

COVID-19 Relief Provisions

Division N – Additional Coronavirus Response and Relief

Title IX – Broadband Internet Access Services

What It Is: Division N includes three sections of particular importance related to broadband internet access:

Section 903 - Federal Communications Commission (FCC) COVID-19 Telehealth Program

What Happened: Additional funds have been appropriated to the FCC for its COVID-19 Telehealth Program authorized under the CARES Act, which helps providers utilize connected care services for patients. Additionally, it puts in place new transparency obligations for the program surrounding the FCC’s review of applications and directs the Commission to ensure that all states benefit from the program.

Funding Amount: An additional $250 million appropriated to the COVID-19 Telehealth Program.

Section 905 - Grants for Broadband Connectivity

What Happened: Two grant programs were established at the National Telecommunications and Information Administration (NTIA).

• The first is a grant program to support broadband connectivity on tribal lands throughout the country. The grants would be directed to tribal governments to be used for broadband deployment on tribal lands, telehealth, distance learning, broadband affordability and digital inclusion.

Funding Amount: $1 billion is appropriated for this program.

• The second is a broadband deployment program to support broadband infrastructure deployment to areas lacking broadband, especially rural areas.

Funding Amount: $300 million.

These grants would be issued to qualifying partnerships between state and local governments and fixed broadband providers. Priority will be given to networks that would reach the most unserved consumers.

Section 906 - Appropriations for FCC Activities

What Happened: This section appropriates funds to the FCC to create broadband data maps required under the Broadband DATA Act and the FCC’s Secure and Trusted Reimbursement Program.

Funding Amount: $65 million towards creating broadband data maps; $1.9 billion for the FCC’s Secure and Trusted Reimbursement Program.

Authorizing Provisions

Division BB - Private Health Insurance and Public Health Provisions

Title III – Public Health

Funding for Community Health Centers:

What It Is: The primary form of federal funding for community health centers (CHCs) is the Health Center Program, which is authorized in Section 330 of the Public Health Services Act. Funding for the Health Center Program is a combination of discretionary funding as well as mandatory funding from the Community Health Center Fund (CHCF).

What Happened: Discretionary as well as mandatory funding increases were enacted in the       end-of-year package.

Funding Amount: In terms of discretionary funding, FY 2021 annual appropriations included $1.68 billion for health centers, a $57 million or 3.5 percent increase over FY 2020 levels. On the mandatory funding side, the reauthorized Community Health Center Fund received $4 billion per year for FY 2021-2023, level funding from last year. 

Additional Requirements: The end-of-year package also provided health centers with access to      the $3 billion Provider Relief Fund, which was originally established under the CARES Act, and focused on offering reimbursement to providers for healthcare-related expenses or lost revenue directly attributable to the public health emergency.

Subtitle B – Strengthening Public Health

Section 313 – Expanding Capacity for Health Outcomes

What It Is: This section allows for grants to evaluate, develop and expand the use of technology-enabled collaborative learning and capacity building models to increase access to specialized healthcare services in medically underserved areas and for medically underserved populations. Grant awardees may be required to collect information on the effect of the use of technology-enabled collaborative learning and capacity building model. Additionally, this section allows the HHS Secretary to coordinate with other agencies on opportunities to support broadband access for grantees. Grants are awarded for 5-year periods.

Funding Amount: $10 million for each FY 2022-2026

Section 314 – Public Health Data Modernization Authorizing

What It Is: This provides authorizing language for CDC’s public health data modernization initiative. It includes funding to reduce lag in and increase the accuracy of public health data reporting among public health authorities. Requires the Secretary of HHS, in consultation with all relevant stakeholders, to submit to Congress a coordinated strategy and accompanying implementation plan that identifies and demonstrates measures utilized to improve public health data systems.

What Happened: This provision will require the Secretary of HHS to conduct activities to expand, modernize, improve and sustain applicable public health data systems used by the CDC. The Secretary will award grants or cooperative agreements to state, local, tribal or territorial public health departments for the expansion and modernization of public health data systems based on data and technology standards established by the CDC and the ONC.

Funding Amount: $100 million for each FY 2021-2025

Division CC – Health Extenders

Title I – Medicare Provisions

Section 105 - Extending the Independence at Home Medical Practice Demonstration Program Under the Medicare Program

What It Is: An extension of the existing Independence at Home Demonstration.

What Happened: The Independence at Home demonstration is extended for an additional three years (through December 2023) and additionally has expanded in size from 15,000 beneficiaries to 20,000.

Funding Amount: $9 million for each FY 2021-2025

Section 123 - Expanding Access to Mental Health Services Furnished Through Telehealth

What It Is: Expands access to telehealth in Medicare for mental health services, including allowing the beneficiary’s home to serve as an originating site, regardless of geographic location.

What Happened:  While this provision would expand access to mental health services delivered via telehealth for Medicare beneficiaries by removing certain 1834(m) restrictions, including geographic and originating sites, it does place additional burdens to be eligible for these telehealth services. Specifically, the beneficiary must have had at least one in-person visit during the previous 6 months before the telehealth visit.

Why This Matters: This in-person requirement doesn’t align with or reflect any applicable state laws around telehealth visits for mental health services, which do not have any such requirement. While it does expand access to tele-behavioral health, it sets a bad precedent that assumes a person can’t establish a relationship with a mental healthcare provider via telehealth. Further, it threatens to impact people who are home-bound, transient or have other barriers to accessing health care in-person.

Other End-of-the-Year Legislation Passed

HR 7898:

To amend the Health Information Technology for Economic and Clinical Health Act to require the Secretary of Health and Human Services to consider certain recognized security practices of covered entities and business associates when making certain determinations, and for other purposes.

What It Is: H.R. 7898 recognizes increasing and dire cyber threats against the health system. At the same time, there is a perception among many in healthcare that regulatory enforcement actions taken under HIPAA have applied severe penalties against organizations victimized by cyber-attacks despite  their well-resourced programs that employ industry-best cybersecurity practices.

What Happened: The bill rebalances this inequity by directing the U.S. Department of HHS, when making determinations against HIPAA-covered entities and their business associates victimized by a cyber-attack, to consider their use of recognized security best practices during the past 12 months.