DEPARTMENT OF HEALTH AND HUMAN SERVICES · 2018-02-12 · DEPARTMENT OF HEALTH AND HUMAN SERVICES...

DEPARTMENT OF HEALTH AND HUMAN SERVICES

FOOD AND DRUG ADMINISTRATIONFederal Funds

SALARIES AND EXPENSES

For necessary expenses of the Food and Drug Administration, including hire andpurchase of passenger motor vehicles; for payment of space rental and related costspursuant to Public Law 92–313 for programs and activities of the Food and DrugAdministration which are included in this Act; for rental of special purpose spacein the District of Columbia or elsewhere; for miscellaneous and emergency expensesof enforcement activities, authorized and approved by the Secretary and to be ac-counted for solely on the Secretary's certificate, not to exceed $25,000; and notwith-standing section 521 of Public Law 107–188; $5,083,474,000: Provided, That ofthe amount provided under this heading, $960,568,000 shall be derived from pre-scription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to thisaccount and remain available until expended; $196,668,000 shall be derived frommedical device user fees authorized by 21 U.S.C. 379j, and shall be credited to thisaccount and remain available until expended; $501,396,000 shall be derived fromhuman generic drug user fees authorized by 21 U.S.C. 379j–42, and shall be creditedto this account and remain available until expended; $40,922,000 shall be derivedfrom biosimilar biological product user fees authorized by 21 U.S.C. 379j–52, andshall be credited to this account and remain available until expended; $712,000,000shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, andshall be credited to this account and remain available until expended: Providedfurther, That in addition to and notwithstanding any other provision under thisheading, amounts collected for prescription drug user fees, medical device userfees, human generic drug user fees, and biosimilar biological product user fees thatexceed the respective fiscal year 2019 limitations are appropriated and shall becredited to this account and remain available until expended: Provided further,That fees derived from prescription drug, medical device, human generic drug, andbiosimilar biological product assessments for fiscal year 2019, including any suchfees collected prior to fiscal year 2019 but credited for fiscal year 2019, shall besubject to the fiscal year 2019 limitations: Provided further, That the Secretary mayaccept payment during fiscal year 2019 of user fees specified under this headingand authorized for fiscal year 2020, prior to the due date for such fees, and thatamounts of such fees assessed for fiscal year 2020 for which the Secretary acceptspayment in fiscal year 2019 shall not be included in amounts under this heading:Provided further, That none of these funds shall be used to develop, establish, oroperate any program of user fees authorized by 31 U.S.C. 9701: Provided further,That not to exceed $25,000 of this amount shall be for official reception and repres-entation expenses, not otherwise provided for, as determined by the Commissioner:Provided further, That funds may be transferred from one specified activity to an-other with the prior notification of the Committees on Appropriations of both Housesof Congress.

In addition, mammography user fees authorized by 42 U.S.C. 263b, export certi-fication user fees authorized by 21 U.S.C. 381, priority review user fees authorizedby 21 U.S.C. 360n and 360ff, food and feed recall fees, food reinspection fees, andvoluntary qualified importer program fees authorized by 21 U.S.C. 379j–31, out-sourcing facility fees authorized by 21 U.S.C. 379j–62, prescription drug wholesaledistributor licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), third-party logistics provider licensing and inspection fees authorized by 21 U.S.C.360eee–3(c)(1), third-party auditor fees authorized by 21 U.S.C. 384d(c)(8), andMedical Countermeasure Priority Review Voucher User Fees authorized by 21U.S.C. 360bbb–4a, shall be credited to this account, to remain available until expen-ded.

BUILDINGS AND FACILITIES

For plans, construction, repair, improvement, extension, alteration, demolition,and purchase of fixed equipment or facilities of or used by the Food and Drug Ad-ministration, where not otherwise provided, $11,788,000, to remain available untilexpended.

Note.—A full-year 2018 appropriation for this account was not enacted at the time the budgetwas prepared; therefore, the budget assumes this account is operating under the ContinuingAppropriations Act, 2018 (Division D of P.L. 115–56, as amended). The amounts included for2018 reflect the annualized level provided by the continuing resolution.

Special and Trust Fund Receipts (in millions of dollars)

2019 est.2018 est.2017 actualIdentification code 075–9911–0–1–554

211Balance, start of year ....................................................................0100

Receipts:Current law:

332Cooperative Research and Development Agreements, FDA .....1130

543Total: Balances and receipts .....................................................2000Appropriations:

Current law:–2–2–2Salaries and Expenses ..........................................................2101

321Balance, end of year ..................................................................5099

Program and Financing (in millions of dollars)


Obligations by program activity:1,0201,0221,026Foods .........................................................................................0001461488489Human Drugs ............................................................................0002323327330Devices and Radiological Health ...............................................0003636363National Center for Toxicological Research ................................0004

122181187FDA Other Activities (FDA Headquaters) ....................................0005

136114115FDA Other Rent and Rent Related Activities (Including White Oak

Consolidation) .......................................................................0006

168169170FDA GSA Rental Payments .........................................................000712129FDA Buildings and Facilities .....................................................0008221Cooperative Research and Development (CRADA) .....................0009

170162163Animal Drugs and Feed .............................................................0010204214216Biologics ...................................................................................0011

..................................2Food and Drug Safety (no-year) .................................................0012

..................................3Zika Activities ...........................................................................00147020.................CURES Activities .......................................................................0015

..................................2Emerging Health Threats ...........................................................0016

2,7512,7742,776Total direct obligations ..................................................................07992,4602,3452,312FDA Reimbursable program (User fees) .....................................0801

..................................45FDA Reimbursable program (Federal sources) ...........................0802

2,4602,3452,357Total reimbursable obligations ......................................................0899

5,2115,1195,133Total new obligations, unexpired accounts ....................................0900

Budgetary resources:Unobligated balance:

9199271,117Unobligated balance brought forward, Oct 1 .........................1000.................9271,117Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................57Recoveries of prior year unpaid obligations ...........................1021

9199271,174Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, discretionary:2,6842,7612,781Appropriation ....................................................................1100

.................–1–2Appropriations transferred to other accts [075–0128] .......1120–5..................................Appropriations transferred to other acct [075–4613] ........11207020.................Appropriations transferred from other acct [075–5629] ....1121

2,7492,7802,779Appropriation, discretionary (total) .......................................1160Appropriations, mandatory:

222Appropriation (special or trust fund) .................................1201Spending authority from offsetting collections, discretionary:

2,4642,3451,655Collected ...........................................................................1700.................35.................Collected ...........................................................................1700.................–3535Change in uncollected payments, Federal sources ............1701..................................611Offsetting collections (previously unavailable) .................1702

.................–16.................New and/or unobligated balance of spending authority from

offsetting collections temporarily reduced ....................1723

..................................–197Spending authority from offsetting collections precluded

from obligation (limitation on obligations) ...................1725

2,4642,3292,104Spending auth from offsetting collections, disc (total) .........1750Spending authority from offsetting collections, mandatory:

..................................1Collected ...........................................................................18005,2155,1114,886Budget authority (total) .............................................................19006,1346,0386,060Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:923919927Unexpired unobligated balance, end of year ..........................1941

Change in obligated balance:Unpaid obligations:

2,8742,7232,710Unpaid obligations, brought forward, Oct 1 ..........................30005,2115,1195,133New obligations, unexpired accounts ....................................3010

..................................40Obligations ("upward adjustments"), expired accounts ........3011–5,242–4,968–4,989Outlays (gross) ......................................................................3020

..................................–57Recoveries of prior year unpaid obligations, unexpired .........3040

..................................–114Recoveries of prior year unpaid obligations, expired .............3041

2,8432,8742,723Unpaid obligations, end of year .................................................3050

415

SALARIES AND EXPENSES—Continued

Program and Financing—Continued


Uncollected payments:–30–65–71Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060

.................35–35Change in uncollected pymts, Fed sources, unexpired ..........3070

..................................41Change in uncollected pymts, Fed sources, expired ..............3071

–30–30–65Uncollected pymts, Fed sources, end of year .............................3090Memorandum (non-add) entries:

2,8442,6582,639Obligated balance, start of year ............................................31002,8132,8442,658Obligated balance, end of year ..............................................3200

Budget authority and outlays, net:Discretionary:

5,2135,1094,883Budget authority, gross .........................................................4000Outlays, gross:

4,2144,0792,795Outlays from new discretionary authority ..........................40101,0248852,192Outlays from discretionary balances .................................4011

5,2384,9644,987Outlays, gross (total) .............................................................4020Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:.................–35–31Federal sources: ................................................................4030

–2,464–2,345–1,645Non-Federal sources: ........................................................4033

–2,464–2,380–1,676Offsets against gross budget authority and outlays (total) ....4040Additional offsets against gross budget authority only:

.................35–35Change in uncollected pymts, Fed sources, unexpired .......4050

..................................21Offsetting collections credited to expired accounts ...........4052

.................35–14Additional offsets against budget authority only (total) ........4060

2,7492,7643,193Budget authority, net (discretionary) .........................................40702,7742,5843,311Outlays, net (discretionary) .......................................................4080

Mandatory:223Budget authority, gross .........................................................4090

Outlays, gross:22.................Outlays from new mandatory authority .............................4100222Outlays from mandatory balances ....................................4101

442Outlays, gross (total) .............................................................4110Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:..................................–4Federal sources: ................................................................4120..................................–1Non-Federal sources: ........................................................4123

..................................–5Offsets against gross budget authority and outlays (total) ....4130Additional offsets against gross budget authority only:


222Budget authority, net (mandatory) ............................................416044–3Outlays, net (mandatory) ...........................................................4170

2,7512,7663,195Budget authority, net (total) ..........................................................41802,7782,5883,308Outlays, net (total) ........................................................................4190

Memorandum (non-add) entries:245229643Unexpired unavailable balance, SOY: Offsetting collections .......5090245245229Unexpired unavailable balance, EOY: Offsetting collections .......5092

The Food and Drug Administration (FDA) promotes and protects publichealth by overseeing the safety, efficacy, quality, and security of humanand veterinary drugs, biological products, medical devices, foods, cosmetics,and products that emit radiation. FDA also has responsibility for regulatingthe manufacturing, marketing, and distribution of tobacco products toprotect public health and to reduce tobacco use by minors. FDA advancespublic health by helping to speed innovations that make medicines moreeffective, safe, and affordable and by helping the public get the accurate,science-based information they need to use medicines and foods to maintainand improve their health. FDA supports the Nation's counterterrorismcapability by ensuring the security of the food supply and by fostering thedevelopment of medical products and countermeasures to respond to delib-erate and naturally emerging public health threats. The FY 2019 Budgetincludes $5.3 billion in total resources for FDA. The Budget prioritizesresources across core public health activities to support food and medicalproduct safety, including implementation of the 21st Century Cures Actand the FDA Reauthorization Act of 2017.

Object Classification (in millions of dollars)


Direct obligations:Personnel compensation:

926952939Full-time permanent .............................................................11.1889089Other than full-time permanent ............................................11.3464746Other personnel compensation ..............................................11.5666463Military personnel ..................................................................11.7111Special personal services payments ......................................11.8

1,1271,1541,138Total personnel compensation ...........................................11.9345354350Civilian personnel benefits ........................................................12.1333232Military personnel benefits ........................................................12.2484749Travel and transportation of persons .........................................21.0333Transportation of things ............................................................22.0

168169170Rental payments to GSA ............................................................23.1333Rental payments to others ........................................................23.2

222222Communications, utilities, and miscellaneous charges ............23.3222Printing and reproduction .........................................................24.0

525153Advisory and assistance services ..............................................25.1356355357Other services from non-Federal sources ..................................25.2139137142Other goods and services from Federal sources ........................25.3858385Operation and maintenance of facilities ...................................25.4191919Research and development contracts .......................................25.59997100Operation and maintenance of equipment ................................25.7504951Supplies and materials .............................................................26.0363637Equipment .................................................................................31.0333Land and structures ..................................................................32.0

159156157Grants, subsidies, and contributions ........................................41.0222Insurance claims and indemnities ............................................42.0

2,7512,7742,775Direct obligations ..................................................................99.02,4602,3452,358Reimbursable obligations .....................................................99.0

5,2115,1195,133Total new obligations, unexpired accounts ............................99.9

Employment Summary


9,4029,7049,748Direct civilian full-time equivalent employment ............................1001690690690Direct military average strength employment ................................1101

6,7396,7776,167Reimbursable civilian full-time equivalent employment ...............2001428437437Reimbursable military average strength employment ...................2101252525Allocation account civilian full-time equivalent employment ........3001111Allocation account military average strength employment ............3101

SALARIES AND EXPENSES

(Legislative proposal, not subject to PAYGO)

Contingent upon the enactment of authorizing legislation, the Secretary shallcharge a fee for animal drug review, animal generic drug review activities, andover-the-counter monograph drug activities: Provided, That fees of $25,129,000,for animal drug reviews, shall be credited to this account and remain available untilexpended; $13,076,000 for animal generic drug reviews, shall be credited to thisaccount and remain available until expended; $22,000,000 for over-the-countermonograph drug activities, shall be credited to this account and remain availableuntil expended: Provided further, That, in addition to and notwithstanding anyother provision under this heading, amounts collected for animal drug, animalgeneric drug, and over-the-counter monograph drug user fees that exceed the re-spective fiscal year 2019 limitations are appropriated and shall be credited to thisaccount and remain available until expended: Provided further, That fees derivedfrom animal drug, animal generic drug, and over-the-counter monograph drug re-views for fiscal year 2019 received during fiscal year 2019, including any such feesassessed prior to fiscal year 2019 but credited for fiscal year 2019, shall be subjectto the fiscal year 2019 limitations: Provided further, That the Secretary may acceptpayment during fiscal year 2019 of user fees specified in this paragraph and author-ized for fiscal year 2020, prior to the due date for such fees, and that amounts ofsuch fees assessed for fiscal year 2020 for which the Secretary accepts payment infiscal year 2019 shall not be included in amounts in this paragraph.



Obligations by program activity:

22..................................Reimbursable program (Over-the-Counter Monograph User

fees) ......................................................................................0801

25..................................Reimbursable program activity (ADUFA) ....................................080313..................................Reimbursable program activity (AGDUFA) .................................0804

THE BUDGET FOR FISCAL YEAR 2019416 Food and Drug Administration—ContinuedFederal Funds—Continued

60..................................Total reimbursable obligations ......................................................0899

60..................................Total new obligations, unexpired accounts ....................................0900

Budgetary resources:Budget authority:

Spending authority from offsetting collections, discretionary:60..................................Collected ...........................................................................170060..................................Budget authority (total) .............................................................190060..................................Total budgetary resources available ..............................................1930


60..................................New obligations, unexpired accounts ....................................3010–60..................................Outlays (gross) ......................................................................3020


60..................................Budget authority, gross .........................................................4000Outlays, gross:

60..................................Outlays from new discretionary authority ..........................4010Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:–60..................................Non-Federal sources: ........................................................4033

–60..................................Offsets against gross budget authority and outlays (total) ....4040...................................................Budget authority, net (total) ..........................................................4180...................................................Outlays, net (total) ........................................................................4190

The FY 2019 Budget proposes to reauthorize the expiring fee programsand propose a new fee program. The budget includes a total of $25 millionin animal drug fees and $13 million in animal generic drug fees. FDA alsoproposes reforms to the Over-the-Counter Monograph program and includesa total of $22 million in new over-the-counter drug fees. The proposed le-gislation authorizes the collection and spending of these fees subject toappropriations.



Reimbursable obligations:Personnel compensation:

12..................................Full-time permanent .............................................................11.12..................................Other than full-time permanent ............................................11.31..................................Other personnel compensation ..............................................11.51..................................Military personnel ..................................................................11.7

16..................................Total personnel compensation ...........................................11.95..................................Civilian personnel benefits ........................................................12.13..................................Rental payments to GSA ............................................................23.11..................................Advisory and assistance services ..............................................25.1

19..................................Other services from non-Federal sources ..................................25.211..................................Other goods and services from Federal sources ........................25.31..................................Research and development contracts .......................................25.51..................................Operation and maintenance of equipment ................................25.73..................................Grants, subsidies, and contributions ........................................41.0

60..................................Reimbursable obligations .....................................................99.0

60..................................Total new obligations, unexpired accounts ............................99.9

Employment Summary


144..................................Reimbursable civilian full-time equivalent employment ...............20019..................................Reimbursable military average strength employment ...................2101

✦

FDA WORKING CAPITAL FUND




Appropriations, discretionary:5..................................Appropriations transferred from other acct [075–9911] ....11215..................................Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:5..................................Unexpired unobligated balance, end of year ..........................1941


5..................................Budget authority, gross .........................................................40005..................................Budget authority, net (total) ..........................................................4180

...................................................Outlays, net (total) ........................................................................4190

✦

PAYMENT TO THE FDA INNOVATION ACCOUNT, CURES ACT



Obligations by program activity:706020Direct program activity ..............................................................0001

706020Total new obligations, unexpired accounts (object class 94.0) .......0900


Appropriations, mandatory:706020Appropriation ....................................................................1200706020Total budgetary resources available ..............................................1930


706020New obligations, unexpired accounts ....................................3010–70–60–20Outlays (gross) ......................................................................3020

Budget authority and outlays, net:Mandatory:

706020Budget authority, gross .........................................................4090Outlays, gross:

706020Outlays from new mandatory authority .............................4100706020Budget authority, net (total) ..........................................................4180706020Outlays, net (total) ........................................................................4190

This account, and a related special receipt account, were established tosupport the execution structure necessary to implement the 21st CenturyCures Act.

✦

FDA INNOVATION, CURES ACT

For necessary expenses to carry out the purposes described under section1002(b)(4) of the 21st Century Cures Act, in addition to amounts available for suchpurposes under the heading "Salaries and Expenses", $70,000,000, to remainavailable until expended: Provided, That amounts appropriated in this paragraphare appropriated pursuant to section 1002(b)(3) of the 21st Century Cures Act, areto be derived from amounts transferred under section 1002(b)(2)(A) of such Act,and may be transferred by the Secretary of Health and Human Services to otheraccounts of the Department solely for the purposes provided in such Act: Providedfurther, That such transfer authority is in addition to any other transfer authorityprovided by law.



40..................................Balance, start of year ....................................................................0100Receipts:

Current law:706020General Fund Payment, FDA Innovation, CURES Act ..............1140


Current law:–70–20–20FDA Innovation, Cures Act .....................................................2101

4040.................Balance, end of year ..................................................................5099

417DEPARTMENT OF HEALTH AND HUMAN SERVICESFood and Drug Administration—Continued

Federal Funds—Continued

FDA INNOVATION, CURES ACT—Continued



Obligations by program activity:..................................12New Obligations for CURES Activities ........................................0001


88.................Unobligated balance brought forward, Oct 1 .........................1000Budget authority:

Appropriations, discretionary:702020Appropriation (special or trust fund) .................................1101

–70–20.................Appropriations transferred to other acct [075–9911] ........1120

..................................20Appropriation, discretionary (total) .......................................11608820Total budgetary resources available ..............................................1930



.................8.................Unpaid obligations, brought forward, Oct 1 ..........................3000

..................................12New obligations, unexpired accounts ....................................3010

.................–8–4Outlays (gross) ......................................................................3020

..................................8Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

.................8.................Obligated balance, start of year ............................................3100

..................................8Obligated balance, end of year ..............................................3200


..................................20Budget authority, gross .........................................................4000Outlays, gross:

..................................4Outlays from new discretionary authority ..........................4010

.................8.................Outlays from discretionary balances .................................4011

.................84Outlays, gross (total) .............................................................4020

..................................20Budget authority, net (total) ..........................................................4180

.................84Outlays, net (total) ........................................................................4190

The 21st Century Cures Act was enacted into law on December 13, 2016.The Act includes authorities FDA can use to help modernize drug, biolo-gical, and device product development and review, and to create greaterefficiencies and predictability in product development and review.



Direct obligations:..................................3Personnel compensation: Full-time permanent .........................11.1..................................1Civilian personnel benefits ........................................................12.1..................................5Other services from non-Federal sources ..................................25.2..................................3Grants, subsidies, and contributions ........................................41.0

..................................12Total new obligations, unexpired accounts ............................99.9

Employment Summary


..................................26Direct civilian full-time equivalent employment ............................1001

✦

REVOLVING FUND FOR CERTIFICATION AND OTHER SERVICES




101010Revolving Fund for Certification and Other Services

(Reimbursable) .....................................................................0801


445Unobligated balance brought forward, Oct 1 .........................1000

Budget authority:Spending authority from offsetting collections, mandatory:

9109Collected ...........................................................................1800111Offsetting collections (previously unavailable) .................1802

.................–1–1New and/or unobligated balance of spending authority from


10109Spending auth from offsetting collections, mand (total) .......185010109Budget authority (total) .............................................................1900141414Total budgetary resources available ..............................................1930



.................43Unpaid obligations, brought forward, Oct 1 ..........................3000101010New obligations, unexpired accounts ....................................3010–9–14–9Outlays (gross) ......................................................................3020

1.................4Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

.................43Obligated balance, start of year ............................................31001.................4Obligated balance, end of year ..............................................3200



9104Outlays from new mandatory authority .............................4100.................45Outlays from mandatory balances ....................................4101


Offsetting collections (collected) from:–9–10–9Non-Federal sources .........................................................41231..................................Budget authority, net (total) ..........................................................4180

.................4.................Outlays, net (total) ........................................................................4190

Memorandum (non-add) entries:111Unexpired unavailable balance, SOY: Offsetting collections .......5090

.................11Unexpired unavailable balance, EOY: Offsetting collections .......5092

FDA certifies color additives for use in foods, drugs, and cosmetics. Italso lists color additives for use in foods, drugs, medical devices, and cos-metics. These services are financed wholly by fees paid by the industriesaffected.



Reimbursable obligations:555Personnel compensation: Full-time permanent .........................11.1111Civilian personnel benefits ........................................................12.1111Rental payments to GSA ............................................................23.1111Other goods and services from Federal sources ........................25.3111Supplies and materials .............................................................26.0111Equipment .................................................................................31.0

101010Total new obligations, unexpired accounts ............................99.9

Employment Summary


373740Reimbursable civilian full-time equivalent employment ...............2001

✦

HEALTH RESOURCES AND SERVICES ADMINISTRATIONFederal Funds

PRIMARY HEALTH CARE

For carrying out titles II and III of the Public Health Service Act (referred to inthis Act as the "PHS Act") with respect to primary health care and the NativeHawaiian Health Care Act of 1988, $1,491,522,000: Provided, That no more than$1,000,000 shall be available until expended for carrying out the provisions ofsection 224(o) of the PHS Act: Provided further, That no more than $99,893,000shall be available until expended for carrying out subsections (g) through (n) and(q) of section 224 of the PHS Act, and for expenses incurred by the Department ofHealth and Human Services (referred to in this Act as "HHS") pertaining to admin-istrative claims made under such law: Provided further, That the ninth provisos

THE BUDGET FOR FISCAL YEAR 2019418 Food and Drug Administration—ContinuedFederal Funds—Continued

under the heading "Department of Health and Human Services—Health Resourcesand Services Administration—Health Resources and Services" in Public Laws104–208 and 105–78 are amended by striking "$80,000,000" and inserting"$152,700,000" in each such ninth proviso and by adding at the end of each suchninth proviso the following new proviso: "Provided further, That such costs, includingthe cost of modifying such loans, shall be as defined in section 502 of the Congres-sional Budget Act of 1974:".

HEALTH WORKFORCE

For carrying out titles III, VII, and VIII of the PHS Act with respect to the healthworkforce, sections 1128E and 1921(b) of the Social Security Act, and the HealthCare Quality Improvement Act of 1986, $87,798,000: Provided, That sections 751and 762(k) of the PHS Act shall not apply to funds made available under thisheading: Provided further, That fees collected for the disclosure of information undersection 427(b) of the Health Care Quality Improvement Act of 1986 and sections1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover thefull costs of operating the programs authorized by such sections and shall remainavailable until expended for the National Practitioner Data Bank: Provided further,That funds transferred to this account to carry out section 846 and subpart 3 of partD of title III of the PHS Act may be used to make prior year adjustments to awardsmade under such sections.

MATERNAL AND CHILD HEALTH

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternaland child health, title V of the Social Security Act, and section 712 of the AmericanJobs Creation Act of 2004, $731,200,000: Provided, That notwithstanding sections502(a)(1) and 502(b)(1) of the Social Security Act, not more than $66,593,000 shallbe available for carrying out special projects of regional and national significancepursuant to section 501(a)(2) of such Act and $10,276,000 shall be available forprojects described in subparagraphs (A) through (F) of section 501(a)(3) of suchAct.

RYAN WHITE HIV/AIDS PROGRAM

For carrying out title XXVI of the PHS Act with respect to the Ryan WhiteHIV/AIDS program, $2,260,170,000, of which $1,970,881,000 shall remain availableto the Secretary of Health and Human Services (referred to in this title as the "Sec-retary") through September 30, 2021, for parts A and B of title XXVI of the PHSAct, and of which not less than $900,313,000 shall be for State AIDS Drug AssistancePrograms under the authority of section 2616 or 311(c) of such Act: Provided, Thatsection 2691 of the PHS Act shall not apply to funds appropriated under this heading.

HEALTH CARE SYSTEMS

For carrying out titles III and XII of the PHS Act with respect to health care sys-tems, and the Stem Cell Therapeutic and Research Act of 2005, $100,518,000:Provided, That the Secretary may collect a fee of 0.1 percent of each purchase of340B drugs from entities participating in the Drug Pricing Program pursuant tosection 340B of the PHS Act to pay for the operating costs of such program: Providedfurther, That fees pursuant to the 340B Drug Pricing Program shall be collectedby the Secretary based on sales data that shall be submitted by drug manufacturersand shall be credited to this account, to remain available until expended.

RURAL HEALTH

For carrying out titles III and IV of the PHS Act with respect to rural health, section427(a) of the Federal Coal Mine Health and Safety Act of 1969, and section 711 ofthe Social Security Act, $74,911,000.

FAMILY PLANNING

For carrying out the program under title X of the PHS Act to provide for voluntaryfamily planning projects, $286,479,000: Provided, That amounts provided to saidprojects under such title shall not be expended for abortions, that all pregnancycounseling shall be nondirective, and that such amounts shall not be expended forany activity (including the publication or distribution of literature) that in any waytends to promote public support or opposition to any legislative proposal or candidatefor public office.

PROGRAM MANAGEMENT

For program support in the Health Resources and Services Administration,$151,993,000: Provided, That funds made available under this heading may be usedto supplement program support funding provided under the headings "PrimaryHealth Care", "Health Workforce", "Maternal and Child Health", "Ryan WhiteHIV/AIDS Program", "Health Care Systems", and "Rural Health".




Obligations by program activity:1,4921,4811,518Primary Health Care (Health Centers, Free Clinics) ...................0005

25623,670Primary Health Care (Mandatory) ..............................................001088833834Health Workforce .......................................................................0015

.................96354Health Workforce (Mandatory) ...................................................0020731843860Maternal and Child Health ........................................................0025

..................................15Maternal and Child Health (Mandatory) ....................................00302,2602,3692,339Ryan White HIV/AIDS .................................................................0035101104104Health Care Systems .................................................................004075155156Rural Health ..............................................................................0045

286285286Family Planning ........................................................................0050152153154HRSA Program Management .....................................................0055

5,1876,88110,290Total direct programs ....................................................................0300

5,1876,88110,290Total direct obligations ..................................................................0799605373Health Resources and Services (Reimbursable) ........................0801

605373Total reimbursable obligations ......................................................0899



223310482Unobligated balance brought forward, Oct 1 .........................1000.................158211Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................–2Unobligated balance transfer to other accts [075–1503] ......1010.................–5.................Unobligated balance transfer to other accts [015–5606] ......1010..................................84Recoveries of prior year unpaid obligations ...........................1021

223305564Unobligated balance (total) ......................................................1050Budget authority:


..................................–14Appropriations transferred to other acct [075–1503] ........1120


.................6453,975Appropriation ....................................................................1200


..................................–115Appropriations and/or unobligated balance of

appropriations permanently reduced ............................1230

.................6453,855Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, discretionary:

383018Collected ...........................................................................1700..................................10Change in uncollected payments, Federal sources ............1701

383028Spending auth from offsetting collections, disc (total) .........1750Spending authority from offsetting collections, mandatory:

202031Offsetting collections (cash)(HPSL&NSL) ..........................1800122Offsetting collections (previously unavailable) .................1802



212131Spending auth from offsetting collections, mand (total) .......18505,2446,85210,113Budget authority (total) .............................................................19005,4677,15710,677Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:..................................–4Unobligated balance expiring ................................................1940

220223310Unexpired unobligated balance, end of year ..........................1941






4,4925,7027,626Unpaid obligations, end of year .................................................3050Uncollected payments:

–15–15–22Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................–10Change in uncollected pymts, Fed sources, unexpired ..........3070..................................17Change in uncollected pymts, Fed sources, expired ..............3071




5,2236,1866,227Budget authority, gross .........................................................4000

419DEPARTMENT OF HEALTH AND HUMAN SERVICESHealth Resources and Services Administration—Continued


HEALTH RESOURCES AND SERVICES—Continued



Outlays, gross:1,6081,9601,973Outlays from new discretionary authority ..........................40104,2134,1604,152Outlays from discretionary balances .................................4011


Offsetting collections (collected) from:–3–11–13Federal sources .................................................................4030

–19–19–17Non-Federal sources .........................................................4033–16..................................Non-Federal sources .........................................................4033

–38–30–30Offsets against gross budget authority and outlays (total) ....4040Additional offsets against gross budget authority only:

..................................–10Change in uncollected pymts, Fed sources, unexpired .......4050


..................................2Additional offsets against budget authority only (total) ........4060


Mandatory:216663,886Budget authority, gross .........................................................4090

Outlays, gross:213131,691Outlays from new mandatory authority .............................4100

6152,4252,420Outlays from mandatory balances ....................................4101

6362,7384,111Outlays, gross (total) .............................................................4110Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:–20–20–31Non-Federal sources .........................................................4123




.................11Unexpired unavailable balance, SOY: Fulfilled purpose .............5103

..................................1Unexpired unavailable balance, EOY: Fulfilled purpose .............5104

Summary of Budget Authority and Outlays (in millions of dollars)

2019 est.2018 est.2017 actual

Enacted/requested:5,1866,80210,054Budget Authority .......................................................................6,3998,80810,175Outlays ......................................................................................

Legislative proposal, subject to PAYGO:3,9703,330.................Budget Authority .......................................................................3,5081,457.................Outlays ......................................................................................

Total:9,15610,13210,054Budget Authority .......................................................................9,90710,26510,175Outlays ......................................................................................

Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)


Guaranteed loan levels supportable by subsidy budget authority:33.................Health centers: Facilities renovation loan guarantee levels .......215001

33.................Total loan guarantee levels .......................................................215999Guaranteed loan subsidy (in percent):

2.712.692.65Health centers: Facilities renovation loan guarantee levels .......232001

2.712.69.................Weighted average subsidy rate ..................................................232999Guaranteed loan reestimates:

..................................–1Health centers: Facilities renovation loan guarantee levels .......235001

..................................–1Total guaranteed loan reestimates ............................................235999

Resources displayed here support grants and contracts managed by HealthResources and Services Administration (HRSA). These activities includesupport for Health Centers, treatment and care for those living withHIV/AIDS, health workforce training, maternal and child health care ser-vices, promotion of organ and bone marrow donation, rural health activities,and the medical malpractice claims funds, which pay malpractice claimsfiled against employees of federally-supported health centers and freeclinics. HRSA is also responsible for oversight of the 340B Drug DiscountProgram.

HRSA administers the following revolving loan programs: Health Profes-sions Student Loans (HPSL), Nursing Student Loans (NSL), Primary CareLoans (PCL) and Loans for Disadvantaged Students (LDS). These programsare financed through revolving accounts (Federal Capital Contribution)and do not receive annual appropriations. Through these revolving fundaccounts, funds are awarded to institutions that in turn provide loans toindividual students. As borrowers pay back loans the programs revolvingaccount gets replenished, and the collected funds are then used to give outnew loans in the following academic years. If the program's revolving ac-count has excess funds that will not be used to provide new loans, theseexcess funds are returned to HRSA. Funds returned to HRSA are thenawarded to programs that are in need of additional funds. The informationbelow reflects Academic Year 2016–2017 data reported in the AnnualOperating Report.

Health Professions Revolving Loan Programs

Federal Capital ContributionAccountBalance

Program

416,265,386HPSL188,621,972NSL239,076,684PCL157,612,046LDS

1,001,576,088Total




145161195Full-time permanent .............................................................11.1678Other than full-time permanent ............................................11.3334Other personnel compensation ..............................................11.5

171821Military personnel ..................................................................11.7

171189228Total personnel compensation ...........................................11.9485365Civilian personnel benefits ........................................................12.191011Military personnel benefits ........................................................12.2233Travel and transportation of persons .........................................21.0

141720Rental payments to GSA ............................................................23.1111Rental payments to others ........................................................23.26810Communications, utilities, and miscellaneous charges ............23.3

111413Advisory and assistance services ..............................................25.1183198224Other services from non-Federal sources ..................................25.2145178287Other goods and services from Federal sources ........................25.3

111Operation and maintenance of facilities ...................................25.4333Medical care ..............................................................................25.6458Operation and maintenance of equipment ................................25.7111Supplies and materials .............................................................26.0899Equipment .................................................................................31.0

4,4926,1039,286Grants, subsidies, and contributions ........................................41.08888120Insurance claims and indemnities ............................................42.0

5,1876,88110,290Direct obligations ..................................................................99.0605373Reimbursable obligations .....................................................99.0


Employment Summary


1,3361,4851,826Direct civilian full-time equivalent employment ............................1001155173205Direct military average strength employment ................................1101575757Reimbursable civilian full-time equivalent employment ...............2001444Reimbursable military average strength employment ...................2101

HEALTH RESOURCES AND SERVICES

(Legislative proposal, subject to PAYGO)



Obligations by program activity:3,5953,050.................Primary Health Care (Mandatory) ..............................................0010370275.................Health Workforce (Mandatory) ...................................................0020

THE BUDGET FOR FISCAL YEAR 2019420 Health Resources and Services Administration—ContinuedFederal Funds—Continued

55.................Maternal and Child Health (Mandatory) ....................................0030

3,9703,330.................Total direct programs ....................................................................0300

3,9703,330.................Total new obligations, unexpired accounts ....................................0900


Appropriations, mandatory:3,9753,330.................Appropriation ....................................................................1200

–5..................................Appropriations transferred to other acct [015–5606] ........1220

3,9703,330.................Appropriations, mandatory (total) .........................................12603,9703,330.................Budget authority (total) .............................................................19003,9703,330.................Total budgetary resources available ..............................................1930


1,873..................................Unpaid obligations, brought forward, Oct 1 ..........................30003,9703,330.................New obligations, unexpired accounts ....................................3010

–3,508–1,457.................Outlays (gross) ......................................................................3020

2,3351,873.................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

1,873..................................Obligated balance, start of year ............................................31002,3351,873.................Obligated balance, end of year ..............................................3200


3,9703,330.................Budget authority, gross .........................................................4090Outlays, gross:

1,7471,457.................Outlays from new mandatory authority .............................41001,761..................................Outlays from mandatory balances ....................................4101

3,5081,457.................Outlays, gross (total) .............................................................41103,9703,330.................Budget authority, net (total) ..........................................................41803,5081,457.................Outlays, net (total) ........................................................................4190

Resources displayed here support grants and contracts managed by HealthResources and Services Administration (HRSA). These activities includesupport for Health Centers, health workforce programs, and maternal andchild health care services.




4538.................Full-time permanent .............................................................11.111.................Other than full-time permanent ............................................11.311.................Other personnel compensation ..............................................11.543.................Military personnel ..................................................................11.7

5143.................Total personnel compensation ...........................................11.91512.................Civilian personnel benefits ........................................................12.122.................Military personnel benefits ........................................................12.242.................Rental payments to GSA ............................................................23.122.................Communications, utilities, and miscellaneous charges ............23.3

2828.................Other services from non-Federal sources ..................................25.2107106.................Other goods and services from Federal sources ........................25.3

33.................Operation and maintenance of equipment ................................25.73,7583,132.................Grants, subsidies, and contributions ........................................41.0

3,9703,330.................Total new obligations, unexpired accounts ............................99.9

Employment Summary


419341.................Direct civilian full-time equivalent employment ............................10014032.................Direct military average strength employment ................................1101

✦

VACCINE INJURY COMPENSATION





..................................2Recoveries of prior year paid obligations ...............................1033

313131Unobligated balance (total) ......................................................1050313131Total budgetary resources available ..............................................1930



Offsets against gross budget authority and outlays:Offsetting collections (collected) from:

..................................–2Non-Federal sources .........................................................4123Additional offsets against gross budget authority only:

..................................2Recoveries of prior year paid obligations, unexpired

accounts .......................................................................4143

..................................–2Outlays, net (mandatory) ...........................................................4170

...................................................Budget authority, net (total) ..........................................................4180

..................................–2Outlays, net (total) ........................................................................4190

The Vaccine Injury Compensation Program was established pursuant toPublic Law 99–660 and Public Law 100–203, and serves as a source offunds to pay claims for compensation for vaccine related injury or death.Payment of claims associated with vaccine related injury or death occurringbefore October 1, 1988, are financed from the General Fund and are reflec-ted in this account. Given sufficient carry-over funds from prior years' ap-propriations to pay for the balance of the pre–1988 claims yet to be adju-dicated, no appropriation is requested to cover payment of pre–1988 claims.By statute, no new claims are accepted for this account. Payment of claimsassociated with vaccine related injury or death occurring after October 1,1988, are reflected in the Vaccine Injury Compensation Program trust fundaccount.

✦

COVERED COUNTERMEASURE PROCESS FUND



Obligations by program activity:112Claims .......................................................................................000122.................Admin Expense ..........................................................................0103

332Total new obligations, unexpired accounts ....................................0900


.................11Unobligated balance brought forward, Oct 1 .........................1000322Unobligated balance transfer from other acct [075–0140] ....1011


Memorandum (non-add) entries:..................................1Unexpired unobligated balance, end of year ..........................1941


111Unpaid obligations, brought forward, Oct 1 ..........................3000332New obligations, unexpired accounts ....................................3010

–3–3–2Outlays (gross) ......................................................................3020

111Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

111Obligated balance, start of year ............................................3100111Obligated balance, end of year ..............................................3200


Outlays, gross:332Outlays from discretionary balances .................................4011

...................................................Budget authority, net (total) ..........................................................4180332Outlays, net (total) ........................................................................4190

The Covered Countermeasure Process Fund is established pursuant tothe Public Health Service (PHS) Act, as amended by Division C of PublicLaw 109–148, to serve as a source of funds to pay for compensation forinjuries, illnesses or death, or losses resulting from the administration toor use by an individual of a covered countermeasure for which a SecretarialDeclaration has been issued, pursuant to section 319F-3(b) of the PHS Act.



COVERED COUNTERMEASURE PROCESS FUND—Continued

Additionally, authority is provided to address any unexpected claims thatmay arise under the Smallpox Emergency Personnel Protection Act of 2003(P.L. 108–20).



Direct obligations:111Personnel compensation: Full-time permanent .........................11.1111Other services from non-Federal sources ..................................25.211.................Insurance claims and indemnities ............................................42.0

332Direct obligations ..................................................................99.0


Employment Summary


444Direct civilian full-time equivalent employment ............................1001222Direct military average strength employment ................................1101

✦

MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS




.................13408Maternal, Infant, and Early Childhood Home Visiting

Programs ...............................................................................0010


.................1337Unobligated balance brought forward, Oct 1 .........................1000

..................................12Recoveries of prior year unpaid obligations ...........................1021

.................1349Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, mandatory:..................................400Appropriation ....................................................................1200



..................................372Appropriations, mandatory (total) .........................................1260

.................13421Total budgetary resources available ..............................................1930Memorandum (non-add) entries:

..................................13Unexpired unobligated balance, end of year ..........................1941


360719739Unpaid obligations, brought forward, Oct 1 ..........................3000.................13408New obligations, unexpired accounts ....................................3010

–269–372–416Outlays (gross) ......................................................................3020..................................–12Recoveries of prior year unpaid obligations, unexpired .........3040




..................................372Budget authority, gross .........................................................4090Outlays, gross:

..................................11Outlays from new mandatory authority .............................4100269372405Outlays from mandatory balances ....................................4101

269372416Outlays, gross (total) .............................................................4110..................................372Budget authority, net (total) ..........................................................4180

269372416Outlays, net (total) ........................................................................4190



Enacted/requested:..................................372Budget Authority .......................................................................

269372416Outlays ......................................................................................

Legislative proposal, subject to PAYGO:400400.................Budget Authority .......................................................................12016.................Outlays ......................................................................................

Total:400400372Budget Authority .......................................................................389388416Outlays ......................................................................................

The Maternal, Infant and Early Childhood Home Visiting Programprovides comprehensive services for at risk communities. These activitiesare administered by HRSA.




.................55Full-time permanent .............................................................11.1

.................11Military personnel ..................................................................11.7

.................66Total personnel compensation ...........................................11.9

.................22Civilian personnel benefits ........................................................12.1

..................................25Advisory and assistance services ..............................................25.1

.................5375Grants, subsidies, and contributions ........................................41.0

.................13408Total new obligations, unexpired accounts ............................99.9

Employment Summary


.................4040Direct civilian full-time equivalent employment ............................1001

.................33Direct military average strength employment ................................1101

MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS





400400.................Maternal, Infant, and Early Childhood Home Visiting

Programs ...............................................................................0010


Appropriations, mandatory:400400.................Appropriation ....................................................................1200400400.................Total budgetary resources available ..............................................1930


384..................................Unpaid obligations, brought forward, Oct 1 ..........................3000400400.................New obligations, unexpired accounts ....................................3010

–120–16.................Outlays (gross) ......................................................................3020

664384.................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

384..................................Obligated balance, start of year ............................................3100664384.................Obligated balance, end of year ..............................................3200


400400.................Budget authority, gross .........................................................4090Outlays, gross:

1616.................Outlays from new mandatory authority .............................4100104..................................Outlays from mandatory balances ....................................4101

12016.................Outlays, gross (total) .............................................................4110400400.................Budget authority, net (total) ..........................................................418012016.................Outlays, net (total) ........................................................................4190

The Maternal, Infant and Early Childhood Home Visiting Programprovides comprehensive services for at risk communities. These activitiesare administered by HRSA.

THE BUDGET FOR FISCAL YEAR 2019422 Health Resources and Services Administration—ContinuedFederal Funds—Continued




5..................................Full-time permanent .............................................................11.11..................................Military personnel ..................................................................11.7

6..................................Total personnel compensation ...........................................11.92..................................Civilian personnel benefits ........................................................12.1

2525.................Advisory and assistance services ..............................................25.1367375.................Grants, subsidies, and contributions ........................................41.0

400400.................Total new obligations, unexpired accounts ............................99.9

Employment Summary


40..................................Direct civilian full-time equivalent employment ............................10013..................................Direct military average strength employment ................................1101

✦

HEALTH CENTER GUARANTEED LOAN FINANCING ACCOUNT



Obligations by program activity:Credit program obligations:

..................................1Downward reestimates paid to receipt accounts ...................0742

..................................1Total new obligations, unexpired accounts ....................................0900


112Unobligated balance brought forward, Oct 1 .........................1000112Total budgetary resources available ..............................................1930




..................................–1Outlays (gross) ......................................................................3020

Financing authority and disbursements, net:Mandatory:

Financing disbursements:..................................1Outlays, gross (total) .............................................................4110...................................................Budget authority, net (total) ..........................................................4180..................................1Outlays, net (total) ........................................................................4190

Status of Guaranteed Loans (in millions of dollars)


Position with respect to appropriations act limitation oncommitments:

366Limitation available from carry-forward ....................................2121.................–3–6Uncommitted limitation carried forward ...................................2143

33.................Total guaranteed loan commitments .....................................215022.................Guaranteed amount of guaranteed loan commitments .................2199

Cumulative balance of guaranteed loans outstanding:616974Outstanding, start of year .........................................................221033.................Disbursements of new guaranteed loans ..................................2231

–10–10–5Repayments and prepayments ..................................................2251Adjustments:

–1–1.................Terminations for default that result in claim payments ........2263...................................................Other adjustments, net .........................................................2264

536169Outstanding, end of year .......................................................2290

Memorandum:

404653Guaranteed amount of guaranteed loans outstanding, end of

year .......................................................................................2299

Public Law 104–299 and Public Law 104–208 authorize Health Resourcesand Services Administration (HRSA) to guarantee up to $160 million in

private loans to health centers for the costs of developing and operatingmanaged care networks or plans and for the construction, renovation, andmodernization of medical facilities. The program account for this activityis displayed in the Health Resources and Services account (75–0350) as aline in the program and financing schedule.

Balance Sheet (in millions of dollars)

2017 actual2016 actualIdentification code 075–4442–0–3–551

ASSETS:22Federal assets: Fund balances with Treasury .................................1101

22Total assets ...............................................................................1999LIABILITIES:

22Non-Federal liabilities: Liabilities for loan guarantees ..................2204

22Total liabilities and net position .....................................................4999

✦

MEDICAL FACILITIES GUARANTEE AND LOAN FUND

Status of Direct Loans (in millions of dollars)


Cumulative balance of direct loans outstanding:556Outstanding, start of year .........................................................1210

..................................–1Repayments: Repayments and prepayments .............................1251


Titles VI and XVI of the PHS Act established a loan and loan guaranteefund for medical facilities with a maximum amount allowable for theGovernment's liability. Direct loans were made available for public facilitiesand guaranteed loans for private, nonprofit facilities. Funds under this au-thority were established in the amount of $50 million for use in fulfillingguarantees in the event of default, $30 million as a revolving fund for directloans, and an amount for interest subsidy payments on guaranteed loans.



ASSETS:56Direct loans, gross .........................................................................1601


56Non-Federal liabilities: Accounts payable ......................................2201


✦

Trust Funds

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

For payments from the Vaccine Injury Compensation Program Trust Fund (the"Trust Fund"), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30,1988, pursuant to subtitle 2 of title XXI of the PHS Act, to remain available untilexpended: Provided, That for necessary administrative expenses, not to exceed$9,200,000 shall be available from the Trust Fund to the Secretary.Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget

was prepared; therefore, the budget assumes this account is operating under the ContinuingAppropriations Act, 2018 (Division D of P.L. 115–56, as amended). The amounts included for2018 reflect the annualized level provided by the continuing resolution.



3,6893,6193,571Balance, start of year ....................................................................0100Receipts:

Current law:303296270Deposits, Vaccine Injury Compensation Trust Fund ...............1110

11410684Interest and Profits on Investments, Vaccine Injury

Compensation Trust Fund .................................................1140


Trust Funds

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND—Continued

Special and Trust Fund Receipts—Continued


417402354Total current law receipts ..................................................1199

417402354Total receipts .............................................................................1999

4,1064,0213,925Total: Balances and receipts .....................................................2000Appropriations:

Current law:–27–24–24Vaccine Injury Compensation Program Trust Fund ................2101

–308–308–282Vaccine Injury Compensation Program Trust Fund ................2101

–335–332–306Total current law appropriations .......................................2199

–335–332–306Total appropriations ..................................................................2999

3,7713,6893,619Balance, end of year ..................................................................5099



Obligations by program activity:308308282Compensation: Claims for post - FY 1989 injuries ....................0001

966Claims processing (Claims Court) .............................................0103988Claims processing (HRSA) .........................................................010491010Claims processing (Dept. of Justice) .........................................0105

272424Direct program activities, subtotal ................................................0191





..................................–7Unobligated balance of appropriations withdrawn ................1035Budget authority:


Appropriations, mandatory:308308282Appropriation (special or trust fund) .................................1201335332306Budget authority (total) .............................................................1900335332306Total budgetary resources available ..............................................1930


.................913Unpaid obligations, brought forward, Oct 1 ..........................3000335332306New obligations, unexpired accounts ....................................3010



.................913Obligated balance, start of year ............................................3100




272417Outlays from new discretionary authority ..........................4010..................................8Outlays from discretionary balances .................................4011

272425Outlays, gross (total) .............................................................4020Mandatory:


308308282Outlays from new mandatory authority .............................4100.................9.................Outlays from mandatory balances ....................................4101


Offsetting collections (collected) from:..................................–4Non-Federal sources .........................................................4123

Additional offsets against gross budget authority only:


accounts .......................................................................4143

308308282Budget authority, net (mandatory) ............................................4160308317278Outlays, net (mandatory) ...........................................................4170335332306Budget authority, net (total) ..........................................................4180335341303Outlays, net (total) ........................................................................4190

Memorandum (non-add) entries:3,6893,5953,605Total investments, SOY: Federal securities: Par value ...............50003,7983,6893,595Total investments, EOY: Federal securities: Par value ...............5001

The Vaccine Injury Compensation Program was established pursuant toPublic Law 99–660 and Public Law 100–203 and serves as a source offunds to pay claims for compensation for vaccine-related injury or death.This account reflects payments for claims for vaccine-related injury ordeath occurring after October 1, 1988.



Direct obligations:222Personnel compensation: Full-time permanent .........................11.1111Civilian personnel benefits ........................................................12.1444Other goods and services from Federal sources ........................25.3

328325299Insurance claims and indemnities ............................................42.0


Employment Summary



✦

INDIAN HEALTH SERVICEFederal Funds

INDIAN HEALTH SERVICES

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674),the Indian Self-Determination and Education Assistance Act, the Indian HealthCare Improvement Act, and titles II and III of the Public Health Service Act withrespect to the Indian Health Service, $3,850,529,000, together with payments re-ceived during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b, for servicesfurnished by the Indian Health Service: Provided, That funds made available totribes and tribal organizations through contracts, grant agreements, or any otheragreements or compacts authorized by the Indian Self-Determination and EducationAssistance Act of 1975 (25 U.S.C. 450), shall be deemed to be obligated at thetime of the grant or contract award and thereafter shall remain available to thetribe or tribal organization without fiscal year limitation: Provided further, That,$932,492,000 for Purchased/Referred Care, including $51,500,000 for the IndianCatastrophic Health Emergency Fund, shall remain available until expended:Provided further, That, of the funds provided, up to $36,000,000 shall remainavailable until expended for implementation of the loan repayment program undersection 108 of the Indian Health Care Improvement Act: Provided further, That,of the funds provided, $11,000,000 shall remain available until expended to sup-plement funds available for operational costs at tribal clinics operated under anIndian Self-Determination and Education Assistance Act compact or contractwhere health care is delivered in space acquired through a full service lease,which is not eligible for maintenance and improvement and equipment funds fromthe Indian Health Service, and not less than $58,000,000 shall be for accreditationemergencies, including supplementing activities funded under the heading "IndianHealth Facilities": Provided further, That the amounts collected by the FederalGovernment as authorized by sections 104 and 108 of the Indian Health CareImprovement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal yearfor breach of contracts shall be deposited in the Fund authorized by section 108Aof the Act (25 U.S.C. 1616a–1) and shall remain available until expended and,notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a–1(c)), funds shallbe available to make new awards under the loan repayment and scholarship pro-grams under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a):Provided further, That, notwithstanding any other provision of law, the amountsmade available within this account for the Substance Abuse and Suicide PreventionProgram, for the Domestic Violence Prevention Program, to improve collectionsfrom public and private insurance at Indian Health Service and tribally operatedfacilities, and for accreditation emergencies shall be allocated at the discretionof the Director of the Indian Health Service and shall remain available until ex-pended: Provided further, That funds provided in this Act may be used for annualcontracts and grants that fall within 2 fiscal years, provided the total obligation

THE BUDGET FOR FISCAL YEAR 2019424 Health Resources and Services Administration—ContinuedTrust Funds—Continued

is recorded in the year the funds are appropriated: Provided further, That theamounts collected by the Secretary of Health and Human Services under the au-thority of title IV of the Indian Health Care Improvement Act shall remain availableuntil expended for the purpose of achieving compliance with the applicable condi-tions and requirements of titles XVIII and XIX of the Social Security Act, exceptfor those related to the planning, design, or construction of new facilities: Providedfurther, That funding contained herein for scholarship programs under the IndianHealth Care Improvement Act (25 U.S.C. 1613) shall remain available until ex-pended: Provided further, That amounts received by tribes and tribal organizationsunder title IV of the Indian Health Care Improvement Act shall be reported andaccounted for and available to the receiving tribes and tribal organizations untilexpended: Provided further, That the Bureau of Indian Affairs may collect fromthe Indian Health Service, tribes and tribal organizations operating health facilitiespursuant to Public Law 93–638, such individually identifiable health informationrelating to disabled children as may be necessary for the purpose of carrying outits functions under the Individuals with Disabilities Education Act (20 U.S.C.1400, et seq.): Provided further, That the Indian Health Care Improvement Fundmay be used, as needed, to carry out activities typically funded under the IndianHealth Facilities account.Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget




Obligations by program activity:3,5993,3363,359Clinical services ........................................................................0001

86159160Preventive health ......................................................................0002454748Urban health .............................................................................0003434949Indian health professions ..........................................................0004

.................22Tribal management ...................................................................0005727070Direct operations .......................................................................0006566Self-governance ........................................................................0007

150150147Diabetes funds ..........................................................................0009

4,0003,8193,841Total direct obligations ..................................................................07991,1931,1931,557Indian Health Services (Reimbursable) .....................................0801



1,1991,007829Unobligated balance brought forward, Oct 1 .........................1000.................1,007829Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................192Recoveries of prior year unpaid obligations ...........................1021..................................2Recoveries of prior year paid obligations ...............................1033

1,1991,0071,023Unobligated balance (total) ......................................................1050Budget authority:


Appropriations, mandatory:.................75151Appropriation ....................................................................1200



.................75148Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, discretionary:

1,4501,4481,545Collected ...........................................................................1700..................................3Change in uncollected payments, Federal sources ............1701

1,4501,4481,548Spending auth from offsetting collections, disc (total) .........17505,3005,2045,390Budget authority (total) .............................................................19006,4996,2116,413Total budgetary resources available ..............................................1930


1,3061,1991,007Unexpired unobligated balance, end of year ..........................1941


6001,034983Unpaid obligations, brought forward, Oct 1 ..........................30005,1935,0125,398New obligations, unexpired accounts ....................................3010




5206001,034Unpaid obligations, end of year .................................................3050Uncollected payments:

–100–100–98Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................–3Change in uncollected pymts, Fed sources, unexpired ..........3070






4,6074,4664,177Outlays from new discretionary authority ..........................4010663902847Outlays from discretionary balances .................................4011



–1,174–1,172–1,075Non-Federal sources .........................................................4033





accounts .......................................................................4053



Mandatory:.................75148Budget authority, gross .........................................................4090

Outlays, gross:.................7247Outlays from new mandatory authority .............................4100

3693Outlays from mandatory balances ....................................4101

378140Outlays, gross (total) .............................................................41103,8503,7563,842Budget authority, net (total) ..........................................................41803,8233,9983,613Outlays, net (total) ........................................................................4190






The Indian Health Services account provides medical care, public healthservices, and health professions training opportunities to American Indiansand Alaska Natives. More than $2.2 billion, primarily through self-determ-ination contracts and compacts, will be administered by tribal governmentsin 2019.




415397397Full-time permanent .............................................................11.1191818Other than full-time permanent ............................................11.3626060Other personnel compensation ..............................................11.5656262Military personnel ..................................................................11.7

561537537Total personnel compensation ...........................................11.9167159159Civilian personnel benefits ........................................................12.1282727Military personnel benefits ........................................................12.2101010Benefits for former personnel ....................................................13.0444343Patient travel ............................................................................21.0877Transportation of things ............................................................22.0

171616Rental payments to GSA ............................................................23.1222Rental payments to others ........................................................23.2

141313Communications, utilities, and miscellaneous charges ............23.3666Advisory and assistance services ..............................................25.1

110104105Other services from non-Federal sources ..................................25.2847676Other goods and services from Federal sources ........................25.3222Operation and maintenance of facilities ...................................25.4

382377380Medical care ..............................................................................25.6151414Operation and maintenance of equipment ................................25.7

425DEPARTMENT OF HEALTH AND HUMAN SERVICESIndian Health Service—Continued


INDIAN HEALTH SERVICES—Continued

Object Classification—Continued


333Subsistence and support of persons .........................................25.81009192Supplies and materials .............................................................26.0131212Equipment .................................................................................31.0

2,4332,3192,337Grants, subsidies, and contributions ........................................41.011.................Insurance claims and indemnities ............................................42.0



Employment Summary



5,7106,5845,684Reimbursable civilian full-time equivalent employment ...............2001764790790Reimbursable military average strength employment ...................2101

INDIAN HEALTH SERVICES




Obligations by program activity:15075.................Diabetes funds ..........................................................................0009

15075.................Direct program activities, subtotal ................................................0100


Appropriations, mandatory:15075.................Appropriation ....................................................................120015075.................Budget authority (total) .............................................................190015075.................Total budgetary resources available ..............................................1930


3..................................Unpaid obligations, brought forward, Oct 1 ..........................300015075.................New obligations, unexpired accounts ....................................3010

–147–72.................Outlays (gross) ......................................................................3020







This activity supports evidence-based diabetes treatment and preventionservices across Indian Country.



Direct obligations:21.................Patient travel ............................................................................21.01..................................Transportation of things ............................................................22.053.................Other services from non-Federal sources ..................................25.232.................Operation and maintenance of facilities ...................................25.4

2010.................Medical care ..............................................................................25.61..................................Operation and maintenance of equipment ................................25.753.................Supplies and materials .............................................................26.01..................................Equipment .................................................................................31.0

11256.................Grants, subsidies, and contributions ........................................41.0


✦

CONTRACT SUPPORT COSTS

For payments to tribes and tribal organizations for contract support costs associ-ated with Indian Self-Determination and Education Assistance Act agreements withthe Indian Health Service for fiscal year 2019, such sums as may be necessary:Provided, That amounts obligated but not expended by a tribe or tribal organizationfor contract support costs for such agreements for the current fiscal year shall beapplied to contract support costs otherwise due for such agreements for subsequentfiscal years: Provided further, That, notwithstanding any other provision of law, noamounts made available under this heading shall be available for transfer to anotherbudget account.




Obligations by program activity:797795712Contract Support Costs .............................................................0001

797795712Total new obligations (object class 25.3) ......................................0900


Appropriations, discretionary:797795712Appropriation ....................................................................1100797795712Total budgetary resources available ..............................................1930



..................................62Obligations ("upward adjustments"), expired accounts ........3011–797–843–716Outlays (gross) ......................................................................3020







797795688Outlays from new discretionary authority ..........................4010.................4828Outlays from discretionary balances .................................4011

797843716Outlays, gross (total) .............................................................4020797795712Budget authority, net (total) ..........................................................4180797843716Outlays, net (total) ........................................................................4190

The Contract Support Costs account provides for the reasonable and al-lowable costs for direct program expenses for the operation of, and anyadditional administrative or other expense related to, the overhead incurredby tribes and tribal organizations who operate health programs throughself-determination contracts and compacts. An estimated $797 million incontract support costs funds will be provided to tribal governments andtribal organizations in 2019.

✦

INDIAN HEALTH FACILITIES

For construction, repair, maintenance, improvement, and equipment of healthand related auxiliary facilities, including quarters for personnel; preparation ofplans, specifications, and drawings; acquisition of sites, purchase and erection ofmodular buildings, and purchases of trailers; and for provision of domestic andcommunity sanitation facilities for Indians, as authorized by section 7 of the Act ofAugust 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the IndianHealth Care Improvement Act, and for expenses necessary to carry out such Actsand titles II and III of the Public Health Service Act with respect to environmentalhealth and facilities support activities of the Indian Health Service, $426,267,000,

THE BUDGET FOR FISCAL YEAR 2019426 Indian Health Service—ContinuedFederal Funds—Continued

to remain available until expended: Provided, That, notwithstanding any otherprovision of law, funds appropriated for the planning, design, construction, renov-ation or expansion of health facilities for the benefit of an Indian tribe or tribes maybe used to purchase land on which such facilities will be located: Provided further,That not to exceed $500,000 may be used by the Indian Health Service to purchaseTRANSAM equipment from the Department of Defense for distribution to the IndianHealth Service and tribal facilities: Provided further, That none of the funds appro-priated to the Indian Health Service may be used for sanitation facilities constructionfor new homes funded with grants by the housing programs of the United StatesDepartment of Housing and Urban Development: Provided further, That not to ex-ceed $2,700,000 from this account and the "Indian Health Services" account maybe used by the Indian Health Service to obtain ambulances for the Indian HealthService and tribal facilities in conjunction with an existing interagency agreementbetween the Indian Health Service and the General Services Administration: Providedfurther, That not to exceed $500,000 may be placed in a Demolition Fund, to remainavailable until expended, and be used by the Indian Health Service for the demolitionof Federal buildings.




...................................................Balance, start of year ....................................................................0100Receipts:

Current law:998Rent and Charges for Quarters, Indian Health Service ..........1130


Current law:–9–9–8Indian Health Facilities .........................................................2101

...................................................Balance, end of year ..................................................................5099



Obligations by program activity:140218220Maintenance .............................................................................0001607578Maintenance .............................................................................0002

207225227Facilities and environmental health ..........................................0003202323Equipment .................................................................................0004

427541548Total direct program ......................................................................0100

427541548Total direct obligations ..................................................................07999925Indian Health Facilities (Reimbursable) ....................................0801



366309285Unobligated balance brought forward, Oct 1 .........................1000.................309285Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................11Recoveries of prior year unpaid obligations ...........................1021


Appropriations, discretionary:427541545Appropriation ....................................................................1100

Appropriations, mandatory:998Appropriation (special or trust fund) .................................1201

Spending authority from offsetting collections, discretionary:575732Collected ...........................................................................1700

..................................1Change in uncollected payments, Federal sources ............1701

575733Spending auth from offsetting collections, disc (total) .........1750493607586Budget authority (total) .............................................................1900859916882Total budgetary resources available ..............................................1930





398532575Unpaid obligations, end of year .................................................3050

Uncollected payments:–9–9–8Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060

..................................–1Change in uncollected pymts, Fed sources, unexpired ..........3070





185219267Outlays from new discretionary authority ..........................4010376365202Outlays from discretionary balances .................................4011





427541545Budget authority, net (discretionary) .........................................4070504527437Outlays, net (discretionary) .......................................................4080


Outlays, gross:993Outlays from new mandatory authority .............................4100

..................................6Outlays from mandatory balances ....................................4101


The Indian Health Facilities account supports construction, repair andimprovement, equipment, and environmental health and facilities supportfor the Indian Health Service. More than 169 million, primarily throughself-determination contracts and compacts, will be administered by tribalgovernments in 2019.






837878Total personnel compensation ...........................................11.9201818Civilian personnel benefits ........................................................12.1988Military personnel benefits ........................................................12.2233Travel and transportation of persons .........................................21.0333Transportation of things ............................................................22.0111Rental payments to GSA ............................................................23.1

121514Communications, utilities, and miscellaneous charges ............23.3233Advisory and assistance services ..............................................25.1

71108109Other services from non-Federal sources ..................................25.2232Other goods and services from Federal sources ........................25.3688Operation and maintenance of facilities ...................................25.4344Operation and maintenance of equipment ................................25.7588Subsistence and support of persons .........................................25.8677Supplies and materials .............................................................26.0

101313Equipment .................................................................................31.0557980Land and structures ..................................................................32.0

137182189Grants, subsidies, and contributions ........................................41.0

427541548Direct obligations ..................................................................99.09925Reimbursable obligations .....................................................99.0


Employment Summary



427DEPARTMENT OF HEALTH AND HUMAN SERVICESIndian Health Service—Continued


INDIAN HEALTH FACILITIES—Continued

Employment Summary—Continued



✦

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

Appropriations provided in this Act to the Indian Health Service shall be availablefor services as authorized by 5 U.S.C. 3109 at rates not to exceed the per diem rateequivalent to the maximum rate payable for senior-level positions under 5 U.S.C.5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment;purchase of reprints; purchase, renovation and erection of modular buildings andrenovation of existing facilities; payments for telephone service in private residencesin the field, when authorized under regulations approved by the Secretary; uniformsor allowances therefor as authorized by 5 U.S.C. 5901–5902; and for expenses ofattendance at meetings that relate to the functions or activities of the Indian HealthService: Provided, That in accordance with the provisions of the Indian Health CareImprovement Act, non-Indian patients may be extended health care at all triballyadministered or Indian Health Service facilities, subject to charges, and the proceedsalong with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C.2651–2653) shall be credited to the account of the facility providing the service andshall be available without fiscal year limitation: Provided further, That notwithstand-ing any other law or regulation, funds transferred from the Department of Housingand Urban Development to the Indian Health Service shall be administered underPublic Law 86–121, the Indian Sanitation Facilities Act and Public Law 93–638:Provided further, That funds appropriated to the Indian Health Service in this Act,except those used for administrative and program direction purposes, shall not besubject to limitations directed at curtailing Federal travel and transportation:Provided further, That none of the funds made available to the Indian Health Servicein this Act shall be used for any assessments or charges by the Department of Healthand Human Services unless identified in the budget justification and provided inthis Act, or the House and Senate Committees on Appropriations are notified throughthe reprogramming process: Provided further, That notwithstanding any otherprovision of law, funds previously or herein made available to a tribe or tribal or-ganization through a contract, grant, or agreement authorized by title I or title Vof the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C.450), may be deobligated and reobligated to a self-determination contract undertitle I, or a self-governance agreement under title V of such Act and thereafter shallremain available to the tribe or tribal organization without fiscal year limitation:Provided further, That none of the funds made available to the Indian Health Servicein this Act shall be used to implement the final rule published in the Federal Registeron September 16, 1987, by the Department of Health and Human Services, relatingto the eligibility for the health care services of the Indian Health Service until theIndian Health Service has submitted a budget request reflecting the increased costsassociated with the proposed final rule, and such request has been included in anappropriations Act and enacted into law: Provided further, That with respect tofunctions transferred by the Indian Health Service to tribes or tribal organizations,the Indian Health Service is authorized to provide goods and services to those entitieson a reimbursable basis, including payments in advance with subsequent adjustment,and the reimbursements received therefrom, along with the funds received fromthose entities pursuant to the Indian Self-Determination Act, may be credited to thesame or subsequent appropriation account from which the funds were originallyderived, with such amounts to remain available until expended: Provided further,That reimbursements for training, technical assistance, or services provided by theIndian Health Service will contain total costs, including direct, administrative, andoverhead associated with the provision of goods, services, or technical assistance:Provided further, That, notwithstanding any other provision of law, for any leaseunder section 105(l) of the Indian Self-Determination and Education AssistanceAct, as amended, no additional compensation is required by the Act above the amountprovided to the tribe or tribal organization under section 106(a)(1), except theSecretary, in the discretion of the Secretary, may award compensation for suchleases, above the section 106(a)(1) amount, and if the Secretary awards such addi-tional compensation the amount of such compensation may be based on such reas-onable expenses, if any, as the Secretary determines to be appropriate, which mayinclude the expenses described in section 105(l)(2), and the exercise of this discretion

to award additional compensation and determine its amount is not subject to sections102(a)-(b), (e) or 507(b)-(d) of the Act.

✦

CENTERS FOR DISEASE CONTROL AND PREVENTIONFederal Funds

IMMUNIZATION AND RESPIRATORY DISEASES

For carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act,titles II and IV of the Immigration and Nationality Act, and section 501 of the RefugeeEducation Assistance Act, with respect to immunization and respiratory diseases,$437,828,000.

HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND

TUBERCULOSIS PREVENTION

For carrying out titles II, III, XVII, and XXIII of the PHS Act with respect toHIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention,$1,067,278,000.

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

For carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles IIand IV of the Immigration and Nationality Act, and section 501 of the RefugeeEducation Assistance Act, with respect to emerging and zoonotic infectious diseases,$371,328,000: Provided, That of the amounts available to pay for the transportation,medical care, treatment, and other related costs of persons quarantined or isolatedunder federal or state quarantine law, up to $1,000,000 shall remain available untilexpended.

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

For carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respectto chronic disease prevention and health promotion, $439,250,000: Provided, Thatamounts in this account, including amounts transferred to this account, are availablefor the Director of the Centers for Disease Control and Prevention (CDC) to admin-ister a program, to be known as America's Health State Block Grant, to provide in-creased flexibility for States, territories, tribes, and tribal organizations to improvepublic health: Provided further, That for purposes of carrying out such program,the Director is hereby authorized to award grants to States, territories, tribes, andtribal organizations, and such grant awards shall be provided through a formula,as determined by the Director, that takes into account the population and diseaseburden of the grantee: Provided further, That the Director may set aside not morethan 15 percent of the amounts awarded for grants described in the previous provisofor the same purposes, on a competitive basis, to cities, Federally-recognized tribes,and public health entities serving rural and frontier areas or other entities: Providedfurther, That funds appropriated under this account may be available for makinggrants under section 1509 of the PHS Act for not less than 21 States, tribes, or tribalorganizations: Provided further, That the proportional funding requirements undersection 1503(a) of the PHS Act shall not apply to funds made available under thisheading.

BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

For carrying out titles II, III, XI, and XVII of the PHS Act with respect to birthdefects, developmental disabilities, disabilities and health, $110,000,000.

PUBLIC HEALTH SCIENTIFIC SERVICES

For carrying out titles II, III, and XVII of the PHS Act with respect to health stat-istics, surveillance, health informatics, and workforce development, $332,180,000:Provided, That in addition to amounts provided herein, $135,820,000 shall beavailable from amounts available under section 241 of the PHS Act to carry out thePublic Health Scientific Services.

ENVIRONMENTAL HEALTH

For carrying out titles II, III, and XVII of the PHS Act with respect to environmentalhealth, $157,000,000.

INJURY PREVENTION AND CONTROL

For carrying out titles II, III, and XVII of the PHS Act with respect to injury pre-vention and control, $266,309,000.

THE BUDGET FOR FISCAL YEAR 2019428 Indian Health Service—ContinuedFederal Funds—Continued

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

GLOBAL HEALTH

For carrying out titles II, III, and XVII of the PHS Act with respect to global health,$408,762,000, of which $69,547,000 for international HIV/AIDS shall remainavailable through September 30, 2020 and $58,762,000 for global public healthprotection shall remain available through September 30, 2020: Provided, That fundsmay be used for purchase and insurance of official motor vehicles in foreign coun-tries.

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

For carrying out titles II, III, and XVII of the PHS Act with respect to public healthpreparedness and response, and for expenses necessary to support activities relatedto countering potential biological, nuclear, radiological, and chemical threats tocivilian populations, $691,000,000: Provided, That the Director of the CDC or theAdministrator of the Agency for Toxic Substances and Disease Registry may detailstaff without reimbursement for up to 180 days to support an activation of the CDCEmergency Operations Center.

CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

For carrying out titles II, III, XVII, and XIX, and section 2821 of the PHS Act andfor cross-cutting activities and program support for activities funded in other appro-priations included in this Act for the Centers for Disease Control and Prevention,$105,000,000: Provided, That paragraphs (1) through (3) of subsection (b) of section2821 of the PHS Act shall not apply to funds appropriated under this heading andin all other accounts of the CDC: Provided further, That funds appropriated underthis heading and in all other accounts of CDC may be used to support the purchase,hire, maintenance, and operation of aircraft for use and support of the activities ofCDC: Provided further, That employees of CDC or the Public Health Service, bothcivilian and commissioned officers, detailed to States, municipalities, or other or-ganizations under authority of section 214 of the PHS Act, or in overseas assign-ments, shall be treated as non-Federal employees for reporting purposes only andshall not be included within any personnel ceiling applicable to the Agency, Service,or HHS during the period of detail or assignment: Provided further, That CDC mayuse up to $10,000 from amounts appropriated to CDC in this Act for official receptionand representation expenses when specifically approved by the Director of CDC:Provided further, That in addition, such sums as may be derived from authorizeduser fees, which shall be credited to the appropriation charged with the cost thereof:Provided further, That with respect to the previous proviso, authorized user feesfrom the Vessel Sanitation Program and the Respirator Certification Program shallbe available through September 30, 2020: Provided further, That the Director maytransfer discretionary funds (pursuant to the Balanced Budget and Emergency De-ficit Control Act of 1985) which are appropriated for the current fiscal year forCDC in this Act between any of the accounts of CDC with notification to the Com-mittees on Appropriations of both Houses of Congress at least 15 days in advanceof any transfer, but no such account shall be decreased by more than 3 percent byany such transfer.





Current law:

221Cooperative Research and Development Agreements, Centers

for Disease Control ............................................................1130


Current law:–2–2–1CDC-wide Activities and Program Support ............................2101





110137137Birth Defects, Developmental Disabilities, Disability and Health

(0958) ...................................................................................0001

105257323CDC-Wide Activities and Program Support (0943) ....................00028391,0781,109Chronic Disease Prevention and Health Promotion (0948) ........0004508568584Emerging and Zoonotic Infectious Diseases (0949) ..................0005

.................5551Energy Employee Illness Occupational Compensation Program

Act (EEOICPA) (0954) ............................................................0006

157178189Environmental Health (0947) ....................................................0007409432438Global Health (0955) .................................................................0008

1,0671,1101,114HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950) ...........0012701745802Immunization and Respiratory Diseases (0951) ........................0013266284285Injury Prevention and Control (0952) .........................................0015

.................333334Occupational Safety and Health (0953) ....................................00166911,3951,393Public Health Preparedness and Response (0956) ....................0019332494488Public Health Scientific Services (0959) ...................................0020

..................................1Cooperative Research and Development Agreements (CRADA)

(5146) ...................................................................................0021

72157352Ebola (Emergency pursuant to 2011 BCA) .................................0022..................................397Zika (Emergency pursuant to 2011 BCA) ...................................0023

5,2577,2237,997Total direct obligations ..................................................................0799197197197CDC-Wide Activities and Program Support (Reimbursable) ........0802

197197197Reimbursable program activities, subtotal ...................................0809



5224711,157Unobligated balance brought forward, Oct 1 .........................1000.................4711,040Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................–4Unobligated balance transfer to other accts [075–0960] ......1010..................................–3Unobligated balance transfer to other accts [075–9915] ......1010..................................23Unobligated balance transfer from other acct [075–0140] ....1011

..................................28Unobligated balance transfers between expired and unexpired

accounts ...........................................................................1012






.................805.................Appropriations transferred from other acct (CHIMPS)

[075–0116] ..................................................................1121

.................–5.................Appropriations permanently reduced ................................1130


.................5555Appropriation (075–0954 - EEOICPA) ...............................1200221Appropriation (075–5146 CRADA) .....................................1201

800.................891Appropriations transferred from other acct PPHF

[075–0116] ..................................................................1221

.................–5–5Appropriations and/or unobligated balance of


80252942Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, discretionary:



445Collected ...........................................................................18005,6007,4717,410Budget authority (total) .............................................................19006,1227,9428,670Total budgetary resources available ..............................................1930










429DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention—Continued


CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT—Continued








2,1193,0452,502Outlays from new discretionary authority ..........................40104,8004,1664,288Outlays from discretionary balances .................................4011



..................................–10Non-Federal sources .........................................................4033







Outlays, gross:16542212Outlays from new mandatory authority .............................4100233818824Outlays from mandatory balances ....................................4101

3988601,036Outlays, gross (total) .............................................................4110Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:–4–4–7Non-Federal sources .........................................................4123



accounts .......................................................................4143

80252942Budget authority, net (mandatory) ............................................41603948561,029Outlays, net (mandatory) ...........................................................4170


The Centers for Disease Control and Prevention (CDC) supports a numberof categorical programs designed to improve the health, safety, and protec-tion of all Americans. These activities include immunization and respiratorydiseases, HIV/AIDS, Hepatitis, STDs, and Tuberculosis prevention,emerging and zoonotic infectious diseases, chronic disease prevention andhealth promotion, public health and scientific services, injury preventionand control, environmental health, global health, programs that reduce theoccurrence of birth defects and developmental disabilities, public healthpreparedness and emergency response, and CDC-wide activities and pro-gram support. The FY 2019 Budget maintains the proposal to establish anew block grant, proposed at $400 million, to increase flexibility for Statesto address their population's unique public health needs.





1,0261,0221,005Total personnel compensation ...........................................11.9309307301Civilian personnel benefits ........................................................12.1505055Military personnel benefits ........................................................12.2324260Travel and transportation of persons .........................................21.0111416Transportation of things ............................................................22.021278Rental payments to GSA ............................................................23.1111Rental payments to others ........................................................23.2

283422Communications, utilities, and miscellaneous charges ............23.3333Printing and reproduction .........................................................24.0

334865876Advisory and assistance services ..............................................25.174224177Other services from non-Federal sources ..................................25.2

149443783Other goods and services from Federal sources ........................25.3102117Operation and maintenance of facilities ...................................25.482628Research and development contracts .......................................25.5

123844Medical care ..............................................................................25.6298651Operation and maintenance of equipment ................................25.7

401472515Supplies and materials .............................................................26.0526462Equipment .................................................................................31.0571Land and structures ..................................................................32.0

2,7013,4763,971Grants, subsidies, and contributions ........................................41.0111Insurance claims and indemnities ............................................42.0



Employment Summary


7,5208,6209,079Direct civilian full-time equivalent employment ............................1001694788858Direct military average strength employment ................................1101218218218Reimbursable civilian full-time equivalent employment ...............2001373737Reimbursable military average strength employment ...................2101

✦


For acquisition of real property, equipment, construction, demolition, and renov-ation of facilities, $20,000,000, to remain available until September 30, 2023.




Obligations by program activity:20109CDC Buildings and Facilities (0960) .........................................0001


883Unobligated balance brought forward, Oct 1 .........................1000..................................4Unobligated balance transfer from other acct [075–0943] ....1011






–14–10–7Outlays (gross) ......................................................................3020







THE BUDGET FOR FISCAL YEAR 2019430 Centers for Disease Control and Prevention—ContinuedFederal Funds—Continued



Direct obligations:111Advisory and assistance services ..............................................25.1

1998Operation and maintenance of facilities ...................................25.4


✦

CDC WORKING CAPITAL FUND



Obligations by program activity:532532549CDC Working Capital Fund (Reimbursable) ...............................0801


555553Unobligated balance brought forward, Oct 1 .........................1000..................................15Recoveries of prior year unpaid obligations ...........................1021



..................................–1Change in uncollected payments, Federal sources ............1701

532532536Spending auth from offsetting collections, disc (total) .........1750587587604Total budgetary resources available ..............................................1930





193193195Unpaid obligations, end of year .................................................3050Uncollected payments:

–1–1–2Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................1Change in uncollected pymts, Fed sources, unexpired ..........3070








Additional offsets against gross budget authority only:..................................1Change in uncollected pymts, Fed sources, unexpired .......4050.................219Outlays, net (discretionary) .......................................................4080...................................................Budget authority, net (total) ..........................................................4180.................219Outlays, net (total) ........................................................................4190

Implemented in fiscal year 2014, CDC's Working Capital Fund has ex-tended availability and serves as the funding mechanism to finance central-ized business services support across CDC. Services rendered under thefund are performed at pre-established rates that are used to cover the fullcost of operations and future investments. Contributions are collected forservices, thereby creating market-like incentives to maximize efficiencyand quality.





159159159Total personnel compensation ...........................................11.9505050Civilian personnel benefits ........................................................12.1222Military personnel benefits ........................................................12.2111Travel and transportation of persons .........................................21.0222Transportation of things ............................................................22.0

323232Rental payments to GSA ............................................................23.1222222Communications, utilities, and miscellaneous charges ............23.3313131Advisory and assistance services ..............................................25.1777786Other services from non-Federal sources ..................................25.2686876Other goods and services from Federal sources ........................25.3101010Operation and maintenance of facilities ...................................25.4575757Operation and maintenance of equipment ................................25.7111Supplies and materials .............................................................26.0

121212Equipment .................................................................................31.0888Land and structures ..................................................................32.0


Employment Summary



✦

TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTH

For necessary expenses for the Agency for Toxic Substances and Disease Registry(ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of theComprehensive Environmental Response, Compensation, and Liability Act of 1980(CERCLA) and section 3019 of the Solid Waste Disposal Act, $62,000,000: Provided,That notwithstanding any other provision of law, in lieu of performing a health as-sessment under section 104(i)(6) of CERCLA, the Administrator of ATSDR mayconduct other appropriate health studies, evaluations, or activities, including, withoutlimitation, biomedical testing, clinical evaluations, medical monitoring, and referralto accredited healthcare providers: Provided further, That in performing any suchhealth assessment or health study, evaluation, or activity, the Administrator ofATSDR shall not be bound by the deadlines in section 104(i)(6)(A) of CERCLA:Provided further, That none of the funds appropriated under this heading shall beavailable for ATSDR to issue in excess of 40 toxicological profiles pursuant to section104(i) of CERCLA during fiscal year 2019, and existing profiles may be updated asnecessary.





627481Agency for Toxic Substances and Disease Registry, Toxic Substanc

(Direct) ..................................................................................0001


282526Unobligated balance brought forward, Oct 1 .........................1000Budget authority:





431DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention—Continued


TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTH—Continued























Mandatory:Outlays, gross:

..................................3Outlays from mandatory balances ....................................4101627475Budget authority, net (total) ..........................................................4180729278Outlays, net (total) ........................................................................4190





282828Total personnel compensation ...........................................11.9888Civilian personnel benefits ........................................................12.1111Military personnel benefits ........................................................12.2111Travel and transportation of persons .........................................21.0388Advisory and assistance services ..............................................25.1355Other services from non-Federal sources ..................................25.2499Other goods and services from Federal sources ........................25.3111Operation and maintenance of equipment ................................25.7


627477Direct obligations ..................................................................99.0..................................4Reimbursable obligations .....................................................99.0


Employment Summary


219219219Direct civilian full-time equivalent employment ............................1001

363636Direct military average strength employment ................................1101

✦

WORLD TRADE CENTER HEALTH PROGRAM FUND




469420351World Trade Center Health Program—Federal Share

(CDC/NIOSH) .........................................................................0001

524239World Trade Center Health Program—NYC ................................0002




838362Unobligated balance transfers between expired and unexpired

accounts ...........................................................................1012



Appropriations, mandatory:440380320Appropriation (WTC (CDC Direct)) .....................................1200494236Appropriation (WTC—NYC DHSS—CDC) ..........................1200

489422356Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, mandatory:

..................................28Collected ...........................................................................1800489422384Budget authority (total) .............................................................1900

1,4851,3751,260Total budgetary resources available ..............................................1930Memorandum (non-add) entries:











225194.................Outlays from new mandatory authority .............................4100190151342Outlays from mandatory balances ....................................4101



Additional offsets against gross budget authority only:..................................6Offsetting collections credited to expired accounts ...........4142


HHS, along with CDC, began implementing provisions of the JamesZadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347) onJuly 1, 2011, to provide monitoring and treatment benefits to eligible re-sponders and survivors. CDC serves as the Program Administrator for theWorld Trade Center (WTC) Health Program. The WTC Health Programprovides quality care for WTC-related health conditions, conducts WTCresearch, and maintains a health registry to collect data on victims of theSeptember 11, 2001, terrorist attacks. The WTC Health Program has beenextended through FY 2090 under the James Zadroga 9/11 Health andCompensation Reauthorization Act of 2015 (P.L. 114–113, Division O,Title III). The amounts included for 2018 and 2019 in the Budget reflectestimated Federal obligations for the WTC Health Program.

THE BUDGET FOR FISCAL YEAR 2019432 Centers for Disease Control and Prevention—ContinuedFederal Funds—Continued




333Full-time permanent .............................................................11.1111Military personnel ..................................................................11.7

444Total personnel compensation ...........................................11.9111Civilian personnel benefits ........................................................12.1111Military personnel benefits ........................................................12.2

434331Advisory and assistance services ..............................................25.1978874Other services from non-Federal sources ..................................25.2121210Other goods and services from Federal sources ........................25.3242420Grants, subsidies, and contributions ........................................41.0

339289249Insurance claims and indemnities ............................................42.0


Employment Summary



✦

NATIONAL INSTITUTES OF HEALTHFederal Funds

NATIONAL CANCER INSTITUTE

For carrying out section 301 and title IV of the PHS Act with respect to cancer,$3,756,093,000, of which up to $10,000,000 may be used for facilities repairs andimprovements at the National Cancer Institute—Frederick Federally Funded Re-search and Development Center in Frederick, Maryland.

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

For carrying out section 301 and title IV of the PHS Act with respect to cardiovas-cular, lung, and blood diseases, and blood and blood products, $2,237,268,000.

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

For carrying out section 301 and title IV of the PHS Act with respect to dentaland craniofacial diseases, $297,050,000.

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

For carrying out section 301 and title IV of the PHS Act with respect to diabetesand digestive and kidney disease, $1,305,132,000.

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

For carrying out section 301 and title IV of the PHS Act with respect to neurolo-gical disorders and stroke, $1,294,472,000.

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

For carrying out section 301 and title IV of the PHS Act with respect to allergyand infectious diseases, $3,423,408,000.

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

For carrying out section 301 and title IV of the PHS Act with respect to generalmedical sciences, $1,849,515,000, of which $741,000,000 shall be from fundsavailable under section 241 of the PHS Act.

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND

HUMAN DEVELOPMENT

For carrying out section 301 and title IV of the PHS Act with respect to childhealth and human development, $963,045,000.

NATIONAL EYE INSTITUTE

For carrying out section 301 and title IV of the PHS Act with respect to eye diseasesand visual disorders, $511,155,000.

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

For carrying out section 301 and title IV of the PHS Act with respect to environ-mental health sciences, $498,347,000.

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

For necessary expenses for the National Institute of Environmental Health Sciencesin carrying out activities set forth in section 311(a) of the Comprehensive Environ-

mental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) andsection 126(g) of the Superfund Amendments and Reauthorization Act of 1986,$53,967,000.

NATIONAL INSTITUTE ON AGING

For carrying out section 301 and title IV of the PHS Act with respect to aging,$1,429,335,000.

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

For carrying out section 301 and title IV of the PHS Act with respect to arthritisand musculoskeletal and skin diseases, $393,311,000.

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

For carrying out section 301 and title IV of the PHS Act with respect to deafnessand other communication disorders, $304,812,000.

NATIONAL INSTITUTE OF NURSING RESEARCH

For carrying out section 301 and title IV of the PHS Act with respect to nursingresearch, $104,847,000.

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

For carrying out section 301 and title IV of the PHS Act with respect to alcoholabuse and alcoholism, $337,247,000

NATIONAL INSTITUTE ON DRUG ABUSE

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse,$839,816,000.

NATIONAL INSTITUTE OF MENTAL HEALTH

For carrying out section 301 and title IV of the PHS Act with respect to mentalhealth, $1,117,682,000.

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

For carrying out section 301 and title IV of the PHS Act with respect to humangenome research, $368,785,000.

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

For carrying out section 301 and title IV of the PHS Act with respect to biomedicalimaging and bioengineering research, $249,138,000.

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

For carrying out section 301 and title IV of the PHS Act with respect to comple-mentary and integrative health, $93,974,000.

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

For carrying out section 301 and title IV of the PHS Act with respect to minorityhealth and health disparities research, $201,686,000.

JOHN E. FOGARTY INTERNATIONAL CENTER

For carrying out the activities of the John E. Fogarty International Center (de-scribed in subpart 2 of part E of title IV of the PHS Act), $50,384,000.

NATIONAL LIBRARY OF MEDICINE

For carrying out section 301 and title IV of the PHS Act with respect to healthinformation communications, $284,324,000: Provided, That of the amounts availablefor improvement of information systems, $4,000,000 shall be available untilSeptember 30, 2020: Provided further, That in fiscal year 2019, the National Libraryof Medicine may enter into personal services contracts for the provision of servicesin facilities owned, operated, or constructed under the jurisdiction of the NationalInstitutes of Health (referred to in this title as "NIH").

NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

For carrying out section 301 and title IV of the PHS Act with respect to transla-tional sciences, $492,515,000: Provided, That up to 10 percent of the amountavailable under this heading shall be available to implement section 480 of the PHSAct, relating to the Cures Acceleration Network.

OFFICE OF THE DIRECTOR

For carrying out the responsibilities of the Office of the Director, NIH,$1,338,005,000: Provided, That funding shall be available for the purchase of notto exceed 29 passenger motor vehicles for replacement only: Provided further, Thatall funds credited to the NIH Management Fund shall remain available for onefiscal year after the fiscal year in which they are deposited: Provided further, That$431,924,000 shall be available for the Common Fund established under section402A(c)(1) of the PHS Act: Provided further, That of the funds provided, $10,000shall be for official reception and representation expenses when specifically approved

433DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of Health

Federal Funds

NATIONAL INSTITUTES OF HEALTH—Continued

by the Director of the NIH: Provided further, That the Office of AIDS Researchwithin the Office of the Director of the NIH may spend up to $8,000,000 to makegrants for construction or renovation of facilities as provided for in section2354(a)(5)(B) of the PHS Act.

In addition to other funds appropriated for the Common Fund established undersection 402A(c) of the PHS Act, $12,600,000 is appropriated to the Common Fundfrom the 10-year Pediatric Research Initiative Fund described in section 9008 oftitle 26, United States Code, for the purpose of carrying out section 402(b)(7)(B)(ii)of the PHS Act (relating to pediatric research), as authorized in the Gabriella MillerKids First Research Act.


For the study of, construction or demolition of, renovation of, and acquisition ofequipment for, facilities of or used by NIH, including the acquisition of real property,$200,000,000, to remain available through September 30, 2023.

NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

For carrying out titles III and IX of the PHS Act, part A of title XI of the SocialSecurity Act, and section 1013 of the Medicare Prescription Drug, Improvement,and Modernization Act of 2003, $255,960,000: Provided, That section 947(c) of thePHS Act shall not apply in fiscal year 2019: Provided further, That in addition,amounts received from Freedom of Information Act fees, reimbursable and inter-agency agreements, and the sale of data shall be credited to this appropriation andshall remain available until expended.

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

For carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103,201, 202, 203, 301, and 501 of the Federal Mine Safety and Health Act, section 13of the Mine Improvement and New Emergency Response Act, and sections 20, 21,and 22 of the Occupational Safety and Health Act, with respect to occupationalsafety and health, $200,000,000.

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

For necessary expenses to administer the Energy Employees Occupational IllnessCompensation Program Act, $55,358,000, to remain available until expended:Provided, That this amount shall be available consistent with the provision regardingadministrative expenses in section 151(b) of division B, title I of Public Law 106–554.

NATIONAL INSTITUTE ON DISABILITY, INDEPENDENT LIVING, AND

REHABILITATION RESEARCH

For carrying out title II (and section 14 with respect to such title) of the Rehabil-itation Act of 1973, $95,127,000.





Current law:424242Cooperative Research and Development Agreements, NIH .....1130


Current law:–42–42–42National Institutes of Health .................................................2101




Obligations by program activity:3,7565,3535,637National Cancer Institute (0849) ...............................................00012,2373,1853,210National Heart, Lung, and Blood Institute (0872) ......................0002

297423425National Institute of Dental and Craniofacial Research

(0873) ...................................................................................0003

1,3051,8581,870National Institute of Diabetes and Digestive and Kidney Disease

(0884) ...................................................................................0004

1,2941,7721,779National Institute of Neurological Disorders and Stroke

(0886) ...................................................................................0005

3,4234,8735,102National Institute of Allergy and Infectious Diseases (0885) ......00061,1091,8141,822National Institute of General Medical Sciences (0851) ..............0007

9631,3711,377National Institute of Child Health and Human Development

(0844) ...................................................................................0008

511728731National Eye Institute (0887) ....................................................0009552709793National Institute of Environmental Health Sciences (0862) ......0010

1,4292,0352,049National Institute on Aging (0843) ............................................0011

393554557National Institute of Arthritis and Musculoskeletal and Skin

Disease (0888) ......................................................................0012

305434436National Institute on Deafness and Other Communication Disorder

(0890) ...................................................................................0013

1,1181,5911,605National Institute of Mental Health (0892) ................................00148401,0831,071National Institute on Drug Abuse (0893) ...................................0015337480482National Institute on Alcohol Abuse and Alcoholism (0894) .......0016105149150National Institute of Nursing Research (0889) ..........................0017369525528National Human Genome Research Institute (0891) .................0018

249355357National Institute of Biomedical Imaging and Bioengineering

(0898) ...................................................................................0019

94134134National Center for Complementary and Integrative Health

(0896) ...................................................................................0021

202287288National Institute on Minority Health and Health Disparities

(0897) ...................................................................................0022

507272John E. Fogarty International Center (0819) ..............................0023284405406National Library of Medicine (0807) ..........................................0024

1,3381,6541,676NIH Office of the Director (0846) ...............................................0025200128113NIH Buildings and facilities (0838) ...........................................0026323232NIH Cooperative Research and Development Agreements .........0027

493701704National Center for Advancing Translational Sciences

(0875) ...................................................................................0028

256..................................National Institute for Research on Safety and Quality ...............002915038140Type 1 Diabetes .........................................................................0031200..................................National Institute of Occupational Safety and Health ...............0032

95..................................National Institute on Disability, Independent Living, and

Rehabilitation .......................................................................0033

55..................................EEOICPA ....................................................................................0035

24,04132,74333,546Total direct obligations ..................................................................07993,4514,2993,880NIH Reimbursable - Other .........................................................0801141141141NIH Royalties .............................................................................0802

3,5924,4404,021Reimbursable program activities, subtotal ...................................0809




4959921,363Unobligated balance brought forward, Oct 1 .........................1000.................9921,363Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................66Unobligated balance transfer from other acct [075–0140] ....1011..................................3Unobligated balance transfer from other acct [075–0943] ....1011

22..................................Unobligated balance transfer from other acct [075–1700] ....1011..................................–8Adjustment of unobligated bal brought forward, Oct 1 .........1020..................................78Recoveries of prior year unpaid obligations ...........................1021..................................1Recoveries of prior year paid obligations ...............................1033



..................................–72Appropriations transferred to other acct [075–1503] ........1120515298300Appropriations transferred from other acct [075–5628] ....112113113Appropriations transferred from other acct [075–5736] ....1121


.................38150Appropriation ....................................................................1200424242Appropriation (special or trust fund) .................................1201



4280182Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, discretionary:

3,5593,5593,737Collected ...........................................................................1700..................................–74Change in uncollected payments, Federal sources ............1701

3,5593,5593,663Spending auth from offsetting collections, disc (total) .........175027,93436,68637,059Budget authority (total) .............................................................190028,45137,67838,562Total budgetary resources available ..............................................1930




33,98834,68432,960Unpaid obligations, brought forward, Oct 1 ..........................3000

..................................20Adjustments to unpaid obligations, brought forward, Oct

1 .......................................................................................3001

27,63337,18337,567New obligations, unexpired accounts ....................................3010..................................546Obligations ("upward adjustments"), expired accounts ........3011

–36,029–37,879–35,316Outlays (gross) ......................................................................3020

THE BUDGET FOR FISCAL YEAR 2019434 National Institutes of Health—ContinuedFederal Funds—Continued


..................................–1,015Recoveries of prior year unpaid obligations, expired .............3041


–671–671–1,207Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060

..................................8Adjustments to uncollected pymts, Fed sources, brought

forward, Oct 1 ...................................................................3061

..................................74Change in uncollected pymts, Fed sources, unexpired ..........3070








Offsetting collections (collected) from:–3,559–3,559–3,950Federal sources .................................................................4030



..................................74Change in uncollected pymts, Fed sources, unexpired .......4050



accounts .......................................................................4053





96160163Outlays, gross (total) .............................................................411024,37533,12733,396Budget authority, net (total) ..........................................................418032,47034,32031,062Outlays, net (total) ........................................................................4190






This program funds biomedical research and research training. Theseaccounts will continue to be appropriated separately, and are displayed ina consolidated format to improve the readability of the presentation. TheFY 2019 Budget consolidates the activities of the Agency for HealthcareResearch and Quality within the National Institutes of Health as the NationalInstitute for Research on Safety and Quality. It also consolidates the Na-tional Institute for Occupational Safety and Health (currently administeredby the Centers for Disease Control and Prevention) and the National Insti-tute on Disability, Independent Living, and Rehabilitation Research (cur-rently administered by the Administration for Community Living) withinthe National Institutes of Health. Detailed information is available throughthe Department of Health and Human Services.




1,1811,007976Full-time permanent .............................................................11.1535529520Other than full-time permanent ............................................11.3

454646Other personnel compensation ..............................................11.5201918Military personnel ..................................................................11.7

158177176Special personal services payments ......................................11.8

1,9391,7781,736Total personnel compensation ...........................................11.9536518506Civilian personnel benefits ........................................................12.1131212Military personnel benefits ........................................................12.2225151Travel and transportation of persons .........................................21.0255Transportation of things ............................................................22.082423Rental payments to GSA ............................................................23.1111Rental payments to others ........................................................23.2

193131Communications, utilities, and miscellaneous charges ............23.3.................11Printing and reproduction .........................................................24.0

100200231Advisory and assistance services ..............................................25.16141,1891,445Other services from non-Federal sources ..................................25.2

2,6693,1863,177Other goods and services from Federal sources ........................25.3368208201Operation and maintenance of facilities ...................................25.4

1,0121,4021,534Research and development contracts .......................................25.5112526Medical care ..............................................................................25.651121122Operation and maintenance of equipment ................................25.7122Subsistence and support of persons .........................................25.8

67219231Supplies and materials .............................................................26.050147154Equipment .................................................................................31.0

16,55823,62324,057Grants, subsidies, and contributions ........................................41.0



Employment Summary




NATIONAL INSTITUTES OF HEALTH




Obligations by program activity:150113.................Type 1 Diabetes .........................................................................0031

150113.................Total direct obligations ..................................................................0799

150113.................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:150113.................Appropriation ....................................................................1200150113.................Total budgetary resources available ..............................................1930


101..................................Unpaid obligations, brought forward, Oct 1 ..........................3000150113.................New obligations, unexpired accounts ....................................3010–56–12.................Outlays (gross) ......................................................................3020







The Budget proposes to extend the Special Diabetes Program for Type1 Diabetes through fiscal year 2019.

✦

435DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of Health—Continued


PAYMENT TO THE NIH INNOVATION ACCOUNT, CURES ACT



Obligations by program activity:711496352Payment to NIH Innovation (object class 94.0) ..........................0001








711496352Outlays from new mandatory authority .............................4100711496352Budget authority, net (total) ..........................................................4180711496352Outlays, net (total) ........................................................................4190


✦

NIH INNOVATION, CURES ACT

For necessary expenses to carry out the purposes described in section 1001(b)(4)of the 21st Century Cures Act, in addition to amounts available for such purposesin the appropriations provided to the National Institutes of Health in this Act,$711,000,000, to remain available until expended: Provided, That such amountsare appropriated pursuant to section 1001(b)(3) of such Act and are to be derivedfrom amounts transferred under section 1001(b)(2)(A) of such Act: Provided further,That of the amount appropriated under this heading, $400,000,000 shall be trans-ferred to the "National Cancer Institute" for the purposes described in section1001(b)(4)(C) of such Act, $57,500,000 shall be transferred to the "National Instituteof Neurological Disorders and Stroke" for the purposes described in section1001(b)(4)(B) of such Act, and $57,500,000 shall be transferred to the "NationalInstitute of Mental Health" for the purposes described in section 1001(b)(4)(B) ofsuch Act: Provided further, That remaining amounts may be transferred by theDirector of the National Institutes of Health to any accounts of the National Institutesof Health: Provided further, That upon a determination by the Director that fundstransferred pursuant to any of the previous provisos are not necessary for the pur-poses provided, such amounts may be transferred back to this account: Providedfurther, That the transfer authority provided under this heading is in addition to anyother transfer authority provided by law.




Current law:711496352General Fund Payment, NIH Innovation, CURES Act ...............1140


Current law:–711–350–352NIH Innovation, Cures Act ......................................................2101




Obligations by program activity:1965212CURES obligations ....................................................................0001





–515–298–300Appropriations transferred to other acct [075–9915] ........1120

1965252Appropriation, discretionary (total) .......................................11602369252Total budgetary resources available ..............................................1930



2712.................Unpaid obligations, brought forward, Oct 1 ..........................30001965212New obligations, unexpired accounts ....................................3010–81–37.................Outlays (gross) ......................................................................3020


2712.................Obligated balance, start of year ............................................31001422712Obligated balance, end of year ..............................................3200



4712.................Outlays from new discretionary authority ..........................40103425.................Outlays from discretionary balances .................................4011

8137.................Outlays, gross (total) .............................................................40201965252Budget authority, net (total) ..........................................................41808137.................Outlays, net (total) ........................................................................4190

The Cures Act was enacted into law on December 13, 2016. The CuresAct authorizes $4.8 billion over 10 years for four NIH Innovation Projects,and includes amendments to the Public Health Service Act to advancePrecision Medicine and other high priority NIH activities.

✦

10-YEAR PEDIATRIC RESEARCH INITIATIVE FUND



..................................13Balance, start of year ....................................................................0100Receipts:

Current law:411.................Transfers from Presidential Election Campaign Fund ............1140


Current law:–13–1–1310-Year Pediatric Research Initiative Fund ...........................2101

28..................................Balance, end of year ..................................................................5099





–13–1–13Appropriations transferred to other accts [075–9915] .......1120...................................................Budget authority, net (total) ..........................................................4180...................................................Outlays, net (total) ........................................................................4190

✦

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICESADMINISTRATION

Federal Funds

MENTAL HEALTH

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health,and the Protection and Advocacy for Individuals with Mental Illness Act,

THE BUDGET FOR FISCAL YEAR 2019436 National Institutes of Health—ContinuedFederal Funds—Continued

$1,043,883,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act,no funds appropriated for carrying out section 520A shall be available for carryingout section 1971 of the PHS Act: Provided further, That in addition to amountsprovided herein, $21,039,000 shall be available under section 241 of the PHS Actto supplement funds otherwise available for mental health activities and to carryout subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technicalassistance, national data, data collection and evaluation activities, and further thatthe total available under this Act for section 1920(b) activities shall not exceed 5percent of the amounts appropriated for subpart I of part B of title XIX: Providedfurther, That up to 10 percent of the amounts made available to carry out the Chil-dren's Mental Health Services program may be used to carry out demonstrationgrants or contracts for early interventions with persons not more than 25 years ofage at clinical high risk of developing a first episode of psychosis: Provided further,That none of the funds provided for section 1911 of the PHS Act shall be subject tosection 241 of such Act: Provided further, That of the funds made available underthis heading, $15,000,000 shall be to carry out section 224 of the Protecting Accessto Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22 note).

SUBSTANCE ABUSE TREATMENT

For carrying out titles III and V of the PHS Act with respect to substance abusetreatment and title XIX of such Act with respect to substance abuse treatment andprevention, $2,034,197,000: Provided, That in addition to amounts provided herein,$79,200,000 shall be available under section 241 of the PHS Act to supplementfunds otherwise available for substance abuse treatment activities and to carry outsubpart II of part B of title XIX of the PHS Act to fund section 1935(b) technicalassistance, national data, data collection and evaluation activities, and further thatthe total available under this Act for section 1935(b) activities shall not exceed 5percent of the amounts appropriated for subpart II of part B of title XIX: Providedfurther, That none of the funds provided for section 1921 of the PHS Act shall besubject to section 241 of such Act.

SUBSTANCE ABUSE PREVENTION

For carrying out titles III and V of the PHS Act with respect to substance abuseprevention and for the Drug-Free Communities Support Program authorized by theDrug-Free Communities Act of 1997, as amended, $220,885,000, of which $2,000,000shall be made available as directed by section 4 of Public Law 107–82, as amendedby Public Law 109–469 (21 U.S.C. 1521 note) and $3,000,000, to remain availableuntil expended, shall be for activities authorized by section 103 of Public Law114–198.

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

For program support and cross-cutting activities that supplement activities fundedunder the headings "Mental Health", "Substance Abuse Treatment", and "SubstanceAbuse Prevention" in carrying out titles III, V, and XIX of the PHS Act, the Drug-Free Communities Act of 1997, as amended, and the Protection and Advocacy forIndividuals with Mental Illness Act in the Substance Abuse and Mental Health Ser-vices Administration ("SAMHSA"), $126,922,000: Provided, That in addition toamounts provided herein, $20,426,000 shall be available under section 241 of thePHS Act to supplement funds available to carry out national surveys on drug abuseand mental health, to collect and analyze program data, and to conduct publicawareness and technical assistance activities: Provided further, That, in addition,fees may be collected for the costs of publications, data, data tabulations, and dataanalysis completed under title V of the PHS Act and provided to a public or privateentity upon request, which shall be credited to this appropriation and shall remainavailable until expended for such purposes: Provided further, That amounts madeavailable in this Act for carrying out section 501(o) of the PHS Act shall remainavailable through September 30, 2020: Provided further, That funds made availableunder this heading may be used to supplement program support funding providedunder the headings "Mental Health", "Substance Abuse Treatment", and "SubstanceAbuse Prevention": Provided further, That the Assistant Secretary for Mental Healthand Substance Use may transfer discretionary funds (pursuant to the BalancedBudget and Emergency Deficit Control Act of 1985) which are appropriated for thecurrent fiscal year for SAMHSA in this Act between any of the accounts of SAMHSAwith notification to the Committees on Appropriations of both Houses of Congressat least 15 days in advance of any transfer, but no such account shall be decreasedby more than 3 percent by any such transfer.




Obligations by program activity:1,0441,1401,145Mental Health ............................................................................00062,0342,6132,627Substance Abuse Treatment ......................................................0007221222222Substance Abuse Prevention .....................................................0008127116117Health Surveillance and Program Support .................................0009

.................1112SAMHSA Prevention Fund ..........................................................0011

3,4264,1024,123Total, direct program .....................................................................0100

3,4264,1024,123Total direct obligations ..................................................................079919108108SAMHSA Reimbursables ............................................................0802

121133134SAMHSA Reimbursable: PHS Evaluation ....................................0810




1331Unobligated balance brought forward, Oct 1 .........................1000.................11Discretionary unobligated balance brought fwd, Oct 1 ......1001.................10.................Adjustment of unobligated bal brought forward, Oct 1 .........1020




.................497500Appropriations transferred from other acct [075–5627] ....1121

.................11.................Appropriations transferred from other acct [075–0116] ....1121


..................................12Appropriations transferred from the Prevention and Public

Health Fund [075–0116] ..............................................1221


.................8191Change in uncollected payments, Federal sources ............1701

137241244Spending auth from offsetting collections, disc (total) .........17503,5634,3434,367Budget authority (total) .............................................................19003,5764,3564,368Total budgetary resources available ..............................................1930





.................–326–95Recoveries of prior year unpaid obligations, expired .............3041


–224–143–245Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060.................–81–91Change in uncollected pymts, Fed sources, unexpired ..........3070..................................193Change in uncollected pymts, Fed sources, expired ..............3071





9931,1181,144Outlays from new discretionary authority ..........................40102,7592,9212,579Outlays from discretionary balances .................................4011



–2–2–1Non-Federal sources .........................................................4033


.................–81–91Change in uncollected pymts, Fed sources, unexpired .......4050

.................153192Offsetting collections credited to expired accounts ...........4052

.................72101Additional offsets against budget authority only (total) ........4060


437DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services Administration—Continued


SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION—Continued



Mandatory:..................................12Budget authority, gross .........................................................4090

Outlays, gross:1836Outlays from mandatory balances ....................................4101


This program provides Federal support to strengthen the capacity of theNation's health care delivery system to provide effective substance abuseprevention, addiction treatment, and mental health services for people atrisk for or experiencing substance abuse or mental illness. SAMHSA buildspartnerships with States, communities, tribal organizations, and privatenot-for-profit organizations to enhance health and reduce the adverse impactof substance abuse and mental illness on America's communities.





605852Total personnel compensation ...........................................11.9181716Civilian personnel benefits ........................................................12.1222Military personnel benefits ........................................................12.2222Travel and transportation of persons .........................................21.0777Rental payments to GSA ............................................................23.1111Communications, utilities, and miscellaneous charges ............23.3111Printing and reproduction .........................................................24.0

313129Advisory and assistance services ..............................................25.1196179191Other services from non-Federal sources ..................................25.2484745Other goods and services from Federal sources ........................25.3111Operation and maintenance of facilities ...................................25.4111Supplies and materials .............................................................26.0




Employment Summary


475475451Direct civilian full-time equivalent employment ............................1001313131Direct military average strength employment ................................110171101101Reimbursable civilian full-time equivalent employment ...............2001777Reimbursable military average strength employment ...................2101

✦

AGENCY FOR HEALTHCARE RESEARCH AND QUALITYFederal Funds

HEALTHCARE RESEARCH AND QUALITY




Obligations by program activity:.................186186Research on Health Costs, Quality and Outcomes .....................0001.................6666Medical Expenditure Panel Survey .............................................0002.................7071AHRQ Program Support .............................................................0003

.................322323Total direct obligations ..................................................................0799

.................1616Research on Health Costs, Quality and Outcomes

(Reimbursable) .....................................................................0803

.................11Medical Expenditure Panel Survey (Reimbursable) ....................0804

.................11AHRQ Program Support (Reimbursable) ....................................0805

.................1818Total reimbursable obligations ......................................................0899

.................340341Total new obligations, unexpired accounts ....................................0900


222316Unobligated balance brought forward, Oct 1 .........................1000.................2316Discretionary unobligated balance brought fwd, Oct 1 ......1001

–22..................................Unobligated balance transfer to other accts [075–9915] ......1010.................1.................Adjustment of unobligated bal brought forward, Oct 1 .........1020..................................2Recoveries of prior year unpaid obligations ...........................1021


Appropriations, discretionary:.................322324Appropriation ....................................................................1100..................................–1Appropriations transferred to other acct [075–1503] ........1120

.................322323Appropriation, discretionary (total) .......................................1160Spending authority from offsetting collections, discretionary:

..................................1Collected ...........................................................................1700

.................815Change in uncollected payments, Federal sources ............1701

.................816Spending auth from offsetting collections, disc (total) .........1750Spending authority from offsetting collections, mandatory:

.................87Collected ...........................................................................1800

.................338346Budget authority (total) .............................................................1900

.................362364Total budgetary resources available ..............................................1930Memorandum (non-add) entries:

.................2223Unexpired unobligated balance, end of year ..........................1941


377345383Unpaid obligations, brought forward, Oct 1 ..........................3000.................340341New obligations, unexpired accounts ....................................3010..................................1Obligations ("upward adjustments"), expired accounts ........3011

–240–308–365Outlays (gross) ......................................................................3020..................................–2Recoveries of prior year unpaid obligations, unexpired .........3040..................................–13Recoveries of prior year unpaid obligations, expired .............3041


–61–53–85Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060.................–8–15Change in uncollected pymts, Fed sources, unexpired ..........3070..................................47Change in uncollected pymts, Fed sources, expired ..............3071




.................330339Budget authority, gross .........................................................4000Outlays, gross:

.................121134Outlays from new discretionary authority ..........................4010240183224Outlays from discretionary balances .................................4011


Offsetting collections (collected) from:..................................–40Federal sources .................................................................4030

..................................–40Offsets against gross budget authority and outlays (total) ....4040Additional offsets against gross budget authority only:

.................–8–15Change in uncollected pymts, Fed sources, unexpired .......4050


.................–824Additional offsets against budget authority only (total) ........4060

.................322323Budget authority, net (discretionary) .........................................4070240304318Outlays, net (discretionary) .......................................................4080


Outlays, gross:.................1.................Outlays from new mandatory authority .............................4100.................37Outlays from mandatory balances ....................................4101

.................47Outlays, gross (total) .............................................................4110Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:.................–8–7Non-Federal sources .........................................................4123.................322323Budget authority, net (total) ..........................................................4180


THE BUDGET FOR FISCAL YEAR 2019438 Substance Abuse and Mental Health Services Administration—ContinuedFederal Funds—Continued

The FY 2019 Budget consolidates the activities of the Agency forHealthcare Research and Quality within the National Institutes of Healthas the National Institute for Research on Safety and Quality.




.................3330Full-time permanent .............................................................11.1

.................34Other than full-time permanent ............................................11.3

.................11Other personnel compensation ..............................................11.5

.................11Military personnel ..................................................................11.7

.................3836Total personnel compensation ...........................................11.9

.................1011Civilian personnel benefits ........................................................12.1

.................1.................Military personnel benefits ........................................................12.2

.................43Rental payments to GSA ............................................................23.1

.................1.................Communications, utilities, and miscellaneous charges ............23.3

.................1512Other services from non-Federal sources ..................................25.2

.................1922Other goods and services from Federal sources ........................25.3

.................130134Research and development contracts .......................................25.5

.................21Equipment .................................................................................31.0

.................102104Grants, subsidies, and contributions ........................................41.0

.................322323Direct obligations ..................................................................99.0

.................1818Reimbursable obligations .....................................................99.0


Employment Summary



.................77Direct military average strength employment ................................1101

.................22Reimbursable civilian full-time equivalent employment ...............2001

.................88Allocation account civilian full-time equivalent employment ........3001

✦

CENTERS FOR MEDICARE AND MEDICAID SERVICESFederal Funds

GRANTS TO STATES FOR MEDICAID

For carrying out, except as otherwise provided, titles XI and XIX of the SocialSecurity Act, $276,236,212,000, to remain available until expended.

In addition, for carrying out such titles after May 31, 2019, for the last quarter offiscal year 2019 for unanticipated costs incurred for the current fiscal year, suchsums as may be necessary, to remain available until expended.

In addition, for carrying out such titles for the first quarter of fiscal year 2020,$137,931,797,000, to remain available until expended.

Payment under such title XIX may be made for any quarter with respect to a Stateplan or plan amendment in effect during such quarter, if submitted in or prior tosuch quarter and approved in that or any subsequent quarter.




Obligations by program activity:433,103407,290394,370Medicaid Vendor Payments ........................................................000121,47520,96022,596State and local administration ..................................................00024,7264,4014,427Vaccines for Children ................................................................0003

459,304432,651421,393Total direct obligations ..................................................................07991,0541,000652Medicare Part B premiums ........................................................0801

43.................Medicare Part D .........................................................................0802

1,0581,003652Total reimbursable obligations ......................................................0899



11,545309413Unobligated balance brought forward, Oct 1 .........................100036,67533,87034,566Recoveries of prior year unpaid obligations ...........................1021

..................................–15,728Other balances withdrawn to Treasury ..................................1029

..................................12,812Recoveries of prior year paid obligations ...............................1033


Appropriations, mandatory:276,236284,798273,767Appropriation ....................................................................1200

Advance appropriations, mandatory:134,848125,219115,583Advance appropriation ..................................................1270

Spending authority from offsetting collections, mandatory:1,0581,003652Collected ...........................................................................1800


1,0581,003941Spending auth from offsetting collections, mand (total): ......1850412,142411,020390,291Budget authority (total) .............................................................1900460,362445,199422,354Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:.................11,545309Unexpired unobligated balance, end of year ..........................1941



–421,300–403,091–388,146Outlays (gross) ......................................................................3020–36,675–33,870–34,566Recoveries of prior year unpaid obligations, unexpired .........3040







412,142363,110356,275Outlays from new mandatory authority .............................41009,15839,98131,871Outlays from mandatory balances ....................................4101


Offsetting collections (collected) from:–1,058–1,003–652Federal sources .................................................................4120

..................................–12,812Non-Federal sources .........................................................4123



..................................12,812Recoveries of prior year paid obligations, unexpired

accounts .......................................................................4143

..................................12,523Additional offsets against budget authority only (total) ........4150

411,084410,017389,350Budget authority, net (mandatory) ............................................4160420,242402,088374,682Outlays, net (mandatory) ...........................................................4170411,084410,017389,350Budget authority, net (total) ..........................................................4180420,242402,088374,682Outlays, net (total) ........................................................................4190




Legislative proposal, subject to PAYGO:–8,209–1,700.................Budget Authority .......................................................................–8,209–1,700.................Outlays ......................................................................................


Medicaid assists States in providing medical care to their low-incomepopulations by granting Federal matching payments under title XIX of theSocial Security Act to States with approved plans.

Medicaid estimates assume budget authority for expenses that are incurredbut not reported (IBNR).

Authorized as part of title XIX, Vaccines for Children (VFC) financesthe purchase of vaccines for low-income, eligible children. VFC is admin-istered by the Centers for Disease Control and Prevention and is fundedentirely by the Federal Government.

439DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare and Medicaid Services

Federal Funds

GRANTS TO STATES FOR MEDICAID—Continued

Vaccines for Children (in millions of dollars)201920182017Obligations4,4274,1934,241Vaccine Purchase .....................................................................................1122714Vaccine Stockpile ......................................................................................136130133Ordering, Distribution, and Operations .....................................................

000Vaccine Management Contract Support ...................................................525150Evaluation Activities .................................................................................

4,7264,4014,437Total Obligations ..................................................................................



459,304432,651421,393Direct obligations: Grants, subsidies, and contributions ...............41.01,0581,003652Reimbursable obligations .....................................................99.0


GRANTS TO STATES FOR MEDICAID




Obligations by program activity:–8,209–1,700.................Medicaid Vendor Payments ........................................................0001

–8,209–1,700.................Total direct obligations ..................................................................0799

–8,209–1,700.................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:–8,209–1,700.................Appropriation ....................................................................1200–8,209–1,700.................Budget authority (total) .............................................................1900–8,209–1,700.................Total budgetary resources available ..............................................1930


–8,209–1,700.................New obligations, unexpired accounts ....................................30108,2091,700.................Outlays (gross) ......................................................................3020


–8,209–1,700.................Budget authority, gross .........................................................4090Outlays, gross:

–8,209–1,700.................Outlays from new mandatory authority .............................4100–8,209–1,700.................Budget authority, net (total) ..........................................................4180–8,209–1,700.................Outlays, net (total) ........................................................................4190

This schedule reflects the Administration's Medicaid proposals.✦

STATE GRANTS AND DEMONSTRATIONS



Obligations by program activity:..................................1Emergency health services for undocumented aliens ................0011

878692Medicaid integrity program .......................................................0012..................................18Grants to improve outreach and enrollment ..............................0023

8786111Total direct obligations ..................................................................0799



2382441,006Unobligated balance brought forward, Oct 1 .........................1000..................................32Recoveries of prior year unpaid obligations ...........................1021..................................1Recoveries of prior year paid obligations ...............................1033


Appropriations, mandatory:878684Appropriation ....................................................................1200





8780–682Appropriations, mandatory (total) .........................................12608780–682Budget authority (total) .............................................................1900

325324357Total budgetary resources available ..............................................1930Memorandum (non-add) entries:

..................................–2Unobligated balance expiring ................................................1940238238244Unexpired unobligated balance, end of year ..........................1941


8001,2971,721Unpaid obligations, brought forward, Oct 1 ..........................30008786111New obligations, unexpired accounts ....................................3010




3098001,297Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

8001,2971,721Obligated balance, start of year ............................................31003098001,297Obligated balance, end of year ..............................................3200


8780–682Budget authority, gross .........................................................4090Outlays, gross:

1467Outlays from new mandatory authority .............................4100564577496Outlays from mandatory balances ....................................4101





accounts .......................................................................4143

8780–682Budget authority, net (mandatory) ............................................4160578583502Outlays, net (mandatory) ...........................................................41708780–682Budget authority, net (total) ..........................................................4180


State Grants and Demonstrations includes funding for grant programsenacted in several legislative authorities, including the Ticket to Work andWork Incentives Improvement Act of 1999 (P.L. 106–170), the MedicarePrescription Drug, Improvement, and Modernization Act of 2003 (P.L.108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children'sHealth Insurance Program Reauthorization Act of 2009 (P.L. 111–3), thePatient Protection and Affordable Care Act (P.L. 111–148), the HealthCare and Education Reconciliation Act of 2010 (P.L. 111–152), the Pro-tecting Access to Medicare Act of 2014 (P.L. 113–93), and the MedicareAccess and CHIP Reauthorization Act of 2015 (P.L. 114–10).



Direct obligations:

121210Personnel compensation: Full-time permanent - Medicaid

Integrity Program ..................................................................11.1

665Civilian personnel benefits - Medicaid Integrity Program ..........12.1

..................................1Grants, subsidies, and contributions - Emergency services for

undocumented aliens ............................................................41.0

696877Grants, subsidies, and contributions - Medicaid Integrity

Program ................................................................................41.0

..................................18Grants, subsidies, and contributions - Grants to improve outreach

and enrollment ......................................................................41.0



Employment Summary



✦

THE BUDGET FOR FISCAL YEAR 2019440 Centers for Medicare and Medicaid Services—ContinuedFederal Funds—Continued

PAYMENTS TO HEALTH CARE TRUST FUNDS

For payment to the Federal Hospital Insurance Trust Fund and the Federal Sup-plementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844,and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the SocialSecurity Amendments of 1965, section 278(d)(3) of Public Law 97–248, and foradministrative expenses incurred pursuant to section 201(g) of the Social SecurityAct, $378,343,800,000.

In addition, for making matching payments under section 1844 and benefit pay-ments under section 1860D-16 of the Social Security Act that were not anticipatedin budget estimates, such sums as may be necessary.




Obligations by program activity:284,288262,496229,733Federal contribution to match premiums (SMI) .........................000192,07088,13382,382Part D benefits (Rx Drug) ..........................................................0002

642422405Part D Federal administration (Rx Drug) ...................................00031,3391,5431,293General Fund Transfers to HI .....................................................0004147135131Federal Bureau of Investigation (HCFAC) ...................................0006

24,94323,68424,206Federal payments from taxation of OASDI benefits (HI) .............000715010912Criminal fines (HCFAC) ..............................................................0008

525146Civil penalties and damages (HCFAC—DOJ and CMS

administration) .....................................................................0009

313025Asset Forfeiture .........................................................................0010433State Low Income Determinations .............................................0011



1,928..................................Unobligated balance brought forward, Oct 1 .........................1000Budget authority:

Appropriations, mandatory:378,323352,597313,816Appropriation (definite, annual) ........................................120029,06525,61224,206Appropriation (indefinite, permanent) ...............................1200

147135131Appropriation (HCFAC for FBI) ...........................................120025419083Appropriation (indefinite for HCFAC) .................................1200

407,789378,534338,236Appropriations, mandatory (total) .........................................1260409,717378,534338,236Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:6,0511,928.................Unexpired unobligated balance, end of year ..........................1941



..................................1,306Obligations ("upward adjustments"), expired accounts ........3011–364,182–342,358–335,137Outlays (gross) ......................................................................3020

..................................–12,732Recoveries of prior year unpaid obligations, expired .............3041

92,47552,99118,743Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:






Offsetting collections (collected) from:..................................–931Federal sources .................................................................4120..................................–1,306Non-Federal sources .........................................................4123

..................................–2,237Offsets against gross budget authority and outlays (total) ....4130Additional offsets against gross budget authority only:

..................................2,237Offsetting collections credited to expired accounts ...........4142





Legislative proposal, not subject to PAYGO:–2,328–39.................Budget Authority .......................................................................–2,328–39.................Outlays ......................................................................................


Payments are made to the Federal Hospital Insurance and Federal Supple-mentary Medical Insurance trust funds from the general fund of theTreasury to finance Medicare's medical and drug benefits for beneficiaries,and administrative expenses that are properly chargeable to the generalfund.



Direct obligations:401,684374,641336,507Grants, subsidies, and contributions ........................................41.0

127132147Insurance claims and indemnities (HI Uninsured Federal) ........42.01,8551,8331,582Financial transfers (Federal admin) ..........................................94.0


PAYMENTS TO HEALTH CARE TRUST FUNDS




Obligations by program activity:–2,484..................................Federal contribution to match premiums (SMI) .........................0001

156–39.................Part D benefits (Rx Drug) ..........................................................0002

–2,328–39.................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:–2,328–39.................Appropriation (definite, annual) ........................................1200–2,328–39.................Total budgetary resources available ..............................................1930


–2,328–39.................New obligations, unexpired accounts ....................................30102,32839.................Outlays (gross) ......................................................................3020


–2,328–39.................Budget authority, gross .........................................................4090Outlays, gross:

–2,328–39.................Outlays from new mandatory authority .............................4100–2,328–39.................Budget authority, net (total) ..........................................................4180–2,328–39.................Outlays, net (total) ........................................................................4190

✦

QUALITY IMPROVEMENT ORGANIZATIONS



Obligations by program activity:1,297603397QIO contracts ............................................................................0001155171180QIO support contracts ...............................................................0002

1,452774577Total new obligations, unexpired accounts ....................................0900


Spending authority from offsetting collections, mandatory:1,452774124Collected ...........................................................................1800

441DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare and Medicaid Services—Continued


QUALITY IMPROVEMENT ORGANIZATIONS—Continued




1,452774615Spending auth from offsetting collections, mand (total) .......18501,452774615Total budgetary resources available ..............................................1930



1,1871,1871,519Unpaid obligations, brought forward, Oct 1 ..........................30001,452774577New obligations, unexpired accounts ....................................3010

..................................1Obligations ("upward adjustments"), expired accounts ........3011–1,452–774–883Outlays (gross) ......................................................................3020



–1,983–1,983–2,488Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................–491Change in uncollected pymts, Fed sources, unexpired ..........3070..................................996Change in uncollected pymts, Fed sources, expired ..............3071

–1,983–1,983–1,983Uncollected pymts, Fed sources, end of year .............................3090Memorandum (non-add) entries:

–796–796–969Obligated balance, start of year ............................................3100–796–796–796Obligated balance, end of year ..............................................3200


1,452774615Budget authority, gross .........................................................4090Outlays, gross:



Offsetting collections (collected) from:–1,452–774–957Federal sources .................................................................4120

Additional offsets against gross budget authority only:..................................–491Change in uncollected pymts, Fed sources, unexpired .......4140..................................833Offsetting collections credited to expired accounts ...........4142


..................................–74Outlays, net (mandatory) ...........................................................4170


..................................–74Outlays, net (total) ........................................................................4190

Memorandum (non-add) entries:505050Expired unavailable balance, SOY: Offsetting collections ..........5093505050Expired unavailable balance, EOY: Offsetting collections ..........5095

Part B of title XI of the Social Security Act, as amended by the Peer Re-view Improvement Act of 1982, provides the statutory authority for theMedicare Quality Improvement Organization (QIO) Program. The missionof the program is to promote the effectiveness, efficiency, economy, andquality of services delivered to Medicare beneficiaries and to ensure thatthose services are reasonable and necessary. The program is funded throughtransfers from the Medicare Hospital Insurance Trust Fund and the MedicareSupplementary Medical Insurance Trust Fund. In FY 2012, a Treasuryaccount specific to the QIO program was established to improve budgetaryoperations.



Direct obligations:343434Personnel compensation: Full-time permanent .........................11.1311Communications, utilities, and miscellaneous charges ............23.3

1,336699511Other services from non-Federal sources ..................................25.2512620Other goods and services from Federal sources ........................25.3281411Operation and maintenance of facilities ...................................25.4

1,452774577Total new obligations, unexpired accounts ............................99.9

Employment Summary



✦

PROGRAM MANAGEMENT

For carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI ofthe Social Security Act, titles XIII and XXVII of the PHS Act, the Clinical LaboratoryImprovement Amendments of 1988, and other responsibilities of the Centers forMedicare and Medicaid Services, not to exceed $3,343,879,000, to be transferredfrom the Federal Hospital Insurance Trust Fund and the Federal SupplementaryMedical Insurance Trust Fund, as authorized by section 201(g) of the Social SecurityAct; together with all funds collected in accordance with section 353 of the PHSAct and section 1857(e)(2) of the Social Security Act, funds retained by the Secretarypursuant to section 1893(h) of the Social Security Act, and such sums as may becollected from authorized user fees and the sale of data, which shall be credited tothis account and remain available until expended: Provided, That all funds derivedin accordance with 31 U.S.C. 9701 from organizations established under title XIIIof the PHS Act shall be credited to and available for carrying out the purposes ofthis appropriation: Provided further, That the Secretary is directed to collect feesin fiscal year 2019 from Medicare Advantage organizations pursuant to section1857(e)(2) of the Social Security Act and from eligible organizations with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D)of that Act.




Obligations by program activity:2,4223,1723,094Program operations ...................................................................0001733775762Federal administration ..............................................................0002444425409State survey and certification ...................................................0003298558Research, demonstrations, and evaluation projects ..................00042312356ARRA Medicare/Medicaid HIT ....................................................0007

..................................3,953Risk Corridor .............................................................................0008

3,6514,5808,332Total direct program ......................................................................0100

3,6514,5808,332Total direct obligations ..................................................................0799504750Clinical laboratory improvement amendments ..........................0801202012Sale of data ...............................................................................0802302834Coordination of benefits ............................................................0803838180Medicare advantage/Prescription drug plan .............................0804242418Provider enrollment ...................................................................0805

57228589Recovery audit contractors ........................................................08069621,2121,126Marketplace User Fees ..............................................................0808381922Risk Adjustment Administrative Expenses ................................08101615209Other reimbursable program activity .........................................0813




1,871–9,239–5,575Unobligated balance brought forward, Oct 1 .........................1000.................–129–500Adjustment of unobligated bal brought forward, Oct 1 .........1020..................................97Recoveries of prior year unpaid obligations ...........................1021..................................8Recoveries of prior year paid obligations ...............................1033

1,871–9,368–5,970Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, mandatory:312,3033Appropriation ....................................................................1200

.................–812.................Appropriations and/or unobligated balance of


311,4913Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, discretionary:

3,3783,9931,973Collected ...........................................................................1700..................................2,372Change in uncollected payments, Federal sources ............1701

3,3783,9934,345Spending auth from offsetting collections, disc (total) .........1750Spending authority from offsetting collections, mandatory:

1,9192,0411,931Collected ...........................................................................1800


..................................386Change in uncollected payments, Federal sources ............18011032586Offsetting collections (previously unavailable) .................1802

..................................–8New and/or unobligated balance of spending authority from


2,0222,0662,395Spending auth from offsetting collections, mand (total) .......18505,40317,5506,743Budget authority (total) .............................................................19007,2748,182773Total budgetary resources available ..............................................1930


1,8281,871–9,239Unexpired unobligated balance, end of year ..........................1941



.................25536Adjustments to unpaid obligations, brought forward, Oct

1 .......................................................................................3001


–5,683–18,048–6,066Outlays (gross) ......................................................................3020..................................–97Recoveries of prior year unpaid obligations, unexpired .........3040..................................–231Recoveries of prior year unpaid obligations, expired .............3041


–6,083–6,083–5,470Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................–2,758Change in uncollected pymts, Fed sources, unexpired ..........3070..................................2,145Change in uncollected pymts, Fed sources, expired ..............3071


–1,18810,5497,138Obligated balance, start of year ............................................3100–1,425–1,18810,524Obligated balance, end of year ..............................................3200



3,3783,9931,906Outlays from new discretionary authority ..........................4010..................................2,388Outlays from discretionary balances .................................4011





..................................–2,372Change in uncollected pymts, Fed sources, unexpired .......4050

..................................2,314Offsetting collections credited to expired accounts ...........4052

..................................–58Additional offsets against budget authority only (total) ........4060

..................................7Outlays, net (discretionary) .......................................................4080Mandatory:


1,9532,115548Outlays from new mandatory authority .............................410035211,9401,224Outlays from mandatory balances ....................................4101



–1,774–1,852–1,596Non-Federal sources .........................................................4123




accounts .......................................................................4143


10611,51681Budget authority, net (mandatory) ............................................416038612,014–167Outlays, net (mandatory) ...........................................................417010611,51681Budget authority, net (total) ..........................................................418038612,014–160Outlays, net (total) ........................................................................4190


..................................–1Expiring unavailable balance: Offsetting collections ................5091

.................103128Unexpired unavailable balance, EOY: Offsetting collections .......5092221Expired unavailable balance, SOY: Offsetting collections ..........5093221Expired unavailable balance, EOY: Offsetting collections ..........5095



Enacted/requested:10611,51681Budget Authority .......................................................................38612,014–160Outlays ......................................................................................


Total:11812,32881Budget Authority .......................................................................39812,826–160Outlays ......................................................................................

Program management activities include funding for program operations,survey and certification, the Clinical Laboratory Improvement Amendments(CLIA), Medicare Advantage, Medicare Part D coordination of benefits,recovery audit contracts and other administrative costs. The 2019 Budgetincludes mandatory resources for the Risk Corridor Program.






483516502Total personnel compensation ...........................................11.9149153158Civilian personnel benefits ........................................................12.1

779Military personnel benefits ........................................................12.2..................................11Rental payments to GSA ............................................................23.1..................................48Communications, utilities, and miscellaneous charges ............23.3..................................60Printing and reproduction .........................................................24.0

3,0123,9043,121Other services from non-Federal sources ..................................25.2..................................77Other goods and services from Federal sources ........................25.3..................................380Medical care ..............................................................................25.6..................................1Operation and maintenance of equipment ................................25.7..................................12Grants, subsidies, and contributions ........................................41.0..................................3,953Insurance claims and indemnities ............................................42.0



Employment Summary


4,0994,3654,376Direct civilian full-time equivalent employment ............................1001157157159Direct civilian full-time equivalent employment ............................1001138138138Direct military average strength employment ................................1101249249240Reimbursable civilian full-time equivalent employment ...............2001

PROGRAM MANAGEMENT




Obligations by program activity:12..................................Program operations ...................................................................0001

12..................................Total direct program ......................................................................0100

12..................................Total direct obligations ..................................................................07991313.................ACL SHIPs ..................................................................................080130..................................Medicare advantage/Prescription drug plan .............................0804

4313.................Total reimbursable obligations ......................................................0899

5513.................Total new obligations, unexpired accounts ....................................0900


812..................................Unobligated balance brought forward, Oct 1 .........................1000Budget authority:

Appropriations, mandatory:12..................................Appropriation ....................................................................1200



PROGRAM MANAGEMENT—Continued



.................812.................Appropriations and/or unobligated balance of


12812.................Appropriations, mandatory (total) .........................................1260Spending authority from offsetting collections, mandatory:

4313.................Collected ...........................................................................180055825.................Budget authority (total) .............................................................1900

867825.................Total budgetary resources available ..............................................1930Memorandum (non-add) entries:

812812.................Unexpired unobligated balance, end of year ..........................1941


–812..................................Unpaid obligations, brought forward, Oct 1 ..........................30005513.................New obligations, unexpired accounts ....................................3010

–55–825.................Outlays (gross) ......................................................................3020

–812–812.................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

–812..................................Obligated balance, start of year ............................................3100–812–812.................Obligated balance, end of year ..............................................3200



5513.................Outlays from new mandatory authority .............................4100.................812.................Outlays from mandatory balances ....................................4101

55825.................Outlays, gross (total) .............................................................4110Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:–13–13.................Federal sources .................................................................4120–30..................................Non-Federal sources .........................................................4123

–43–13.................Offsets against gross budget authority and outlays (total) ....4130

12812.................Budget authority, net (mandatory) ............................................416012812.................Outlays, net (mandatory) ...........................................................417012812.................Budget authority, net (total) ..........................................................418012812.................Outlays, net (total) ........................................................................4190



12..................................Direct obligations: Other goods and services from Federal

sources ......................................................................................25.3

12..................................Direct obligations ..................................................................99.04313.................Reimbursable obligations .....................................................99.0


✦

PAYMENTS TO HOSPITALS




Obligations by program activity:14,540..................................Grants to hospitals ....................................................................0001

14,540..................................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:14,540..................................Appropriation ....................................................................120014,540..................................Total budgetary resources available ..............................................1930


14,540..................................New obligations, unexpired accounts ....................................3010–14,540..................................Outlays (gross) ......................................................................3020


14,540..................................Budget authority, gross .........................................................4090Outlays, gross:

14,540..................................Outlays from new mandatory authority .............................410014,540..................................Budget authority, net (total) ..........................................................418014,540..................................Outlays, net (total) ........................................................................4190

This account reflects the Budget's proposals to modify payments to hos-pitals for uncompensated care and consolidate graduate medical educationspending.

✦

CHILDREN'S HEALTH INSURANCE FUND



Obligations by program activity:5,7005,70015,952Grants to states and US territories ............................................0001

.................3,0528CHIP Redistribution Funds ........................................................000224206Child health quality ...................................................................0003

5,7248,77215,966Total new obligations, unexpired accounts (object class 41.0) .......0900


2,7476,4413,013Unobligated balance brought forward, Oct 1 .........................1000..................................3,656Unobligated balance transfer from other acct [075–5551] ....1011

.................101704Unobligated balance transfers between expired and unexpired

accounts ...........................................................................1012

.................–170.................Adjustment of unobligated bal brought forward, Oct 1 .........1020

.................2,1888Recoveries of prior year unpaid obligations ...........................1021


Appropriations, discretionary:

.................–2,652.................Unobligated balance of appropriations permanently

reduced, Sec. 108/MACRA Sec. 310 ..............................1131

.................–89.................Unobligated balance of appropriations permanently

reduced, Perf. Bonus Pmts. ...........................................1131

.................–2,741.................Appropriation, discretionary (total): ......................................1160Appropriations, mandatory:

5,7005,70020,400Appropriation ....................................................................1200..................................2,050Appropriations transferred from other acct [075–5551] ....1221

..................................–7,424Appropriations and/or unobligated balance of


5,7005,70015,026Appropriations, mandatory (total) .........................................12605,7002,95915,026Budget authority (total) .............................................................19008,44711,51922,407Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:2,7232,7476,441Unexpired unobligated balance, end of year ..........................1941



–5,724–12,620–16,224Outlays (gross) ......................................................................3020.................–2,188–8Recoveries of prior year unpaid obligations, unexpired .........3040




.................–2,741.................Budget authority, gross .........................................................4000Mandatory:


5,7005,7008,826Outlays from new mandatory authority .............................4100246,9207,398Outlays from mandatory balances ....................................4101

5,72412,62016,224Outlays, gross (total) .............................................................41105,7002,95915,026Budget authority, net (total) ..........................................................41805,72412,62016,224Outlays, net (total) ........................................................................4190





Legislative proposal, not subject to PAYGO:–3,118..................................Budget Authority .......................................................................

Legislative proposal, subject to PAYGO:9,1725,643.................Budget Authority .......................................................................5,7004,500.................Outlays ......................................................................................


The Balanced Budget Act of 1997 established the Children's Health In-surance Program (CHIP) under title XXI of the Social Security Act. TitleXXI provides Federal matching funds to States to enable them to extendcoverage to uninsured children from low-income families. States are ableto use title XXI funds for obtaining health benefit coverage for uninsuredchildren through a separate CHIP program, a CHIP Medicaid expansionprogram, or a combination of both. The Children's Health Insurance Pro-gram Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) reauthorized theCHIP program and appropriated funding for CHIP through fiscal year2013. CHIPRA made some modifications to the program, including in-creased funding for States and territories, bonus payments for States thatexceed Medicaid child enrollment targets, and support for child healthquality and outreach activities. A contingency fund to assist States whoproject spending above their available allocated CHIP funds was also cre-ated by CHIPRA and funding is included in a separate account. The PatientProtection and Affordable Care Act of 2010 (P.L. 111–148) extendedfunding for CHIP, providing appropriations through fiscal year 2015. TheMedicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10)extended CHIP funding through fiscal year 2017, and the Further AdditionalContinuing Appropriations Act of 2018 (P.L. 115–96) provided partialyear funding for FY 2018.







–3,118..................................Unobligated balance of appropriations permanently

reduced, Sec. 108/MACRA Sec. 310 ..............................1131

–3,118..................................Budget authority (total) .............................................................1900–3,118..................................Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:–3,118..................................Unexpired unobligated balance, end of year ..........................1941


–3,118..................................Budget authority, gross .........................................................4000–3,118..................................Budget authority, net (total) ..........................................................4180








Appropriations, mandatory:5,7004,500.................Appropriation ....................................................................12003,4721,143.................Appropriations transferred from other acct [075–5551] ....1221

9,1725,643.................Appropriations, mandatory (total) .........................................126014,8155,643.................Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:14,8155,643.................Unexpired unobligated balance, end of year ..........................1941


–4,500..................................Unpaid obligations, brought forward, Oct 1 ..........................3000–5,700–4,500.................Outlays (gross) ......................................................................3020

–10,200–4,500.................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

–4,500..................................Obligated balance, start of year ............................................3100–10,200–4,500.................Obligated balance, end of year ..............................................3200



5,7004,500.................Outlays from new mandatory authority .............................41009,1725,643.................Budget authority, net (total) ..........................................................41805,7004,500.................Outlays, net (total) ........................................................................4190

The Budget proposes to extend CHIP funding through fiscal year 2019with reforms.

✦

CENTER FOR MEDICARE AND MEDICAID INNOVATION



Obligations by program activity:342395302Administration ..........................................................................0001

1,3631,383699Innovation Activities ..................................................................0002



1,7063,4844,404Unobligated balance brought forward, Oct 1 .........................1000..................................81Recoveries of prior year unpaid obligations ...........................1021

1,7063,4844,485Unobligated balance (total) ......................................................10501,7063,4844,485Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:11,7063,484Unexpired unobligated balance, end of year ..........................1941



–1,592–1,278–1,136Outlays (gross) ......................................................................3020..................................–81Recoveries of prior year unpaid obligations, unexpired .........3040




Outlays, gross:1,5921,2781,136Outlays from mandatory balances ....................................4101

...................................................Budget authority, net (total) ..........................................................41801,5921,2781,136Outlays, net (total) ........................................................................4190

The Center for Medicare and Medicaid Innovation ("Innovation Center")was established by section 1115A of the Social Security Act (as added bysection 3021 of the Patient Protection and Affordable Care Act). The In-novation Center is tasked with testing innovative payment and service de-livery models to reduce program expenditures while preserving or enhancingthe quality of care provided to individuals under Medicare, Medicaid, orthe Children's Health Insurance Program (CHIP). The statute provides $10billion in mandatory funding for these purposes in fiscal years 2011 through2019.



Direct obligations:707062Personnel compensation: Full-time permanent .........................11.1



CENTER FOR MEDICARE AND MEDICAID INNOVATION—Continued



222219Civilian personnel benefits ........................................................12.1433Communications, utilities, and miscellaneous charges ............23.3

1,2801,220502Other services from non-Federal sources ..................................25.2224391375Grants, subsidies, and contributions ........................................41.01057240Insurance claims and indemnities ............................................42.0


Employment Summary



✦

CHILD ENROLLMENT CONTINGENCY FUND



1,1605702,048Balance, start of year ....................................................................0100

..................................–2,048Adjustment for appropriation derived from the general fund of the

US Treasury ...............................................................................0198

1,160570.................Balance, start of year ................................................................0199Receipts:

Current law:27176Interest, Child Enrollment Contingency Fund ........................1140

Proposed:.................35.................Interest, Child Enrollment Contingency Fund ........................1240

27526Total receipts .............................................................................1999

1,1876226Total: Balances and receipts .....................................................2000Appropriations:

Current law:–27–17–6Child Enrollment Contingency Fund ......................................2101

–1,160–570–2,048Child Enrollment Contingency Fund ......................................2103.................1,160.................Child Enrollment Contingency Fund ......................................2134..................................570Child Enrollment Contingency Fund ......................................2134

..................................2,048Adjustment for appropriation derived from the general fund

of the US Treasury .............................................................2198

–1,187573564Total current law appropriations .......................................2199Proposed:

.................–35.................Child Enrollment Contingency Fund ......................................2201667..................................Child Enrollment Contingency Fund ......................................2234

667–35.................Total proposed appropriations ...............................................2299

–520538564Total appropriations ..................................................................2999

6671,160570Balance, end of year ..................................................................5099



Obligations by program activity:..................................1Grants to States and US Territories ...........................................0001

..................................1Total new obligations (object class 41.0) ......................................0900


.................5733,656Unobligated balance brought forward, Oct 1 .........................1000

..................................–3,656Unobligated balance transfer to other accts [075–0515] ......1010

.................573.................Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, discretionary:.................–1,160.................Appropriations precluded from obligation .........................1134

Appropriations, mandatory:..................................1,140Appropriation ....................................................................1200

27176Appropriation (special or trust fund) .................................12011,1605702,048Appropriation (previously unavailable) .............................1203

..................................–2,050Appropriations transferred to other acct [075–0515] ........1220

..................................–570Appropriations precluded from obligation .........................1234

1,187587574Appropriations, mandatory (total) .........................................1260

1,187–573574Budget authority (total) .............................................................19001,187.................574Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:1,187.................573Unexpired unobligated balance, end of year ..........................1941


.................198224Unpaid obligations, brought forward, Oct 1 ..........................3000


.................–198–27Outlays (gross) ......................................................................3020





.................–1,160.................Budget authority, gross .........................................................4000Mandatory:


.................19827Outlays from mandatory balances ....................................41011,187–573574Budget authority, net (total) ..........................................................4180


Memorandum (non-add) entries:1,1601,145571Total investments, SOY: Federal securities: Par value ...............50001,1871,1601,145Total investments, EOY: Federal securities: Par value ...............5001



Enacted/requested:1,187–573574Budget Authority .......................................................................

.................19827Outlays ......................................................................................Legislative proposal, not subject to PAYGO:

–667..................................Budget Authority .......................................................................Legislative proposal, subject to PAYGO:

–2,3322,312.................Budget Authority .......................................................................Total:

–1,8121,739574Budget Authority ........................................................................................19827Outlays ......................................................................................

The Children's Health Insurance Program Reauthorization Act of 2009(P.L. 111–3) established the Child Enrollment Contingency Fund undertitle XXI of the Social Security Act. Beginning in 2009, a State may qual-ify for a Contingency Fund payment if it projects a funding shortfall forthe fiscal year and if its average monthly child enrollment exceeds its targetaverage number of enrollees for the fiscal year. The Patient Protection andAffordable Care Act of 2010 (P.L. 111–148) extended the ContingencyFund through fiscal year 2015. The Medicare Access and CHIP Reauthor-ization Act of 2015 (P.L. 114–10) extended the Contingency Fund throughfiscal year 2017. There is no authority to make payments from the Fundin fiscal year 2018.

The Fund receives an appropriation equal to 20 percent of the Sec. 2104(a)CHIP national allotment appropriation under the Social Security Act. TheContingency Fund is invested in interest bearing securities of the UnitedStates, and the income derived from these investments constitutes a partof the fund.






Appropriations, discretionary:–667..................................Appropriations precluded from obligation .........................1134–667..................................Budget authority (total) .............................................................1900–667..................................Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:–667..................................Unexpired unobligated balance, end of year ..........................1941



–667..................................Budget authority, gross .........................................................4000–667..................................Budget authority, net (total) ..........................................................4180








Appropriations, mandatory:1,1403,420.................Appropriation (annual appropriation) ...............................1200

.................35.................Appropriation (special or trust fund) .................................1201–3,472–1,143.................Appropriations transferred to other acct [075–0515] ........1220

–2,3322,312.................Appropriations, mandatory (total) .........................................1260–202,312.................Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:–202,312.................Unexpired unobligated balance, end of year ..........................1941


–2,3322,312.................Budget authority, gross .........................................................4090–2,3322,312.................Budget authority, net (total) ..........................................................4180


Memorandum (non-add) entries:2,312..................................Total investments, SOY: Federal securities: Par value ...............5000–202,312.................Total investments, EOY: Federal securities: Par value ...............5001

The Budget proposes to extend the Contingency Fund through fiscal year2019.

✦

MEDICARE HEALTH INFORMATION TECHNOLOGY INCENTIVE PAYMENTS, RECOVERY

ACT



Obligations by program activity:2065610Incentive payments to hospitals ................................................0801

..................................393Incentive payments to eligible professionals .............................0802

20651,003Total new obligations (object class 42.0) ......................................0900



Spending authority from offsetting collections, mandatory:2065649Collected from the HI Trust Fund .......................................1800

..................................435Collected from the SMI Trust Fund ....................................1800

..................................–75Change in uncollected payments, Federal sources ............1801

20651,009Spending auth from offsetting collections, mand (total) .......185026711,009Total budgetary resources available ..............................................1930



191980Unpaid obligations, brought forward, Oct 1 ..........................300020651,003New obligations, unexpired accounts ....................................3010

–20–65–1,064Outlays (gross) ......................................................................3020


–171–171–246Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................75Change in uncollected pymts, Fed sources, unexpired ..........3070





2047984Outlays from new mandatory authority .............................4100.................1880Outlays from mandatory balances ....................................4101


Offsetting collections (collected) from:–20–65–1,084Federal sources .................................................................4120

Additional offsets against gross budget authority only:..................................75Change in uncollected pymts, Fed sources, unexpired .......4140..................................–20Outlays, net (mandatory) ...........................................................4170...................................................Budget authority, net (total) ..........................................................4180..................................–20Outlays, net (total) ........................................................................4190


✦

RATE REVIEW GRANTS



Obligations by program activity:.................826Premium rate review grants ......................................................0001

.................826Total new obligations (object class 41.0) ......................................0900


1329Unobligated balance brought forward, Oct 1 .........................1000196.................Recoveries of prior year unpaid obligations ...........................1021





–13–26–23Outlays (gross) ......................................................................3020–19–6.................Recoveries of prior year unpaid obligations, unexpired .........3040







The Patient Protection and Affordable Care Act (P.L. 111–148) amendedSection 2794 of the Public Health Service Act and provided that the Sec-retary carry out a program to award grants to States for a five-year periodbeginning in fiscal year 2010. The program provided $250 million in grantsto help States develop or enhance their current rate review activities from2010 through 2014, with remaining unobligated balances subsequentlyavailable for state implementation of consumer protections and other insur-ance reform activities consistent with Section 2794 (c)(2)(B).

✦

PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM



Obligations by program activity:..................................66Pre-Existing Condition Insurance Plan Program (Direct) ...........0001



PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM—Continued



.................103.................Administration ..........................................................................0002

.................10366Total direct obligations ..................................................................0799

.................10366Total new obligations, unexpired accounts (object class 25.2) .......0900


230332389Unobligated balance brought forward, Oct 1 .........................1000.................18Recoveries of prior year unpaid obligations ...........................1021..................................1Recoveries of prior year paid obligations ...............................1033





–56–84–33Outlays (gross) ......................................................................3020.................–1–8Recoveries of prior year unpaid obligations, unexpired .........3040

.................5638Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

563813Obligated balance, start of year ............................................3100.................5638Obligated balance, end of year ..............................................3200



Offsets against gross budget authority and outlays:Offsetting collections (collected) from:

..................................–1Non-Federal sources .........................................................4123Additional offsets against gross budget authority only:


accounts .......................................................................4143

568432Outlays, net (mandatory) ...........................................................4170...................................................Budget authority, net (total) ..........................................................4180


This account funds the Pre-Existing Condition Insurance Plan program(PCIP), which made health insurance available to people who had beenunable to purchase insurance due to a pre-existing condition. Enrolleespaid monthly premiums similar to those charged in the commercial indi-vidual market, and the Federal government pays for remaining costs thatexceed enrollee contributions. The funding for this program, includingoperating costs, was provided in the Patient Protection and Affordable CareAct (P.L. 111–148). The PCIP program ended in fiscal year 2014, andoutlays reflected in subsequent fiscal years reflect program close out andclaims run out costs, as well as allowable administrative costs in the currentyear.

✦

EARLY RETIREE REINSURANCE PROGRAM







41010Unpaid obligations, brought forward, Oct 1 ..........................3000–4–6.................Outlays (gross) ......................................................................3020


41010Obligated balance, start of year ............................................3100

.................410Obligated balance, end of year ..............................................3200


Outlays, gross:46.................Outlays from mandatory balances ....................................4101

...................................................Budget authority, net (total) ..........................................................418046.................Outlays, net (total) ........................................................................4190

The Patient Protection and Affordable Care Act (P.L. 111–148) authorizedand appropriated $5 billion for the Early Retiree Reinsurance Program(ERRP). By statute, ERRP sunset on January 1, 2014, and is no longerproviding reimbursements to plan sponsors.

✦

AFFORDABLE INSURANCE EXCHANGE GRANTS



Obligations by program activity:.................1318Administration ..........................................................................0002





.................1318Appropriations, mandatory (total) .........................................1260

.................1318Total budgetary resources available ..............................................1930



–24–135–160Outlays (gross) ......................................................................3020..................................–54Recoveries of prior year unpaid obligations, expired .............3041


24146342Obligated balance, start of year ............................................3100.................24146Obligated balance, end of year ..............................................3200



.................99Outlays from new mandatory authority .............................410024126151Outlays from mandatory balances ....................................4101




.................1318Budget authority, net (mandatory) ............................................416024135147Outlays, net (mandatory) ...........................................................4170

.................1318Budget authority, net (total) ..........................................................418024135147Outlays, net (total) ........................................................................4190

This program provided funding for Planning and Establishment Grantsto States for their activities to implement Health Insurance Exchanges. TheExchanges facilitate the purchase of qualified health plans in the individualmarket and allow small businesses to offer qualified health plans to theiremployees through the Small Business Health Options Program (SHOP).Section 1311 of the Patient Protection and Affordable Care Act (P.L.111–148) provided amounts necessary to enable the Secretary to awardgrants to States beginning no later than March 23, 2011, and allowed forrenewal of grants through January 1, 2015. The final round of grants wasawarded to States in December 2014.




Direct obligations:.................33Personnel compensation: Full-time permanent .........................11.1.................1015Other services from non-Federal sources ..................................25.2


Employment Summary



✦

COST-SHARING REDUCTIONS



Obligations by program activity:7,5077,197.................Cost Sharing Reductions ...........................................................00011,0601,000.................Basic Health Program ...............................................................0002

8,5678,197.................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:8,5678,197.................Appropriation ....................................................................12008,5678,197.................Total budgetary resources available ..............................................1930


8,5678,197.................New obligations, unexpired accounts ....................................3010–8,567–8,197.................Outlays (gross) ......................................................................3020



8,5678,197.................Outlays from new mandatory authority .............................41008,5678,197.................Budget authority, net (total) ..........................................................41808,5678,197.................Outlays, net (total) ........................................................................4190



Enacted/requested:8,5678,197.................Budget Authority .......................................................................8,5678,197.................Outlays ......................................................................................

Legislative proposal, subject to PAYGO:–471–180.................Budget Authority .......................................................................–471–180.................Outlays ......................................................................................

Total:8,0968,017.................Budget Authority .......................................................................8,0968,017.................Outlays ......................................................................................

Under current law, insurers are required to offer reduced cost-sharing toeligible, low-income consumers. The FY 2019 Budget provides a mandatoryappropriation for Cost Sharing Reduction (CSR) payments for fiscal year2018 through the end of calendar year 2019.

COST-SHARING REDUCTIONS




Obligations by program activity:–471–180.................Cost Sharing Reductions ...........................................................0001

–471–180.................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:–471–180.................Appropriation ....................................................................1200–471–180.................Total budgetary resources available ..............................................1930


–471–180.................New obligations, unexpired accounts ....................................3010471180.................Outlays (gross) ......................................................................3020


–471–180.................Budget authority, gross .........................................................4090Outlays, gross:

–471–180.................Outlays from new mandatory authority .............................4100–471–180.................Budget authority, net (total) ..........................................................4180–471–180.................Outlays, net (total) ........................................................................4190

✦

RISK ADJUSTMENT PROGRAM PAYMENTS



526371248Balance, start of year ....................................................................0100..................................–1Reconciliation adjustment .............................................................0198

526371247Balance, start of year ................................................................0199Receipts:

Current law:7,0947,9745,228Receipts, Risk Adjustment Program ......................................1110


Current law:–7,094–7,974–5,228Risk Adjustment Program Payments .....................................2101–526–371–247Risk Adjustment Program Payments .....................................2103

.................526371Risk Adjustment Program Payments .....................................2132

–7,620–7,819–5,104Total current law appropriations .......................................2199

–7,620–7,819–5,104Total appropriations ..................................................................2999

.................526371Balance, end of year ..................................................................5099



Obligations by program activity:7,6209,1543,768Risk Adjustment Program Payments (Direct) .............................0001

7,6209,1543,768Total new obligations (object class 41.0) ......................................0900


11,336.................Unobligated balance brought forward, Oct 1 .........................1000Budget authority:

Appropriations, mandatory:7,0947,9745,228Appropriation (special or trust fund) .................................1201526371247Appropriation (previously unavailable) .............................1203


appropriations temporarily reduced ..............................1232


Memorandum (non-add) entries:111,336Unexpired unobligated balance, end of year ..........................1941



–7,620–9,154–4,100Outlays (gross) ......................................................................3020


9159151,247Obligated balance, start of year ............................................3100915915915Obligated balance, end of year ..............................................3200


7,6207,8195,104Budget authority, gross .........................................................4090



RISK ADJUSTMENT PROGRAM PAYMENTS—Continued



Outlays, gross:7,6207,4472,853Outlays from new mandatory authority .............................4100

.................1,7071,247Outlays from mandatory balances ....................................4101


Section 1343 of the Patient Protection and Affordable Care Act (P.L.111–148) established a permanent risk adjustment program for non-grandfathered plans in the individual and small group markets. Risk adjust-ment is budget neutral within each state and market, such that chargescollected from plans with lower than average actuarial risk are used tomake payments to plans with higher than average actuarial risk. Risk ad-justment may be operated by a State, or by the Federal government in theevent a State chooses not to operate risk adjustment. Payments and chargesare made in the year following the plan year for which they are calculated.

✦

TRANSITIONAL REINSURANCE PROGRAM



22285455Balance, start of year ....................................................................0100Receipts:

Current law:.................3764,546Contributions, Transitional Reinsurance Program .................1110

226615,001Total: Balances and receipts .....................................................2000Appropriations:

Current law:.................–375–4,546Transitional Reinsurance Program ........................................2101

–22–286–456Transitional Reinsurance Program ........................................2103.................22286Transitional Reinsurance Program ........................................2132

–22–639–4,716Total current law appropriations .......................................2199

–22–639–4,716Total appropriations ..................................................................2999

.................22285Balance, end of year ..................................................................5099



Obligations by program activity:226324,715Transitional reinsurance payments ...........................................0001

.................71Administrative expenses ...........................................................0002

226394,716Total new obligations, unexpired accounts ....................................0900


Appropriations, mandatory:.................3754,546Appropriation (special or trust fund) .................................1201

22286456Appropriation (previously unavailable) .............................1203



226394,716Appropriations, mandatory (total) .........................................1260226394,716Total budgetary resources available ..............................................1930


.................248223Unpaid obligations, brought forward, Oct 1 ..........................3000226394,716New obligations, unexpired accounts ....................................3010

–22–887–4,691Outlays (gross) ......................................................................3020





226394,716Budget authority, gross .........................................................4090

Outlays, gross:226394,468Outlays from new mandatory authority .............................4100

.................248223Outlays from mandatory balances ....................................4101

228874,691Outlays, gross (total) .............................................................4110226394,716Budget authority, net (total) ..........................................................4180228874,691Outlays, net (total) ........................................................................4190

Section 1341 of the Patient Protection and Affordable Care Act (P.L.111–148) established a transitional, temporary, three-year reinsuranceprogram to minimize the impact of high-cost enrollees in plans in the indi-vidual market for plan years 2014, 2015, and 2016. The Centers forMedicare & Medicaid Services assesses contributing entities a per enrolleefee to fund the reinsurance program, and makes payments to issuers in theindividual market for enrollees whose medical costs exceed a certainthreshold, up to a reinsurance cap. Reinsurance collections and paymentsare made in the year following the plan year for which they are applicable.Reinsurance collections and payments for the 2016 plan year, the final yearof the program, were announced in June of 2017.



Direct obligations:

226324,715Grants, subsidies, and contributions - Transitional

Reinsurance ..........................................................................41.0

.................71Grants, subsidies, and contributions - Administration ..............41.0

226394,716Total new obligations, unexpired accounts ............................99.9

✦

CONSUMER OPERATED AND ORIENTED PLAN PROGRAM CONTINGENCY FUND




.................12416Reestimates of direct loan subsidy .......................................0705

.................111Interest on reestimates of direct loan subsidy .......................0706

..................................1Administrative expenses .......................................................0709



.................11Recoveries of prior year unpaid obligations ...........................1021Budget authority:

Appropriations, mandatory:.................13417Appropriation ....................................................................1200.................13518Total budgetary resources available ..............................................1930


1316Unpaid obligations, brought forward, Oct 1 ..........................3000.................13518New obligations, unexpired accounts ....................................3010.................–136–30Outlays (gross) ......................................................................3020.................–1–1Recoveries of prior year unpaid obligations, unexpired .........3040





.................13417Outlays from new mandatory authority .............................4100

.................213Outlays from mandatory balances ....................................4101


.................13417Budget authority, net (total) ..........................................................4180





Direct loan subsidy outlays:..................................13Solvency Loans ..........................................................................134002

..................................13Total subsidy outlays .................................................................134999Direct loan reestimates:

.................17–8Startup Loans ............................................................................135001

.................1175Solvency Loans ..........................................................................135002

.................134–3Total direct loan reestimates .....................................................135999

Administrative expense data:.................2.................Outlays from balances ..............................................................3580

The Consumer Operated and Oriented Plan Contingency Fund was estab-lished by the American Taxpayer Relief Act of 2012 (P.L. 112–240). Thisfund provides assistance and oversight to qualified nonprofit health insur-ance issuers that have been awarded loans or grants under section 1322 ofthe Patient Protection and Affordable Care Act (P.L. 111–148).



Direct obligations:..................................1Other services from non-Federal sources ..................................25.2.................13517Grants, subsidies, and contributions ........................................41.0


✦

CONSUMER OPERATED AND ORIENTED PLAN PROGRAM ACCOUNT



..................................7Balance, start of year ....................................................................0100

..................................–7Reconciliation adjustment .............................................................0198

...................................................Balance, start of year ................................................................0199

...................................................Total: Balances and receipts .....................................................2000





.................22674Reestimates of direct loan subsidy .......................................0705

.................337Interest on reestimates of direct loan subsidy .......................0706

..................................1Administrative expenses .......................................................0709



1.................1Unobligated balance brought forward, Oct 1 .........................1000.................1.................Recoveries of prior year unpaid obligations ...........................1021




11.................Unexpired unobligated balance, end of year ..........................1941


243Unpaid obligations, brought forward, Oct 1 ..........................3000.................25982New obligations, unexpired accounts ....................................3010.................–260–81Outlays (gross) ......................................................................3020.................–1.................Recoveries of prior year unpaid obligations, unexpired .........3040


243Obligated balance, start of year ............................................3100

224Obligated balance, end of year ..............................................3200




.................1.................Outlays from mandatory balances ....................................4101






Direct loan reestimates:.................–8–65Startup Loans ............................................................................135002.................25238Solvency Loans ..........................................................................135003

.................244–27Total direct loan reestimates .....................................................135999

Administrative expense data:.................1.................Outlays from balances ..............................................................3580

Section 1322 of the Patient Protection and Affordable Care Act (P.L.111–148) authorized and appropriated funding for the Consumer Operatedand Oriented Plan (CO-OP) Program. The CO-OP Program fosters thecreation of qualified nonprofit health insurance issuers that operate with astrong consumer focus to offer qualified health plans in the individual andsmall group markets in the States. The Secretary shall award loans toqualified nonprofit issuers to fund start-up costs and reserves which enablequalified issuers to meet state solvency requirements. The Secretary mayalso award loans for the purposes of encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer underSection 1322.



Direct obligations:..................................1Other goods and services from Federal sources ........................25.3.................25981Grants, subsidies, and contributions ........................................41.0


✦

CONSUMER OPERATED AND ORIENTED PLAN FINANCING ACCOUNT




151818Payment of interest to Treasury .............................................0713.................1499Downward reestimates paid to receipt accounts ...................0742.................18Interest on downward reestimates ........................................0743




.................3.................Recoveries of prior year unpaid obligations ...........................1021

..................................–1Capital transfer of unobligated balances to general fund ......1022

.................–143–478Unobligated balances applied to repay debt .........................1023

.................–3.................Unobligated balance of borrowing authority withdrawn ........1024

..................................44Unobligated balance (total) ......................................................1050Financing authority:

Borrowing authority, mandatory:.................15121Borrowing authority ...........................................................1400

Spending authority from offsetting collections, mandatory:114369103Collected ...........................................................................1800

.................–1.................Change in uncollected payments, Federal sources ............1801

–99–350.................Spending authority from offsetting collections applied to

repay debt .....................................................................1825

1518103Spending auth from offsetting collections, mand (total) .......1850



CONSUMER OPERATED AND ORIENTED PLAN FINANCING ACCOUNT—Continued



1533224Budget authority (total) .............................................................19001533268Total budgetary resources available ..............................................1930




–15–33–125Outlays (gross) ......................................................................3020.................–3.................Recoveries of prior year unpaid obligations, unexpired .........3040

..................................3Unpaid obligations, end of year .................................................3050Uncollected payments:

.................–1–1Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060

.................1.................Change in uncollected pymts, Fed sources, unexpired ..........3070

..................................–1Uncollected pymts, Fed sources, end of year .............................3090Memorandum (non-add) entries:




1533224Budget authority, gross .........................................................4090Financing disbursements:

1533125Outlays, gross (total) .............................................................4110Offsets against gross financing authority and disbursements:

Offsetting collections (collected) from:.................–259–80Federal sources .................................................................4120

–1–2–6Interest on uninvested funds ............................................4122–113–108–17Non-Federal sources .........................................................4123

–114–369–103Offsets against gross budget authority and outlays (total) ....4130Additional offsets against financing authority only (total):

.................1.................Change in uncollected pymts, Fed sources, unexpired .......4140

–99–335121Budget authority, net (mandatory) ............................................4160–99–33622Outlays, net (mandatory) ...........................................................4170–99–335121Budget authority, net (total) ..........................................................4180–99–33622Outlays, net (total) ........................................................................4190



Cumulative balance of direct loans outstanding:1,7851,8931,909Outstanding, start of year .........................................................1210–112–108–16Repayments: Repayments and prepayments .............................1251–493..................................Write-offs for default: Direct loans ............................................1263

1,1801,7851,893Outstanding, end of year .......................................................1290



ASSETS:Federal assets:

16506Fund balances with Treasury .....................................................1101Investments in US securities:

...........................81Receivables, net ....................................................................1106Net value of assets related to post–1991 direct loans receivable:

1,8931,909Direct loans receivable, gross ....................................................14012012Interest receivable .....................................................................1402

–1,278–1,284Allowance for subsidy cost (-) ....................................................1405

635637Net present value of assets related to direct loans ................1499

6511,224Total assets ...............................................................................1999LIABILITIES:

6511,224Federal liabilities: Debt ..................................................................2103

6511,224Total liabilities and net position .....................................................4999

✦

CONSUMER OPERATED AND ORIENTED PLAN PROGRAM CONTINGENCY FUND FINANCING

ACCOUNT




566Payment of interest to Treasury .............................................0713..................................19Downward reestimates paid to receipt accounts ...................0742..................................1Interest on downward reestimates ........................................0743



132101Unobligated balance brought forward, Oct 1 .........................1000.................32Recoveries of prior year unpaid obligations ...........................1021.................–32–93Unobligated balances applied to repay debt .........................1023.................–3.................Unobligated balance of borrowing authority withdrawn ........1024

1.................10Unobligated balance (total) ......................................................1050Financing authority:

Borrowing authority, mandatory:9730Borrowing authority ...........................................................1400


.................–1–13Change in uncollected payments, Federal sources ............1801

–4–137.................Spending authority from offsetting collections applied to

repay debt .....................................................................1825

..................................18Spending auth from offsetting collections, mand (total) .......18509748Budget authority (total) .............................................................1900





–5–6–54Outlays (gross) ......................................................................3020.................–3–2Recoveries of prior year unpaid obligations, unexpired .........3040


.................–1–14Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060

.................113Change in uncollected pymts, Fed sources, unexpired ..........3070

..................................–1Uncollected pymts, Fed sources, end of year .............................3090Memorandum (non-add) entries:



9748Budget authority, gross .........................................................4090Financing disbursements:

5654Outlays, gross (total) .............................................................4110Offsets against gross financing authority and disbursements:


–2–2–2Interest on uninvested funds ............................................4122–2–2.................Non-Federal sources .........................................................4123

–4–138–31Offsets against gross budget authority and outlays (total) ....4130Additional offsets against financing authority only (total):

.................113Change in uncollected pymts, Fed sources, unexpired .......4140

5–13030Budget authority, net (mandatory) ............................................41601–13223Outlays, net (mandatory) ...........................................................41705–13030Budget authority, net (total) ..........................................................41801–13223Outlays, net (total) ........................................................................4190



Cumulative balance of direct loans outstanding:478480451Outstanding, start of year .........................................................1210

..................................29Disbursements: Direct loan disbursements ...............................1231–2–2.................Repayments: Repayments and prepayments .............................1251

–138..................................Write-offs for default: Direct loans ............................................1263





ASSETS:9124Federal assets: Fund balances with Treasury .................................1101417Non-Federal assets: Receivables, net ............................................1206

Net value of assets related to post–1991 direct loans receivable:480451Direct loans receivable, gross ....................................................1401

...........................2Interest receivable .....................................................................1402–291–281Allowance for subsidy cost (-) ....................................................1405

189172Net present value of assets related to direct loans ................1499


202293Federal liabilities: Resources payable to Treasury ..........................2104...........................20Non-Federal liabilities: Other .........................................................2207

202313Total liabilities ...........................................................................2999


✦

Trust Funds

FEDERAL HOSPITAL INSURANCE TRUST FUND



164,640160,218158,585Balance, start of year ....................................................................0100..................................127Unavailable unobligated balance adjustment ...............................0198.................–197.................Adjustment for change in allocation ..............................................0198

164,640160,021158,712Balance, start of year ................................................................0199Receipts:

Current law:255,083240,175237,667FHI Trust Fund, Transfers from General Fund (FICA Taxes) .....1110

587567606FHI Trust Fund, Receipts from Railroad Retirement Board .....1110

19,54418,39617,657FHI Trust Fund, Transfers from General Fund (SECA

Taxes) ................................................................................1110

683641446FHI Trust Fund, Civil Penalties and Damages ........................1110221FHI Trust Fund, Other Proprietary Interest from the Public .....1130

429398389FHI Trust Fund, Basic Premium, Medicare Advantage ...........11306,3506,3005,841FHI Trust Fund, Medicare Refunds .........................................1130

331Affordable Care Act Medicare Shared Savings Models (HI) .....1130

3,9483,7333,492FHI Trust Fund, Premiums Collected for Uninsured Individuals

not Otherwise Eligible .......................................................1130

3,9373,8383,733FHI Trust Fund, Federal Employer Contributions (FICA) .........1140

625639683FHI Trust Fund, Postal Service Employer Contributions

(FICA) ................................................................................1140

6,8807,1687,423FHI Trust Fund, Interest Received by Trust Funds ..................114024,94323,68424,206FHI Trust Fund, Taxation on OASDI Benefits ...........................1140

147135131FHI Trust Fund, Payment from the General Fund for Health

Care Fraud and Abuse Control Account .............................1140

15010912FHI Trust Fund, Transfers from General Fund (criminal

Fines) ................................................................................1140

525146FHI Trust Fund, Transfers from General Fund (civil Monetary

Penalties) ..........................................................................1140

313025FHI Trust Fund, Transfers from General Fund (asset

Forfeitures) .......................................................................1140

282631FHI Trust Fund, Interest Payments by Railroad Retirement

Board ................................................................................1140

1,3301,3231,973FHI Trust Fund, Payments from the General Fund (uninsured

and Program Management) ..............................................1140

324,752307,218304,363Total current law receipts ..................................................1199Proposed:

–2..................................FHI Trust Fund, Transfers from General Fund (FICA Taxes) .....12102–50.................FHI Trust Fund, Transfers from General Fund (FICA Taxes) .....1210

–190..................................FHI Trust Fund, Premiums Collected for Uninsured Individuals

not Otherwise Eligible .......................................................1230

27032.................FHI Trust Fund, Interest Received by Trust Funds ..................1240

2..................................FHI Trust Fund, Transfers from General Fund (civil Monetary

Penalties) ..........................................................................1240

82–18.................Total proposed receipts .........................................................1299

324,834307,200304,363Total receipts .............................................................................1999


Current law:–2,022–1,933–2,110Federal Hospital Insurance Trust Fund ..................................2101

–325,008–305,249–300,240Federal Hospital Insurance Trust Fund ..................................2101–770–725–725Health Care Fraud and Abuse Control Account ......................2101

–1,186–1,320–1,320Health Care Fraud and Abuse Control Account ......................2101

..................................7Federal Hospital Insurance Trust Fund ..................................2132

.................5050Health Care Fraud and Abuse Control Account ......................213226,6141,449Federal Hospital Insurance Trust Fund ..................................2134

–328,984–302,563–302,889Total current law appropriations .......................................2199Proposed:

27033.................Federal Hospital Insurance Trust Fund ..................................2201192..................................Federal Hospital Insurance Trust Fund ..................................2201

–270–33.................Federal Hospital Insurance Trust Fund ..................................220313,083–18.................Federal Hospital Insurance Trust Fund ..................................2203

13,275–18.................Total proposed appropriations ...............................................2299

–315,709–302,581–302,889Total appropriations ..................................................................2999..................................32Unavailable unobligated balance adjustment ...............................5098




Obligations by program activity:323,801297,842297,122Benefit payments, HI .................................................................0001

2065648HIT Incentive Payments .............................................................00022,2272,1302,580Administration, HI .....................................................................0003980522552Quality improvement organizations, HI ......................................0004

327,028300,559300,902Total direct obligations ..................................................................0799





..................................8Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, discretionary:2,0221,9332,110Appropriation (special or trust fund) .................................1101



325,008305,249300,240Appropriation (special or trust fund) .................................1201


appropriations temporarily reduced (Sequester) ...........1232

–2–6,614–1,449Appropriations precluded from obligation .........................1234




.................197.................Adjustments to unpaid obligations, brought forward, Oct

1 .......................................................................................3001

327,028300,559300,902New obligations, unexpired accounts ....................................3010–327,099–300,808–297,566Outlays (gross) ......................................................................3020






1,3571,2301,254Outlays from new discretionary authority ..........................4010709906.................Outlays from discretionary balances .................................4011

2,0662,1361,254Outlays, gross (total) .............................................................4020Mandatory:







accounts .......................................................................4143


Trust Funds

FEDERAL HOSPITAL INSURANCE TRUST FUND—Continued




Memorandum (non-add) entries:200,449197,835192,209Total investments, SOY: Federal securities: Par value ...............5000209,551200,449197,835Total investments, EOY: Federal securities: Par value ...............5001




Legislative proposal, subject to PAYGO:–13,27518.................Budget Authority .......................................................................–13,27518.................Outlays ......................................................................................


The Hospital Insurance (HI) program funds the costs of hospital and re-lated care for individuals age 65 or older and for eligible disabled persons.

In addition, the Budget includes a package of targeted Medicare proposalsdesigned to eliminate wasteful Federal spending, reduce provider burden,and address fraud and abuse. This package strengthens the solvency of theHospital Insurance Trust Fund.

Status of Funds (in millions of dollars)


Unexpended balance, start of year:201,343197,520192,518Balance, start of year ................................................................0100

201,343197,520192,518Total balance, start of year ........................................................0999Cash income during the year:

Current law:Receipts:

255,083240,175237,667FHI Trust Fund, Transfers from General Fund (FICA

Taxes) ...........................................................................1110

587567606FHI Trust Fund, Receipts from Railroad Retirement

Board ............................................................................1110

19,54418,39617,657FHI Trust Fund, Transfers from General Fund (SECA

Taxes) ...........................................................................1110

683641446FHI Trust Fund, Civil Penalties and Damages ....................1110429398389FHI Trust Fund, Basic Premium, Medicare Advantage ........1130

6,3506,3005,841FHI Trust Fund, Medicare Refunds .....................................1130

331Affordable Care Act Medicare Shared Savings Models

(HI) ...............................................................................1130

3,9483,7333,492FHI Trust Fund, Premiums Collected for Uninsured

Individuals not Otherwise Eligible ................................1130

..................................6Federal Hospital Insurance Trust Fund ..............................11306,8807,1687,423FHI Trust Fund, Interest Received by Trust Funds ..............1150

221FHI Trust Fund, Other Proprietary Interest from the

Public ...........................................................................1150

282631FHI Trust Fund, Interest Payments by Railroad Retirement

Board ............................................................................1150

3,9373,8383,733FHI Trust Fund, Federal Employer Contributions (FICA) ......1160

625639683FHI Trust Fund, Postal Service Employer Contributions

(FICA) ............................................................................1160

24,94323,68424,206FHI Trust Fund, Taxation on OASDI Benefits .......................1160

147135131FHI Trust Fund, Payment from the General Fund for Health

Care Fraud and Abuse Control Account .........................1160

15010912FHI Trust Fund, Transfers from General Fund (criminal

Fines) ............................................................................1160

525146FHI Trust Fund, Transfers from General Fund (civil Monetary

Penalties) .....................................................................1160

313025FHI Trust Fund, Transfers from General Fund (asset

Forfeitures) ...................................................................1160

1,3301,3231,973FHI Trust Fund, Payments from the General Fund (uninsured

and Program Management) ..........................................1160

324,752307,218304,369Income under present law .............................................1199Proposed:

–2..................................FHI Trust Fund, Transfers from General Fund (FICA Taxes) .....12102–50.................FHI Trust Fund, Transfers from General Fund (FICA Taxes) .....1210

Offsetting receipts (proprietary):

–190..................................FHI Trust Fund, Premiums Collected for Uninsured

Individuals not Otherwise Eligible ................................1230

27032.................FHI Trust Fund, Interest Received by Trust Funds ..................1250Offsetting governmental receipts:

2..................................FHI Trust Fund, Transfers from General Fund (civil Monetary

Penalties) .....................................................................1260

82–18.................Income proposed ...............................................................1299

324,834307,200304,369Total cash income .................................................................1999Cash outgo during year:

Current law:–327,099–300,808–297,566Federal Hospital Insurance Trust Fund [009–38–8005–0] .....2100

–2,228–2,542–1,802Health Care Fraud and Abuse Control Account

[009–38–8393–0] ............................................................2100

–329,327–303,350–299,368Outgo under current law ...................................................2199Proposed:

13,275–18.................Federal Hospital Insurance Trust Fund ..................................2200

13,275–18.................Outgo under proposed legislation .....................................2299

–316,052–303,368–299,368Total cash outgo (-) ...................................................................2999Surplus or deficit::

1,602–3,396–2,454Excluding interest .....................................................................31107,1807,2287,455Interest ......................................................................................3120

8,7823,8325,001Subtotal, surplus or deficit ....................................................3199.................–9.................Federal Hospital Insurance Trust Fund ..........................................3220..................................1Rounding adjustment ....................................................................3298

.................–91Total adjustments .....................................................................3299

8,7823,8235,002Total change in fund balance ....................................................3999Unexpended balance, end of year::

574894–315Uninvested balance (net), end of year .......................................4100209,551200,449197,835Federal Hospital Insurance Trust Fund ......................................4200

210,125201,343197,520Total balance, end of year .........................................................4999



Direct obligations:

980522552Payment for Quality Improvement Organization (QIO)

activities ...............................................................................41.0

323,821297,907297,770Insurance claims and indemnities (benefits) ............................42.02,2272,1302,580Financial transfers ....................................................................94.0


Employment Summary








Appropriations, mandatory:–270–33.................Appropriation (special or trust fund) .................................120127033.................Appropriation (previously unavailable) .............................1203







Obligations by program activity:–13,293..................................Benefit payments, HI .................................................................0001

1818.................Administration, HI .....................................................................0003

–13,27518.................Total direct obligations ..................................................................0799

THE BUDGET FOR FISCAL YEAR 2019454 Centers for Medicare and Medicaid Services—ContinuedTrust Funds—Continued

–13,27518.................Total new obligations, unexpired accounts ....................................0900


Appropriations, mandatory:–192..................................Appropriation (special or trust fund) .................................1201

–13,08318.................Appropriation (previously unavailable) .............................1203

–13,27518.................Appropriations, mandatory (total) .........................................1260–13,27518.................Budget authority (total) .............................................................1900–13,27518.................Total budgetary resources available ..............................................1930


–13,27518.................New obligations, unexpired accounts ....................................301013,275–18.................Outlays (gross) ......................................................................3020


–13,27518.................Budget authority, gross .........................................................4090Outlays, gross:

–13,27518.................Outlays from new mandatory authority .............................4100–13,27518.................Budget authority, net (total) ..........................................................4180–13,27518.................Outlays, net (total) ........................................................................4190



Direct obligations:–13,293..................................Insurance claims and indemnities (benefits) ............................42.0

1818.................Financial transfers ....................................................................94.0

–13,27518.................Total new obligations, unexpired accounts ............................99.9

✦

HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT

In addition to amounts otherwise available for program integrity and programmanagement, $770,000,000, to remain available through September 30, 2020, tobe transferred from the Federal Hospital Insurance Trust Fund and the FederalSupplementary Medical Insurance Trust Fund, as authorized by section 201(g) ofthe Social Security Act, of which $604,389,000 shall be for the Centers for Medicareand Medicaid Services program integrity activities, of which $87,230,000 shall befor the Department of Health and Human Services Office of Inspector General tocarry out fraud and abuse activities authorized by section 1817(k)(3) of such Act,and of which $78,381,000 shall be for the Department of Justice to carry out fraudand abuse activities authorized by section 1817(k)(3) of such Act: Provided, Thatthe report required by section 1817(k)(5) of the Social Security Act for fiscal year2019 shall include measures of the operational efficiency and impact on fraud,waste, and abuse in the Medicare, Medicaid, and CHIP programs for the fundsprovided by this appropriation: Provided further, That of the amount provided underthis heading, $311,000,000 is provided to meet the terms of section 251(b)(2)(C)(ii)of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended,and $454,000,000 is additional new budget authority specified for purposes of section251(b)(2)(C) of such Act: Provided further, That the Secretary shall support theSenior Medicare Patrol program to combat health care fraud and abuse from thefunds provided to this account.




Obligations by program activity:917877795Medicare integrity program .......................................................0001147135131FBI fraud and abuse control ......................................................0002313286279Other fraud and abuse control ..................................................0003

–191–28.................Undistributed Savings, HCFAC and SSA ....................................0005

1,1861,2701,205Total Mandatory .............................................................................0091604569614CMS discretionary .....................................................................0101166156156Other discretionary ....................................................................0102

770725770Total Discretionary .........................................................................0191



430430406Unobligated balance brought forward, Oct 1 .........................1000.................199248Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................10Recoveries of prior year unpaid obligations ...........................1021



Appropriations, mandatory:1,1861,3201,320Appropriation (special or trust fund) .................................1201





430430430Unexpired unobligated balance, end of year ..........................1941Special and non-revolving trust funds:

..................................6Unobligated balance expiring ................................................1951282839Expired unobligated balance, start of year ............................1952282822Expired unobligated balance, end of year ..............................1953



–2,228–2,542–1,802Outlays (gross) ......................................................................3020..................................–10Recoveries of prior year unpaid obligations, unexpired .........3040..................................–16Recoveries of prior year unpaid obligations, expired .............3041

9451,2171,764Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

1,2171,7641,617Obligated balance, start of year ............................................31009451,2171,764Obligated balance, end of year ..............................................3200








The Health Insurance Portability and Accountability Act of 1996 (P.L.104–191) established the Health Care Fraud and Abuse Control (HCFAC)account within the Federal Hospital Insurance Trust Fund and appropriatedfunds from the Trust Fund to the HCFAC account for specified health carefraud and abuse control activities of the Department of Health and HumanServices (HHS), the Department of Justice, and other agencies.

The Budget includes a discretionary request for efforts to safeguardCenters for Medicare and Medicaid Services (CMS) program integrity thatwill supplement other CMS program integrity funds. See additional discus-sion in the Budget Process chapter in the Analytical Perspectives volume.



Direct obligations:464646Personnel compensation: Full-time permanent (CMS) ...............11.1121212Civilian personnel benefits (CMS) .............................................12.1121212Communications, utilities, and miscellaneous charges ............23.3

1148268Other services (CMS/Medicaid) .................................................25.2

143132132Other purchases of goods and services from Government accounts

(HHS/DOJ) ..............................................................................25.3


(HHS/OIG) ..............................................................................25.3


(HHS/OGC) .............................................................................25.3

21198Other goods and services from Federal sources (HHS/CMS) .......25.3


Trust Funds—Continued

HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT—Continued



555Other goods and services from Government accounts

(HHS/FDA) .............................................................................25.3

1,3381,2941,280Medical care (CMS) ...................................................................25.6–191–28.................Undistributed ............................................................................92.0147135131Financial transfers (FBI) ...........................................................94.0


Employment Summary



✦

FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND



75,60447,10539,603Balance, start of year ....................................................................0100.................–298.................Obligated balance (unpaid obligations) adjustment .....................0198

75,60446,80739,603Balance, start of year ................................................................0199Receipts:

Current law:

2,8265,9974,147Fee on Branded Prescription Pharmaceutical Manufacturers

and Importers, SMI ............................................................1110

337Other Proprietary Interest from the Public, FSMI Fund ...........1130

5,6565,2404,936Premiums Collected for Medicare Prescription Drug Account,

FSMI ..................................................................................1130

12,55811,93811,072Payments from States, Medicare Prescription Drug Account,

FSMI ..................................................................................1130

553492457Basic Premium, Medicare Advantage, FSMI Trust Fund .........11305,2925,2425,011Medicare Refunds, SMI ..........................................................1130

331Affordable Care Act Medicare Shared Savings Models,

SMI ....................................................................................1130

84,29678,02167,357Premiums Collected for the Aged, FSMI Fund ........................113012,64812,46112,326Premiums Collected for the Disabled, FSMI Fund ..................1130

263,711244,685227,879Federal Contributions, FSMI Fund ..........................................11401,2101,2272,262Interest Received by Trust Fund, FSMI Fund ..........................1140

43.................Federal Contribution, State Low-income Determinations,

Prescription Drug Account, FSMI .......................................1140

152253Interest, Medicare Prescription Drug Account, FSMI ..............1140

642422–131Federal Contribution for Admin. Contribution for Admin. Costs,

Prescription Drug Account, FSMI .......................................1140

73,17171,91578,791Federal Contributions for Benefits, Prescription Drug Account,

SMI ....................................................................................1140

112Miscellaneous Federal Payments, Federal Supplementary

Medical Insurance Trust Fund ...........................................1140

462,589437,672414,170Total current law receipts ..................................................1199Proposed:

922..................................Premiums Collected for Medicare Prescription Drug Account,

FSMI ..................................................................................1230

–160..................................Payments from States, Medicare Prescription Drug Account,

FSMI ..................................................................................1230

–711..................................Premiums Collected for the Aged, FSMI Fund ........................1230–107..................................Premiums Collected for the Disabled, FSMI Fund ..................1230

–2,484..................................Federal Contributions, FSMI Fund ..........................................1240

156–39.................Federal Contributions for Benefits, Prescription Drug Account,

SMI ....................................................................................1240

–2,384–39.................Total proposed receipts .........................................................1299

460,205437,633414,170Total receipts .............................................................................1999


Current law:–3,032–3,441–3,314Federal Supplementary Medical Insurance Trust Fund ..........2101

–368,115–351,477–315,747Federal Supplementary Medical Insurance Trust Fund ..........2101

–634–413–402Medicare Prescription Drug Account, Federal Supplementary

Insurance Trust Fund ........................................................2101

–90,808–82,347–94,837Medicare Prescription Drug Account, Federal Supplementary


8,45328,8627,632Federal Supplementary Medical Insurance Trust Fund ..........2134

–454,136–408,816–406,668Total current law appropriations .......................................2199Proposed:

2,523..................................Federal Supplementary Medical Insurance Trust Fund ..........2201

974..................................Federal Supplementary Medical Insurance Trust Fund ..........2201

–918..................................Medicare Prescription Drug Account, Federal Supplementary


–2,523..................................Federal Supplementary Medical Insurance Trust Fund ..........2203.................–20.................Federal Supplementary Medical Insurance Trust Fund ..........2203

2,308..................................Federal Supplementary Medical Insurance Trust Fund ..........2234

2,364–20.................Total proposed appropriations ...............................................2299

–451,772–408,836–406,668Total appropriations ..................................................................2999




Obligations by program activity:357,948321,129310,129Benefit payments, SMI ..............................................................0001

1,0541,000652Transfer to Medicaid for payment of SMI premiums ..................0002..................................435HIT Incentive Payments .............................................................0003

3,2133,6632,825Administration, SMI ...................................................................0004472252502Quality Improvement Organizations, SMI ...................................0005




6..................................Unobligated balance brought forward, Oct 1 .........................1000..................................2Recoveries of prior year unpaid obligations ...........................1021..................................5Recoveries of prior year paid obligations ...............................1033

6.................7Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, discretionary:3,0323,4413,314Appropriation (special or trust fund) .................................1101



368,115351,477315,747Appropriation (special or trust fund) .................................1201–8,453–28,862–7,632Appropriations precluded from obligation .........................1234

..................................–613Appropriations applied to repay debt ................................1236

359,662322,615307,502Appropriations, mandatory (total) .........................................1260Borrowing authority, mandatory:

..................................3,720Borrowing authority ...........................................................1400362,694326,050314,536Budget authority (total) .............................................................1900362,700326,050314,543Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:136.................Unexpired unobligated balance, end of year ..........................1941




1 .......................................................................................3001

362,687326,044314,543New obligations, unexpired accounts ....................................3010–362,834–326,181–314,067Outlays (gross) ......................................................................3020







3,0863,4854,177Outlays, gross (total) .............................................................4020Mandatory:








accounts .......................................................................4143


Memorandum (non-add) entries:95,78970,58963,336Total investments, SOY: Federal securities: Par value ...............5000

102,49095,78970,589Total investments, EOY: Federal securities: Par value ...............5001–6,396–6,396–3,289Outstanding debt, SOY ..............................................................5080–6,396–6,396–6,396Outstanding debt, EOY ..............................................................5081

..................................–3,720Borrowing ..................................................................................5082




Legislative proposal, subject to PAYGO:–3,28220.................Budget Authority .......................................................................–3,28220.................Outlays ......................................................................................


The Supplementary Medical Insurance (SMI) program is a voluntaryprogram that affords protection against the costs of physician care andcertain other medical services. The program also covers treatment of end-stage renal disease for eligible enrollees. SMI costs are generally financedby premium payments from enrollees and contributions from the generalrevenues.

In addition, the Budget includes a package of targeted Medicare proposalsdesigned to improve drug pricing and payment, address opioids, eliminatewasteful Federal spending and spending on government-imposed providerburdens, address fraud and abuse, and reform the Medicare appeals process.

Status of Funds (in millions of dollars)


Unexpended balance, start of year:96,78968,00862,774Balance, start of year ................................................................0100

96,78968,00862,774Total balance, start of year ........................................................0999Cash income during the year:

Current law:Receipts:

2,8265,9974,147Fee on Branded Prescription Pharmaceutical Manufacturers

and Importers, SMI .......................................................1110

5,6565,2404,936Premiums Collected for Medicare Prescription Drug Account,

FSMI ..............................................................................1130

12,55811,93811,072Payments from States, Medicare Prescription Drug Account,

FSMI ..............................................................................1130

553492457Basic Premium, Medicare Advantage, FSMI Trust Fund ......11305,2925,2425,011Medicare Refunds, SMI .....................................................1130

331Affordable Care Act Medicare Shared Savings Models,

SMI ...............................................................................1130

84,29678,02167,357Premiums Collected for the Aged, FSMI Fund ....................113012,64812,46112,326Premiums Collected for the Disabled, FSMI Fund ..............1130

..................................5Federal Supplementary Medical Insurance Trust Fund .......1130

..................................380Medicare Prescription Drug Account, Federal Supplementary

Insurance Trust Fund ....................................................1130

1,2101,2272,262Interest Received by Trust Fund, FSMI Fund ......................1150337Other Proprietary Interest from the Public, FSMI Fund ........1150

152253Interest, Medicare Prescription Drug Account, FSMI ..........1150263,711244,685227,879Federal Contributions, FSMI Fund .....................................1160

43.................Federal Contribution, State Low-income Determinations,

Prescription Drug Account, FSMI ...................................1160

642422–131Federal Contribution for Admin. Contribution for Admin.

Costs, Prescription Drug Account, FSMI ........................1160

73,17171,91578,791Federal Contributions for Benefits, Prescription Drug

Account, SMI .................................................................1160

112Miscellaneous Federal Payments, Federal Supplementary

Medical Insurance Trust Fund .......................................1160

462,589437,672414,555Income under present law .............................................1199Proposed:

Offsetting receipts (proprietary):

922..................................Premiums Collected for Medicare Prescription Drug Account,

FSMI ..............................................................................1230

–160..................................Payments from States, Medicare Prescription Drug Account,

FSMI ..............................................................................1230

–711..................................Premiums Collected for the Aged, FSMI Fund ....................1230–107..................................Premiums Collected for the Disabled, FSMI Fund ..............1230

Offsetting governmental receipts:–2,484..................................Federal Contributions, FSMI Fund .....................................1260

156–39.................Federal Contributions for Benefits, Prescription Drug

Account, SMI .................................................................1260

–2,384–39.................Income proposed ...............................................................1299

460,205437,633414,555Total cash income .................................................................1999Cash outgo during year:

Current law:

–362,834–326,181–314,067Federal Supplementary Medical Insurance Trust Fund

[009–38–8004–0] ............................................................2100

–91,245–82,645–95,254Medicare Prescription Drug Account, Federal Supplementary

Insurance Trust Fund [009–38–8308–0] ..........................2100

–454,079–408,826–409,321Outgo under current law ...................................................2199Proposed:

3,282–20.................Federal Supplementary Medical Insurance Trust Fund ..........2200

–918..................................Medicare Prescription Drug Account, Federal Supplementary


2,364–20.................Outgo under proposed legislation .....................................2299

–451,715–408,846–409,321Total cash outgo (-) ...................................................................2999Surplus or deficit::

7,26227,5352,912Excluding interest .....................................................................31101,2281,2522,322Interest ......................................................................................3120

8,49028,7875,234Subtotal, surplus or deficit ....................................................3199.................–6.................Federal Supplementary Medical Insurance Trust Fund ...................3220

.................–6.................Total adjustments .....................................................................3299

8,49028,7815,234Total change in fund balance ....................................................3999Unexpended balance, end of year::

2,7891,000–2,581Uninvested balance (net), end of year .......................................4100102,49095,78970,589Federal Supplementary Medical Insurance Trust Fund ..............4200

105,27996,78968,008Total balance, end of year .........................................................4999



Direct obligations:11.................Personnel compensation: Full-time permanent .........................11.1

472252502Payment for Quality Improvement Organization (QIO) activity ....41.0359,002322,129310,781Insurance claims and indemnities ............................................42.0

3,2123,6623,260Financial transfers ....................................................................94.0

362,687326,044314,543Direct obligations ..................................................................99.0


Employment Summary








Appropriations, mandatory:–2,523..................................Appropriation (special or trust fund) .................................12012,523..................................Appropriation (previously unavailable) .............................1203



Trust Funds—Continued

FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND—Continued








Obligations by program activity:–3,302..................................Benefit payments, SMI ..............................................................0001

2020.................Administration, SMI ...................................................................0004

–3,28220.................Total direct obligations ..................................................................0799

–3,28220.................Total new obligations, unexpired accounts ....................................0900


Appropriations, mandatory:–974..................................Appropriation (special or trust fund) .................................1201

.................20.................Appropriation (previously unavailable) .............................1203–2,308..................................Appropriations precluded from obligation .........................1234

–3,28220.................Appropriations, mandatory (total) .........................................1260–3,28220.................Budget authority (total) .............................................................1900–3,28220.................Total budgetary resources available ..............................................1930


–3,28220.................New obligations, unexpired accounts ....................................30103,282–20.................Outlays (gross) ......................................................................3020


–3,28220.................Budget authority, gross .........................................................4090Outlays, gross:

–3,28220.................Outlays from new mandatory authority .............................4100–3,28220.................Budget authority, net (total) ..........................................................4180–3,28220.................Outlays, net (total) ........................................................................4190



Direct obligations:–3,302..................................Insurance claims and indemnities ............................................42.0

2020.................Financial transfers ....................................................................94.0

–3,28220.................Direct obligations ..................................................................99.0

–3,28220.................Total new obligations, unexpired accounts ............................99.9

✦

MEDICARE PRESCRIPTION DRUG ACCOUNT, FEDERAL SUPPLEMENTARY INSURANCE

TRUST FUND



Obligations by program activity:85,99682,34088,263Prescription Drug Benefits ........................................................0001

642422405Administrative Costs .................................................................0002




.................2.................Unobligated balance brought forward, Oct 1 .........................1000Budget authority:


Appropriations, mandatory:90,80882,34794,837Appropriation (special or trust fund) .................................1201

Spending authority from offsetting collections, mandatory:..................................–6,569Change in uncollected payments, Federal sources ............1801

91,44282,76088,670Budget authority (total) .............................................................190091,44282,76288,670Total budgetary resources available ..............................................1930

Memorandum (non-add) entries:4,804.................2Unexpired unobligated balance, end of year ..........................1941

Special and non-revolving trust funds:3341Expired unobligated balance, start of year ............................1952333Expired unobligated balance, end of year ..............................1953




1 .......................................................................................3001


–91,245–82,645–95,254Outlays (gross) ......................................................................3020..................................–70Recoveries of prior year unpaid obligations, expired .............3041


–7,541–7,541–14,110Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................6,569Change in uncollected pymts, Fed sources, unexpired ..........3070


1,005888528Obligated balance, start of year ............................................3100–3,6021,005861Obligated balance, end of year ..............................................3200







634413402Budget authority, net (discretionary) .........................................4070432293–132Outlays, net (discretionary) .......................................................4080

Mandatory:90,80882,34788,268Budget authority, gross .........................................................4090

Outlays, gross:81,40574,21280,633Outlays from new mandatory authority .............................41009,4088,14014,373Outlays from mandatory balances ....................................4101

90,81382,35295,006Outlays, gross (total) .............................................................4110Additional offsets against gross budget authority only:

..................................6,569Change in uncollected pymts, Fed sources, unexpired .......414091,44282,76095,239Budget authority, net (total) ..........................................................418091,24582,64594,874Outlays, net (total) ........................................................................4190




Legislative proposal, subject to PAYGO:918..................................Budget Authority .......................................................................918..................................Outlays ......................................................................................


Since January 2006, Medicare beneficiaries have had the opportunity toenroll in a comprehensive voluntary prescription drug benefit. The Budgetincludes a package of proposals designed to modernize the Part D benefitby realigning incentives and enhancing benefit management.



Direct obligations:642422405Other services from non-Federal sources ..................................25.2

85,99682,34088,263Insurance claims and indemnities ............................................42.0

86,63882,76288,668Direct obligations ..................................................................99.0



Employment Summary



MEDICARE PRESCRIPTION DRUG ACCOUNT, FEDERAL SUPPLEMENTARY INSURANCE

TRUST FUND




Obligations by program activity:918..................................Prescription Drug Benefits ........................................................0001

918..................................Total direct obligations ..................................................................0799

918..................................Total new obligations, unexpired accounts (object class 42.0) .......0900


Appropriations, mandatory:918..................................Appropriation (special or trust fund) .................................1201918..................................Budget authority (total) .............................................................1900918..................................Total budgetary resources available ..............................................1930





918..................................Outlays from new mandatory authority .............................4100918..................................Budget authority, net (total) ..........................................................4180918..................................Outlays, net (total) ........................................................................4190

✦

ADMINISTRATION FOR CHILDREN AND FAMILIESFederal Funds

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES



Obligations by program activity:16,43316,43316,432State family assistance grant ...................................................0001

787878Territories - family assistance grants ........................................0002888Tribal work programs .................................................................0006

150148144Healthy marriage and responsible fatherhood grants ...............0009454544Evaluation Funding and What Works Clearinghouse ..................0010101010Census Bureau Research ..........................................................0011







Memorandum (non-add) entries:–15–15–21Unobligated balance expiring ................................................1940














Legislative proposal, subject to PAYGO:–1,602..................................Budget Authority .......................................................................–1,155..................................Outlays ......................................................................................


This account provides funding for the Temporary Assistance for Needy

Families (TANF) block grant and related activities authorized by the Per-

sonal Responsibility and Work Opportunity Reconciliation Act of 1996

(P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L.

109–171). The Consolidated Appropriations Act, 2017 (P.L. 115–31) au-

thorized TANF for fiscal years 2017 and 2018. The Budget proposes to

create a comprehensive demonstration opportunity for states to grow capa-

city across public safety net benefit programs to reduce dependency; con-

tinue and modify TANF to refocus the program on the core principle of

promoting employment; continue the 0.33 percent set-aside for TANF

evaluation, research, and technical assistance; and to reduce the authorized

funding for TANF Family Assistance Grants to States, territories, and tribes

by 10 percent.




776Full-time permanent .............................................................11.1111Other than full-time permanent ............................................11.3

..................................1Other personnel compensation ..............................................11.5

888Total personnel compensation ...........................................11.9222Civilian personnel benefits ........................................................12.1111Travel and transportation of persons .........................................21.0111Rental payments to GSA ............................................................23.1

676871Advisory and assistance services ..............................................25.1772Other goods and services from Federal sources ........................25.3

..................................1Operation and maintenance of facilities ...................................25.4111Operation and maintenance of equipment ................................25.7



459DEPARTMENT OF HEALTH AND HUMAN SERVICESAdministration for Children and Families

Federal Funds

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES—Continued

Employment Summary



TEMPORARY ASSISTANCE FOR NEEDY FAMILIES




Obligations by program activity:–1,594..................................State family assistance grant ...................................................0001

–8..................................Territories - family assistance grants ........................................0002

–1,602..................................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:–1,602..................................Appropriation ....................................................................1200–1,602..................................Total budgetary resources available ..............................................1930


–1,602..................................New obligations, unexpired accounts ....................................30101,155..................................Outlays (gross) ......................................................................3020

–447..................................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

–447..................................Obligated balance, end of year ..............................................3200


–1,602..................................Budget authority, gross .........................................................4090Outlays, gross:

–1,155..................................Outlays from new mandatory authority .............................4100–1,602..................................Budget authority, net (total) ..........................................................4180–1,155..................................Outlays, net (total) ........................................................................4190

✦

CONTINGENCY FUND



Obligations by program activity:608608608Contingency Fund for State Welfare Programs ..........................0001



Appropriations, mandatory:608608608Appropriation ....................................................................1200608608608Budget authority (total) .............................................................1900608608608Total budgetary resources available ..............................................1930



–609–626–567Outlays (gross) ......................................................................3020






609626567Outlays, gross (total) .............................................................4110608608608Budget authority, net (total) ..........................................................4180




Enacted/requested:608608608Budget Authority .......................................................................609626567Outlays ......................................................................................

Legislative proposal, subject to PAYGO:–608..................................Budget Authority .......................................................................–545..................................Outlays ......................................................................................

Total:.................608608Budget Authority .......................................................................

64626567Outlays ......................................................................................

The Budget proposes to eliminate funding for the Contingency Fund.

CONTINGENCY FUND




Obligations by program activity:–608..................................Contingency fund ......................................................................0001

–608..................................Total new obligations (object class 41.0) ......................................0900


Appropriations, mandatory:–608..................................Appropriation ....................................................................1200–608..................................Total budgetary resources available ..............................................1930


–608..................................New obligations, unexpired accounts ....................................3010545..................................Outlays (gross) ......................................................................3020




–608..................................Budget authority, gross .........................................................4090Outlays, gross:

–545..................................Outlays from new mandatory authority .............................4100–608..................................Budget authority, net (total) ..........................................................4180–545..................................Outlays, net (total) ........................................................................4190

✦

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT

PROGRAMS

For carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVIof the Social Security Act and the Act of July 5, 1960 (24 U.S.C. 321–329),$2,922,247,000, to remain available until expended; and for such purposes for thefirst quarter of fiscal year 2020, $1,400,000,000, to remain available until expended.

For carrying out, after May 31 of the current fiscal year, except as otherwiseprovided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Actof July 5, 1960 (24 U.S.C. 321–329), for the last 3 months of the current fiscal yearfor unanticipated costs, incurred for the current fiscal year, such sums as may benecessary.




Obligations by program activity:3,8903,9013,826State child support administrative costs ..................................0001589581572Child support incentive payments .............................................0002101010Access and visitation grants .....................................................0003

4,4894,4924,408Subtotal, child support enforcement .............................................0091

THE BUDGET FOR FISCAL YEAR 2019460 Administration for Children and Families—ContinuedFederal Funds—Continued

333333Payments to territories ..............................................................0102113Repatriation ..............................................................................0103

343436Subtotal, other payments ..............................................................0191

4,5234,5264,444Total direct obligations ..................................................................0799131310Offset obligations (CSE grants to States) ..................................0801



2235.................Unobligated balance brought forward, Oct 1 .........................1000200200187Recoveries of prior year unpaid obligations ...........................1021

..................................–32Other balances withdrawn to Treasury ..................................1029



Advance appropriations, mandatory:1,4001,4001,300Advance appropriation ..................................................1270

Spending authority from offsetting collections, mandatory:13.................23Collected ...........................................................................1800

4,3354,3264,334Budget authority (total) .............................................................19004,5574,5614,489Total budgetary resources available ..............................................1930




–4,271–4,206–4,098Outlays (gross) ......................................................................3020–200–200–187Recoveries of prior year unpaid obligations, unexpired .........3040





3,6863,6763,663Outlays from new mandatory authority .............................4100585530435Outlays from mandatory balances ....................................4101


Offsetting collections (collected) from:–13.................–23Non-Federal sources .........................................................4123







This account provides for payments to States for child support enforce-ment and other family support programs, including access and visitationprograms for families. The Federal share of child support collections isreturned to the Treasury in a receipt account. The Budget improves estab-lishment and enforcement procedures by closing loopholes and improvingFederal processes. Proposals target systems modernization, increased col-lections, expanded distribution, and improved program efficiency.



4,5234,5264,444Direct obligations: Grants, subsidies, and contributions ...............41.0131310Reimbursable obligations .....................................................99.0


PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT

PROGRAMS




Obligations by program activity:76..................................State child support administrative costs ..................................0001

76..................................Subtotal, child support enforcement .............................................0091

76..................................Total direct obligations ..................................................................0799


Appropriations, mandatory:76..................................Appropriation ....................................................................120076..................................Budget authority (total) .............................................................190076..................................Total budgetary resources available ..............................................1930








Direct obligations:120..................................Advisory and assistance services ..............................................25.1–44..................................Grants, subsidies, and contributions ........................................41.0

76..................................Direct obligations ..................................................................99.0


✦

LOW INCOME HOME ENERGY ASSISTANCE




Obligations by program activity:.................3,3673,394LIHEAP Block Grant ...................................................................0001



accounts ...........................................................................1012


..................................4Unobligated balance (total) ......................................................1050Budget authority:

Appropriations, discretionary:.................3,3673,390Appropriation ....................................................................1100.................3,3673,394Total budgetary resources available ..............................................1930


1,5171,4211,229Unpaid obligations, brought forward, Oct 1 ..........................3000.................3,3673,394New obligations, unexpired accounts ....................................3010

–1,079–3,271–3,183Outlays (gross) ......................................................................3020..................................–1Recoveries of prior year unpaid obligations, unexpired .........3040

461DEPARTMENT OF HEALTH AND HUMAN SERVICESAdministration for Children and Families—Continued


LOW INCOME HOME ENERGY ASSISTANCE—Continued




4381,5171,421Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:



.................3,3673,390Budget authority, gross .........................................................4000Outlays, gross:

.................2,1552,170Outlays from new discretionary authority ..........................40101,0791,1161,013Outlays from discretionary balances .................................4011

1,0793,2713,183Outlays, gross (total) .............................................................4020.................3,3673,390Budget authority, net (total) ..........................................................4180

1,0793,2713,183Outlays, net (total) ........................................................................4190



Direct obligations:.................33Advisory and assistance services ..............................................25.1.................3,3643,391Grants, subsidies, and contributions ........................................41.0

.................3,3673,394Total new obligations, unexpired accounts ............................99.9

✦

REFUGEE AND ENTRANT ASSISTANCE

For necessary expenses for refugee and entrant assistance activities authorizedby section 414 of the Immigration and Nationality Act and section 501 of the RefugeeEducation Assistance Act of 1980, and for carrying out section 462 of the HomelandSecurity Act of 2002, section 235 of the William Wilberforce Trafficking VictimsProtection Reauthorization Act of 2008, the Trafficking Victims Protection Act of2000 ("TVPA"), and the Torture Victims Relief Act of 1998, $1,242,311,000, ofwhich $1,212,821,000 shall remain available through September 30, 2021 for car-rying out such sections 414, 501, 462, and 235: Provided, That amounts availableunder this heading to carry out the TVPA shall also be available for research andevaluation with respect to activities under those authorities: Provided further, Thatthe limitation in section 204 of this Act regarding transfers increasing any appropri-ation shall apply to transfers to appropriations under this heading by substituting"10 percent" for "3 percent": Provided further, That funds made available underthis heading in this and prior Acts shall be available to reimburse other Federalagencies for the costs of making land or facilities available for temporary housingof unaccompanied alien children as defined in section 235 of the William WilberforceTrafficking Victims Protection Reauthorization Act of 2008, if the Secretary determ-ines that such housing is needed for purposes of carrying out such section 235 andsection 462 of the Homeland Security Act of 2002: Provided further, That such fundsmay be used for construction and improvements to property and demolition as ne-cessary for this purpose: Provided further, That other Federal agencies are herebyauthorized for the current fiscal year to make land or facilities available for thepurposes described in the third proviso, and to retain and use such reimbursementsto cover costs incurred.

In addition, $200,000,000 shall be available to carry out such sections 235 and462: (1) if, at any point during this fiscal year the Secretary has transferred fromother accounts to this account an amount equal to at least 3 percent of the amountappropriated to this account in the first paragraph, and has determined that suchtransfers are needed to support caseloads that are higher than average; (2) if theSecretary has determined that, in each of two consecutive months during this fiscalyear, the number of unaccompanied alien children transferred to the custody of theSecretary pursuant to such section 235 has increased from the number so transferredin the previous month, and that, in the second of such months, the number so trans-ferred is at least 120 percent of the number so transferred in the first of such months;and (3) if the Secretary has determined that, for each of two non-overlapping seven-day periods during the two-month period, the average number of unaccompaniedalien children in the custody of the Office of Refugee Resettlement who are dischargedin a day is less than 1.2 percent of the average number of such children who are insuch custody in a day.




Obligations by program activity:514692705Refugee and entrant assistance ...............................................0001111111Assistance for treatment of torture victims ...............................0002

7989421,395Unaccompanied Children ..........................................................0003191911Trafficking Victims program ......................................................0005



19019098Unobligated balance brought forward, Oct 1 .........................1000..................................300Unobligated balance transfer from other acct [075–0125] ....1011..................................6Unobligated balance transfer from other acct [075–1536] ....1011..................................2Unobligated balance transfer from other acct [075–0350] ....1011..................................72Recoveries of prior year unpaid obligations ...........................1021


Appropriations, discretionary:1,2421,6641,676Base Appropriation ...........................................................1100100..................................UAC Contingency Fund ......................................................1100

..................................1Appropriations transferred from other acct [075–9912] ....1121









1,3421,6641,833Appropriation, discretionary (total) .......................................1160Spending authority from offsetting collections, discretionary:

..................................8Collected ...........................................................................17001,3421,6641,841Budget authority (total) .............................................................19001,5321,8542,319Total budgetary resources available ..............................................1930









8881,003996Obligated balance, start of year ............................................31007888881,003Obligated balance, end of year ..............................................3200



8721,0821,260Outlays from new discretionary authority ..........................4010570697747Outlays from discretionary balances .................................4011




This account provides funds to States and non-governmental organizationsto administer the refugee and entrant assistance programs. Funds supportcash and medical assistance and social services for refugees, asylees, andother arrivals eligible for refugee benefits. The account also includesfunding for the rehabilitation of victims of torture and human traffickingand for the care and placement of unaccompanied alien children.





10911Full-time permanent .............................................................11.111.................Military personnel ..................................................................11.7

111011Total personnel compensation ...........................................11.9334Civilian personnel benefits ........................................................12.1444Rental payments to GSA ............................................................23.1


232337Other goods and services from Federal sources ........................25.31,2191,3931,835Grants, subsidies, and contributions ........................................41.0


Employment Summary



✦

PROMOTING SAFE AND STABLE FAMILIES

For carrying out, except as otherwise provided, section 436 of the Social SecurityAct, $345,000,000 and, for carrying out, except as otherwise provided, section 437of such Act, $59,765,000.




Obligations by program activity:364343343Grants to States and Tribes .......................................................0001

878Research, training and technical assistance ............................0002321130State court improvement activities ...........................................0003112Family Connection Grants .........................................................000491770Personal Responsibility Education (PREP) .................................0005

..................................63Abstinence Education ................................................................0006





accounts ...........................................................................1012





603960Appropriation, discretionary (total) .......................................1160Appropriations, mandatory:

345345495Appropriation ....................................................................1200



345322461Appropriations, mandatory (total) .........................................1260405361521Budget authority (total) .............................................................1900415389550Total budgetary resources available ..............................................1930



















Enacted/requested:405361521Budget Authority .......................................................................434496465Outlays ......................................................................................


Total:595361521Budget Authority .......................................................................451496465Outlays ......................................................................................

This account provides funds for a broad range of child welfare services,including family preservation and support services and grants to increasethe well-being of and improve the permanency outcomes for children af-fected by substance abuse, through Promoting Safe and Stable Families.The Budget includes a proposal to expand the Regional Partnership Grantsprogram, a five-year reauthorization of Promoting Safe and Stable Families,and a one-year reauthorization, with modifications, of Abstinence Educationand the Personal Responsibility Education Program (PREP).



Direct obligations:111Personnel compensation: Full-time permanent .........................11.17712Advisory and assistance services ..............................................25.1222Other goods and services from Federal sources ........................25.3



Employment Summary



PROMOTING SAFE AND STABLE FAMILIES




Obligations by program activity:40..................................Grants to States and Tribes .......................................................000175..................................PREP .........................................................................................000575..................................Abstinence Education ................................................................0006




PROMOTING SAFE AND STABLE FAMILIES—Continued




Appropriations, mandatory:190..................................Appropriation ....................................................................1200190..................................Total budgetary resources available ..............................................1930



173..................................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

173..................................Obligated balance, end of year ..............................................3200






Direct obligations:1..................................Rental payments to GSA ............................................................23.1

10..................................Advisory and assistance services ..............................................25.11..................................Other goods and services from Federal sources ........................25.3

178..................................Grants, subsidies, and contributions ........................................41.0


Employment Summary


3..................................Direct civilian full-time equivalent employment ............................1001

✦

CHILD CARE ENTITLEMENT TO STATES



Obligations by program activity:1,1781,1781,178Mandatory child care .................................................................00011,6511,6621,689Matching child care ..................................................................0002

151514Child Care Training and technical assistance ...........................0003585858Child care tribal grants .............................................................00041544Child Care Research ..................................................................0005




accounts ...........................................................................1012

Budget authority:Appropriations, mandatory:

2,9172,9172,917Appropriation ....................................................................12002,9172,9172,944Total budgetary resources available ..............................................1930



9671,0601,053Unpaid obligations, brought forward, Oct 1 ..........................30002,9172,9172,943New obligations, unexpired accounts ....................................3010



9671,0601,053Obligated balance, start of year ............................................3100

9419671,060Obligated balance, end of year ..............................................3200










This account provides child care subsidies for low-income workingfamilies and was established by the Personal Responsibility and WorkOpportunity Reconciliation Act of 1996 (P.L. 104–193), as amended bythe Deficit Reduction Act of 2005 (P.L. 109–171). Since 2010, this accounthas been temporarily reauthorized by a series of Acts, most recently in theConsolidated Appropriations Act, 2017 (P.L. 115–31). The Budget increasesfunding for this account to ensure federal funding for key child care pro-grams is maintained, given the effects of other Budget proposals on childcare spending.



Direct obligations:1877Advisory and assistance services ..............................................25.1111Other goods and services from Federal sources ........................25.3



CHILD CARE ENTITLEMENT TO STATES




Obligations by program activity:651..................................Matching child care ..................................................................0002

3..................................Child Care Training and technical assistance ...........................000314..................................Child care tribal grants .............................................................00043..................................Child Care Research ..................................................................0005



Appropriations, mandatory:671..................................Appropriation ....................................................................1200671..................................Total budgetary resources available ..............................................1930



172..................................Unpaid obligations, end of year .................................................3050Memorandum (non-add) entries:

172..................................Obligated balance, end of year ..............................................3200


671..................................Budget authority, gross .........................................................4090


Outlays, gross:499..................................Outlays from new mandatory authority .............................4100671..................................Budget authority, net (total) ..........................................................4180499..................................Outlays, net (total) ........................................................................4190



Direct obligations:7..................................Advisory and assistance services ..............................................25.1

664..................................Grants, subsidies, and contributions ........................................41.0


✦

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

For carrying out the Child Care and Development Block Grant Act of 1990("CCDBG Act"), $2,560,000,000 shall be used to supplement, not supplant Stategeneral revenue funds for child care assistance for low-income families: Provided,That technical assistance under section 658I(a)(3) of such Act may be provideddirectly, or through the use of contracts, grants, cooperative agreements, or inter-agency agreements: Provided further, That all funds made available to carry outsection 418 of the Social Security Act (42 U.S.C. 618), including funds appropriatedfor that purpose in such section 418 or any other provision of law, shall be subjectto the reservation of funds authority in paragraphs (4) and (5) of section 658O(a)of the CCDBG Act: Provided further, That none of the funds provided under thisheading may be used to implement the national toll-free hotline under section 658L(b)of the CCDBG Act.




Obligations by program activity:2,5472,8272,845Child Care Block grant payments to States ...............................0001

131010Child Care Research and evaluation fund .................................0004



Appropriations, discretionary:2,5602,8372,856Appropriation ....................................................................11002,5602,8372,856Total budgetary resources available ..............................................1930











This program provides grants to States for child care subsidies for low-income working families and activities to improve child care quality.



Direct obligations:232122Advisory and assistance services ..............................................25.122.................Other goods and services from Federal sources ........................25.3



✦

SOCIAL SERVICES BLOCK GRANT




Obligations by program activity:1,7001,5881,583Social Services Block Grant .......................................................0001

..................................79Health Profession Opportunity Grants .......................................0002



223132Unobligated balance brought forward, Oct 1 .........................1000.................–9.................Other balances not available ................................................1031









435468480Unpaid obligations, brought forward, Oct 1 ..........................30001,7001,5881,662New obligations, unexpired accounts ....................................3010











Legislative proposal, subject to PAYGO:–1,615..................................Budget Authority .......................................................................–1,408..................................Outlays ......................................................................................

Total:851,5881,662Budget Authority .......................................................................

3101,6211,661Outlays ......................................................................................



SOCIAL SERVICES BLOCK GRANT—Continued

The Budget proposes to reduce the authorized funding level for the SocialServices Block Grant to $0. The account also provides funding for theHealth Profession Opportunity Grants demonstration to provide educationand training to Temporary Assistance for Needy Families recipients andother low income individuals for health care occupations in high demand.The Budget proposes extending the demonstration through FY 2019.



Direct obligations:..................................1Personnel compensation: Full-time permanent .........................11.1..................................13Advisory and assistance services ..............................................25.1



Employment Summary


..................................8Direct civilian full-time equivalent employment ............................1001

SOCIAL SERVICES BLOCK GRANT




Obligations by program activity:85..................................Health Profession Opportunity Grants .......................................0002

–1,700..................................Social Services Block Grant .......................................................0003

–1,615..................................Total new obligations, unexpired accounts ....................................0900


Appropriations, mandatory:–1,615..................................Appropriation ....................................................................1200–1,615..................................Budget authority (total) .............................................................1900–1,615..................................Total budgetary resources available ..............................................1930


–1,615..................................New obligations, unexpired accounts ....................................30101,408..................................Outlays (gross) ......................................................................3020




–1,615..................................Budget authority, gross .........................................................4090Outlays, gross:

–1,408..................................Outlays from new mandatory authority .............................4100–1,615..................................Budget authority, net (total) ..........................................................4180–1,408..................................Outlays, net (total) ........................................................................4190



Direct obligations:1..................................Personnel compensation: Full-time permanent .........................11.1

11..................................Advisory and assistance services ..............................................25.1–1,627..................................Grants, subsidies, and contributions ........................................41.0

–1,615..................................Total new obligations, unexpired accounts ............................99.9

Employment Summary



✦

CHILDREN AND FAMILIES SERVICES PROGRAMS

For carrying out, except as otherwise provided, the Runaway and Homeless YouthAct, the Head Start Act, the Child Abuse Prevention and Treatment Act, sections303 and 313 of the Family Violence Prevention and Services Act, the Native Amer-ican Programs Act of 1974, title II of the Child Abuse Prevention and Treatmentand Adoption Reform Act of 1978 (adoption opportunities), part B-1 of title IV andsections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social Security Act; andfor necessary administrative expenses to carry out titles I, IV, V, X, XI, XIV, XVI,and XX-A of the Social Security Act, the Act of July 5, 1960, the Child Care andDevelopment Block Grant Act of 1990, title IV of the Immigration and NationalityAct, and section 501 of the Refugee Education Assistance Act of 1980;$10,323,890,000, of which $37,943,000, to remain available through September30, 2020, shall be for grants to States for adoption and legal guardianship incentivepayments, as defined by section 473A of the Social Security Act and may be madefor adoptions and legal guardianships completed before September 30, 2019:Provided, That $9,275,000,000 shall be for making payments under the Head StartAct: Provided further, That of the amount in the previous proviso, $21,905,000 shallbe available for a cost of living adjustment notwithstanding section 640(a)(3)(A) ofsuch Act: Provided further, That with respect to any subsequent continuing appro-priations act, the previous proviso shall not be construed as an authority or conditionunder this Act and shall not apply in fiscal year 2020 to amounts provided by sucha continuing appropriations act, notwithstanding any other law: Provided further,That of the amount identified in the first proviso, $14,000,000 shall be available tosupplement funding otherwise available for research, evaluation, and federal admin-istrative costs: Provided further, That of the amount identified in the first proviso,$25,000,000 shall be available for allocation by the Secretary to supplement activ-ities described in paragraphs (7)(B) and (9) of section 641(c) of the Head Start Actunder the Designation Renewal System, established under the authority of sections641(c)(7), 645A(b)(12) and 645A(d) of such Act: Provided further, That funds de-scribed in the preceding proviso shall not be included in the calculation of "basegrant" in subsequent fiscal years, as such term is used in section 640(a)(7)(A) ofsuch Act: Provided further, That notwithstanding any proviso under this headingin a prior Act making appropriations for a prior fiscal year (other than amountsthat were designated by the Congress as an emergency requirement pursuant to aconcurrent resolution on the budget or the Balanced Budget and Emergency DeficitControl Act of 1985), any amount issued through a grant for the purposes describedin the following proviso shall be included in any calculation of "base grant", assuch term is used in section 640(a)(7)(A) of such Act, that affects the allocation offunds appropriated in this Act: Provided further, That the previous proviso appliesto funds granted for Early Head Start programs as described in section 645A of theHead Start Act, for conversion of Head Start services to Early Head Start servicesas described in section 645(a)(5)(A) of such Act, and for discretionary grants forhigh quality infant and toddler care through Early Head Start-Child Care Partner-ships, to entities defined as eligible under section 645A(d) of such Act: Providedfurther, That the Secretary may reduce the reservation of funds under section640(a)(2)(C) of such Act in lieu of reducing the reservation of funds under sections640(a)(2)(B), 640(a)(2)(D), and 640(a)(2)(E) of such Act: Provided further, That$1,864,000 shall be for a human services case management system for federallydeclared disasters, to include a comprehensive national case management contractand Federal costs of administering the system: Provided further, That up to$2,000,000 shall be for improving the Public Assistance Reporting InformationSystem, including grants to States to support data collection for a study of the system'seffectiveness.




Obligations by program activity:9,2759,1909,554Head Start .................................................................................0101

.................498.................Preschool Development Grants ..................................................0102545354Runaway and homeless youth (basic centers) ...........................0103484848Transitional living .....................................................................0104171717Education grants to reduce sexual abuse of runaway youth .......0106252525Child abuse State grants ..........................................................0109333333Child abuse discretionary activities ..........................................0110403940Community-based child abuse prevention ................................0111

269267268Child welfare services ...............................................................0112181818Child welfare training, research, or demonstration projects .......0113393939Adoption opportunities ..............................................................0114383838Adoption and Legal Guardianship Incentives ............................0116


434343Independent living education and training vouchers ................0117525252Native American programs ........................................................0124766Social services and income maintenance research ...................0125

205204203ACF Federal administration .......................................................0128222Disaster human services case management .............................0131

10,16510,57210,440Direct program activities, subtotal ................................................0191.................710707Community services block grant ...............................................0301.................77Rural community facilities ........................................................0303.................2020Community economic development ...........................................0304

888Domestic violence hotline ..........................................................0308151150151Family violence prevention and services ...................................0309

159895893Direct program activities, subtotal ................................................0391


10,32411,46711,333Total direct obligations ..................................................................0799212121Children and Families Services Programs (Reimbursable) ........0801




81330426Unobligated balance brought forward, Oct 1 .........................1000.................330426Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................–6Unobligated balance transfer to other accts [075–1503] ......1010



..................................–39Appropriations transferred to other accts [075–1503] .......1120


191919Collected ...........................................................................1700..................................–1Change in uncollected payments, Federal sources ............1701



223Spending auth from offsetting collections, mand (total) .......185010,34511,23911,276Budget authority (total) .............................................................190010,42611,56911,696Total budgetary resources available ..............................................1930








–4–4–8Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................4Change in uncollected pymts, Fed sources, expired ..............3071









..................................1Change in uncollected pymts, Fed sources, unexpired .......4050333Offsetting collections credited to expired accounts ...........4052

334Additional offsets against budget authority only (total) ........4060

10,32411,21811,255Budget authority, net (discretionary) .........................................4070

10,95612,04210,599Outlays, net (discretionary) .......................................................4080Mandatory:


..................................2Outlays from new mandatory authority .............................4100Offsets against gross budget authority and outlays:


Additional offsets against gross budget authority only:..................................–1Change in uncollected pymts, Fed sources, unexpired .......4140

–2–2.................Outlays, net (mandatory) ...........................................................417010,32411,21811,255Budget authority, net (total) ..........................................................418010,95412,04010,599Outlays, net (total) ........................................................................4190

The request totals $10.3 billion, including almost $9.3 billion for HeadStart. This request discontinues funding for the Community Services BlockGrant, Rural Community Facilities, and Community Economic Develop-ment.




114116113Full-time permanent .............................................................11.1444Other than full-time permanent ............................................11.3111Military personnel ..................................................................11.7

119121118Total personnel compensation ...........................................11.9363636Civilian personnel benefits ........................................................12.1333Travel and transportation of persons .........................................21.0

161710Rental payments to GSA ............................................................23.1221Communications, utilities, and miscellaneous charges ............23.3


434649Other goods and services from Federal sources ........................25.3221Operation and maintenance of facilities ...................................25.4111Supplies and materials .............................................................26.0




Employment Summary




✦

CHILDREN'S RESEARCH AND TECHNICAL ASSISTANCE



Obligations by program activity:121910Training and technical assistance ............................................0001252824Federal parent locator service ...................................................0002

374734Total direct obligations ..................................................................0799323124Federal Parent Locator Service reimbursable ............................0801










373534Appropriations, mandatory (total) .........................................1260



CHILDREN'S RESEARCH AND TECHNICAL ASSISTANCE—Continued



Spending authority from offsetting collections, mandatory:313122Collected ...........................................................................1800111Offsetting collections (previously unavailable) .................1802









–6–6–6Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060




Outlays, gross:..................................3Outlays from discretionary balances .................................4011






–31–31–22Offsets against gross budget authority and outlays (total) ....4130




This account provides funding for research and technical assistanceactivities established by the Personal Responsibility and Work OpportunityReconciliation Act of 1996 (P.L. 104–193), as amended by the DeficitReduction Act of 2005 (P.L. 109–171). A set of proposals would provideadditional access to the National Directory of New Hires.



Direct obligations:987Personnel compensation: Full-time permanent .........................11.1332Civilian personnel benefits ........................................................12.1111Travel and transportation of persons .........................................21.0333Rental payments to GSA ............................................................23.1

.................21Advisory and assistance services ..............................................25.1788Other services from non-Federal sources ..................................25.26126Other goods and services from Federal sources ........................25.39106Operation and maintenance of equipment ................................25.7



Employment Summary



CHILDREN'S RESEARCH AND TECHNICAL ASSISTANCE




Obligations by program activity:3..................................Federal Parent Locator Service reimbursable ............................0801



Spending authority from offsetting collections, mandatory:3..................................Collected ...........................................................................18003..................................Budget authority (total) .............................................................19003..................................Total budgetary resources available ..............................................1930





3..................................Outlays from new mandatory authority .............................4100Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:–3..................................Federal sources .................................................................4120





Reimbursable obligations:1..................................Advisory and assistance services ..............................................25.12..................................Other goods and services from Federal sources ........................25.3



Employment Summary



✦

PAYMENTS FOR FOSTER CARE AND PERMANENCY

For carrying out, except as otherwise provided, title IV-E of the Social SecurityAct, $6,035,000,000.

For carrying out, except as otherwise provided, title IV-E of the Social SecurityAct, for the first quarter of fiscal year 2020, $2,800,000,000.

For carrying out, after May 31 of the current fiscal year, except as otherwiseprovided, section 474 of title IV-E of the Social Security Act, for the last 3 monthsof the current fiscal year for unanticipated costs, incurred for the current fiscalyear, such sums as may be necessary.





Obligations by program activity:5,3295,2785,363Foster care ................................................................................0001140140140Independent living ....................................................................0002

3,0632,8612,706Adoption assistance ..................................................................0004203186145Guardianship ............................................................................0005

333Technical Assistance and Implementation Services for Tribal

Programs ...............................................................................0006






6,0385,9686,057Appropriations, mandatory (total) .........................................1260Advance appropriations, mandatory:

2,7002,5002,300Advance appropriation ..................................................12708,7388,4688,357Budget authority (total) .............................................................19008,7388,4688,357Total budgetary resources available ..............................................1930
















This account provides formula grants for Foster Care, Adoption Assist-ance, Guardianship Assistance Program, and the Chafee Foster Care Inde-pendence Program, as well as technical assistance and implementationservices for tribal programs.

Foster Care—The proposed level will support eligible low-income chil-dren who must be placed outside the home. An average of 171,400 childrenper month are estimated to be served in FY 2019.

Adoption Assistance—The proposed funding level will support subsidiesfor families adopting eligible low-income children with special needs. Anaverage of 496,300 children per month are estimated to be served in FY2019.

Guardianship Assistance Program—The proposed funding level willprovide payments for relatives taking legal guardianship of eligible childrenwho have been in foster care. An average of 35,600 children per monthare estimated to be served in FY 2019.

The Budget includes proposals to create the Child Welfare FlexibleFunding Option for title IV-E agencies, create a performance incentive forachieving or exceeding Child and Family Services Reviews outcomes, re-form the requirement for title IV-E agencies to calculate the savings incosts based on obsolete adoption program criteria, and authorize tribal titlesIV-B and IV-E agencies to access certain information from the FederalParent Locator Service. Additionally, the Budget includes the interactioneffects from the proposal to eliminate SSBG funding, which increases costsin FCP due to State agencies shifting eligible expenses previously fundedby SSBG to FCP.



Direct obligations:11.................Travel and transportation of persons .........................................21.0111Rental payments to GSA ............................................................23.1

353432Advisory and assistance services ..............................................25.1..................................1Other services from non-Federal sources ..................................25.2



Employment Summary



PAYMENTS FOR FOSTER CARE AND PERMANENCY




Obligations by program activity:4..................................Foster care ................................................................................0001

13..................................Adoption assistance ..................................................................00041..................................Guardianship ............................................................................0005

18..................................Total new obligations, unexpired accounts (object class 41.0) .......0900


Appropriations, mandatory:18..................................Appropriation ....................................................................120018..................................Budget authority (total) .............................................................190018..................................Total budgetary resources available ..............................................1930






✦

ADMINISTRATION FOR COMMUNITY LIVINGFederal Funds

AGING AND DISABILITY SERVICES PROGRAMS

(INCLUDING TRANSFER OF FUNDS)

For carrying out, to the extent not otherwise provided, the Older Americans Actof 1965 ("OAA"), titles III and XXIX of the PHS Act, sections 1252 and 1253 of thePHS Act, section 119 of the Medicare Improvements for Patients and Providers Actof 2008, title XX-B of the Social Security Act, the Developmental Disabilities Assist-ance and Bill of Rights Act, parts 2 and 5 of subtitle D of title II of the Help AmericaVote Act of 2002, the Assistive Technology Act of 1998, title VII (and section 14

469DEPARTMENT OF HEALTH AND HUMAN SERVICESAdministration for Community Living

Federal Funds

AGING AND DISABILITY SERVICES PROGRAMS—Continued

with respect to such title) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals with dis-abilities, $1,781,181,000: Provided, That amounts appropriated under this headingmay be used for grants to States under section 361 of the OAA only for diseaseprevention and health promotion programs and activities which have been demon-strated through rigorous evaluation to be evidence-based and effective: Providedfurther, That of amounts made available under this heading to carry out sections311, 331, and 336 of the OAA, up to one percent of such amounts shall be availablefor developing and implementing evidence-based practices for enhancing seniornutrition: Provided further, That notwithstanding any other provision of this Act,funds made available under this heading to carry out section 311 of the OAA maybe transferred to the Secretary of Agriculture in accordance with such section:Provided further, That none of the funds made available under this heading may beused by an eligible system (as defined in section 102 of the Protection and Advocacyfor Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue anylegal action in a Federal or State court on behalf of an individual or group of indi-viduals with a developmental disability (as defined in section 102(8)(A) of the De-velopmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 U.S.C.15002(8)(A)) that is attributable to a mental impairment (or a combination of mentaland physical impairments), that has as the requested remedy the closure of Stateoperated intermediate care facilities for people with intellectual or developmentaldisabilities, unless reasonable public notice of the action has been provided to suchindividuals (or, in the case of mental incapacitation, the legal guardians who havebeen specifically awarded authority by the courts to make healthcare and residentialdecisions on behalf of such individuals) who are affected by such action, within 90days of instituting such legal action, which informs such individuals (or such legalguardians) of their legal rights and how to exercise such rights consistent withcurrent Federal Rules of Civil Procedure: Provided further, That the limitations inthe immediately preceding proviso shall not apply in the case of an individual whois neither competent to consent nor has a legal guardian, nor shall the proviso applyin the case of individuals who are a ward of the State or subject to public guardian-ship.




Obligations by program activity:1,4631,4381,468Aging Services Programs ...........................................................0101

383939ACL Program Administration .....................................................0102414343Integrated Aging and Disability Services Programs ...................0103

239283284Disability Services Programs .....................................................0104

.................103104National Institute on Disability, Independent Living & Rehab

Research ...............................................................................0105


1,7811,9061,938Total direct obligations ..................................................................0799189090ACL Reimbursable Programs .....................................................0801





accounts ...........................................................................1012




..................................–3Appropriations transferred to other accts [012–3507] .......1120


.................25.................Appropriations transferred from other acct [075–0116] ....1121


..................................28PPHF Appropriations transferred from other accounts

[075–0116] ..................................................................1221



186567Spending auth from offsetting collections, disc (total) .........1750

Spending authority from offsetting collections, mandatory:.................231Collected ...........................................................................1800..................................23Change in uncollected payments, Federal sources ............1801

.................2324Spending auth from offsetting collections, mand (total) .......18501,7992,0192,031Budget authority (total) .............................................................19001,8292,0262,036Total budgetary resources available ..............................................1930





















Outlays, gross:.................51Outlays from new mandatory authority .............................4100






..................................28Budget authority, net (mandatory) ............................................4160435346Outlays, net (mandatory) ...........................................................4170


This account funds formula and discretionary grants that provide homeand community-based services and supports to assist older adults and peopleof all ages with disabilities to live independently and to fully participatein their communities. ACL works with states, localities, tribal organizations,nonprofit organizations, businesses and families, and through networks ofaging and disability organizations, to provide these services and supportswhich include nutrition, supportive, caregiver, independent living, andprotection and advocacy services.



Direct obligations:172122Personnel compensation: Full-time permanent .........................11.1667Civilian personnel benefits ........................................................12.1

THE BUDGET FOR FISCAL YEAR 2019470 Administration for Community Living—ContinuedFederal Funds—Continued

332Rental payments to GSA ............................................................23.1313341Advisory and assistance services ..............................................25.1




Employment Summary


139170181Direct civilian full-time equivalent employment ............................1001101315Reimbursable civilian full-time equivalent employment ...............2001

AGING AND DISABILITY SERVICES PROGRAMS




Obligations by program activity:2525.................Integrated Aging and Disability Services Programs ...................0103

2525.................Total, direct program .....................................................................0300

2525.................Total direct obligations ..................................................................0799


Spending authority from offsetting collections, mandatory:2525.................Collected ...........................................................................18002525.................Budget authority (total) .............................................................19002525.................Total budgetary resources available ..............................................1930


2525.................New obligations, unexpired accounts ....................................3010–25–25.................Outlays (gross) ......................................................................3020



2525.................Outlays from new mandatory authority .............................4100Offsets against gross budget authority and outlays:

Offsetting collections (collected) from:–25–25.................Federal sources .................................................................4120



The Budget extends mandatory funding for ACL's Medicare EnrollmentAssistance Programs through fiscal year 2019.



Direct obligations:11.................Personnel compensation: Full-time permanent .........................11.1

2424.................Grants, subsidies, and contributions ........................................41.0

2525.................Direct obligations ..................................................................99.0


Employment Summary


64.................Direct civilian full-time equivalent employment ............................1001

✦

DEPARTMENTAL MANAGEMENTFederal Funds

GENERAL DEPARTMENTAL MANAGEMENT

For necessary expenses, not otherwise provided, for general departmental man-agement, including the hire of six passenger motor vehicles, and for carrying out

titles III, XVII, XXI, and section 229 of the PHS Act, the United States-Mexico BorderHealth Commission Act, and research studies under section 1110 of the Social Se-curity Act, $289,545,000, together with $53,445,000 from the amounts availableunder section 241 of the PHS Act to carry out national health or human servicesresearch and evaluation activities: Provided, That funds provided in this Act forembryo adoption activities may be used to provide to individuals adopting embryos,through grants and other mechanisms, medical and administrative services deemednecessary for such adoptions: Provided further, That such services shall be providedconsistent with 42 CFR 59.5(a)(4).




Obligations by program activity:290458461General Departmental Management ..........................................0001191195153GDM Collected (Reimbursable) ..................................................08011077HCFAC (Mandatory) ...................................................................0802536464PHS Evaluation (Collected) ........................................................0803555MACRA (Mandatory) ..................................................................0804




111110Unobligated balance brought forward, Oct 1 .........................1000..................................10Discretionary unobligated balance brought fwd, Oct 1 ......1001

Budget authority:Appropriations, discretionary:

290458461Appropriation ....................................................................1100..................................–1Appropriations transferred to other accts [075–1503] .......1120

290458460Appropriation, discretionary (total) .......................................1160Spending authority from offsetting collections, discretionary:



1512.................Collected ...........................................................................1800..................................12Change in uncollected payments, Federal sources ............1801
















Offsetting collections (collected) from:–244–259–158Federal sources: ................................................................4030


471DEPARTMENT OF HEALTH AND HUMAN SERVICESDepartmental Management

Federal Funds

GENERAL DEPARTMENTAL MANAGEMENT—Continued







Outlays, gross:15126Outlays from new mandatory authority .............................4100

..................................5Outlays from mandatory balances ....................................4101





..................................8Outlays, net (mandatory) ...........................................................4170290458460Budget authority, net (total) ..........................................................4180471348555Outlays, net (total) ........................................................................4190

Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflectsestimates of the allocation for 2019. Actual allocation will be determined annually.

General Departmental Management (GDM) funds activities that provideleadership, policy, legal, and administrative guidance to HHS components,and support research to develop policy initiatives and improve existingHHS programs. GDM also funds the activities of the Office of the AssistantSecretary for Health, including adolescent health, disease prevention andhealth promotion, physical fitness and sports, minority health, researchintegrity, women's health, and programs funded through the Preventionand Public Health Fund.





103102101Total personnel compensation ...........................................11.9292928Civilian personnel benefits ........................................................12.1111Military personnel benefits ........................................................12.2444Travel and transportation of persons .........................................21.0

161617Rental payments to GSA ............................................................23.1222Communications, utilities, and miscellaneous charges ............23.3111Printing and reproduction .........................................................24.0

162122Advisory and assistance services ..............................................25.1284545Other services from non-Federal sources ..................................25.2316770Other goods and services from Federal sources ........................25.3666Operation and maintenance of facilities ...................................25.4555Operation and maintenance of equipment ................................25.7222Supplies and materials .............................................................26.0222Equipment .................................................................................31.0




Employment Summary




242422Reimbursable military average strength employment ...................2101

GENERAL DEPARTMENTAL MANAGEMENT




Obligations by program activity:4..................................DAB (Mandatory Proposal and User Fee Collections) .................0804



Spending authority from offsetting collections, mandatory:4..................................Collected ...........................................................................18004..................................Total budgetary resources available ..............................................1930









Legislative proposals provide the Departmental Appeals Board (DAB)mandatory resources to address the Medicare appeals backlog.



2..................................Reimbursable obligations: Personnel compensation: Full-time

permanent .............................................................................11.1

2..................................Total personnel compensation ...........................................11.92..................................Other goods and services from Federal sources ........................25.3



Employment Summary


14..................................Reimbursable civilian full-time equivalent employment ...............2001

✦

PAYMENT TO THE STATE RESPONSE TO THE OPIOID ABUSE CRISIS ACCOUNT, CURES

ACT



Obligations by program activity:.................500500Opioid Funding ..........................................................................0001

.................500500Total new obligations, unexpired accounts (object class 94.0) .......0900


Appropriations, mandatory:.................500500Appropriation ....................................................................1200.................500500Total budgetary resources available ..............................................1930


.................500500New obligations, unexpired accounts ....................................3010

THE BUDGET FOR FISCAL YEAR 2019472 Departmental Management—ContinuedFederal Funds—Continued

.................–500–500Outlays (gross) ......................................................................3020







✦

STATE RESPONSE TO THE OPIOID ABUSE CRISIS, CURES ACT




Current law:

.................500500General Fund Payment, State Response to the Opioid Abuse

Crisis, CURES Act ..............................................................1140


Current law:.................–497–500State Response to the Opioid Abuse Crisis, Cures Act ...........2101





Appropriations, discretionary:.................497500Appropriation (special or trust fund) .................................1101.................–497–500Appropriations transferred to other acct [075–1362] ........1120...................................................Budget authority, net (total) ..........................................................4180...................................................Outlays, net (total) ........................................................................4190

The 21st Century Cures Act authorized in 2017 and 2018 grants to states,the District of Columbia, and territories to develop and provide opioid abuseprevention, treatment, and recovery support services.

✦

OFFICE FOR CIVIL RIGHTS

For expenses necessary for the Office for Civil Rights, $30,904,000.Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget




Obligations by program activity:313939Office for Civil Rights (Direct) ...................................................00011398Office for Civil Rights (Reimbursable) .......................................0801



373624Unobligated balance brought forward, Oct 1 .........................1000..................................–1Adjustment of unobligated bal brought forward, Oct 1 .........1020




..................................2Offsetting collections (previously unavailable) .................1802







–44–47–43Outlays (gross) ......................................................................3020


..................................–1Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060

..................................1Change in uncollected pymts, Fed sources, expired ..............3071Memorandum (non-add) entries:











Outlays, gross:11.................Outlays from new mandatory authority .............................4100



Offsetting collections (collected) from:–10–10–20Non-Federal sources .........................................................4123313940Budget authority, net (total) ..........................................................4180343722Outlays, net (total) ........................................................................4190


The Office for Civil Rights funds activities that carry out the Department'scivil rights nondiscrimination, health information privacy, and securitycompliance programs.





171817Total personnel compensation ...........................................11.9666Civilian personnel benefits ........................................................12.1333Rental payments to GSA ............................................................23.141011Other goods and services from Federal sources ........................25.3111Operation and maintenance of facilities ...................................25.4

.................11Operation and maintenance of equipment ................................25.7



Employment Summary



473DEPARTMENT OF HEALTH AND HUMAN SERVICESDepartmental Management—Continued


OFFICE FOR CIVIL RIGHTS—Continued

Employment Summary—Continued


111Direct military average strength employment ................................1101111Reimbursable civilian full-time equivalent employment ...............2001

✦

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION

TECHNOLOGY

For expenses necessary for the Office of the National Coordinator for Health In-formation Technology, including grants, contracts, and cooperative agreements forthe development and advancement of interoperable health information technology,$38,381,000.




Obligations by program activity:386060Health information technology (IT) ............................................0001

..................................2Recovery Act activities ..............................................................0002

386062Total direct obligations ..................................................................0799

151919Office of the National Coordinator for Health IT (ONC):

Reimbursable ........................................................................0801




112Unobligated balance brought forward, Oct 1 .........................1000Budget authority:


Spending authority from offsetting collections, discretionary:15199PHS and Other ...................................................................1700











34566Obligated balance, start of year ............................................3100–5345Obligated balance, end of year ..............................................3200









386060Budget authority, net (discretionary) .........................................40704610281Outlays, net (discretionary) .......................................................4080386060Budget authority, net (total) ..........................................................41804610281Outlays, net (total) ........................................................................4190

This program supports coordination, leadership, and development ofFederal health information technology activities and Federal initiatives forthe nationwide advancement of private and secure interoperable health in-formation technology, in cooperation with participants in the health sector.The Office of the National Coordinator for Health Information Technologywas authorized in Title XXX of the PHS Act as added by the Health In-formation Technology for Economic and Clinical Health (HITECH) Act(P.L. 111–5, Title XIII) and the 21st Century Cures Act (P.L. 114–255),for the purpose of addressing strategic planning, coordination, and theanalysis of key technical, economic and other issues related to the publicand private adoption of health information technology.





202021Total personnel compensation ...........................................11.9456Civilian personnel benefits ........................................................12.1224Rental payments to GSA ............................................................23.1111Communications, utilities, and miscellaneous charges ............23.3

..................................1Advisory and assistance services ..............................................25.151512Other services from non-Federal sources ..................................25.261613Other goods and services from Federal sources ........................25.3

.................11Operation and maintenance of facilities ...................................25.4

..................................1Grants, subsidies, and contributions ........................................41.0



Employment Summary



✦

OFFICE OF MEDICARE HEARINGS AND APPEALS

For expenses necessary for the Office of Medicare Hearings and Appeals,$112,381,000, to be transferred in appropriate part from the Federal Hospital In-surance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund:Provided, That, in addition, of the amounts the Secretary retains for adjudicationsrelated to Recovery Audit Contractor (RAC) appeals under section 1893(h)(1)(C)of the Social Security Act, $10,000,000 shall be used as additional funds for thenecessary expenses of the Office of Medicare Hearings and Appeals and the Depart-mental Appeals Board to process RAC-related appeals.




Obligations by program activity:112107107Office of Medicare Hearings and Appeals (Direct) .....................0001

112107107Total direct obligations ..................................................................079910..................................Office of Medicare Hearings and Appeals (RAC Mandatory) .......0801







10..................................Collected ...........................................................................1800122107107Budget authority (total) .............................................................1900122107107Total budgetary resources available ..............................................1930





..................................28Unpaid obligations, end of year .................................................3050Uncollected payments:











.................28–5Outlays, net (discretionary) .......................................................4080Mandatory:





.................28–5Outlays, net (total) ........................................................................4190

This appropriation funds the operations of the Office of Medicare Hear-ings and Appeals (OMHA), as authorized by the Medicare PrescriptionDrug, Improvement, and Modernization Act of 2003. OMHA provides anindependent and impartial forum for the adjudication of claims brought byor on behalf of Medicare beneficiaries related to their benefits and care.




636155Full-time permanent .............................................................11.111.................Other personnel compensation ..............................................11.5

646255Total personnel compensation ...........................................11.9212018Civilian personnel benefits ........................................................12.1778Rental payments to GSA ............................................................23.1443Communications, utilities, and miscellaneous charges ............23.32110Other services from non-Federal sources ..................................25.2

11109Other goods and services from Federal sources ........................25.3111Operation and maintenance of facilities ...................................25.4111Operation and maintenance of equipment ................................25.71.................1Supplies and materials .............................................................26.0

.................11Equipment .................................................................................31.0




Employment Summary


705690603Direct civilian full-time equivalent employment ............................100145..................................Reimbursable civilian full-time equivalent employment ...............2001

OFFICE OF MEDICARE HEARINGS AND APPEALS




Obligations by program activity:129..................................Reimbursable program activity .................................................0801


Spending authority from offsetting collections, mandatory:129..................................Collected ...........................................................................1800129..................................Total budgetary resources available ..............................................1930









This legislative proposal provides the Office of Medicare Hearings andAppeals (OMHA) mandatory resources to address the Medicare appealsbacklog. An additional legislative proposal would establish a post-adjudic-ation user fee for Medicare Parts A and B claim appeals filed by a provideror supplier, or a State Medicaid Agency, with respect to appeals that areunfavorable to the appellant and for appeals that are dismissed.



Reimbursable obligations:28..................................Personnel compensation: Full-time permanent .........................11.19..................................Civilian personnel benefits ........................................................12.11..................................Transportation of things ............................................................22.04..................................Rental payments to GSA ............................................................23.18..................................Communications, utilities, and miscellaneous charges ............23.3

25..................................Other services from non-Federal sources ..................................25.29..................................Other goods and services from Federal sources ........................25.3

38..................................Operation and maintenance of facilities ...................................25.42..................................Supplies and materials .............................................................26.05..................................Equipment .................................................................................31.0


Employment Summary



✦

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

For expenses necessary to support activities related to countering potential biolo-gical, nuclear, radiological, chemical, and cybersecurity threats to civilian popula-tions, and for other public health emergencies, $941,523,000, of which $511,700,000



PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND—Continued

shall remain available until expended for expenses necessary to support advancedresearch and development pursuant to section 319L of the PHS Act and other ad-ministrative expenses of the Biomedical Advanced Research and Development Au-thority: Provided, That funds provided under this heading for the purpose of acquis-ition of security countermeasures shall be in addition to any other funds availablefor such purpose: Provided further, That products purchased with funds providedunder this heading may, at the discretion of the Secretary, be deposited in the Stra-tegic National Stockpile pursuant to section 319F-2 of the PHS Act: Provided further,That $5,000,000 of the amounts made available to support emergency operationsshall remain available through September 30, 2021: Provided further, That up to10 percent of the amounts made available in this paragraph to support advancedresearch and development pursuant to section 319L of the PHS Act may also beused to supplement funds made available in the second paragraph for the purposesprovided therein.

For expenses necessary for procuring security countermeasures (as defined insection 319F-2(c)(1)(B) of the PHS Act) and for carrying out section 319F-2(a) ofthe PHS Act, $1,085,000,000, to remain available until expended: Provided, Thatup to 10 percent of the amounts made available in this paragraph may also be usedto supplement funds made available in the first paragraph to support advanced re-search and development pursuant to section 319L of the PHS Act.

For an additional amount for expenses necessary to prepare for or respond to aninfluenza pandemic, $202,378,000; of which $162,378,000 shall be available untilexpended, for activities including the development and purchase of vaccines, anti-virals, necessary medical supplies, diagnostics, and other surveillance tools:Provided, That funds may be used for the construction or renovation of privatelyowned facilities for the production of pandemic influenza vaccines and other biolo-gics, if the Secretary finds such construction or renovation necessary to secure suf-ficient supplies of such vaccines or biologics.




Obligations by program activity:2,2291,5972,307Public Health and Social Services Emergency Fund ..................0001

2,2291,5972,307Direct program activities, subtotal ................................................010010410476Reimbursable program (FEMA) ..................................................0801

222Reimbursable program activity (OPP) .......................................0802




63123945Unobligated balance brought forward, Oct 1 .........................1000..................................–1Unobligated balance transfer to other accts [075–0128] ......1010

–3–2–2Unobligated balance transfer to other accts [075–0343] ......1010..................................–23Unobligated balance transfer to other accts [075–0943] ......1010..................................–66Unobligated balance transfer to other accts [075–9915] ......1010..................................64Recoveries of prior year unpaid obligations ...........................1021






828278Spending auth from offsetting collections, disc (total) .........17502,3111,6451,592Budget authority (total) .............................................................19002,3711,7662,509Total budgetary resources available ..............................................1930














2,3061,641283Outlays from new discretionary authority ..........................40107672,9081,538Outlays from discretionary balances .................................4011








2,2291,5631,514Budget authority, net (discretionary) .........................................40702,9914,4671,770Outlays, net (discretionary) .......................................................40802,2291,5631,514Budget authority, net (total) ..........................................................41802,9914,4671,770Outlays, net (total) ........................................................................4190

The Public Health and Social Services Emergency Fund (PHSSEF)provides resources to support a comprehensive program to prepare for thehealth and medical consequences of bioterrorism or other public healthemergencies. This account includes funding for the Office of the AssistantSecretary for Preparedness and Response (ASPR), as authorized by thePandemic and All-Hazards Preparedness Reauthorization Act of 2013.Funds will be used for hospital preparedness and other emergency prepared-ness activities including the National Disaster Medical System. ThePHSSEF continues to support the advanced development and procurementof biodefense and pandemic influenza countermeasures. The FY 2019Budget reflects the transfer of the Strategic National Stockpile (SNS) fromthe Centers for Disease Control and Prevention to ASPR.

The PHSSEF also supports the HHS Cybersecurity program, NationalSecurity and Strategic Information programs, and the Medical ReserveCorps.




1268873Full-time permanent .............................................................11.1..................................18Other than full-time permanent ............................................11.3


1349799Total personnel compensation ...........................................11.9463225Civilian personnel benefits ........................................................12.1334Military personnel benefits ........................................................12.2

1768Travel and transportation of persons .........................................21.01.................1Transportation of things ............................................................22.0

29815Rental payments to GSA ............................................................23.1456Communications, utilities, and miscellaneous charges ............23.3

474745904Advisory and assistance services ..............................................25.1116199236Other services from non-Federal sources ..................................25.22225469Other goods and services from Federal sources ........................25.31516Operation and maintenance of facilities ...................................25.4

7541178Research and development contracts .......................................25.5911821Operation and maintenance of equipment ................................25.738358449Supplies and materials .............................................................26.0112Equipment .................................................................................31.0





Employment Summary



✦

TRANSFERS FROM THE PATIENT-CENTERED OUTCOMES RESEARCH TRUST FUND



Obligations by program activity:..................................57AHRQ .........................................................................................0001

272826Office of the Secretary ...............................................................00025079.................NIRSQ ........................................................................................0003





Spending authority from offsetting collections, mandatory:155125115Collected ...........................................................................1800261213171Total budgetary resources available ..............................................1930












...................................................Budget authority, net (total) ..........................................................4180–57–93–3Outlays, net (total) ........................................................................4190

Public Law 111–148 established the Patient-Centered Outcomes ResearchTrust Fund (PCORTF). Beginning in FY 2011, a total of 20 percent of thefunds appropriated or credited to the PCORTF will be transferred eachyear to the Department of Health and Human Services (HHS). As authorizedin section 937 of the Public Health Service Act, HHS will disseminate re-search findings from the Patient-Centered Outcomes Research Instituteand other government-funded comparative clinical effectiveness researchand coordinate Federal health programs to build research and data capacityfor comparative clinical effectiveness research. Transferred funds weredistributed to the Secretary of HHS and the Agency for Healthcare Researchand Quality to carry out these activities. The FY 2019 Budget consolidatesthe Agency for Healthcare Research and Quality within the National Insti-tutes of Health as the National Institute for Research on Safety and Quality.This Institute is proposed to receive the resources from the PCORTF thatthe Agency for Healthcare Research and Quality would have received undercurrent law.



Direct obligations:333Personnel compensation: Full-time permanent .........................11.1

26307Advisory and assistance services ..............................................25.1313122Other goods and services from Federal sources ........................25.3174351Grants, subsidies, and contributions ........................................41.0


Employment Summary



✦

NONRECURRING EXPENSES FUND



Obligations by program activity:175397526Nonrecurring Expenses Fund Projects ........................................0001


693565830Unobligated balance brought forward, Oct 1 .........................1000..................................–300Unobligated balance transfer to other accts [075–1503] ......1010

450525652Unobligated balance transfers between expired and unexpired

accounts ...........................................................................1012




..................................–100Unobligated balance of appropriations permanently

reduced .........................................................................1131

1,1431,0901,091Total budgetary resources available ..............................................1930Memorandum (non-add) entries:








..................................–100Budget authority, gross .........................................................4000Outlays, gross:

307404384Outlays from discretionary balances .................................4011..................................–100Budget authority, net (total) ..........................................................4180


The Nonrecurring Expenses Fund is a no-year account that receivestransfers of expired unobligated balances from discretionary accounts priorto cancellation. The Fund is used for capital acquisition, including facilitiesinfrastructure and information technology infrastructure.



Direct obligations:122Rental payments to GSA ............................................................23.1

102333Advisory and assistance services ..............................................25.154122161Other services from non-Federal sources ..................................25.292026Other goods and services from Federal sources ........................25.3

71156206Operation and maintenance of facilities ...................................25.4134Research and development contracts .......................................25.551013Operation and maintenance of equipment ................................25.7

174560Equipment .................................................................................31.0



NONRECURRING EXPENSES FUND—Continued



71520Land and structures ..................................................................32.0

175396525Direct obligations ..................................................................99.0.................11Adjustment for rounding ...........................................................99.5


Employment Summary



✦

HEALTH INSURANCE REFORM IMPLEMENTATION FUND








151719Unpaid obligations, brought forward, Oct 1 ..........................3000–2–2–1Outlays (gross) ......................................................................3020







Section 1005 of the Health Care and Education Reconciliation Act of2010 (P.L. 111–152) appropriated $1,000,000,000 to the Health InsuranceReform Implementation Fund within the Department of Health and HumanServices. The Fund shall be used for Federal administrative expenses ne-cessary to carry out the requirements of the Patient Protection and Afford-able Care Act of 2010 (P.L. 111–148) and the Health Care and EducationReconciliation Act of 2010.

✦

PREVENTION AND PUBLIC HEALTH FUND




Appropriations, discretionary:.................–25.................Appropriations transferred to other acct [075–0142] ........1120.................–805.................Appropriations transferred to other acct [075–0943] ........1120.................–11.................Appropriations transferred to other acct [075–1362] ........1120

.................–841.................Appropriation, discretionary (total) .......................................1160Appropriations, mandatory:

8009001,000Appropriation ....................................................................1200..................................–28Appropriations transferred to other accts [075–0142] .......1220

–800.................–891Appropriations transferred to other accts [075–0943] .......1220..................................–12Appropriations transferred to other accts [075–1362] .......1220


appropriations permanently reduced [SEQ] ..................1230

.................841.................Appropriations, mandatory (total) .........................................1260


.................–841.................Budget authority, gross .........................................................4000Mandatory:

.................841.................Budget authority, gross .........................................................4090



The Prevention and Public Health Fund supports prevention and publichealth activities. In FY 2019, $800 million is available to support a rangeof public health efforts intended to prevent disease and reduce health carecosts. The Secretary has authority to transfer to accounts within HHS.

✦

PREGNANCY ASSISTANCE FUND



Obligations by program activity:252323Pregnancy Assistance Fund (Direct) ..........................................0001






252523Appropriations, mandatory (total) .........................................1260272523Total budgetary resources available ..............................................1930




–23–24–23Outlays (gross) ......................................................................3020





.................1.................Outlays from new mandatory authority .............................4100232323Outlays from mandatory balances ....................................4101


This appropriation funds competitive grants to States to assist pregnantand parenting teens and women.



Direct obligations:.................11Other goods and services from Federal sources ........................25.3




Employment Summary



✦

SECTION 241 EVALUATION TRANSACTIONS ACCOUNT




418473476Section 241 Evaluation Transactions Account

(Reimbursable) .....................................................................0801






418473476Spending auth from offsetting collections, disc (total) .........1750418473476Total budgetary resources available ..............................................1930



..................................200Obligations ("upward adjustments"), expired accounts ........3011–418–1,003–823Outlays (gross) ......................................................................3020





–5273–18Obligated balance, start of year ............................................3100–527–5273Obligated balance, end of year ..............................................3200










.................530–21Outlays, net (discretionary) .......................................................4080



The Public Health Service (PHS) Act Evaluation Transactions accountsupports the execution of section 241 of the PHS Act.

✦

PROGRAM SUPPORT CENTERFederal Funds

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

For retirement pay and medical benefits of Public Health Service CommissionedOfficers as authorized by law, for payments under the Retired Serviceman's FamilyProtection Plan and Survivor Benefit Plan, and for medical care of dependents and

retired personnel under chapter 55 of title 10, United States Code, such amountsas may be required during the current fiscal year.




Obligations by program activity:469455441Retirement payments ................................................................0001323130Survivors' benefits ....................................................................0002

128121122Medical care ..............................................................................0003
















The number of beneficiaries using the Commissioned Corps system isestimated as follows:

Retirement Pay, Survivor Benefits, and Medical Benefits201920182017

Active Duty:474847674821HHS ......................................................................................................853853832DOJ, BOP ..............................................................................................740646488Homeland Security ...............................................................................565655EPA .......................................................................................................

308289283All Other ...............................................................................................

670566116479Total Active Duty .......................................................................................

Retirees & Survivors:615062006162Retirees ................................................................................................112511351127Retiree family members and survivors .................................................

727573357289Total Retirement Pay ............................................................................141011405913768Total Beneficiaries (active duty, retirees, survivors) .................................

This activity funds annuities of retired Public Health Service (PHS)commissioned officers and survivors of retirees, and medical benefits foractive duty PHS commissioned officers, retirees, and dependents of mem-bers and retirees of the PHS Commissioned Corps.



Direct obligations:501486471Benefits for former personnel ....................................................13.0

479DEPARTMENT OF HEALTH AND HUMAN SERVICESProgram Support Center

Federal Funds

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS—Continued



128121122Medical care ..............................................................................25.6


✦

HHS ACCRUAL CONTRIBUTION TO THE UNIFORMED SERVICES RETIREE HEALTH CARE

FUND



Obligations by program activity:303328Medicare eligible accruals ........................................................0001








303328Outlays from new discretionary authority ..........................4010303328Budget authority, net (total) ..........................................................4180303328Outlays, net (total) ........................................................................4190

The cost of medical benefits for Medicare-eligible beneficiaries is paidfrom the Department of Defense Medicare-Eligible Retiree Health CareFund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authorityis provided for a discretionary appropriation of the annual accrual paymentinto this fund (P.L. No. 108–375, section 725).

✦

HEALTH ACTIVITIES FUNDS








✦

HHS SERVICE AND SUPPLY FUND



Obligations by program activity:1,3331,3951,176Program Support Center ............................................................0801470454441OS activities ..............................................................................0802



295201181Unobligated balance brought forward, Oct 1 .........................100018118176Recoveries of prior year unpaid obligations ...........................1021


Spending authority from offsetting collections, discretionary:1,5081,7621,485Collected ...........................................................................1700


1,5081,7621,561Spending auth from offsetting collections, disc (total) .........17501,9842,1441,818Total budgetary resources available ..............................................1930




–1,508–2,379–1,439Outlays (gross) ......................................................................3020–181–181–76Recoveries of prior year unpaid obligations, unexpired .........3040

4143001,011Unpaid obligations, end of year .................................................3050Uncollected payments:



–236475449Obligated balance, start of year ............................................3100–122–236475Obligated balance, end of year ..............................................3200



1,5081,762857Outlays from new discretionary authority ..........................4010.................617582Outlays from discretionary balances .................................4011






.................617–46Outlays, net (discretionary) .......................................................4080



The HHS Service and Supply Fund (SSF) provides a wide range of logist-ical and support services to components of the Department and other Fed-eral agencies. The Program Support Center includes activities such aspersonnel and payroll support, information technology, financial manage-ment operations, and administrative services, including acquisitions man-agement, building and property management, telecommunication services,medical supplies repackaging and distribution services, and the FederalOccupational Health Service. The Office of the Secretary activities includethe Service and Supply Fund Manager's Office, departmental contracts,audit resolutions, Commissioned Corps force management, web manage-ment, claims, acquisition integration and modernization, small businessconsolidation, grants tracking, the physical security component of the De-partment's implementation of Homeland Security Presidential Directive12, and commercial services management.

Most Commissioned Corps officers work for agencies in the Departmentof Health and Human Services and are reflected in the agencies' personnelsummaries. However, some officers are assigned to other Federal agencies.The allocation account section in the following personnel summary showsofficers assigned to other agencies, which are paid directly by that agency,either through an allocation account or by directly citing that agency's ap-propriation.

THE BUDGET FOR FISCAL YEAR 2019480 Program Support Center—ContinuedFederal Funds—Continued





128127115Total personnel compensation ...........................................11.9343331Civilian personnel benefits ........................................................12.1223Military personnel benefits ........................................................12.2242Travel and transportation of persons .........................................21.0552Transportation of things ............................................................22.0

212019Rental payments to GSA ............................................................23.112128Communications, utilities, and miscellaneous charges ............23.3665Printing and reproduction .........................................................24.0

172165122Advisory and assistance services ..............................................25.11,1471,1651,102Other services from non-Federal sources ..................................25.2

9010987Other goods and services from Federal sources ........................25.3142010Operation and maintenance of facilities ...................................25.4363523Medical care ..............................................................................25.6666645Operation and maintenance of equipment ................................25.7637539Supplies and materials .............................................................26.0554Equipment .................................................................................31.0


Employment Summary


930930930Reimbursable civilian full-time equivalent employment ...............2001717171Reimbursable military average strength employment ...................2101

1,9011,7881,603Allocation account military average strength employment ............3101

✦

Trust Funds

MISCELLANEOUS TRUST FUNDS




Current law:484814Contributions, Indian Health Facilities ..................................1130336Contributions, N.I.H., Unconditional Gift Fund .......................1130

151520Centers for Disease Control, Gifts and Donations .................1130272747Contributions, N.I.H., Conditional Gift Fund ..........................113011.................Contributions to the Indian Health Service Gift Fund ............1130111Interest, Miscellaneous Trust Funds ......................................1140

959588Total current law receipts ..................................................1199

959588Total receipts .............................................................................1999


Current law:–84–90–88Miscellaneous Trust Funds ....................................................2101




Obligations by program activity:11011079Gifts ..........................................................................................0002

9913Contributions, Indian Health Facilities ......................................0003



239199198Unobligated balance brought forward, Oct 1 .........................1000885Recoveries of prior year unpaid obligations ...........................1021

6161.................Recoveries of prior year paid obligations ...............................1033

308268203Unobligated balance (total) ......................................................1050

Budget authority:Appropriations, mandatory:

849088Appropriation (special or trust fund) .................................1201392358291Total budgetary resources available ..............................................1930




–142–142–76Outlays (gross) ......................................................................3020–8–8–5Recoveries of prior year unpaid obligations, unexpired .........3040







Offsetting collections (collected) from:–61–61.................Federal sources .................................................................4120


6161.................Recoveries of prior year paid obligations, unexpired

accounts .......................................................................4143


Memorandum (non-add) entries:343421Total investments, SOY: Federal securities: Par value ...............5000343434Total investments, EOY: Federal securities: Par value ...............5001

Gifts to the Public Health Service are for the benefit of patients and forresearch. Contributions are made for the construction, improvement, exten-sion, and provision of sanitation facilities.





444Total personnel compensation ...........................................11.9111Civilian personnel benefits ........................................................12.1222Travel and transportation of persons .........................................21.0664Advisory and assistance services ..............................................25.1

252517Other services from non-Federal sources ..................................25.2777Other goods and services from Federal sources ........................25.3555Research and development contracts .......................................25.5333Medical care ..............................................................................25.6777Supplies and materials .............................................................26.0111Equipment .................................................................................31.0



Employment Summary



✦

OFFICE OF THE INSPECTOR GENERALFederal Funds

OFFICE OF INSPECTOR GENERAL

For expenses necessary for the Office of Inspector General, including the hire ofpassenger motor vehicles for investigations, in carrying out the provisions of the

481DEPARTMENT OF HEALTH AND HUMAN SERVICESOffice of the Inspector General

Federal Funds

OFFICE OF INSPECTOR GENERAL—Continued

Inspector General Act of 1978, $80,000,000: Provided, That of such amount, neces-sary sums shall be available for providing protective services to the Secretary andinvestigating non-payment of child support cases for which non-payment is a Fed-eral offense under 18 U.S.C. 228.




Obligations by program activity:808181Office of Inspector General (Direct) ...........................................0001

232217206Office of Inspector General HCFAC Trust Fund ...........................0801212116Office of Inspector General (Direct Reimbursable) ....................0802878886Office of Inspector General HCFAC Discretionary .......................0803




204134Unobligated balance brought forward, Oct 1 .........................1000.................71Discretionary unobligated balance brought fwd, Oct 1 ......1001..................................1Unobligated balance transfer from other acct [075–0140] ....1011..................................13Recoveries of prior year unpaid obligations ...........................1021



.................12Appropriations transferred from other acct [075–9911] ....1121

808182Appropriation, discretionary (total) .......................................1160Spending authority from offsetting collections, discretionary:



220202209Collected ...........................................................................1800..................................–7Change in uncollected payments, Federal sources ............1801..................................1Offsetting collections (previously unavailable) .................1802











–114–114–130Uncollected pymts, Fed sources, brought forward, Oct 1 ........3060..................................5Change in uncollected pymts, Fed sources, unexpired ..........3070..................................11Change in uncollected pymts, Fed sources, expired ..............3071














Offsetting collections (collected) from:–208–191–199Federal sources .................................................................4120–12–11–10Non-Federal sources .........................................................4123


..................................7Change in uncollected pymts, Fed sources, unexpired .......41404–8–19Outlays, net (mandatory) ...........................................................4170

808182Budget authority, net (total) ..........................................................4180847647Outlays, net (total) ........................................................................4190


The mission of the Office of Inspector General (OIG) is to protect theintegrity of the U.S. Department of Health and Human Services (HHS)programs and the health and welfare of the people they serve. As establishedby the Inspector General Act of 1978, OIG is an independent and objectiveorganization that fights fraud, waste, and abuse and promotes efficiency,economy, and effectiveness in HHS programs and operations. OIG worksto ensure that Federal dollars are used appropriately and that HHS programswell serve the people that use them. OIG fulfills its mission through a broadrange of audits, evaluations, investigations, and enforcement and complianceactivities. In addition to discretionary appropriations, OIG receives fundsthrough the Health Care Fraud and Abuse Control (HCFAC) account createdby the Health Insurance Portability and Accountability Act of 1996.





424242Total personnel compensation ...........................................11.9161616Civilian personnel benefits ........................................................12.1212Travel and transportation of persons .........................................21.0111Transportation of things ............................................................22.0554Rental payments to GSA ............................................................23.1111Communications, utilities, and miscellaneous charges ............23.3211Other services from non-Federal sources ..................................25.2788Other goods and services from Federal sources ........................25.3111Operation and maintenance of facilities ...................................25.4555Equipment .................................................................................31.0



Employment Summary


347347355Direct civilian full-time equivalent employment ............................10011,3031,2851,253Reimbursable civilian full-time equivalent employment ...............2001

✦

THE BUDGET FOR FISCAL YEAR 2019482 Office of the Inspector General—ContinuedFederal Funds—Continued

GENERAL FUND RECEIPT ACCOUNTS(in millions of dollars)


Offsetting receipts from the public:

9090106General Fund Proprietary Interest Receipts, not Otherwise

Classified ...................................................................075–143500

.................15127Consumer Operated and Oriented Plan Direct Loan

Program, Downward Reestimate of Subsidies ............075–267403

..................................1Downward Reestimates of Subsidies, Health Centers .....075–275830608621633Federal Share of Child Support Collections ....................075–310700

11..................................Federal Share of Child Support Collections: Legislative

proposal, subject to PAYGO ........................................075–310700

343457All Other General Fund Proprietary Receipts Including

Budget Clearing Accounts ..........................................075–322000

743760924General Fund Offsetting receipts from the public .....................................

Intragovernmental payments:

..................................87Undistributed Intragovernmental Payments and

Receivables from Cancelled Accounts ........................075–388500

..................................87General Fund Intragovernmental payments ..............................................

✦

GENERAL PROVISIONSSEC. 201. Funds appropriated in this title shall be available for not to exceed

$50,000 for official reception and representation expenses when specifically approvedby the Secretary.

SEC. 202. None of the funds appropriated in this title shall be used to pay the salaryof an individual, through a discretionary grant or other extramural mechanism, ata rate in excess of Executive Level V, except that this section shall not apply to theHead Start program.

SEC. 203. Notwithstanding section 241(a) of the PHS Act, such portion as theSecretary shall determine, but not more than 2.9 percent, of any amounts appropri-ated for programs authorized under such Act shall be made available for the evalu-ation (directly, or by grants or contracts) and the implementation and effectivenessof programs funded in this title.

(TRANSFER OF FUNDS)SEC. 204. Not to exceed 1 percent of any discretionary funds (pursuant to the

Balanced Budget and Emergency Deficit Control Act of 1985) which are appropriatedfor the current fiscal year for HHS in this Act may be transferred between appropri-ations, but no such appropriation shall be increased by more than 3 percent by anysuch transfer: Provided, That the transfer authority granted by this section shallnot be used to create any new program or to fund any project or activity for whichno funds are provided in this Act: Provided further, That the Committees on Appro-priations of the House of Representatives and the Senate are notified at least 15days in advance of any transfer.

SEC. 205. In lieu of the timeframe specified in section 338E(c)(2) of the PHS Act,terminations described in such section may occur up to 60 days after the executionof a contract awarded in fiscal year 2019 under section 338B of such Act.

SEC. 206. None of the funds appropriated in this Act may be made available toany entity under title X of the PHS Act unless the applicant for the award certifiesto the Secretary that it encourages family participation in the decision of minors toseek family planning services and that it provides counseling to minors on how toresist attempts to coerce minors into engaging in sexual activities.

SEC. 207. Notwithstanding any other provision of law, no provider of servicesunder title X of the PHS Act shall be exempt from any State law requiring notificationor the reporting of child abuse, child molestation, sexual abuse, rape, or incest.

SEC. 208. None of the funds appropriated by this Act (including funds appropriatedto any trust fund) may be used to carry out the Medicare Advantage program if theSecretary denies participation in such program to an otherwise eligible entity (in-cluding a Provider Sponsored Organization) because the entity informs the Secretarythat it will not provide, pay for, provide coverage of, or provide referrals for abor-tions: Provided, That the Secretary shall make appropriate prospective adjustmentsto the capitation payment to such an entity (based on an actuarially sound estimateof the expected costs of providing the service to such entity's enrollees): Providedfurther, That nothing in this section shall be construed to change the Medicareprogram's coverage for such services and a Medicare Advantage organization de-scribed in this section shall be responsible for informing enrollees where to obtaininformation about all Medicare covered services.

SEC. 209. None of the funds made available in this title may be used, in whole orin part, to advocate or promote gun control.

SEC. 210. In order for HHS to carry out international health activities, includingHIV/AIDS and other infectious disease, chronic and environmental disease, andother health activities abroad during fiscal year 2019:

(1) The Secretary may exercise authority equivalent to that available to theSecretary of State in section 2(c) of the State Department Basic Authorities Actof 1956. The Secretary shall consult with the Secretary of State and relevantChief of Mission to ensure that the authority provided in this section is exercisedin a manner consistent with section 207 of the Foreign Service Act of 1980 andother applicable statutes administered by the Department of State.

(2) The Secretary is authorized to provide such funds by advance or reimburse-ment to the Secretary of State as may be necessary to pay the costs of acquisition,lease, alteration, renovation, and management of facilities outside of the UnitedStates for the use of HHS. The Department of State shall cooperate fully withthe Secretary to ensure that HHS has secure, safe, functional facilities thatcomply with applicable regulation governing location, setback, and other facil-ities requirements and serve the purposes established by this Act. The Secretaryis authorized, in consultation with the Secretary of State, through grant or co-operative agreement, to make available to public or nonprofit private institutionsor agencies in participating foreign countries, funds to acquire, lease, alter, orrenovate facilities in those countries as necessary to conduct programs of assist-ance for international health activities, including activities relating to HIV/AIDSand other infectious diseases, chronic and environmental diseases, and otherhealth activities abroad.

(3) The Secretary is authorized to provide to personnel appointed or assignedby the Secretary to serve abroad, allowances and benefits similar to thoseprovided under chapter 9 of title I of the Foreign Service Act of 1980, and 22U.S.C. 4081 through 4086 and subject to such regulations prescribed by theSecretary. The Secretary is further authorized to provide locality-based compar-ability payments (stated as a percentage) up to the amount of the locality-basedcomparability payment (stated as a percentage) that would be payable to suchpersonnel under section 5304 of title 5, United States Code if such personnel'sofficial duty station were in the District of Columbia. Leaves of absence forpersonnel under this subsection shall be on the same basis as that provided undersubchapter I of chapter 63 of title 5, United States Code, or section 903 of theForeign Service Act of 1980, to individuals serving in the Foreign Service.

(TRANSFER OF FUNDS)SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS

Research, may transfer up to 3 percent among institutes and centers from the totalamounts identified by these two Directors as funding for research pertaining to thehuman immunodeficiency virus: Provided, That the Committees on Appropriationsof the House of Representatives and the Senate are notified at least 15 days in ad-vance of any transfer.

(TRANSFER OF FUNDS)SEC. 212. Of the amounts made available in this Act for NIH, the amount for re-

search related to the human immunodeficiency virus, as jointly determined by theDirector of NIH and the Director of the Office of AIDS Research, shall be madeavailable to the "Office of AIDS Research" account. The Director of the Office ofAIDS Research shall transfer from such account amounts necessary to carry outsection 2353(d)(3) of the PHS Act.

SEC. 213. (a) AUTHORITY.—Notwithstanding any other provision of law, the Dir-ector of NIH ("Director") may use funds available under section 402(b)(7) or402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooper-ative agreements, or grants) to carry out research identified pursuant to such section402(b)(7) (pertaining to the Common Fund) or research and activities described insuch section 402(b)(12).

(b) PEER REVIEW.—In entering into transactions under subsection (a), the Directormay utilize such peer review procedures (including consultation with appropriatescientific experts) as the Director determines to be appropriate to obtain assessmentsof scientific and technical merit. Such procedures shall apply to such transactionsin lieu of the peer review and advisory council review procedures that would other-wise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A),492, and 494 of the PHS Act.

SEC. 214. Not to exceed $45,000,000 of funds appropriated by this Act to the insti-tutes and centers of the National Institutes of Health may be used for alteration,repair, or improvement of facilities, as necessary for the proper and efficient conductof the activities authorized herein, at not to exceed $3,500,000 per project.

(TRANSFER OF FUNDS)SEC. 215. (a) The Biomedical Advanced Research and Development Authority

("BARDA") may enter into a contract, for more than one but no more than 10 pro-gram years, for purchase of research services or of security countermeasures, asthat term is defined in section 319F-2(c)(1)(B) of the PHS Act (42 U.S.C.247d–6b(c)(1)(B)), if—

483DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS

(1) funds are available and obligated—(A) for the full period of the contract or for the first fiscal year in which the

contract is in effect; and(B) for the estimated costs associated with a necessary termination of the

contract; and(2) the Secretary determines that a multi-year contract will serve the best interests

of the Federal Government by encouraging full and open competition or promotingeconomy in administration, performance, and operation of BARDA's programs.(b) A contract entered into under this section—

(1) shall include a termination clause as described by subsection (c) of section3903 of title 41, United States Code; and

(2) shall be subject to the congressional notice requirement stated in subsection(d) of such section.SEC. 216. Section 229 of division H of Public Law 114–113 shall continue in effect

through January 1, 2020.SEC. 217. (a) IN GENERAL.—Under the conditions listed in subsection (b), the

Secretary or the head of a major organizational unit within the Department may inthis fiscal year enter into a reimbursable agreement with the head of another majororganizational unit within the Department or of another agency under which—

(1) the head of the ordering agency or unit delegates to the head of the servicingagency or unit the authority to issue a grant or cooperative agreement on behalfof the ordering agency or unit;

(2) the servicing agency or unit will execute or manage a grant or cooperativeagreement on behalf of the ordering agency or unit; and

(3) the ordering agency or unit will reimburse the servicing unit or agency forthe amount of the grant or cooperative agreement and for the service of executingor managing the grant or cooperative agreement.(b) CONDITIONS.—The conditions for making an agreement described in subsection

(a) are that —(1) amounts are available;(2) the head of the ordering agency or unit decides the agreement is in the best

interest of the United States Government; and(3) the agency or unit to execute or manage the grant or cooperative agreement

is able to provide that service.(c) PAYMENT.—Payment shall be made promptly through the Intra-governmental

Payment and Collection system at the request of the agency or unit providing theservice. Payment may be in advance or on providing all or part of the service, andshall be for any part of the estimated or actual cost as determined by the agency orunit providing the service. A bill submitted or a request for payment is not subjectto audit or certification in advance of payment. Proper adjustment of amounts paidin advance shall be made as agreed to by the heads of the agencies or units on thebasis of the amount of the grant or cooperative agreement and the actual cost ofthe service provided.

(d) LIMITATIONS ON FUNDS.—A condition or limitation applicable to amountsfor grant or cooperative agreements of the ordering agency or unit applies to anagreement made under this section and to a grant or cooperative agreement madeunder such agreement.

(e) OBLIGATION OF APPROPRIATIONS.—An agreement made under this sectionobligates an appropriation of the ordering agency or unit. The amount obligated isdeobligated to the extent that the agency or unit providing the service has not in-curred obligations, before the end of the period of availability of the appropriation,in —

(1) awarding the grant or cooperative agreement; or(2) providing the agreed-on services.

(f) NO EFFECT ON OTHER LAWS.—This section does not affect other laws aboutreimbursable agreements.

SEC. 218. There is hereby established in the Treasury of the United States a fundto be known as the "Federal Emergency Response Fund" (the Fund). Amounts inthe Fund shall be available, in addition to any other amount appropriated for suchpurposes, to carry out titles II, III, and XVII of the PHS Act with respect to domesticpreparedness and global health; to prevent, prepare for, or respond to a chemical,biological, radiological, or nuclear threat; to prevent, prepare for, or respond toan emerging infectious disease; and to purchase or lease, and provide for the insur-ance of, passenger motor vehicles for official use in foreign countries. Amounts inthe Fund may only be used for a public health threat or emergency that the Secretarydetermines has significant potential to occur and potential, on occurrence, to affectnational security or the health and security of United States citizens, domesticallyor internationally. The Secretary may transfer to the Fund in this fiscal year andhereafter such amounts as are necessary from any discretionary amounts (pursuantto the Balanced Budget and Emergency Deficit Control Act of 1985) appropriatedin this and subsequent Acts, provided that no such appropriation is reduced by morethan 1 percent. Such transferred amounts shall remain available until expended.

When implementing response activities, amounts in the Fund may be transferred toother accounts of the Department of Health and Human Services for the purposesprovided in this section. The Committees on Appropriations of the House of Repres-entatives and the Senate shall be notified promptly of the initiation of responseactivities under this authority and of any transfer made under the authority providedin this section. The Committees on Appropriations of the House of Representativesand the Senate shall receive a report not later than 45 days after the end of eachquarter in a fiscal year on the unobligated balances in the Response Fund and allactual obligations incurred for that fiscal year, including obligations by program,project, or activity. The transfer authorities in this section are in addition to anyother transfer authority otherwise available to the Department of Health and HumanServices. Products purchased using amounts in the Fund may, at the discretion ofthe Secretary of Health and Human Services, be deposited in the Strategic NationalStockpile under section 319F-2 of the PHS Act.

SEC. 219. Funds appropriated in this Act to accounts that received appropriationsin the Department of Health and Human Services Appropriations Act, 2017, for theadministrative expenses of programs or activities that do not receive appropriationsfrom this Act shall be available for necessary expenses to carry out closure of suchprograms or activities.

SEC. 220. Notwithstanding section 1864(e) of the Social Security Act (42 U.S.C.1395aa(e)), the Secretary shall charge health care facilities or entities fees in caseswhere such facilities or entities have been cited for deficiencies during initial certi-fication, recertification, or substantiated complaint surveys to cover all or a portionof the costs incurred for conducting substantiated complaint surveys and revisitsurveys on such health care facilities and entities. Such fees shall be in addition toany other funds available for conducting such surveys and shall be credited to the"Department of Health and Human Services—Centers for Medicare and MedicaidServices—Program Management" account, to remain available until expended forsuch purpose. No such fees shall be charged to an Indian Health Program (as thatterm is defined in section 4 of the Indian Health Care Improvement Act).

SEC. 221. Section 340B of the Public Health Service Act (42 U.S.C. 256b) isamended—

(a) in subsection (a)(5)(C)—(1) by striking "A covered entity shall permit" and inserting "(i) DUPLICATE

DISCOUNTS AND DRUG RESALE.—A covered entity shall permit"(2) by inserting at the end the following:"(ii) USE OF SAVINGS.—A covered entity shall permit the Secretary to audit

at the Secretary's expense the records of the entity to determine how net incomefrom purchases under this section are used by the covered entity.

"(iii) RECORDS RETENTION.— Covered entities shall retain such recordsand provide such records and reports as deemed necessary by the Secretary forcarrying out this subparagraph.".(b) by adding at the end the following new subsection: "(f) REGULA-

TIONS.—The Secretary may promulgate such regulations as the Secretary determ-ines necessary or appropriate to carry out the provisions of this section.".SEC. 222. (a) IN GENERAL.—A State or tribal organization which receives grant

funds attributable to appropriations under the heading "Department of Health andHuman Services—Administration for Community Living—Aging and DisabilityServices Programs" to carry out programs under parts B, C, D, or E of title III (withrespect to States) or under title VI (with respect to tribal organizations) of the OlderAmericans Act of 1965 (OAA) may elect to transfer up to 100 percent of such receivedfunds among such title III or title VI programs (respectively), subject to OAA sections306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable limitationson such transfers under the OAA or such heading.

(b) NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROV-AL.—A State or tribal organization which elects to make a transfer under subsection(a) shall notify the Secretary of Health and Human Services of such proposedtransfer, including a description of the amount to be transferred, the purposes ofthe transfer, the need for the transfer, and the impact of the transfer on the provisionof services from which the funding would be transferred. The Secretary shall approveany such transfer unless the Secretary determines that such transfer is not consistentwith the objectives of the OAA.

(c) RULES OF CONSTRUCTION.—No transfer of grant funds by a State or tribalorganization under this section shall be construed—

(1) as inconsistent with the authorized use of such funds under the OAA, includ-ing for purposes of OAA administration and oversight by the Secretary; or

(2) to relieve the State or tribal organization from applicable reporting require-ments under the OAA regarding the use of such funds.SEC. 223. Funds available to the Secretary under this or any prior Act that are

available for acquisition of real property or for construction or improvement of fa-cilities shall also be available to make transportation and infrastructure relatedimprovements on property located directly adjacent to property owned by the Fed-

THE BUDGET FOR FISCAL YEAR 2019484 GENERAL PROVISIONS—Continued

eral Government, provided that the primary benefit of such improvements accruesto HHS or the component thereof funding the improvements.

SEC. 224. With respect to an individual who is serving as principal investigatoron one or more grants or cooperative agreements funded by the National Institutesof Health (NIH) under this title, none of the funds made available to NIH by thistitle shall be used, together with any funds from the analogous title in any previousappropriations act, to pay the salary of such individual at a rate exceeding 90 percentof such salary.

SEC. 225. Funds appropriated in this or any prior Act or the Patient Protectionand Affordable Care Act that are available for salaries and expenses of employeesof the Department of Health and Human Services shall also be available for theprimary and secondary schooling of eligible dependents of HHS personnel stationedin the Commonwealth of Puerto Rico, the Commonwealth of the Northern MarianaIslands, and the possessions of the United States at costs not in excess of those paidfor or reimbursed by the Department of Defense.

SEC. 226. Funds appropriated in this or any prior Act or the Patient Protectionand Affordable Care Act that are available for salaries and expenses of employeesof the Department of Health and Human Services shall also be available to paytravel and related expenses of such an employee or of a member of his or her family,when such employee is assigned to duty, in the United States or in a U.S. territory,during a period and in a location that are the subject of a determination of a publichealth emergency under section 319 of the Public Health Service Act and such travelis necessary to obtain medical care for an illness, injury, or medical condition thatcannot be adequately addressed in that location at that time. For purposes of thissection, the term "U.S. territory" means Guam, the Commonwealth of Puerto Rico,the Northern Mariana Islands, the Virgin Islands, American Samoa, or the TrustTerritory of the Pacific Islands.

SEC. 227. Notwithstanding section 12(b) of the Federal Advisory Committee Act,funds made available by this Act for the "National Institutes of Health—Office ofthe Director" account shall also be available to establish and operate the ResearchPolicy Board authorized by section 2034(f) of Public Law 114–255.

485DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES · 2018-02-12 · DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Documents

Transcript of DEPARTMENT OF HEALTH AND HUMAN SERVICES · 2018-02-12 · DEPARTMENT OF HEALTH AND HUMAN SERVICES...