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Department of Health and Human Services

200 Independence Avenue S.W., Washington, D.C. 20201


This document also available at http://www.hhs.gov/asrt/ob/docbudget/2011budgetinbrief.pdf.
TABLE OF CONTENTS

Overview……………………………………………………………………………………. 1
Health Reform……………….…………………………………………………………....... 12
American Recovery and Reinvestment Act………………………………………………... 13
Food and Drug Administration……………………………………………………………... 19
Health Resources and Services Administration…………………………………………….. 22
Indian Health Service………………………………………………………………………. 27
Centers for Disease Control and Prevention………………………………………………... 31
National Institutes of Health………………………………………………………………... 37
Substance Abuse and Mental Health Services Administration…………………………….. 43
Agency for Healthcare Research and Quality……………………………………………… 47
Centers for Medicare & Medicaid Services………………………………………………… 51
Medicare………………………………………………………………………………... 53
Program Integrity Initiative………………………………….......................................... 57
Medicaid………………………………………………………………………………... 60
Children’s Health Insurance Program………………………………………………….. 64
State Grants and Demonstrations……………………………………………………….. 66
Program Management…………………………………………………………………... 69
Administration for Children and Families………………………………………………….. 74
Discretionary Spending…………………………………………………………............ 75
Entitlement Spending…………………………………………………………………... 79
Administration on Aging…………………………………………………………………… 86
Office of the Secretary
General Departmental Management…………...………………………………………... 89
Office of Medicare Hearings and Appeals…………………………...…………………. 91
Office of the National Coordinator for Health Information Technology…...…………... 92
Office for Civil Rights…………...……………………………………………………… 95
Service and Supply Fund………………...……………………………………………… 97
Retirement Pay and Medical Benefits for Commissioned Officers………………..…… 99
Office of Inspector General………………………………………………………………… 100
Emergency Preparedness…………………………………………………………………… 102
Abbreviations and Acronyms……………………………………………………………… 109
ADVANCING THE HEALTH, SAFETY, AND WELL-BEING
OF OUR PEOPLE
FY 2011 President’s Budget for HHS
(dollars in millions)

2011
2009 2010 2011 +/- 2010

Budget Authority (excluding Recovery Act)........................................ 779,419 800,271 880,861 +80,591


Recovery Act Budget Authority............................................................ 55,087 45,162 21,066 -24,096
Total Budget Authority...................................................................... 834,506 845,432 901,927 +56,495
Total Outlays....................................................................................... 794,234 859,763 910,679 +50,916

Full-Time Equivalents........................................................................... 67,875 70,028 72,923 +2,895

Composition of the FY 2011 Budget


$911 Billion in Outlays

Children's
Entitlement
Programs Discretionary
(includes Programs
CHIP) 10%
3.0%
Medicare
51%
TANF
2.3%

Other
Mandatory
Programs
0.4%

Medicaid
33%

General Notes
Detail in this document may not add to the totals due to rounding.

Budget data in this book are presented “comparably” with the FY 2011 Budget, since the location of programs may have
changed in prior years or be proposed for change in FY 2011. This is consistent with past practice, and allows increases
and decreases in this book to reflect true funding changes.

In addition – consistent with past practice – the FY 2010 figures herein reflect final enacted levels.

1 Advancing the Health, Safety, and Well-Being of Our People


ADVANCING THE HEALTH, SAFETY, AND WELL-BEING
OF OUR PEOPLE
The Department of Health and Human Services enhances the health and well-being of Americans by providing for
effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine,
public health, and social services.

T he Department of Health and


Human Services (HHS) Budget,
fraud in the field, increasing
Medicaid audits, and strengthening
Strengthening the Centers for
Medicare & Medicaid Services
consistent with the President’s program oversight while reducing (CMS): The Budget includes
goals, invests in health care, disease costs. $3.6 billion, an increase of
prevention, social services, and $186 million. The request is
scientific research. These This investment, as part of a multi- necessary to meet current
investments will enable HHS to year effort, will augment existing administrative workload demands
protect the health of all Americans resources for combating health care from recent legislative
and provide essential human fraud and abuse and save requirements and continuous
services, especially for those who $9.9 billion over ten years. The beneficiary growth. The request
are least able to help themselves. additional funding will better equip provides targeted investments to
the Federal government to revamp information technology
The President’s FY 2011 Budget minimize inappropriate payments, (IT) systems and optimize staffing
totals $911 billion in outlays, an pinpoint potential weaknesses in levels so that CMS can meet the
increase of $51 billion over program integrity oversight, target future challenges of the Medicare
FY 2010. The Budget proposes emerging fraud schemes by and Medicaid programs and can be
$81 billion in discretionary budget provider and type of service, and an active purchaser of high quality
authority, an increase of establish safeguards to correct and efficient care.
$2.3 billion over FY 2010 on a programmatic vulnerabilities.
comparable basis. Specifically, $110 million of CMS’
The Budget also includes a set of increase is for a new,
HHS’s portion of the American new program integrity proposals comprehensive Health Care Data
Recovery and Reinvestment Act of that will give HHS the necessary Improvement Initiative to transform
2009 (Recovery Act) addresses and tools to fight fraud by enhancing CMS’s data environment from one
responds to critical challenges in provider enrollment scrutiny, focused primarily on claims
our health care and human services increasing claims oversight, processing to one also focused on
systems through investments that improving Medicare’s data analysis state-of-the art data analysis and
immediately impact the lives of capabilities, and reducing information sharing. These
Americans. To fulfill the overutilization of Medicaid changes are vital to modernizing
President’s health care vision, the prescription drugs. These the Medicare and Medicaid
Budget builds on Recovery Act proposals will save approximately programs by making CMS a leader
investments and continues on the $14.7 billion over 10 years. in value-based purchasing,
path to health insurance reform in improving systems security, and
key HHS priority areas. increasing analytic capabilities and
IMPROVING QUALITY OF AND
ACCESS TO HEALTH CARE data sharing with key stakeholders.
REDUCING HEALTH FRAUD
Health Insurance Reform: Increasing Child Health Care
Enhancing Medicare and Congress is focused on health Access: Additional resources
Medicaid Program Integrity: insurance reform to provide distributed to States and Territories
Reducing fraud, waste, and abuse security and stability for Americans after the enactment of the
in government spending is a top with health insurance and expand Children’s Health Insurance
priority for the President. The coverage to those Americans who Program Reauthorization Act of
Budget includes $561 million in do not have insurance. These 2009 resulted in 38 percent of
discretionary resources, an increase reforms will improve the quality of States expanding or improving
of $250 million, to strengthen care, lower costs for families and child health coverage in FY 2009.
Medicare and Medicaid program businesses, and help reduce the Forty-seven States now cover
integrity activities, with a particular Nation’s deficit. children in families with incomes at
emphasis on fighting health care or above 200 percent of the Federal

Advancing the Health, Safety, and Well-Being of Our People 2


poverty guidelines. In September increase of $354 million, that will proposal to extend by an additional
of 2009, CMS awarded $40 million enable the Indian Health Service six months, through June 2011, the
in grants to assist in enrolling the (IHS) to focus on reducing health temporary Federal Medical
over 5 million children who are disparities, supporting Tribal efforts Assistance Percentage (FMAP)
uninsured but eligible for either to deliver quality care, ensuring that increase provided by the Recovery
Medicaid or the Children’s Health IHS services can be supplemented Act. The extension will result in an
Insurance Program. by care purchased outside the additional $25.5 billion to States for
Indian health system where maintaining support for children
Strengthening the Health necessary, and funding health and families helped by Medicaid.
Professions Workforce: facility and medical equipment
The Budget includes $995 million, upgrades. These investments will Advancing Patient-Centered
an increase of $33 million, to ensure continued improvement to Health Research: The Budget
address the shortage of health care support the Administration’s goal includes an additional $261 million,
providers in underserved areas. of significantly reducing health including program support costs, in
This funding will expand loan disparities for American Indians the Agency for Healthcare Research
repayment programs for physicians, and Alaska Natives. and Quality (AHRQ) to support
nurses, and dentists who agree to new research projects. This
practice in medically underserved Enhancing Health Information funding will support the generation,
areas. This funding will also Technology (Health IT): translation, and dissemination of
enable nursing schools to expand The Budget includes $78 million, research that will improve health
their nursing student capacity, and an increase of $17 million, for the care quality and efficiency by
it will provide for workforce Office of the National Coordinator providing patients and clinicians
development grants that will enable for Health Information Technology with evidence-based information to
States to increase access to oral (ONC) to advance the President’s enhance medical decision-making.
health care. health IT initiative by accelerating The Budget also continues to
health IT adoption and electronic support Patient-Centered Health
Expanding Health Centers: health records (EHRs) utilization as Research within NIH. HHS
The Administration remains essential tools to modernizing the continues to invest the $1.1 billion
committed to building on Recovery health care system. The increase for this research provided in
Act investments and ensuring will enable ONC to lead and FY 2009 to AHRQ, NIH, and the
quality access to health centers. coordinate Federal health IT efforts Office of the Secretary by the
The Budget includes an increase of while implementing and evaluating Recovery Act.
$290 million for further expansions Recovery Act health IT programs.
of health center services, including PROMOTING PUBLIC HEALTH
the creation of 25 new access points The Recovery Act also established Transforming Food Safety:
in communities without access to a Medicare and Medicaid health IT The President is committed to
health center, and will facilitate the incentive programs to provide an securing our Nation’s food supply
integration of behavioral health into estimated $20.6 billion over by transforming and improving our
the existing health centers’ primary 10 years for the adoption and food safety system. The Budget
care system. With this increased meaningful use of EHRs. In includes $1.4 billion, an increase of
funding, health centers will be able FY 2011, these programs begin $327 million or 30 percent, for food
to serve a total of more than providing incentive payments to safety efforts that will strengthen
20 million patients in FY 2011. eligible providers. The use of the ability of the Food and Drug
EHRs will improve the reporting of Administration (FDA) and the
Improving Health Outcomes of clinical quality measures and will Centers for Disease Control and
American Indian and Alaska promote health care quality, Prevention (CDC) to prioritize
Natives: The President is efficiency, and patient safety. prevention, strengthen surveillance
committed to improving health and enforcement, and improve
outcomes for American Indian and Protecting Access to Medicaid for response and recovery – key
Alaska Native communities and Low-Income Families: To priorities of the Food Safety
supporting the provision of health continue to fulfill the President’s Working Group the President
care for American Indians and commitment to ensuring access to established in March 2009. CDC
Alaska Natives. The Budget health care for millions of will improve the speed and
includes nearly $5.4 billion, an Americans, the Budget includes a accuracy of foodborne disease

3 Advancing the Health, Safety, and Well-Being of Our People


outbreak detection and also includes $40 million for $222 million, an increase of
investigation. FDA will increase HRSA’s Ryan White program to $16 million, for Autism Spectrum
inspections to improve the security expand access to care for Disorders (ASD). NIH research
of the supply chain and invest in underserved populations, provide will pursue comprehensive and
the analytical tools needed to make life-saving drugs, and improve the innovative approaches to defining
data-driven decisions about how to quality of life for people living with the genetic and environmental
best deploy food safety resources to HIV/AIDS. factors that contribute to ASD,
prevent foodborne illnesses. investigate epigenomic changes in
Prevention: Reducing the burden the brain, and accelerate clinical
Reducing Tobacco Use: In June of chronic disease, collecting and trials of novel pharmacological and
2009, the President signed the using health data to inform behavioral interventions. CDC will
Family Smoking Prevention and decision-making and research, and expand autism monitoring and
Control Act, providing FDA with building an interdisciplinary public surveillance and support an autism
new authorities and responsibilities health workforce are critical awareness campaign. HRSA will
for regulating tobacco use and components to successful increase resources to support
establishing the FDA Center for prevention efforts. The Budget children and families affected by
Tobacco Products. The Budget includes $20 million for a CDC ASD through screening programs
includes $450 million from user initiative to reduce the rates of and evidence-based interventions.
fees to reduce tobacco use in morbidity and disability due to
minors by regulating marketing and chronic disease in up to ten of the Preventing Teen Pregnancy: The
distribution of tobacco products, largest U.S. cities. These cities will Budget includes $183 million
promote public health be able to incorporate the lessons within the Office of Public Health
understanding of harmful learned from implementing and Science for teen pregnancy
constituents of tobacco products, evidence-based prevention and prevention programs. These
and reduce the toll of tobacco- wellness strategies of the Recovery programs will support State, Tribal,
related disease, disability, and Act’s Communities Putting Territory, and community-based
mortality. In addition, $504 million Prevention to Work Initiative. efforts to reduce teen pregnancy
in funding from CDC, the National using evidence-based models and
Institutes of Health (NIH), and the The Budget also includes promising programs needing
Substance Abuse and Mental $10 million at CDC for a new further evaluation. The Budget also
Health Services Administration Health Prevention Corps, which includes $22 million, an increase of
(SAMHSA), will further help will recruit, train, and assign a $7 million, for CDC teen
reduce smoking among teens and cadre of public health professionals pregnancy activities to reduce the
adults and will support research on in State and local health number of unintended pregnancies
preventing tobacco use, departments. This program will through science-based prevention
understanding the basic science of target disciplines with known approaches.
the consequences of tobacco use, shortages such as epidemiology,
and improving treatments for environmental health, and Investing in Drug Demand
tobacco-related illnesses. laboratory science. Reduction: The Budget invests in
innovative approaches to prevent
Preventing and Treating The Budget also includes and treat substance abuse. These
HIV/AIDS: The Budget includes $162 million for Health Statistics, efforts include $23 million to
more than $3 billion, an increase of an increase of $23 million, to implement evidence-based
$70 million, for CDC and the improve CDC’s ability to collect community prevention programs
Health Resources and Services data on the health of the Nation for for young people throughout their
Administration (HRSA) to enhance use by policy-makers and Federal, at-risk years, $14 million to design
HIV/AIDS prevention, care, and State, and local leaders. This and test a community-level early
treatment. This increase includes increase will ensure data warning system to detect emerging
$31 million for CDC to integrate availability on key national health drug threats, and an additional
surveillance and monitoring indicators by supporting electronic $13 million to expand the treatment
systems, address high-risk birth and death records in States capacity of drug courts.
populations, and support and enhancing national surveys.
HIV/AIDS coordination and Global Health: The Budget
service integration with other Addressing Autism Spectrum includes $352 million, an increase
infectious diseases. This increase Disorders: The Budget includes of $16 million, for CDC Global

Advancing the Health, Safety, and Well-Being of Our People 4


Health Programs to build global Protecting Against Pandemic new antiviral drug for critically ill
public health capacity by Influenza: Reassortment of avian, patients, and provided experience
strengthening the global public swine, and human influenza viruses in vaccine and antiviral stockpiling.
health workforce; integrating has led to the emergence of a new
maternal, newborn, and child health strain of H1N1 influenza A virus,
programs; and improving global 2009 H1N1 flu, that is IMPROVING THE WELLBEING
access to clean water, sanitation, transmissible among humans. OF CHILDREN, SENIORS, AND
and hygiene. Additionally, the According to the World Health HOUSEHOLDS
Budget includes $6.4 million in the Organization, more than
Enhancing Quality Early Care
Office of Global Health Affairs 208 countries and overseas
and Education and the Zero to
(OGHA) to support global health territories have reported cases of
Five Plan: The Budget provides
policy leadership and coordination. 2009 H1N1 infection. CDC
critical support for the President’s
estimates that through December
Zero to Five Plan to enhance
FDA Medical Product Safety 12, 2009, there were approximately
quality early care and education for
Initiative: The Budget includes 55 million cases of 2009 H1N1 in
our Nation’s children.
$1.4 billion, an increase of the United States, resulting in about
$101 million, for medical product 246,000 related hospitalizations and
The Budget lays the groundwork
safety. This increase will enable about 11,160 related deaths. On
for a reauthorization of the Child
FDA to invest in tools that will June 24, 2009, Congress
Care and Development Block Grant
enhance the safety of increasingly appropriated $7.65 billion to HHS
and entitlement funding for child
complex drugs, medical devices, for pandemic influenza
care. The Budget includes a total
and biological products. With these preparedness and response to 2009
of $6.6 billion for the Child Care
additional resources, FDA also will H1N1 flu. HHS has been able to
and Development Fund
increase inspections to improve the use these resources to support
(discretionary and entitlement child
security of the supply chain and H1N1 preparedness and response in
care assistance), an increase of
reduce the potential for harm. States and hospitals ($1.44 billion),
$1.6 billion. These resources will
invest in the H1N1 vaccine
PROTECTING AMERICANS enable 1.6 million children to
production ($1.6 billion), and
FROM PUBLIC HEALTH
receive child care assistance in
conduct domestic and international
FY 2011 – approximately
THREATS AND TERRORISM response activities ($75 million).
235,000 more than could be served
Supporting Advanced The Budget includes $302 million in the absence of these additional
Development: The Budget for ongoing pandemic influenza funds. The Budget will help more
includes $476 million, an increase preparedness activities at the CDC, low-income families access critical
of $136 million, for the Biomedical NIH, FDA, and the Office of the services during this continued time
Advanced Research and Secretary for international of economic hardship.
Development Authority (BARDA). activities, virus detection, The Administration’s principles for
This funding will sustain the communications, and research. In reform of the Child Care and
support of next generation addition, the use of balances from Development Fund include
countermeasure development in the June 2009 funds, including establishing a high standard of
high priority areas including approximately $330 million in quality across child care settings,
anthrax and acute radiation FY 2011, will enable HHS to expanding professional
syndrome by allowing the continue advanced development of development opportunities for the
BioShield Special Reserve Fund to cell-based and recombinant child care workforce, and
support both procurement activities vaccines, antivirals, respirators, and promoting coordination across the
and advanced research and other activities that will help ensure spectrum of early childhood
development. The increased the Nation's preparedness for future education programs. The
flexibility will enable BARDA to pandemics. Previous pandemic Administration looks forward to
use Project BioShield to target influenza investments enabled the working with Congress to begin
resources to the most promising 2009 H1N1 response, including crafting a reauthorization proposal
countermeasure candidates, investments that increased the level that will make needed reforms to
whether through advanced of domestic vaccine manufacturing ensure that children receive high
development or acquisition. capacity, supported the quality care that meets the diverse
development and procurement of needs of families and fosters
adjuvants and antivirals, provided a healthy child development.

5 Advancing the Health, Safety, and Well-Being of Our People


Also in support of the President’s such as counseling, training, and includes two proposals focused on
Zero to Five Plan, the Budget respite care for the families of increasing child support collections
includes $8.2 billion, an increase of elderly individuals; $50 million for and a proposal to expand resources
$989 million, for Head Start to transportation, homemaker for non-custodial parents’ access to
serve an estimated assistance, adult day care, and and visitation with their children.
971,000 children, an increase of personal care assistance for elderly
approximately 66,500 children over individuals and their families; and Low Income Home Energy
FY 2008. Early Head Start will $2.5 million for respite care for Assistance (LIHEAP): The
serve approximately family members of people of all Budget proposes a new way to fund
116,000 infants and toddlers in ages with special needs. This LIHEAP to help low-income
FY 2011, nearly twice as many as funding will support households heat and cool their
were served in FY 2008. The 755,000 caregivers with 12 million homes. It provides $3.3 billion in
Budget also includes $118 million hours of respite care and more than discretionary funding and an
for quality enhancements. Since 186,000 caregivers with estimated $2 billion in mandatory
FY 2008, the Administration has counseling, peer support groups, funding. Under this proposal,
invested almost $500 million in and training. mandatory funds will be released
improving the quality of Head Start almost immediately in response to
programs. Additionally, the Supporting Low-Income Families: changes in energy prices or the
Administration plans to implement The Budget includes an extension number of people living in poverty.
key provisions of the 2007 Head of the Temporary Assistance for The $2 billion estimate is based on
Start Act that will improve the Needy Families (TANF) block current projections of Supplemental
quality of Head Start programs. grant and related programs, Nutrition Assistance usage and
including the Contingency Fund energy prices.
Protecting Access to Foster Care and Supplemental Grants, through
and Adoption Assistance for FY 2011. The Budget also includes
INVESTING IN SCIENTIFIC
Vulnerable Children and Youth: $500 million for a new Fatherhood,
RESEARCH AND DEVELOPMENT
To continue to fulfill the Marriage, and Families Innovation
President’s commitment to Fund. The fund will provide Exploring Scientific Opportunities
improving the development, safety, competitive grants to States to in Biomedical Research: The
well-being, and permanency of conduct and rigorously evaluate Budget includes $32.2 billion for
children and youth in foster care, comprehensive responsible NIH, an increase of $1 billion, to
adoption assistance, and fatherhood programs and support innovative projects from
guardianship assistance, the Budget demonstrations geared towards basic to clinical research. This
includes a proposal to extend by an improving child outcomes by effort will be guided by NIH’s five
additional six months, through June improving outcomes for custodial areas of exceptional research
2011, the temporary FMAP parents with serious barriers to opportunities: supporting genomics
increase for foster care and self-sufficiency. The Budget also and other high-throughput
adoption assistance provided by the includes an increase of $2.5 billion technologies; translating basic
Recovery Act. This extension will for the TANF Emergency Fund and science into new and better
result in an additional $237 million makes several program changes treatments; reinvigorating the
over five years to States for focused on strengthening States’ biomedical research community;
maintaining critical services to efforts to enhance using science to enable health care
vulnerable children and youth. employment-related assistance to reform; and focusing on global
low-income families. health. The Administration interest
Administration on Aging (AoA) The Budget includes a one-year, for the high-priority areas of cancer
Caregiver Initiative: $669 million extension of the and autism fits well into these five
To enable families to better care for Federal match to States’ NIH theme areas. In FY 2011, NIH
their aging relatives and support reinvestment of incentive payments estimates it will support a total of
seniors trying to remain into Child Support Enforcement 37,001 research project grants,
independent in their communities, programs. Without this critical including 9,052 new and competing
the Budget provides $102.5 million extension of resources, it is awards.
for a new Caregiver Initiative at estimated that States would reduce
AoA. This funding includes program expenditures by The additional $1 billion will
$50 million for caregiver services, 10 percent. The Budget also enable NIH to capitalize upon

Advancing the Health, Safety, and Well-Being of Our People 6


recent successful investments in disease. New partnerships between Investing in FDA’s Scientific
biomedical research, such as the academia and industry are working Infrastructure: The Budget
Human Genome Project, that have to revitalize the drug development includes $25 million for advancing
provided a powerful foundation for pipeline. An era of personalized regulatory science at FDA. This
a deeper level of understanding medicine is emerging where initiative builds on the President’s
human biology and have opened prevention, diagnosis, and commitment to harness the power
another window into the causes of treatment of disease can be tailored of science for America’s benefit
to an individual rather than using and includes $15 million for
the one-size-fits-all approach that nanotechnology related research,
all too often falls short, wasting which holds great promise for
health care resources and advances in medical products and
potentially subjecting patients to cosmetics. The additional
unnecessary and dangerous medical resources will also enable FDA to
treatments and diagnostic update review standards and
procedures. provide regulatory pathways for
new technologies, such as
biosimilars.

7 Advancing the Health, Safety, and Well-Being of Our People


HHS BUDGET BY OPERATING DIVISON
(mandatory and discretionary dollars in millions)

2011
2009 2010 2011 +/- 2010
Food & Drug Administration:
Program Level....................................................................... 2,751 3,287 4,033 746
Budget Authority .................................................................. 2,062 2,365 2,510 145
Outlays................................................................................... 1,843 2,349 2,429 80

Health Resources and Services Administration:


Budget Authority (excl. Recovery Act) /3........................ 7,328 7,587 7,635 48
Recovery Act Budget Authority /1................................... 2,500 - - -
Outlays................................................................................... 7,267 8,488 8,532 44

Indian Health Service:


Budget Authority (excl. Recovery Act)................................. 3,731 4,202 4,556 354
Recovery Act Budget Authority /1................................... 500 - - -
Outlays................................................................................... 3,644 4,505 4,612 107

Centers for Disease Control and Prevention:


Budget Authority (excl. Recovery Act) /5............................ 6,370 6,477 6,342 -135
Recovery Act Budget Authority /1................................... 300 - - -
Outlays................................................................................... 6,247 6,581 6,491 -90

National Institutes of Health:


Budget Authority (excl. Recovery Act)................................. 30,096 31,255 32,255 1,000
Recovery Act Budget Authority /1................................... 10,400 - -
Outlays................................................................................... 29,847 31,807 37,189 5,382

Substance Abuse and Mental Health Services:


Budget Authority .................................................................. 3,335 3,432 3,541 110
Outlays................................................................................... 3,369 3,349 3,457 108

Agency for Healthcare Research and Quality:


Program Level /6.................................................................. 372 397 611 214
Budget Authority (excl. Recovery Act) ................................ 3 - - -
Recovery Act Budget Authority /2........................................ 700 - - -
Outlays................................................................................... -80 141 317 176

Centers for Medicare & Medicaid Services:


Budget Authority (excl. Recovery Act) /5....................... 657,147 696,077 763,290 67,213
Recovery Act Budget Authority /1,7................................... 31,887 39,865 20,138 -19,727
Outlays .................................................................................. 686,791 733,457 781,713 48,256

Administration for Children and Families:


Budget Authority (excl. Recovery Act)................................. 56,564 46,337 57,897 11,560
Recovery Act Budget Authority.................................. 5,933 5,284 913 -4,371
Outlays................................................................................... 52,211 61,281 58,472 -2,809

Administration on Aging:
Budget Authority (excl. Recovery Act)................................. 1,488 1,513 1,625 112
Recovery Act Budget Authority /1................................... 100 - - -
Outlays................................................................................... 1,453 1,596 1,583 -13

Office of the National Coordinator:


Budget Authority (excl. Recovery Act)................................. 44 42 78 36
Recovery Act Budget Authority /4.................................... 2,000 - - -
Outlays................................................................................... 21 639 851 212

1/ FY 2009 Recovery Act appropriations were provided to fund programmatic costs in multiple fiscal years.
2/ The Recovery Act appropriated $1.1 billion for research that compares the effectiveness of medical options and transferred
$400 million of this amount to NIH. Of the remaining $700 million, $400 million is for allocation at the discretion of the Secretary.
3/ Does not include C/J/S vaccines.
4/ Total includes $20 million transfer to NIST.
5/ Levels are comparably adjusted to show transfer of OGHA activities to CDC.
6/ The AHRQ program level includes $3 million in mandatory BA from the Medicare Improvements for Patients and Providers Act of 2008
(MPIPPA)
7/ Budget Authority for CMS defined as program outlays.

Advancing the Health, Safety, and Well-Being of Our People 8


HHS BUDGET BY OPERATING DIVISON
(mandatory and discretionary dollars in millions)

2011
2009 2010 2011 +/- 2010

Medicare Hearings and Appeals:


Budget Authority................................................................... 65 71 78 7
Outlays................................................................................... 67 71 78 7

Office for Civil Rights


Budget Authority................................................................... 40 43 45 2
Outlays................................................................................... 32 38 42 4

Departmental Management:
Budget Authority (excl. Recovery Act) /5....................... 384 490 594 104
Recovery Act Budget Authority /1................................... - - - -
Outlays .................................................................................. 355 443 543 100

Prevention and Wellness ..........................................................


Recovery Act Budget Authority /1................................... 700
Outlays................................................................................... 158 314 156

Public Health Social Service Emergency Fund:


Budget Authority (excl. Recovery Act)................................. 10,611 738 735 -3
Recovery Act Budget Authority /1................................... 50 - - -
Outlays................................................................................... 1,868 5,179 4,325 -854

Office of Inspector General:


Budget Authority (excl. Recovery Act)................................. 126 62 37 -26
Recovery Act Budget Authority /1................................... 17 13 16 3
Outlays................................................................................... 56 99 90 -9

Program Support Center


(Retirement Pay, Medical Benefits, Misc. Trust Funds):
Budget Authority................................................................... 553 594 637 43
Outlays................................................................................... 466 590 633 43

Offsetting Collections:
Budget Authority................................................................... -1,223 -1,008 -992 16
Outlays................................................................................... -1,223 -1,008 -992 16

Budget Authority (excl. Recovery Act).............................. 779,419 800,271 880,861 +80,591


Total Recovery Act Budget Authority............................... 55,087 45,162 21,066 -24,096
Total Budget Authority....................................................... 834,506 845,432 901,927 +56,495
Outlays.................................................................................. 794,234 859,763 910,679 +50,916

Full-Time Equivalents............................................................ 67,875 70,028 72,923 +2,895

9 Advancing the Health, Safety, and Well-Being of Our People


COMPOSITION OF THE HHS BUDGET
(dollars in millions)
2009 2011
2009 ARRA* 2010 2011 +/- 2010
Discretionary Programs (Budget Authority)
Food and Drug Administration /1............................................ 2,055 -- 2,362 2,508 +146
FDA Program Level /4.............................................. 2,691 -- 3,284 4,032 +748
Health Resources and Services Administration................... 7,243 2,500 7,483 7,511 +28
HRSA Program Level...................................................... 7,296 2,500 7,531 7,561 +29
Indian Health Service.......................................................... 3,581 500 4,052 4,406 +354
IHS Program Level.......................................................... 4,551 500 5,037 5,392 +354
Centers for Disease Control and Prevention........................ 6,568 300 6,475 6,342 -133
CDC Program Level........................................................ 10,339 300 10,521 10,622 +101
National Institutes of Health................................................ 30,396 10,400 31,089 32,089 +1,000
NIH Program Level......................................................... 30,554 10,400 31,247 32,247 +1,000
Substance Abuse and Mental Health Services..................... 3,335 -- 3,432 3,541 +110
SAMHSA Program Level................................................. 3,466 -- 3,563 3,674 +110
Agency for Healthcare Research and Quality...................... -- 700 -- -- --
AHRQ Program Level..................................................... 372 700 397 611 +214
Centers for Medicare & Medicaid Services ....................... 3,230 -- 3,415 3,601 +186
CMS Program Level (Excluding HCFAC)...................... 3,843 -- 4,084 4,211 +126
Administration for Children and Families Services............. 17,307 5,150 17,336 17,480 +144
ACF Program Level........................................................ 17,355 5,150 17,342 17,486 +144
Administration on Aging..................................................... 1,494 100 1,516 1,625 +108
AoA Program Level......................................................... 1,515 100 1,519 1,628 +109
General Departmental Management.................................... 382 -- 490 544 +54
OS Program Level........................................................... 434 -- 562 618 +56
Office for Civil Rights......................................................... 40 -- 41 44 +3
Office of the National Coordinator..................................... 44 2,000 42 78 +36
ONC Program Level........................................................ 61 2,000 61 78 --
Medicare Hearings and Appeals.......................................... 65 -- 71 78 +7
Office of Inspector General................................................. 45 17 50 52 +1
OIG Program Level......................................................... 301 17 292 334 +42
Health Care Fraud and Abuse Control (Discretionary)....... 198 -- 311 561 +250
HCFAC Program Level................................................... 1,459 -- 1,584 1,809 +225
Public Health and Social Services Emergency Fund /2... 10,611 50 738 734 -3
PHSSEF Program Level.................................................. 10,611 50 1,347 1,541 +194
Prevention and Wellness (OS)............................................ -- 700 -- -- --
Medicare Eligible Healthcare Accruals (Com. Corps)........ 35 -- 36 37 +1
Aligning Head Start to Budget Year................................... 1,389 -- -- -- 0
Rescissions of Prior Year Balances..................................... -22 -- -- -- 0
Offset for PHS Evaluation Funds (Prog. Level)................. -943 -- -1,004 -1,193 -189
HCFAC Funds in Agency Prog. Levels or DOJ /3.... -456 -- -455 -556 -101
Total, Discretionary Budget Authority /5................. 87,995 22,417 78,940 81,233 +2,293
Subtotal, Discretionary Program Level 94,957 22,417 87,064 90,252 +3,189
Discretionary Outlays ................................................ 75,603 -- 90,703 92,903 +2,200
*American Recovery and Reinvestment Act of 2009 (ARRA).
1/ FY 2009 budget authority level reflected in the Budget Appendix differ due to the timing and availability of user fee collections.
2/ Reflects Bioshield funding in the year appropriated not in the year funds were transferred from DHS to HHS.
3/ In addition to HCFAC amounts in Agency program levels, $25 million is shown in OIG for Medicaid Integrity (FY 2009, 2010, and 2011);
$25 million in OIG for Medicaid Fraud in FY 2009; and the following amounts transferred to the Department of Justice (DOJ):
$201 million in FY 2009, $211 million in FY 2010, $272 million in FY 2011.
4/ FY 2009 Program Level includes $23.5 million in tobacco fees which are categorized as mandatory only in FY 2009.
5/ As footnote 2 indicates, Bioshield funds transferred from DHS are included on a comparable basis so that changes in the location of funds do not distort the year-to-year
comparisions. In addition, some of the OMB-published tables include an additional $19 million in the FY 2009 accounting adjustments. As a result, on a purely accounting
basis, the FY 2009 total would be $1,744 million lower ($86,250 million); the FY 2010 number $3,033 million higher ($81,972 million), and the change from FY 2010 to
FY 2011 would be $3,033 million lower (-$739 million).

Advancing the Health, Safety, and Well-Being of Our People 10


COMPOSITION OF THE HHS BUDGET
(dollars in millions)
2011
2009 2010 2011 +/- 2010
Mandatory Programs (Outlays) /1:
Medicare................................................................... 424,747 444,003 468,601 +24,598
Medicaid ................................................................. 250,924 275,383 296,841 +21,458
Temporary Assistance for Needy Families................ 18,933 22,083 21,001 -1,082
Foster Care & Adoption Assistance.......................... 6,859 7,403 7,442 +39
Children's Health Insurance Program /2............... 7,547 9,103 10,485 +1,382
Child Support Enforcement....................................... 4,352 4,710 4,324 -386
Child Care................................................................. 2,952 2,925 3,417 +492
Social Services Block Grant...................................... 1,854 2,118 1,832 -286
Other Mandatory Programs....................................... 1,686 2,340 4,825 +2,485
Offsetting Collections................................................ -1,223 -1,008 -992 +16
Subtotal, Mandatory Outlays.................................. 718,631 769,060 817,776 +48,716
Total, HHS Outlays .......................................... 794,234 859,763 910,679 +50,916

1/ FY 2009 and FY 2010 Recovery Act funding included in this table. See details on Mandatory Recovery Act table.
2/ Includes outlays for the Child Enrollment Contingency Fund in FY 2010 & FY 2011.

11 Advancing the Health, Safety, and Well-Being of Our People


HEALTH REFORM
The Administration is committed to reforming the health care system to assure affordable, quality, health coverage for
all Americans.

A HISTORIC STEP FORWARD

H ealth care costs are


consuming an ever-
increasing amount of our
the quality of care, lowering
costs for families and businesses
and helping to both reduce the ♦
65 percent for laid-off
workers and their families;
Ending Insurance
Nation’s resources, straining Nation’s deficit and improve the Discrimination: CMS
family, business, and bottom-line budget of America’s issued rules that protect
government budgets. Rising families. The goal is to ensure Americans’ genetic
premiums hurt the that from now on, Americans information from
competitiveness of American who change or lose their job discrimination by insurers
businesses and erode workers’ will always be able to find and employers.
take-home pay. Health care affordable health insurance ♦ Health Centers: Investing
costs take up a growing share of coverage, regardless of their $2 billion to support
Federal and State budgets and health status. needed capital
are the greatest threat to the improvements and
government’s long-term fiscal PROGRESS TOWARD expanded services,
outlook. HEALTH INSURANCE including new sites and
REFORM extended hours; and
The President laid out principles ♦ Workforce: Investing
in the FY 2010 Budget to As Congress has worked toward $500 million to address
reform health care without health reform, major strides workforce shortages
increasing the deficit and has have already been made in through the National
worked closely with Congress improving care and cutting costs Health Service Corps and
to bring about this much-needed at the Department of Health and other health professions
change. Human Services through key activities.
iniatives like the Recovery Act , ♦ Health IT: Embarking on
Health Reform is necessary to the Genetic Information and an effort to improve health
provide security and stability for Non Discrimination Act and the care quality and efficiency
Americans, who are paying Children’s Health Insurance by computerizing health
more and more for less and less Program (CHIP) records;
high quality health care. It reauthorization: ♦ Prevention: Investing
starts by making insurance ♦ CHIP: Covering millions $1 billion in prevention and
coverage stronger for Americans more uninsured children wellness;
who have insurance ending and providing new tools to ♦ Patient-Centered Health
many of the worst insurance increase outreach and Research: Devoting
industry practices. Reform will enrollment; $1.1 billion to patient-
also expand coverage to ♦ COBRA: Temporarily centered health research.
millions of Americans who do lowering the cost of
not have insurance; improving COBRA coverage by

Health Reform 12
RECOVERY ACT
The American Recovery and Reinvestment Act was signed into law on February 17, 2009. The Recovery Act provides
funding for health IT, research that compares the effectiveness of different medical options, prevention and wellness,
scientific research, social and health care services, and Medicaid relief to the States.

T he American Recovery and


Reinvestment Act (the
meals delivered at home and
in community settings.
with greater transparency and
accountability than ever before.
Recovery Act) provides HHS ♦ Health Centers provided In October 2009, HHS collected
programs an estimated $141 primary health care services the first round of quarterly
billion for Fiscal Years 2009 – to over 1 million new recipient reports as required by
2019. While most provisions in patients. the Recovery Act. About
HHS programs involve rapid 18,000 HHS reports were
These programs and activities
investments, the Recovery Act submitted for discretionary grant
will continue in FY 2010, and
also includes longer term programs and contracts. Although
more will come on line. For
investments in health information HHS managed more reports than
example,
technology (primarily through any other Federal agency, over
Medicare and Medicaid). As a ♦ 64,000 additional children 98 percent of HHS recipients
result, HHS plans to have outlays and their families will entered required data into
totaling $87 billion through participate in a Head Start or FederalReporting.gov. This data
FY 2010. Early Head Start experience. can now be found on
♦ Approximately Recovery.gov.
Since the Recovery Act was
passed in February 2009, HHS 30,000 American Indian and
Accountability: HHS has placed
has made great strides in Alaska Natives’ homes will
a strong emphasis on ensuring
improving access to health and have safe drinking water and
that risks for fraud, waste and
social services, stimulating job adequate waste disposal
abuse are minimized. The
creation, and investing in the facilities.
Department has evaluated all
future of health care reform ♦ HHS will be assisting States
Recovery Act-funded programs to
through advances in health and communities to develop
ensure that funds are awarded and
information technology, capacity, technical assistance
distributed promptly, fairly and in
prevention and scientific research. and a trained workforce to
a responsible manner for
support the rapid adoption of
authorized purposes. HHS will
health IT (information
PROGRAM PERFORMANCE also review projects for
technology) by hospitals and
unnecessary delays or cost
HHS Recovery Act funds have clinicians.
overruns and make sure program
had an immediate impact on the ♦ The Centers for Disease
outcomes are achieved.
lives of individuals and Control and Prevention will
communities across the country support community efforts to HHS RECOVERY ACT
affected by the economic crisis reduce the incidence of PROGRAMS
and the loss of jobs. As of obesity and tobacco use.
New research grants will be HHS Recovery Act activities
September 30, 2009, ♦
awarded to improve health touch the lives of Americans in
♦ The $31.5 billion in Federal numerous areas.
outcomes by developing and
Payments to States helped
disseminating evidence- IMPROVING AND PRESERVING
maintain State Medicaid
based information to HEALTH CARE
services to a growing
patients, clinicians, and other
number of beneficiaries and Medicaid FMAP Increase: The
decision-makers about what
provided fiscal relief to Recovery Act temporarily
interventions are most
States. increases the Federal share of
effective for patients under
♦ The National Institutes of Medicaid expenditures by an
specific circumstances.
Health awarded $5 billion estimated $84.5 billion through a
for biomedical research in 6.2 percent increase in the Federal
TRANSPARENCY AND
over 12,000 grants. Medical Assistance Percentage
♦ Area agencies on aging
ACCOUNTABILITY
(FMAP) for all States, with
provided more than 350,000 Transparency: HHS Recovery additional relief tied to rates of
seniors with over 6 million Act funds are being managed unemployment. Territories also

13 Recovery Act
benefit from increased Medicaid strengthen the health workforce in adoption would be a maximum of
funding. These funds are key areas through direct student $18,000 in 2011, decreasing to
available for obligation until the support, loan repayment, and zero by 2015. Physicians not
end of 2010. support for the purchase of adopting EHRs will see their fee
equipment. schedule payments reduced by
Temporary Increase in DSH
one percent in 2015, growing to
Allotments: The Recovery Act
ACCELERATING THE three percent in 2017 and between
provides an estimated
three to five percent thereafter.
$595 million in increased State ADOPTION OF HEALTH IT
For hospitals, incentive payments
Disproportionate Share Hospital
The Recovery Act includes both will vary based on Medicare
(DSH) payments through a
additional resources and a new inpatient days, hospital
2.5 percent increase in FY 2009
authorization to guide the Federal discharges, and charity care.
and FY 2010 allotments. These
government's health IT activities. Hospitals not adopting EHRs by
payments assist hospitals that
Medicare and Medicaid estimates 2014 will receive a reduced
serve a disproportionate share of
for health IT reflect revised market basket update beginning
low-income or uninsured patients.
estimates of the enacted in 2015.
Transitional Medical Assistance: legislation based on newly
Medicaid Incentives
Beginning in July 2009, the proposed regulations.
($9.7 billion): The Recovery Act
Recovery Act provides an
Incentives for Electronic Health also provides 100 percent Federal
estimated $915 million in
Records: The Recovery Act match of State expenditures for
additional Medicaid expenditures
provides an estimated incentive payments to eligible
by extending Transitional
$20.6 billion in incentives, from Medicaid providers for adoption
Medical Assistance (TMA)
FY 2009 to FY 2019, through and meaningful use of certified
through December 31, 2010. This
Medicare and Medicaid to EHR technology and 90 percent
extension allows States to provide
encourage providers and hospitals Federal match for related State
assistance for longer periods and
to adopt certified electronic health administrative expenses.
waive some requirements for
record (EHR) technology. On Physician payments are subject to
families seeking assistance.
December 30, 2009, the Centers provider dollar limits, and
Qualified Individuals Program: for Medicare & Medicaid hospital payments are based on a
The Recovery Act provides Services (CMS) published a formula prescribed in statute and
approximately $563 million to proposed regulation and the are available to providers over a
extend premium assistance for Office of the National six-year period.
Medicare beneficiaries who are Coordinator (ONC) published an
Office of the National
Qualified Individuals (incomes of interim final regulation (IFR).
Coordinator for Health IT: The
120-135 percent of the poverty These actions lay a foundation for
Recovery Act authorizes Federal
line) through December 31, 2010. improving quality, efficiency, and
health IT efforts through the
safety through meaningful use of
Medicaid and CHIP Provisions Health Information Technology
electronic health record (EHR)
to Benefit American Indians and for Economic and Clinical Health
technology. In the proposed
Alaska Natives: The Recovery Act (HITECH Act) and provides
regulation, CMS outlines
Act provides protections for $2 billion for those efforts. Of
provisions governing the
Indians under Medicaid and the this amount, $693 million will
incentive program, including
Children’s Health Insurance support the HIT Extension
defining the central concept of
Program (CHIP), including Program, $564 million is for the
“meaningful use” of EHR
requirements for managed care State Health Information
technology. The IFR, issued by
organizations, limits on cost- Cooperative Agreement Program,
ONC, sets initial standards,
sharing, and exclusion of certain $235 million will support Beacon
implementation specifications,
property for purposes of Communities to demonstrate the
and certification criteria for
determining eligibility for vision of the future where
EHRs.
Medicaid and CHIP. providers and patients are
Medicare Incentives meaningful users of health IT,
Health Professions: The
($10.9 billion): For each $118 million will support
Recovery Act includes
qualified physician, incentive workforce development, and the
$200 million for HRSA’s health
payments to encourage EHR remainder will focus on privacy
workforce training programs to

Recovery Act 14
and security, standards and water and wastewater sanitation enforcement efforts in a
interoperability, public health, projects, and the purchase of challenging economic climate.
research and evaluation, technical medical equipment.
Foster Care and Permanency:
assistance and funding for the
In addition, $85 million is The Recovery Act provides an
National Institute of Standards
provided for health IT activities estimated $929 million through a
and Technology.
including EHR, telehealth, and 6.2 percentage point FMAP
The HITECH Act also enhances infrastructure developments. increase through December 2010
privacy protections by expanding for maintenance payments to the
the Health Insurance Portability States and Puerto Rico for foster
STRENGTHENING SCIENTIFIC
and Accountability Act (HIPAA) care, adoption assistance, and
to include Medicare Part D, RESEARCH AND FACILITIES kinship guardianship assistance
applying HIPAA security NIH: NIH's two-year infusion of programs.
standards and privacy rules to $10 billion in Recovery Act funds Temporary Assistance for Needy
business associates, and will empower the Nation's best Families (TANF): The Recovery
increasing enforcement and biomedical scientists to discover Act provides $5 billion to States,
penalties for violations. new cures, advance technology, Territories, and Tribes through a
and solve some of our greatest new Emergency Contingency
health challenges. Within the Fund to assist low-income
STRENGTHENING total, the Recovery Act provides
COMMUNITY HEALTH CARE families during the economic
$8.2 billion for general downturn.
SERVICES biomedical research. These funds
support cutting edge research into States can request Emergency
HRSA Health Centers and
treating and preventing such Funds if they have increased
National Health Service Corps:
diseases as cancer, heart disease TANF caseloads and related basic
The Recovery Act provides
and HIV/AIDS. The funds will assistance spending; increased
$1.5 billion to modernize,
allow NIH to expand the Cancer spending on non-recurrent short-
renovate and repair health centers.
Genome Atlas, collecting more term benefits; or increased
These funds will also be used for
that 20,000 tissue samples to spending on subsidized
the acquisition of health IT
sequence the DNA of more than employment. As of December
systems. An additional
20 types of cancer and provide 31, 2009, States have expended
$500 million supports the
the potential to better understand $614 million in TANF Recovery
establishment of 127 new health
and treat this extraordinarily Act funds.
center sites and service areas, and
increased services at over destructive disease. The Recovery Act also includes
1,100 existing sites. $319 million to extend TANF
Of the remaining funds, Supplemental grants through
The Recovery Act also provides $1.3 billion is for extramural FY 2010. These grants provide
$300 million to increase the ranks research infrastructure, including additional assistance to 17 States
of the National Health Service laboratories and shared with historically high population
Corps by placing clinicians in equipment; and $500 million is growth or increased poverty since
health professional shortage for facility construction, repairs, the mid 1990s.
areas. As of December 31, 2009, and renovations at NIH.
the Recovery Act has added more Child Care and Development
than 1,600 primary care Block Grant: The Recovery Act
providers, for a total of
IMPROVING SERVICES FOR provides $2 billion for
4,000 primary care providers that CHILDREN AND supplementing State funds for
have already begun providing COMMUNITIES child care assistance to low-
needed health services in health Child Support Enforcement: An income families. A portion of the
profession shortage areas. estimated $1.8 billion is made funds are also reserved for quality
available to the States through improvement activities. As of the
IHS Facilities: The Recovery Act
FY 2010 to match Federal end of FY 2009, States reported
provides $415 million for the
incentive payments that are spending $247 million in
construction of priority health
reinvested into State programs. Recovery Act funds on direct
care facilities, building
The funding will improve and child care services for low-
maintenance and improvement,
strengthen child support income families, allowing States

15 Recovery Act
to: shorten, eliminate or avoid Nutrition Programs for Seniors: level, and strengthen the capacity
waiting lists for services; increase The Recovery Act includes $100 of States to reduce obesity and
periods of eligibility for job million for nutrition programs for tobacco use, as well as better
search in recognition of high seniors. The funds are bolstering manage chronic disease for the
unemployment; and lower co- assistance provided through Nation’s elderly. The initiative
payments for families who are Congregate Nutrition Services, has a strong emphasis on policy
under economic stress. Home-Delivered Nutrition and environmental change at both
Services, and Native American the State and local levels to:
Head Start and Early Head
Nutrition Services. By the end of increase levels of physical
Start: The Recovery Act provides
FY 2010, programs are expected activity; improve nutrition;
$2.1 billion for Head Start,
to serve nearly 14 million meals. decrease obesity rates; and
including $1.1 billion for Early
decrease smoking prevalence,
Head Start. This significant
SUPPORTING PATIENT- teen smoking initiation, and
increase will expand Head Start
CENTERED HEALTH RESEARCH exposure to second-hand smoke.
and Early Head Start services to
approximately 64,000 additional The Recovery Act provides Of the remaining funds,
children, 50,000 of whom are $1.1 billion in total for research $300 million is for the CDC
children, from birth up to age that compares the effectiveness of Section 317 Immunization
three. Additionally, the Recovery different medical treatments Program; over 1.5 million
Act enabled all grantees to including $300 million for childhood vaccines doses will be
receive a full Head Start staff cost AHRQ, $400 million for NIH, available in FY 2010.
of living increase for FY 2009 and $400 million allocated by the Additionally, $50 million is for
and provides funds to improve the Secretary. The Recovery Act also States to implement strategies for
quality of Head Start and Early established the Federal reducing health care-associated
Head Start programs. Coordinating Council for infections.
Community Services Block Comparative Effectiveness
Grant: The Recovery Act Research, which has developed
definitions, criteria for
IMPROVING ACCOUNTABILITY
provides $1 billion to States to AND IT SECURITY
distribute to community action prioritization and a strategic
agencies to reduce poverty and framework for investments which IT Security: The Recovery Act
assist low-income residents in categorize current activity, provides $50 million to improve
becoming self-sufficient. Eligible identified gaps, and high-priority the security of the HHS IT
entities can serve individuals with recommendations. At the infrastructure. The Recovery Act
incomes up to 200 percent of the framework’s core is funding will support agency-wide
poverty line – an increase above responsiveness to expressed investments and accelerate efforts
the previous limit of 125 percent needs for comparative by HHS to improve security
of the poverty line. effectiveness research to inform architecture. Funds will also
health care decision-making by support security tools to protect
Strengthening Communities patients, clinicians, and the sensitive information and
Fund: The Recovery Act clinical and public health strengthen computer defense
provides $50 million to build the communities. mechanisms against attacks.
capacity of non-profit
organizations, including faith and Accountability: The Recovery
PROMOTING PREVENTION
community-based organizations, Act provides $48 million to the
AND WELLNESS
and government entities to Office of Inspector General for
address the needs of low-income A total of $1 billion is provided oversight and review of HHS
and disadvantaged populations. for prevention and wellness Recovery Act spending and the
The Administration for Children activities. Within this amount, Medicaid Program and to enhance
and Families has made 35 awards $650 million is for the new accountability and enforcement
to community non-profit Communities Putting Prevention activities to prevent fraud, waste
organizations, local foundations, to Work Initiative, which will and abuse.
universities, and 49 awards to expand the use of evidence-based
State, local and Tribal strategies and programs, mobilize
governments. local resources at the community-
.

Recovery Act 16
RECOVERY ACT
(dollars in millions)
Discretionary Programs

Total Resources Obligations


Available FY 2009 FY 2010 FY 2011
Health Resources and Services Administration
Health Centers Modernization, Renovation, and Repair.............................................. 1,500 889 611 --
Health Center Services................................................................................................. 500 497 3 --
National Health Service Corps..................................................................................... 300 66 159 75
Health Professions........................................................................................................ 200 67 133 --
Subtotal, Health Resources and Services Administration....................................... 2,500 1,519 906 75

Indian Health Service


Buildings and Facilities /1............................................................................................ 415 254 161 --
Health Information Technology.................................................................................... 85 40 45 --
Subtotal, Indian Health Service................................................................................ 500 294 206 --

National Institutes of Health


Scientific Research....................................................................................................... 8,200 4,607 3,593 --
Extramural Lab Construction and Renovation.............................................................. 1,000 52 948 --
Buildings and Facilities................................................................................................ 500 50 450 --
Shared Instrumentation grants/contracts....................................................................... 300 53 247 --
Subtotal, National Institutes of Health..................................................................... 10,000 4,762 5,238 --

Administration for Children and Families


Child Care and Development Block Grant (CCDBG).................................................. 2,000 1,997 3 --
Early Head Start........................................................................................................... 1,100 8 1,092 --
Head Start..................................................................................................................... 1,000 569 431 --
Community Services Block Grant (CSBG).................................................................. 1,000 992 8 --
Strengthening Communities Fund................................................................................. 50 48 2 --
Subtotal, Administration for Children and Families............................................... 5,150 3,614 1,536 --

Administration on Aging
Congregate Nutrition Services...................................................................................... 65 65 -- --
Home-Delivered Nutrition Services............................................................................. 32 32 -- --
Native American Nutrition Services............................................................................. 3 3 -- --
Subtotal, Administration on Aging........................................................................... 100 100 -- --

Office of the Inspector General.................................................................................... 17 3 5 5

HHS Information Technology Security....................................................................... 50 6 44 --

Health Information Technology (ONC) /2................................................................... 2,000 1 1,919 35

Prevention and Wellness


Section 317 Immunization Program (CDC).................................................................. 300 155 145 --
Healthy Communities Initiative (CDC, AoA, OS)........................................................ 650 -- 650 --
Healthcare Associated Infections (CDC, CMS)........................................................... 50 41 9 --
Subtotal, Prevention and Wellness............................................................................ 1,000 196 804 --

Patient-Centered Health Research/Comparative Effectiveness


AHRQ........................................................................................................................... 300 5 295 --
NIH............................................................................................................................... 400 192 208 --
Department-wide.......................................................................................................... 400 2 398 --
Subtotal, Patient-Centered Health Research........................................................... 1,100 198 902 --

Total, HHS Recovery Act Discretionary Obligations................................................. 22,417 10,692 11,560 115

Total, HHS Recovery Act Discretionary Outlays....................................................... 22,417 682 8,437 10,100

1/ This does not include $90 million in Sanitation funds from EPA.
2/ These funds remain available until expended.

17 Recovery Act
RECOVERY ACT
(dollars in millions)
Mandatory Programs

FY 2009-FY 2019 FY 2009 FY 2010 FY 2011


Centers for Medicare & Medicaid Services (CMS)
Medicaid
Temporary Increase in Medicaid FMAP....................................................... 84,511 31,511 38,100 14,900
Temporary Increase in Disproportionate Share Hospital Payments.............. 595 75 520 --
Transitional Medical Assistance (TMA) Extension/1................................... 915 30 480 395
Qualified Individuals (QI) Extension............................................................ 563 -- 413 150
Protections for Indians under Medicaid and CHIP/1.................................... 150 5 10 10
Interaction of FMAP Increase with other Medicaid Provisions/1................. 115 5 90 20
Subtotal, Medicaid...................................................................................... 86,849 31,626 39,613 15,475

Medicare & Medicaid Health Information Technology Incentives


Medicare Incentives to Providers.................................................................. 10,850 -- -- 2,410
Medicaid Incentives to Providers.................................................................. 9,729 -- -- 1,828
Medicaid HIT Efficiency Savings................................................................. -100 -- -- -3
State Administrative Costs for Medicaid HIT Implementation..................... 2,308 -- 152 283
Subtotal, Medicare & Medicaid HIT Incentive Payments...................... 22,787 -- 152 4,518

CMS Administration
Medicare HIT Implementation...................................................................... 745 1 62 102
Medicaid HIT Implementation ..................................................................... 300 -- 37 43
Subtotal, CMS Administration of HIT Incentive Payments................... 1,045 1 99 145

Total, CMS HIT Funding (non-add)................................................... 23,832 1 251 4,663

Medicare
Moratorium on Medicare Regulations (Hospice, IME Reduction)/2............ 200 300 ** **
Medicare Moratoria CMS Administration.................................................... 2 2 -- --
Subtotal, Medicare...................................................................................... 202 302 -- --

Administration for Children and Families


TANF Emergency Fund/3............................................................................. 5,000 251 3,229 452
TANF Supplemental Grants.......................................................................... 319 -- 255 64
Child Support Enforcement.......................................................................... 1,817 274 1,300 243
FMAP Increase for Foster Care and Adoption Assistance............................ 929 258 500 154
Subtotal, Administration for Children and Families............................... 8,065 783 5,284 913

Medicaid and Foster Care FMAP Increase Implementation..................... 5 1 4 **

Office of the Inspector General..................................................................... 31 -- 13 16

Total, HHS Recovery Act Mandatory Outlays............................................ 118,984 32,713 45,164 21,066
Total, HHS Recovery Act Discretionary Outlays........................................ 22,417 682 8,437 10,100

Total, HHS Recovery Act Outlays................................................................ 141,401 33,395 53,601 31,166

** Numbers round to zero.


1/ Outlays reflect actuarial estimates of spending because actual outlays associated with these provisions are not tracked separately.
2/ Policies had costs of $300 million in FY 2009, and small savings in each year thereafter (FY 2010-FY 2019),
resulting in a net ten-year cost of $200 million.
3/ Reflects current law baseline estimates. Total FY 2009-2019 number represents budget authority for the TANF Emergency Fund.

Recovery Act 18
FOOD AND DRUG ADMINISTRATION
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Program
Foods....................................................................................... 644 784 1,042 +258
Human Drugs........................................................................... 774 880 1,000 +120
Biologics.................................................................................. 270 305 329 +23
Animal Drugs and Feeds.......................................................... 133 156 175 +19
Medical Devices...................................................................... 328 368 385 +16
National Center for Toxicological Research............................ 52 59 61 +3
Center for Tobacco Products................................................... 27 217 421 +205
Headquarters and Office of the Commissioner........................ 159 200 256 +56
FDA Consolidation at White Oak............................................ 41 41 42 --
GSA Rental Payments............................................................. 159 172 194 +22
Other Rent and Rent Related Activities................................... 79 76 103 +27
Export/Color Certification Fund.............................................. 10
_____ 10
_____ 10
_____ --
_____
Subtotal, Salaries and Expenses 2,675 3,268 4,019 +751
Buildings and Facilities........................................................... 12 12 12 --
National Center for Natural Products Research....................... _____3 _____3 _____-- -3
_____
Total, Program Level 2,691 3,284 4,032 +748
Less User Fees:
Current Law
Prescription Drug (PDUFA).................................................... 511 578 667 +89
Medical Device (MDUFMA).................................................. 53 57 62 +5
Animal Drug (ADUFA)........................................................... 15 17 19 +2
Animal Generic Drug............................................................... 5 5 5 --
Mammography Quality Standards Act (MQSA)...................... 19 19 19 --
Family Smoking Prevention and Tobacco Control Act........... 24 235 450 +215
Export/Color Certification Fund.............................................. 10
_____ 10
_____ 10
_____ --
_____
Subtotal, Current Law User Fees 636 922 1,233 +311

Proposed Law
Food Inspection and Food Facility Registration...................... -- -- 220 +220
Human Generic Drug............................................................... -- -- 38 +38
Reinspection............................................................................ -- -- 27 +27
Export Certification Fund (Foods and Feeds).......................... --
_____ --
_____ _____4 +4
_____
Subtotal, Proposed Law User Fees --
_____ --
_____ 289
_____ +289
_____
Total, User Fees 636
_____ 922
_____ 1,523
_____ +601
_____
Total, Budget Authority /1 2,055 2,362 2,508 +146
Initiative
FDA Food Safety (non-add) 876 1,049 1,368 +318

FTE............................................................................................. 11,413 12,335 13,677 +1,342

1/ The FY 2009 Budget Authority level reflected in the Budget Appendix differs due to the timing and availability of
user fee collections.

19 Food and Drug Administration


FOOD AND DRUG ADMINISTRATION
The Food and Drug Administration is responsible for protecting the public health by assuring the safety, efficacy, and
security of human and veterinary drugs, biological products, medical devices, our Nation’s food supply, cosmetics, and
products that emit radiation. The Food and Drug Administration is also responsible for advancing the public health by
helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the
public get accurate, science-based information they need to use medicines and food to improve their health.

T he FY 2011 Budget requests


more than $4 billion for the
American public, FDA will focus
greater efforts and resources on
inspections as new staff is fully
trained and deployed.
Food and Drug Administration the science-based prevention of
(FDA), a net program level foodborne illness, strengthening PROTECTING PATIENTS
increase of $748 million, or surveillance and enforcement FDA is the global leader for
23 percent, over FY 2010. The through more frequent and regulating medical products, and
FDA budget includes increased targeted inspections, and FDA regulatory activities assure
investments to improve the safety improving response and recovery that Americans have access to
of the Nation’s food supply, from outbreaks of food-related thousands of drugs and devices
drugs, and other medical illnesses. that are safe and effective for
products, advance the agency’s treating everything from seasonal
scientific infrastructure, and With an increase in food safety allergies to aggressive cancers.
further develop and implement resources of $318 million in The FY 2011 Budget request will
public health strategies to prevent FY 2011, FDA will work with provide an investment of
youth from using tobacco and States to set standards for State $1.4 billion for medical product
help adults to quit tobacco use. inspection programs and build the safety, which is an increase of
Given the need to enhance FDA’s infrastructure needed to integrate $101 million above FY 2010.
ability to protect the public health Federal and State food safety This increase will allow FDA to
and recognizing the importance of activities. FDA will invest in invest in tools to assure the safety
shared responsibility, the Budget analytical tools needed to make of increasingly complex drugs,
proposes new user fees to help data-driven decisions about how medical devices and biological
finance these increased demands. to best deploy its safety strategies products. Specifically, this
and resources to prevent and initiative focuses additional
TRANSFORMING FOOD SAFETY respond to foodborne illness. funding on three critical areas:
FDA plays a critical role in FDA will also invest in the import safety, high-risk products,
helping to ensure that the food we modernized laboratory capacity and partnerships for patient
eat is safe and does not cause and test methods needed to more safety. The FY 2011 investments
harm. In March 2009, President rapidly detect harmful food are vital to FDA’s ability to
Obama established the Food contaminants, which are essential understand and respond to the
Safety Working Group to develop for preventing, containing, and growing challenge of
solutions to the problems that our recovering from illness outbreaks. globalization and to act as a
Nation’s food safety system has The FY 2011 Budget will allow public health agency committed
experienced. To achieve the for an additional 159 foreign to safety. Within the increase of
President’s vision of a new food inspections and 1,978 domestic $101 million for FY 2011, FDA
safety system to protect the will devote an additional $40
million to the generic drugs
Investing in a New Food Safety System program, at least $10 million for
Recent food outbreaks have left thousands of Americans ill, and postmarket drug safety, and $4
associated recalls have devastated industries. FDA is working to million to establish a medical
transform our Nation’s food safety system to protect the public and device registry. The FY 2011
reduce undue harm to affected industries. The FY 2011 Budget adds an President’s Budget increases
additional $318 million towards this effort to help: inspections to improve the
♦ Prioritize prevention by developing an integrated national food safety security of the supply chain and
system and setting new standards for food safety. reduce the potential for harm to
♦ Strengthen surveillance and enforcement by improving risk analysis patients.
and research for food safety.
♦ Improve response and recovery by working to integrate Federal,
State, and local government roles and responsibilities to an outbreak.

Food and Drug Administration 20


ADVANCING REGULATORY public health and reducing affordable generic drugs. The
SCIENCE FOR PUBLIC HEALTH tobacco use by minors. reinspection user fee requires
Accordingly, the Center for manufacturers to pay the full
The FY 2011 Budget proposes a
Tobacco Products was established costs of reinspections and
$25 million increase for
within FDA, a user fee program associated follow-up work due to
advancing regulatory science at
was created, and a center director their failure to meet FDA health
FDA. With this initiative, the
and key staff were hired. In and safety standards during an
Budget includes $15 million for
FY 2011, the center will take inspection, thus rewarding firms
nanotechnology related research,
steps to reduce the appeal of and that do comply. The export
which holds great promise for
access to tobacco products by certification for food and animal
advances in medical products and
young people, work with retailers feeds user fee will expand the
cosmetics. The nanotechnology
to ensure compliance with all current drug, animal drug, and
investment will help assure that
advertising and marketing medical device export
FDA’s regulatory research offers
requirements, and coordinate with certification user fee program by
Americans both the protection
State, local, and Tribal $4 million to also include export
they deserve and the assurance
governments to prevent the sale certificates for food and animal
that approved nanotechnology
of tobacco products to children. feed. Export certificates issued
products are indeed safe. The
In total, the Budget includes by FDA enhance the global
increased resources will also
$450 million in user fees for FDA competitiveness of American
allow FDA to update review
to implement the new tobacco food and animal feed producers
standards and provide regulatory
control law. by ensuring that the products
pathways for new technologies
meet regulatory requirements.
such as biosimilars. Given the USER FEES The Budget also includes an
tremendous potential for
The Budget re-proposes four new additional $311 million increase
biotechnology to improve health
user fees and increases in existing for current law user fees.
and reduce illness, FDA will use
these resources to define user fees, which will provide
SUPPORTING FDA FACILITIES
regulatory pathways for animal critical resources to FDA to
biotechnology products and perform its public health mission. The Budget requests $39 million
provide product guidance to The food registration and in budget authority for
industry. inspection user fee will aid FDA headquarters consolidation at the
with resources to ensure the new FDA campus in White Oak,
REDUCING TOBACCO USE safety and security of America’s Maryland. These resources will
food supply. With these enable FDA to continue to
On June 22, 2009, the President
resources, FDA will increase its transition to the newly
signed the Family Smoking
capacity to establish an integrated consolidated facility under
Prevention and Tobacco Control
national food safety system and construction by the General
Act, which provides FDA
further strengthen food safety Services Administration (GSA).
important new responsibilities for
inspection, response, and import The White Oak complex will
regulating the manufacture,
review. The generic drug user fee replace and centralize existing
marketing and distribution of
will give Americans greater geographically disparate facilities
tobacco products, protecting
access to safer and more with new, state-of-the-art
laboratories, office buildings and
support facilities into one
Performance Highlight location. The Budget also
FDA scientists designed and trained a new method to increase the ease requests an increase of $50
and accuracy of interpreting complex magnetic resonance spectroscopy million for GSA rental payments
scans that are expected to detect early-stage cancers. In FY 2008, the and other rent and rent related
experiment was expanded to include more than 130 brain scans which costs. In FY 2011, the Budget
provided confirmation that the approach can provide enough information provides $12 million to pay for
to classify and grade tumors at an accuracy rate of about 85 percent. In necessary repair and maintenance
2009, a major breakthrough was made when FDA scientists reanalyzed of FDA-owned facilities
the data and in the process discovered patentable spectral processing that nationwide.
improved the analytical models to an accuracy rate of over 96 percent for
nine different types of brain tissue lesions and are now capable of grading
tumors, far exceeding the original goals.

21 Food and Drug Administration


HEALTH RESOURCES AND
SERVICES ADMINISTRATION
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010
Primary Care
Health Centers:
Health Centers...................................................................................... 2,146 2,000 2,146 2,436 +290
Health Centers Tort Claims.................................................................. 44
_____ --
_____ 44
_____ 44
_____ --
_____
Subtotal, Health Centers 2,190 2,000 2,190 2,480 +290
Free Clinics Medical Malpractice............................................................ .04 -- .04 .04 --
Hansen's Disease Programs...................................................................... 18
_____ --
_____ 18
_____ 18
_____ --
_____
Subtotal, Primary Care 2,208 2,000 2,208 2,498 +290
Clinician Recruitment and Service
National Health Service Corps:
National Health Service Corps Field.................................................... 40 60 41 46 +5
National Health Service Corps Recruitment......................................... 95
_____ 240
_____ 101
_____ 123
_____ +22
_____
Subtotal, National Health Service Corps 135 300 142 169 +27
Nurse Loan Repayment and Scholarship Program.................................. 37 27 94 94 --
Loan Repayment / Faculty Fellowships................................................... 1
_____ 1
_____ 1
_____ 1
_____ --
_____
Subtotal, Clinician Recruitment and Service 173 328 237 264 +27
Health Professions
Health Professions Training for Diversity:
Centers of Excellence........................................................................... 21 5 25 25 --
Scholarships for Disadvantaged Students............................................. 46 40 49 49 --
Health Careers Opportunity Program................................................... 19
_____ 3
_____ 22
_____ 22
_____ --
_____
Subtotal, Training for Diversity 86 47 96 96 --
Training in Primary Care Medicine and Dentistry................................... 48 48 54 54 --
Health Workforce Information and Analysis........................................... -- -- 3 9 +6
Interdisciplinary, Community-Based Linkages:
Area Health Education Centers............................................................ 33 -- 33 33 --
Geriatric Programs................................................................................ 31 -- 34 34 --
Allied Health and Other Disciplines..................................................... 14
_____ --
_____ 22
_____ 22
_____ --
_____
Subtotal, Interdisciplinary, Community-Based Linkages 77 -- 89 89 --
Public Health Workforce Development: 9 11 10 10 --
Nursing Workforce Development:
Advance Nursing Education................................................................. 64 -- 64 64 --
Nursing Workforce Diversity............................................................... 16 3 16 16 --
Nurse Education, Practice and Retention............................................. 37 -- 40 40 --
Nurse Faculty Loan Program................................................................ 12 12 25 25 --
Nurse Managed Care ........................................................................... -- --
Comprehensive Geriatric Education..................................................... 5
_____ --
_____ 5
_____ 5
_____ --
_____
Subtotal, Nursing Workforce Development 134 15 150 150 --
Patient Navigator...................................................................................... 4 -- 5 5 --
Equipment................................................................................................ -- 52 -- -- --
Children's Hospital Graduate Medical Education Program...................... 310
_____ --
_____ 318
_____ 318
_____ --
_____
Subtotal, Health Professions 668 172 725 731 +6
Maternal and Child Health
Maternal and Child Health Block Grant.................................................. 662 -- 662 673 +11
Heritable Disorders.................................................................................. 10 -- 10 10 --
Congenital Disabilities............................................................................. 1 -- 1 1 --
Autism and Other Developmental Disorders........................................... 42 -- 48 55 +7
Traumatic Brain Injury............................................................................. 10 -- 10 10 --
Sickle Cell Service Demonstrations......................................................... 4 -- 5 5 --
Universal Newborn Hearing Screening.................................................... 19 -- 19 19 --
Emergency Medical Services for Children............................................... 20 -- 22 22 --
Healthy Start............................................................................................ 102 -- 105 110 +5
Family-to-Family Health Information Centers (mandatory)..................... 5
_____ --
_____ --
_____ --
_____ --
_____
Subtotal, Maternal and Child Health 876 -- 881 904 +23

Health Resources and Services Administration 22


HEALTH RESOURCES AND
SERVICES ADMINISTRATION
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010
HIV/AIDS
Emergency Relief - Part A....................................................................... 663 -- 679 679 --
Comprehensive Care - Part B................................................................... 1,224 -- 1,254 1,284 +30
AIDS Drug Assistance Program (non add).......................................... 815 -- 835 855 +20
Early Intervention - Part C....................................................................... 202 -- 207 212 +5
Children, Youth, Women, and Families - Part D..................................... 77 -- 78 78 --
Education and Training Centers - Part F.................................................. 34 -- 35 37 +3
Dental Services - Part F............................................................................ 13
_____ --
_____ 14
_____ 15
_____ +2
_____
Subtotal, HIV/AIDS 2,213 -- 2,266 2,305 +40
Public Health Services (PHS) Evaluation Funding.................................. 25
_____ --
_____ 25
_____ 25
_____ --
_____
Subtotal, HIV/AIDS 2,238 -- 2,291 2,330 +40
Health Care Systems
Organ Transplantation.............................................................................. 24 -- 26 26 --
Cord Blood Stem Cell Bank..................................................................... 12 -- 12 14 +2
C.W. Bill Young Cell Transplantation Program...................................... 24 -- 24 27 +3
Office of Pharmacy Affairs, 340B Program............................................. 1 -- 2 5 +3
Poison Control Centers............................................................................ 28 -- 29 29 --
State Health Access Grants...................................................................... 75 -- 75 75 --
Countermeasures Injury Compensation Program..................................... --
_____ --
_____ --
_____ 3
_____ +3
_____
Subtotal, Health Care Systems 164 -- 168 179 +10
Rural Health
Rural Health Policy Development............................................................ 10 -- 10 10 --
Rural Health Outreach Grants.................................................................. 54 -- 56 57 +1
Rural and Community Access to Emergency Devices............................. 2 -- 3 3 --
Rural Hospital Flexibility Grants............................................................. 39 -- 41 41 --
State Offices of Rural Health................................................................... 9 -- 10 10 --
Delta Health Initiative.............................................................................. 26 -- 35 -- -35
Denali Project........................................................................................... 20 -- 10 -- -10
Radiogenic Diseases................................................................................ 2 -- 2 2 --
Black Lung Clinics................................................................................... 7 -- 7 7 --
Telehealth................................................................................................. 8
_____ --
_____ 12
_____ 12
_____ --
_____
Subtotal, Rural Health 176 -- 186 142 -44
Facilities and Other Projects........................................................................ 310 -- 338 -- -338
Family Planning........................................................................................... 307 -- 317 327 +10
Program Management.................................................................................. 142 -- 147 154 +7
Vaccine Injury Compensation Program ...................................................... 5 -- 7 7 --
HEAL Direct Operations 1/......................................................................... 3 -- 3 -- -3
National Practitioner Data Bank (User Fees)............................................... 20 -- 20 21 +1
Healthcare Integrity and Protection Data Bank (User Fees)........................ 4
_____ --
_____ 4
_____ 4
_____ --
_____
Total, Program Level 7,296 2,500 7,531 7,561 +29
Less Funds From Other Sources
User Fees.................................................................................................. -24 -- -24 -25 -1
PHS Evaluation Funds (HIV/AIDS)........................................................ -25 -- -25 -25 --
Family-to-Family Health Information Centers (mandatory)..................... -5
_____ --
_____ --
_____ --
_____ --
_____
Total, Budget Authority 7,243 2,500 7,483 7,511 +28
FTE.............................................................................................................. 1,492 102 1,518 1,518 --
*American Recovery and Reinvestment Act of 2009 (Recovery Act)
1/ In FY 2011 President's Budget proposes a transfer to Department of Education

23 Health Resources and Services Administration


HEALTH RESOURCES AND
SERVICES ADMINISTRATION
The Health Resources and Services Administration provides national leadership, program resources, and services
needed to improve access to culturally competent, quality health care.

T he FY 2011 Budget requests


$7.6 billion for the Health
HEALTH WORKFORCE:
BUILDING A WORKFORCE
and support over 1,370 loan
repayments and scholarship
Resources and Services ST
FOR THE 21 CENTURY awards.
Administration, a net increase of
$29 million above FY 2010. As the Nation expands access to Health Professions Diversity:
When excluding one-time health services through reform Minority and disadvantaged
Congressional projects, the of the health care system, it is health professionals are more
Budget provides an increase of critical to simultaneously make likely to serve in areas with a
$412 million, or six percent, to investments to increase the high proportion of
improve access to health care in supply of well trained health underrepresented racial and
underserved areas and enhance professionals. The Budget ethnic groups and to practice in
the capacity of the health care includes $995 million, an or near designated health care
workforce. increase of $33 million, to shortage areas. The Budget
support health care workforce includes $113 million for
IMPROVING ACCESS TO programs that will increase the maintaining our national
HEALTH CARE IN
number of providers practicing capacity to train
in underserved areas. underrepresented minorities and
UNDERSERVED AREAS
financially disadvantaged
Health Centers: The Budget Within this total, the Budget students in health professions.
includes $2.5 billion, an includes $169 million, an These funds will provide
increase of $290 million, for increase of $27 million above disadvantaged and
health centers to expand service FY 2010, for the National underrepresented minority
capacity beyond the Recovery Health Service Corps to recruit students and faculty with
Act and make investments in and retain clinicians, including opportunities to enhance their
behavioral health services. primary care, dental, and academic skills and obtain the
Health centers provide access to behavioral health professionals, support needed to graduate from
comprehensive primary and in communities of greatest need. health professions schools or
preventive services to people in Nearly 80 percent of these faculty development programs.
need, many of whom are clinicians stay in an underserved
uninsured. Currently, area after fulfilling their service The Budget provides
70 percent of health center commitment and more than half $33 million to support State
patients live in poverty and make a career of caring for efforts to improve and address
39 percent are uninsured. The underserved people. The
Budget will provide funding for Budget will support 400 new
the expansion of health centers loan repayments and 49 new
to communities that currently do scholarship awards. Investing in
not have a health center and can Primary Care Providers
support one. In FY 2011 health Nurse Workforce: The Budget
centers will provide services to includes $228 million for In FY 2009, the National
more than 20 million patients. investments to increase the Health Service Corps (NHSC)
The budget will expand services capacity of the nurse workforce. placed 4,664 primary care
for behavioral health, directing As the population continues to providers in health centers and
funding towards the integration grow and age, the need for other community-based
of behavioral services into nurses continues to increase. systems of care to improve the
primary care health systems in The Budget will support the quality of care provided. In
health centers. recruitment, education, and FY 2011, the Budget will
retention of 20,000 nursing provide funding for a total of
students and registered nurses 8,561 providers.

Health Resources and Services Administration 24


oral health workforce needs
National Health Service Corps Field Strength
and $34 million to provide
training and education to 9000
individuals who provide care for
8000
the aging population.
7000

The Budget also includes 6000


$318 million for the Children’s 5000
Hospitals Graduate Medical
4000
Education Payment Program
that provides payments to 3000
children’s hospitals for the 2000
training of future physicians 1000
who work to improve the
quality of care to children. 0
2005 2006 2007 2008 2009* 2010 est.* 2011 est.*

In addition, $101 million will * Includes clinicians supported through the Recovery Act Annual Funding Recovery Act Funding

fund a range of other health


professions programs to support funding supports a $34 million for Maternal and
the collection of core data on comprehensive approach to Child Health and Family
the health workforce and to address the health needs of Planning activities that provide
strengthen and improve the persons living with HIV/AIDS, quality health care and support
pipeline of clinicians for future including medical treatment, life to families and communities.
years. saving medications, and access
to care. The program addresses Autism and Other
Improving Rural Health: There the unmet health needs of Developmental Disorders: The
are nearly 50 million people persons living with HIV by Budget requests $55 million, an
living in 2,052 rural counties funding primary health care and increase of $7 million, as part of
throughout America who vital health-related support the President’s Initiative to
experience ongoing challenges services that enhance access to support children with autism
in accessing health care. The and retention in care. The spectrum disorders and their
Budget includes $142 million to program reaches over half a families. This funding will
improve access to quality health million individuals each year, continue to expand Federal and
care in rural areas. Within this making it the Federal State programs authorized in the
total, $62 million is included to government’s largest program Combating Autism Act to
work with Critical Access specifically for people living research, and support screening
Hospitals, conduct research on with HIV/AIDS. and evidence-based
rural health issues and support interventions when a diagnosis
community access to emergency Making Prescription Drugs is confirmed.
devices. As part of the Affordable: The FY 2011
President’s initiative to improve request includes $5 million to Family Planning: The
rural health care, HRSA will improve access to potentially FY 2011 Budget includes
develop stronger links between lifesaving drugs as authorized $327 million, an increase of
telehealth activities and other by section 340B of the Public $10 million, to expand family
investments in rural health. Health Service Act, allowing planning services to low-income
Federally funded grantees and individuals by improving access
PROTECTING AT-RISK other health safety net providers to family planning centers and
POPULATIONS to purchase medications at preventive services. This
significantly discounted prices. funding will provide services to
HIV/AIDS: The request nearly 5 million low-income
includes $2.3 billion, a women and men at more than
SUPPORTING HEALTHY
$40 million increase, for 4,500 clinics each year, at least
FAMILIES
HIV/AIDS treatment activities 90 percent of whom are at or
authorized by the Ryan White The Budget provides
CARE Act of 2009. This $1.2 billion, an increase of

25 Health Resources and Services Administration


below 200 percent of the
Federal poverty level.
Recovery Act
HRSA has awarded $2 billion to expand health care services to 2 million
Maternal and Child Health low-income and uninsured individuals through its Health Centers
Programs: The Budget provides program. This includes $500 million for expanded services to over
$673 million, an increase of 7,500 service delivery sites and $1.5 billion for needed capital
$11 million, for the Maternal improvements to over 1,500 existing health centers. On December 9,
and Child Health Block Grant to 2009, HRSA awarded $509 million for major construction and renovation
provide funding to States to to health centers to build new facilities.
improve the health of mothers,
children, and their families Crusader Community Health Center in Rockford, Illinois received
through greater access to $5 million to construct a new facility to accommodate four medical
coordinated comprehensive providers-a family practice physician, a pediatrician, a mid-level medical
care. The block grant will provider, a dentist and specialty clinics including OB/GYN, podiatry, and
support services for over pain management.
40 million women, children, and
their families. $3 million to support the Within this total, $26 million
administrative and claim costs supports a national system to
Healthy Start: The request associated with Public develop policies to ensure the
includes $110 million, an Readiness and Emergency fair allocation and distribution
increase of $5 million, to Preparedness Act (PREP) of organs. The Budget also
provide services that reduce the declarations. These declarations requests $26 million for
incidence of risk factors that limit liability for the use of potentially life-saving efforts to
contribute to infant mortality in countermeasures such as support individuals who need
high risk communities and vaccines and medical devices marrow or cord blood
provide services to mothers in during public health transplants, and $14 million for
geographically, racially, emergencies. the National Cord Blood
ethnically, and linguistically Inventory program to collect
diverse communities. The National Vaccine Injury and purchase approximately
Budget will support a total of Compensation Program: The 9,100 new cord blood units.
107 Healthy Start projects. The Budget requests $7 million for
Budget will also continue to the Vaccine Injury Program Management: The
provide critical support that Compensation Program to Budget requests $154 million to
includes peer mentoring, prepare for projected increases fund rent, salaries, information
technical assistance, and sharing in claims and continue reviews technology, utilities, and agency
of best practices among of over 5,100 claims from oversight of its programs. The
projects. autism proceedings. Budget transfers the Health
Education Assistance Loan
OTHER ACTIVITIES AND Supporting Transplantation: program to the Department of
PROGRAM MANAGEMENT The Budget includes Education which has expertise
Countermeasures Injury $66 million to support organ, managing a number of other
Compensation Program: The bone marrow, and cord blood loan guarantee programs.
Budget includes stem cell transplantation.

Health Resources and Services Administration 26


INDIAN HEALTH SERVICE
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010

Services
Clinical Services: 3,439 85 3,782 4,029 +247
Contract Health Services (non add)................ 634 -- 779 864 +84
Health Information Technology (non add)...... 115 85 131 135 +4
Preventive Health................................................ 135 -- 144 151 +7
Contract Support Costs........................................ 282 -- 398 444 +46
Tribal Management/Self-Governance................. 9 -- 9 9 +0
Urban Health....................................................... 36 -- 43 46 +2
Indian Health Professions.................................... 38 -- 41 42 +1
Direct Operations................................................ 65 -- 69 70 +1
Diabetes Grants................................................... 150
_____ _____-- 150
_____ 150
_____ --
_____
Subtotal, Services Program Level 4,155 85 4,636 4,940 +304

Facilities
Health Care Facilities Construction..................... 40 227 29 66 +37
Sanitation Facilities Construction........................ 96 68 96 98 +2
Facilities & Environmental Health Support......... 178 -- 193 202 +9
Maintenance & Improvement.............................. 60 100 60 62 +2
Medical Equipment............................................. 22
_____ 20
_____ 23
_____ 24
_____ +1
_____
Subtotal, Facilities Program Level 396
_____ 415
_____ 401
_____ 452
_____ +50
_____
Total, Program Level 4,551 500 5,037 5,392 +354

Less Funds From Other Sources


Health Insurance Collections /1........................... -814 -- -829 -829 --
Rental of Staff Quarters....................................... -6 -- -6 -6 --
Diabetes Grants /2............................................... -150
_____ --
_____ -150
_____ -150
_____ --
_____
Total, Budget Authority 3,581 500 4,052 4,406 +354

FTE......................................................................... 15,461 -- 15,634 15,649 +15

1/ Represents estimates of collections from public and private insurers for current and future fiscal years. Estimates are
based on actual FY 2008 collections and current reimbursement rates. These estimates may change as a result of actual FY
2009 collections.
2/ These mandatory funds were pre-appropriated in P.L. 110-275, the Medicare Improvements for Patients and
Providers Act of 2008.
*American Recovery and Reinvestment Act of 2009 (Recovery Act)

27 Indian Health Service


INDIAN HEALTH SERVICE
The mission of the Indian Health Service is to raise the physical, mental, social, and spiritual health of American
Indians and Alaska Natives to the highest level.

T he FY 2011 Budget requests


$5.4 billion for the Indian
care services, IHS activities include
building sanitation systems to
increases are coupled with the
rising cost of health care and
Health Service (IHS), an increase provide water and waste disposal salaries for Federal and Tribal
of $354 million, or nine percent, for Indian homes; supporting Tribal employees who provide needed
over FY 2010. The Budget self-governance through contract health services in often remote
continues the Administration’s funding; and providing scholarships areas. The Budget includes an
policy from the FY 2010 Budget of and loan repayment awards to additional $176 million to cover
strengthening the Indian health recruit health professionals, pay increases, population growth,
system to improve the quality of including American Indians and and inflation. The Budget includes
health services to American Indians Alaska Natives, to serve in areas $44 million for the Indian Health
and Alaska Natives. The funding with high provider vacancies. Care Improvement Fund, a
will reduce the disparities significant investment aimed at
experienced by American Indians STRENGTHENING THE INDIAN creating parity in funding among
and Alaska Natives and provide HEALTH SYSTEM service sites. Providing additional
funds to improve the Indian health funds to service sites with the
system. IHS, in partnership with The Budget includes significant greatest resource deficiencies will
Tribes, provides primary care, increases to support and expand the help ensure that all eligible
behavioral and community health, provision of health care services American Indians and Alaska
and sanitation services for a and public health programs for Natives have access to quality
growing population of eligible American Indians and Alaska health care.
American Indians and Alaska Natives. The Budget also makes
Natives. key investments that build on the Contract Health Services: IHS
resources provided in the Recovery purchases health care from outside
FULFILLING THE UNIQUE ROLE
Act. the IHS system in cases where no
OF THE INDIAN HEALTH IHS-funded direct care facility
Population Growth and the Cost of exists, the direct care facility cannot
SERVICE
Providing Care: The Budget provide the required emergency or
IHS provides comprehensive health reflects a sustained investment in specialty services, or the facility
services to members of more than providing care to a growing has more demand for services than
560 Federally recognized Tribes population of American Indians and it can meet. The Budget includes
through direct services in Alaska Natives. The Indian $864 million, an increase of
45 hospitals, 288 health centers, population is growing at a faster $84 million, for the purchase of
and 313 health stations, school rate than the U.S. population as a medical care, including essential
health centers, and Alaska village whole, and the IHS service services such as inpatient and
clinics. As part of the unique population is expected to increase outpatient care, routine and
relationship between Tribes and the by 1.5 percent in FY 2011. These emergency care, and medical
Federal Government, IHS provides
American Indians and Alaska Initiative: Ensuring Access to Care
Natives with preventive health care
and direct medical care, and The FY 2011 Budget provides $864 million, an increase of
contracts with hospitals and health $84 million, to cover the cost of care purchased outside the IHS
care providers outside the IHS system, as part of the commitment to strengthen the Indian health
system to purchase care it cannot system with sustained investments that improve health outcomes and
provide through its own network. expand access to care for American Indians and Alaska Natives.
IHS works with Tribes to ensure
their maximum participation in In FY 2008, there were 35,953 Contract Health Services (CHS) cases
administering the programs that that could not be funded, often causing patients to delay or defer
impact their communities. In needed medical treatment or cover costly procedures out of pocket.
addition to the provision of health The FY 2011 budget will cover additional CHS cases to address the
need for medical treatment outside the IHS system.

Indian Health Service 28


communities. The Budget includes facilities are joint venture projects,
Recovery Act an increase of $4 million to support where IHS partners with a Tribal
IHS received $227 million in secure data exchange. entity to provide funds for staffing,
Recovery Act funds for equipping, and operating a facility,
health care facilities Construction: The Budget and participating Tribes cover the
construction. IHS is using includes $66 million for Health costs of design and construction.
these funds to complete Care Facilities Construction to When these facilities are fully
construction of a hospital in continue construction of a hospital operational, they will be able to
Nome, Alaska and a health in Barrow, Alaska and two meet the increasing demand for
facility in Eagle Butte, South outpatient facilities in San Carlos services at their sites, where the
Dakota. The sites will serve and Kayenta, Arizona. Once existing capacity is overextended.
a combined total of 19,300 completed, these facilities will
users. serve a combined projected annual Alcohol and Substance Abuse: A
user population of 38,380 patients. new competitive grant program will
support services, such as diagnostic expand access to and improve the
imaging, physical therapy, and Staffing New and Renovated quality of treatment for substance
laboratory services. These funds Health Facilities: Construction abuse treatment services. The
are crucial to covering the cost of and renovation funds for IHS health program will target sites with the
care for injuries, heart disease, facilities have been targeted to greatest need for substance abuse
digestive diseases, and cancer, expand services at sites services. The program will enable
some of the leading causes of death experiencing overcrowding. These service sites to hire additional staff
among American Indians and expansions require new staff and to provide evidence-based and
Alaska Natives. operating support. An additional practice-based culturally competent
$39 million is included in the treatment services.
Health Information Technology: Budget to support staffing and
IHS has been a recognized leader in operating costs for new or Health Insurance
health information technology and expanded facilities to be completed Reimbursements: IHS relies on
continues to develop and deploy in FY 2011. These facilities the collection of third party
innovative health IT tools that include a Hospital in Ada, resources for as much as 50 percent
improve the lives of individual Okalahoma as well as health of the operating budgets for some
patients, populations and centers elsewhere. Some of the facilities. In FY 2011, IHS

Alaska Projected Indian Health Service Population by Area/Region, CY 2011


129,441

Portland
182,941 Billings
Bemidji
72,869
127,185
Aberdeen
126,616

Phoenix
215,186 IHS Headquarters
California Rockville, MD
Navajo
186,970
255,397
Oklahoma
Albuquerque 385,137
112,874
Tucson Nashville
38,539 128,547

TOTAL IHS SERVICE POPULATION


FOR FY 2011: 1,961,702

29 Indian Health Service


of hiring additional medical staff, programs. These funds provide
Performance Highlight purchasing equipment, making Tribes with additional support in
Depression is often a factor necessary building improvements, the operation of their own health
contributing to suicide, and maintaining accreditation programs. This investment will
domestic and intimate partner standards. allow IHS to increase funding
violence, and alcohol and significantly to Tribes with existing
substance abuse. Early SUPPORTING INDIAN SELF- self-determination agreements and
identification allows DETERMINATION for new or expanded contracts in
providers to plan order to ensure Tribes have the
interventions and treatment to IHS recognizes that Tribes and resources they need to successfully
reduce the impact of Tribal organizations are the most manage programs at the local level.
depression, including the knowledgeable about the type of
reduction of suicide rates, services needed in their own Consultation: One of the key
which are disproportionately communities, and that the planning components of the government to
high in Indian communities. and delivery of health services at government relationship with
In order to improve the the local level ensures effective, Tribes is consultation, in which
mental health and well-being quality health care. More than Tribal governments and
of American Indians and 57 percent of the IHS budget is organizations play an integral role
Alaska Natives, IHS administered by Tribes through the in the agency’s budget and policy
increased the proportion of authority provided to them under decision-making processes. In
patients aged 18 and older the Indian Self-Determination and addition to extensive solicitation of
who are screened for Education Assistance Act of 1975. Tribal input used to determine the
depression from 24 percent in The Act allows Tribes to assume way IHS operates at the local, area,
FY 2007, to 35 percent in the administration of programs that and national level, HHS holds an
FY 2008, and to 44 percent in were previously carried out by the annual department-wide budget
FY 2009. Federal Government. consultation. This process gives
Tribal leaders the opportunity to
Contract Support Costs: The express their budget priorities, and
estimates it will receive Budget includes $444 million for
approximately $829 million in continues to affirm the unique
contract support costs, an increase political and legal partnership
health insurance reimbursements of $46 million. Contract support
for the provision of care to people between Tribes and the Federal
costs are defined as reasonable Government.
covered by Medicare, Medicaid, costs for activities that enable
and private insurers. These funds Tribes to develop the infrastructure
are essential for covering the costs needed to administer Federal

Indian Health Service 30


CENTERS FOR DISEASE CONTROL
AND PREVENTION
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010
Infectious Diseases
Immunization and Respiratory Disease..................................................................... 916 300 718 736 +17
Section 317 Discretionary Program (non-add)................................................ 560 300 562 579 +17
Pandemic Influenza (non-add).......................................................................... 356 -- 156 156 --
Balances from P.L. 111-32 Pandemic Flu (non-add)................................. -- -- -- 156 +156
Vaccines For Children ............................................................................................. 3,383 -- 3,636 3,651 +15
HIV/AIDS, Viral Hepatitis, STDs and TB Prevention............................................. 1,006 -- 1,045 1,083 +38
Zoonotic, Vector-Borne, and Enteric Diseases......................................................... 68 -- 77 58 -19
Preparedness, Detection, and Control of Infectious Diseases................................... 157
_____ _____-- 169
_____ 192
_____ +23
_____
Subtotal, Infectious Diseases 5,531 300 5,645 5,721 +75
Health Promotion
Chronic Disease Prevention and Health Promotion.................................................. 882 -- 931 937 +6
Birth Defects, Disability and Health......................................................................... 138
_____ --
_____ 143
_____ 144
_____ --
_____
Subtotal, Health Promotion 1,020 -- 1,075 1,081 +6
Health Information and Service
Health Statistics......................................................................................................... 125 -- 139 162 +23
Informatics and Health Marketing............................................................................ 155
_____ --
_____ 150
_____ 145
_____ -5
_____
Subtotal, Health Information and Service 279 -- 289 307 +18

Environmental Health and Injury


Environmental Health............................................................................................... 185 -- 187 182 -5
Injury Prevention and Control................................................................................... 145
_____ --
_____ 149
_____ 148
_____ -1
_____
Subtotal, Environmental Health and Injury 331 -- 336 330 -6

Occupational Safety & Health...................................................................................... 415 -- 429 511 +83


Energy Employee Occupational Illness Compensation Program (non-add) .......... 55 -- 55 55 --
World Trade Center Treatment and Screening (non-add)....................................... 70 -- 71 150 +79
Global Health /1.......................................................................................................... 319 -- 336 352 +16
Public Health Research................................................................................................ 31 -- 31 31 --
Public Health Improvement and Leadership................................................................ 209 -- 211 193 -19
Preventive Health and Health Services Block Grant.................................................... 102 -- 102 102 --
Buildings and Facilities................................................................................................ 152 -- 69 -- -69
Business Services Support............................................................................................ 360 -- 370 382 +12

Terrorism Preparedness and Emergency Response


State and Local Preparedness and Response Capability............................................ 747 -- 761 758 -3
CDC Preparedness and Response Capability............................................................. 198 -- 193 183 -9
Strategic National Stockpile....................................................................................... 570 -- 596 592 -4
Balances from P.L. 111-32 Pandemic Flu (non-add)......................................... --
_____ --
_____ --
_____ 69
_____ +69
_____
Subtotal, Terrorism Preparedness and Emergency Response 1,515 -- 1,549 1,533 -16

Agency for Toxic Substances and Disease Registry..................................................... 74 -- 77 76 --


User Fees ..................................................................................................................... _____2 --
_____ _____2 _____2 --
_____
Subtotal, Program Level 10,339 300 10,521 10,622 +101

Less Funds Allocated from Other Sources


Vaccines for Children (mandatory) /2....................................................................... -3,383 -- -3,636 -3,651 -15
Energy Employee Occupational Injury Compensation Program (mandatory).......... -55 -- -55 -55 --
PHS Evaluation Transfers......................................................................................... -331 -- -352 -346 +7
Balances from P.L. 111-32 Pandemic Flu................................................................. -- -- -- -225 -225
User Fees................................................................................................................... _____-2 --
_____ _____-2 -2
_____ --
_____
Total, Discretionary Budget Authority 6,568 300 6,475 6,342 -133

Total, Discretionary Program Level 6,901 300 6,830 6,915 +86

FTE.............................................................................................................................. 9,635 9,735 9,835 +100

*American Recovery and Reinvestment Act of 2009 (Recovery Act)


1/ Adjusts FY 2009 and FY 2010 levels comparable with FY 2011.
2/ The estimates for the Vaccines for Children Program reflect the anticipated transfer from Medicaid and do not reflect FY 2009 carry-forward
funds available for obligation. VFC is funded through the Medicaid appropriation is reflected in the Medicaid baseline.

31 Centers for Disease Control and Prevention


CENTERS FOR DISEASE CONTROL
AND PREVENTION
The mission of the Centers for Disease Control and Prevention (CDC) is to collaborate to create the expertise,
information, and tools that people and communities need to protect their health – through health promotion, prevention
of disease, injury and disability, and preparedness for new health threats.

T he FY 2011 Budget request for


the Centers for Disease Control Global Health
and Prevention (CDC) and the The FY 2011 Budget increases global public health capacity by
Agency for Toxic Substances and $19 million to monitor, prevent, and control and to improve life
Disease Registry (ATSDR) is expectancy and the quality of life for the developing world, especially
$10.6 billion, an increase of for mothers and children. CDC’s Global Public Health Capacity
$101 million above FY 2010. Due Building program provides technical assistance to help Ministries of
to the availability of unobligated Health build capacity in a range of areas, including epidemiology,
balances from the FY 2009 outbreak investigation, health surveillance systems, applied
pandemic influenza supplemental, economics, communications, and resource management. In 2008, the
less resources are requested, as Field Epidemiology and Laboratory Training program had 276 active
reflected by a reduction of $133 trainees. The trainees and graduates conducted over 300 outbreak
million in budget authority below investigations. Data indicate that the vast majority of graduates move
FY 2010. into leadership positions within the Ministries of Health in their own
country, which is critical to sustain public health capacity in these
The Budget request increases countries.
support for prevention of infectious
diseases, such as vaccine contracts, through an agency-wide prevention programs for
preventable diseases and effort to reduce inefficiencies and HIV/AIDS, Viral Hepatitis,
HIV/AIDS; for improved data improve overall management of Sexually Transmitted Diseases
collection and establishment of program activities. These savings (STD), and Tuberculosis (TB).
State electronic birth and death will allow CDC to achieve These programs support prevention,
records; for efforts to build global efficiencies without impacting CDC control services, surveillance, and
public health capacity; and for program activities. The Budget research.
treatment and monitoring services finances pandemic flu and a portion Of the increased funds, $10 million
for those affected by the of Strategic National Stockpile supports comprehensive and
September 11, 2001, World Trade activities with $225 million in integrated surveillance and
Center attacks. The Budget unobligated balances from the monitoring system demonstrations,
request funds new programs, such FY 2009 pandemic influenza and $10 million supports program
as a community health program that supplemental. coordination and service integration
engages large cities to prevent grants across HIV/AIDS, Viral
chronic disease, and for PROTECTING THE NATION Hepatitis, STD, and TB Prevention
development of the Health AGAINST INFECTIOUS AGENTS activities. The request also
Prevention Corps to build an includes increased funds to support
interdisciplinary public health The Budget includes a total of key components of a National
workforce. In addition, the Budget $1.9 billion in discretionary HIV/AIDS Strategy under
request includes both programmatic funding for Infectious Diseases and development. CDC will address
and administrative savings. $3.7 billion in mandatory funding high-risk populations and use new
Specifically, the Budget includes for the Vaccines for Children (VFC) medical approaches to
targeted programmatic savings for program . communicate culturally appropriate
completed, duplicative, and and effective messages about HIV
one-time activities funded in HIV/AIDS, Viral Hepatitis, STD risk reduction behavior. The
FY 2010. The Budget achieves a and TB Prevention: The FY 2011 increased funds in FY 2011 will
total of $100 million in Budget provides $1.1 billion, an help CDC work towards decreasing
administrative savings, by increase of $38 million above annual HIV incidence, the HIV
decreasing travel and reducing FY 2010, to develop, implement, transmission rate, and the
advisory and assistance service and evaluate effective domestic prevalence of risk behaviors among

Centers for Disease Control and Prevention 32


persons at risk for acquiring HIV; savings. Within this request, the
and increasing the proportion of budget includes $35 million, Recovery Act
HIV-infected people who know $8 million above FY 2010, to The Recovery Act provided
they are infected. reduce the public health burden of HHS $650 million to
foodborne illness. CDC will implement evidenced-based
Immunization and Respiratory expand the network of prevention and wellness
Diseases: Children can now be OutbreakNet Sentinel Sites, which strategies through the
protected from more vaccine are used to assess multi-State Communities Putting
preventable diseases than ever foodborne outbreaks to improve Prevention to Work Initiative.
before due to advances in State and local capacity to identify As part of this initiative, CDC
biotechnology. In 1985, vaccines and stop outbreaks, and will will mobilize local resources
for seven diseases were available improve the speed and accuracy of at the community-level and
and recommended for routine use foodborne disease outbreak strengthen the capacity of
in children in the United States. detection and investigation. States to implement strategies
Now, vaccines for 17 diseases are that improve physical activity
available and routinely The FY 2011 Budget includes and nutrition, address obesity,
recommended for children and $192 million, $23 million above and decreases smoking
adolescents. FY 2010, for the Prevention, prevalence and exposure to
Detection, and Control of second-hand smoke. In
CDC's $4 billion immunization Infectious Diseases. Within the FY 2011, CDC will continue
program has two components: the total, $27 million is included for to provide programmatic
mandatory VFC program and the prevention of healthcare-associated support to communities and
discretionary Section 317 program. infections to expand the National States participating in this
These two programs combined Healthcare Safety Network to initiative.
provide nearly 50 percent of the approximately 2,500 new
pediatric vaccines and thirty hospitals. This expansion builds Disability and Health. These
percent of the adolescent vaccines on progress CDC has made with increases are the net result of
distributed in the United States each FY 2009 Recovery Act funds to increased programmatic
year. The discretionary Section 317 leverage the National Health Care investments, targeted programmatic
program provides funds to support Safety Network and support the reductions to eliminate duplicative
State immunization infrastructure dissemination of HHS evidence- and less effective activities, and
and operational costs as well as based practices within hospitals to administrative savings.
many of the vaccines public health reduce these infections and save
departments provide to individuals lives. CDC will also use increased Chronic diseases are among the
not eligible for VFC, including funds in FY 2011 to build the most prevalent, costly, and
adults. The FY 2011 Budget workforce capacity, laboratory preventable of all health problems.
includes $579 million, an increase facilities, and skills sets within The increased FY 2011 investments
of $17 million, for the Section 317 State and local health departments in Health Promotion include
program to build on gains made to enhance the ability to detect and $20 million for the CDC Big Cities
with FY 2009 Recovery Act funds control emerging infectious Initiative to reduce the rates of
to increase vaccination coverage diseases. morbidity and disability due to
and to support States in obtaining chronic disease in up to ten of the
reimbursement of immunization PROMOTING HEALTH AND largest U.S. cities. This focused
services provided to children with PREVENTING CHRONIC investment is an efficient way to
private health insurance. DISEASE reach large populations with high
population densities. Funded cities
The FY 2011 Budget includes The Budget includes $1.1 billion,
can incorporate lessons learned
$58 million, a decrease of $6 million above FY 2010, for
from the Recovery Act
$19 million, for Zoonotic, Vector- Health Promotion. Within this
Communities Putting Prevention to
Borne, and Enteric Diseases, which total, $937 million, $6 million
Work Initiative, which is focused
is the net result of programmatic above FY 2010, is for Chronic
on the implementation of evidence-
increases, the elimination of Disease Prevention, Health
based prevention and wellness
dedicated funding for West Nile Promotion, and Genomics and
strategies. In addition to increased
Virus activities, and administrative $144 million is for Birth Defects,
funds for the Big Cities Initiative,
Developmental Disabilities,

33 Centers for Disease Control and Prevention


the Budget’s increased investments health threats. The Public Health States, for a total of 24 States, and
in Health Promotion continue the Informatics Budget request link with State vital statistics to
initiative to expand support for includes $67 million, a decrease of enhance the timeliness of data.
children, families, and communities $3 million for contract and travel
affected by autism spectrum savings, to design information
disorders. In FY 2011, CDC will systems and technology tools that IMPROVING PREPAREDNESS
expand autism monitoring and foster the exchange of, and access AND RESPONSE TO TERRORISM
surveillance and support an autism to, data to improve public health. The Budget includes $1.5 billion, a
awareness campaign. The net decrease of $16 million
increased investments in Health The Budget includes $78 million, a resulting from improved
Promotion also support adolescent decrease of $2 million, for contract efficiencies in travel and
and school health and the and travel savings, for Health contracting for CDC’s terrorism
prevention of teen pregnancies. Marketing activities. Within the preparedness and emergency
Additionally, the Budget provides request, $5 million is included for response activities. The
new funds to address the risk the Guide to Community bioterrorism budget supports the
factors associated with the most Preventive Services. Strategic National Stockpile (SNS),
prevalent birth defects and blood State and local preparedness and
disorders. Finally, the Budget ENVIRONMENTAL HEALTH AND response capabilities, as well as
increases State flexibility to address INJURY PREVENTION AND CDC-wide preparedness and
the leading causes of death and CONTROL response capabilities.
improve overall health outcomes.
The Budget includes $330 million
Strategic National Stockpile: The
USING HEALTH INFORMATION for Environmental Health and
Budget focuses on ensuring a
AND SERVICE FOR PUBLIC
Injury Prevention and Control.
sufficient supply of
CDC’s Environmental Health
HEALTH countermeasures and other medical
programs protect human health by
supplies to protect and care for
The Budget includes $307 million, preventing disability, disease, and
victims of a bioterrorism attack or
$18 million above FY 2010, for death from environmental causes.
other public health emergency. The
Health Statistics, Health Marketing, The FY 2011 Budget provides
Budget includes a program level of
and Public Health Informatics. The $182 million, a decrease of
$592 million for the SNS to finance
FY 2011 Budget for Health $5 million, which is the net result
the procurement of critical
Statistics includes $162 million, of programmatic increases, targeted
pharmaceuticals and vaccines
$23 million above FY 2010, to programmatic savings for
needed to protect Americans from
obtain and use statistics to completed and duplicative
threat agents and support the
understand health problems, activities, and administrative
capacity to deliver drugs, vaccines,
recognize emerging trends, identify savings. Within the programmatic
and supplies anywhere in the
risk factors, and guide programs increases, $4 million will support
Nation within 12 hours.
and policy. Funds will also support Safe Routes to School programs to
electronic birth and death records in encourage healthy community
State and Local Response
States. In addition, CDC will design.
Capability: In FY 2011,
maintain its FY 2010 enhancements
$715 million is requested for the
to national survey systems to The CDC Injury Prevention and
Public Health and Emergency
ensure data availability on key Control program supports efforts to
Preparedness Program, the same as
national health indicators such as reduce premature deaths, disability,
FY 2010, bringing the total
diet and nutrition, blood pressure, and the medical costs associated
investment to over $8.2 billion
and mental health. Policy-makers, with injuries and violence, such as
since September 11, 2001. The
researchers, and the public rely on motor vehicle safety, intimate
Budget request also includes
data from these surveys to support partner and sexual violence
$30 million for the Centers for
decision making and research on prevention, and child abuse and
Public Health Preparedness, which
health. neglect. The Budget includes
is a network of 27 universities
$148 million for Injury Prevention
working with States and
Public health informatics uses and Control, a decrease of
collaborating with one another to
information systems and $1 million below FY 2010, for the
develop and support the public
information technology to prevent National Violent Death Reporting
health emergency preparedness-
diseases, disability, and other public System to expand to six additional

Centers for Disease Control and Prevention 34


related knowledge and skills of first extent of WTC-related health maternal, newborn, and child health
responders and other public health conditions for the exposed will allow CDC to decrease the
professionals. population. number of preventable child deaths
Within the total for Occupational in countries with high infant and
CDC Preparedness and Response Safety and Health, $17 million under-five mortality rates by over
Capability: The FY 2011 Budget supports the elimination and 50 percent.
request includes $183 million for mitigation of the hazards associated Within the total for Global Health,
improving CDC’s preparedness and with nanomaterial development, $6 million supports the Afghanistan
response efforts. These funds and $55 million in mandatory Health Initiative and $2 million
continue support of the Laboratory funding is included for CDC’s role supports the Health Diplomacy
Response Network, the Select in the Energy Employees Initiative. The FY 2011 Budget
Agent Program, and research and Occupational Illness Compensation maintains support for other CDC
surveillance on potential emergency Program. global health programs, including
situations such as biothreat agent the Global AIDS Program, which
releases. In addition, these GLOBAL HEALTH plays a vital role in implementation
programs ensure the ongoing of the CDC responsibilities under
evaluation and improvements of The FY 2011 Budget includes the President’s Emergency Plan for
surveillance, laboratory science, $352 million, $16 million above AIDS Relief.
FY 2010, for Global Health
research, and support throughout
programs to protect the U.S. and
CDC and its grantees while SUPPORTING PUBLIC HEALTH
world populations from emerging
continuing to advance public health RESEARCH
preparedness and response global health threats. The increased
capabilities through technical investments will build global public Public Health Research provides
health capacity by strengthening the evidence to support specific
assistance, resource allocation,
global public health workforce; programs, practices, and policies
planning tools, education and
integrating maternal, newborn, and that affect health decisions made by
training.
child health programs; and the American public and those
improving global access to clean responsible for health policies and
ADVANCING OCCUPATIONAL
water, sanitation, and hygiene. For programs. With funding of
SAFETY AND HEALTH instance, CDC will develop at least $31 million for health protection
The FY 2011 Budget provides three new Field Epidemiology and research, the same as FY 2010,
$511 million for Occupational Laboratory Training Programs and CDC is building a cadre of health
Safety and Health programs, expand capacity at four existing protection researchers, research
$83 million above FY 2010. The programs; and will initiate safe training programs, and centers of
National Institute for Occupational water programs in three to four excellence that enable
Safety and Health is the primary countries and expand programs in multidisciplinary approaches to
Federal entity responsible for four to five countries. The health public health practice.
conducting research, making impact of the investment in
recommendations, and translating
knowledge for the prevention of
work-related illness and injury. Performance Highlight
Within the request, $150 million, HIV testing is a valuable tool to decrease HIV transmission and to
an increase of $79 million, is improve the health of those aware of their infections. CDC initiated a
included to support treatment and 3-year project to investigate the feasibility and acceptability of
monitoring services for conducting voluntary opt-out HIV testing in the emergency room (ER)
responders of the World Trade setting. Preliminary results indicate that opt-out HIV testing in ERs is
Center (WTC) attacks and for not only possible, but also well-received and highly valuable for
non-responders in the community identifying new infections. At the two project sites in Colorado and
directly affected by the attacks. California, the number of HIV tests increased by over 600 percent,
CDC currently funds support six from 4,353 to 27,859. The number of confirmed positive diagnoses
clinical centers and two data and also increased over nine-fold, from 16 diagnoses to 152 diagnoses. In
coordination centers throughout a survey of 204 ER staff involved with the HIV testing project,
the New York City metropolitan 90 percent rated the testing program as excellent or very good.
area as well as the WTC Health Similarly, results from a survey of 207 patients indicated that
Registry, which assesses the 97 percent were satisfied with the HIV testing process.

35 Centers for Disease Control and Prevention


Improvement and Leadership to CDC will fund repairs and
PREVENTIVE HEALTH AND support cross-cutting areas in CDC improvements with unobligated
HEALTH SERVICES BLOCK that seek to ensure the effectiveness balances from FY 2010.
GRANT of public health programs and
science. This decrease is the net
The FY 2011 Budget provides AGENCY FOR TOXIC
result of programmatic increases,
$102 million, the same as FY 2010, SUBSTANCES AND DISEASE
the elimination of one-time
for the Preventive Health and REGISTRY (ATSDR)
Congressional projects included in
Health Services Block Grant.
FY 2010, and administrative The Budget request for ATSDR is
These funds will support primary
savings. Within the request, $76 million, $0.5 million below
prevention activities and health
$10 million is included for a new FY 2010, for contract and travel
services in States and local
Health Prevention Corps, which savings. Managed as part of CDC,
communities.
will recruit, train, and assign a ATSDR is the lead agency
cadre of public health professionals responsible for public health
MANAGING CDC in State and local health
INFRASTRUCTURE AND HUMAN activities related to toxic substance
departments. This program will exposures. The Agency’s mission
CAPITAL target disciplines with known is to use the best science, take
The Budget includes $575 million shortages such as epidemiology, responsive action, and provide
in administrative and infrastructure environmental health, and trustworthy health information to
activities to support CDC laboratory. CDC will use FY 2011 prevent and mitigate harmful
mission-critical efforts. funds to establish the program exposures and related disease.
framework, which includes the Within the funds requested,
Business Services Support: program design, a plan to phase-in $2 million continues the
CDC has improved and achieved and pilot test programmatic tracks, epidemiologic studies of health
efficiencies in its business and and the development of curriculum conditions caused by non-
management operations and will for members. CDC will also occupational exposures to uranium
continue to find ways to achieve conduct outreach to States and will released from past mining and
higher performance at lower costs. train and place members in State milling operations on the Navajo
The Budget includes $382 million, and local health departments. Nation. Created in 1980 by the
$12 million above FY 2010, for Comprehensive Environmental
agency-wide operating costs, such Buildings and Facilities: CDC has Response, Compensation and
as rent, utilities, and security. made remarkable progress on its Liability Act, ATSDR leads Federal
10-year Master Plan through its public health efforts at Superfund
Public Health Improvement and investments to build and upgrade and other sites with known or
Leadership: The Budget includes facilities and laboratories. The potential toxic exposures.
$193 million, $19 million below FY 2011 Budget does not request
FY 2010, for Public Health funds for Buildings and Facilities.

Centers for Disease Control and Prevention 36


NATIONAL INSTITUTES OF HEALTH
OVERVIEW BY INSTITUTE
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010
Institutes
National Cancer Institute....................................................... 4,969 1,257 5,102 5,265 +163
National Heart, Lung and Blood Institute............................. 3,016 763 3,096 3,188 +92
National Institute of Dental and Craniofacial Research........ 403 102 413 424 +10
Natl Inst. of Diabetes & Digestive & Kidney Diseases......... 1,911 445 1,957 2,008 +50
National Institute of Neurological Disorders and Stroke...... 1,593 403 1,636 1,681 +46
National Institute of Allergy and Infectious Diseases........... 4,703 1,113 4,817 4,977 +160
National Institute of General Medical Sciences.................... 1,998 505 2,051 2,125 +74
Eunice K. Shriver Natl Inst. of Child Hlth & Human Dev.... 1,295 327 1,329 1,369 +40
National Eye Institute............................................................ 688 174 707 724 +18
National Institute of Environmental Health Sciences:
Labor/HHS Appropriation................................................. 663 168 690 707 +18
Interior Appropriation........................................................ 78 19 79 82 +3
National Institute on Aging................................................... 1,081 273 1,110 1,142 +33
Natl Inst. of Arthritis & Musculoskeletal & Skin Diseases... 525 133 539 556 +17
Natl Inst. on Deafness and Communication Disorders.......... 407 103 419 429 +10
National Institute of Mental Health....................................... 1,451 367 1,490 1,540 +51
National Institute on Drug Abuse.......................................... 1,033 261 1,059 1,094 +35
National Institute on Alcohol Abuse and Alcoholism........... 450 114 462 475 +12
National Institute of Nursing Research................................. 142 36 146 150 +5
National Human Genome Research Institute........................ 502 127 516 534 +18
Natl Inst. of Biomedical Imaging and Bioengineering.......... 308 78 316 326 +9
National Center for Research Resources............................... 1,226 1,610 1,269 1,309 +40
Natl Center for Complementary and Alternative Medicine... 125 32 129 132 +3
Natl Center on Minority Health and Health Disparities........ 206 52 212 219 +8
Fogarty International Center................................................. 69 17 70 73 +3
National Library of Medicine................................................ 339 84 359 373 +14
Office of the Director............................................................ 1,247 1,337 1,177 1,220 +43
Buildings and Facilities......................................................... 126
_____ 500
_____ 100
_____ 126
_____ +26
_____
Total, Program Level 30,554 10,400 31,247 32,247 +1,000

Less Funds Allocated from Other Sources


PHS Evaluation Funds (NLM)............................................... -8 -- -8 -8 --
Type 1 Diabetes Research (NIDDK) /1.................................. -150
_____ _____-- -150
_____ -150
_____ --
_____
Total, Budget Authority 30,396 10,400 31,089 32,089 +1,000

Labor/HHS Appropriation.................................................... 30,318 10,381 31,010 32,007 +997


Interior Appropriation........................................................... 78 19 79 82 +3

FTE.......................................................................................... 17,926 -- 17,890 18,784 +894

1/ These mandatory funds were pre-appropriated in P.L. 110-275, the Medicare Improvements for Patients and Providers Act of 2008.

*American Recovery and Reinvestment Act of 2009 (Recovery Act), including $400 million transfer from the
Agency for Healthcare Research and Quality for patient-centered health research.

37 National Institutes of Health


NATIONAL INSTITUTES OF HEALTH
The National Institutes of Health uncovers new knowledge that will lead to better health for everyone.

T he FY 2011 Budget requests


$32.2 billion for the National NIH is the world's largest and most
distinguished organization
and support, and facilities
maintenance and improvements.
Institutes of Health (NIH), an
increase of $1.0 billion, or dedicated to maintaining and ADDRESSING RESEARCH
3.2 percent, over the FY 2010 improving health through medical PRIORITIES IN FY 2011
enacted level. science. Its budget is composed of
27 appropriations for its Institutes In fulfilling its mission, NIH strives
The success of the Human Genome and Centers, Office of the Director, to maintain a diverse portfolio of
Project and several other major and Buildings and Facilities. In research founded on both public
projects that have followed quickly FY 2011, about 83 percent of the health need and scientific
afterward have provided a powerful funds appropriated to NIH will opportunity. In FY 2011, NIH will
foundation for a new level of flow out to the extramural utilize the $32.2 billion Budget to
understanding human biology, and community, which supports work support innovative research across
have opened a new window into the by more than 300,000 scientists and the spectrum from basic to clinical,
causes of disease. This includes the research personnel affiliated with guided by the NIH Director’s five
revelation of hundreds of over 3,100 organizations, including areas of exceptional research
previously unknown risk factors for universities, medical schools, opportunities that includes:
cancer, diabetes, heart disease, hospitals, and other research 1) supporting genomics and other
hypertension, and a long list of facilities. About 11 percent of the high-throughput technologies;
other common illnesses that have budget will support an in-house, or 2) translating basic science into
previously been unapproachable. intramural, program of basic and new and better treatments;
In the area of cancer, for example, a clinical research activities managed 3) reinvigorating the biomedical
new ability to comprehensively by world-class physicians and research community; 4) using
understand the mechanisms scientists. This intramural research science to enable health care
responsible for malignancy has program, which includes the NIH reform; and 5) focusing on global
already provided insights into Clinical Center, gives our Nation health.
diagnostics and pointed to a whole the unparalleled ability to respond
Genomics: Science-driven
new array of drug targets. New immediately to national and global
increases in genomics and other
partnerships between academia and health challenges. Another
high-throughput technologies in
industry are working to revitalize 6 percent will provide for agency
FY 2011 will support a range of
the flagging drug development leadership, research management
pipeline. An era of personalized
medicine is appearing, where Cancer and Autism Research Initiatives
prevention, diagnosis, and
treatment of disease can be NIH believes that exceptional scientific opportunities will exist in
individualized, instead of using the FY 2011 for combating cancer and autism. Consequently, the
one-size-fits-all approach that all President’s Budget will support a range of bold and innovative cancer
too often falls short, wasting health efforts, including the initiation of 30 new drug trials in FY 2011, and a
care resources and potentially doubling of the number of novel compounds in Phase 1-3 clinical trials
subjecting patients to unnecessary by 2016. In addition, FY 2011 will support the completion of a
and dangerous medical treatments comprehensive catalog of cancer mutations for the 20 most common
and diagnostic procedures. malignancies, setting the stage for complete genomic characterization of
Vigorous support of biomedical every cancer as part of medical care within 10 years. Critical research
research in all of these areas to improve the effectiveness of smoking cessation interventions and
promises to save lives, reduce the reduce the use of smokeless tobacco will also be supported, as will
burden of chronic diseases, 10 clinical trials of potential smoking cessation medications. For
stimulate the economy, empower autism, NIH will pursue comprehensive and innovative approaches to
new and more effective prevention defining the genetic and environmental factors that contribute to autism
strategies, and reduce health care spectrum disorders; investigate epigenomic changes in the brain; and
costs. accelerate clinical trials of novel pharmacological and behavioral
interventions by 2016.

National Institutes of Health 38


Recovery Act To shorten the timeline for
NIH provided support to about 12,800 research projects in FY 2009 with development of new cancer drugs
Recovery Act funds. In one such project, NIH awarded $751,060 to the and move promising new
University of Vermont for Dr. David Krag to continue operations of treatments into human clinical
large, randomized surgical trial for 5,000 breast cancer patients. This trials as quickly as possible, NIH
project is testing whether an individually tailored approach to breast will initiate 30 new trials in
cancer treatment using a radiotracer technique to identify which lymph FY 2011 to rapidly test the
nodes are cancerous can reduce potential side effects for the patient and effectiveness of molecularly-
avoid unnecessary treatment. This technique would enable non- targeted cancer therapies, and
cancerous lymph nodes to be left in place to perform their normal expects to double the number of
function of managing fluid balance and providing immune defense. novel compounds in Phase 1-3
clinical trials by FY 2016. In
bold and innovative efforts against By increasing its nanotechnology FY 2011, NIH will also accelerate
cancer and autism. With this research portfolio by $30 million, Phase 3 clinical trials of a
support in FY 2011, and building for a total of $359 million, NIH will promising mGluR5 antagonist,
on a major kick start from support the National begin a clinical trial of the drug
Recovery Act funds, The Cancer Nanotechnology Initiative and rapamycin, and create a
Genome Atlas will be able to nanotechnology-related translational pipeline for advancing
complete a comprehensive catalog environmental, health, and safety additional small molecule drugs for
of all the reasons why normal cells research for efforts such as autism.
become malignant for twenty of the expanding nanomaterial
most common malignancies, characterization, broadening data With the issuance of the President's
including prostate, breast and dissemination, and optimizing Executive Order 13505 on
pancreatic cancer. This research scalable designs of nanosystems. March 9, 2009, that established the
will enable precise diagnosis of conditions for Federal funding of
cancer subtypes with different Translational Research: As responsible research involving
prognoses, as well as identify at examples of projects that translate human embryonic stem cells,
least 10 new drug targets based on basic science into new and better followed by formal NIH approval
the detailed understanding of what treatments, NIH plans to double of 40 new stem cell lines in
pathways within the cell have gone support for its Therapeutic Rare and December 2009, the field of stem
awry. These activities will set the Neglected Diseases Initiative in cell research is being invigorated.
stage for complete genomic FY 2011 to a total of $50 million. Along with the development of
characterization of every cancer as These funds will support more induced pluripotent stem cells,
part of medical care within rapid drug development through a human embryonic stem cells will
10 years. truly integrated partnership provide an unprecedented
between NIH and the private sector. opportunity in FYs 2010 and 2011
In FY 2011, for autism spectrum The Clinical and Translational to understand the earliest stages of
disorders, again building on Science Award (CTSA) program, human development, and to explore
significant Recovery Act begun in FY 2006, will also receive powerful new therapeutic
investments, NIH will undertake increased support to stimulate approaches to Parkinson's disease,
complete genome sequencing and research institutions to foster more type 1 diabetes, spinal cord injury,
comprehensive DNA analyses of productive collaborations among and a long list of rare genetic
300 autism spectrum disorder investigators in different fields, diseases.
cases, and will launch the first encouraging creative organizational
models and training programs, and Launched with Recovery Act
epigenomic studies of brain support in FY 2010, the NIH Basic
samples from individuals with and producing new approaches to
complex medical mysteries. NIH Behavioral and Social Sciences
without autism. NIH will also use a Opportunity Network (OppNet) is a
network of health maintenance plans to add another $20 million in
new and reallocated funds within new NIH-wide initiative to
organizations to identify patterns of accelerate and expand basic
environmental exposure during the National Center for Research
Resources for a total CTSA behavioral and social sciences
pregnancy and perinatal life that research. The mission of OppNet is
may contribute to autism. program level of $500 million in
FY 2011. to pursue opportunities for

39 National Institutes of Health


Performance Highlight studies, or research centers for
genomic and other high-throughput
Goal: By 2012, increase the probability that predoctoral and
technologies. Consequently, NIH
postdoctoral scientists newly-trained through the Ruth L. Kirschstein
estimates that it will support
National Research Service Award program remain involved in NIH-
9,052 new and competing RPGs in
funded research in the 10 years following their training.
FY 2011, a decrease of 199 below
Performance: NIH has routinely met the targets for this training the estimated level for FY 2010,
program measure. In 2009, NIH postdoctoral fellows were excluding Recovery Act funds. The
14 percent more likely to remain active in biomedical research than total number of RPGs to be funded
non-NIH fellows, exceeding the annual target of 12 percent. NIH in FY 2011 is expected to be
predoctoral trainees and fellows were also 13 percent more likely to 37,001, an increase of 195 above
remain active than non-NIH trainees and fellows, exceeding the FY 2010 non-Recovery Act levels.
annual target of 12 percent. Over time, NIH postdoctoral and
predoctoral fellows have consistently been about 13 percent more As part of the President’s initiative
likely to remain active in biomedical research than non-NIH fellows. in FY 2011 to emphasize support
for science, technology,
strengthening basic behavioral and Reinvigorating Biomedical engineering, and mathematics
social sciences research at the NIH Research: To reinvigorate the (STEM) education programs, the
while innovating beyond existing biomedical research community, budget proposes a six percent
investments. Twenty-four NIH the FY 2011 budget request stipend increase for predoctoral and
Institutes and Centers and four provides for a two percent increase postdoctoral research trainees
program offices in the NIH Office to help cover inflationary increases supported by NIH’s Ruth L.
of the Director will collaborate on and thus preserve purchasing power Kirschstein National Research
new research initiatives supported for both new and competing and Service Awards program. This
through shared OppNet-specific non-competing continuation awards $42 million increase in stipends
funds over an initial five-year for research project grants (RPGs). will allow NIH to continue to
period. A total of $20 million is The average cost of a new and attract high-quality research
provided for this program in competing RPG in FY 2011 will be trainees that will be available to
FY 2011. about $443,000. The $17.1 billion address the Nation’s future
provided by NIH in total for these biomedical, behavioral, and clinical
NIH estimates it will devote nearly peer-reviewed and investigator- research needs.
$3.2 billion for research on initiated RPGs represent 53 percent
HIV/AIDS in FY 2011. of the total NIH budget request in INTRAMURAL BUILDINGS AND
Controlling and ultimately FY 2011. FACILITIES
eliminating HIV/AIDS will require
safe, effective vaccines and other The backbone of biomedical A total of $133 million is requested
preventive measures. Developing research has been and will continue for NIH Intramural Buildings and
such vaccines remains a priority to be the creativity of investigator- Facilities (B&F) in FY 2011, an
and one of NIH’s greatest initiated research. However, increase of $26 million above
challenges. This effort will require increasingly, investigators are FY 2010, to sustain and improve
significant advances in basic working in interdisciplinary teams, the physical infrastructure used to
research to both better understand utilizing newly accessible tools, carry out quality biomedical
the virus and the disease and to databases, and technologies, which research on the NIH campuses. In
develop new vaccine strategies. has raised the need to carefully FY 2011, NIH will focus on
balance the biomedical enterprise upgrades to ensure essential safety
In addition to these funds, the between individual investigator- and regulatory compliance, as well
budget for the National Institute of initiated projects and large-scale as on facility repairs and
Allergy and Infectious Diseases community resource research improvements to address the most
includes $300 million, the same programs. Many of the critical utility systems, fire safety,
level as in FY 2010, as part of the opportunities that will advance the and environmental deficiencies.
United States Government’s NIH Director’s scientific themes Within the B&F mechanism total,
$1 billion contribution to the may best be accomplished through $8 million is appropriated to the
Global Fund to Fight HIV/AIDS, other research mechanisms, such as National Cancer Institute for
Tuberculosis in FY 2011. research and development contracts facilities projects at its Frederick,
for comparative effectiveness Maryland campus.

National Institutes of Health 40


NIH Total Funding
(dollars in billions)
45
40
35 30.6 31.2 32.2
29.1 29.6
30
25
20
15 10.4
10
5 ARRA

0
2007 2008 2009 2009 2010 2011
Fiscal Year

ARRA (American Recovery and Reinvestment Act) funds are available for obligation
in both FY 2009 and FY 2010.

FY 2011 NIH Budget


$32.2 Billion – Percent Total by Mechanism
Research Centers
9.6%

Intramural
Research
10.6%

Research Project
Grants Research &
53.1% Development
Contracts
11.0%

Research Training
2.6%
Research
Management and
Support
4.7%
Other Research,
Superfund, Office Facilities
of the Director Construction
8.0% 0.4%

41 National Institutes of Health


NATIONAL INSTITUTES OF HEALTH
OVERVIEW BY MECHANISM
(dollars in millions)
2009 2011
2009 ARRA* 2010 2011 +/- 2010
Mechanism
Research Project Grants (dollars)........................ 16,106 6,615 16,598 17,132 +533
[ # of Non-Competing Grants ]............................... [26,217] [n/a] ] [25,779] [26,150] [+371]
[ # of New/Competing Grants]................................ [9,111] [n/a] ] [9,251] [9,052] [-199]
[ # of Small Business Grants]................................. [1,740] [n/a] ] [1,776] [1,799] [+23]
[ Total # of Grants ]............................................ [37,068] [n/a] ] [36,806] [37,001] [+195]

Research Centers................................................. 3,019 666 3,034 3,090 +56


Other Research.................................................... 1,773 528 1,807 1,854 +47
Research Training............................................... 776 33 783 824 +42
Research and Development Contracts................. 3,387 715 3,459 3,546 +86

Intramural Research............................................ 3,238 73 3,294 3,402 +109


Research Management and Support.................... 1,426 268 1,452 1,525 +73
Extramural Research Facilities Construction...... -- 1,000 -- -- --
Office of the Director.......................................... 617 ** * 633 659 +26
[ NIH Common Fund (non-add)]................................ [541] ** * [544] [562] [+18]
Buildings and Facilities....................................... 134 500 108 133 +26
NIEHS Interior Appropriation (Superfund)........ 78
_____ **_*
_____ 79
_____ 82
_____ +3
_____
Total, Program Level 30,554 10,400 31,247 32,247 +1,000

Less Funds Allocated from Other Sources


PHS Evaluation Funds (NLM)............................. -8 -- -8 -8 --
Type 1 Diabetes Research (NIDDK) /1................ -150
_____ -- _
_____ -150
_____ -150
_____ --
_____
Total, Budget Authority 30,396 10,400 31,089 32,089 +1,000

Labor/HHS Appropriation................................ 30,318 10,381 31,010 32,007 +997


Interior Appropriation....................................... 78 19 79 82 +3

FTE......................................................................... 17,926 -- 17,890 18,784 +894

1/ These mandatory funds were pre-appropriated in P.L. 110-275, the Medicare Improvements for Patients and Providers Act
of 2008.
*American Recovery and Reinvestment Act of 2009 (Recovery Act), including $400 million transfer from the
Agency for Healthcare Research and Quality for patient-centered health research.
** Funds are rolled up into the above mechanisms.

National Institutes of Health 42


SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Substance Abuse:
Substance Abuse Block Grant.................................... 1,779 1,799 1,799 --
PHS Evaluation Funds (non-add)...................... 79 79 79 --
Programs of Regional and National Significance:
Treatment................................................................ 412 453 487 +34
PHS Evaluation Funds (non-add)...................... 9 9 9 --
Prevention............................................................... 201 202 223 +21
Prescription Drug Monitoring.................................... _____2 _____2 _____2 --
_____
Subtotal, Substance Abuse 2,394 2,455 2,510 +55

Mental Health:
Mental Health Block Grant........................................ 421 421 421 --
PHS Evaluation Funds (non-add).......................... 21 21 21 --
PATH Homeless Formula Grant................................ 60 65 70 +5
Programs of Regional and National Significance....... 344 362 374 +13
Children's Mental Health Services............................. 108 121 126 +5
Protection and Advocacy........................................... 36
_____ 36
_____ 36
_____ --
_____
Subtotal, Mental Health 969 1,005 1,028 +23

Program Management/Data Collection......................... 100 102 136 +34


PHS Evaluation Funds (non-add)............................. 23 23 23 +1
St. Elizabeths Hospital.................................................. 1 1 -- -1
Data Evaluation............................................................. 3
_____ --
_____ --
_____ --
_____
Program Level Total 3,466 3,563 3,674 +110

Less Funds Allocated from Other Sources:


PHS Evaluation Funds............................................... -132
_____ -132
_____ -132
_____ -1
_____
Budget Authority Total 3,335 3,432 3,541 +110

FTE................................................................................ 528 549 553 +4

43 Substance Abuse and Mental Health Services Administration


SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION
The Substance Abuse and Mental Health Services Administration builds resilience and facilitates recovery for people
with or at risk for substance abuse and mental illness.

T he FY 2011 Budget requests


$3.7 billion for the
Promoting Wellness Among
Children and Adolescents: The
Providing Screening and Brief
Intervention: Early
Substance Abuse and Mental Budget includes $37 million for identification and interventions
Health Services Administration, Project LAUNCH (Linking can decrease total health care
a net increase of $110 million Actions for Unmet Needs in costs by impeding progression
over FY 2010. The Budget Children’s Health), an increase to addiction. The Budget
includes funding increases to of $12 million for new grants provides $37 million, an
expand community prevention that will enable communities to increase of $8 million, for
and wellness efforts, the conduct evidence-based substance abuse and mental
treatment capacity of drug prevention and wellness health screening and
courts, screening and brief interventions focused on interventions within general
intervention, children’s mental children. This funding will medical and primary care
health services, and support for prevent substance abuse and settings. This funding level
those suffering from mental mental illness concurrently by supports a pilot project to better
illness and facing homelessness. targeting the common set of risk equip primary health care
factors that lead to these physicians and other healthcare
SUBSTANCE ABUSE disorders. providers to screen for,
diagnose, and treat a broad
An estimated 23 million Expanding the Treatment range of substance abuse
Americans struggle with a Capacity of Drug Courts: The disorders.
serious substance abuse problem Budget includes $56 million to
that requires treatment. expand the treatment capacity of Supporting Treatment and
Substance abuse affects not only drug courts, an increase of Prevention: Substance Abuse
the individuals suffering from it, $13 million. Drug courts use Block Grant funds support
but families, schools, close supervision, drug testing, approximately 2 million client
workplaces, and communities. sanctions, and incentives to admissions annually, and are the
Recognizing the devastating ensure adherence to treatment cornerstone of States’ and
impacts of substance abuse, the plans to help break the cycle of Territories’ substance abuse-
FY 2011 Budget includes drug abuse. States and localities related programs. The Budget
$2.5 billion, an increase of increasingly use drug courts to includes $1.8 billion for the
$55 million, for substance abuse effectively facilitate recovery Substance Abuse and Treatment
prevention and treatment. and reduce recidivism. Block Grant. Block grant funds
are used by 60 jurisdictions to
plan, implement, and evaluate
Promoting Behavioral Health substance abuse prevention and
treatment services.
The Michigan State Department of Community Health was recently
awarded a grant to improve comprehensive wellness for young children and Providing Access to Recovery:
their families using a public health approach expanding and enhancing The Budget includes
early childhood systems of care, including the integration of behavioral $109 million, an increase of
health into primary care. $10 million over FY 2010, to
support States and Tribes in
Building on this approach to integrated and comprehensive prevention
providing a choice of treatment
through an expansion of Project LAUNCH in FY 2011, approximately 20
opportunities for individuals
additional communities will receive Federal support to assist them in
with substance use disorders.
developing and implementing effective mental illness and substance abuse
The additional funding will
prevention practices for children. This funding will support communities
support up to 4 new grants.
in their development of comprehensive prevention and health promotion
More than 80 percent of clients
systems of care.

Substance Abuse and Mental Health Services Administration 44


Performance Highlight Linking Funding to children and adolescents with
Performance: In order to serious emotional disturbances.
A national evaluation found
encourage treatment providers
that children receiving services Assisting in the Transition
to enhance the overall quality of
through systems of care from Homelessness:
substance abuse treatment, the
developed through the Approximately one-fifth of
Budget invests
Children’s Mental Health homeless individuals also have
$6 million to provide
Services program demonstrated serious mental illness. The
supplemental grants to providers
improved mental health and Budget dedicates a total of
who achieve specific
substance abuse outcomes, $159 million, an increase of
performance targets.
better school performance, and $17 million, for services to
fewer disciplinary and law Preventing Addiction to support individuals suffering
enforcement encounters. These Prescription Drugs: While from mental illness and facing
comprehensive results are prescription medications are homelessness. Included within
achieved by integrating the beneficial treatments for many this funding is a new
efforts of previously health conditions, they can lead $16 million Homelessness
fragmented child-serving to adverse health effects and Initiative to provide behavioral
systems into a single system of addiction when abused. The health and other support
care. For example, within such Budget provides $2 million, the services to homeless individuals
a system, the teacher, coach, same level as FY 2010, for and families with the aim of
physician, and State-administered controlled preventing and reducing
prevention/promotion specialist substance monitoring programs, homelessness. This funding
for a given student work in a as authorized by the National also includes $70 million, an
coordinated fashion to All Schedules Prescription increase of $5 million, for
reinforce positive behavior and Electronic Reporting Act of Projects for Assistance in
ensure the proper supports are 2005. These programs ensure Transition from Homelessness
available. that health care providers can to increase State formula grant
access accurate and timely allotments for expanding
receiving services through this prescription information, services.
program abstained from facilitating early identification
of patients at risk of addiction. Supporting Community Mental
substance use in FY 2009.
Health Services: The Budget
Reducing the Burden of provides $421 million for the
MENTAL HEALTH Community Mental Health
HIV/AIDS Among Minority
Populations: The Budget Untreated serious mental illness Block Grant. States and
includes $117 million to reduce can make it difficult to hold a Territories have significant
health disparities in minority job, go to school, relate to flexibility to target services
communities by delivering high others, and cope with day-to- supported through this funding
quality substance abuse, mental day life demands. The Budget stream to their unique needs,
health, and HIV prevention and includes $1 billion, an increase including infrastructure, service
treatment services. of $23 million, for the delivery, planning, and
prevention and treatment of evaluation to develop
Establishing Prevention mental illness. comprehensive community-
Prepared Communities: The based mental health service
Budget includes $23 million for Improving Children’s Mental delivery systems.
a new initiative to implement Health: Fifty percent of
comprehensive, evidence-based children with serious emotional Preventing Youth Violence:
community prevention disturbances drop out of high SAMHSA collaborates with the
programs that serve young school. The Budget provides Departments of Education and
people during their at-risk years. $126 million, an increase of Justice through local
This new program also funds $5 million, for grants to States partnerships to implement best
grants to States for community and localities to support the practices for education, justice,
prevention specialists to assist development of comprehensive, law enforcement and mental
in implementation. community-based, age health services through the Safe
appropriate systems of care for Schools/Healthy Students

45 Substance Abuse and Mental Health Services Administration


program. The Budget includes Protecting Individuals With Program Management and
$95 million, the same as Mental Illness: Individuals Data Collection: The Budget
FY 2010, for the prevention of with mental illness and serious includes $136 million, an
youth violence. SAMHSA- emotional disturbances who increase of $34 million, for the
supported interventions foster reside in treatment facilities are administration of SAMHSA
early childhood development of vulnerable to neglect and abuse. programs and the support of
mental and physical health, The Budget provides national data collection efforts.
reduce or delay the onset of $36 million, the same level as The majority of this increase
emotional and behavioral FY 2010, to support State will support data collection and
problems, and treat children protection and advocacy analysis, including increased
with serious emotional systems to monitor residential costs associated with ongoing
disturbances. treatment facilities. More than efforts as well as enhancing data
80 percent of the substantiated collection on drug related
Preventing Suicide: The complaints handled through emergency room visits and
Budget dedicates $54 million, these systems result in positive deaths. Analyses conducted
an increase of $6 million, to changes for their clients. through SAMHSA’s national
prevent suicide. The Budget surveys are used by Federal,
continues to invest in activities Fostering Community State, and local authorities, as
authorized by the Garrett Lee Resilience: Many Americans well as health care providers, to
Smith Memorial Act that continue to experience inform policy regarding
support intervention and heightened levels of stress and substance use and mental
prevention strategies in schools, anxiety associated with financial disorders, the impact and
institutions of higher education, and job insecurity. The Budget treatment of these disorders, and
juvenile justice systems, and invests $5 million to continue to the recovery process.
other youth support promote stress reduction and Additionally, it will fund a new
organizations. The Budget behavioral health. initiative to design and test a
increases the capacity of the In addition to these targeted community-level early warning
national hotline that routes calls resources, broader investments system to detect the emergence
across the country to a network made by SAMHSA in the of new drug threats and assist in
of certified local crisis centers prevention and treatment of identifying the public health and
that can link callers to local mental health and substance safety consequences of drug
emergency, mental health, and abuse disorders will continue to abuse. These investments will
social service resources. play a key role in facilitating enable policymakers and
resilience and recovery. practitioners to stay ahead of
emerging substance abuse
trends.

Substance Abuse and Mental Health Services Administration 46


AGENCY FOR HEALTHCARE
RESEARCH AND QUALITY
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010
Health Costs, Quality and Outcomes Research
Patient Safety Research:
Health Information Technology.............................. 45 -- 28 32 +4
General Patient Safety Research............................. 49
_____ --
_____ 91
_____ 65
_____ -26
_____
Subtotal, Patient Safety 94 -- 118 96 -22

Patient-Centered Health Research.............................. 50 700 21 273 ** +252


Crosscutting Activities .............................................. 97 112 90 -21
Value.......................................................................... 4 4 4 --
Prevention/Care Management.................................... 7
_____ --
_____ 16
_____ 16
_____ --
_____
Total, Health Costs, Quality and Outcomes 252 700 271 479 +208

Medical Expenditure Panel Surveys.............................. 55 -- 59 59 +1


Program Support............................................................ 65
_____ --
_____ 68
_____ 73
_____ +5
_____
Total, Program Level 372 700 397 611 +214

Less Funds From Other Sources


PHS Evaluation Funds................................................ -372
_____ --
_____ -397
_____ 611
_____ +214
_____
Total, Budget Authority -- 700* -- -- --

FTE................................................................................ 289 38 338 315 -23

*American Recovery and Reinvestment Act of 2009 (Recovery Act) appropriated $1.1 billion to AHRQ of which $400 was for transfer to NIH. Of the $700
remaining million, $400 million is for allocation across the Department at the discretion of the Secretary.
** In addition, $13 million within Program Support is for Patient-Centered Health Research activities, for a total of $286 million in FY 2011.

47 Agency for Healthcare Research and Quality


AGENCY FOR HEALTHCARE
RESEARCH AND QUALITY
The Agency for Healthcare Research and Quality is charged with improving the quality, safety, efficiency, and
effectiveness of health care for all Americans.

T he FY 2011 Budget request for


the Agency for Healthcare
effectiveness and efficiency within
six research priorities including
stakeholders, ranging from
consumers to clinicians and
Research and Quality (AHRQ) is prevention and care management, policymakers, with timely and
$611 million, an increase of improving patient safety, achieving usable state-of-the-science
$214 million above FY 2010. The greater health care value, information for informed decision-
FY 2011 Budget request, includes a improving health care through making related to health care. This
significant investment in Patient- health IT, conducting patient- program supports the generation of
Centered Health Research. The centered health research, and new scientific information through
Budget request also continues to crosscutting research on health research on the outcomes of health
support efforts to improve research cost, quality and outcomes. care services and therapies.
in patient safety and prevention and
care management research, as well Patient-Centered Health In FY 2011, these funds will
as investing in improving the Research: The Recovery Act continue to build on previous
capacity of data collection through appropriated $1.1 billion to AHRQ investments to support the
the Medical Expenditure Panel for research to compare the following activities: identifying
Surveys (MEPS) and the effectiveness of different health new and emerging issues;
Healthcare Cost and Utilization treatments and medical options, of synthesizing current, existing
Project (HCUP). which the Act specified evidence; identifying evidence gap
$400 million for transfer to the areas; generating new evidence;
AHRQ conducts and sponsors National Institutes of Health and translating and disseminating
health services research within the $400 million for allocation at the knowledge generated; training and
agency and across many other discretion of the Secretary. The career development; and,
settings including leading academic remaining $300 million were comprehensively engaging
institutions, hospitals, and health provided to expand and broaden stakeholders. A total of
care systems to inform decision- these efforts within AHRQ. $116 million, an increase of
making and improve health care Specifically, AHRQ funds will $104 million over FY 2010, will
clinical care, organization, and build on its Effective Health Care fund 138 research grants, of which
financing. AHRQ evaluates both Program to increase national output 105 are new and competing in
clinical services and the system in of research data, build research FY 2011.
which these services are provided. infrastructure and capacity, and
This work contributes not only to address existing research gaps. AHRQ will continue to support the
improved clinical care, but also to Recovery Act funds for allocation Developing Evidence to Inform
more efficient and safer care. The by the Secretary similarly invest in Decisions about Effectiveness
agency’s research agenda is broad high priority issues while (DEcIDE) Network, which
and spans from medical informatics strengthening and sustaining the generates new knowledge through
to health care system redesign, and foundation for this research in the the conduct of studies on outcomes,
from research that compares the long-term. comparative clinical effectiveness,
effectiveness of medical treatment safety, and appropriateness of
to patient safety research. The FY 2011 Budget request health care items and services. To
provides a total of $286 million date, the DEcIDE network has
HEALTH COSTS, QUALITY, AND (including $273 million for produced 14 Effective Health Care
OUTCOMES research and $13 million for related research reports in addition to a
program support), which, including series of methodological tools for
The FY 2011 Budget request program support, is a total increase researchers which are available on
provides a total of $479 million, an of $261 million above FY 2010, for the AHRQ Effective Health Care
increase of $208 million over Patient-Centered Health Research. website,
FY 2010, to support research on This investment will continue to www.effectivehealthcare.ahrq.gov.
health care cost, quality, provide a broad range of

Agency for Healthcare Research and Quality 48


AHRQ will also continue to type of research, including research disseminate evidence and
support the John M. Eisenberg synthesis, generation, and evidence-based tools on the use of
Clinical Decisions and translation of new scientific health IT.
Communications Science Center to evidence.
make patient-centered health Supporting Other Patient Safety
research findings and products Investing in Health IT: The Activities: The FY 2011 Budget
available to consumers, clinicians, FY 2011 Budget includes request includes $65 million for the
and policy makers, through $32 million, $4 million above the AHRQ patient safety program
translation and dissemination FY 2010 level, for health IT comprised of two research
efforts. From FY 2008 to FY 2009, research to develop and disseminate components: Patient Safety Threats
the Eisenberg Center produced a evidence and evidence-based tools and Medical Errors, and Patient
total of 30 summary guides which to inform stakeholders about how Safety Organizations that support
translated complex scientific health IT can improve the quality, efforts to identify the most
research from the Effective Health safety, and efficiency of health care. significant causes of threats to
Care Program into concise and The AHRQ health IT program both patient safety, identify best
usable products for the health care translates and conducts innovative practices to address these threats,
community. In FY 2011, AHRQ research and continues to serve as a and widely disseminate lessons
will build on expansions made valuable science partner for HHS learned. The FY 2011 budget does
possible through the Recovery Act agencies as well as entities across not continue funding for one-time
investments to develop and the Federal government. The medical liability reform
implement innovative approaches health IT program will also demonstration projects, funded at
to integrate findings into clinical continue to fund research in $25 million in FY 2010.
practice and inform health care strategic focus areas that are
decision making. Funds will also aligned with “meaningful use”, in In FY 2011, AHRQ will invest
continue to support innovative collaboration with the Office of the $34 million to reduce and prevent
approaches for translation and National Coordinator for Health healthcare-associated infections
dissemination activities. Information Technology. The (HAIs). Of this total, $9 million
FY 2011 Budget level for health IT will specifically be used to focus on
Finally, AHRQ will strengthen the will fund 44 research and training the Methicillin-Resistant
patient-centered health research grants to improve the quality and Staphylococcus Aureus
infrastructure and capacity by safety of care by demonstrating Collaborative Research Initiative.
investing in the development of best approaches to broader AHRQ funding has targeted the
knowledgeable researchers through diffusion, implementation, and reduction of HAIs with projects
training and career development. effective use of health IT, and such as a patient safety program to
FY 2011 funds will support career contracts to support the National reduce blood steam infections in
development of clinicians and Resource Center for Health IT as hospital intensive care units by
research doctorates focusing on this well as projects to develop and implementing a safety compliance
checklist and providing staff with
evidence-based practices. This
Recovery Act project was expanded to all States,
The Recovery Act provided $1.1 billion, of which $400 million was Puerto Rico and the District of
directed to be transferred to NIH, and $400 million is was allocated at Columbia, and has increased the
the discretion of the Secretary, for research that compares the number of intensive care units in
effectiveness of health care services. The Department’s overall goal hospitals implementing the
for these Recovery Act investments is to build a sustainable program throughout the country. In
foundation for promoting high quality health care through broad FY 2011 AHRQ will continue to
availability of information for patients and clinicians that will match work closely with partners,
the best science to individual needs and preferences. One example of including CDC and CMS, to
a research project grant funded by the Recovery Act will build new identify and design appropriate
clinical infrastructure and improve practices for collecting clinical projects to reduce the incidence of
information from electronic databases. Studies will enhance the HAIs.
Nation’s capacity and ability to systemically collect data to inform
this research, particularly in populations with limited access to health
care or that are typically under-represented in clinical trials.

49 Agency for Healthcare Research and Quality


Performance Highlight encounter-level data in the U.S. At
this level, AHRQ will support all
AHRQ is focusing on best practices for healthcare-associated infection
continuation grants in FY 2011.
(HAI) prevention through disseminating proven techniques for
reducing central-line associated blood stream infections in hospital
intensive care units in all 50 States, the District of Columbia, and MEDICAL EXPENDITURE PANEL
Puerto Rico. AHRQ will also initiate testing of similar techniques for SURVEYS (MEPS)
other infection sites, including catheter-associated urinary tract The FY 2011 Budget request for
infections and surgical site infections. MEPS is $59 million, an increase
of nearly 1 million over FY 2010,
Each year, an estimated 250,000 cases of central line-associated to support a sample size for MEPS
bloodstream infections occur in hospitals in the United States, leading that ensures full analytical capacity
to at least 30,000 deaths, according to the Centers for Disease Control and precision. MEPS is the only
and Prevention. The average additional hospital cost for each infection national source on how Americans
is over $36,000, which totals over $9 billion in excess costs annually. use and pay for health care. The
survey collects detailed information
Results from this project will improve care, save lives, and lead to from individuals and families on
substantial cost savings for participating hospitals and the health care medical utilization and expenditure.
system. Data produced by MEPS has
enabled the projection of regional
Supporting Other Research and and efficiency. AHRQ will and national estimates on the
Dissemination Activities: The improve primary care and clinical impact of changes in financing,
FY 2011 Budget invests outcomes by supporting activities coverage and reimbursement
$16 million for research and such as health care redesign, policy.
dissemination activities in clinical-community linkages, care
prevention and care management, coordination, and integration of PROGRAM SUPPORT
$4 million for activities aimed at health IT. Within the crosscutting In addition, the FY 2011 Budget
increasing the value of health are, portfolio, which would be funded at will provide $73 million, an
and $90 million for research and $90 million, AHRQ will increase increase of $5 million, for program
dissemination of activities on funding for the Healthcare Cost and support across the agency. Of this
crosscutting topics aimed at Utilization Project (HCUP), by total, $13 million will support
improving healthcare quality, safety nearly $2 million, which provides patient-centered health research.

Agency for Healthcare Research and Quality 50


CENTERS FOR MEDICARE &
MEDICAID SERVICES
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Current Law:
Medicare /1...................................................................................................... 430,066 450,476 475,915 +25,439
Medicaid /2...................................................................................................... 250,924 275,368 271,446 -3,922
CHIP /3............................................................................................................ 7,547 9,103 10,485 +1,382
State Grants and Demonstrations..................................................................... 498 980 1,036 +56
Recovery Act Provisions (non-add)................................................................ 31,887
______ 39,828
______ 20,095
______ --
______
Total Net Outlays, Current Law 689,035 735,927 758,882 +22,955

Proposed Law:
Medicare ......................................................................................................... -- -- 11 +11
Medicaid.......................................................................................................... --
______ 15
______ 25,395
______ +25,380
______
Total, Proposed Law -- 15 25,406 +25,391
______ ______ ______ ______
Total Net Outlays, Proposed Law /4 689,035 735,942 784,288 +48,346

1/ Current law Medicare outlays net of offsetting receipts.


2/ Net outlays net of Qualified Individuals.
3/ Includes the Child Enrollment Contingency Fund.
4/ Total net proposed law outlays equal current law outlays plus the impact of proposed legislation and offsetting receipts.

The Centers for Medicare & Medicaid Services ensures effective, up-to-date health care coverage and promotes quality
care for beneficiaries.

T he FY 2011 Budget request for


the Centers for Medicare &
coverage to millions of uninsured
children who qualify for Medicaid
Medicare and Medicaid providers
starting in FY 2011.
Medicaid Services (CMS) is or CHIP. It increased funding for
$784.3 billion in mandatory and State CHIP allotments and created BUDGETARY REQUEST
discretionary outlays, a net increase several new initiatives to increase
of $48.3 billion over the FY 2010 innovation and enrollment in the Program Integrity: The FY 2011
level. This request finances Medicaid and CHIP programs. Budget makes fighting health care
Medicare, Medicaid, the Children’s fraud a top priority by safeguarding
Health Insurance Program (CHIP), public funds and sending a clear
The Recovery Act has allowed
program integrity efforts, and message that fraud and waste in our
States to protect health care
operating costs. coverage for millions of Americans health programs will not be
during the recession by temporarily tolerated. The Budget invests
CMS is the largest purchaser of $250 million in new fraud-fighting
increasing Federal Medicaid
health care in the United States, resources to allow HHS and its
funding to help States facing budget
serving almost 102 million partners to take ground breaking
shortfalls maintain their current
Medicare, Medicaid, and CHIP programs. new steps to detect, prevent, and
beneficiaries, almost one in three prosecute health care fraud. The
Americans. The Recovery Act also includes an Budget also proposes a package of
estimated $20 billion over 10 years new authorities that will strengthen
RECENT LEGISLATION in funding to accelerate the existing program integrity
adoption of electronic health oversight. These investments will
The recent reauthorization of CHIP records through incentives to show real, measurable results and
fulfills the President’s commitment return money to the Medicare Trust
to expand health insurance Funds.

51 Centers for Medicare & Medicaid Services


Medicaid: The Budget includes
CMS FY 2011 Net Outlays, Proposed Law $25.5 billion for a 6 month
extension through June 2011 of the
$784.3 billion Recovery Act’s temporary increase
in Medicaid Federal medical
assistance percentage (FMAP) rates
to maintain support for children and
families helped by Medicaid.
Discretionary Program
M edicaid Management: The Budget makes a
38% robust investment in CMS program
management. It invests $110
million for a Health Care Data
Improvement Initiative to begin
needed investments to aging
information systems, transforming
CMS’s health care data
environment so that the Agency can
M edicare CHIP meet current needs and be prepared
60% 1% for future growth. The Budget also
includes an increase of $28 million
Administration
1%
to support increased CMS staffing
levels to handle expanding program
workloads. Transforming CMS’s
Note: State Grants and Demos accounts for 0.14 percent of net outlays. information systems and investing
in human capital are infrastructure
investments that will ensure that the
Agency can meet existing workload
demands.

Centers for Medicare & Medicaid Services 52


MEDICARE
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Current Law:

Outlays
Benefits Spending (gross) /1........................................................................ 491,133 515,803 549,825 +34,022
Less: Premiums Paid Directly to Part D Plans /2........................................ -3,654
______ -4,282
______ -4,773
______ -491
______
Subtotal, Benefits Net of Direct Part D Premium Payments 487,479 511,521 545,052 +33,531

Related-benefit Expenses/3.......................................................................... 9,885 10,189 10,066 -123


Administration /4......................................................................................... 6,579 8,076 8,062 -14
Recovery Act Provisions (non-Add)............................................................ 301
______ 475
______ 2,662
______ +2,187
______
Total Outlays, Current Law (CL) 503,943 529,786 563,180 +33,394

Offsetting Receipts
Premiums and Offsetting Receipts /5........................................................... -73,877
______ -79,310
______ -87,265
______ -7,955
______
Current Law Outlays, Net of Offsetting Receipts 430,066 450,476 475,915 +25,439

Proposed Law:
Offsetting Receipts (from Program Integrity Package)................................ --
______ --
______ 11
______ +11
______
Total Medicare Proposals 0 0 11 +11

Total Net Outlays, Proposed Law/6 430,066 450,476 475,926 +25,450

Current Policy:
Adjustment to Physician Payments.............................................................. ______-- 6,638
______ 22,146
______ +15,508
______
Net Current Policy Outlays 430,066 457,114 498,072 +40,947

1/ Represents all spending on Medicare benefits by either the Federal government or beneficiaries.
2/ In Part D only, some beneficiary premiums are paid directly to plans and are netted out here because
those payments are not paid out of the Trust Funds.
3/ Includes related benefit payments, including refundable payments made to providers and plans,
transfers to Medicaid, and additional Medicare Advantage benefits.
4/ Includes Program Management, non-CMS administration, HCFAC, Recovery Act Administration and QIOs. Of this total in FY
2011, $6.6 billion represents discretionary and non-HHS spending.
5/ Includes beneficiary premiums, State contributions to Part D, and other offsets.
6/ FY 2011 does not include $733 million in non-PAYGO scorecard savings from program integrity efforts.

53 Centers for Medicare & Medicaid Services


MEDICARE

I n FY 2011, gross current law


spending on Medicare benefits Medicare Enrollment
will total $549.8 billion. Medicare (enrollees in millions)
will provide health insurance to
48.1 million individuals who are
either 65 or older, disabled, or have 2009 2010 2011 2011 +/- 2010
end–stage renal disease (ESRD). Aged 38.5 39.0 39.8 +0.8
Disabled 7.6 8.0 8.3 +0.3
THE FOUR PARTS OF
Total Beneficiaries 46.1 47.0 48.1 +1.1
MEDICARE
Part A ($193 billion in 2011):
Medicare Part A, or Hospital Part B ($154 billion gross premium is $110.50 in 2010.
Insurance (HI), pays for inpatient spending in 2011): Medicare Part However, most beneficiaries will
hospital, skilled nursing facility, B, or Supplementary Medical continue to pay a $96.40 monthly
home health (related to a hospital Insurance (SMI), pays for premium, the same level as 2009,
stay), and hospice care. Part A physician, outpatient hospital, because current law protects them
financing comes primarily from a ESRD, laboratory, durable medical from a reduction in Social Security
2.9 percent payroll tax split equipment, certain home health, benefits as a result of Medicare
between employees and employers. and other medical services. Part B premium increases. In 2010, the
coverage is voluntary, and about Social Security cost-of-living
Individuals with 40 quarters of 93 percent of Medicare adjustment did not increase. Some
Medicare-covered employment are beneficiaries are enrolled in Part B. beneficiaries pay a higher premium
entitled to Part A without paying a Approximately 25 percent of Part B based on their income: those with
premium, but most services require costs are financed by beneficiary annual incomes above $85,000
a beneficiary co-payment or premiums, with the remaining (single) or $170,000 (married
coinsurance. In 2010, beneficiaries 75 percent covered by general couple) will pay from $154.70 to
pay a $1,100 deductible for a revenues. $353.60 per month.
hospital stay of 1-60 days, and
$137.50 daily coinsurance for days Part B premiums are based on Part C ($132 billion in 2011):
21-100 in a skilled nursing facility. income. The standard monthly Medicare Part C, the Medicare
Advantage (MA) program, offers
Medicare Benefits by Service, 2011 beneficiaries a variety of coverage
options including health
Current Law Estimate: $549.8 maintenance organizations,
billion preferred provider organizations,
special needs plans, and private
Drug Benefit
fee-for-service plans. MA
13.0%
Inpatient enrollment will total more than
Other Hospital
9.6%
11 million in 2010.
26.2%
Hospice Medicare pays MA plans a
2.4% capitated monthly payment to
provide all Parts A and B services
Home Health Outpatient
3.7%
(and Part D if offered by the plan).
Hospital Plans can also offer additional
Skilled 6.4%
benefits or a variety of cost sharing
Nursing
Facilities
arrangements. Beneficiaries pay
Managed Physicians
5.0% 9.6%
monthly premiums to MA plans to
Care cover all Medicare services plus
24.0%

Centers for Medicare & Medicaid Services 54


any additional benefits. The
premium varies depending on the Recovery Act
services offered by the plan; Electronic Health Records
therefore, it can be higher or lower
The Recovery Act invests approximately $20 billion over ten years
than the regular Part B premium.
for Medicare and Medicaid incentive payments to encourage
provider adoption of electronic health records.
Part D ($72 billion gross spending
in 2011): Medicare Part D offers a
standard prescription drug benefit those with Part D coverage are future Congressional action based
with a 2010 deductible of $310 and enrolled in a stand-alone Part D on what the Congress has done in
an average monthly premium of prescription drug plans and 35 recent years for physician
about $30. The standard benefit percent are enrolled in a Medicare payments. However, this
includes a coverage gap in which Advantage Prescription Drug Plan adjustment does not signal a
beneficiaries are responsible for all (MA-PD). Overall, approximately specific Administration policy.
of their drug costs, but once out-of- 90 percent of all Medicare
pocket spending reaches $4,550, beneficiaries receive prescription MEDICARE QUALITY
Medicare covers 95 percent or drug coverage through Medicare IMPROVEMENT
more of drug costs. For people Part D, employer-sponsored retiree ORGANIZATIONS
who are low-income, varying health plans, or other creditable
degrees of cost sharing are coverage. Between 2008 and 2011,
available with co-payments ranging approximately $1.1 billion will be
from $0 to $6.30 in 2010 and low provided to Quality Improvement
or no monthly premiums. PHYSICIAN PAYMENTS Organizations (QIOs) under the
To promote more honest and current (9th) contract cycle. This
As of December 2009, there were transparent budgeting, the Budget contracting cycle includes
about 27.3 million beneficiaries in includes an adjustment totaling significant reforms to the
Medicare Part D, including over 10 $371 billion over ten years (FY management of the program and
million low-income subsidy (LIS) 2011–FY 2020) to reflect the increases the expected performance
beneficiaries. About 65 percent of Administration’s best estimate of of the QIOs. The major goals of
the 9th contracting cycle include
preventing illness, increasing the
safety of care provided, reducing
Medicare Prescription Drug Benefit health care disparities, and
Beneficiary Cost Sharing in 2010 promoting the use of efficient and
high quality care. The 9th
Beneficiary Out-of-Pocket Spending
contracting cycle aims to
Beneficiary Annual Monthly For Total Drug Expenditures:
measurably reduce illness, injury,
Income Level Deductible Premium ≤ $6,440 > $6,440 and re-hospitalization.
≥150% FPL 25% from
Greater of 5% or
(standard $310 $30 (avg) $310-2,830; 100%
$2.50-6.30 copay Clinical Quality Efforts: Under
benefit) from $2,830-6,440 the 9th contracting cycle, clinical
Copayment of
135-150% 25-75% of care efforts will focus on
$63 15% from $2.50 generic preventing disease, improving the
FPL* $30 (avg)**
$63-6,440 $6.30 brand coordination of care to avoid
Copayment of: unnecessary re-hospitalizations,
100-135%
$0 $0** $2.50 generic $0
FPL* identifying and intervening in the
$6.30 brand name
area of health care disparities, and
Copayment of:
increasing patient safety. In
≤100% FPL* $0 $0** $1.10 generic $0
addition to the clinical quality
$3.30 brand name
efforts, QIOs will continue to
FPL=Federal Poverty Level / LIS=Low-Income Subsidy
protect beneficiaries by
*At these income levels, beneficiaries must also meet an asset test.
responding to quality of care
complaints and making
**Monthly prescription drug premium will be the amount shown in the table if the beneficiary information available to support
enrolls in a basic Part D plan with a premium that is below the LIS premium amount.
public reporting.

55 Centers for Medicare & Medicaid Services


New Performance
Estimated Quality Improvement Organization Funding
Management Strategy: The by Major Task – 9th Contract Cycle (2008-2011)
9th contracting cycle (dollars in millions)
includes several innovations Funds
in QIO contract management, Clinical Quality Improvement………………...……….…………….409
including ongoing Prevention…………………………………………………………….126
performance management Care Transitions………………………………………………………41
reviews, mid-contract Patient Safety…………………………………………………….…..227
performance assessments, Provider Performance………………………………………………..15
and financial consequences if Data Processing, Theme Implementation, and Collaboration……...262
contractors do not maintain
Other Support Contracts……………………………………………220
pre-specified performance
Protecting Beneficiaries and the Trust Funds……………………..208
levels.
Total, QIO Ninth Cycle of Contracts………………………….…..1,099

Centers for Medicare & Medicaid Services 56


PROGRAM INTEGRITY INITIATIVE
(dollars in millions)

2011- 2011-
2011 2015 2020
Program Integrity Legislative Proposals:
Medicare:
Modify Certain Medical Review Limitations............................................................................ -- -28 -73
Establish a CMS-IRS Data Match to Identify Fraudulent Providers......................................... 3 -227 -1,211
Extrapolate MA Plan Sample Error Rate to Entire Plan Payment in Risk Adjustment Audits.. ______8 -2,266
______ -7,594
______
Subtotal, Medicare 11 -2,521 -8,878

Medicaid:
Track Drug Utilizers and Prescribers to Reduce Over-utilization............................................. -120
______ -1,590
______ -4,200
______
Subtotal, Medicaid -120
______ -1,590
______ -4,200
______
Total, Program Integrity Legislative Proposals -109 -4,111 -13,078

Medicare Program Integrity Administrative Policies:


Consolidate Medical Review........................................................................................................ -40 -550 -1,530
Consolidate Medicare Provider Enrollment Activities................................................................. -- -40 -140
Expand Medicare Revocations for Abuse of Billing Privileges.................................................... --
______ --
______ --
______
Total, Program Integrity Administrative Policies -40 -590 -1,670
______ ______ ______
Total, Program Integrity Budget Proposals and Policies -149 -4,701 -14,748

Savings from Discretionary HCFAC Investment:


Return-on-Investment /1............................................................................................................... -740
______ -4,470
______ -9,870
______
Total, Savings from Discretionary HCFAC Investment -740 -4,470 -9,870
______ ______ ______
Total, Program Integrity Initiative Savings -889 -9,171 -24,618

1/ These additional savings are beyond what would be scored under PAYGO rules.

57 Centers for Medicare & Medicaid Services


PROGRAM INTEGRITY INITIATIVE

The FY 2011 Budget makes


fighting health care fraud a
Health Care Fraud and Abuse Control (HCFAC)
(dollars in millions)
priority by investing an additional
$250 million in new resources and 2010 2011-
supporting a package of legislative Base 2011 2012 2013 2014 2015 2015
and administrative changes that will Mandatory Base Funding 1,172 1,172 1,172 1,172 1,172 1,172 5,860
give HHS new tools that enhance Discretionary Funding 311 561 589 619 649 682 3,100
program integrity oversight and Total Program Level 1,483 1,733 1,761 1,791 1,821 1,854 8,960
generate $14.7 billion in program Savings from Discretionary Investment: -485 -740 -860 -910 -960 -1,000 -4,470
savings over ten years.
to the Medicare Trust Fund for each our field presence, and ensure
HEALTH CARE FRAUD AND dollar spent. For MIP, the actual greater value for program
ABUSE CONTROL (HCFAC) return on investment (ROI) expenditures.
FUNDING averages 14 to 1, and for the
This investment supports initiatives
The FY 2011 Budget proposes to HCFAC Account, the ROI averages
of the newly established joint HHS-
continue funding the HCFAC 6 to 1. From 1997 to 2008, HCFAC
DOJ Health Care Fraud Prevention
program through both mandatory activities (excluding MIP) have
and Enforcement Action Team
and discretionary funding streams. returned over $13 billion to the
(HEAT) task force by adding up to
The FY 2011 HCFAC program Trust Fund. MIP activities have
13 new Strike Force cities to
level is over $1.7 billion, yielded an average of almost
combat fraud and abuse on the front
$250 million more than in FY 2010. $10 billion annually in recoveries,
lines, which would bring the total
Of this total program level, claims denials, and accounts
number of Strike Force cities to 20.
approximately $1.2 billion is receivable over the past decade. In
The HEAT task force is a joint
mandatory and $561 million is FY 2008 alone, more than
effort between HHS and DOJ that
requested in discretionary funding. $1.9 billion in recoveries were
has made fighting health care fraud
returned to the Trust Fund and
a Cabinet level priority. It brings
HCFAC Mandatory Funds: approximately $344 million in
together the best minds and
The $1.2 billion in mandatory Medicaid recoveries were returned
resources from two Departments to
funds for FY 2011 are financed to the Treasury as a result of
share best practices, prosecute
from the Medicare Part A Trust program integrity efforts.
criminals, and recover billions in
Fund. This funding is allocated taxpayer dollars.
HCFAC Discretionary Funds:
into three major parts: 1) the As part of a government-wide
Medicare Integrity Program (MIP); Strike Forces have a proven record
proposal to fund successful
2) the Federal Bureau of of success in combating Medicare
program integrity activities through
Investigation (FBI); and 3) the and Medicaid fraud. Since March
an adjustment to discretionary
HCFAC Account, which is divided 2007, Strike Force cases that
spending totals, the FY 2011
annually among the HHS Office of included HHS agents have obtained
Budget requests $561 million in
the Inspector General (OIG), other 200 convictions, 500 indictments,
discretionary HCFAC funding, an
HHS agencies, and law and an estimated $235 million in
increase of $250 million over
enforcement partners at the expected recoveries. The FY 2011
FY 2010. This total will be
Department of Justice (DOJ). Budget builds on this effective
allocated as follows:
These dollars fund efforts to Strike Force model.
♦ Medicare: $328.4 million
combat health care fraud, waste, ♦ Medicaid: $47.7 million The additional $250 million in
and abuse, including prevention
♦ DOJ: $90.0 million discretionary funding will also
activities, provider education, data ♦ OIG: $94.8 million expand data sharing and
analysis, audits, investigations, and
coordination between HHS and
enforcement. The additional funding will better DOJ. This increased data sharing
equip HHS and its DOJ partners to will not only help stop fraudulent
Mandatory HCFAC funding has a prevent improper payments, schemes and practices before they
proven record of returning money increase data sharing, strengthen take root, but will also expose

Centers for Medicare & Medicaid Services 58


Combating Health Care Fraud Extrapolate Medicare Advantage
Plan Sample Error Rate to Entire
The Budget fulfills the President’s commitment to strengthen efforts to Plan Payment in Risk Adjustment
combat health care fraud and abuse with a $250 million discretionary Audits: Clarify in statute that CMS
HCFAC increase, the largest one-year increase in HCFAC since its can extrapolate the error rate found
inception in 1997. in the risk adjustment validation
The entire program integrity initiative in the Budget will generate nearly (RADV) audits to the entire MA
$25 billion in Medicare and Medicaid savings over ten years, including plan payment for a given year when
$15 billion in savings from seven proposals to strengthen program integrity recouping overpayments. [Effective
oversight and $10 billion from estimated return-on-investment savings CY 2011]
resulting from the discretionary investment. Track Drug Utilizers and
The increased discretionary funding supports efforts of the newly launched Prescribers to Reduce Over-
HHS-DOJ HEAT Task Force. Specifically, it can finance up to 13 new utilization under Medicaid:
Strike Force cities, bringing the total number of cities to 20. Require States to monitor and
remediate high-risk billing activity,
systemic vulnerabilities that have not just claims limited to high
NEW PROGRAM INTEGRITY
been exploited by fraudulent health volume, to improve Medicaid
PROPOSALS integrity and beneficiary quality of
care providers. Investment in
cutting-edge technology and data The Budget includes seven new care. States may choose one or
mining technologies will allow for legislative and administrative more drug classes and must
the analysis of potential fraud with proposals to fight Medicare and develop or review and update their
unprecedented speed and Medicaid fraud and abuse, saving care plan to reduce utilization and
efficiency, such as receiving almost $14.7 billion over ten years, remediate any preventable episodes
snapshots of fraudulent claims $13 billion through proposed of care where possible. [Effective
activity in real-time and completing legislation and $1.7 billion through FY 2011]
analyses that previously took administrative policies.
Administrative Proposals
months or years in a matter of days. Legislative Proposals
Consolidate Medical Review:
Finally, the increased funding will Modify Medical Review Consolidate medical review
cover the implementation costs of Limitations: Modify existing activities into fewer Medicare
new authorities that will provide statutory provisions that currently Administrative Contractors
CMS with better tools to carry out limit random medical review and (MACs) to promote efficiency and
its program integrity activities. place statutory limitations on the encourage consistency in reviewing
Based on the proven success of the application of Medicare and paying for Medicare claims.
mandatory HCFAC program, it is prepayment review. [Effective CY
2011] Consolidate Medicare Provider
expected that this additional Enrollment Activities: Create a
discretionary investment will also Establish a CMS-Internal Revenue limited number of MACs to carry
aid in the reduction of improper Service (IRS) Data Match to out provider enrollment. Each
payments and recoup many times Identify Fraudulent Providers: contractor would enroll providers
its initial investment. Authorize CMS to work for designated regions of the
CMS actuaries currently estimate collaboratively with the IRS to country, standardizing the process
that for every new dollar spent by determine which providers have not and creating efficiencies.
HHS to combat health care fraud, filed Federal tax returns to help
identify potentially fraudulent Expand Medicare Revocations for
$1.55 is saved or averted. Based on Abuse of Billing Privileges: Allow
these projections, the $561 million providers sooner. The data match
will primarily target certain high- CMS to revoke Medicare billing
in HCFAC discretionary funding privileges in response to abusive
will yield Medicare and Medicaid risk provider types in high-
vulnerability areas. This proposal billing practices, such as instances
savings of $4.5 billion over five where the provider claims to have
years and $9.9 billion over ten also ensures that both IRS and
Medicare recoup any monies owed provided a service or supply, but
years. the beneficiary and/or physician
to the Federal government through
this program. [Effective CY 2013] attest that they did not receive
and/or prescribe the service.

59 Centers for Medicare & Medicaid Services


MEDICAID
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Current Law:
Benefits /1.................................................................................... 240,575 264,298 257,878 -6,420
State Administration..................................................................... 10,349 11,070 13,567 +2,497
Recovery Act Impact (non-add) /2............................................... 31,586 39,353 17,433
_______ _______ _______ _______
Total Net Outlays, Current Law 250,924 275,368 271,446 -3,922

Proposed Law:
Legislative Proposals................................................................... -- 15 25,395 +25,380
_______ _______ _______ _______
Total Net Outlays, Proposed Law 250,924 275,383 296,841 +21,458

1/ Includes Vaccines for Children outlays.


2/ Represents the impact of the American Recovery and Reinvestment Act of 2009 on the level of Benefits and
State Administration in the Medicaid program. For more information please see the Recovery Act Chapter.

M edicaid is the primary source


of medical assistance for Medicaid Enrollment
millions of low-income and (enrollees in millions)
disabled Americans and is a central
2009 2010 2011
component of our Nation’s medical
safety net, providing health Aged 65 and Over................................ 4.8 4.9 5.1
coverage to millions who would Blind and Disabled............................... 9.0 9.3 9.5
otherwise be unable to obtain Children................................................ 25.4 27.0 27.8
health insurance. In FY 2011, an Adults................................................... 11.5 12.4 12.8
estimated 56 million people will Territories............................................. 1.0
_____ 1.0
_____ 1.0
_____
receive health coverage through Total 51.7 54.6 56.1
Medicaid. Source: CMS Office of the Actuary estimates
Although the Federal government
establishes general guidelines for disabled, and people who meet
Six-month Extension of the program, States design, certain minimum income eligibility
the Recovery Act implement, and administer their criteria. States also have the
Temporary Increase in own Medicaid programs. The flexibility to extend coverage to
Medicaid FMAP Federal Government matches State higher income groups through
expenditures on medical assistance waivers and amended State plans to
The Recovery Act provides a based on the Federal medical provide benefits to larger groups of
temporary increase in the assistance percentage (FMAP) beneficiaries. In FY 2011, the
Federal medical assistance which can be no lower than 50 Federal share of current law
percentage (FMAP) through percent. For FY 2009, FY 2010, Medicaid outlays is expected to be
December 31, 2010. The FY and part of FY 2011, State FMAP $271 billion. This is a $4 billion
2011 President’s Budget rates are adjusted to reflect (1.4 percent) decrease below
proposes to provide this temporary increases enacted by the projected FY 2010 spending,
increased match rate to States Recovery Act. mainly due to the end of the
through June 2011, providing Recovery Act’s increased match
Medicaid beneficiaries include
an additional $25.5 billion in rate.
children, the aged, blind, and/or
Federal support to States.

Centers for Medicare & Medicaid Services 60


HOW MEDICAID WORKS
FY 2008 – Percent of Medicaid Beneficiaries vs.
States are required to cover Payments (by beneficiary group)
individuals who meet certain 100% Other, 4%
minimum categorical and financial Other, 8%
90% Adults, 12%
eligibility levels, including
Adults, 22%
individuals who qualified under the 80%
Children, 19 %
former Aid to Families with 70%

Dependent Children program, most 60%

Percent
Supplemental Security Income 50%
Children, 48%
(SSI) recipients, pregnant women 40%
and children under age 6 whose 30%
Aged, Blind, and
Dis abled, 65 %
family income is at or below 133
20%
percent of the Federal poverty level Aged, Blind, and
10%
(FPL), and children ages 6 through Disabled, 22%

18 whose family income is below 0%


People Served Expenditures
the FPL, all of whom are
Sour ce: M edicaid Statistical Informat ion Sys tem, F Y 2008 , CM S.
N ote: F Y 2007 data used for A Z, HI , M I, ND , P A, TX , U T, VT and WI.

Recovery Act:
Medicaid Health IT Program Integrity: Track Drug
FY 2011 LEGISLATIVE Utilizers and Prescribers to
Incentive Payments Reduce Over-utilization: This
PROPOSALS
The Recovery Act provides proposal improves Medicaid
an estimated $10 billion Six-month Temporary FMAP integrity and beneficiary quality of
over ten years for incentive Increase: To protect Medicaid care by requiring States to track and
payments to eligible access for low-income families and monitor prescription drug billing,
Medicaid providers for provide additional fiscal relief to prescribing, and utilization patterns
efforts to adopt, implement, States and support their Medicaid that could be indicative of abuse or
upgrade, and meaningfully programs, the FY 2011 President’s over-utilization. For more
use certified EHRs. These Budget includes a proposal to information on this proposal and
incentive payments will extend by six months the temporary other program integrity initiatives,
help improve health care increased FMAP that was first see the chapter on Program
quality, efficiency, and provided by the Recovery Act. The Integrity.
safety for Medicaid increased FMAP rate would be
beneficiaries. provided to States through June 30,
2011.

commonly referred to as the


“categorically eligible.”
States may also cover
medically needy individuals. Performance Highlight
These individuals meet the Improve Health Care Quality across Medicaid and CHIP through
categorical eligibility criteria, Implementation of CHIPRA Quality Initiatives:
but have too much income or
resources to meet the financial As required by the Children’s Health Insurance Program Reauthorization
criteria. These individuals Act of 2009 (CHIPRA), HHS published a core set of child health quality
include pregnant women, measures in December 2009. CMS has developed a new performance goal
children under age 18, to measure State adoption of these measures. Beginning in FY 2011, States
newborns, and certain blind will report on at least one core child health quality measure to CMS, with
individuals, among others. For the target of at least 90 percent of States reporting.
more information, see ♦ FY 2012 target: At least 90 percent of States report on 5 core measures to
http://aspe.hhs.gov/poverty/09 CMS.
poverty.shtml. ♦ FY 2013 target: At least 90 percent of States report on 10 core measures
to CMS.

61 Centers for Medicare & Medicaid Services


RECENT PROGRAM
DEVELOPMENTS Estimated State and Federal Medicaid Outlays
American Recovery and
FY 2011-2020
Reinvestment Act of 2009 (dollars in billions)
(P.L. 111-5)
Temporary Increase in Medicaid $1,000
FMAP: The Recovery Act provides
$900
a temporary increase in each State’s
FMAP rate from October 1, 2008 to $800

December 31, 2010. In FY 2009, $700


CMS awarded over $34 billion to $600
States to protect people whose
$500
Medicaid eligibility might
otherwise have been at risk if $400

State budget shortfalls resulted $300


in Medicaid cutbacks, and to $200
generate State economic
$100
activity.
$0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Incentives for Adoption of
Federal and State Outlays Federal Outlays
Health Information Technology:
Source: CM S Office of the Actuary
The Recovery Act provides a
100 percent Federal match for
incentive payments to Medicaid
providers for the adoption and Family Smoking Prevention Medicaid spending by almost
meaningful use of certified and Tobacco Control Act of $100 million by 2020.
electronic health records 2009 (P.L. 111-31)
(EHRs) and a 90 percent Children’s Health Insurance
Federal match for State This landmark legislation allows Program Reauthorization Act
administrative expenditures. the Food and Drug of 2009 (P.L. 111-3) - Medicaid
The Recovery Act also provides Administration (FDA) to limit Provisions
implementation funding for the amount of nicotine in Numerous provisions in the
CMS. Several States have cigarettes and place limits on Children’s Health Insurance
already begun planning certain marketing and Program Reauthorization Act of
activities for implementation of labeling practices. The reduced 2009 apply to both Medicaid
the Medicaid incentive negative health outcomes and CHIP. Please refer to the
payments. Incentive payments associated with a decrease in CHIP chapter for updates on the
will likely begin in 2011. smoking as a result of this new implementation of these
law are estimated to lower provisions.

Centers for Medicare & Medicaid Services 62


MEDICAID PROPOSALS
(dollars in millions)

2011 2011
2011 -2015 -2020
Medicaid Proposals
Extend the Recovery Act Increased FMAP for 6 Months..................................... +25,500 +25,500 +25,500
Track High Prescription Drug Utilizers and Prescribers....................................... -120 -1,590 -4,200
______ ______ ______
Total, Medicaid Proposals 25,380 +23,910 +21,300

Medicaid Interactions
Exclude refundable tax credits from means-tested programs /1............................ +15 +75 +150
Veterans Affairs Reduced Pension Extension /2.................................................. -- +1,330 +1,697
______ ______ ______
Total, Medicaid Interactions +15 +1,405 +1,847

1/ This proposal is a multi-agency proposal with costs to Medicaid.


2/ This proposal is included in the Department of Veteran's Affairs FY 2011 Budget Request.
The proposal results in Federal savings overall but is a cost to Medicaid.

63 Centers for Medicare & Medicaid Services


CHILDREN'S HEALTH
INSURANCE PROGRAM
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Current Law:
Children's Health Insurance Program....................... 7,547 8,903 10,285 +1,382
Child Enrollment Contingency Fund....................... _______-- 200
_______ 200
_______ --
_______
Total Outlays 7,547 9,103 10,485 +1,382

T he Balanced Budget Act (BBA)


of 1997 (P.L. 105-33) created
too low to afford private health
insurance.
enrolled in CHIP at some point
during the year. This represents an
the Children's Health Insurance increase of 7.8 percent over
Program (CHIP) under Title XXI of States with an approved CHIP plan FY 2008 enrollment.
the Social Security Act. The BBA are eligible to receive an enhanced
appropriated almost $40 billion in Federal matching rate, which RECENT PROGRAM
mandatory funding to the program ranges from 65 to 85 percent of DEVELOPMENTS
over 10 years (FY 1998 through total costs for child health care
services and program Children’s Health Insurance
FY 2007). The program was Reauthorization Act (CHIPRA) of
extended by the Medicare, administration, drawn from a
capped allotment. Since 2009 (P.L. 111-3): In addition to
Medicaid, and SCHIP Extension providing access to health care
Act of 2007 (P.L. 110-173) through September 1999, every State, the
District of Columbia, and all five coverage for a greater number of
March 2009 with supplemental uninsured children, additional
appropriations for States Territories have had approved
CHIP plans. resources in CHIPRA also supports
experiencing shortfalls in FY 2009 the goals of improving the quality
funding. of child health care, increasing
States have a high degree of
The Children’s Health Insurance flexibility in designing their enrollment and retention of difficult
Program Reauthorization Act programs. They can implement to reach populations, and
(CHIPRA) of 2009 (P.L. 111-3) CHIP by expanding Medicaid, expanding the range of services
reauthorized the CHIP program creating a separate title XXI available to children enrolled in
through FY 2013, providing an program, or a combination of both CHIP.
additional $44 billion in funding approaches. As of December 2009,
there were 12 Medicaid expansion Financing CHIP: The funding for
over five years and creating several CHIP allotments to States increased
new initiatives to increase programs, 18 separate programs,
and 26 combination programs under CHIPRA by $44 billion in
innovation and enrollment in the FY 2009 through FY 2013 for a
program. among the States and Territories.
five-year total of $69 billion. This
HOW CHIP WORKS In FY 2009, an estimated expansion allowed for better
8.3 million individuals were funding predictability at the State
CHIP is a partnership between
Federal and State Governments that
helps provide low-income children Performance Bonus Payments
with the health insurance coverage In December 2009 CMS awarded more than $72 million to States that
they need. The program improves made significant improvement in enrolling children in Medicaid and title
access to health care and quality of XIX CHIP programs in FY 2009.
life for millions of vulnerable ♦ To qualify for a bonus payment, States must perform five of eight
children under 19 years of age. In specific enrollment and retention activities set out in CHIPRA.
general, CHIP reaches children ♦ Performance bonus payments were awarded to States that exceeded a
whose families have incomes too target enrollment figure. Alaska, Alabama, Illinois, Louisiana,
high to qualify for Medicaid, but Michigan, New Jersey, New Mexico, Oregon, and Washington received
performance bonus payments for FY 2009.

Centers for Medicare & Medicaid Services 64


level. A Child Enrollment CHIP Enrollment FY 2000 through FY 2009
Contingency Fund was established (includes adults)
for States that predict a funding
shortfall based on higher than Average Monthly Enrollment Ever-Enrolled
expected enrollment. The 10
contingency fund received an initial 9 8.3
appropriation of $2.1 billion in 8 7.5 7.7
FY 2009 and is invested in interest 7
6.9 6.9
6.0 6.1
bearing securities of the United

in millions
6 5.3 5.3
States. 5 4.6 4.4 4.4
4.8 5.0
4.2 4.3
3.4 3.8
4
Increasing Enrollment and 3.0
Improving Retention: CHIPRA 3
2.0
provided $100 million in funding 2

for grants to States, community- 1

based organizations, Indian health 0

care providers, and other local 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

entities to perform outreach and Source: CMS Office of the Actuary. FY 2009 figure is estimated.

enrollment work. Through this


funding CMS will assist States to
provide health care coverage to panel consisting of State and To ensure children in CHIP receive
low-income children eligible for Federal stakeholder groups a full spectrum of health services,
CHIP or Medicaid, but not yet identified a core set of existing CHIPRA added provisions to title
enrolled. (See the State Grants and child health measures to be applied XXI to guarantee that States
Demonstrations section for details.) to CHIP and Medicaid programs provide mental health and
CHIPRA included new State plan (see inset on Performance Highlight substance abuse services on par
options for facilitating enrollment in Medicaid section). with medical and surgical services
and retention of children into CHIP through their CHIP State plans, and
Partnerships with the Agency for that all CHIP enrollees are provided
and the Medicaid program, such as Healthcare Research and Quality
Express Lane Eligibility (ELE). coverage of dental benefits.
(AHRQ) will result in development
Under ELE, findings of income and of new child health quality Additional information regarding
other criteria are obtained from tax measures, a model electronic health implementation of these provisions
records or public services agencies record for children, and technical can be located here:
to streamline enrollment in assistance to States in developing http://www.cms.hhs.gov/CHIPRA/
Medicaid and CHIP. CMS has quality improvement programs. 05_Guidance.asp.
been working closely with States to In FY 2010, up to ten States and
develop this option and identify child health providers will receive
opportunities for data sharing with grant funding to conduct
demonstrations for improving
other agencies.
quality of children’s health care
Performance Highlight
States are also able to take under CHIP and Medicaid. Decrease the Number of
advantage of new opportunities to Uninsured Children by Working
provide premium assistance to Expanding Services: CHIPRA with States to Enroll Children in
families with access to employer- created a State option to CHIP: In FY 2008, CMS reported
sponsored insurance for their provide coverage under an 11 percent increase in
children that would be unaffordable Medicaid and CHIP for enrollment over the FY 2006
if not for the subsidies. otherwise eligible pregnant baseline, substantially exceeding
women and children who are the target of a two percent
Improving Quality: Under the lawfully residing in the United increase. This measure was
authority and funding provided by States, without application of a rebased for FY 2009 with the
CHIPRA, CMS is undertaking new five-year waiting period. To following targets for children
activities to improve the quality of date, 24 States have submitted ever-enrolled during the year:
child health care provided by CHIP proposals to elect this option in ♦ FY 2009: + 1% over FY 2008
and Medicaid. In 2009, an expert Medicaid and/or CHIP. ♦ FY 2010: + 5% over FY 2008
♦ FY 2011: + 7% over FY 2008

65 Centers for Medicare & Medicaid Services


STATE GRANTS AND
DEMONSTRATIONS
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Current Law Budget Authority:
CHIP Outreach and Enrollment Grants 100 -- -- --
CHIP Grants for Prospective Payment System Transition......................... 5 -- -- --
Medicaid Integrity Program ...................................................................... 75 75 75 --
Psychiatric Residential Treatment Demo. and Evaluation......................... 49 53 57 +4
Money Follows the Person (MFP):
MFP Demonstration ............................................................................... 349 399 449 +50
MFP Evaluation...................................................................................... 1 1 1 --
Expansion of State Long-Term Care Partnership Program ....................... 3 3 -- -3
Ticket to Work Grant Programs................................................................. 46 47 47 --
Rescission of Section 204 funding.......................................................... -22 -- -- --
Drug Surveys and Reports.......................................................................... 5 5 -- -5
_____ _____ _____ _____
Total, Current Law B.A. 612 583 629 46

Current Law Outlays:


CHIP Outreach and Enrollment Grants 2 25 32 +7
CHIP Grants for Prospective Payment System Transition......................... -- 2 3 +1
Medicaid Integrity Program ...................................................................... 53 133 75 -58
Psychiatric Residential Treatment Demo. and Evaluation......................... 4 30 29 -1
Money Follows the Person (MFP):
MFP Demonstration ............................................................................... 64 425 681 +256
MFP Evaluations and Technical Support............................................... 2 2 2 --
Expansion of State Long-Term Care Partnership Program ....................... 1 3 3 --
Ticket to Work Grant Programs................................................................. 73 136 100 -36
Drug Surveys and Reports.......................................................................... -- * -- * -- --
Medicaid Transformation Grants /1........................................................... 39 51 26 -25
Emergency Services for Undocumented Aliens /1……………................. 181 111 70 -41
High Risk Pools /2 /3................................................................................. 3 1 -- * --
Katrina Hurricane Relief /4........................................................................ 60 36 -- * -36
Program of All-Inclusive Care for the Elderly (PACE):............................
PACE Rural Site Development Grants /5 .............................................. 2 -- -- --
PACE Funds for Outlier Costs /6........................................................... -- 2 4 +2
Alternate Non-Emergency Network Providers /4....................................... 14 23 11 -12
_____ _____ _____ _____
Total, Current Law Outlays 498 980 1,036 56

1/ FY 2009 through FY 2011 outlays are from FY 2008 budget authority.


2/ FY 2009 and 2010 outlays are from FY 2006 budget authority.
3/ The Consolidated Appropriations Act, 2010 (P.L. 111-117) appropriated $55 million for State High Risk Pools
for FY 2010, which are administered in the Program Management budget.
4/ FY 2009 through 2011 outlays are from FY 2006 budget authority.
5/ FY 2009 outlays from FY 2006 budget authority.
6/ FY 2010 and FY 2011 outlays from FY 2007 budget authority.
* Outlays are less than $500,000

Centers for Medicare & Medicaid Services 66


STATE GRANTS AND
DEMONSTRATIONS

T he State Grants and


Demonstrations budget funds a
system for CHIP. CMS anticipates
awarding these grants in FY 2010.
alternatives to psychiatric
residential treatment facilities for
diverse group of program activities. individuals under the age of 21. In
The Children’s Health Insurance DEFICIT REDUCTION ACT addition, $1 million is available for
Program Reauthorization Act of (DRA) OF 2005 (P.L. 109-171) evaluation of the program.
2009; the Deficit Reduction Act of
2005; the Medicare Prescription Medicaid Integrity Program: The
Drug, Improvement, and Medicaid Integrity Program (MIP) Promoting Outreach and
Modernization Act of 2003; and the was established by Section 6034 of Enrollment in CHIP
Ticket to Work and Work the DRA and was implemented in
Incentives Improvement Act of ♦ On September 30, 2009, CMS
FY 2006. Congress appropriated
1999 added many activities to this announced that 69 grantees in
resources to the MIP as follows: $5
account. 41 States and the District of
million in FY 2006, $50 million in
Columbia were awarded
each of FY 2007 and FY 2008, and
CHILDREN’S HEALTH amounts totaling $40 million to
$75 million in FY 2009 and for
perform outreach and
INSURANCE PROGRAM each year thereafter. States have
enrollment activities through
REAUTHORIZATION ACT the primary responsibility for
September 2011. Awardees will
(CHIPRA) OF 2009 (P.L. 111- combating fraud and abuse in the
report on achievements in
3) Medicaid system. HHS supports
enrollment and retention of
State efforts through contracting
children in Medicaid and CHIP
with eligible entities to carry out
Outreach and Enrollment Grants: to facilitate dissemination of
Section 201 of CHIPRA provided activities including reviews, audits,
best practices.
funding for Outreach and identification of overpayments,
♦ In April 2010, CMS will award
Enrollment Grants in the Children’s education, and technical support to
$10 million in grants to
Health Insurance Program (CHIP). States.
improve outreach and
The Act appropriates $100 million enrollment of Native American
for FY 2009 available through In collaboration with the and Alaskan Native children in
FY 2013 for these grants, of which Department of Justice, CMS also Medicaid and CHIP.
$90 million is allocated for established the Medicaid Integrity ♦ In November 2009, CMS
competitive grants to States, Institute to provide State employees kicked-off a national enrollment
community-based organizations, with a comprehensive program of campaign with a National
Indian Tribes, providers, schools, course work encompassing all Children's Health Insurance
and other groups. Of this amount, aspects of Medicaid program Summit that brought together
$10 million is set aside specifically integrity. These initiatives are grantees, States, advocates, and
to increase enrollment of Indian highlighted in annual reports found members of the policy
children in Medicaid and CHIP. at: http://www.cms.hhs.gov/Deficit community. The campaign has
Another $10 million is dedicated to ReductionAct/021_repcongress.asp. also produced outreach and
a national enrollment campaign to (See Program Integrity section for enrollment toolkits and
improve enrollment of eligible more information on HHS efforts to revamped the
children in Medicaid and CHIP. improve program integrity). www.insurekidsnow.gov
(See highlight in this section for website in support of State and
more details.) Alternatives to Psychiatric local outreach efforts.
Residential Treatment Facilities
Grants for Transitioning to a for Children: This five-year
Prospective Payment System: demonstration (FY 2007-FY 2011)
authorized by Section 6063 of the Money Follows the Person
Section 503 of CHIPRA provided Demonstration: Section 6071 of
$5 million for grants to States to DRA provides up to 10 States with
funds totaling no more than $217 the DRA established this
help Federally Qualified Health demonstration that allows States to
Centers and Rural Health Clinics million to provide home and
community-based services as work toward sustaining their
transition to a prospective payment

67 Centers for Medicare & Medicaid Services


Medicaid programs while helping Performance Highlight
individuals achieve independence.
Medicaid Integrity Program, Percentage Return on Investment:
States are awarded competitive
To evaluate implementation and success of the Medicaid Integrity
grants along with an increased
Program (MIP), CMS has developed a measure to demonstrate the
Medicaid matching rate for
program's return on investment (ROI). Through the program, CMS
transitioning individuals from an
has Medicaid Integrity Contractors who review and audit provider
institutional setting to a qualified
claims to identify potential fraud, abuse, and overpayments.
home or community-based setting.
Overpayments identified and recouped are compared to the total
Federal funding for the Medicaid Integrity Contractors to establish
The DRA appropriated $1.75 ROI. In FY 2009, these efforts yielded a 175 percent ROI which was
billion over five years (FY 2007 – well above the target of greater than 100 percent. The targets for
FY 2011) for this demonstration, FY 2009 and FY 2010 are greater than 100 percent ROI, and the FY
with grants committed to 31 States 2011 target is greater than 200 percent ROI.
totaling $1.4 billion in FY 2007.
Further information on projects TICKET TO WORK AND WORK
Expansion of State Long-Term funded through the DRA can be INCENTIVES IMPROVEMENT
Care Partnership Program: The found here:
expansion of the State Long-Term
ACT (TWWIIA) OF 1999
http://www.cms.hhs.gov/DeficitRed (P.L. 106-170)
Care (LTC) Partnership Program, uctionAct/01_Overview.asp.
enacted under Section 6021 of the TWWIIA of 1999 authorized two
DRA, established authority for all MEDICARE PRESCRIPTION grant programs designed to assist
States to implement LTC States in developing services and
DRUG, IMPROVEMENT, AND
partnership plans that provide a supports to aid the competitive
dollar for dollar disregard of assets
MODERNIZATION ACT (MMA)
employment of people with
or resources equal to the insurance OF 2003 (P.L. 108-173)
disabilities by extending Medicaid
benefit payments on behalf of the Federal Reimbursement of coverage to these individuals. The
individual. Emergency Health Services authority to provide payments for
Furnished To Undocumented the Demonstration to Maintain
Medicaid Transformation Grants: Aliens: Section 1011 of the MMA Independence & Employment in
Established by Section 6081 of the appropriated $250 million per year Section 204 expired
DRA, this program provides grant in FY 2005 through FY 2008 for September 30, 2009. The Medicaid
funds to States for the adoption of payments to eligible providers for Infrastructure Grants, established in
innovative methods to improve the emergency health services provided Section 203, continues through
effectiveness and efficiency in to undocumented aliens and other FY 2011. More information about
providing medical assistance under specified non-citizens who are not the grants can be found here:
Medicaid. eligible for Medicaid and other http://www.cms.hhs.gov/TWWIIA/
public programs. 01_Overview.asp

Centers for Medicare & Medicaid Services 68


PROGRAM MANAGEMENT
(dollars in millions)

2009 2011
2009 ARRA 2010 2011 +/-2010
Discretionary Administration
Medicare Operations 2,266 -- 2,336 2,357 21
Federal Administration 641 -- 697 725 28
Survey and Certification 293 -- 347 362 15
Research 30 -- 36 47 12
Health Care Data Improvement Initiative -- -- -- 110 110
State High-Risk Pools /1 -- -- -- -- --
_____ _____ _____ _____ _____
Total, Discretionary 3,230 -- 3,415 3,601 186

Mandatory Administration
Medicare Improvement Patient and Provider Act 183 -- 35 38 3
Children's Health Insurance Program Reauthorization Act 5 -- -- -- --
State High Risk Pools 75 -- 55 -- -55
American Recovery and Reinvestment Act 142 142 140 140 --
_____ _____ _____ _____ _____
Total, Mandatory 405 142 230 178 -52

Reimbursable Administration (non-add) /2 209 -- 430 429 -1


_____ _____ _____ _____ _____
Subtotal, Discretionary and Mandatory 3,635 142 3,645 3,779 134

FTE /3 4,407 -- 4,717 4,869 152

1/ State High Risk Pools recategorized as mandatory Program Management in 2009 and 2010.
2/ Includes Clinical Laboratory Improvement Amendments of 1988, sale of research data, coordination of benefits for the Medicare
prescription drug program, MA/prescription drug program information campaign, and recovery audit contracts.
3/ FTE totals include FTE from other funding sources, including HCFAC, State Grants, reimbursable, and the Recovery Act. CMS will fund
the following FTEs from these other sources: FY 2009 - 285 FTEs; FY 2010 - 441 FTEs; FY 2011 - 543 FTEs.

69 Centers for Medicare & Medicaid Services


PROGRAM MANAGEMENT

T he FY 2011 discretionary
budget request for CMS Health Care Date Improvement Initiative (HCDII)
Program Management is
(dollars in millions)
$3.6 billion, an increase of
$186 million over FY 2010. This Data Improvement..................................................................... 45
request will allow CMS to continue Medicare Transformation.......................................................... 16
to effectively administer Medicare, Encounter Data for Medicare Advantage Plan Analysis........... 6
Medicaid and the Children’s Health Modernize IT Infrastructure...................................................... 34
Insurance Program (CHIP). With Systems Security....................................................................... 5
the funding requested for FY 2011, Systems Sustainability for Medicare......................................... 5
CMS will achieve its priority goals: Total.......................................................................................... 110
make targeted investments and
increase security in information
technology (IT); achieve optimal ♦ Medicare Transformation CMS’s data infrastructure is
staffing levels; increase survey Initiative: Transform payment modernized over time.
frequencies; administer new systems to improve payment
legislation; augment its research accuracy and provide the OTHER BUDGET ACCOUNT
agenda; and administer basic infrastructure for value-based SUMMARIES
operations. purchasing and comparative
effectiveness research. Medicare Operations: The
Medicare Operations request is
HEALTH CARE DATA ♦ Encounter Data for Medicare $2.4 billion, an increase of
INITIATIVE Advantage (MA) Plans: Begin $21 million above FY 2010. The
The Budget requests an initial collecting, editing, and storing Medicare Operations account funds
investment of $110 million for the new data for 10 million MA mission-critical contractor and IT
new Health Care Data beneficiaries, allowing CMS to activities necessary to administer
Improvement Initiative. This more accurately risk adjust MA the Medicare program and
initiative will transform the focus plan payments. implement activities required by
of CMS’s data environment from legislation. Top priority activities
♦ Modernize IT Infrastructure: for FY 2011 include:
claims processing to state-of-the art
Improve the ability to track and
data analysis and information
store data so that CMS can ♦ MIPPA Implementation: The
sharing. It will allow CMS to
respond more quickly to data Budget requests $89 million to
become a leader in value-based
requests from Congress and other continue implementing the
purchasing, improve systems
partners, better address disaster Medicare Improvement for
security, and increase analytic
recovery needs, and strengthen Patients and Providers Act of
capabilities and data sharing with
the security of sensitive 2008 (MIPPA). This funding
key stakeholders, giving CMS the
beneficiary data being used will supplement the mandatory
tools necessary to manage the
internally and externally. appropriation provided in the law
Medicare and Medicaid programs
of the future. The key objectives of for implementation. The
♦ Systems Security: Create an
this investment include: complexity and volume of
updated inventory and
monitoring process which better provisions in MIPPA require
♦ Data Improvement: Enhance the additional administrative
detects, prevents, and responds to
quality and timeliness of data so investment. Specifically, the
cyber-attacks.
that CMS can conduct more request will allow CMS to
robust data analysis to identify continue implementing end-stage
♦ Systems Sustainability for
aberrant billing patterns using renal disease (ESRD) pay-for-
Medicare: Sustain existing
up-to-date, authoritative claims performance.
systems so that current
information.
operations can continue as

Centers for Medicare & Medicaid Services 70


♦ Ongoing Contractor Operations
and Support: A little over Performance Highlight
42 percent, or $998 million, of CMS has a goal to reduce the use of physical restraints in nursing
the FY 2011 Medicare homes, an indicator of low quality of care in nursing homes. The use
Operations request supports of restraints has declined dramatically from the 1996 baseline of
ongoing contractor operations, 17.2 percent of residents. CMS exceeded its FY 2008 target, achieving
3.5 percent below the FY 2010 an historic low level of 4 percent. This recent success can be attributed
level. These savings have been to CMS’s major quality initiatives including CMS annual surveys,
achieved due to a multiyear efforts of the Quality Improvement Organizations, and the national
commitment to radically reform campaign entitled Advancing Excellence in Nursing Homes. The
Medicare’s contracting system. FY 2010 target is 3.8 percent, and the FY 2011 target is 3.7 percent.
Despite numerous bid protests
slowing down the reform
$387 million in projected earned purchasing, and help protect against
process, CMS plans to complete
interest through FY 2011. Apart fraud and abuse. Regulations
the conversion to 15 Part A/B
from the budget request above, promulgated January 2009 require
Medicare Administrative
an additional $9 million will be CMS and other insurers to convert
Contractors (MACs) and four
used to perform financial to ICD-10 by October 1, 2013.
durable medical equipment
statement audits.
Medicare Administrative
Federal Administration: For
Contractors (DME MACs) by the
♦ IT Systems and Other Supporting FY 2011, the President's Budget
end of FY 2011. Contracting
Activities: The Budget includes requests $725 million for CMS
reform will generate $3.1 billion
$732 million for IT systems and Federal administrative costs, a
in Trust Fund savings over the
other support, such as: systems to $28 million increase over FY 2010.
next five years (FY 2010 – FY
manage and administer Medicare
2014) through more accurate
Advantage and the Part D Of this total, $592 million will
payment of claims.
benefit; CMS’s data center and support a Full Time Equivalent
telecommunications (FTE) complement of 4,326, an
♦ Beneficiary Education and
infrastructure; and funding for increase of 50 FTE over FY 2010.
Outreach: The Budget includes
HIPAA, qualified independent This staffing increase will enable
$363 million for mandated and
contractor appeals, Part B drug CMS to administer increasing
other beneficiary education and
competitive bidding, operations responsibilities resulting from
outreach activities through the
support, claims processing legislation passed in recent years,
National Medicare & You
investments, and the final stages such as the Recovery Act and the
Education Program (described in
of contracting reform. Children’s Health Insurance
a later section).
Program Reauthorization Act of
This amount also includes 2009 (CHIPRA). In addition, this
♦ Healthcare Integrated General
$60.million to continue converting staffing level will allow CMS to
Ledger and Accounting System
to ICD-10, a classification system begin transformation of its data
(HIGLAS): The Budget requests
of diseases, injuries, and medical environment and position the
$156 million to implement
conditions developed by the World agency to effectively manage the
HIGLAS, a state-of-the-art
Health Organization. The amount modernization of Medicare and
accounting system for CMS. Of
consists of $40 million for systems Medicaid into the future.
this total, $118 million supports
costs, code policy analysis,
ongoing HIGLAS operations at
training, and planning Survey and Certification: The
25 contractors (MACs and the
requirements, as well as FY 2011 Survey and Certification
remaining legacy contractors)
$20 million for the development of request is $362 million, a
that will be operating HIGLAS
a new ICD-10 compliant $15 million increase over FY 2010.
by the end of FY 2010, and
transaction format for billing. The At this funding level, CMS will
$37.7 million will be used to
ICD-10 code set, currently used by maintain the more frequent surveys
transition additional MACs to
much of the industrialized world, of health facilities achieved in
HIGLAS. HIGLAS yields
will make it easier to determine if a FY 2010. Prior to FY 2010, survey
significant savings and
claim was appropriately billed, frequencies had steadily declined,
efficiencies through more rapid
provide more specific data potentially compromising the safety
recovery collections, resulting in
necessary for value-based

71 Centers for Medicare & Medicaid Services


and quality of care provided to Survey and Certification Frequencies
beneficiaries. Type of Facility 2009 2010 2011
Long-Term Care Facilities /1 Every Every Year Every Year
All facilities participating in the Year
Medicare and Medicaid programs Home Health Agencies /1 Every 3 Every 3 Every 3
must undergo an inspection when Years Years Years
entering the program, and on a Accredited Hospitals 1% Per 2% Per 3.3% Per
Year Year Year
regular basis thereafter, to ensure
Non-Accredited Hospitals Every 5 Every 3 Every 3
compliance with Federal health, Years Years Years
safety, and program standards. Organ Transplant Facilities Every 3 Every 3 Every 2.6
CMS contracts with State agencies Years Years Years
to conduct these inspections. ESRD Facilities Every 4.6 Every 3 Every 3
Between FY 2003 and FY 2011, the Years Years Years
number of Medicare-certified Ambulatory Surgical Centers /2 Every Every 6 Every 4
facilities increased by 20 percent. 11.5 Years Years
CMS expects States to complete Years
25,500 certifications and over Hospices, Outpatient Physical Therapy, Every Every 6 Every 6
55,000 complaint visits in FY 2011. Outpatient Rehabilitation, Portable X- 11.5 Years Years
Rays, Rural Health Clinics, and Years
Ambulatory Surgical Centers
States will inspect long-term care /1 Legislatively Mandated
facilities and home health agencies /2 Does not reflect increased survey frequency of every 3 years in 2010 due to
at their statutorily mandated Recovery Act funding.
frequencies. Survey frequencies
for all other facility types will be systems to promote better outcomes Medicare Advantage/Prescription
maintained at no less than once and quality of care. Drug Program user fees, and QIOs.
every six years (see table this Beneficiary education remains a top
page). The funding in the Budget Additionally, the Medicare Current priority for CMS, as recent
request is essential to ensure Beneficiary Survey (MCBS) is enhancements and changes to the
adequate oversight and improve the fully funded at $15 million within Medicare program will give
quality of care for Medicare- the request. The MCBS, a beneficiaries more responsibility
participating providers. continuous, multi-purpose survey for making their own health care
that represents the Medicare decisions.
Research, Demonstrations, and population, aids CMS in
Evaluation: The FY 2011 monitoring and evaluating the Of the total, $287 million, or
Research, Demonstrations and Medicare program. 66 percent, supports the
Evaluation request is $47 million, a 1-800-MEDICARE call center,
$12 million increase over FY 2010. The request also includes which provides customer service in
$2.5 million to fund Real Choice English and Spanish. The request
Of this total, $30 million will be Systems Change grants. The grants is $42 million higher than the FY
dedicated to expanding the will assist States in designing and 2010 level to support 30 million
Medicare and Medicaid research implementing improvements to calls (an increase of 1.9 million
agenda. In addition to continuing community-based support systems over FY 2010), as well as salary
existing research, CMS will that enable people with disabilities increases for call center employees.
develop new demonstration and and long-term illnesses to live and CMS anticipates increased call
pilot projects that will focus on participate in the community. volume mainly because of a
payment reforms, such as better projected increase in Medicare
aligning provider payments with National Medicare & You eligible beneficiaries, but continues
costs, providing higher quality care Education Program (NMEP): The to improve call center efficiencies.
at a lower cost, and improving total FY 2011 program level for
beneficiary education. Research NMEP is $436 million, an increase The remaining NMEP funding
projects conducted with this of approximately $39 million from supports other important
funding will advance efforts to the FY 2010 level. The NMEP beneficiary education activities.
change incentives in CMS payment program level includes funding $53 million will be used to
from Program Management, distribute about 45 million

Centers for Medicare & Medicaid Services 72


Medicare & You handbooks, 1
million more than in FY 2010. National Medicare & You Education Program
Another $32 million will support (dollars in millions)
421 million page views at
www.medicare.gov, 6 million
more than FY 2010. Since one- Activity 2010 2011
on-one counseling is an important Beneficiary Materials (e.g. Handbook).............................. 51.0 52.7
method to help beneficiaries 1-800-MEDICARE Toll Free Line /1................................ 244.8 287.0
navigate their health plan options, Internet/2............................................................................ 34.1 31.8
the Budget allocates $53 million Community-Based Outreach /3.......................................... 47.4 52.9
for community-based outreach, Program Support Services /2/4........................................... 18.9 11.3
including $50 million for State Total, NMEP Program Level /5...................................... $396.3 $435.7
Health Insurance Assistance
Program (SHIP) grants. The /1 Includes funding previously allotted to Medicare contractors for claims-
SHIP request will fund more than related inquiries
12,000 counselors in more than /2 FY 2011 QIO funding amounts are not included, as the 10th scope of work
1,300 community based (SOW) has yet to be approved. This impacts the FY 2011 funding levels of
organizations that will provide the Internet and Program Support Services
one-on-one assistance to /3 Includes State Health Insurance and Assistance Program (SHIP) grants
beneficiaries on complex /4 Includes multi-media campaign and consumer research
Medicare related topics. Finally, /5 Includes funding from Program Management, user fees and QIOs.
NMEP includes $11 million for
program support services and a
multi-media Medicare education
program to inform beneficiaries
about their benefits and plan
choices.

73 Centers for Medicare & Medicaid Services


ADMINISTRATION FOR CHILDREN
AND FAMILIES
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Discretionary /1
Program Level.......................................................................................................... 22,505 17,342 17,486 +144
Budget Authority..................................................................................................... 22,457 17,336 17,480 +144
Entitlement /2
Budget Authority..................................................................................................... 38,652 34,284 41,329 +7,045

Total, ACF Budget Authority 61,109 51,620 58,809 +7,189


Total, ACF Budget Authority, Excluding Recovery Act 50,144 49,490 58,809 +9,319

1/ Includes Recovery Act funding of $5.1 billion in FY 2009.


2/ Includes Recovery Act funding of $5.8 billion in FY 2009 and $2.1 billion in FY 2010.

The Administration for Children and Families promotes the economic and social well-being of children, youth,
families, and communities, focusing particular attention on vulnerable populations, such as children in low-income
families, refugees, Native Americans, and people with developmental disabilities.

T he FY 2011 Budget request for


the Administration for Children
ACF FY 2011 Budget
and Families (ACF) is Other ACF Programs
6%
$58.8 billion, a net increase of
Social Services Block
$9.3 billion above FY 2010, Grant
excluding Recovery Act funding. 3%
Temporary Assistance
ACF administers over 60 programs LIHEAP for Needy Families
9% 30%
to fulfill its mission of serving
America’s children and families.
The discretionary Budget includes Child Care and
Development Fund
additional funding for Head Start, 11%
Child Care, Refugee programs, and
a new child welfare initiative. The TANF Contingency Fund
Child Support
mandatory Budget includes $17.4 Enforcement and Family
3%

billion for Temporary Assistance Support


TANF Emergency Fund
4%
for Needy Families, $7.5 billion for 7%

Foster Care and related programs, Head Start Foster Care and
14% Permanency
$4.3 billion for Child Support 13%
Enforcement and Family Support,
and $3.7 for Child Care Entitlement
to States.

Administration for Children and Families 74


ADMINISTRATION FOR CHILDREN AND
FAMILIES: DISCRETIONARY SPENDING
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010

Head Start......................................................................................... 7,113 2,100 7,235 8,224 989


Child Care and Development Block Grant (disc.)............................ 2,127 2,000 2,127 2,927 800
Child Care Entitlement (non add)................................................... 2,917 -- 2,917 3,717 800
Refugee Programs
Transitional and Medical Services (TAMS).................................. 282 -- 353 417 64
Unaccompanied Alien Children (UAC)........................................ 205 -- 149 207 58
Social Services and other Refugee Programs................................ 228 -- 228 253 25
Subtotal, Refugee Programs 715 -- 731 878 147
Child Abuse Programs..................................................................... 110 -- 97 107 10
Family Violence Prevention............................................................. 131 -- 133 145 11
Child Welfare/Adoption Assistance Programs................................. 340 -- 360 360 --
Adoption Opportunities (non add)................................................ 26 -- 26 39 13
Children's Health Act Programs (non add).................................. 13 -- 13 -- -13
Adoption Incentives......................................................................... 37 -- 40 42 3
LIHEAP 1/
Formula Grants.............................................................................. 4,510 -- 4,510 2,510 -2,000
Contingency Fund......................................................................... 590 -- 590 790 200
Subtotal, LIHEAP Discretionary Budget Authority 5,100 -- 5,100 3,300 -1,800
Subtotal, Including Legislative Proposal (non add) 5,100 -- 5,100 5,300 200
Promoting Safe and Stable Families (disc)....................................... 63 -- 63 63 --
Runaway and Homeless Youth Programs........................................ 115 -- 116 116 --
Mentoring Children of Prisoners...................................................... 49 -- 49 49 --
Chafee Education & Training Vouchers.......................................... 45 -- 45 45 --
Abstinence Education, discretionary................................................ 95 -- -- -- --
PHS Evaluation Funds .................................................................... 4 -- -- -- --
Abstinence Education, mandatory.................................................... 38 -- -- -- --
Subtotal, Abstinence Education Program Level 137 -- -- --
Disaster Human Services Case Management .................................. -- -- 2 2 --
Community Services Block Grant.................................................... 700 1,000 700 700 --
Other Community Services Programs.............................................. 75 -- 73 60 -13
Rural Community Facilities (non add)......................................... 10 -- 10 -- -10
Job Opportunities for Low Income Individuals (non add)........... 5 -- 3 -- -3
Subtotal, Community Service Programs 775 1,000 773 760 -13
Native Americans............................................................................. 47 -- 49 49 --
Developmental Disabilities.............................................................. 184 -- 187 187 --
Compassion Capital Fund (CCF)..................................................... 48 -- -- -- --
Strengthening Communities Fund.................................................... -- 50 -- -- --
Center for Faith Based and Community Initiatives.......................... 1 -- 1 1 --
Social Services Research & Demonstration..................................... 14 -- 20 3 -17
PHS Evaluation Funds.................................................................... 6 -- 6 6 --
Subtotal, Social Services R&D 20 -- 25 9 -17
Federal Administration.................................................................... 197 -- 208 222 14
Total, Program Level 17,355
_____ 5,150
_____ 17,342
_____ 17,486
_____ 144
_____
Less Funds From Other Sources:
PHS Evaluation Funding............................................................... -10 -- -6 -6 --
Mandatory Abstinence Education................................................. -38 -- -- -- --
Total, Budget Authority 17,307
_____ 5,150
_____ 17,336
_____ 17,480
_____ 144
_____
FTE (including those financed with mandatory funds).................. 1,246 1,422 1,471 +49
*American Recovery and Reinvestment Act 2009
1/ The Budget includes a legislative proposal to provide an additional $2 billion based on the Administration's
projections for energy prices and the number of people in poverty.

75 Administration for Children and Families


ADMINISTRATION FOR CHILDREN
AND FAMILIES

T he FY 2011 discretionary
Budget request for ACF is
FY 2011 funding, this
Administration has invested nearly
early childhood education
programs.
$17.5 billion, a net increase of $500 million in improving the
$144 million over FY 2010. Within quality of Head Start programs. PROMOTING THE WELL BEING
this total, annual funding for early OF CHILDREN AND FAMILIES:
childhood programs is increased by Child Care: The Budget prepares
$1.8 billion, including increases of for a reauthorization of the Child Refugees: ACF provides services
$989 million for Head Start and Care and Development Block Grant to newly arrived refugees and other
$800 million for Child Care. The (CCDBG) and the Child Care entrants, unaccompanied alien
discretionary budget request for the Entitlement. The FY 2011 request children, and victims of trafficking
Low-Income Home Energy for CCDBG is $2.9 billion, an and torture. New arrivals receive
Assistance Program (LIHEAP) is increase of $800 million over the time-limited cash and medical
$3.3 billion, a $1.8 billion FY 2010 enacted level. The request assistance, English instruction, and
reduction from FY 2010, but the also includes an $800 million job-training to help them achieve
Budget includes a legislative increase to the Child Care economic self-sufficiency as
proposal to provide an additional Entitlement. Total funding for the quickly as possible. ACF also has
$2 billion in mandatory funds not Child Care and Development Fund legal custody of unaccompanied
reflected in the ACF discretionary is $6.6 billion in FY 2011, an alien children apprehended in the
total in response to higher energy increase of $1.6 billion over United States by the Department of
prices and increases in the FY 2010. The proposal calls for Homeland Security or other law
proportion of people in poverty. mandatory child care funding to be enforcement. Shelter is provided
adjusted for inflation in the years until these children’s immigration
Zero to Five Plan: As part of the after FY 2011, representing a firm relief claims are resolved or they
President’s Zero to Five Plan, the commitment to maintaining child can be released to relatives or
Budget provides significant care funding at these levels in the sponsors.
increases to improve access to high future and ensuring that these funds The Budget includes $878 million
quality, affordable child care and do not erode with inflation. for these activities, an increase of
continue the major investments in The FY 2011 request serves $147 million. This increase
Head Start expansion and quality 1.6 million children, approximately includes an additional $64 million
made by the Recovery Act. 235,000 more than would have for transitional cash and medical
otherwise been served. The assistance for new arrivals and an
Head Start: The FY 2011 Budget Administration supports reforms in additional $25 million for refugee
request for Head Start is CCDBG that would establish a high social services – homelessness
$8.2 billion, an increase of standard of quality across child care assistance and case management.
$989 million over FY 2010. Head settings, expand professional These additional funds are
Start will serve an estimated development opportunities for the requested because refugees are
971,000 children from birth to age child care workforce, and promote having more difficulty achieving
five in FY 2011, approximately coordination across the spectrum of self-sufficiency and making ends
66,500 more children than FY
2008. This number includes
approximately 116,000 infants and Recovery Act
toddlers in Early Head Start, nearly
twice the number served in The Recovery Act provided $2.1 billion for Head Start, $1.1 billion of
FY 2008. The FY 2011 funding which was specifically for Early Head Start expansion. This historic
increase will maintain services to investment is providing quality early childhood experiences to
children currently supported by the approximately 64,000 additional children, including 50,000 infants
Recovery Act and provide a cost of and toddlers. The Head Start program helps low-income children
living increase for grantees. The arrive at school ready to learn by enhancing their social and cognitive
Budget also dedicates $118 million development through the provision of educational health, nutritional,
to improve Head Start program social and other services. The program has served more than
quality. Including requested 25 million children since it began in 1965.

Administration for Children and Families 76


meet in the current economy. The permanency, and well being of triggered by increases in energy
overall increase also includes an children. Within this total, prices and the percent of the
additional $58 million to provide $13 million is redirected from two population living in poverty (as
shelter to additional children, adoption programs authorized by measured by those receiving
implement provisions of the the Children’s Health Act to the supplemental nutrition assistance).
Trafficking Victims Protection Adoption Opportunities program.
reauthorization, and locate Funding is redirected because the A legislative proposal would
additional shelter capacity closer to Adoption Opportunities program provide this mandatory funding in
the border with Mexico where most can fund the Children’s Health Act FY 2011. Under this proposal,
children served by this program are programs, but it has broader mandatory funds would be released
apprehended. Since the annual authority to help eliminate barriers almost immediately in response to
costs of refugee cash and medical to adoption, particularly for changes in actual energy prices and
assistance are difficult to estimate, children with special needs. the anticipated number of people
the Budget includes a new receiving supplemental nutrition
$25 million contingency fund Adoption Incentives: To increase assistance.
which will remain available until the adoption of children, ACF
expended. provides bonuses to States if they Other Programs for Children and
increase the number of children Youth: The Budget maintains
Child Abuse Prevention: The adopted from their public foster funding for Promoting Safe and
Budget request includes care systems. Additional bonuses Stable Families to continue support
$107 million for Child Abuse are provided for adoption of for States’ efforts related to child
Prevention programs, an increase of children nine and older, and for abuse prevention services and
$10 million. This funding prevents adoption of younger children with promote family preservation. It
child abuse and neglect by special needs. To fully cover also includes $116 million for
improving investigations of abuse, anticipated State bonuses, the Runaway and Homeless Youth
training child protection workers, Budget includes $42 million, an programs, the same as FY 2010, to
and enhancing the capacity of the increase of $3 million over make grants to public and private
program to prevent and treat child FY 2010. organizations that establish and
abuse and neglect. The additional operate shelters for youth, offer
$10 million will be used for a new supportive services, like
competitive grant program to Performance Highlight Transitional Living Programs,
encourage States to use evidence- The percentage of Head Start including Maternity Group Homes.
based practices for preventing child and Early Head Start teachers The Budget maintains funding at
abuse and neglect. with an Associates degree or $49 million for the Mentoring
higher, or a relevant Children of Prisoners program to
Family Violence Prevention: The credential, increased from provide grants to eligible entities
Budget includes $145 million for 69 percent in FY 2005 to that support one on one mentoring
family violence prevention 77 percent in FY 2009, for children of incarcerated parents
programs, an $11 million increase exceeding the FY 2009 target and those recently released from
over FY 2010, which is the primary of 75 percent. prison. ACF will continue to
Federal-funding stream dedicated enhance the quality of these
to the support of domestic violence mentorships by working with
shelters and services for victims of Low Income Home Energy grantees to implement evidence-
domestic violence and their Assistance: The Budget proposes a based models. To continue to
dependents. The additional funding new way to fund the LIHEAP provide post secondary educational
will be used to expand shelter program to help low income assistance to foster care youth ages
capacity and support services, households heat and cool their 16 to 21, the Budget includes
provide services to children who homes. The proposal will adjust $45 million for Chafee Education
witness domestic violence, and annual funding levels according to and Training Vouchers
support increased call volume to changes in the need for assistance. (Independent Living) providing up
the Domestic Violence Hotline. to $5,000 per participant for
The Budget includes $5.3 billion in expenses like tuition, books, and
Child Welfare/Adoption LIHEAP funding, $3.3 billion in other fees.
Assistance: The Budget requests discretionary funding and $2.0
$360 million to promote the safety, billion in mandatory funds

77 Administration for Children and Families


COMMUNITY AND OTHER ACF develop projects specifically disabilities and to increase voter
PROGRAMS targeted toward improving access participation.
to grocery stores, farmers markets, Research: There is a continuing
Disaster Human Services Case and other venues for fresh need for research to help low-
Management: The Budget groceries. income families become
requests $2 million to continue economically self-sufficient,
preparations to assist individuals Native Americans: The Budget promote the social and cognitive
affected by disasters regain self- includes $49 million to assist Tribes development of young children,
sufficiency. This funding will be and tribal communities in and assist at-risk youth in making a
used to identify and pre-screen developing and supporting their successful transition to adulthood.
volunteers that will be ready to local economies through business The Budget includes $9 million to
provide case management services expansion, job creation, and support research and evaluation
in the event of a national disaster. improved provision of social projects in these critical areas,
services. In addition to these including $3 million for an
Community Services Programs: economic benefits, this funding evaluation related to early
The FY 2011 Budget includes also preserves Native American childhood care and education.
$760 million for Community languages, builds the capacity of
Services Programs, a reduction of tribal governments, and improves Federal Administration: The
$13 million from FY 2010. The tribal control of local natural Budget includes $222 million for
Budget maintains funding for the resources. the administration of ACF
Community Services Block Grant,
Developmental Disabilities: The programs, an increase of
while discontinuing funding for
Budget includes $187 million to $14 million that will enable ACF to
two discretionary grant programs
ensure that individuals with meet new program responsibilities
that finance projects that could be
developmental disabilities have resulting from recently enacted
supported by other Federal funding
access to consumer-centered legislation. This includes re-
streams.
support services and have competition for certain Head Start
The Budget maintains $36 million opportunities to participate in grants under Head Start
for Community Economic community life. This funding is Reauthorization and the significant
Development, including also used to protect the legal and expansion of Head Start and Early
$20 million for community human rights of individuals with Head Start programs since
development corporations to FY 2008.

Administration for Children and Families 78


ADMINISTRATION FOR CHILDREN AND
FAMILIES: ENTITLEMENT SPENDING
(dollars in millions)
2011
2009 2010 2011 +/- 2010
Current Law B.A.:
Temporary Assistance for Needy Families (TANF) /1 17,059 17,059 16,740 -319
Supplemental Grants (non-add) /2 319 319 -- -319
TANF Contingency Fund /3 -- -- 1,855 +1,855
TANF Emergency Fund /4 5,000 -- -- --
Child Care Entitlement to States 2,917 2,917 2,917 --
Child and Development Block Grant (non-add) 4,127 2,127 2,127 --
Child Care and Development Fund (non-add) 7,044 5,044 5,044 --
Child Support Enforcement and Family Support 4,282 4,789 3,583 -1,206
Recovery Act Child Support Enforcement (non-add) 429 1,388 -- -1,388
Foster Care and Permanency 7,218 7,381 7,219 -162
Recovery Act Foster Care and Permanency (non-add) /5 389 425 118 -307
Children's Research and Technical Asst. 58 58 52 -6
Promoting Safe and Stable Families (mandatory only) 380 380 360 -20
Social Services Block Grant 1,700 1,700 1,700 --
Abstinence Education 38
______ --
______ --
______ ______--
Total, Current Law B.A. 38,971 34,284 34,426 +142

Proposed Law B.A.:


TANF 17,059 17,059 17,409 +350
Supplemental Grants (non-add) /2 319 319 319 --
Healthy Marriage Responsible Fatherhood (non-add) /6 150 150 -- -150
Fatherhood, Marriage, and Families Innovation Fund (non-add) -- -- 500 +500
TANF Contingency Fund -- -- 1,855 +1,855
TANF Emergency Fund /4 5,000 -- 2,500 +2,500
Child Care Entitlement to States 2,917 2,917 3,717 +800
Child Care and Development Block Grant (non-add) 4,127 2,127 2,927 +800
Child Care and Development Fund (non-add) 7,044 5,044 6,644 +1,600
Child Support Enforcement and Family Support /7 4,282 4,789 4,256 -533
Recovery Act Child Support Enforcement (non-add) 429 1,388 -- -1,388
Foster Care and Permanency /8 7,218 7,381 7,455 +74
Recovery Act Foster Care and Permanency (non-add) 389 425 118 -307
Children's Research and Technical Assistance 58 58 58 --
Promoting Safe and Stable Families (mandatory only) /9 380 380 380 --
Social Services Block Grant 1,700 1,700 1,700 --
Abstinence Education /10 38 -- -- --
LIHEAP /11 --
______ --
______ 2,000
______ +2,000
______
Total, Proposed Law B.A. 38,652 34,284 41,329 +7,045
Total, Proposed Law B.A. Excluding Recovery Act 32,834 32,152 41,211 +9,059

1/ TANF programs include family assistance grants to States and Territories, Matching Grants to Territories, TANF Supplemental Grants
for Population Increases, Healthy Marriage and Responsible Fatherhood Grants, and Tribal Work Programs.
2/ The Recovery Act extended the TANF Supplemental Grants through FY 2010. The Budget extends the grants for one year.
3/ The Deficit Reduction Act of 2005 (DRA) extended the availability of unobligated Contingency Fund balances through FY 2010. The
FY 2011 baseline assumes the fund is reauthorized at $1.855 billion, the same level available at the time DRA was enacted.
4/ The Recovery Act established a $5 billion TANF Emergency Fund for FY 2009 and FY 2010 to address rising costs related to basic
assistance and other employment related services. The Budget proposes a new TANF Emergency Fund in FY 2011.
5/ The Recovery Act provision increasing the FMAP rate is effective FY 2009 through the first quarter of FY 2011.
6/ The Budget proposes to redirect funding for the Healthy Marriage and Responsible Fatherhood grants to the Fatherhood, Marriage, and
Families Innovation Fund.
7/ The Budget includes $669 million for a proposal to extend for one year a provision in the Recovery Act that allows States to receive a
Federal match for incentive payments reinvested in their child support programs.
8/ The Budget includes $214 million for a proposal to extend for six months a provision in the Recovery Act that increases the FMAP rate.
9/ The Budget includes a proposal to reauthorize the State Court Improvement Program.
10/ The Budget includes $183 million in the Office of Public Health and Science for teen pregnancy prevention programs that could
include abstinence education.
11/ See ACF Discretionary Programs Section for further explanation.

79 Administration for Children and Families


ADMINISTRATION FOR CHILDREN AND
FAMILIES: ENTITLEMENT SPENDING

TheACFFYEntitlements
2011 Budget request for
is
Foster Care, Adoption Assistance,
and Guardianship Assistance.
available to TANF recipients. In
addition, States may transfer up to a
$41.2 billion, a net increase of Other major increases are attributed combined 30 percent of their TANF
$9.1 billion over FY 2010, to the modification and additional funding to the Child Care and
excluding Recovery Act funding. funding for the TANF Emergency Development Fund (CCDF) and
ACF serves the Nation’s most Fund, the creation of a new Social Services Block Grant
vulnerable populations through LIHEAP mandatory funding (SSBG), with not more than
entitlement programs such as trigger, additional funds for child 10 percent transferred to SSBG.
Temporary Assistance for Needy care assistance, and creation of a
Since welfare reform was enacted
Families, Child Care Entitlement to Fatherhood, Marriage, and Families
through the Personal Responsibility
States, Child Support Enforcement, Innovation Fund.
and Work Opportunity
Foster Care, Adoption Assistance,
TEMPORARY ASSISTANCE FOR Reconciliation Act of 1996
Guardianship Assistance,
(P.L. 104-193), States are spending
Independent Living, and Promoting NEEDY FAMILIES (TANF)
less on cash assistance and more on
Safe and Stable Families. TANF provides approximately education and training, child care,
The Budget proposes to extend $17.1 billion annually to States, and other work supports to help
several provisions originally Territories, and eligible Tribes to families achieve self-sufficiency.
enacted in the Recovery Act support low income working In 1998, States spent 63 percent of
including a one-year extension of families. The Deficit Reduction combined State and Federal funds
the TANF Supplemental Grants; a Act of 2005 (DRA) (P.L. 109-171) on cash assistance, compared to
one-year resumption of State child reauthorized TANF through 33 percent in FY 2008.
support enforcement programs’ FY 2010.
ability to draw a Federal match by The economic crisis has put
States have enormous flexibility
reinvesting incentive payments; and enormous pressure on low-income
under TANF to determine their own
extending for six months the families and TANF. The Recovery
eligibility criteria, benefit levels,
additional increase in the match for Act made several temporary
and types of services and benefits
changes to the TANF program to
help States facing rising
Fatherhood, Marriage, and Families Innovation Fund expenditures for TANF and other
low-income families. In 2009, the
The Budget includes a legislative proposal for a new mandatory fund that
Recovery Act’s $5 billion
would provide competitive grants to States for program innovations in
Emergency Fund provided
two areas focused on helping hard-to-reach populations.
assistance to 37 States and
Strengthening families by investing in comprehensive responsible 12 Tribes facing higher cash
fatherhood initiatives. Programs might include expanding service assistance caseloads and related
provided through child support enforcement offices, funding spending, and increased spending
comprehensive responsible fatherhood programs, eliminating barriers to on subsidized employment and
employment, providing enhanced training, and employment opportunities. non-recurrent short-term benefits
States will partner with non-profits and community organizations with for low-income families. The
these programs. Recovery Act also extended the
TANF Supplemental Grants
Improving child outcomes by improving outcomes for custodial
through FY 2010, temporarily
parents facing serious barriers to self-sufficiency. Funded activities
allowed certain adjustments to the
would focus on barriers to employment and could include interventions
caseload reduction credit, and
like home visitation, subsidized employment, transitional jobs, and mental
permanently expanded use of
health and substance abuse treatment.
TANF carry-over funds.
General specifications for the fund include: Three-year grants to States
on a competitive basis; States proposing activities supported by strong TANF LEGISLATIVE
evidence will be prioritized; States that receive funding will be expected PROPOSALS
to rigorously evaluate programs; and, funds may be for statewide or The Budget extends the TANF
community-specific initiatives. block grant and related programs,

Administration for Children and Families 80


including the Contingency Fund these levels in the future and $4.3 billion in net budget authority
and Supplemental Grants, through ensuring that these funds do not for CSE and Family Support
FY 2011. It also creates a new erode with inflation. In FY 2011, Programs.
Fatherhood, Marriage, and Families the request would enable
Custodial families that have never
Innovation Fund that will provide 1.6 million children to receive child
received TANF get all child support
competitive grants to States to care assistance – approximately
collected on their behalf. Child
conduct and evaluate 235,000 more than could be served
support collections on behalf of
comprehensive responsible in the absence of these additional
families receiving TANF and some
fatherhood programs that rely on funds.
arrearage collections on behalf of
strong partnerships with
Child Care Performance: ACF former TANF recipients are shared
community-based organizations as
continues its efforts to improve the between the State and Federal
well as demonstrations geared
quality of child care providers. governments as reimbursement for
toward improving child outcomes
In CY 2007, CCDF successfully providing TANF or Foster Care
by improving outcomes for
encouraged 32 States to implement benefits. Beginning in FY 2009,
custodial parents experiencing
early learning guidelines linked to the Federal government shares in
serious barriers to self-sufficiency.
the education and training of the cost when States opt to
The Budget assumes a cap on
caregivers, preschool teachers, and distribute more collections directly
Contingency Fund obligations in
administrators. This performance to current and former TANF
FY 2011 to reflect its one-year
exceeds the CY 2007 target of families.
extension. The Budget includes a
28 States.
legislative proposal that provides The Federal government shares in
$2.5 billion for the TANF CHILD SUPPORT the financing of this program by
Emergency Fund. This proposal providing matching funds for
ENFORCEMENT (CSE) AND
expands the allowable uses for the general State administrative costs
FAMILY SUPPORT PROGRAMS and paternity testing, as well as by
Emergency Fund made available by
CSE is a joint Federal, State, Tribal,
the Recovery Act and helps pay for funding incentive payments.
and local partnership that seeks to
increased expenditures on cash The Recovery Act temporarily
ensure financial and emotional
assistance, employment-related allowed States to use Federal
support for children from both
services (including subsidized incentive payments as their State
parents by locating non-custodial
jobs), and other related services in share of expenditures eligible for
parents, establishing paternity, and
the States, Territories, and Tribes. Federal match in FY 2009 and
establishing and enforcing child
support orders. Title IV-D of the FY 2010. States receive Federal
CHILD CARE ENTITLEMENT Social Security Act establishes incentive payments based on their
(CCE) child support services that are performance in paternity
The Budget prepares for a available for all families regardless establishment, support order
reauthorization of the Child Care of welfare status. The FY 2011 establishment, collection of current
and Development Block Grant and President’s Budget request is support and arrearages,
the Child Care Entitlement. The
FY 2011 request for CCES is
$3.7 billion, an increase of Recovery Act
$800 million over the FY 2010 ♦ To date, 37 States and 12 Tribes have accessed the $5 billion Emergency
enacted level. The request also Fund available to provide assistance to States, Tribes, and Territories
includes an $800 million increase facing higher cash assistance caseloads and related spending, and
to the Child Care and Development increased spending on subsidized employment and non-recurrent short-
Block Grant. Total child care term benefits for low-income families. These funds are available
funding for the Child Care and through FY 2010.
Development Fund is $6.6 billion ♦ Provides an estimated $929 million to States for a temporary
in FY 2011, an increase of 6.2 percentage point increase in the Federal Medical Assistance
$1.6 billion over FY 2010. The Percentage (FMAP) rate used to determine the Federal match for
proposal calls for mandatory child maintenance payments for Foster Care, Adoption Assistance, and
care funding to be adjusted for Kinship Guardianship through December 2010.
inflation in the years after FY 2011, ♦ Temporarily restored States’ ability to use Federal child support incentive
representing a firm commitment to payments as their State share of expenditures eligible for Federal match,
maintaining child care funding at bringing an estimated $1.8 billion to support State efforts.

81 Administration for Children and Families


and cost-effectiveness. Performance Highlight
The CSE program also provides The Child Support Enforcement (CSE) program continues to make
$10 million annually for grants to strong gains in child support collections as well as support order and
States to facilitate non-custodial paternity establishment. In FY 2008:
parents’ access to and visitation ♦ Child support collections reached $26.6 billion, a seven percent
with their children. increase from the previous year.
♦ 1.8 million paternities were established and acknowledged, a
Other family support programs 3.1 percent increase from the previous year.
funded in this account include ♦ CSE achieved a 96 percent paternity establishment rate, exceeding its
Payments to Territories and target of 95 percent in 2008.
Repatriation. Payments to ♦ CSE surpassed its target for establishing child support orders,
Territories funds approximately generating support orders for 79 percent of all child support cases,
$33 million in State maintenance which is four percentage points above the target of 75 percent for 2008.
assistance programs for eligible ♦ For every dollar invested in the program, CSE collected $4.80 in child
aged, blind, and disabled support, exceeding the target of $4.63. CSE aims to increase the cost
residents of Guam, Puerto Rico, effectiveness ratio to $4.84 by FY 2011.
and the Virgin Islands, per Title
XVI of the Social Security Act. Recognizing that healthy families come into contact with the child
The Repatriation program, need more than financial support welfare system.
authorized by section 1113 of the alone, the fourth FY 2011 proposal
would increase resources for FOSTER CARE AND
Social Security Act and the Act of
July 5, 1960, provides assistance to Access and Visitation Programs by PERMANENCY
United States citizens and their $2 million to support and facilitate The Budget request for the Foster
dependents who are returning from non-custodial parents’ access to and Care, Adoption Assistance,
foreign countries and are deemed to visitation with their children. In Guardianship Assistance, and
be destitute, mentally ill, or in need FY 2011, these four proposals will Independent Living programs is
of emergency evacuation due to cost $672 million in new budget $7.5 billion in budget authority.
threatened armed conflict, civil resources with an expected These programs, authorized by
strife, or natural disasters. The cap $558 million to be spent in Title IV-E of the Social Security
for this program is $1 million FY 2011. Act, support safe living
annually, although it has been environments for vulnerable
CHILDREN'S RESEARCH AND
necessary to raise or lift the cap in children and prepare older foster
the past. In the aftermath of the TECHNICAL ASSISTANCE
youth for independence.
earthquake that devastated Haiti, The Budget request includes $58
Of the total request, $4.6 billion in
Congress, the Administration, and million for activities in three areas:
budget authority will support the
the States have recently focused on child support enforcement training
Foster Care program, including
the program. and technical assistance; operation
maintenance payments to children.
of the Federal Parent Locator
CSE LEGISLATIVE PROPOSALS This is a $36 million decrease from
Service (FPLS) which assists States
the FY 2010 level. The proposed
The Budget includes four in locating absent parents; and
level of funding will support
legislative proposals for this research on welfare and child well-
approximately 168,200 children
program. The request includes a being. Of the total, $12 million
each month, about 6,500 fewer
one-year extension of States’ ability will fund child support enforcement
children than in FY 2010. This is
to draw a match when they reinvest training and technical assistance,
partially due to placement of more
incentive payments in their and $25 million will support FPLS
children in permanent settings. It is
respective programs provided by operations. The remaining
also due to a reduction in the foster
the Recovery Act. This will allow $21 million will fund a proposal for
care children funded under the
States to maintain program efforts. a one-year extension of funds for
Federal program because the
The Budget also includes two child welfare research ($15 million) and
income eligibility criteria required
support proposals aimed at for the National Survey of Child
by statute is tied to the old Aid to
increasing collections. Together and Adolescent Well-Being
Families with Dependent Children
these two proposals will increase ($6 million), a longitudinal study
(AFDC) which has resulted in the
child support collections by $271 on the well-being of children who
payment’s value eroding over time
million over five years. due to inflation.

Administration for Children and Families 82


entitlement programs by children exited Foster Care (within
The Budget also includes 6.2 percentage points. It is two years of placement) either
$2.5 billion in budget authority for estimated that States will receive an through guardianship or adoption,
the Adoption Assistance program, additional $929 million between exceeding the target of 36 percent.
an increase of $84 million above October 1, 2008 and
the FY 2010 enacted level. This Promoting Safe And Stable
December 31, 2010 due to this
increase reflects a rise in the Families (PSSF): The Budget
provision.
number of children participating in maintains funding for PSSF to
the Adoption Assistance program, FOSTER CARE AND ensure continued support for a
as well as the legislative proposal to variety of important State child
PERMANANCY LEGISLATIVE
extend the enhanced Federal welfare activities, including post-
PROPOSAL adoptive services. This program
Medical Assistance Percentage
(FMAP) match rates for The Budget includes a legislative has two distinct funding streams,
maintenance payments for an proposal to extend the increased one discretionary and one
additional two quarters through FMAP under the Recovery Act for mandatory. The total FY 2011
June 30, 2011. An estimated six additional months. This Budget request for PSSF is
average of 453,900 children per proposal adds $237 million for $423 million. The mandatory
month, an increase of 19,600 over States in their Federal match rate portion of this Budget request
FY 2010, will have payments made for maintenance payments for Title provides funding for this capped
on their behalf. IV-E foster care, adoption entitlement at $360 million.
assistance, and guardianship The Budget includes a proposal for
In FY 2011, the Budget includes assistance. The increased match
$78 million for the Guardianship a five-year reauthorization of
rate will help provide fiscal relief to
Assistance program, an increase of $20 million in funds for two
States.
$27 million above FY 2010 elements within the State Court
reflecting an increase in the number Foster Care and Permanency Improvement program, improved
of children participating in the Performance: The Foster Care, data collection and training and
Guardianship Assistance program, Adoption Assistance, and collaboration between courts and
as well as the impact of the Independent Living programs child welfare agencies.
legislative proposal to extend the demonstrated success in improving
Promoting Safe and Stable
enhanced FMAP match rate for safety, permanency, and well-being
Families Performance: In FY 2008
maintenance payments for an of children in FY 2008, the latest the percentage of children in Foster
additional two quarters through year for which complete Care without a case plan goal was
June 30, 2011. An estimated performance data are available.
reduced to 3.4 percent, exceeding
average of 14,300 children per Working with the States, these
the goal of 5.9 percent. By
month, an increase of 5,800 over programs supported the goal of
increasing the proportion of cases
FY 2010, will have payments made minimizing disruptions to the
with a case plan goal developed in
on their behalf in FY 2011. continuity of family and other a timely manner, ACF is helping to
relationships for children in Foster
The Budget also contains ensure that there is a focus on
Care by decreasing the number of
$140 million in budget authority for moving children from Foster Care
placement settings per year for a
the Independent Living Program, to a permanent home.
child in care. In FY 2008, almost
the same as the FY 2010 level. 84 percent of children who had
This program funds services for
SOCIAL SERVICES BLOCK
been in care less than 12 months GRANT (SSBG)
youth who will likely remain in had no more than two placement
foster care until they turn 18 and settings, exceeding the target of SSBG is a capped entitlement
for former foster children between 80 percent. which provides flexible grants to
the ages of 18 and 21. States for the provision of social
The programs also supported goals services ranging from child care to
The Federal government uses the to provide children in Foster Care
FMAP to match State maintenance residential treatment. SSBG is
with permanency and stability in funded at $1.7 billion for FY 2011,
payments for Foster Care, Adoption their living situations by improving
Assistance, and Guardianship which is the same as the FY 2010
the timeliness of reunification, if funding level. States have broad
Assistance under Title IV-E of the possible, and promoting
Social Security Act. The Recovery discretion over the use of these
guardianship or adoption when funds. SSBG funds are allocated to
Act temporarily increased the reunification was not possible. In
FMAP rate for these Title IV-E States according to population size.
FY 2008, almost 42 percent of

83 Administration for Children and Families


ACF ENTITLEMENT- CURRENT LAW OUTLAYS
(dollars in millions)

2011
2009 2010 2011 +/- 2010
Current Law Outlays:
Temporary Assistance for Needy Families (TANF) /1 17,861 17,753 17,462 -291
Recovery Act Supplemental Grants (non-add) /2 -- 255 64 -185
TANF Contingency Fund /3 820 592 1,597 +1,005
TANF Emergency Fund /4 251 3,229 452 -2,777
Child Care Entitlement 2,952 2,925 2,915 -10
Child and Development Block Grant (non-add) 2,353 3,393 2,670 -723
Child Care and Development Fund (non-add) 5,305 6,318 5,585 -733
Child Support Enforcement and Family Support 4,352 4,710 3,766 -944
Recovery Act Child Support Enforcement (non-add) 274 1,300 243 -1,057
Foster Care and Permanency 6,859 7,403 7,228 -175
Recovery Act Foster Care and Permanency (non-add) /5 258 500 154 -346
Children's Research and Technical Assistance 63 63 62 -1
Promoting Safe and Stable Families (mandatory only) 387 349 373 +24
Social Services Block Grant 1,854 2,118 1,832 -286
Abstinence Education 20 22 10 -12
______ ______ ______ ______
Total, Current Law Outlays 35,419 39,164 35,697 -3,467
Total, Current Law Outlays Excluding Recovery Act 34,636 33,880 34,784 +898

1/ TANF programs include family assistance grants to States and Territories, Matching Grants to Territories, TANF
Supplemental Grants for Population Increases, Healthy Marriage Promotion and Responsible Fatherhood Grants, and
Tribal Work Programs.
2/ The Recovery Act extended the TANF Supplemental Grants through FY 2010.
3/ In FY 2006, the Deficit Reduction Act of 2005 extended the availability of unobligated Contingency Fund balances
through FY 2010. The FY 2010 beginning balance of $212 million was completely obligated by December 2009.
4/ The Recovery Act established a $5 billion TANF Emergency Fund to address rising costs related to basic assistance
and other related services.
5/ The Recovery Act provision increasing the FMAP rate is effective FY 2009 through the first quarter of FY 2011.

Administration for Children and Families 84


ACF ENTITLEMENT LEGISLATIVE PROPOSALS
(outlays in millions)

2011 2011
2010 2011 - 2015 - 2020
Temporary Assistance for Needy Families (TANF)
TANF Contingency Fund /1 -- -1,240 -- --
TANF Emergency Fund /2 +508 +2,597 +3,500 +3,500
Extend Supplemental Grants for Population Increases -- +255 +319 +319
Fatherhood, Marriage, and Families Innovation Fund /3 -- -- +500 +500
Healthy Marriage and Responsible Fatherhood Grants -- -118 -150 -150
_____ _____ _____ _____
Subtotal +508 +1,494 +4,169 +4,169

Child Care Entitlement /4 -- +502 +4,436 +11,015

Child Support Enforcement and Family Support Programs


Federal Match for Incentive Payments -- +555 +669 +669
Federal Seizure of Accounts in Multi-State Financial Institutions -- +1 -2 -7
Garnishment of Longshore and Harbor Worker's Compensation Act
Benefits -- -- -4 -9
Increase Access and Visitation Funding -- +2 +2 +2
_____ _____ _____ _____
Subtotal -- +558 +665 +655

Children's Research and Technical Asst. - Child Welfare Study -- +3 +6 +6

Promoting Safe and Stable Families - State Court Improvement Program -- +1 +59 +100

Increased Foster Care and Permanency FMAP Rate -- +214 +237 +237

Create LIHEAP Mandatory Funding Trigger /5 -- +1,460 +5,113 +6,406


_____ _____ _____ _____
Total, ACF Proposals +508 +4,232 +14,685 +22,588

1/ Under current law the Contingency Fund baseline assumes the fund will be reauthorized for five years at $1.855 billion in
FY 2011 and FY 2016, and completely outlayed in FY 2011. Negative outlays in FY 2011 reflect the legislative proposal to
limit FY 2011 obligations to 20 percent of total budget authority.
2/ The Budget assumes a legislative proposal that expands the allowable uses of funds under the Recovery Act's TANF
Emergency Fund in FY 2010 and provides funding for a new TANF Emergency Fund in FY 2011.
3/ Due to their competitive nature, these grants are assumed to be awarded late September 2011;
outlays would start in FY 2012.
4/ The Budget includes an additional $800 million in FY 2011 for the Child Care and Development Block Grant,
the discretionary component of the Child Care and Development Fund.
5/ See ACF Discretionary Programs Section for further explanation.

85 Administration for Children and Families


ADMINISTRATION ON AGING
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010
Health and Independence
Home and Community-Based Supportive Services................................. 361 -- 368 416 +48
Congregate Nutrition Services................................................................. 434 65 441 446 +5
Home-Delivered Nutrition Services......................................................... 214 32 218 221 +3
Native American Nutrition and Supportive Services............................... 27 3 28 30 +2
Nutrition Services Incentive Program...................................................... 161 -- 161 161 --
Preventive Health Services....................................................................... 21
_____ --
_____ 21
_____ 21
_____ --
_____
Subtotal, Health and Independence 1,219 100 1,237 1,295 +58
Caregiver Services
Family Caregiver Support Services.......................................................... 154 -- 154 202 +48
Native American Caregiver Support Services.......................................... 6 -- 6 8 +2
Alzheimer's Disease Supportive Services Program.................................. 11 -- 11 11 --
Lifespan Respite Care.............................................................................. 3
_____ --
_____ 3
_____ 5
_____ +3
_____
Subtotal, Caregiver Services 175 -- 175 227 +53
Protection of Vulnerable Older Americans
Long-Term Care Ombudsman Program................................................... 16 -- 17 18 +1
Prevention of Elder Abuse and Neglect................................................... 5
_____ --
_____ 5
_____ 6
_____ +0.5
_____
Subtotal, Vulnerable Older Americans 21 -- 22 23 +1
Network Support and Demonstrations
Health and Long-Term Care Programs.................................................... 28 -- 31 30 -0.1
Program Innovations................................................................................ 18 -- 19 13 -6
Aging Network Support Activities........................................................... 14
_____ --
_____ 14
_____ 14
_____ --
_____
Subtotal, Network Support and Demonstrations 60 -- 63 57 -6
Health Care Fraud and Abuse Control**..................................................... 3 -- 3 3 +0.1
Chronic Disease Self-Management Programs............................................. -- -- -- -- --
Medicare Enrollment Assistance**............................................................. 18 -- -- -- --
Program Administration.............................................................................. 19
_____ --
_____ 20
_____ 23
_____ +3
_____
Total, Program Level 1,515 100 +1,519 +1,628 +109

Less Funds from Other Sources


Health Care Fraud and Abuse Control **................................................ -3 -- -3 -3 -0.1
Chronic Disease Self-Management Programs.......................................... -- -- -- -- --
Medicare Enrollment Assistance.............................................................. -18
_____ --
_____ --
_____ --
_____ --
_____
Total, Budget Authority 1,494 100 +1,516 +1,625 +108
FTE.............................................................................................................. 103 -- 108 112 +4
* American Reinvestment and Recovery Act of 2009 (Recovery Act)
**Funding from Medicare Trust Funds

Administration on Aging 86
ADMINISTRATION ON AGING
The mission of the Administration on Aging (AoA) is to help elderly individuals maintain their dignity and independence
in their homes and communities through comprehensive, coordinated, and cost effective systems of long-term care, and
livable communities across the U.S.

T he FY 2011 Budget requests


$1.6 billion for the
additional $50 million to
continue funding for programs
otherwise would have been
possible.
Administration on Aging that support caregivers. It also
(AoA), an increase of doubles funding, to $5 million, MAINTAINING HEALTH AND
$109 million above FY 2010. for the Lifespan Respite Care INDEPENDENCE
Of this increase, $102.5 million program which improves respite
will fund AoA’s new Caregiver care for those caring to family In order to serve a growing
Initiative, of which $50 million members with special needs. senior population, AoA’s vision
will support caregiver services, Combined, these programs is to ensure the continuation of a
such as counseling, training, and supporting caregiving provide vibrant aging services network
respite care; $50 million will information, assistance, at State, Territory, local and
support services to enable those counseling, training, respite, and Tribal levels, through funding of
elderly individuals with other services which enable lower-cost, non-medical
disabilities with routine daily elderly individuals to remain services and supports that
activities such as transportation, independent and at home longer provide the means by which
homemaker assistance, adult and less expensively. The more seniors can maintain their
day care; and $2.5 million will Budget will support health and independence. The
support respite for family 755,000 caregivers with Budget includes an additional
members of any individual with 12 million hours of respite care $50 million to fund services
special needs. or temporary relief from their including transportation
caregiving responsibilities. It assistance, case management,
The request also provides will also provide more than and information and referrals;
continued support to 186,000 caregivers with in-home services such as
demonstrate and evaluate counseling, peer support groups, personal care, chore, and help
evidence-based disease and training to help them better eating, dressing, and bathing;
prevention programs, Aging and cope with the stresses of and community services such as
Disability Resource Centers, caregiving. Family caregivers adult day care and physical
and other ongoing activities of value these services and 81 fitness programs to support
national significance. percent report that services seniors to remain independent in
enable them to care for their their communities. The Budget
SUPPORTING FAMILY loved ones longer than will support 28.5 million rides
CAREGIVERS
Families are the Nation’s Helping Middle Class Families Care for Aging Relatives
primary provider of long-term
care, but societal changes such Caregiving responsibilities demand time and money from families who
as increasing geographic too often are already strapped for both. The Budget includes an additional
separation of families and $102.5 million to enable families to better care for their aging relatives
smaller family sizes are placing and to support seniors trying to remain independent in their communities.
great pressure on caregivers. The initiative builds on the successful network of agencies in local
Caregivers often experience communities across the country that already provide critical help to
conflicts between work and seniors and their caregivers. More specifically, this initiative includes:
♦ An increase of $50 million for caregiver services, such as counseling,
care-giving, with 25 percent
reporting that they have had to training, and respite care for the families of elderly individuals
make adjustments such as including Native Americans;
♦ An increase of $50 million for services such as transportation,
changing or reducing work
hours. homemaker assistance, adult day care, personal care assistance to
elderly individuals and their families, including Native Americans; and,
♦ An increase of $2.5 million for respite for family members of people of
As part the Caregiver Initiative,
the FY 2011 Budget requests an all ages with special needs.

87 Administration on Aging
Recovery Act will support 214 million home- program, more than 12,000
delivered and congregate meals individuals regularly visit long-
In FY 2010, AoA will
to over 2.3 million elderly term care facilities, monitor
distribute $32 million in
individuals in a variety of conditions and care, resolve
Recovery Act funds to
community settings as well as problems of individual residents
improve seniors’ ability to
4.7 million meals to and provide a voice for those
manage chronic diseases by
66,000 Native American unable to speak for themselves.
following evidence-based
seniors.
chronic disease self-
management programs that SUPPORTING THE NATIONAL
The Budget maintains funding AGING NETWORK SERVICES
have been proven effective
for activities that educate older
through randomized control AoA identifies, evaluates, and
adults about the importance of
trials. replicates the best models and
healthy lifestyles and that
promote healthy behaviors that practices nationwide as part of
AoA expects its overall strategy for
can prevent or delay chronic
50,000 individuals will strengthening its core programs
disease and disability, thereby
complete a program to and the national aging services
reducing the need for more
improve their management network. The Budget includes
costly medical interventions.
of chronic diseases. Data $30 million for Aging and
will also be collected to Disability Resource Centers and
assess the impact on PROTECTING VUNERABLE
Evidence-Based Disease
participant health behaviors, OLDER AMERICANS
Prevention programs, two
health status, health care Up to 2 million Americans age examples of state-of-the-art
utilization and health care 65 or older have been injured, approaches that AoA is
costs. exploited, or otherwise continuing to evaluate and
mistreated by someone they replicate in support of the core
for critical daily activities such depended on for care or programs. In addition to these
as visiting the doctor, the protection. The Budget includes programs, the Budget also
pharmacy, or grocery stores; $6 million to enable States to requests $27 million for
33 million hours of assistance to develop and carry out ongoing activities of national
seniors unable to perform daily comprehensive statewide significance and for investment
activities; and over 9 million systems of elder justice and in other innovative approaches
hours of care for adult day care, elder rights protections. These to further strengthen the core
enabling working families to programs address public programs.
remain on the job. It will also education and outreach,
provide one million rides for coordination of services with PROGRAM ADMINISTRATION
Native American seniors to adult protective services
critical daily activities such as A total of $23 million is
programs, law enforcement,
meal sites, medical requested in the Budget for
protection and advocacy
appointments, and grocery program management and
programs, licensure and
stores. certifications programs, and support activities, including
costs associated with AoA’s
victim assistance programs. In
The Budget also requests headquarters lease renewal and
addition, the Budget includes
$828 million, an increase of increases for purchase of
$18 million for Long-Term Care
$8 million, for Nutrition external services, and to more
Ombudsmen services. The
services to ensure that millions effectively and efficiently
ombudsmen supported with this
of older adults have access to funding are advocates for address the needs of the
the nutritious food needed to growing aging population.
residents of nursing homes and
stay healthy and decrease their other adult residential care
risk of disability. The Budget facilities. As part of this

Administration on Aging 88
OFFICE OF THE SECRETARY
GENERAL DEPARTMENTAL MANAGEMENT
(dollars in millions)
2011
2009 2010 2011 +/- 2010

Teen Pregnancy Prevention……………………………………....... 110 179 +69


Other General Departmental Management........................................ 382 380 415 +35
Evaluation Activities......................................................................... 47 65 65 --
Health Care Fraud and Abuse Control.............................................. 6 9 9 --
_____ _____ _____ _____
Subtotal, GDM Program Level 435 564 668 +104

Less funds from other sources:


Evaluation Activities......................................................................... 47 65 65 --
Health Care Fraud and Abuse Control.............................................. 6 9 9 --
Teen Pregnancy Prevention (mandatory funding for States)............ -- -- 50 +50
_____ _____ _____ _____
Total, GDM Budget Authority 382 490 544 +54

FTE .................................................................................................. 1,358 1,417 1,417 --

General Departmental Management supports the Secretary in her role as chief policy officer and general manager of
the Department.

T he FY 2011 Budget request


for General Departmental
Office of Adolescent Health
(OAH), in the Office of Public
$4 million to carry out
longitudinal evaluations of
Management (GDM) is Health and Science, which will teenage pregnancy prevention
$668 million, a net increase of coordinate with the Centers for approaches. In addition to the
$104 million. This request Disease Control and Prevention $179 million, $4 million is also
supports some grant programs (CDC) and other HHS provided in PHS evaluation
as well as those activities Operating Divisions in funds for this activitiy. Also,
associated with the Secretary's implementing teenage the FY 2011 Adolescent Family
roles in administering and pregnancy prevention programs. Life (AFL) Budget includes a
overseeing the organization, Funding of $125 million will be total of $17 million to provide
programs and activities of the used for: replicating programs support for AFL Care
Department. These activities that have proven effective demonstration grants and
are carried out through 12 Staff through rigorous evaluation to research programs. In an effort
Divisions and Offices in GDM. reduce teenage pregnancy; to ameliorate the negative
research and demonstration effects of childbearing on teen
The FY 2011 Budget request grants to develop, replicate, parents, their infants and their
provides increased funding for a refine and test additional models families, care grant community-
variety of critical activities. and innovative strategies; and based projects develop, test and
training, technical assistance evaluate interventions with
Teen Pregnancy Prevention: and outreach. The Budget also pregnant and parenting teens,
The FY 2011 Budget request to requests $50 million in and focus on ways to build and
support community-based mandatory funds for new strengthen families.
efforts to reduce teen pregnancy formula grants to support teen
totals $179 million, an increase pregnancy prevention efforts in Office of Minority Health
of $69 million over FY 2010. States, Tribes and Territories. (OMH): The FY 2011 Budget
These efforts will be managed Also provided in the request is request for OMH is $58 million,
through the newly established

89 General Department Management


an increase of $2 million. This government organizations, and the capacity and capabilities of
funding will enable OMH to with consumer and health the Department’s acquisition
enhance disease prevention, professional groups. workforce.
health promotion, service
demonstration, and educational Commissioned Corps: The Other General Departmental
efforts to reduce and ultimately FY 2011 Budget request Management: The FY 2011
eliminate disparities in racial includes $14 million for the Budget request includes
and ethnic minority populations continued support of the Public $226 million for the remainder
across the country. The increase Health Service’s Commissioned of GDM, an increase of $4
will also support activities Corps. Activities will focus on million. This funds activities
related to minority health and modernizing the force and within offices which provide
disparities in the U.S. management of the leadership, policy, legal, and
Commissioned Corps. FY 2011 administrative guidance to HHS
Minority HIV/AIDS: The funding will be used to train and components, and also includes
Budget includes $54 million to equip officers to respond to funding to continue ongoing
support innovative approaches emerging public health threats programmatic activities.
to HIV/AIDS prevention and and to improve response
treatment in minority operations. PHS Evaluation Funds: The
communities disproportionately FY 2011 Budget request also
impacted by this disease. These Office of Global Health Affairs includes $65 million in PHS
funds will allow the Department (OGHA): The FY 2011 Budget Evaluation Funds, as authorized
to continue priority investments includes $6 million which will by section 241 of the Public
and public health strategies enable OGHA to support global Health Service Act. In addition
targeted to reduce the disparities health policy leadership and to investments in Healthcare
and burden of HIV/AIDS in coordination. This does not Reform activities, these funds
racial and ethnic minority include funding formerly will support evaluation activities
populations. located in OGHA for the Health related to Teen Pregnancy
Diplomacy and Afghanistan Prevention, policy research and
Office on Women's Health Health Initiatives, which will be evaluation activities in the
(OWH): The Budget request of transferred in FY 2011 to the Office of the Assistant Secretary
$34 million will allow OWH to CDC. for Planning and Evaluation,
continue support for the and evaluation activities in the
advancement of women's health Acquisition Reform: An Office of Public Health and
programs through the promotion additional $7 million is included Science and the Office of the
and coordination of research, for the HHS portion of a Assistant Secretary for Financial
service delivery and education government-wide initiative in Resources.
throughout the agencies and contract and acquisition reform.
offices of HHS, with other Funding will be used to increase

General Department Management 90


OFFICE OF THE SECRETARY
OFFICE OF MEDICARE HEARINGS & APPEALS
(dollars in millions)

2011
2009 2010 2011 +/- 2010

Total, Program Level.................. 65 71 78 +7

FTE............................................. 357 378 422 +44

The Office of Medicare Hearings and Appeals provides an independent forum for the fair and efficient
adjudication of Medicare appeals for beneficiaries and other parties. This mission is carried out by a cadre of
knowledgeable Administrative Law Judges (ALJs) exercising judicial and decisional independence under the
Administrative Procedures Act, with the support of a professional legal and administrative staff.

T he FY 2011 Budget request


for the Office of Medicare
OMHA administers appeals in
four field offices: Southern
Recovery Audit Contractor
(RAC) program, administered
Hearings and Appeals (OMHA) (Miami, Florida), Midwestern by the Centers for Medicare &
is $78 million, a net increase of (Cleveland, Ohio), Western Medicaid Services (the
$7 million over FY 2010. (Irvine, California), and Atlantic demonstration phase of the
Funds are requested from the (Arlington, Virginia). OMHA RAC program in FY 2008 and
Federal Hospital Insurance and extensively utilizes hearings FY 2009 included only five
Supplementary Medical held via video-teleconference States). During FY 2009,
Insurance Trust Funds, to hear (VTC) and telephone, in order OMHA received a total of
cases under Title XVIII of the to provide appellants with 215,847 claims, an increase of
Social Security Act and related hearings which are timely, close 16 percent over FY 2008.
provisions in Title XI of the Act. to their homes, and with a broad OMHA projects that its caseload
array of access points. VTC will continue increasing, to
OMHA was established by technology, which is commonly approximately 297,000 total
Public Law 108-173, the used throughout the country in claims in FY 2010 (a 38 percent
Medicare Prescription Drug, courtrooms and for increase over FY 2009) and
Improvement, and tele-medicine, plays a critical 336,000 total claims in FY 2011
Modernization Act of 2003 role in OMHA’s ability to both (a 13 percent increase over FY
(MMA). MMA transferred the meet the BIPA timeframes and 2010).
responsibility for hearing provide expanded access for
Medicare appeals at the ALJ appellants to ALJ hearings. With the requested funding level
level – the third level of of $78 million, OMHA will
Medicare claims appeals – from OMHA began processing cases continue to process its ALJ
the Social Security on July 1, 2005; since then, it appeals workload within the
Administration to the HHS has received more than 650,000 BIPA-mandated timeframes. To
Office of the Secretary. In claims from across the United accomplish this while also
addition, the Medicare Benefits States for Medicare Parts A, B, maintaining the quality and
Improvement and Protection Act C, and D appeals, as well as accuracy of its decisions,
of 2000 (BIPA) mandated that Medicare entitlement and OMHA will continue to utilize
such ALJ appeals be heard eligibility appeals. Beginning in state-of-the-art technology and
within 90 days after receipt of a FY 2010, OMHA will also to offer appellants access to
request from a Medicare receive additional claims multiple hearing venues and
appellant for a hearing. resulting from the permanent services.
expansion to all 50 States of the

91 Office of Medicare Hearings and Appeals


OFFICE OF THE SECRETARY
OFFICE OF THE NATIONAL COORDINATOR FOR
HEALTH INFORMATION TECHNOLOGY
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010

Budget Authority........................................................... 44 2,000 42 78 +36


PHS Evaluation Funds................................................... 18
_______ _______-- 19
_______ --
_______ -19
_______
Total, Program Level 61 2,000** 61 78 +17

FTE................................................................................ 31 -- 75 120 +45

*American Recovery and Reinvestment Act of 2009 (Recovery Act)


**The Recovery Act appropriation to ONC includes $20 million to be transferred to NIST.

T he FY 2011 Budget request


for the Office of the
National Coordinator for Health
accelerating the adoption of
health IT and helping physicians
achieve meaningful use of
payments to eligible
professionals may begin in
January 2011.
Information Technology (ONC) electronic health records (EHR). In addition to funds requested
is $78 million, $17 million ONC and the Centers for for ONC, the FY 2011 Budget
above FY 2010. The FY 2011 Medicare & Medicaid Services request for other HHS divisions
President’s Budget includes (CMS) have worked closely to includes funds to advance the
resources for ONC to serve as develop rules defining the Administration’s health IT
the Federal health IT leader and “meaningful use” of EHRs and agenda. The Budget request
coordinator and to continue setting initial standards, includes $32 million in the
implementing Recovery Act implementation specifications, Agency for Healthcare Research
programs. These roles are vital and certification criteria for and Quality (AHRQ) to advance
to achieving the goals of the EHR technology. In FY 2011 the use of health IT to enhance
President’s health IT initiative ONC and CMS will update patient safety, $1.6 million in
and health reform. The these rules as needed. CMS, the Office of Civil Rights
FY 2011 Budget request, in with Recovery Act funding, will (OCR) for regional privacy
conjunction with the $2 billion provide financial incentives to advisors, and $1 million in the
appropriated to ONC under the help Medicare and Medicaid Office of the Assistant Secretary
Recovery Act, will enable HHS providers adopt and for Planning and Evaluation
to continue implementing the meaningfully use EHRs. (ASPE) for independent
Health Information Technology Incentive payments to eligible evaluations of EHR adoption
for Economic and Clinical hospitals may begin as soon as and economic factors
Health (HITECH) Act, October 2010. Incentive influencing health IT, in
coordination with ONC. In
addition, the Budget request for
Electronic Health Records Standards and Certification CMS includes resources to
As required by HITECH, ONC has issued an interim final rule (IFR) conduct the third year of a
describing the standards that certified EHR technology must meet to demonstration project to
exchange healthcare information among providers and between encourage small physician
providers and patients. These standards will support meaningful use practices to adopt EHRs.
and data exchange among providers who must use certified EHR
technology to qualify for the Medicare and Medicaid incentives.

Office of the National Coordinator for 92


Health Information Technology
RECOVERY ACT Department’s statutory standards are available for both
IMPLEMENTATION responsibilities under the private sector and Federal use.
HITECH Act to draft This funding will support the
The Recovery Act provided regulations, guidance, and ongoing standards
$2 billion for health IT and reports, and to conduct harmonization process, which is
includes the authorization of studies and audits to required for IT systems to
ONC; two new Federal strengthen privacy protections exchange data across different
Advisory Committees to guide and security safeguards; health care settings. ONC will
standards and policy ♦ $20 million for the National also continue implementing the
development processes; new Institute of Standards and new processes outlined in the
grant and loan programs; and Technology to develop health HITECH Act for standards
increased privacy and security IT standards testing and development, which include
protections. ONC’s plans for evaluation infrastructure; and recommendations from the
the $2 billion Recovery Act ♦ $345 million for a variety of Health IT Policy Committee and
investment in health IT include: activities designed to a Health IT Standards
♦ $693 million to establish the complement and advance the Committee. The Health IT
Health IT Extension Program goal of supporting the care of Policy Committee also provides
to disseminate best practices all Americans with EHRs by policy recommendations related
for health IT implementation, 2014. to the implementation of a
adoption, and use, and nationwide health information
provide technical assistance In FY 2011, ONC will continue technology infrastructure. The
supporting the adoption and implementing Recovery Act Health IT Standards Committee
meaningful use of health IT; programs, evaluate Recovery recommends standards,
♦ $564 million for a Health Act funded programs, and implementation specifications,
Information Exchange State update rules and regulations as and certification criteria for the
Grant Program to support needed. ONC will also involve electronic exchange and use of
sub-national and regional stakeholders and fulfill the health information.
efforts toward health unprecedented transparency and
information exchange, accountability reporting Realizing the full benefits of
nationwide interoperability, requirements for recipients of reliable and secure health
and statewide planning; Recovery Act funding. information exchange across
♦ $118 million to develop the organizations and jurisdictions
health IT workforce; INTEROPERABILITY requires a health information
♦ $235 million for a Beacon exchange network of common
Communities Program to The interoperability of EHRs is
technical, privacy, and security
demonstrate the potential of a critical element of the national
standards and policies. The
health IT and convey health IT agenda and a
FY 2011 Budget request
evidence to providers and necessary building block for
includes support for expanding
other communities that the achieving the President’s health
health information exchange
widespread adoption of health IT goals. The FY 2011 budget
network capabilities. In
IT and exchange of health request includes $23 million to
FY 2011 ONC will also
information is feasible and support the development of
continue supporting Recovery
improves care delivery and health data standards necessary
Act activities that will further
health outcomes; to enable the interoperability of
develop the nationwide health
♦ $24 million to carry out the EHRs, and to ensure that
information network (NHIN)
and support expanding health
information exchange
Recovery Act Programs capabilities.
The Recovery Act encourages accelerating the adoption of health
information technology and utilization of electronic health records. In addition to supporting the
Building on this unprecedented investment, the Administration will implementation of Recovery Act
continue efforts to further the adoption and implementation of health activities, ONC will also
information technology – an essential tool in modernizing the health promote the adoption of health
care system. IT through working with mental
health and substance abuse
93 Office of the National Coordinator for
Health Information Technology
providers to integrate substance In FY 2011, ONC will continue analysis and develop models
abuse and mental health working with partners, such as describing the factors driving
prevention and treatment into OCR, CMS, States, and other the adoption, meaningful use,
the larger primary care delivery stakeholders to protect patients’ and interoperability of EHRs,
system health IT framework and health information. ONC will and to evaluate and measure the
with Medicaid and other safety also continue to support the success of programs funded
net services. ONC will work implementation and under the Recovery Act and
closely with the Substance development of HITECH Act other ONC efforts to further the
Abuse and Mental Health privacy and security regulations adoption and meaningful use of
Services Administration in and guidance, and to update health IT. ONC will use
developing this new $4 million these regulations and guidance $38 million to increase Federal
effort. as necessary. staff and reduce contractor
support to continue efficiently
PRIVACY AND SECURITY ADOPTION implementing Recovery Act
programs and to continue a
The FY 2011 Budget includes Increasing the adoption of
communications and outreach
$7 million to support the health IT and reducing barriers program begun in CY 2009.
continued development of to achieving the meaningful use
appropriate Federal privacy and of EHRs are essential to
MEASURING SUCCESS
security protections of achieving the President’s health
electronic health information, IT initiative. The FY 2011 In FY 2011, ONC will continue
and State consensus efforts to budget includes $4 million for to define measures of success
address patient protections. ONC to identify consumer and report on these measures as
Ensuring adequate Federal perspectives on consumer e- appropriate. ONC will use
protections and facilitating health tools and the existing performance measures
multi-State collaboration is development of patient decision as well as the milestones and
essential to building public aids, anticipate and mitigate objectives of the Federal Health
confidence and trust in unintended consequences of the IT Strategic Plan (as will be
nationwide health information electronic exchange of health reflected in the CY 2010
exchange. ONC will also work information, and support State revision), and the Recovery Act
with other Federal agencies to governments as they implement operating plans in developing
protect and secure the their HITECH grants. these measures. ONC will also
transmission of health measure its success by
information over computer RESEARCH, EVALUATIONS, continuing to fund surveys on
networks through a health IT AND OPERATIONS the adoption rates of EHRs
cybersecurity program. among physicians and hospitals.
The FY 2011 budget includes
$7 million to conduct economic

Office of the National Coordinator for 94


Health Information Technology
OFFICE OF THE SECRETARY
OFFICE FOR CIVIL RIGHTS
(dollars in millions)

2011
2009 2010 2011 +/- 2010

Total, Program Level.......................... 40 41 44 +3

FTE..................................................... 227 270 280 +10

The Office for Civil Rights (OCR) ensures that people have equal access to and the opportunity to participate in and
receive services from all HHS programs without facing unlawful discrimination and that the privacy and security of their
health information is protected while ensuring access to care. By enforcing our Nation’s civil rights laws in health and
human services settings and protecting the privacy and security of individually identifiable health information, OCR
helps HHS carry out its overall mission of improving the health and well-being of all Americans affected by its many
programs.

T he FY 2011 Budget request is


$44 million for the Office for
Economic and Clinical Health Act
(HITECH Act) of 2009.
As the Department’s civil rights
and health privacy law
Civil Rights (OCR). The budget OCR assesses compliance with enforcement agency, OCR’s key
supports OCR’s activities as the nondiscrimination and Privacy and priorities in FY 2010 and FY 2011
primary defender of the public's Security Rule requirements are: ensuring understanding of and
right to nondiscriminatory access through: compliance with the HIPAA
to and receipt of Federally funded ♦ Complaint investigation, Privacy and Security Rules;
health and human services, violation findings, resolution implementing statutory privacy
pursuant to Title VI of the Civil agreements, enforcement protections for genetic information;
Rights Act of 1964; Section 504 of actions, and monitoring; promoting adequate privacy
the Rehabilitation Act of 1964; ♦ Public education; protections in the use of health
Title II of the Americans with ♦ Technical assistance; and information technology; enforcing
Disabilisites Act of 1990; Titles VI ♦ Compliance reviews, the confidentiality protections
and XVI of the Public Health including civil rights reviews afforded to patient safety
Services Act (Hill-Burton Act); the of new Medicare provider information; enforcing Federal
Multi-Ethnic Placement (MEPA); applicants. civil rights laws to increase non-
the Age Discrmination Act of 1975; discriminatory access to health care
and Title IX of the Education In July 2009, the Secretary and human services, including
Amendments of 1972. delegated to OCR the authority to adoption, foster care, and TANF;
administer and enforce the Security promoting best practices for
In addition, the budget supports Standards for the Protection of effective communication in
OCR’s significantly expanded Electronic Protected Health hospital settings with persons who
compliance responsibilities that Information (HIPAA Security are deaf or hard of hearing and
protect individuals’ personal health Rule). Combining the authority for persons of limited English
information under the Privacy and both administering and enforcing proficiency; strategically
Security Rules issued pursuant to Federal standards for health disseminating an OCR-developed
the Health Insurance Portability information privacy and security Federal civil rights curriculum for
and Accountability Act (HIPAA), under HIPAA will improve HHS’ medical schools to help narrow
and supports the creation of ten ability to protect individuals’ health disparities in health care quality,
regional office privacy advisors as information. access and patient safety;
mandated by the Health supporting appropriate services in
Information Technology for the most integrated setting for

95 Office for Civil Rights


persons with disabilities; and required by GINA, to prohibit Enforcing Compliance with Civil
promoting non-discrimination and health plans from using or Rights Laws: OCR investigates
privacy protections in emergency disclosing an individual’s genetic and resolves nearly
preparedness and response information for underwriting 3,000 administrative discrimination
activities. purposes. complaints annually. For example,
in 2009, following OCR’s
Through these varied efforts, OCR Privacy and Security Provisions of investigation of a complaint filed
promotes integrity in the the HITECH Act: HITECH Act on behalf of a Spanish-speaking
expenditure of Federal funds by provisions include extending member, Medco, the nation’s
ensuring that these funds support security and privacy rule liability to largest pharmacy benefit manager,
programs which provide access to business associates, new took steps to implement a multi-
services free from discrimination limitations on marketing and faceted plan to improve services to
on the basis of race, color, national fundraising communications, a individuals with limited English
origin, disability, age, religion and prohibition on the sale of protected proficiency. Medco will expand its
sex. OCR’s efforts also promote health information, stronger pool of bilingual customer service
public trust and confidence that the individuals’ rights to electronic representatives who speak Spanish
health care system will maintain access and to request restrictions, a and redesign its referral system to
the privacy of protected health requirement to notify individuals of more quickly link Spanish-
information while ensuring access breaches of their protected health speaking members to bilingual
to care. information and to report breaches staff. Medco will continue to use a
of protected health information to telephonic interpreter service
ENSURING PRIVACY AND the Secretary, and enhanced available for more than
CONFIDENTIALITY IN HEALTH enforcement authority, including 150 languages to improve
CARE increasing the civil monetary communication with limited
penalties up to $50,000 per English proficient individuals.
Enforcing HIPAA: OCR violation with an annual cap of
investigates and resolves $1.5 million. The Act also In FY 2010 and FY 2011, OCR
approximately 8,000 complaints of mandates the development and will strengthen efforts to improve
alleged HIPAA violations annually. maintenance of a multi-faceted statewide compliance with civil
A noteworthy example of OCR national public education rights laws and ensure that civil
enforcement action was a 2009 campaign, to be conducted in a rights enforcement outcomes
resolution agreement for $2.25 variety of languages, which will impact the lives of those who have
million with CVS for improper enhance public transparency suffered discrimination. For
disposal of personal health regarding the uses of protected example, in FY 2008, OCR entered
information. Under this resolution health information and the rights of into a statewide agreement with
agreement, CVS agreed to individuals with respect to those Georgia to remedy Olmstead
implement a robust corrective uses. violations, reduce institutional bias,
action plan that requires Privacy and ensure that 2,500 individuals
Rule-compliant policies and In September 2009, the interim now in public psychiatric hospitals
procedures for safeguarding patient final rule implementing the breach and facilities for the
information during disposal, notification provisions of HITECH developmentally disabled will have
employee training and employee went into effect. In the first quarter the opportunity to live in the
sanctions for noncompliance. of FY 2010, OCR received community. Such statewide
23 notifications involving breaches agreements provide a cost effective
Privacy Provisions of the Genetic affecting 500 or more individuals. way to ensure that the states are in
Information Non-discrimination OCR is in the process of verifying compliance with the law with
Act of 2008 (GINA): GINA the breach reports and will respect to how they administer
protects individuals against investigate these cases, to HHS-funded programs impacting
discrimination by employers and determine the underlying causes of the lives of tens of millions of
health plans based on an the breaches and ensure that citizens.
individual’s genetic information. appropriate corrective action is
OCR will enforce amendments to taken by the covered entities.
the HIPAA Privacy Rule, as

Office for Civil Rights 96


OFFICE OF THE SECRETARY
Service and Supply Fund
(dollars in millions)

2011
2009 2010 2011 +/- 2010

Non-PSC...................... 52 70 56 -14
PSC.................................. 807 957 1,009 +52
Revenues.............................................................. 859 1,027 1,065 38

Non-PSC.......................... 128 141 142 1


PSC.................................. 1,207 1,253 1,312 59

FTE...................................................................... 1,335 1,394 1,454 60

The Service and Supply Fund Provides consolidated financing and accounting for business-type operations which
involve the provisions of common services to customers at HHS and other government departments and agencies.

T he Service and Supply Fund


(SSF) governed by a Board
up the remainder of SSF
activities.
health services for Federal
employees, including health and
of Directors, consisting of wellness programs, employee
representatives from each of the PSC products and services are assistance, work/life, and
Department’s ten Operating provided in broad business areas environmental health and safety
Divisions (OPDIVs) and the described below. services. Over 1.5 million
Office of the Secretary Staff Federal employees in 45 Federal
Administrative Operations
Divisions (STAFFDIVs). A departments and agencies are
Services (AOS): AOS provides
representative from the Office serviced by FOHS.
a wide range of administrative
of Inspector General (OIG)
and information technical Financial Management Service
serves as a non-voting member.
services within the Department, (FMS): FMS supports HHS
The SSF does not have its own
both at headquarters and in the financial operations through the
appropriation, and is funded
regions, and to customers provision of fund accounting,
entirely through charges to its
throughout the Federal disbursement, financial
customers (HHS OPDIVs and
government. Services include: reporting, financial statement
STAFFDIVs, plus other Federal
HHS payroll processing, preparation, payroll accounting,
agencies) for their usage of
building management and and debt management and
goods and services. Each
operations, safety, security collection services. It supports
activity financed through the
services, lease management, Federal grantor and contracting
SSF is billed to the Fund’s
alterations and maintenance, agencies efforts to negotiate and
customers, based on either fee-
parking management, locator approve indirect costs, fringe
for-service billing determined
services and supply and benefits and other specialty
by actual usage of service or an
inventory management. AOS rates used by not-for-profit
allocated methodology.
also provides shipping and labor organizations receiving Federal
Many of the Fund’s activities services, real property surpluses, awards. Lastly, grant
and business lines are based at mail and messenger services, disbursement, cash
the Program Support Center conference room facilities management, and grant
(PSC), and they represent the support services, graphic design, accounting support services are
largest portion of the SSF printing, and copier also provided.
budget. The non-PSC activities, maintenance throughout HHS.
many of which facilitate Federal Occupational Health Information and Systems
compliance with public laws, Service: The Federal Management Service (ISMS):
regulations, or other Federal Occupational Health Service ISMS provides high-quality
management guidelines, make (FOHS) provides occupational information technology and

97 Service and Supply Fund


technical services including: creates a seamless integration of provision of competitive
human resource systems; HHS-wide acquisition process sourcing, procurement, and
Freedom of Information Act standardization, internal grants databases. The Tracking
(FOIA) on implementation and controls and oversight, and Accountability in Government
records management; Web performance measurement Grants System is HHS’ central
content and publications inputs to serve employees, repository of grant award data.
management; IT infrastructure customers and vendors. AIM is The publicly searchable
operations and consulting used to improve a number of database houses HHS
services; overseeing the PSC acquisitions-related processes discretionary and mandatory
information systems security related to purchase cards, grant funding data awarded
program; maintenance of the acquisition plans, interagency from 1995 to the present. The
Unified Financial Management contracting, and emergency Departmental Contracts
System (UFMS) and the HHS contracting procedures. Information System serves as
Consolidated Acquisition the central repository for
System. Audit Resolution: Audit Department-wide procurement
Resolution, as mandated by data, and is the primary system
Strategic Acquisition Service P.L. 96-304 and P.L. 98-502, used by HHS to fulfill
(SAS): The SAS is responsible resolves grantee audit findings procurement reporting
for providing leadership, within a statutorily mandated requirements under the Federal
guidance, and supervision to the six month period. Procurement Data System Next
procurement operations of the Generation/OMB, which is
PSC and for improving Claims: Claims does mission
mandated by Public Law 93-
procurement operations within critical work that is required by
400. This system compiles
HHS. The SAS provides the Federal Tort Claims Act
contract information to produce
acquisition services, strategic (FTCA). This act requires
geographically-based reports to
sourcing services, including a claimants to file administrative
OMB and Congress. High
Strategic Sourcing Center of claims with the responsible
Performing Organizations and
Excellence; and provides agency before filing suit against
Commercial Services
pharmaceutical, medical, and the United States in Federal
Management maintains a
dental supplies to HHS and court.
database to gather Federal
other Federal agencies. Activities Inventory Reform Act
Commissioned Corps Force
Management (CCFM): CCFM inventory data at all levels of
Human Resources (HR)
provides personnel support to the Department.
Centers and HHS University
(HHSU): The HR Centers active-duty, inactive reserve and
Web Communications and New
represent a consolidation of retired PHS Commissioned
Media Division (WCD): The
human resources services within Officers as well as force
WCD is responsible for HHS
the Department, with sites management activities for the
Department Web sites. The
located in Maryland, Atlanta, Corps as a whole.
Web Policy Testers enhances
and Georgia. HHSU provides Section 508 Compliance efforts
Office of Small and
training and development and improves web page
Disadvantaged Business
opportunities, including both maintenance efforts.
Utilization: The Small
online and classroom training.
Business Office provides
Homeland Security
Below are descriptions of non- leadership, guidance and
Presidential Directive 12
PSC activities, many of which recommendations to insure that
(HSPD-12): The HSPD-12
facilitate compliance with small businesses are given an
activity is managed by the
public laws, regulations, or equitable opportunity to
Office of Security and Strategic
other Federal management participate in the provision of
Information and addresses
guidelines. goods and services to HHS.
control of “physical access” to
Grants and Contracts Data: buildings.
Acquisition Integration and
Modernization (AIM): AIM Several activities focus on the

Service and Supply Fund 98


OFFICE OF THE SECRETARY
RETIREMENT PAY & MEDICAL BENEFITS
FOR COMMISSIONED OFFICERS
2011
2009 2010 2011 +/- 2010

Retirement Payments.................................................... 333 356 386 +30


Survivor's Benefits........................................................ 24 25 28 +3
Medical Care for Retirees and Survivors...................... 92 94 104 +10
Accrued Medical Benefits for over-65 /1..................... 35
_____ 36
_____ 37
_____ +1
_____
Total, Budget Authority 485 510 555 +45

1/ The FY 2010 amount has been adjusted to reflect an anticipated increase in average force Appendix, Budget of the United States
Government, Fiscal Year 2011 includes $37 million, the amount adjusted to reflect the revised on-board projections for FY 2010.

T he FY 2011 Budget of
$555 million is a net
accrued medical benefit
payments for PHS
Medicare-eligible Retiree
Healthcare Funds for the
increase of $45 million over Commissioned Corps officers accrued costs of health care for
FY 2010. This Budget request and beneficiaries over age 65. beneficiaries over the age of 65.
provides for annuities retirement
payments of retired Public The Budget also funds the The Budget reflects increased
Health Service (PHS) provision of medical care to costs in medical benefits, an
Commissioned Corps Officers active duty and retired members annualization of amounts paid
and payments to survivors of of the Corps under the age of to retirees and survivors, and a
deceased retired officers; and 65, and dependents of deceased net increase in the number of
medical care to active duty PHS members. This account retirees and survivors during
commissioned officers, retirees, includes payments to the FY 2011.
and dependents of members and Department of Defense

99 Retirement Pay & Medical Benefits for Commissioned Officers


OFFICE OF INSPECTOR GENERAL
(dollars in millions)

2009 2011
2009 ARRA* 2010 2011 +/- 2010

Discretionary Appropriation........... 45 17 50 52 +2
Discretionary HCFAC..................... 19 -- 30 95 +65
Mandatory HCFAC......................... 177 -- 177 177 --
Medicaid Integrity Program DRA... 25 25 -- -25
Medicaid Oversight**..................... 25 31 -- -- --
Total Funding, All Sources 291 48 282 324 +42

FTE................................................. 1,512 1,566 1,776


*American Recovery and Reinvestment Act of 2009 (Recovery Act)
**The Supplemental Approriations Act of 2008 (P.L. 110-252) provides $25 million for Medicaid oversight in
FY 2009.

The Office of Inspector General mission is to protect program integrity and the well-being of program beneficiaries by
detecting and preventing waste, fraud, and abuse; identifying opportunities to improve program economy, efficiency,
and effectiveness; providing industry guidance; and holding accountable those who do not meet program requirements
or who violate Federal laws.

T he FY 2011 Budget request


for the Office of Inspector
General (OIG) is $324 million
inspections; recommending
corrective action for
vulnerabilities identified during
in the Medicare, Medicaid, and
CHIP programs will be guided
by five principles. These
in mandatory and discretionary these inquiries; referring principles offer a framework for
budget authority, a net increase suspected criminal action for implementing programs, as well
of $42 million over FY 2010; of prosecution, imposing as designing and implementing
which $40 million is for the administrative sanctions such as integrity safeguards.
joint DOJ-HHS Health Care exclusions from Federal health ♦ Enrollment: Scrutinize
Fraud Prevention and programs and civil monetary individuals and entities that
Enforcement Action Team penalties, and providing seek to participate as
initiative. industry guidance to HHS providers and suppliers prior
program participants. to their enrollment in health
The request will enable OIG to
care programs.
protect program integrity and The HHS top management
♦ Payment: Establish payment
the well-being of program challenges identified by OIG for
methodologies that are
beneficiaries by detecting and the most recent year fall into
reasonable and responsive to
preventing waste, fraud, and three broad categories:
changes in the marketplace.
abuse; identifying opportunities ♦ Integrity of Medicare,
♦ Compliance: Assist health
to improve program economy, Medicaid, and the Children’s
care providers and suppliers
efficiency, and effectiveness; Health Insurance Program;
in adopting practices that
and holding accountable those ♦ Integrity of the Department’s
promote compliance with
who do not meet program public health and human
program requirements,
requirements or who violate services programs; and
including quality and safety
Federal laws. ♦ Cross-cutting issues that span
standards.
the Department.
Ativities in FY 2011 will be ♦ Oversight: Vigilantly
determined by its annual work monitor programs for fraud,
planning process and the INTEGRITY OF MEDICARE, waste, and abuse.
assessment of the top MEDICAID, AND THE ♦ Response: Respond swiftly
management and performance CHILDREN’S HEALTH to detected fraud, impose
challenges facing HHS. The INSURANCE PROGRAM appropriate punishment to
mission is accomplished by (CHIP) deter others, and promptly
conducting audits, remedy program
In FY 2011, OIG efforts to
investigations, evaluations and vulnerabilities.
combat waste, fraud and abuse

Office of Inspector General 100


INTEGRITY OF THE ensure the integrity of medical States Marshals Service, and
DEPARTMENT’S PUBLIC research endeavors, protect State and county child support
HEALTH AND HUMAN human research subjects, and personnel, to identify and
SERVICES PROGRAMS provide for pre-approval and resolve egregious cases of
post-approval monitoring of nonsupport.
Emergency Preparedness and regulated medical products and
Response: Events like treatments.
Hurricanes Katrina and Rita, CROSS-CUTTING ISSUES
Grants Oversight: HHS
and more recently the outbreak receives and distributes more THAT SPAN THE
of the H1N1 virus, highlight the DEPARTMENT
grant money than all other
importance of a comprehensive
Federal agencies combined. Ethics Program Oversight and
national public health
OIG will continue providing Enforcement: OIG has long
infrastructure that is prepared to
oversight to ensure that HHS been involved in oversight and
respond rapidly to public health grants are appropriately
emergencies. Since 2002, HHS enforcement related to the
monitored and managed Department’s ethics program.
has provided over $10 billion to
throughout the grant life-cycle. Prior OIG work identified
States and localities through
In FY 2011 OIG will assess the vulnerabilities in HHS oversight
various programs to enhance
mechanisms in place to ensure of outside activities and
their emergency preparedness that proper procedures are used
activities and to better enable potential conflicts of interest. In
to award and fund grants, FY 2011 OIG will continue to
them to respond to large-scale,
account for expenditures, and ensure the effectiveness of the
natural or man-made public
verify that grant dollars are only HHS ethics program.
health emergencies, such as acts
used for authorized purposes.
of bioterrorism or infectious Health Information
disease outbreaks. In FY 2011 Child Support Enforcement Technology: HHS has a
OIG will continue its work in Program: OIG will continue to significant role in advancing the
monitoring the public and provide coverage of all 50 development and
private sectors’ preparedness for States and the District of implementation of a national
and response to public health Columbia through its multi- health information network.
emergencies. agency task forces that identify, OIG will continue its oversight
Oversight of Food, Drug and investigate, and prosecute efforts of HHS health
Medical Device Safety: OIG individuals who willfully avoid information technology
will continue to focus on public payment of their child support programs and objectives by
health agencies, such as FDA obligations under the Child monitoring HHS
and NIH, responsible for food, Support Recovery Act. OIG implementation efforts
drug and medical device safety. task forces bring together State andexamining HHS grantees’
These agencies are required to and local law enforcement and compliance with applicable
have policies and programs in prosecutors, United States requirements.
place that create safeguards to Attorneys’ Offices, United

101 Office of Inspector General


EMERGENCY PREPAREDNESS
(dollars in millions)

2009 2011
2009 ARRA 2010 2011* +/- 2010
Pandemic Influenza
Agency Budgets................................................................ 430 -- 231 237 +6
PHSSEF............................................................................ 8,026 -- 341 396 +55
_____ _____ _____ _____ _____
Subtotal, Pandemic Influenza Program Level 8,456 -- 572 632 +61

Terrorism Preparedness
Agency Budgets................................................................ 3,594 -- 3,651 3,693 +41
PHSSEF............................................................................ 822
_____ 50
_____ 936
_____ 1,110
_____ +182
_____
Subtotal, Terrorism Preparedness 4,415
_____ 50
_____ 4,588
_____ 4,803
_____ +223
_____
Total, Emergency Preparedness 12,871 50 5,159 5,435 +284

Transfer of Funds
Transfer of Project BioShield SRF from DHS to HHS -- -- 2,424 -- -2,424

* FY 2011 PHSSEF funding includes $330 million in balances from the FY 2009 pandemic influenza supplemental.

T o protect our Nation from the


threat of pandemic influenza,
FY 2009 supplemental will be used
in FY 2011 to continue the
supported pandemic vaccine
manufacturing, performed clinical
the FY 2011 Budget request advanced development of antiviral trials, and licensed five 2009 H1N1
includes $632 million in HHS- drugs and influenza vaccines, and influenza vaccines with
wide funding. The FY 2011 to ensure that the U.S. has unprecedented speed. The
Budget request also includes sufficient vaccine manufacturing efficiency of H1N1 vaccine
approximately $4.8 billion for capacity in the event of a pandemic. development and manufacturing
bioterrorism and emergency A transfer from FY 2009 was possible due to investments
preparedness activities across the supplemental funding will also over the past four years in influenza
Department. Funding for these support pandemic influenza vaccine advanced research and
activities is appropriated to the activities at CDC. development, and manufacturing
Public Health and Social Services Reassortment of avian, swine and infrastructure building.
Emergency Fund (PHSSEF) and human influenza viruses has led to
directly to agencies. the emergence of a new strain of Prior pandemic preparedness
H1N1 influenza A virus investments resulted in the
PANDEMIC INFLUENZA (2009-H1N1 influenza) that is development of medical
transmissible among humans. countermeasures that are currently
The FY 2011 Budget request for
During the fall H1N1 peak, there being used in the present H1N1
pandemic influenza preparedness
was widespread influenza activity pandemic response. Those
includes $302 million in annual in 48 States. Visits to doctors for investments increased the level of
funding to continue pandemic influenza-like illness as well as domestic vaccine manufacturing
influenza activities at CDC, FDA,
flu-related hospitalizations and capacity, supported the
NIH, and the Office of the
deaths among children and young development and procurement of
Secretary (OS), including
adults were also higher than adjuvants and antivirals, provided a
international activities,
expected for that time of year. In new antiviral drug for critically ill
communications, and research. In response to the H1N1 pandemic patients with H1N1 influenza under
addition, approximately threat, HHS characterized the virus, Emergency Usage Authorization,
$330 million in balances from the
identified candidate strains,

Emergency Preparedness 102


and provided experience in vaccine
and antiviral stockpiling. H1N1 Response
On June 24, 2009, Congress The Centers for Disease Control and Prevention (CDC) and the Office
appropriated $7.65 billion to HHS of the Assistant Secretary for Preparedness and Response (ASPR)
for pandemic influenza provided $1.44 billion to States and hospitals to support H1N1
preparedness and response to planning, preparation, and implementation efforts. Through the
respond to the 2009 H1N1 Hospital Preparedness Program, ASPR provided $90 million for
influenza, including $1.85 billion in improving healthcare workforce protection and optimizing health care
direct appropriations and during a pandemic. CDC provided $1.36 billion to States and local
$5.8 billion in contingent governments through the Public Health Emergency Response grants to
appropriations. HHS has submitted enhance pandemic preparedness, response, and surveillance, as well as
plans for $6.1 billion of the for the implementation of an H1N1 vaccination campaign. An
$7.65 billion FY 2009 supplemental additional $500 million has also been made available to States in need
appropriation. HHS has been of additional support for their H1N1 vaccination efforts. As of
obligating these funds for H1N1 January 7, 2010, more than 115 million doses of H1N1 vaccine have
response activities, including been ordered by States and private partners.
vaccine production, distribution,
and administration; antiviral drugs; FDA, NIH, and the OS, including a
domestic and international Remaining FY 2009 supplemental transfer from the FY 2009
surveillance; communications and funding, including an estimated supplemental to CDC, to finance
community mitigation; and $330 million in FY 2011, and the ongoing preparedness activities
laboratory support for virus FY 2010 appropriation will be used including:
detection. Just over $2 billion has to advance the Nation’s pandemic
been obligated to purchase bulk and preparedness through investments ♦ Expanding international and
finished vaccine and adjuvant in development of next generation domestic surveillance and
products and ancillary supplies for recombinant and molecular vaccine detection capabilities, including
administration of the vaccine. In technologies; further expanding identification of vaccine virus
addition, $1.44 billion was domestic vaccine manufacturing strains and identify emerging
provided to States and hospitals for capacity; continuing development viruses with pandemic potential;
preparedness activities, and for of antigen-sparing adjuvant ♦ Accelerating research and
vaccination campaign planning and technology; continuing development of rapid diagnostic
implementation. development of new and better tests;
influenza antiviral drugs; and ♦ Improving pandemic
The original plan for the FY 2009 continuing advanced development preparedness and response
supplemental appropriation in technologies that help us identify capabilities on the National,
included $3 billion for the purchase influenza. These continued efforts State, and local levels;
of H1N1 vaccine, enough to will enhance the Nation’s ♦ Improving our Nation’s ability
purchase 600 million doses of the preparedness in the event of to contain a potential pandemic
vaccine, or two doses for every another influenza pandemic. influenza outbreak; and
American. However, due to the Additionally, HHS will continue to ♦ Supporting international efforts
strong immunogenic response evaluate priorities for pandemic designed to strengthen the
produced by the vaccine, we now influenza funding, including public health and vaccine
know that adults and children ten FY 2009 supplemental balances, manufacturing infrastructure,
years and older only require one and will notify Congress of any expand surveillance systems,
dose of the vaccine. As a result, changes to current plans. and improve pandemic influenza
funding previously set aside for preparedness and response
H1N1 vaccine can be directed to A total of $302 million is requested capabilities.
other pandemic influenza activities. in the FY 2011 budgets of the CDC,

103 Emergency Preparedness


EMERGENCY PREPAREDNESS
(dollars in millions)
2011
2009 2010 2011 +/- 2010
Pandemic Influenza:
PHSSEF
Vaccine:
Achieve capacity and/or buy courses from egg-based manufacturers.. 279 -- -- --
Pandemic vaccine potency reagents library.......................................... -- 5 -- -5
Cell based and recombinant vaccine development............................... -- 50 -- -50
Advanced development of antigen sparing technologies...................... 65 -- -- --
Cell based vaccine production facility................................................. -- 63 -- -63
Vaccine fill/finish mfg warm base........................................................ --
_____ 40
_____ --
_____ -40
_____
Subtotal, Vaccine 344 158 -- -158

Antivirals:
Antiviral drug advanced development.................................................. 123
_____ 53
_____ --
_____ -53
_____
Subtotal, Antivirals 123 53 -- -53

Ventilators:
Next Generation Ventilators:................................................................ --
_____ 65
_____ --
_____ -65
_____
Subtotal, Ventilators -- 65 -- -65

Shared Responsibility:
Countermeasures and PPE for HHS clinical and patient populations.. 40
_____ --
_____ --
_____ --
_____
Subtotal, Shared Responsibility 40 -- -- --

Pandemic Influenza Emergency Supplemental:


Preparedness and response, inlcuding H1N1 response........................ 7,450
______ --
______ --
______ --
_____
Subtotal, Pandemic Influenza Emergency Supplemental Funding 7,450 -- -- --
______ ______ ______ _____
Subtotal, No-Year Funding BA 7,957 276 -- -276

Program Level:
2009 Supplemental Balances............................................................... -- -- 330 +330
_____ _____ _____ _____
Subtotal, No-Year Funding Program Level 7,957 276 330 +54

Office of the Secretary:


Annual Request.................................................................................... 69
_____ 65
_____ 66
_____ +1
_____
Subtotal, PHSSEF 8,026 341 396 +55

Agency Budgets
CDC......................................................................................................... 356 156 156 --
FDA......................................................................................................... 39 39 45 +6
NIH.......................................................................................................... 35
_____ 35
_____ 35
_____ --
_____
Subtotal, Agency Budgets 430
_____ 231
_____ 237
_____ +6
_____
Total, Program Level 8,456 572 632 +61

Emergency Preparedness 104


EMERGENCY PREPAREDNESS
BIOTERRORISM AND The Budget requests $1.1 billion development activities after
EMERGENCY PREPAREDNESS for ASPR, an increase of notification of Congress. This
$162 million. In December, 2009, flexibility would enable BARDA to
The FY 2011 Budget requests Secretary Sebelius announced a target resources to the most
$4.8 billion for HHS bioterrorism review of the public health promising countermeasure
and emergency response, an countermeasures enterprise with the candidates whether through
increase of $169 million over goal of improving our ability to advanced development or through
FY 2010. These funds, prepare for, respond to, and recover acquisition using Project BioShield.
appropriated to the Public Health from public health threats. ASPR works with Federal, State,
and Social Services Emergency Improving this system is an local, and Tribal partners to ensure
Fund (PHSSEF) and directly to iterative process and represents a coordinated planning and response
agency budgets, are to protect long-term commitment to to bioterrorism and other public
Americans from a possible preparedness. health and medical emergencies.
bioterrorist attack or other public
health emergency. There are steps that can be taken The ASPR budget request includes
PHSSEF ACTIVITIES now to make progress in critical $44 million for Preparedness and
areas. The Budget includes Emergency Operations, an increase
The FY 2011 Budget request for the $476 million, to be made available of $11 million over FY 2010. This
PHSSEF bioterrorism and from current BioShield Special funding will support improved
emergency preparedness activities Reserve Fund (SRF) balances, for regional coordination; increased
is $1.1 billion, a net increase of the Biomedical Advanced Research interagency coordination for
$182 million over FY 2010. The and Development Authority ESF #8; improved Federal response
PHSSEF Budget request will (BARDA), which will continue capabilities; and address the special
support coordination of support for the development of needs of at-risk populations. Also
preparedness and response existing and new promising next- included within this budget request
activities across HHS to improve generation medical is $15 million, available until
the Nation’s ability to prepare for, countermeasures. This represents expended, to prepare for and
respond to, and recover from the an increase of $136 million over respond to National Special
adverse health effects of public FY 2010. BARDA is responsible Security Events and other planned
health emergencies and disasters. for coordinating and administering and unplanned events.
Federal efforts to develop and
Assistant Secretary for procure vaccines and The Budget also includes
Preparedness and Response: The countermeasures to mitigate the $57 million for the National
Office of the Assistant Secretary for medical consequences of potential Disaster Medical System (NDMS)
Preparedness and Response chemical, biological, radiological, to implement emergency readiness
(ASPR) is the lead for the Federal and nuclear threat events. Funding response improvements. The
Government for public health and in FY 2011 will be targeted to request will support training,
medical services response efforts countermeasure development in the exercises, medical equipment and
under the National Response high priority areas of anthrax, other deployable assets for over
Framework, Emergency Support enhanced biothreats, and acute 100 Disaster Medical Assistance
Function (ESF) #8. ASPR radiation syndrome. BARDA also Teams, Disaster Mortuary
coordinates the bioterrorism and manages pandemic influenza and Operational Response Teams, and
emergency preparedness activities Project BioShield, and the request other NDMS Teams to improve our
of HHS agencies, develops and consolidates the associated Nation’s capacity to respond to a
coordinates national policies and management costs. terrorist attack or other public
plans, provides program oversight, health emergency.
and serves as the Secretary’s public Additionally, the Budget will
health emergency representative to permit the Secretary to make In the FY 2011 Budget, $10 million
other Federal, State and local additional BioShield funds is included to continue the HHS
agencies. available for advanced research and medical countermeasure dispensing

105 Emergency Preparedness


demonstration project with the and the White House while Reserve Corps in FY 2011 to
United States Postal Service preparing for and responding to enhance the leverage of these
(USPS), of which up to $8 million public health emergencies, as well efforts during a national
may be transferred to the USPS. as implementing the National catastrophic emergency.
The USPS is a unique Federal Health Security Strategy, which
entity because it reaches the homes was released in December 2009. Office of Security and Strategic
of every American, and will be a Information: The Budget includes
significant asset in the distribution Cybersecurity: The Budget request $6.5 million for the Office of
of medical countermeasures to the provides $37 million for Security and Strategic Information
public in the event of a public cybersecurity, an increase of (OSSI), an increase of $1.6 million
health emergency. ASPR will work $10 million, to protect the over FY 2010, to increase the
with the USPS to expand the Department’s information efficiency of processing HHS
number of cities in the technology infrastructure from security clearances, improve
demonstration project from the four cyber attacks by providing physical security across the
planned in FY 2010 to eight in continuous security monitoring for Department, and create a new
FY 2011. all HHS systems, assets, and liaison position with the National
services. This funding will build Counter Terrorism Center. OSSI is
In FY 2011, $426 million is off of the $50 million provided in responsible for the development,
requested for Hospital the Recovery Act, and will support maintenance, and operation of
Preparedness, which provides a Department-wide collaboration to policy and programming in areas of
cooperative agreements to States, identify and address security physical security, personnel
cities, and territories to strengthen vulnerabilities. Additionally, this security, communications security
the capability of hospitals and will enhance Department-wide and strategic information. OSSI is
healthcare systems to plan for, computer systems intrusion also the point of contact for all of
respond to and recover from all- detection capabilities, security HHS in working with the Director
hazards events. The Budget also information event management of National Intelligence.
requests $41 million to support systems, and network forensics
ASPR strategic oversight and capabilities. HIGHLIGHTED BIOTERRORISM
operational coordination for PREPAREDNESS ACTIVITIES
preparedness and response Medical Reserve Corps:
activities. This includes Comprised of medical and public In addition to ASPR, many of the
$10 million to co-locate the health volunteers, the Medical agencies and offices across HHS
majority of ASPR staff in a single Reserve Corps contributes its play important roles in ensuring
facility, instead of the current five expertise to local public health that the country is prepared for and
sites. These activities are key to initiatives on an ongoing basis. The able to respond to a bioterrorist
improving ASPR’s ability to Budget request includes attack or significant public health
properly advise the Secretary, HHS, $13 million for the Medical emergency. In addition to funding
in the PHSSEF, another $3.7 billion
in bioterrorism and emergency
Medical Countermeasure Review preparedness funding is requested
directly in the appropriations for
Medical countermeasures are a critical element for achieving the CDC, FDA, NIH, ACF, HRSA, and
objectives of HHS and ASPR – to ensure that our communities are the Office of the Secretary.
prepared for, can respond, and can quickly recover from events with
public health consequences. The successes of the Nation’s Pandemic The CDC has a lead role for the
Influenza strategy translate well to all aspects of all-hazards detection and containment of bio-
preparedness. However, challenges remain as we prepare for a range threats, as well as for ensuring that
of threats – an anthrax attack, a dirty bomb, or exposure to smallpox. the country has the right medical
Therefore in December, 2009, Secretary Sebelius announced a review countermeasures and the ability to
of the public health countermeasure enterprise. The goal is a use them in the event of an attack.
modernized countermeasure production process with more promising Quarantine stations improve CDC
discoveries, more advanced development, more robust manufacturing, capacity to respond to natural and
better stockpiling, and more advanced distribution practices. The intentional communicable disease
review is being led by ASPR and is expected to be completed in spring emergencies of public health
2010. significance by catching disease at

Emergency Preparedness 106


the border and preventing it from Performance Highlight
spreading to the American public.
Within days of the devastating earthquake hitting Haiti on January
The FY 2011 Budget provides
12, 2010, HHS launched a medical response. As of January 26, 2010,
$27 million to continue support of
HHS has:
the 20 quarantine stations located at
♦ Approximately 275 medical personnel on the ground in Haiti as
airports across the country. This
part of the international medical response, led by the United
effort will also support more robust
Nations.
partnerships with Federal agencies
♦ Supported missions that include hospital augmentation, care at the
operating at the ports of entry,
embassy, assessment to assist the Haitian government with fatality
including Customs and Border
management, and technical assistance in public health.
Patrol. The request also provides
♦ Seen more than 15,500 patients; the most common medical
$34 million for BioSense, to
conditions being treated are traumatic injuries and exacerbations
improve open collaboration and
of chronic disease. In some cases treatment has required surgery
communication across State and
by our medical personnel.
local jurisdictions and begin
♦ Provided a surgical cache of medical equipment and supplies to
integration with the National Health
USAID that will be distributed to medical facilities in Haiti. Four
Information Network.
planeloads of the medicine, medical equipment and medical
supplies have arrived in Haiti for use by HHS medical teams.
The Budget includes a program
♦ Provided, through its State partners, a range of temporary
level of $592 million for the CDC
assistance including cash, travel, immediate medical care,
Strategic National Stockpile (SNS),
hotel/lodging, and food for over 15,000 U.S. citizens who have
a Federally-owned repository of
returned from Haiti.
countermeasures. These funds will
help support the replacement of
expiring products and increasing $715 million is requested in CDC, planning and coordination effort in
warehousing costs as the volume of which complements the ACF. This program is a
the Stockpile increases, and $426 million requested in ASPR. collaboration between ACF, ASPR,
additional products are added The Upgrading State and Local and the Federal Emergency
through Project BioShield. Capacity Grants Program at CDC Management Agency consistent
and the Hospital Preparedness with the command structure and
The Preparedness Countermeasures Cooperative Agreement Grants reporting requirements in the
Injury Compensation Fund is Program at ASPR prepare States National Incident Management
authorized to provide compensation and local public health departments Plan and the National Response
to individuals suffering from any and hospitals for public health Framework.
unintended side effects of a covered emergencies and acts of terrorism.
countermeasure administered HHS has invested of over Our bioterrorism readiness relies on
during a disaster. Within HRSA, $12 billion since September quickly protecting Americans that
$2.5 million is included for this 11, 2001 on these efforts. have been exposed to a biological,
program. As of January 2010, there chemical, or radiological threat
have been 13 declarations for In addition to the grant programs, agent and treating those who have
pandemic influenza, anthrax, HHS has several efforts to help the become sick following an exposure.
botulism, smallpox, and acute public respond during a public Our Nation's ability to counter
radiation syndrome. health emergency. The FY 2011 bioterrorism ultimately depends on
budget request provides $13 million advancing biomedical science to
In order to ensure that the public is to support the Commissioned Corps develop next generation
able to use the countermeasures response to public health challenges countermeasures. HHS activities in
distributed from the Stockpile and and health care crises that can result NIH and FDA, in addition to those
that local communities are able to from natural disasters, in ASPR, are vital to ensuring that
respond effectively during a public technological catastrophes, terrorist next generation medical
health emergency, HHS helps attacks, and other extraordinary countermeasures move from
States, local public health needs. concept to licensed product.
departments and hospitals prepare The budget request also includes
for public health emergencies and $2 million for the Disaster Human The Budget request for NIH
acts of bioterrorism. In FY 2011, Services Case Management biodefense activities is $1.8 billion,

107 Emergency Preparedness


which includes $100 million for approve vaccines, drugs, and defense activities, including support
radiological/nuclear and chemical diagnostic equipment that will be for the Food Emergency Response
countermeasures research. These part of the next generation of Network. This funding builds on
funds will support basic and medical countermeasures. the $1.3 billion in food safety
applied research on agents with funding in FDA, which will
bioterrorism potential which will Protecting our Nation’s food supply increase and improve inspections,
ultimately lead to the availability of from intentional contamination is domestic surveillance, laboratory
new or improved vaccines and an important responsibility of the capacity, and domestic response to
therapies to protect or treat persons FDA food defense program. To prevent and control foodborne
exposed to threat agents. In protect our Nation's food supply, illnesses.
addition, the budget for FDA $217 million is included in the
includes $68 million to review and budget request, to support key food

Emergency Preparedness 108


EMERGENCY PREPAREDNESS
(dollars in millions)

2009 2011
2009 ARRA 2010 2011 +/- 2010
Bioterrorism and Emergency Preparedness:
Direct Appropriations to Agency Budgets
Centers for Disease Control and Prevention:
State and Local Preparedness and Response Capability... 747 -- 761 758 -3
CDC Preparedness and Response Capability................... 198 -- 193 183 -9
Strategic National Stockpile............................................. 570
_____ --
_____ 596
_____ 592
_____ -4
_____
Subtotal, CDC 1,515 -- 1,549 1,533 -16

National Institutes of Health:


Biodefense Research........................................................ 1,681 -- 1,696 1,749 +53
Radiological/Nuclear Countermeasures Research............ 48 -- 48 51 +3
Chemical Countermeasures Research............................... 49
_____ --
_____ 49
_____ 49
_____ -0
_____
Subtotal, NIH 1,777 -- 1,793 1,849 +56

Food and Drug Administration:


Food Defense................................................................... 213 -- 217 217 --
Vaccines/Drugs/Diagnostics............................................. 67 -- 68 68 --
Physical Security.............................................................. _____7 --
_____ _____7 _____7 --
_____
Subtotal, FDA 287 -- 292 292 --

Adminstration for Children and Families:


Disaster Human Services Case Management Initiative.... -- -- 2 2 --

Health Resources Services Administration:


Covered Countermeasures Fund....................................... -- -- -- 3 +3

Office of the Secretary:


Revitalization of Commissioned Corps............................ 15
_____ --
_____ 15
_____ 14
_____ -1
_____
Subtotal, Direct Appropriations 3,594 -- 3,651 3,693 +41

Office of the Secretary, PHSSEF


Assistant Secretary for Preparedness and Response (ASPR):
Operations........................................................................ 13 -- 13 12 -1
Preparedness and Emergency Operations......................... 22 -- 33 45 +12
National Disaster Medical System (NDMS)................... 50 -- 56 57 +1
Hospital Preparedness..................................................... 394 -- 426 426 --
BARDA**....................................................................... 306 -- 341 476 +136
Medical Countermeasure Dispensing.............................. -- -- 10 10 --
Medicine Science and Public Health............................... 9 -- 9 10 +1
Policy, Strategic Planning, and Communications............ 4 -- 4 8 +4
Policy, Strategic Planning, and Communications............ --
_____ --
_____ --
_____ 10
_____ +10
_____
Subtotal, ASPR 797 -- 892 1,054 +162
Other Office of the Secretary:
Office of Security and Strategic Information (OSSI)...... 3 -- 5 6 +2
CyberSecurity.................................................................. 9 50 27 37 +10
Medical Reserve Corps .................................................. 12
_____ --
_____ 13
_____ 13
_____ +0.1
_____
Subtotal, Other Office of the Secretary 25
_____ 50
_____ 45
_____ 56
_____ +20
_____
Subtotal, PHSSEF 822
_____ 50
_____ 936
_____ 1,110
_____ +182
_____
Total Program Level 4,415 50 4,588 4,803 +172

Less Funds from Other Sources


BioShield Funds available for Advanced Development.. -- -- -476 -476
Transfer from P.L. 111-32 Pandemic Flu........................ _____-- _____ _____-- -69
_____ -69
_____
Total Budget Authority 4,415 4,588 4,258 -372

Transfer of Funds
Transfer of Project BioShield SRF from DHS to HHS... -- -- 2,424 -- -2,424

**FY 2011 Funds are from existing BioShield SRF funds by making those funds available for advanced development in addition

109 Emergency Preparedness


ABBREVATIONS AND ACRONYMS
A E
ACF Administrations for Children and Families EEOICPA Energy Employees Occupational Illness
ADA Americans with Disabilities Act Compensation Program Act
ADAP AIDS Drug Assistance Program EHR Electronic Health Record
ADUFA Animal Drug User Fee Act ESRD End Stage Renal Disease
ADRC Aging and Disability Resource Centers
AFDC Aid to Families with Dependent Children F
AFL Adolescent and Family Life FBI Federal Bureau of Investigation
AHRQ Agency for Healthcare Research and Quality FCC Federal Coordinating Council for Comparative
AIDS Acquired Immune Deficiency Syndrome Effectiveness Research
ALJ Administrative Law Judge FDA Food and Drug Administration
AoA Administration on Aging FFS Fee-For-Service
ARRA American Recovery and Reinvestment Act FHA Federal Health Architecture
ASD Autism Spectrum Disorder FMAP Federal Medical Assistance Percentage
ASPR Assistant Secretary for Preparedness and FMS Financial Management Services
Response FOHS Federal Occupational Health Service
ATSDR Agency for Toxic Substances and Disease FPL Federal Poverty Level
Registry FPLS Federal Parent Locator Service
FTE Full Time Equivalent
B FY Fiscal Year
B&F Buildings and Facilities
B.A. Budget Authority G
BARDA Biomedical Advanced Research and GDM General Departmental Management
Development Authority GINA Genetic Information Non-Discrimination Act
BBA Balanced Budget Act of 1997
GME Graduate Medical Education
BIPA Medicare Benefits Improvement and Protection
GSA General Services Administration
Act of 2000

C H
CBRN Chemical, Biological, Radiological and Nuclear HAI Healthcare Associated Infections
CCDBG Child Care and Development Block Grant HCFAC Health Care Fraud and Abuse Control
CCDF Child Care and Development Fund HCUP Health Care Cost and Utilization Project
HEAT Health Care Fraud Prevention and Enforcement
CCES Child Care Entitlement to States
Action Team
CDC Centers for Disease Control and Prevention HHS Department of Health and Human Services
CHIP Children’s Health Insurance Program HI Federal Hospital Insurance
CHIPRA Children’s Health Insurance Program HI Hospital Insurance (Trust Fund)
Reauthorization Act HIE Health Information Exchange
CMS Centers for Medicare & Medicaid Services
HIGLAS Healthcare Integrated General Ledger
COBRA Consolidate Omnibus Budget Reconcillation Accounting System
Act HIPAA Health Insurance Portability and
CSBG Community Services Block Grant Accountability Act
CSE Child Support Enforcement HITECH Act Health Information Technology for Economic
CTSA Clinical and Translational Science Award and Clinical Health Act
CY Calendar Year HIV Human Immunodeficiency Virus
HIV/AIDS Human Immunodeficiency Virus/Acquired
D Immune Deficiency Syndrome
DEcIDE Developing Evidence to Inform Decisions HRSA Health Resources and Services Administration
about Effectiveness
DME Durable Medical Equipment I
DOJ Department of Justice IHS Indian Health Service
DRA Deficit Reduction Act of 2005 IME Indirect Medical Education
DSH Disproportionate Share Hospitals

Abbrevations and Acronyms 110


ABBREVATIONS AND ACRONYMS
P
IRS Internal Revenue Service PAHPA Pandemic and All-Hazards Preparedness Act
IT Information Technology PDP Prescription Drug Plan
L PDUFA
PHS
Prescription Drug User Fee Act
Public Health Service
LIHEAP Low Income Home Energy Assistance Program PHSSEF Public Health and Social Services Emergency
LTC Long-Term Care Fund
PQRI Physician Quality Reporting Initiative
M PREP Act Public Readiness and Emergency Preparedness
MA Medicare Advantage Act
MAC Medicare Administrative Contractor PSC Program Support Center
MCH Maternal and Child Health PSSF Promoting Safe and Stable Families
MDUFA
MEPS
Medical Device User Fee Act
Medical Expenditure Panel Surveys
Q
MIP Medicaid Integrity Program QIO Quality Improvement Organization
MIPPA Medicare Improvements for Patients and
Providers Act of 2008 R
MMA Medicare Prescription Drug, Improvement, and ROI Return on Investment
Modernization Act of 2003 RPG Research Project Grant
MQSA Mammography Quality Standards Act
S
N SAMHSA Substance Abuse and Mental Health Services
NCRR National Center for Research Resources Administration
NDMS National Disaster Medical System SAS Strategic Acquisition Service
NHIN Nationwide Health Information Network SHIP State Health Insurance Assistance Program
NHSC National Health Service Corps SNS Strategic National Stockpile
NIDDK National Institute of Diabetes and Digestive and SSA Social Security Administration
Kidney Diseases SSBG Social Services Block Grant
NIEHS National Institute of Environmental Health SSF Service and Supply Fund
Sciences SSI Supplemental Security Income
NIH National Institutes of Health STAFFDIV Staff Division
NIOSH National Institute for Occupational Safety and STD Sexually Transmitted Diseases
Health STEM Science, Technology, Engineering, and
NMEP National Medicare & You Education Program Mathematics Education Programs
O T
OCR Office for Civil Rights TAGGS Tracking Accountability in Government Grants
OGHA Office of Global Health Affairs System
OIG Office of Inspector General TANF Temporary Assistance for Needy Families
OMH Office of Minority Health TB Tuberculosis
OMHA Office of Medicare Hearings and Appeals TMA Transitional Medical Assistance
ONC Office of the National Coordinator for Health TRNDI Theraputic Rare and Neglected Disease
Information Technology Iniatives
OPDIV Operating Division TWIIA Ticket to Work and Work Incentives
Improvement Act of 1999
ORR Office of Refugee Resettlement
OS Office of the Secretary U
OSSI Office of Security and Strategic Information UAC Unaccompanied Alien Children
OWH Office on Women’s Health
V
VFC Vaccines for Children
VTC Video Teleconference

111 Abbrevations and Acronyms

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