[House Document 111-139]
[From the U.S. Government Publishing Office]
111th Congress, 2d Session - - - - - - - - - - - House Document 111-139
REQUEST FOR FY 2011 BUDGET AMENDMENTS
__________
COMMUNICATION
from
THE PRESIDENT OF THE UNITED STATES
transmitting
A REQUEST FOR BUDGET AMENDMENTS FOR FISCAL YEAR 2011 PROPOSALS IN THE
FISCAL YEAR 2011 BUDGET FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
September 16, 2010.--Referred to the Committee on Appropriations and
ordered to be printed
The White House,
Washington, DC, August 20, 2010.
Hon. Nancy Pelosi,
Speaker of the House of Representatives,
Washington, DC.
Dear Madam Speaker: I ask the Congress to consider the
enclosed Fiscal Year (FY) 2011 budget amendments for the
Department of Health and Human Services. Overall, the
discretionary budget authority proposed in my FY 2011 Budget
would not be increased by these proposed requests.
Included are proposed increases for healthcare workforce
enhancement activities; HIV/AIDS treatment and prevention;
State health insurance consumer assistance programs; and
existing State high-risk health insurance pools. Also included
are requests for necessary changes to appropriations language
that support the Public Health Emergency Medical Countermeasure
Enterprise Review described in the report issued by the
Secretary of Health and Human Services on August 19, 2010.
The details of these amendments are set forth in the
enclosed letter from the Acting Deputy Director of the Office
of Management and Budget.
Sincerely,
Barack Obama.
Enclosure.
Estimate No. 10, 111th Cong. 2nd Sess.
Executive Office of the President,
Office of Management and Budget,
Washington, DC, August 20, 2010.
The President,
The White House.
Submitted for your consideration are amendments to your FY
2011 Budget for the Department of Health and Human Services.
These requests include proposed increases to accounts that
would be fully offset by proposed reductions of funding from
lower-priority Federal programs and excess funds. Overall, the
discretionary budget totals would not be increased by these
proposed amendments.
This request would provide $400 million in additional funds
for the following accounts, as described below and in more
detail in the enclosures:
$250 million increase to the Health Resources and
Services account for health workforce training enhancements.
$30 million increase to the Health Resources and
Services account for State AIDS Drug Assistance Programs with
waiting lists and other signs of distress.
$35 million increase to the Disease Control,
Research, and Training account for domestic HIV/AIDS prevention
and research.
$55 million increase to the Centers for Medicare
and Medicaid Services (CMS) Program Management account for
State high-risk health insurance pools.
$30 million increase to the Health Insurance
Consumer Information account.
These requested increases would be fully offset by reducing
funding from other Federal programs and excess funds, as
described below and in more detail in the enclosures:
$184 million decrease in the Centers for Disease
Control and Prevention's (CDC's) Disease Control, Research, and
Training account for Public Health Emergency Preparedness
grants.
$103 million decrease in budget authority for
CDC's occupational safety and health activities; this is fully
offset by a corresponding increase in Public Health Service Act
Evaluation Funds to support these activities.
$103 million decrease in the National Institutes
of Health's Buildings and Facilities account.
$10 million decrease in the CMS Program Management
account for research, demonstrations, and evaluation projects.
In addition, the request would decrease Public Health
Service Act Evaluation Funds for Patient-Centered Health
Research within the Agency for Healthcare Research and Quality;
authorize the transfer of $200 million from prior BioShield
Special Reserve Fund (SRF) to the Department of Defense to
establish a Technical Center of Excellence for Advanced
Development and Manufacturing; authorize the creation of and
$200 million in resources to support a strategic investor
entity with BioShield SRF balances; and provide authority to
use pandemic influenza appropriations to promote regulatory
science.
RECOMMENDATION
I have reviewed these requests and am satisfied that they
are necessary at this time. Therefore, I join the Secretary of
Health and Human Services in recommending that you transmit the
proposals to the Congress.
Sincerely,
Robert L. Nabors II,
Acting Deputy Director.
Enclosures.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
HEALTH RESOURCES AND SERVICES
House Doc. 111-91 Page: 16
FY 2011 Budget Appendix Page: 464
FY 2011 Pending Request: $7,601,658,000
Proposed Amendment: $280,000,000
FY 2011 Revised Request: $7,881,658,000
(In the appropriations language under the above heading delete
``$7,601,658,000'' and substitute $7,881,658,000; delete
``$1,962,865,000'' and substitute $1,992,865,000; delete
``$855,000,000'' and substitute $885,000,000; and add the
following new proviso before the concluding period:)
: Provided further, That of the funds provided under this
heading, $30,000,000 shall be available for AIDS drug
assistance under section 311 of the Public Health Service Act
and shall be provided to those States that received funds for
this purpose in fiscal year 2010 pursuant to sections 311 and
2620 of such Act
This amendment would provide an additional $250 million for
Health Professions programs to help the health professions
training infrastructure expand and sustain training efforts and
address the expected demand for primary care providers and the
geriatric health professions workforce. Also, it provides an
additional $30 million for States with AIDS Drug Assistance
Program waiting lists or other signs of distress.
The $280 million proposed increase in FY 2011 would be
fully offset by proposed decreases to other accounts, as
described in the accompanying amendments.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
DISEASE CONTROL, RESEARCH, AND TRAINING
FY 2011 Budget Appendix Pages: 472-473
FY 2011 Pending Request: $6,265,806,000
Proposed Amendment: -$252,209,000
Revised Request: $6,013,597,000
(In the appropriations language under the above heading, delete
``$6,265,806,000'' and substitute $6,013,597,000; and in the
third proviso, delete ``$91,724,000'' and substitute
$194,514,000, insert opening and closing brackets around
``activities within the National Occupational Research
Agenda'', and add related to occupational safety and health
immediately after the newly inserted closing bracket.)
This amendment would decrease the total budget authority
for the Centers for Disease Control and Prevention (CDC) by
$252 million by decreasing funding for the Public Health
Emergency Preparedness (PHEP) grants ($184 million); increasing
funding for Domestic HIV/AIDS Prevention and Research to
support the implementation of the National HIV/AIDS Strategy
($35 million); and decreasing budget authority funding for
occupational safety and health ($103 million). While the
amendment decreases budget authority funding for occupational
safety and health, this is fully offset by a $103 million
increase in Public Health Service (PHS) Act Evaluation Funds
(under section 241 of the PHS Act) to support these activities.
The $184 million decrease for PHEP grants included in this
amendment would be balanced out by pandemic influenza grants
that States were permitted to carry over for an additional
budget year, beyond the original expiration date of July 31,
2010. CDC will make appropriate adjustments in the FY 2011 PHEP
formula grant awards to account for individual States' carry-
over resources.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
BUILDINGS AND FACILITIES
FY 2011 Budget Appendix Page: 477
FY 2011 Pending Request: $125,581,000
Proposed Amendment: -$102,791,000
Revised Request: $22,790,000
(In the appropriations language under the above heading, delete
``$125,581,000'' and substitute $22,790,000.)
This amendment would decrease funding for the Building and
Facilities (B&F) account by $103 million. Due to dramatic
reductions in facilities construction costs, the National
Institutes of Health will be able to finance all of its B&F
projects funded under the American Recovery and Reinvestment
Act (ARRA) of 2009 for about $139 million, or 28 percent, less
than originally projected. NIH is able to construct additional
B&F projects with ARRA funds and plans to use this as the
source for facilities construction and repair and improvement
projects. Additionally, based on historic spending patterns and
current estimates, NIH is likely to carry over unobligated
balances from prior-year B&F (no-year) appropriated amounts.
The $103 million proposed decrease in FY 2011 would offset
proposed increases to the Health Resources and Services
Administration and the Centers for Medicare and Medicaid
Services, as described in the accompanying amendments.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
HEALTHCARE RESEARCH AND QUALITY
FY 2011 Budget Appendix Page: 479
FY 2011 Pending Request: $610,912,000
Proposed Amendment: -$102,790,000
Revised Request: $508,122,000
(In the appropriations language under the above heading, delete
``$610,912,000'' and substitute $508,122,000.)
This amendment would decrease funding for Patient-Centered
Health Research within the Agency for Healthcare Research and
Quality (AHRQ) by $103 million. This would offset the proposed
increase in the use of Public Health Service (PHS) Act
Evaluation Funds (under section 241 of the PHS Act), in the
Centers for Disease Control and Prevention. Patient-Centered
Health Research at AHRQ is similar to research that will be
funded by the new Patient-Centered Outcomes Research Institute
established in the Affordable Care Act (Public Law 111-148).
The amendment would decrease discretionary funding for AHRQ
research, since it can be accomplished with Affordable Care Act
mandatory funds instead. The Budget proposed funding AHRQ
entirely using PHS Act Evaluation Funds, as in past years.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
PROGRAM MANAGEMENT
FY 2011 Budget Appendix Page: 483
FY 2011 Pending Request: $3,601,147,000
Proposed Amendment: $45,000,000
Revised Request: $3,646,147,000
(In the appropriations language under the above heading delete
``$3,601,147,000'' and substitute $3,646,147,000; remove the
opening and closing brackets around the fourth proviso and, in
the fourth proviso, insert opening and closing brackets around
``as authorized by the State High Risk Pool Funding Extension
Act of 2006'' and add under section 2745 of the Public Health
Service Act immediately after the newly inserted closing
bracket.)
This amendment would provide an additional $45 million for
the Centers for Medicare and Medicaid Services (CMS). It
includes a $55 million increase for high-risk health insurance
pool grants, which would allow CMS to continue supporting
existing State-operated high-risk health insurance pool
programs. In addition, the amendment would decrease funding for
research, demonstrations, and evaluation projects within the
CMS Program Management account by $10 million. The Affordable
Care Act (Public Law 111-148) included $10 billion from FY 2011
to FY 2019 for the Center for Medicare and Medicaid Innovation
(CMI), of which at least $25 million is for designing,
implementing, and evaluating various models in each year. CMI
is charged with testing innovative payment and service delivery
models to reduce program expenditures while preserving or
enhancing quality of care. As such, many activities that were
previously funded under the research, demonstrations, and
evaluations projects in the CMS Program Management account can
be implemented through CMI.
The $45 million proposed increase in FY 2011 would be fully
offset by proposed decreases to other accounts, as described in
the accompanying amendments.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Departmental Management
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND
FY 2011 Budget Appendix Page: 505
FY 2011 Pending Request: - - -
Proposed Amendment: Language
Revised Request: - - -
(In the appropriations language under the above heading, insert
the following new paragraphs at the end of the section:)
Funds provided under this heading in Public Laws 111-8 and 111-
117 and available for expenses necessary to prepare for and
respond to an influenza pandemic may also be used for research
to advance regulatory science to improve the ability to
determine safety, quality, and performance of medical
countermeasures against chemical, biological, radiological, and
nuclear agents including influenza virus.
Of remaining balances of funds appropriated under the heading
`Biodefense Countermeasures' in Public Law 108-90, and
transferred to this account by Division D, title II of Public
Law 111-117. $200,000,000 shall be available to the Secretary
for the purpose of funding a strategic investment corporation
established pursuant to section 319L of the Public Health
Service Act (42 U.S.C. 247d-7e) to foster innovation in the
development of medical countermeasures; and, in addition, not
to exceed $200,000,000 of such remaining balances may be
transferred by the Secretary to ``Research, Development, Test
and Evaluation, Defense-Wide, Department of Defense'' for the
purpose of developing medical countermeasures against chemical,
biological, radiological, and nuclear threats and emerging
infectious diseases: Provided, That this transfer authority is
in addition to any other transfer authority available to the
Secretary.
This amendment would make available balances from prior
pandemic influenza appropriations to support research to
modernize regulatory science and enhance the safety, quality,
and performance of medical countermeasures against chemical,
biological, radiological, and nuclear threats and emerging
infectious diseases.
This amendment would allow the Secretary of Health and
Human Services (HHS) to transfer up to $200 million from prior
BioShield Special Reserve Fund balances to the Department of
Defense to establish a Technical Center of Excellence for
Advanced Development and Manufacturing, which would improve the
capability to more rapidly and efficiently develop medical
countermeasures against chemical, biological, radiological, and
nuclear threats and emerging infectious diseases.
In addition, this amendment would create a new strategic
investment corporation with up to $200 million by transferring
funds from the BioShield Special Reserve Fund within HHS. Funds
would support investments in the private sector with specific
focus on disruptive technologies including novel antimicrobials
and multi-use platform technologies for diagnostics and medical
countermeasures.
The overall budget authority requested in the FY 2011
Budget would not be increased by this amendment.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Departmental Management
HEALTH INSURANCE CONSUMER INFORMATION
FY 2011 Budget Appendix Page: 507
FY 2011 Pending Request: - - -
Proposed Amendment: $30,000,000
Revised Request: $30,000,000
(In the appropriations language under the above Bureau, insert
the above new heading and the following new language just after
the Bodoni dash and immediately before the heading ``Program
Support Center'':)
For expenses necessary for Health Insurance Consumer
Information, including grants to States to enable such States
(or the Exchanges operating in such States) to establish,
expand, and provide support for offices of health insurance
consumer assistance or health insurance ombudsman programs as
authorized by section 2793 of the Public Health Service Act (42
U.S.C. 300gg-93), $30,000,000.
This amendment would provide $30 million for the Health
Insurance Consumer Information account. The funding would allow
the Office of Consumer Information and Insurance Oversight and
States to continue supporting health insurance consumer
assistance or ombudsman programs in FY 2011.
The $30 million proposed increase in FY 2011 would be fully
offset by proposed reductions to other accounts, as described
in the accompanying amendments.