[Appendix]
[Detailed Budget Estimates by Agency]
[Department of Health and Human Services, except Social Security]
[From the U.S. Government Printing Office, www.gpo.gov]


                     THE BUDGET FOR FISCAL YEAR 1999

[[Page 395]]


                 DEPARTMENT OF HEALTH AND HUMAN SERVICES

 
                      FOOD AND DRUG ADMINISTRATION

                              Federal Funds

General and special funds:

                          Salaries and Expenses

    For necessary expenses of the Food and Drug Administration, 
including hire and purchase of passenger motor vehicles; for rental of 
special purpose space in the District of Columbia or elsewhere; and for 
miscellaneous and emergency expenses of enforcement activities, 
authorized and approved by the Secretary and to be accounted for solely 
on the Secretary's certificate, not to exceed $25,000; [$948,705,000] 
$878,884,000. In addition, fees collected for fiscal year 1999 [of which 
not to exceed $91,204,000 in fees] pursuant to section 736 of the 
Federal Food, Drug, and Cosmetic Act may be credited to this 
appropriation and remain available until expended: Provided, That fees 
derived from applications received during fiscal year [1998] 1999 shall 
be subject to the fiscal year [1998] 1999 limitation[: Provided further, 
That none of these funds shall be used to develop, establish, or operate 
any program of user fees authorized by 31 U.S.C. 9701].
    In addition, fees pursuant to section 354 of the Public Health 
Service Act may be credited to this account, to remain available until 
expended.
    In addition, fees pursuant to section 801 of the Federal Food, Drug, 
and Cosmetic Act may be credited to this account, to remain available 
until expended.

                        Buildings and Facilities

    For plans, construction, repair, improvement, extension, alteration, 
and purchase of fixed equipment or facilities of or used by the Food and 
Drug Administration, where not otherwise provided, [$21,350,000] 
$8,350,000, to remain available until expended (7 U.S.C. 2209b).

                          Rental Payments (FDA)

                     (including transfers of funds)

    For payment of space rental and related costs pursuant to Public Law 
92-313 for programs and activities of the Food and Drug Administration 
which are included in this Act, [$46,294,000] $88,294,000, including not 
to exceed $5,428,000 to be transferred to this appropriation from fees 
collected pursuant to section 736 of the Federal Food, Drug, and 
Cosmetic Act and credited to the Food and Drug Administration Salaries 
and Expenses appropriation: Provided, That in the event the Food and 
Drug Administration should require modification of space needs, a share 
of the salaries and expenses appropriation may be transferred to this 
appropriation, or a share of this appropriation may be transferred to 
the salaries and expenses appropriation, but such transfers shall not 
exceed 5 percent of the funds made available for rental payments (FDA) 
to or from this account. (Agriculture, Rural Development, Food and Drug 
Administration, and Related Agencies Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Foods...........................         191         204         198
00.02   Drugs...........................         334         337         300
00.03   Devices and radiological 
          products......................         147         142         103
00.04   National center for 
          toxicological research........          32          31          32
00.05   Tobacco.........................           5          34         134
00.06   Other activities................          87          83          84
00.07   Other rent and rent related 
          activities....................          24          26          28
00.08   Rental payments.................          46          46          83
00.09   Buildings and facilities........          15          48           8
00.10   CRADAs..........................                       1           1
09.01 Reimbursable program..............         111         141         161
                                           ---------   ---------  ----------
10.00   Total obligations...............         992       1,093       1,132
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          54          68          42
22.00 New budget authority (gross)......       1,006       1,067       1,132
22.22 Unobligated balance transferred 
        from other accounts.............                       1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,060       1,136       1,174
23.95 New obligations...................        -992      -1,093      -1,132
24.40 Unobligated balance available, end 
        of year: Uninvested.............          68          42          42
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................         888         925         970
      Permanent:

60.00   Appropriation...................                       1           1
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).         118         141         161
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       1,006       1,067       1,132
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         293         277         253
73.10 New obligations...................         992       1,093       1,132
73.20 Total outlays (gross).............        -993      -1,116      -1,157
73.40 Adjustments in expired accounts...         -17
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         277         253         228
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         703         735         785
86.93 Outlays from current balances.....         172         239         209
86.97 Outlays from new permanent 
        authority.......................         118         141         161
86.98 Outlays from permanent balances...                       1           1
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         993       1,116       1,157
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.40     Non-Federal sources...........        -107        -130        -150
88.45     Offsetting governmental 
            collections.................         -11         -11         -11
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -118        -141        -161
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         888         926         971
90.00 Outlays...........................         874         975         996
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................         888         926         971
  Outlays...........................         875         975         995
Supplemental proposal:
  Budget Authority..................
  Outlays...........................
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................
  Outlays...........................
                                    ------------------------------------
Total:
  Budget Authority..................         888         926         971
  Outlays...........................         875         975         995
                                    ====================================

                        [In millions of dollars]

                                        1997         1998        1999
Distribution of budget authority by 
    account:
  Salaries and expenses.............         820         858         879
  Rental payments (FDA).............          46          46          83
  Buildings and facilities..........          21          21           8
Distribution of outlays by account:
  Salaries and expenses.............         818         897         886
  Rental payments (FDA).............          47          48          83
  Buildings and facilities..........           9          29          27


[[Page 396]]



    The Food and Drug Administration (FDA) administers laws concerning 
misbranded and adulterated foods, drugs, human biologics, medical 
devices, cosmetics, and human-made sources of radiation. The Budget 
includes $878.9 million for Salaries and Expenses, which includes 
funding for new food safety initiatives and tobacco regulation. In 
addition, the Budget includes $280.9 million for user fees, an increase 
of $142.4 million in user fees over FY 1998, which will be used to 
finance FDA activities. Of the $280.9 million in user fees, $127.7 
million consists of new user fees, which are represented in the 
legislative proposal schedule. The buildings and facilities 
appropriation of $8.3 million provides funds for projects related to the 
repair, construction, alteration, and improvement of all buildings and 
facilities of FDA. The rental payments appropriation of $88.3 million, 
which consists of $82.9 million in budget authority and up to $5.4 
million from user fees, provides funds for payments of GSA space rental 
and related costs.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         416         442         411
11.3      Other than full-time permanent          30          28          26
11.5      Other personnel compensation..          16          15          14
                                           ---------   ---------  ----------
11.9        Total personnel compensation         462         485         451
12.1    Civilian personnel benefits.....         104         108         101
21.0    Travel and transportation of 
          persons.......................          17          17          17
22.0    Transportation of things........           2           2           2
23.1    Rental payments to GSA..........          42          42          79
23.2    Rental payments to others.......           5           5           5
23.3    Communications, utilities, and 
          miscellaneous charges.........          24          24          24
24.0    Printing and reproduction.......           3           3           3
25.1    Advisory and assistance services          10           9           9
25.2    Other services..................          25          40         100
25.3    Purchases of goods and services 
          from Government accounts......          42          41          41
25.4    Operation and maintenance of 
          facilities....................          26          38          37
25.5    Research and development 
          contracts.....................          18          18          18
25.7    Operation and maintenance of 
          equipment.....................          22          21          21
26.0    Supplies and materials..........          17          17          18
31.0    Equipment.......................          26          26          26
32.0    Land and structures.............          17          37
41.0    Grants, subsidies, and 
          contributions.................          18          18          18
42.0    Insurance claims and indemnities           1           1           1
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..         881         952         971
99.0  Reimbursable obligations..........         111         141         161
                                           ---------   ---------  ----------
99.9    Total obligations...............         992       1,093       1,132
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......       8,353       8,319       7,402
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......         776         789         909
---------------------------------------------------------------------------

                                

                          Salaries and Expenses

              (Legislative proposal, not subject to PAYGO)

    Upon enactment of authorization to establish fees to cover the costs 
of regulation of products under the jurisdiction of the Food and Drug 
Administration, such fees may be collected and credited to this account 
as offsetting collections: Provided, That not to exceed $127,717,000 of 
such fees shall be available until expended for authorized purposes. 

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-2-1-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations.................                                 128
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 128
23.95 New obligations...................                                -128
----------------------------------------------------------------------------

    New budget authority (gross), detail:
68.00 Spending authority from offsetting 
        collections (gross): Offsetting 
        collections (cash)..............                                 128
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 128
73.20 Total outlays (gross).............                                -128
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                 128
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....                                -128
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................
---------------------------------------------------------------------------

    The Budget includes $280.9 million in user fees, of which $127.7 
million are new user fees to finance FDA activities as reflected in the 
legislative proposal schedule. Additional appropriations language is 
being proposed contingent upon the enactment of authorizing legislation. 
The authorizing legislation will be proposed to authorize the collection 
and spending of the fee subject to appropriations action. 

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-2-1-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
99.0  Reimbursable obligations: 
        Subtotal, reimbursable 
        obligations.....................                                 128
                                           ---------   ---------  ----------
99.9    Total obligations...............                                 128
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9911-2-1-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......                               1,183
---------------------------------------------------------------------------

                                

Public enterprise funds:

           Revolving Fund for Certification and Other Services

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4309-0-3-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
09.01 Color additives...................           3           4           4
09.02 Insulin...........................           1
                                           ---------   ---------  ----------
10.00   Total obligations...............           4           4           4
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......           4           4           5
22.00 New budget authority (gross)......           5           4           4
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......           9           8           9
23.95 New obligations...................          -4          -4          -4

[[Page 397]]

24.40 Unobligated balance available, end 
        of year: Uninvested.............           4           5           5
----------------------------------------------------------------------------

    New budget authority (gross), detail:
68.00 Spending authority from offsetting 
        collections (gross): Offsetting 
        collections (cash)..............           5           4           4
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           1           2           2
73.10 New obligations...................           4           4           4
73.20 Total outlays (gross).............          -4          -3          -4
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           2           2           2
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................           4           3           4
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....          -5          -4          -4
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................          -1          -1
---------------------------------------------------------------------------

    FDA certifies color additives for use in foods, drugs, and 
cosmetics. It also lists color additives for use in foods, drugs, 
medical devices, and cosmetics (21 U.S.C. 346a, 356, 357, 376). These 
services are financed wholly by fees paid by the industries affected. 

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4309-0-3-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           2           2           2
23.1  Rental payments to GSA............           1           1           1
26.0  Supplies and materials............           1           1           1
                                           ---------   ---------  ----------
99.9    Total obligations...............           4           4           4
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-4309-0-3-554      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
2001  Total compensable workyears: Full-
        time equivalent employment......          42          36          36
---------------------------------------------------------------------------

                                


 
              HEALTH RESOURCES AND SERVICES ADMINISTRATION

                              Federal Funds

General and special funds:

                      Health Resources and Services

    For carrying out titles II, III, VII, VIII, X, XII, XIX, and XXVI of 
the Public Health Service Act, section 427(a) of the Federal Coal Mine 
Health and Safety Act, title V of the Social Security Act, the Health 
Care Quality Improvement Act of 1986, as amended, and the Native 
Hawaiian Health Care Act of 1988, as amended, [$3,618,137,000] 
$3,773,338,000, of which [$225,000] $150,000 shall remain available 
until expended for interest subsidies on loan guarantees made prior to 
fiscal year 1981 under part B of title VII of the Public Health Service 
Act [and of which $28,000,000 shall be available for the construction 
and renovation of health care and other facilities]: Provided, That the 
Division of Federal Occupational Health may utilize personal services 
contracting to employ professional management/administrative and 
occupational health professionals: Provided further, That of the funds 
made available under this heading, [$2,500,000] $250,000 shall be 
available until expended for facilities renovations at the Gillis W. 
Long Hansen's Disease Center: Provided further, That in addition to fees 
authorized by section 427(b) of the Health Care Quality Improvement Act 
of 1986, fees shall be collected for the full disclosure of information 
under the Act sufficient to recover the full costs of operating the 
National Practitioner Data Bank, and shall remain available until 
expended to carry out that Act: Provided further, That no more than 
$5,000,000 is available for carrying out the provisions of Public Law 
104-73: Provided further, That of the funds made available under this 
heading, [$203,452,000] $218,452,000 shall be for the program under 
title X of the Public Health Service Act to provide for voluntary family 
planning projects: Provided further, That amounts provided to said 
projects under such title shall not be expended for abortions, that all 
pregnancy counseling shall be nondirective, and that such amounts shall 
not be expended for any activity (including the publication or 
distribution of literature) that in any way tends to promote public 
support or opposition to any legislative proposal or candidate for 
public office: Provided further, That [$285,500,000] $385,500,000 shall 
be for State AIDS Drug Assistance Programs authorized by section 2616 of 
the Public Health Service Act, and for providing AIDS drugs in the most 
inexpensive manner possible: Provided further, That notwithstanding any 
other provision of law, funds made available under this heading may be 
used to continue operating the Council on Graduate Medical Education 
established by section 301 of Public Law 102-408: [Provided further, 
That, of the funds made available under this heading, not more than 
$6,000,000 shall be made available and shall remain available until 
expended for loan guarantees for loans funded under part A of title XVI 
of the Public Health Service Act as amended, made by non-Federal lenders 
for the construction, renovation, and modernization of medical 
facilities that are owned and operated by health centers, and for loans 
made to health centers under section 330(d) of the Public Health Service 
Act as amended by Public Law 104-299, and that such funds be available 
to subsidize guarantees of total loan principal in an amount not to 
exceed $80,000,000:] Provided further, That notwithstanding section 
502[(a)(1)] of the Social Security Act, not to exceed $103,863,000 is 
available for carrying out special projects of regional and national 
significance pursuant to section 501(a)(2) of such Act. (Department of 
Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Health centers..................         791         815         836
00.02   National Health Service Corps...          37          37          37
00.03   National Health Service Corps 
          recruitment...................          78          78          78
00.04   Hansen's disease center.........          17          17          17
00.05   Payment to Hawaii for the 
          treatment of Hansen's disease.           2           2           2
00.06   Buildings and facilities........           1           3
00.07   Black lung clinics..............           4           5           5
00.08   Alzheimer's demonstration grants           6           6
00.09   Nursing loan repayment..........           2           2
00.10   Health professions..............         290         291         291
00.11   Maternal and child health block 
          grant.........................         681         683         683
00.12   Emergency medical services for 
          children......................          13          13          11
00.13   Healthy start...................          96          96          96
00.14   HIV/AIDS........................         996       1,150       1,315
00.15   Organ transplantation...........           2           3           4
00.16   Health care facilities..........          13          28
00.17   Bone marrow donor registry......          15          15          15
00.18   Rural health policy development.           9          12          12
00.19   Rural health outreach grants....          28          33          33
00.20   Program management..............         113         114         114
00.21   Family planning.................         198         203         219
00.22   Abstinence education............                      50          50
00.23   Health centers tort claims fund.           1           2           2
00.24   Health centers loan guarantee 
          program account...............                       6           6
00.25   Other HRSA programs.............           1           1
                                           ---------   ---------  ----------
00.91     Total direct program..........       3,394       3,665       3,826
09.01 Reimbursable program..............          65          82          85
                                           ---------   ---------  ----------
10.00   Total obligations...............       3,459       3,747       3,911
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          29          39          42
22.00 New budget authority (gross)......       3,470       3,750       3,906
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       3,500       3,789       3,948
23.95 New obligations...................      -3,459      -3,747      -3,911

[[Page 398]]

24.40 Unobligated balance available, end 
        of year: Uninvested.............          39          42          37
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       3,405       3,618       3,773
      Permanent:

60.00   Appropriation...................                      50          50
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          65          82          83
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       3,470       3,750       3,906
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...       2,299       2,397       2,553
73.10 New obligations...................       3,459       3,747       3,911
73.20 Total outlays (gross).............      -3,433      -3,591      -3,822
73.40 Adjustments in expired accounts...          73
73.45 Adjustments in unexpired accounts.          -1
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...       2,397       2,553       2,642
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       1,349       1,423       1,484
86.93 Outlays from current balances.....       2,019       2,066       2,208
86.97 Outlays from new permanent 
        authority.......................          65         102         103
86.98 Outlays from permanent balances...                                  26
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       3,433       3,591       3,822
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............         -55         -71         -71
88.40     Non-Federal sources...........         -10         -11         -12
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........         -65         -82         -83
88.95 Change in orders on hand from 
        Federal sources.................
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       3,405       3,668       3,823
90.00 Outlays...........................       3,368       3,509       3,739
---------------------------------------------------------------------------

                          [Dollars in millions]

                                        1997         1998        1999
Distribution of budget authority by 
    account:
  Health resources and services.....       3,400       3,663       3,818
  Health centers malpractice claims.           5           5           5
Distribution of outlays by account:
  Health resources and services.....       3,367       3,507       3,737
  Health centers malpractice claims.           1           2           2

               Status of Direct Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Cumulative balance of direct loans 
                outstanding:
1210  Outstanding, start of year........         800         797         773
1231  Disbursements: Direct loan 
        disbursements...................          21
1251  Repayments: Repayments and 
        prepayments.....................         -22         -22         -22
1263  Write-offs for default: Direct 
        loans...........................          -2          -2          -2
                                           ---------   ---------  ----------
1290    Outstanding, end of year........         797         773         749
---------------------------------------------------------------------------

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

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Guaranteed loan levels supportable by subsidy 
                budget authority:
2150  Loan guarantee levels.............                      26          26
2150  Loan guarantee levels.............                      27          27
2150  Loan guarantee levels.............                      27          27
                                           ---------   ---------  ----------
2159    Total loan guarantee levels.....                      80          80
    Guaranteed loan subsidy (in percent):
2320  Subsidy rate......................                    2.21        2.26
2320  Subsidy rate......................                    8.40        8.59
2320  Subsidy rate......................                    5.03        5.11
                                           ---------   ---------  ----------
2329    Weighted average subsidy rate...                    5.11        5.32
    Guaranteed loan subsidy budget authority:
2330  Subsidy budget authority..........                       1           1
2330  Subsidy budget authority..........                       2           2
2330  Subsidy budget authority..........                       1           1
                                           ---------   ---------  ----------
2339    Total subsidy budget authority..                       4           4
    Guaranteed loan subsidy outlays:
2340  Subsidy outlays...................                       1           1
2340  Subsidy outlays...................                       2           2
2340  Subsidy outlays...................                       1           1
                                           ---------   ---------  ----------
2349    Total subsidy outlays...........                       4           4
---------------------------------------------------------------------------

    Activities displayed here support categorical health resources and 
services grants and the Medical Malpractice Claims Fund, which pays 
malpractice claims filed against employees of federally-supported health 
centers.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          87          94          98
11.3      Other than full-time permanent           2           2           2
11.5      Other personnel compensation..           4           4           5
                                           ---------   ---------  ----------
11.9        Total personnel compensation          93         100         105
12.1    Civilian personnel benefits.....          22          24          25
13.0    Benefits for former personnel...           1
21.0    Travel and transportation of 
          persons.......................           3           3           3
23.1    Rental payments to GSA..........           7           8           8
23.3    Communications, utilities, and 
          miscellaneous charges.........           4           4           4
24.0    Printing and reproduction.......           1           1           1
25.1    Advisory and assistance services          32          37          37
25.2    Other services..................          41          36          34
25.3    Purchases of goods and services 
          from Government accounts......          55          53          61
25.6    Medical care....................           2           2           2
25.7    Operation and maintenance of 
          equipment.....................           1           1           1
26.0    Supplies and materials..........           2           3           2
31.0    Equipment.......................           5           2           2
41.0    Grants, subsidies, and 
          contributions.................       3,124       3,389       3,539
42.0    Insurance claims and indemnities           1           2           2
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..       3,394       3,665       3,826
99.0  Reimbursable obligations..........          65          82          85
                                           ---------   ---------  ----------
99.9    Total obligations...............       3,459       3,747       3,911
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Full-time equivalent employment.       1,477       1,588       1,588
1011    Exempt Full-time equivalent 
          employment....................         126         146         146
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......         188         216         216
    Allocation account:
3001  Total compensable workyears: Full-
        time equivalent employment......           1           1           1
---------------------------------------------------------------------------

                                

                       Vaccine Injury Compensation

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0320-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        42.0)...........................          71          75          19
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......         106         145          70

[[Page 399]]

22.00 New budget authority (gross)......         110
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         216         145          70
23.95 New obligations...................         -71         -75         -19
24.40 Unobligated balance available, end 
        of year: Uninvested.............         145          70          51
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.05 Appropriation (indefinite)........         110
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...                       3           3
73.10 New obligations...................          71          75          19
73.20 Total outlays (gross).............         -67         -75         -22
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           3           3
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.93 Outlays from current balances.....          67          75          22
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         110
90.00 Outlays...........................          67          75          22
---------------------------------------------------------------------------

    The Vaccine Improvement Program was established pursuant to Public 
Law 99-660 and Public Law 100-203, and serves as a source of funds to 
pay claims for compensation for vaccine related injury or death. Payment 
of claims associated with vaccine related injury or death occurring 
before October 1, 1988 are financed from the General Fund and are 
reflected in this account. Given sufficient carry-over funds from prior 
years' appropriations to pay for the balance of the pre-1988 backlog of 
claims yet to be adjudicated, no appropriation is requested in FY 1999 
to cover payment of pre-1988 claims. Payment of claims associated with 
vaccine related injury or death occurring after October 1, 1988 are 
reflected in the Vaccine Improvement Trust Fund account.

                                

Credit accounts:

             Health Center Guaranteed Loan Financing Account

             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4442-0-3-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Position with respect to appropriations act 
                limitation on commitments:
2111  Limitation on guaranteed loans 
        made by private lenders.........                     160
                                           ---------   ---------  ----------
2150    Total guaranteed loan 
          commitments...................                     160
----------------------------------------------------------------------------

    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........                                  67
2231  Disbursements of new guaranteed 
        loans...........................                      67          74
2251  Repayments and prepayments........                                  -3
2261  Adjustments: Terminations for 
        default that result in loans 
        receivable......................
                                           ---------   ---------  ----------
2290    Outstanding, end of year........                      67         138
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..                      67         138
----------------------------------------------------------------------------

    Addendum:
      Cumulative balance of defaulted guaranteed 
          loans that result in loans receivable:

2310    Outstanding, start of year......
2331    Disbursements for guaranteed 
          loan claims...................
2351    Repayments of loans receivable..
                                           ---------   ---------  ----------
2390      Outstanding, end of year......
---------------------------------------------------------------------------

    P.L. 104-299 and P.L. 104-208 authorize HRSA to guarantee up to $80 
million in private loans to Health Centers for the costs of developing 
and operating managed care networks or plans and for the construction, 
renovation and modernization of medical facilities. Since this program 
has not yet used any of its current $160 million in loan guarantee 
authority, HRSA will use this existing loan guarantee limit over FY 1998 
and FY 1999. As required by the Federal Credit Reform Act of 1990, this 
Financing Account records all cash flows to and from the Government 
resulting from the Health Center Loan Guarantee Program. The Program 
Account for this activity is displayed in the Health Resources and 
Services account (75-0350) as a line in the Program and Financing 
Schedule.

                             Balance Sheet (in millions of dollars)

-----------------------------------------------------------------------------------------------
Identification code   75-4442-0-3-551    1996 actual    1997 actual     1998 est.      1999 est.
-----------------------------------------------------------------------------------------------
    ASSETS:
      Investments in US securities:

1106    Federal assets: Receivables, net                                       80             80
                                        ------------ --------------  ------------  -------------
1999    Total assets....................                                       80             80
    LIABILITIES:
2204  Non-Federal liabilities: 
        Liabilities for loan guarantees.                                       80             80
                                        ------------ --------------  ------------  -------------
2999    Total liabilities...............                                       80             80
                                        ------------ --------------  ------------  -------------
4999  Total liabilities and net position                                       80             80
-----------------------------------------------------------------------------------------------

                                

                Health Education Assistance Loans Program

                      (including transfer of funds)

    [For the cost of guaranteed loans, such sums as may be necessary to 
carry out the purpose of the program, as authorized by title VII of the 
Public Health Service Act, as amended: Provided, That such costs, 
including the cost of modifying such loans, shall be as defined in 
section 502 of the Congressional Budget Act of 1974: Provided further, 
That these funds are available to subsidize gross obligations for the 
total loan principal any part of which is to be guaranteed at not to 
exceed $85,000,000: Provided further, That the Secretary may use up to 
$1,000,000 derived by transfer from insurance premiums collected from 
guaranteed loans made under title VII of the Public Health Service Act 
for the purpose of carrying out section 709 of that Act. In addition, 
for] For administrative expenses to carry out the guaranteed loan 
program, including section 709 of the Public Health Service Act, 
[$2,688,000] $3,688,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.02 Guaranteed loan subsidy...........                       1
00.09 Administrative expenses subject to 
        limitation......................           3           4           4
                                           ---------   ---------  ----------
10.00   Total obligations...............           3           5           4
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......           3           5           4
23.95 New obligations...................          -3          -5          -4
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................           3           3           4
42.00   Transferred from other accounts.                       1
                                           ---------   ---------  ----------
43.00     Appropriation (total).........           3           4           4
      Permanent:

60.05   Appropriation (indefinite)......                       1
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................           3           5           4
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           2           1
73.10 New obligations...................           3           5           4
73.20 Total outlays (gross).............          -4          -6          -4
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           1
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority           3           4           4

[[Page 400]]

86.97 Outlays from new permanent 
        authority.......................                       1
86.98 Outlays from permanent balances...           1           1
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........           4           6           4
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................           3           5           4
90.00 Outlays...........................           4           6           4
---------------------------------------------------------------------------

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

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Guaranteed loan levels supportable by subsidy 
                budget authority:
2150  Loan guarantee levels.............         140          85
                                           ---------   ---------  ----------
2159    Total loan guarantee levels.....         140          85
    Guaranteed loan subsidy (in percent):
2320  Subsidy rate......................        0.34        1.09
                                           ---------   ---------  ----------
2329    Weighted average subsidy rate...        0.34        1.09
    Guaranteed loan subsidy budget authority:
2330  Subsidy budget authority..........                       1
                                           ---------   ---------  ----------
2339    Total subsidy budget authority..                       1
    Guaranteed loan subsidy outlays:
2340  Subsidy outlays...................                       1
                                           ---------   ---------  ----------
2349    Total subsidy outlays...........                       1
---------------------------------------------------------------------------

    The Health Education Assistance Loan (HEAL) program guarantees loans 
from private lenders to health professions students to help pay for the 
costs of their training. As required by the Federal Credit Reform Act of 
1990, this account records, for the HEAL program, the subsidy costs 
associated with HEAL loan guarantees committed in 1992 and beyond 
(including modifications of HEAL loan guarantees that resulted from 
obligations or commitments in any year), as well as administrative 
expenses of the program. The subsidy amounts are estimated on a present 
value basis; the administrative expenses are estimated on a cash basis. 

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           2           2           2
25.2  Other services....................           1           1           1
41.0  Grants, subsidies, and 
        contributions...................                       1
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..           3           4           3
99.5  Below reporting threshold.........                       1           1
                                           ---------   ---------  ----------
99.9    Total obligations...............           3           5           4
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Total compensable workyears:
1001  Full-time equivalent employment...          20          20          20
1011  Exempt Full-time equivalent 
        employment......................           6           6           6
---------------------------------------------------------------------------

                                

       Health Education Assistance Loans Program Financing Account

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4304-0-3-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations.................          12          11          16
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......         226         247         266
22.00 New financing authority (gross)...          33          30          26
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         259         277         292
23.95 New obligations...................         -12         -11         -16
24.40 Unobligated balance available, end 
        of year: Uninvested.............         247         266         276
----------------------------------------------------------------------------

    New financing authority (gross), detail:
      Current:

41.00   Transferred to other accounts...                      -1
      Permanent:

68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          33          31          26
                                           ---------   ---------  ----------
70.00   Total new financing authority 
          (gross).......................          33          30          26
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................          12          11          16
73.20 Total financing disbursements 
        (gross).........................         -12         -11         -16
87.00 Total financing disbursements 
        (gross).........................          12          11          16
----------------------------------------------------------------------------

    Offsets:
      Against gross financing authority and 
          financing disbursements:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............                      -1
88.25     Interest on uninvested funds..         -19         -24         -25
          Non-Federal sources:
88.40       Premium income..............         -14          -5
88.40       Recoveries of defaulted 
              loans.....................                      -1          -1
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........         -33         -31         -26
----------------------------------------------------------------------------

    Net financing authority and financing 
        disbursements:
89.00 Financing authority...............                      -1
90.00 Financing disbursements...........         -21         -20         -10
---------------------------------------------------------------------------

             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4304-0-3-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Position with respect to appropriations act 
                limitation on commitments:
2111  Limitation on guaranteed loans 
        made by private lenders.........         140          85
                                           ---------   ---------  ----------
2150    Total guaranteed loan 
          commitments...................         140          85
----------------------------------------------------------------------------

    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........       1,366       1,494       1,568
2231  Disbursements of new guaranteed 
        loans...........................         140          85
      Adjustments:

2261    Terminations for default that 
          result in loans receivable....         -11         -10         -15
2263    Terminations for default that 
          result in claim payments......          -1          -1          -1
                                           ---------   ---------  ----------
2290    Outstanding, end of year........       1,494       1,568       1,552
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..       1,494       1,568       1,552
----------------------------------------------------------------------------

    Addendum:
      Cumulative balance of defaulted guaranteed 
          loans that result in loans receivable:

2310    Outstanding, start of year......           7          18          27
2331    Disbursements for guaranteed 
          loan claims...................          11          10          15
2351    Repayments of loans receivable..                      -1          -1
                                           ---------   ---------  ----------
2390      Outstanding, end of year......          18          27          41
---------------------------------------------------------------------------



[[Page 401]]



    This account records all cash flows to and from the Government 
resulting from (HEAL) loan guarantees committed between 1992 and 1998. 

                             Balance Sheet (in millions of dollars)

-----------------------------------------------------------------------------------------------
Identification code   75-4304-0-3-552    1996 actual    1997 actual     1998 est.      1999 est.
-----------------------------------------------------------------------------------------------
    ASSETS:
      Federal assets:

1101    Fund balances with Treasury.....         202            226           247            266
        Investments in US securities:
1106      Receivables, net..............                                        1
      Non-Federal assets:

1201    Investments in non-Federal 
          securities, net...............          15             19            24             25
1206    Receivables, net................          15             14             5              1
                                        ------------ --------------  ------------  -------------
1999    Total assets....................         232            259           277            292
    LIABILITIES:
2204  Non-Federal liabilities: 
        Liabilities for loan guarantees.       1,366          1,494         1,568          1,552
                                        ------------ --------------  ------------  -------------
2999    Total liabilities...............       1,366          1,494         1,568          1,552
    NET POSITION:
3300  Cumulative results of operations..      -1,134         -1,235        -1,291         -1,260
                                        ------------ --------------  ------------  -------------
3999    Total net position..............      -1,134         -1,235        -1,291         -1,260
                                        ------------ --------------  ------------  -------------
4999  Total liabilities and net position         232            259           277            292
-----------------------------------------------------------------------------------------------

                                

      Health Education Assistance Loans Program Liquidating Account

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4305-0-3-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Operating expenses: death and 
        disability......................           5           8           9
00.02 Capital investment................          47          42          40
00.03 Collection costs..................           5           5           8
                                           ---------   ---------  ----------
10.00   Total obligations...............          57          55          57
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          12           5
22.00 New budget authority (gross)......          51          50          57
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          63          55          57
23.95 New obligations...................         -57         -55         -57
24.40 Unobligated balance available, end 
        of year: Uninvested.............           5
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.05 Appropriation (indefinite)........          38          30          37
68.00 Spending authority from offsetting 
        collections: Offsetting 
        collections (cash)..............          13          20          20
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          51          50          57
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           1           6
73.10 New obligations...................          57          55          57
73.20 Total outlays (gross).............         -51         -61         -57
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           6
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................          38          50          57
86.98 Outlays from permanent balances...          13          11
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          51          61          57
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....         -13         -20         -20
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          38          30          37
90.00 Outlays...........................          38          41          37
---------------------------------------------------------------------------

             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4305-0-3-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........       1,559       1,475       1,387
2251  Repayments and prepayments........         -48         -52         -58
      Adjustments:

2261    Terminations for default that 
          result in loans receivable....         -29         -23         -28
2263    Terminations for default that 
          result in claim payments......          -3          -8          -5
2264    Other adjustments, net..........          -4          -5          -8
                                           ---------   ---------  ----------
2290    Outstanding, end of year........       1,475       1,387       1,288
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..       1,475       1,387       1,288
----------------------------------------------------------------------------

    Addendum:
      Cumulative balance of defaulted guaranteed 
          loans that result in loans receivable:

2310    Outstanding, start of year......         422         470         489
2331    Disbursements for guaranteed 
          loan claims...................          47          42          40
2351    Repayments of loans receivable..         -13         -13         -13
2361    Write-offs of loans receivable..         -10         -10         -10
2364    Other adjustments, net..........          24
                                           ---------   ---------  ----------
2390      Outstanding, end of year......         470         489         506
---------------------------------------------------------------------------

    Note.--Includes carryover commitments from prior years.
    Note.--The adjustment to loans receivable represents interest, which 
had not previously been reflected in cumulative outstanding balances.

    This account records all cash flows to and from the Government 
resulting from HEAL loan guarantees committed prior to 1992.

                              DATA ON LOANS

                                     1997 actual  1998 est.   1999 est.
Dollar volume of loans insured ($ in 
millions)...........................         140          85
Number of students..................      12,035       7,727
Average value of loans..............      11,602      11,000

                        Statement of Operations (in millions of dollars)

-----------------------------------------------------------------------------------------------
Identification code   75-4305-0-3-552    1996 actual    1997 actual     1998 est.      1999 est.
-----------------------------------------------------------------------------------------------
0101  Revenue...........................          80             74            60             57
0102  Expense...........................         -44            -57           -55            -57
                                        ------------ --------------  ------------  -------------
0109  Net loss..........................          36             17             5
-----------------------------------------------------------------------------------------------

                             Balance Sheet (in millions of dollars)

-----------------------------------------------------------------------------------------------
Identification code   75-4305-0-3-552    1996 actual    1997 actual     1998 est.      1999 est.
-----------------------------------------------------------------------------------------------
    ASSETS:
1101  Federal assets: Fund balances with 
        Treasury........................          12
      Net value of assets related to 
          pre-1992 direct loans 
          receivable and acquired 
          defaulted guaranteed loans 
          receivable:

1701    Defaulted guaranteed loans, 
          gross.........................         422            470           489            506
1702    Interest receivable.............           6              6             6              6
1703    Allowance for estimated 
          uncollectible loans and 
          interest (-)..................          -7
1704    Defaulted guaranteed loans and 
          interest receivable, net......         421            476           495            512
                                        ------------ --------------  ------------  -------------
1799      Value of assets related to 
            loan guarantees.............         421            476           495            512
1801  Other Federal assets: Cash and 
        other monetary assets...........          44             57            55             57
                                        ------------ --------------  ------------  -------------
1999    Total assets....................         477            533           550            569
    LIABILITIES:
2104  Federal liabilities: Resources 
        payable to Treasury.............           5              3             8              5
2201  Non-Federal liabilities: Accounts 
        payable.........................          38             47            42             40
                                        ------------ --------------  ------------  -------------
2999    Total liabilities...............          43             50            50             45
    NET POSITION:
3300  Cumulative results of operations..         434            483           500            524
                                        ------------ --------------  ------------  -------------
3999    Total net position..............         434            483           500            524
                                        ------------ --------------  ------------  -------------

[[Page 402]]


4999  Total liabilities and net position         477            533           550            569
-----------------------------------------------------------------------------------------------

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4305-0-3-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.2  Other services....................           6           5           5
42.0  Insurance claims and indemnities..          51          50          52
                                           ---------   ---------  ----------
99.9    Total obligations...............          57          55          57
---------------------------------------------------------------------------

                                

               Medical Facilities Guarantee and Loan Fund

            federal interest subsidies for medical facilities

    For carrying out subsections (d) and (e) of section 1602 of the 
Public Health Service Act, [$6,000,000] $1,000,000, together with any 
amounts received by the Secretary in connection with loans and loan 
guarantees under title VI of the Public Health Service Act, to be 
available without fiscal year limitation for the payment of interest 
subsidies. During the fiscal year, no commitments for direct loans or 
loan guarantees shall be made. (Department of Health and Human Services 
Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Operating expenses: Interest 
        subsidies, private..............           4           4           4
01.01 Capital investment: Direct loans..                       1           1
                                           ---------   ---------  ----------
10.00   Total obligations...............           4           5           5
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          58          66          63
22.00 New budget authority (gross)......          18          14           9
22.60 Redemption of debt................          -6         -12         -12
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          70          68          60
23.95 New obligations...................          -4          -5          -5
24.40 Unobligated balance available, end 
        of year: Uninvested.............          66          63          55
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................           7           6           1
      Permanent:

68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          11           8           8
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          18          14           9
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           8           7           4
73.10 New obligations...................           4           5           5
73.20 Total outlays (gross).............          -5          -6          -6
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           7           4           3
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority           4           6           1
86.93 Outlays from current balances.....           1                       5
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........           5           6           6
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
          Non-Federal sources:
88.40       Interest repaid on loans not 
              sold......................          -1          -1          -1
88.40       Principal collections from 
              FFB.......................          -6          -6          -6
88.40       Default collections, 
              principal.................          -3
88.40       Interest collections from 
              FFB.......................          -1          -1          -1
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........         -11          -8          -8
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................           7           6           1
90.00 Outlays...........................          -6          -2          -2
---------------------------------------------------------------------------

               Status of Direct Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Cumulative balance of direct loans 
                outstanding:
1210  Outstanding, start of year........          34          24          17
1251  Repayments: Repayments and 
        prepayments.....................         -10          -5          -5
1264  Write-offs for default: Other 
        adjustments, net................                      -2          -2
                                           ---------   ---------  ----------
1290    Outstanding, end of year........          24          17          10
---------------------------------------------------------------------------

             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........         188         142          98
2251  Repayments and prepayments........         -46         -44         -40
                                           ---------   ---------  ----------
2290    Outstanding, end of year........         142          98          58
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..         142          98          58
---------------------------------------------------------------------------

    Title VII, part C of the Public Health Service Act established a 
revolving fund from which health professions schools could borrow in 
order to provide loans to their students.

    Public Law 89-751, the Allied Health Professions Personnel Training 
Act of 1966, amended the Public Health Service Act to authorize the 
Federal Government to pay the difference between the interest paid by 
students to the schools and the interest payable by the schools to the 
Government National Mortgage Association (GNMA) and the Treasury.

    Title VI and subsequently title XVI of the Public Health Service Act 
established a loan and loan guarantee fund for medical facilities with a 
maximum amount allowable for the Government's liability. Direct loans 
were made available for public facilities and guaranteed loans for 
private, nonprofit facilities. Funds under this authority were 
established in the amount of $50 million for use in fulfilling 
guarantees in event of default, $30 million as a revolving fund for 
direct loans and an amount for interest subsidy payments on guaranteed 
loans. Default and interest subsidy funds are replenished as necessary 
through the annual appropriation process.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
33.0  Investments and loans.............                       1           1
41.0  Grants, subsidies, and 
        contributions...................           4           3           3
43.0  Interest and dividends............                       1           1
                                           ---------   ---------  ----------
99.9    Total obligations...............           4           5           5
---------------------------------------------------------------------------

                                

  

                               Trust Funds

             Vaccine Injury Compensation Program Trust Fund

    For payments from the Vaccine Injury Compensation Program Trust 
Fund, such sums as may be necessary for claims associated with vaccine-
related injury or death with respect to vaccines administered after 
September 30, 1988, pursuant to subtitle 2 of title XXI of the Public 
Health Service Act, to remain available until expended: Provided, That 
for necessary administrative expenses, not to exceed $3,000,000 shall be 
available from the Trust Fund to the Secretary of Health and Human 
Services. (Department of Health and Human Services Appropriations Act, 
1998.)

[[Page 403]]

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8175-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............       1,047       1,193       1,336
    Receipts:
02.01 Deposits..........................         123         111         111
02.03 Interest income...................          81          93         104
                                           ---------   ---------  ----------
02.99   Total receipts..................         204         204         215
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...       1,251       1,397       1,551
    Appropriation:
05.01 Vaccine injury compensation 
        program trust fund..............         -58         -61         -61
                                           ---------   ---------  ----------
05.99 Subtotal appropriation............         -58         -61         -61
07.99 Total balance, end of year........       1,193       1,336       1,490
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8175-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Compensation: Claims for post--FY 
        1989 injuries...................          49          52          52
      Administrative expenses:

01.03   Claims processing (Claims Court)           3           3           3
01.04   Claims processing (Public Health 
          Service)......................           3           3           3
01.05   Claims processing (Dept. of 
          Justice)......................                       6           3
                                           ---------   ---------  ----------
01.91     Total, administrative expenses           6          12           9
                                           ---------   ---------  ----------
10.00   Total obligations...............          55          64          61
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......                       3
22.00 New budget authority (gross)......          58          61          61
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          58          64          61
23.95 New obligations...................         -55         -64         -61
24.40 Unobligated balance available, end 
        of year: Uninvested.............           3
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.26 Appropriation (trust fund, 
        definite).......................           9           9           9
40.27 Appropriation (trust fund, 
        indefinite).....................          49          52          52
                                           ---------   ---------  ----------
43.00   Appropriation (total)...........          58          61          61
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          58          61          61
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...                       1
73.10 New obligations...................          55          64          61
73.20 Total outlays (gross).............         -54         -65         -61
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           1
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority          54          61          61
86.93 Outlays from current balances.....                       4
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          54          65          61
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          58          61          61
90.00 Outlays...........................          54          65          61
---------------------------------------------------------------------------

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

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8175-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.2  Other services....................           3           3           3
25.3  Purchases of goods and services 
        from Government accounts........           3           9           6
42.0  Insurance claims and indemnities..          49          52          52
                                           ---------   ---------  ----------
99.9    Total obligations...............          55          64          61
---------------------------------------------------------------------------

                                


 
                          INDIAN HEALTH SERVICE

                              Federal Funds

General and special funds:

                         Indian Health Services

    For expenses necessary to carry out the Act of August 5, 1954 (68 
Stat. 674), the Indian Self-Determination Act, the Indian Health Care 
Improvement Act, and titles II and III of the Public Health Service Act 
with respect to the Indian Health Service, [$1,841,074,000] 
$1,843,873,000, together with payments received during the fiscal year 
pursuant to 42 U.S.C. 238(b) for services furnished by the Indian Health 
Service: Provided, That funds made available to tribes and tribal 
organizations through contracts, grant agreements, or any other 
agreements or compacts authorized by the Indian Self-Determination and 
Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed to be 
obligated at the time of the grant or contract award and thereafter 
shall remain available to the tribe or tribal organization without 
fiscal year limitation: Provided further, That $12,000,000 shall remain 
available until expended, for the Indian Catastrophic Health Emergency 
Fund: Provided further, That $361,375,000 for contract medical care 
shall remain available for obligation until September 30, [1999] 2000: 
Provided further, That of the funds provided, not less than $11,889,000 
shall be used to carry out the loan repayment program under section 108 
of the Indian Health Care Improvement Act: Provided further, That funds 
provided in this Act may be used for one-year contracts and grants which 
are to be performed in two fiscal years, so long as the total obligation 
is recorded in the year for which the funds are appropriated: Provided 
further, That the amounts collected by the Secretary of Health and Human 
Services under the authority of title IV of the Indian Health Care 
Improvement Act shall remain available until expended for the purpose of 
achieving compliance with the applicable conditions and requirements of 
titles XVIII and XIX of the Social Security Act (exclusive of planning, 
design, or construction of new facilities): [Provided further, That of 
the funds provided, $7,500,000 shall remain available until expended, 
for the Indian Self-Determination Fund, which shall be available for the 
transitional costs of initial or expanded tribal contracts, compacts, 
grants or cooperative agreements with the Indian Health Service under 
the provisions of the Indian Self-Determination Act:] Provided further, 
That funding contained herein, and in any earlier appropriations Acts 
for scholarship programs under the Indian Health Care Improvement Act 
(25 U.S.C. 1613) shall remain available for obligation until September 
30, [1999] 2000: Provided further, That amounts received by tribes and 
tribal organizations under title IV of the Indian Health Care 
Improvement Act shall be reported and accounted for and available to the 
receiving tribes and tribal organizations until expended: Provided 
further, That not to exceed $168,702,000 shall be for payments to tribes 
and tribal organizations for contract support costs associated with 
ongoing contracts or grants or compacts entered into with the Indian 
Health Service prior to fiscal year [1998] 1999, as authorized by the 
Indian Self-Determination Act of 1975, as amended. (Department of the 
Interior and Related Agencies Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0390-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Clinical services...............       1,485       1,477       1,479
00.02   Preventive health...............          81          83          83
00.03   Urban health....................          25          25          26
00.04   Indian health professions.......          28          29          29
00.05   Tribal management...............           2           2           2
00.06   Direct operations...............          43          47          47
00.07   Self-governance.................           7           9           9
00.08   Contract support costs..........         155         169         169
00.09   Diabetes funds..................                      30          30
                                           ---------   ---------  ----------
00.91     Total direct program..........       1,826       1,871       1,874
09.01 Reimbursable program..............         308         298         323
                                           ---------   ---------  ----------
10.00   Total obligations...............       2,134       2,169       2,197
----------------------------------------------------------------------------

[[Page 404]]



    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          77          98          98
22.00 New budget authority (gross)......       2,158       2,169       2,197
22.30 Unobligated balance expiring......          -3
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       2,232       2,267       2,295
23.95 New obligations...................      -2,134      -2,169      -2,197
24.40 Unobligated balance available, end 
        of year: Uninvested.............          98          98          98
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       1,806       1,841       1,844
40.15   Appropriation (emergency).......           1
                                           ---------   ---------  ----------
43.00     Appropriation (total).........       1,807       1,841       1,844
      Permanent:

62.00   Transferred from HCFA for 
          Diabetes......................                      30          30
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).         351         298         323
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       2,158       2,169       2,197
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         565         481         509
73.10 New obligations...................       2,134       2,169       2,197
73.20 Total outlays (gross).............      -2,271      -2,141      -2,146
73.40 Adjustments in expired accounts...          53
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         481         509         560
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       1,409       1,437       1,438
86.93 Outlays from current balances.....         511         397         358
86.97 Outlays from new permanent 
        authority.......................         351         307         332
86.98 Outlays from permanent balances...                                  18
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,271       2,141       2,146
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............         -74         -74         -78
88.40     Non-Federal sources...........        -277        -224        -245
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -351        -298        -323
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       1,807       1,871       1,874
90.00 Outlays...........................       1,920       1,843       1,823
---------------------------------------------------------------------------

    The Indian Health Services account provides medical care, public 
health services, and health professions training opportunities to 
American Indians and Alaska Natives. An estimated $444 million will be 
administered by tribal governments under self-governance compacts in FY 
1999.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0390-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         368         364         381
11.3      Other than full-time permanent          18          16          17
11.5      Other personnel compensation..          12          31          32
                                           ---------   ---------  ----------
11.9        Total personnel compensation         398         411         430
12.1    Civilian personnel benefits.....         116         119         125
13.0    Benefits for former personnel...           6           6           6
21.0    Travel and transportation of 
          persons.......................          28          29          29
22.0    Transportation of things........          11          11          11
23.1    Rental payments to GSA..........           8           8           8
23.2    Rental payments to others.......           2
23.3    Communications, utilities, and 
          miscellaneous charges.........          26          20          20
24.0    Printing and reproduction.......           2           2           2
25.1    Advisory and assistance services           1           4           4
25.2    Other services..................         120         161         132
25.3    Purchases of goods and services 
          from Government accounts......           4           5           8
25.4    Operation and maintenance of 
          facilities....................           8          14          15
25.6    Medical care....................         187         243         248
25.7    Operation and maintenance of 
          equipment.....................          15          21          20
25.8    Subsistence and support of 
          persons.......................          22          30          30
26.0    Supplies and materials..........         103          88          87
31.0    Equipment.......................          22          22          22
32.0    Land and structures.............           2           2           2
41.0    Grants, subsidies, and 
          contributions.................         745         675         675
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..       1,826       1,871       1,874
99.0  Reimbursable obligations..........         308         298         323
                                           ---------   ---------  ----------
99.9    Total obligations...............       2,134       2,169       2,197
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0390-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Full-time equivalent employment.      10,271      10,085      10,071
1011    Exempt Full-time equivalent 
          employment....................                       5           5
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......       2,691       2,691       2,691
---------------------------------------------------------------------------

                                

                        Indian Health Facilities

    For construction, repair, maintenance, improvement, and equipment of 
health and related auxiliary facilities, including quarters for 
personnel; preparation of plans, specifications, and drawings; 
acquisition of sites, purchase and erection of modular buildings, and 
purchases of trailers; and for provision of domestic and community 
sanitation facilities for Indians, as authorized by section 7 of the Act 
of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, 
and the Indian Health Care Improvement Act, and for expenses necessary 
to carry out such Acts and titles II and III of the Public Health 
Service Act with respect to environmental health and facilities support 
activities of the Indian Health Service, [$257,538,000] $235,576,000, to 
remain available until expended: Provided, That notwithstanding any 
other provision of law, funds appropriated for the planning, design, 
construction or renovation of health facilities for the benefit of an 
Indian tribe or tribes may be used to purchase land for sites to 
construct, improve, or enlarge health or related facilities. In 
addition, to become available on October 1 of the fiscal year specified 
and remain available until expended: for construction of a replacement 
of the health facility at Fort Defiance, Arizona, up to $25,000,000 for 
fiscal year 1999, up to $25,000,000 for fiscal year 2000, and up to 
$28,000,000 for fiscal year 2001; for construction of the health 
facility at Keams Canyon, Arizona, up to $13,900,000 for fiscal year 
1999, and up to $3,200,000 for fiscal year 2000. (Department of the 
Interior and Related Agencies Appropriations Act, 1998.)

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............
    Receipts:
02.01 Rent and charges for quarters, 
        Indian Health Service, HHS......           5           5           5
    Appropriation:
05.01 Indian health facilities..........          -5          -5          -5
07.99 Total balance, end of year........
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Sanitation and health facilities 
          construction..................         104         103         123
00.02   Maintenance.....................          53          45          40
00.03   Facilities and environmental 
          health........................          95         102         103
00.04   Equipment.......................          10          13          13
                                           ---------   ---------  ----------

[[Page 405]]


01.00     Total direct program..........         262         263         279
09.01 Reimbursable program..............          18          12          12
                                           ---------   ---------  ----------
10.00   Total obligations...............         280         275         291
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          25          11          11
22.00 New budget authority (gross)......         267         275         291
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         292         286         302
23.95 New obligations...................        -280        -275        -291
24.40 Unobligated balance available, end 
        of year: Uninvested.............          11          11          11
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................         250         258         274
      Permanent:

60.25   Appropriation (special fund, 
          indefinite)...................           5           5           5
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          12          12          12
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         267         275         291
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         380         392         382
73.10 New obligations...................         280         275         291
73.20 Total outlays (gross).............        -266        -285        -314
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         392         382         359
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority          57          64          69
86.93 Outlays from current balances.....         204         204         228
86.97 Outlays from new permanent 
        authority.......................           5          17          17
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         266         285         314
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.45   Offsetting collections (cash) 
          from: Offsetting governmental 
          collections...................         -12         -12         -12
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         255         263         279
90.00 Outlays...........................         256         273         302
---------------------------------------------------------------------------

    The Indian health facilities account supports construction, repair 
and improvement, equipment, and environmental health and facilities 
support for the Indian health services.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          44          45          48
11.3      Other than full-time permanent           5           5           6
11.5      Other personnel compensation..           2           2           2
                                           ---------   ---------  ----------
11.9        Total personnel compensation          51          52          56
12.1    Civilian personnel benefits.....          14          16          16
21.0    Travel and transportation of 
          persons.......................           4           4           4
22.0    Transportation of things........           5           5           5
23.3    Communications, utilities, and 
          miscellaneous charges.........           7          15          15
25.1    Advisory and assistance services           3           2           3
25.2    Other services..................          57          52          53
25.3    Purchases of goods and services 
          from Government accounts......           2           7           6
25.4    Operation and maintenance of 
          facilities....................          32          21          28
25.6    Medical care....................           8           4           7
26.0    Supplies and materials..........          10          10          10
31.0    Equipment.......................           4           4           4
32.0    Land and structures.............          27          45          45
41.0    Grants, subsidies, and 
          contributions.................          38          26          27
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..         262         263         279
99.0  Reimbursable obligations..........          18          12          12
                                           ---------   ---------  ----------
99.9    Total obligations...............         280         275         291
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
1001  Total compensable workyears: Full-
        time equivalent employment......       1,437       1,456       1,470
---------------------------------------------------------------------------

                                

            Administrative Provisions, Indian Health Service

    Appropriations in this Act to the Indian Health Service shall be 
available for services as authorized by 5 U.S.C. 3109 but at rates not 
to exceed the per diem rate equivalent to the maximum rate payable for 
senior-level positions under 5 U.S.C. 5376; hire of passenger motor 
vehicles and aircraft; purchase of medical equipment; purchase of 
reprints; purchase, renovation and erection of modular buildings and 
renovation of existing facilities; payments for telephone service in 
private residences in the field, when authorized under regulations 
approved by the Secretary; and for uniforms or allowances therefore as 
authorized by 5 U.S.C. 5901-5902; and for expenses of attendance at 
meetings which are concerned with the functions or activities for which 
the appropriation is made or which will contribute to improved conduct, 
supervision, or management of those functions or activities: Provided, 
That in accordance with the provisions of the Indian Health Care 
Improvement Act, non-Indian patients may be extended health care at all 
tribally administered or Indian Health Service facilities, subject to 
charges, and the proceeds along with funds recovered under the Federal 
Medical Care Recovery Act (42 U.S.C. 2651-2653) shall be credited to the 
account of the facility providing the service and shall be available 
without fiscal year limitation: Provided further, That notwithstanding 
any other law or regulation, funds transferred from the Department of 
Housing and Urban Development to the Indian Health Service shall be 
administered under Public Law 86-121 (the Indian Sanitation Facilities 
Act) and Public Law 93-638, as amended: Provided further, That funds 
appropriated to the Indian Health Service in this Act, except those used 
for administrative and program direction purposes, shall not be subject 
to limitations directed at curtailing Federal travel and transportation: 
Provided further, That notwithstanding any other provision of law, funds 
previously or herein made available to a tribe or tribal organization 
through a contract, grant, or agreement authorized by title I or title 
III of the Indian Self-Determination and Education Assistance Act of 
1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-
determination contract under title I, or a self-governance agreement 
under title III of such Act and thereafter shall remain available to the 
tribe or tribal organization without fiscal year limitation: Provided 
further, That none of the funds made available to the Indian Health 
Service in this Act shall be used to implement the final rule published 
in the Federal Register on September 16, 1987, by the Department of 
Health and Human Services, relating to the eligibility for the health 
care services of the Indian Health Service until the Indian Health 
Service has submitted a budget request reflecting the increased costs 
associated with the proposed final rule, and such request has been 
included in an appropriations Act and enacted into law: Provided 
further, That funds made available in this Act are to be apportioned to 
the Indian Health Service as appropriated in this Act, and accounted for 
in the appropriation structure set forth in this Act: Provided further, 
That with respect to functions transferred by the Indian Health Service 
to tribes or tribal organizations, the Indian Health Service is 
authorized to provide goods and services to those entities, on a 
reimbursable basis, including payment in advance with subsequent 
adjustment, and the reimbursements received therefrom, along with the 
funds received from those entities pursuant to the Indian Self-
Determination Act, may be credited to the same or subsequent 
appropriation account which provided the funding, said amounts to remain 
available until expended: Provided further, That reimbursements for 
training, technical assistance, or services provided by the Indian 
Health Service will contain total costs, including direct, 
administrative, and overhead associated with the provision of goods, 
services, or technical assistance: Provided further, That the 
appropriation structure for the Indian Health Service may not be altered 
without advance [approval of] notice submitted to the House and Senate 
Committees on Appropriations. (Department of the Interior and Related 
Agencies Appropriations Act, 1998.)

[[Page 406]]

                                


 
               CENTERS FOR DISEASE CONTROL AND PREVENTION

                              Federal Funds

General and special funds:

                 Disease Control, Research, and Training

    To carry out titles II, III, VII, XI, XV, XVII, and XIX of the 
Public Health Service Act, sections 101, 102, 103, 201, 202, 203, 301, 
and 501 of the Federal Mine Safety and Health Act of 1977, and sections 
20, 21 and 22 of the Occupational Safety and Health Act of 1970, title 
IV of the Immigration and Nationality Act and section 501 of the Refugee 
Education Assistance Act of 1980; including insurance of official motor 
vehicles in foreign countries; and hire, maintenance, and operation of 
aircraft, [$2,327,552,000] $2,414,197,000, of which [$21,504,000] 
$6,800,000 shall remain available until expended for equipment and 
construction and renovation of facilities, and in addition, such sums as 
may be derived from authorized user fees, which shall be credited to 
this account: Provided, That in addition to amounts provided herein, up 
to [$59,232,000] $86,012,000 shall be available from amounts available 
under section 241 of the Public Health Service Act, to carry out the 
National Center for Health Statistics surveys: Provided further, That 
none of the funds made available for injury prevention and control at 
the Centers for Disease Control and Prevention may be used to advocate 
or promote gun control: Provided further, That the Director may redirect 
the total amount made available under authority of Public Law 101-502, 
section 3, dated November 3, 1990, to activities the Director may so 
designate: Provided further, That the Congress is to be notified 
promptly of any such transfer.
     In addition, $[51,000,000,] $43,000,000 to be derived from the 
Violent Crime Reduction Trust Fund, for carrying out sections 40151 and 
40261 of Public Law 103-322. (Department of Health and Human Services 
Appropriations Act, 1998.)

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............
    Receipts:
02.01 Cooperative research and 
        development agreements, Centers 
        for Disease Control.............           1           1           1
    Appropriation:
05.01 Disease control, research, and 
        training........................          -1          -1          -1
07.99 Total balance, end of year........
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Preventive health block grant...         154         150         150
00.02   Prevention centers..............           8           8           8
00.03   Sexually transmitted diseases...         106         114         124
00.04   Immunization....................         468         407         407
00.05   Infectious diseases.............         207         234         259
00.06   Other chronic and environmental 
          diseases......................         367         403         419
00.07   Tobacco.........................          21          28          74
00.08   Occupational safety and health..         141         153         153
00.09   Mine safety and health..........          30          36          36
00.10   Epidemic services...............          70          89          89
00.11   Health statistics...............          38          27
00.12   HIV.............................         616         634         634
00.13   Research for America............                                  25
00.14   Buildings and facilities........          44          94           7
00.15   Program management..............           3           2           2
00.16   Violent crime reduction programs          41          51          51
00.17   Office of the Director savings..                                 -11
00.18   Demonstrations to address health 
          disparities...................                                  30
                                           ---------   ---------  ----------
00.91     Total direct program..........       2,314       2,430       2,457
09.01 Reimbursable program..............         147         150         182
                                           ---------   ---------  ----------
10.00   Total obligations...............       2,461       2,580       2,639
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          51          52
22.00 New budget authority (gross)......       2,455       2,530       2,640
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
22.22 Unobligated balance transferred 
        from other accounts.............           5
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       2,512       2,582       2,640
23.95 New obligations...................      -2,461      -2,580      -2,639
24.40 Unobligated balance available, end 
        of year: Uninvested.............          52
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       2,261       2,327       2,414
42.00   Transferred from other accounts.          41          52          43
                                           ---------   ---------  ----------
43.00     Appropriation (total).........       2,302       2,379       2,457
      Permanent:

60.25   Appropriation (special fund, 
          indefinite)...................           1           1           1
        Spending authority from 
            offsetting collections:
68.00     Offsetting collections (cash).         147         150         182
68.10     Change in orders on hand from 
            Federal sources.............           5
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total)...................         152         150         182
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       2,455       2,530       2,640
----------------------------------------------------------------------------

    Change in unpaid obligations:
      Unpaid obligations, start of year:

72.40   Obligated balance: Uninvested...       2,061       2,070       2,230
72.95   Orders on hand from Federal 
          sources.......................                       5           5
                                           ---------   ---------  ----------
72.99     Total unpaid obligations, 
            start of year...............       2,061       2,075       2,235
73.10 New obligations...................       2,461       2,580       2,639
73.20 Total outlays (gross).............      -2,396      -2,420      -2,533
73.40 Adjustments in expired accounts...         -50
73.45 Adjustments in unexpired accounts.          -1
      Unpaid obligations, end of year:

74.40   Obligated balance: Uninvested...       2,070       2,230       2,336
74.95   Orders on hand from Federal 
          sources.......................           5           5           5
                                           ---------   ---------  ----------
74.99     Total unpaid obligations, end 
            of year.....................       2,075       2,235       2,341
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         801         804         829
86.93 Outlays from current balances.....       1,447       1,465       1,521
86.97 Outlays from new permanent 
        authority.......................         147         150         182
86.98 Outlays from permanent balances...           1           1           1
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,396       2,420       2,533
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -147        -150        -182
88.95 Change in orders on hand from 
        Federal sources.................          -5
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       2,303       2,380       2,458
90.00 Outlays...........................       2,249       2,270       2,351
---------------------------------------------------------------------------

                          [Dollars in millions]

                                        1997         1998        1999
Distribution of budget authority by 
    account:
  Disease control, research and 
    training........................       2,262       2,328       2,414
  Violent crime reduction programs..          41          51          43
Distribution of outlays by account:
  Disease control, research and 
    training........................       2,219       2,220       2,310
  Violent crime reduction programs..          30          50          41

    The Centers for Disease Control and Prevention (CDC) supports a 
number of categorical programs including grants for immunizations, 
control of sexually transmitted diseases, HIV prevention, and control of 
other infectious and chronic diseases. CDC also supports the Preventive 
Health Block Grant.

    This display also includes amounts derived from the Violent Crime 
Reduction Trust Fund.

    A portion of the funding for the Centers for Disease Control's 
Prevention Research is proposed as part of the Research Fund for 
America. This proposal highlights the Administration's priority to 
providing needed and sustained investments in important Federal research 
programs on a deficit neutral basis. A discussion of the Research Fund 
for America, and two other funds for the environment and transportation, 
can be found in Section II of the Budget volume.

[[Page 407]]

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         256         290         298
11.3      Other than full-time permanent          14          15          16
11.5      Other personnel compensation..          14          15          16
                                           ---------   ---------  ----------
11.9        Total personnel compensation         284         320         330
12.1    Civilian personnel benefits.....          82          87          90
21.0    Travel and transportation of 
          persons.......................          22          23          23
22.0    Transportation of things........           4           4           4
23.1    Rental payments to GSA..........          15          20          20
23.3    Communications, utilities, and 
          miscellaneous charges.........          26          27          27
24.0    Printing and reproduction.......           7           7           7
25.1    Advisory and assistance services          10          11          11
25.2    Other services..................          83          75          78
25.5    Research and development 
          contracts.....................         196         200         206
25.7    Operation and maintenance of 
          equipment.....................          13          13          13
26.0    Supplies and materials..........         164         164         166
31.0    Equipment.......................          42          38          38
32.0    Land and structures.............          16          72           7
41.0    Grants, subsidies, and 
          contributions.................       1,348       1,367       1,435
43.0    Interest and dividends..........           2           2           2
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..       2,314       2,430       2,457
99.0  Reimbursable obligations..........         147         150         182
                                           ---------   ---------  ----------
99.9    Total obligations...............       2,461       2,580       2,639
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Full-time equivalent employment.       5,583       5,987       5,958
1011    Exempt Full-time equivalent 
          employment....................          37          60          60
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......       1,000       1,000       1,097
---------------------------------------------------------------------------

                                

                Allocations Received From Other Accounts

    Note.--Obligations incurred under allocations from other accounts 
are included in the schedules of the parent appropriation as follows:
    Environmental Protection Agency: ``Hazardous substance response 
trust fund.''

                                


 
                      NATIONAL INSTITUTES OF HEALTH

                              Federal Funds

General and special funds:

                        National Cancer Institute

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to cancer, [$2,547,314,000] $2,536,061,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

                National Heart, Lung, and Blood Institute

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to cardiovascular, lung, and blood diseases, 
and blood and blood products, [$1,531,061,000] $1,646,479,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

                  National Institute of Dental Research

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to dental disease, [$209,415,000] $214,559,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

    National Institute of Diabetes and Digestive and Kidney Diseases

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to diabetes and digestive and kidney disease, 
[$873,860,000] $927,492,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

         National Institute of Neurological Disorders and Stroke

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to neurological disorders and stroke, 
[$780,713,000] $815,649,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

          National Institute of Allergy and Infectious Diseases

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to allergy and infectious diseases, 
[$1,351,655,000] $702,040,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

             National Institute of General Medical Sciences

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to general medical sciences, [$1,065,947,000] 
$1,114,886,000. (Department of Health and Human Services Appropriations 
Act, 1998.)

        National Institute of Child Health and Human Development

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to child health and human development, 
[$674,766,000] $654,716,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

                         National Eye Institute

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to eye diseases and visual disorders, 
[$355,691,000] $374,356,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

           National Institute of Environmental Health Sciences

    For carrying out sections 301 and 311 and title IV of the Public 
Health Service Act with respect to environmental health sciences, 
[$330,108,000] $348,090,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

                       National Institute on Aging

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to aging, [$519,279,000] $556,070,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

  National Institute of Arthritis and Musculoskeletal and Skin Diseases

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to arthritis and musculoskeletal and skin 
diseases, [$274,760,000] $291,053,000. (Department of Health and Human 
Services Appropriations Act, 1998.)

    National Institute on Deafness and Other Communication Disorders

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to deafness and other communication disorders, 
[$200,695,000] $213,834,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

                 National Institute of Nursing Research

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to nursing research, [$63,597,000] $62,416,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

           National Institute on Alcohol Abuse and Alcoholism

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to alcohol abuse and alcoholism, [$227,175,000] 
$230,243,000. (Department of Health and Human Services Appropriations 
Act, 1998.)

                    National Institute on Drug Abuse

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to drug abuse, [$527,175,000] $395,129,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

                   National Institute of Mental Health

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to mental health, [$750,241,000] $701,790,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

[[Page 408]]

                National Human Genome Research Institute

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to human genome research, [$217,704,000] 
$236,996,000. (Department of Health and Human Services Appropriations 
Act, 1998.)

                 National Center for Research Resources

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to research resources and general research 
support grants, [$453,883,000] $422,995,000: Provided, That none of 
these funds shall be used to pay recipients of the general research 
support grants program any amount for indirect expenses in connection 
with such grants: Provided further, That [$20,000,000] $20,000,000 shall 
be for extramural facilities construction grants. (Department of Health 
and Human Services Appropriations Act, 1998.)

                  John E. Fogarty International Center

    For carrying out the activities at the John E. Fogarty International 
Center, [$28,289,000] $19,105,000. (Department of Health and Human 
Services Appropriations Act, 1998.)

                      National Library of Medicine

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to health information communications, 
[$161,185,000] $171,253,000, of which $4,000,000 shall be available 
until expended for improvement of information systems: Provided, That in 
fiscal year [1998] 1999, the Library may enter into personal services 
contracts for the provision of services in facilities owned, operated, 
or constructed under the jurisdiction of the National Institutes of 
Health. (Department of Health and Human Services Appropriations Act, 
1998.)

                         Office of the Director

                      (including transfer of funds)

    For carrying out the responsibilities of the Office of the Director, 
National Institutes of Health, [$296,373,000, of which $40,536,000 shall 
be for the Office of AIDS Research] $212,949,000: Provided, That funding 
shall be available for the purchase of not to exceed five passenger 
motor vehicles for replacement only: Provided further, That the Director 
may direct up to 1 percent of the total amount made available in this or 
any other Act to all National Institutes of Health appropriations to 
activities the Director may so designate: Provided further, That no such 
appropriation shall be decreased by more than 1 percent by any such 
transfers and that the Congress is promptly notified of the transfer: 
Provided further, That NIH is authorized to collect third party payments 
for the cost of clinical services that are incurred in National 
Institutes of Health research facilities and that such payments shall be 
credited to the National Institutes of Health Management Fund: Provided 
further, That all funds credited to the NIH Management Fund shall remain 
available for one fiscal year after the fiscal year in which they are 
deposited: Provided further, That up to [$500,000] $300,000 shall be 
available to carry out section 499 of the Public Health Service Act for 
the final year of Federal support for the National Foundation for 
Biomedical Research and that these funds shall be available for 
obligation only after the Secretary of Health and Human Services 
certifies a plan for the self-sufficiency of the Foundation after fiscal 
year 1999: Provided further, That, notwithstanding section 499(k)(10) of 
the Public Health Service Act, funds from the National Foundation for 
Biomedical Research may be transferred to the National Institutes of 
Health[: Provided further, That $20,000,000 shall be available to carry 
out section 404E of the Public Health Service Act: Provided further, 
That of the funds available to carry out section 404E of the Public 
Health Service Act, not less than $7,000,000 shall be for peer reviewed 
complementary and alternative medicine research grants and contracts 
that respond to program announcements and requests for proposals issued 
by the Office of Alternative Medicine]. (Department of Health and Human 
Services Appropriations Act, 1998.)

                         Office of AIDS Research

                    (including the transfer of funds)

    For carrying out part D of title XXIII of the Public Health Service 
Act, $1,730,796,000, of which $6,100,000 shall be transferred to 
Buildings and Facilities and remain available until expended: Provided, 
That the Director of the Office of AIDS Research shall transfer from 
this appropriation the amounts necessary to carry out subsection 2353(d) 
of the Act.

                        Buildings and Facilities

    For the study of, construction of, and acquisition of equipment for, 
facilities of or used by the National Institutes of Health, including 
the acquisition of real property, [$206,957,000] $128,886,000, to remain 
available until expended[, of which $90,000,000 shall be for the 
clinical research center and $16,957,000 for the Vaccine Facility: 
Provided, That notwithstanding any other provision of law, a single 
contract or related contracts for the development and construction of 
the clinical research center may be employed which collectively include 
the full scope of the project: Provided further, That the solicitation 
and contract shall contain the clause ``availability of funds'' found at 
48 CFR 52.232-18: Provided further, That notwithstanding any other 
provision of law, a single contract or related contracts for the 
development and construction of the Vaccine Facility may be employed 
which collectively include the full scope of the project: Provided 
further, That the solicitation and contract shall contain the clause 
``availability of funds'' found in 48 CFR 52.232-18].
    In addition, to become available on October 1 of the fiscal year 
specified and remain available until expended, for the Mark O. Hatfield 
Clinical Research Center: $90,000,000 for fiscal year 1999, and 
$40,000,000 for fiscal year 2000. (Department of Health and Human 
Services Appropriations Act, 1998.)

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............
    Receipts:
02.01 Cooperative research and 
        development agreements, NIH.....          28          28          28
    Appropriation:
05.01 National Institutes of Health.....         -28         -28         -28
07.99 Total balance, end of year........
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   National Cancer Institute.......       2,389       2,547       2,536
00.02   National Heart, Lung, and Blood 
          Institute.....................       1,432       1,531       1,647
00.03   National Institute of Dental 
          Research......................         197         209         215
00.04   National Institute of Diabetes 
          and Digestive and Kidney 
          Disease.......................         813         874         927
00.05   National Institute of 
          Neurological Disorders and 
          Stroke........................         729         781         816
00.06   National Institute of Allergy 
          and Infectious Diseases.......       1,258       1,352         702
00.07   National Institute of General 
          Medical Sciences..............         995       1,066       1,115
00.08   National Institute of Child 
          Health and Human Development..         631         675         655
00.09   National Eye Institute..........         332         356         374
00.10   National Institute of 
          Environmental Health Sciences.         308         330         348
00.11   National Institute on Aging.....         484         519         556
00.12   National Institute of Arthritis 
          and Musculoskeletal and Skin 
          Disease.......................         256         275         291
00.13   National Institute on Deafness 
          and Other Communication 
          Disorder......................         188         201         214
00.14   National Institute of Nursing 
          Research......................          60          64          62
00.15   National Institute of Alcohol 
          Abuse and Alcoholism..........         211         227         230
00.16   National Institute on Drug Abuse         499         527         395
00.17   National Institute of Mental 
          Health........................         701         750         702
00.18   National Center for Research 
          Resources.....................         414         454         423
00.19   National Human Genome Research 
          Institute.....................         189         218         237
00.20   John E. Fogarty International 
          Center........................          27          28          19
00.21   National Library of Medicine....         150         161         171
00.22   Office of the Director..........         286         296         213
00.23   Office of AIDS Research.........                               1,731
00.24   Buildings and facilities........         222         207         219
00.25   Cooperative research and 
          development agreements........          17          17          17
00.26   Royalities......................          29          29          29
                                           ---------   ---------  ----------
00.91     Total direct program..........      12,817      13,694      14,844
09.00 Reimbursable program..............       1,052       1,159       1,145
                                           ---------   ---------  ----------
10.00   Total obligations...............      13,869      14,853      15,989
----------------------------------------------------------------------------

[[Page 409]]



    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......         221         197         179
22.00 New budget authority (gross)......      13,848      14,835      15,971
22.30 Unobligated balance expiring......          -1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......      14,068      15,032      16,150
23.95 New obligations...................     -13,869     -14,853     -15,989
24.40 Unobligated balance available, end 
        of year: Uninvested.............         197         179         161
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................      12,741      13,648      14,798
42.00   Transferred from other accounts.          10
                                           ---------   ---------  ----------
43.00     Appropriation (total).........      12,751      13,648      14,798
      Permanent:

60.25   Appropriation (special fund, 
          indefinite)...................          28          28          28
        Spending authority from 
            offsetting collections:
68.00     Offsetting collections (cash).       1,052       1,159       1,145
68.10     Change in orders on hand from 
            Federal sources.............          17
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total)...................       1,069       1,159       1,145
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................      13,848      14,835      15,971
----------------------------------------------------------------------------

    Change in unpaid obligations:
      Unpaid obligations, start of year:

72.40   Obligated balance: Uninvested...       9,247      10,973      11,746
72.95   Orders on hand from Federal 
          sources.......................       4,422       4,439       4,439
                                           ---------   ---------  ----------
72.99     Total unpaid obligations, 
            start of year...............      13,669      15,412      16,185
73.10 New obligations...................      13,869      14,853      15,989
73.20 Total outlays (gross).............     -12,251     -14,080     -15,071
73.40 Adjustments in expired accounts...         125
      Unpaid obligations, end of year:

74.40   Obligated balance: Uninvested...      10,973      11,746      12,664
74.95   Orders on hand from Federal 
          sources.......................       4,439       4,439       4,439
                                           ---------   ---------  ----------
74.99     Total unpaid obligations, end 
            of year.....................      15,412      16,185      17,103
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       3,973       4,251       4,618
86.93 Outlays from current balances.....       7,293       8,642       9,280
86.97 Outlays from new permanent 
        authority.......................         985       1,187       1,173
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........      12,251      14,080      15,071
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........      -1,052      -1,159      -1,145
88.95 Change in orders on hand from 
        Federal sources.................         -17
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................      12,779      13,676      14,826
90.00 Outlays...........................      11,199      12,921      13,926
---------------------------------------------------------------------------

                          [Dollars in millions]

                                        1997         1998        1999
Distribution of budget authority by 
    account:
  National Cancer Institute.........       2,389       2,547       2,536
  National Heart, Lung, and Blood 
    Institute.......................       1,432       1,531       1,646
  National Institute of Dental 
    Research........................         197         209         215
  National Institute of Diabetes and 
    Digestive and Kidney Diseases...         813         874         927
  National Institute of Neurological 
    Disorder and Stroke.............         729         781         816
  National Institute of Allergy and 
    Infectious Diseases.............       1,258       1,352         702
  National Institute of General 
    Medical Sciences................         995       1,066       1,115
  National Institute of Child Health 
    and Human Development...........         632         675         655
  National Eye Institute............         332         356         374
  National Institute of 
    Environmental Health Sciences...         308         330         348
  National Institute on Aging.......         484         519         556
  National Institute of Arthritis 
    and Musculoskeletal and Skin 
    Diseases........................         256         275         291
  National Institute on Deafness and 
    Other Communication Disorders...         188         201         214
  National Institute of Nursing 
    Research........................          60          64          62
  National Institute on Alcohol 
    Abuse and Alcoholism............         211         227         230
  National Institute on Drug Abuse..         500         527         395
  National Institute of Mental 
    Health..........................         701         750         702
  National Center for Research 
    Resources.......................         414         454         423
  National Human Genome Research 
    Institute.......................         189         218         237
  John E. Fogarty International 
    Center..........................          27          28          19
  National Library of Medicine......         150         161         171
  Office of the Director............         286         298         213
  Office of AIDS Research...........                               1,731
  Buildings and Facilities..........         200         207         219
                                    ------------------------------------
      Subtotal......................      12,751      13,650      14,797
  Cooperative Research and 
    Development Agreements..........          26          28          28
                                    ------------------------------------
      Total Budget Authority, NIH...      12,777      13,678      14,825
                                    ====================================

                          [Dollars in millions]

                                        1997         1998        1999
Distribution of outlays by account:
  National Cancer Institute.........       2,148       2,423       2,382
  National Heart, Lung, and Blood 
    Institute.......................       1,083       1,442       1,503
  National Institute of Dental 
    Research........................         168         199         200
  National Institute of Diabetes and 
    Digestive and Kidney Diseases...         627         823         870
  National Institute of Neurological 
    Disorders and Stroke............         701         742         767
  National Institute of Allergy and 
    Infectious Diseases.............       1,216       1,266         655
  National Institute of General 
    Medical Sciences................         882       1,002       1,051
  National Institute of Child Health 
    and Human Development...........         566         638         620
  National Eye Institute............         337         338         351
  National Institute of 
    Environmental Health Sciences...         286         308         332
  National Institute on Aging.......         426         490         522
  National Institute of Arthritis 
    and Musculoskeletal and Skin 
    Diseases........................         230         258         274
  National Institute on Deafness and 
    Other Communication Disorders...         177         190         202
  National Institute of Nursing 
    Research........................          48          59          58
  National Institute on Alcohol 
    Abuse and Alcoholism............         171         215         216
  National Institute on Drug Abuse..         437         496         364
  National Institute of Mental 
    Health..........................         638         710         658
  National Center for Research 
    Resources.......................         302         432         385
  National Human Genome Research 
    Institute.......................         165         197         220
  John E. Fogarty International 
    Center..........................          15          25          18
  National Library of Medicine......         144         155         163
  Office of the Director............         315         277         237
  Office of AIDS Research...........                               1,609
  Buildings and Facilities..........          94         208         241
  Service and Supply Fund/Management 
    Fund............................          17
                                    ------------------------------------
      Subtotal Outlays..............      11,193      12,893      13,898
  Cooperative Research and 
    Development Agreements..........           6          28          28
                                    ------------------------------------
      Total Outlays, NIH............      11,199      12,921      13,926
                                    ====================================
    Note: The total amount for FY 1998 AIDS research was $1,607,053, which 
was jointly determined by the Director of NIH and the Director of the Office 
of AIDS Research pursuant to section 209 of P.L. 105-78. $1,566,517,000 was 
made available to OAR. This amount is net of the $40,536,000 in AIDS funds 
earmarked in P.L. 105-78 in the Office of the Director account.

    This program funds biomedical research and research training. These 
accounts will continue to be appropriated separately, and are displayed 
in a consolidated format to improve the readability of the presentation. 
Detailed information is available through the Department of Health and 
Human Services.

    The funding for the National Institutes of Health is proposed as 
part of the Research Fund for America. This proposal highlights the 
Administration's priority to providing needed and sustained investments 
in important Federal research programs on a deficit neutral basis. A 
discussion of the Research Fund for America, and two other funds for the 
environment and transportation, can be found in Section II of the Budget 
volume. 

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         477         507         548
11.3      Other than full-time permanent         101         107         115
11.5      Other personnel compensation..          32          34          34
11.8      Special personal services 
            payments....................          82          92          97
                                           ---------   ---------  ----------
11.9        Total personnel compensation         692         740         794
12.1    Civilian personnel benefits.....         144         152         165
21.0    Travel and transportation of 
          persons.......................          22          22          23
22.0    Transportation of things........           4           4           4
23.1    Rental payments to GSA..........           5           5           5
23.2    Rental payments to others.......           7           7           8
23.3    Communications, utilities, and 
          miscellaneous charges.........          36          39          40
24.0    Printing and reproduction.......          13          13          14

[[Page 410]]

25.1    Advisory and assistance services          26          29          30
25.2    Other services..................         234         442         479
25.3    Purchases of goods and services 
          from Government accounts......         992         789         822
25.4    Operation and maintenance of 
          facilities....................         228         104         107
25.5    Research and development 
          contracts.....................         742         809         878
25.6    Medical care....................          11          11          12
25.7    Operation and maintenance of 
          equipment.....................          34          25          26
26.0    Supplies and materials..........         133         137         143
31.0    Equipment.......................         113         120         127
41.0    Grants, subsidies, and 
          contributions.................       9,378      10,243      11,164
42.0    Insurance claims and indemnities           3           3           3
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..      12,817      13,694      14,844
99.0  Reimbursable obligations..........       1,052       1,159       1,145
                                           ---------   ---------  ----------
99.9    Total obligations...............      13,869      14,853      15,989
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Full-time equivalent employment.      10,785      11,012      11,462
1011    Exempt Full-time equivalent 
          employment....................                      29          33
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......       4,347       4,421       4,515
---------------------------------------------------------------------------

                                


 
        SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

                              Federal Funds

General and special funds:

               Substance Abuse and Mental Health Services

    For carrying out titles V and XIX of the Public Health Service Act 
with respect to substance abuse and mental health services, the 
Protection and Advocacy for Mentally Ill Individuals Act of 1986, and 
section 301 of the Public Health Service Act with respect to program 
management, [$2,146,743,000, of which $10,000,000 shall be for grants to 
rural and Native American projects: Provided, That notwithstanding any 
other provision of law, each State's allotment for fiscal year 1998 for 
each of the programs under subparts I and II of part B of title XIX of 
the Public Health Service Act shall be equal to such State's allotment 
for such programs for fiscal year 1997.] $2,279,643,000. (Department of 
Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1362-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Mental health and substance 
          abuse activities..............         506         507         442
00.02   Mental health partnership.......         275         275         275
00.03   Substance abuse partnership.....       1,310       1,310       1,510
00.04   Substance abuse partnership 
          temporary supplement 
          (mandatory)...................          50          50
00.05   Program management..............          54          55          53
                                           ---------   ---------  ----------
00.91   Total, direct program...........       2,195       2,197       2,280
09.01 Reimbursable program..............          22          22          22
                                           ---------   ---------  ----------
10.00   Total obligations...............       2,217       2,219       2,302
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......           2
22.00 New budget authority (gross)......       2,216       2,219       2,302
22.30 Unobligated balance expiring......          -1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       2,217       2,219       2,302
23.95 New obligations...................      -2,217      -2,219      -2,302
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       2,134       2,147       2,280
42.00   Transferred from other accounts.          11
                                           ---------   ---------  ----------
43.00     Appropriation (total).........       2,145       2,147       2,280
      Permanent:

65.00   Advance appropriation (definite)          50          50
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          22          22          22
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       2,217       2,219       2,302
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...       1,048       1,642       1,675
73.10 New obligations...................       2,217       2,219       2,302
73.20 Total outlays (gross).............      -1,644      -2,186      -2,215
73.40 Adjustments in expired accounts...          21
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...       1,642       1,675       1,762
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         842         859         912
86.93 Outlays from current balances.....         759       1,280       1,281
86.97 Outlays from new permanent 
        authority.......................          43          47          22
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,644       2,186       2,215
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -22         -22         -22
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       2,195       2,197       2,280
90.00 Outlays...........................       1,622       2,164       2,193
---------------------------------------------------------------------------

    This program provides Federal support for treatment and prevention 
in the areas of alcoholism, drug abuse, and mental health.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1362-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          31          35          38
11.3      Other than full-time permanent           1           1           1
11.5      Other personnel compensation..           1           1           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation          33          37          40
12.1    Civilian personnel benefits.....           6           7           8
21.0    Travel and transportation of 
          persons.......................           1           1           1
23.1    Rental payments to GSA..........           3           4           4
23.3    Communications, utilities, and 
          miscellaneous charges.........           1           1           1
24.0    Printing and reproduction.......           2           2           1
25.1    Advisory and assistance services          48          76          82
25.2    Other services..................          96          97          94
25.3    Purchases of goods and services 
          from Government accounts......          14          16          12
31.0    Equipment.......................           2           1           1
41.0    Grants, subsidies, and 
          contributions.................       1,987       1,953       2,034
42.0    Insurance claims and indemnities           2           2           2
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..       2,195       2,197       2,280
99.0  Reimbursable obligations..........          22          22          22
                                           ---------   ---------  ----------
99.9    Total obligations...............       2,217       2,219       2,302
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1362-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......         535         559         593
    Reimbursable:
      Total compensable workyears:

2001    Full-time equivalent employment.           2          13           6
2011    Exempt Full-time equivalent 
          employment....................          58          92          92
---------------------------------------------------------------------------

[[Page 411]]



                                


 
               AGENCY FOR HEALTH CARE POLICY AND RESEARCH

                              Federal Funds

General and special funds:

                     Health Care Policy and Research

    For carrying out titles III and IX of the Public Health Service Act, 
and part A of title XI of the Social Security Act, [$90,229,000] 
$100,788,000; in addition, amounts received from Freedom of Information 
Act fees, reimbursable and interagency agreements, and the sale of data 
tapes shall be credited to this appropriation and shall remain available 
until expended: Provided, That the amount made available pursuant to 
section 926(b) of the Public Health Service Act shall not exceed 
[$56,206,000] $70,647,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1700-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

01.01   Research on health costs, 
          quality, and outcomes.........          95          88          99
01.04   Program support.................           2           2           2
09.00 Reimbursable program..............          57          65          80
                                           ---------   ---------  ----------
10.00   Total obligations...............         154         155         181
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......           1
22.00 New budget authority (gross)......         154         155         181
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         155         155         181
23.95 New obligations...................        -154        -155        -181
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................          96          90         101
42.00   Transferred from other accounts.           1
                                           ---------   ---------  ----------
43.00     Appropriation (total).........          97          90         101
      Permanent:

        Spending authority from 
            offsetting collections:
68.00     Offsetting collections (cash).          55          65          80
68.10     Change in orders on hand from 
            Federal sources.............           2
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total)...................          57          65          80
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         154         155         181
----------------------------------------------------------------------------

    Change in unpaid obligations:
      Unpaid obligations, start of year:

72.40   Obligated balance: Uninvested...         142         129         126
72.95   Orders on hand from Federal 
          sources.......................           4           6           6
                                           ---------   ---------  ----------
72.99     Total unpaid obligations, 
            start of year...............         146         135         132
73.10 New obligations...................         154         155         181
73.20 Total outlays (gross).............        -165        -158        -173
      Unpaid obligations, end of year:

74.40   Obligated balance: Uninvested...         129         126         134
74.95   Orders on hand from Federal 
          sources.......................           6           6           6
                                           ---------   ---------  ----------
74.99     Total unpaid obligations, end 
            of year.....................         135         132         140
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority           9          14          15
86.93 Outlays from current balances.....         101          79          79
86.97 Outlays from new permanent 
        authority.......................          55          65          80
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         165         158         173
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -55         -65         -80
88.95 Change in orders on hand from 
        Federal sources.................          -2
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          97          90         101
90.00 Outlays...........................         110          93          93
---------------------------------------------------------------------------

    This activity supports research and information dissemination on 
health care services and technology, medical effectiveness, and patient 
outcomes.

    A portion of the funding for the Agency for Health Care Policy and 
Research is proposed as part of the Research Fund for America. This 
proposal highlights the Administration's priority of providing needed 
and sustained investments in important Federal research programs on a 
deficit neutral basis. A discussion of the Research Fund for America, 
and two other funds for the environment and transportation, can be found 
in Section II of the Budget volume.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1700-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          11          13          14
11.3      Other than full-time permanent           2           2           2
                                           ---------   ---------  ----------
11.9        Total personnel compensation          13          15          16
12.1    Civilian personnel benefits.....           3           4           4
21.0    Travel and transportation of 
          persons.......................                       1           1
23.1    Rental payments to GSA..........           2           2           3
23.3    Communications, utilities, and 
          miscellaneous charges.........           1           1           1
24.0    Printing and reproduction.......           1           1           1
25.2    Other services..................           5           4           5
25.3    Purchases of goods and services 
          from Government accounts......           2           2           1
25.5    Research and development 
          contracts.....................           9          19          16
31.0    Equipment.......................           1           1           1
41.0    Grants, subsidies, and 
          contributions.................          60          40          52
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..          97          90         101
99.0  Reimbursable obligations..........          57          65          80
                                           ---------   ---------  ----------
99.9    Total obligations...............         154         155         181
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1700-0-1-552      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......         198         203         211
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......          59          64          64
---------------------------------------------------------------------------

                                


 
                  HEALTH CARE FINANCING ADMINISTRATION

                              Federal Funds

General and special funds:

                      Grants to States for Medicaid

    For carrying out, except as otherwise provided, titles XI and XIX of 
the Social Security Act, [$71,602,429,000] $74,593,733,000, to remain 
available until expended.
     For making, after May 31, [1998] 1999, payments to States under 
title XIX of the Social Security Act for the last quarter of fiscal year 
[1998] 1999 for unanticipated costs, incurred for the current fiscal 
year, such sums as may be necessary.
     For making payments to States under title XIX of the Social 
Security Act for the first quarter of fiscal year [1999, 
$27,800,689,000] 2000, $28,733,605,000, to remain available until 
expended.
     Payment under title XIX may be made for any quarter with respect to 
a State plan or plan amendment in effect during such quarter, if 
submitted in or prior to such quarter and approved in that or any 
subsequent quarter. (Department of Health and Human Services 
Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0512-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Medicaid vendor payments..........      91,744      95,263     101,711
00.02 State and local administration....       4,340       5,210       5,640

[[Page 412]]

00.03 Vaccine purchases.................         393         487         566
09.00 Medicare Part B premium transfer..                     200         250
                                           ---------   ---------  ----------
10.00   Total obligations...............      96,477     101,160     108,167
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......       2,155       6,890       5,522
22.00 New budget authority (gross)......     101,212      99,791     102,644
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......     103,367     106,681     108,167
23.95 New obligations...................     -96,477    -101,160    -108,167
24.40 Unobligated balance available, end 
        of year: Uninvested.............       6,890       5,522
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................      75,057      71,602      74,594
      Permanent:

65.00   Advance appropriation (definite)      26,155      27,989      27,801
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).                     200         250
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................     101,212      99,791     102,644
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...       5,344       6,268       6,268
73.10 New obligations...................      96,477     101,160     108,167
73.20 Total outlays (gross).............     -95,552    -101,160    -108,167
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...       6,268       6,268       6,268
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority      61,898      59,813      68,326
86.93 Outlays from current balances.....       7,499      13,158      11,790
86.97 Outlays from new permanent 
        authority.......................      26,155      28,189      28,051
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........      95,552     101,160     108,167
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........                    -200        -250
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................     101,212      99,591     102,394
90.00 Outlays...........................      95,552     100,960     107,917
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................     101,212      99,591     102,395
  Outlays...........................      95,552     100,960     107,917
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                -210
  Outlays...........................                                -210
                                    ------------------------------------
Total:
  Budget Authority..................     101,212      99,591     102,185
  Outlays...........................      95,552     100,960     107,707
                                    ====================================

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

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0512-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
41.0  Direct obligations: Grants, 
        subsidies, and contributions....      96,477     100,960     107,917
99.0  Reimbursable obligations: 
        Subtotal, reimbursable 
        obligations.....................                     200         250
                                           ---------   ---------  ----------
99.9    Total obligations...............      96,477     101,160     108,167
---------------------------------------------------------------------------

                                

                      Grants to States for Medicaid

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0512-4-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................                                -210
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                -210
23.95 New obligations...................                                 210
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................                                -210
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                -210
73.20 Total outlays (gross).............                                 210
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority                                -210
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                -210
90.00 Outlays...........................                                -210
---------------------------------------------------------------------------

    This schedule reflects the effects of Medicaid, Medicare, and 
welfare proposals included in the Budget on the Grants to States for 
Medicaid account. Medicaid costs associated with children's health 
outreach proposals will be financed by receipts from tobacco 
legislation.

                                

                   Payments to Health Care Trust Funds

    For payment to the Federal Hospital Insurance and the Federal 
Supplementary Medical Insurance Trust Funds, as provided under sections 
217(g) and 1844 of the Social Security Act, sections 103(c) and 111(d) 
of the Social Security Amendments of 1965, section 278(d) of Public Law 
97-248, and for administrative expenses incurred pursuant to section 
201(g) of the Social Security Act, [$60,904,000,000] $62,953,000,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0580-0-1-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Supplementary medical insurance 
        (SMI)...........................      59,456      59,773      62,171
00.02 Hospital insurance for uninsured 
        (HI)............................         405         -52         555
00.03 Federal uninsured payment (HI)....          76          86          97
00.04 Program management (HI)...........         116         131         130
00.06 Federal payments from taxation of 
        OASDI benefits (HI).............       3,558       5,193       5,173
00.08 Fraud and abuse control, FBI......          47          56          66
00.10 Fraud and abuse control, criminal 
        fines...........................          46          15          16
00.11 Fraud and abuse control, civil 
        monetary penalties..............           1           1           1
                                           ---------   ---------  ----------
10.00   Total obligations...............      63,705      65,203      68,209
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......      63,731      66,169      68,209
22.30 Unobligated balance expiring......         -26        -966
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......      63,705      65,203      68,209
23.95 New obligations...................     -63,705     -65,203     -68,209
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................      60,079      60,904      62,953
      Permanent:

60.00   Appropriation...................          47          56          66
60.05   Appropriation (indefinite)......       3,605       5,209       5,190
                                           ---------   ---------  ----------
63.00     Appropriation (total).........       3,652       5,265       5,256
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................      63,731      66,169      68,209
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................      63,705      65,203      68,209

[[Page 413]]

73.20 Total outlays (gross).............     -63,720     -65,203     -68,209
73.40 Adjustments in expired accounts...          15
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority      60,053      59,938      62,953
86.93 Outlays from current balances.....          15
86.97 Outlays from new permanent 
        authority.......................       3,652       5,265       5,256
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........      63,720      65,203      68,209
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................      63,731      66,169      68,209
90.00 Outlays...........................      63,722      65,203      68,209
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................      63,731      66,169      68,209
  Outlays...........................      63,720      65,203      68,209
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                -135
  Outlays...........................                                -135
                                    ------------------------------------
Total:
  Budget Authority..................      63,731      66,169      68,074
  Outlays...........................      63,720      65,203      68,074
                                    ====================================

    Payments are made (1) to the Federal Supplementary Medical Insurance 
Trust Fund; and (2) to the Federal Hospital Insurance Trust Fund for 
individuals aged 65 and over who meet certain transitional insured 
status requirements, and for civil service employees and annuitants who 
worked before 1983 and who were employed during January 1983. Since 
1992, amounts have been included for non-Medicare activities of HCFA 
Program Management.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0580-0-1-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
41.0  Grants, subsidies, and 
        contributions...................      63,108      65,038      67,427
42.0  Insurance claims and indemnities..         481          34         652
92.0  Undistributed.....................         116         131         130
                                           ---------   ---------  ----------
99.9    Total obligations...............      63,705      65,203      68,209
---------------------------------------------------------------------------

                                

                   Payments to Health Care Trust Funds

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0580-4-1-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Supplementary medical insurance 
        (SMI)...........................                                -135
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          41.0).........................                                -135
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                -135
23.95 New obligations...................                                 135
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................                                -135
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                -135
73.20 Total outlays (gross).............                                 135
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority                                -135
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                -135
90.00 Outlays...........................                                -135
---------------------------------------------------------------------------

    This schedule reflects the effects of the Medicare proposals 
contained in the Budget on the Payments to Health Care Trust Funds 
account.

                                

                           Program Management

    For carrying out, except as otherwise provided, titles XI, XVIII, 
XIX and XXI of the Social Security Act, titles XIII and XXVII of the 
Public Health Service Act, and the Clinical Laboratory Improvement 
Amendments of 1988, not to exceed [$1,743,066,000] $1,678,000,000 to be 
transferred from the Federal Hospital Insurance and the Federal 
Supplementary Medical Insurance Trust Funds, as authorized by section 
201(g) of the Social Security Act; together with all funds collected in 
accordance with section 353 of the Public Health Service Act and such 
sums as may be collected from authorized user fees and the sale of data, 
which shall remain available until expended, and together with 
administrative fees collected relative to Medicare overpayment recovery 
activities, which shall be transferred to the Health Care Fraud and 
Abuse Control (HCFAC) account and shall remain available until expended: 
Provided, That all funds derived in accordance with 31 U.S.C. 9701 from 
organizations established under title XIII of the Public Health Service 
Act shall be credited to and available for carrying out the purposes of 
this appropriation: [Provided further, That $900,000 shall be for 
carrying out section 4021 of Public Law 105-33: Provided further, That 
in carrying out its legislative mandate, the National Bipartisan 
Commission on the Future of Medicare shall examine the impact of 
increased investments in health research on future Medicare costs, and 
the potential for coordinating Medicare with cost-effective long-term 
care services:] Provided further, That [$40,000,000] $45,000,000 
appropriated under this heading for the transition to a single Part A 
and Part B processing system shall remain available until expended: 
[Provided further, That funds appropriated under this heading may be 
obligated to increase Medicare provider audits and implement the 
Department's corrective action plan to the Chief Financial Officer's 
audit of the Health Care Financing Administration's oversight of 
Medicare:] Provided further, That the Secretary of Health and Human 
Services is directed to collect, in aggregate, [$95,000,000] 
$150,000,000 in fees in fiscal year [1998] 1999 from Medicare+Choice 
organizations pursuant to section 1857(e)(2) of the Social Security Act 
and from eligible organizations with risk-sharing contracts under 
section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act. 
(Department of Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Research, demonstrations, and 
          evaluation projects...........          44          50          50
00.02   Medicare contractors............       1,176       1,174       1,104
00.04   State certification.............         156         154         105
00.05   Administrative costs............         334         365         419
                                           ---------   ---------  ----------
00.91     Total direct program..........       1,710       1,743       1,678
      Reimbursable program:

08.01   CLIA............................          29          43          43
08.02   Other reimbursements............           6          97         152
                                           ---------   ---------  ----------
08.91     Total reimbursable program....          35         140         195
                                           ---------   ---------  ----------
10.00   Total obligations...............       1,745       1,883       1,873
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          99          18          18
22.00 New budget authority (gross)......       1,687       1,883       1,873
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
22.30 Unobligated balance expiring......         -24
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,763       1,901       1,891
23.95 New obligations...................      -1,745      -1,883      -1,873
24.40 Unobligated balance available, end 
        of year: Uninvested.............          18          18          17
----------------------------------------------------------------------------

    New budget authority (gross), detail:
68.00 Spending authority from offsetting 
        collections (gross): Offsetting 
        collections (cash)..............       1,687       1,883       1,873
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         452         495         495
73.10 New obligations...................       1,745       1,883       1,873
73.20 Total outlays (gross).............      -1,691      -1,883      -1,873
73.40 Adjustments in expired accounts...         -10

[[Page 414]]

73.45 Adjustments in unexpired accounts.          -1
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         495         495         495
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................       1,687       1,883       1,873
86.98 Outlays from permanent balances...           4
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,691       1,883       1,873
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............      -1,653      -1,743      -1,678
88.40     Non-Federal sources...........         -34        -140        -195
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........      -1,687      -1,883      -1,873
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................           4
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................
  Outlays...........................           4
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................
  Outlays...........................
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                 220
  Outlays...........................                                 220
                                    ------------------------------------
Total:
  Budget Authority..................                                 220
  Outlays...........................           4                     220
                                    ====================================

    Program management activities include funding for research, Medicare 
contractors, survey and certification, CLIA, and administrative costs. 

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Personnel compensation:

11.1    Full-time permanent.............         222         242         270
11.3    Other than full-time permanent..           5           5           5
11.5    Other personnel compensation....           1           2           2
                                           ---------   ---------  ----------
11.9      Total personnel compensation..         228         249         277
12.1  Civilian personnel benefits.......          40          45          51
21.0  Travel and transportation of 
        persons.........................           5           2           7
23.1  Rental payments to GSA............          29          24          25
23.3  Communications, utilities, and 
        miscellaneous charges...........          16           3           7
24.0  Printing and reproduction.........           6           2           5
25.1  Advisory and assistance services..           1           2           2
25.2  Other services....................         332         368         373
25.6  Medical care......................       1,045       1,172       1,102
26.0  Supplies and materials............           2           1           1
31.0  Equipment.........................          16           7           7
32.0  Land and structures...............                                  10
41.0  Grants, subsidies, and 
        contributions...................          25           8           6
                                           ---------   ---------  ----------
99.9    Total obligations...............       1,745       1,883       1,873
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0511-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
1001  Total compensable workyears: Full-
        time equivalent employment......       3,979       4,002       4,217
---------------------------------------------------------------------------

                                

                           Program Management

              (Legislative proposal, not subject to PAYGO)

    Upon enactment of authorization to establish fees to cover 
administrative costs of the Health Care Financing Administration and its 
contractors, such fees may be collected and credited to this account as 
offsetting collections: Provided, That not to exceed $264,500,000 of 
such fees shall be available until expended for authorized purposes.

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-2-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
08.03 Survey and certification initial 
        fee.............................                                  10
08.04 Survey and certification 
        recertification fee.............                                  52
08.05 Duplicate claim fee...............                                  36
08.06 Paper claim fee...................                                 110
08.07 Provider enrollment registration 
        fee.............................                                  20
08.08 Health plan initial application 
        fee.............................                                  37
                                           ---------   ---------  ----------
10.00   Total obligations...............                                 265
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 265
23.95 New obligations...................                                -265
----------------------------------------------------------------------------

    New budget authority (gross), detail:
68.00 Spending authority from offsetting 
        collections (gross): Offsetting 
        collections (cash)..............                                 265
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 265
73.20 Total outlays (gross).............                                -265
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                 265
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....                                -265
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................
---------------------------------------------------------------------------

    The Budget includes $264.5 million in new user fees to finance HCFA 
activities as reflected in the legislative proposal schedule. Proposed 
user fees include: a duplicate or unprocessable claims fee; a paper 
claims fee; a physician, provider, and supplier enrollment registration 
fee; a managed care organization application and renewal fee; an initial 
survey and certification fee; and a recertification fee. Additional 
appropriations language is being proposed contingent upon the enactment 
of authorizing legislation. The authorizing legislation will be proposed 
to authorize the collection and spending of the fee subject to 
appropriations action.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-2-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.2  Other services....................                                  99
25.6  Medical care......................                                 166
                                           ---------   ---------  ----------
99.9    Total obligations...............                                 265
---------------------------------------------------------------------------

                                

                           Program Management

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-4-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Voluntary insurance cooperatives..                                  20
00.02 Medicare cancer clinical trials 
        demonstration...................                                 200
                                           ---------   ---------  ----------

[[Page 415]]


10.00   Total obligations (object class 
          41.0).........................                                 220
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 220
23.95 New obligations...................                                -220
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.00 Appropriation.....................                                 220
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 220
73.20 Total outlays (gross).............                                -220
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                 220
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                 220
90.00 Outlays...........................                                 220
---------------------------------------------------------------------------

    This schedule reflects the effects on the Program Management account 
of the Administration's proposals to: (1) provide competitive grants 
designed to facilitate the development of state-based health insurance 
purchasing cooperatives; and (2) create a time-limited demonstration of 
Medicare coverage of patient care costs associated with Medicare 
beneficiary participation in NIH sponsored clinical trials for cancer. 
The demonstration's costs will be financed by receipts from tobacco 
legislation.

                                

                 State Children's Health Insurance Fund

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0515-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................                   4,235       4,215
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                   4,235       4,215
23.95 New obligations...................                  -4,235      -4,215
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.00 Appropriation.....................                   4,295       4,275
61.00 Transferred to other accounts.....                     -60         -60
                                           ---------   ---------  ----------
63.00   Appropriation (total)...........                   4,235       4,215
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                   4,235       4,215
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...                               3,856
73.10 New obligations...................                   4,235       4,215
73.20 Total outlays (gross).............                    -379      -1,834
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...                   3,856       6,237
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                     379       1,834
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                   4,235       4,215
90.00 Outlays...........................                     379       1,834
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................                   4,235       4,215
  Outlays...........................                     379       1,834
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                  34
  Outlays...........................                                  34
                                    ------------------------------------
Total:
  Budget Authority..................                   4,235       4,249
  Outlays...........................                     379       1,868
                                    ====================================

    The Balanced Budget Act of 1997 established the Children's Health 
Insurance Program (CHIP) under Title XXI of the Social Security Act. 
This new Title provides Federal matching funds to States to enable them 
to extend coverage to uninsured children from low-income families. 
States are able to use Title XXI funds for obtaining health benefit 
coverage for uninsured children through a CHIP State program, a CHIP 
Medicaid expansion program, or a combination of both.

                                

                 State Children's Health Insurance Fund

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0515-4-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................                                  34
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                  34
23.95 New obligations...................                                 -34
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.00 Appropriation.....................                                  34
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                  34
73.20 Total outlays (gross).............                                 -34
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                  34
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                  34
90.00 Outlays...........................                                  34
---------------------------------------------------------------------------

    This schedule reflects the effects of the proposed increase in CHIP 
payments to the territories.

                                

      Health Maintenance Organization Loan and Loan Guarantee Fund

    For carrying out subsections (d) and (e) of section 1308 of the 
Public Health Service Act, any amounts received by the Secretary in 
connection with loans and loan guarantees under title XIII of the Public 
Health Service Act, to be available without fiscal year limitation for 
the payment of outstanding obligations. During fiscal year [1998] 1999, 
no commitments for direct loans or loan guarantees shall be made. 
(Department of Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4420-0-3-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.05 Interest payments to FFB..........           1
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          43.0).........................           1
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          11          10          10
22.00 New budget authority (gross)......           2           2           2
22.60 Redemption of debt................          -2          -1          -1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          11          11          11
23.95 New obligations...................          -1
24.40 Unobligated balance available, end 
        of year: Uninvested.............          10          10          10
----------------------------------------------------------------------------

    New budget authority (gross), detail:
68.00 Spending authority from offsetting 
        collections (gross): Offsetting 
        collections (cash)..............           2           2           2
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................           1

[[Page 416]]

73.20 Total outlays (gross).............          -1          -1          -1
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.93 Outlays from current balances.....           1           1           1
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Other...................          -2          -2          -2
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................          -2          -1          -1
---------------------------------------------------------------------------

                                

  

                               Trust Funds

                  Federal Hospital Insurance Trust Fund

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............     106,230      96,931      92,149
    Receipts:
02.01 Transfers from general fund (FICA 
        taxes)..........................     103,500     109,125     113,632
02.02 Receipts from Railroad Retirement 
        Board...........................         380         393         394
02.03 Transfers from general fund (SECA 
        taxes)..........................       6,844       8,511       8,600
02.04 Federal employer contributions 
        (FICA)..........................       1,790       1,835       1,905
02.05 Postal service employer 
        contributions (FICA)............         605         597         620
02.06 Refunds...........................           3
02.07 Interest received by trust funds..       9,718       9,153       8,765
02.09 Premium receipts from displaced 
        workers and early retirees, 
        legislative proposal subject to 
        PAYGO...........................                                  87
02.10 Taxation on OASDI benefits........       3,558       5,193       5,173
02.11 Deposits by States................         -17
02.12 Interest payments by Railroad 
        Retirement Board................          39          38          36
02.13 Payments from the general fund 
        (uninsured and program 
        management).....................         597         165         782
02.14 Payments for military service 
        credits.........................          70          67          71
02.15 Premiums collected for uninsured 
        individuals not otherwise 
        eligible........................       1,279       1,310       1,323
02.16 FBI, Payment from the general fund          47          56          66
02.17 Criminal fines, transfers from the 
        general fund....................          46          15          16
02.18 Civil monetary penalties, 
        transfers from the general fund.           1           1           1
02.20 Civil penalties and damages.......          89          50          53
                                           ---------   ---------  ----------
02.99   Total receipts..................     128,549     136,509     141,524
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...     234,779     233,440     233,673
    Appropriation:
05.01 Federal hospital insurance trust 
        fund............................    -137,259    -140,615    -144,074
05.02 Health care fraud and abuse 
        control account.................        -591        -676        -764
05.04 Federal hospital insurance trust 
        fund, legislative proposal 
        subject to PAYGO................                                 -93
                                           ---------   ---------  ----------
05.99 Subtotal appropriation............    -137,850    -141,291    -144,931
06.10 Unobligated balance returned to 
        receipts........................           2
07.99 Total balance, end of year........      96,931      92,149      88,742
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, HI..............     135,991     131,595     131,856
00.02 Administration, HI................       1,183       1,231       1,209
00.03 Peer review organizations, HI.....          58          67         553
00.04 Research, HI......................          28          32          32
00.05 HI partial transfer of home health 
        to SMI..........................                   7,690      10,424
                                           ---------   ---------  ----------
10.00   Total obligations...............     137,259     140,615     144,074
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......     137,259     140,615     144,074
23.95 New obligations...................    -137,259    -140,615    -144,074
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.26   Appropriation (trust fund, 
          definite).....................       1,169       1,218       1,196
      Permanent:

60.27   Appropriation (trust fund, 
          indefinite)...................     126,922     135,291     140,241
60.28   Appropriation (unavailable 
          balances).....................       9,168       4,106       2,637
                                           ---------   ---------  ----------
63.00     Appropriation (total).........     136,090     139,397     142,878
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................     137,259     140,615     144,074
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.41 Unpaid obligations, start of year: 
        Obligated balance: U.S. 
        Securities: Par value...........      19,107      18,988      18,816
73.10 New obligations...................     137,259     140,615     144,074
73.20 Total outlays (gross).............    -137,378    -140,787    -143,762
74.41 Unpaid obligations, end of year: 
        Obligated balance: U.S. 
        Securities: Par value...........      18,988      18,816      19,128
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       1,084       1,128       1,114
86.93 Outlays from current balances.....         119         136         132
86.97 Outlays from new permanent 
        authority.......................     117,187     120,671     123,833
86.98 Outlays from permanent balances...      18,988      18,852      18,684
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........     137,378     140,787     143,762
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................     137,259     140,615     144,074
90.00 Outlays...........................     137,378     140,787     143,762
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................     137,259     140,615     144,074
  Outlays...........................     137,378     140,787     143,763
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                  93
  Outlays...........................                                  93
                                    ------------------------------------
Total:
  Budget Authority..................     137,259     140,615     144,167
  Outlays...........................     137,378     140,787     143,856
                                    ====================================

    The Hospital Insurance (HI) program funds the costs of hospital and 
related care for individuals age 65 or older and for eligible disabled 
people.

    The estimate of administrative expenses borne by each of the 
financing sources, including the Hospital Insurance (HI) and 
Supplemental Medical Insurance (SMI) trust funds for Medicare-related 
activities performed by the Social Security Administration (SSA), has 
been made by SSA based on the current cost allocation methodology. 
Pursuant to section 201(g) of the Social Security Act, a final 
accounting of actual payments is made after the close of each fiscal 
year. In the Conference Committee Report for Public Law 103-296, The 
Social Security Independence and Program Improvements Act of 1994, the 
conferees requested that the Secretary of Health and Human Services and 
the Commissioner of Social Security make a joint examination of the most 
appropriate cost allocation methodology and report their joint findings 
to the Congress within 36 months of enactment. The Secretary and the 
Commissioner are in the process of transmitting the required report to 
Congress.

    The status of the trust fund is as follows:

                  Status of Funds (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Unexpended balance, start of year:
0100  Treasury balance..................        -467        -619           1
0101  U.S. Securities: Par value........     125,805     116,621     110,990
                                           ---------   ---------  ----------
0199    Total balance, start of year....     125,337     116,002     110,991

[[Page 417]]

    Cash income during the year:
      Governmental receipts:

0200    FHI trust fund, transfers from 
          general fund (FICA taxes).....     103,500     109,125     113,632
0201    FHI trust fund, transfers from 
          general fund (SECA taxes).....       6,844       8,511       8,600
0202    Refunds.........................           3
0205    FHI trust fund, receipts from 
          Railroad Retirement Board.....         380         393         394
0206    HCFAC: Civil penalties and 
          damages.......................          89          50          53
0207    FHI trust fund, deposits by 
          States........................         -17
      Proprietary receipts:

0221    FHI trust fund, premiums 
          collected for uninsured 
          individuals not otherwise 
          eligible......................       1,279       1,310       1,323
0223    Other proprietary receipts......
0224    Premiums from aged 62-64 & 
          displaced workers, proposed 
          legislation...................                                  87
      Intragovernmental transactions:

0240    FHI trust fund, Federal employer 
          contributions (FICA)..........       1,790       1,835       1,905
0241    FHI trust fund, Postal Service 
          employer contributions (FICA).         605         597         620
0242    FHI trust fund, Federal payment 
          for transitional coverage for 
          uninsured Federal employees...          76          86          97
0243    FHI trust fund, Federal payment 
          for transitional coverage for 
          the uninsured.................         405         -52         555
0244    FHI trust fund, Federal payment 
          for SECA tax credits..........
0245    FHI trust fund, general fund 
          transfer, Program management 
          (HI)..........................         116         131         130
0246    FHI trust fund, Federal payments 
          for OASDI taxes...............       3,558       5,193       5,173
0248    FHI trust fund, interest payment 
          from Railroad Retirement Board          39          38          36
0249    FHI trust fund, interest on 
          investments...................       9,718       9,153       8,765
0250    FHI trust fund, interest on 
          investments...................
0251    FHI trust fund, transfer from 
          Department of Defense for 
          military service credits......          70          67          71
0252    HCFAC: FBI......................          47          56          66
0253    HCFAC: Criminal fines...........          46          15          16
0254    HCFAC: Civil monetary penalties.           1           1           1
      Offsetting collections:

0281    HCFAC user fees, proposed.......                                 395
0297  Income under present law..........     128,548     136,509     141,437
0298  Income under proposed legislation.                                 482
                                           ---------   ---------  ----------
0299    Total cash income...............     128,548     136,509     141,919
    Cash outgo during year:
0500  Benefit payments..................    -136,010    -131,595    -131,856
0501  Benefit payments (proposed 
        legislation)....................                                 -93
0502  Administration....................      -1,161      -1,235      -1,213
0504  Peer review organizations.........        -165        -238        -236
0505  Research..........................         -42         -29         -32
0506  HCFAC.............................        -506        -733        -764
0507  HI partial transfer of home health 
        to SMI..........................                  -7,690     -10,424
0508  HCFAC, proposed (-)...............                                -395
0597  Outgo under present law (-).......    -137,884    -141,520    -144,526
0598  Outgo under proposed legislation 
        (-).............................                                -488
                                           ---------   ---------  ----------
0599  Total cash outgo (-)..............    -137,884    -141,520    -145,014
    Unexpended balance, end of year:
0700  Treasury Balance..................        -619           1           1
0701  U.S. Securities: Par value........     116,621     110,990     107,895
                                           ---------   ---------  ----------
0799    Total balance, end of year......     116,002     110,991     107,896
---------------------------------------------------------------------------

                Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Grants, subsidies, and contributions:

41.0    Payment for health insurance 
          experiments and demonstration 
          projects......................          28          32          32
41.0    Payment for peer review 
          organization (PRO) activities.          58          67         553
42.0  Insurance claims and indemnities..     135,990     131,595     131,856
      Undistributed:

92.0    HI Partial Transfer of Home 
          Health to SMI.................                   7,690      10,424
92.0    Reimbursement for administrative 
          expenses for other than SSA 
          LAE...........................          42          45          45
92.0    Purchases of goods and services.         611         625         605
93.0  Administrative expenses: Portion 
        of limitation on salaries and 
        expenses: Social Security 
        Administration..................         531         561         559
                                           ---------   ---------  ----------
99.9    Total obligations...............     137,259     140,615     144,074
---------------------------------------------------------------------------

                                

                  Federal Hospital Insurance Trust Fund

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-4-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        42.0)...........................                                  93
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                  93
23.95 New obligations...................                                 -93
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.27 Appropriation (trust fund, 
        indefinite).....................                                  87
60.28 Appropriation (unavailable 
        balances).......................                                   6
                                           ---------   ---------  ----------
63.00   Appropriation (total)...........                                  93
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                                  93
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                  93
73.20 Total outlays (gross).............                                 -93
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                  93
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                  93
90.00 Outlays...........................                                  93
---------------------------------------------------------------------------

    This schedule reflects the effects of the Medicare proposals 
contained in the Budget on the Hospital Insurance Trust Fund.

                                

               Health Care Fraud and Abuse Control Account

                 (federal hospital insurance trust fund)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8393-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Medicare integrity program........         439         500         560
00.02 FBI fraud and abuse control.......          47          56          66
00.03 Other fraud and abuse control.....         103         120         138
                                           ---------   ---------  ----------
10.00   Total obligations...............         589         676         764
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         591         676         764
22.30 Unobligated balance expiring......          -2
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         589         676         764
23.95 New obligations...................        -589        -676        -764
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.26 Appropriation (trust fund, 
        definite).......................         591         676         764
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...                      83          26
73.10 New obligations...................         589         676         764
73.20 Total outlays (gross).............        -506        -733        -764
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          83          26          26
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................         506         676         764
86.98 Outlays from permanent balances...                      57
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         506         733         764
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         591         676         764
90.00 Outlays...........................         506         733         764
---------------------------------------------------------------------------

[[Page 418]]



                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................         591         676         764
  Outlays...........................         506         733         764
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................
  Outlays...........................
                                    ------------------------------------
Total:
  Budget Authority..................         591         676         764
  Outlays...........................         506         733         764
                                    ====================================

    The Health Care Fraud and Abuse Control (HCFAC) Account was 
established by Sec. 201 of Public Law 104-191, the Health Insurance 
Portability and Accountability Act of 1996. P.L. 104-191 established the 
HCFAC Account within the Federal Hospital Insurance Trust Fund and 
appropriated funds, to be available without further appropriation, from 
the Trust Fund to the HCFAC Account for specified health care fraud and 
abuse control activities of the Department of Health and Human Services 
(HHS), the Department of Justice, and other agencies.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8393-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

25.6    Medical care (HCFA).............         439         500         560
92.0    Undistributed (FBI).............          47          56          66
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..         486         556         626
      Allocation Account:

        Personnel compensation:
          Full-time permanent:
11.1        Full-time permanent (OIG)...          38          50          58
11.1        Full-time permanent (DoJ)...           2          16          17
11.1        Full-time permanent (OGC)...           1           1           2
11.3      Other than full-time permanent 
            (DoJ).......................           1
11.5      Other personnel compensation 
            (OIG).......................           1           1           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation          43          68          78
        Civilian personnel benefits:
12.1      Civilian personnel benefits 
            (OIG).......................           8          11          13
12.1      Civilian personnel benefits 
            (DoJ).......................           1           4           4
        Travel and transportation of 
            persons:
21.0      Travel and transportation of 
            persons (OIG)...............           2           3           4
21.0      Travel and transportation of 
            persons (DoJ)...............           1           1           1
        Rental payments to GSA:
23.1      Rental payments to GSA (OIG)..           4           5           6
23.1      Rental payments to GSA (DoJ)..                       3           3
23.1      Rental payments to GSA (OGC)..           1           1           1
23.2    Rental payments to others (HCFA)                       1           1
23.3    Communications, utilities, and 
          miscellaneous charges (OIG)...           1           1           1
        Advisory and assistance 
            services:
25.1      Advisory and assistance 
            services (OIG)..............           1
25.1      Advisory and assistance 
            services (HCFA).............           2
        Other services:
25.2      Other services (OIG)..........           1           1           1
25.2      Other services (DoJ)..........          10           6           9
25.2      Other services (HCFA).........           1
25.2      Other services (AoA)..........                                   1
25.2      Other services (HRSA).........           2
        Purchases of goods and services 
            from Government accounts:
25.3      Purchases of goods and 
            services from Government 
            accounts (OIG)..............           8           9           9
25.3      Purchases of goods and 
            services from Government 
            accounts (DoJ)..............           1
25.7    Operation and maintenance of 
          equipment (OIG)...............                       1           1
26.0    Supplies and materials (OIG)....           1           1           1
        Equipment:
31.0      Equipment (OIG)...............           4           2           2
31.0      Equipment (DoJ)...............           6
31.0      Equipment (HCFA)..............           2
        Grants, subsidies, and 
            contributions:
41.0      Grants, subsidies, and 
            contributions (AoA).........           1           1           1
41.0      Grants, subsidies, and 
            contributions (Non-HHS/DoJ).           2           1           1
                                           ---------   ---------  ----------
99.0      Subtotal, allocation account..         103         120         138
                                           ---------   ---------  ----------
99.9    Total obligations...............         589         676         764
---------------------------------------------------------------------------

    This schedule reflects estimated distribution of the Allocation 
Account. Actual FY 1999 distribution will be determined by the Secretary 
of HHS and the Attorney General. Contingent on their agreement, the 
amount shown under ``Other non-HHS/DOJ'' would fund incentive grants for 
States to develop Medicaid fraud and abuse performance measures.

                                     1997 actual  1998 est.   1999 est.
Department of Justice (DOJ).........          22          30          27
Office of the Inspector General, HHS          70          85         100
Health Care Financing Administration           5           1           1
Office of General Counsel, HHS......           2           2           2
Administration on Aging.............           1           1           1
Other HHS...........................           2                       2
Other non-HHS/DOJ...................           2           1           5
                                    ------------------------------------
    Total...........................         104         120         138
                                    ====================================

                                

                   Health Care Fraud and Abuse Account

                 (federal hospital insurance trust fund)

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8393-4-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Medicare integrity program........                                 395
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          25.6).........................                                 395
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 395
23.95 New obligations...................                                -395
----------------------------------------------------------------------------

    New budget authority (gross), detail:
68.00 Spending authority from offsetting 
        collections (gross): Offsetting 
        collections (cash)..............                                 395
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 395
73.20 Total outlays (gross).............                                -395
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                 395
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....                                -395
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................
---------------------------------------------------------------------------

    This schedule reflects the Administration's policies related to the 
Medicare Integrity Program.

                                

           Federal Supplementary Medical Insurance Trust Fund

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............      21,963      30,210      34,548
    Receipts:
02.01 Federal contributions.............      59,471      59,773      62,171
02.02 Interest received by trust fund...       2,192       2,451       2,565
02.03 Other proprietary receipts from 
        the public......................           1
02.05 Premiums collected for the aged...      16,984      17,008      17,547

[[Page 419]]

02.06 Premiums collected for the 
        disabled........................       2,158       2,354       2,514
02.07 Federal contributions, proposed 
        legislation subject to PAYGO....                                -135
02.09 Premiums collected for the aged, 
        proposed legislation............                                 -39
02.10 Premiums collected for the 
        disabled, proposed legislation..                                  -6
02.11 Premium receipts from displaced 
        workers and early retirees, 
        legislative proposal subject to 
        PAYGO...........................                                  85
                                           ---------   ---------  ----------
02.99   Total receipts..................      80,806      81,586      84,702
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...     102,769     111,796     119,250
    Appropriation:
05.01 Federal supplementary medical 
        insurance trust fund............     -72,559     -77,248     -84,296
05.03 Federal supplementary medical 
        insurance trust fund, proposed 
        legislation.....................                                  45
                                           ---------   ---------  ----------
05.99 Subtotal appropriation............     -72,559     -77,248     -84,251
07.99 Total balance, end of year........      30,210      34,548      34,999
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, SMI.............      71,093      75,521      82,452
00.02 Administration, SMI...............       1,444       1,492       1,438
00.03 Peer review organizations, SMI....           6          17         138
00.04 Research, SMI.....................          16          18          18
00.06 Transfer to Medicaid for payment 
        of SMI premiums.................                     200         250
09.01 HI partial transfer of home health                   7,690      10,424
                                           ---------   ---------  ----------
10.00   Total obligations...............      72,559      84,938      94,720
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......      72,559      84,938      94,720
23.95 New obligations...................     -72,559     -84,938     -94,720
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.26   Appropriation (trust fund, 
          definite).....................       1,454       1,506       1,452
      Permanent:

60.27   Appropriation (trust fund, 
          indefinite)...................      79,352      80,080      83,345
60.45   Portion precluded from 
          obligation....................      -8,247      -4,338        -501
                                           ---------   ---------  ----------
63.00     Appropriation (total).........      71,105      75,742      82,844
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).                   7,690      10,424
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................      72,559      84,938      94,720
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.41 Unpaid obligations, start of year: 
        Obligated balance: U.S. 
        Securities: Par value...........       4,990       4,996       4,956
73.10 New obligations...................      72,559      84,938      94,720
73.20 Total outlays (gross).............     -72,553     -84,978     -94,631
74.41 Unpaid obligations, end of year: 
        Obligated balance: U.S. 
        Securities: Par value...........       4,996       4,956       5,045
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       1,268       1,320       1,274
86.93 Outlays from current balances.....         152         217         188
86.97 Outlays from new permanent 
        authority.......................      66,295      78,661      88,401
86.98 Outlays from permanent balances...       4,838       4,779       4,768
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........      72,553      84,978      94,631
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........                  -7,690     -10,424
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................      72,559      77,248      84,296
90.00 Outlays...........................      72,553      77,288      84,207
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................      72,559      77,248      84,296
  Outlays...........................      72,553      77,287      84,207
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                 -45
  Outlays...........................                                 -45
                                    ------------------------------------
Total:
  Budget Authority..................      72,559      77,248      84,251
  Outlays...........................      72,553      77,287      84,162
                                    ====================================

    The Supplementary Medical Insurance (SMI) program is a voluntary 
program which affords protection against the costs of physician and 
certain other medical services. The program also covers treatment of 
end-stage renal disease for eligible enrollees. SMI costs are financed 
by premium payments from enrollees and contributions from the general 
revenues.

    The estimate of administrative expenses borne by each of the 
financing sources, including the Hospital Insurance (HI) and 
Supplemental Medical Insurance (SMI) trust funds for Medicare-related 
activities performed by the Social Security Administration (SSA), has 
been made by SSA based on the current cost allocation methodology. 
Pursuant to section 201(g) of the Social Security Act, a final 
accounting of actual payments is made after the close of each fiscal 
year. In the Conference Committee Report for Public Law 103-296, The 
Social Security Independence and Program Improvements Act of 1994, the 
conferees requested that the Secretary of Health and Human Services and 
the Commissioner of Social Security make a joint examination of the most 
appropriate cost allocation methodology and report their joint findings 
to the Congress within 36 months of enactment. The Secretary and the 
Commissioner are in the process of transmitting the required report to 
Congress.

    The status of the trust fund is as follows:

                  Status of Funds (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Unexpended balance, start of year:
0100  Treasury balance..................        -222         742
0101  U.S. Securities: Par value........      27,175      34,464      39,504
                                           ---------   ---------  ----------
0199    Total balance, start of year....      26,953      35,206      39,504
    Cash income during the year:
      Proprietary receipts:

0221    Premiums collected for the aged, 
          FSMI Fund.....................      16,984      17,008      17,547
0222    Premiums collected for the aged, 
          FSMI Fund, proposed 
          legislation...................                                 -39
        Proprietary receipts:
0223      Premiums collected for the 
            disabled, FSMI Fund.........       2,158       2,354       2,514
0223      Premiums collected for the 
            disabled, FSMI Fund, 
            proposed legislation........                                  -6
0224    Premiums for aged 62-64 and 
          Displaced Workers, proposed 
          legislation...................                                  85
0225    Other Proprietary receipts......           1
      Intragovernmental transactions:

0240    Federal contributions, FSMI Fund      59,471      59,773      62,171
0241    Federal contributions, FSMI 
          Fund, proposed legislation....                                -135
0242    Interest received by trust fund, 
          FSMI Fund.....................       2,192       2,451       2,565
      Offsetting collections:

0280    HI Partial Transfer of Home 
          Health........................                   7,690      10,424
0297  Income under present law..........      80,806      89,276      95,221
0298  Income under proposed legislation.                                 -95
                                           ---------   ---------  ----------
0299    Total cash income...............      80,806      89,276      95,126
    Cash outgo during year:
      Cash outgo during the year (-):

0501    Benefit payments & ESRD.........     -71,115     -75,521     -82,452
0501    Benefit payments, proposed 
          legislation...................                                  45
0502  Administration....................      -1,396      -1,520      -1,443
0504  Peer review organizations.........         -18         -29         -43
0505  Research..........................         -24         -17         -19
0506  HI Partial Transfer of Home Health                  -7,690     -10,424
0507  Transfer to Medicaid for payment 
        of SMI premiums.................                    -200        -250
0597  Outgo under present law (-).......     -72,553     -84,977     -94,631
0598  Outgo under proposed legislation 
        (-).............................                                  45
                                           ---------   ---------  ----------
0599  Total cash outgo (-)..............     -72,553     -84,977     -94,586
    Unexpended balance, end of year:
0700  Treasury balance..................         742
0701  U.S. Securities: Par value........      34,464      39,504      40,044
                                           ---------   ---------  ----------
0799    Total balance, end of year......      35,206      39,504      40,044
---------------------------------------------------------------------------

    Note.--This status of funds table displays the gross outlay and 
income effect on the SMI trust fund of the administrative mechanism used 
to implement the home health transfer policy authorized in PL 105-33. 
Showing

[[Page 420]]

the net outlay and income effect of this administrative mechanism 
requires the following substitutions to the table above:

                                                                        
                                                     FY 1998    FY 1999 
                                                                        
  line 0280: HI partial transfer of Home Health...                      
(1)line deleted                                                         
  line 0501: Benefit payments and ESRD............    -83,211    -92,876
  line 0506: HI partial transfer of Home Health...     +7,690    +10,424
                                                                        

    The totals would also be decreased in FYs 1998 and 1999 by 7,690 and 
10,424 respectively, so as to leave end of year balances unchanged.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Grants, subsidies, and 
            contributions:
41.0      Payment for peer review 
            organization (PRO) activity.           6          17         138
41.0      Payment for health insurance 
            experiments and 
            demonstration projects......          16          18          18
42.0    Insurance claims and indemnities      71,093      75,721      82,702
92.0    Undistributed...................       1,072       1,088       1,045
93.0    Administrative expenses: Portion 
          of limitation on salaries and 
          expenses: Social Security 
          Administration................         372         404         393
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..      72,559      77,248      84,296
99.0  Reimbursable obligations..........                   7,690      10,424
                                           ---------   ---------  ----------
99.9    Total obligations...............      72,559      84,938      94,720
---------------------------------------------------------------------------

                                

           Federal Supplementary Medical Insurance Trust Fund

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-4-7-571      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, SMI.............                                 -45
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          42.0).........................                                 -45
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 -45
23.95 New obligations...................                                  45
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.27 Appropriation (trust fund, 
        indefinite).....................                                 -95
60.45 Portion precluded from obligation.                                  50
                                           ---------   ---------  ----------
63.00   Appropriation (total)...........                                 -45
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                                 -45
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 -45
73.20 Total outlays (gross).............                                  45
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                                 -45
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                 -45
90.00 Outlays...........................                                 -45
---------------------------------------------------------------------------

    This schedule reflects the effects of the Medicare proposals 
contained in the Budget on the Supplementary Medical Insurance Trust 
Fund.

                                

                Allocations Received From Other Accounts

    Note.--Obligations incurred under allocations from other accounts 
are included in the schedules of the parent appropriation as follows: 
Health Care Financing Administration: ``Health Care Fraud and Abuse 
Control Account.''

                                


 
                ADMINISTRATION FOR CHILDREN AND FAMILIES

                              Federal Funds

General and special funds:

                 Temporary Assistance for Needy Families

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1552-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 State family assistance grant.....      13,403      16,489      16,489
00.02 State penalties...................                                 -50
00.03 Territories--family assistance 
        grants..........................                      78          78
00.04 Matching grants to territories....                      20          20
00.05 Bonus to reward decrease in 
        illegitimacy....................                                  75
00.06 Supplemental grants for population 
        increases.......................                      79         161
00.07 Bonus to reward high performance 
        States..........................                                 200
00.08 Tribal work programs..............           8           8           8
                                           ---------   ---------  ----------
00.91   Subtotal........................      13,411      16,674      16,981
      Loan program:

01.01   Loan fund disbursements.........                      32          48
01.02   Loan fund repayments............                      -6         -31
                                           ---------   ---------  ----------
01.91   Total loan program..............                      26          17
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          41.0).........................      13,411      16,700      16,998
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......      13,411      16,700      16,998
23.95 New obligations...................     -13,411     -16,700     -16,998
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.05 Appropriation (indefinite)........      13,411      16,700      16,998
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         111       3,807       6,705
73.10 New obligations...................      13,411      16,700      16,998
73.20 Total outlays (gross).............      -9,726     -13,802     -15,933
73.40 Adjustments in expired accounts...          12
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...       3,807       6,705       7,770
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................       9,641      12,027      12,240
86.98 Outlays from permanent balances...          85       1,775       3,693
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       9,726      13,802      15,933
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................      13,411      16,700      16,998
90.00 Outlays...........................       9,726      13,802      15,933
---------------------------------------------------------------------------

    This account provides funding for activities established by the 
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 
(P.L. 104-193). The Temporary Assistance for Needy Families block grant 
provides funding to States for aid to poor families with children.

    This account also includes Federal loans for State welfare programs, 
established by section 406 of the Social Security Act as amended.

                                

                            Contingency Fund

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1522-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................                      20          28
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                      20          28
23.95 New obligations...................                     -20         -28
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.00 Appropriation.....................                      20          28
----------------------------------------------------------------------------

[[Page 421]]



    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...                                   6
73.10 New obligations...................                      20          28
73.20 Total outlays (gross).............                     -14         -23
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...                       6          11
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                      14          20
86.98 Outlays from permanent balances...                                   3
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                      14          23
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                      20          28
90.00 Outlays...........................                      14          23
---------------------------------------------------------------------------

    The Contingency Fund for State Welfare Programs supplements the 
Temporary Assistance for Needy Families block grant by providing 
matching amounts to States that reach certain unemployment or Food Stamp 
caseload thresholds and maintain 100 percent of historical State 
spending on block-granted programs.

                                

                    Family Support Payments to States

     For making payments to States or other non-Federal entities under 
titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the 
Act of July 5, 1960 (24 U.S.C. ch. 9), to remain available until 
expended, $1,989,000,000; and for such purposes for the first quarter of 
fiscal year [1999, $660,000,000, to remain available until expended] 
2000, $750,000,000.
    For making payments to each State for carrying out the program of 
Aid to Families with Dependent Children under title IV-A of the Social 
Security Act before the effective date of the program of Temporary 
Assistance to Needy Families (TANF) with respect to such State, such 
sums as may be necessary: Provided, That the sum of the amounts 
available to a State with respect to expenditures under such title IV-A 
in fiscal year 1997 under this appropriation and under such title IV-A 
as amended by the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 shall not exceed the limitations under 
section 116(b) of such Act[: Provided further, That, notwithstanding 
section 418(a) of the Social Security Act, for fiscal year 1997 only, 
the amount of payment under section 418(a)(1) to which each State is 
entitled shall equal the amount specified as mandatory funds with 
respect to such State for such fiscal year in the table transmitted by 
the Administration for Children and Families to State Child Care and 
Development Block Grant Lead Agencies on August 27, 1996, and the amount 
of State expenditures in fiscal year 1994 or 1995 (whichever is greater) 
that equals the non-Federal share for the programs described in section 
418(a)(1)(A) shall be deemed to equal the amount specified as 
maintenance of effort with respect to such State for fiscal year 1997 in 
such table].
     For making, after May 31 of the current fiscal year, payments to 
States or other non-Federal entities under titles I, IV-D, X, XI, XIV, 
and XVI of the Social Security Act and the Act of July 5, 1960 (24 
U.S.C. ch. 9), for the last three months of the current year for 
unanticipated costs, incurred for the current fiscal year, such sums as 
may be necessary. (Department of Health and Human Services 
Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1501-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Child support Enforcement (CSE):

        Benefit payments:
00.01     State child support 
            administrative costs........       2,445       2,255       2,749
00.02     Federal incentive/hold 
            harmless payments to States.         401         423         469
00.03     Access and visitation grants..          10          10          10
                                           ---------   ---------  ----------
00.91   Subtotal, child support 
          enforcement...................       2,856       2,688       3,228
01.02 Payments to territories...........          11          21          21
01.03 Repatriation......................           1           1           1
                                           ---------   ---------  ----------
01.91   Subtotal, other payments........          12          22          22
      Aid to families with dependent children (AFDC) 
          payments:

02.01   AFDC benefit payments...........       3,206         300          35
02.02   Emergency assistance............         854         200          65
02.03   State and local welfare 
          administration................         425         146
02.04   AFDC/JOBS child care............           1           5
02.05   At-risk child care..............                      10
02.06   Collection of excess State 
          errors........................                     -15         -25
                                           ---------   ---------  ----------
02.91     Subtotal, AFDC Programs.......       4,486         646          75
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          41.0).........................       7,354       3,356       3,325
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......       1,343       2,046         207
22.00 New budget authority (gross)......       8,057       1,030       3,118
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................                     487
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       9,400       3,563       3,325
23.95 New obligations...................      -7,354      -3,356      -3,325
24.40 Unobligated balance available, end 
        of year: Uninvested.............       2,046         207
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       2,158                   1,989
      Permanent:

65.00   Advance appropriation (definite)       4,800         607         660
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).       1,099         423         469
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       8,057       1,030       3,118
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...       1,691       2,603         673
73.10 New obligations...................       7,354       3,356       3,325
73.20 Total outlays (gross).............      -6,442      -4,799      -3,645
73.45 Adjustments in unexpired accounts.                    -487
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...       2,603         673         353
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       1,074                   1,651
86.93 Outlays from current balances.....         813       2,823         645
86.97 Outlays from new permanent 
        authority.......................       4,555       1,030       1,129
86.98 Outlays from permanent balances...                     946         220
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       6,442       4,799       3,645
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....      -1,099        -423        -469
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       6,958         607       2,649
90.00 Outlays...........................       5,345       4,376       3,176
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................       6,958         607       2,649
  Outlays...........................       5,343       4,376       3,176
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                  -8
  Outlays...........................                                  -8
                                    ------------------------------------
Total:
  Budget Authority..................       6,958         607       2,641
  Outlays...........................       5,343       4,376       3,168
                                    ====================================

    P.L. 104-93 modified the treatment of child support collections so 
that once a State enters TANF, collections are no longer used to reduce 
the budget authority requested. Instead, spending authority from 
offsetting collections is limited to incentive and hold harmless 
payments. The net federal share of collections remaininng after 
incentive and hold harmless payments are made to States is returned to 
the treasury in a receipt account. The text table below shows the 
traditional display of child support enforcement costs:

[[Page 422]]

             Net Federal Costs of Child Support Enforcement

                        (In millions of dollars)

                                        1997         1998        1999
Gross Federal share of collections..      -1,424      -1,445      -1,530
Federal incentive payments to States         401         406         429
Hold harmless payments..............                      17          40
State child support administrative 
costs...............................       2,334       2,430       2,651
Access and visitation grants........          10          10          10
                                    ------------------------------------
    Subtotal........................       1,321       1,418       1,600

                                

                    Family Support Payments to States

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1501-4-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Benefit payments:

00.01   State child support 
          administrative costs..........                                  -8
00.02   Federal incentive/hold harmless 
          payments to States............                                 -40
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          41.0).........................                                 -48
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 -48
23.95 New obligations...................                                  48
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................                                  -8
      Permanent:

68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).                                 -40
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                                 -48
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 -48
73.20 Total outlays (gross).............                                  48
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority                                  -8
86.97 Outlays from new permanent 
        authority.......................                                 -40
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                                 -48
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....                                  40
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                  -8
90.00 Outlays...........................                                  -8
---------------------------------------------------------------------------

    This proposal simplifies the child support funding structure by: (1) 
conforming the match rate for paternity testing with the base 
administrative match rate; and, (2) repealing the hold harmless 
provision established in welfare reform.

                                

                    Low Income Home Energy Assistance

    For making payments under title XXVI of the Omnibus Budget 
Reconciliation Act of 1981, $1,100,000,000, to be available for 
obligation in the period October 1, [1998] 1999 through September 30, 
[1999] 2000.
     For making payments under title XXVI of such Act, $300,000,000: 
Provided, That these funds are hereby designated by Congress to be 
emergency requirements pursuant to section 251(b)(2)(D) of the Balanced 
Budget and Emergency Deficit Control Act of 1985: Provided further, That 
these funds shall be made available only after submission to Congress of 
a formal budget request by the President that includes designation of 
the entire amount of the request as an emergency requirement as defined 
in the Balanced Budget and Emergency Deficit Control Act. (Department of 
Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1502-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................       1,215       1,000       1,100
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       1,215       1,000       1,100
23.95 New obligations...................      -1,215      -1,000      -1,100
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       1,000
40.15   Appropriation (emergency).......                     300         300
40.60   Contingent emergency 
          appropriation not available 
          for obligations...............                    -300        -300
                                           ---------   ---------  ----------
43.00     Appropriation (total).........       1,000
      Permanent:

60.65   Contingent emergency 
          appropriation released........         215
65.00   Advance appropriation (definite)                   1,000       1,100
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       1,215       1,000       1,100
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         358         352         278
73.10 New obligations...................       1,215       1,000       1,100
73.20 Total outlays (gross).............      -1,221      -1,074      -1,077
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         352         278         301
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         897
86.93 Outlays from current balances.....                     318
86.97 Outlays from new permanent 
        authority.......................                     740         814
86.98 Outlays from permanent balances...         324          16         263
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,221       1,074       1,077
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       1,215       1,000       1,100
90.00 Outlays...........................       1,221       1,074       1,077
---------------------------------------------------------------------------

       Status of Contingent Emergency Funding (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1502-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
0199  Balance of contingent emergency 
        funding, start of year..........         420
0300  New emergency funding not 
        available for obligation........                     300         300
0400  Releases of contingent emergency 
        appropriations..................        -215
0599  Adjustments.......................        -205        -300        -300
                                           ---------   ---------  ----------
0799  Balance of contingent emergency 
        funding, end of year............
---------------------------------------------------------------------------

    This program makes grants to States and Indian tribes to aid low-
income households with high energy costs through payments to eligible 
households, energy suppliers, and weatherization providers.

                                

                     Refugee and Entrant Assistance

    For making payments for refugee and entrant assistance activities 
authorized by title IV of the Immigration and Nationality Act and 
section 501 of the Refugee Education Assistance Act of 1980 (Public Law 
96-422), $415,000,000 [Provided, That funds appropriated pursuant to 
section 414(a) of the Immigration and Nationality Act under Public Law 
104-134 for fiscal year 1996 shall be available for the costs of 
assistance provided and other activities conducted in such year and in 
fiscal years 1997 and 1998]. (Department of Health and Human Services 
Appropriations Act, 1998.)

                    [Refugee Resettlement Assistance]

    [For necessary expenses for the targeted assistance program 
authorized by title IV of the Immigration and Nationality Act and

[[Page 423]]

section 501 of the Refugee Education Assistance Act of 1980 and 
administered by the Office of Refugee Resettlement of the Department of 
Health and Human Services, in addition to amounts otherwise available 
for such purposes, $5,000,000.] (Foreign Operations, Export Financing, 
and Related Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1503-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations.................         404         423         415
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......           2           2           2
22.00 New budget authority (gross)......         425         423         415
22.30 Unobligated balance expiring......         -20
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         407         425         417
23.95 New obligations...................        -404        -423        -415
24.40 Unobligated balance available, end 
        of year: Uninvested.............           2           2           2
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................         417         420         415
41.00 Transferred to other accounts.....          -2
                                           ---------   ---------  ----------
43.00   Appropriation (total)...........         415         420         415
50.00 Reappropriation...................          10           3
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         425         423         415
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         337         436         449
73.10 New obligations...................         404         423         415
73.20 Total outlays (gross).............        -323        -410        -408
73.40 Adjustments in expired accounts...          18
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         436         449         456
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         136         148         145
86.93 Outlays from current balances.....         187         262         263
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         323         410         408
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         425         423         415
90.00 Outlays...........................         323         410         408
---------------------------------------------------------------------------

    States are subsidized for administering the refugee assistance 
program.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1503-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..           2           2           2
25.3  Purchases of goods and services 
        from Government accounts........           6
41.0  Grants, subsidies, and 
        contributions...................         396         421         413
                                           ---------   ---------  ----------
99.9    Total obligations...............         404         423         415
---------------------------------------------------------------------------

                                

                     Family Preservation and Support

    For carrying out section 430 of the Social Security Act, 
[$255,000,000] $275,000,000. (Department of Health and Human Services 
Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1512-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Grants to States and Tribes.......         224         239         259
00.02 Training and technical assistance.           6           6           6
00.03 State court assessment activities.          10          10          10
                                           ---------   ---------  ----------
10.00   Total obligations...............         240         255         275
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         240         255         275
23.95 New obligations...................        -240        -255        -275
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................         240         255         275
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         270         293         312
73.10 New obligations...................         240         255         275
73.20 Total outlays (gross).............        -216        -236        -252
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         293         312         335
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority          41          44          48
86.93 Outlays from current balances.....         175         192         204
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         216         236         252
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         240         255         275
90.00 Outlays...........................         216         236         252
---------------------------------------------------------------------------

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1512-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..           6           6           6
41.0  Grants, subsidies, and 
        contributions...................         234         249         269
                                           ---------   ---------  ----------
99.9    Total obligations...............         240         255         275
---------------------------------------------------------------------------

                                

                   Job Opportunities and Basic Skills

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1509-0-1-504      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................         283
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       1,000
22.30 Unobligated balance expiring......        -717
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         283
23.95 New obligations...................        -283
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................       1,000
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         254         158           6
73.10 New obligations...................         283
73.20 Total outlays (gross).............        -445        -152          -6
73.40 Adjustments in expired accounts...          66
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         158           6
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         211
86.93 Outlays from current balances.....         234         152           6
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         445         152           6
88.95 Change in orders on hand from 
        Federal sources.................
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       1,000
90.00 Outlays...........................         445         152           6
---------------------------------------------------------------------------

    This activity is replaced by Temporary Assistance for Needy 
Families.

[[Page 424]]

                                

               State Legalization Impact-Assistance Grants

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1508-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           2           7           7
73.20 Total outlays (gross).............           5
73.40 Adjustments in expired accounts...          -1
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...           7           7           7
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.93 Outlays from current balances.....          -5
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................          -5
---------------------------------------------------------------------------

                                

                    Child Care Entitlement to States

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1550-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Mandatory child care..............       1,238       1,219       1,221
00.02 Matching child care...............         724         847         941
00.03 Training and technical assistance.           5           5           5
                                           ---------   ---------  ----------
10.00   Total obligations...............       1,967       2,071       2,167
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       1,967       2,071       2,167
23.95 New obligations...................      -1,967      -2,071      -2,167
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

50.00   Reappropriation.................                       4
      Permanent:

60.00   Appropriation...................       1,967       2,067       2,167
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       1,967       2,071       2,167
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...                     569         801
73.10 New obligations...................       1,967       2,071       2,167
73.20 Total outlays (gross).............      -1,398      -1,835      -2,056
73.40 Adjustments in expired accounts...                      -4
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         569         801         912
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................       1,398       1,468       1,534
86.98 Outlays from permanent balances...                     367         522
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,398       1,835       2,056
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       1,967       2,071       2,167
90.00 Outlays...........................       1,398       1,835       2,056
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................       1,967       2,071       2,167
  Outlays...........................       1,398       1,835       2,056
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                               1,755
  Outlays...........................                               1,170
                                    ------------------------------------
Total:
  Budget Authority..................       1,967       2,071       3,922
  Outlays...........................       1,398       1,835       3,226
                                    ====================================

    This account provides child care funding for welfare recipients and 
low-income working families established by the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193).

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1550-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..           5           5           5
41.0  Grants, subsidies, and 
        contributions...................       1,962       2,066       2,162
                                           ---------   ---------  ----------
99.9    Total obligations...............       1,967       2,071       2,167
---------------------------------------------------------------------------

                                

                    Child Care Entitlement to States

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1550-4-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Early learning fund...............                                 600
00.02 Matching funds to States..........                               1,129
00.03 Tribal mandatory funds............                                  23
00.04 Training and technical assistance.                                   3
                                           ---------   ---------  ----------
10.00   Total obligations...............                               1,755
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                               1,755
23.95 New obligations...................                              -1,755
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.00 Appropriation.....................                               1,755
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                               1,755
73.20 Total outlays (gross).............                              -1,170
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...                                 585
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................                               1,170
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                               1,755
90.00 Outlays...........................                               1,170
---------------------------------------------------------------------------

    This legislative proposal will provide child care funding for low-
income working families and provide challenge grants to communities to 
support programs to improve early learning and the quality and safety of 
child care for children ages zero to five.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1550-4-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..                                   3
41.0  Grants, subsidies, and 
        contributions...................                               1,752
                                           ---------   ---------  ----------
99.9    Total obligations...............                               1,755
---------------------------------------------------------------------------
                                             -------

                                

    Payments to States for the Child Care and Development Block Grant

                      [including transfer of funds]

    For carrying out sections 658A through 658R of the Omnibus Budget 
Reconciliation Act of 1981 (The Child Care and Development Block Grant 
Act of 1990), in addition to amounts already appropriated for fiscal 
year [1998, $65,672,000] 1999, $2,672,000; and to become available on 
October 1, [1998] 1999 and remain available through September 30, [1999, 
$1,000,000,000: Provided, That of funds appropriated for each of fiscal 
years 1998 and 1999, $19,120,000 shall be available for child care 
resource and referral and school-aged child

[[Page 425]]

care activities, of which for fiscal year 1998 $3,000,000 shall be 
derived from an amount that shall be transferred from the amount 
appropriated under section 452(j) of the Social Security Act (42 U.S.C. 
652(j)) for fiscal year 1997 and remaining available for expenditure: 
Provided further, That of the funds provided for fiscal year 1998, 
$50,000,000 shall be reserved by the States for activities authorized 
under section 658G of the Omnibus Budget Reconciliation Act of 1981 (The 
Child Care and Development Block Grant Act of 1990), such funds to be in 
addition to the amounts required to be reserved by States under such 
section 658G] 2000, $1,002,672,000. (Department of Health and Human 
Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1515-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Block grant payments to States....          19       1,000       1,000
00.02 Advisory and assistance services..                       3           3
                                           ---------   ---------  ----------
10.00   Total obligations...............          19       1,003       1,003
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......          19       1,003       1,003
23.95 New obligations...................         -19      -1,003      -1,003
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................          13          63           3
42.00   Transferred from other accounts.           6           3
                                           ---------   ---------  ----------
43.00     Appropriation (total).........          19          66           3
      Permanent:

65.00   Advance appropriation (definite)                     937       1,000
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          19       1,003       1,003
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...       1,413         521         546
73.10 New obligations...................          19       1,003       1,003
73.20 Total outlays (gross).............        -909        -978        -993
73.40 Adjustments in expired accounts...          -2
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         521         546         556
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority          13          41           2
86.93 Outlays from current balances.....         896         356         166
86.97 Outlays from new permanent 
        authority.......................                     581         620
86.98 Outlays from permanent balances...                                 206
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         909         978         993
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          19       1,003       1,003
90.00 Outlays...........................         909         978         993
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     1997 actual  1998 est.   1999 est.
Enacted/requested:
  Budget Authority..................          19       1,003       1,003
  Outlays...........................         909         978         994
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                 180
  Outlays...........................                                  75
                                    ------------------------------------
Total:
  Budget Authority..................          19       1,003       1,183
  Outlays...........................         909         978       1,069
                                    ====================================

    This appropriation helps low-income families pay for child care and 
related services.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1515-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..                       3           3
41.0  Grants, subsidies, and 
        contributions...................          19       1,000       1,000
                                           ---------   ---------  ----------
99.9    Total obligations...............          19       1,003       1,003
---------------------------------------------------------------------------

                                

                 Child Care and Development Block Grant

              (Legislative proposal, not subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1515-2-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Standards enforcement fund........                                 100
00.02 Child care provider scholarship 
        fund............................                                  50
00.03 Research and evaluation fund......                                  30
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          41.0).........................                                 180
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 180
23.95 New obligations...................                                -180
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................                                 180
----------------------------------------------------------------------------

    Change in unpaid obligations:
73.10 New obligations...................                                 180
73.20 Total outlays (gross).............                                 -75
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...                                 105
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority                                  75
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................                                 180
90.00 Outlays...........................                                  75
---------------------------------------------------------------------------

    This legislative proposal will provide funds: (1) to States to 
improve licensing systems and enforce State child care health and safety 
standards; (2) for scholarships to students working toward a child care 
credential; and (3) to support a National Center on Child Care 
Statistics, a child care hotline, and research and demonstration 
projects.

                                

                       Social Services Block Grant

    For making grants to States pursuant to section 2002 of the Social 
Security Act, [$2,299,000,000] $1,909,000,000: Provided, That 
notwithstanding section 2003(c) of such Act, as amended, the amount 
specified for allocation under such section for fiscal year [1998] 1999 
shall be [$2,299,000,000] $1,909,000,000. (Department of Health and 
Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1534-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
10.00 Total obligations (object class 
        41.0)...........................       2,500       2,299       1,909
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       2,500       2,299       1,909
23.95 New obligations...................      -2,500      -2,299      -1,909
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................       2,500       2,299       1,909
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...       1,217       1,149       1,005
73.10 New obligations...................       2,500       2,299       1,909
73.20 Total outlays (gross).............      -2,571      -2,443      -2,049
73.40 Adjustments in expired accounts...           3
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...       1,149       1,005         865
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       2,233       2,069       1,718
86.93 Outlays from current balances.....         338         374         331
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,571       2,443       2,049
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       2,500       2,299       1,909

[[Page 426]]

90.00 Outlays...........................       2,572       2,443       2,049
---------------------------------------------------------------------------

    Social services block grant.--The proposed level will support grants 
to States for social services.

                                

                 Children and Families Services Programs

                        [(including rescissions)]

    For carrying out, except as otherwise provided, the Runaway and 
Homeless Youth Act, the Developmental Disabilities Assistance and Bill 
of Rights Act, the Families of Children with Disabilities Support Act 
under part I of the Individuals with Disabilities Education Act (20 
U.S.C. 149 et seq.), notwithstanding section 203(a) of the Individuals 
with Disabilities Education Act Amendments of 1997 (P.L. 105-17), the 
Head Start Act, the Child Abuse Prevention and Treatment Act[ (including 
section 105(a)(2) of the Child Abuse Prevention and Treatment Act), the 
Family Violence Prevention and Services Act], the Native American 
Programs Act of 1974, title II of Public Law 95-266 (adoption 
opportunities), the Adoption and Safe Families Act of 1997 (Public Law 
105-89), the Abandoned Infants Assistance Act of 1988, part B(1) of 
title IV and sections 413, 429A and 1110 of the Social Security Act; for 
making payments under the Community Services Block Grant Act; and for 
necessary administrative expenses to carry out said Acts and titles I, 
IV, X, XI, XIV, XVI, and XX of the Social Security Act, the Act of July 
5, 1960 (24 U.S.C. ch. 9), the Omnibus Budget Reconciliation Act of 
1981, title IV of the Immigration and Nationality Act, section 501 of 
the Refugee Education Assistance Act of 1980, sections 40155, 40211, and 
40241 of Public Law 103-322, and section 126 and titles IV and V of 
Public Law 100-485, [$5,682,916,000] $5,944,100,000, of which 
[$542,165,000] $20,000,000, to remain available until September 30, 
2003, for grants to States for adoption incentive payments, as 
authorized by section 473A of title IV of the Social Security Act (42 
U.S.C. 670-679); of which $490,600,000 shall be for making payments 
under the Community Services Block Grant Act[,] ; and of which 
[$4,355,000,000] $4,660,000,000 shall be for making payments under the 
Head Start Act, of which up to $90,000,000 may be used for making 
payments under section 640(g)(1) of Public Law 103-252, and up to 
$56,000,000 may be used for making payments under section 640(a)(3) of 
such law: Provided, That, notwithstanding section 640(a)(6) of Public 
Law 103-252, of the funds made available for the Head Start Act, 
[$279,250,000] $350,000,000 shall be set aside for the Head Start 
Program for Families with Infants and Toddlers (Early Head Start): 
Provided further, That[ to the extent Community Services Block Grant 
funds are distributed as grant funds by a State to an eligible entity as 
provided under the Act, and have not been expended by such entity, they 
shall remain with such entity for carryover into the next fiscal year 
for expenditure by such entity consistent with program purposes], 
notwithstanding section 203(d)(3)(A) of Public Law 95-266, up to 
$5,000,000 shall be available for improving State efforts to increase 
the placement of foster care children.
    [In addition, $93,000,000, to be derived from the Violent Crime 
Reduction Trust Fund, for carrying out sections 40155, 40211 and 40241 
of Public Law 103-322.]
    [Funds appropriated for fiscal year 1998 under section 429A(e), part 
B of title IV of the Social Security Act shall be reduced by $6,000,000.
     Funds appropriated for fiscal year 1998 under section 413(h)(1) of 
the Social Security Act shall be reduced by $15,000,000.] (Department of 
Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Head Start........................       3,981       4,355       4,660
      Social services programs:

        Children, youth, and families:
01.03     Runaway and homeless youth....          44          44          44
01.04     Runaway youth transitional 
            living......................          15          15          15
01.07     Child abuse state grants......          21          21          21
01.08     Child abuse discretionary 
            grants......................          14          14          14
01.09     Community based resource 
            centers.....................          33          33          33
01.11     Abandoned infants assistance..          12          12          12
01.14     Child welfare services........         292         292         292
01.15     Child welfare training........           4           6           6
01.17     Adoption opportunities........          13          23          27
01.19     Family violence grants........          62          10
01.20     Social services and income 
            maintenance research........          44          26          10
        Developmental disabilities:
01.23     State grants..................          65          65          65
01.24     Protection and advocacy.......          27          27          27
01.25     Special projects..............           5           5           5
01.26     University affiliated projects          17          17          17
01.27     States support systems........                                   5
01.28   Native American programs........          35          35          35
01.29   Adoption incentive payments.....                                  20
                                           ---------   ---------  ----------
01.91     Subtotal social services 
            programs....................         703         645         648
02.01 ACF Federal administration........         143         141         145
                                           ---------   ---------  ----------
02.93   Total direct program............       4,827       5,141       5,453
      Community services programs:

03.01   Community services block grants.         490         491         491
03.03   Community food and nutrition....           4           4
03.04   Community services discretionary          31          33
03.05   National youth sports...........          12          14
                                           ---------   ---------  ----------
03.91   Subtotal, community services....         537         542         491
09.01 Reimbursable program..............          13          11          11
                                           ---------   ---------  ----------
10.00   Total obligations...............       5,377       5,694       5,955
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......           7           3           3
22.00 New budget authority (gross)......       5,373       5,694       5,955
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       5,380       5,697       5,958
23.95 New obligations...................      -5,377      -5,694      -5,955
24.40 Unobligated balance available, end 
        of year: Uninvested.............           3           3           3
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       5,364       5,683       5,944
      Permanent:

        Spending authority from 
            offsetting collections:
68.00     Offsetting collections (cash).           7          30          11
68.10     Change in orders on hand from 
            Federal sources.............           3         -19
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total)...................          10          11          11
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       5,374       5,694       5,955
----------------------------------------------------------------------------

    Change in unpaid obligations:
      Unpaid obligations, start of year:

72.40   Obligated balance: Uninvested...       3,225       3,605       3,788
72.95   Orders on hand from Federal 
          sources.......................          16          19
                                           ---------   ---------  ----------
72.99     Total unpaid obligations, 
            start of year...............       3,241       3,624       3,788
73.10 New obligations...................       5,377       5,694       5,955
73.20 Total outlays (gross).............      -5,129      -5,530      -5,795
73.40 Adjustments in expired accounts...         135
      Unpaid obligations, end of year:

74.40   Obligated balance: Uninvested...       3,605       3,788       3,948
74.95   Orders on hand from Federal 
          sources.......................          19
                                           ---------   ---------  ----------
74.99     Total unpaid obligations, end 
            of year.....................       3,624       3,788       3,948
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       2,257       2,410       2,523
86.93 Outlays from current balances.....       2,865       3,109       3,263
86.97 Outlays from new permanent 
        authority.......................           7          11          11
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       5,129       5,530       5,795
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........          -7         -30         -11
88.95 Change in orders on hand from 
        Federal sources.................          -3          19
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       5,364       5,683       5,944

[[Page 427]]

90.00 Outlays...........................       5,122       5,500       5,784
---------------------------------------------------------------------------

    Head Start.--The proposed level will enable Head Start projects to 
continue comprehensive early childhood development services and is 
consistent with the President's goal to serve 1 million children by 
2002, including a doubling of the number of infants and toddlers in 
Early Head Start to 80,000.

    Social Services.--The proposed level will continue to support State, 
local, and private efforts to provide developmental and other services 
for children and youth, grants to improve support networks for persons 
with developmental disabilities, and economic development assistance to 
Native American populations.

    Adoption Incentive Payments.--The proposed level includes $20 
million for bonus payments to States that increase the number of 
children adopted from the foster care system.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          91          91          92
11.3      Other than full-time permanent           1           1           1
11.5      Other personnel compensation..           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation          93          92          93
12.1    Civilian personnel benefits.....          16          16          17
21.0    Travel and transportation of 
          persons.......................           2           2           3
22.0    Transportation of things........           1
23.1    Rental payments to GSA..........          12          12          12
23.2    Rental payments to others.......           6
23.3    Communications, utilities, and 
          miscellaneous charges.........           2           2           2
24.0    Printing and reproduction.......           1           1           1
25.1    Advisory and assistance services          54          61          61
25.2    Other services..................           2           1           1
25.3    Purchases of goods and services 
          from Government accounts......          20          16          16
25.7    Operation and maintenance of 
          equipment.....................           3           2           2
31.0    Equipment.......................           2           2           2
41.0    Grants, subsidies, and 
          contributions.................       5,156       5,476       5,734
43.0    Interest and dividends..........          -6
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..       5,364       5,683       5,944
99.0  Reimbursable obligations..........          13          11          11
                                           ---------   ---------  ----------
99.9    Total obligations...............       5,377       5,694       5,955
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1536-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
1001  Total compensable workyears: Full-
        time equivalent employment......       1,657       1,588       1,562
---------------------------------------------------------------------------

                                

                    Violent Crime Reduction Programs

    For activities authorized by sections 40155, 40211, and 40241 of 
Public Law 103-322, $105,000,000, to remain available until expended, of 
which $101,000,000 shall be derived from the Violent Crime Reduction 
Trust Fund: Provided, That $88,800,000 shall be for Family Violence 
(including Battered Women's Shelters); $15,000,000 for Education and 
Prevention Grants to Reduce Sexual Abuse of Runaway, Homeless and Street 
Youth; and $1,200,000 for the National Domestic Violence Hotline.

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8605-0-1-754      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Family violence/battered women's 
        shelters and domestic violence 
        hotline.........................          12          78          90
00.02 Education and prevention grants to 
        reduce sexual abuse of runaway, 
        homeless and street youth.......           8          15          15
09.01 Community schools.................          11
                                           ---------   ---------  ----------
10.00   Total obligations...............          31          93         105
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......          31          93         105
23.95 New obligations...................         -31         -93        -105
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................                                   4
42.00   Transferred from other accounts.          20          93         101
                                           ---------   ---------  ----------
43.00     Appropriation (total).........          20          93         105
      Permanent:

68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          11
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          31          93         105
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...          21          28          68
73.10 New obligations...................          31          93         105
73.20 Total outlays (gross).............         -23         -53         -84
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          28          68          89
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority          -3          37          42
86.93 Outlays from current balances.....          15          16          42
86.97 Outlays from new permanent 
        authority.......................          11
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          23          53          84
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -11
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          20          93         105
90.00 Outlays...........................          12          53          84
---------------------------------------------------------------------------

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8605-0-1-754      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

25.1    Advisory and assistance services           1           1           1
41.0    Grants, subsidies, and 
          contributions.................          19          92         104
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..          20          93         105
99.0  Reimbursable obligations..........          11
                                           ---------   ---------  ----------
99.9    Total obligations...............          31          93         105
---------------------------------------------------------------------------

                                

              Children's Research and Technical Assistance 

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1553-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Training and technical assistance.          17          15          15
00.02 Federal parent locator service....          17          39          30
00.03 Child welfare study...............                                   6
00.04 Welfare research..................                                  15
00.05 Evaluation of welfare to work.....                       9           9
00.06 Evaluation of abstinence education                       3           3
                                           ---------   ---------  ----------
10.00   Total obligations...............          34          66          78
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          12          12
22.00 New budget authority (gross)......          34          54          78
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          46          66          78
23.95 New obligations...................         -34         -66         -78
24.40 Unobligated balance available, end 
        of year: Uninvested.............          12
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

41.00   Transferred to other accounts...          -6          -3

[[Page 428]]

      Permanent:

60.00   Appropriation...................          39          55          76
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).           1           2           2
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          34          54          78
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...          24          40          55
73.10 New obligations...................          34          66          78
73.20 Total outlays (gross).............         -18         -51         -56
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          40          55          77
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................          12          21          19
86.98 Outlays from permanent balances...           6          30          37
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          18          51          56
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....          -1          -2          -2
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          33          52          76
90.00 Outlays...........................          17          49          54
---------------------------------------------------------------------------

    This provides funding for research and technical assistance 
activities established in P.L. 104-193. Amounts for child welfare study 
and welfare research are in addition to research amounts in the Children 
and Families Services Program account.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1553-0-1-609      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
21.0  Travel and transportation of 
        persons.........................           2           1           1
23.3  Communications, utilities, and 
        miscellaneous charges...........           1           1           1
25.1  Advisory and assistance services..           2          12          19
25.2  Other services....................          10          22           9
25.3  Purchases of goods and services 
        from Government accounts........          13          21          27
25.5  Research and development contracts           1           1           1
25.7  Operation and maintenance of 
        equipment.......................           3           5           5
31.0  Equipment.........................           1           1           1
41.0  Grants, subsidies, and 
        contributions...................           1           2          14
                                           ---------   ---------  ----------
99.9    Total obligations...............          34          66          78
---------------------------------------------------------------------------

                                

       Payments to States for Foster Care and Adoption Assistance

    For making payments to States or other non-Federal entities, under 
title IV-E of the Social Security Act, [$3,200,000,000] $3,984,000,000, 
of which $200,000,000 shall be placed in reserve for use only in such 
amounts and such times as may become necessary to make payments to 
States.
     For making payments to States or other non-Federal entities, under 
title IV-E of the Social Security Act, for the first quarter of fiscal 
year [1999] 2000, [$1,157,500,000] $1,355,300,000. (Department of Health 
and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1545-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Foster care.......................       3,292       3,340       3,983
00.02 Independent living................          70          70          70
00.03 Adoption assistance...............         590         701         869
00.04 Adoption incentives...............                                  20
                                           ---------   ---------  ----------
10.00   Total obligations (object class 
          41.0).........................       3,952       4,111       4,942
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       4,445       4,311       5,142
22.30 Unobligated balance expiring......        -493        -200        -200
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       3,952       4,111       4,942
23.95 New obligations...................      -3,952      -4,111      -4,942
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................       4,445       3,200       3,984
      Permanent:

65.00   Advance appropriation (definite)                   1,111       1,158
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       4,445       4,311       5,142
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         870         829         716
73.10 New obligations...................       3,952       4,111       4,942
73.20 Total outlays (gross).............      -4,047      -4,224      -4,803
      Adjustments in expired accounts:

73.40   Adjustments in expired accounts.                                  -5
73.40   Adjustments in expired accounts.          54
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         829         716         850
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority       3,331       2,526       3,181
86.93 Outlays from current balances.....         716         763         647
86.97 Outlays from new permanent 
        authority.......................                     935         975
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       4,047       4,224       4,803
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................       4,445       4,311       5,142
90.00 Outlays...........................       4,047       4,224       4,803
---------------------------------------------------------------------------

    Foster care.--The proposed level will support eligible low-income 
children who must be placed outside the home. An average of 323,000 
children per month will be served in 1999.

    Adoption assistance.--The proposed funding level will support 
subsidies for families adopting eligible low-income children with 
special needs. An average of 197,100 children per month will be served 
in 1999.

                                


 
                         ADMINISTRATION ON AGING

                              Federal Funds

General and special funds:

                         Aging Services Programs

    For carrying out, to the extent not otherwise provided, the Older 
Americans Act of 1965, as amended, [$865,050,000] $871,050,000: 
Provided, That notwithstanding section 308(b)(1) of such Act, the 
amounts available to each State for administration of the State plan 
under title III of such Act shall be reduced not more than 5 percent 
below the amount that was available to such State for such purpose for 
fiscal year 1995: [Provided further, That of the funds appropriated to 
carry out section 303(a)(1) of such Act, $4,449,000 shall be available 
for carrying out section 702(a) of such Act and $4,732,000 shall be 
available for carrying out section 702(b) of such Act:] Provided 
further, That in considering grant applications for nutrition services 
for elder Indian recipients, the Assistant Secretary shall provide 
maximum flexibility to applicants who seek to take into account 
subsistence, local customs, and other characteristics that are 
appropriate to the unique cultural, regional, and geographic needs of 
the American Indian, Alaska and Hawaiian Native communities to be 
served. (Department of Health and Human Services Appropriations Act, 
1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0142-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
01.01 Supportive services and centers...         302         310         301
01.02 Preventive health.................          16          16          16

[[Page 429]]

01.05 Congregate meals..................         365         374         374
01.06 Home-delivered meals..............         105         112         112
01.07 In-home services..................           9          10          10
01.08 Grants to Indian tribes...........          16          18          18
01.09 Research, training and 
        discretionary projects..........           4          10          10
01.10 Federal administration............          15          15          15
01.13 Alzheimer's disease demonstration 
        grants to States................                                   6
01.14 Grants for protection of 
        vulnerable older Americans......                                   9
                                           ---------   ---------  ----------
10.00   Total obligations...............         832         865         871
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         832         865         871
23.95 New obligations...................        -832        -865        -871
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.00 Appropriation.....................         832         865         871
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         222         226         240
73.10 New obligations...................         832         865         871
73.20 Total outlays (gross).............        -828        -851        -860
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         226         240         251
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         626         672         679
86.93 Outlays from current balances.....         202         179         181
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         828         851         860
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         832         865         871
90.00 Outlays...........................         828         851         860
---------------------------------------------------------------------------

    Administration on Aging.--The proposed level will continue to 
provide supportive and nutrition services, research, training and 
demonstration projects for the elderly.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0142-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           9           9           9
12.1  Civilian personnel benefits.......           2           2           2
23.1  Rental payments to GSA............           1           1           1
25.2  Other services....................           3           3           3
41.0  Grants, subsidies, and 
        contributions...................         817         850         856
                                           ---------   ---------  ----------
99.9    Total obligations...............         832         865         871
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0142-0-1-506      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......         130         139         141
    Allocation account:
3001  Total compensable workyears: Full-
        time equivalent employment......           1           1           1
---------------------------------------------------------------------------

                                


 
                         DEPARTMENTAL MANAGEMENT

                              Federal Funds

General and special funds:

                     General Departmental Management

    For necessary expenses, not otherwise provided, for general 
departmental management, including hire of six sedans, and for carrying 
out titles III, XVII, and XX of the Public Health Service Act, [and the 
United States-Mexico Border Health Commission Act, $171,631,000, of 
which $500,000 shall remain available until expended] $154,092,000, 
together with $5,851,000, to be transferred and expended as authorized 
by section 201(g)(1) of the Social Security Act from the Hospital 
Insurance Trust Fund and the Supplemental Medical Insurance Trust Fund[: 
Provided, That of the funds made available under this heading for 
carrying out title XVII of the Public Health Service Act, $1,500,000 
shall be available until expended for extramural construction]. 
(Department of Health and Human Services Appropriations Act, 1998.)

                         Office for Civil Rights

    For expenses necessary for the Office for Civil Rights, 
[$16,345,000] $17,345,000, together with not to exceed $3,314,000, to be 
transferred and expended as authorized by section 201(g)(1) of the 
Social Security Act from the Hospital Insurance Trust Fund and the 
Supplemental Medical Insurance Trust Fund. (Department of Health and 
Human Services Appropriations Act, 1998.)

                             Policy Research

    For carrying out, to the extent not otherwise provided, research 
studies under section 1110 of the Social Security Act, $14,000,000. 
(Department of Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9912-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct activities:

00.01   General departmental management.         181         177         160
00.02   U.S. Office of Consumer Affairs.           2
00.03   Office for Civil Rights.........          20          20          21
00.04   Policy research.................          18          14          14
00.05   Emergency supplement............           1          15
00.06   Diabetes funds..................                      30          30
09.01 Reimbursable program..............          84          89          89
                                           ---------   ---------  ----------
10.00   Total obligations...............         306         345         314
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          13          25          10
22.00 New budget authority (gross)......         320         329         312
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         333         354         322
23.95 New obligations...................        -306        -345        -314
24.40 Unobligated balance available, end 
        of year: Uninvested.............          25          10           8
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................         211         202         185
40.15   Appropriation (emergency).......          15
42.00   Transferred from other accounts.           1
                                           ---------   ---------  ----------
43.00     Appropriation (total).........         227         202         185
      Permanent:

62.00   Transferred from other accounts.                      30          30
68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          93          97          97
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         320         329         312
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...         210         249         269
73.10 New obligations...................         306         345         314
73.20 Total outlays (gross).............        -270        -325        -337
73.40 Adjustments in expired accounts...           3
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...         249         269         246
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         111         100          92
86.93 Outlays from current balances.....          66         119         121
86.97 Outlays from new permanent 
        authority.......................          93         106         106
86.98 Outlays from permanent balances...                                  18
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         270         325         337
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -93         -97         -97
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         227         232         215
90.00 Outlays...........................         177         228         240
---------------------------------------------------------------------------



[[Page 430]]



                          [Dollars in millions]

                                     1997 actual  1998 est.   1999 est.
Distribution of budget authority by 
    account:
  General departmental management...         175         172         154
  Office of Consumer Affairs........           2
  Office for Civil Rights...........          17          16          17
  Policy research...................          18          14          14
  Diabetes funds....................                      30          30
Distribution of outlays by account:
  General departmental management...         132         172         180
  Office of Consumer Affairs........           2
  Office for Civil Rights...........          15          16          18
  Policy research...................          21           8           8
  Emergency supplemental............           7          23           7
  Diabetes funds....................                       9          27

    Departmental Management (DM) is a consolidated display of accounts 
that fund activities which provide leadership, policy, legal, and 
administrative guidance to HHS components; carry out the Department's 
civil rights and nondiscrimination enforcement programs; and support 
research to develop policy initiatives and improve existing HHS 
programs. DM also includes the activities of the Office of Public Health 
and Science, including adolescent family life, disease prevention and 
health promotion, physical fitness and sports, minority health, research 
integrity, women's health, and emergency preparedness. These accounts 
will continue to be appropriated separately, and are being displayed in 
a consolidated format to improve the readability of the presentation. 
Detailed information will continue to be available through the 
Department of Health and Human Services.

    The Balanced Budget Act of 1997 appropriated mandatory funds of $30 
million per year in FY 1998-FY 2002 for research into the prevention and 
cure of type 1 diabetes, to be transferred from the Children's Health 
Insurance Program in the Health Care Financing Administration. These 
funds are temporarily reflected within Departmental Management; once the 
selection of specific research initiatives has been completed, the funds 
will be allocated to the National Institutes of Health and the Centers 
for Disease Control and Prevention.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9912-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          77          81          83
11.3      Other than full-time permanent           3           3           3
11.5      Other personnel compensation..           1           1           2
                                           ---------   ---------  ----------
11.9        Total personnel compensation          81          85          88
12.1    Civilian personnel benefits.....          15          16          17
21.0    Travel and transportation of 
          persons.......................           1           2           2
23.1    Rental payments to GSA..........          11          12          12
23.3    Communications, utilities, and 
          miscellaneous charges.........           4           4           4
24.0    Printing and reproduction.......                       1           1
25.1    Advisory and assistance services           4           2           2
25.2    Other services..................          16          13          13
25.3    Purchases of goods and services 
          from Government accounts......          33          21          21
25.4    Operation and maintenance of 
          facilities....................           4           4           2
25.5    Research and development 
          contracts.....................           1          20           4
25.7    Operation and maintenance of 
          equipment.....................           4           2           3
26.0    Supplies and materials..........           3           1
31.0    Equipment.......................           3           4           4
41.0    Grants, subsidies, and 
          contributions.................          42          69          52
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..         222         256         225
99.0  Reimbursable obligations..........          84          89          89
                                           ---------   ---------  ----------
99.9    Total obligations...............         306         345         314
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9912-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......       1,332       1,302       1,316
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......         139         141         143
    Allocation account:
3001  Total compensable workyears: Full-
        time equivalent employment......          14          20          22
---------------------------------------------------------------------------

                                

                Allocations Received From Other Accounts

    Note.--Obligations incurred under allocations from other accounts 
are included in the schedules of the parent appropriation as follows: 
Health Care Financing Administration: ``Health Care Fraud and Abuse 
Control Account.''

                                


 
                         PROGRAM SUPPORT CENTER

General and special funds:

      Retirement Pay and Medical Benefits for Commissioned Officers

    For retirement pay and medical benefits of Public Health Service 
Commissioned Officers as authorized by law, [and] for payments under the 
Retired Serviceman's Family Protection Plan and Survivor Benefit Plan 
[and], for medical care of dependents and retired personnel under the 
Dependents' Medical Care Act (10 U.S.C. ch. 55), and for payments 
pursuant to section 229(b) of the Social Security Act (42 U.S.C. 
429(b)), such amounts as may be required during the current fiscal year. 
(Department of Health and Human Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0379-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Retirement payments...............         139         149         159
00.02 Survivors' benefits...............          11          12          12
00.03 Medical care......................          26          28          29
00.04 Military service credits..........           3           2           2
                                           ---------   ---------  ----------
10.00   Total obligations...............         179         191         202
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         180         191         202
22.30 Unobligated balance expiring......          -1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         179         191         202
23.95 New obligations...................        -179        -191        -202
----------------------------------------------------------------------------

    New budget authority (gross), detail:
40.05 Appropriation (indefinite)........         180         191         202
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           8          19          18
73.10 New obligations...................         179         191         202
73.20 Total outlays (gross).............        -180        -192        -201
73.40 Adjustments in expired accounts...          12
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          19          18          19
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.90 Outlays from new current authority         162         173         183
86.93 Outlays from current balances.....          18          19          18
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         180         192         201
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................         180         191         202
90.00 Outlays...........................         180         192         201
---------------------------------------------------------------------------

    This activity funds annuities of retired Public Health Service (PHS) 
commissioned officers and survivors of retirees, and medical care to 
active duty PHS commissioned officers, retir

[[Page 431]]

ees, and dependents of members and retirees of the PHS Commissioned 
Corps.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0379-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
13.0  Benefits for former personnel.....         150         161         171
25.2  Other services....................          26          28          29
25.3  Purchases of goods and services 
        from Government accounts........           3           2           2
                                           ---------   ---------  ----------
99.9    Total obligations...............         179         191         202
---------------------------------------------------------------------------

                                

                         Health Activities Funds

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9913-0-1-550      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...          11          10           9
73.20 Total outlays (gross).............          -1          -1          -1
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          10           9           8
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.93 Outlays from current balances.....           1           1           1
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................                       1           1
---------------------------------------------------------------------------

    This display shows activities in support of St. Elizabeths Hospital 
and scientific activities overseas that were supported by foreign 
currencies by the United States abroad.

                                

Intragovernmental funds:

                      HHS Service and Supply Fund 

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9941-0-4-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
09.01 Program support center............         236         258         257
09.02 Federal employee occupational 
        health..........................          79         104         143
09.03 OS activities.....................           7           7           6
                                           ---------   ---------  ----------
10.00   Total obligations...............         322         369         406
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......          32          42          42
22.00 New budget authority (gross)......         279         369         406
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................          53
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         364         411         448
23.95 New obligations...................        -322        -369        -406
24.40 Unobligated balance available, end 
        of year: Uninvested.............          42          42          42
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Spending authority from offsetting 
          collections:

68.00   Offsetting collections (cash)...         297         369         406
68.10   Change in orders on hand from 
          Federal sources...............         -18
                                           ---------   ---------  ----------
68.90     Spending authority from 
            offsetting collections 
            (total).....................         279         369         406
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         279         369         406
----------------------------------------------------------------------------

    Change in unpaid obligations:
      Unpaid obligations, start of year:

72.40   Obligated balance: Uninvested...          -9         -14
72.95   Orders on hand from Federal 
          sources.......................         149         131         131
                                           ---------   ---------  ----------
72.99     Total unpaid obligations, 
            start of year...............         140         117         131
73.10 New obligations...................         322         369         406
73.20 Total outlays (gross).............        -292        -355        -406
73.45 Adjustments in unexpired accounts.         -53
      Unpaid obligations, end of year:

74.40   Obligated balance: Uninvested...         -14
74.95   Orders on hand from Federal 
          sources.......................         131         131         131
                                           ---------   ---------  ----------
74.99     Total unpaid obligations, end 
            of year.....................         117         131         131
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................         279         369         406
86.98 Outlays from permanent balances...          13         -14
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         292         355         406
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -297        -369        -406
88.95 Change in orders on hand from 
        Federal sources.................          18
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................          -5         -14
---------------------------------------------------------------------------

    The HHS Service and Supply Fund (SSF) provides common centralized 
services to HHS components. The Program Support Center (PSC) line 
includes activities such as personnel and payroll administration, 
financial management operations, and a wide array of administrative 
services, including acquisitions management, building and property 
management, and technical support. The Office of the Secretary (OS) 
activities line includes the fund manager, departmental contracts and 
grants, audit resolution, OS graphics, and the regional health 
administrators. The Federal Employee Occupational Health (FOH) program 
is also funded through the SSF. FOH includes clinical services, 
environmental health services and employee assistance programs.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9941-0-4-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Personnel compensation:

11.1    Full-time permanent.............          63          54          56
11.3    Other than full-time permanent..           2           9           9
11.5    Other personnel compensation....           6           3           3
                                           ---------   ---------  ----------
11.9      Total personnel compensation..          71          66          68
12.1  Civilian personnel benefits.......          13          14          14
21.0  Travel and transportation of 
        persons.........................           2           4           5
22.0  Transportation of things..........           2           2           3
23.1  Rental payments to GSA............          10           9           9
23.3  Communications, utilities, and 
        miscellaneous charges...........          48          49          54
24.0  Printing and reproduction.........           1           1           1
25.1  Advisory and assistance services..           4           2           2
25.2  Other services....................          77         101         115
25.3  Purchases of goods and services 
        from Government accounts........          34          35          35
26.0  Supplies and materials............          53          81          93
31.0  Equipment.........................           7           5           7
                                           ---------   ---------  ----------
99.9    Total obligations...............         322         369         406
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9941-0-4-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
2001  Total compensable workyears: Full-
        time equivalent employment......       1,241       1,256       1,261
---------------------------------------------------------------------------

                                

  

                               Trust Funds

                        Miscellaneous Trust Funds

              Unavailable Collections (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Balance, start of year:
01.99 Balance, start of year............

[[Page 432]]

    Receipts:
02.01 Contributions, Indian health 
        facilities, Health Services 
        Administration..................          32          32          32
02.02 Gifts and contributions, 
        Miscellaneous trust funds.......          11          11          11
02.03 Interest, Miscellaneous trust 
        funds...........................           1           1           1
                                           ---------   ---------  ----------
02.99   Total receipts..................          44          44          44
    Appropriation:
05.01 Miscellaneous trust funds.........         -44         -44         -44
07.99 Total balance, end of year........
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.02 Gifts.............................          13          12          12
00.03 Contributions, Indian health 
        facilities......................          39          32          32
                                           ---------   ---------  ----------
10.00   Total obligations...............          52          44          44
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
      Unobligated balance available, start of year:

21.40   Uninvested......................          25          23          23
21.41   U.S. Securities: Par value......           9          14          14
                                           ---------   ---------  ----------
21.99     Total unobligated balance, 
            start of year...............          34          37          37
22.00 New budget authority (gross)......          46          44          44
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           9
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          89          81          81
23.95 New obligations...................         -52         -44         -44
      Unobligated balance available, end of year:

24.40   Uninvested......................          23          23          23
24.41   U.S. Securities: Par value......          14          14          14
                                           ---------   ---------  ----------
24.99   Total unobligated balance, end 
          of year.......................          37          37          37
----------------------------------------------------------------------------

    New budget authority (gross), detail:
60.27 Appropriation (trust fund, 
        indefinite).....................          44          44          44
68.00 Spending authority from offsetting 
        collections: Offsetting 
        collections (cash)..............           2
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          46          44          44
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...          96          88          83
73.10 New obligations...................          52          44          44
73.20 Total outlays (gross).............         -51         -49         -47
73.45 Adjustments in unexpired accounts.          -9
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          88          83          80
----------------------------------------------------------------------------

    Outlays (gross), detail:
86.97 Outlays from new permanent 
        authority.......................          12          10           9
86.98 Outlays from permanent balances...          39          39          38
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          51          49          47
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........          -2
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          44          44          44
90.00 Outlays...........................          49          49          47
---------------------------------------------------------------------------

                          [Dollars in millions]

                                        1997         1998        1999
Distribution of budget authority by 
    account:
  Gifts.............................          12          12          12
  Contributions, Indian health 
    facilities......................          32          32          32
Distribution of outlays by account:
  Gifts.............................          18          18          16
  Contributions, Indian health 
    facilities......................          31          31          31

    Gifts to the Public Health Service are for the benefit of patients 
and for research. Contributions are made for the construction, 
improvement, extension, and provision of sanitation facilities.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Personnel compensation:

11.3    Other than full-time permanent..           3           3           3
11.5    Other personnel compensation....           1           1           1
11.8    Special personal services 
          payments......................           1           1           1
                                           ---------   ---------  ----------
11.9      Total personnel compensation..           5           5           5
12.1  Civilian personnel benefits.......           1           1           1
21.0  Travel and transportation of 
        persons.........................           1           1           1
22.0  Transportation of things..........           2           2           2
25.2  Other services....................           2           1           1
25.3  Purchases of goods and services 
        from Government accounts........           5           2           2
25.7  Operation and maintenance of 
        equipment.......................          12          12          12
26.0  Supplies and materials............           5           3           3
31.0  Equipment.........................           1
32.0  Land and structures...............          15          15          15
41.0  Grants, subsidies, and 
        contributions...................           3           2           2
                                           ---------   ---------  ----------
99.9    Total obligations...............          52          44          44
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
1001  Total compensable workyears: Full-
        time equivalent employment......          67          67          67
---------------------------------------------------------------------------

                                


 
                     OFFICE OF THE INSPECTOR GENERAL

General and special funds:

                       Office of Inspector General

    For expenses necessary for the Office of Inspector General in 
carrying out the provisions of the Inspector General Act of 1978, as 
amended, [$31,921,000] $29,000,000. (Department of Health and Human 
Services Appropriations Act, 1998.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0128-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Direct program....................          33          32          29
09.01 Reimbursable program..............          11          11          12
                                           ---------   ---------  ----------
10.00   Total obligations...............          44          43          41
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance available, 
        start of year: Uninvested.......           1           1           1
22.00 New budget authority (gross)......          44          43          41
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          45          44          42
23.95 New obligations...................         -44         -43         -41
24.40 Unobligated balance available, end 
        of year: Uninvested.............           1           1           1
----------------------------------------------------------------------------

    New budget authority (gross), detail:
      Current:

40.00   Appropriation...................          33          32          29
      Permanent:

68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          11          11          12
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          44          43          41
----------------------------------------------------------------------------

    Change in unpaid obligations:
72.40 Unpaid obligations, start of year: 
        Obligated balance: Uninvested...           9          13           9
73.10 New obligations...................          44          43          41
73.20 Total outlays (gross).............         -39         -47         -46
73.40 Adjustments in expired accounts...          -1
74.40 Unpaid obligations, end of year: 
        Obligated balance: Uninvested...          13           9           4
----------------------------------------------------------------------------

[[Page 433]]



    Outlays (gross), detail:
86.90 Outlays from new current authority          25          28          26
86.93 Outlays from current balances.....           3           8           8
86.97 Outlays from new permanent 
        authority.......................          11          11          12
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          39          47          46
----------------------------------------------------------------------------

    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -11         -11         -12
88.95 Change in orders on hand from 
        Federal sources.................
----------------------------------------------------------------------------

    Net budget authority and outlays:
89.00 Budget authority..................          33          32          29
90.00 Outlays...........................          28          36          34
---------------------------------------------------------------------------

    The Office of Inspector General identifies and recommends actions to 
correct fraud, waste, and abuse in HHS administered and assisted 
programs and operations through audits and investigations.

    In addition to the discretionary resources appropriated to the 
Office of the Inspector General (OIG), the Health Insurance Portability 
and Accountability Act of 1996 makes available mandatory funding for use 
by the OIG to combat Medicare fraud and abuse through a coordinated 
Health Care Fraud and Abuse Control (HCFAC) Program with the Department 
of Justice. The following table shows total funding resources for the 
OIG:

                          (In millions of dollars)

                                         1997 actual   1998 est.   1999 est.
Budget Authority:
  Discretionary appropriations..........          33          32          29
  Mandatory (HCFAC Account).............          70          85          97
                                           ---------   ---------  ----------
      Total.............................         103         117         126
Outlays:
  Discretionary appropriations..........          28          36          34
  Mandatory (HCFAC Account).............          70          85          97
                                           ---------   ---------  ----------
      Total.............................          98         121         131

    This schedule reflects estimated distribution of mandatory funds 
from the HCFAC Account in FY 1999. Actual FY 1999 distribution will be 
determined by the Secretary of HHS and the Attorney General.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0128-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------

      Direct obligations:

11.1    Personnel compensation: Full-
          time permanent................          19          20          17
12.1    Civilian personnel benefits.....           4           4           4
21.0    Travel and transportation of 
          persons.......................           2           1           1
23.1    Rental payments to GSA..........           2           2           2
23.3    Communications, utilities, and 
          miscellaneous charges.........           1           1           1
25.3    Purchases of goods and services 
          from Government accounts......           4           3           3
31.0    Equipment.......................           1           1           1
                                           ---------   ---------  ----------
99.0      Subtotal, direct obligations..          33          32          29
99.0  Reimbursable obligations..........          11          11          12
                                           ---------   ---------  ----------
99.9    Total obligations...............          44          43          41
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0128-0-1-551      1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: Full-
        time equivalent employment......         327         328         286
    Reimbursable:
2001  Total compensable workyears: Full-
        time equivalent employment......          33          24          23
    Allocation account:
3001  Total compensable workyears: Full-
        time equivalent employment......         658         851         966
---------------------------------------------------------------------------

                                

                Allocations Received From Other Accounts

    Note.--Obligations incurred under allocations from other accounts 
are included in the schedules of the parent appropriations as follows: 
Health Care Financing Administration: ``Health Care Fraud and Abuse 
Control Account.''

                                

    Note for Entire HHS Chapter.--The HHS FTE totals reflect compliance 
with section 416 of the Social Security Act, as amended by Public Law 
104-193, the Personal Responsibility and Work Opportunity Act of 1996, 
which requires a reduction of FTE consistent with the replacement of Aid 
to Families with Dependent Children and Job Opportunities and Basic 
Skills training program with Temporary Assistance for Needy Families.

                                

      


 
                      GENERAL FUND RECEIPT ACCOUNTS

                           (in millions of dollars)

----------------------------------------------------------------------------
                                         1997 actual   1998 est.   1999 est.
----------------------------------------------------------------------------
Offsetting receipts from the public:
  75-310700  Federal share of child 
    support collections.................         325       1,022       1,063
    Legislative proposal, subject to 
      PAYGO.............................                                  40
                                           ---------   ---------  ----------
General Fund Offsetting receipts from 
 the public.............................         325       1,022       1,103
---------------------------------------------------------------------------

                                


 
                           GENERAL PROVISIONS

    Sec. 201. Funds appropriated in this title shall be available for 
not to exceed $37,000 for official reception and representation expenses 
when specifically approved by the Secretary.
    Sec. 202. The Secretary shall make available through assignment not 
more than 60 employees of the Public Health Service to assist in child 
survival activities and to work in AIDS programs through and with funds 
provided by the Agency for International Development, the United Nations 
International Children's Emergency Fund or the World Health 
Organization.
    Sec. 203. None of the funds appropriated under this Act may be used 
to implement section 399L(b) of the Public Health Service Act or section 
1503 of the National Institutes of Health Revitalization Act of 1993, 
Public Law 103-43.
    Sec. 204. None of the funds appropriated in this Act for the 
National Institutes of Health and the Substance Abuse and Mental Health 
Services Administration shall be used to pay the salary of an 
individual, through a grant or other extramural mechanism, at a rate in 
excess of $125,000 per year.
    [Sec. 205. None of the funds appropriated in this Act may be 
expended pursuant to section 241 of the Public Health Service Act, 
except for funds specifically provided for in this Act, or for other 
taps and assessments made by any office located in the Department of 
Health and Human Services, prior to the Secretary's preparation and 
submission of a report to the Committee on Appropriations of the Senate 
and of the House detailing the planned uses of such funds.]
    [Sec. 206. None of the funds appropriated in this Act may be 
obligated or expended for the Federal Council on Aging under the Older 
Americans Act or the Advisory Board on Child Abuse and Neglect under the 
Child Abuse Prevention and Treatment Act.]

                           (transfer of funds)

    Sec. [207] 205. Not to exceed 1 percent of any discretionary funds 
(pursuant to the Balanced Budget and Emergency Deficit Control Act, as 
amended) which are appropriated for the current fiscal year for the 
Department of Health and Human Services in this Act may be transferred 
between appropriations, but no such appropriation shall be increased by 
more than 3 percent by any such transfer except the Public Health and 
Social Services Emergency Fund, which shall be subject to no such 
limitation: Provided, That the Appropriations Committees of both Houses 
of Congress are notified at least fifteen days in advance of any 
transfer.
    Sec. [208] 206. The Director of the National Institutes of Health, 
jointly with the Director of the Office of AIDS Research, may transfer

[[Page 434]]

up to 3 percent among institutes, centers, and divisions from the total 
amounts identified by these two Directors as funding for research 
pertaining to the human immunodeficiency virus: Provided, That the 
Congress is promptly notified of the transfer.
    [Sec. 209. Of the amounts made available in this Act for the 
National Institutes of Health, the amount for research related to the 
human immunodeficiency virus, as jointly determined by the Director of 
NIH and the Director of the Office of AIDS Research, shall be made 
available to the ``Office of AIDS Research'' account. The Director of 
the Office of AIDS Research shall transfer from such account amounts 
necessary to carry out section 2353(d)(3) of the Public Health Service 
Act.]
    Sec. [210] 207. Funds appropriated in this Act for the National 
Institutes of Health may be used to provide transit subsidies in amounts 
consistent with the transportation subsidy programs authorized under 
section 629 of Public Law 101-509 to non-FTE bearing positions including 
trainees, visiting fellows and volunteers.
    [Sec. 211. (a) The Secretary of Health and Human Services may in 
accordance with this section provide for the relocation of the Federal 
facility known as the Gillis W. Long Hansen's Disease Center (located in 
the vicinity of Carville, in the State of Louisiana), including the 
relocation of the patients of the Center.
     (b)(1) Subject to paragraph (2), in relocating the Center the 
Secretary may on behalf of the United States transfer to the State of 
Louisiana, without charge, title to the real property and improvements 
that as of the date of the enactment of this Act constitute the Center. 
Such real property is a parcel consisting of approximately 330 acres. 
The exact acreage and legal description used for purposes of the 
transfer shall be in accordance with a survey satisfactory to the 
Secretary.
     (2) Any conveyance under paragraph (1) is not effective unless the 
deed or other instrument of conveyance contains the conditions specified 
in subsection (d); the instrument specifies that the United States and 
the State of Louisiana agree to such conditions; and the instrument 
specifies that, if the State engages in a material breach of the 
conditions, title to the real property and improvements involved reverts 
to the United States at the election of the Secretary.
     (c)(1) With respect to Federal equipment and other items of Federal 
personal property that are in use at the Center as of the date of the 
enactment of this Act, the Secretary may, subject to paragraph (2), 
transfer to the State such items as the Secretary determines to be 
appropriate, if the Secretary makes the transfer under subsection (b).
     (2) A transfer of equipment or other items may be made under 
paragraph (1) only if the State agrees that, during the 30-year period 
beginning on the date on which the transfer under subsection (b) is 
made, the items will be used exclusively for purposes that promote the 
health or education of the public, except that the Secretary may 
authorize such exceptions as the Secretary determines to be appropriate.
     (d) For purposes of subsection (b)(2), the conditions specified in 
this subsection with respect to a transfer of title are the following:
         (1) During the 30-year period beginning on the date on which 
    the transfer is made, the real property and improvements referred to 
    in subsection (b)(1) (referred to in this subsection as the 
    ``transferred property'') will be used exclusively for purposes that 
    promote the health or education of the public, with such incidental 
    exceptions as the Secretary may approve.
         (2) For purposes of monitoring the extent to which the 
    transferred property is being used in accordance with paragraph (1), 
    the Secretary will have access to such documents as the Secretary 
    determines to be necessary, and the Secretary may require the 
    advance approval of the Secretary for such contracts, conveyances of 
    real or personal property, or other transactions as the Secretary 
    determines to be necessary.
         (3) The relocation of patients from the transferred property 
    will be completed not later than 3 years after the date on which the 
    transfer is made, except to the extent the Secretary determines that 
    relocating particular patients is not feasible. During the period of 
    relocation, the Secretary will have unrestricted access to the 
    transferred property, and after such period will have such access as 
    may be necessary with respect to the patients who pursuant to the 
    preceding sentence are not relocated.
         (4)(A) With respect to projects to make repairs and energy-
    related improvements at the transferred property, the Secretary will 
    provide for the completion of all such projects for which contracts 
    have been awarded and appropriations have been made as of the date 
    on which the transfer is made.
         (B) If upon completion of the projects referred to in 
    subparagraph (A) there are any unobligated balances of amounts 
    appropriated for the projects, and the sum of such balances is in 
    excess of $100,000--
             (i) the Secretary will transfer the amount of such excess 
        to the State; and
             (ii) the State will expend such amount for the purposes 
        referred to in paragraph (1), which may include the renovation 
        of facilities at the transferred property.
         (5)(A) The State will maintain the cemetery located on the 
    transferred property, will permit individuals who were long-term-
    care patients of the Center to be buried at the cemetery, and will 
    permit members of the public to visit the cemetery.
         (B) The State will permit the Center to maintain a museum on 
    the transferred property, and will permit members of the public to 
    visit the museum.
         (C) In the case of any waste products stored at the transferred 
    property as of the date of the transfer, the Federal Government will 
    after the transfer retain title to and responsibility for the 
    products, and the State will not require that the Federal Government 
    remove the products from the transferred property.
         (6) In the case of each individual who as of the date of the 
    enactment of this Act is a Federal employee at the transferred 
    property with facilities management or dietary duties:
             (A) The State will offer the individual an employment 
        position with the State, the position with the State will have 
        duties similar to the duties the individual performed in his or 
        her most recent position at the transferred property, and the 
        position with the State will provide compensation and benefits 
        that are similar to the compensation and benefits provided for 
        such most recent position, subject to the concurrence of the 
        Governor of the State.
             (B) If the individual becomes an employee of the State 
        pursuant to subparagraph (A), the State will make payments in 
        accordance with subsection (e)(2)(B) (relating to disability), 
        as applicable with respect to the individual.
         (7) The Federal Government may, consistent with the intended 
    uses by the State of the transferred property, carry out at such 
    property activities regarding at-risk youth.
         (8) Such additional conditions as the Secretary determines to 
    be necessary to protect the interests of the United States.
     (e)(1) This subsection applies if the transfer under subsection (b) 
is made.
     (2) In the case of each individual who as of the date of the 
enactment of this Act is a Federal employee at the Center with 
facilities management or dietary duties, and who becomes an employee of 
the State pursuant to subsection (d)(6)(A):
         (A) The provisions of subchapter III of chapter 83 of title 5, 
    United States Code, or of chapter 84 of such title, whichever are 
    applicable, that relate to disability shall be considered to remain 
    in effect with respect to the individual (subject to subparagraph 
    (C)) until the earlier of--
             (i) the expiration of the 2-year period beginning on the 
        date on which the transfer under subsection (b) is made; or
             (ii) the date on which the individual first meets all 
        conditions for coverage under a State program for payments 
        during retirement by reason of disability.
         (B) The payments to be made by the State pursuant to subsection 
    (d)(6)(B) with respect to the individual are payments to the Civil 
    Service Retirement and Disability Fund, if the individual is 
    receiving Federal disability coverage pursuant to subparagraph (A). 
    Such payments are to be made in a total amount equal to that portion 
    of the normal-cost percentage (determined through the use of dynamic 
    assumptions) of the basic pay of the individual that is allocable to 
    such coverage and is paid for service performed during the period 
    for which such coverage is in effect. Such amount is to be 
    determined in accordance with chapter 84 of such title 5, is to be 
    paid at such time and in such manner as mutually agreed by the State 
    and the Office of Personnel Management, and is in lieu of individual 
    or agency contributions otherwise required.
         (C) In the determination pursuant to subparagraph (A) of 
    whether the individual is eligible for Federal disability coverage 
    (during the applicable period of time under such subparagraph), 
    service as an employee of the State after the date of the transfer 
    under subsection (b) shall be counted toward the service requirement 
    specified in the first sentence of section 8337(a) or 8451(a)(1)(A) 
    of such title 5 (whichever is applicable).

[[Page 435]]

     (3) In the case of each individual who as of the date of the 
enactment of this Act is a Federal employee with a position at the 
Center and is, for duty at the Center, receiving the pay differential 
under section 208(e) of the Public Health Service Act or under section 
5545(d) of title 5, United States Code:
         (A) If as of the date of the transfer under subsection (b) the 
    individual is eligible for an annuity under section 8336 or 8412 of 
    title 5, United States Code, then once the individual separates from 
    the service and thereby becomes entitled to receive the annuity, the 
    pay differential shall be included in the computation of the annuity 
    if the individual separated from the service not later than the 
    expiration of the 90-day period beginning on the date of the 
    transfer.
         (B) If the individual is not eligible for such an annuity as of 
    the date of the transfer under subsection (b) but subsequently does 
    become eligible, then once the individual separates from the service 
    and thereby becomes entitled to receive the annuity, the pay 
    differential shall be included in the computation of the annuity if 
    the individual separated from the service not later than the 
    expiration of the 90-day period beginning on the date on which the 
    individual first became eligible for the annuity.
         (C) For purposes of this paragraph, the individual is eligible 
    for the annuity if the individual meets all conditions under such 
    section 8336 or 8412 to be entitled to the annuity, except the 
    condition that the individual be separated from the service.
     (4) With respect to individuals who as of the date of the enactment 
of this Act are Federal employees with positions at the Center and are 
not, for duty at the center, receiving the pay differential under 
section 208(e) of the Public Health Service Act or under section 5545(d) 
of title 5, United States Code:
         (A) During the calendar years 1997 and 1998, the Secretary may 
    in accordance with this paragraph provide to any such individual a 
    voluntary separation incentive payment. The purpose of such payments 
    is to avoid or minimize the need for involuntary separations under a 
    reduction in force with respect to the Center.
         (B) During calendar year 1997, any payment under subparagraph 
    (A) shall be made under section 663 of the Treasury, Postal Service, 
    and General Government Appropriations Act, 1997 (as contained in 
    section 101(f) of division A of Public Law 104-208), except that, 
    for purposes of this subparagraph, subsection (b) of such section 
    663 does not apply.
         (C) During calendar year 1998, such section 663 applies with 
    respect to payments under subparagraph (A) to the same extent and in 
    the same manner as such section applied with respect to the payments 
    during fiscal year 1997, and for purposes of this subparagraph, the 
    reference in subsection (c)(2)(D) of such section 663 to December 
    31, 1997, is deemed to be a reference to December 31, 1998.
     (f) The following provisions apply if under subsection (a) the 
Secretary makes the decision to relocate the Center:
         (1) The site to which the Center is relocated shall be in the 
    vicinity of Baton Rouge, in the State of Louisiana.
         (2) The facility involved shall continue to be designated as 
    the Gillis W. Long Hansen's Disease Center.
         (3) The Secretary shall make reasonable efforts to inform the 
    patients of the Center with respect to the planning and carrying out 
    of the relocation.
         (4) In the case of each individual who as of October 1, 1996, 
    was a patient of the Center and is considered by the Director of the 
    Center to be a long-term-care patient (referred to in this 
    subsection as an ``eligible patient''), the Secretary shall continue 
    to provide for the long-term care of the eligible patient, without 
    charge, for the remainder of the life of the patient.
         (5)(A) For purposes of paragraph (4), an eligible patient who 
    is legally competent has the following options with respect to 
    support and maintenance and other nonmedical expenses:
             (i) For the remainder of his or her life, the patient may 
        reside at the Center.
             (ii) For the remainder of his or her life, the patient may 
        receive payments each year at an annual rate of $33,000 
        (adjusted in accordance with subparagraphs (C) and (D)), and may 
        not reside at the Center. Payments under this clause are in 
        complete discharge of the obligation of the Federal Government 
        under paragraph (4) for support and maintenance and other 
        nonmedical expenses of the patient.
         (B) The choice by an eligible patient of the option under 
    clause (i) of subparagraph (A) may at any time be revoked by the 
    patient, and the patient may instead choose the option under clause 
    (ii) of such subparagraph. The choice by an eligible patient of the 
    option under such clause (ii) is irrevocable.
         (C) Payments under subparagraph (A)(ii) shall be made on a 
    monthly basis, and shall be pro rated as applicable. In 1999 and 
    each subsequent year, the monthly amount of such payments shall be 
    increased by a percentage equal to any percentage increase taking 
    effect under section 215(i) of the Social Security Act (relating to 
    a cost-of-living increase) for benefits under title II of such Act 
    (relating to Federal old-age, survivors, and disability insurance 
    benefits). Any such percentage increase in monthly payments under 
    subparagraph (A)(ii) shall take effect in the same month as the 
    percentage increase under such section 215(i) takes effect.
         (D) With respect to the provision of outpatient and inpatient 
    medical care for Hansen's disease and related complications to an 
    eligible patient:
             (i) The choice the patient makes under subparagraph (A) 
        does not affect the responsibility of the Secretary for 
        providing to the patient such care at or through the Center.
             (ii) If the patient chooses the option under subparagraph 
        (A)(ii) and receives inpatient care at or through the Center, 
        the Secretary may reduce the amount of payments under such 
        subparagraph, except to the extent that reimbursement for the 
        expenses of such care is available to the provider of the care 
        through the program under title XVIII of the Social Security Act 
        or the program under title XIX of such Act. Any such reduction 
        shall be made on the basis of the number of days for which the 
        patient received the inpatient care.
         (6) The Secretary shall provide to each eligible patient such 
    information and time as may be necessary for the patient to make an 
    informed decision regarding the options under paragraph (5)(A).
         (7) After the date of the enactment of this Act, the Center may 
    not provide long-term care for any individual who as of such date 
    was not receiving such care as a patient of the Center.
         (8) If upon completion of the projects referred to in 
    subsection (d)(4)(A) there are unobligated balances of amounts 
    appropriated for the projects, such balances are available to the 
    Secretary for expenses relating to the relocation of the Center, 
    except that, if the sum of such balances is in excess of $100,000, 
    such excess is available to the State in accordance with subsection 
    (d)(4)(B). The amounts available to the Secretary pursuant to the 
    preceding sentence are available until expended.
     (g) For purposes of this section:
         (1) The term ``Center'' means the Gillis W. Long Hansen's 
    Disease Center.
         (2) The term ``Secretary'' means the Secretary of Health and 
    Human Services.
         (3) The term ``State'' means the State of Louisiana.
     (h) Section 320 of the Public Health Service Act (42 U.S.C. 247e) 
is amended by striking the section designation and all that follows and 
inserting the following:
     ``Sec. 320. (a)(1) At or through the Gillis W. Long Hansen's 
Disease Center (located in the State of Louisiana), the Secretary shall 
without charge provide short-term care and treatment, including 
outpatient care, for Hansen's disease and related complications to any 
person determined by the Secretary to be in need of such care and 
treatment. The Secretary may not at or through such Center provide long-
term care for any such disease or complication.
     ``(2) The Center referred to in paragraph (1) shall conduct 
training in the diagnosis and management of Hansen's disease and related 
complications, and shall conduct and promote the coordination of 
research (including clinical research), investigations, demonstrations, 
and studies relating to the causes, diagnosis, treatment, control, and 
prevention of Hansen's disease and other mycobacterial diseases and 
complications related to such diseases.
     ``(3) Paragraph (1) is subject to section 211 of the Department of 
Health and Human Services Appropriations Act, 1998.
     ``(b) In addition to the Center referred to in subsection (a), the 
Secretary may establish sites regarding persons with Hansen's disease. 
Each such site shall provide for the outpatient care and treatment for 
Hansen's disease and related complications to any person determined by 
the Secretary to be in need of such care and treatment.
     ``(c) The Secretary shall carry out subsections (a) and (b) acting 
through an agency of the Service. For purposes of the preceding 
sentence, the agency designated by the Secretary shall carry out both 
activities relating to the provision of health services and activities 
relating to the conduct of research.
     ``(d) The Secretary shall make payments to the Board of Health of 
the State of Hawaii for the care and treatment (including out

[[Page 436]]

patient care) in its facilities of persons suffering from Hansen's 
disease at a rate determined by the Secretary. The rate shall be 
approximately equal to the operating cost per patient of such 
facilities, except that the rate may not exceed the comparable costs per 
patient with Hansen's disease for care and treatment provided by the 
Center referred to in subsection (a). Payments under this subsection are 
subject to the availability of appropriations for such purpose.''.]
    Sec. [212] 208. None of the funds appropriated in the Act may be 
made available to any entity under title X of the Public Health Service 
Act unless the applicant for the award certifies to the Secretary that 
it encourages family participation in the decision of minors to seek 
family planning services and that it provides counseling to minors on 
how to resist attempts to coerce minors into engaging in sexual 
activities.

   [comprehensive independent study of nih research priority setting]

    [Sec. 213. (a) Study by the Institute of Medicine.--Not later than 
30 days after the date of enactment of this Act, the Secretary of Health 
and Human Services shall enter into a contract with the Institute of 
Medicine to conduct a comprehensive study of the policies and process 
used by the National Institutes of Health to determine funding 
allocations for biomedical research.
     (b) Matters To Be Assessed.--The study under subsection (a) shall 
assess--
         (1) the factors or criteria used by the National Institutes of 
    Health to determine funding allocations for disease research;
         (2) the process by which research funding decisions are made;
         (3) the mechanisms for public input into the priority setting 
    process; and
         (4) the impact of statutory directives on research funding 
    decisions.
     (c) Report.--
         (1) In general.--Not later than 6 months after the date on 
    which the Secretary of Health and Human Services enters into the 
    contract under subsection (a), the Institute of Medicine shall 
    submit a report concerning the study to the Committee on Labor and 
    Human Resources and the Committee on Appropriations of the Senate, 
    and the Committee on Commerce and the Committee on Appropriations of 
    the House of Representatives.
         (2) Requirement.--The report under paragraph (1) shall set 
    forth the findings, conclusions, and recommendations of the 
    Institute of Medicine for improvements in the National Institutes of 
    Health research funding policies and processes and for any necessary 
    congressional action.] (Department of Health and Human Services 
    Appropriations Act, 1998.)