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