[Appendix]
[Detailed Budget Estimates by Agency]
[Department of Health and Human Services]
[From the U.S. Government Publishing Office, www.gpo.gov]
<h1>DEPARTMENT OF HEALTH AND HUMAN SERVICES
</h1>
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
Federal Funds
Salaries and expenses
For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; 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; for rental of special purpose space in the District of Columbia or elsewhere; 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; and notwithstanding section 521 of Public Law 107–188; $2,527,960,000: Provided, That of the amount provided under this heading, $24,142,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j–12, and shall be credited to this account and remain available until expended; $12,100,000 shall be derived from animal generic drug user fees authorized by 21 U.S.C. 379j-21, and shall be credited to this account
and remain available until expended; $672,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain
available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for animal drug user fees and animal generic drug user fees that exceed the respective fiscal year 2018 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from animal drug and animal generic drug assessments for fiscal year 2018, including any such fees collected prior to fiscal year 2018 but credited for fiscal year 2018, shall be subject to the fiscal year 2018 limitations: Provided further, That the Secretary may accept payment during fiscal year 2018 of user fees specified under this heading and authorized for fiscal year 2019, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2019 for which the Secretary accepts payment in fiscal year 2018 shall not be included in amounts under this heading: 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: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided
for, as determined by the Commissioner: Provided further, That funds may be transferred from one specified activity to another with the prior notification of the Committees on Appropriations of both Houses of Congress.
In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381,
priority review user fees authorized by 21 U.S.C. 360n and 360ff, food and feed recall fees, food reinspection fees, and voluntary
qualified importer program fees authorized by 21 U.S.C. 379j-31, outsourcing facility fees authorized by 21 U.S.C. 379j-62,
prescription drug wholesale distributor licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), third-party logistics provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), third-party auditor fees authorized by 21 U.S.C. 384d(c)(8), and Medical Countermeasure Priority Review Voucher User Fees authorized by 21 U.S.C. 360bbb-4a, shall be credited to this account, to remain available until expended.
Buildings and facilities
For plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided,
$8,771,000, to remain available until expended.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–9911–0–1–554
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
1
1
2
Receipts:
Current law:
1130
Cooperative Research and Development Agreements, FDA
2
3
3
2000
Total: Balances and receipts
3
4
5
Appropriations:
Current law:
2101
Salaries and Expenses
–2
–2
–2
5099
Balance, end of year
1
2
3
Program and Financing (in millions of dollars)
Identification code 075–9911–0–1–554
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Foods
1,002
985
910
0002
Human Drugs
491
491
179
0003
Devices and Radiological Health
323
323
140
0004
National Center for Toxicological Research
63
63
60
0005
FDA Other Activities (FDA Headquaters)
182
183
125
0006
FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)
121
121
73
0007
FDA GSA Rental Payments
162
176
128
0008
FDA Buildings and Facilities
8
9
9
0009
Cooperative Research and Development (CRADA)
2
2
2
0010
Animal Drugs and Feed
159
158
108
0011
Biologics
215
215
96
0012
Food and Drug Safety (no-year)
2
0013
Ebola (Emergency pursuant to 2011 BCA)
9
0014
Zika Activities
2
0015
CURES Act
20
60
0799
Total direct obligations
2,741
2,746
1,890
0801
FDA Reimbursable program (User fees)
1,930
1,908
757
0802
FDA Reimbursable program (Federal sources)
40
0899
Total reimbursable obligations
1,970
1,908
757
0900
Total new obligations, unexpired accounts
4,711
4,654
2,647
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
948
1,117
1,116
1001
Discretionary unobligated balance brought fwd, Oct 1
948
1,117
1021
Recoveries of prior year unpaid obligations
17
1050
Unobligated balance (total)
965
1,117
1,116
Budget authority:
Appropriations, discretionary:
1100
Appropriation
2,730
2,724
1,828
1120
Appropriations transferred to other accts [075–0128]
–2
–1
1121
Appropriations transferred from other acct [075–5629]
20
60
1160
Appropriation, discretionary (total)
2,728
2,743
1,888
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
2
2
2
Spending authority from offsetting collections, discretionary:
1700
Collected
2,108
1,908
761
1700
Collected
33
1701
Change in uncollected payments, Federal sources
33
–33
1702
Offsetting collections (previously unavailable)
615
333
1723
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–4
1725
Spending authority from offsetting collections precluded from obligation (limitation on obligations)
–620
–333
1750
Spending auth from offsetting collections, disc (total)
2,136
1,904
761
Spending authority from offsetting collections, mandatory:
1800
Collected
1
4
1801
Change in uncollected payments, Federal sources
4
1850
Spending auth from offsetting collections, mand (total)
5
4
1900
Budget authority (total)
4,871
4,653
2,651
1930
Total budgetary resources available
5,836
5,770
3,767
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–8
1941
Unexpired unobligated balance, end of year
1,117
1,116
1,120
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
2,781
2,710
2,721
3010
New obligations, unexpired accounts
4,711
4,654
2,647
3011
Obligations ("upward adjustments"), expired accounts
20
3020
Outlays (gross)
–4,693
–4,643
–2,840
3040
Recoveries of prior year unpaid obligations, unexpired
–17
3041
Recoveries of prior year unpaid obligations, expired
–92
3050
Unpaid obligations, end of year
2,710
2,721
2,528
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–59
–71
–38
3070
Change in uncollected pymts, Fed sources, unexpired
–37
33
3071
Change in uncollected pymts, Fed sources, expired
25
3090
Uncollected pymts, Fed sources, end of year
–71
–38
–38
Memorandum (non-add) entries:
3100
Obligated balance, start of year
2,722
2,639
2,683
3200
Obligated balance, end of year
2,639
2,683
2,490
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
4,864
4,647
2,649
Outlays, gross:
4010
Outlays from new discretionary authority
2,654
3,631
1,967
4011
Outlays from discretionary balances
2,032
1,006
871
4020
Outlays, gross (total)
4,686
4,637
2,838
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–28
–33
4033
Non-Federal sources
–2,098
–1,908
–761
4040
Offsets against gross budget authority and outlays (total)
–2,126
–1,941
–761
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–33
33
4052
Offsetting collections credited to expired accounts
18
4060
Additional offsets against budget authority only (total)
–15
33
4070
Budget authority, net (discretionary)
2,723
2,739
1,888
4080
Outlays, net (discretionary)
2,560
2,696
2,077
Mandatory:
4090
Budget authority, gross
7
6
2
Outlays, gross:
4100
Outlays from new mandatory authority
5
6
2
4101
Outlays from mandatory balances
2
4110
Outlays, gross (total)
7
6
2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–4
4123
Non-Federal sources
–1
4130
Offsets against gross budget authority and outlays (total)
–1
–4
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–4
4160
Budget authority, net (mandatory)
2
2
2
4170
Outlays, net (mandatory)
6
2
2
4180
Budget authority, net (total)
2,725
2,741
1,890
4190
Outlays, net (total)
2,566
2,698
2,079
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
638
643
647
5092
Unexpired unavailable balance, EOY: Offsetting collections
643
647
647
The Food and Drug Administration (FDA) promotes and protects public health by overseeing the safety, efficacy, quality, and
security of human and veterinary drugs, biological products, medical devices, foods, cosmetics, and products that emit radiation.
FDA also has responsibility for regulating the manufacturing, marketing, and distribution of tobacco products to protect public
health and to reduce tobacco use by minors. FDA advances public health by helping to speed innovations that make medicines
more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need
to use medicines and foods to maintain and improve their health. FDA supports the Nation's counterterrorism capability by
ensuring the security of the food supply and by fostering the development of medical products and countermeasures to respond
to deliberate and naturally emerging public health threats. The FY 2018 Budget provides funding to support food and medical
product safety, including implementation of the 21st Century Cures Act. The budget also includes a package of administrative
actions designed to achieve regulatory efficiency and speed the development of safe and effective medical products.
Object Classification (in millions of dollars)
Identification code 075–9911–0–1–554
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
910
886
613
11.3
Other than full-time permanent
92
90
62
11.5
Other personnel compensation
40
39
27
11.7
Military personnel
64
63
64
11.8
Special personal services payments
1
1
1
11.9
Total personnel compensation
1,107
1,079
767
12.1
Civilian personnel benefits
338
330
228
12.2
Military personnel benefits
33
32
33
13.0
Benefits for former personnel
1
21.0
Travel and transportation of persons
50
51
33
22.0
Transportation of things
3
3
2
23.1
Rental payments to GSA
162
176
128
23.2
Rental payments to others
3
3
2
23.3
Communications, utilities, and miscellaneous charges
19
19
12
24.0
Printing and reproduction
2
2
1
25.1
Advisory and assistance services
57
55
36
25.2
Other services from non-Federal sources
361
372
242
25.3
Other goods and services from Federal sources
135
139
91
25.4
Operation and maintenance of facilities
104
108
70
25.5
Research and development contracts
20
20
13
25.7
Operation and maintenance of equipment
91
94
61
26.0
Supplies and materials
47
48
31
31.0
Equipment
47
48
31
32.0
Land and structures
3
3
2
41.0
Grants, subsidies, and contributions
156
162
105
42.0
Insurance claims and indemnities
2
2
2
99.0
Direct obligations
2,741
2,746
1,890
99.0
Reimbursable obligations
1,970
1,908
757
99.9
Total new obligations, unexpired accounts
4,711
4,654
2,647
Employment Summary
Identification code 075–9911–0–1–554
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
9,605
9,768
6,663
1101
Direct military average strength employment
692
703
703
2001
Reimbursable civilian full-time equivalent employment
5,737
6,163
1,292
2101
Reimbursable military average strength employment
413
420
56
3001
Allocation account civilian full-time equivalent employment
43
43
43
3101
Allocation account military average strength employment
1
1
1
Salaries and Expenses
(Legislative proposal, not subject to PAYGO)
Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for prescription drug review activities,
medical device review activities, biosimilar biological products review activities, and human generic drugs review activities:
Provided, That fees of $1,262,182,000, for prescription drug reviews, shall be credited to this account and remain available
until expended; $439,001,000 for medical device reviews, shall be credited to this account and remain available until expended;
$615,746,000 for human generic drug reviews, shall be credited to this account and remain available until expended; and $86,736,000
for biosimilar biological product reviews, shall be credited to this account and remain available until expended: Provided
further, That, in addition and notwithstanding any other provision under this heading, amounts collected for prescription
drug user fees, medical device user fees, biosimilar biological product user fees, and human generic drug user fees that exceed
the respective fiscal year 2018 limitations are appropriated and shall be credited to this account and remain available until
expended: Provided further, That fees derived from prescription drug reviews, medical device reviews, biosimilar biological
products reviews, and human generic drugs reviews for fiscal year 2018 received during fiscal year 2018, including any such
fees assessed prior to fiscal year 2018 but credited for fiscal year 2018, shall be subject to the fiscal year 2018 limitations:
Provided further, That the Secretary may accept payment during fiscal year 2018 of user fees specified in this paragraph and
authorized for fiscal year 2019, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year
2019 for which the Secretary accepts payment in fiscal year 2018 shall not be included in amounts in this paragraph.
In addition, contingent upon the enactment of authorizing legislation, the Secretary shall increase the fees for animal drug
review activities and animal generic drug review activities: Provided, That additional fees of $46,110,000, for animal drug
reviews, shall be credited to this account and remain available until expended; and $6,375,000, for animal generic drug reviews,
shall be credited to this account and remain available until expended.
Program and Financing (in millions of dollars)
Identification code 075–9911–2–1–554
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
Reimbursable program (User fees)
2,458
0899
Total reimbursable obligations
2,458
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700
Collected
2,458
1900
Budget authority (total)
2,458
1930
Total budgetary resources available
2,458
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
2,458
3020
Outlays (gross)
–2,458
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
2,458
Outlays, gross:
4010
Outlays from new discretionary authority
2,458
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033
Non-Federal sources
–2,458
4040
Offsets against gross budget authority and outlays (total)
–2,458
4180
Budget authority, net (total)
4190
Outlays, net (total)
The FY 2018 Budget includes proposals to reauthorize expiring fee programs and amend currently authorized fee programs. The
Budget includes a total of $1.3 billion in prescription drug fees, $439 million in medical device fees, $616 million in human
generic drug fees, and $87 million in biosimilar user fees. The proposed legislation authorizes the collection and spending
of these fees subject to appropriations. FDA also proposes to increase animal drug user fees by $46 million and animal generic
drug user fees by $7 million in their final year of authorization.
Object Classification (in millions of dollars)
Identification code 075–9911–2–1–554
2016 actual
2017 est.
2018 est.
Reimbursable obligations:
Personnel compensation:
11.1
Full-time permanent
720
11.3
Other than full-time permanent
102
11.5
Other personnel compensation
77
11.7
Military personnel
32
11.9
Total personnel compensation
931
12.1
Civilian personnel benefits
278
12.2
Military personnel benefits
18
21.0
Travel and transportation of persons
16
23.1
Rental payments to GSA
92
23.3
Communications, utilities, and miscellaneous charges
4
24.0
Printing and reproduction
3
25.1
Advisory and assistance services
74
25.2
Other services from non-Federal sources
467
25.3
Other goods and services from Federal sources
262
25.4
Operation and maintenance of facilities
31
25.5
Research and development contracts
18
25.7
Operation and maintenance of equipment
44
26.0
Supplies and materials
17
31.0
Equipment
27
41.0
Grants, subsidies, and contributions
176
99.0
Reimbursable obligations
2,458
99.9
Total new obligations, unexpired accounts
2,458
Employment Summary
Identification code 075–9911–2–1–554
2016 actual
2017 est.
2018 est.
2001
Reimbursable civilian full-time equivalent employment
8,456
2101
Reimbursable military average strength employment
364
Payment to the FDA Innovation Account, CURES Act
Program and Financing (in millions of dollars)
Identification code 075–0148–0–1–554
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Direct program activity
20
60
0900
Total new obligations, unexpired accounts (object class 94.0)
20
60
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
20
60
1930
Total budgetary resources available
20
60
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
20
60
3020
Outlays (gross)
–20
–60
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
20
60
Outlays, gross:
4100
Outlays from new mandatory authority
20
60
4180
Budget authority, net (total)
20
60
4190
Outlays, net (total)
20
60
This account, and a related special receipt account, were established to support the execution structure necessary to implement
the 21st Century Cures Act.
FDA Innovation, CURES Act
For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition
to amounts available for such purposes under the heading "Salaries and Expenses", $60,000,000, to remain available until expended:
Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century
Cures Act, are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the
Secretary of Health and Human Services to other accounts of the Department solely for the purposes provided in such Act: Provided
further, That such transfer authority is in addition to any other transfer authority provided by law.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5629–0–2–554
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
Receipts:
Current law:
1140
General Fund Payment, FDA Innovation, CURES Act
20
60
2000
Total: Balances and receipts
20
60
Appropriations:
Current law:
2101
FDA Innovation, Cures Act
–20
–60
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–5629–0–2–554
2016 actual
2017 est.
2018 est.
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
20
60
1120
Appropriations transferred to other acct [075–9911]
–20
–60
4180
Budget authority, net (total)
4190
Outlays, net (total)
The 21st Century Cures Act was enacted into law on December 13, 2016. The Act includes authorities FDA can use to help modernize
drug, biological, and device product development and review, and to create greater efficiencies and predictability in product
development and review.
Revolving Fund for Certification and Other Services
Program and Financing (in millions of dollars)
Identification code 075–4309–0–3–554
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
Revolving Fund for Certification and Other Services (Reimbursable)
9
10
10
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
5
5
5
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
9
10
9
1802
Offsetting collections (previously unavailable)
1
1
1
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–1
–1
1850
Spending auth from offsetting collections, mand (total)
9
10
10
1900
Budget authority (total)
9
10
10
1930
Total budgetary resources available
14
15
15
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
5
5
5
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
2
2
2
3010
New obligations, unexpired accounts
9
10
10
3020
Outlays (gross)
–9
–10
–10
3050
Unpaid obligations, end of year
2
2
2
Memorandum (non-add) entries:
3100
Obligated balance, start of year
2
2
2
3200
Obligated balance, end of year
2
2
2
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
9
10
10
Outlays, gross:
4100
Outlays from new mandatory authority
3
10
10
4101
Outlays from mandatory balances
6
4110
Outlays, gross (total)
9
10
10
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–9
–10
–9
4180
Budget authority, net (total)
1
4190
Outlays, net (total)
1
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
1
1
1
5092
Unexpired unavailable balance, EOY: Offsetting collections
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. These services are financed wholly by fees paid by the industries affected.
Object Classification (in millions of dollars)
Identification code 075–4309–0–3–554
2016 actual
2017 est.
2018 est.
Reimbursable obligations:
11.1
Personnel compensation: Full-time permanent
4
5
5
12.1
Civilian personnel benefits
1
1
1
23.1
Rental payments to GSA
1
1
1
25.7
Operation and maintenance of equipment
1
1
1
26.0
Supplies and materials
1
1
1
31.0
Equipment
1
1
1
99.9
Total new obligations, unexpired accounts
9
10
10
Employment Summary
Identification code 075–4309–0–3–554
2016 actual
2017 est.
2018 est.
2001
Reimbursable civilian full-time equivalent employment
36
36
36
Health Resources and Services Administration
Federal Funds
Primary health care
For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect
to primary health care and the Native Hawaiian Health Care Act of 1988, $1,488,687,000: Provided, That no more than $100,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $99,703,000 shall be available until expended for carrying out subsections (g) through (n) and (q) of section 224 of the PHS Act, and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS") pertaining to administrative
claims made under such law.
Health workforce
For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $382,631,000: Provided, That sections 751 and 762(k) of the PHS Act shall not apply to funds made available under this heading: Provided further, That fees collected for the disclosure of information under section 427(b) of the Health Care Quality Improvement Act of
1986 and sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover the full costs of operating
the programs authorized by such sections and shall remain available until expended for the National Practitioner Data Bank:
Provided further, That funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may
be used to make prior year adjustments to awards made under such sections.
maternal and child health
For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social
Security Act, and section 712 of the American Jobs Creation Act of 2004, $795,290,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $76,946,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2)
of such Act and $10,256,000 shall be available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such Act.
Ryan white HIV/AIDS program
For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,260,008,000, of which $1,967,134,000 shall remain available to the Secretary of Health and Human Services (referred to in this title as the "Secretary") through September 30, 2020, for parts A and B of title XXVI of the PHS Act, and of which not less than $898,602,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That section 2691 of the PHS Act shall not apply to funds appropriated under this heading.
health care systems
For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and
Research Act of 2005, $99,351,000.
Rural health
For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
and Safety Act of 1969, and section 711 of the Social Security Act, $74,395,000.
Family Planning
For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $286,479,000: Provided, 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.
program management
For program support in the Health Resources and Services Administration, $151,993,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings
"Primary Health Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program", "Health Care Systems",
and "Rural Health".
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0350–0–1–550
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0005
Primary Health Care (Health Centers, Free Clinics)
1,492
1,489
1,489
0010
Primary Health Care (Mandatory)
3,651
3,607
2
0015
Health Workforce
785
785
383
0020
Health Workforce (Mandatory)
368
367
0025
Maternal and Child Health
843
859
795
0030
Maternal and Child Health (Mandatory)
5
5
0035
Ryan White HIV/AIDS
2,266
2,396
2,260
0040
Health Care Systems
103
103
99
0045
Rural Health
151
149
74
0050
Family Planning
286
286
286
0055
HRSA Program Management
154
154
152
0300
Total direct programs
10,104
10,200
5,540
0799
Total direct obligations
10,104
10,200
5,540
0801
Health Resources and Services (Reimbursable)
57
58
47
0899
Total reimbursable obligations
57
58
47
0900
Total new obligations, unexpired accounts
10,161
10,258
5,587
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
406
482
273
1001
Discretionary unobligated balance brought fwd, Oct 1
141
211
1012
Unobligated balance transfers between expired and unexpired accounts
1
1020
Adjustment of unobligated bal brought forward, Oct 1
2
1021
Recoveries of prior year unpaid obligations
80
1031
Other balances not available
–1
1050
Unobligated balance (total)
488
482
273
Budget authority:
Appropriations, discretionary:
1100
Appropriation
6,140
6,143
5,539
1120
Appropriations transferred to other acct [075–0140]
–7
1160
Appropriation, discretionary (total)
6,133
6,143
5,539
Appropriations, mandatory:
1200
Appropriation
3,975
3,975
1220
Appropriations transferred to other acct [015–5606]
–5
–5
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–115
1260
Appropriations, mandatory (total)
3,970
3,855
Spending authority from offsetting collections, discretionary:
1700
Collected
24
31
26
1701
Change in uncollected payments, Federal sources
12
1750
Spending auth from offsetting collections, disc (total)
36
31
26
Spending authority from offsetting collections, mandatory:
1800
Offsetting collections (cash)(HPSL&NSL)
24
19
19
1802
Offsetting collections (previously unavailable)
1
2
1
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–2
–1
1850
Spending auth from offsetting collections, mand (total)
23
20
20
1900
Budget authority (total)
10,162
10,049
5,585
1930
Total budgetary resources available
10,650
10,531
5,858
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–7
1941
Unexpired unobligated balance, end of year
482
273
271
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
7,399
7,701
8,229
3010
New obligations, unexpired accounts
10,161
10,258
5,587
3011
Obligations ("upward adjustments"), expired accounts
19
3020
Outlays (gross)
–9,674
–9,730
–8,623
3040
Recoveries of prior year unpaid obligations, unexpired
–80
3041
Recoveries of prior year unpaid obligations, expired
–124
3050
Unpaid obligations, end of year
7,701
8,229
5,193
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–36
–22
–22
3070
Change in uncollected pymts, Fed sources, unexpired
–12
3071
Change in uncollected pymts, Fed sources, expired
26
3090
Uncollected pymts, Fed sources, end of year
–22
–22
–22
Memorandum (non-add) entries:
3100
Obligated balance, start of year
7,363
7,679
8,207
3200
Obligated balance, end of year
7,679
8,207
5,171
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
6,169
6,174
5,565
Outlays, gross:
4010
Outlays from new discretionary authority
1,938
1,953
1,733
4011
Outlays from discretionary balances
3,987
3,993
4,265
4020
Outlays, gross (total)
5,925
5,946
5,998
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–27
–13
–8
4033
Non-Federal sources
–23
–18
–18
4040
Offsets against gross budget authority and outlays (total)
–50
–31
–26
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–12
4052
Offsetting collections credited to expired accounts
26
4060
Additional offsets against budget authority only (total)
14
4070
Budget authority, net (discretionary)
6,133
6,143
5,539
4080
Outlays, net (discretionary)
5,875
5,915
5,972
Mandatory:
4090
Budget authority, gross
3,993
3,875
20
Outlays, gross:
4100
Outlays from new mandatory authority
1,480
1,537
20
4101
Outlays from mandatory balances
2,269
2,247
2,605
4110
Outlays, gross (total)
3,749
3,784
2,625
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–24
–19
–19
4180
Budget authority, net (total)
10,102
9,999
5,540
4190
Outlays, net (total)
9,600
9,680
8,578
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
1
2
1
5092
Unexpired unavailable balance, EOY: Offsetting collections
2
1
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
10,102
9,999
5,540
Outlays
9,600
9,680
8,578
Legislative proposal, subject to PAYGO:
Budget Authority
3,970
Outlays
1,561
Total:
Budget Authority
10,102
9,999
9,510
Outlays
9,600
9,680
10,139
Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
Identification code 075–0350–0–1–550
2016 actual
2017 est.
2018 est.
Guaranteed loan levels supportable by subsidy budget authority:
215001
Health centers: Facilities renovation loan guarantee levels
9
3
3
215999
Total loan guarantee levels
9
3
3
Guaranteed loan subsidy (in percent):
232001
Health centers: Facilities renovation loan guarantee levels
2.67
2.65
2.69
232999
Weighted average subsidy rate
2.67
2.65
2.69
Guaranteed loan reestimates:
235001
Health centers: Facilities renovation loan guarantee levels
–1
235999
Total guaranteed loan reestimates
–1
Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce training,
maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, and the medical
malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free
clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program.
HRSA Program Activity Crosswalk FY 2018 President's Budget to FY 2017 President's Budget Dollars in Millions
FY 2018 Program Activities
FY 2017 Program Activities
FY 2016 Obligations
FY 2017 Obligations
FY 2018 Obligations
0005 Primary Health Care (Health Centers, Free Clinics)
1,492
1,489
1,489
Health Centers
1,390
1,389
1,389
Free Clinics Medical Malpractice
0
0
0
Health Centers Tort Claims
102
100
100
0010 Primary Health Care (Health Centers Mandatory)
3,651
3,607
2
Health Centers ACA
3,650
3,605
0
School Based Health Centers ACA
1
2
2
0015 Health Workforce
785
785
383
Health Workforce
407
407
5
Children's Hospital Graduate Medical Education
294
294
295
NURSE Corps Scholarship and Loan Repayment Program
83
83
83
Loan Repayment/Faculty Fellowships
1
1
0
0020 Health Workforce Mandatory
368
367
0
National Health Service Corps ACA
308
311
0
GME Payments THC ACA
60
56
0
0025 Maternal and Child Health
843
859
795
Maternal and Child Health Block Grant
637
637
667
Healthy Start
103
119
128
Emergency Medical Services for Children
20
20
0
James T. Walsh Universal Newborn Hearing Screening
18
18
0
Heritable Disorders
14
14
0
Autism and Other Developmental Disorders
47
47
0
Sickle Cell Service Demonstrations
4
4
0
0030 Maternal and Child Health Mandatory
5
5
0
Family to Family Health Information Centers ACA
5
5
0
0035 Ryan White HIV/AIDS
2,266
2,396
2,260
HIV/AIDS
2,266
2,396
2,260
0040 Health Care Systems
103
103
99
Organ Transplantation
24
24
24
C.W. Bill Young Cell Transplantation Program
22
22
22
Poison Control Centers
19
19
19
Hansen's Disease Center
15
15
11
Payment to Hawaii for the Treatment of Hansen's Disease
2
2
2
National Cord Blood Inventory
11
11
11
340 B Drug Pricing Program/Office of Pharmacy Affairs
10
10
10
0045 Rural Health
151
149
74
Rural Health Outreach Grants
64
63
50
Rural Hospital Flexibility Grants
42
42
0
Telehealth
17
17
10
State Offices of Rural Health
10
9
0
Rural Health Policy Development
9
9
5
Black Lung Clinics
7
7
7
Radiation Exposure Screening and Education Program
2
2
2
0050 Family Planning
286
286
286
Family Planning
286
286
286
0055 HRSA Program Management
154
154
152
Program Management
154
154
152
0801 Health Resources and Services (Reimbursable)
57
58
47
Health Resources and Services (Reimbursable)
0
0
0802 HRSA reimbursable program: PHS evaluation
0
0
0
Reimbursable program: PHS evaluation
0
0
0
HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL),
Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts
(Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are
awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans the programs revolving
account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If
the program's revolving account has excess funds that will not be used to provide new loans, these excess funds are returned
to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects
Academic Year 2015–2016 data reported in the Annual Operating Report.
Health Professions Revolving Loan Programs Federal Capital Contribution
Program
Account Balance
HPSL
412,794,283
NSL
186,799,617
PCL
247,553,867
LDS
154,323,482
Total
1,001,471,249
Object Classification (in millions of dollars)
Identification code 075–0350–0–1–550
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
177
199
146
11.3
Other than full-time permanent
8
8
5
11.5
Other personnel compensation
3
3
2
11.7
Military personnel
19
20
15
11.9
Total personnel compensation
207
230
168
12.1
Civilian personnel benefits
58
64
47
12.2
Military personnel benefits
11
11
9
21.0
Travel and transportation of persons
3
3
2
23.1
Rental payments to GSA
28
28
23
23.2
Rental payments to others
1
1
1
23.3
Communications, utilities, and miscellaneous charges
7
7
5
25.1
Advisory and assistance services
10
10
7
25.2
Other services from non-Federal sources
238
240
187
25.3
Other goods and services from Federal sources
292
278
152
25.4
Operation and maintenance of facilities
1
1
1
25.6
Medical care
3
3
25.7
Operation and maintenance of equipment
4
4
3
26.0
Supplies and materials
1
1
1
31.0
Equipment
9
9
6
41.0
Grants, subsidies, and contributions
9,138
9,219
4,837
42.0
Insurance claims and indemnities
93
91
91
99.0
Direct obligations
10,104
10,200
5,540
99.0
Reimbursable obligations
57
58
47
99.9
Total new obligations, unexpired accounts
10,161
10,258
5,587
Employment Summary
Identification code 075–0350–0–1–550
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
1,692
1,873
1,362
1101
Direct military average strength employment
187
207
160
2001
Reimbursable civilian full-time equivalent employment
51
58
53
2101
Reimbursable military average strength employment
4
4
4
Health Resources and Services
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0350–4–1–550
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0010
Primary Health Care (Mandatory)
3,595
0020
Health Workforce (Mandatory)
370
0030
Maternal and Child Health (Mandatory)
5
0300
Total direct programs
3,970
0900
Total new obligations, unexpired accounts
3,970
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
3,975
1220
Appropriations transferred to other acct [015–5606]
–5
1260
Appropriations, mandatory (total)
3,970
1900
Budget authority (total)
3,970
1930
Total budgetary resources available
3,970
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
3,970
3020
Outlays (gross)
–1,561
3050
Unpaid obligations, end of year
2,409
Memorandum (non-add) entries:
3200
Obligated balance, end of year
2,409
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
3,970
Outlays, gross:
4100
Outlays from new mandatory authority
1,561
4180
Budget authority, net (total)
3,970
4190
Outlays, net (total)
1,561
Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
activities include support for Health Centers, health workforce programs, and maternal and child health care services.
Object Classification (in millions of dollars)
Identification code 075–0350–4–1–550
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
49
11.3
Other than full-time permanent
2
11.5
Other personnel compensation
1
11.7
Military personnel
4
11.9
Total personnel compensation
56
12.1
Civilian personnel benefits
15
12.2
Military personnel benefits
2
23.1
Rental payments to GSA
5
23.3
Communications, utilities, and miscellaneous charges
2
25.2
Other services from non-Federal sources
37
25.3
Other goods and services from Federal sources
125
31.0
Equipment
2
41.0
Grants, subsidies, and contributions
3,726
99.9
Total new obligations, unexpired accounts
3,970
Employment Summary
Identification code 075–0350–4–1–550
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
425
1101
Direct military average strength employment
41
Vaccine Injury Compensation
Program and Financing (in millions of dollars)
Identification code 075–0320–0–1–551
2016 actual
2017 est.
2018 est.
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
27
29
29
1033
Recoveries of prior year paid obligations
2
1050
Unobligated balance (total)
29
29
29
1930
Total budgetary resources available
29
29
29
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
29
29
29
Budget authority and outlays, net:
Mandatory:
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–2
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
2
4170
Outlays, net (mandatory)
–2
4180
Budget authority, net (total)
4190
Outlays, net (total)
–2
The Vaccine Injury Compensation 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 claims yet to be
adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
in the Vaccine Injury Compensation Program trust fund account.
Covered Countermeasure Process Fund
Program and Financing (in millions of dollars)
Identification code 075–0343–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Claims
3
1
1
0103
Admin Expense
1
2
2
0900
Total new obligations, unexpired accounts
4
3
3
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
2
1011
Unobligated balance transfer from other acct [075–0140]
2
3
3
1050
Unobligated balance (total)
4
3
3
1930
Total budgetary resources available
4
3
3
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
2
2
3010
New obligations, unexpired accounts
4
3
3
3020
Outlays (gross)
–2
–3
–3
3050
Unpaid obligations, end of year
2
2
2
Memorandum (non-add) entries:
3100
Obligated balance, start of year
2
2
3200
Obligated balance, end of year
2
2
2
Budget authority and outlays, net:
Discretionary:
Outlays, gross:
4011
Outlays from discretionary balances
2
3
3
4180
Budget authority, net (total)
4190
Outlays, net (total)
2
3
3
The Covered Countermeasure Process Fund is established pursuant to the PHS Act, as amended by Division C of Public Law 109–148,
to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration
to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section
319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected claims that may arise under the Smallpox
Emergency Personnel Protection Act of 2003 (P.L. 108–20).
Object Classification (in millions of dollars)
Identification code 075–0343–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
1
1
25.2
Other services from non-Federal sources
1
1
1
42.0
Insurance claims and indemnities
2
1
1
99.0
Direct obligations
4
3
3
99.9
Total new obligations, unexpired accounts
4
3
3
Employment Summary
Identification code 075–0343–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
5
5
5
1101
Direct military average strength employment
1
1
1
Maternal, Infant, and Early Childhood Home Visiting Programs
Program and Financing (in millions of dollars)
Identification code 075–0321–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0010
Maternal, Infant, and Early Childhood Home Visiting Programs
391
405
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
16
37
4
1012
Unobligated balance transfers between expired and unexpired accounts
1
1021
Recoveries of prior year unpaid obligations
11
1050
Unobligated balance (total)
28
37
4
Budget authority:
Appropriations, mandatory:
1200
Appropriation
400
400
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–28
1260
Appropriations, mandatory (total)
400
372
1930
Total budgetary resources available
428
409
4
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
37
4
4
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
750
739
750
3010
New obligations, unexpired accounts
391
405
3020
Outlays (gross)
–390
–394
–375
3040
Recoveries of prior year unpaid obligations, unexpired
–11
3041
Recoveries of prior year unpaid obligations, expired
–1
3050
Unpaid obligations, end of year
739
750
375
Memorandum (non-add) entries:
3100
Obligated balance, start of year
750
739
750
3200
Obligated balance, end of year
739
750
375
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
400
372
Outlays, gross:
4100
Outlays from new mandatory authority
14
15
4101
Outlays from mandatory balances
376
379
375
4110
Outlays, gross (total)
390
394
375
4180
Budget authority, net (total)
400
372
4190
Outlays, net (total)
390
394
375
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
400
372
Outlays
390
394
375
Legislative proposal, subject to PAYGO:
Budget Authority
400
Outlays
16
Total:
Budget Authority
400
372
400
Outlays
390
394
391
The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These
activities are administered by HRSA.
Object Classification (in millions of dollars)
Identification code 075–0321–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
4
5
11.7
Military personnel
1
1
11.9
Total personnel compensation
5
6
12.1
Civilian personnel benefits
1
1
25.1
Advisory and assistance services
25
25
41.0
Grants, subsidies, and contributions
360
373
99.9
Total new obligations, unexpired accounts
391
405
Employment Summary
Identification code 075–0321–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
33
39
1101
Direct military average strength employment
5
5
Maternal, Infant, and Early Childhood Home Visiting Programs
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0321–4–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0010
Maternal, Infant, and Early Childhood Home Visiting Programs
400
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
400
1930
Total budgetary resources available
400
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
400
3020
Outlays (gross)
–16
3050
Unpaid obligations, end of year
384
Memorandum (non-add) entries:
3200
Obligated balance, end of year
384
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
400
Outlays, gross:
4100
Outlays from new mandatory authority
16
4180
Budget authority, net (total)
400
4190
Outlays, net (total)
16
The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These
activities are administered by HRSA.
Object Classification (in millions of dollars)
Identification code 075–0321–4–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
5
11.7
Military personnel
1
11.9
Total personnel compensation
6
12.1
Civilian personnel benefits
1
25.1
Advisory and assistance services
25
41.0
Grants, subsidies, and contributions
368
99.9
Total new obligations, unexpired accounts
400
Employment Summary
Identification code 075–0321–4–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
39
1101
Direct military average strength employment
5
Health Center Guaranteed Loan Financing Account
Program and Financing (in millions of dollars)
Identification code 075–4442–0–3–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
Credit program obligations:
0711
Default claim payments on principal
1
0742
Downward reestimates paid to receipt accounts
1
0900
Total new obligations, unexpired accounts
2
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
2
2
1930
Total budgetary resources available
2
2
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
2
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
2
3010
New obligations, unexpired accounts
2
3050
Unpaid obligations, end of year
2
2
Memorandum (non-add) entries:
3100
Obligated balance, start of year
2
3200
Obligated balance, end of year
2
2
4180
Budget authority, net (total)
4190
Outlays, net (total)
Status of Guaranteed Loans (in millions of dollars)
Identification code 075–4442–0–3–551
2016 actual
2017 est.
2018 est.
Position with respect to appropriations act limitation on commitments:
2121
Limitation available from carry-forward
15
6
3
2143
Uncommitted limitation carried forward
–6
–3
2150
Total guaranteed loan commitments
9
3
3
2199
Guaranteed amount of guaranteed loan commitments
4
2
2
Cumulative balance of guaranteed loans outstanding:
2210
Outstanding, start of year
76
74
66
2231
Disbursements of new guaranteed loans
9
3
3
2251
Repayments and prepayments
–30
–10
–10
Adjustments:
2263
Terminations for default that result in claim payments
–1
–1
2264
Other adjustments, net
19
2290
Outstanding, end of year
74
66
58
Memorandum:
2299
Guaranteed amount of guaranteed loans outstanding, end of year
57
50
44
Public Law 104–299 and Public Law 104–208 authorize Health Resources and Services Administration (HRSA) to guarantee up to
$160 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. 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 075–4442–0–3–551
2015 actual
2016 actual
ASSETS:
1101
Federal assets: Fund balances with Treasury
3
2
1999
Total assets
3
2
LIABILITIES:
2204
Non-Federal liabilities: Liabilities for loan guarantees
3
2
4999
Total liabilities and net position
3
2
Medical Facilities Guarantee and Loan Fund
Status of Direct Loans (in millions of dollars)
Identification code 075–9931–0–3–551
2016 actual
2017 est.
2018 est.
Cumulative balance of direct loans outstanding:
1210
Outstanding, start of year
6
6
6
1290
Outstanding, end of year
6
6
6
Titles VI and XVI of the PHS 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 the
event of default, $30 million as a revolving fund for direct loans, and an amount for interest subsidy payments on guaranteed
loans.
Balance Sheet (in millions of dollars)
Identification code 075–9931–0–3–551
2015 actual
2016 actual
ASSETS:
1601
Direct loans, gross
6
6
1999
Total assets
6
6
LIABILITIES:
2201
Non-Federal liabilities: Accounts payable
6
6
4999
Total liabilities and net position
6
6
Trust Funds
Vaccine injury compensation program trust fund
For payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for
claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant
to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $9,200,000 shall be available from the Trust Fund to the Secretary.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–8175–0–7–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
3,452
3,571
3,691
0198
Rounding adjustment
1
0199
Balance, start of year
3,453
3,571
3,691
Receipts:
Current law:
1110
Deposits, Vaccine Injury Compensation Trust Fund
291
293
300
1140
Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
99
110
135
1199
Total current law receipts
390
403
435
1999
Total receipts
390
403
435
2000
Total: Balances and receipts
3,843
3,974
4,126
Appropriations:
Current law:
2101
Vaccine Injury Compensation Program Trust Fund
–22
–23
–27
2101
Vaccine Injury Compensation Program Trust Fund
–253
–260
–268
2199
Total current law appropriations
–275
–283
–295
2999
Total appropriations
–275
–283
–295
Special and trust fund receipts returned:
3010
Vaccine Injury Compensation Program Trust Fund
1
5098
Rounding adjustment
2
5099
Balance, end of year
3,571
3,691
3,831
Program and Financing (in millions of dollars)
Identification code 075–8175–0–7–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Compensation: Claims for post - FY 1989 injuries
253
260
268
0103
Claims processing (Claims Court)
5
6
9
0104
Claims processing (HRSA)
8
8
9
0105
Claims processing (Dept. of Justice)
9
9
9
0191
Direct program activities, subtotal
22
23
27
0900
Total new obligations, unexpired accounts
275
283
295
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
1
1
1001
Discretionary unobligated balance brought fwd, Oct 1
1
1021
Recoveries of prior year unpaid obligations
2
1030
Other balances withdrawn to special or trust funds
–1
1033
Recoveries of prior year paid obligations
3
1035
Unobligated balance of appropriations withdrawn
–3
1050
Unobligated balance (total)
1
1
1
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
22
23
27
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
253
260
268
1900
Budget authority (total)
275
283
295
1930
Total budgetary resources available
276
284
296
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1
1
1
Special and non-revolving trust funds:
1950
Other balances withdrawn and returned to unappropriated receipts
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
15
12
3010
New obligations, unexpired accounts
275
283
295
3020
Outlays (gross)
–276
–295
–295
3040
Recoveries of prior year unpaid obligations, unexpired
–2
3050
Unpaid obligations, end of year
12
Memorandum (non-add) entries:
3100
Obligated balance, start of year
15
12
3200
Obligated balance, end of year
12
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
22
23
27
Outlays, gross:
4010
Outlays from new discretionary authority
18
23
27
4011
Outlays from discretionary balances
5
12
4020
Outlays, gross (total)
23
35
27
Mandatory:
4090
Budget authority, gross
253
260
268
Outlays, gross:
4100
Outlays from new mandatory authority
253
260
268
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–3
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
3
4160
Budget authority, net (mandatory)
253
260
268
4170
Outlays, net (mandatory)
250
260
268
4180
Budget authority, net (total)
275
283
295
4190
Outlays, net (total)
273
295
295
Memorandum (non-add) entries:
5000
Total investments, SOY: Federal securities: Par value
3,453
3,605
3,718
5001
Total investments, EOY: Federal securities: Par value
3,605
3,718
3,854
The Vaccine Injury Compensation 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 075–8175–0–7–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
2
2
2
12.1
Civilian personnel benefits
1
1
1
25.3
Other goods and services from Federal sources
4
4
4
42.0
Insurance claims and indemnities
268
276
288
99.9
Total new obligations, unexpired accounts
275
283
295
Employment Summary
Identification code 075–8175–0–7–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
14
13
16
1101
Direct military average strength employment
4
6
6
Indian Health Service
Federal Funds
Indian health services
For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education
Assistance Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect
to the Indian Health Service, $3,574,365,000, together with payments received during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b, 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, $914,139,000 for Purchased/Referred Care, including $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available
until expended: Provided further, That, of the funds provided, up to $36,000,000 shall remain available until expended for implementation of the loan repayment
program under section 108 of the Indian Health Care Improvement Act: Provided further, That, of the funds provided, $2,000,000 shall remain available until expended to supplement funds available for operational costs at tribal clinics operated under an Indian Self-Determination and Education
Assistance Act compact or contract where health care is delivered in space acquired through a full service lease, which is
not eligible for maintenance and improvement and equipment funds from the Indian Health Service, and $2,000,000 shall be for
accreditation emergencies: Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement
Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized
by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c)
of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs
under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a): Provided further, That, notwithstanding any other provision of law, the amounts made available within this account for the Substance Abuse and Suicide Prevention Program, for the Domestic Violence Prevention Program, to improve collections from public and private insurance at Indian Health Service and tribally operated facilities, and for
accreditation emergencies shall be allocated at the discretion of the Director of the Indian Health Service and shall remain
available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 fiscal years, provided the
total obligation is recorded in the year 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, except for those related to the planning, design, or
construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall
remain available until expended: 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 the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating
health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children
as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
Indian Health Facilities account.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0390–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Clinical services
3,237
3,231
3,252
0002
Preventive health
156
155
157
0003
Urban health
45
45
45
0004
Indian health professions
48
48
43
0005
Tribal management
2
2
0006
Direct operations
72
72
72
0007
Self-governance
6
6
5
0009
Diabetes funds
150
150
0799
Total direct obligations
3,716
3,709
3,574
0801
Indian Health Services (Reimbursable)
1,491
1,194
1,194
0900
Total new obligations, unexpired accounts
5,207
4,903
4,768
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
741
828
1,053
1001
Discretionary unobligated balance brought fwd, Oct 1
741
828
1021
Recoveries of prior year unpaid obligations
131
1050
Unobligated balance (total)
872
828
1,053
Budget authority:
Appropriations, discretionary:
1100
Appropriation
3,566
3,559
3,574
Appropriations, mandatory:
1200
Appropriation
150
150
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–3
1260
Appropriations, mandatory (total)
150
147
Spending authority from offsetting collections, discretionary:
1700
Collected
1,426
1,422
1,450
1701
Change in uncollected payments, Federal sources
30
1750
Spending auth from offsetting collections, disc (total)
1,456
1,422
1,450
1900
Budget authority (total)
5,172
5,128
5,024
1930
Total budgetary resources available
6,044
5,956
6,077
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–9
1941
Unexpired unobligated balance, end of year
828
1,053
1,309
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
917
984
542
3010
New obligations, unexpired accounts
5,207
4,903
4,768
3011
Obligations ("upward adjustments"), expired accounts
44
3020
Outlays (gross)
–5,031
–5,345
–5,028
3040
Recoveries of prior year unpaid obligations, unexpired
–131
3041
Recoveries of prior year unpaid obligations, expired
–22
3050
Unpaid obligations, end of year
984
542
282
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–67
–98
–98
3070
Change in uncollected pymts, Fed sources, unexpired
–30
3071
Change in uncollected pymts, Fed sources, expired
–1
3090
Uncollected pymts, Fed sources, end of year
–98
–98
–98
Memorandum (non-add) entries:
3100
Obligated balance, start of year
850
886
444
3200
Obligated balance, end of year
886
444
184
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
5,022
4,981
5,024
Outlays, gross:
4010
Outlays from new discretionary authority
4,038
4,340
4,381
4011
Outlays from discretionary balances
827
858
641
4020
Outlays, gross (total)
4,865
5,198
5,022
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–231
–271
–276
4033
Non-Federal sources
–1,196
–1,151
–1,174
4040
Offsets against gross budget authority and outlays (total)
–1,427
–1,422
–1,450
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–30
4052
Offsetting collections credited to expired accounts
1
4060
Additional offsets against budget authority only (total)
–29
4070
Budget authority, net (discretionary)
3,566
3,559
3,574
4080
Outlays, net (discretionary)
3,438
3,776
3,572
Mandatory:
4090
Budget authority, gross
150
147
Outlays, gross:
4100
Outlays from new mandatory authority
58
141
4101
Outlays from mandatory balances
108
6
6
4110
Outlays, gross (total)
166
147
6
4180
Budget authority, net (total)
3,716
3,706
3,574
4190
Outlays, net (total)
3,604
3,923
3,578
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
3,716
3,706
3,574
Outlays
3,604
3,923
3,578
Legislative proposal, subject to PAYGO:
Budget Authority
150
Outlays
144
Total:
Budget Authority
3,716
3,706
3,724
Outlays
3,604
3,923
3,722
The Indian Health Services account provides medical care, public health services, and health professions training opportunities
to American Indians and Alaska Natives. More than $2.2 billion, primarily through self-determination contracts and compacts,
will be administered by tribal governments in 2018.
Object Classification (in millions of dollars)
Identification code 075–0390–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
393
398
406
11.3
Other than full-time permanent
18
18
18
11.5
Other personnel compensation
58
59
60
11.7
Military personnel
66
67
68
11.9
Total personnel compensation
535
542
552
12.1
Civilian personnel benefits
156
158
161
12.2
Military personnel benefits
29
30
30
13.0
Benefits for former personnel
2
1
2
21.0
Patient travel
46
46
43
22.0
Transportation of things
6
6
6
23.1
Rental payments to GSA
16
16
15
23.2
Rental payments to others
1
1
1
23.3
Communications, utilities, and miscellaneous charges
14
14
13
25.1
Advisory and assistance services
5
5
5
25.2
Other services from non-Federal sources
106
106
101
25.3
Other goods and services from Federal sources
72
71
66
25.4
Operation and maintenance of facilities
2
2
2
25.6
Medical care
392
391
371
25.7
Operation and maintenance of equipment
12
12
10
25.8
Subsistence and support of persons
4
4
4
26.0
Supplies and materials
98
98
93
31.0
Equipment
13
13
12
41.0
Grants, subsidies, and contributions
2,207
2,193
2,087
99.0
Direct obligations
3,716
3,709
3,574
99.0
Reimbursable obligations
1,491
1,194
1,194
99.9
Total new obligations, unexpired accounts
5,207
4,903
4,768
Employment Summary
Identification code 075–0390–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
6,563
6,595
6,595
1101
Direct military average strength employment
963
968
968
2001
Reimbursable civilian full-time equivalent employment
5,460
5,460
5,460
2101
Reimbursable military average strength employment
802
802
802
Indian Health Services
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0390–4–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0009
Diabetes funds
150
0799
Total direct obligations
150
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
150
1930
Total budgetary resources available
150
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
150
3020
Outlays (gross)
–144
3050
Unpaid obligations, end of year
6
Memorandum (non-add) entries:
3200
Obligated balance, end of year
6
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
150
Outlays, gross:
4100
Outlays from new mandatory authority
144
4180
Budget authority, net (total)
150
4190
Outlays, net (total)
144
This activity supports evidence-based diabetes treatment and prevention services across Indian Country.
Object Classification (in millions of dollars)
Identification code 075–0390–4–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
21.0
Patient travel
2
23.1
Rental payments to GSA
1
25.2
Other services from non-Federal sources
5
25.3
Other goods and services from Federal sources
3
25.6
Medical care
20
25.7
Operation and maintenance of equipment
1
26.0
Supplies and materials
5
31.0
Equipment
1
41.0
Grants, subsidies, and contributions
112
99.0
Direct obligations
150
99.9
Total new obligations, unexpired accounts
150
Contract support costs
For payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education
Assistance Act agreements with the Indian Health Service for fiscal year 2018, such sums as may be necessary: Provided, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements
for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal
years: Provided further, That, notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer
to another budget account.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0344–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Contract Support Costs
670
716
718
0900
Total new obligations (object class 25.3)
670
716
718
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1100
Appropriation
670
716
718
1930
Total budgetary resources available
670
716
718
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
40
3010
New obligations, unexpired accounts
670
716
718
3020
Outlays (gross)
–630
–756
–718
3050
Unpaid obligations, end of year
40
Memorandum (non-add) entries:
3100
Obligated balance, start of year
40
3200
Obligated balance, end of year
40
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
670
716
718
Outlays, gross:
4010
Outlays from new discretionary authority
630
716
718
4011
Outlays from discretionary balances
40
4020
Outlays, gross (total)
630
756
718
4180
Budget authority, net (total)
670
716
718
4190
Outlays, net (total)
630
756
718
The Contract Support Costs account provides for the reasonable and allowable costs for direct program expenses for the operation
of, and any additional administrative or other expense related to, the overhead incurred by tribes and tribal organizations
who operate health programs through self-determination contracts and compacts. An estimated $718 million in contract support
costs funds will be provided to tribal governments and tribal organizations in 2018.
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, $446,956,000, to remain available until expended: Provided, That, notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation
or expansion of health facilities for the benefit of an Indian tribe or tribes may be used to purchase land on which such
facilities will be located: Provided further, That not to exceed $500,000 may be used by the Indian Health Service to purchase TRANSAM equipment from the Department of
Defense for distribution to the Indian Health Service and tribal facilities: Provided further, That none of the funds appropriated to the Indian Health Service may be used for sanitation facilities construction for
new homes funded with grants by the housing programs of the United States Department of Housing and Urban Development: Provided further, That not to exceed $2,700,000 from this account and the "Indian Health Services" account may be used by the Indian Health
Service to obtain ambulances for the Indian Health Service and tribal facilities in conjunction with an existing interagency
agreement between the Indian Health Service and the General Services Administration: Provided further, That not to exceed $500,000 may be placed in a Demolition Fund, to remain available until expended, and be used by the Indian
Health Service for the demolition of Federal buildings.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–0391–0–1–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
Receipts:
Current law:
1130
Rent and Charges for Quarters, Indian Health Service
7
9
9
2000
Total: Balances and receipts
7
9
9
Appropriations:
Current law:
2101
Indian Health Facilities
–7
–9
–9
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–0391–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Maintenance
198
204
175
0002
Maintenance
74
73
60
0003
Facilities and environmental health
223
222
192
0004
Equipment
23
23
20
0100
Total direct program
518
522
447
0799
Total direct obligations
518
522
447
0801
Indian Health Facilities (Reimbursable)
9
9
9
0900
Total new obligations, unexpired accounts
527
531
456
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
236
284
340
1001
Discretionary unobligated balance brought fwd, Oct 1
236
284
1021
Recoveries of prior year unpaid obligations
11
1050
Unobligated balance (total)
247
284
340
Budget authority:
Appropriations, discretionary:
1100
Appropriation
523
522
447
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
7
9
9
Spending authority from offsetting collections, discretionary:
1700
Collected
31
56
57
1701
Change in uncollected payments, Federal sources
3
1750
Spending auth from offsetting collections, disc (total)
34
56
57
1900
Budget authority (total)
564
587
513
1930
Total budgetary resources available
811
871
853
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
284
340
397
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
455
492
455
3010
New obligations, unexpired accounts
527
531
456
3020
Outlays (gross)
–479
–568
–556
3040
Recoveries of prior year unpaid obligations, unexpired
–11
3050
Unpaid obligations, end of year
492
455
355
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–5
–8
–8
3070
Change in uncollected pymts, Fed sources, unexpired
–3
3090
Uncollected pymts, Fed sources, end of year
–8
–8
–8
Memorandum (non-add) entries:
3100
Obligated balance, start of year
450
484
447
3200
Obligated balance, end of year
484
447
347
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
557
578
504
Outlays, gross:
4010
Outlays from new discretionary authority
293
213
191
4011
Outlays from discretionary balances
181
346
356
4020
Outlays, gross (total)
474
559
547
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–31
–56
–57
4040
Offsets against gross budget authority and outlays (total)
–31
–56
–57
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–3
4070
Budget authority, net (discretionary)
523
522
447
4080
Outlays, net (discretionary)
443
503
490
Mandatory:
4090
Budget authority, gross
7
9
9
Outlays, gross:
4100
Outlays from new mandatory authority
3
9
9
4101
Outlays from mandatory balances
2
4110
Outlays, gross (total)
5
9
9
4180
Budget authority, net (total)
530
531
456
4190
Outlays, net (total)
448
512
499
The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
facilities support for the Indian Health Service. More than $186 million, primarily through self-determination contracts and
compacts, will be administered by tribal governments in 2018.
Object Classification (in millions of dollars)
Identification code 075–0391–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
52
53
54
11.3
Other than full-time permanent
2
2
2
11.5
Other personnel compensation
2
2
3
11.7
Military personnel
22
22
23
11.9
Total personnel compensation
78
79
82
12.1
Civilian personnel benefits
18
18
19
12.2
Military personnel benefits
8
8
8
21.0
Travel and transportation of persons
3
3
3
22.0
Transportation of things
3
3
3
23.1
Rental payments to GSA
1
1
1
23.3
Communications, utilities, and miscellaneous charges
15
15
15
25.1
Advisory and assistance services
3
3
3
25.2
Other services from non-Federal sources
76
76
76
25.3
Other goods and services from Federal sources
2
2
2
25.4
Operation and maintenance of facilities
6
6
6
25.7
Operation and maintenance of equipment
2
2
2
25.8
Subsistence and support of persons
13
13
13
26.0
Supplies and materials
7
7
7
31.0
Equipment
13
13
13
32.0
Land and structures
107
107
102
41.0
Grants, subsidies, and contributions
163
166
92
99.0
Direct obligations
518
522
447
99.0
Reimbursable obligations
9
9
9
99.9
Total new obligations, unexpired accounts
527
531
456
Employment Summary
Identification code 075–0391–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
1,071
1,076
1,076
1101
Direct military average strength employment
163
158
158
2001
Reimbursable civilian full-time equivalent employment
37
37
37
ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE
Administrative provisions—indian health service
Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
3109 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; uniforms or allowances therefor as authorized by
5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
Service: 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: 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 none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
the House and Senate Committees on Appropriations are notified through the reprogramming process: 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 V 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 V 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 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 payments 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 from which the funds
were originally derived, with such 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, notwithstanding any other provision of law, for any lease under section 105(l) of the Indian Self-Determination
and Education Assistance Act, as amended, no additional compensation is required by the Act above the amount provided to the
tribe or tribal organization under section 106(a)(1), except the Secretary, in the discretion of the Secretary, may award
compensation for such leases, above the section 106(a)(1) amount, and if the Secretary awards such additional compensation
the amount of such compensation may be based on such reasonable expenses, if any, as the Secretary determines to be appropriate,
which may include the expenses described in section 105(l)(2), and the exercise of this discretion to award additional compensation
and determine its amount is not subject to sections 102(a)-(b), (e) or 507(b)-(d) of the Act.
Centers for Disease Control and Prevention
Federal Funds
Immunization and respiratory diseases
For carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, $497,228,000.
HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention
For carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted
diseases, and tuberculosis prevention, $934,000,000.
Emerging and zoonotic infectious diseases
For carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, $377,000,000: Provided, That of the amounts available to pay for the transportation, medical care, treatment, and other related
costs of persons quarantined or isolated under federal or state quarantine law, up to $1,000,000 shall remain available until
expended.
Chronic disease prevention and health promotion
For carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health
promotion, $452,250,000: Provided, That amounts in this account, including amounts transferred to this account, are available for the Director of the
Centers for Disease Control and Prevention (CDC) to administer a program, to be known as America's Health State Block Grant,
to provide increased flexibility for States, territories, tribes, and tribal organizations to improve public health: Provided
further, That for purposes of carrying out such program, the Director is hereby authorized to award grants to States, territories,
tribes, and tribal organizations, and such grant awards shall be provided through a formula, as determined by the Director,
that takes into account the population and disease burden of the grantee: Provided further, That the Director may set aside
not more than 15 percent of the amounts awarded for grants described in the previous proviso for the same purposes, on a competitive
basis, to cities, Federally-recognized tribes, and public health entities serving rural and frontier areas or other entities:
Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for not
less than 21 States, tribes, or tribal organizations: Provided further, That the proportional funding requirements under section 1503(a) of the PHS Act shall not apply to funds made available
under this heading.
Birth defects, developmental disabilities, disabilities and health
For carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities
and health, $100,000,000.
Public Health Scientific Services
For carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics,
and workforce development, $317,032,000: Provided, That in addition to amounts provided herein, $142,968,000 shall be available from amounts available under section
241 of the PHS Act to carry out the Public Health Scientific Services.
Environmental health
For carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, $157,000,000.
Injury prevention and control
For carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $216,165,000.
National Institute for Occupational Safety and Health
For carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal
Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22
of the Occupational Safety and Health Act, with respect to occupational safety and health, $200,000,000.
Energy employees occupational illness compensation program
For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain
available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of
division B, title I of Public Law 106–554.
Global health
For carrying out titles II, III, and XVII of the PHS Act with respect to global health, $350,000,000, of which $69,547,000 for international HIV/AIDS shall remain available through September 30, 2019: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.
public health preparedness and response
For carrying out titles II, III, and XVII of the PHS Act with respect to public health preparedness and response, and for
expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats
to civilian populations, $1,266,000,000, of which $575,000,000 shall remain available until expended for the Strategic National Stockpile: Provided, That the Director of the CDC or the Administrator of the Agency for Toxic Substances and Disease Registry may detail staff without reimbursement for up to 180 days to support an activation of the CDC Emergency Operations Center: Provided further, That in making awards under section 319C-1 of the PHS Act from funds made available under this heading,
the Secretary may determine the amounts of such awards without regard to paragraph (3)(B)-(D) and paragraph (4)(C) of subsection
(h) of such section.
cdc-wide activities and program support
For carrying out titles II, III, XVII, and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program support for activities funded in other
appropriations included in this Act for the Centers for Disease Control and Prevention, $105,000,000: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under
this heading and in all other accounts of the CDC: Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase,
hire, maintenance, and operation of aircraft for use and support of the activities of CDC: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities,
or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal
employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service,
or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses
when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged
with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program and the Respirator Certification
Program shall be available through September 30, 2019: Provided further, That the Director may transfer discretionary funds (pursuant to the Balanced Budget and Emergency
Deficit Control Act of 1985) which are appropriated for the current fiscal year for CDC in this Act between any of the accounts
of CDC with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any
transfer, but no such account shall be decreased by more than 3 percent by any such transfer.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–0943–0–1–999
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
Receipts:
Current law:
1130
Cooperative Research and Development Agreements, Centers for Disease Control
1
2
2
2000
Total: Balances and receipts
1
2
2
Appropriations:
Current law:
2101
CDC-wide Activities and Program Support
–1
–2
–2
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–0943–0–1–999
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Birth Defects, Developmental Disabilities, Disability and Health (0958)
135
135
100
0002
CDC-Wide Activities and Program Support (0943)
464
273
105
0004
Chronic Disease Prevention and Health Promotion (0948)
1,173
1,175
952
0005
Emerging and Zoonotic Infectious Diseases (0949)
583
579
514
0006
Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
49
50
55
0007
Environmental Health (0947)
182
217
157
0008
Global Health (0955)
426
426
350
0012
HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
1,121
1,120
934
0013
Immunization and Respiratory Diseases (0951)
797
783
701
0015
Injury Prevention and Control (0952)
236
236
216
0016
Occupational Safety and Health (0953)
338
338
200
0019
Public Health Preparedness and Response (0956)
1,370
1,402
1,266
0020
Public Health Scientific Services (0959)
490
491
317
0021
Cooperative Research and Development Agreements (CRADA) (5146)
1
2
2
0022
Ebola (Emergency pursuant to 2011 BCA)
380
0799
Total direct obligations
7,745
7,227
5,869
0802
CDC-Wide Activities and Program Support (Reimbursable)
322
412
411
0809
Reimbursable program activities, subtotal
322
412
411
0900
Total new obligations, unexpired accounts
8,067
7,639
6,280
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
1,223
1,155
1,155
1001
Discretionary unobligated balance brought fwd, Oct 1
1,107
1,110
1010
Unobligated balance transfer to other accts [075–9915]
–3
1010
Unobligated balance transfer to other accts [075–0140]
–14
1011
Unobligated balance transfer from other acct [075–0140]
15
1011
Unobligated balance transfer from other acct [075–0140]
10
1012
Unobligated balance transfers between expired and unexpired accounts
20
1021
Recoveries of prior year unpaid obligations
40
1050
Unobligated balance (total)
1,291
1,155
1,155
Budget authority:
Appropriations, discretionary:
1100
Appropriation
6,655
6,284
4,972
1121
Appropriations transferred from other acct [075–9912]
1
1121
Appropriations transferred from other acct [075–1362]
4
1160
Appropriation, discretionary (total)
6,660
6,284
4,972
Appropriations, mandatory:
1200
Appropriation (075–0954 - EEOICPA)
55
55
55
1200
Appropriation (075–0943 - Chilhood Obesity Demonstration Project)
10
1201
Appropriation (075–5146 CRADA)
1
2
2
1221
Appropriations transferred from other acct [075–0116]
892
891
841
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–5
–5
1260
Appropriations, mandatory (total)
953
943
898
Spending authority from offsetting collections, discretionary:
1700
Collected
138
408
408
1700
Collected
4
1701
Change in uncollected payments, Federal sources
177
1750
Spending auth from offsetting collections, disc (total)
319
408
408
Spending authority from offsetting collections, mandatory:
1800
Collected
4
4
4
1900
Budget authority (total)
7,936
7,639
6,282
1930
Total budgetary resources available
9,227
8,794
7,437
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–5
1941
Unexpired unobligated balance, end of year
1,155
1,155
1,157
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
6,500
6,949
6,639
3010
New obligations, unexpired accounts
8,067
7,639
6,280
3011
Obligations ("upward adjustments"), expired accounts
51
3020
Outlays (gross)
–7,426
–7,949
–7,253
3040
Recoveries of prior year unpaid obligations, unexpired
–40
3041
Recoveries of prior year unpaid obligations, expired
–203
3050
Unpaid obligations, end of year
6,949
6,639
5,666
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–132
–232
–232
3070
Change in uncollected pymts, Fed sources, unexpired
–177
3071
Change in uncollected pymts, Fed sources, expired
77
3090
Uncollected pymts, Fed sources, end of year
–232
–232
–232
Memorandum (non-add) entries:
3100
Obligated balance, start of year
6,368
6,717
6,407
3200
Obligated balance, end of year
6,717
6,407
5,434
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
6,979
6,692
5,380
Outlays, gross:
4010
Outlays from new discretionary authority
2,663
2,916
2,381
4011
Outlays from discretionary balances
3,842
4,317
3,911
4020
Outlays, gross (total)
6,505
7,233
6,292
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–199
–408
–408
4033
Non-Federal sources
–7
4040
Offsets against gross budget authority and outlays (total)
–206
–408
–408
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–177
4052
Offsetting collections credited to expired accounts
64
4060
Additional offsets against budget authority only (total)
–113
4070
Budget authority, net (discretionary)
6,660
6,284
4,972
4080
Outlays, net (discretionary)
6,299
6,825
5,884
Mandatory:
4090
Budget authority, gross
957
947
902
Outlays, gross:
4100
Outlays from new mandatory authority
177
158
155
4101
Outlays from mandatory balances
744
558
806
4110
Outlays, gross (total)
921
716
961
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–4
–4
–4
4180
Budget authority, net (total)
7,613
7,227
5,870
4190
Outlays, net (total)
7,216
7,537
6,841
The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve the health,
safety, and protection of all Americans. These activities include immunization and respiratory diseases, HIV/AIDS, Hepatitis,
STDs, and Tuberculosis prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion,
occupational safety and health, public health and scientific services, injury prevention and control, environmental health,
global health, programs that reduce the occurrence of birth defects and developmental disabilities, public health preparedness
and emergency response, and CDC-wide activities and program support. The FY 2018 Budget reforms CDC's funding by establishing
a new $500 million block grant to increase flexibility for States to address their population's unique public health needs.
Object Classification (in millions of dollars)
Identification code 075–0943–0–1–999
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
714
802
800
11.3
Other than full-time permanent
124
107
107
11.5
Other personnel compensation
39
35
35
11.7
Military personnel
77
75
75
11.8
Special personal services payments
9
8
8
11.9
Total personnel compensation
963
1,027
1,025
12.1
Civilian personnel benefits
287
308
308
12.2
Military personnel benefits
54
50
49
13.0
Benefits for former personnel
1
1
1
21.0
Travel and transportation of persons
78
46
34
22.0
Transportation of things
16
13
10
23.1
Rental payments to GSA
8
28
21
23.2
Rental payments to others
1
23.3
Communications, utilities, and miscellaneous charges
17
36
27
24.0
Printing and reproduction
3
3
2
25.1
Advisory and assistance services
922
866
684
25.2
Other services from non-Federal sources
197
251
188
25.3
Other goods and services from Federal sources
780
351
268
25.4
Operation and maintenance of facilities
19
57
40
25.5
Research and development contracts
35
35
26
25.6
Medical care
31
28
21
25.7
Operation and maintenance of equipment
52
90
66
25.8
Subsistence and support of persons
2
2
2
26.0
Supplies and materials
456
438
333
31.0
Equipment
59
69
51
32.0
Land and structures
6
10
1
41.0
Grants, subsidies, and contributions
3,758
3,518
2,711
99.0
Direct obligations
7,745
7,227
5,868
99.0
Reimbursable obligations
322
412
412
99.9
Total new obligations, unexpired accounts
8,067
7,639
6,280
Employment Summary
Identification code 075–0943–0–1–999
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
9,096
9,287
9,287
1101
Direct military average strength employment
876
877
877
2001
Reimbursable civilian full-time equivalent employment
218
184
184
2101
Reimbursable military average strength employment
37
30
30
buildings and facilities
For equipment, construction, demolition, and renovation of facilities, $20,000,000, to remain available until September 30, 2022.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0960–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
CDC Buildings and Facilities (0960)
9
10
20
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
2
3
3
Budget authority:
Appropriations, discretionary:
1100
Appropriation
10
10
20
1930
Total budgetary resources available
12
13
23
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
3
3
3
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
6
6
7
3010
New obligations, unexpired accounts
9
10
20
3020
Outlays (gross)
–9
–9
–14
3050
Unpaid obligations, end of year
6
7
13
Memorandum (non-add) entries:
3100
Obligated balance, start of year
6
6
7
3200
Obligated balance, end of year
6
7
13
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
10
10
20
Outlays, gross:
4010
Outlays from new discretionary authority
2
4
8
4011
Outlays from discretionary balances
7
5
6
4020
Outlays, gross (total)
9
9
14
4180
Budget authority, net (total)
10
10
20
4190
Outlays, net (total)
9
9
14
Object Classification (in millions of dollars)
Identification code 075–0960–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
25.1
Advisory and assistance services
2
2
3
25.4
Operation and maintenance of facilities
4
4
4
25.7
Operation and maintenance of equipment
1
2
32.0
Land and structures
3
3
11
99.9
Total new obligations, unexpired accounts
9
10
20
CDC Working Capital Fund
Program and Financing (in millions of dollars)
Identification code 075–4553–0–4–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
CDC Working Capital Fund (Reimbursable)
590
532
532
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
52
52
52
1021
Recoveries of prior year unpaid obligations
19
1050
Unobligated balance (total)
71
52
52
Budget authority:
Spending authority from offsetting collections, discretionary:
1700
Collected
569
532
532
1701
Change in uncollected payments, Federal sources
2
1750
Spending auth from offsetting collections, disc (total)
571
532
532
1930
Total budgetary resources available
642
584
584
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
52
52
52
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
175
217
204
3010
New obligations, unexpired accounts
590
532
532
3020
Outlays (gross)
–529
–545
–534
3040
Recoveries of prior year unpaid obligations, unexpired
–19
3050
Unpaid obligations, end of year
217
204
202
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–2
–2
3070
Change in uncollected pymts, Fed sources, unexpired
–2
3090
Uncollected pymts, Fed sources, end of year
–2
–2
–2
Memorandum (non-add) entries:
3100
Obligated balance, start of year
175
215
202
3200
Obligated balance, end of year
215
202
200
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
571
532
532
Outlays, gross:
4010
Outlays from new discretionary authority
377
351
351
4011
Outlays from discretionary balances
152
194
183
4020
Outlays, gross (total)
529
545
534
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–569
–532
–532
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–2
4080
Outlays, net (discretionary)
–40
13
2
4180
Budget authority, net (total)
4190
Outlays, net (total)
–40
13
2
Implemented in fiscal year 2014, CDC's Working Capital Fund has extended availability and serves as the funding mechanism
to finance centralized business services support across CDC. Services rendered under the fund are performed at pre-established
rates that are used to cover the full cost of operations and future investments. Contributions are collected for services,
thereby creating market-like incentives to maximize efficiency and quality.
Object Classification (in millions of dollars)
Identification code 075–4553–0–4–551
2016 actual
2017 est.
2018 est.
Reimbursable obligations:
Personnel compensation:
11.1
Full-time permanent
143
160
160
11.3
Other than full-time permanent
4
4
4
11.5
Other personnel compensation
3
3
3
11.7
Military personnel
3
3
3
11.9
Total personnel compensation
153
170
170
12.1
Civilian personnel benefits
48
53
53
12.2
Military personnel benefits
1
1
1
21.0
Travel and transportation of persons
1
2
2
22.0
Transportation of things
1
1
1
23.1
Rental payments to GSA
33
33
33
23.3
Communications, utilities, and miscellaneous charges
27
27
27
25.1
Advisory and assistance services
31
25
25
25.2
Other services from non-Federal sources
89
57
57
25.3
Other goods and services from Federal sources
66
63
63
25.4
Operation and maintenance of facilities
54
40
40
25.7
Operation and maintenance of equipment
55
40
40
26.0
Supplies and materials
1
3
3
31.0
Equipment
22
9
9
32.0
Land and structures
8
8
8
99.9
Total new obligations, unexpired accounts
590
532
532
Employment Summary
Identification code 075–4553–0–4–551
2016 actual
2017 est.
2018 est.
2001
Reimbursable civilian full-time equivalent employment
1,265
1,256
1,256
2101
Reimbursable military average strength employment
22
22
22
Toxic substances and environmental public health
For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth
in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
and section 3019 of the Solid Waste Disposal Act, $62,000,000: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA,
the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation,
biomedical testing, clinical evaluations, medical monitoring, and referral to accredited healthcare providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall
not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological
profiles pursuant to section 104(i) of CERCLA during fiscal year 2018, and existing profiles may be updated as necessary.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0944–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Agency for Toxic Substances and Disease Registry, Toxic Substanc (Direct)
78
75
62
0801
Agency for Toxic Substances and Disease Registry, Toxic Substanc (Reimbursable)
5
6
6
0900
Total new obligations, unexpired accounts
83
81
68
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
27
25
25
1021
Recoveries of prior year unpaid obligations
1
1050
Unobligated balance (total)
28
25
25
Budget authority:
Appropriations, discretionary:
1100
Appropriation
75
75
62
Spending authority from offsetting collections, discretionary:
1700
Collected
2
6
3
1701
Change in uncollected payments, Federal sources
3
1750
Spending auth from offsetting collections, disc (total)
5
6
3
1900
Budget authority (total)
80
81
65
1930
Total budgetary resources available
108
106
90
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
25
25
22
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
44
47
28
3010
New obligations, unexpired accounts
83
81
68
3011
Obligations ("upward adjustments"), expired accounts
1
3020
Outlays (gross)
–79
–100
–76
3040
Recoveries of prior year unpaid obligations, unexpired
–1
3041
Recoveries of prior year unpaid obligations, expired
–1
3050
Unpaid obligations, end of year
47
28
20
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–5
–5
–5
3070
Change in uncollected pymts, Fed sources, unexpired
–3
3071
Change in uncollected pymts, Fed sources, expired
3
3090
Uncollected pymts, Fed sources, end of year
–5
–5
–5
Memorandum (non-add) entries:
3100
Obligated balance, start of year
39
42
23
3200
Obligated balance, end of year
42
23
15
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
80
81
65
Outlays, gross:
4010
Outlays from new discretionary authority
49
56
45
4011
Outlays from discretionary balances
27
44
31
4020
Outlays, gross (total)
76
100
76
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–5
–6
–3
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–3
4052
Offsetting collections credited to expired accounts
3
4070
Budget authority, net (discretionary)
75
75
62
4080
Outlays, net (discretionary)
71
94
73
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
3
4180
Budget authority, net (total)
75
75
62
4190
Outlays, net (total)
74
94
73
Object Classification (in millions of dollars)
Identification code 075–0944–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
22
20
20
11.3
Other than full-time permanent
2
2
2
11.7
Military personnel
4
4
4
11.9
Total personnel compensation
28
26
26
12.1
Civilian personnel benefits
7
7
7
12.2
Military personnel benefits
1
1
1
21.0
Travel and transportation of persons
1
1
1
25.1
Advisory and assistance services
11
11
7
25.2
Other services from non-Federal sources
4
4
3
25.3
Other goods and services from Federal sources
10
11
7
25.7
Operation and maintenance of equipment
1
1
1
41.0
Grants, subsidies, and contributions
16
13
9
99.0
Direct obligations
79
75
62
99.0
Reimbursable obligations
4
6
6
99.9
Total new obligations, unexpired accounts
83
81
68
Employment Summary
Identification code 075–0944–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
222
227
227
1101
Direct military average strength employment
38
33
33
2001
Reimbursable civilian full-time equivalent employment
9
9
9
World Trade Center Health Program Fund
Program and Financing (in millions of dollars)
Identification code 075–0946–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
World Trade Center Health Program - Federal Share (CDC/NIOSH)
313
347
366
0002
World Trade Center Health Program - NYC
39
41
0900
Total new obligations, unexpired accounts
313
386
407
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
797
967
1012
Unobligated balance transfers between expired and unexpired accounts
98
160
1050
Unobligated balance (total)
98
957
967
Budget authority:
Appropriations, mandatory:
1200
Appropriation (WTC (CDC Direct))
990
346
380
1200
Appropriation (WTC—NYC DHSS—CDC)
33
38
42
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–23
1260
Appropriations, mandatory (total)
1,000
384
422
Spending authority from offsetting collections, mandatory:
1800
Collected
12
12
1900
Budget authority (total)
1,012
396
422
1930
Total budgetary resources available
1,110
1,353
1,389
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
797
967
982
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
161
168
275
3010
New obligations, unexpired accounts
313
386
407
3011
Obligations ("upward adjustments"), expired accounts
31
3020
Outlays (gross)
–293
–279
–345
3041
Recoveries of prior year unpaid obligations, expired
–44
3050
Unpaid obligations, end of year
168
275
337
Memorandum (non-add) entries:
3100
Obligated balance, start of year
161
168
275
3200
Obligated balance, end of year
168
275
337
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
1,012
396
422
Outlays, gross:
4100
Outlays from new mandatory authority
204
182
194
4101
Outlays from mandatory balances
89
97
151
4110
Outlays, gross (total)
293
279
345
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–48
–12
Additional offsets against gross budget authority only:
4142
Offsetting collections credited to expired accounts
36
4160
Budget authority, net (mandatory)
1,000
384
422
4170
Outlays, net (mandatory)
245
267
345
4180
Budget authority, net (total)
1,000
384
422
4190
Outlays, net (total)
245
267
345
HHS, along with CDC, began implementing provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347)
on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the
Program Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
Compensation Reauthorization Act of 2015 (P.L. 114–113, Division O, Title III). The amounts included for 2017 and 2018 in
the Budget reflect estimated Federal obligations for the WTC Health Program.
Object Classification (in millions of dollars)
Identification code 075–0946–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
2
2
2
11.7
Military personnel
1
1
1
11.9
Total personnel compensation
3
3
3
12.1
Civilian personnel benefits
1
1
1
25.1
Advisory and assistance services
23
32
36
25.2
Other services from non-Federal sources
58
74
72
25.3
Other goods and services from Federal sources
11
13
13
25.6
Medical care
1
41.0
Grants, subsidies, and contributions
15
24
24
42.0
Insurance claims and indemnities
201
239
258
99.9
Total new obligations, unexpired accounts
313
386
407
Employment Summary
Identification code 075–0946–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
16
16
16
1101
Direct military average strength employment
7
7
7
National Institutes of Health
Federal Funds
national cancer institute
For carrying out section 301 and title IV of the PHS Act with respect to cancer, $4,174,222,000, of which up to $10,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research
and Development Center in Frederick, Maryland.
national heart, lung, and blood institute
For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
and blood products, $2,534,803,000.
national institute of dental and craniofacial research
For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $320,749,000.
national institute of diabetes and digestive and kidney diseases
For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,449,534,000.
national institute of neurological disorders and stroke
For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,312,998,000.
national institute of allergy and infectious diseases
For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $3,782,670,000.
national institute of general medical sciences
For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $2,185,509,000, of which $780,000,000 shall be from funds available under section 241 of the PHS Act.
eunice kennedy shriver national institute of child health and human development
For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $1,032,029,000.
national eye institute
For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $549,847,000.
national institute of environmental health sciences
For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $533,537,000.
National institute of environmental health sciences
For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in
section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and
section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $59,607,000.
national institute on aging
For carrying out section 301 and title IV of the PHS Act with respect to aging, $1,303,541,000.
national institute of arthritis and musculoskeletal and skin diseases
For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases,
$417,898,000.
national institute on deafness and other communication disorders
For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $325,846,000.
national institute of nursing research
For carrying out section 301 and title IV of the PHS Act with respect to nursing research, $113,688,000.
national institute on alcohol abuse and alcoholism
For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $361,356,000
national institute on drug abuse
For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $864,998,000.
national institute of mental health
For carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,201,901,000.
national human genome research institute
For carrying out section 301 and title IV of the PHS Act with respect to human genome research, $399,622,000.
national institute of biomedical imaging and bioengineering
For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $282,614,000.
national center for complementary and integrative health
For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $101,793,000.
national institute on minority health and health disparities
For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
$214,723,000.
john e. fogarty international center
national library of medicine
For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $373,258,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30,
2019: Provided further, That in fiscal year 2018, the National Library of Medicine 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 (referred to in this title as
"NIH").
national center for advancing translational sciences
For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $557,373,000: Provided, That up to $24,496,593 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network.
office of the director
For carrying out the responsibilities of the Office of the Director, NIH, $1,329,833,000: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: 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 $441,823,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided, $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $4,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act.
In addition to other funds appropriated for the Common Fund established under section 402A(c) of the PHS Act, $12,600,000 is appropriated to the Common Fund from the 10-year Pediatric Research Initiative Fund described in section 9008 of title
26, United States Code, for the purpose of carrying out section 402(b)(7)(B)(ii) of the PHS Act (relating to pediatric research),
as authorized in the Gabriella Miller Kids First Research Act.
Buildings and facilities
For the study of, construction or demolition of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, $98,615,000, to remain available through September 30, 2022.
National Institute for Research on Safety and Quality
For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003, $272,000,000: Provided, That section 947(c) of the
PHS Act shall not apply in fiscal year 2018: Provided further, That in addition, amounts received from Freedom of Information
Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this appropriation and shall
remain available until expended.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–9915–0–1–552
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
11
Receipts:
Current law:
1130
Cooperative Research and Development Agreements, NIH
34
17
17
2000
Total: Balances and receipts
34
17
28
Appropriations:
Current law:
2101
National Institutes of Health
–34
–16
–16
2134
National Institutes of Health
10
2199
Total current law appropriations
–34
–6
–16
2999
Total appropriations
–34
–6
–16
5099
Balance, end of year
11
12
Program and Financing (in millions of dollars)
Identification code 075–9915–0–1–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
National Cancer Institute (0849)
5,356
5,505
4,474
0002
National Heart, Lung, and Blood Institute (0872)
3,109
3,110
2,535
0003
National Institute of Dental and Craniofacial Research (0873)
413
415
321
0004
National Institute of Diabetes and Digestive and Kidney Disease (0884)
1,814
1,815
1,450
0005
National Institute of Neurological Disorders and Stroke (0886)
1,693
1,693
1,356
0006
National Institute of Allergy and Infectious Diseases (0885)
4,827
4,621
3,783
0007
National Institute of General Medical Sciences (0851)
1,729
1,729
1,406
0008
National Institute of Child Health and Human Development (0844)
1,338
1,337
1,032
0009
National Eye Institute (0887)
707
715
550
0010
National Institute of Environmental Health Sciences (0862)
695
770
593
0011
National Institute on Aging (0843)
1,602
1,597
1,304
0012
National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
541
541
418
0013
National Institute on Deafness and Other Communication Disorder (0890)
422
422
326
0014
National Institute of Mental Health (0892)
1,516
1,545
1,245
0015
National Institute on Drug Abuse (0893)
1,049
1,075
865
0016
National Institute on Alcohol Abuse and Alcoholism (0894)
467
467
361
0017
National Institute of Nursing Research (0889)
146
146
114
0018
National Human Genome Research Institute (0891)
512
518
400
0019
National Institute of Biomedical Imaging and Bioengineering (0898)
343
346
283
0021
National Center for Complementary and Integrative Health (0896)
130
131
102
0022
National Institute on Minority Health and Health Disparities (0897)
280
279
215
0023
John E. Fogarty International Center (0819)
70
70
0024
National Library of Medicine (0807)
395
394
373
0025
NIH Office of the Director (0846)
1,571
1,568
1,342
0026
NIH Buildings and facilities (0838)
80
129
99
0027
NIH Cooperative Research and Development Agreements
26
16
16
0028
National Center for Advancing Translational Sciences (0875)
684
684
557
0029
National Institute for Research on Safety and Quality
272
0031
Type 1 Diabetes
150
140
0799
Total direct obligations
31,665
31,778
25,792
0801
NIH Reimbursable - Other
3,598
3,767
3,609
0802
NIH Royalties
132
105
105
0809
Reimbursable program activities, subtotal
3,730
3,872
3,714
0899
Total reimbursable obligations
3,730
3,872
3,714
0900
Total new obligations, unexpired accounts
35,395
35,650
29,506
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
722
1,363
1,049
1001
Discretionary unobligated balance brought fwd, Oct 1
722
1,363
1011
Unobligated balance transfer from other acct [075–0140]
47
1011
Unobligated balance transfer from other acct [075–0140]
4
1011
Unobligated balance transfer from other acct [075–0943]
3
1021
Recoveries of prior year unpaid obligations
131
1033
Recoveries of prior year paid obligations
35
1050
Unobligated balance (total)
942
1,363
1,049
Budget authority:
Appropriations, discretionary:
1100
Appropriation
31,521
31,308
25,374
1121
Appropriations transferred from other acct [075–5736]
13
13
13
1121
Appropriations transferred from other acct [075–5628]
300
386
1160
Appropriation, discretionary (total)
31,534
31,621
25,773
Appropriations, mandatory:
1200
Appropriation
150
150
1201
Appropriation (special or trust fund)
34
16
16
1234
Appropriations precluded from obligation
–10
1260
Appropriations, mandatory (total)
184
156
16
Spending authority from offsetting collections, discretionary:
1700
Collected
3,563
3,559
3,559
1701
Change in uncollected payments, Federal sources
540
1750
Spending auth from offsetting collections, disc (total)
4,103
3,559
3,559
1900
Budget authority (total)
35,821
35,336
29,348
1930
Total budgetary resources available
36,763
36,699
30,397
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–5
1941
Unexpired unobligated balance, end of year
1,363
1,049
891
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
31,352
32,959
32,945
3010
New obligations, unexpired accounts
35,395
35,650
29,506
3011
Obligations ("upward adjustments"), expired accounts
883
3020
Outlays (gross)
–33,453
–35,664
–33,667
3040
Recoveries of prior year unpaid obligations, unexpired
–131
3041
Recoveries of prior year unpaid obligations, expired
–1,087
3050
Unpaid obligations, end of year
32,959
32,945
28,784
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–979
–1,207
–1,207
3070
Change in uncollected pymts, Fed sources, unexpired
–540
3071
Change in uncollected pymts, Fed sources, expired
312
3090
Uncollected pymts, Fed sources, end of year
–1,207
–1,207
–1,207
Memorandum (non-add) entries:
3100
Obligated balance, start of year
30,373
31,752
31,738
3200
Obligated balance, end of year
31,752
31,738
27,577
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
35,637
35,180
29,332
Outlays, gross:
4010
Outlays from new discretionary authority
9,817
12,096
11,933
4011
Outlays from discretionary balances
23,462
23,403
21,609
4020
Outlays, gross (total)
33,279
35,499
33,542
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–4,013
–3,559
–3,559
4033
Non-Federal sources
–157
4040
Offsets against gross budget authority and outlays (total)
–4,170
–3,559
–3,559
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–540
4052
Offsetting collections credited to expired accounts
575
4053
Recoveries of prior year paid obligations, unexpired accounts
32
4060
Additional offsets against budget authority only (total)
67
4070
Budget authority, net (discretionary)
31,534
31,621
25,773
4080
Outlays, net (discretionary)
29,109
31,940
29,983
Mandatory:
4090
Budget authority, gross
184
156
16
Outlays, gross:
4100
Outlays from new mandatory authority
2
50
16
4101
Outlays from mandatory balances
172
115
109
4110
Outlays, gross (total)
174
165
125
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–3
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
3
4160
Budget authority, net (mandatory)
184
156
16
4170
Outlays, net (mandatory)
171
165
125
4180
Budget authority, net (total)
31,718
31,777
25,789
4190
Outlays, net (total)
29,280
32,105
30,108
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
31,718
31,777
25,789
Outlays
29,280
32,105
30,108
Legislative proposal, subject to PAYGO:
Budget Authority
150
Outlays
36
Total:
Budget Authority
31,718
31,777
25,939
Outlays
29,280
32,105
30,144
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. The FY 2018 Budget consolidates
the Agency for Healthcare Research and Quality within the National Institutes of Health as the National Institute for Research
on Safety and Quality, and dissolves the Fogarty International Center. Detailed information is available through the Department
of Health and Human Services.
Object Classification (in millions of dollars)
Identification code 075–9915–0–1–552
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
941
971
1,021
11.3
Other than full-time permanent
505
514
527
11.5
Other personnel compensation
37
37
38
11.7
Military personnel
19
20
20
11.8
Special personal services payments
168
168
160
11.9
Total personnel compensation
1,670
1,710
1,766
12.1
Civilian personnel benefits
482
496
518
12.2
Military personnel benefits
12
12
14
21.0
Travel and transportation of persons
53
53
33
22.0
Transportation of things
5
5
3
23.1
Rental payments to GSA
22
23
18
23.3
Communications, utilities, and miscellaneous charges
26
26
18
24.0
Printing and reproduction
1
1
1
25.1
Advisory and assistance services
171
166
120
25.2
Other services from non-Federal sources
1,244
1,130
790
25.3
Other goods and services from Federal sources
3,048
3,092
2,769
25.4
Operation and maintenance of facilities
168
215
167
25.5
Research and development contracts
1,515
1,457
1,250
25.6
Medical care
34
34
21
25.7
Operation and maintenance of equipment
116
117
80
26.0
Supplies and materials
209
212
114
31.0
Equipment
173
168
97
41.0
Grants, subsidies, and contributions
22,716
22,861
18,013
99.0
Direct obligations
31,665
31,778
25,792
99.0
Reimbursable obligations
3,730
3,872
3,714
99.9
Total new obligations, unexpired accounts
35,395
35,650
29,506
Employment Summary
Identification code 075–9915–0–1–552
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
12,958
13,335
13,581
1101
Direct military average strength employment
175
165
165
2001
Reimbursable civilian full-time equivalent employment
4,490
4,515
4,516
2101
Reimbursable military average strength employment
100
90
90
National Institutes of Health
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–9915–4–1–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0031
Type 1 Diabetes
150
0799
Total direct obligations
150
0900
Total new obligations, unexpired accounts (object class 41.0)
150
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
150
1900
Budget authority (total)
150
1930
Total budgetary resources available
150
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
150
3020
Outlays (gross)
–36
3050
Unpaid obligations, end of year
114
Memorandum (non-add) entries:
3200
Obligated balance, end of year
114
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
150
Outlays, gross:
4100
Outlays from new mandatory authority
36
4180
Budget authority, net (total)
150
4190
Outlays, net (total)
36
Payment to the NIH Innovation Account, CURES Act
Program and Financing (in millions of dollars)
Identification code 075–0147–0–1–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Payment to NIH Innovation (object class 94.0)
352
496
0900
Total new obligations, unexpired accounts (object class 94.0)
352
496
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
352
496
1930
Total budgetary resources available
352
496
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
352
496
3020
Outlays (gross)
–352
–496
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
352
496
Outlays, gross:
4100
Outlays from new mandatory authority
352
496
4180
Budget authority, net (total)
352
496
4190
Outlays, net (total)
352
496
This account, and a related special receipt account, were established to support the execution structure necessary to implement
the 21st Century Cures Act.
NIH Innovation, CURES Act
For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition
to amounts available for such purposes in the appropriations provided to the National Institutes of Health in this Act, $496,000,000,
to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act
and are to be derived from amounts transferred under section 1001(b)(2)(A) of such Act: Provided further, That of the amount
appropriated under this heading, $300,000,000 shall be transferred to the "National Cancer Institute" for the purposes described
in section 1001(b)(4)(C) of such Act, $43,000,000 shall be transferred to the "National Institute of Neurological Disorders
and Stroke" for the purposes described in section 1001(b)(4)(B) of such Act, and $43,000,000 shall be transferred to the "National
Institute of Mental Health" for the purposes described in section 1001(b)(4)(B) of such Act: Provided further, That remaining
amounts may be transferred by the Director of the National Institutes of Health to any accounts of the National Institutes
of Health: Provided further, That upon a determination by the Director that funds transferred pursuant to any of the previous
provisos are not necessary for the purposes provided, such amounts may be transferred back to this account: Provided further,
That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5628–0–2–552
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
Receipts:
Current law:
1140
General Fund Payment, NIH Innovation, CURES Act
352
496
2000
Total: Balances and receipts
352
496
Appropriations:
Current law:
2101
NIH Innovation, Cures Act
–352
–496
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–5628–0–2–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
CURES obligations
52
110
0900
Total new obligations, unexpired accounts (object class 41.0)
52
110
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
352
496
1120
Appropriations transferred to other acct [075–9915]
–300
–386
1160
Appropriation, discretionary (total)
52
110
1930
Total budgetary resources available
52
110
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
40
3010
New obligations, unexpired accounts
52
110
3020
Outlays (gross)
–12
–51
3050
Unpaid obligations, end of year
40
99
Memorandum (non-add) entries:
3100
Obligated balance, start of year
40
3200
Obligated balance, end of year
40
99
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
52
110
Outlays, gross:
4010
Outlays from new discretionary authority
12
26
4011
Outlays from discretionary balances
25
4020
Outlays, gross (total)
12
51
4180
Budget authority, net (total)
52
110
4190
Outlays, net (total)
12
51
The Cures Act was enacted into law on December 13, 2016. The Cures Act authorizes $4.8 billion over 10 years for four NIH
Innovation Projects, and includes amendments to the Public Health Service Act to advance Precision Medicine and other high
priority NIH activities.
10-Year Pediatric Research Initiative Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5736–0–2–552
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
26
13
Receipts:
Current law:
1140
Transfers from Presidential Election Campaign Fund
13
2000
Total: Balances and receipts
26
13
13
Appropriations:
Current law:
2101
10-Year Pediatric Research Initiative Fund
–13
–13
–13
5099
Balance, end of year
13
Program and Financing (in millions of dollars)
Identification code 075–5736–0–2–552
2016 actual
2017 est.
2018 est.
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
13
13
13
1120
Appropriations transferred to other accts [075–9915]
–13
–13
–13
4180
Budget authority, net (total)
4190
Outlays, net (total)
Substance Abuse and Mental Health Services Administration
Federal Funds
MENTAL HEALTH
For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
Individuals with Mental Illness Act, $896,808,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available
for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, $15,539,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for mental health activities and to carry out subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data
collection and evaluation activities, and further that the total available under this Act for section 1920(b) activities shall
not exceed 5 percent of the amounts appropriated for subpart I of part B of title XIX: Provided further, That up to 10 percent of the amounts made available to carry out the Children's Mental Health Services
program may be used to carry out demonstration grants or contracts for early interventions with persons not more than 25 years
of age at clinical high risk of developing a first episode of psychosis: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act: Provided further, That of the funds made available under this heading, $14,971,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22
note).
SUBSTANCE ABUSE TREATMENT
For carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with respect to substance abuse treatment and prevention, $2,115,235,000: Provided, That in addition to amounts provided herein, $81,200,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for substance abuse treatment activities and to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data, data
collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities shall
not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX: Provided further, That none of the funds provided for section 1921 of the PHS Act shall be subject to section 241 of such Act.
SUBSTANCE ABUSE PREVENTION
For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, $149,703,000.
HEALTH SURVEILLANCE AND PROGRAM SUPPORT
For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act and the Protection
and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration ("SAMHSA"), $108,922,000: Provided, That in addition to amounts provided herein, $23,426,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug abuse
and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities:
Provided further, That, in addition, fees may be collected for the costs of publications, data, data tabulations, and data analysis completed
under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation
and shall remain available until expended for such purposes: Provided further, That amounts made available in this Act for carrying out section 501(o) of the PHS Act shall remain available through September 30, 2019: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings
"Mental Health", "Substance Abuse Treatment", and "Substance Abuse Prevention": Provided further, That the Assistant Secretary for Mental Health and Substance Use may transfer discretionary funds (pursuant
to the Balanced Budget and Emergency Deficit Control Act of 1985) which are appropriated for the current fiscal year for SAMHSA
in this Act between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of
Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any
such transfer.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1362–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0006
Mental Health
1,133
1,132
897
0007
Substance Abuse Treatment
2,111
2,615
2,615
0008
Substance Abuse Prevention
211
223
150
0009
Health Surveillance and Program Support
175
175
109
0011
SAMHSA Prevention Fund
12
12
0100
Total, direct program
3,642
4,157
3,771
0799
Total direct obligations
3,642
4,157
3,771
0802
SAMHSA Reimbursables
117
117
117
0810
SAMHSA Reimbursable: PHS Evaluation
133
133
120
0899
Total reimbursable obligations
250
250
237
0900
Total new obligations, unexpired accounts
3,892
4,407
4,008
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
1
1
1001
Discretionary unobligated balance brought fwd, Oct 1
1
1
Budget authority:
Appropriations, discretionary:
1100
Appropriation
3,634
3,644
3,271
1120
Appropriations transferred to other acct [075–0943]
–4
1121
Appropriations transferred from other acct [075–5627]
500
500
1160
Appropriation, discretionary (total)
3,630
4,144
3,771
Appropriations, mandatory:
1221
Appropriations transferred from the Prevention and Public Health Fund [075–0116]
12
12
Spending authority from offsetting collections, discretionary:
1700
Collected
53
250
237
1701
Change in uncollected payments, Federal sources
197
1750
Spending auth from offsetting collections, disc (total)
250
250
237
1900
Budget authority (total)
3,892
4,406
4,008
1930
Total budgetary resources available
3,893
4,407
4,008
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
3,728
3,977
4,462
3010
New obligations, unexpired accounts
3,892
4,407
4,008
3011
Obligations ("upward adjustments"), expired accounts
20
3020
Outlays (gross)
–3,575
–3,922
–3,925
3041
Recoveries of prior year unpaid obligations, expired
–88
3050
Unpaid obligations, end of year
3,977
4,462
4,545
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–126
–245
–245
3070
Change in uncollected pymts, Fed sources, unexpired
–197
3071
Change in uncollected pymts, Fed sources, expired
78
3090
Uncollected pymts, Fed sources, end of year
–245
–245
–245
Memorandum (non-add) entries:
3100
Obligated balance, start of year
3,602
3,732
4,217
3200
Obligated balance, end of year
3,732
4,217
4,300
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
3,880
4,394
4,008
Outlays, gross:
4010
Outlays from new discretionary authority
1,118
1,222
1,114
4011
Outlays from discretionary balances
2,417
2,686
2,803
4020
Outlays, gross (total)
3,535
3,908
3,917
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–131
–248
–235
4033
Non-Federal sources
–1
–2
–2
4040
Offsets against gross budget authority and outlays (total)
–132
–250
–237
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–197
4052
Offsetting collections credited to expired accounts
79
4060
Additional offsets against budget authority only (total)
–118
4070
Budget authority, net (discretionary)
3,630
4,144
3,771
4080
Outlays, net (discretionary)
3,403
3,658
3,680
Mandatory:
4090
Budget authority, gross
12
12
Outlays, gross:
4100
Outlays from new mandatory authority
4
4101
Outlays from mandatory balances
40
10
8
4110
Outlays, gross (total)
40
14
8
4180
Budget authority, net (total)
3,642
4,156
3,771
4190
Outlays, net (total)
3,443
3,672
3,688
This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective
substance abuse prevention, addiction treatment, and mental health services for people at risk for or experiencing substance
abuse or mental illness. SAMHSA builds partnerships with States, communities, tribal, and private not-for-profit organizations
to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities.
Object Classification (in millions of dollars)
Identification code 075–1362–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
47
48
48
11.3
Other than full-time permanent
3
3
3
11.5
Other personnel compensation
1
1
1
11.7
Military personnel
4
4
4
11.9
Total personnel compensation
55
56
56
12.1
Civilian personnel benefits
16
16
16
12.2
Military personnel benefits
2
2
2
21.0
Travel and transportation of persons
1
1
1
23.1
Rental payments to GSA
10
6
6
23.3
Communications, utilities, and miscellaneous charges
1
1
1
24.0
Printing and reproduction
1
1
1
25.1
Advisory and assistance services
30
33
33
25.2
Other services from non-Federal sources
185
172
174
25.3
Other goods and services from Federal sources
93
99
45
25.4
Operation and maintenance of facilities
1
1
1
26.0
Supplies and materials
1
1
1
41.0
Grants, subsidies, and contributions
3,246
3,768
3,434
99.0
Direct obligations
3,642
4,157
3,771
99.0
Reimbursable obligations
250
250
237
99.9
Total new obligations, unexpired accounts
3,892
4,407
4,008
Employment Summary
Identification code 075–1362–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
462
455
451
1101
Direct military average strength employment
41
40
40
2001
Reimbursable civilian full-time equivalent employment
103
105
104
2101
Reimbursable military average strength employment
14
15
15
Agency for Healthcare Research and Quality
Federal Funds
Healthcare research and quality
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1700–0–1–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Research on Health Costs, Quality and Outcomes
197
196
0002
Medical Expenditure Panel Survey
66
66
0003
AHRQ Program Support
71
71
0799
Total direct obligations
334
333
0803
Research on Health Costs, Quality and Outcomes (Reimbursable)
22
22
0899
Total reimbursable obligations
22
22
0900
Total new obligations, unexpired accounts
356
355
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
16
15
19
Budget authority:
Appropriations, discretionary:
1100
Appropriation
334
333
Spending authority from offsetting collections, discretionary:
1700
Collected
1
26
1701
Change in uncollected payments, Federal sources
20
1750
Spending auth from offsetting collections, disc (total)
21
26
1900
Budget authority (total)
355
359
1930
Total budgetary resources available
371
374
19
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
15
19
19
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
392
382
411
3010
New obligations, unexpired accounts
356
355
3011
Obligations ("upward adjustments"), expired accounts
2
3020
Outlays (gross)
–349
–326
–288
3041
Recoveries of prior year unpaid obligations, expired
–19
3050
Unpaid obligations, end of year
382
411
123
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–156
–85
–85
3070
Change in uncollected pymts, Fed sources, unexpired
–20
3071
Change in uncollected pymts, Fed sources, expired
91
3090
Uncollected pymts, Fed sources, end of year
–85
–85
–85
Memorandum (non-add) entries:
3100
Obligated balance, start of year
236
297
326
3200
Obligated balance, end of year
297
326
38
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
355
359
Outlays, gross:
4010
Outlays from new discretionary authority
123
143
4011
Outlays from discretionary balances
218
183
288
4020
Outlays, gross (total)
341
326
288
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–80
–26
4040
Offsets against gross budget authority and outlays (total)
–80
–26
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–20
4052
Offsetting collections credited to expired accounts
79
4060
Additional offsets against budget authority only (total)
59
4070
Budget authority, net (discretionary)
334
333
4080
Outlays, net (discretionary)
261
300
288
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
8
4180
Budget authority, net (total)
334
333
4190
Outlays, net (total)
269
300
288
The FY 2018 Budget consolidates the Agency for Healthcare Research and Quality within the National Institutes of Health as
the National Institute for Research on Safety and Quality.
Object Classification (in millions of dollars)
Identification code 075–1700–0–1–552
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
31
31
11.3
Other than full-time permanent
4
4
11.5
Other personnel compensation
1
1
11.7
Military personnel
1
1
11.9
Total personnel compensation
37
37
12.1
Civilian personnel benefits
10
10
23.1
Rental payments to GSA
4
4
23.3
Communications, utilities, and miscellaneous charges
1
1
25.2
Other services from non-Federal sources
10
10
25.3
Other goods and services from Federal sources
25
25
25.5
Research and development contracts
135
135
31.0
Equipment
1
1
41.0
Grants, subsidies, and contributions
111
110
99.0
Direct obligations
334
333
99.0
Reimbursable obligations
22
22
99.9
Total new obligations, unexpired accounts
356
355
Employment Summary
Identification code 075–1700–0–1–552
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
275
293
1101
Direct military average strength employment
7
7
2001
Reimbursable civilian full-time equivalent employment
2
6
3001
Allocation account civilian full-time equivalent employment
10
25
Centers for Medicare and Medicaid Services
Federal Funds
Grants to states for medicaid
For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $284,798,384,000, to remain available until expended.
In addition, for carrying out such titles after May 31, 2018, for the last quarter of fiscal year 2018 for unanticipated costs incurred for the current fiscal year, such sums as may be necessary, to remain available until expended.
In addition, for carrying out such titles for the first quarter of fiscal year 2019, $134,847,759,000, to remain available until expended.
Payment under such 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.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0512–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Medicaid Vendor Payments
372,603
354,194
384,609
0002
State and local administration
20,451
20,831
20,811
0003
Vaccines for Children
4,396
4,437
4,598
0799
Total direct obligations
397,450
379,462
410,018
0801
Medicare Part B premiums
767
941
1,026
0802
Medicare Part D
3
3
0899
Total reimbursable obligations
767
944
1,029
0900
Total new obligations, unexpired accounts
398,217
380,406
411,047
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
343
413
1
1021
Recoveries of prior year unpaid obligations
30,729
1033
Recoveries of prior year paid obligations
14
1050
Unobligated balance (total)
31,086
413
1
Budget authority:
Appropriations, mandatory:
1200
Appropriation
253,400
263,467
284,798
Advance appropriations, mandatory:
1270
Advance appropriation
113,272
115,583
125,219
Spending authority from offsetting collections, mandatory:
1800
Collected
767
944
1,029
1801
Change in uncollected payments, Federal sources
105
1850
Spending auth from offsetting collections, mand (total):
872
944
1,029
1900
Budget authority (total)
367,544
379,994
411,046
1930
Total budgetary resources available
398,630
380,407
411,047
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
413
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
42,222
40,649
41,656
3010
New obligations, unexpired accounts
398,217
380,406
411,047
3020
Outlays (gross)
–369,061
–379,399
–408,599
3040
Recoveries of prior year unpaid obligations, unexpired
–30,729
3050
Unpaid obligations, end of year
40,649
41,656
44,104
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–105
–105
3070
Change in uncollected pymts, Fed sources, unexpired
–105
3090
Uncollected pymts, Fed sources, end of year
–105
–105
–105
Memorandum (non-add) entries:
3100
Obligated balance, start of year
42,222
40,544
41,551
3200
Obligated balance, end of year
40,544
41,551
43,999
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
367,544
379,994
411,046
Outlays, gross:
4100
Outlays from new mandatory authority
332,002
350,020
396,915
4101
Outlays from mandatory balances
37,059
29,379
11,684
4110
Outlays, gross (total)
369,061
379,399
408,599
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–767
–944
–1,029
4123
Non-Federal sources
–14
4130
Offsets against gross budget authority and outlays (total)
–781
–944
–1,029
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–105
4143
Recoveries of prior year paid obligations, unexpired accounts
14
4150
Additional offsets against budget authority only (total)
–91
4160
Budget authority, net (mandatory)
366,672
379,050
410,017
4170
Outlays, net (mandatory)
368,280
378,455
407,570
4180
Budget authority, net (total)
366,672
379,050
410,017
4190
Outlays, net (total)
368,280
378,455
407,570
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
366,672
379,050
410,017
Outlays
368,280
378,455
407,570
Legislative proposal, subject to PAYGO:
Budget Authority
–3,857
Outlays
–3,857
Total:
Budget Authority
366,672
379,050
406,160
Outlays
368,280
378,455
403,713
Medicaid assists States in providing medical care to their low-income populations by granting Federal matching payments under
title XIX of the Social Security Act to States with approved plans.
Medicaid estimates assume budget authority for expenses that are incurred but not reported (IBNR).
Authorized as part of title XIX, Vaccines for Children (VFC) finances the purchase of vaccines for low-income, eligible children.
VFC is administered by the Centers for Disease Control and Prevention and is funded entirely by the Federal Government.
Vaccines for Children (in millions of dollars)
Obligations
2016
2017
2018
Vaccine Purchase
4,211
4,241
4,277
Vaccine Stockpile
8
14
129
Ordering, Distribution, and Operations
132
133
141
Vaccine Management Contract Support
0
0
0
Evaluation Activities
48
50
51
Total Obligations
4,400
4,437
4,598
Object Classification (in millions of dollars)
Identification code 075–0512–0–1–551
2016 actual
2017 est.
2018 est.
41.0
Direct obligations: Grants, subsidies, and contributions
397,450
379,462
410,018
99.0
Reimbursable obligations
767
944
1,029
99.9
Total new obligations, unexpired accounts
398,217
380,406
411,047
Grants to States for Medicaid
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0512–4–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Medicaid Vendor Payments
–3,857
0799
Total direct obligations
–3,857
0900
Total new obligations, unexpired accounts (object class 41.0)
–3,857
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–3,857
1900
Budget authority (total)
–3,857
1930
Total budgetary resources available
–3,857
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–3,857
3020
Outlays (gross)
3,857
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–3,857
Outlays, gross:
4100
Outlays from new mandatory authority
–3,857
4180
Budget authority, net (total)
–3,857
4190
Outlays, net (total)
–3,857
This schedule reflects the Administration's Medicaid proposals. This schedule reflects the Administration's Medicaid proposals.
State Grants and Demonstrations
Program and Financing (in millions of dollars)
Identification code 075–0516–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0012
Medicaid integrity program
79
113
86
0018
Money follows the person (MFP) demonstration
1,435
0019
MFP evaluations and technical support
1
0023
Grants to improve outreach and enrollment
20
20
0025
Medicaid emergency psychiatric demonstration
1
0027
Demonstration Programs to Improve Mental Health Services
23
0799
Total direct obligations
1,559
133
86
0900
Total new obligations, unexpired accounts
1,559
133
86
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
2,251
1,007
488
1012
Unobligated balance transfers between expired and unexpired accounts
2
1021
Recoveries of prior year unpaid obligations
2
1050
Unobligated balance (total)
2,255
1,007
488
Budget authority:
Appropriations, mandatory:
1200
Appropriation
597
84
86
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–38
–6
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–168
–464
1260
Appropriations, mandatory (total)
391
–386
86
1900
Budget authority (total)
391
–386
86
1930
Total budgetary resources available
2,646
621
574
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–80
1941
Unexpired unobligated balance, end of year
1,007
488
488
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
787
1,721
1,317
3010
New obligations, unexpired accounts
1,559
133
86
3011
Obligations ("upward adjustments"), expired accounts
12
3020
Outlays (gross)
–559
–537
–534
3040
Recoveries of prior year unpaid obligations, unexpired
–2
3041
Recoveries of prior year unpaid obligations, expired
–76
3050
Unpaid obligations, end of year
1,721
1,317
869
Memorandum (non-add) entries:
3100
Obligated balance, start of year
787
1,721
1,317
3200
Obligated balance, end of year
1,721
1,317
869
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
391
–386
86
Outlays, gross:
4100
Outlays from new mandatory authority
28
8
21
4101
Outlays from mandatory balances
531
529
513
4110
Outlays, gross (total)
559
537
534
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–12
Additional offsets against gross budget authority only:
4142
Offsetting collections credited to expired accounts
12
4160
Budget authority, net (mandatory)
391
–386
86
4170
Outlays, net (mandatory)
547
537
534
4180
Budget authority, net (total)
391
–386
86
4190
Outlays, net (total)
547
537
534
State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including
the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170), the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance
Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), the Health
Care and Education Reconciliation Act of 2010 (P.L. 111–152), the Protecting Access to Medicare Act of 2014 (P.L. 113–93),
and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10).
Object Classification (in millions of dollars)
Identification code 075–0516–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent - Medicaid Integrity Program
9
10
10
12.1
Civilian personnel benefits - Medicaid Integrity Program
4
5
5
41.0
Grants, subsidies, and contributions - Medicaid Integrity Program
67
98
71
41.0
Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations
1,435
41.0
Grants, subsidies, and contributions - MFP evaluations and technical support
1
41.0
Grants, subsidies, and contributions - Grants to improve outreach and enrollment
20
20
41.0
Grants, subsidies, and contributions - Demos to Improve Mental Health
23
99.0
Direct obligations
1,559
133
86
99.9
Total new obligations, unexpired accounts
1,559
133
86
Employment Summary
Identification code 075–0516–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
80
120
120
Payments to health care trust funds
For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the
Social Security Act, $323,497,300,000.
In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
Act that were not anticipated in budget estimates, such sums as may be necessary.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0580–0–1–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Federal contribution to match premiums (SMI)
219,759
229,782
245,396
0002
Part D benefits (Rx Drug)
88,000
82,512
76,133
0003
Part D Federal administration (Rx Drug)
691
405
422
0004
General Fund Transfers to HI
1,493
1,324
1,543
0006
Federal Bureau of Investigation (HCFAC)
130
131
144
0007
Federal payments from taxation of OASDI benefits (HI)
23,022
24,210
27,425
0008
Criminal fines (HCFAC)
24
590
630
0009
Civil penalties and damages (HCFAC - DOJ and CMS administration)
24
32
33
0010
Asset Forfeiture
54
30
31
0011
State Low Income Determinations
3
3
0900
Total new obligations, unexpired accounts
333,197
339,019
351,760
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation (definite, annual)
309,933
314,026
323,497
1200
Appropriation (indefinite, permanent)
23,027
24,210
27,425
1200
Appropriation (HCFAC for FBI)
130
131
144
1200
Appropriation (indefinite for HCFAC)
107
652
694
1260
Appropriations, mandatory (total)
333,197
339,019
351,760
1930
Total budgetary resources available
333,197
339,019
351,760
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
14,161
27,070
31,014
3010
New obligations, unexpired accounts
333,197
339,019
351,760
3011
Obligations ("upward adjustments"), expired accounts
39
3020
Outlays (gross)
–319,843
–335,075
–351,776
3041
Recoveries of prior year unpaid obligations, expired
–484
3050
Unpaid obligations, end of year
27,070
31,014
30,998
Memorandum (non-add) entries:
3100
Obligated balance, start of year
14,161
27,070
31,014
3200
Obligated balance, end of year
27,070
31,014
30,998
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
333,197
339,019
351,760
Outlays, gross:
4100
Outlays from new mandatory authority
308,597
309,264
327,237
4101
Outlays from mandatory balances
11,246
25,811
24,539
4110
Outlays, gross (total)
319,843
335,075
351,776
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–72
4123
Non-Federal sources
–39
4130
Offsets against gross budget authority and outlays (total)
–111
Additional offsets against gross budget authority only:
4142
Offsetting collections credited to expired accounts
111
4160
Budget authority, net (mandatory)
333,197
339,019
351,760
4170
Outlays, net (mandatory)
319,732
335,075
351,776
4180
Budget authority, net (total)
333,197
339,019
351,760
4190
Outlays, net (total)
319,732
335,075
351,776
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
333,197
339,019
351,760
Outlays
319,732
335,075
351,776
Legislative proposal, not subject to PAYGO:
Budget Authority
–72
Outlays
–72
Total:
Budget Authority
333,197
339,019
351,688
Outlays
319,732
335,075
351,704
Payments are made to the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds from the general
fund of the Treasury to finance Medicare's medical and drug benefits for beneficiaries, and administrative expenses that are
properly chargeable to the general fund.
Object Classification (in millions of dollars)
Identification code 075–0580–0–1–571
2016 actual
2017 est.
2018 est.
Direct obligations:
41.0
Grants, subsidies, and contributions
330,883
337,287
349,792
42.0
Insurance claims and indemnities (HI Uninsured Federal)
158
147
132
94.0
Financial transfers (Federal admin)
2,156
1,585
1,836
99.9
Total new obligations, unexpired accounts
333,197
339,019
351,760
Payments to Health Care Trust Funds
(Legislative proposal, not subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0580–2–1–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Federal contribution to match premiums (SMI)
–72
0900
Total new obligations, unexpired accounts (object class 41.0)
–72
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation (definite, annual)
–72
1930
Total budgetary resources available
–72
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–72
3020
Outlays (gross)
72
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–72
Outlays, gross:
4100
Outlays from new mandatory authority
–72
4180
Budget authority, net (total)
–72
4190
Outlays, net (total)
–72
Quality Improvement Organizations
Program and Financing (in millions of dollars)
Identification code 075–0519–0–1–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
QIO contracts
696
389
622
0002
QIO support contracts
167
167
184
0900
Total new obligations, unexpired accounts
863
556
806
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
38
556
806
1801
Change in uncollected payments, Federal sources
922
1850
Spending auth from offsetting collections, mand (total)
960
556
806
1930
Total budgetary resources available
960
556
806
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–97
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,488
1,519
1,519
3010
New obligations, unexpired accounts
863
556
806
3011
Obligations ("upward adjustments"), expired accounts
5
3020
Outlays (gross)
–776
–556
–806
3041
Recoveries of prior year unpaid obligations, expired
–61
3050
Unpaid obligations, end of year
1,519
1,519
1,519
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–2,431
–2,488
–2,488
3070
Change in uncollected pymts, Fed sources, unexpired
–922
3071
Change in uncollected pymts, Fed sources, expired
865
3090
Uncollected pymts, Fed sources, end of year
–2,488
–2,488
–2,488
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–943
–969
–969
3200
Obligated balance, end of year
–969
–969
–969
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
960
556
806
Outlays, gross:
4100
Outlays from new mandatory authority
141
145
396
4101
Outlays from mandatory balances
635
411
410
4110
Outlays, gross (total)
776
556
806
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–682
–556
–806
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–922
4142
Offsetting collections credited to expired accounts
644
4150
Additional offsets against budget authority only (total)
–278
4170
Outlays, net (mandatory)
94
4180
Budget authority, net (total)
4190
Outlays, net (total)
94
Memorandum (non-add) entries:
5093
Expired unavailable balance, SOY: Offsetting collections
50
50
50
5095
Expired unavailable balance, EOY: Offsetting collections
50
50
50
Part B of title XI of the Social Security Act, as amended by the Peer Review Improvement Act of 1982, provides the statutory
authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to promote the effectiveness,
efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure that those services are reasonable
and necessary. The program is funded through transfers from the Medicare Hospital Insurance Trust Fund and the Medicare Supplementary
Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO program was established to improve budgetary
operations.
Object Classification (in millions of dollars)
Identification code 075–0519–0–1–571
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
30
21
30
23.3
Communications, utilities, and miscellaneous charges
1
1
1
25.2
Other services from non-Federal sources
803
514
745
25.3
Other goods and services from Federal sources
18
14
21
25.4
Operation and maintenance of facilities
11
6
9
99.9
Total new obligations, unexpired accounts
863
556
806
Employment Summary
Identification code 075–0519–0–1–571
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
208
232
232
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 PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for
Medicare and Medicaid Services, not to exceed $3,587,996,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353
of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary pursuant to section 1893(h) of the Social Security Act, and such sums as may be collected from authorized user fees and the sale of data, which shall be credited to this account
and 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 PHS Act shall
be credited to and available for carrying out the purposes of this appropriation: Provided further, That the Secretary is directed to collect fees in fiscal year 2018 from Medicare Advantage 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.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0511–0–1–550
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Program operations
3,022
3,041
2,698
0002
Federal administration
763
763
735
0003
State survey and certification
410
420
429
0004
Research, demonstrations, and evaluation projects
85
31
29
0007
ARRA Medicare/Medicaid HIT
86
23
23
0008
Risk Corridor
5,400
5,917
0100
Total direct program
9,766
10,195
3,914
0799
Total direct obligations
9,766
10,195
3,914
0801
Clinical laboratory improvement amendments
53
47
50
0802
Sale of data
10
8
8
0803
Coordination of benefits
30
28
30
0804
Medicare advantage/Prescription drug plan
80
81
80
0805
Provider enrollment
12
24
25
0806
Recovery audit contractors
105
105
563
0808
Marketplace User Fees
1,129
1,239
1,170
0810
Risk Adjustment Administrative Expenses
5
25
18
0813
Other reimbursable program activity
206
29
21
0899
Total reimbursable obligations
1,630
1,586
1,965
0900
Total new obligations, unexpired accounts
11,396
11,781
5,879
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
–1,091
–5,574
–11,967
1020
Adjustment of unobligated bal brought forward, Oct 1
52
–517
1021
Recoveries of prior year unpaid obligations
32
1033
Recoveries of prior year paid obligations
11
1050
Unobligated balance (total)
–996
–6,091
–11,967
Budget authority:
Appropriations, mandatory:
1200
Appropriation
68
3
3
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–5
1260
Appropriations, mandatory (total)
63
3
3
Spending authority from offsetting collections, discretionary:
1700
Collected
2,391
4,079
3,725
1701
Change in uncollected payments, Federal sources
2,172
1750
Spending auth from offsetting collections, disc (total)
4,563
4,079
3,725
Spending authority from offsetting collections, mandatory:
1800
Collected
1,580
1,862
2,052
1801
Change in uncollected payments, Federal sources
674
1802
Offsetting collections (previously unavailable)
75
86
99
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–94
–125
1850
Spending auth from offsetting collections, mand (total)
2,235
1,823
2,151
1900
Budget authority (total)
6,861
5,905
5,879
1930
Total budgetary resources available
5,865
–186
–6,088
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–43
1941
Unexpired unobligated balance, end of year
–5,574
–11,967
–11,967
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
6,739
12,072
17,944
3001
Adjustments to unpaid obligations, brought forward, Oct 1
517
3010
New obligations, unexpired accounts
11,396
11,781
5,879
3011
Obligations ("upward adjustments"), expired accounts
103
3020
Outlays (gross)
–5,948
–6,426
–6,117
3040
Recoveries of prior year unpaid obligations, unexpired
–32
3041
Recoveries of prior year unpaid obligations, expired
–186
3050
Unpaid obligations, end of year
12,072
17,944
17,706
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–5,011
–5,470
–5,470
3070
Change in uncollected pymts, Fed sources, unexpired
–2,846
3071
Change in uncollected pymts, Fed sources, expired
2,387
3090
Uncollected pymts, Fed sources, end of year
–5,470
–5,470
–5,470
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,728
7,119
12,474
3200
Obligated balance, end of year
6,602
12,474
12,236
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
4,563
4,079
3,725
Outlays, gross:
4010
Outlays from new discretionary authority
2,055
4,079
3,725
4011
Outlays from discretionary balances
2,270
4020
Outlays, gross (total)
4,325
4,079
3,725
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–4,252
–4,071
–3,691
4033
Non-Federal sources
–378
–8
–34
4040
Offsets against gross budget authority and outlays (total)
–4,630
–4,079
–3,725
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–2,172
4052
Offsetting collections credited to expired accounts
2,239
4060
Additional offsets against budget authority only (total)
67
4080
Outlays, net (discretionary)
–305
Mandatory:
4090
Budget authority, gross
2,298
1,826
2,154
Outlays, gross:
4100
Outlays from new mandatory authority
452
1,956
2,154
4101
Outlays from mandatory balances
1,171
391
238
4110
Outlays, gross (total)
1,623
2,347
2,392
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–222
–240
–189
4123
Non-Federal sources
–1,372
–1,622
–1,863
4130
Offsets against gross budget authority and outlays (total)
–1,594
–1,862
–2,052
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–674
4142
Offsetting collections credited to expired accounts
3
4143
Recoveries of prior year paid obligations, unexpired accounts
11
4150
Additional offsets against budget authority only (total)
–660
4160
Budget authority, net (mandatory)
44
–36
102
4170
Outlays, net (mandatory)
29
485
340
4180
Budget authority, net (total)
44
–36
102
4190
Outlays, net (total)
–276
485
340
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
130
148
187
5091
Expiring unavailable balance: Offsetting collections
–1
5092
Unexpired unavailable balance, EOY: Offsetting collections
148
187
88
5093
Expired unavailable balance, SOY: Offsetting collections
59
60
60
5095
Expired unavailable balance, EOY: Offsetting collections
59
60
60
Note: The figure for the risk corridors program in this table for fiscal year 2017 is not an estimate. Amounts for fiscal
year 2017 are uncertain and therefore the figure in this table simply reflects imbalances between payments out and payments
in by participating plans equal to those that occurred for fiscal year 2016.
Program management activities include funding for program operations, survey and certification, the Clinical Laboratory Improvement
Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts and other administrative
costs.
Object Classification (in millions of dollars)
Identification code 075–0511–0–1–550
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
459
464
464
11.3
Other than full-time permanent
12
22
11
11.5
Other personnel compensation
7
8
8
11.7
Military personnel
14
14
14
11.9
Total personnel compensation
492
508
497
12.1
Civilian personnel benefits
162
146
147
12.2
Military personnel benefits
7
7
7
21.0
Travel and transportation of persons
5
3
5
22.0
Transportation of things
1
1
1
23.1
Rental payments to GSA
19
23.3
Communications, utilities, and miscellaneous charges
74
74
74
24.0
Printing and reproduction
58
58
58
25.2
Other services from non-Federal sources
2,836
2,065
1,646
25.3
Other goods and services from Federal sources
87
3
3
25.6
Medical care
485
1,275
1,338
25.7
Operation and maintenance of equipment
1
1
1
26.0
Supplies and materials
1
31.0
Equipment
1
1
1
41.0
Grants, subsidies, and contributions
136
136
136
42.0
Insurance claims and indemnities
5,400
5,917
99.0
Direct obligations
9,765
10,195
3,914
99.0
Reimbursable obligations
1,631
1,586
1,965
99.9
Total new obligations, unexpired accounts
11,396
11,781
5,879
Employment Summary
Identification code 075–0511–0–1–550
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
4,329
4,387
4,232
1001
Direct civilian full-time equivalent employment
159
166
164
1101
Direct military average strength employment
189
138
138
2001
Reimbursable civilian full-time equivalent employment
188
267
267
Program Management
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0511–4–1–550
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
ACL SHIPs
13
0899
Total reimbursable obligations
13
0900
Total new obligations, unexpired accounts (object class 25.2)
13
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
13
1900
Budget authority (total)
13
1930
Total budgetary resources available
13
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
13
3020
Outlays (gross)
–13
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
13
Outlays, gross:
4100
Outlays from new mandatory authority
13
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–13
4180
Budget authority, net (total)
4190
Outlays, net (total)
Children's Health Insurance Fund
Program and Financing (in millions of dollars)
Identification code 075–0515–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Grants to states and US territories
14,062
15,952
5,700
0003
Child health quality
7
16
17
0900
Total new obligations, unexpired accounts (object class 41.0)
14,069
15,968
5,717
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
7,502
3,014
6,955
1011
Unobligated balance transfer from other acct [075–5551]
3,656
570
1012
Unobligated balance transfers between expired and unexpired accounts
216
186
104
1021
Recoveries of prior year unpaid obligations
2
1050
Unobligated balance (total)
7,720
6,856
7,629
Budget authority:
Appropriations, discretionary:
1120
Appropriations transferred to other acct [075–5551]
–570
1131
Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310
–542
–3,279
1131
Unobligated balance of appropriations permanently reduced, Perf. Bonus Pmts.
–5,669
–1,193
1160
Appropriation, discretionary (total):
–6,781
–4,472
Appropriations, mandatory:
1200
Appropriation
19,320
20,400
5,700
1221
Appropriations transferred from other acct [075–5551]
2,618
570
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–4,679
–170
1260
Appropriations, mandatory (total)
14,641
22,848
6,270
1900
Budget authority (total)
14,641
16,067
1,798
1930
Total budgetary resources available
22,361
22,923
9,427
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–5,278
1941
Unexpired unobligated balance, end of year
3,014
6,955
3,710
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
8,722
8,069
7,382
3010
New obligations, unexpired accounts
14,069
15,968
5,717
3020
Outlays (gross)
–14,305
–16,655
–12,017
3040
Recoveries of prior year unpaid obligations, unexpired
–2
3041
Recoveries of prior year unpaid obligations, expired
–415
3050
Unpaid obligations, end of year
8,069
7,382
1,082
Memorandum (non-add) entries:
3100
Obligated balance, start of year
8,722
8,069
7,382
3200
Obligated balance, end of year
8,069
7,382
1,082
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
–6,781
–4,472
Mandatory:
4090
Budget authority, gross
14,641
22,848
6,270
Outlays, gross:
4100
Outlays from new mandatory authority
6,194
8,300
5,700
4101
Outlays from mandatory balances
8,111
8,355
6,317
4110
Outlays, gross (total)
14,305
16,655
12,017
4180
Budget authority, net (total)
14,641
16,067
1,798
4190
Outlays, net (total)
14,305
16,655
12,017
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
14,641
16,067
1,798
Outlays
14,305
16,655
12,017
Legislative proposal, subject to PAYGO:
Budget Authority
1,400
Outlays
1,400
Total:
Budget Authority
14,641
16,067
3,198
Outlays
14,305
16,655
13,417
The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under title XXI of the Social Security
Act. Title XXI 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 separate
CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization
Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding for CHIP through fiscal year 2013.
CHIPRA made some modifications to the program, including increased funding for States and territories, bonus payments for
States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency
fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding
is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding
for CHIP, providing appropriations through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L.
114–10, MACRA) extended funding for CHIP for two years, through fiscal year 2017. The Budget proposes a two-year extension
of CHIP funding through fiscal year 2019.
Children's Health Insurance Fund
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0515–4–1–551
2016 actual
2017 est.
2018 est.
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
1,400
1930
Total budgetary resources available
1,400
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1,400
Change in obligated balance:
Unpaid obligations:
3020
Outlays (gross)
–1,400
3050
Unpaid obligations, end of year
–1,400
Memorandum (non-add) entries:
3200
Obligated balance, end of year
–1,400
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
1,400
Outlays, gross:
4100
Outlays from new mandatory authority
1,400
4180
Budget authority, net (total)
1,400
4190
Outlays, net (total)
1,400
This schedule reflects the Administration's Children's Health Insurance Program (CHIP) proposals.
Center for Medicare and Medicaid Innovation
Program and Financing (in millions of dollars)
Identification code 075–0522–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Administration
282
353
330
0002
Innovation Activities
1,011
1,137
1,063
0900
Total new obligations, unexpired accounts
1,293
1,490
1,393
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
5,669
4,404
2,914
1021
Recoveries of prior year unpaid obligations
28
1050
Unobligated balance (total)
5,697
4,404
2,914
1930
Total budgetary resources available
5,697
4,404
2,914
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
4,404
2,914
1,521
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,482
1,591
1,787
3010
New obligations, unexpired accounts
1,293
1,490
1,393
3020
Outlays (gross)
–1,156
–1,294
–1,408
3040
Recoveries of prior year unpaid obligations, unexpired
–28
3050
Unpaid obligations, end of year
1,591
1,787
1,772
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,482
1,591
1,787
3200
Obligated balance, end of year
1,591
1,787
1,772
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
1,156
1,294
1,408
4180
Budget authority, net (total)
4190
Outlays, net (total)
1,156
1,294
1,408
The Center for Medicare and Medicaid Innovation ("Innovation Center") was established by section 1115A of the Social Security
Act (as added by section 3021 of the Patient Protection and Affordable Care Act). The Innovation Center is tasked with testing
innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of
care provided to individuals under Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). The statute provides
$10 billion in mandatory funding for these purposes in fiscal years 2011 through 2019.
Object Classification (in millions of dollars)
Identification code 075–0522–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
56
69
70
12.1
Civilian personnel benefits
18
21
22
23.3
Communications, utilities, and miscellaneous charges
2
4
3
25.2
Other services from non-Federal sources
644
670
623
41.0
Grants, subsidies, and contributions
464
615
572
42.0
Insurance claims and indemnities
109
111
103
99.9
Total new obligations, unexpired accounts
1,293
1,490
1,393
Employment Summary
Identification code 075–0522–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
521
615
617
Child Enrollment Contingency Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5551–0–2–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
2,048
577
Receipts:
Current law:
1140
Interest, Child Enrollment Contingency Fund
20
7
2000
Total: Balances and receipts
20
2,055
577
Appropriations:
Current law:
2101
Child Enrollment Contingency Fund
–20
2103
Child Enrollment Contingency Fund
–2,048
–570
2132
Child Enrollment Contingency Fund
2,048
2134
Child Enrollment Contingency Fund
570
2199
Total current law appropriations
2,028
–1,478
–570
2999
Total appropriations
2,028
–1,478
–570
5099
Balance, end of year
2,048
577
7
Program and Financing (in millions of dollars)
Identification code 075–5551–0–2–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Grants to States and US Territories
224
0900
Total new obligations (object class 41.0)
224
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
2,048
3,656
570
1010
Unobligated balance transfer to other accts [075–0515]
–3,656
–570
1050
Unobligated balance (total)
2,048
Budget authority:
Appropriations, discretionary:
1121
Delay of transfer to other acct [075–0515]
570
1134
Appropriations precluded from obligation
–570
Appropriations, mandatory:
1200
Appropriation
3,860
1,140
1201
Appropriation (special or trust fund)
20
1203
Appropriation (previously unavailable)
2,048
570
1220
Appropriations transferred to other acct [075–0515]
–2,618
–570
1232
Appropriations and/or unobligated balance of appropriations temporarily reduced
–2,048
1260
Appropriations, mandatory (total)
1,832
570
1900
Budget authority (total)
1,832
570
1930
Total budgetary resources available
3,880
570
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
3,656
570
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
53
224
3010
New obligations, unexpired accounts
224
3020
Outlays (gross)
–53
–224
3050
Unpaid obligations, end of year
224
Memorandum (non-add) entries:
3100
Obligated balance, start of year
53
224
3200
Obligated balance, end of year
224
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
1,832
570
Outlays, gross:
4101
Outlays from mandatory balances
53
224
4180
Budget authority, net (total)
1,832
570
4190
Outlays, net (total)
53
224
Memorandum (non-add) entries:
5000
Total investments, SOY: Federal securities: Par value
2,053
571
578
5001
Total investments, EOY: Federal securities: Par value
571
578
The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) established the Child Enrollment
Contingency Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund
payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target
average number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended
the Contingency Fund through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended
the Contingency Fund through fiscal year 2017. The Budget proposes a two-year extension of CHIP funding, including an extension
of the Contingency Fund through fiscal year 2019.
The Fund received an initial appropriation equal to 20 percent of the fiscal year 2009 national allotment ($2.1 billion).
In fiscal years 2010 through 2017, the statute appropriates the amount necessary to make payments to eligible States, but
not to exceed 20 percent of the total annual appropriation for CHIP allotments to States. Any amounts in excess of this aggregate
cap will be made available for CHIP performance bonus payments. The Contingency Fund is invested in interest bearing securities
of the United States, and the income derived from these investments constitutes a part of the fund.
Medicare Health Information Technology Incentive Payments, Recovery Act
Program and Financing (in millions of dollars)
Identification code 075–0508–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
Incentive payments to hospitals
1,822
462
15
0802
Incentive payments to eligible professionals
972
460
0900
Total new obligations (object class 42.0)
2,794
922
15
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected from the HI Trust Fund
1,845
462
15
1800
Collected from the SMI Trust Fund
930
460
1801
Change in uncollected payments, Federal sources
19
1850
Spending auth from offsetting collections, mand (total)
2,794
922
15
1930
Total budgetary resources available
2,794
922
15
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
51
80
80
3010
New obligations, unexpired accounts
2,794
922
15
3020
Outlays (gross)
–2,765
–922
–15
3050
Unpaid obligations, end of year
80
80
80
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–227
–246
–246
3070
Change in uncollected pymts, Fed sources, unexpired
–19
3090
Uncollected pymts, Fed sources, end of year
–246
–246
–246
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–176
–166
–166
3200
Obligated balance, end of year
–166
–166
–166
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
2,794
922
15
Outlays, gross:
4100
Outlays from new mandatory authority
2,765
846
15
4101
Outlays from mandatory balances
76
4110
Outlays, gross (total)
2,765
922
15
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–2,775
–922
–15
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–19
4170
Outlays, net (mandatory)
–10
4180
Budget authority, net (total)
4190
Outlays, net (total)
–10
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
133
133
133
5092
Unexpired unavailable balance, EOY: Offsetting collections
133
133
133
Rate Review Grants
Program and Financing (in millions of dollars)
Identification code 075–0112–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Premium rate review grants
26
0900
Total new obligations (object class 41.0)
26
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
7
29
8
1012
Unobligated balance transfers between expired and unexpired accounts
22
1021
Recoveries of prior year unpaid obligations
5
25
1050
Unobligated balance (total)
29
34
33
1930
Total budgetary resources available
29
34
33
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
29
8
33
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
105
71
64
3010
New obligations, unexpired accounts
26
3020
Outlays (gross)
–29
–28
–26
3040
Recoveries of prior year unpaid obligations, unexpired
–5
–25
3041
Recoveries of prior year unpaid obligations, expired
–5
3050
Unpaid obligations, end of year
71
64
13
Memorandum (non-add) entries:
3100
Obligated balance, start of year
105
71
64
3200
Obligated balance, end of year
71
64
13
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
29
28
26
4180
Budget authority, net (total)
4190
Outlays, net (total)
29
28
26
The Patient Protection and Affordable Care Act (P.L. 111–148) amended Section 2794 of the Public Health Service Act and provided
that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
insurance reform activities consistent with Section 2794 (c)(2)(B).
Pre-Existing Condition Insurance Plan Program
Program and Financing (in millions of dollars)
Identification code 075–0113–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Pre-Existing Condition Insurance Plan Program (Direct)
1
0002
Administration
75
0799
Total direct obligations
1
75
0900
Total new obligations, unexpired accounts (object class 25.2)
1
75
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
173
389
322
1021
Recoveries of prior year unpaid obligations
217
8
1050
Unobligated balance (total)
390
397
322
1930
Total budgetary resources available
390
397
322
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
389
322
322
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
231
15
3010
New obligations, unexpired accounts
1
75
3020
Outlays (gross)
–82
3040
Recoveries of prior year unpaid obligations, unexpired
–217
–8
3050
Unpaid obligations, end of year
15
Memorandum (non-add) entries:
3100
Obligated balance, start of year
231
15
3200
Obligated balance, end of year
15
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
82
4180
Budget authority, net (total)
4190
Outlays, net (total)
82
This account funds the Pre-Existing Condition Insurance Plan program (PCIP), which made health insurance available to people
who had been unable to purchase insurance due to a pre-existing condition. Enrollees paid monthly premiums similar to those
charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions.
The funding for this program, including operating costs, was provided in the Patient Protection and Affordable Care Act (P.L.
111–148). The PCIP program ended in fiscal year 2014 as new insurance options became available to the enrolled population,
and outlays reflected in subsequent fiscal years reflect program close out and claims run out costs, as well as allowable
administrative costs in the current year.
Early Retiree Reinsurance Program
Program and Financing (in millions of dollars)
Identification code 075–0114–0–1–551
2016 actual
2017 est.
2018 est.
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
26
26
26
1930
Total budgetary resources available
26
26
26
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
26
26
26
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
11
11
5
3020
Outlays (gross)
–6
–5
3050
Unpaid obligations, end of year
11
5
Memorandum (non-add) entries:
3100
Obligated balance, start of year
11
11
5
3200
Obligated balance, end of year
11
5
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
6
5
4180
Budget authority, net (total)
4190
Outlays, net (total)
6
5
The Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated $5 billion for the Early Retiree
Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
sponsors.
Affordable Insurance Exchange Grants
Program and Financing (in millions of dollars)
Identification code 075–0115–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0002
Administration
20
24
17
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
22
26
17
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–2
–2
1260
Appropriations, mandatory (total)
20
24
17
1930
Total budgetary resources available
20
24
17
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,005
342
79
3010
New obligations, unexpired accounts
20
24
17
3011
Obligations ("upward adjustments"), expired accounts
1
3020
Outlays (gross)
–446
–287
–59
3041
Recoveries of prior year unpaid obligations, expired
–238
3050
Unpaid obligations, end of year
342
79
37
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,005
342
79
3200
Obligated balance, end of year
342
79
37
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
20
24
17
Outlays, gross:
4100
Outlays from new mandatory authority
11
7
5
4101
Outlays from mandatory balances
435
280
54
4110
Outlays, gross (total)
446
287
59
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–2
Additional offsets against gross budget authority only:
4142
Offsetting collections credited to expired accounts
2
4160
Budget authority, net (mandatory)
20
24
17
4170
Outlays, net (mandatory)
444
287
59
4180
Budget authority, net (total)
20
24
17
4190
Outlays, net (total)
444
287
59
This program provided funding for Planning and Establishment Grants to States for their activities to implement Health Insurance
Exchanges. The Exchanges facilitate the purchase of qualified health plans in the individual market and allow small businesses
to offer qualified health plans to their employees through the Small Business Health Options Program (SHOP). Section 1311
of the Patient Protection and Affordable Care Act (P.L. 111–148) provided amounts necessary to enable the Secretary to award
grants to States beginning no later than March 23, 2011, and allowed for renewal of grants through January 1, 2015. The final
round of grants was awarded to States in December 2014.
Object Classification (in millions of dollars)
Identification code 075–0115–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
4
5
5
25.2
Other services from non-Federal sources
16
19
12
99.9
Total new obligations, unexpired accounts
20
24
17
Employment Summary
Identification code 075–0115–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
34
34
34
Risk Adjustment Program Payments
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5733–0–2–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
174
248
332
Receipts:
Current law:
1110
Receipts, Risk Adjustment Program
3,619
4,806
6,361
2000
Total: Balances and receipts
3,793
5,054
6,693
Appropriations:
Current law:
2101
Risk Adjustment Program Payments
–3,618
–4,807
–6,361
2103
Risk Adjustment Program Payments
–174
–247
–332
2132
Risk Adjustment Program Payments
247
332
2199
Total current law appropriations
–3,545
–4,722
–6,693
2999
Total appropriations
–3,545
–4,722
–6,693
5099
Balance, end of year
248
332
Program and Financing (in millions of dollars)
Identification code 075–5733–0–2–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Risk Adjustment Program Payments (Direct)
3,545
4,722
6,693
0900
Total new obligations (object class 41.0)
3,545
4,722
6,693
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
3,618
4,807
6,361
1203
Appropriation (previously unavailable)
174
247
332
1232
Appropriations and/or unobligated balance of appropriations temporarily reduced
–247
–332
1260
Appropriations, mandatory (total)
3,545
4,722
6,693
1930
Total budgetary resources available
3,545
4,722
6,693
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
442
1,247
1,232
3010
New obligations, unexpired accounts
3,545
4,722
6,693
3020
Outlays (gross)
–2,740
–4,737
–6,693
3050
Unpaid obligations, end of year
1,247
1,232
1,232
Memorandum (non-add) entries:
3100
Obligated balance, start of year
442
1,247
1,232
3200
Obligated balance, end of year
1,247
1,232
1,232
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
3,545
4,722
6,693
Outlays, gross:
4100
Outlays from new mandatory authority
2,128
3,552
6,693
4101
Outlays from mandatory balances
612
1,185
4110
Outlays, gross (total)
2,740
4,737
6,693
4180
Budget authority, net (total)
3,545
4,722
6,693
4190
Outlays, net (total)
2,740
4,737
6,693
Section 1343 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a permanent risk adjustment program
for non-grandfathered plans in the individual and small group markets. Charges are collected from health insurance issuers
that enroll healthier than average enrollees and payments are made to issuers that enroll sicker than average enrollees. Risk
adjustment may be operated by a State, or by the Federal government in the event a State chooses not to operate risk adjustment.
Payments and charges are made in the year following the plan year for which they are calculated.
Transitional Reinsurance Program
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5735–0–2–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
649
455
273
Receipts:
Current law:
1110
Contributions, Transitional Reinsurance Program
6,713
3,978
167
2000
Total: Balances and receipts
7,362
4,433
440
Appropriations:
Current law:
2101
Transitional Reinsurance Program
–6,713
–3,978
–166
2103
Transitional Reinsurance Program
–650
–456
–274
2132
Transitional Reinsurance Program
456
274
2199
Total current law appropriations
–6,907
–4,160
–440
2999
Total appropriations
–6,907
–4,160
–440
5099
Balance, end of year
455
273
Program and Financing (in millions of dollars)
Identification code 075–5735–0–2–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Transitional reinsurance payments
7,847
4,151
435
0002
Administrative expenses
9
6
0900
Total new obligations, unexpired accounts
7,847
4,160
441
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
941
1
1
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
6,713
3,978
166
1203
Appropriation (previously unavailable)
650
456
274
1232
Appropriations and/or unobligated balance of appropriations temporarily reduced
–456
–274
1260
Appropriations, mandatory (total)
6,907
4,160
440
1930
Total budgetary resources available
7,848
4,161
441
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
224
1
3010
New obligations, unexpired accounts
7,847
4,160
441
3020
Outlays (gross)
–7,623
–4,383
–440
3050
Unpaid obligations, end of year
224
1
2
Memorandum (non-add) entries:
3100
Obligated balance, start of year
224
1
3200
Obligated balance, end of year
224
1
2
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
6,907
4,160
440
Outlays, gross:
4100
Outlays from new mandatory authority
6,033
4,160
440
4101
Outlays from mandatory balances
1,590
223
4110
Outlays, gross (total)
7,623
4,383
440
4180
Budget authority, net (total)
6,907
4,160
440
4190
Outlays, net (total)
7,623
4,383
440
Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a transitional, temporary, three-year
reinsurance program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015,
and 2016. The Centers for Medicare & Medicaid Services assesses contributing entities a per enrollee fee to fund the reinsurance
program, and makes payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold,
up to a reinsurance cap. Reinsurance collections and payments are made in the year following the plan year for which they
are applicable. Reinsurance collections and payments for the 2016 plan year, the final year of the program, will be announced
in June of 2017.
Object Classification (in millions of dollars)
Identification code 075–5735–0–2–551
2016 actual
2017 est.
2018 est.
Direct obligations:
41.0
Grants, subsidies, and contributions - Transitional Reinsurance
7,847
4,151
435
41.0
Grants, subsidies, and contributions - Administration
9
6
99.9
Total new obligations, unexpired accounts
7,847
4,160
441
Consumer Operated and Oriented Plan Program Contingency Fund
Program and Financing (in millions of dollars)
Identification code 075–0524–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
Credit program obligations:
0705
Reestimates of direct loan subsidy
89
16
0706
Interest on reestimates of direct loan subsidy
4
1
0709
Administrative expenses
2
1
0900
Total new obligations, unexpired accounts
95
18
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
3
1
Budget authority:
Appropriations, mandatory:
1200
Appropriation
93
17
1930
Total budgetary resources available
96
18
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
69
16
2
3010
New obligations, unexpired accounts
95
18
3020
Outlays (gross)
–148
–32
–1
3050
Unpaid obligations, end of year
16
2
1
Memorandum (non-add) entries:
3100
Obligated balance, start of year
69
16
2
3200
Obligated balance, end of year
16
2
1
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
93
17
Outlays, gross:
4100
Outlays from new mandatory authority
93
17
4101
Outlays from mandatory balances
55
15
1
4110
Outlays, gross (total)
148
32
1
4180
Budget authority, net (total)
93
17
4190
Outlays, net (total)
148
32
1
Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
Identification code 075–0524–0–1–551
2016 actual
2017 est.
2018 est.
Direct loan subsidy outlays:
134002
Solvency Loans
48
13
134999
Total subsidy outlays
48
13
Direct loan reestimates:
135001
Startup Loans
4
–8
135002
Solvency Loans
88
5
135999
Total direct loan reestimates
92
–3
Administrative expense data:
3580
Outlays from balances
7
2
1
The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L.
112–240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148).
Object Classification (in millions of dollars)
Identification code 075–0524–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
25.2
Other services from non-Federal sources
2
1
41.0
Grants, subsidies, and contributions
93
17
99.9
Total new obligations, unexpired accounts
95
18
Consumer Operated and Oriented Plan Program Account
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–0118–0–1–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
7
7
7
2000
Total: Balances and receipts
7
7
7
5099
Balance, end of year
7
7
7
Program and Financing (in millions of dollars)
Identification code 075–0118–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
Credit program obligations:
0705
Reestimates of direct loan subsidy
430
74
0706
Interest on reestimates of direct loan subsidy
46
7
0709
Administrative expenses
5
1
0900
Total new obligations, unexpired accounts
481
82
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
6
1
Budget authority:
Appropriations, mandatory:
1200
Appropriation
476
81
1930
Total budgetary resources available
482
82
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
98
2
2
3010
New obligations, unexpired accounts
481
82
3020
Outlays (gross)
–577
–82
–1
3050
Unpaid obligations, end of year
2
2
1
Memorandum (non-add) entries:
3100
Obligated balance, start of year
98
2
2
3200
Obligated balance, end of year
2
2
1
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
476
81
Outlays, gross:
4100
Outlays from new mandatory authority
476
81
4101
Outlays from mandatory balances
101
1
1
4110
Outlays, gross (total)
577
82
1
4180
Budget authority, net (total)
476
81
4190
Outlays, net (total)
577
82
1
Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
Identification code 075–0118–0–1–551
2016 actual
2017 est.
2018 est.
Direct loan subsidy outlays:
134003
Solvency Loans
96
1
134999
Total subsidy outlays
96
1
Direct loan reestimates:
135002
Startup Loans
57
–65
135003
Solvency Loans
416
38
135999
Total direct loan reestimates
473
–27
Administrative expense data:
3580
Outlays from balances
5
1
Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated funding for the
Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves
which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of
encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section
1322.
Object Classification (in millions of dollars)
Identification code 075–0118–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
2
25.2
Other services from non-Federal sources
1
25.3
Other goods and services from Federal sources
2
1
41.0
Grants, subsidies, and contributions
476
81
99.9
Total new obligations, unexpired accounts
481
82
Employment Summary
Identification code 075–0118–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
18
Consumer Operated and Oriented Plan Financing Account
Program and Financing (in millions of dollars)
Identification code 075–4418–0–3–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
Credit program obligations:
0713
Payment of interest to Treasury
23
33
33
0742
Downward reestimates paid to receipt accounts
3
99
0743
Interest on downward reestimates
8
0900
Total new obligations, unexpired accounts
26
140
33
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
523
1023
Unobligated balances applied to repay debt
–523
Financing authority:
Borrowing authority, mandatory:
1400
Borrowing authority
16
Spending authority from offsetting collections, mandatory:
1800
Collected
629
148
110
1801
Change in uncollected payments, Federal sources
–96
–1
1825
Spending authority from offsetting collections applied to repay debt
–7
–77
1850
Spending auth from offsetting collections, mand (total)
533
140
33
1900
Budget authority (total)
549
140
33
1930
Total budgetary resources available
549
140
33
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
523
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
226
4
1
3010
New obligations, unexpired accounts
26
140
33
3020
Outlays (gross)
–248
–143
–33
3050
Unpaid obligations, end of year
4
1
1
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–97
–1
3070
Change in uncollected pymts, Fed sources, unexpired
96
1
3090
Uncollected pymts, Fed sources, end of year
–1
Memorandum (non-add) entries:
3100
Obligated balance, start of year
129
3
1
3200
Obligated balance, end of year
3
1
1
Financing authority and disbursements, net:
Mandatory:
4090
Budget authority, gross
549
140
33
Financing disbursements:
4110
Outlays, gross (total)
248
143
33
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120
Federal sources
–572
–82
4122
Interest on uninvested funds
–12
–12
–12
4123
Non-Federal sources
–45
–54
–98
4130
Offsets against gross budget authority and outlays (total)
–629
–148
–110
Additional offsets against financing authority only (total):
4140
Change in uncollected pymts, Fed sources, unexpired
96
1
4160
Budget authority, net (mandatory)
16
–7
–77
4170
Outlays, net (mandatory)
–381
–5
–77
4180
Budget authority, net (total)
16
–7
–77
4190
Outlays, net (total)
–381
–5
–77
Status of Direct Loans (in millions of dollars)
Identification code 075–4418–0–3–551
2016 actual
2017 est.
2018 est.
Cumulative balance of direct loans outstanding:
1210
Outstanding, start of year
1,727
1,909
1,858
1231
Disbursements: Direct loan disbursements
222
3
1251
Repayments: Repayments and prepayments
–45
–54
–98
1263
Write-offs for default: Direct loans
5
1290
Outstanding, end of year
1,909
1,858
1,760
Balance Sheet (in millions of dollars)
Identification code 075–4418–0–3–551
2015 actual
2016 actual
Group heading
ASSETS:
Federal assets:
1101
Fund balances with Treasury
68
506
Investments in US securities:
1106
Receivables, net
79
81
Net value of assets related to post-1991 direct loans receivable:
1401
Direct loans receivable, gross
1,727
1,909
1402
Interest receivable
12
1405
Allowance for subsidy cost (-)
–813
–1,284
1499
Net present value of assets related to direct loans
914
637
1999
Total assets
1,061
1,224
LIABILITIES:
2103
Federal liabilities: Debt
1,061
1,224
4999
Total liabilities and net position
1,061
1,224
Consumer Operated and Oriented Plan Program Contingency Fund Financing Account
Program and Financing (in millions of dollars)
Identification code 075–4482–0–3–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
Credit program obligations:
0713
Payment of interest to Treasury
6
9
9
0742
Downward reestimates paid to receipt accounts
19
0743
Interest on downward reestimates
1
0900
Total new obligations, unexpired accounts
6
29
9
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
102
1
1023
Unobligated balances applied to repay debt
–101
1050
Unobligated balance (total)
1
1
Financing authority:
Borrowing authority, mandatory:
1400
Borrowing authority
4
4
5
Spending authority from offsetting collections, mandatory:
1800
Collected
152
41
17
1801
Change in uncollected payments, Federal sources
–48
–14
1825
Spending authority from offsetting collections applied to repay debt
–2
–14
1850
Spending auth from offsetting collections, mand (total)
104
25
3
1900
Budget authority (total)
108
29
8
1930
Total budgetary resources available
108
30
9
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
102
1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
148
33
2
3010
New obligations, unexpired accounts
6
29
9
3020
Outlays (gross)
–121
–60
–9
3050
Unpaid obligations, end of year
33
2
2
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–62
–14
3070
Change in uncollected pymts, Fed sources, unexpired
48
14
3090
Uncollected pymts, Fed sources, end of year
–14
Memorandum (non-add) entries:
3100
Obligated balance, start of year
86
19
2
3200
Obligated balance, end of year
19
2
2
Financing authority and disbursements, net:
Mandatory:
4090
Budget authority, gross
108
29
8
Financing disbursements:
4110
Outlays, gross (total)
121
60
9
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120
Federal sources
–141
–30
4122
Interest on uninvested funds
–3
–4
–3
4123
Non-Federal sources
–8
–7
–14
4130
Offsets against gross budget authority and outlays (total)
–152
–41
–17
Additional offsets against financing authority only (total):
4140
Change in uncollected pymts, Fed sources, unexpired
48
14
4160
Budget authority, net (mandatory)
4
2
–9
4170
Outlays, net (mandatory)
–31
19
–8
4180
Budget authority, net (total)
4
2
–9
4190
Outlays, net (total)
–31
19
–8
Status of Direct Loans (in millions of dollars)
Identification code 075–4482–0–3–551
2016 actual
2017 est.
2018 est.
Cumulative balance of direct loans outstanding:
1210
Outstanding, start of year
343
451
475
1231
Disbursements: Direct loan disbursements
115
31
1251
Repayments: Repayments and prepayments
–7
–7
–14
1290
Outstanding, end of year
451
475
461
Balance Sheet (in millions of dollars)
Identification code 075–4482–0–3–551
2015 actual
2016 actual
ASSETS:
1101
Federal assets: Fund balances with Treasury
44
124
1206
Non-Federal assets: Receivables, net
16
17
Net value of assets related to post-1991 direct loans receivable:
1401
Direct loans receivable, gross
343
451
1402
Interest receivable
1
2
1405
Allowance for subsidy cost (-)
–153
–281
1499
Net present value of assets related to direct loans
191
172
1999
Total assets
251
313
LIABILITIES:
2104
Federal liabilities: Resources payable to Treasury
244
293
2207
Non-Federal liabilities: Other
7
20
2999
Total liabilities
251
313
4999
Total liabilities and net position
251
313
Trust Funds
Federal Hospital Insurance Trust Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–8005–0–7–571
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
161,965
158,585
166,974
0198
Unavailable unobligated balance adjustment
45
0199
Balance, start of year
162,010
158,585
166,974
Receipts:
Current law:
1110
FHI Trust Fund, Transfers from General Fund (FICA Taxes)
229,769
239,894
250,094
1110
FHI Trust Fund, Receipts from Railroad Retirement Board
625
570
595
1110
FHI Trust Fund, Transfers from General Fund (SECA Taxes)
16,418
17,732
19,606
1110
FHI Trust Fund, Civil Penalties and Damages
788
775
815
1130
FHI Trust Fund, Other Proprietary Interest from the Public
2
2
2
1130
FHI Trust Fund, Basic Premium, Medicare Advantage
364
161
175
1130
FHI Trust Fund, Medicare Refunds
8,273
6,550
6,600
1130
Affordable Care Act Medicare Shared Savings Models (HI)
11
12
9
1130
FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
3,232
3,520
3,713
1140
FHI Trust Fund, Federal Employer Contributions (FICA)
3,625
3,734
3,806
1140
FHI Trust Fund, Postal Service Employer Contributions (FICA)
660
683
700
1140
FHI Trust Fund, Interest Received by Trust Funds
8,011
7,383
7,770
1140
FHI Trust Fund, Taxation on OASDI Benefits
23,022
24,210
27,425
1140
FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
130
131
144
1140
FHI Trust Fund, Transfers from General Fund (criminal Fines)
24
590
630
1140
FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
60
36
36
1140
FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
54
30
31
1140
FHI Trust Fund, Interest Payments by Railroad Retirement Board
32
28
30
1140
FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
279
1,149
1,323
1199
Total current law receipts
295,379
307,190
323,504
1999
Total receipts
295,379
307,190
323,504
2000
Total: Balances and receipts
457,389
465,775
490,478
Appropriations:
Current law:
2101
Federal Hospital Insurance Trust Fund
–2,278
–2,362
–2,204
2101
Federal Hospital Insurance Trust Fund
–291,219
–303,011
–319,072
2101
Health Care Fraud and Abuse Control Account
–681
–681
–751
2101
Health Care Fraud and Abuse Control Account
–1,329
–1,293
–1,062
2103
Federal Hospital Insurance Trust Fund
–3,354
2132
Federal Hospital Insurance Trust Fund
7
2132
Health Care Fraud and Abuse Control Account
50
50
2134
Federal Hospital Insurance Trust Fund
8,496
19,644
2199
Total current law appropriations
–298,804
–298,801
–303,445
Proposed:
2201
Federal Hospital Insurance Trust Fund
–79
2203
Federal Hospital Insurance Trust Fund
26
2299
Total proposed appropriations
–53
2999
Total appropriations
–298,804
–298,801
–303,498
5099
Balance, end of year
158,585
166,974
186,980
Program and Financing (in millions of dollars)
Identification code 075–8005–0–7–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Benefit payments, HI
291,248
293,284
298,434
0002
HIT Incentive Payments
1,845
459
15
0003
Administration, HI
3,308
2,680
2,538
0004
Quality improvement organizations, HI
447
445
645
0799
Total direct obligations
296,848
296,868
301,632
0900
Total new obligations, unexpired accounts
296,848
296,868
301,632
Budgetary resources:
Unobligated balance:
1021
Recoveries of prior year unpaid obligations
2
1033
Recoveries of prior year paid obligations
2
1050
Unobligated balance (total)
4
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
2,278
2,362
2,204
1130
Appropriations permanently reduced
–9
1160
Appropriation, discretionary (total)
2,278
2,353
2,204
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
291,219
303,011
319,072
1203
Appropriation (previously unavailable)
3,354
1232
Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
–7
1234
Appropriations precluded from obligation
–8,496
–19,644
1260
Appropriations, mandatory (total)
294,566
294,515
299,428
1900
Budget authority (total)
296,844
296,868
301,632
1930
Total budgetary resources available
296,848
296,868
301,632
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
32,217
31,859
30,951
3010
New obligations, unexpired accounts
296,848
296,868
301,632
3020
Outlays (gross)
–297,204
–297,776
–302,481
3040
Recoveries of prior year unpaid obligations, unexpired
–2
3050
Unpaid obligations, end of year
31,859
30,951
30,102
Memorandum (non-add) entries:
3100
Obligated balance, start of year
32,217
31,859
30,951
3200
Obligated balance, end of year
31,859
30,951
30,102
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
2,278
2,353
2,204
Outlays, gross:
4010
Outlays from new discretionary authority
1,506
2,201
2,055
4011
Outlays from discretionary balances
1,222
961
889
4020
Outlays, gross (total)
2,728
3,162
2,944
Mandatory:
4090
Budget authority, gross
294,566
294,515
299,428
Outlays, gross:
4100
Outlays from new mandatory authority
265,163
265,375
268,957
4101
Outlays from mandatory balances
29,313
29,239
30,580
4110
Outlays, gross (total)
294,476
294,614
299,537
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–2
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
2
4160
Budget authority, net (mandatory)
294,566
294,515
299,428
4170
Outlays, net (mandatory)
294,474
294,614
299,537
4180
Budget authority, net (total)
296,844
296,868
301,632
4190
Outlays, net (total)
297,202
297,776
302,481
Memorandum (non-add) entries:
5000
Total investments, SOY: Federal securities: Par value
195,458
192,209
198,402
5001
Total investments, EOY: Federal securities: Par value
192,209
198,402
217,915
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
296,844
296,868
301,632
Outlays
297,202
297,776
302,481
Legislative proposal, subject to PAYGO:
Budget Authority
53
Outlays
43
Total:
Budget Authority
296,844
296,868
301,685
Outlays
297,202
297,776
302,524
The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible
disabled people.
In addition, the Budget includes a package of proposals that repeals the Independent Payment Advisory Board and has other
indirect effects on Medicare spending.
Status of Funds (in millions of dollars)
Identification code 075–8005–0–7–571
2016 actual
2017 est.
2018 est.
Unexpended balance, start of year:
0100
Balance, start of year
196,064
192,518
199,159
0999
Total balance, start of year
196,064
192,518
199,159
Cash income during the year:
Current law:
Receipts:
1110
FHI Trust Fund, Transfers from General Fund (FICA Taxes)
229,769
239,894
250,094
1110
FHI Trust Fund, Receipts from Railroad Retirement Board
625
570
595
1110
FHI Trust Fund, Transfers from General Fund (SECA Taxes)
16,418
17,732
19,606
1110
FHI Trust Fund, Civil Penalties and Damages
788
775
815
1130
FHI Trust Fund, Basic Premium, Medicare Advantage
364
161
175
1130
FHI Trust Fund, Medicare Refunds
8,273
6,550
6,600
1130
Affordable Care Act Medicare Shared Savings Models (HI)
11
12
9
1130
FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
3,232
3,520
3,713
1130
Federal Hospital Insurance Trust Fund
2
1130
Health Care Fraud and Abuse Control Account
2
1150
FHI Trust Fund, Interest Received by Trust Funds
8,011
7,383
7,770
1150
FHI Trust Fund, Other Proprietary Interest from the Public
2
2
2
1150
FHI Trust Fund, Interest Payments by Railroad Retirement Board
32
28
30
1160
FHI Trust Fund, Federal Employer Contributions (FICA)
3,625
3,734
3,806
1160
FHI Trust Fund, Postal Service Employer Contributions (FICA)
660
683
700
1160
FHI Trust Fund, Taxation on OASDI Benefits
23,022
24,210
27,425
1160
FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
130
131
144
1160
FHI Trust Fund, Transfers from General Fund (criminal Fines)
24
590
630
1160
FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
60
36
36
1160
FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
54
30
31
1160
FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
279
1,149
1,323
1199
Income under present law
295,383
307,190
323,504
Proposed:
Offsetting receipts (proprietary):
1230
FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
1250
FHI Trust Fund, Interest Received by Trust Funds
1299
Income proposed
1999
Total cash income
295,383
307,190
323,504
Cash outgo during year:
Current law:
2100
Federal Hospital Insurance Trust Fund [009–38–8005–0]
–297,204
–297,776
–302,481
2100
Health Care Fraud and Abuse Control Account [009–38–8393–0]
–1,727
–2,764
–1,988
2199
Outgo under current law
–298,931
–300,540
–304,469
Proposed:
2200
Federal Hospital Insurance Trust Fund
–43
2299
Outgo under proposed legislation
–43
2999
Total cash outgo (-)
–298,931
–300,540
–304,512
Surplus or deficit::
3110
Excluding interest
–11,593
–763
11,190
3120
Interest
8,045
7,413
7,802
3199
Subtotal, surplus or deficit
–3,548
6,650
18,992
3220
Federal Hospital Insurance Trust Fund
–9
3298
Rounding adjustment
2
3299
Total adjustments
2
–9
3999
Total change in fund balance
–3,546
6,641
18,992
Unexpended balance, end of year::
4100
Uninvested balance (net), end of year
309
757
236
4200
Federal Hospital Insurance Trust Fund
192,209
198,402
217,915
4999
Total balance, end of year
192,518
199,159
218,151
Object Classification (in millions of dollars)
Identification code 075–8005–0–7–571
2016 actual
2017 est.
2018 est.
Direct obligations:
41.0
Payment for Quality Improvement Organization (QIO) activities
447
445
645
42.0
Insurance claims and indemnities (benefits)
293,093
293,743
298,449
94.0
Financial transfers
3,308
2,680
2,538
99.9
Total new obligations, unexpired accounts
296,848
296,868
301,632
Employment Summary
Identification code 075–8005–0–7–571
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
2
2
2
Federal Hospital Insurance Trust Fund
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–8005–4–7–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Benefit payments, HI
–16
0003
Administration, HI
61
0799
Total direct obligations
45
0900
Total new obligations, unexpired accounts
45
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
79
1203
Appropriation (previously unavailable)
–26
1260
Appropriations, mandatory (total)
53
1900
Budget authority (total)
53
1930
Total budgetary resources available
53
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
8
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
45
3020
Outlays (gross)
–43
3050
Unpaid obligations, end of year
2
Memorandum (non-add) entries:
3200
Obligated balance, end of year
2
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
53
Outlays, gross:
4100
Outlays from new mandatory authority
43
4180
Budget authority, net (total)
53
4190
Outlays, net (total)
43
Object Classification (in millions of dollars)
Identification code 075–8005–4–7–571
2016 actual
2017 est.
2018 est.
Direct obligations:
42.0
Insurance claims and indemnities (benefits)
–16
94.0
Financial transfers
61
99.9
Total new obligations, unexpired accounts
45
health care fraud and abuse control account
In addition to amounts otherwise available for program integrity and program management, $751,000,000, to remain available through September 30, 2019, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
as authorized by section 201(g) of the Social Security Act, of which $610,391,000 shall be for the Centers for Medicare and Medicaid Services program integrity activities, of which $74,246,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities
authorized by section 1817(k)(3) of such Act, and of which $66,363,000 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act:
Provided, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year 2018 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and
CHIP programs for the funds provided by this appropriation: Provided further, That of the amount provided under this heading, $311,000,000 is provided to meet the terms of section 251(b)(2)(C)(ii) of
the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and $434,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That the Secretary shall support the Senior Medicare Patrol program to combat health care fraud and abuse from the funds provided to this account.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–8393–0–7–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Medicare integrity program
843
859
899
0002
FBI fraud and abuse control
130
131
144
0003
Other fraud and abuse control
283
280
307
0005
Undistributed Savings, HCFAC and SSA
–27
–290
0091
Total Mandatory
1,256
1,243
1,060
0101
CMS discretionary
488
553
610
0102
Other discretionary
128
128
141
0191
Total Discretionary
616
681
751
0900
Total new obligations, unexpired accounts
1,872
1,924
1,811
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
321
406
406
1001
Discretionary unobligated balance brought fwd, Oct 1
188
248
1021
Recoveries of prior year unpaid obligations
3
1050
Unobligated balance (total)
324
406
406
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
681
681
751
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
1,329
1,293
1,062
1232
Appropriations and/or unobligated balance of appropriations temporarily reduced
–50
–50
1260
Appropriations, mandatory (total)
1,279
1,243
1,062
1900
Budget authority (total)
1,960
1,924
1,813
1930
Total budgetary resources available
2,284
2,330
2,219
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–6
1941
Unexpired unobligated balance, end of year
406
406
408
Special and non-revolving trust funds:
1951
Unobligated balance expiring
6
1952
Expired unobligated balance, start of year
33
23
23
1953
Expired unobligated balance, end of year
17
23
23
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,498
1,617
777
3010
New obligations, unexpired accounts
1,872
1,924
1,811
3011
Obligations ("upward adjustments"), expired accounts
2
3020
Outlays (gross)
–1,727
–2,764
–1,988
3040
Recoveries of prior year unpaid obligations, unexpired
–3
3041
Recoveries of prior year unpaid obligations, expired
–25
3050
Unpaid obligations, end of year
1,617
777
600
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,498
1,617
777
3200
Obligated balance, end of year
1,617
777
600
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
681
681
751
Outlays, gross:
4010
Outlays from new discretionary authority
67
681
751
4011
Outlays from discretionary balances
435
248
4020
Outlays, gross (total)
502
929
751
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033
Non-Federal sources
–2
Additional offsets against gross budget authority only:
4052
Offsetting collections credited to expired accounts
2
4070
Budget authority, net (discretionary)
681
681
751
4080
Outlays, net (discretionary)
500
929
751
Mandatory:
4090
Budget authority, gross
1,279
1,243
1,062
Outlays, gross:
4100
Outlays from new mandatory authority
546
879
638
4101
Outlays from mandatory balances
679
956
599
4110
Outlays, gross (total)
1,225
1,835
1,237
4180
Budget authority, net (total)
1,960
1,924
1,813
4190
Outlays, net (total)
1,725
2,764
1,988
The Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) established the Health Care Fraud and Abuse
Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds 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.
The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
in the Analytical Perspectives volume.
Object Classification (in millions of dollars)
Identification code 075–8393–0–7–571
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent (CMS)
47
78
78
12.1
Civilian personnel benefits (CMS)
13
21
21
23.3
Communications, utilities, and miscellaneous charges
13
21
21
25.2
Other services (CMS/Medicaid)
75
55
62
25.3
Other purchases of goods and services from Government accounts (HHS/DOJ)
119
119
130
25.3
Other purchases of goods and services from Government accounts (HHS/OIG)
255
259
284
25.3
Other purchases of goods and services from Government accounts (HHS/OGC)
8
7
8
25.3
Other goods and services from Federal sources (HHS/CMS)
9
5
5
25.3
Other goods and services from Government accounts (HHS/FDA)
4
4
4
25.6
Medical care (CMS)
1,199
1,251
1,344
92.0
Undistributed
–27
–290
94.0
Financial transfers (FBI)
130
131
144
99.9
Total new obligations, unexpired accounts
1,872
1,924
1,811
Employment Summary
Identification code 075–8393–0–7–571
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
506
525
525
Federal Supplementary Medical Insurance Trust Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–8004–0–7–571
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
39,267
39,603
44,064
0198
Unavailable unobligated balance adjustment
53
0199
Balance, start of year
39,320
39,603
44,064
Receipts:
Current law:
1110
Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
2,853
4,067
4,098
1130
Other Proprietary Interest from the Public, FSMI Fund
10
3
3
1130
Premiums Collected for Medicare Prescription Drug Account, FSMI
4,514
5,006
5,689
1130
Payments from States, Medicare Prescription Drug Account, FSMI
9,755
11,029
11,875
1130
Basic Premium, Medicare Advantage, FSMI Trust Fund
422
189
210
1130
Medicare Refunds, SMI
5,084
5,150
5,200
1130
Affordable Care Act Medicare Shared Savings Models, SMI
8
8
8
1130
Premiums Collected for the Aged, FSMI Fund
60,630
67,400
78,657
1130
Premiums Collected for the Disabled, FSMI Fund
11,835
11,806
12,787
1140
Federal Contributions, FSMI Fund
219,761
229,782
245,396
1140
Interest Received by Trust Fund, FSMI Fund
1,992
1,520
1,029
1140
Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
3
3
1140
Interest, Medicare Prescription Drug Account, FSMI
28
18
15
1140
Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
434
716
659
1140
Federal Contributions for Benefits, Prescription Drug Account, SMI
76,007
78,433
76,133
1140
Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
2
1
1
1199
Total current law receipts
393,335
415,131
441,763
Proposed:
1230
Premiums Collected for the Aged, FSMI Fund
–21
1230
Premiums Collected for the Disabled, FSMI Fund
–3
1240
Federal Contributions, FSMI Fund
–72
1299
Total proposed receipts
–96
1999
Total receipts
393,335
415,131
441,667
2000
Total: Balances and receipts
432,655
454,734
485,731
Appropriations:
Current law:
2101
Federal Supplementary Medical Insurance Trust Fund
–2,959
–3,085
–2,881
2101
Federal Supplementary Medical Insurance Trust Fund
–300,593
–316,225
–352,198
2101
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
–687
–699
–644
2101
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
–89,106
–95,128
–86,013
2134
Federal Supplementary Medical Insurance Trust Fund
283
4,467
27,519
2199
Total current law appropriations
–393,062
–410,670
–414,217
Proposed:
2201
Federal Supplementary Medical Insurance Trust Fund
72
2201
Federal Supplementary Medical Insurance Trust Fund
–42
2203
Federal Supplementary Medical Insurance Trust Fund
–72
2234
Federal Supplementary Medical Insurance Trust Fund
58
2299
Total proposed appropriations
16
2999
Total appropriations
–393,062
–410,670
–414,201
5098
Unavailable unobligated balance adjustment
10
5099
Balance, end of year
39,603
44,064
71,530
Program and Financing (in millions of dollars)
Identification code 075–8004–0–7–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Benefit payments, SMI
300,922
310,022
323,265
0002
Transfer to Medicaid for payment of SMI premiums
767
941
1,026
0003
HIT Incentive Payments
930
460
0004
Administration, SMI
3,826
3,300
3,111
0005
Quality Improvement Organizations, SMI
117
111
161
0799
Total direct obligations
306,562
314,834
327,563
0900
Total new obligations, unexpired accounts
306,562
314,834
327,563
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
3
1021
Recoveries of prior year unpaid obligations
1
1033
Recoveries of prior year paid obligations
4
1050
Unobligated balance (total)
5
3
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
2,959
3,085
2,881
1130
Appropriations permanently reduced
–6
1160
Appropriation, discretionary (total)
2,959
3,079
2,881
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
300,593
316,225
352,198
1234
Appropriations precluded from obligation
–283
–4,467
–27,519
1236
Appropriations applied to repay debt
–432
1260
Appropriations, mandatory (total)
299,878
311,758
324,679
Borrowing authority, mandatory:
1400
Borrowing authority
3,720
1900
Budget authority (total)
306,557
314,837
327,560
1930
Total budgetary resources available
306,562
314,837
327,563
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
3
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
23,289
25,829
26,270
3010
New obligations, unexpired accounts
306,562
314,834
327,563
3020
Outlays (gross)
–304,021
–314,393
–327,176
3040
Recoveries of prior year unpaid obligations, unexpired
–1
3050
Unpaid obligations, end of year
25,829
26,270
26,657
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–11,172
3061
Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
11,172
Memorandum (non-add) entries:
3100
Obligated balance, start of year
23,289
25,829
26,270
3200
Obligated balance, end of year
25,829
26,270
26,657
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
2,959
3,079
2,881
Outlays, gross:
4010
Outlays from new discretionary authority
1,291
1,886
1,785
4011
Outlays from discretionary balances
1,224
704
658
4020
Outlays, gross (total)
2,515
2,590
2,443
Mandatory:
4090
Budget authority, gross
303,598
311,758
324,679
Outlays, gross:
4100
Outlays from new mandatory authority
280,159
288,117
296,521
4101
Outlays from mandatory balances
21,347
23,686
28,212
4110
Outlays, gross (total)
301,506
311,803
324,733
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–4
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
4
4160
Budget authority, net (mandatory)
303,598
311,758
324,679
4170
Outlays, net (mandatory)
301,502
311,803
324,733
4180
Budget authority, net (total)
306,557
314,837
327,560
4190
Outlays, net (total)
304,017
314,393
327,176
Memorandum (non-add) entries:
5000
Total investments, SOY: Federal securities: Par value
66,128
63,336
66,361
5001
Total investments, EOY: Federal securities: Par value
63,336
66,361
93,481
5080
Outstanding debt, SOY
–3,288
–3,288
5081
Outstanding debt, EOY
–3,288
–3,288
–3,288
5082
Borrowing
–3,720
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
306,557
314,837
327,560
Outlays
304,017
314,393
327,176
Legislative proposal, subject to PAYGO:
Budget Authority
–16
Outlays
–26
Total:
Budget Authority
306,557
314,837
327,544
Outlays
304,017
314,393
327,150
The Supplementary Medical Insurance (SMI) program is a voluntary program that affords protection against the costs of physician
care and certain other medical services. The program also covers treatment of end-stage renal disease for eligible enrollees.
SMI costs are generally financed by premium payments from enrollees and contributions from the general revenues. In addition,
the Budget includes a package of proposals that repeals the Independent Payment Advisory Board and has other indirect effects
on Medicare spending.
Status of Funds (in millions of dollars)
Identification code 075–8004–0–7–571
2016 actual
2017 est.
2018 est.
Unexpended balance, start of year:
0100
Balance, start of year
69,122
62,774
67,931
0999
Total balance, start of year
69,122
62,774
67,931
Cash income during the year:
Current law:
Receipts:
1110
Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
2,853
4,067
4,098
1130
Premiums Collected for Medicare Prescription Drug Account, FSMI
4,514
5,006
5,689
1130
Payments from States, Medicare Prescription Drug Account, FSMI
9,755
11,029
11,875
1130
Basic Premium, Medicare Advantage, FSMI Trust Fund
422
189
210
1130
Medicare Refunds, SMI
5,084
5,150
5,200
1130
Affordable Care Act Medicare Shared Savings Models, SMI
8
8
8
1130
Premiums Collected for the Aged, FSMI Fund
60,630
67,400
78,657
1130
Premiums Collected for the Disabled, FSMI Fund
11,835
11,806
12,787
1130
Federal Supplementary Medical Insurance Trust Fund
4
1130
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
39
1150
Interest Received by Trust Fund, FSMI Fund
1,992
1,520
1,029
1150
Other Proprietary Interest from the Public, FSMI Fund
10
3
3
1150
Interest, Medicare Prescription Drug Account, FSMI
28
18
15
1160
Federal Contributions, FSMI Fund
219,761
229,782
245,396
1160
Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
3
3
1160
Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
434
716
659
1160
Federal Contributions for Benefits, Prescription Drug Account, SMI
76,007
78,433
76,133
1160
Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
2
1
1
1199
Income under present law
393,378
415,131
441,763
Proposed:
Offsetting receipts (proprietary):
1230
Premiums Collected for Medicare Prescription Drug Account, FSMI
1230
Payments from States, Medicare Prescription Drug Account, FSMI
1230
Premiums Collected for the Aged, FSMI Fund
–21
1230
Premiums Collected for the Disabled, FSMI Fund
–3
Offsetting governmental receipts:
1260
Federal Contributions, FSMI Fund
–72
1260
Federal Contributions for Benefits, Prescription Drug Account, SMI
1299
Income proposed
–96
1999
Total cash income
393,378
415,131
441,667
Cash outgo during year:
Current law:
2100
Federal Supplementary Medical Insurance Trust Fund [009–38–8004–0]
–304,021
–314,393
–327,176
2100
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009–38–8308–0]
–95,705
–95,575
–86,432
2199
Outgo under current law
–399,726
–409,968
–413,608
Proposed:
2200
Federal Supplementary Medical Insurance Trust Fund
26
2299
Outgo under proposed legislation
26
2999
Total cash outgo (-)
–399,726
–409,968
–413,582
Surplus or deficit::
3110
Excluding interest
–8,378
3,622
27,038
3120
Interest
2,030
1,541
1,047
3199
Subtotal, surplus or deficit
–6,348
5,163
28,085
3220
Federal Supplementary Medical Insurance Trust Fund
–6
3299
Total adjustments
–6
3999
Total change in fund balance
–6,348
5,157
28,085
Unexpended balance, end of year::
4100
Uninvested balance (net), end of year
–562
1,570
2,535
4200
Federal Supplementary Medical Insurance Trust Fund
63,336
66,361
93,481
4999
Total balance, end of year
62,774
67,931
96,016
Object Classification (in millions of dollars)
Identification code 075–8004–0–7–571
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
1
41.0
Payment for Quality Improvement Organization (QIO) activity
117
111
161
42.0
Insurance claims and indemnities
303,486
311,422
324,290
94.0
Financial transfers
2,959
3,300
3,111
99.0
Direct obligations
306,562
314,834
327,563
99.9
Total new obligations, unexpired accounts
306,562
314,834
327,563
Employment Summary
Identification code 075–8004–0–7–571
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
2
5
5
Federal Supplementary Medical Insurance Trust Fund
(Legislative proposal, not subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–8004–2–7–571
2016 actual
2017 est.
2018 est.
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
–72
1203
Appropriation (previously unavailable)
72
4180
Budget authority, net (total)
4190
Outlays, net (total)
Federal Supplementary Medical Insurance Trust Fund
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–8004–4–7–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Benefit payments, SMI
–96
0004
Administration, SMI
80
0900
Total new obligations, unexpired accounts
–16
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
42
1234
Appropriations precluded from obligation
–58
1260
Appropriations, mandatory (total)
–16
1900
Budget authority (total)
–16
1930
Total budgetary resources available
–16
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–16
3020
Outlays (gross)
26
3050
Unpaid obligations, end of year
10
Memorandum (non-add) entries:
3200
Obligated balance, end of year
10
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–16
Outlays, gross:
4100
Outlays from new mandatory authority
–26
4180
Budget authority, net (total)
–16
4190
Outlays, net (total)
–26
Object Classification (in millions of dollars)
Identification code 075–8004–4–7–571
2016 actual
2017 est.
2018 est.
Direct obligations:
42.0
Insurance claims and indemnities
–96
94.0
Financial transfers
80
99.0
Direct obligations
–16
99.9
Total new obligations, unexpired accounts
–16
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
Program and Financing (in millions of dollars)
Identification code 075–8308–0–7–571
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Prescription Drug Benefits
89,102
95,108
85,996
0002
Administrative Costs
690
716
659
0799
Total direct obligations
89,792
95,824
86,655
0801
Reimbursable program activity
2,937
0900
Total new obligations, unexpired accounts
92,729
95,824
86,655
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
3
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
687
699
644
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
89,106
95,128
86,013
Spending authority from offsetting collections, mandatory:
1801
Change in uncollected payments, Federal sources
2,937
1900
Budget authority (total)
92,730
95,827
86,657
1930
Total budgetary resources available
92,730
95,827
86,660
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–1
1941
Unexpired unobligated balance, end of year
3
5
Special and non-revolving trust funds:
1951
Unobligated balance expiring
1
1952
Expired unobligated balance, start of year
132
40
40
1953
Expired unobligated balance, end of year
39
40
40
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
17,553
14,638
14,887
3010
New obligations, unexpired accounts
92,729
95,824
86,655
3011
Obligations ("upward adjustments"), expired accounts
75
3020
Outlays (gross)
–95,705
–95,575
–86,432
3041
Recoveries of prior year unpaid obligations, expired
–14
3050
Unpaid obligations, end of year
14,638
14,887
15,110
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–14,109
–14,109
3061
Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
–11,172
3070
Change in uncollected pymts, Fed sources, unexpired
–2,937
3090
Uncollected pymts, Fed sources, end of year
–14,109
–14,109
–14,109
Memorandum (non-add) entries:
3100
Obligated balance, start of year
6,381
529
778
3200
Obligated balance, end of year
529
778
1,001
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
687
699
644
Outlays, gross:
4010
Outlays from new discretionary authority
303
281
264
4011
Outlays from discretionary balances
167
123
112
4020
Outlays, gross (total)
470
404
376
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033
Non-Federal sources
–39
Additional offsets against gross budget authority only:
4052
Offsetting collections credited to expired accounts
39
4070
Budget authority, net (discretionary)
687
699
644
4080
Outlays, net (discretionary)
431
404
376
Mandatory:
4090
Budget authority, gross
92,043
95,128
86,013
Outlays, gross:
4100
Outlays from new mandatory authority
77,667
81,350
76,801
4101
Outlays from mandatory balances
17,568
13,821
9,255
4110
Outlays, gross (total)
95,235
95,171
86,056
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–2,937
4180
Budget authority, net (total)
89,793
95,827
86,657
4190
Outlays, net (total)
95,666
95,575
86,432
Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug
benefit. The Budget includes a proposal to repeal the Independent Payment Advisory Board, which impacts Medicare Part D.
Object Classification (in millions of dollars)
Identification code 075–8308–0–7–571
2016 actual
2017 est.
2018 est.
Direct obligations:
25.2
Other services from non-Federal sources
690
716
659
42.0
Insurance claims and indemnities
89,102
95,108
85,996
99.0
Direct obligations
89,792
95,824
86,655
99.0
Reimbursable obligations
2,937
99.9
Total new obligations, unexpired accounts
92,729
95,824
86,655
Employment Summary
Identification code 075–8308–0–7–571
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
2
4
4
Administration for Children and Families
Federal Funds
Temporary Assistance for Needy Families
Program and Financing (in millions of dollars)
Identification code 075–1552–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
State family assistance grant
16,488
16,486
16,486
0002
Territories - family assistance grants
78
78
78
0006
Tribal work programs
8
8
8
0009
Healthy marriage and responsible fatherhood grants
148
148
150
0900
Total new obligations, unexpired accounts
16,722
16,720
16,722
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
2
Budget authority:
Appropriations, mandatory:
1200
Appropriation
16,739
16,739
16,739
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–2
–2
1260
Appropriations, mandatory (total)
16,737
16,737
16,739
1930
Total budgetary resources available
16,737
16,737
16,741
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–15
–15
–15
1941
Unexpired unobligated balance, end of year
2
4
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
5,940
7,037
7,253
3010
New obligations, unexpired accounts
16,722
16,720
16,722
3020
Outlays (gross)
–15,624
–16,504
–16,628
3041
Recoveries of prior year unpaid obligations, expired
–1
3050
Unpaid obligations, end of year
7,037
7,253
7,347
Memorandum (non-add) entries:
3100
Obligated balance, start of year
5,940
7,037
7,253
3200
Obligated balance, end of year
7,037
7,253
7,347
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
16,737
16,737
16,739
Outlays, gross:
4100
Outlays from new mandatory authority
11,962
12,540
12,542
4101
Outlays from mandatory balances
3,662
3,964
4,086
4110
Outlays, gross (total)
15,624
16,504
16,628
4180
Budget authority, net (total)
16,737
16,737
16,739
4190
Outlays, net (total)
15,624
16,504
16,628
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
16,737
16,737
16,739
Outlays
15,624
16,504
16,628
Legislative proposal, subject to PAYGO:
Budget Authority
–1,268
Outlays
–1,243
Total:
Budget Authority
16,737
16,737
15,471
Outlays
15,624
16,504
15,385
This account provides funding for the Temporary Assistance for Needy Families (TANF) block grant and related activities authorized
by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction
Act of 2005 (P.L. 109–171). Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently
in the Further Continuing and Security Assistance Appropriations Act, 2017 (P.L. 114–254). The Budget proposes to allocate
funding for Welfare Research and the Census Bureau's Survey of Income and Program Participation from the amount provided for
TANF Family Assistance Grants, and to reduce the authorized funding for these grants, resulting in a 10 percent reduction
in the TANF Family Assistance Grants to States, territories, and tribes.
Object Classification (in millions of dollars)
Identification code 075–1552–0–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
1
1
12.1
Civilian personnel benefits
1
1
1
23.1
Rental payments to GSA
1
1
1
25.1
Advisory and assistance services
31
29
31
25.3
Other goods and services from Federal sources
1
1
1
41.0
Grants, subsidies, and contributions
16,687
16,687
16,687
99.9
Total new obligations, unexpired accounts
16,722
16,720
16,722
Employment Summary
Identification code 075–1552–0–1–609
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
13
13
13
Temporary Assistance for Needy Families
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1552–4–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
State family assistance grant
–1,262
0002
Territories - family assistance grants
–6
0900
Total new obligations, unexpired accounts (object class 41.0)
–1,268
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–1,243
1220
Appropriations transferred to other acct [013–0401]
–10
1220
Appropriations transferred to other acct [075–1553]
–15
1260
Appropriations, mandatory (total)
–1,268
1930
Total budgetary resources available
–1,268
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–1,268
3020
Outlays (gross)
1,243
3050
Unpaid obligations, end of year
–25
Memorandum (non-add) entries:
3200
Obligated balance, end of year
–25
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–1,268
Outlays, gross:
4100
Outlays from new mandatory authority
–1,243
4180
Budget authority, net (total)
–1,268
4190
Outlays, net (total)
–1,243
Contingency Fund
Program and Financing (in millions of dollars)
Identification code 075–1522–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Contingency Fund for State Welfare Programs
583
583
608
0900
Total new obligations (object class 41.0)
583
583
608
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1120
Appropriations transferred to other acct [075–1553]
–15
1120
Appropriations transferred to other acct [013–0401]
–10
1160
Appropriation, discretionary (total)
–25
Appropriations, mandatory:
1200
Appropriation
608
608
608
1220
Appropriations transferred to other accts [075–1553]
–15
1220
Appropriations transferred to other accts [013–0401]
–10
1260
Appropriations, mandatory (total)
583
608
608
1900
Budget authority (total)
583
583
608
1930
Total budgetary resources available
583
583
608
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
61
72
61
3010
New obligations, unexpired accounts
583
583
608
3020
Outlays (gross)
–572
–594
–616
3050
Unpaid obligations, end of year
72
61
53
Memorandum (non-add) entries:
3100
Obligated balance, start of year
61
72
61
3200
Obligated balance, end of year
72
61
53
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
–25
Outlays, gross:
4010
Outlays from new discretionary authority
–22
4011
Outlays from discretionary balances
–2
4020
Outlays, gross (total)
–22
–2
Mandatory:
4090
Budget authority, gross
583
608
608
Outlays, gross:
4100
Outlays from new mandatory authority
544
567
567
4101
Outlays from mandatory balances
28
49
51
4110
Outlays, gross (total)
572
616
618
4180
Budget authority, net (total)
583
583
608
4190
Outlays, net (total)
572
594
616
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
583
583
608
Outlays
572
594
616
Legislative proposal, subject to PAYGO:
Budget Authority
–608
Outlays
–567
Total:
Budget Authority
583
583
Outlays
572
594
49
The Budget proposes to eliminate funding for the Contingency Fund.
Contingency Fund
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1522–4–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Contingency fund
–608
0900
Total new obligations (object class 41.0)
–608
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–608
1930
Total budgetary resources available
–608
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–608
3020
Outlays (gross)
567
3050
Unpaid obligations, end of year
–41
Memorandum (non-add) entries:
3200
Obligated balance, end of year
–41
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–608
Outlays, gross:
4100
Outlays from new mandatory authority
–567
4180
Budget authority, net (total)
–608
4190
Outlays, net (total)
–567
Payments to states for child support enforcement and family support programs
For carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
of July 5, 1960 (24 U.S.C. 321–329), $2,995,400,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2019, $1,400,000,000, to remain available until expended.
For carrying out, after May 31 of the current fiscal year, except as otherwise provided, 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. 321–329), for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal year, such sums
as may be necessary.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1501–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
State child support administrative costs
3,740
3,743
3,963
0002
Child support incentive payments
568
580
588
0003
Access and visitation grants
10
10
10
0091
Subtotal, child support enforcement
4,318
4,333
4,561
0102
Payments to territories
33
33
33
0103
Repatriation
1
1
1
0191
Subtotal, other payments
34
34
34
0799
Total direct obligations
4,352
4,367
4,595
0801
Offset obligations (CSE grants to States)
15
12
13
0900
Total new obligations, unexpired accounts
4,367
4,379
4,608
Budgetary resources:
Unobligated balance:
1021
Recoveries of prior year unpaid obligations
227
200
200
Budget authority:
Appropriations, mandatory:
1200
Appropriation
2,965
2,867
2,995
Advance appropriations, mandatory:
1270
Advance appropriation
1,160
1,300
1,400
Spending authority from offsetting collections, mandatory:
1800
Collected
15
12
13
1900
Budget authority (total)
4,140
4,179
4,408
1930
Total budgetary resources available
4,367
4,379
4,608
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,047
1,093
994
3010
New obligations, unexpired accounts
4,367
4,379
4,608
3020
Outlays (gross)
–4,094
–4,278
–4,425
3040
Recoveries of prior year unpaid obligations, unexpired
–227
–200
–200
3050
Unpaid obligations, end of year
1,093
994
977
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,047
1,093
994
3200
Obligated balance, end of year
1,093
994
977
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
4,140
4,179
4,408
Outlays, gross:
4100
Outlays from new mandatory authority
3,521
3,564
3,776
4101
Outlays from mandatory balances
573
714
649
4110
Outlays, gross (total)
4,094
4,278
4,425
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–15
–12
–13
4180
Budget authority, net (total)
4,125
4,167
4,395
4190
Outlays, net (total)
4,079
4,266
4,412
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
4,125
4,167
4,395
Outlays
4,079
4,266
4,412
Legislative proposal, subject to PAYGO:
Budget Authority
–110
Outlays
–110
Total:
Budget Authority
4,125
4,167
4,285
Outlays
4,079
4,266
4,302
This account provides for payments to States for child support enforcement and other family support programs, including access
and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt
account. The Budget improves establishment and enforcement procedures by closing loopholes and improving Federal processes.
Proposals target systems modernization, increased collections, expanded distribution, and improved program efficiency.
Object Classification (in millions of dollars)
Identification code 075–1501–0–1–609
2016 actual
2017 est.
2018 est.
41.0
Direct obligations: Grants, subsidies, and contributions
4,352
4,367
4,595
99.0
Reimbursable obligations
15
12
13
99.9
Total new obligations, unexpired accounts
4,367
4,379
4,608
Payments to States for Child Support Enforcement and Family Support Programs
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1501–4–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
State child support administrative costs
–110
0091
Subtotal, child support enforcement
–110
0799
Total direct obligations
–110
0900
Total new obligations, unexpired accounts (object class 41.0)
–110
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–110
1900
Budget authority (total)
–110
1930
Total budgetary resources available
–110
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–110
3020
Outlays (gross)
110
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–110
Outlays, gross:
4100
Outlays from new mandatory authority
–110
4180
Budget authority, net (total)
–110
4190
Outlays, net (total)
–110
Low income home energy assistance
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1502–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
LIHEAP Block Grant
3,372
3,384
Budgetary resources:
Unobligated balance:
1012
Unobligated balance transfers between expired and unexpired accounts
1
Budget authority:
Appropriations, discretionary:
1100
Appropriation
3,390
3,384
1120
Appropriations transferred to other acct [075–0140]
–19
1160
Appropriation, discretionary (total)
3,371
3,384
1930
Total budgetary resources available
3,372
3,384
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,134
1,230
1,513
3010
New obligations, unexpired accounts
3,372
3,384
3020
Outlays (gross)
–3,262
–3,101
–1,113
3041
Recoveries of prior year unpaid obligations, expired
–14
3050
Unpaid obligations, end of year
1,230
1,513
400
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,134
1,230
1,513
3200
Obligated balance, end of year
1,230
1,513
400
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
3,371
3,384
Outlays, gross:
4010
Outlays from new discretionary authority
2,293
2,132
4011
Outlays from discretionary balances
969
969
1,113
4020
Outlays, gross (total)
3,262
3,101
1,113
4180
Budget authority, net (total)
3,371
3,384
4190
Outlays, net (total)
3,262
3,101
1,113
Object Classification (in millions of dollars)
Identification code 075–1502–0–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
25.1
Advisory and assistance services
2
2
41.0
Grants, subsidies, and contributions
3,370
3,382
99.9
Total new obligations, unexpired accounts
3,372
3,384
Refugee and entrant assistance
For necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality
Act and section 501 of the Refugee Education Assistance Act of 1980, and for carrying out section 462 of the Homeland Security
Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, the Trafficking
Victims Protection Act of 2000 ("TVPA"), section 203 of the Trafficking Victims Protection Reauthorization Act of 2005, and
the Torture Victims Relief Act of 1998, $1,456,755,000 of which $1,427,321,000 shall remain available through September 30, 2020 for carrying out such sections 414, 501, 462, and 235: Provided, That amounts available under this heading to carry out such section 203 and the TVPA shall also be available for research
and evaluation with respect to activities under those authorities: Provided further, That the limitation in section 204 of this Act regarding transfers increasing any appropriation shall apply to transfers to appropriations under this heading
by substituting "10 percent" for "3 percent": Provided further, That funds made available under this heading in this and prior Acts shall be available to reimburse other
Federal agencies for the costs of making land or facilities available for temporary housing of unaccompanied alien children
as defined in section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, if the Secretary
determines that such housing is needed for purposes of carrying out such section 235 and section 462 of the Homeland Security
Act of 2002: Provided further, That such funds may be used for construction and improvements to property and demolition as
necessary for this purpose: Provided further, That other Federal agencies are hereby authorized for the current fiscal year
to make land or facilities available for the purposes described in the third proviso, and to retain and use such reimbursements
to cover costs incurred.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1503–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Refugee and entrant assistance
735
695
479
0002
Assistance for treatment of torture victims
11
11
11
0003
Unaccompanied Children
1,101
1,398
948
0005
Trafficking Victims program
18
18
19
0900
Total new obligations, unexpired accounts
1,865
2,122
1,457
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
278
96
96
1021
Recoveries of prior year unpaid obligations
12
1050
Unobligated balance (total)
290
96
96
Budget authority:
Appropriations, discretionary:
1100
Base Appropriation
1,675
1,672
1,457
1100
UC Contingency Fund
150
1121
Appropriations transferred from other acct [075–0125]
300
1160
Appropriation, discretionary (total)
1,675
2,122
1,457
1930
Total budgetary resources available
1,965
2,218
1,553
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–4
1941
Unexpired unobligated balance, end of year
96
96
96
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
781
995
741
3010
New obligations, unexpired accounts
1,865
2,122
1,457
3020
Outlays (gross)
–1,632
–2,376
–1,451
3040
Recoveries of prior year unpaid obligations, unexpired
–12
3041
Recoveries of prior year unpaid obligations, expired
–7
3050
Unpaid obligations, end of year
995
741
747
Memorandum (non-add) entries:
3100
Obligated balance, start of year
781
995
741
3200
Obligated balance, end of year
995
741
747
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
1,675
2,122
1,457
Outlays, gross:
4010
Outlays from new discretionary authority
906
1,464
1,005
4011
Outlays from discretionary balances
726
912
446
4020
Outlays, gross (total)
1,632
2,376
1,451
4180
Budget authority, net (total)
1,675
2,122
1,457
4190
Outlays, net (total)
1,632
2,376
1,451
This account provides funds to States and non-governmental organizations to administer the refugee and entrant assistance
programs. Funds support cash and medical assistance and social services for refugees, asylees, and other arrivals eligible
for refugee benefits. The account also includes funding for the rehabilitation of victims of torture and human trafficking
and for the care and placement of unaccompanied alien children.
Object Classification (in millions of dollars)
Identification code 075–1503–0–1–609
2016 actual
2017 est.
2018 est.
11.1
Direct obligations: Personnel compensation: Full-time permanent
10
11
11
11.9
Total personnel compensation
10
11
11
12.1
Civilian personnel benefits
2
4
4
23.1
Rental payments to GSA
4
4
4
25.1
Advisory and assistance services
256
227
128
25.2
Other services from non-Federal sources
4
4
4
25.3
Other goods and services from Federal sources
57
37
21
41.0
Grants, subsidies, and contributions
1,532
1,835
1,285
99.9
Total new obligations, unexpired accounts
1,865
2,122
1,457
Employment Summary
Identification code 075–1503–0–1–609
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
95
96
96
1101
Direct military average strength employment
3
4
4
Promoting Safe and Stable Families
For carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, for carrying out,
except as otherwise provided, section 437 of such Act, $59,651,000.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1512–0–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Grants to States and Tribes
343
343
362
0002
Research, training and technical assistance
8
8
11
0003
State court improvement activities
30
30
32
0004
Family Connection Grants
3
2
1
0005
Personal Responsibility Education (PREP)
76
71
10
0006
Abstinence Education
67
63
0900
Total new obligations, unexpired accounts
527
517
416
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
25
27
31
1021
Recoveries of prior year unpaid obligations
5
1050
Unobligated balance (total)
30
27
31
Budget authority:
Appropriations, discretionary:
1100
Appropriation
60
60
60
Appropriations, mandatory:
1200
Appropriation
495
495
345
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–23
–34
1260
Appropriations, mandatory (total)
472
461
345
1900
Budget authority (total)
532
521
405
1930
Total budgetary resources available
562
548
436
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–8
1941
Unexpired unobligated balance, end of year
27
31
20
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
537
562
533
3010
New obligations, unexpired accounts
527
517
416
3020
Outlays (gross)
–479
–524
–509
3040
Recoveries of prior year unpaid obligations, unexpired
–5
3041
Recoveries of prior year unpaid obligations, expired
–18
–22
3050
Unpaid obligations, end of year
562
533
440
Memorandum (non-add) entries:
3100
Obligated balance, start of year
537
562
533
3200
Obligated balance, end of year
562
533
440
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
60
60
60
Outlays, gross:
4010
Outlays from new discretionary authority
23
21
21
4011
Outlays from discretionary balances
35
38
37
4020
Outlays, gross (total)
58
59
58
Mandatory:
4090
Budget authority, gross
472
461
345
Outlays, gross:
4100
Outlays from new mandatory authority
113
114
107
4101
Outlays from mandatory balances
308
351
344
4110
Outlays, gross (total)
421
465
451
4180
Budget authority, net (total)
532
521
405
4190
Outlays, net (total)
479
524
509
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
532
521
405
Outlays
479
524
509
Legislative proposal, subject to PAYGO:
Budget Authority
150
Outlays
3
Total:
Budget Authority
532
521
555
Outlays
479
524
512
This account provides funds for a broad range of child welfare services, including family preservation and support services
and grants to increase the well-being of and improve the permanency outcomes for children affected by substance abuse, through
Promoting Safe and Stable Families. The Budget includes a five-year reauthorization of Promoting Safe and Stable Families,
and a two-year reauthorization of Abstinence Education and the Personal Responsibility Education Program (PREP).
Object Classification (in millions of dollars)
Identification code 075–1512–0–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
1
25.1
Advisory and assistance services
12
10
5
25.3
Other goods and services from Federal sources
3
4
3
41.0
Grants, subsidies, and contributions
511
502
408
99.9
Total new obligations, unexpired accounts
527
517
416
Employment Summary
Identification code 075–1512–0–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
10
9
2
Promoting Safe and Stable Families
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1512–4–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0005
PREP
75
0006
Abstinence Education
68
0900
Total new obligations, unexpired accounts
143
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
150
1930
Total budgetary resources available
150
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
7
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
143
3020
Outlays (gross)
–3
3050
Unpaid obligations, end of year
140
Memorandum (non-add) entries:
3200
Obligated balance, end of year
140
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
150
Outlays, gross:
4100
Outlays from new mandatory authority
3
4180
Budget authority, net (total)
150
4190
Outlays, net (total)
3
Object Classification (in millions of dollars)
Identification code 075–1512–4–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
25.1
Advisory and assistance services
5
41.0
Grants, subsidies, and contributions
137
99.9
Total new obligations, unexpired accounts
143
Employment Summary
Identification code 075–1512–4–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
7
Child Care Entitlement to States
Program and Financing (in millions of dollars)
Identification code 075–1550–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Mandatory child care
1,178
1,178
1,178
0002
Matching child care
1,697
1,662
1,662
0003
Child Care Training and technical assistance
14
15
15
0004
Child care tribal grants
58
58
58
0005
Child Care Research
4
4
4
0900
Total new obligations, unexpired accounts
2,951
2,917
2,917
Budgetary resources:
Unobligated balance:
1012
Unobligated balance transfers between expired and unexpired accounts
34
Budget authority:
Appropriations, mandatory:
1200
Appropriation
2,917
2,917
2,917
1930
Total budgetary resources available
2,951
2,917
2,917
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
927
1,054
1,003
3010
New obligations, unexpired accounts
2,951
2,917
2,917
3020
Outlays (gross)
–2,788
–2,968
–2,946
3041
Recoveries of prior year unpaid obligations, expired
–36
3050
Unpaid obligations, end of year
1,054
1,003
974
Memorandum (non-add) entries:
3100
Obligated balance, start of year
927
1,054
1,003
3200
Obligated balance, end of year
1,054
1,003
974
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
2,917
2,917
2,917
Outlays, gross:
4100
Outlays from new mandatory authority
2,052
2,175
2,175
4101
Outlays from mandatory balances
736
793
771
4110
Outlays, gross (total)
2,788
2,968
2,946
4180
Budget authority, net (total)
2,917
2,917
2,917
4190
Outlays, net (total)
2,788
2,968
2,946
This account provides child care subsidies for low-income working families and was established by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the Further Continuing and
Security Assistance Appropriations Act, 2017 (P.L. 114–254).
Object Classification (in millions of dollars)
Identification code 075–1550–0–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
25.1
Advisory and assistance services
7
7
7
25.3
Other goods and services from Federal sources
1
1
1
41.0
Grants, subsidies, and contributions
2,943
2,909
2,909
99.9
Total new obligations, unexpired accounts
2,951
2,917
2,917
Payments to states for the child care and development block grant
For carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $2,761,000,000 shall be used to supplement, not supplant State general revenue funds for child care assistance
for low-income families: Provided, That technical assistance under section 658I(a)(3) of such Act may be provided directly, or through the use of contracts,
grants, cooperative agreements, or interagency agreements: Provided further, That all funds made available to carry out section 418 of the Social Security Act (42 U.S.C. 618), including funds appropriated
for that purpose in such section 418 or any other provision of law, shall be subject to the reservation of funds authority
in paragraphs (4) and (5) of section 658O(a) of the CCDBG Act.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1515–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Child Care Block grant payments to States
2,751
2,746
2,751
0004
Child Care Research and evaluation fund
10
10
10
0900
Total new obligations, unexpired accounts
2,761
2,756
2,761
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1100
Appropriation
2,761
2,756
2,761
1930
Total budgetary resources available
2,761
2,756
2,761
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
829
1,070
1,101
3010
New obligations, unexpired accounts
2,761
2,756
2,761
3020
Outlays (gross)
–2,518
–2,725
–2,772
3041
Recoveries of prior year unpaid obligations, expired
–2
3050
Unpaid obligations, end of year
1,070
1,101
1,090
Memorandum (non-add) entries:
3100
Obligated balance, start of year
829
1,070
1,101
3200
Obligated balance, end of year
1,070
1,101
1,090
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
2,761
2,756
2,761
Outlays, gross:
4010
Outlays from new discretionary authority
1,881
1,929
1,933
4011
Outlays from discretionary balances
637
796
839
4020
Outlays, gross (total)
2,518
2,725
2,772
4180
Budget authority, net (total)
2,761
2,756
2,761
4190
Outlays, net (total)
2,518
2,725
2,772
This program provides grants to States for child care subsidies for low-income working families and activities to improve
child care quality.
Object Classification (in millions of dollars)
Identification code 075–1515–0–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
25.1
Advisory and assistance services
21
21
21
41.0
Grants, subsidies, and contributions
2,740
2,735
2,740
99.9
Total new obligations, unexpired accounts
2,761
2,756
2,761
Social services block grant
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1534–0–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Social Services Block Grant
1,584
1,583
1,700
0002
Health Profession Opportunity Grants
85
79
0900
Total new obligations, unexpired accounts
1,669
1,662
1,700
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
30
29
29
Budget authority:
Appropriations, mandatory:
1200
Appropriation
1,785
1,785
1,700
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–116
–123
1260
Appropriations, mandatory (total)
1,669
1,662
1,700
1930
Total budgetary resources available
1,699
1,691
1,729
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–1
1941
Unexpired unobligated balance, end of year
29
29
29
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
592
480
443
3010
New obligations, unexpired accounts
1,669
1,662
1,700
3020
Outlays (gross)
–1,780
–1,699
–1,770
3041
Recoveries of prior year unpaid obligations, expired
–1
3050
Unpaid obligations, end of year
480
443
373
Memorandum (non-add) entries:
3100
Obligated balance, start of year
592
480
443
3200
Obligated balance, end of year
480
443
373
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
1,669
1,662
1,700
Outlays, gross:
4100
Outlays from new mandatory authority
1,372
1,318
1,411
4101
Outlays from mandatory balances
408
381
359
4110
Outlays, gross (total)
1,780
1,699
1,770
4180
Budget authority, net (total)
1,669
1,662
1,700
4190
Outlays, net (total)
1,780
1,699
1,770
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
1,669
1,662
1,700
Outlays
1,780
1,699
1,770
Legislative proposal, subject to PAYGO:
Budget Authority
–1,615
Outlays
–1,408
Total:
Budget Authority
1,669
1,662
85
Outlays
1,780
1,699
362
The Budget proposes to reduce the authorized funding level for the Social Services Block Grant to $0. The account also provides
funding for the Health Profession Opportunity Grants demonstration to provide education and training to Temporary Assistance
for Needy Families recipients and other low income individuals for health care occupations in high demand. The Budget proposes
extending the demonstration through FY 2019.
Object Classification (in millions of dollars)
Identification code 075–1534–0–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
1
25.1
Advisory and assistance services
12
11
41.0
Grants, subsidies, and contributions
1,656
1,650
1,700
99.9
Total new obligations, unexpired accounts
1,669
1,662
1,700
Employment Summary
Identification code 075–1534–0–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
7
8
Social Services Block Grant
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1534–4–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0002
Health Profession Opportunity Grants
85
0003
Social Services Block Grant
–1,700
0900
Total new obligations, unexpired accounts
–1,615
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–1,615
1900
Budget authority (total)
–1,615
1930
Total budgetary resources available
–1,615
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–1,615
3020
Outlays (gross)
1,408
3050
Unpaid obligations, end of year
–207
Memorandum (non-add) entries:
3200
Obligated balance, end of year
–207
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–1,615
Outlays, gross:
4100
Outlays from new mandatory authority
–1,408
4180
Budget authority, net (total)
–1,615
4190
Outlays, net (total)
–1,408
Object Classification (in millions of dollars)
Identification code 075–1534–4–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
25.1
Advisory and assistance services
11
41.0
Grants, subsidies, and contributions
–1,627
99.9
Total new obligations, unexpired accounts
–1,615
Employment Summary
Identification code 075–1534–4–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
8
Children and families services programs
For carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Head Start Act, the Child Abuse Prevention
and Treatment Act, sections 303 and 313 of the Family Violence Prevention and Services Act, the Native American Programs Act
of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 (adoption opportunities), part
B-1 of title IV and sections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social Security Act; and for necessary administrative expenses to carry out titles I, IV, V, X, XI, XIV, XVI, and XX-A of the Social Security Act,
the Act of July 5, 1960, the Child Care and Development Block Grant Act of 1990, title IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act of 1980; $10,204,294,000, of which $37,871,000, to remain available through September 30, 2019, shall be for grants to States for adoption and legal guardianship incentive payments, as defined by section 473A of the
Social Security Act and may be made for adoptions and legal guardianships completed before September 30, 2018: Provided, That $9,168,095,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, $8,508,095,000 shall be available for payments under section 640 of the Head Start Act: Provided further, That in addition to the amounts for such purposes identified in section 640(a)(2)(D) of the Head Start Act, up to $1,500,000 of
amounts made available in the previous proviso may be reserved for research and evaluation on hours of programs operations,
notwithstanding paragraphs (3) and (4) of section 640(a) of such Act: Provided further, That of the amount provided for making payments under the Head Start Act, $25,000,000 shall be available for allocation
by the Secretary to supplement activities described in paragraphs (7)(B) and (9) of section 641(c) of such Act under the Designation
Renewal System, established under the authority of sections 641(c)(7), 645A(b)(12) and 645A(d) of such Act: Provided further, That notwithstanding such section 640, of the amount provided for making payments under the Head Start Act, and in addition
to funds otherwise available under such section 640 for such purposes, $635,000,000 shall be available through March 31, 2019 for Early Head Start programs as described in section 645A of such Act, for conversion of Head Start services to Early Head
Start services as described in section 645(a)(5)(A) of such Act, for discretionary grants for high quality infant and toddler
care through Early Head Start-Child Care Partnerships, to entities defined as eligible under section 645A(d) of such Act,
for training and technical assistance for such activities, and for up to $14,000,000 in Federal costs of administration and
evaluation, and, notwithstanding section 645A(c)(2) of such Act, these funds are available to serve children under age 4:
Provided further, That funds described in the preceding two provisos shall not be included in the calculation of "base grant" in subsequent
fiscal years, as such term is used in section 640(a)(7)(A) of such Act: Provided further, That $1,860,000 shall be for a human services case management system for federally declared disasters, to include a comprehensive national
case management contract and Federal costs of administering the system: Provided further, That up to $2,000,000 shall be for improving the Public Assistance Reporting Information System, including grants to States
to support data collection for a study of the system's effectiveness.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1536–0–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0101
Head Start
9,119
9,151
9,168
0103
Runaway and homeless youth (basic centers)
54
54
54
0104
Transitional living
48
48
48
0106
Education grants to reduce sexual abuse of runaway youth
17
17
17
0109
Child abuse State grants
25
25
25
0110
Child abuse discretionary activities
33
33
33
0111
Community-based child abuse prevention
40
40
40
0112
Child welfare services
269
267
268
0113
Child welfare training, research, or demonstration projects
18
18
18
0114
Adoption opportunities
39
39
30
0116
Adoption and Legal Guardianship Incentives
38
38
38
0117
Independent living education and training vouchers
43
43
43
0124
Native American programs
50
50
50
0125
Social services and income maintenance research
6
6
6
0128
ACF Federal administration
204
205
205
0131
Disaster human services case management
2
2
2
0191
Direct program activities, subtotal
10,005
10,036
10,045
0301
Community services block grant
715
714
0303
Rural community facilities
6
6
0304
Community services discretionary (JOLI & CED)
30
30
0306
Assets for independence
19
19
0308
Domestic violence hotline
8
8
8
0309
Family violence prevention and services
150
150
151
0391
Direct program activities, subtotal
928
927
159
0400
Total, direct program
10,933
10,963
10,204
0799
Total direct obligations
10,933
10,963
10,204
0801
Children and Families Services Programs (Reimbursable)
14
20
20
0809
Reimbursable program activities, subtotal
14
20
20
0900
Total new obligations, unexpired accounts
10,947
10,983
10,224
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
377
427
432
1001
Discretionary unobligated balance brought fwd, Oct 1
377
427
1021
Recoveries of prior year unpaid obligations
1
1050
Unobligated balance (total)
378
427
432
Budget authority:
Appropriations, discretionary:
1100
Appropriation
10,984
10,963
10,204
Spending authority from offsetting collections, discretionary:
1700
Collected
6
19
24
1701
Change in uncollected payments, Federal sources
5
4
1750
Spending auth from offsetting collections, disc (total)
11
23
24
Spending authority from offsetting collections, mandatory:
1800
Collected
1
1
1
1801
Change in uncollected payments, Federal sources
1
1
1850
Spending auth from offsetting collections, mand (total)
2
2
1
1900
Budget authority (total)
10,997
10,988
10,229
1930
Total budgetary resources available
11,375
11,415
10,661
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–1
1941
Unexpired unobligated balance, end of year
427
432
437
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
7,114
7,620
6,939
3010
New obligations, unexpired accounts
10,947
10,983
10,224
3011
Obligations ("upward adjustments"), expired accounts
27
3020
Outlays (gross)
–10,402
–11,664
–10,902
3040
Recoveries of prior year unpaid obligations, unexpired
–1
3041
Recoveries of prior year unpaid obligations, expired
–65
3050
Unpaid obligations, end of year
7,620
6,939
6,261
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–5
–9
–14
3070
Change in uncollected pymts, Fed sources, unexpired
–6
–5
3071
Change in uncollected pymts, Fed sources, expired
2
3090
Uncollected pymts, Fed sources, end of year
–9
–14
–14
Memorandum (non-add) entries:
3100
Obligated balance, start of year
7,109
7,611
6,925
3200
Obligated balance, end of year
7,611
6,925
6,247
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
10,995
10,986
10,228
Outlays, gross:
4010
Outlays from new discretionary authority
4,138
4,629
4,312
4011
Outlays from discretionary balances
6,262
7,033
6,590
4020
Outlays, gross (total)
10,400
11,662
10,902
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–7
–18
–18
4033
Non-Federal sources
–2
–6
4040
Offsets against gross budget authority and outlays (total)
–7
–20
–24
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–5
–4
4052
Offsetting collections credited to expired accounts
1
1
4060
Additional offsets against budget authority only (total)
–4
–3
4070
Budget authority, net (discretionary)
10,984
10,963
10,204
4080
Outlays, net (discretionary)
10,393
11,642
10,878
Mandatory:
4090
Budget authority, gross
2
2
1
Outlays, gross:
4100
Outlays from new mandatory authority
2
2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–2
–1
–1
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–1
–1
4142
Offsetting collections credited to expired accounts
1
4150
Additional offsets against budget authority only (total)
–1
4170
Outlays, net (mandatory)
1
–1
4180
Budget authority, net (total)
10,984
10,963
10,204
4190
Outlays, net (total)
10,393
11,643
10,877
The request totals $10.2 billion, including almost $9.2 billion for Head Start. This request discontinues funding for the
Community Services Block Grant, Rural Community Facilities, Community Economic Development, and Assets for Independence.
Object Classification (in millions of dollars)
Identification code 075–1536–0–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
108
112
112
11.3
Other than full-time permanent
6
5
6
11.7
Military personnel
1
1
1
11.9
Total personnel compensation
115
118
119
12.1
Civilian personnel benefits
34
36
36
21.0
Travel and transportation of persons
4
4
4
23.1
Rental payments to GSA
16
16
16
23.3
Communications, utilities, and miscellaneous charges
2
2
2
24.0
Printing and reproduction
1
1
1
25.1
Advisory and assistance services
192
196
194
25.2
Other services from non-Federal sources
5
7
7
25.3
Other goods and services from Federal sources
57
51
49
25.4
Operation and maintenance of facilities
4
3
3
26.0
Supplies and materials
1
1
1
41.0
Grants, subsidies, and contributions
10,502
10,528
9,772
99.0
Direct obligations
10,933
10,963
10,204
99.0
Reimbursable obligations
14
20
20
99.9
Total new obligations, unexpired accounts
10,947
10,983
10,224
Employment Summary
Identification code 075–1536–0–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
1,118
1,132
1,117
1101
Direct military average strength employment
8
9
9
2001
Reimbursable civilian full-time equivalent employment
9
9
Children's Research and Technical Assistance
Program and Financing (in millions of dollars)
Identification code 075–1553–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Training and technical assistance
10
18
12
0002
Federal parent locator service
23
29
25
0004
Welfare research
15
15
0799
Total direct obligations
48
62
37
0801
Federal Parent Locator Service reimbursable
24
28
27
0899
Total reimbursable obligations
24
28
27
0900
Total new obligations, unexpired accounts
72
90
64
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
6
13
1021
Recoveries of prior year unpaid obligations
6
1
1
1050
Unobligated balance (total)
12
14
1
Budget authority:
Appropriations, discretionary:
1121
Appropriations transferred from other acct [075–1522]
15
Appropriations, mandatory:
1200
Appropriation
37
37
37
1200
Appropriation [Pop-up]
1
1
1221
Appropriations transferred from other acct [075–1522]
15
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–3
–3
1260
Appropriations, mandatory (total)
49
35
38
Spending authority from offsetting collections, mandatory:
1800
Collected
24
26
26
1802
Offsetting collections (previously unavailable)
1
1
1
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–1
–1
1850
Spending auth from offsetting collections, mand (total)
24
26
27
1900
Budget authority (total)
73
76
65
1930
Total budgetary resources available
85
90
66
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
13
2
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
79
43
52
3010
New obligations, unexpired accounts
72
90
64
3020
Outlays (gross)
–102
–80
–74
3040
Recoveries of prior year unpaid obligations, unexpired
–6
–1
–1
3050
Unpaid obligations, end of year
43
52
41
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–6
–6
–6
3090
Uncollected pymts, Fed sources, end of year
–6
–6
–6
Memorandum (non-add) entries:
3100
Obligated balance, start of year
73
37
46
3200
Obligated balance, end of year
37
46
35
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
15
Outlays, gross:
4010
Outlays from new discretionary authority
2
4011
Outlays from discretionary balances
11
6
4020
Outlays, gross (total)
11
2
6
Mandatory:
4090
Budget authority, gross
73
61
65
Outlays, gross:
4100
Outlays from new mandatory authority
44
42
44
4101
Outlays from mandatory balances
47
36
24
4110
Outlays, gross (total)
91
78
68
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–7
–7
–7
4123
Non-Federal sources
–17
–19
–19
4130
Offsets against gross budget authority and outlays (total)
–24
–26
–26
4160
Budget authority, net (mandatory)
49
35
39
4170
Outlays, net (mandatory)
67
52
42
4180
Budget authority, net (total)
49
50
39
4190
Outlays, net (total)
78
54
48
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
1
1
1
5092
Unexpired unavailable balance, EOY: Offsetting collections
1
1
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
49
50
39
Outlays
78
54
48
Legislative proposal, subject to PAYGO:
Budget Authority
15
Outlays
15
Total:
Budget Authority
49
50
54
Outlays
78
54
63
This account provides funding for research and technical assistance activities established by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
For fiscal years 2010–2014, Welfare Research had been temporarily reauthorized; for FY 2015 and FY 2016, annual appropriations
provided funds for Welfare Research via a transfer from the TANF Contingency Fund. The Budget includes a legislative proposal
to transfer $15 million to Welfare Research from the TANF Block Grant beginning in FY 2018.
Object Classification (in millions of dollars)
Identification code 075–1553–0–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
7
7
7
12.1
Civilian personnel benefits
2
2
2
23.1
Rental payments to GSA
3
4
4
25.1
Advisory and assistance services
13
13
25.2
Other services from non-Federal sources
13
19
14
25.3
Other goods and services from Federal sources
5
7
7
25.6
Medical care
5
25.7
Operation and maintenance of equipment
3
4
3
41.0
Grants, subsidies, and contributions
2
1
99.0
Direct obligations
48
62
37
99.0
Reimbursable obligations
24
28
27
99.9
Total new obligations, unexpired accounts
72
90
64
Employment Summary
Identification code 075–1553–0–1–609
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
68
68
68
Children's Research and Technical Assistance
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1553–4–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0004
Welfare research
15
0799
Total direct obligations
15
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1221
Appropriations transferred from other acct [075–1552]
15
1900
Budget authority (total)
15
1930
Total budgetary resources available
15
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
15
3020
Outlays (gross)
–15
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
15
Outlays, gross:
4100
Outlays from new mandatory authority
15
4180
Budget authority, net (total)
15
4190
Outlays, net (total)
15
Object Classification (in millions of dollars)
Identification code 075–1553–4–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
25.1
Advisory and assistance services
13
25.3
Other goods and services from Federal sources
1
99.0
Direct obligations
14
99.0
Reimbursable obligations
1
99.9
Total new obligations, unexpired accounts
15
Payments for foster care and permanency
For carrying out, except as otherwise provided, title IV-E of the Social Security Act, $6,225,000,000.
For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
2019, $2,700,000,000.
For carrying out, after May 31 of the current fiscal year, except as otherwise provided, section 474 of title IV-E of the
Social Security Act, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal
year, such sums as may be necessary.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–1545–0–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Foster care
4,815
5,302
5,537
0002
Independent living
140
140
140
0004
Adoption assistance
2,587
2,658
2,867
0005
Guardianship
120
151
181
0006
Technical Assistance and Implementation Services for Tribal Programs
3
3
3
0900
Total new obligations, unexpired accounts
7,665
8,254
8,728
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
5,367
5,956
6,228
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–2
–2
1260
Appropriations, mandatory (total)
5,365
5,954
6,228
Advance appropriations, mandatory:
1270
Advance appropriation
2,300
2,300
2,500
1900
Budget authority (total)
7,665
8,254
8,728
1930
Total budgetary resources available
7,665
8,254
8,728
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,089
1,114
1,343
3010
New obligations, unexpired accounts
7,665
8,254
8,728
3011
Obligations ("upward adjustments"), expired accounts
193
3020
Outlays (gross)
–7,700
–8,025
–8,439
3041
Recoveries of prior year unpaid obligations, expired
–133
3050
Unpaid obligations, end of year
1,114
1,343
1,632
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,089
1,114
1,343
3200
Obligated balance, end of year
1,114
1,343
1,632
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
7,665
8,254
8,728
Outlays, gross:
4100
Outlays from new mandatory authority
6,815
7,118
7,530
4101
Outlays from mandatory balances
885
907
909
4110
Outlays, gross (total)
7,700
8,025
8,439
4180
Budget authority, net (total)
7,665
8,254
8,728
4190
Outlays, net (total)
7,700
8,025
8,439
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
7,665
8,254
8,728
Outlays
7,700
8,025
8,439
Legislative proposal, subject to PAYGO:
Budget Authority
18
Outlays
18
Total:
Budget Authority
7,665
8,254
8,746
Outlays
7,700
8,025
8,457
This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, and the Chafee
Foster Care Independence Program, as well as technical assistance and implementation services for tribal programs.
Foster Care—The proposed level will support eligible low-income children who must be placed outside the home. An average of 176,500 children
per month are estimated to be served in FY 2018.
Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
An average of 499,600 children per month are estimated to be served in FY 2018.
Guardianship Assistance Program—The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
in foster care. An average of 32,300 children per month are estimated to be served in FY 2018.
The account includes the interaction effects from the proposal to eliminate SSBG funding, which increases costs in FCP due
to State agencies shifting eligible expenses previously funded by SSBG to FCP.
Object Classification (in millions of dollars)
Identification code 075–1545–0–1–609
2016 actual
2017 est.
2018 est.
Direct obligations:
23.1
Rental payments to GSA
1
1
1
25.1
Advisory and assistance services
35
34
35
41.0
Grants, subsidies, and contributions
7,629
8,219
8,692
99.9
Total new obligations, unexpired accounts
7,665
8,254
8,728
Employment Summary
Identification code 075–1545–0–1–609
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
3
4
4
Payments for Foster Care and Permanency
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1545–4–1–609
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Foster care
5
0004
Adoption assistance
12
0005
Guardianship
1
0900
Total new obligations, unexpired accounts (object class 41.0)
18
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
18
1900
Budget authority (total)
18
1930
Total budgetary resources available
18
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
18
3020
Outlays (gross)
–18
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
18
Outlays, gross:
4100
Outlays from new mandatory authority
18
4180
Budget authority, net (total)
18
4190
Outlays, net (total)
18
Administration for Community Living
Federal Funds
aging and disability services programs
(including transfer of funds)
For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), titles III and XXIX of the
PHS Act, sections 1252 and 1253 of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of
2008, title XX-B of the Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and
5 of subtitle D of title II of the Help America Vote Act of 2002, the Assistive Technology Act of 1998, titles II and VII
(and section 14 with respect to such titles) of the Rehabilitation Act of 1973 , and for Department-wide coordination of policy
and program activities that assist individuals with disabilities, $1,851,450,000: Provided, That amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease
prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based
and effective: Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of
the OAA may be transferred to the Secretary of Agriculture in accordance with such section: Provided further, That none of the funds made available under this heading may be used by an eligible system (as defined in section 102 of
the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal action
in a Federal or State court on behalf of an individual or group of individuals with a developmental disability (as defined
in section 102(8)(A) of the Developmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A))
that is attributable to a mental impairment (or a combination of mental and physical impairments), that has as the requested
remedy the closure of State operated intermediate care facilities for people with intellectual or developmental disabilities,
unless reasonable public notice of the action has been provided to such individuals (or, in the case of mental incapacitation,
the legal guardians who have been specifically awarded authority by the courts to make healthcare and residential decisions
on behalf of such individuals) who are affected by such action, within 90 days of instituting such legal action, which informs
such individuals (or such legal guardians) of their legal rights and how to exercise such rights consistent with current Federal
Rules of Civil Procedure: Provided further, That the limitations in the immediately preceding proviso shall not apply in the case of an individual who is neither competent
to consent nor has a legal guardian, nor shall the proviso apply in the case of individuals who are a ward of the State or
subject to public guardianship.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0142–0–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0101
Aging Services Programs
1,463
1,463
1,461
0102
ACL Program Administration
40
40
38
0103
Integrated Aging and Disability Services Programs
119
119
66
0104
Disability Services Programs
287
286
216
0105
National Institute on Disability, Independent Living & Rehab Research
104
104
95
0300
Total, direct program
2,013
2,012
1,876
0799
Total direct obligations
2,013
2,012
1,876
0801
ACL Reimbursable Programs
18
18
18
0900
Total new obligations, unexpired accounts
2,031
2,030
1,894
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
3
3
34
Budget authority:
Appropriations, discretionary:
1100
Appropriation
1,912
1,909
1,851
1120
Appropriations transferred to other accts [012–3507]
–2
1120
Appropriations transferred to other accts [075–0140]
–2
1160
Appropriation, discretionary (total)
1,908
1,909
1,851
Appropriations, mandatory:
1221
PPHF Appropriations transferred from other accounts [075–0116]
28
28
Spending authority from offsetting collections, discretionary:
1700
Collected
14
62
18
1701
Change in uncollected payments, Federal sources
57
1750
Spending auth from offsetting collections, disc (total)
71
62
18
Spending authority from offsetting collections, mandatory:
1800
Collected
6
62
25
1801
Change in uncollected payments, Federal sources
19
1850
Spending auth from offsetting collections, mand (total)
25
62
25
1900
Budget authority (total)
2,032
2,061
1,894
1930
Total budgetary resources available
2,035
2,064
1,928
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–1
1941
Unexpired unobligated balance, end of year
3
34
34
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
1,245
1,261
1,211
3010
New obligations, unexpired accounts
2,031
2,030
1,894
3011
Obligations ("upward adjustments"), expired accounts
5
3020
Outlays (gross)
–2,009
–2,080
–1,998
3041
Recoveries of prior year unpaid obligations, expired
–11
3050
Unpaid obligations, end of year
1,261
1,211
1,107
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–105
–163
–163
3070
Change in uncollected pymts, Fed sources, unexpired
–76
3071
Change in uncollected pymts, Fed sources, expired
18
3090
Uncollected pymts, Fed sources, end of year
–163
–163
–163
Memorandum (non-add) entries:
3100
Obligated balance, start of year
1,140
1,098
1,048
3200
Obligated balance, end of year
1,098
1,048
944
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
1,979
1,971
1,869
Outlays, gross:
4010
Outlays from new discretionary authority
1,032
1,215
1,170
4011
Outlays from discretionary balances
923
744
748
4020
Outlays, gross (total)
1,955
1,959
1,918
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–23
–62
–18
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–57
4052
Offsetting collections credited to expired accounts
9
4060
Additional offsets against budget authority only (total)
–48
4070
Budget authority, net (discretionary)
1,908
1,909
1,851
4080
Outlays, net (discretionary)
1,932
1,897
1,900
Mandatory:
4090
Budget authority, gross
53
90
25
Outlays, gross:
4100
Outlays from new mandatory authority
1
13
5
4101
Outlays from mandatory balances
53
108
75
4110
Outlays, gross (total)
54
121
80
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–14
–62
–25
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–19
4142
Offsetting collections credited to expired accounts
8
4150
Additional offsets against budget authority only (total)
–11
4160
Budget authority, net (mandatory)
28
28
4170
Outlays, net (mandatory)
40
59
55
4180
Budget authority, net (total)
1,936
1,937
1,851
4190
Outlays, net (total)
1,972
1,956
1,955
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
1,936
1,937
1,851
Outlays
1,972
1,956
1,955
Legislative proposal, subject to PAYGO:
Outlays
–20
Total:
Budget Authority
1,936
1,937
1,851
Outlays
1,972
1,956
1,935
This account funds formula and discretionary grants that provide home and community-based services and supports to assist
older adults and people of all ages with disabilities to live independently and to fully participate in their communities.
ACL works with states, localities, tribal organizations, nonprofit organizations, businesses and families, and through networks
of aging and disability organizations, to provide these services and supports which include nutrition, supportive, caregiver,
independent living and protection and advocacy services. In FY 2018, a new Partnerships for Innovation, Inclusion, and Independence
consolidates funding from three disability programs: State Councils on Developmental Disabilities, Traumatic Brain Injury,
and Independent Living-State Grants. Additionally in FY 2018, a new Alzheimer's Disease Program consolidates funding from
three Alzheimer's Disease programs: Demo Grants ADSSP, Communications Campaign, and Services.
Administration for Community Living Program Activity Table Dollars in Millions
FY 2018 Program Activity
FY 2017 Program Activity
FY 2016 Obligations
FY 2017 Obligations
FY 2018 Obligations
0101 Aging Services Programs
1,463
1,463
1,461
Home and community-based supportive services
348
347
347
Preventive health services
20
20
20
National family caregiver support program
151
150
150
Native American caregiver support program
8
8
8
Congregate nutrition services
448
447
447
Home-delivered nutrition services
226
226
226
Nutrition services incentive program
160
160
160
Native American nutrition and supportive services
31
31
31
Long-term care ombudsmen program
16
16
16
Prevention of elder abuse and neglect
5
5
5
Alzheimer's Disease Demo Grants ADSSP
5
5
0
Aging network support activities
10
10
10
Elder Rights Support Activities
12
12
12
Chronic Disease Self-Management Education Program
8
8
5
Falls Prevention
5
5
5
Alzheimer's Disease Communications Campaign
4
4
0
Alzheimer's Disease Initiative - Services
11
11
0
Alzheimer's Disease Program
0
0
19
0102 ACL Program Administration
40
40
38
Program administration
40
40
38
0103 Integrated Aging and Disability Services Programs
119
119
66
Assistive Technology
34
34
32
Lifespan respite care program
3
3
3
SHIP
52
52
0
Aging and Disability Resource Centers (ADRC)
6
6
6
ARDC's MIPPA (MACRA)
5
5
5
Area Agencies on Aging - MIPPA (MACRA)
8
7
8
MIPPA - Nat'l Center Benefits Outreach Enrollment (MACRA)
12
11
12
0104 Disability Services Programs
287
286
216
Voting Access for People With Disabilities (HAVA)
5
5
5
Partnerships for Innovation, Inclusion, and Independence
0
0
45
State Councils on Developmental Disabilities
73
73
0
Protection and Advocacy
39
39
39
Traumatic Brain Injury (TBI)
9
9
3
Independent Living - State Grants
23
23
0
Independent Living - Centers (CILs)
78
78
78
University Centers for Excellence in Developmental Disabilities
39
39
39
Projects of National Significance
10
10
8
Paralysis Resource Center
3
3
0
Limb Loss Resource Center
8
8
0
0105 National Institute on Disability, Independent Living and Rehab Research
104
104
95
National Institute on Disability, Independent Living and Rehab Research
104
104
95
0801 ACL Reimbursable Programs
18
18
18
Reimbursable program - Other
0
0
0
Senior Medicare Patrol/HCFAC Program (Disc - CMS)
18
18
18
Object Classification (in millions of dollars)
Identification code 075–0142–0–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
22
23
21
12.1
Civilian personnel benefits
7
7
7
23.1
Rental payments to GSA
3
3
3
25.1
Advisory and assistance services
34
28
26
25.3
Other goods and services from Federal sources
10
15
15
41.0
Grants, subsidies, and contributions
1,937
1,936
1,804
99.0
Direct obligations
2,013
2,012
1,876
99.0
Reimbursable obligations
18
18
18
99.9
Total new obligations, unexpired accounts
2,031
2,030
1,894
Employment Summary
Identification code 075–0142–0–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
177
192
171
2001
Reimbursable civilian full-time equivalent employment
19
7
10
Aging and Disability Services Programs
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0142–4–1–506
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0103
Integrated Aging and Disability Services Programs
25
0300
Total, direct program
25
0799
Total direct obligations
25
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
25
1900
Budget authority (total)
25
1930
Total budgetary resources available
25
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
25
3020
Outlays (gross)
–5
3050
Unpaid obligations, end of year
20
Memorandum (non-add) entries:
3200
Obligated balance, end of year
20
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
25
Outlays, gross:
4100
Outlays from new mandatory authority
5
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–25
4180
Budget authority, net (total)
4190
Outlays, net (total)
–20
Object Classification (in millions of dollars)
Identification code 075–0142–4–1–506
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
1
25.3
Other goods and services from Federal sources
1
41.0
Grants, subsidies, and contributions
23
99.0
Direct obligations
25
99.9
Total new obligations, unexpired accounts
25
Employment Summary
Identification code 075–0142–4–1–506
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
6
Departmental Management
Federal Funds
General departmental management
For necessary expenses, not otherwise provided, for general departmental management, including the hire of six passenger motor vehicles, and for carrying out titles III, XVII, XXI, and section 229 of the PHS Act, the United
States-Mexico Border Health Commission Act, and research studies under section 1110 of the Social Security Act, $304,501,000, together with $57,465,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation
activities: Provided, That of the funds made available under this heading, $10,000,000 shall be for making competitive grants which exclusively implement education in sexual risk avoidance (defined as voluntarily
refraining from non-marital sexual activity): Provided further, That funding for such competitive grants for sexual risk avoidance shall use medically accurate information referenced to
peer-reviewed publications by educational, scientific, governmental, or health organizations; implement an evidence-based
approach integrating research findings with practical implementation that aligns with the needs and desired outcomes for the
intended audience; and teach the benefits associated with self-regulation, success sequencing for poverty prevention, healthy
relationships, goal setting, and resisting sexual coercion, dating violence, and other youth risk behaviors such as underage
drinking or illicit drug use without normalizing teen sexual activity: Provided further, That no more than 10 percent of the funding for such competitive grants for sexual risk avoidance shall be available for
technical assistance and administrative costs of such programs: Provided further, That funds provided in this Act for embryo adoption activities may be used to provide to individuals adopting embryos, through
grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4).
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–9912–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
General Departmental Management
456
455
305
0801
GDM (Collected)
161
195
198
0802
HCFAC (Mandatory)
8
8
10
0803
PHS Evaluation (Collected)
65
65
57
0804
MACRA (Mandatory)
5
5
5
0899
Total reimbursable obligations
239
273
270
0900
Total new obligations, unexpired accounts
695
728
575
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
9
9
22
1001
Discretionary unobligated balance brought fwd, Oct 1
9
Budget authority:
Appropriations, discretionary:
1100
Appropriation
456
455
305
1120
Appropriations transferred to other accts [075–0943]
–1
1160
Appropriation, discretionary (total)
455
455
305
Spending authority from offsetting collections, discretionary:
1700
Collected
92
273
270
1701
Change in uncollected payments, Federal sources
136
1750
Spending auth from offsetting collections, disc (total)
228
273
270
Spending authority from offsetting collections, mandatory:
1800
Collected
5
13
15
1801
Change in uncollected payments, Federal sources
8
1850
Spending auth from offsetting collections, mand (total)
13
13
15
1900
Budget authority (total)
696
741
590
1930
Total budgetary resources available
705
750
612
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–1
1941
Unexpired unobligated balance, end of year
9
22
37
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
535
517
504
3010
New obligations, unexpired accounts
695
728
575
3011
Obligations ("upward adjustments"), expired accounts
9
3020
Outlays (gross)
–677
–741
–679
3041
Recoveries of prior year unpaid obligations, expired
–45
3050
Unpaid obligations, end of year
517
504
400
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–220
–230
–230
3070
Change in uncollected pymts, Fed sources, unexpired
–144
3071
Change in uncollected pymts, Fed sources, expired
134
3090
Uncollected pymts, Fed sources, end of year
–230
–230
–230
Memorandum (non-add) entries:
3100
Obligated balance, start of year
315
287
274
3200
Obligated balance, end of year
287
274
170
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
683
728
575
Outlays, gross:
4010
Outlays from new discretionary authority
333
350
282
4011
Outlays from discretionary balances
330
378
382
4020
Outlays, gross (total)
663
728
664
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–217
–273
–270
4033
Non-Federal sources:
–3
4040
Offsets against gross budget authority and outlays (total)
–220
–273
–270
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–136
4052
Offsetting collections credited to expired accounts
128
4060
Additional offsets against budget authority only (total)
–8
4070
Budget authority, net (discretionary)
455
455
305
4080
Outlays, net (discretionary)
443
455
394
Mandatory:
4090
Budget authority, gross
13
13
15
Outlays, gross:
4100
Outlays from new mandatory authority
7
13
15
4101
Outlays from mandatory balances
7
4110
Outlays, gross (total)
14
13
15
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–6
–13
–15
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–8
4142
Offsetting collections credited to expired accounts
1
4150
Additional offsets against budget authority only (total)
–7
4170
Outlays, net (mandatory)
8
4180
Budget authority, net (total)
455
455
305
4190
Outlays, net (total)
451
455
394
Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
account for 2018. Actual allocation will be determined annually.
General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance
to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the
activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health
promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the
Prevention and Public Health Fund.
Object Classification (in millions of dollars)
Identification code 075–9912–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
85
85
87
11.3
Other than full-time permanent
10
10
11
11.5
Other personnel compensation
2
2
2
11.7
Military personnel
3
3
3
11.9
Total personnel compensation
100
100
103
12.1
Civilian personnel benefits
27
27
28
12.2
Military personnel benefits
2
1
1
21.0
Travel and transportation of persons
5
5
4
23.1
Rental payments to GSA
17
17
16
23.3
Communications, utilities, and miscellaneous charges
2
2
2
24.0
Printing and reproduction
1
1
1
25.1
Advisory and assistance services
22
22
19
25.2
Other services from non-Federal sources
42
42
41
25.3
Other goods and services from Federal sources
70
70
33
25.4
Operation and maintenance of facilities
6
6
6
25.7
Operation and maintenance of equipment
5
5
5
26.0
Supplies and materials
1
1
1
31.0
Equipment
1
1
1
41.0
Grants, subsidies, and contributions
155
155
44
99.0
Direct obligations
456
455
305
99.0
Reimbursable obligations
239
273
270
99.9
Total new obligations, unexpired accounts
695
728
575
Employment Summary
Identification code 075–9912–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
902
965
971
1101
Direct military average strength employment
25
27
26
2001
Reimbursable civilian full-time equivalent employment
527
541
546
2101
Reimbursable military average strength employment
28
24
24
General Departmental Management
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–9912–4–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0805
DAB (Mandatory)
2
0899
Total reimbursable obligations
2
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
2
1930
Total budgetary resources available
2
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
2
3020
Outlays (gross)
–2
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
2
Outlays, gross:
4100
Outlays from new mandatory authority
2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–2
4180
Budget authority, net (total)
4190
Outlays, net (total)
This legislative proposal provides the Departmental Appeals Board (DAB) mandatory resources to address the Medicare appeals
backlog.
Object Classification (in millions of dollars)
Identification code 075–9912–4–1–551
2016 actual
2017 est.
2018 est.
11.1
Reimbursable obligations: Personnel compensation: Full-time permanent
1
11.9
Total personnel compensation
1
25.3
Other goods and services from Federal sources
1
99.0
Reimbursable obligations
2
99.9
Total new obligations, unexpired accounts
2
Employment Summary
Identification code 075–9912–4–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
14
Payment to the State Response to the Opioid Abuse Crisis Account, CURES Act
Program and Financing (in millions of dollars)
Identification code 075–0146–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Opioid Funding
500
500
0900
Total new obligations, unexpired accounts (object class 94.0)
500
500
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
500
500
1930
Total budgetary resources available
500
500
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
500
500
3020
Outlays (gross)
–500
–500
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
500
500
Outlays, gross:
4100
Outlays from new mandatory authority
500
500
4180
Budget authority, net (total)
500
500
4190
Outlays, net (total)
500
500
This account, and a related special receipt account, were established to support the execution structure necessary to implement
the 21st Century Cures Act.
State Response to the Opioid Abuse Crisis, CURES Act
For necessary expenses to carry out the purposes described under section 1003(c) of the 21st Century Cures Act, $500,000,000,
to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1003(b)(3) of the 21st
Century Cures Act, are to be derived from amounts transferred under section 1003(b)(2)(A) of such Act, and may be transferred
by the Secretary of Health and Human Services to other accounts of the Department solely for the purposes provided in such
Act: Provided further, That such transfer authority is in addition to any other transfer authority provided by law.
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5627–0–2–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
Receipts:
Current law:
1140
General Fund Payment, State Response to the Opioid Abuse Crisis, CURES Act
500
500
2000
Total: Balances and receipts
500
500
Appropriations:
Current law:
2101
State Response to the Opioid Abuse Crisis, Cures Act
–500
–500
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–5627–0–2–551
2016 actual
2017 est.
2018 est.
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1101
Appropriation (special or trust fund)
500
500
1120
Appropriations transferred to other acct [075–1362]
–500
–500
4180
Budget authority, net (total)
4190
Outlays, net (total)
This program provides grants to states, the District of Columbia, and territories to develop and provide opioid abuse prevention,
treatment, and recovery support services.
Office for civil rights
For expenses necessary for the Office for Civil Rights, $32,530,000.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0135–0–1–751
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Office for Civil Rights (Direct)
39
39
33
0801
Office for Civil Rights (Reimbursable)
6
14
11
0900
Total new obligations, unexpired accounts
45
53
44
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
4
24
17
Budget authority:
Appropriations, discretionary:
1100
Appropriation
39
39
33
Spending authority from offsetting collections, discretionary:
1700
Collected
1
1701
Change in uncollected payments, Federal sources
1
–1
1750
Spending auth from offsetting collections, disc (total)
1
Spending authority from offsetting collections, mandatory:
1800
Collected
26
8
10
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–1
–1
1850
Spending auth from offsetting collections, mand (total)
25
7
10
1900
Budget authority (total)
65
46
43
1930
Total budgetary resources available
69
70
60
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
24
17
16
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
10
12
15
3010
New obligations, unexpired accounts
45
53
44
3011
Obligations ("upward adjustments"), expired accounts
1
3020
Outlays (gross)
–42
–50
–43
3041
Recoveries of prior year unpaid obligations, expired
–2
3050
Unpaid obligations, end of year
12
15
16
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–1
3070
Change in uncollected pymts, Fed sources, unexpired
–1
1
3090
Uncollected pymts, Fed sources, end of year
–1
Memorandum (non-add) entries:
3100
Obligated balance, start of year
10
11
15
3200
Obligated balance, end of year
11
15
16
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
40
39
33
Outlays, gross:
4010
Outlays from new discretionary authority
34
31
26
4011
Outlays from discretionary balances
6
12
7
4020
Outlays, gross (total)
40
43
33
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–1
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–1
1
4060
Additional offsets against budget authority only (total)
–1
1
4070
Budget authority, net (discretionary)
39
39
33
4080
Outlays, net (discretionary)
40
42
33
Mandatory:
4090
Budget authority, gross
25
7
10
Outlays, gross:
4100
Outlays from new mandatory authority
7
10
4101
Outlays from mandatory balances
2
4110
Outlays, gross (total)
2
7
10
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123
Non-Federal sources
–26
–8
–10
4180
Budget authority, net (total)
38
38
33
4190
Outlays, net (total)
16
41
33
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
1
2
5092
Unexpired unavailable balance, EOY: Offsetting collections
1
2
2
The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination, health information
privacy, and security compliance programs.
Object Classification (in millions of dollars)
Identification code 075–0135–0–1–751
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
16
16
16
11.3
Other than full-time permanent
1
1
1
11.9
Total personnel compensation
17
17
17
12.1
Civilian personnel benefits
6
6
5
21.0
Travel and transportation of persons
1
1
23.1
Rental payments to GSA
3
3
3
25.2
Other services from non-Federal sources
1
1
1
25.3
Other goods and services from Federal sources
10
10
6
25.7
Operation and maintenance of equipment
1
1
1
99.0
Direct obligations
39
39
33
99.0
Reimbursable obligations
6
14
11
99.9
Total new obligations, unexpired accounts
45
53
44
Employment Summary
Identification code 075–0135–0–1–751
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
168
177
161
1101
Direct military average strength employment
2
2
1
2001
Reimbursable civilian full-time equivalent employment
1
1
1
Office of the national coordinator for health information technology
For expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts,
and cooperative agreements for the development and advancement of interoperable health information technology, $38,381,000.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0130–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Health information technology (IT)
60
60
38
0002
Recovery Act activities
6
0799
Total direct obligations
66
60
38
0801
Office of the National Coordinator for Health IT (ONC): Reimbursable
17
20
15
0899
Total reimbursable obligations
17
20
15
0900
Total new obligations, unexpired accounts
83
80
53
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
3
1021
Recoveries of prior year unpaid obligations
3
1050
Unobligated balance (total)
6
Budget authority:
Appropriations, discretionary:
1100
Appropriation
60
60
38
Spending authority from offsetting collections, discretionary:
1700
PHS and Other
7
20
15
1701
Change in uncollected payments, Federal sources
10
1750
Spending auth from offsetting collections, disc (total)
17
20
15
1900
Budget authority (total)
77
80
53
1930
Total budgetary resources available
83
80
53
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
121
95
27
3010
New obligations, unexpired accounts
83
80
53
3011
Obligations ("upward adjustments"), expired accounts
1
3020
Outlays (gross)
–105
–148
–58
3040
Recoveries of prior year unpaid obligations, unexpired
–3
3041
Recoveries of prior year unpaid obligations, expired
–2
3050
Unpaid obligations, end of year
95
27
22
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–30
–26
–26
3070
Change in uncollected pymts, Fed sources, unexpired
–10
3071
Change in uncollected pymts, Fed sources, expired
14
3090
Uncollected pymts, Fed sources, end of year
–26
–26
–26
Memorandum (non-add) entries:
3100
Obligated balance, start of year
91
69
1
3200
Obligated balance, end of year
69
1
–4
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
77
80
53
Outlays, gross:
4010
Outlays from new discretionary authority
50
68
45
4011
Outlays from discretionary balances
55
80
13
4020
Outlays, gross (total)
105
148
58
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–20
–20
–15
4040
Offsets against gross budget authority and outlays (total)
–20
–20
–15
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–10
4052
Offsetting collections credited to expired accounts
13
4060
Additional offsets against budget authority only (total)
3
4070
Budget authority, net (discretionary)
60
60
38
4080
Outlays, net (discretionary)
85
128
43
4180
Budget authority, net (total)
60
60
38
4190
Outlays, net (total)
85
128
43
This program supports coordination, leadership, and development of Federal health information technology activities and Federal
initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation
with participants in the health sector. The Office of the National Coordinator for Health Information Technology was established
in the Health Information Technology for Economic and Clinical Health Act (P.L. 111–5, Title XIII), for the purpose of addressing
strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private
adoption of health information technology.
Object Classification (in millions of dollars)
Identification code 075–0130–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
17
19
17
11.3
Other than full-time permanent
2
3
2
11.5
Other personnel compensation
1
1
1
11.9
Total personnel compensation
20
23
20
12.1
Civilian personnel benefits
6
7
5
23.1
Rental payments to GSA
3
3
2
23.3
Communications, utilities, and miscellaneous charges
1
1
1
25.1
Advisory and assistance services
1
1
25.2
Other services from non-Federal sources
15
12
4
25.3
Other goods and services from Federal sources
12
11
5
25.4
Operation and maintenance of facilities
1
1
1
41.0
Grants, subsidies, and contributions
7
1
99.0
Direct obligations
66
60
38
99.0
Reimbursable obligations
17
20
15
99.9
Total new obligations, unexpired accounts
83
80
53
Employment Summary
Identification code 075–0130–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
174
188
162
1101
Direct military average strength employment
2
2
2
Office of medicare hearings and appeals
For expenses necessary for the Office of Medicare Hearings and Appeals, $117,177,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0139–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Office of Medicare Hearings and Appeals (Direct)
106
107
117
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700
Collected
71
107
117
1701
Change in uncollected payments, Federal sources
36
1750
Spending auth from offsetting collections, disc (total)
107
107
117
1930
Total budgetary resources available
107
107
117
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–1
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
19
29
1
3010
New obligations, unexpired accounts
106
107
117
3020
Outlays (gross)
–94
–135
–117
3041
Recoveries of prior year unpaid obligations, expired
–2
3050
Unpaid obligations, end of year
29
1
1
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–26
–42
–42
3070
Change in uncollected pymts, Fed sources, unexpired
–36
3071
Change in uncollected pymts, Fed sources, expired
20
3090
Uncollected pymts, Fed sources, end of year
–42
–42
–42
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–7
–13
–41
3200
Obligated balance, end of year
–13
–41
–41
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
107
107
117
Outlays, gross:
4010
Outlays from new discretionary authority
81
107
117
4011
Outlays from discretionary balances
13
28
4020
Outlays, gross (total)
94
135
117
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–91
–107
–117
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–36
4052
Offsetting collections credited to expired accounts
20
4060
Additional offsets against budget authority only (total)
–16
4080
Outlays, net (discretionary)
3
28
4180
Budget authority, net (total)
4190
Outlays, net (total)
3
28
This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003. OMHA provides an independent and impartial forum for the adjudication
of claims brought by or on behalf of Medicare beneficiaries related to their benefits and care.
Object Classification (in millions of dollars)
Identification code 075–0139–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
49
60
64
12.1
Civilian personnel benefits
17
21
21
22.0
Transportation of things
1
1
23.1
Rental payments to GSA
8
8
8
23.3
Communications, utilities, and miscellaneous charges
4
4
5
25.2
Other services from non-Federal sources
9
2
6
25.3
Other goods and services from Federal sources
9
8
8
25.4
Operation and maintenance of facilities
7
1
1
25.7
Operation and maintenance of equipment
1
1
1
26.0
Supplies and materials
1
1
31.0
Equipment
1
1
1
99.9
Total new obligations, unexpired accounts
106
107
117
Employment Summary
Identification code 075–0139–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
557
671
725
Office of Medicare Hearings and Appeals
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0139–4–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
Reimbursable program activity
125
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
125
1930
Total budgetary resources available
125
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
125
3020
Outlays (gross)
–125
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
125
Outlays, gross:
4100
Outlays from new mandatory authority
125
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–125
4180
Budget authority, net (total)
4190
Outlays, net (total)
This legislative proposal provides the Office of Medicare Hearings and Appeals (OMHA) mandatory resources to address the Medicare
appeals backlog.
Object Classification (in millions of dollars)
Identification code 075–0139–4–1–551
2016 actual
2017 est.
2018 est.
Reimbursable obligations:
11.1
Personnel compensation: Full-time permanent
23
12.1
Civilian personnel benefits
8
22.0
Transportation of things
1
23.1
Rental payments to GSA
4
23.3
Communications, utilities, and miscellaneous charges
9
25.2
Other services from non-Federal sources
20
25.3
Other goods and services from Federal sources
9
25.4
Operation and maintenance of facilities
38
25.7
Operation and maintenance of equipment
5
26.0
Supplies and materials
2
31.0
Equipment
6
99.9
Total new obligations, unexpired accounts
125
Employment Summary
Identification code 075–0139–4–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
255
Public health and social services emergency fund
For expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical,
and cybersecurity threats to civilian populations, and for other public health emergencies, $945,753,000, of which $511,700,000 shall remain available until expended for expenses necessary to support advanced research and development pursuant to section 319L of the PHS Act and other administrative
expenses of the Biomedical Advanced Research and Development Authority: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures shall be in addition to
any other funds available for such purpose: Provided further, That products purchased with funds provided under this heading may, at the discretion of the Secretary, be deposited in
the Strategic National Stockpile pursuant to section 319F-2 of the PHS Act: Provided further, That $5,000,000 of the amounts made available to support emergency operations shall remain available through September 30,
2020: Provided further, That in making awards under section 319C-2 of the PHS Act from funds made available in this paragraph,
the Secretary may determine the amounts of such awards without regard to subsection (j)(3)(B) of such section: Provided further,
That up to 10 percent of the amounts made available in this paragraph to support advanced research and development pursuant
to section 319L of the PHS Act may also be used to supplement funds made available in the second paragraph for the purposes
provided therein.
For expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act), $510,000,000,
to remain available until expended: Provided, That up to 10 percent of the amounts made available in this paragraph may also be used to supplement funds made
available in the first paragraph to support advanced research and development pursuant to section 319L of the PHS Act.
For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic, $206,863,000; of which $174,924,000 shall be available until expended, for activities including the development and purchase of vaccines, antivirals, necessary medical supplies, diagnostics, and other surveillance tools: Provided, That funds may be used for the construction or renovation of privately owned facilities for the production of pandemic influenza
vaccines and other biologics, if the Secretary finds such construction or renovation necessary to secure sufficient supplies
of such vaccines or biologics.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0140–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Public Health and Social Services Emergency Fund
1,777
2,003
1,653
0100
Direct program activities, subtotal
1,777
2,003
1,653
0801
Reimbursable program (FEMA)
18
80
80
0802
Reimbursable program activity (OPP)
2
2
0899
Total reimbursable obligations
20
82
80
0900
Total new obligations, unexpired accounts
1,797
2,085
1,733
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
825
945
469
1010
Unobligated balance transfer to other accts [075–0343]
–2
–3
–3
1010
Unobligated balance transfer to other accts [075–0943]
–15
1010
Unobligated balance transfer to other accts [075–0943]
–10
1010
Unobligated balance transfer to other accts [075–9915]
–4
1010
Unobligated balance transfer to other accts [075–9915]
–47
1011
Unobligated balance transfer from other acct [075–0943]
14
1021
Recoveries of prior year unpaid obligations
15
1050
Unobligated balance (total)
776
942
466
Budget authority:
Appropriations, discretionary:
1100
Appropriation
1,533
1,530
1,663
1100
Appropriation - Emergency Pursuant to 2011 BCA
387
1121
Appropriations transferred from other acct [075–1502]
19
1121
Appropriations transferred from other acct [075–0350]
7
1121
Appropriations transferred from other acct [075–0142]
2
1160
Appropriation, discretionary (total)
1,948
1,530
1,663
Spending authority from offsetting collections, discretionary:
1700
Collected
4
82
82
1701
Change in uncollected payments, Federal sources
17
1750
Spending auth from offsetting collections, disc (total)
21
82
82
1900
Budget authority (total)
1,969
1,612
1,745
1930
Total budgetary resources available
2,745
2,554
2,211
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–3
1941
Unexpired unobligated balance, end of year
945
469
478
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
4,052
4,269
3,480
3010
New obligations, unexpired accounts
1,797
2,085
1,733
3011
Obligations ("upward adjustments"), expired accounts
5
3020
Outlays (gross)
–1,537
–2,874
–1,818
3040
Recoveries of prior year unpaid obligations, unexpired
–15
3041
Recoveries of prior year unpaid obligations, expired
–33
3050
Unpaid obligations, end of year
4,269
3,480
3,395
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–83
–81
–81
3070
Change in uncollected pymts, Fed sources, unexpired
–17
3071
Change in uncollected pymts, Fed sources, expired
19
3090
Uncollected pymts, Fed sources, end of year
–81
–81
–81
Memorandum (non-add) entries:
3100
Obligated balance, start of year
3,969
4,188
3,399
3200
Obligated balance, end of year
4,188
3,399
3,314
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
1,969
1,612
1,745
Outlays, gross:
4010
Outlays from new discretionary authority
245
488
504
4011
Outlays from discretionary balances
1,292
2,386
1,314
4020
Outlays, gross (total)
1,537
2,874
1,818
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–12
–82
–82
4033
Non-Federal sources
–9
4040
Offsets against gross budget authority and outlays (total)
–21
–82
–82
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–17
4052
Offsetting collections credited to expired accounts
17
4070
Budget authority, net (discretionary)
1,948
1,530
1,663
4080
Outlays, net (discretionary)
1,516
2,792
1,736
4180
Budget authority, net (total)
1,948
1,530
1,663
4190
Outlays, net (total)
1,516
2,792
1,736
The Public Health and Social Services Emergency Fund (PHSSEF) provides resources to support a comprehensive program to prepare
for the health and medical consequences of bioterrorism or other public health emergencies. This account includes funding
for the Office of the Assistant Secretary for Preparedness and Response, as authorized by the Pandemic and All-Hazards Preparedness
Reauthorization Act. Funds will be used for hospital preparedness and other emergency preparedness activities including the
National Disaster Medical System. The PHSSEF also supports the HHS Cybersecurity, Security and Strategic Information programs,
and the Medical Reserve Corps.
The PHSSEF continues to support the advanced development and procurement of biodefense and pandemic influenza countermeasures.
Object Classification (in millions of dollars)
Identification code 075–0140–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
66
96
101
11.3
Other than full-time permanent
18
11.7
Military personnel
8
7
7
11.9
Total personnel compensation
92
103
108
12.1
Civilian personnel benefits
23
36
39
12.2
Military personnel benefits
4
3
3
21.0
Travel and transportation of persons
7
6
9
22.0
Transportation of things
1
1
1
23.1
Rental payments to GSA
15
19
20
23.3
Communications, utilities, and miscellaneous charges
5
1
1
25.1
Advisory and assistance services
585
468
515
25.2
Other services from non-Federal sources
144
94
32
25.3
Other goods and services from Federal sources
74
109
114
25.4
Operation and maintenance of facilities
3
4
4
25.5
Research and development contracts
77
806
452
25.7
Operation and maintenance of equipment
21
45
68
26.0
Supplies and materials
441
2
2
31.0
Equipment
2
1
1
41.0
Grants, subsidies, and contributions
283
305
284
99.0
Direct obligations
1,777
2,003
1,653
99.0
Reimbursable obligations
20
82
80
99.9
Total new obligations, unexpired accounts
1,797
2,085
1,733
Employment Summary
Identification code 075–0140–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
640
675
705
1101
Direct military average strength employment
74
75
75
Transfers from the Patient-Centered Outcomes Research Trust Fund
Program and Financing (in millions of dollars)
Identification code 075–0145–0–1–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
AHRQ
98
99
0002
Office of the Secretary
18
33
25
0003
NIRSQ
104
0900
Total new obligations, unexpired accounts
116
132
129
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
52
54
38
1021
Recoveries of prior year unpaid obligations
1
1050
Unobligated balance (total)
53
54
38
Budget authority:
Spending authority from offsetting collections, mandatory:
1800
Collected
117
116
133
1930
Total budgetary resources available
170
170
171
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
54
38
42
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
134
153
215
3010
New obligations, unexpired accounts
116
132
129
3020
Outlays (gross)
–96
–70
–87
3040
Recoveries of prior year unpaid obligations, unexpired
–1
3050
Unpaid obligations, end of year
153
215
257
Memorandum (non-add) entries:
3100
Obligated balance, start of year
134
153
215
3200
Obligated balance, end of year
153
215
257
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
117
116
133
Outlays, gross:
4100
Outlays from new mandatory authority
5
3
4
4101
Outlays from mandatory balances
91
67
83
4110
Outlays, gross (total)
96
70
87
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–117
–116
–133
4180
Budget authority, net (total)
4190
Outlays, net (total)
–21
–46
–46
Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and
Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings
from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research
and coordinate Federal health programs to build research and data capacity for comparative clinical effectiveness research.
Transferred funds were distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality through FY 2017
to carry out these activities. The FY 2018 Budget consolidates the Agency for Healthcare Research and Quality within the National
Institutes of Health as the National Institute for Research on Safety and Quality. This Institute is proposed to receive the
resources from the PCORTF that the Agency for Healthcare Research and Quality would have received under current law.
Object Classification (in millions of dollars)
Identification code 075–0145–0–1–552
2016 actual
2017 est.
2018 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
2
3
3
25.1
Advisory and assistance services
19
19
23
25.3
Other goods and services from Federal sources
18
32
25
41.0
Grants, subsidies, and contributions
77
78
78
99.9
Total new obligations, unexpired accounts
116
132
129
Employment Summary
Identification code 075–0145–0–1–552
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
4
4
4
Nonrecurring Expenses Fund
Program and Financing (in millions of dollars)
Identification code 075–0125–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Nonrecurring Expenses Fund Projects
594
694
228
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
871
830
444
1012
Unobligated balance transfers between expired and unexpired accounts
550
708
344
1021
Recoveries of prior year unpaid obligations
3
1050
Unobligated balance (total)
1,424
1,538
788
Budget authority:
Appropriations, discretionary:
1120
Appropriations transferred to other acct [075–1503]
–300
1131
Unobligated balance of appropriations permanently reduced
–100
–560
1160
Appropriation, discretionary (total):
–400
–560
1930
Total budgetary resources available
1,424
1,138
228
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
830
444
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
349
536
854
3010
New obligations, unexpired accounts
594
694
228
3020
Outlays (gross)
–404
–376
530
3040
Recoveries of prior year unpaid obligations, unexpired
–3
3050
Unpaid obligations, end of year
536
854
1,612
Memorandum (non-add) entries:
3100
Obligated balance, start of year
349
536
854
3200
Obligated balance, end of year
536
854
1,612
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
–400
–560
Outlays, gross:
4010
Outlays from new discretionary authority
–100
–560
4011
Outlays from discretionary balances
404
476
30
4020
Outlays, gross (total)
404
376
–530
4180
Budget authority, net (total)
–400
–560
4190
Outlays, net (total)
404
376
–530
The Nonrecurring Expenses Fund is a no-year account that receives transfers of expired unobligated balances from discretionary
accounts prior to cancellation. The Fund is used for capital acquisition, including facilities infrastructure and information
technology infrastructure.
Object Classification (in millions of dollars)
Identification code 075–0125–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
23.1
Rental payments to GSA
1
1
1
25.1
Advisory and assistance services
75
87
29
25.2
Other services from non-Federal sources
249
291
96
25.3
Other goods and services from Federal sources
155
181
59
25.4
Operation and maintenance of facilities
54
63
21
25.5
Research and development contracts
3
4
1
25.7
Operation and maintenance of equipment
27
32
10
31.0
Equipment
20
23
8
32.0
Land and structures
9
11
3
99.0
Direct obligations
593
693
228
99.5
Adjustment for rounding
1
1
99.9
Total new obligations, unexpired accounts
594
694
228
Employment Summary
Identification code 075–0125–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
4
4
Health Insurance Reform Implementation Fund
Program and Financing (in millions of dollars)
Identification code 075–0119–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Health Insurance Reform Implementation Fund (Direct)
4
0900
Total new obligations, unexpired accounts (object class 25.2)
4
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
5
5
5
1021
Recoveries of prior year unpaid obligations
4
1050
Unobligated balance (total)
9
5
5
1930
Total budgetary resources available
9
5
5
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
5
5
5
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
33
19
1
3010
New obligations, unexpired accounts
4
3020
Outlays (gross)
–14
–18
3040
Recoveries of prior year unpaid obligations, unexpired
–4
3050
Unpaid obligations, end of year
19
1
1
Memorandum (non-add) entries:
3100
Obligated balance, start of year
33
19
1
3200
Obligated balance, end of year
19
1
1
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101
Outlays from mandatory balances
14
18
4180
Budget authority, net (total)
4190
Outlays, net (total)
14
18
Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriated $1,000,000,000 to the
Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.
Prevention and Public Health Fund
Program and Financing (in millions of dollars)
Identification code 075–0116–0–1–551
2016 actual
2017 est.
2018 est.
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
1,000
1,000
900
1220
Appropriations transferred to other accts [075–0142]
–28
–28
1220
Appropriations transferred to other accts [075–0943]
–892
–891
–841
1220
Appropriations transferred to other accts [075–1362]
–12
–12
1230
Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
–68
–69
–59
4180
Budget authority, net (total)
4190
Outlays, net (total)
The Prevention and Public Health Fund supports prevention and public health activities. In FY 2018, $837 million is available
to support a range of public health efforts intended to prevent disease and reduce health care costs. The Secretary has authority
to transfer to accounts within HHS.
Pregnancy Assistance Fund
Program and Financing (in millions of dollars)
Identification code 075–0117–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Pregnancy Assistance Fund (Direct)
23
23
25
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
25
25
25
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–2
–2
1260
Appropriations, mandatory (total)
23
23
25
1930
Total budgetary resources available
23
23
25
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
29
27
24
3010
New obligations, unexpired accounts
23
23
25
3020
Outlays (gross)
–25
–26
–24
3050
Unpaid obligations, end of year
27
24
25
Memorandum (non-add) entries:
3100
Obligated balance, start of year
29
27
24
3200
Obligated balance, end of year
27
24
25
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
23
23
25
Outlays, gross:
4100
Outlays from new mandatory authority
2
1
1
4101
Outlays from mandatory balances
23
25
23
4110
Outlays, gross (total)
25
26
24
4180
Budget authority, net (total)
23
23
25
4190
Outlays, net (total)
25
26
24
For awarding competitive grants to States to assist pregnant and parenting teens and women.
Object Classification (in millions of dollars)
Identification code 075–0117–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
25.3
Other goods and services from Federal sources
1
1
1
41.0
Grants, subsidies, and contributions
22
22
24
99.9
Total new obligations, unexpired accounts
23
23
25
Employment Summary
Identification code 075–0117–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
2
2
2
Section 241 Evaluation Transactions Account
Program and Financing (in millions of dollars)
Identification code 075–3902–0–1–552
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
Section 241 Evaluation Transactions Account (Reimbursable)
473
473
425
0809
Reimbursable program activities, subtotal
473
473
425
0900
Total new obligations (object class 25.3)
473
473
425
Budgetary resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700
Collected
91
473
425
1701
Change in uncollected payments, Federal sources
382
1750
Spending auth from offsetting collections, disc (total)
473
473
425
1930
Total budgetary resources available
473
473
425
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
738
906
279
3010
New obligations, unexpired accounts
473
473
425
3011
Obligations ("upward adjustments"), expired accounts
4
3020
Outlays (gross)
–309
–1,100
–659
3050
Unpaid obligations, end of year
906
279
45
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–739
–923
–923
3070
Change in uncollected pymts, Fed sources, unexpired
–382
3071
Change in uncollected pymts, Fed sources, expired
198
3090
Uncollected pymts, Fed sources, end of year
–923
–923
–923
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–1
–17
–644
3200
Obligated balance, end of year
–17
–644
–878
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
473
473
425
Outlays, gross:
4010
Outlays from new discretionary authority
91
473
425
4011
Outlays from discretionary balances
218
627
234
4020
Outlays, gross (total)
309
1,100
659
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–293
–473
–425
4040
Offsets against gross budget authority and outlays (total)
–293
–473
–425
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–382
4052
Offsetting collections credited to expired accounts
202
4060
Additional offsets against budget authority only (total)
–180
4080
Outlays, net (discretionary)
16
627
234
4180
Budget authority, net (total)
4190
Outlays, net (total)
16
627
234
The Public Health Service Act (PHS) Evaluation Transactions account supports the execution of section 241 of the PHS Act.
Program Support Center
Federal 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, for payments
under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
personnel under chapter 55 of title 10, United States Code, such amounts as may be required during the current fiscal year.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0379–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Retirement payments
433
441
456
0002
Survivors' benefits
29
30
32
0003
Medical care
128
123
131
0900
Total new obligations, unexpired accounts
590
594
619
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
597
594
619
1930
Total budgetary resources available
597
594
619
Memorandum (non-add) entries:
1940
Unobligated balance expiring
–7
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
70
64
64
3010
New obligations, unexpired accounts
590
594
619
3011
Obligations ("upward adjustments"), expired accounts
11
3020
Outlays (gross)
–592
–594
–649
3041
Recoveries of prior year unpaid obligations, expired
–15
3050
Unpaid obligations, end of year
64
64
34
Memorandum (non-add) entries:
3100
Obligated balance, start of year
70
64
64
3200
Obligated balance, end of year
64
64
34
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
597
594
619
Outlays, gross:
4100
Outlays from new mandatory authority
541
564
588
4101
Outlays from mandatory balances
51
30
61
4110
Outlays, gross (total)
592
594
649
4180
Budget authority, net (total)
597
594
619
4190
Outlays, net (total)
592
594
649
The number of beneficiaries using the Commissioned Corps system is estimated as follows:
Retirement Pay, Survivor Benefits, and Medical Benefits
2016
2017
2018
Active Duty:
HHS
4945
4904
4889
DOJ, BOP
865
879
879
Homeland Security
454
505
644
EPA
56
58
50
All Other
274
262
271
Total Active Duty
6594
6608
6733
Retirees & Survivors:
Retirees
6130
6130
6200
Retiree family members and survivors
1097
1097
1105
Total Retirement Pay
7227
7227
7305
Total Beneficiaries (active duty, retirees, survivors)
13821
13962
14720
This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and
medical benefits for active duty PHS commissioned officers, retirees, and dependents of members and retirees of the PHS Commissioned
Corps.
Object Classification (in millions of dollars)
Identification code 075–0379–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
13.0
Benefits for former personnel
462
472
488
25.6
Medical care
128
122
131
99.9
Total new obligations, unexpired accounts
590
594
619
HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund
Program and Financing (in millions of dollars)
Identification code 075–0170–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Medicare eligible accruals
26
28
32
0900
Total new obligations (object class 12.2)
26
28
32
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1100
Appropriation
26
28
32
1930
Total budgetary resources available
26
28
32
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
26
28
32
3020
Outlays (gross)
–26
–28
–32
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
26
28
32
Outlays, gross:
4010
Outlays from new discretionary authority
26
28
32
4180
Budget authority, net (total)
26
28
32
4190
Outlays, net (total)
26
28
32
Summary of Budget Authority and Outlays (in millions of dollars)
2016 actual
2017 est.
2018 est.
Enacted/requested:
Budget Authority
26
28
32
Outlays
26
28
32
Legislative proposal, not subject to PAYGO:
Budget Authority
–1
Outlays
–1
Total:
Budget Authority
26
28
31
Outlays
26
28
31
The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible
Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary
appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).
HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund
(Legislative proposal, not subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–0170–2–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Medicare eligible accruals
–1
0900
Total new obligations (object class 12.2)
–1
Budgetary resources:
Budget authority:
Appropriations, discretionary:
1100
Appropriation
–1
1930
Total budgetary resources available
–1
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–1
3020
Outlays (gross)
1
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
–1
Outlays, gross:
4010
Outlays from new discretionary authority
–1
4180
Budget authority, net (total)
–1
4190
Outlays, net (total)
–1
Health Activities Funds
Program and Financing (in millions of dollars)
Identification code 075–9913–0–1–551
2016 actual
2017 est.
2018 est.
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
1
1
1
1930
Total budgetary resources available
1
1
1
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
1
1
1
4180
Budget authority, net (total)
4190
Outlays, net (total)
HHS Service and Supply Fund
Program and Financing (in millions of dollars)
Identification code 075–9941–0–4–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0801
Program Support Center
918
1,001
933
0802
OS activities
435
476
463
0900
Total new obligations, unexpired accounts
1,353
1,477
1,396
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
115
181
17
1021
Recoveries of prior year unpaid obligations
84
45
181
1050
Unobligated balance (total)
199
226
198
Budget authority:
Spending authority from offsetting collections, discretionary:
1700
Collected
1,303
1,268
1,251
1701
Change in uncollected payments, Federal sources
32
1750
Spending auth from offsetting collections, disc (total)
1,335
1,268
1,251
1930
Total budgetary resources available
1,534
1,494
1,449
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
181
17
53
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
791
909
209
3010
New obligations, unexpired accounts
1,353
1,477
1,396
3020
Outlays (gross)
–1,151
–2,132
–1,251
3040
Recoveries of prior year unpaid obligations, unexpired
–84
–45
–181
3050
Unpaid obligations, end of year
909
209
173
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–428
–460
–460
3070
Change in uncollected pymts, Fed sources, unexpired
–32
3090
Uncollected pymts, Fed sources, end of year
–460
–460
–460
Memorandum (non-add) entries:
3100
Obligated balance, start of year
363
449
–251
3200
Obligated balance, end of year
449
–251
–287
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
1,335
1,268
1,251
Outlays, gross:
4010
Outlays from new discretionary authority
648
1,268
1,251
4011
Outlays from discretionary balances
503
864
4020
Outlays, gross (total)
1,151
2,132
1,251
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–1,295
–1,268
–1,251
4033
Non-Federal sources
–8
4040
Offsets against gross budget authority and outlays (total)
–1,303
–1,268
–1,251
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–32
4080
Outlays, net (discretionary)
–152
864
4180
Budget authority, net (total)
4190
Outlays, net (total)
–152
864
The HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department
and other Federal agencies. The Program Support Center includes activities such as personnel and payroll support, information
technology, financial management operations, and administrative services, including acquisitions management, building and
property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational
Health Service. The Office of the Secretary activities include the Service and Supply Fund Manager's Office, departmental
contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization,
small business consolidation, grants tracking, the physical security component of the Department's implementation of Homeland
Security Presidential Directive 12, and commercial services management.
Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the
agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section
in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either
through an allocation account or by directly citing that agency's appropriation.
Object Classification (in millions of dollars)
Identification code 075–9941–0–4–551
2016 actual
2017 est.
2018 est.
Reimbursable obligations:
Personnel compensation:
11.1
Full-time permanent
92
100
102
11.3
Other than full-time permanent
4
4
4
11.5
Other personnel compensation
2
2
2
11.7
Military personnel
6
6
6
11.8
Special personal services payments
9
2
11.9
Total personnel compensation
113
114
114
12.1
Civilian personnel benefits
30
33
35
12.2
Military personnel benefits
3
3
3
21.0
Travel and transportation of persons
1
2
2
22.0
Transportation of things
2
4
4
23.1
Rental payments to GSA
23
22
22
23.3
Communications, utilities, and miscellaneous charges
9
9
8
24.0
Printing and reproduction
8
8
8
25.1
Advisory and assistance services
33
23
23
25.2
Other services from non-Federal sources
815
941
889
25.3
Other goods and services from Federal sources
167
171
141
25.4
Operation and maintenance of facilities
12
13
13
25.6
Medical care
23
24
24
25.7
Operation and maintenance of equipment
58
56
56
26.0
Supplies and materials
49
46
46
31.0
Equipment
7
8
8
99.9
Total new obligations, unexpired accounts
1,353
1,477
1,396
Employment Summary
Identification code 075–9941–0–4–551
2016 actual
2017 est.
2018 est.
2001
Reimbursable civilian full-time equivalent employment
924
974
987
2101
Reimbursable military average strength employment
62
62
62
3101
Allocation account military average strength employment
1,593
1,646
1,794
Trust Funds
Miscellaneous Trust Funds
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–9971–0–7–551
2016 actual
2017 est.
2018 est.
0100
Balance, start of year
10
Receipts:
Current law:
1130
Contributions, Indian Health Facilities
4
48
48
1130
Contributions, N.I.H., Unconditional Gift Fund
3
3
3
1130
Centers for Disease Control, Gifts and Donations
23
15
15
1130
Contributions, N.I.H., Conditional Gift Fund
51
27
27
1130
Contributions to the Indian Health Service Gift Fund
1
1
1140
Interest, Miscellaneous Trust Funds
1
1
1
1198
Rounding adjustment
2
1199
Total current law receipts
84
95
95
1999
Total receipts
84
95
95
2000
Total: Balances and receipts
84
95
105
Appropriations:
Current law:
2101
Miscellaneous Trust Funds
–84
–85
–84
2103
Miscellaneous Trust Funds
–3
–3
2132
Miscellaneous Trust Funds
3
2199
Total current law appropriations
–84
–85
–87
2999
Total appropriations
–84
–85
–87
5099
Balance, end of year
10
18
Program and Financing (in millions of dollars)
Identification code 075–9971–0–7–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0002
Gifts
110
110
110
0003
Contributions, Indian Health Facilities
9
9
9
0900
Total new obligations, unexpired accounts
119
119
119
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
164
198
233
1021
Recoveries of prior year unpaid obligations
8
8
8
1033
Recoveries of prior year paid obligations
61
61
61
1050
Unobligated balance (total)
233
267
302
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
84
85
84
1203
Appropriation (previously unavailable)
3
3
1232
Appropriations and/or unobligated balance of appropriations temporarily reduced
–3
1260
Appropriations, mandatory (total)
84
85
87
1930
Total budgetary resources available
317
352
389
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
198
233
270
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
93
63
31
3010
New obligations, unexpired accounts
119
119
119
3020
Outlays (gross)
–141
–143
–141
3040
Recoveries of prior year unpaid obligations, unexpired
–8
–8
–8
3050
Unpaid obligations, end of year
63
31
1
Memorandum (non-add) entries:
3100
Obligated balance, start of year
93
63
31
3200
Obligated balance, end of year
63
31
1
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
84
85
87
Outlays, gross:
4100
Outlays from new mandatory authority
6
8
8
4101
Outlays from mandatory balances
135
135
133
4110
Outlays, gross (total)
141
143
141
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–61
–61
–61
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
61
61
61
4160
Budget authority, net (mandatory)
84
85
87
4170
Outlays, net (mandatory)
80
82
80
4180
Budget authority, net (total)
84
85
87
4190
Outlays, net (total)
80
82
80
Memorandum (non-add) entries:
5000
Total investments, SOY: Federal securities: Par value
28
21
21
5001
Total investments, EOY: Federal securities: Par value
21
21
21
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 075–9971–0–7–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
4
4
4
11.8
Special personal services payments
6
6
6
11.9
Total personnel compensation
10
10
10
12.1
Civilian personnel benefits
1
1
1
21.0
Travel and transportation of persons
3
3
3
25.1
Advisory and assistance services
4
4
4
25.2
Other services from non-Federal sources
19
19
19
25.5
Research and development contracts
4
4
4
25.6
Medical care
5
5
5
26.0
Supplies and materials
4
4
4
31.0
Equipment
1
1
1
41.0
Grants, subsidies, and contributions
68
68
68
99.9
Total new obligations, unexpired accounts
119
119
119
Employment Summary
Identification code 075–9971–0–7–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
35
35
35
Office of the Inspector General
Federal Funds
Office of inspector general
For expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations,
in carrying out the provisions of the Inspector General Act of 1978, $68,085,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary and investigating
non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228.
Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
included for 2017 reflect the annualized level provided by the continuing resolution.
Program and Financing (in millions of dollars)
Identification code 075–0128–0–1–551
2016 actual
2017 est.
2018 est.
Obligations by program activity:
0001
Office of Inspector General (Direct)
76
76
68
0801
OIG HCFAC Trust Fund
194
210
230
0802
OIG Direct Reimbursable activity
14
21
21
0803
OIG HCFAC Discretionary allocation adjustment
72
67
74
0899
Total reimbursable obligations
280
298
325
0900
Total new obligations, unexpired accounts
356
374
393
Budgetary resources:
Unobligated balance:
1000
Unobligated balance brought forward, Oct 1
32
36
26
1001
Discretionary unobligated balance brought fwd, Oct 1
1
1
1021
Recoveries of prior year unpaid obligations
2
2
1050
Unobligated balance (total)
34
38
26
Budget authority:
Appropriations, discretionary:
1100
Appropriation
75
75
68
1121
Appropriations transferred from other acct [075–9911]
2
1
1160
Appropriation, discretionary (total)
77
76
68
Spending authority from offsetting collections, discretionary:
1700
Collected
68
74
80
1701
Change in uncollected payments, Federal sources
13
14
15
1750
Spending auth from offsetting collections, disc (total)
81
88
95
Spending authority from offsetting collections, mandatory:
1800
Collected
179
197
216
1801
Change in uncollected payments, Federal sources
21
1802
Offsetting collections (previously unavailable)
1
1
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–1
1850
Spending auth from offsetting collections, mand (total)
200
198
216
1900
Budget authority (total)
358
362
379
1930
Total budgetary resources available
392
400
405
Memorandum (non-add) entries:
1941
Unexpired unobligated balance, end of year
36
26
12
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
52
67
61
3010
New obligations, unexpired accounts
356
374
393
3011
Obligations ("upward adjustments"), expired accounts
1
3020
Outlays (gross)
–338
–378
–380
3040
Recoveries of prior year unpaid obligations, unexpired
–2
–2
3041
Recoveries of prior year unpaid obligations, expired
–2
3050
Unpaid obligations, end of year
67
61
74
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–106
–130
–144
3070
Change in uncollected pymts, Fed sources, unexpired
–34
–14
–15
3071
Change in uncollected pymts, Fed sources, expired
10
3090
Uncollected pymts, Fed sources, end of year
–130
–144
–159
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–54
–63
–83
3200
Obligated balance, end of year
–63
–83
–85
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
158
164
163
Outlays, gross:
4010
Outlays from new discretionary authority
134
149
148
4011
Outlays from discretionary balances
20
17
19
4020
Outlays, gross (total)
154
166
167
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030
Federal sources
–77
–74
–80
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–13
–14
–15
4052
Offsetting collections credited to expired accounts
9
4060
Additional offsets against budget authority only (total)
–4
–14
–15
4070
Budget authority, net (discretionary)
77
76
68
4080
Outlays, net (discretionary)
77
92
87
Mandatory:
4090
Budget authority, gross
200
198
216
Outlays, gross:
4100
Outlays from new mandatory authority
135
180
197
4101
Outlays from mandatory balances
49
32
16
4110
Outlays, gross (total)
184
212
213
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–167
–185
–204
4123
Non-Federal sources
–12
–12
–12
4130
Offsets against gross budget authority and outlays (total)
–179
–197
–216
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–21
4160
Budget authority, net (mandatory)
1
4170
Outlays, net (mandatory)
5
15
–3
4180
Budget authority, net (total)
77
77
68
4190
Outlays, net (total)
82
107
84
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
1
1
5092
Unexpired unavailable balance, EOY: Offsetting collections
1
The mission of the Office of Inspector General (OIG) is to protect the integrity of the U.S. Department of Health and Human
Services (HHS) programs and the health and welfare of the people they serve. As established by the Inspector General Act of
1978, OIG is an independent and objective organization that fights fraud, waste, and abuse and promotes efficiency, economy,
and effectiveness in HHS programs and operations. OIG works to ensure that Federal dollars are used appropriately and that
HHS programs well serve the people that use them. OIG fulfills its mission through a broad range of audits, evaluations, investigations,
and enforcement and compliance activities. In addition to discretionary appropriations, OIG receives funds through the Health
Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996.
Object Classification (in millions of dollars)
Identification code 075–0128–0–1–551
2016 actual
2017 est.
2018 est.
Direct obligations:
Personnel compensation:
11.1
Full-time permanent
38
39
37
11.3
Other than full-time permanent
1
1
1
11.9
Total personnel compensation
39
40
38
12.1
Civilian personnel benefits
15
15
14
21.0
Travel and transportation of persons
1
1
2
22.0
Transportation of things
1
1
1
23.1
Rental payments to GSA
5
5
5
23.3
Communications, utilities, and miscellaneous charges
1
1
1
25.2
Other services from non-Federal sources
3
3
1
25.3
Other goods and services from Federal sources
8
6
4
25.6
Medical care
1
1
31.0
Equipment
3
3
1
99.0
Direct obligations
76
76
68
99.0
Reimbursable obligations
280
298
325
99.9
Total new obligations, unexpired accounts
356
374
393
Employment Summary
Identification code 075–0128–0–1–551
2016 actual
2017 est.
2018 est.
1001
Direct civilian full-time equivalent employment
346
345
315
2001
Reimbursable civilian full-time equivalent employment
1,229
1,245
1,362
General and Administrative Provisions
GENERAL FUND RECEIPT ACCOUNTS
(in millions of dollars)
2016 actual
2017 est.
2018 est.
Offsetting receipts from the public:
075–143500
General Fund Proprietary Interest Receipts, not Otherwise Classified
148
90
90
075–267403
Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
3
127
075–275830
Downward Reestimates of Subsidies, Health Centers
1
075–310700
Federal Share of Child Support Collections
668
661
642
075–310700
Legislative proposal, subject to PAYGO
6
075–322000
All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
164
34
34
General Fund Offsetting receipts from the public
983
913
772
Intragovernmental payments:
075–388500
Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
67
General Fund Intragovernmental payments
67
GENERAL PROVISIONS
SEC. 201. Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses
when specifically approved by the Secretary.SEC. 202. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a discretionary grant or other extramural mechanism, at a rate in excess of Executive Level V, except that this section shall not apply to the Head Start program.SEC. 203. Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than 2.9 percent, of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly,
or by grants or contracts) and the implementation and effectiveness of programs funded in this title.'
(transfer of funds)
SEC. 204. Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but no such
appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
of any transfer.SEC. 205. In lieu of the timeframe specified in section 338E(c)(2) of the PHS Act, terminations described in such section may occur
up to 60 days after the execution of a contract awarded in fiscal year 2018 under section 338B of such Act.SEC. 206. None of the funds appropriated in this Act may be made available to any entity under title X of the PHS 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.SEC. 207. Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. 208. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare
Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including a Provider
Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or
provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
about all Medicare covered services.SEC. 209. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.SEC. 210. In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
environmental disease, and other health activities abroad during fiscal year 2018:
(1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
of 1980 and other applicable statutes administered by the Department of State.
(2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
chronic and environmental diseases, and other health activities abroad.
(3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
Service Act of 1980, to individuals serving in the Foreign Service.
'
(transfer of funds)
SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
of any transfer.'
(transfer of funds)
SEC. 212. Of the amounts made available in this Act for NIH, 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 PHS Act.SEC. 213. (a) Authority.—Notwithstanding any other provision of law, the Director of NIH ("Director") may use funds available under section 402(b)(7)
or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
in such section 402(b)(12).
(b) Peer review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
Act.
SEC. 214. Not to exceed $45,000,000 of funds appropriated by this Act to the institutes and centers of the National Institutes of Health
may be used for alteration, repair, or improvement of facilities, as necessary for the proper and efficient conduct of the
activities authorized herein, at not to exceed $3,500,000 per project.'
(transfer of funds)
SEC. 215. (a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more
than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section
319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), if—
(1) funds are available and obligated—
(A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
(B) for the estimated costs associated with a necessary termination of the contract; and
(2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
(b) A contract entered into under this section—
(1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
(2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
SEC. 216. None of the funds made available by this Act from the Federal Hospital Insurance Trust Fund or the Federal Supplemental Medical
Insurance Trust Fund, or transferred from other accounts funded by this Act to the "Centers for Medicare and Medicaid Services—Program
Management" account, may be used for payments under section 1342(b)(1) of Public Law 111–148 (relating to risk corridors).SEC. 217. Section 229 of division H of Public Law 114–113 shall continue in effect through January 1, 2019. '
SEC. 218. (a) In general.—Under the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
within the Department or of another agency under which— (1) the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
or cooperative agreement on behalf of the ordering agency or unit;
(2) the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or
unit; and
(3) the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
and for the service of executing or managing the grant or cooperative agreement.
(b) Conditions.—The conditions for making an agreement described in subsection (a) are that —
(1) amounts are available;
(2) the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and
(3) the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service.
(c) Payment.—Payment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
and the actual cost of the service provided.
(d) Limitations on funds.—A condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement.
(e) Obligation of appropriations.—An agreement made under this section obligates an appropriation of the ordering agency or unit.
The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
before the end of the period of availability of the appropriation, in —
(1) awarding the grant or cooperative agreement; or
(2) providing the agreed-on services.
(f) No effect on other laws.—This section does not affect other laws about reimbursable agreements.
SEC. 219. There is hereby established in the Treasury of the United States a fund to be known as the "Federal Emergency Response Fund"
(the Fund). Amounts in the Fund shall be available, in addition to any other amount appropriated for such purposes, to carry
out titles II, III, and XVII of the PHS Act with respect to domestic preparedness and global health; to prevent, prepare for,
or respond to a chemical, biological, radiological, or nuclear threat; to prevent, prepare for, or respond to an emerging
infectious disease; and to purchase or lease, and provide for the insurance of, passenger motor vehicles for official use
in foreign countries. Amounts in the Fund may only be used for a public health threat or emergency that the Secretary determines
has significant potential to occur and potential, on occurrence, to affect national security or the health and security of
United States citizens, domestically or internationally. The Secretary may transfer to the Fund in this fiscal year and hereafter
such amounts as are necessary from any discretionary amounts (pursuant to the Balanced Budget and Emergency Deficit Control
Act of 1985) appropriated in this and subsequent Acts, provided that no such appropriation is reduced by more than 1 percent.
Such transferred amounts shall remain available until expended. When implementing response activities, amounts in the Fund
may be transferred to other accounts of the Department of Health and Human Services for the purposes provided in this section.
The Committees on Appropriations of the House of Representatives and the Senate shall be notified promptly of the initiation
of response activities under this authority and of any transfer made under the authority provided in this section. The Committees
on Appropriations of the House of Representatives and the Senate shall receive a report not later than 45 days after the end
of each quarter in a fiscal year on the unobligated balances in the Response Fund and all actual obligations incurred for
that fiscal year, including obligations by program, project, or activity. The transfer authorities in this section are in
addition to any other transfer authority otherwise available to the Department of Health and Human Services. Products purchased
using amounts in the Fund may, at the discretion of the Secretary of Health and Human Services, be deposited in the Strategic
National Stockpile under section 319F-2 of the PHS Act. SEC. 220. Funds appropriated in this Act to accounts that received appropriations in the Department of Health and Human Services Appropriations
Act, 2016, for the administrative expenses of programs or activities that do not receive appropriations from this Act shall
be available for necessary expenses to carry out closure of such programs or activities. SEC. 221. Notwithstanding section 1864(e) of the Social Security Act (42 U.S.C. 1395aa(e)), the Secretary shall charge fees upon health
care facilities or entities in cases where such facilities or entities have been cited for deficiencies during initial certification,
recertification, or substantiated complaint surveys to cover all or a portion of the costs incurred for conducting substantiated
complaint surveys and revisit surveys on such health care facilities and entities. Such fees shall be available to supplement
funding for such surveys and shall be credited to the "Department of Health and Human Services, Centers for Medicare and Medicaid
Services, Program Management" account, to remain available until expended.