Appendix - Department of Health and Human Services

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; $5,083,474,000: Provided, That of the amount provided under this heading, $960,568,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to this account and remain available until expended; $196,668,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain available until expended; $501,396,000 shall be derived from human generic drug user fees authorized by 21 U.S.C. 379j-42, and shall be credited to this account and remain available until expended; $40,922,000 shall be derived from biosimilar biological product user fees authorized by 21 U.S.C. 379j-52, and shall be credited to this account and remain available until expended; $712,000,000 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 prescription drug user fees, medical device user fees, human generic drug user fees, and biosimilar biological product user fees that exceed the respective fiscal year 2019 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device, human generic drug, and biosimilar biological product assessments for fiscal year 2019, including any such fees collected prior to fiscal year 2019 but credited for fiscal year 2019, shall be subject to the fiscal year 2019 limitations: Provided further, That the Secretary may accept payment during fiscal year 2019 of user fees specified under this heading and authorized for fiscal year 2020, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2020 for which the Secretary accepts payment in fiscal year 2019 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.

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, $11,788,000, to remain available until expended.

Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended). The amounts included for 2018 reflect the annualized level provided by the continuing resolution.


Identification code 075–9911–0–1–554		2017 actual	2018 est.	2019 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


Identification code 075–9911–0–1–554		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Foods	1,026	1,022	1,020
0002	Human Drugs	489	488	461
0003	Devices and Radiological Health	330	327	323
0004	National Center for Toxicological Research	63	63	63
0005	FDA Other Activities (FDA Headquaters)	187	181	122
0006	FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)	115	114	136
0007	FDA GSA Rental Payments	170	169	168
0008	FDA Buildings and Facilities	9	12	12
0009	Cooperative Research and Development (CRADA)	1	2	2
0010	Animal Drugs and Feed	163	162	170
0011	Biologics	216	214	204
0012	Food and Drug Safety (no-year)	2
0014	Zika Activities	3
0015	CURES Activities		20	70
0016	Emerging Health Threats	2

0799	Total direct obligations	2,776	2,774	2,751
0801	FDA Reimbursable program (User fees)	2,312	2,345	2,460
0802	FDA Reimbursable program (Federal sources)	45

0899	Total reimbursable obligations	2,357	2,345	2,460

0900	Total new obligations, unexpired accounts	5,133	5,119	5,211

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,117	927	919
1001	Discretionary unobligated balance brought fwd, Oct 1	1,117	927
1021	Recoveries of prior year unpaid obligations	57

1050	Unobligated balance (total)	1,174	927	919
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,781	2,761	2,684
1120	Appropriations transferred to other accts [075–0128]	–2	–1
1120	Appropriations transferred to other acct [075–4613]			–5
1121	Appropriations transferred from other acct [075–5629]		20	70

1160	Appropriation, discretionary (total)	2,779	2,780	2,749
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	2	2	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,655	2,345	2,464
1700	Collected		35
1701	Change in uncollected payments, Federal sources	35	–35
1702	Offsetting collections (previously unavailable)	611
1723	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced		–16
1725	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–197

1750	Spending auth from offsetting collections, disc (total)	2,104	2,329	2,464
	Spending authority from offsetting collections, mandatory:
1800	Collected	1
1900	Budget authority (total)	4,886	5,111	5,215
1930	Total budgetary resources available	6,060	6,038	6,134
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	927	919	923

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,710	2,723	2,874
3010	New obligations, unexpired accounts	5,133	5,119	5,211
3011	Obligations ("upward adjustments"), expired accounts	40
3020	Outlays (gross)	–4,989	–4,968	–5,242
3040	Recoveries of prior year unpaid obligations, unexpired	–57
3041	Recoveries of prior year unpaid obligations, expired	–114

3050	Unpaid obligations, end of year	2,723	2,874	2,843
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–71	–65	–30
3070	Change in uncollected pymts, Fed sources, unexpired	–35	35
3071	Change in uncollected pymts, Fed sources, expired	41

3090	Uncollected pymts, Fed sources, end of year	–65	–30	–30
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,639	2,658	2,844
3200	Obligated balance, end of year	2,658	2,844	2,813

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,883	5,109	5,213
	Outlays, gross:
4010	Outlays from new discretionary authority	2,795	4,079	4,214
4011	Outlays from discretionary balances	2,192	885	1,024

4020	Outlays, gross (total)	4,987	4,964	5,238
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–31	–35
4033	Non-Federal sources:	–1,645	–2,345	–2,464

4040	Offsets against gross budget authority and outlays (total)	–1,676	–2,380	–2,464
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–35	35
4052	Offsetting collections credited to expired accounts	21

4060	Additional offsets against budget authority only (total)	–14	35

4070	Budget authority, net (discretionary)	3,193	2,764	2,749
4080	Outlays, net (discretionary)	3,311	2,584	2,774
	Mandatory:
4090	Budget authority, gross	3	2	2
	Outlays, gross:
4100	Outlays from new mandatory authority		2	2
4101	Outlays from mandatory balances	2	2	2

4110	Outlays, gross (total)	2	4	4
	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)	–5
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	4

4160	Budget authority, net (mandatory)	2	2	2
4170	Outlays, net (mandatory)	–3	4	4
4180	Budget authority, net (total)	3,195	2,766	2,751
4190	Outlays, net (total)	3,308	2,588	2,778

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	643	229	245
5092	Unexpired unavailable balance, EOY: Offsetting collections	229	245	245

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, safe, and 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 2019 Budget includes $5.3 billion in total resources for FDA. The Budget prioritizes resources across core public health activities to support food and medical product safety, including implementation of the 21st Century Cures Act and the FDA Reauthorization Act of 2017.


Identification code 075–9911–0–1–554		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	939	952	926
11.3	Other than full-time permanent	89	90	88
11.5	Other personnel compensation	46	47	46
11.7	Military personnel	63	64	66
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	1,138	1,154	1,127
12.1	Civilian personnel benefits	350	354	345
12.2	Military personnel benefits	32	32	33
21.0	Travel and transportation of persons	49	47	48
22.0	Transportation of things	3	3	3
23.1	Rental payments to GSA	170	169	168
23.2	Rental payments to others	3	3	3
23.3	Communications, utilities, and miscellaneous charges	22	22	22
24.0	Printing and reproduction	2	2	2
25.1	Advisory and assistance services	53	51	52
25.2	Other services from non-Federal sources	357	355	356
25.3	Other goods and services from Federal sources	142	137	139
25.4	Operation and maintenance of facilities	85	83	85
25.5	Research and development contracts	19	19	19
25.7	Operation and maintenance of equipment	100	97	99
26.0	Supplies and materials	51	49	50
31.0	Equipment	37	36	36
32.0	Land and structures	3	3	3
41.0	Grants, subsidies, and contributions	157	156	159
42.0	Insurance claims and indemnities	2	2	2

99.0	Direct obligations	2,775	2,774	2,751
99.0	Reimbursable obligations	2,358	2,345	2,460

99.9	Total new obligations, unexpired accounts	5,133	5,119	5,211


Identification code 075–9911–0–1–554		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	9,748	9,704	9,402
1101	Direct military average strength employment	690	690	690
2001	Reimbursable civilian full-time equivalent employment	6,167	6,777	6,739
2101	Reimbursable military average strength employment	437	437	428
3001	Allocation account civilian full-time equivalent employment	25	25	25
3101	Allocation account military average strength employment	1	1	1

Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for animal drug review, animal generic drug review activities, and over-the-counter monograph drug activities: Provided, That fees of $25,129,000, for animal drug reviews, shall be credited to this account and remain available until expended; $13,076,000 for animal generic drug reviews, shall be credited to this account and remain available until expended; $22,000,000 for over-the-counter monograph drug activities, 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, animal generic drug, and over-the-counter monograph drug user fees that exceed the respective fiscal year 2019 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from animal drug, animal generic drug, and over-the-counter monograph drug reviews for fiscal year 2019 received during fiscal year 2019, including any such fees assessed prior to fiscal year 2019 but credited for fiscal year 2019, shall be subject to the fiscal year 2019 limitations: Provided further, That the Secretary may accept payment during fiscal year 2019 of user fees specified in this paragraph and authorized for fiscal year 2020, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2020 for which the Secretary accepts payment in fiscal year 2019 shall not be included in amounts in this paragraph.


Identification code 075–9911–2–1–554		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Reimbursable program (Over-the-Counter Monograph User fees)			22
0803	Reimbursable program activity (ADUFA)			25
0804	Reimbursable program activity (AGDUFA)			13

0899	Total reimbursable obligations			60

0900	Total new obligations, unexpired accounts			60

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			60
1900	Budget authority (total)			60
1930	Total budgetary resources available			60

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			60
3020	Outlays (gross)			–60

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			60
	Outlays, gross:
4010	Outlays from new discretionary authority			60
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources:			–60

4040	Offsets against gross budget authority and outlays (total)			–60
4180	Budget authority, net (total)
4190	Outlays, net (total)

The FY 2019 Budget proposes to reauthorize the expiring fee programs and propose a new fee program. The budget includes a total of $25 million in animal drug fees and $13 million in animal generic drug fees. FDA also proposes reforms to the Over-the-Counter Monograph program and includes a total of $22 million in new over-the-counter drug fees. The proposed legislation authorizes the collection and spending of these fees subject to appropriations.


Identification code 075–9911–2–1–554		2017 actual	2018 est.	2019 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent			12
11.3	Other than full-time permanent			2
11.5	Other personnel compensation			1
11.7	Military personnel			1

11.9	Total personnel compensation			16
12.1	Civilian personnel benefits			5
23.1	Rental payments to GSA			3
25.1	Advisory and assistance services			1
25.2	Other services from non-Federal sources			19
25.3	Other goods and services from Federal sources			11
25.5	Research and development contracts			1
25.7	Operation and maintenance of equipment			1
41.0	Grants, subsidies, and contributions			3

99.0	Reimbursable obligations			60

99.9	Total new obligations, unexpired accounts			60


Identification code 075–9911–2–1–554		2017 actual	2018 est.	2019 est.

2001	Reimbursable civilian full-time equivalent employment			144
2101	Reimbursable military average strength employment			9


Identification code 075–4613–0–4–554		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1121	Appropriations transferred from other acct [075–9911]			5
1930	Total budgetary resources available			5
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year			5

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			5
4180	Budget authority, net (total)			5
4190	Outlays, net (total)


Identification code 075–0148–0–1–554		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Direct program activity	20	60	70

0900	Total new obligations, unexpired accounts (object class 94.0)	20	60	70

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	20	60	70
1930	Total budgetary resources available	20	60	70

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	20	60	70
3020	Outlays (gross)	–20	–60	–70

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	20	60	70
	Outlays, gross:
4100	Outlays from new mandatory authority	20	60	70
4180	Budget authority, net (total)	20	60	70
4190	Outlays, net (total)	20	60	70

This account, and a related special receipt account, were established to support the execution structure necessary to implement the 21st Century 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", $70,000,000, 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.


Identification code 075–5629–0–2–554		2017 actual	2018 est.	2019 est.

0100	Balance, start of year			40
	Receipts:
	Current law:
1140	General Fund Payment, FDA Innovation, CURES Act	20	60	70

2000	Total: Balances and receipts	20	60	110
	Appropriations:
	Current law:
2101	FDA Innovation, Cures Act	–20	–20	–70

5099	Balance, end of year		40	40


Identification code 075–5629–0–2–554		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	New Obligations for CURES Activities	12

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		8	8
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	20	20	70
1120	Appropriations transferred to other acct [075–9911]		–20	–70

1160	Appropriation, discretionary (total)	20
1930	Total budgetary resources available	20	8	8
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	8	8	8

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		8
3010	New obligations, unexpired accounts	12
3020	Outlays (gross)	–4	–8

3050	Unpaid obligations, end of year	8
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		8
3200	Obligated balance, end of year	8

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	20
	Outlays, gross:
4010	Outlays from new discretionary authority	4
4011	Outlays from discretionary balances		8

4020	Outlays, gross (total)	4	8
4180	Budget authority, net (total)	20
4190	Outlays, net (total)	4	8

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.


Identification code 075–5629–0–2–554		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3
12.1	Civilian personnel benefits	1
25.2	Other services from non-Federal sources	5
41.0	Grants, subsidies, and contributions	3

99.9	Total new obligations, unexpired accounts	12


Identification code 075–5629–0–2–554		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	26


Identification code 075–4309–0–3–554		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Revolving Fund for Certification and Other Services (Reimbursable)	10	10	10

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	4	4
	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	14	14
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	4	4	4

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3	4
3010	New obligations, unexpired accounts	10	10	10
3020	Outlays (gross)	–9	–14	–9

3050	Unpaid obligations, end of year	4		1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3	4
3200	Obligated balance, end of year	4		1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	9	10	10
	Outlays, gross:
4100	Outlays from new mandatory authority	4	10	9
4101	Outlays from mandatory balances	5	4

4110	Outlays, gross (total)	9	14	9
	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)		4

	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.


Identification code 075–4309–0–3–554		2017 actual	2018 est.	2019 est.

	Reimbursable obligations:
11.1	Personnel compensation: Full-time permanent	5	5	5
12.1	Civilian personnel benefits	1	1	1
23.1	Rental payments to GSA	1	1	1
25.3	Other goods and services from Federal sources	1	1	1
26.0	Supplies and materials	1	1	1
31.0	Equipment	1	1	1

99.9	Total new obligations, unexpired accounts	10	10	10


Identification code 075–4309–0–3–554		2017 actual	2018 est.	2019 est.

2001	Reimbursable civilian full-time equivalent employment	40	37	37

Federal Funds

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, $1,491,522,000: Provided, That no more than $1,000,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $99,893,000 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: Provided further, That the ninth provisos under the heading "Department of Health and Human Services—Health Resources and Services Administration—Health Resources and Services" in Public Laws 104–208 and 105–78 are amended by striking "$80,000,000" and inserting "$152,700,000" in each such ninth proviso and by adding at the end of each such ninth proviso the following new proviso: "Provided further, That such costs, including the cost of modifying such loans, shall be as defined in section 502 of the Congressional Budget Act of 1974:".

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, $87,798,000: 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.

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, $731,200,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $66,593,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and $10,276,000 shall be available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such Act.

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,260,170,000, of which $1,970,881,000 shall remain available to the Secretary of Health and Human Services (referred to in this title as the "Secretary") through September 30, 2021, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 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.

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, $100,518,000: Provided, That the Secretary may collect a fee of 0.1 percent of each purchase of 340B drugs from entities participating in the Drug Pricing Program pursuant to section 340B of the PHS Act to pay for the operating costs of such program: Provided further, That fees pursuant to the 340B Drug Pricing Program shall be collected by the Secretary based on sales data that shall be submitted by drug manufacturers and shall be credited to this account, to remain available until expended.

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, $74,911,000.

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.

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".


Identification code 075–0350–0–1–550		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0005	Primary Health Care (Health Centers, Free Clinics)	1,518	1,481	1,492
0010	Primary Health Care (Mandatory)	3,670	562	2
0015	Health Workforce	834	833	88
0020	Health Workforce (Mandatory)	354	96
0025	Maternal and Child Health	860	843	731
0030	Maternal and Child Health (Mandatory)	15
0035	Ryan White HIV/AIDS	2,339	2,369	2,260
0040	Health Care Systems	104	104	101
0045	Rural Health	156	155	75
0050	Family Planning	286	285	286
0055	HRSA Program Management	154	153	152

0300	Total direct programs	10,290	6,881	5,187

0799	Total direct obligations	10,290	6,881	5,187
0801	Health Resources and Services (Reimbursable)	73	53	60

0899	Total reimbursable obligations	73	53	60

0900	Total new obligations, unexpired accounts	10,363	6,934	5,247

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	482	310	223
1001	Discretionary unobligated balance brought fwd, Oct 1	211	158
1010	Unobligated balance transfer to other accts [075–1503]	–2
1010	Unobligated balance transfer to other accts [015–5606]		–5
1021	Recoveries of prior year unpaid obligations	84

1050	Unobligated balance (total)	564	305	223
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,213	6,156	5,185
1120	Appropriations transferred to other acct [075–1503]	–14

1160	Appropriation, discretionary (total)	6,199	6,156	5,185
	Appropriations, mandatory:
1200	Appropriation	3,975	645
1220	Appropriations transferred to other acct [015–5606]	–5
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–115

1260	Appropriations, mandatory (total)	3,855	645
	Spending authority from offsetting collections, discretionary:
1700	Collected	18	30	38
1701	Change in uncollected payments, Federal sources	10

1750	Spending auth from offsetting collections, disc (total)	28	30	38
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	31	20	20
1802	Offsetting collections (previously unavailable)	2	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)	31	21	21
1900	Budget authority (total)	10,113	6,852	5,244
1930	Total budgetary resources available	10,677	7,157	5,467
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–4
1941	Unexpired unobligated balance, end of year	310	223	220

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,702	7,626	5,702
3010	New obligations, unexpired accounts	10,363	6,934	5,247
3011	Obligations ("upward adjustments"), expired accounts	16
3020	Outlays (gross)	–10,236	–8,858	–6,457
3040	Recoveries of prior year unpaid obligations, unexpired	–84
3041	Recoveries of prior year unpaid obligations, expired	–135

3050	Unpaid obligations, end of year	7,626	5,702	4,492
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–22	–15	–15
3070	Change in uncollected pymts, Fed sources, unexpired	–10
3071	Change in uncollected pymts, Fed sources, expired	17

3090	Uncollected pymts, Fed sources, end of year	–15	–15	–15
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,680	7,611	5,687
3200	Obligated balance, end of year	7,611	5,687	4,477

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,227	6,186	5,223
	Outlays, gross:
4010	Outlays from new discretionary authority	1,973	1,960	1,608
4011	Outlays from discretionary balances	4,152	4,160	4,213

4020	Outlays, gross (total)	6,125	6,120	5,821
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–13	–11	–3
4033	Non-Federal sources	–17	–19	–19
4033	Non-Federal sources			–16

4040	Offsets against gross budget authority and outlays (total)	–30	–30	–38
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10
4052	Offsetting collections credited to expired accounts	12

4060	Additional offsets against budget authority only (total)	2

4070	Budget authority, net (discretionary)	6,199	6,156	5,185
4080	Outlays, net (discretionary)	6,095	6,090	5,783
	Mandatory:
4090	Budget authority, gross	3,886	666	21
	Outlays, gross:
4100	Outlays from new mandatory authority	1,691	313	21
4101	Outlays from mandatory balances	2,420	2,425	615

4110	Outlays, gross (total)	4,111	2,738	636
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–31	–20	–20
4180	Budget authority, net (total)	10,054	6,802	5,186
4190	Outlays, net (total)	10,175	8,808	6,399

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	2	2	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	2	1
5103	Unexpired unavailable balance, SOY: Fulfilled purpose	1	1
5104	Unexpired unavailable balance, EOY: Fulfilled purpose	1


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	10,054	6,802	5,186
	Outlays	10,175	8,808	6,399
Legislative proposal, subject to PAYGO:
	Budget Authority		3,330	3,970
	Outlays		1,457	3,508
Total:
	Budget Authority	10,054	10,132	9,156
	Outlays	10,175	10,265	9,907

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


Identification code 075–0350–0–1–550		2017 actual	2018 est.	2019 est.

	Guaranteed loan levels supportable by subsidy budget authority:
215001	Health centers: Facilities renovation loan guarantee levels		3	3

215999	Total loan guarantee levels		3	3
	Guaranteed loan subsidy (in percent):
232001	Health centers: Facilities renovation loan guarantee levels	2.65	2.69	2.71

232999	Weighted average subsidy rate	0.00	2.69	2.71
	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 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 2016–2017 data reported in the Annual Operating Report.


Program	Account Balance


HPSL	416,265,386
NSL	188,621,972
PCL	239,076,684
LDS	157,612,046

Total	1,001,576,088


Identification code 075–0350–0–1–550		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	195	161	145
11.3	Other than full-time permanent	8	7	6
11.5	Other personnel compensation	4	3	3
11.7	Military personnel	21	18	17

11.9	Total personnel compensation	228	189	171
12.1	Civilian personnel benefits	65	53	48
12.2	Military personnel benefits	11	10	9
21.0	Travel and transportation of persons	3	3	2
23.1	Rental payments to GSA	20	17	14
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	10	8	6
25.1	Advisory and assistance services	13	14	11
25.2	Other services from non-Federal sources	224	198	183
25.3	Other goods and services from Federal sources	287	178	145
25.4	Operation and maintenance of facilities	1	1	1
25.6	Medical care	3	3	3
25.7	Operation and maintenance of equipment	8	5	4
26.0	Supplies and materials	1	1	1
31.0	Equipment	9	9	8
41.0	Grants, subsidies, and contributions	9,286	6,103	4,492
42.0	Insurance claims and indemnities	120	88	88

99.0	Direct obligations	10,290	6,881	5,187
99.0	Reimbursable obligations	73	53	60

99.9	Total new obligations, unexpired accounts	10,363	6,934	5,247


Identification code 075–0350–0–1–550		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	1,826	1,485	1,336
1101	Direct military average strength employment	205	173	155
2001	Reimbursable civilian full-time equivalent employment	57	57	57
2101	Reimbursable military average strength employment	4	4	4


Identification code 075–0350–4–1–550		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0010	Primary Health Care (Mandatory)		3,050	3,595
0020	Health Workforce (Mandatory)		275	370
0030	Maternal and Child Health (Mandatory)		5	5

0300	Total direct programs		3,330	3,970

0900	Total new obligations, unexpired accounts		3,330	3,970

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		3,330	3,975
1220	Appropriations transferred to other acct [015–5606]			–5

1260	Appropriations, mandatory (total)		3,330	3,970
1900	Budget authority (total)		3,330	3,970
1930	Total budgetary resources available		3,330	3,970

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			1,873
3010	New obligations, unexpired accounts		3,330	3,970
3020	Outlays (gross)		–1,457	–3,508

3050	Unpaid obligations, end of year		1,873	2,335
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			1,873
3200	Obligated balance, end of year		1,873	2,335

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		3,330	3,970
	Outlays, gross:
4100	Outlays from new mandatory authority		1,457	1,747
4101	Outlays from mandatory balances			1,761

4110	Outlays, gross (total)		1,457	3,508
4180	Budget authority, net (total)		3,330	3,970
4190	Outlays, net (total)		1,457	3,508

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.


Identification code 075–0350–4–1–550		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent		38	45
11.3	Other than full-time permanent		1	1
11.5	Other personnel compensation		1	1
11.7	Military personnel		3	4

11.9	Total personnel compensation		43	51
12.1	Civilian personnel benefits		12	15
12.2	Military personnel benefits		2	2
23.1	Rental payments to GSA		2	4
23.3	Communications, utilities, and miscellaneous charges		2	2
25.2	Other services from non-Federal sources		28	28
25.3	Other goods and services from Federal sources		106	107
25.7	Operation and maintenance of equipment		3	3
41.0	Grants, subsidies, and contributions		3,132	3,758

99.9	Total new obligations, unexpired accounts		3,330	3,970


Identification code 075–0350–4–1–550		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment		341	419
1101	Direct military average strength employment		32	40


Identification code 075–0320–0–1–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	29	31	31
1033	Recoveries of prior year paid obligations	2

1050	Unobligated balance (total)	31	31	31
1930	Total budgetary resources available	31	31	31
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	31	31	31

	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.


Identification code 075–0343–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Claims	2	1	1
0103	Admin Expense		2	2

0900	Total new obligations, unexpired accounts	2	3	3

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	1
1011	Unobligated balance transfer from other acct [075–0140]	2	2	3

1050	Unobligated balance (total)	3	3	3
1930	Total budgetary resources available	3	3	3
	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	1	1	1
3010	New obligations, unexpired accounts	2	3	3
3020	Outlays (gross)	–2	–3	–3

3050	Unpaid obligations, end of year	1	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1	1	1
3200	Obligated balance, end of year	1	1	1

	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 Public Health Service (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).


Identification code 075–0343–0–1–551		2017 actual	2018 est.	2019 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		1	1

99.0	Direct obligations	2	3	3

99.9	Total new obligations, unexpired accounts	2	3	3


Identification code 075–0343–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	4	4	4
1101	Direct military average strength employment	2	2	2


Identification code 075–0321–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	408	13

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	37	13
1021	Recoveries of prior year unpaid obligations	12

1050	Unobligated balance (total)	49	13
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	400
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–28

1260	Appropriations, mandatory (total)	372
1930	Total budgetary resources available	421	13
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	13

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	739	719	360
3010	New obligations, unexpired accounts	408	13
3020	Outlays (gross)	–416	–372	–269
3040	Recoveries of prior year unpaid obligations, unexpired	–12

3050	Unpaid obligations, end of year	719	360	91
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	739	719	360
3200	Obligated balance, end of year	719	360	91

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	372
	Outlays, gross:
4100	Outlays from new mandatory authority	11
4101	Outlays from mandatory balances	405	372	269

4110	Outlays, gross (total)	416	372	269
4180	Budget authority, net (total)	372
4190	Outlays, net (total)	416	372	269


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	372
	Outlays	416	372	269
Legislative proposal, subject to PAYGO:
	Budget Authority		400	400
	Outlays		16	120
Total:
	Budget Authority	372	400	400
	Outlays	416	388	389

The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These activities are administered by HRSA.


Identification code 075–0321–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	5	5
11.7	Military personnel	1	1

11.9	Total personnel compensation	6	6
12.1	Civilian personnel benefits	2	2
25.1	Advisory and assistance services	25
41.0	Grants, subsidies, and contributions	375	5

99.9	Total new obligations, unexpired accounts	408	13


Identification code 075–0321–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	40	40
1101	Direct military average strength employment	3	3


Identification code 075–0321–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs		400	400

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		400	400
1930	Total budgetary resources available		400	400

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			384
3010	New obligations, unexpired accounts		400	400
3020	Outlays (gross)		–16	–120

3050	Unpaid obligations, end of year		384	664
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			384
3200	Obligated balance, end of year		384	664

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		400	400
	Outlays, gross:
4100	Outlays from new mandatory authority		16	16
4101	Outlays from mandatory balances			104

4110	Outlays, gross (total)		16	120
4180	Budget authority, net (total)		400	400
4190	Outlays, net (total)		16	120

The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These activities are administered by HRSA.


Identification code 075–0321–4–1–551		2017 actual	2018 est.	2019 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			2
25.1	Advisory and assistance services		25	25
41.0	Grants, subsidies, and contributions		375	367

99.9	Total new obligations, unexpired accounts		400	400


Identification code 075–0321–4–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment			40
1101	Direct military average strength employment			3


Identification code 075–4442–0–3–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
	Credit program obligations:
0742	Downward reestimates paid to receipt accounts	1

0900	Total new obligations, unexpired accounts	1

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	1	1
1930	Total budgetary resources available	2	1	1
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	1
3020	Outlays (gross)	–1

	Financing authority and disbursements, net:
	Mandatory:
	Financing disbursements:
4110	Outlays, gross (total)	1
4180	Budget authority, net (total)
4190	Outlays, net (total)	1


Identification code 075–4442–0–3–551		2017 actual	2018 est.	2019 est.

	Position with respect to appropriations act limitation on commitments:
2121	Limitation available from carry-forward	6	6	3
2143	Uncommitted limitation carried forward	–6	–3

2150	Total guaranteed loan commitments		3	3
2199	Guaranteed amount of guaranteed loan commitments		2	2

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	74	69	61
2231	Disbursements of new guaranteed loans		3	3
2251	Repayments and prepayments	–5	–10	–10
	Adjustments:
2263	Terminations for default that result in claim payments		–1	–1
2264	Other adjustments, net

2290	Outstanding, end of year	69	61	53

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	53	46	40

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.


Identification code 075–4442–0–3–551		2016 actual	2017 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	2	2

1999	Total assets	2	2
	LIABILITIES:
2204	Non-Federal liabilities: Liabilities for loan guarantees	2	2

4999	Total liabilities and net position	2	2


Identification code 075–9931–0–3–551		2017 actual	2018 est.	2019 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	6	5	5
1251	Repayments: Repayments and prepayments	–1

1290	Outstanding, end of year	5	5	5

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.


Identification code 075–9931–0–3–551		2016 actual	2017 actual

	ASSETS:
1601	Direct loans, gross	6	5

1999	Total assets	6	5
	LIABILITIES:
2201	Non-Federal liabilities: Accounts payable	6	5

4999	Total liabilities and net position	6	5

Trust Funds

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.


Identification code 075–8175–0–7–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	3,571	3,619	3,689
	Receipts:
	Current law:
1110	Deposits, Vaccine Injury Compensation Trust Fund	270	296	303
1140	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	84	106	114

1199	Total current law receipts	354	402	417

1999	Total receipts	354	402	417

2000	Total: Balances and receipts	3,925	4,021	4,106
	Appropriations:
	Current law:
2101	Vaccine Injury Compensation Program Trust Fund	–24	–24	–27
2101	Vaccine Injury Compensation Program Trust Fund	–282	–308	–308

2199	Total current law appropriations	–306	–332	–335

2999	Total appropriations	–306	–332	–335

5099	Balance, end of year	3,619	3,689	3,771


Identification code 075–8175–0–7–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	282	308	308
0103	Claims processing (Claims Court)	6	6	9
0104	Claims processing (HRSA)	8	8	9
0105	Claims processing (Dept. of Justice)	10	10	9

0191	Direct program activities, subtotal	24	24	27

0900	Total new obligations, unexpired accounts	306	332	335

	Budgetary resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	3
1033	Recoveries of prior year paid obligations	4
1035	Unobligated balance of appropriations withdrawn	–7
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	24	24	27
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	282	308	308
1900	Budget authority (total)	306	332	335
1930	Total budgetary resources available	306	332	335

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	13	9
3010	New obligations, unexpired accounts	306	332	335
3020	Outlays (gross)	–307	–341	–335
3040	Recoveries of prior year unpaid obligations, unexpired	–3

3050	Unpaid obligations, end of year	9
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	13	9
3200	Obligated balance, end of year	9

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	24	24	27
	Outlays, gross:
4010	Outlays from new discretionary authority	17	24	27
4011	Outlays from discretionary balances	8

4020	Outlays, gross (total)	25	24	27
	Mandatory:
4090	Budget authority, gross	282	308	308
	Outlays, gross:
4100	Outlays from new mandatory authority	282	308	308
4101	Outlays from mandatory balances		9

4110	Outlays, gross (total)	282	317	308
	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)	282	308	308
4170	Outlays, net (mandatory)	278	317	308
4180	Budget authority, net (total)	306	332	335
4190	Outlays, net (total)	303	341	335

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	3,605	3,595	3,689
5001	Total investments, EOY: Federal securities: Par value	3,595	3,689	3,798

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.


Identification code 075–8175–0–7–551		2017 actual	2018 est.	2019 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	299	325	328

99.9	Total new obligations, unexpired accounts	306	332	335


Identification code 075–8175–0–7–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	14	14	16
1101	Direct military average strength employment	6	6	6

Federal Funds

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, $3,850,529,000, 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, $932,492,000 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, $11,000,000 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 not less than $58,000,000 shall be for accreditation emergencies, including supplementing activities funded under the heading "Indian Health Facilities": 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 in 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.


Identification code 075–0390–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Clinical services	3,359	3,336	3,599
0002	Preventive health	160	159	86
0003	Urban health	48	47	45
0004	Indian health professions	49	49	43
0005	Tribal management	2	2
0006	Direct operations	70	70	72
0007	Self-governance	6	6	5
0009	Diabetes funds	147	150	150

0799	Total direct obligations	3,841	3,819	4,000
0801	Indian Health Services (Reimbursable)	1,557	1,193	1,193

0900	Total new obligations, unexpired accounts	5,398	5,012	5,193

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	829	1,007	1,199
1001	Discretionary unobligated balance brought fwd, Oct 1	829	1,007
1021	Recoveries of prior year unpaid obligations	192
1033	Recoveries of prior year paid obligations	2

1050	Unobligated balance (total)	1,023	1,007	1,199
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,694	3,681	3,850
	Appropriations, mandatory:
1200	Appropriation	151	75
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–3

1260	Appropriations, mandatory (total)	148	75
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,545	1,448	1,450
1701	Change in uncollected payments, Federal sources	3

1750	Spending auth from offsetting collections, disc (total)	1,548	1,448	1,450
1900	Budget authority (total)	5,390	5,204	5,300
1930	Total budgetary resources available	6,413	6,211	6,499
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8
1941	Unexpired unobligated balance, end of year	1,007	1,199	1,306

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	983	1,034	600
3010	New obligations, unexpired accounts	5,398	5,012	5,193
3011	Obligations ("upward adjustments"), expired accounts	42
3020	Outlays (gross)	–5,164	–5,446	–5,273
3040	Recoveries of prior year unpaid obligations, unexpired	–192
3041	Recoveries of prior year unpaid obligations, expired	–33

3050	Unpaid obligations, end of year	1,034	600	520
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–98	–100	–100
3070	Change in uncollected pymts, Fed sources, unexpired	–3
3071	Change in uncollected pymts, Fed sources, expired	1

3090	Uncollected pymts, Fed sources, end of year	–100	–100	–100
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	885	934	500
3200	Obligated balance, end of year	934	500	420

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5,242	5,129	5,300
	Outlays, gross:
4010	Outlays from new discretionary authority	4,177	4,466	4,607
4011	Outlays from discretionary balances	847	902	663

4020	Outlays, gross (total)	5,024	5,368	5,270
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–476	–276	–276
4033	Non-Federal sources	–1,075	–1,172	–1,174

4040	Offsets against gross budget authority and outlays (total)	–1,551	–1,448	–1,450
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–3
4052	Offsetting collections credited to expired accounts	4
4053	Recoveries of prior year paid obligations, unexpired accounts	2

4060	Additional offsets against budget authority only (total)	3

4070	Budget authority, net (discretionary)	3,694	3,681	3,850
4080	Outlays, net (discretionary)	3,473	3,920	3,820
	Mandatory:
4090	Budget authority, gross	148	75
	Outlays, gross:
4100	Outlays from new mandatory authority	47	72
4101	Outlays from mandatory balances	93	6	3

4110	Outlays, gross (total)	140	78	3
4180	Budget authority, net (total)	3,842	3,756	3,850
4190	Outlays, net (total)	3,613	3,998	3,823


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	3,842	3,756	3,850
	Outlays	3,613	3,998	3,823
Legislative proposal, subject to PAYGO:
	Budget Authority		75	150
	Outlays		72	147
Total:
	Budget Authority	3,842	3,831	4,000
	Outlays	3,613	4,070	3,970

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 2019.


Identification code 075–0390–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	397	397	415
11.3	Other than full-time permanent	18	18	19
11.5	Other personnel compensation	60	60	62
11.7	Military personnel	62	62	65

11.9	Total personnel compensation	537	537	561
12.1	Civilian personnel benefits	159	159	167
12.2	Military personnel benefits	27	27	28
13.0	Benefits for former personnel	10	10	10
21.0	Patient travel	43	43	44
22.0	Transportation of things	7	7	8
23.1	Rental payments to GSA	16	16	17
23.2	Rental payments to others	2	2	2
23.3	Communications, utilities, and miscellaneous charges	13	13	14
25.1	Advisory and assistance services	6	6	6
25.2	Other services from non-Federal sources	105	104	110
25.3	Other goods and services from Federal sources	76	76	84
25.4	Operation and maintenance of facilities	2	2	2
25.6	Medical care	380	377	382
25.7	Operation and maintenance of equipment	14	14	15
25.8	Subsistence and support of persons	3	3	3
26.0	Supplies and materials	92	91	100
31.0	Equipment	12	12	13
41.0	Grants, subsidies, and contributions	2,337	2,319	2,433
42.0	Insurance claims and indemnities		1	1

99.0	Direct obligations	3,841	3,819	4,000
99.0	Reimbursable obligations	1,557	1,193	1,193

99.9	Total new obligations, unexpired accounts	5,398	5,012	5,193


Identification code 075–0390–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	6,705	6,705	7,204
1101	Direct military average strength employment	932	932	964
2001	Reimbursable civilian full-time equivalent employment	5,684	6,584	5,710
2101	Reimbursable military average strength employment	790	790	764


Identification code 075–0390–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0009	Diabetes funds		75	150

0100	Direct program activities, subtotal		75	150

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		75	150
1900	Budget authority (total)		75	150
1930	Total budgetary resources available		75	150

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			3
3010	New obligations, unexpired accounts		75	150
3020	Outlays (gross)		–72	–147

3050	Unpaid obligations, end of year		3	6
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			3
3200	Obligated balance, end of year		3	6

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		75	150
	Outlays, gross:
4100	Outlays from new mandatory authority		72	144
4101	Outlays from mandatory balances			3

4110	Outlays, gross (total)		72	147
4180	Budget authority, net (total)		75	150
4190	Outlays, net (total)		72	147

This activity supports evidence-based diabetes treatment and prevention services across Indian Country.


Identification code 075–0390–4–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
21.0	Patient travel		1	2
22.0	Transportation of things			1
25.2	Other services from non-Federal sources		3	5
25.4	Operation and maintenance of facilities		2	3
25.6	Medical care		10	20
25.7	Operation and maintenance of equipment			1
26.0	Supplies and materials		3	5
31.0	Equipment			1
41.0	Grants, subsidies, and contributions		56	112

99.9	Total new obligations, unexpired accounts		75	150

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 2019, 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.


Identification code 075–0344–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Contract Support Costs	712	795	797

0900	Total new obligations (object class 25.3)	712	795	797

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	712	795	797
1930	Total budgetary resources available	712	795	797

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	39	48
3010	New obligations, unexpired accounts	712	795	797
3011	Obligations ("upward adjustments"), expired accounts	62
3020	Outlays (gross)	–716	–843	–797
3041	Recoveries of prior year unpaid obligations, expired	–49

3050	Unpaid obligations, end of year	48
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	39	48
3200	Obligated balance, end of year	48

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	712	795	797
	Outlays, gross:
4010	Outlays from new discretionary authority	688	795	797
4011	Outlays from discretionary balances	28	48

4020	Outlays, gross (total)	716	843	797
4180	Budget authority, net (total)	712	795	797
4190	Outlays, net (total)	716	843	797

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 $797 million in contract support costs funds will be provided to tribal governments and tribal organizations in 2019.

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, $426,267,000, 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.


Identification code 075–0391–0–1–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Rent and Charges for Quarters, Indian Health Service	8	9	9

2000	Total: Balances and receipts	8	9	9
	Appropriations:
	Current law:
2101	Indian Health Facilities	–8	–9	–9

5099	Balance, end of year


Identification code 075–0391–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Maintenance	220	218	140
0002	Maintenance	78	75	60
0003	Facilities and environmental health	227	225	207
0004	Equipment	23	23	20

0100	Total direct program	548	541	427

0799	Total direct obligations	548	541	427
0801	Indian Health Facilities (Reimbursable)	25	9	9

0900	Total new obligations, unexpired accounts	573	550	436

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	285	309	366
1001	Discretionary unobligated balance brought fwd, Oct 1	285	309
1021	Recoveries of prior year unpaid obligations	11

1050	Unobligated balance (total)	296	309	366
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	545	541	427
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	8	9	9
	Spending authority from offsetting collections, discretionary:
1700	Collected	32	57	57
1701	Change in uncollected payments, Federal sources	1

1750	Spending auth from offsetting collections, disc (total)	33	57	57
1900	Budget authority (total)	586	607	493
1930	Total budgetary resources available	882	916	859
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	309	366	423

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	491	575	532
3010	New obligations, unexpired accounts	573	550	436
3020	Outlays (gross)	–478	–593	–570
3040	Recoveries of prior year unpaid obligations, unexpired	–11

3050	Unpaid obligations, end of year	575	532	398
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–8	–9	–9
3070	Change in uncollected pymts, Fed sources, unexpired	–1

3090	Uncollected pymts, Fed sources, end of year	–9	–9	–9
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	483	566	523
3200	Obligated balance, end of year	566	523	389

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	578	598	484
	Outlays, gross:
4010	Outlays from new discretionary authority	267	219	185
4011	Outlays from discretionary balances	202	365	376

4020	Outlays, gross (total)	469	584	561
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–32	–57	–57

4040	Offsets against gross budget authority and outlays (total)	–32	–57	–57
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–1

4070	Budget authority, net (discretionary)	545	541	427
4080	Outlays, net (discretionary)	437	527	504
	Mandatory:
4090	Budget authority, gross	8	9	9
	Outlays, gross:
4100	Outlays from new mandatory authority	3	9	9
4101	Outlays from mandatory balances	6

4110	Outlays, gross (total)	9	9	9
4180	Budget authority, net (total)	553	550	436
4190	Outlays, net (total)	446	536	513

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. More than 169 million, primarily through self-determination contracts and compacts, will be administered by tribal governments in 2019.


Identification code 075–0391–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	51	51	57
11.3	Other than full-time permanent	2	2	3
11.5	Other personnel compensation	3	3	3
11.7	Military personnel	22	22	20

11.9	Total personnel compensation	78	78	83
12.1	Civilian personnel benefits	18	18	20
12.2	Military personnel benefits	8	8	9
21.0	Travel and transportation of persons	3	3	2
22.0	Transportation of things	3	3	3
23.1	Rental payments to GSA	1	1	1
23.3	Communications, utilities, and miscellaneous charges	14	15	12
25.1	Advisory and assistance services	3	3	2
25.2	Other services from non-Federal sources	109	108	71
25.3	Other goods and services from Federal sources	2	3	2
25.4	Operation and maintenance of facilities	8	8	6
25.7	Operation and maintenance of equipment	4	4	3
25.8	Subsistence and support of persons	8	8	5
26.0	Supplies and materials	7	7	6
31.0	Equipment	13	13	10
32.0	Land and structures	80	79	55
41.0	Grants, subsidies, and contributions	189	182	137

99.0	Direct obligations	548	541	427
99.0	Reimbursable obligations	25	9	9

99.9	Total new obligations, unexpired accounts	573	550	436


Identification code 075–0391–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	968	968	976
1101	Direct military average strength employment	147	147	141
2001	Reimbursable civilian full-time equivalent employment	37	37	37

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.

Federal Funds

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, $437,828,000.

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, $1,067,278,000.

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, $371,328,000: 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.

For carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health promotion, $439,250,000: 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.

For carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, $110,000,000.

For carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics, and workforce development, $332,180,000: Provided, That in addition to amounts provided herein, $135,820,000 shall be available from amounts available under section 241 of the PHS Act to carry out the Public Health Scientific Services.

For carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, $157,000,000.

For carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $266,309,000.

For carrying out titles II, III, and XVII of the PHS Act with respect to global health, $408,762,000, of which $69,547,000 for international HIV/AIDS shall remain available through September 30, 2020 and $58,762,000 for global public health protection shall remain available through September 30, 2020: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.

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, $691,000,000: 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.

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, 2020: 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.


Identification code 075–0943–0–1–999		2017 actual	2018 est.	2019 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


Identification code 075–0943–0–1–999		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Birth Defects, Developmental Disabilities, Disability and Health (0958)	137	137	110
0002	CDC-Wide Activities and Program Support (0943)	323	257	105
0004	Chronic Disease Prevention and Health Promotion (0948)	1,109	1,078	839
0005	Emerging and Zoonotic Infectious Diseases (0949)	584	568	508
0006	Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)	51	55
0007	Environmental Health (0947)	189	178	157
0008	Global Health (0955)	438	432	409
0012	HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)	1,114	1,110	1,067
0013	Immunization and Respiratory Diseases (0951)	802	745	701
0015	Injury Prevention and Control (0952)	285	284	266
0016	Occupational Safety and Health (0953)	334	333
0019	Public Health Preparedness and Response (0956)	1,393	1,395	691
0020	Public Health Scientific Services (0959)	488	494	332
0021	Cooperative Research and Development Agreements (CRADA) (5146)	1
0022	Ebola (Emergency pursuant to 2011 BCA)	352	157	72
0023	Zika (Emergency pursuant to 2011 BCA)	397

0799	Total direct obligations	7,997	7,223	5,257
0802	CDC-Wide Activities and Program Support (Reimbursable)	197	197	197

0809	Reimbursable program activities, subtotal	197	197	197

0900	Total new obligations, unexpired accounts	8,194	7,420	5,454

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,157	471	522
1001	Discretionary unobligated balance brought fwd, Oct 1	1,040	471
1010	Unobligated balance transfer to other accts [075–0960]	–4
1010	Unobligated balance transfer to other accts [075–9915]	–3
1011	Unobligated balance transfer from other acct [075–0140]	23
1012	Unobligated balance transfers between expired and unexpired accounts	28
1021	Recoveries of prior year unpaid obligations	57
1033	Recoveries of prior year paid obligations	2

1050	Unobligated balance (total)	1,260	471	522
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,284	6,207	4,386
1120	Appropriations transferred to other acct [075–1503]	–14
1121	Appropriations transferred from other acct (CHIMPS) [075–0116]		805
1130	Appropriations permanently reduced		–5

1160	Appropriation, discretionary (total)	6,270	7,007	4,386
	Appropriations, mandatory:
1200	Appropriation (075–0954 - EEOICPA)	55	55
1201	Appropriation (075–5146 CRADA)	1	2	2
1221	Appropriations transferred from other acct PPHF [075–0116]	891		800
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–5	–5

1260	Appropriations, mandatory (total)	942	52	802
	Spending authority from offsetting collections, discretionary:
1700	Collected	177	408	408
1701	Change in uncollected payments, Federal sources	16

1750	Spending auth from offsetting collections, disc (total)	193	408	408
	Spending authority from offsetting collections, mandatory:
1800	Collected	5	4	4
1900	Budget authority (total)	7,410	7,471	5,600
1930	Total budgetary resources available	8,670	7,942	6,122
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–5
1941	Unexpired unobligated balance, end of year	471	522	668

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,951	7,137	6,486
3010	New obligations, unexpired accounts	8,194	7,420	5,454
3011	Obligations ("upward adjustments"), expired accounts	61
3020	Outlays (gross)	–7,826	–8,071	–7,317
3040	Recoveries of prior year unpaid obligations, unexpired	–57
3041	Recoveries of prior year unpaid obligations, expired	–186

3050	Unpaid obligations, end of year	7,137	6,486	4,623
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–233	–190	–190
3070	Change in uncollected pymts, Fed sources, unexpired	–16
3071	Change in uncollected pymts, Fed sources, expired	59

3090	Uncollected pymts, Fed sources, end of year	–190	–190	–190
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,718	6,947	6,296
3200	Obligated balance, end of year	6,947	6,296	4,433

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,463	7,415	4,794
	Outlays, gross:
4010	Outlays from new discretionary authority	2,502	3,045	2,119
4011	Outlays from discretionary balances	4,288	4,166	4,800

4020	Outlays, gross (total)	6,790	7,211	6,919
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–222	–408	–408
4033	Non-Federal sources	–10

4040	Offsets against gross budget authority and outlays (total)	–232	–408	–408
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–16
4052	Offsetting collections credited to expired accounts	55

4060	Additional offsets against budget authority only (total)	39

4070	Budget authority, net (discretionary)	6,270	7,007	4,386
4080	Outlays, net (discretionary)	6,558	6,803	6,511
	Mandatory:
4090	Budget authority, gross	947	56	806
	Outlays, gross:
4100	Outlays from new mandatory authority	212	42	165
4101	Outlays from mandatory balances	824	818	233

4110	Outlays, gross (total)	1,036	860	398
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–7	–4	–4
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	2

4160	Budget authority, net (mandatory)	942	52	802
4170	Outlays, net (mandatory)	1,029	856	394
4180	Budget authority, net (total)	7,212	7,059	5,188
4190	Outlays, net (total)	7,587	7,659	6,905

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, 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 2019 Budget maintains the proposal to establish a new block grant, proposed at $400 million, to increase flexibility for States to address their population's unique public health needs.


Identification code 075–0943–0–1–999		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	759	801	803
11.3	Other than full-time permanent	117	101	102
11.5	Other personnel compensation	40	37	37
11.7	Military personnel	81	75	76
11.8	Special personal services payments	8	8	8

11.9	Total personnel compensation	1,005	1,022	1,026
12.1	Civilian personnel benefits	301	307	309
12.2	Military personnel benefits	55	50	50
21.0	Travel and transportation of persons	60	42	32
22.0	Transportation of things	16	14	11
23.1	Rental payments to GSA	8	27	21
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	22	34	28
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	876	865	334
25.2	Other services from non-Federal sources	177	224	74
25.3	Other goods and services from Federal sources	783	443	149
25.4	Operation and maintenance of facilities	17	21	10
25.5	Research and development contracts	28	26	8
25.6	Medical care	44	38	12
25.7	Operation and maintenance of equipment	51	86	29
26.0	Supplies and materials	515	472	401
31.0	Equipment	62	64	52
32.0	Land and structures	1	7	5
41.0	Grants, subsidies, and contributions	3,971	3,476	2,701
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	7,997	7,223	5,257
99.0	Reimbursable obligations	197	197	197

99.9	Total new obligations, unexpired accounts	8,194	7,420	5,454


Identification code 075–0943–0–1–999		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	9,079	8,620	7,520
1101	Direct military average strength employment	858	788	694
2001	Reimbursable civilian full-time equivalent employment	218	218	218
2101	Reimbursable military average strength employment	37	37	37

For acquisition of real property, equipment, construction, demolition, and renovation of facilities, $20,000,000, to remain available until September 30, 2023.


Identification code 075–0960–0–1–551		2017 actual	2018 est.	2019 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	3	8	8
1011	Unobligated balance transfer from other acct [075–0943]	4

1050	Unobligated balance (total)	7	8	8
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	10	10	20
1930	Total budgetary resources available	17	18	28
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	8	8	8

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7	9	9
3010	New obligations, unexpired accounts	9	10	20
3020	Outlays (gross)	–7	–10	–14

3050	Unpaid obligations, end of year	9	9	15
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7	9	9
3200	Obligated balance, end of year	9	9	15

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	10	10	20
	Outlays, gross:
4010	Outlays from new discretionary authority	1	4	8
4011	Outlays from discretionary balances	6	6	6

4020	Outlays, gross (total)	7	10	14
4180	Budget authority, net (total)	10	10	20
4190	Outlays, net (total)	7	10	14


Identification code 075–0960–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.1	Advisory and assistance services	1	1	1
25.4	Operation and maintenance of facilities	8	9	19

99.9	Total new obligations, unexpired accounts	9	10	20


Identification code 075–4553–0–4–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	CDC Working Capital Fund (Reimbursable)	549	532	532

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	53	55	55
1021	Recoveries of prior year unpaid obligations	15

1050	Unobligated balance (total)	68	55	55
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	537	532	532
1701	Change in uncollected payments, Federal sources	–1

1750	Spending auth from offsetting collections, disc (total)	536	532	532
1930	Total budgetary resources available	604	587	587
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	55	55	55

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	217	195	193
3010	New obligations, unexpired accounts	549	532	532
3020	Outlays (gross)	–556	–534	–532
3040	Recoveries of prior year unpaid obligations, unexpired	–15

3050	Unpaid obligations, end of year	195	193	193
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2	–1	–1
3070	Change in uncollected pymts, Fed sources, unexpired	1

3090	Uncollected pymts, Fed sources, end of year	–1	–1	–1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	215	194	192
3200	Obligated balance, end of year	194	192	192

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	536	532	532
	Outlays, gross:
4010	Outlays from new discretionary authority	385	351	351
4011	Outlays from discretionary balances	171	183	181

4020	Outlays, gross (total)	556	534	532
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–537	–532	–532
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	1
4080	Outlays, net (discretionary)	19	2
4180	Budget authority, net (total)
4190	Outlays, net (total)	19	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.


Identification code 075–4553–0–4–551		2017 actual	2018 est.	2019 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	148	148	148
11.3	Other than full-time permanent	4	4	4
11.5	Other personnel compensation	4	4	4
11.7	Military personnel	3	3	3

11.9	Total personnel compensation	159	159	159
12.1	Civilian personnel benefits	50	50	50
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	1	1
22.0	Transportation of things	2	2	2
23.1	Rental payments to GSA	32	32	32
23.3	Communications, utilities, and miscellaneous charges	22	22	22
25.1	Advisory and assistance services	31	31	31
25.2	Other services from non-Federal sources	86	77	77
25.3	Other goods and services from Federal sources	76	68	68
25.4	Operation and maintenance of facilities	10	10	10
25.7	Operation and maintenance of equipment	57	57	57
26.0	Supplies and materials	1	1	1
31.0	Equipment	12	12	12
32.0	Land and structures	8	8	8

99.9	Total new obligations, unexpired accounts	549	532	532


Identification code 075–4553–0–4–551		2017 actual	2018 est.	2019 est.

2001	Reimbursable civilian full-time equivalent employment	1,276	1,276	1,276
2101	Reimbursable military average strength employment	22	22	22

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 2019, and existing profiles may be updated as necessary.


Identification code 075–0944–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Agency for Toxic Substances and Disease Registry, Toxic Substanc (Direct)	81	74	62

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	26	25	28
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	75	74	62
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	3	3
1701	Change in uncollected payments, Federal sources	2

1750	Spending auth from offsetting collections, disc (total)	5	3	3
1900	Budget authority (total)	80	77	65
1930	Total budgetary resources available	106	102	93
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	25	28	31

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	46	40	19
3010	New obligations, unexpired accounts	81	74	62
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–85	–95	–75
3041	Recoveries of prior year unpaid obligations, expired	–4

3050	Unpaid obligations, end of year	40	19	6
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–5	–4	–4
3070	Change in uncollected pymts, Fed sources, unexpired	–2
3071	Change in uncollected pymts, Fed sources, expired	3

3090	Uncollected pymts, Fed sources, end of year	–4	–4	–4
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	41	36	15
3200	Obligated balance, end of year	36	15	2

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	80	77	65
	Outlays, gross:
4010	Outlays from new discretionary authority	52	52	44
4011	Outlays from discretionary balances	30	43	31

4020	Outlays, gross (total)	82	95	75
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–6	–3	–3
4033	Non-Federal sources	–1

4040	Offsets against gross budget authority and outlays (total)	–7	–3	–3
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2
4052	Offsetting collections credited to expired accounts	4

4060	Additional offsets against budget authority only (total)	2

4070	Budget authority, net (discretionary)	75	74	62
4080	Outlays, net (discretionary)	75	92	72
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3
4180	Budget authority, net (total)	75	74	62
4190	Outlays, net (total)	78	92	72


Identification code 075–0944–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	22	22	22
11.3	Other than full-time permanent	2	2	2
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	3	3	3

11.9	Total personnel compensation	28	28	28
12.1	Civilian personnel benefits	8	8	8
12.2	Military personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
25.1	Advisory and assistance services	8	8	3
25.2	Other services from non-Federal sources	5	5	3
25.3	Other goods and services from Federal sources	9	9	4
25.7	Operation and maintenance of equipment	1	1	1
41.0	Grants, subsidies, and contributions	16	13	13

99.0	Direct obligations	77	74	62
99.0	Reimbursable obligations	4

99.9	Total new obligations, unexpired accounts	81	74	62


Identification code 075–0944–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	219	219	219
1101	Direct military average strength employment	36	36	36


Identification code 075–0946–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	World Trade Center Health Program—Federal Share (CDC/NIOSH)	351	420	469
0002	World Trade Center Health Program—NYC	39	42	52

0900	Total new obligations, unexpired accounts	390	462	521

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	799	870	913
1012	Unobligated balance transfers between expired and unexpired accounts	62	83	83
1021	Recoveries of prior year unpaid obligations	15

1050	Unobligated balance (total)	876	953	996
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (WTC (CDC Direct))	320	380	440
1200	Appropriation (WTC—NYC DHSS—CDC)	36	42	49

1260	Appropriations, mandatory (total)	356	422	489
	Spending authority from offsetting collections, mandatory:
1800	Collected	28
1900	Budget authority (total)	384	422	489
1930	Total budgetary resources available	1,260	1,375	1,485
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	870	913	964

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	168	184	301
3010	New obligations, unexpired accounts	390	462	521
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–342	–345	–415
3040	Recoveries of prior year unpaid obligations, unexpired	–15
3041	Recoveries of prior year unpaid obligations, expired	–19

3050	Unpaid obligations, end of year	184	301	407
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	168	184	301
3200	Obligated balance, end of year	184	301	407

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	384	422	489
	Outlays, gross:
4100	Outlays from new mandatory authority		194	225
4101	Outlays from mandatory balances	342	151	190

4110	Outlays, gross (total)	342	345	415
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–34
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	6

4160	Budget authority, net (mandatory)	356	422	489
4170	Outlays, net (mandatory)	308	345	415
4180	Budget authority, net (total)	356	422	489
4190	Outlays, net (total)	308	345	415

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 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 2018 and 2019 in the Budget reflect estimated Federal obligations for the WTC Health Program.


Identification code 075–0946–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	3	3	3
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	4	4	4
12.1	Civilian personnel benefits	1	1	1
12.2	Military personnel benefits	1	1	1
25.1	Advisory and assistance services	31	43	43
25.2	Other services from non-Federal sources	74	88	97
25.3	Other goods and services from Federal sources	10	12	12
41.0	Grants, subsidies, and contributions	20	24	24
42.0	Insurance claims and indemnities	249	289	339

99.9	Total new obligations, unexpired accounts	390	462	521


Identification code 075–0946–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	16	16	16
1101	Direct military average strength employment	7	7	7

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, $3,756,093,000, 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.

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, $2,237,268,000.

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $297,050,000.

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,305,132,000.

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,294,472,000.

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $3,423,408,000.

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $1,849,515,000, of which $741,000,000 shall be from funds available under section 241 of the PHS Act.

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $963,045,000.

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $511,155,000.

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $498,347,000.

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, $53,967,000.

For carrying out section 301 and title IV of the PHS Act with respect to aging, $1,429,335,000.

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $393,311,000.

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $304,812,000.

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, $104,847,000.

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $337,247,000

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $839,816,000.

For carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,117,682,000.

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, $368,785,000.

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $249,138,000.

For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $93,974,000.

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, $201,686,000.

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), $50,384,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $284,324,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2020: Provided further, That in fiscal year 2019, 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").

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $492,515,000: Provided, That up to 10 percent of the amount available under this heading shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network.

For carrying out the responsibilities of the Office of the Director, NIH, $1,338,005,000: 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 $431,924,000 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 $8,000,000 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.

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, $200,000,000, to remain available through September 30, 2023.

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, $255,960,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year 2019: 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.

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.

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.

For carrying out title II (and section 14 with respect to such title) of the Rehabilitation Act of 1973, $95,127,000.


Identification code 075–9915–0–1–552		2017 actual	2018 est.	2019 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, NIH	42	42	42

2000	Total: Balances and receipts	42	42	42
	Appropriations:
	Current law:
2101	National Institutes of Health	–42	–42	–42

5099	Balance, end of year


Identification code 075–9915–0–1–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	National Cancer Institute (0849)	5,637	5,353	3,756
0002	National Heart, Lung, and Blood Institute (0872)	3,210	3,185	2,237
0003	National Institute of Dental and Craniofacial Research (0873)	425	423	297
0004	National Institute of Diabetes and Digestive and Kidney Disease (0884)	1,870	1,858	1,305
0005	National Institute of Neurological Disorders and Stroke (0886)	1,779	1,772	1,294
0006	National Institute of Allergy and Infectious Diseases (0885)	5,102	4,873	3,423
0007	National Institute of General Medical Sciences (0851)	1,822	1,814	1,109
0008	National Institute of Child Health and Human Development (0844)	1,377	1,371	963
0009	National Eye Institute (0887)	731	728	511
0010	National Institute of Environmental Health Sciences (0862)	793	709	552
0011	National Institute on Aging (0843)	2,049	2,035	1,429
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)	557	554	393
0013	National Institute on Deafness and Other Communication Disorder (0890)	436	434	305
0014	National Institute of Mental Health (0892)	1,605	1,591	1,118
0015	National Institute on Drug Abuse (0893)	1,071	1,083	840
0016	National Institute on Alcohol Abuse and Alcoholism (0894)	482	480	337
0017	National Institute of Nursing Research (0889)	150	149	105
0018	National Human Genome Research Institute (0891)	528	525	369
0019	National Institute of Biomedical Imaging and Bioengineering (0898)	357	355	249
0021	National Center for Complementary and Integrative Health (0896)	134	134	94
0022	National Institute on Minority Health and Health Disparities (0897)	288	287	202
0023	John E. Fogarty International Center (0819)	72	72	50
0024	National Library of Medicine (0807)	406	405	284
0025	NIH Office of the Director (0846)	1,676	1,654	1,338
0026	NIH Buildings and facilities (0838)	113	128	200
0027	NIH Cooperative Research and Development Agreements	32	32	32
0028	National Center for Advancing Translational Sciences (0875)	704	701	493
0029	National Institute for Research on Safety and Quality			256
0031	Type 1 Diabetes	140	38	150
0032	National Institute of Occupational Safety and Health			200
0033	National Institute on Disability, Independent Living, and Rehabilitation			95
0035	EEOICPA			55

0799	Total direct obligations	33,546	32,743	24,041
0801	NIH Reimbursable - Other	3,880	4,299	3,451
0802	NIH Royalties	141	141	141

0809	Reimbursable program activities, subtotal	4,021	4,440	3,592

0899	Total reimbursable obligations	4,021	4,440	3,592

0900	Total new obligations, unexpired accounts	37,567	37,183	27,633

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,363	992	495
1001	Discretionary unobligated balance brought fwd, Oct 1	1,363	992
1011	Unobligated balance transfer from other acct [075–0140]	66
1011	Unobligated balance transfer from other acct [075–0943]	3
1011	Unobligated balance transfer from other acct [075–1700]			22
1020	Adjustment of unobligated bal brought forward, Oct 1	–8
1021	Recoveries of prior year unpaid obligations	78
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	1,503	992	517
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	32,973	32,748	23,805
1120	Appropriations transferred to other acct [075–1503]	–72
1121	Appropriations transferred from other acct [075–5628]	300	298	515
1121	Appropriations transferred from other acct [075–5736]	13	1	13

1160	Appropriation, discretionary (total)	33,214	33,047	24,333
	Appropriations, mandatory:
1200	Appropriation	150	38
1201	Appropriation (special or trust fund)	42	42	42
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–10

1260	Appropriations, mandatory (total)	182	80	42
	Spending authority from offsetting collections, discretionary:
1700	Collected	3,737	3,559	3,559
1701	Change in uncollected payments, Federal sources	–74

1750	Spending auth from offsetting collections, disc (total)	3,663	3,559	3,559
1900	Budget authority (total)	37,059	36,686	27,934
1930	Total budgetary resources available	38,562	37,678	28,451
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	992	495	818

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	32,960	34,684	33,988
3001	Adjustments to unpaid obligations, brought forward, Oct 1	20
3010	New obligations, unexpired accounts	37,567	37,183	27,633
3011	Obligations ("upward adjustments"), expired accounts	546
3020	Outlays (gross)	–35,316	–37,879	–36,029
3040	Recoveries of prior year unpaid obligations, unexpired	–78
3041	Recoveries of prior year unpaid obligations, expired	–1,015

3050	Unpaid obligations, end of year	34,684	33,988	25,592
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,207	–671	–671
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	8
3070	Change in uncollected pymts, Fed sources, unexpired	74
3071	Change in uncollected pymts, Fed sources, expired	454

3090	Uncollected pymts, Fed sources, end of year	–671	–671	–671
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	31,781	34,013	33,317
3200	Obligated balance, end of year	34,013	33,317	24,921

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	36,877	36,606	27,892
	Outlays, gross:
4010	Outlays from new discretionary authority	11,344	12,482	11,544
4011	Outlays from discretionary balances	23,809	25,237	24,389

4020	Outlays, gross (total)	35,153	37,719	35,933
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,950	–3,559	–3,559
4033	Non-Federal sources	–304

4040	Offsets against gross budget authority and outlays (total)	–4,254	–3,559	–3,559
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	74
4052	Offsetting collections credited to expired accounts	516
4053	Recoveries of prior year paid obligations, unexpired accounts	1

4060	Additional offsets against budget authority only (total)	591

4070	Budget authority, net (discretionary)	33,214	33,047	24,333
4080	Outlays, net (discretionary)	30,899	34,160	32,374
	Mandatory:
4090	Budget authority, gross	182	80	42
	Outlays, gross:
4100	Outlays from new mandatory authority	22	51	42
4101	Outlays from mandatory balances	141	109	54

4110	Outlays, gross (total)	163	160	96
4180	Budget authority, net (total)	33,396	33,127	24,375
4190	Outlays, net (total)	31,062	34,320	32,470


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	33,396	33,127	24,375
	Outlays	31,062	34,320	32,470
Legislative proposal, subject to PAYGO:
	Budget Authority		113	150
	Outlays		12	56
Total:
	Budget Authority	33,396	33,240	24,525
	Outlays	31,062	34,332	32,526

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 2019 Budget consolidates the activities of the Agency for Healthcare Research and Quality within the National Institutes of Health as the National Institute for Research on Safety and Quality. It also consolidates the National Institute for Occupational Safety and Health (currently administered by the Centers for Disease Control and Prevention) and the National Institute on Disability, Independent Living, and Rehabilitation Research (currently administered by the Administration for Community Living) within the National Institutes of Health. Detailed information is available through the Department of Health and Human Services.


Identification code 075–9915–0–1–552		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	976	1,007	1,181
11.3	Other than full-time permanent	520	529	535
11.5	Other personnel compensation	46	46	45
11.7	Military personnel	18	19	20
11.8	Special personal services payments	176	177	158

11.9	Total personnel compensation	1,736	1,778	1,939
12.1	Civilian personnel benefits	506	518	536
12.2	Military personnel benefits	12	12	13
21.0	Travel and transportation of persons	51	51	22
22.0	Transportation of things	5	5	2
23.1	Rental payments to GSA	23	24	8
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	31	31	19
24.0	Printing and reproduction	1	1
25.1	Advisory and assistance services	231	200	100
25.2	Other services from non-Federal sources	1,445	1,189	614
25.3	Other goods and services from Federal sources	3,177	3,186	2,669
25.4	Operation and maintenance of facilities	201	208	368
25.5	Research and development contracts	1,534	1,402	1,012
25.6	Medical care	26	25	11
25.7	Operation and maintenance of equipment	122	121	51
25.8	Subsistence and support of persons	2	2	1
26.0	Supplies and materials	231	219	67
31.0	Equipment	154	147	50
41.0	Grants, subsidies, and contributions	24,057	23,623	16,558

99.0	Direct obligations	33,546	32,743	24,041
99.0	Reimbursable obligations	4,021	4,440	3,592

99.9	Total new obligations, unexpired accounts	37,567	37,183	27,633


Identification code 075–9915–0–1–552		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	13,251	13,314	14,571
1101	Direct military average strength employment	167	168	260
2001	Reimbursable civilian full-time equivalent employment	4,506	4,529	4,531
2101	Reimbursable military average strength employment	90	90	90


Identification code 075–9915–4–1–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0031	Type 1 Diabetes		113	150

0799	Total direct obligations		113	150

0900	Total new obligations, unexpired accounts (object class 41.0)		113	150

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		113	150
1930	Total budgetary resources available		113	150

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			101
3010	New obligations, unexpired accounts		113	150
3020	Outlays (gross)		–12	–56

3050	Unpaid obligations, end of year		101	195
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			101
3200	Obligated balance, end of year		101	195

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		113	150
	Outlays, gross:
4100	Outlays from new mandatory authority		12	15
4101	Outlays from mandatory balances			41

4110	Outlays, gross (total)		12	56
4180	Budget authority, net (total)		113	150
4190	Outlays, net (total)		12	56

The Budget proposes to extend the Special Diabetes Program for Type 1 Diabetes through fiscal year 2019.


Identification code 075–0147–0–1–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Payment to NIH Innovation (object class 94.0)	352	496	711

0900	Total new obligations, unexpired accounts (object class 94.0)	352	496	711

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	352	496	711
1930	Total budgetary resources available	352	496	711

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	352	496	711
3020	Outlays (gross)	–352	–496	–711

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	352	496	711
	Outlays, gross:
4100	Outlays from new mandatory authority	352	496	711
4180	Budget authority, net (total)	352	496	711
4190	Outlays, net (total)	352	496	711

This account, and a related special receipt account, were established to support the execution structure necessary to implement the 21st Century 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, $711,000,000, 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, $400,000,000 shall be transferred to the "National Cancer Institute" for the purposes described in section 1001(b)(4)(C) of such Act, $57,500,000 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 $57,500,000 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.


Identification code 075–5628–0–2–552		2017 actual	2018 est.	2019 est.

0100	Balance, start of year			146
	Receipts:
	Current law:
1140	General Fund Payment, NIH Innovation, CURES Act	352	496	711

2000	Total: Balances and receipts	352	496	857
	Appropriations:
	Current law:
2101	NIH Innovation, Cures Act	–352	–350	–711

5099	Balance, end of year		146	146


Identification code 075–5628–0–2–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	CURES obligations	12	52	196

0900	Total new obligations, unexpired accounts (object class 41.0)	12	52	196

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		40	40
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	352	350	711
1120	Appropriations transferred to other acct [075–9915]	–300	–298	–515

1160	Appropriation, discretionary (total)	52	52	196
1930	Total budgetary resources available	52	92	236
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	40	40	40

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		12	27
3010	New obligations, unexpired accounts	12	52	196
3020	Outlays (gross)		–37	–81

3050	Unpaid obligations, end of year	12	27	142
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		12	27
3200	Obligated balance, end of year	12	27	142

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	52	52	196
	Outlays, gross:
4010	Outlays from new discretionary authority		12	47
4011	Outlays from discretionary balances		25	34

4020	Outlays, gross (total)		37	81
4180	Budget authority, net (total)	52	52	196
4190	Outlays, net (total)		37	81

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.


Identification code 075–5736–0–2–552		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	13
	Receipts:
	Current law:
1140	Transfers from Presidential Election Campaign Fund		1	41

2000	Total: Balances and receipts	13	1	41
	Appropriations:
	Current law:
2101	10-Year Pediatric Research Initiative Fund	–13	–1	–13

5099	Balance, end of year			28


Identification code 075–5736–0–2–552		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	13	1	13
1120	Appropriations transferred to other accts [075–9915]	–13	–1	–13
4180	Budget authority, net (total)
4190	Outlays, net (total)

Federal Funds

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, $1,043,883,000: 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, $21,039,000 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, $15,000,000 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).

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, $2,034,197,000: Provided, That in addition to amounts provided herein, $79,200,000 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.

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention and for the Drug-Free Communities Support Program authorized by the Drug-Free Communities Act of 1997, as amended, $220,885,000, of which $2,000,000 shall be made available as directed by section 4 of Public Law 107–82, as amended by Public Law 109–469 (21 U.S.C. 1521 note) and $3,000,000, to remain available until expended, shall be for activities authorized by section 103 of Public Law 114–198.

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, the Drug-Free Communities Act of 1997, as amended, and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration ("SAMHSA"), $126,922,000: Provided, That in addition to amounts provided herein, $20,426,000 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, 2020: 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.


Identification code 075–1362–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0006	Mental Health	1,145	1,140	1,044
0007	Substance Abuse Treatment	2,627	2,613	2,034
0008	Substance Abuse Prevention	222	222	221
0009	Health Surveillance and Program Support	117	116	127
0011	SAMHSA Prevention Fund	12	11

0100	Total, direct program	4,123	4,102	3,426

0799	Total direct obligations	4,123	4,102	3,426
0802	SAMHSA Reimbursables	108	108	19
0810	SAMHSA Reimbursable: PHS Evaluation	134	133	121

0899	Total reimbursable obligations	242	241	140

0900	Total new obligations, unexpired accounts	4,365	4,343	3,566

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	3	13
1001	Discretionary unobligated balance brought fwd, Oct 1	1	1
1020	Adjustment of unobligated bal brought forward, Oct 1		10

1050	Unobligated balance (total)	1	13	13
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,619	3,594	3,426
1120	Appropriations transferred to other acct [075–1503]	–8
1121	Appropriations transferred from other acct [075–5627]	500	497
1121	Appropriations transferred from other acct [075–0116]		11

1160	Appropriation, discretionary (total)	4,111	4,102	3,426
	Appropriations, mandatory:
1221	Appropriations transferred from the Prevention and Public Health Fund [075–0116]	12
	Spending authority from offsetting collections, discretionary:
1700	Collected	153	160	137
1701	Change in uncollected payments, Federal sources	91	81

1750	Spending auth from offsetting collections, disc (total)	244	241	137
1900	Budget authority (total)	4,367	4,343	3,563
1930	Total budgetary resources available	4,368	4,356	3,576
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	13	10

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3,977	4,506	4,476
3010	New obligations, unexpired accounts	4,365	4,343	3,566
3011	Obligations ("upward adjustments"), expired accounts	18
3020	Outlays (gross)	–3,759	–4,047	–3,753
3041	Recoveries of prior year unpaid obligations, expired	–95	–326

3050	Unpaid obligations, end of year	4,506	4,476	4,289
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–245	–143	–224
3070	Change in uncollected pymts, Fed sources, unexpired	–91	–81
3071	Change in uncollected pymts, Fed sources, expired	193

3090	Uncollected pymts, Fed sources, end of year	–143	–224	–224
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3,732	4,363	4,252
3200	Obligated balance, end of year	4,363	4,252	4,065

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,355	4,343	3,563
	Outlays, gross:
4010	Outlays from new discretionary authority	1,144	1,118	993
4011	Outlays from discretionary balances	2,579	2,921	2,759

4020	Outlays, gross (total)	3,723	4,039	3,752
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–344	–311	–135
4033	Non-Federal sources	–1	–2	–2

4040	Offsets against gross budget authority and outlays (total)	–345	–313	–137
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–91	–81
4052	Offsetting collections credited to expired accounts	192	153

4060	Additional offsets against budget authority only (total)	101	72

4070	Budget authority, net (discretionary)	4,111	4,102	3,426
4080	Outlays, net (discretionary)	3,378	3,726	3,615
	Mandatory:
4090	Budget authority, gross	12
	Outlays, gross:
4101	Outlays from mandatory balances	36	8	1
4180	Budget authority, net (total)	4,123	4,102	3,426
4190	Outlays, net (total)	3,414	3,734	3,616

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 organizations, and private not-for-profit organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities.


Identification code 075–1362–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	46	50	52
11.3	Other than full-time permanent	2	3	3
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	3	4	4

11.9	Total personnel compensation	52	58	60
12.1	Civilian personnel benefits	16	17	18
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	2	2	2
23.1	Rental payments to GSA	7	7	7
23.3	Communications, utilities, and miscellaneous charges	1	1	1
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	29	31	31
25.2	Other services from non-Federal sources	191	179	196
25.3	Other goods and services from Federal sources	45	47	48
25.4	Operation and maintenance of facilities	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	3,775	3,755	3,058

99.0	Direct obligations	4,123	4,102	3,426
99.0	Reimbursable obligations	242	241	140

99.9	Total new obligations, unexpired accounts	4,365	4,343	3,566


Identification code 075–1362–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	451	475	475
1101	Direct military average strength employment	31	31	31
2001	Reimbursable civilian full-time equivalent employment	101	101	71
2101	Reimbursable military average strength employment	7	7	7

Federal Funds


Identification code 075–1700–0–1–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Research on Health Costs, Quality and Outcomes	186	186
0002	Medical Expenditure Panel Survey	66	66
0003	AHRQ Program Support	71	70

0799	Total direct obligations	323	322
0803	Research on Health Costs, Quality and Outcomes (Reimbursable)	16	16
0804	Medical Expenditure Panel Survey (Reimbursable)	1	1
0805	AHRQ Program Support (Reimbursable)	1	1

0899	Total reimbursable obligations	18	18

0900	Total new obligations, unexpired accounts	341	340

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	16	23	22
1001	Discretionary unobligated balance brought fwd, Oct 1	16	23
1010	Unobligated balance transfer to other accts [075–9915]			–22
1020	Adjustment of unobligated bal brought forward, Oct 1		1
1021	Recoveries of prior year unpaid obligations	2

1050	Unobligated balance (total)	18	24
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	324	322
1120	Appropriations transferred to other acct [075–1503]	–1

1160	Appropriation, discretionary (total)	323	322
	Spending authority from offsetting collections, discretionary:
1700	Collected	1
1701	Change in uncollected payments, Federal sources	15	8

1750	Spending auth from offsetting collections, disc (total)	16	8
	Spending authority from offsetting collections, mandatory:
1800	Collected	7	8
1900	Budget authority (total)	346	338
1930	Total budgetary resources available	364	362
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	23	22

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	383	345	377
3010	New obligations, unexpired accounts	341	340
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–365	–308	–240
3040	Recoveries of prior year unpaid obligations, unexpired	–2
3041	Recoveries of prior year unpaid obligations, expired	–13

3050	Unpaid obligations, end of year	345	377	137
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–85	–53	–61
3070	Change in uncollected pymts, Fed sources, unexpired	–15	–8
3071	Change in uncollected pymts, Fed sources, expired	47

3090	Uncollected pymts, Fed sources, end of year	–53	–61	–61
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	298	292	316
3200	Obligated balance, end of year	292	316	76

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	339	330
	Outlays, gross:
4010	Outlays from new discretionary authority	134	121
4011	Outlays from discretionary balances	224	183	240

4020	Outlays, gross (total)	358	304	240
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–40

4040	Offsets against gross budget authority and outlays (total)	–40
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–15	–8
4052	Offsetting collections credited to expired accounts	39

4060	Additional offsets against budget authority only (total)	24	–8

4070	Budget authority, net (discretionary)	323	322
4080	Outlays, net (discretionary)	318	304	240
	Mandatory:
4090	Budget authority, gross	7	8
	Outlays, gross:
4100	Outlays from new mandatory authority		1
4101	Outlays from mandatory balances	7	3

4110	Outlays, gross (total)	7	4
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–7	–8
4180	Budget authority, net (total)	323	322
4190	Outlays, net (total)	318	300	240

The FY 2019 Budget consolidates the activities of the Agency for Healthcare Research and Quality within the National Institutes of Health as the National Institute for Research on Safety and Quality.


Identification code 075–1700–0–1–552		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	30	33
11.3	Other than full-time permanent	4	3
11.5	Other personnel compensation	1	1
11.7	Military personnel	1	1

11.9	Total personnel compensation	36	38
12.1	Civilian personnel benefits	11	10
12.2	Military personnel benefits		1
23.1	Rental payments to GSA	3	4
23.3	Communications, utilities, and miscellaneous charges		1
25.2	Other services from non-Federal sources	12	15
25.3	Other goods and services from Federal sources	22	19
25.5	Research and development contracts	134	130
31.0	Equipment	1	2
41.0	Grants, subsidies, and contributions	104	102

99.0	Direct obligations	323	322
99.0	Reimbursable obligations	18	18

99.9	Total new obligations, unexpired accounts	341	340


Identification code 075–1700–0–1–552		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	273	270
1101	Direct military average strength employment	7	7
2001	Reimbursable civilian full-time equivalent employment	2	2
3001	Allocation account civilian full-time equivalent employment	8	8

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $276,236,212,000, to remain available until expended.

In addition, for carrying out such titles after May 31, 2019, for the last quarter of fiscal year 2019 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 2020, $137,931,797,000, 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.


Identification code 075–0512–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments	394,370	407,290	433,103
0002	State and local administration	22,596	20,960	21,475
0003	Vaccines for Children	4,427	4,401	4,726

0799	Total direct obligations	421,393	432,651	459,304
0801	Medicare Part B premiums	652	1,000	1,054
0802	Medicare Part D		3	4

0899	Total reimbursable obligations	652	1,003	1,058

0900	Total new obligations, unexpired accounts	422,045	433,654	460,362

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	413	309	11,545
1021	Recoveries of prior year unpaid obligations	34,566	33,870	36,675
1029	Other balances withdrawn to Treasury	–15,728
1033	Recoveries of prior year paid obligations	12,812

1050	Unobligated balance (total)	32,063	34,179	48,220
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	273,767	284,798	276,236
	Advance appropriations, mandatory:
1270	Advance appropriation	115,583	125,219	134,848
	Spending authority from offsetting collections, mandatory:
1800	Collected	652	1,003	1,058
1801	Change in uncollected payments, Federal sources	289

1850	Spending auth from offsetting collections, mand (total):	941	1,003	1,058
1900	Budget authority (total)	390,291	411,020	412,142
1930	Total budgetary resources available	422,354	445,199	460,362
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	309	11,545

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	40,649	39,982	36,675
3010	New obligations, unexpired accounts	422,045	433,654	460,362
3020	Outlays (gross)	–388,146	–403,091	–421,300
3040	Recoveries of prior year unpaid obligations, unexpired	–34,566	–33,870	–36,675

3050	Unpaid obligations, end of year	39,982	36,675	39,062
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–105	–394	–394
3070	Change in uncollected pymts, Fed sources, unexpired	–289

3090	Uncollected pymts, Fed sources, end of year	–394	–394	–394
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	40,544	39,588	36,281
3200	Obligated balance, end of year	39,588	36,281	38,668

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	390,291	411,020	412,142
	Outlays, gross:
4100	Outlays from new mandatory authority	356,275	363,110	412,142
4101	Outlays from mandatory balances	31,871	39,981	9,158

4110	Outlays, gross (total)	388,146	403,091	421,300
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–652	–1,003	–1,058
4123	Non-Federal sources	–12,812

4130	Offsets against gross budget authority and outlays (total)	–13,464	–1,003	–1,058
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–289
4143	Recoveries of prior year paid obligations, unexpired accounts	12,812

4150	Additional offsets against budget authority only (total)	12,523

4160	Budget authority, net (mandatory)	389,350	410,017	411,084
4170	Outlays, net (mandatory)	374,682	402,088	420,242
4180	Budget authority, net (total)	389,350	410,017	411,084
4190	Outlays, net (total)	374,682	402,088	420,242


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	389,350	410,017	411,084
	Outlays	374,682	402,088	420,242
Legislative proposal, subject to PAYGO:
	Budget Authority		–1,700	–8,209
	Outlays		–1,700	–8,209
Total:
	Budget Authority	389,350	408,317	402,875
	Outlays	374,682	400,388	412,033

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.


Obligations	2017	2018	2019

Vaccine Purchase	4,241	4,193	4,427
Vaccine Stockpile	14	27	112
Ordering, Distribution, and Operations	133	130	136
Vaccine Management Contract Support	0	0	0
Evaluation Activities	50	51	52

Total Obligations	4,437	4,401	4,726


Identification code 075–0512–0–1–551		2017 actual	2018 est.	2019 est.

41.0	Direct obligations: Grants, subsidies, and contributions	421,393	432,651	459,304
99.0	Reimbursable obligations	652	1,003	1,058

99.9	Total new obligations, unexpired accounts	422,045	433,654	460,362


Identification code 075–0512–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments		–1,700	–8,209

0799	Total direct obligations		–1,700	–8,209

0900	Total new obligations, unexpired accounts (object class 41.0)		–1,700	–8,209

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		–1,700	–8,209
1900	Budget authority (total)		–1,700	–8,209
1930	Total budgetary resources available		–1,700	–8,209

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		–1,700	–8,209
3020	Outlays (gross)		1,700	8,209

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–1,700	–8,209
	Outlays, gross:
4100	Outlays from new mandatory authority		–1,700	–8,209
4180	Budget authority, net (total)		–1,700	–8,209
4190	Outlays, net (total)		–1,700	–8,209


Identification code 075–0516–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0011	Emergency health services for undocumented aliens	1
0012	Medicaid integrity program	92	86	87
0023	Grants to improve outreach and enrollment	18

0799	Total direct obligations	111	86	87

0900	Total new obligations, unexpired accounts	111	86	87

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,006	244	238
1021	Recoveries of prior year unpaid obligations	32
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	1,039	244	238
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	84	86	87
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–6	–6
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–760

1260	Appropriations, mandatory (total)	–682	80	87
1900	Budget authority (total)	–682	80	87
1930	Total budgetary resources available	357	324	325
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	244	238	238

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,721	1,297	800
3010	New obligations, unexpired accounts	111	86	87
3011	Obligations ("upward adjustments"), expired accounts	4
3020	Outlays (gross)	–503	–583	–578
3040	Recoveries of prior year unpaid obligations, unexpired	–32
3041	Recoveries of prior year unpaid obligations, expired	–4

3050	Unpaid obligations, end of year	1,297	800	309
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,721	1,297	800
3200	Obligated balance, end of year	1,297	800	309

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	–682	80	87
	Outlays, gross:
4100	Outlays from new mandatory authority	7	6	14
4101	Outlays from mandatory balances	496	577	564

4110	Outlays, gross (total)	503	583	578
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–1
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	1

4160	Budget authority, net (mandatory)	–682	80	87
4170	Outlays, net (mandatory)	502	583	578
4180	Budget authority, net (total)	–682	80	87
4190	Outlays, net (total)	502	583	578

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).


Identification code 075–0516–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent - Medicaid Integrity Program	10	12	12
12.1	Civilian personnel benefits - Medicaid Integrity Program	5	6	6
41.0	Grants, subsidies, and contributions - Emergency services for undocumented aliens	1
41.0	Grants, subsidies, and contributions - Medicaid Integrity Program	77	68	69
41.0	Grants, subsidies, and contributions - Grants to improve outreach and enrollment	18

99.0	Direct obligations	111	86	87

99.9	Total new obligations, unexpired accounts	111	86	87


Identification code 075–0516–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	91	207	207

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, $378,343,800,000.

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.


Identification code 075–0580–0–1–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)	229,733	262,496	284,288
0002	Part D benefits (Rx Drug)	82,382	88,133	92,070
0003	Part D Federal administration (Rx Drug)	405	422	642
0004	General Fund Transfers to HI	1,293	1,543	1,339
0006	Federal Bureau of Investigation (HCFAC)	131	135	147
0007	Federal payments from taxation of OASDI benefits (HI)	24,206	23,684	24,943
0008	Criminal fines (HCFAC)	12	109	150
0009	Civil penalties and damages (HCFAC—DOJ and CMS administration)	46	51	52
0010	Asset Forfeiture	25	30	31
0011	State Low Income Determinations	3	3	4

0900	Total new obligations, unexpired accounts	338,236	376,606	403,666

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			1,928
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)	313,816	352,597	378,323
1200	Appropriation (indefinite, permanent)	24,206	25,612	29,065
1200	Appropriation (HCFAC for FBI)	131	135	147
1200	Appropriation (indefinite for HCFAC)	83	190	254

1260	Appropriations, mandatory (total)	338,236	378,534	407,789
1930	Total budgetary resources available	338,236	378,534	409,717
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		1,928	6,051

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	27,070	18,743	52,991
3010	New obligations, unexpired accounts	338,236	376,606	403,666
3011	Obligations ("upward adjustments"), expired accounts	1,306
3020	Outlays (gross)	–335,137	–342,358	–364,182
3041	Recoveries of prior year unpaid obligations, expired	–12,732

3050	Unpaid obligations, end of year	18,743	52,991	92,475
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	27,070	18,743	52,991
3200	Obligated balance, end of year	18,743	52,991	92,475

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	338,236	378,534	407,789
	Outlays, gross:
4100	Outlays from new mandatory authority	324,303	324,552	336,360
4101	Outlays from mandatory balances	10,834	17,806	27,822

4110	Outlays, gross (total)	335,137	342,358	364,182
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–931
4123	Non-Federal sources	–1,306

4130	Offsets against gross budget authority and outlays (total)	–2,237
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	2,237

4160	Budget authority, net (mandatory)	338,236	378,534	407,789
4170	Outlays, net (mandatory)	332,900	342,358	364,182
4180	Budget authority, net (total)	338,236	378,534	407,789
4190	Outlays, net (total)	332,900	342,358	364,182


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	338,236	378,534	407,789
	Outlays	332,900	342,358	364,182
Legislative proposal, not subject to PAYGO:
	Budget Authority		–39	–2,328
	Outlays		–39	–2,328
Total:
	Budget Authority	338,236	378,495	405,461
	Outlays	332,900	342,319	361,854

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.


Identification code 075–0580–0–1–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions	336,507	374,641	401,684
42.0	Insurance claims and indemnities (HI Uninsured Federal)	147	132	127
94.0	Financial transfers (Federal admin)	1,582	1,833	1,855

99.9	Total new obligations, unexpired accounts	338,236	376,606	403,666


Identification code 075–0580–2–1–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)			–2,484
0002	Part D benefits (Rx Drug)		–39	156

0900	Total new obligations, unexpired accounts (object class 41.0)		–39	–2,328

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)		–39	–2,328
1930	Total budgetary resources available		–39	–2,328

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		–39	–2,328
3020	Outlays (gross)		39	2,328

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–39	–2,328
	Outlays, gross:
4100	Outlays from new mandatory authority		–39	–2,328
4180	Budget authority, net (total)		–39	–2,328
4190	Outlays, net (total)		–39	–2,328


Identification code 075–0519–0–1–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	QIO contracts	397	603	1,297
0002	QIO support contracts	180	171	155

0900	Total new obligations, unexpired accounts	577	774	1,452

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	124	774	1,452
1801	Change in uncollected payments, Federal sources	491

1850	Spending auth from offsetting collections, mand (total)	615	774	1,452
1930	Total budgetary resources available	615	774	1,452
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–38

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,519	1,187	1,187
3010	New obligations, unexpired accounts	577	774	1,452
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–883	–774	–1,452
3041	Recoveries of prior year unpaid obligations, expired	–27

3050	Unpaid obligations, end of year	1,187	1,187	1,187
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2,488	–1,983	–1,983
3070	Change in uncollected pymts, Fed sources, unexpired	–491
3071	Change in uncollected pymts, Fed sources, expired	996

3090	Uncollected pymts, Fed sources, end of year	–1,983	–1,983	–1,983
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–969	–796	–796
3200	Obligated balance, end of year	–796	–796	–796

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	615	774	1,452
	Outlays, gross:
4100	Outlays from new mandatory authority	137	118	972
4101	Outlays from mandatory balances	746	656	480

4110	Outlays, gross (total)	883	774	1,452
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–957	–774	–1,452
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–491
4142	Offsetting collections credited to expired accounts	833

4150	Additional offsets against budget authority only (total)	342
4170	Outlays, net (mandatory)	–74
4180	Budget authority, net (total)
4190	Outlays, net (total)	–74

	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.


Identification code 075–0519–0–1–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	34	34	34
23.3	Communications, utilities, and miscellaneous charges	1	1	3
25.2	Other services from non-Federal sources	511	699	1,336
25.3	Other goods and services from Federal sources	20	26	51
25.4	Operation and maintenance of facilities	11	14	28

99.9	Total new obligations, unexpired accounts	577	774	1,452


Identification code 075–0519–0–1–571		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	229	232	232

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 $3,343,879,000, 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 2019 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.


Identification code 075–0511–0–1–550		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Program operations	3,094	3,172	2,422
0002	Federal administration	762	775	733
0003	State survey and certification	409	425	444
0004	Research, demonstrations, and evaluation projects	58	85	29
0007	ARRA Medicare/Medicaid HIT	56	123	23
0008	Risk Corridor	3,953

0100	Total direct program	8,332	4,580	3,651

0799	Total direct obligations	8,332	4,580	3,651
0801	Clinical laboratory improvement amendments	50	47	50
0802	Sale of data	12	20	20
0803	Coordination of benefits	34	28	30
0804	Medicare advantage/Prescription drug plan	80	81	83
0805	Provider enrollment	18	24	24
0806	Recovery audit contractors	89	285	572
0808	Marketplace User Fees	1,126	1,212	962
0810	Risk Adjustment Administrative Expenses	22	19	38
0813	Other reimbursable program activity	209	15	16

0899	Total reimbursable obligations	1,640	1,731	1,795

0900	Total new obligations, unexpired accounts	9,972	6,311	5,446

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	–5,575	–9,239	1,871
1020	Adjustment of unobligated bal brought forward, Oct 1	–500	–129
1021	Recoveries of prior year unpaid obligations	97
1033	Recoveries of prior year paid obligations	8

1050	Unobligated balance (total)	–5,970	–9,368	1,871
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3	12,303	3
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–812

1260	Appropriations, mandatory (total)	3	11,491	3
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,973	3,993	3,378
1701	Change in uncollected payments, Federal sources	2,372

1750	Spending auth from offsetting collections, disc (total)	4,345	3,993	3,378
	Spending authority from offsetting collections, mandatory:
1800	Collected	1,931	2,041	1,919
1801	Change in uncollected payments, Federal sources	386
1802	Offsetting collections (previously unavailable)	86	25	103
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–8

1850	Spending auth from offsetting collections, mand (total)	2,395	2,066	2,022
1900	Budget authority (total)	6,743	17,550	5,403
1930	Total budgetary resources available	773	8,182	7,274
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–40
1941	Unexpired unobligated balance, end of year	–9,239	1,871	1,828

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	12,072	16,607	4,895
3001	Adjustments to unpaid obligations, brought forward, Oct 1	536	25
3010	New obligations, unexpired accounts	9,972	6,311	5,446
3011	Obligations ("upward adjustments"), expired accounts	421
3020	Outlays (gross)	–6,066	–18,048	–5,683
3040	Recoveries of prior year unpaid obligations, unexpired	–97
3041	Recoveries of prior year unpaid obligations, expired	–231

3050	Unpaid obligations, end of year	16,607	4,895	4,658
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–5,470	–6,083	–6,083
3070	Change in uncollected pymts, Fed sources, unexpired	–2,758
3071	Change in uncollected pymts, Fed sources, expired	2,145

3090	Uncollected pymts, Fed sources, end of year	–6,083	–6,083	–6,083
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,138	10,549	–1,188
3200	Obligated balance, end of year	10,524	–1,188	–1,425

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,345	3,993	3,378
	Outlays, gross:
4010	Outlays from new discretionary authority	1,906	3,993	3,378
4011	Outlays from discretionary balances	2,388

4020	Outlays, gross (total)	4,294	3,993	3,378
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–4,161	–3,973	–3,344
4033	Non-Federal sources	–126	–20	–34

4040	Offsets against gross budget authority and outlays (total)	–4,287	–3,993	–3,378
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2,372
4052	Offsetting collections credited to expired accounts	2,314

4060	Additional offsets against budget authority only (total)	–58
4080	Outlays, net (discretionary)	7
	Mandatory:
4090	Budget authority, gross	2,398	13,557	2,025
	Outlays, gross:
4100	Outlays from new mandatory authority	548	2,115	1,953
4101	Outlays from mandatory balances	1,224	11,940	352

4110	Outlays, gross (total)	1,772	14,055	2,305
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–343	–189	–145
4123	Non-Federal sources	–1,596	–1,852	–1,774

4130	Offsets against gross budget authority and outlays (total)	–1,939	–2,041	–1,919
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–386
4143	Recoveries of prior year paid obligations, unexpired accounts	8

4150	Additional offsets against budget authority only (total)	–378

4160	Budget authority, net (mandatory)	81	11,516	106
4170	Outlays, net (mandatory)	–167	12,014	386
4180	Budget authority, net (total)	81	11,516	106
4190	Outlays, net (total)	–160	12,014	386

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	207	128	103
5091	Expiring unavailable balance: Offsetting collections	–1
5092	Unexpired unavailable balance, EOY: Offsetting collections	128	103
5093	Expired unavailable balance, SOY: Offsetting collections	1	2	2
5095	Expired unavailable balance, EOY: Offsetting collections	1	2	2


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	81	11,516	106
	Outlays	–160	12,014	386
Legislative proposal, subject to PAYGO:
	Budget Authority		812	12
	Outlays		812	12
Total:
	Budget Authority	81	12,328	118
	Outlays	–160	12,826	398

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. The 2019 Budget includes mandatory resources for the Risk Corridor Program.


Identification code 075–0511–0–1–550		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	466	483	450
11.3	Other than full-time permanent	12	11	11
11.5	Other personnel compensation	7	8	8
11.7	Military personnel	17	14	14

11.9	Total personnel compensation	502	516	483
12.1	Civilian personnel benefits	158	153	149
12.2	Military personnel benefits	9	7	7
23.1	Rental payments to GSA	11
23.3	Communications, utilities, and miscellaneous charges	48
24.0	Printing and reproduction	60
25.2	Other services from non-Federal sources	3,121	3,904	3,012
25.3	Other goods and services from Federal sources	77
25.6	Medical care	380
25.7	Operation and maintenance of equipment	1
41.0	Grants, subsidies, and contributions	12
42.0	Insurance claims and indemnities	3,953

99.0	Direct obligations	8,332	4,580	3,651
99.0	Reimbursable obligations	1,640	1,731	1,795

99.9	Total new obligations, unexpired accounts	9,972	6,311	5,446


Identification code 075–0511–0–1–550		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	4,376	4,365	4,099
1001	Direct civilian full-time equivalent employment	159	157	157
1101	Direct military average strength employment	138	138	138
2001	Reimbursable civilian full-time equivalent employment	240	249	249


Identification code 075–0511–4–1–550		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Program operations			12

0100	Total direct program			12

0799	Total direct obligations			12
0801	ACL SHIPs		13	13
0804	Medicare advantage/Prescription drug plan			30

0899	Total reimbursable obligations		13	43

0900	Total new obligations, unexpired accounts		13	55

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			812
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			12
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		812

1260	Appropriations, mandatory (total)		812	12
	Spending authority from offsetting collections, mandatory:
1800	Collected		13	43
1900	Budget authority (total)		825	55
1930	Total budgetary resources available		825	867
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		812	812

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			–812
3010	New obligations, unexpired accounts		13	55
3020	Outlays (gross)		–825	–55

3050	Unpaid obligations, end of year		–812	–812
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			–812
3200	Obligated balance, end of year		–812	–812

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		825	55
	Outlays, gross:
4100	Outlays from new mandatory authority		13	55
4101	Outlays from mandatory balances		812

4110	Outlays, gross (total)		825	55
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–13	–13
4123	Non-Federal sources			–30

4130	Offsets against gross budget authority and outlays (total)		–13	–43

4160	Budget authority, net (mandatory)		812	12
4170	Outlays, net (mandatory)		812	12
4180	Budget authority, net (total)		812	12
4190	Outlays, net (total)		812	12


Identification code 075–0511–4–1–550		2017 actual	2018 est.	2019 est.

25.3	Direct obligations: Other goods and services from Federal sources			12

99.0	Direct obligations			12
99.0	Reimbursable obligations		13	43

99.9	Total new obligations, unexpired accounts		13	55


Identification code 075–0514–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Grants to hospitals			14,540

0900	Total new obligations, unexpired accounts (object class 41.0)			14,540

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			14,540
1930	Total budgetary resources available			14,540

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			14,540
3020	Outlays (gross)			–14,540

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			14,540
	Outlays, gross:
4100	Outlays from new mandatory authority			14,540
4180	Budget authority, net (total)			14,540
4190	Outlays, net (total)			14,540

This account reflects the Budget's proposals to modify payments to hospitals for uncompensated care and consolidate graduate medical education spending.


Identification code 075–0515–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Grants to states and US territories	15,952	5,700	5,700
0002	CHIP Redistribution Funds	8	3,052
0003	Child health quality	6	20	24

0900	Total new obligations, unexpired accounts (object class 41.0)	15,966	8,772	5,724

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,013	6,441	2,747
1011	Unobligated balance transfer from other acct [075–5551]	3,656
1012	Unobligated balance transfers between expired and unexpired accounts	704	101
1020	Adjustment of unobligated bal brought forward, Oct 1		–170
1021	Recoveries of prior year unpaid obligations	8	2,188

1050	Unobligated balance (total)	7,381	8,560	2,747
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310		–2,652
1131	Unobligated balance of appropriations permanently reduced, Perf. Bonus Pmts.		–89

1160	Appropriation, discretionary (total):		–2,741
	Appropriations, mandatory:
1200	Appropriation	20,400	5,700	5,700
1221	Appropriations transferred from other acct [075–5551]	2,050
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–7,424

1260	Appropriations, mandatory (total)	15,026	5,700	5,700
1900	Budget authority (total)	15,026	2,959	5,700
1930	Total budgetary resources available	22,407	11,519	8,447
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	6,441	2,747	2,723

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	8,070	7,804	1,768
3010	New obligations, unexpired accounts	15,966	8,772	5,724
3020	Outlays (gross)	–16,224	–12,620	–5,724
3040	Recoveries of prior year unpaid obligations, unexpired	–8	–2,188

3050	Unpaid obligations, end of year	7,804	1,768	1,768
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	8,070	7,804	1,768
3200	Obligated balance, end of year	7,804	1,768	1,768

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–2,741
	Mandatory:
4090	Budget authority, gross	15,026	5,700	5,700
	Outlays, gross:
4100	Outlays from new mandatory authority	8,826	5,700	5,700
4101	Outlays from mandatory balances	7,398	6,920	24

4110	Outlays, gross (total)	16,224	12,620	5,724
4180	Budget authority, net (total)	15,026	2,959	5,700
4190	Outlays, net (total)	16,224	12,620	5,724


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	15,026	2,959	5,700
	Outlays	16,224	12,620	5,724
Legislative proposal, not subject to PAYGO:
	Budget Authority			–3,118
Legislative proposal, subject to PAYGO:
	Budget Authority		5,643	9,172
	Outlays		4,500	5,700
Total:
	Budget Authority	15,026	8,602	11,754
	Outlays	16,224	17,120	11,424

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) extended CHIP funding through fiscal year 2017, and the Further Additional Continuing Appropriations Act of 2018 (P.L. 115–96) provided partial year funding for FY 2018.


Identification code 075–0515–2–1–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310			–3,118
1900	Budget authority (total)			–3,118
1930	Total budgetary resources available			–3,118
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year			–3,118

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–3,118
4180	Budget authority, net (total)			–3,118
4190	Outlays, net (total)


Identification code 075–0515–4–1–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			5,643
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		4,500	5,700
1221	Appropriations transferred from other acct [075–5551]		1,143	3,472

1260	Appropriations, mandatory (total)		5,643	9,172
1930	Total budgetary resources available		5,643	14,815
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		5,643	14,815

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			–4,500
3020	Outlays (gross)		–4,500	–5,700

3050	Unpaid obligations, end of year		–4,500	–10,200
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			–4,500
3200	Obligated balance, end of year		–4,500	–10,200

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		5,643	9,172
	Outlays, gross:
4100	Outlays from new mandatory authority		4,500	5,700
4180	Budget authority, net (total)		5,643	9,172
4190	Outlays, net (total)		4,500	5,700

The Budget proposes to extend CHIP funding through fiscal year 2019 with reforms.


Identification code 075–0522–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Administration	302	395	342
0002	Innovation Activities	699	1,383	1,363

0900	Total new obligations, unexpired accounts	1,001	1,778	1,705

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,404	3,484	1,706
1021	Recoveries of prior year unpaid obligations	81

1050	Unobligated balance (total)	4,485	3,484	1,706
1930	Total budgetary resources available	4,485	3,484	1,706
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3,484	1,706	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,592	1,376	1,876
3010	New obligations, unexpired accounts	1,001	1,778	1,705
3020	Outlays (gross)	–1,136	–1,278	–1,592
3040	Recoveries of prior year unpaid obligations, unexpired	–81

3050	Unpaid obligations, end of year	1,376	1,876	1,989
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,592	1,376	1,876
3200	Obligated balance, end of year	1,376	1,876	1,989

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	1,136	1,278	1,592
4180	Budget authority, net (total)
4190	Outlays, net (total)	1,136	1,278	1,592

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.


Identification code 075–0522–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	62	70	70
12.1	Civilian personnel benefits	19	22	22
23.3	Communications, utilities, and miscellaneous charges	3	3	4
25.2	Other services from non-Federal sources	502	1,220	1,280
41.0	Grants, subsidies, and contributions	375	391	224
42.0	Insurance claims and indemnities	40	72	105

99.9	Total new obligations, unexpired accounts	1,001	1,778	1,705


Identification code 075–0522–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	551	600	600


Identification code 075–5551–0–2–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	2,048	570	1,160
0198	Adjustment for appropriation derived from the general fund of the US Treasury	–2,048

0199	Balance, start of year		570	1,160
	Receipts:
	Current law:
1140	Interest, Child Enrollment Contingency Fund	6	17	27
	Proposed:
1240	Interest, Child Enrollment Contingency Fund		35

1999	Total receipts	6	52	27

2000	Total: Balances and receipts	6	622	1,187
	Appropriations:
	Current law:
2101	Child Enrollment Contingency Fund	–6	–17	–27
2103	Child Enrollment Contingency Fund	–2,048	–570	–1,160
2134	Child Enrollment Contingency Fund		1,160
2134	Child Enrollment Contingency Fund	570
2198	Adjustment for appropriation derived from the general fund of the US Treasury	2,048

2199	Total current law appropriations	564	573	–1,187
	Proposed:
2201	Child Enrollment Contingency Fund		–35
2234	Child Enrollment Contingency Fund			667

2299	Total proposed appropriations		–35	667

2999	Total appropriations	564	538	–520

5099	Balance, end of year	570	1,160	667


Identification code 075–5551–0–2–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Grants to States and US Territories	1

0900	Total new obligations (object class 41.0)	1

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,656	573
1010	Unobligated balance transfer to other accts [075–0515]	–3,656

1050	Unobligated balance (total)		573
	Budget authority:
	Appropriations, discretionary:
1134	Appropriations precluded from obligation		–1,160
	Appropriations, mandatory:
1200	Appropriation	1,140
1201	Appropriation (special or trust fund)	6	17	27
1203	Appropriation (previously unavailable)	2,048	570	1,160
1220	Appropriations transferred to other acct [075–0515]	–2,050
1234	Appropriations precluded from obligation	–570

1260	Appropriations, mandatory (total)	574	587	1,187
1900	Budget authority (total)	574	–573	1,187
1930	Total budgetary resources available	574		1,187
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	573		1,187

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	224	198
3010	New obligations, unexpired accounts	1
3020	Outlays (gross)	–27	–198

3050	Unpaid obligations, end of year	198
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	224	198
3200	Obligated balance, end of year	198

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–1,160
	Mandatory:
4090	Budget authority, gross	574	587	1,187
	Outlays, gross:
4101	Outlays from mandatory balances	27	198
4180	Budget authority, net (total)	574	–573	1,187
4190	Outlays, net (total)	27	198

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	571	1,145	1,160
5001	Total investments, EOY: Federal securities: Par value	1,145	1,160	1,187


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	574	–573	1,187
	Outlays	27	198
Legislative proposal, not subject to PAYGO:
	Budget Authority			–667
Legislative proposal, subject to PAYGO:
	Budget Authority		2,312	–2,332
Total:
	Budget Authority	574	1,739	–1,812
	Outlays	27	198

The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3) 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. There is no authority to make payments from the Fund in fiscal year 2018.

The Fund receives an appropriation equal to 20 percent of the Sec. 2104(a) CHIP national allotment appropriation under the Social Security Act. 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.


Identification code 075–5551–2–2–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1134	Appropriations precluded from obligation			–667
1900	Budget authority (total)			–667
1930	Total budgetary resources available			–667
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year			–667

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–667
4180	Budget authority, net (total)			–667
4190	Outlays, net (total)


Identification code 075–5551–4–2–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			2,312
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (annual appropriation)		3,420	1,140
1201	Appropriation (special or trust fund)		35
1220	Appropriations transferred to other acct [075–0515]		–1,143	–3,472

1260	Appropriations, mandatory (total)		2,312	–2,332
1930	Total budgetary resources available		2,312	–20
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		2,312	–20

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		2,312	–2,332
4180	Budget authority, net (total)		2,312	–2,332
4190	Outlays, net (total)

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value			2,312
5001	Total investments, EOY: Federal securities: Par value		2,312	–20


Identification code 075–0508–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Incentive payments to hospitals	610	65	20
0802	Incentive payments to eligible professionals	393

0900	Total new obligations (object class 42.0)	1,003	65	20

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		6	6
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected from the HI Trust Fund	649	65	20
1800	Collected from the SMI Trust Fund	435
1801	Change in uncollected payments, Federal sources	–75

1850	Spending auth from offsetting collections, mand (total)	1,009	65	20
1930	Total budgetary resources available	1,009	71	26
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	6	6	6

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	80	19	19
3010	New obligations, unexpired accounts	1,003	65	20
3020	Outlays (gross)	–1,064	–65	–20

3050	Unpaid obligations, end of year	19	19	19
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–246	–171	–171
3070	Change in uncollected pymts, Fed sources, unexpired	75

3090	Uncollected pymts, Fed sources, end of year	–171	–171	–171
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–166	–152	–152
3200	Obligated balance, end of year	–152	–152	–152

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,009	65	20
	Outlays, gross:
4100	Outlays from new mandatory authority	984	47	20
4101	Outlays from mandatory balances	80	18

4110	Outlays, gross (total)	1,064	65	20
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,084	–65	–20
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	75
4170	Outlays, net (mandatory)	–20
4180	Budget authority, net (total)
4190	Outlays, net (total)	–20

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	133	133	133
5092	Unexpired unavailable balance, EOY: Offsetting collections	133	133	133


Identification code 075–0112–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Premium rate review grants	26	8

0900	Total new obligations (object class 41.0)	26	8

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	29	3	1
1021	Recoveries of prior year unpaid obligations		6	19

1050	Unobligated balance (total)	29	9	20
1930	Total budgetary resources available	29	9	20
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	1	20

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	71	69	45
3010	New obligations, unexpired accounts	26	8
3020	Outlays (gross)	–23	–26	–13
3040	Recoveries of prior year unpaid obligations, unexpired		–6	–19
3041	Recoveries of prior year unpaid obligations, expired	–5

3050	Unpaid obligations, end of year	69	45	13
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	71	69	45
3200	Obligated balance, end of year	69	45	13

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	23	26	13
4180	Budget authority, net (total)
4190	Outlays, net (total)	23	26	13

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).


Identification code 075–0113–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Pre-Existing Condition Insurance Plan Program (Direct)	66
0002	Administration		103

0799	Total direct obligations	66	103

0900	Total new obligations, unexpired accounts (object class 25.2)	66	103

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	389	332	230
1021	Recoveries of prior year unpaid obligations	8	1
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	398	333	230
1930	Total budgetary resources available	398	333	230
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	332	230	230

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	13	38	56
3010	New obligations, unexpired accounts	66	103
3020	Outlays (gross)	–33	–84	–56
3040	Recoveries of prior year unpaid obligations, unexpired	–8	–1

3050	Unpaid obligations, end of year	38	56
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	13	38	56
3200	Obligated balance, end of year	38	56

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	33	84	56
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–1
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	1
4170	Outlays, net (mandatory)	32	84	56
4180	Budget authority, net (total)
4190	Outlays, net (total)	32	84	56

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, 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.


Identification code 075–0114–0–1–551		2017 actual	2018 est.	2019 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	10	10	4
3020	Outlays (gross)		–6	–4

3050	Unpaid obligations, end of year	10	4
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	10	10	4
3200	Obligated balance, end of year	10	4

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		6	4
4180	Budget authority, net (total)
4190	Outlays, net (total)		6	4

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.


Identification code 075–0115–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0002	Administration	18	13

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	19	14
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–1	–1

1260	Appropriations, mandatory (total)	18	13
1930	Total budgetary resources available	18	13

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	342	146	24
3010	New obligations, unexpired accounts	18	13
3020	Outlays (gross)	–160	–135	–24
3041	Recoveries of prior year unpaid obligations, expired	–54

3050	Unpaid obligations, end of year	146	24
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	342	146	24
3200	Obligated balance, end of year	146	24

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	18	13
	Outlays, gross:
4100	Outlays from new mandatory authority	9	9
4101	Outlays from mandatory balances	151	126	24

4110	Outlays, gross (total)	160	135	24
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–13
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	13

4160	Budget authority, net (mandatory)	18	13
4170	Outlays, net (mandatory)	147	135	24
4180	Budget authority, net (total)	18	13
4190	Outlays, net (total)	147	135	24

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.


Identification code 075–0115–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3	3
25.2	Other services from non-Federal sources	15	10

99.9	Total new obligations, unexpired accounts	18	13


Identification code 075–0115–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	25	26


Identification code 075–0126–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Cost Sharing Reductions		7,197	7,507
0002	Basic Health Program		1,000	1,060

0900	Total new obligations, unexpired accounts (object class 41.0)		8,197	8,567

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		8,197	8,567
1930	Total budgetary resources available		8,197	8,567

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		8,197	8,567
3020	Outlays (gross)		–8,197	–8,567

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		8,197	8,567
	Outlays, gross:
4100	Outlays from new mandatory authority		8,197	8,567
4180	Budget authority, net (total)		8,197	8,567
4190	Outlays, net (total)		8,197	8,567


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority		8,197	8,567
	Outlays		8,197	8,567
Legislative proposal, subject to PAYGO:
	Budget Authority		–180	–471
	Outlays		–180	–471
Total:
	Budget Authority		8,017	8,096
	Outlays		8,017	8,096

Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers. The FY 2019 Budget provides a mandatory appropriation for Cost Sharing Reduction (CSR) payments for fiscal year 2018 through the end of calendar year 2019.


Identification code 075–0126–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Cost Sharing Reductions		–180	–471

0900	Total new obligations, unexpired accounts (object class 41.0)		–180	–471

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		–180	–471
1930	Total budgetary resources available		–180	–471

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		–180	–471
3020	Outlays (gross)		180	471

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–180	–471
	Outlays, gross:
4100	Outlays from new mandatory authority		–180	–471
4180	Budget authority, net (total)		–180	–471
4190	Outlays, net (total)		–180	–471


Identification code 075–5733–0–2–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	248	371	526
0198	Reconciliation adjustment	–1

0199	Balance, start of year	247	371	526
	Receipts:
	Current law:
1110	Receipts, Risk Adjustment Program	5,228	7,974	7,094

2000	Total: Balances and receipts	5,475	8,345	7,620
	Appropriations:
	Current law:
2101	Risk Adjustment Program Payments	–5,228	–7,974	–7,094
2103	Risk Adjustment Program Payments	–247	–371	–526
2132	Risk Adjustment Program Payments	371	526

2199	Total current law appropriations	–5,104	–7,819	–7,620

2999	Total appropriations	–5,104	–7,819	–7,620

5099	Balance, end of year	371	526


Identification code 075–5733–0–2–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Risk Adjustment Program Payments (Direct)	3,768	9,154	7,620

0900	Total new obligations (object class 41.0)	3,768	9,154	7,620

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1,336	1
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	5,228	7,974	7,094
1203	Appropriation (previously unavailable)	247	371	526
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–371	–526

1260	Appropriations, mandatory (total)	5,104	7,819	7,620
1930	Total budgetary resources available	5,104	9,155	7,621
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,336	1	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,247	915	915
3010	New obligations, unexpired accounts	3,768	9,154	7,620
3020	Outlays (gross)	–4,100	–9,154	–7,620

3050	Unpaid obligations, end of year	915	915	915
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,247	915	915
3200	Obligated balance, end of year	915	915	915

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	5,104	7,819	7,620
	Outlays, gross:
4100	Outlays from new mandatory authority	2,853	7,447	7,620
4101	Outlays from mandatory balances	1,247	1,707

4110	Outlays, gross (total)	4,100	9,154	7,620
4180	Budget authority, net (total)	5,104	7,819	7,620
4190	Outlays, net (total)	4,100	9,154	7,620

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. Risk adjustment is budget neutral within each state and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans with higher than average actuarial risk. 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.


Identification code 075–5735–0–2–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	455	285	22
	Receipts:
	Current law:
1110	Contributions, Transitional Reinsurance Program	4,546	376

2000	Total: Balances and receipts	5,001	661	22
	Appropriations:
	Current law:
2101	Transitional Reinsurance Program	–4,546	–375
2103	Transitional Reinsurance Program	–456	–286	–22
2132	Transitional Reinsurance Program	286	22

2199	Total current law appropriations	–4,716	–639	–22

2999	Total appropriations	–4,716	–639	–22

5099	Balance, end of year	285	22


Identification code 075–5735–0–2–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Transitional reinsurance payments	4,715	632	22
0002	Administrative expenses	1	7

0900	Total new obligations, unexpired accounts	4,716	639	22

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	4,546	375
1203	Appropriation (previously unavailable)	456	286	22
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–286	–22

1260	Appropriations, mandatory (total)	4,716	639	22
1930	Total budgetary resources available	4,716	639	22

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	223	248
3010	New obligations, unexpired accounts	4,716	639	22
3020	Outlays (gross)	–4,691	–887	–22

3050	Unpaid obligations, end of year	248
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	223	248
3200	Obligated balance, end of year	248

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,716	639	22
	Outlays, gross:
4100	Outlays from new mandatory authority	4,468	639	22
4101	Outlays from mandatory balances	223	248

4110	Outlays, gross (total)	4,691	887	22
4180	Budget authority, net (total)	4,716	639	22
4190	Outlays, net (total)	4,691	887	22

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, were announced in June of 2017.


Identification code 075–5735–0–2–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions - Transitional Reinsurance	4,715	632	22
41.0	Grants, subsidies, and contributions - Administration	1	7

99.9	Total new obligations, unexpired accounts	4,716	639	22


Identification code 075–0524–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
	Credit program obligations:
0705	Reestimates of direct loan subsidy	16	124
0706	Interest on reestimates of direct loan subsidy	1	11
0709	Administrative expenses	1

0900	Total new obligations, unexpired accounts	18	135

	Budgetary resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	1	1
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	17	134
1930	Total budgetary resources available	18	135

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	16	3	1
3010	New obligations, unexpired accounts	18	135
3020	Outlays (gross)	–30	–136
3040	Recoveries of prior year unpaid obligations, unexpired	–1	–1

3050	Unpaid obligations, end of year	3	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	16	3	1
3200	Obligated balance, end of year	3	1	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	17	134
	Outlays, gross:
4100	Outlays from new mandatory authority	17	134
4101	Outlays from mandatory balances	13	2

4110	Outlays, gross (total)	30	136
4180	Budget authority, net (total)	17	134
4190	Outlays, net (total)	30	136

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


Identification code 075–0524–0–1–551		2017 actual	2018 est.	2019 est.

	Direct loan subsidy outlays:
134002	Solvency Loans	13

134999	Total subsidy outlays	13
	Direct loan reestimates:
135001	Startup Loans	–8	17
135002	Solvency Loans	5	117

135999	Total direct loan reestimates	–3	134

	Administrative expense data:
3580	Outlays from balances		2

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).


Identification code 075–0524–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.2	Other services from non-Federal sources	1
41.0	Grants, subsidies, and contributions	17	135

99.9	Total new obligations, unexpired accounts	18	135


Identification code 075–0118–0–1–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	7
0198	Reconciliation adjustment	–7

0199	Balance, start of year

2000	Total: Balances and receipts

5099	Balance, end of year


Identification code 075–0118–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
	Credit program obligations:
0705	Reestimates of direct loan subsidy	74	226
0706	Interest on reestimates of direct loan subsidy	7	33
0709	Administrative expenses	1

0900	Total new obligations, unexpired accounts	82	259

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1		1
1021	Recoveries of prior year unpaid obligations		1

1050	Unobligated balance (total)	1	1	1
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	81	259
1930	Total budgetary resources available	82	260	1
	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	3	4	2
3010	New obligations, unexpired accounts	82	259
3020	Outlays (gross)	–81	–260
3040	Recoveries of prior year unpaid obligations, unexpired		–1

3050	Unpaid obligations, end of year	4	2	2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3	4	2
3200	Obligated balance, end of year	4	2	2

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	81	259
	Outlays, gross:
4100	Outlays from new mandatory authority	81	259
4101	Outlays from mandatory balances		1

4110	Outlays, gross (total)	81	260
4180	Budget authority, net (total)	81	259
4190	Outlays, net (total)	81	260

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


Identification code 075–0118–0–1–551		2017 actual	2018 est.	2019 est.

	Direct loan reestimates:
135002	Startup Loans	–65	–8
135003	Solvency Loans	38	252

135999	Total direct loan reestimates	–27	244

	Administrative expense data:
3580	Outlays from balances		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.


Identification code 075–0118–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	1
41.0	Grants, subsidies, and contributions	81	259

99.9	Total new obligations, unexpired accounts	82	259


Identification code 075–4418–0–3–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
	Credit program obligations:
0713	Payment of interest to Treasury	18	18	15
0742	Downward reestimates paid to receipt accounts	99	14
0743	Interest on downward reestimates	8	1

0900	Total new obligations, unexpired accounts	125	33	15

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	523	143
1021	Recoveries of prior year unpaid obligations		3
1022	Capital transfer of unobligated balances to general fund	–1
1023	Unobligated balances applied to repay debt	–478	–143
1024	Unobligated balance of borrowing authority withdrawn		–3

1050	Unobligated balance (total)	44
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	121	15
	Spending authority from offsetting collections, mandatory:
1800	Collected	103	369	114
1801	Change in uncollected payments, Federal sources		–1
1825	Spending authority from offsetting collections applied to repay debt		–350	–99

1850	Spending auth from offsetting collections, mand (total)	103	18	15
1900	Budget authority (total)	224	33	15
1930	Total budgetary resources available	268	33	15
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	143

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3	3
3010	New obligations, unexpired accounts	125	33	15
3020	Outlays (gross)	–125	–33	–15
3040	Recoveries of prior year unpaid obligations, unexpired		–3

3050	Unpaid obligations, end of year	3
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1	–1
3070	Change in uncollected pymts, Fed sources, unexpired		1

3090	Uncollected pymts, Fed sources, end of year	–1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2	2
3200	Obligated balance, end of year	2

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	224	33	15
	Financing disbursements:
4110	Outlays, gross (total)	125	33	15
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources	–80	–259
4122	Interest on uninvested funds	–6	–2	–1
4123	Non-Federal sources	–17	–108	–113

4130	Offsets against gross budget authority and outlays (total)	–103	–369	–114
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired		1

4160	Budget authority, net (mandatory)	121	–335	–99
4170	Outlays, net (mandatory)	22	–336	–99
4180	Budget authority, net (total)	121	–335	–99
4190	Outlays, net (total)	22	–336	–99


Identification code 075–4418–0–3–551		2017 actual	2018 est.	2019 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	1,909	1,893	1,785
1251	Repayments: Repayments and prepayments	–16	–108	–112
1263	Write-offs for default: Direct loans			–493

1290	Outstanding, end of year	1,893	1,785	1,180


Identification code 075–4418–0–3–551		2016 actual	2017 actual

	ASSETS:
	Federal assets:
1101	Fund balances with Treasury	506	16
	Investments in US securities:
1106	Receivables, net	81
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross	1,909	1,893
1402	Interest receivable	12	20
1405	Allowance for subsidy cost (-)	–1,284	–1,278

1499	Net present value of assets related to direct loans	637	635

1999	Total assets	1,224	651
	LIABILITIES:
2103	Federal liabilities: Debt	1,224	651

4999	Total liabilities and net position	1,224	651


Identification code 075–4482–0–3–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
	Credit program obligations:
0713	Payment of interest to Treasury	6	6	5
0742	Downward reestimates paid to receipt accounts	19
0743	Interest on downward reestimates	1

0900	Total new obligations, unexpired accounts	26	6	5

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	101	32	1
1021	Recoveries of prior year unpaid obligations	2	3
1023	Unobligated balances applied to repay debt	–93	–32
1024	Unobligated balance of borrowing authority withdrawn		–3

1050	Unobligated balance (total)	10		1
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	30	7	9
	Spending authority from offsetting collections, mandatory:
1800	Collected	31	138	4
1801	Change in uncollected payments, Federal sources	–13	–1
1825	Spending authority from offsetting collections applied to repay debt		–137	–4

1850	Spending auth from offsetting collections, mand (total)	18
1900	Budget authority (total)	48	7	9
1930	Total budgetary resources available	58	7	10
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	32	1	5

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	34	4	1
3010	New obligations, unexpired accounts	26	6	5
3020	Outlays (gross)	–54	–6	–5
3040	Recoveries of prior year unpaid obligations, unexpired	–2	–3

3050	Unpaid obligations, end of year	4	1	1
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–14	–1
3070	Change in uncollected pymts, Fed sources, unexpired	13	1

3090	Uncollected pymts, Fed sources, end of year	–1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	20	3	1
3200	Obligated balance, end of year	3	1	1

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	48	7	9
	Financing disbursements:
4110	Outlays, gross (total)	54	6	5
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources	–29	–134
4122	Interest on uninvested funds	–2	–2	–2
4123	Non-Federal sources		–2	–2

4130	Offsets against gross budget authority and outlays (total)	–31	–138	–4
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired	13	1

4160	Budget authority, net (mandatory)	30	–130	5
4170	Outlays, net (mandatory)	23	–132	1
4180	Budget authority, net (total)	30	–130	5
4190	Outlays, net (total)	23	–132	1


Identification code 075–4482–0–3–551		2017 actual	2018 est.	2019 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	451	480	478
1231	Disbursements: Direct loan disbursements	29
1251	Repayments: Repayments and prepayments		–2	–2
1263	Write-offs for default: Direct loans			–138

1290	Outstanding, end of year	480	478	338


Identification code 075–4482–0–3–551		2016 actual	2017 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	124	9
1206	Non-Federal assets: Receivables, net	17	4
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross	451	480
1402	Interest receivable	2
1405	Allowance for subsidy cost (-)	–281	–291

1499	Net present value of assets related to direct loans	172	189

1999	Total assets	313	202
	LIABILITIES:
2104	Federal liabilities: Resources payable to Treasury	293	202
2207	Non-Federal liabilities: Other	20

2999	Total liabilities	313	202

4999	Total liabilities and net position	313	202

Trust Funds


Identification code 075–8005–0–7–571		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	158,585	160,218	164,640
0198	Unavailable unobligated balance adjustment	127
0198	Adjustment for change in allocation		–197

0199	Balance, start of year	158,712	160,021	164,640
	Receipts:
	Current law:
1110	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	237,667	240,175	255,083
1110	FHI Trust Fund, Receipts from Railroad Retirement Board	606	567	587
1110	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	17,657	18,396	19,544
1110	FHI Trust Fund, Civil Penalties and Damages	446	641	683
1130	FHI Trust Fund, Other Proprietary Interest from the Public	1	2	2
1130	FHI Trust Fund, Basic Premium, Medicare Advantage	389	398	429
1130	FHI Trust Fund, Medicare Refunds	5,841	6,300	6,350
1130	Affordable Care Act Medicare Shared Savings Models (HI)	1	3	3
1130	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,492	3,733	3,948
1140	FHI Trust Fund, Federal Employer Contributions (FICA)	3,733	3,838	3,937
1140	FHI Trust Fund, Postal Service Employer Contributions (FICA)	683	639	625
1140	FHI Trust Fund, Interest Received by Trust Funds	7,423	7,168	6,880
1140	FHI Trust Fund, Taxation on OASDI Benefits	24,206	23,684	24,943
1140	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	131	135	147
1140	FHI Trust Fund, Transfers from General Fund (criminal Fines)	12	109	150
1140	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	46	51	52
1140	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	25	30	31
1140	FHI Trust Fund, Interest Payments by Railroad Retirement Board	31	26	28
1140	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	1,973	1,323	1,330

1199	Total current law receipts	304,363	307,218	324,752
	Proposed:
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–2
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		–50	2
1230	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible			–190
1240	FHI Trust Fund, Interest Received by Trust Funds		32	270
1240	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)			2

1299	Total proposed receipts		–18	82

1999	Total receipts	304,363	307,200	324,834

2000	Total: Balances and receipts	463,075	467,221	489,474
	Appropriations:
	Current law:
2101	Federal Hospital Insurance Trust Fund	–2,110	–1,933	–2,022
2101	Federal Hospital Insurance Trust Fund	–300,240	–305,249	–325,008
2101	Health Care Fraud and Abuse Control Account	–725	–725	–770
2101	Health Care Fraud and Abuse Control Account	–1,320	–1,320	–1,186
2132	Federal Hospital Insurance Trust Fund	7
2132	Health Care Fraud and Abuse Control Account	50	50
2134	Federal Hospital Insurance Trust Fund	1,449	6,614	2

2199	Total current law appropriations	–302,889	–302,563	–328,984
	Proposed:
2201	Federal Hospital Insurance Trust Fund		33	270
2201	Federal Hospital Insurance Trust Fund			192
2203	Federal Hospital Insurance Trust Fund		–33	–270
2203	Federal Hospital Insurance Trust Fund		–18	13,083

2299	Total proposed appropriations		–18	13,275

2999	Total appropriations	–302,889	–302,581	–315,709
5098	Unavailable unobligated balance adjustment	32

5099	Balance, end of year	160,218	164,640	173,765


Identification code 075–8005–0–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Benefit payments, HI	297,122	297,842	323,801
0002	HIT Incentive Payments	648	65	20
0003	Administration, HI	2,580	2,130	2,227
0004	Quality improvement organizations, HI	552	522	980

0799	Total direct obligations	300,902	300,559	327,028

0900	Total new obligations, unexpired accounts	300,902	300,559	327,028

	Budgetary resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	2
1033	Recoveries of prior year paid obligations	6

1050	Unobligated balance (total)	8
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	2,110	1,933	2,022
1130	Appropriations permanently reduced		–9

1160	Appropriation, discretionary (total)	2,110	1,924	2,022
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	300,240	305,249	325,008
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)	–7
1234	Appropriations precluded from obligation	–1,449	–6,614	–2

1260	Appropriations, mandatory (total)	298,784	298,635	325,006
1900	Budget authority (total)	300,894	300,559	327,028
1930	Total budgetary resources available	300,902	300,559	327,028

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	31,859	35,193	35,141
3001	Adjustments to unpaid obligations, brought forward, Oct 1		197
3010	New obligations, unexpired accounts	300,902	300,559	327,028
3020	Outlays (gross)	–297,566	–300,808	–327,099
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	35,193	35,141	35,070
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	31,859	35,390	35,141
3200	Obligated balance, end of year	35,193	35,141	35,070

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,110	1,924	2,022
	Outlays, gross:
4010	Outlays from new discretionary authority	1,254	1,230	1,357
4011	Outlays from discretionary balances		906	709

4020	Outlays, gross (total)	1,254	2,136	2,066
	Mandatory:
4090	Budget authority, gross	298,784	298,635	325,006
	Outlays, gross:
4100	Outlays from new mandatory authority	269,052	267,101	293,667
4101	Outlays from mandatory balances	27,260	31,571	31,366

4110	Outlays, gross (total)	296,312	298,672	325,033
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–6
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	6

4160	Budget authority, net (mandatory)	298,784	298,635	325,006
4170	Outlays, net (mandatory)	296,306	298,672	325,033
4180	Budget authority, net (total)	300,894	300,559	327,028
4190	Outlays, net (total)	297,560	300,808	327,099

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	192,209	197,835	200,449
5001	Total investments, EOY: Federal securities: Par value	197,835	200,449	209,551


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	300,894	300,559	327,028
	Outlays	297,560	300,808	327,099
Legislative proposal, subject to PAYGO:
	Budget Authority		18	–13,275
	Outlays		18	–13,275
Total:
	Budget Authority	300,894	300,577	313,753
	Outlays	297,560	300,826	313,824

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

In addition, the Budget includes a package of targeted Medicare proposals designed to eliminate wasteful Federal spending, reduce provider burden, and address fraud and abuse. This package strengthens the solvency of the Hospital Insurance Trust Fund.


Identification code 075–8005–0–7–571		2017 actual	2018 est.	2019 est.

	Unexpended balance, start of year:
0100	Balance, start of year	192,518	197,520	201,343

0999	Total balance, start of year	192,518	197,520	201,343
	Cash income during the year:
	Current law:
	Receipts:
1110	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	237,667	240,175	255,083
1110	FHI Trust Fund, Receipts from Railroad Retirement Board	606	567	587
1110	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	17,657	18,396	19,544
1110	FHI Trust Fund, Civil Penalties and Damages	446	641	683
1130	FHI Trust Fund, Basic Premium, Medicare Advantage	389	398	429
1130	FHI Trust Fund, Medicare Refunds	5,841	6,300	6,350
1130	Affordable Care Act Medicare Shared Savings Models (HI)	1	3	3
1130	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,492	3,733	3,948
1130	Federal Hospital Insurance Trust Fund	6
1150	FHI Trust Fund, Interest Received by Trust Funds	7,423	7,168	6,880
1150	FHI Trust Fund, Other Proprietary Interest from the Public	1	2	2
1150	FHI Trust Fund, Interest Payments by Railroad Retirement Board	31	26	28
1160	FHI Trust Fund, Federal Employer Contributions (FICA)	3,733	3,838	3,937
1160	FHI Trust Fund, Postal Service Employer Contributions (FICA)	683	639	625
1160	FHI Trust Fund, Taxation on OASDI Benefits	24,206	23,684	24,943
1160	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	131	135	147
1160	FHI Trust Fund, Transfers from General Fund (criminal Fines)	12	109	150
1160	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	46	51	52
1160	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	25	30	31
1160	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	1,973	1,323	1,330

1199	Income under present law	304,369	307,218	324,752
	Proposed:
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–2
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		–50	2
	Offsetting receipts (proprietary):
1230	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible			–190
1250	FHI Trust Fund, Interest Received by Trust Funds		32	270
	Offsetting governmental receipts:
1260	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)			2

1299	Income proposed		–18	82

1999	Total cash income	304,369	307,200	324,834
	Cash outgo during year:
	Current law:
2100	Federal Hospital Insurance Trust Fund [009–38–8005–0]	–297,566	–300,808	–327,099
2100	Health Care Fraud and Abuse Control Account [009–38–8393–0]	–1,802	–2,542	–2,228

2199	Outgo under current law	–299,368	–303,350	–329,327
	Proposed:
2200	Federal Hospital Insurance Trust Fund		–18	13,275

2299	Outgo under proposed legislation		–18	13,275

2999	Total cash outgo (-)	–299,368	–303,368	–316,052
	Surplus or deficit::
3110	Excluding interest	–2,454	–3,396	1,602
3120	Interest	7,455	7,228	7,180

3199	Subtotal, surplus or deficit	5,001	3,832	8,782
3220	Federal Hospital Insurance Trust Fund		–9
3298	Rounding adjustment	1

3299	Total adjustments	1	–9

3999	Total change in fund balance	5,002	3,823	8,782
	Unexpended balance, end of year::
4100	Uninvested balance (net), end of year	–315	894	574
4200	Federal Hospital Insurance Trust Fund	197,835	200,449	209,551

4999	Total balance, end of year	197,520	201,343	210,125


Identification code 075–8005–0–7–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activities	552	522	980
42.0	Insurance claims and indemnities (benefits)	297,770	297,907	323,821
94.0	Financial transfers	2,580	2,130	2,227

99.9	Total new obligations, unexpired accounts	300,902	300,559	327,028


Identification code 075–8005–0–7–571		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	2	3	3


Identification code 075–8005–2–7–571		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		–33	–270
1203	Appropriation (previously unavailable)		33	270
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–8005–4–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Benefit payments, HI			–13,293
0003	Administration, HI		18	18

0799	Total direct obligations		18	–13,275

0900	Total new obligations, unexpired accounts		18	–13,275

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–192
1203	Appropriation (previously unavailable)		18	–13,083

1260	Appropriations, mandatory (total)		18	–13,275
1900	Budget authority (total)		18	–13,275
1930	Total budgetary resources available		18	–13,275

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		18	–13,275
3020	Outlays (gross)		–18	13,275

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		18	–13,275
	Outlays, gross:
4100	Outlays from new mandatory authority		18	–13,275
4180	Budget authority, net (total)		18	–13,275
4190	Outlays, net (total)		18	–13,275


Identification code 075–8005–4–7–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
42.0	Insurance claims and indemnities (benefits)			–13,293
94.0	Financial transfers		18	18

99.9	Total new obligations, unexpired accounts		18	–13,275

In addition to amounts otherwise available for program integrity and program management, $770,000,000, to remain available through September 30, 2020, 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 $604,389,000 shall be for the Centers for Medicare and Medicaid Services program integrity activities, of which $87,230,000 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 $78,381,000 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 2019 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 $454,000,000 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.


Identification code 075–8393–0–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Medicare integrity program	795	877	917
0002	FBI fraud and abuse control	131	135	147
0003	Other fraud and abuse control	279	286	313
0005	Undistributed Savings, HCFAC and SSA		–28	–191

0091	Total Mandatory	1,205	1,270	1,186
0101	CMS discretionary	614	569	604
0102	Other discretionary	156	156	166

0191	Total Discretionary	770	725	770

0900	Total new obligations, unexpired accounts	1,975	1,995	1,956

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	406	430	430
1001	Discretionary unobligated balance brought fwd, Oct 1	248	199
1021	Recoveries of prior year unpaid obligations	10

1050	Unobligated balance (total)	416	430	430
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	725	725	770
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1,320	1,320	1,186
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–50	–50

1260	Appropriations, mandatory (total)	1,270	1,270	1,186
1900	Budget authority (total)	1,995	1,995	1,956
1930	Total budgetary resources available	2,411	2,425	2,386
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	430	430	430
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	6
1952	Expired unobligated balance, start of year	39	28	28
1953	Expired unobligated balance, end of year	22	28	28

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,617	1,764	1,217
3010	New obligations, unexpired accounts	1,975	1,995	1,956
3020	Outlays (gross)	–1,802	–2,542	–2,228
3040	Recoveries of prior year unpaid obligations, unexpired	–10
3041	Recoveries of prior year unpaid obligations, expired	–16

3050	Unpaid obligations, end of year	1,764	1,217	945
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,617	1,764	1,217
3200	Obligated balance, end of year	1,764	1,217	945

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	725	725	770
	Outlays, gross:
4010	Outlays from new discretionary authority	122	725	770
4011	Outlays from discretionary balances	485	83

4020	Outlays, gross (total)	607	808	770
	Mandatory:
4090	Budget authority, gross	1,270	1,270	1,186
	Outlays, gross:
4100	Outlays from new mandatory authority	497	897	754
4101	Outlays from mandatory balances	698	837	704

4110	Outlays, gross (total)	1,195	1,734	1,458
4180	Budget authority, net (total)	1,995	1,995	1,956
4190	Outlays, net (total)	1,802	2,542	2,228

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.


Identification code 075–8393–0–7–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent (CMS)	46	46	46
12.1	Civilian personnel benefits (CMS)	12	12	12
23.3	Communications, utilities, and miscellaneous charges	12	12	12
25.2	Other services (CMS/Medicaid)	68	82	114
25.3	Other purchases of goods and services from Government accounts (HHS/DOJ)	132	132	143
25.3	Other purchases of goods and services from Government accounts (HHS/OIG)	274	279	302
25.3	Other purchases of goods and services from Government accounts (HHS/OGC)	7	7	7
25.3	Other goods and services from Federal sources (HHS/CMS)	8	19	21
25.3	Other goods and services from Government accounts (HHS/FDA)	5	5	5
25.6	Medical care (CMS)	1,280	1,294	1,338
92.0	Undistributed		–28	–191
94.0	Financial transfers (FBI)	131	135	147

99.9	Total new obligations, unexpired accounts	1,975	1,995	1,956


Identification code 075–8393–0–7–571		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	481	403	403


Identification code 075–8004–0–7–571		2017 actual	2018 est.	2019 est.

0100	Balance, start of year	39,603	47,105	75,604
0198	Obligated balance (unpaid obligations) adjustment		–298

0199	Balance, start of year	39,603	46,807	75,604
	Receipts:
	Current law:
1110	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	4,147	5,997	2,826
1130	Other Proprietary Interest from the Public, FSMI Fund	7	3	3
1130	Premiums Collected for Medicare Prescription Drug Account, FSMI	4,936	5,240	5,656
1130	Payments from States, Medicare Prescription Drug Account, FSMI	11,072	11,938	12,558
1130	Basic Premium, Medicare Advantage, FSMI Trust Fund	457	492	553
1130	Medicare Refunds, SMI	5,011	5,242	5,292
1130	Affordable Care Act Medicare Shared Savings Models, SMI	1	3	3
1130	Premiums Collected for the Aged, FSMI Fund	67,357	78,021	84,296
1130	Premiums Collected for the Disabled, FSMI Fund	12,326	12,461	12,648
1140	Federal Contributions, FSMI Fund	227,879	244,685	263,711
1140	Interest Received by Trust Fund, FSMI Fund	2,262	1,227	1,210
1140	Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI		3	4
1140	Interest, Medicare Prescription Drug Account, FSMI	53	22	15
1140	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	–131	422	642
1140	Federal Contributions for Benefits, Prescription Drug Account, SMI	78,791	71,915	73,171
1140	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	2	1	1

1199	Total current law receipts	414,170	437,672	462,589
	Proposed:
1230	Premiums Collected for Medicare Prescription Drug Account, FSMI			922
1230	Payments from States, Medicare Prescription Drug Account, FSMI			–160
1230	Premiums Collected for the Aged, FSMI Fund			–711
1230	Premiums Collected for the Disabled, FSMI Fund			–107
1240	Federal Contributions, FSMI Fund			–2,484
1240	Federal Contributions for Benefits, Prescription Drug Account, SMI		–39	156

1299	Total proposed receipts		–39	–2,384

1999	Total receipts	414,170	437,633	460,205

2000	Total: Balances and receipts	453,773	484,440	535,809
	Appropriations:
	Current law:
2101	Federal Supplementary Medical Insurance Trust Fund	–3,314	–3,441	–3,032
2101	Federal Supplementary Medical Insurance Trust Fund	–315,747	–351,477	–368,115
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–402	–413	–634
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–94,837	–82,347	–90,808
2134	Federal Supplementary Medical Insurance Trust Fund	7,632	28,862	8,453

2199	Total current law appropriations	–406,668	–408,816	–454,136
	Proposed:
2201	Federal Supplementary Medical Insurance Trust Fund			2,523
2201	Federal Supplementary Medical Insurance Trust Fund			974
2201	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund			–918
2203	Federal Supplementary Medical Insurance Trust Fund			–2,523
2203	Federal Supplementary Medical Insurance Trust Fund		–20
2234	Federal Supplementary Medical Insurance Trust Fund			2,308

2299	Total proposed appropriations		–20	2,364

2999	Total appropriations	–406,668	–408,836	–451,772

5099	Balance, end of year	47,105	75,604	84,037


Identification code 075–8004–0–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Benefit payments, SMI	310,129	321,129	357,948
0002	Transfer to Medicaid for payment of SMI premiums	652	1,000	1,054
0003	HIT Incentive Payments	435
0004	Administration, SMI	2,825	3,663	3,213
0005	Quality Improvement Organizations, SMI	502	252	472

0799	Total direct obligations	314,543	326,044	362,687

0900	Total new obligations, unexpired accounts	314,543	326,044	362,687

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			6
1021	Recoveries of prior year unpaid obligations	2
1033	Recoveries of prior year paid obligations	5

1050	Unobligated balance (total)	7		6
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	3,314	3,441	3,032
1130	Appropriations permanently reduced		–6

1160	Appropriation, discretionary (total)	3,314	3,435	3,032
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	315,747	351,477	368,115
1234	Appropriations precluded from obligation	–7,632	–28,862	–8,453
1236	Appropriations applied to repay debt	–613

1260	Appropriations, mandatory (total)	307,502	322,615	359,662
	Borrowing authority, mandatory:
1400	Borrowing authority	3,720
1900	Budget authority (total)	314,536	326,050	362,694
1930	Total budgetary resources available	314,543	326,050	362,700
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		6	13

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	25,829	26,303	26,434
3001	Adjustments to unpaid obligations, brought forward, Oct 1		268
3010	New obligations, unexpired accounts	314,543	326,044	362,687
3020	Outlays (gross)	–314,067	–326,181	–362,834
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	26,303	26,434	26,287
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	25,829	26,571	26,434
3200	Obligated balance, end of year	26,303	26,434	26,287

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,314	3,435	3,032
	Outlays, gross:
4010	Outlays from new discretionary authority	1,806	2,030	2,026
4011	Outlays from discretionary balances	2,371	1,455	1,060

4020	Outlays, gross (total)	4,177	3,485	3,086
	Mandatory:
4090	Budget authority, gross	311,222	322,615	359,662
	Outlays, gross:
4100	Outlays from new mandatory authority	287,121	298,783	330,446
4101	Outlays from mandatory balances	22,769	23,913	29,302

4110	Outlays, gross (total)	309,890	322,696	359,748
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–5
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	5

4160	Budget authority, net (mandatory)	311,222	322,615	359,662
4170	Outlays, net (mandatory)	309,885	322,696	359,748
4180	Budget authority, net (total)	314,536	326,050	362,694
4190	Outlays, net (total)	314,062	326,181	362,834

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	63,336	70,589	95,789
5001	Total investments, EOY: Federal securities: Par value	70,589	95,789	102,490
5080	Outstanding debt, SOY	–3,289	–6,396	–6,396
5081	Outstanding debt, EOY	–6,396	–6,396	–6,396
5082	Borrowing	–3,720


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	314,536	326,050	362,694
	Outlays	314,062	326,181	362,834
Legislative proposal, subject to PAYGO:
	Budget Authority		20	–3,282
	Outlays		20	–3,282
Total:
	Budget Authority	314,536	326,070	359,412
	Outlays	314,062	326,201	359,552

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 targeted Medicare proposals designed to improve drug pricing and payment, address opioids, eliminate wasteful Federal spending and spending on government-imposed provider burdens, address fraud and abuse, and reform the Medicare appeals process.


Identification code 075–8004–0–7–571		2017 actual	2018 est.	2019 est.

	Unexpended balance, start of year:
0100	Balance, start of year	62,774	68,008	96,789

0999	Total balance, start of year	62,774	68,008	96,789
	Cash income during the year:
	Current law:
	Receipts:
1110	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	4,147	5,997	2,826
1130	Premiums Collected for Medicare Prescription Drug Account, FSMI	4,936	5,240	5,656
1130	Payments from States, Medicare Prescription Drug Account, FSMI	11,072	11,938	12,558
1130	Basic Premium, Medicare Advantage, FSMI Trust Fund	457	492	553
1130	Medicare Refunds, SMI	5,011	5,242	5,292
1130	Affordable Care Act Medicare Shared Savings Models, SMI	1	3	3
1130	Premiums Collected for the Aged, FSMI Fund	67,357	78,021	84,296
1130	Premiums Collected for the Disabled, FSMI Fund	12,326	12,461	12,648
1130	Federal Supplementary Medical Insurance Trust Fund	5
1130	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	380
1150	Interest Received by Trust Fund, FSMI Fund	2,262	1,227	1,210
1150	Other Proprietary Interest from the Public, FSMI Fund	7	3	3
1150	Interest, Medicare Prescription Drug Account, FSMI	53	22	15
1160	Federal Contributions, FSMI Fund	227,879	244,685	263,711
1160	Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI		3	4
1160	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	–131	422	642
1160	Federal Contributions for Benefits, Prescription Drug Account, SMI	78,791	71,915	73,171
1160	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	2	1	1

1199	Income under present law	414,555	437,672	462,589
	Proposed:
	Offsetting receipts (proprietary):
1230	Premiums Collected for Medicare Prescription Drug Account, FSMI			922
1230	Payments from States, Medicare Prescription Drug Account, FSMI			–160
1230	Premiums Collected for the Aged, FSMI Fund			–711
1230	Premiums Collected for the Disabled, FSMI Fund			–107
	Offsetting governmental receipts:
1260	Federal Contributions, FSMI Fund			–2,484
1260	Federal Contributions for Benefits, Prescription Drug Account, SMI		–39	156

1299	Income proposed		–39	–2,384

1999	Total cash income	414,555	437,633	460,205
	Cash outgo during year:
	Current law:
2100	Federal Supplementary Medical Insurance Trust Fund [009–38–8004–0]	–314,067	–326,181	–362,834
2100	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009–38–8308–0]	–95,254	–82,645	–91,245

2199	Outgo under current law	–409,321	–408,826	–454,079
	Proposed:
2200	Federal Supplementary Medical Insurance Trust Fund		–20	3,282
2200	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund			–918

2299	Outgo under proposed legislation		–20	2,364

2999	Total cash outgo (-)	–409,321	–408,846	–451,715
	Surplus or deficit::
3110	Excluding interest	2,912	27,535	7,262
3120	Interest	2,322	1,252	1,228

3199	Subtotal, surplus or deficit	5,234	28,787	8,490
3220	Federal Supplementary Medical Insurance Trust Fund		–6

3299	Total adjustments		–6

3999	Total change in fund balance	5,234	28,781	8,490
	Unexpended balance, end of year::
4100	Uninvested balance (net), end of year	–2,581	1,000	2,789
4200	Federal Supplementary Medical Insurance Trust Fund	70,589	95,789	102,490

4999	Total balance, end of year	68,008	96,789	105,279


Identification code 075–8004–0–7–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	1
41.0	Payment for Quality Improvement Organization (QIO) activity	502	252	472
42.0	Insurance claims and indemnities	310,781	322,129	359,002
94.0	Financial transfers	3,260	3,662	3,212

99.0	Direct obligations	314,543	326,044	362,687

99.9	Total new obligations, unexpired accounts	314,543	326,044	362,687


Identification code 075–8004–0–7–571		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	5	8	8


Identification code 075–8004–2–7–571		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–2,523
1203	Appropriation (previously unavailable)			2,523
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–8004–4–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Benefit payments, SMI			–3,302
0004	Administration, SMI		20	20

0799	Total direct obligations		20	–3,282

0900	Total new obligations, unexpired accounts		20	–3,282

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–974
1203	Appropriation (previously unavailable)		20
1234	Appropriations precluded from obligation			–2,308

1260	Appropriations, mandatory (total)		20	–3,282
1900	Budget authority (total)		20	–3,282
1930	Total budgetary resources available		20	–3,282

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		20	–3,282
3020	Outlays (gross)		–20	3,282

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		20	–3,282
	Outlays, gross:
4100	Outlays from new mandatory authority		20	–3,282
4180	Budget authority, net (total)		20	–3,282
4190	Outlays, net (total)		20	–3,282


Identification code 075–8004–4–7–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
42.0	Insurance claims and indemnities			–3,302
94.0	Financial transfers		20	20

99.0	Direct obligations		20	–3,282

99.9	Total new obligations, unexpired accounts		20	–3,282


Identification code 075–8308–0–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Prescription Drug Benefits	88,263	82,340	85,996
0002	Administrative Costs	405	422	642

0799	Total direct obligations	88,668	82,762	86,638

0900	Total new obligations, unexpired accounts	88,668	82,762	86,638

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		2
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	402	413	634
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	94,837	82,347	90,808
	Spending authority from offsetting collections, mandatory:
1801	Change in uncollected payments, Federal sources	–6,569
1900	Budget authority (total)	88,670	82,760	91,442
1930	Total budgetary resources available	88,670	82,762	91,442
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2		4,804
	Special and non-revolving trust funds:
1952	Expired unobligated balance, start of year	41	3	3
1953	Expired unobligated balance, end of year	3	3	3

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	14,638	8,402	8,546
3001	Adjustments to unpaid obligations, brought forward, Oct 1		27
3010	New obligations, unexpired accounts	88,668	82,762	86,638
3011	Obligations ("upward adjustments"), expired accounts	420
3020	Outlays (gross)	–95,254	–82,645	–91,245
3041	Recoveries of prior year unpaid obligations, expired	–70

3050	Unpaid obligations, end of year	8,402	8,546	3,939
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–14,110	–7,541	–7,541
3070	Change in uncollected pymts, Fed sources, unexpired	6,569

3090	Uncollected pymts, Fed sources, end of year	–7,541	–7,541	–7,541
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	528	888	1,005
3200	Obligated balance, end of year	861	1,005	–3,602

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	402	413	634
	Outlays, gross:
4010	Outlays from new discretionary authority	246	221	319
4011	Outlays from discretionary balances	2	72	113

4020	Outlays, gross (total)	248	293	432
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources	–380
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts	380

4070	Budget authority, net (discretionary)	402	413	634
4080	Outlays, net (discretionary)	–132	293	432
	Mandatory:
4090	Budget authority, gross	88,268	82,347	90,808
	Outlays, gross:
4100	Outlays from new mandatory authority	80,633	74,212	81,405
4101	Outlays from mandatory balances	14,373	8,140	9,408

4110	Outlays, gross (total)	95,006	82,352	90,813
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	6,569
4180	Budget authority, net (total)	95,239	82,760	91,442
4190	Outlays, net (total)	94,874	82,645	91,245


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	95,239	82,760	91,442
	Outlays	94,874	82,645	91,245
Legislative proposal, subject to PAYGO:
	Budget Authority			918
	Outlays			918
Total:
	Budget Authority	95,239	82,760	92,360
	Outlays	94,874	82,645	92,163

Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug benefit. The Budget includes a package of proposals designed to modernize the Part D benefit by realigning incentives and enhancing benefit management.


Identification code 075–8308–0–7–571		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.2	Other services from non-Federal sources	405	422	642
42.0	Insurance claims and indemnities	88,263	82,340	85,996

99.0	Direct obligations	88,668	82,762	86,638

99.9	Total new obligations, unexpired accounts	88,668	82,762	86,638


Identification code 075–8308–0–7–571		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	3	4	4


Identification code 075–8308–4–7–571		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Prescription Drug Benefits			918

0799	Total direct obligations			918

0900	Total new obligations, unexpired accounts (object class 42.0)			918

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			918
1900	Budget authority (total)			918
1930	Total budgetary resources available			918

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			918
3020	Outlays (gross)			–918

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			918
	Outlays, gross:
4100	Outlays from new mandatory authority			918
4180	Budget authority, net (total)			918
4190	Outlays, net (total)			918

Federal Funds


Identification code 075–1552–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	State family assistance grant	16,432	16,433	16,433
0002	Territories - family assistance grants	78	78	78
0006	Tribal work programs	8	8	8
0009	Healthy marriage and responsible fatherhood grants	144	148	150
0010	Evaluation Funding and What Works Clearinghouse	44	45	45
0011	Census Bureau Research	10	10	10

0900	Total new obligations, unexpired accounts	16,716	16,722	16,724

	Budgetary resources:
	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	16,739
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–21	–15	–15

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,037	7,772	8,163
3010	New obligations, unexpired accounts	16,716	16,722	16,724
3011	Obligations ("upward adjustments"), expired accounts	5
3020	Outlays (gross)	–15,974	–16,331	–16,511
3041	Recoveries of prior year unpaid obligations, expired	–12

3050	Unpaid obligations, end of year	7,772	8,163	8,376
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,037	7,772	8,163
3200	Obligated balance, end of year	7,772	8,163	8,376

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	16,737	16,737	16,739
	Outlays, gross:
4100	Outlays from new mandatory authority	11,468	12,072	12,073
4101	Outlays from mandatory balances	4,506	4,259	4,438

4110	Outlays, gross (total)	15,974	16,331	16,511
4180	Budget authority, net (total)	16,737	16,737	16,739
4190	Outlays, net (total)	15,974	16,331	16,511


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	16,737	16,737	16,739
	Outlays	15,974	16,331	16,511
Legislative proposal, subject to PAYGO:
	Budget Authority			–1,602
	Outlays			–1,155
Total:
	Budget Authority	16,737	16,737	15,137
	Outlays	15,974	16,331	15,356

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). The Consolidated Appropriations Act, 2017 (P.L. 115–31) authorized TANF for fiscal years 2017 and 2018. The Budget proposes to create a comprehensive demonstration opportunity for states to grow capacity across public safety net benefit programs to reduce dependency; continue and modify TANF to refocus the program on the core principle of promoting employment; continue the 0.33 percent set-aside for TANF evaluation, research, and technical assistance; and to reduce the authorized funding for TANF Family Assistance Grants to States, territories, and tribes by 10 percent.


Identification code 075–1552–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	6	7	7
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1

11.9	Total personnel compensation	8	8	8
12.1	Civilian personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	71	68	67
25.3	Other goods and services from Federal sources	2	7	7
25.4	Operation and maintenance of facilities	1
25.7	Operation and maintenance of equipment	1	1	1
41.0	Grants, subsidies, and contributions	16,629	16,634	16,637

99.9	Total new obligations, unexpired accounts	16,716	16,722	16,724


Identification code 075–1552–0–1–609		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	105	106	106


Identification code 075–1552–4–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	State family assistance grant			–1,594
0002	Territories - family assistance grants			–8

0900	Total new obligations, unexpired accounts (object class 41.0)			–1,602

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–1,602
1930	Total budgetary resources available			–1,602

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–1,602
3020	Outlays (gross)			1,155

3050	Unpaid obligations, end of year			–447
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			–447

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1,602
	Outlays, gross:
4100	Outlays from new mandatory authority			–1,155
4180	Budget authority, net (total)			–1,602
4190	Outlays, net (total)			–1,155


Identification code 075–1522–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Contingency Fund for State Welfare Programs	608	608	608

0900	Total new obligations (object class 41.0)	608	608	608

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	608	608	608
1900	Budget authority (total)	608	608	608
1930	Total budgetary resources available	608	608	608

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	72	113	95
3010	New obligations, unexpired accounts	608	608	608
3020	Outlays (gross)	–567	–626	–609

3050	Unpaid obligations, end of year	113	95	94
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	72	113	95
3200	Obligated balance, end of year	113	95	94

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	608	608	608
	Outlays, gross:
4100	Outlays from new mandatory authority	529	545	545
4101	Outlays from mandatory balances	38	81	64

4110	Outlays, gross (total)	567	626	609
4180	Budget authority, net (total)	608	608	608
4190	Outlays, net (total)	567	626	609


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	608	608	608
	Outlays	567	626	609
Legislative proposal, subject to PAYGO:
	Budget Authority			–608
	Outlays			–545
Total:
	Budget Authority	608	608
	Outlays	567	626	64


Identification code 075–1522–4–1–609		2017 actual	2018 est.	2019 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)			545

3050	Unpaid obligations, end of year			–63
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			–63

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–608
	Outlays, gross:
4100	Outlays from new mandatory authority			–545
4180	Budget authority, net (total)			–608
4190	Outlays, net (total)			–545

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), $2,922,247,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2020, $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.


Identification code 075–1501–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	State child support administrative costs	3,826	3,901	3,890
0002	Child support incentive payments	572	581	589
0003	Access and visitation grants	10	10	10

0091	Subtotal, child support enforcement	4,408	4,492	4,489
0102	Payments to territories	33	33	33
0103	Repatriation	3	1	1

0191	Subtotal, other payments	36	34	34

0799	Total direct obligations	4,444	4,526	4,523
0801	Offset obligations (CSE grants to States)	10	13	13

0900	Total new obligations, unexpired accounts	4,454	4,539	4,536

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		35	22
1021	Recoveries of prior year unpaid obligations	187	200	200
1029	Other balances withdrawn to Treasury	–32

1050	Unobligated balance (total)	155	235	222
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3,011	2,926	2,922
	Advance appropriations, mandatory:
1270	Advance appropriation	1,300	1,400	1,400
	Spending authority from offsetting collections, mandatory:
1800	Collected	23		13
1900	Budget authority (total)	4,334	4,326	4,335
1930	Total budgetary resources available	4,489	4,561	4,557
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	35	22	21

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,093	1,262	1,395
3010	New obligations, unexpired accounts	4,454	4,539	4,536
3020	Outlays (gross)	–4,098	–4,206	–4,271
3040	Recoveries of prior year unpaid obligations, unexpired	–187	–200	–200

3050	Unpaid obligations, end of year	1,262	1,395	1,460
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,093	1,262	1,395
3200	Obligated balance, end of year	1,262	1,395	1,460

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,334	4,326	4,335
	Outlays, gross:
4100	Outlays from new mandatory authority	3,663	3,676	3,686
4101	Outlays from mandatory balances	435	530	585

4110	Outlays, gross (total)	4,098	4,206	4,271
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–23		–13
4180	Budget authority, net (total)	4,311	4,326	4,322
4190	Outlays, net (total)	4,075	4,206	4,258


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	4,311	4,326	4,322
	Outlays	4,075	4,206	4,258
Legislative proposal, subject to PAYGO:
	Budget Authority			76
	Outlays			76
Total:
	Budget Authority	4,311	4,326	4,398
	Outlays	4,075	4,206	4,334

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.


Identification code 075–1501–0–1–609		2017 actual	2018 est.	2019 est.

41.0	Direct obligations: Grants, subsidies, and contributions	4,444	4,526	4,523
99.0	Reimbursable obligations	10	13	13

99.9	Total new obligations, unexpired accounts	4,454	4,539	4,536


Identification code 075–1501–4–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	State child support administrative costs			76

0091	Subtotal, child support enforcement			76

0799	Total direct obligations			76

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			76
1900	Budget authority (total)			76
1930	Total budgetary resources available			76

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			76
3020	Outlays (gross)			–76

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			76
	Outlays, gross:
4100	Outlays from new mandatory authority			76
4180	Budget authority, net (total)			76
4190	Outlays, net (total)			76


Identification code 075–1501–4–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.1	Advisory and assistance services			120
41.0	Grants, subsidies, and contributions			–44

99.0	Direct obligations			76

99.9	Total new obligations, unexpired accounts			76


Identification code 075–1502–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	LIHEAP Block Grant	3,394	3,367

	Budgetary resources:
	Unobligated balance:
1012	Unobligated balance transfers between expired and unexpired accounts	3
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	4
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,390	3,367
1930	Total budgetary resources available	3,394	3,367

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,229	1,421	1,517
3010	New obligations, unexpired accounts	3,394	3,367
3020	Outlays (gross)	–3,183	–3,271	–1,079
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–18

3050	Unpaid obligations, end of year	1,421	1,517	438
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,229	1,421	1,517
3200	Obligated balance, end of year	1,421	1,517	438

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,390	3,367
	Outlays, gross:
4010	Outlays from new discretionary authority	2,170	2,155
4011	Outlays from discretionary balances	1,013	1,116	1,079

4020	Outlays, gross (total)	3,183	3,271	1,079
4180	Budget authority, net (total)	3,390	3,367
4190	Outlays, net (total)	3,183	3,271	1,079


Identification code 075–1502–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.1	Advisory and assistance services	3	3
41.0	Grants, subsidies, and contributions	3,391	3,364

99.9	Total new obligations, unexpired accounts	3,394	3,367

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"), and the Torture Victims Relief Act of 1998, $1,242,311,000, of which $1,212,821,000 shall remain available through September 30, 2021 for carrying out such sections 414, 501, 462, and 235: Provided, That amounts available under this heading to carry out 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.

In addition, $200,000,000 shall be available to carry out such sections 235 and 462: (1) if, at any point during this fiscal year the Secretary has transferred from other accounts to this account an amount equal to at least 3 percent of the amount appropriated to this account in the first paragraph, and has determined that such transfers are needed to support caseloads that are higher than average; (2) if the Secretary has determined that, in each of two consecutive months during this fiscal year, the number of unaccompanied alien children transferred to the custody of the Secretary pursuant to such section 235 has increased from the number so transferred in the previous month, and that, in the second of such months, the number so transferred is at least 120 percent of the number so transferred in the first of such months; and (3) if the Secretary has determined that, for each of two non-overlapping seven-day periods during the two-month period, the average number of unaccompanied alien children in the custody of the Office of Refugee Resettlement who are discharged in a day is less than 1.2 percent of the average number of such children who are in such custody in a day.


Identification code 075–1503–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Refugee and entrant assistance	705	692	514
0002	Assistance for treatment of torture victims	11	11	11
0003	Unaccompanied Children	1,395	942	798
0005	Trafficking Victims program	11	19	19

0900	Total new obligations, unexpired accounts	2,122	1,664	1,342

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	98	190	190
1011	Unobligated balance transfer from other acct [075–0125]	300
1011	Unobligated balance transfer from other acct [075–1536]	6
1011	Unobligated balance transfer from other acct [075–0350]	2
1021	Recoveries of prior year unpaid obligations	72

1050	Unobligated balance (total)	478	190	190
	Budget authority:
	Appropriations, discretionary:
1100	Base Appropriation	1,676	1,664	1,242
1100	UAC Contingency Fund			100
1121	Appropriations transferred from other acct [075–9912]	1
1121	Appropriations transferred from other acct [075–1536]	39
1121	Appropriations transferred from other acct [075–1700]	1
1121	Appropriations transferred from other acct [075–0142]	4
1121	Appropriations transferred from other acct [075–1362]	8
1121	Appropriations transferred from other acct [075–0943]	14
1121	Appropriations transferred from other acct [075–0350]	14
1121	Appropriations transferred from other acct [075–9915]	72
1121	Appropriations transferred from other acct [075–0140]	4

1160	Appropriation, discretionary (total)	1,833	1,664	1,342
	Spending authority from offsetting collections, discretionary:
1700	Collected	8
1900	Budget authority (total)	1,841	1,664	1,342
1930	Total budgetary resources available	2,319	1,854	1,532
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–7
1941	Unexpired unobligated balance, end of year	190	190	190

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	996	1,003	888
3010	New obligations, unexpired accounts	2,122	1,664	1,342
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–2,007	–1,779	–1,442
3040	Recoveries of prior year unpaid obligations, unexpired	–72
3041	Recoveries of prior year unpaid obligations, expired	–37

3050	Unpaid obligations, end of year	1,003	888	788
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	996	1,003	888
3200	Obligated balance, end of year	1,003	888	788

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,841	1,664	1,342
	Outlays, gross:
4010	Outlays from new discretionary authority	1,260	1,082	872
4011	Outlays from discretionary balances	747	697	570

4020	Outlays, gross (total)	2,007	1,779	1,442
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–8
4180	Budget authority, net (total)	1,833	1,664	1,342
4190	Outlays, net (total)	1,999	1,779	1,442

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.


Identification code 075–1503–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	11	9	10
11.7	Military personnel		1	1

11.9	Total personnel compensation	11	10	11
12.1	Civilian personnel benefits	4	3	3
23.1	Rental payments to GSA	4	4	4
25.1	Advisory and assistance services	227	229	80
25.2	Other services from non-Federal sources	4	2	2
25.3	Other goods and services from Federal sources	37	23	23
41.0	Grants, subsidies, and contributions	1,835	1,393	1,219

99.9	Total new obligations, unexpired accounts	2,122	1,664	1,342


Identification code 075–1503–0–1–609		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	86	89	89
1101	Direct military average strength employment	7	11	11

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, $59,765,000.


Identification code 075–1512–0–1–506		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Grants to States and Tribes	343	343	364
0002	Research, training and technical assistance	8	7	8
0003	State court improvement activities	30	11	32
0004	Family Connection Grants	2	1	1
0005	Personal Responsibility Education (PREP)	70	17	9
0006	Abstinence Education	63

0900	Total new obligations, unexpired accounts	516	379	414

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	25	28	10
1012	Unobligated balance transfers between expired and unexpired accounts	1
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	29	28	10
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	60	59	60
1130	Appropriations permanently reduced		–20

1160	Appropriation, discretionary (total)	60	39	60
	Appropriations, mandatory:
1200	Appropriation	495	345	345
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–34	–23

1260	Appropriations, mandatory (total)	461	322	345
1900	Budget authority (total)	521	361	405
1930	Total budgetary resources available	550	389	415
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	28	10	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	563	595	478
3010	New obligations, unexpired accounts	516	379	414
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–465	–496	–434
3040	Recoveries of prior year unpaid obligations, unexpired	–3
3041	Recoveries of prior year unpaid obligations, expired	–18

3050	Unpaid obligations, end of year	595	478	458
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	563	595	478
3200	Obligated balance, end of year	595	478	458

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	60	39	60
	Outlays, gross:
4010	Outlays from new discretionary authority	18	12	21
4011	Outlays from discretionary balances	36	39	28

4020	Outlays, gross (total)	54	51	49
	Mandatory:
4090	Budget authority, gross	461	322	345
	Outlays, gross:
4100	Outlays from new mandatory authority	90	95	109
4101	Outlays from mandatory balances	321	350	276

4110	Outlays, gross (total)	411	445	385
4180	Budget authority, net (total)	521	361	405
4190	Outlays, net (total)	465	496	434


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	521	361	405
	Outlays	465	496	434
Legislative proposal, subject to PAYGO:
	Budget Authority			190
	Outlays			17
Total:
	Budget Authority	521	361	595
	Outlays	465	496	451

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 proposal to expand the Regional Partnership Grants program, a five-year reauthorization of Promoting Safe and Stable Families, and a one-year reauthorization, with modifications, of Abstinence Education and the Personal Responsibility Education Program (PREP).


Identification code 075–1512–0–1–506		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
25.1	Advisory and assistance services	12	7	7
25.3	Other goods and services from Federal sources	2	2	2
41.0	Grants, subsidies, and contributions	501	369	404

99.9	Total new obligations, unexpired accounts	516	379	414


Identification code 075–1512–0–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	11	10	10


Identification code 075–1512–4–1–506		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Grants to States and Tribes			40
0005	PREP			75
0006	Abstinence Education			75

0900	Total new obligations, unexpired accounts			190

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			190
1930	Total budgetary resources available			190

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			190
3020	Outlays (gross)			–17

3050	Unpaid obligations, end of year			173
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			173

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			190
	Outlays, gross:
4100	Outlays from new mandatory authority			17
4180	Budget authority, net (total)			190
4190	Outlays, net (total)			17


Identification code 075–1512–4–1–506		2017 actual	2018 est.	2019 est.

	Direct obligations:
23.1	Rental payments to GSA			1
25.1	Advisory and assistance services			10
25.3	Other goods and services from Federal sources			1
41.0	Grants, subsidies, and contributions			178

99.9	Total new obligations, unexpired accounts			190


Identification code 075–1512–4–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment			3


Identification code 075–1550–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Mandatory child care	1,178	1,178	1,178
0002	Matching child care	1,689	1,662	1,651
0003	Child Care Training and technical assistance	14	15	15
0004	Child care tribal grants	58	58	58
0005	Child Care Research	4	4	15

0900	Total new obligations, unexpired accounts	2,943	2,917	2,917

	Budgetary resources:
	Unobligated balance:
1012	Unobligated balance transfers between expired and unexpired accounts	27
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	2,917	2,917	2,917
1930	Total budgetary resources available	2,944	2,917	2,917
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,053	1,060	967
3010	New obligations, unexpired accounts	2,943	2,917	2,917
3020	Outlays (gross)	–2,905	–3,010	–2,943
3041	Recoveries of prior year unpaid obligations, expired	–31

3050	Unpaid obligations, end of year	1,060	967	941
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,053	1,060	967
3200	Obligated balance, end of year	1,060	967	941

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	2,917	2,917	2,917
	Outlays, gross:
4100	Outlays from new mandatory authority	2,137	2,174	2,167
4101	Outlays from mandatory balances	768	836	776

4110	Outlays, gross (total)	2,905	3,010	2,943
4180	Budget authority, net (total)	2,917	2,917	2,917
4190	Outlays, net (total)	2,905	3,010	2,943


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	2,917	2,917	2,917
	Outlays	2,905	3,010	2,943
Legislative proposal, subject to PAYGO:
	Budget Authority			671
	Outlays			499
Total:
	Budget Authority	2,917	2,917	3,588
	Outlays	2,905	3,010	3,442

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 Consolidated Appropriations Act, 2017 (P.L. 115–31). The Budget increases funding for this account to ensure federal funding for key child care programs is maintained, given the effects of other Budget proposals on child care spending.


Identification code 075–1550–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.1	Advisory and assistance services	7	7	18
25.3	Other goods and services from Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	2,935	2,909	2,898

99.9	Total new obligations, unexpired accounts	2,943	2,917	2,917


Identification code 075–1550–4–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0002	Matching child care			651
0003	Child Care Training and technical assistance			3
0004	Child care tribal grants			14
0005	Child Care Research			3

0900	Total new obligations, unexpired accounts			671

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			671
1930	Total budgetary resources available			671

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			671
3020	Outlays (gross)			–499

3050	Unpaid obligations, end of year			172
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			172

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			671
	Outlays, gross:
4100	Outlays from new mandatory authority			499
4180	Budget authority, net (total)			671
4190	Outlays, net (total)			499


Identification code 075–1550–4–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.1	Advisory and assistance services			7
41.0	Grants, subsidies, and contributions			664

99.9	Total new obligations, unexpired accounts			671

For carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $2,560,000,000 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: Provided further, That none of the funds provided under this heading may be used to implement the national toll-free hotline under section 658L(b) of the CCDBG Act.


Identification code 075–1515–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Child Care Block grant payments to States	2,845	2,827	2,547
0004	Child Care Research and evaluation fund	10	10	13

0900	Total new obligations, unexpired accounts	2,855	2,837	2,560

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,856	2,837	2,560
1930	Total budgetary resources available	2,856	2,837	2,560
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,071	1,122	1,109
3010	New obligations, unexpired accounts	2,855	2,837	2,560
3020	Outlays (gross)	–2,801	–2,850	–2,644
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	1,122	1,109	1,025
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,071	1,122	1,109
3200	Obligated balance, end of year	1,122	1,109	1,025

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,856	2,837	2,560
	Outlays, gross:
4010	Outlays from new discretionary authority	2,036	1,997	1,800
4011	Outlays from discretionary balances	765	853	844

4020	Outlays, gross (total)	2,801	2,850	2,644
4180	Budget authority, net (total)	2,856	2,837	2,560
4190	Outlays, net (total)	2,801	2,850	2,644

This program provides grants to States for child care subsidies for low-income working families and activities to improve child care quality.


Identification code 075–1515–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.1	Advisory and assistance services	22	21	23
25.3	Other goods and services from Federal sources		2	2
41.0	Grants, subsidies, and contributions	2,833	2,814	2,535

99.9	Total new obligations, unexpired accounts	2,855	2,837	2,560


Identification code 075–1534–0–1–506		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Social Services Block Grant	1,583	1,588	1,700
0002	Health Profession Opportunity Grants	79

0900	Total new obligations, unexpired accounts	1,662	1,588	1,700

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	32	31	22
1031	Other balances not available		–9

1050	Unobligated balance (total)	32	22	22
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,785	1,700	1,700
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–123	–112

1260	Appropriations, mandatory (total)	1,662	1,588	1,700
1930	Total budgetary resources available	1,694	1,610	1,722
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	31	22	22

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	480	468	435
3010	New obligations, unexpired accounts	1,662	1,588	1,700
3020	Outlays (gross)	–1,661	–1,621	–1,718
3041	Recoveries of prior year unpaid obligations, expired	–13

3050	Unpaid obligations, end of year	468	435	417
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	480	468	435
3200	Obligated balance, end of year	468	435	417

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,662	1,588	1,700
	Outlays, gross:
4100	Outlays from new mandatory authority	1,313	1,318	1,411
4101	Outlays from mandatory balances	348	303	307

4110	Outlays, gross (total)	1,661	1,621	1,718
4180	Budget authority, net (total)	1,662	1,588	1,700
4190	Outlays, net (total)	1,661	1,621	1,718


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	1,662	1,588	1,700
	Outlays	1,661	1,621	1,718
Legislative proposal, subject to PAYGO:
	Budget Authority			–1,615
	Outlays			–1,408
Total:
	Budget Authority	1,662	1,588	85
	Outlays	1,661	1,621	310

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.


Identification code 075–1534–0–1–506		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1
25.1	Advisory and assistance services	13
41.0	Grants, subsidies, and contributions	1,648	1,588	1,700

99.9	Total new obligations, unexpired accounts	1,662	1,588	1,700


Identification code 075–1534–0–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	8


Identification code 075–1534–4–1–506		2017 actual	2018 est.	2019 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


Identification code 075–1534–4–1–506		2017 actual	2018 est.	2019 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


Identification code 075–1534–4–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment			8

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; $10,323,890,000, of which $37,943,000, to remain available through September 30, 2020, 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, 2019: Provided, That $9,275,000,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, $21,905,000 shall be available for a cost of living adjustment notwithstanding section 640(a)(3)(A) of such Act: Provided further, That with respect to any subsequent continuing appropriations act, the previous proviso shall not be construed as an authority or condition under this Act and shall not apply in fiscal year 2020 to amounts provided by such a continuing appropriations act, notwithstanding any other law: Provided further, That of the amount identified in the first proviso, $14,000,000 shall be available to supplement funding otherwise available for research, evaluation, and federal administrative costs: Provided further, That of the amount identified in the first proviso, $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 the Head Start 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 funds described in the preceding proviso 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 notwithstanding any proviso under this heading in a prior Act making appropriations for a prior fiscal year (other than amounts that were designated by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget or the Balanced Budget and Emergency Deficit Control Act of 1985), any amount issued through a grant for the purposes described in the following proviso shall be included in any calculation of "base grant", as such term is used in section 640(a)(7)(A) of such Act, that affects the allocation of funds appropriated in this Act: Provided further, That the previous proviso applies to funds granted for Early Head Start programs as described in section 645A of the Head Start Act, for conversion of Head Start services to Early Head Start services as described in section 645(a)(5)(A) of such Act, and 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: Provided further, That the Secretary may reduce the reservation of funds under section 640(a)(2)(C) of such Act in lieu of reducing the reservation of funds under sections 640(a)(2)(B), 640(a)(2)(D), and 640(a)(2)(E) of such Act: Provided further, That $1,864,000 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.


Identification code 075–1536–0–1–506		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0101	Head Start	9,554	9,190	9,275
0102	Preschool Development Grants		498
0103	Runaway and homeless youth (basic centers)	54	53	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	39	40
0112	Child welfare services	268	267	269
0113	Child welfare training, research, or demonstration projects	18	18	18
0114	Adoption opportunities	39	39	39
0116	Adoption and Legal Guardianship Incentives	38	38	38
0117	Independent living education and training vouchers	43	43	43
0124	Native American programs	52	52	52
0125	Social services and income maintenance research	6	6	7
0128	ACF Federal administration	203	204	205
0131	Disaster human services case management	2	2	2

0191	Direct program activities, subtotal	10,440	10,572	10,165
0301	Community services block grant	707	710
0303	Rural community facilities	7	7
0304	Community economic development	20	20
0308	Domestic violence hotline	8	8	8
0309	Family violence prevention and services	151	150	151

0391	Direct program activities, subtotal	893	895	159

0400	Total, direct program	11,333	11,467	10,324

0799	Total direct obligations	11,333	11,467	10,324
0801	Children and Families Services Programs (Reimbursable)	21	21	21

0809	Reimbursable program activities, subtotal	21	21	21

0900	Total new obligations, unexpired accounts	11,354	11,488	10,345

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	426	330	81
1001	Discretionary unobligated balance brought fwd, Oct 1	426	330
1010	Unobligated balance transfer to other accts [075–1503]	–6

1050	Unobligated balance (total)	420	330	81
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	11,294	11,218	10,324
1120	Appropriations transferred to other accts [075–1503]	–39

1160	Appropriation, discretionary (total)	11,255	11,218	10,324
	Spending authority from offsetting collections, discretionary:
1700	Collected	19	19	19
1701	Change in uncollected payments, Federal sources	–1

1750	Spending auth from offsetting collections, disc (total)	18	19	19
	Spending authority from offsetting collections, mandatory:
1800	Collected	2	2	2
1801	Change in uncollected payments, Federal sources	1

1850	Spending auth from offsetting collections, mand (total)	3	2	2
1900	Budget authority (total)	11,276	11,239	10,345
1930	Total budgetary resources available	11,696	11,569	10,426
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–12
1941	Unexpired unobligated balance, end of year	330	81	81

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,620	8,269	7,693
3010	New obligations, unexpired accounts	11,354	11,488	10,345
3011	Obligations ("upward adjustments"), expired accounts	8
3020	Outlays (gross)	–10,623	–12,064	–10,978
3041	Recoveries of prior year unpaid obligations, expired	–90

3050	Unpaid obligations, end of year	8,269	7,693	7,060
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–8	–4	–4
3071	Change in uncollected pymts, Fed sources, expired	4

3090	Uncollected pymts, Fed sources, end of year	–4	–4	–4
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,612	8,265	7,689
3200	Obligated balance, end of year	8,265	7,689	7,056

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	11,273	11,237	10,343
	Outlays, gross:
4010	Outlays from new discretionary authority	4,064	4,732	4,357
4011	Outlays from discretionary balances	6,557	7,332	6,621

4020	Outlays, gross (total)	10,621	12,064	10,978
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–22	–22	–22

4040	Offsets against gross budget authority and outlays (total)	–22	–22	–22
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	1
4052	Offsetting collections credited to expired accounts	3	3	3

4060	Additional offsets against budget authority only (total)	4	3	3

4070	Budget authority, net (discretionary)	11,255	11,218	10,324
4080	Outlays, net (discretionary)	10,599	12,042	10,956
	Mandatory:
4090	Budget authority, gross	3	2	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	–2	–2
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–1
4170	Outlays, net (mandatory)		–2	–2
4180	Budget authority, net (total)	11,255	11,218	10,324
4190	Outlays, net (total)	10,599	12,040	10,954

The request totals $10.3 billion, including almost $9.3 billion for Head Start. This request discontinues funding for the Community Services Block Grant, Rural Community Facilities, and Community Economic Development.


Identification code 075–1536–0–1–506		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	113	116	114
11.3	Other than full-time permanent	4	4	4
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	118	121	119
12.1	Civilian personnel benefits	36	36	36
21.0	Travel and transportation of persons	3	3	3
23.1	Rental payments to GSA	10	17	16
23.3	Communications, utilities, and miscellaneous charges	1	2	2
25.1	Advisory and assistance services	235	238	237
25.2	Other services from non-Federal sources	9	9	8
25.3	Other goods and services from Federal sources	49	46	43
25.4	Operation and maintenance of facilities	1	2	2
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	10,870	10,992	9,857

99.0	Direct obligations	11,333	11,467	10,324
99.0	Reimbursable obligations	21	21	21

99.9	Total new obligations, unexpired accounts	11,354	11,488	10,345


Identification code 075–1536–0–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	1,149	1,142	1,122
1101	Direct military average strength employment	8	8	8
2001	Reimbursable civilian full-time equivalent employment	10	10	10


Identification code 075–1553–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Training and technical assistance	10	19	12
0002	Federal parent locator service	24	28	25

0799	Total direct obligations	34	47	37
0801	Federal Parent Locator Service reimbursable	24	31	32

0899	Total reimbursable obligations	24	31	32

0900	Total new obligations, unexpired accounts	58	78	69

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	12	12
1021	Recoveries of prior year unpaid obligations	2

1050	Unobligated balance (total)	14	12
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	37	37	37
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–3	–2

1260	Appropriations, mandatory (total)	34	35	37
	Spending authority from offsetting collections, mandatory:
1800	Collected	22	31	31
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)	22	31	32
1900	Budget authority (total)	56	66	69
1930	Total budgetary resources available	70	78	69
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	12

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	45	30	34
3010	New obligations, unexpired accounts	58	78	69
3020	Outlays (gross)	–71	–74	–83
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	30	34	20
	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	39	24	28
3200	Obligated balance, end of year	24	28	14

	Budget authority and outlays, net:
	Discretionary:
	Outlays, gross:
4011	Outlays from discretionary balances	3
	Mandatory:
4090	Budget authority, gross	56	66	69
	Outlays, gross:
4100	Outlays from new mandatory authority	36	46	47
4101	Outlays from mandatory balances	32	28	36

4110	Outlays, gross (total)	68	74	83
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–8	–9	–9
4123	Non-Federal sources	–14	–22	–22

4130	Offsets against gross budget authority and outlays (total)	–22	–31	–31

4160	Budget authority, net (mandatory)	34	35	38
4170	Outlays, net (mandatory)	46	43	52
4180	Budget authority, net (total)	34	35	38
4190	Outlays, net (total)	49	43	52

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	1	1	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	1	1

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). A set of proposals would provide additional access to the National Directory of New Hires.


Identification code 075–1553–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	7	8	9
12.1	Civilian personnel benefits	2	3	3
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	3	3	3
25.1	Advisory and assistance services	1	2
25.2	Other services from non-Federal sources	8	8	7
25.3	Other goods and services from Federal sources	6	12	6
25.7	Operation and maintenance of equipment	6	10	9

99.0	Direct obligations	34	47	38
99.0	Reimbursable obligations	24	31	31

99.9	Total new obligations, unexpired accounts	58	78	69


Identification code 075–1553–0–1–609		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	56	68	68


Identification code 075–1553–4–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Federal Parent Locator Service reimbursable			3

0899	Total reimbursable obligations			3

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected			3
1900	Budget authority (total)			3
1930	Total budgetary resources available			3

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			3
3020	Outlays (gross)			–3

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			3
	Outlays, gross:
4100	Outlays from new mandatory authority			3
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–3
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–1553–4–1–609		2017 actual	2018 est.	2019 est.

	Reimbursable obligations:
25.1	Advisory and assistance services			1
25.3	Other goods and services from Federal sources			2

99.0	Reimbursable obligations			3

99.9	Total new obligations, unexpired accounts			3


Identification code 075–1553–4–1–609		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment			2

For carrying out, except as otherwise provided, title IV-E of the Social Security Act, $6,035,000,000.

For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year 2020, $2,800,000,000.

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.


Identification code 075–1545–0–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Foster care	5,363	5,278	5,329
0002	Independent living	140	140	140
0004	Adoption assistance	2,706	2,861	3,063
0005	Guardianship	145	186	203
0006	Technical Assistance and Implementation Services for Tribal Programs	3	3	3

0900	Total new obligations, unexpired accounts	8,357	8,468	8,738

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	6,059	5,969	6,038
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–2	–1

1260	Appropriations, mandatory (total)	6,057	5,968	6,038
	Advance appropriations, mandatory:
1270	Advance appropriation	2,300	2,500	2,700
1900	Budget authority (total)	8,357	8,468	8,738
1930	Total budgetary resources available	8,357	8,468	8,738

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,113	1,611	1,813
3010	New obligations, unexpired accounts	8,357	8,468	8,738
3011	Obligations ("upward adjustments"), expired accounts	69
3020	Outlays (gross)	–7,712	–8,266	–8,597
3041	Recoveries of prior year unpaid obligations, expired	–216

3050	Unpaid obligations, end of year	1,611	1,813	1,954
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,113	1,611	1,813
3200	Obligated balance, end of year	1,611	1,813	1,954

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8,357	8,468	8,738
	Outlays, gross:
4100	Outlays from new mandatory authority	6,961	7,380	7,619
4101	Outlays from mandatory balances	751	886	978

4110	Outlays, gross (total)	7,712	8,266	8,597
4180	Budget authority, net (total)	8,357	8,468	8,738
4190	Outlays, net (total)	7,712	8,266	8,597


		2017 actual	2018 est.	2019 est.

Enacted/requested:
	Budget Authority	8,357	8,468	8,738
	Outlays	7,712	8,266	8,597
Legislative proposal, subject to PAYGO:
	Budget Authority			18
	Outlays			18
Total:
	Budget Authority	8,357	8,468	8,756
	Outlays	7,712	8,266	8,615

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 171,400 children per month are estimated to be served in FY 2019.

Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 496,300 children per month are estimated to be served in FY 2019.

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 35,600 children per month are estimated to be served in FY 2019.

The Budget includes proposals to create the Child Welfare Flexible Funding Option for title IV-E agencies, create a performance incentive for achieving or exceeding Child and Family Services Reviews outcomes, reform the requirement for title IV-E agencies to calculate the savings in costs based on obsolete adoption program criteria, and authorize tribal titles IV-B and IV-E agencies to access certain information from the Federal Parent Locator Service. Additionally, the Budget 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.


Identification code 075–1545–0–1–609		2017 actual	2018 est.	2019 est.

	Direct obligations:
21.0	Travel and transportation of persons		1	1
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	32	34	35
25.2	Other services from non-Federal sources	1
41.0	Grants, subsidies, and contributions	8,323	8,432	8,701

99.9	Total new obligations, unexpired accounts	8,357	8,468	8,738


Identification code 075–1545–0–1–609		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	3	4	4


Identification code 075–1545–4–1–609		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Foster care			4
0004	Adoption assistance			13
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

Federal 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, title VII (and section 14 with respect to such title) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals with disabilities, $1,781,181,000: 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 of amounts made available under this heading to carry out sections 311, 331, and 336 of the OAA, up to one percent of such amounts shall be available for developing and implementing evidence-based practices for enhancing senior nutrition: 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.


Identification code 075–0142–0–1–506		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0101	Aging Services Programs	1,468	1,438	1,463
0102	ACL Program Administration	39	39	38
0103	Integrated Aging and Disability Services Programs	43	43	41
0104	Disability Services Programs	284	283	239
0105	National Institute on Disability, Independent Living & Rehab Research	104	103

0300	Total, direct program	1,938	1,906	1,781

0799	Total direct obligations	1,938	1,906	1,781
0801	ACL Reimbursable Programs	90	90	18

0900	Total new obligations, unexpired accounts	2,028	1,996	1,799

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3	7	30
1012	Unobligated balance transfers between expired and unexpired accounts	1
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	5	7	30
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,919	1,906	1,781
1120	Appropriations transferred to other accts [012–3507]	–3
1120	Appropriations transferred to other acct [075–1503]	–4
1121	Appropriations transferred from other acct [075–0116]		25

1160	Appropriation, discretionary (total)	1,912	1,931	1,781
	Appropriations, mandatory:
1221	PPHF Appropriations transferred from other accounts [075–0116]	28
	Spending authority from offsetting collections, discretionary:
1700	Collected	7	65	18
1701	Change in uncollected payments, Federal sources	60

1750	Spending auth from offsetting collections, disc (total)	67	65	18
	Spending authority from offsetting collections, mandatory:
1800	Collected	1	23
1801	Change in uncollected payments, Federal sources	23

1850	Spending auth from offsetting collections, mand (total)	24	23
1900	Budget authority (total)	2,031	2,019	1,799
1930	Total budgetary resources available	2,036	2,026	1,829
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	7	30	30

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,261	1,269	1,224
3010	New obligations, unexpired accounts	2,028	1,996	1,799
3011	Obligations ("upward adjustments"), expired accounts	8
3020	Outlays (gross)	–1,995	–2,041	–1,984
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–32

3050	Unpaid obligations, end of year	1,269	1,224	1,039
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–163	–153	–153
3070	Change in uncollected pymts, Fed sources, unexpired	–83
3071	Change in uncollected pymts, Fed sources, expired	93

3090	Uncollected pymts, Fed sources, end of year	–153	–153	–153
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,098	1,116	1,071
3200	Obligated balance, end of year	1,116	1,071	886

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,979	1,996	1,799
	Outlays, gross:
4010	Outlays from new discretionary authority	1,013	1,214	1,126
4011	Outlays from discretionary balances	934	751	815

4020	Outlays, gross (total)	1,947	1,965	1,941
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–97	–65	–18
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–60
4052	Offsetting collections credited to expired accounts	90

4060	Additional offsets against budget authority only (total)	30

4070	Budget authority, net (discretionary)	1,912	1,931	1,781
4080	Outlays, net (discretionary)	1,850	1,900	1,923
	Mandatory:
4090	Budget authority, gross	52	23
	Outlays, gross:
4100	Outlays from new mandatory authority	1	5
4101	Outlays from mandatory balances	47	71	43

4110	Outlays, gross (total)	48	76	43
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–2	–23
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–23
4142	Offsetting collections credited to expired accounts	1

4150	Additional offsets against budget authority only (total)	–22

4160	Budget authority, net (mandatory)	28
4170	Outlays, net (mandatory)	46	53	43
4180	Budget authority, net (total)	1,940	1,931	1,781
4190	Outlays, net (total)	1,896	1,953	1,966

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.


Identification code 075–0142–0–1–506		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	22	21	17
12.1	Civilian personnel benefits	7	6	6
23.1	Rental payments to GSA	2	3	3
25.1	Advisory and assistance services	41	33	31
41.0	Grants, subsidies, and contributions	1,867	1,843	1,724

99.0	Direct obligations	1,939	1,906	1,781
99.0	Reimbursable obligations	89	90	18

99.9	Total new obligations, unexpired accounts	2,028	1,996	1,799


Identification code 075–0142–0–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	181	170	139
2001	Reimbursable civilian full-time equivalent employment	15	13	10


Identification code 075–0142–4–1–506		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0103	Integrated Aging and Disability Services Programs		25	25

0300	Total, direct program		25	25

0799	Total direct obligations		25	25

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected		25	25
1900	Budget authority (total)		25	25
1930	Total budgetary resources available		25	25

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		25	25
3020	Outlays (gross)		–25	–25

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		25	25
	Outlays, gross:
4100	Outlays from new mandatory authority		25	25
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–25	–25
4180	Budget authority, net (total)
4190	Outlays, net (total)

The Budget extends mandatory funding for ACL's Medicare Enrollment Assistance Programs through fiscal year 2019.


Identification code 075–0142–4–1–506		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	1
41.0	Grants, subsidies, and contributions		24	24

99.0	Direct obligations		25	25

99.9	Total new obligations, unexpired accounts		25	25


Identification code 075–0142–4–1–506		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment		4	6

Federal Funds

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, $289,545,000, together with $53,445,000 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 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).


Identification code 075–9912–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	General Departmental Management	461	458	290
0801	GDM Collected (Reimbursable)	153	195	191
0802	HCFAC (Mandatory)	7	7	10
0803	PHS Evaluation (Collected)	64	64	53
0804	MACRA (Mandatory)	5	5	5

0899	Total reimbursable obligations	229	271	259

0900	Total new obligations, unexpired accounts	690	729	549

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	10	11	11
1001	Discretionary unobligated balance brought fwd, Oct 1	10
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	461	458	290
1120	Appropriations transferred to other accts [075–1503]	–1

1160	Appropriation, discretionary (total)	460	458	290
	Spending authority from offsetting collections, discretionary:
1700	Collected	57	259	244
1701	Change in uncollected payments, Federal sources	163

1750	Spending auth from offsetting collections, disc (total)	220	259	244
	Spending authority from offsetting collections, mandatory:
1800	Collected		12	15
1801	Change in uncollected payments, Federal sources	12

1850	Spending auth from offsetting collections, mand (total)	12	12	15
1900	Budget authority (total)	692	729	549
1930	Total budgetary resources available	702	740	560
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	11	11	11

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	517	467	577
3010	New obligations, unexpired accounts	690	729	549
3011	Obligations ("upward adjustments"), expired accounts	10
3020	Outlays (gross)	–716	–619	–730
3041	Recoveries of prior year unpaid obligations, expired	–34

3050	Unpaid obligations, end of year	467	577	396
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–230	–296	–296
3070	Change in uncollected pymts, Fed sources, unexpired	–175
3071	Change in uncollected pymts, Fed sources, expired	109

3090	Uncollected pymts, Fed sources, end of year	–296	–296	–296
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	287	171	281
3200	Obligated balance, end of year	171	281	100

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	680	717	534
	Outlays, gross:
4010	Outlays from new discretionary authority	356	344	262
4011	Outlays from discretionary balances	349	263	453

4020	Outlays, gross (total)	705	607	715
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–158	–259	–244

4040	Offsets against gross budget authority and outlays (total)	–158	–259	–244
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–163
4052	Offsetting collections credited to expired accounts	101

4060	Additional offsets against budget authority only (total)	–62

4070	Budget authority, net (discretionary)	460	458	290
4080	Outlays, net (discretionary)	547	348	471
	Mandatory:
4090	Budget authority, gross	12	12	15
	Outlays, gross:
4100	Outlays from new mandatory authority	6	12	15
4101	Outlays from mandatory balances	5

4110	Outlays, gross (total)	11	12	15
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:	–3	–12	–15
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–12
4142	Offsetting collections credited to expired accounts	3

4150	Additional offsets against budget authority only (total)	–9
4170	Outlays, net (mandatory)	8
4180	Budget authority, net (total)	460	458	290
4190	Outlays, net (total)	555	348	471

Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation for 2019. 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.


Identification code 075–9912–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	86	87	88
11.3	Other than full-time permanent	10	10	10
11.5	Other personnel compensation	2	2	2
11.7	Military personnel	3	3	3

11.9	Total personnel compensation	101	102	103
12.1	Civilian personnel benefits	28	29	29
12.2	Military personnel benefits	1	1	1
21.0	Travel and transportation of persons	4	4	4
23.1	Rental payments to GSA	17	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	22	21	16
25.2	Other services from non-Federal sources	45	45	28
25.3	Other goods and services from Federal sources	70	67	31
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	2	2	2
31.0	Equipment	2	2	2
41.0	Grants, subsidies, and contributions	155	155	44

99.0	Direct obligations	461	458	290
99.0	Reimbursable obligations	229	271	259

99.9	Total new obligations, unexpired accounts	690	729	549


Identification code 075–9912–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	899	965	978
1101	Direct military average strength employment	18	27	27
2001	Reimbursable civilian full-time equivalent employment	503	529	504
2101	Reimbursable military average strength employment	22	24	24


Identification code 075–9912–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0804	DAB (Mandatory Proposal and User Fee Collections)			4

0899	Total reimbursable obligations			4

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected			4
1930	Total budgetary resources available			4

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			4
3020	Outlays (gross)			–4

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			4
	Outlays, gross:
4100	Outlays from new mandatory authority			4
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–4
4180	Budget authority, net (total)
4190	Outlays, net (total)

Legislative proposals provide the Departmental Appeals Board (DAB) mandatory resources to address the Medicare appeals backlog.


Identification code 075–9912–4–1–551		2017 actual	2018 est.	2019 est.

11.1	Reimbursable obligations: Personnel compensation: Full-time permanent			2

11.9	Total personnel compensation			2
25.3	Other goods and services from Federal sources			2

99.0	Reimbursable obligations			4

99.9	Total new obligations, unexpired accounts			4


Identification code 075–9912–4–1–551		2017 actual	2018 est.	2019 est.

2001	Reimbursable civilian full-time equivalent employment			14


Identification code 075–0146–0–1–551		2017 actual	2018 est.	2019 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.


Identification code 075–5627–0–2–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year			3
	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	3
	Appropriations:
	Current law:
2101	State Response to the Opioid Abuse Crisis, Cures Act	–500	–497

5099	Balance, end of year		3	3


Identification code 075–5627–0–2–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	500	497
1120	Appropriations transferred to other acct [075–1362]	–500	–497
4180	Budget authority, net (total)
4190	Outlays, net (total)

The 21st Century Cures Act authorized in 2017 and 2018 grants to states, the District of Columbia, and territories to develop and provide opioid abuse prevention, treatment, and recovery support services.


Identification code 075–0135–0–1–751		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Office for Civil Rights (Direct)	39	39	31
0801	Office for Civil Rights (Reimbursable)	8	9	13

0900	Total new obligations, unexpired accounts	47	48	44

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	24	36	37
1020	Adjustment of unobligated bal brought forward, Oct 1	–1

1050	Unobligated balance (total)	23	36	37
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	39	39	31
	Spending authority from offsetting collections, mandatory:
1800	Collected	20	10	10
1802	Offsetting collections (previously unavailable)	2
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–1

1850	Spending auth from offsetting collections, mand (total)	21	10	10
1900	Budget authority (total)	60	49	41
1930	Total budgetary resources available	83	85	78
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	36	37	34

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	14	18	19
3010	New obligations, unexpired accounts	47	48	44
3020	Outlays (gross)	–43	–47	–44

3050	Unpaid obligations, end of year	18	19	19
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1
3071	Change in uncollected pymts, Fed sources, expired	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	13	18	19
3200	Obligated balance, end of year	18	19	19

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	39	39	31
	Outlays, gross:
4010	Outlays from new discretionary authority	33	31	25
4011	Outlays from discretionary balances	4	7	8

4020	Outlays, gross (total)	37	38	33
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts	1

4060	Additional offsets against budget authority only (total)	1

4070	Budget authority, net (discretionary)	39	39	31
4080	Outlays, net (discretionary)	36	38	33
	Mandatory:
4090	Budget authority, gross	21	10	10
	Outlays, gross:
4100	Outlays from new mandatory authority		1	1
4101	Outlays from mandatory balances	6	8	10

4110	Outlays, gross (total)	6	9	11
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–20	–10	–10
4180	Budget authority, net (total)	40	39	31
4190	Outlays, net (total)	22	37	34

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	2	1	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	1	1	1

The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination, health information privacy, and security compliance programs.


Identification code 075–0135–0–1–751		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	16	17	16
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	17	18	17
12.1	Civilian personnel benefits	6	6	6
23.1	Rental payments to GSA	3	3	3
25.3	Other goods and services from Federal sources	11	10	4
25.4	Operation and maintenance of facilities	1	1	1
25.7	Operation and maintenance of equipment	1	1

99.0	Direct obligations	39	39	31
99.0	Reimbursable obligations	8	9	13

99.9	Total new obligations, unexpired accounts	47	48	44


Identification code 075–0135–0–1–751		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	149	152	147
1101	Direct military average strength employment	1	1	1
2001	Reimbursable civilian full-time equivalent employment	1	1	1

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.


Identification code 075–0130–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Health information technology (IT)	60	60	38
0002	Recovery Act activities	2

0799	Total direct obligations	62	60	38
0801	Office of the National Coordinator for Health IT (ONC): Reimbursable	19	19	15

0899	Total reimbursable obligations	19	19	15

0900	Total new obligations, unexpired accounts	81	79	53

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	60	60	38
	Spending authority from offsetting collections, discretionary:
1700	PHS and Other	9	19	15
1701	Change in uncollected payments, Federal sources	11

1750	Spending auth from offsetting collections, disc (total)	20	19	15
1900	Budget authority (total)	80	79	53
1930	Total budgetary resources available	82	80	54
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	93	68	26
3010	New obligations, unexpired accounts	81	79	53
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–105	–121	–61
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	68	26	18
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–27	–23	–23
3070	Change in uncollected pymts, Fed sources, unexpired	–11
3071	Change in uncollected pymts, Fed sources, expired	15

3090	Uncollected pymts, Fed sources, end of year	–23	–23	–23
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	66	45	3
3200	Obligated balance, end of year	45	3	–5

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	80	79	53
	Outlays, gross:
4010	Outlays from new discretionary authority	51	67	45
4011	Outlays from discretionary balances	54	54	16

4020	Outlays, gross (total)	105	121	61
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–24	–19	–15

4040	Offsets against gross budget authority and outlays (total)	–24	–19	–15
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–11
4052	Offsetting collections credited to expired accounts	15

4060	Additional offsets against budget authority only (total)	4

4070	Budget authority, net (discretionary)	60	60	38
4080	Outlays, net (discretionary)	81	102	46
4180	Budget authority, net (total)	60	60	38
4190	Outlays, net (total)	81	102	46

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 authorized in Title XXX of the PHS Act as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act (P.L. 111–5, Title XIII) and the 21st Century Cures Act (P.L. 114–255), 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.


Identification code 075–0130–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	18	17	17
11.3	Other than full-time permanent	2	2	2
11.5	Other personnel compensation	1	1	1

11.9	Total personnel compensation	21	20	20
12.1	Civilian personnel benefits	6	5	4
23.1	Rental payments to GSA	4	2	2
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.1	Advisory and assistance services	1
25.2	Other services from non-Federal sources	12	15	5
25.3	Other goods and services from Federal sources	13	16	6
25.4	Operation and maintenance of facilities	1	1
41.0	Grants, subsidies, and contributions	1

99.0	Direct obligations	60	60	38
99.0	Reimbursable obligations	21	19	15

99.9	Total new obligations, unexpired accounts	81	79	53


Identification code 075–0130–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	185	162	162
1101	Direct military average strength employment	2	2	2

For expenses necessary for the Office of Medicare Hearings and Appeals, $112,381,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund: Provided, That, in addition, of the amounts the Secretary retains for adjudications related to Recovery Audit Contractor (RAC) appeals under section 1893(h)(1)(C) of the Social Security Act, $10,000,000 shall be used as additional funds for the necessary expenses of the Office of Medicare Hearings and Appeals and the Departmental Appeals Board to process RAC-related appeals.


Identification code 075–0139–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Office of Medicare Hearings and Appeals (Direct)	107	107	112

0799	Total direct obligations	107	107	112
0801	Office of Medicare Hearings and Appeals (RAC Mandatory)			10

0900	Total new obligations, unexpired accounts	107	107	122

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	86	107	112
1701	Change in uncollected payments, Federal sources	21

1750	Spending auth from offsetting collections, disc (total)	107	107	112
	Spending authority from offsetting collections, mandatory:
1800	Collected			10
1900	Budget authority (total)	107	107	122
1930	Total budgetary resources available	107	107	122

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	30	28
3010	New obligations, unexpired accounts	107	107	122
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–106	–135	–122
3041	Recoveries of prior year unpaid obligations, expired	–4

3050	Unpaid obligations, end of year	28
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–43	–39	–39
3070	Change in uncollected pymts, Fed sources, unexpired	–21
3071	Change in uncollected pymts, Fed sources, expired	25

3090	Uncollected pymts, Fed sources, end of year	–39	–39	–39
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–13	–11	–39
3200	Obligated balance, end of year	–11	–39	–39

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	107	107	112
	Outlays, gross:
4010	Outlays from new discretionary authority	91	107	112
4011	Outlays from discretionary balances	15	28

4020	Outlays, gross (total)	106	135	112
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–111	–107	–112
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–21
4052	Offsetting collections credited to expired accounts	25

4060	Additional offsets against budget authority only (total)	4
4080	Outlays, net (discretionary)	–5	28
	Mandatory:
4090	Budget authority, gross			10
	Outlays, gross:
4100	Outlays from new mandatory authority			10
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–10
4180	Budget authority, net (total)
4190	Outlays, net (total)	–5	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.


Identification code 075–0139–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	55	61	63
11.5	Other personnel compensation		1	1

11.9	Total personnel compensation	55	62	64
12.1	Civilian personnel benefits	18	20	21
23.1	Rental payments to GSA	8	7	7
23.3	Communications, utilities, and miscellaneous charges	3	4	4
25.2	Other services from non-Federal sources	10	1	2
25.3	Other goods and services from Federal sources	9	10	11
25.4	Operation and maintenance of facilities	1	1	1
25.7	Operation and maintenance of equipment	1	1	1
26.0	Supplies and materials	1		1
31.0	Equipment	1	1

99.0	Direct obligations	107	107	112
99.0	Reimbursable obligations			10

99.9	Total new obligations, unexpired accounts	107	107	122


Identification code 075–0139–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	603	690	705
2001	Reimbursable civilian full-time equivalent employment			45


Identification code 075–0139–4–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Reimbursable program activity			129

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected			129
1930	Total budgetary resources available			129

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			129
3020	Outlays (gross)			–129

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			129
	Outlays, gross:
4100	Outlays from new mandatory authority			129
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–129
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. An additional legislative proposal would establish a post-adjudication user fee for Medicare Parts A and B claim appeals filed by a provider or supplier, or a State Medicaid Agency, with respect to appeals that are unfavorable to the appellant and for appeals that are dismissed.


Identification code 075–0139–4–1–551		2017 actual	2018 est.	2019 est.

	Reimbursable obligations:
11.1	Personnel compensation: Full-time permanent			28
12.1	Civilian personnel benefits			9
22.0	Transportation of things			1
23.1	Rental payments to GSA			4
23.3	Communications, utilities, and miscellaneous charges			8
25.2	Other services from non-Federal sources			25
25.3	Other goods and services from Federal sources			9
25.4	Operation and maintenance of facilities			38
26.0	Supplies and materials			2
31.0	Equipment			5

99.9	Total new obligations, unexpired accounts			129


Identification code 075–0139–4–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment			200

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, $941,523,000, 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, 2021: 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) and for carrying out section 319F-2(a) of the PHS Act, $1,085,000,000, 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, $202,378,000; of which $162,378,000 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.


Identification code 075–0140–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Public Health and Social Services Emergency Fund	2,307	1,597	2,229

0100	Direct program activities, subtotal	2,307	1,597	2,229
0801	Reimbursable program (FEMA)	76	104	104
0802	Reimbursable program activity (OPP)	2	2	2

0899	Total reimbursable obligations	78	106	106

0900	Total new obligations, unexpired accounts	2,385	1,703	2,335

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	945	123	63
1010	Unobligated balance transfer to other accts [075–0128]	–1
1010	Unobligated balance transfer to other accts [075–0343]	–2	–2	–3
1010	Unobligated balance transfer to other accts [075–0943]	–23
1010	Unobligated balance transfer to other accts [075–9915]	–66
1021	Recoveries of prior year unpaid obligations	64

1050	Unobligated balance (total)	917	121	60
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,518	1,563	2,229
1120	Appropriations transferred to other acct [075–1503]	–4

1160	Appropriation, discretionary (total)	1,514	1,563	2,229
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	82	82
1701	Change in uncollected payments, Federal sources	75

1750	Spending auth from offsetting collections, disc (total)	78	82	82
1900	Budget authority (total)	1,592	1,645	2,311
1930	Total budgetary resources available	2,509	1,766	2,371
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	123	63	36

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4,268	4,745	1,899
3010	New obligations, unexpired accounts	2,385	1,703	2,335
3011	Obligations ("upward adjustments"), expired accounts	12
3020	Outlays (gross)	–1,821	–4,549	–3,073
3040	Recoveries of prior year unpaid obligations, unexpired	–64
3041	Recoveries of prior year unpaid obligations, expired	–35

3050	Unpaid obligations, end of year	4,745	1,899	1,161
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–80	–107	–107
3070	Change in uncollected pymts, Fed sources, unexpired	–75
3071	Change in uncollected pymts, Fed sources, expired	48

3090	Uncollected pymts, Fed sources, end of year	–107	–107	–107
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4,188	4,638	1,792
3200	Obligated balance, end of year	4,638	1,792	1,054

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,592	1,645	2,311
	Outlays, gross:
4010	Outlays from new discretionary authority	283	1,641	2,306
4011	Outlays from discretionary balances	1,538	2,908	767

4020	Outlays, gross (total)	1,821	4,549	3,073
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–20	–82	–82
4033	Non-Federal sources	–31

4040	Offsets against gross budget authority and outlays (total)	–51	–82	–82
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–75
4052	Offsetting collections credited to expired accounts	48

4060	Additional offsets against budget authority only (total)	–27

4070	Budget authority, net (discretionary)	1,514	1,563	2,229
4080	Outlays, net (discretionary)	1,770	4,467	2,991
4180	Budget authority, net (total)	1,514	1,563	2,229
4190	Outlays, net (total)	1,770	4,467	2,991

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 (ASPR), as authorized by the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013. Funds will be used for hospital preparedness and other emergency preparedness activities including the National Disaster Medical System. The PHSSEF continues to support the advanced development and procurement of biodefense and pandemic influenza countermeasures. The FY 2019 Budget reflects the transfer of the Strategic National Stockpile (SNS) from the Centers for Disease Control and Prevention to ASPR.

The PHSSEF also supports the HHS Cybersecurity program, National Security and Strategic Information programs, and the Medical Reserve Corps.


Identification code 075–0140–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	73	88	126
11.3	Other than full-time permanent	18
11.7	Military personnel	8	9	8

11.9	Total personnel compensation	99	97	134
12.1	Civilian personnel benefits	25	32	46
12.2	Military personnel benefits	4	3	3
21.0	Travel and transportation of persons	8	6	17
22.0	Transportation of things	1		1
23.1	Rental payments to GSA	15	8	29
23.3	Communications, utilities, and miscellaneous charges	6	5	4
25.1	Advisory and assistance services	904	745	474
25.2	Other services from non-Federal sources	236	199	116
25.3	Other goods and services from Federal sources	69	54	222
25.4	Operation and maintenance of facilities	6	1	15
25.5	Research and development contracts	178	1	754
25.7	Operation and maintenance of equipment	21	18	91
26.0	Supplies and materials	449	358	38
31.0	Equipment	2	1	1
41.0	Grants, subsidies, and contributions	284	69	284

99.0	Direct obligations	2,307	1,597	2,229
99.0	Reimbursable obligations	78	106	106

99.9	Total new obligations, unexpired accounts	2,385	1,703	2,335


Identification code 075–0140–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	656	705	940
1101	Direct military average strength employment	75	75	75


Identification code 075–0145–0–1–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	AHRQ	57
0002	Office of the Secretary	26	28	27
0003	NIRSQ		79	50

0900	Total new obligations, unexpired accounts	83	107	77

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	55	88	106
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	56	88	106
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	115	125	155
1930	Total budgetary resources available	171	213	261
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	88	106	184

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	152	122	197
3010	New obligations, unexpired accounts	83	107	77
3020	Outlays (gross)	–112	–32	–98
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	122	197	176
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	152	122	197
3200	Obligated balance, end of year	122	197	176

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	115	125	155
	Outlays, gross:
4100	Outlays from new mandatory authority	2	4	5
4101	Outlays from mandatory balances	110	28	93

4110	Outlays, gross (total)	112	32	98
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–115	–125	–155
4180	Budget authority, net (total)
4190	Outlays, net (total)	–3	–93	–57

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 to carry out these activities. The FY 2019 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.


Identification code 075–0145–0–1–552		2017 actual	2018 est.	2019 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3	3	3
25.1	Advisory and assistance services	7	30	26
25.3	Other goods and services from Federal sources	22	31	31
41.0	Grants, subsidies, and contributions	51	43	17

99.9	Total new obligations, unexpired accounts	83	107	77


Identification code 075–0145–0–1–552		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	5	5	5


Identification code 075–0125–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Nonrecurring Expenses Fund Projects	526	397	175

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	830	565	693
1010	Unobligated balance transfer to other accts [075–1503]	–300
1012	Unobligated balance transfers between expired and unexpired accounts	652	525	450
1021	Recoveries of prior year unpaid obligations	9

1050	Unobligated balance (total)	1,191	1,090	1,143
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced	–100
1930	Total budgetary resources available	1,091	1,090	1,143
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	565	693	968

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	535	668	661
3010	New obligations, unexpired accounts	526	397	175
3020	Outlays (gross)	–384	–404	–307
3040	Recoveries of prior year unpaid obligations, unexpired	–9

3050	Unpaid obligations, end of year	668	661	529
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	535	668	661
3200	Obligated balance, end of year	668	661	529

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	–100
	Outlays, gross:
4011	Outlays from discretionary balances	384	404	307
4180	Budget authority, net (total)	–100
4190	Outlays, net (total)	384	404	307

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.


Identification code 075–0125–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
23.1	Rental payments to GSA	2	2	1
25.1	Advisory and assistance services	33	23	10
25.2	Other services from non-Federal sources	161	122	54
25.3	Other goods and services from Federal sources	26	20	9
25.4	Operation and maintenance of facilities	206	156	71
25.5	Research and development contracts	4	3	1
25.7	Operation and maintenance of equipment	13	10	5
31.0	Equipment	60	45	17
32.0	Land and structures	20	15	7

99.0	Direct obligations	525	396	175
99.5	Adjustment for rounding	1	1

99.9	Total new obligations, unexpired accounts	526	397	175


Identification code 075–0125–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	4	4


Identification code 075–0119–0–1–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	6	6
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	6	6	6
1930	Total budgetary resources available	6	6	6
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	6	6	6

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	19	17	15
3020	Outlays (gross)	–1	–2	–2
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	17	15	13
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	19	17	15
3200	Obligated balance, end of year	17	15	13

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	1	2	2
4180	Budget authority, net (total)
4190	Outlays, net (total)	1	2	2

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.


Identification code 075–0116–0–1–551		2017 actual	2018 est.	2019 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1120	Appropriations transferred to other acct [075–0142]		–25
1120	Appropriations transferred to other acct [075–0943]		–805
1120	Appropriations transferred to other acct [075–1362]		–11

1160	Appropriation, discretionary (total)		–841
	Appropriations, mandatory:
1200	Appropriation	1,000	900	800
1220	Appropriations transferred to other accts [075–0142]	–28
1220	Appropriations transferred to other accts [075–0943]	–891		–800
1220	Appropriations transferred to other accts [075–1362]	–12
1230	Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]	–69	–59

1260	Appropriations, mandatory (total)		841

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–841
	Mandatory:
4090	Budget authority, gross		841
4180	Budget authority, net (total)
4190	Outlays, net (total)

The Prevention and Public Health Fund supports prevention and public health activities. In FY 2019, $800 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.


Identification code 075–0117–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Pregnancy Assistance Fund (Direct)	23	23	25

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			2
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	25	25	25
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–2

1260	Appropriations, mandatory (total)	23	25	25
1930	Total budgetary resources available	23	25	27
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		2	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	28	28	27
3010	New obligations, unexpired accounts	23	23	25
3020	Outlays (gross)	–23	–24	–23

3050	Unpaid obligations, end of year	28	27	29
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	28	28	27
3200	Obligated balance, end of year	28	27	29

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	23	25	25
	Outlays, gross:
4100	Outlays from new mandatory authority		1
4101	Outlays from mandatory balances	23	23	23

4110	Outlays, gross (total)	23	24	23
4180	Budget authority, net (total)	23	25	25
4190	Outlays, net (total)	23	24	23

This appropriation funds competitive grants to States to assist pregnant and parenting teens and women.


Identification code 075–0117–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	1	1
41.0	Grants, subsidies, and contributions	22	22	25

99.9	Total new obligations, unexpired accounts	23	23	25


Identification code 075–0117–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	2	2	2


Identification code 075–3902–0–1–552		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Section 241 Evaluation Transactions Account (Reimbursable)	476	473	418

0809	Reimbursable program activities, subtotal	476	473	418

0900	Total new obligations (object class 25.3)	476	473	418

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	58	473	418
1701	Change in uncollected payments, Federal sources	418

1750	Spending auth from offsetting collections, disc (total)	476	473	418
1930	Total budgetary resources available	476	473	418

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	905	558	28
3010	New obligations, unexpired accounts	476	473	418
3011	Obligations ("upward adjustments"), expired accounts	200
3020	Outlays (gross)	–823	–1,003	–418
3041	Recoveries of prior year unpaid obligations, expired	–200

3050	Unpaid obligations, end of year	558	28	28
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–923	–555	–555
3070	Change in uncollected pymts, Fed sources, unexpired	–418
3071	Change in uncollected pymts, Fed sources, expired	786

3090	Uncollected pymts, Fed sources, end of year	–555	–555	–555
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–18	3	–527
3200	Obligated balance, end of year	3	–527	–527

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	476	473	418
	Outlays, gross:
4010	Outlays from new discretionary authority	58	473	418
4011	Outlays from discretionary balances	765	530

4020	Outlays, gross (total)	823	1,003	418
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–844	–473	–418

4040	Offsets against gross budget authority and outlays (total)	–844	–473	–418
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–418
4052	Offsetting collections credited to expired accounts	786

4060	Additional offsets against budget authority only (total)	368
4080	Outlays, net (discretionary)	–21	530
4180	Budget authority, net (total)
4190	Outlays, net (total)	–21	530

The Public Health Service (PHS) Act Evaluation Transactions account supports the execution of section 241 of the PHS Act.

Federal Funds

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.


Identification code 075–0379–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Retirement payments	441	455	469
0002	Survivors' benefits	30	31	32
0003	Medical care	122	121	128

0900	Total new obligations, unexpired accounts	593	607	629

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			12
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	593	619	629
1930	Total budgetary resources available	593	619	641
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		12	12

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	64	62	20
3010	New obligations, unexpired accounts	593	607	629
3011	Obligations ("upward adjustments"), expired accounts	12
3020	Outlays (gross)	–570	–649	–629
3041	Recoveries of prior year unpaid obligations, expired	–37

3050	Unpaid obligations, end of year	62	20	20
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	64	62	20
3200	Obligated balance, end of year	62	20	20

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	593	619	629
	Outlays, gross:
4100	Outlays from new mandatory authority	553	588	598
4101	Outlays from mandatory balances	17	61	31

4110	Outlays, gross (total)	570	649	629
4180	Budget authority, net (total)	593	619	629
4190	Outlays, net (total)	570	649	629

The number of beneficiaries using the Commissioned Corps system is estimated as follows:


	2017	2018	2019

Active Duty:
HHS	4821	4767	4748
DOJ, BOP	832	853	853
Homeland Security	488	646	740
EPA	55	56	56
All Other	283	289	308

Total Active Duty	6479	6611	6705

Retirees & Survivors:
Retirees	6162	6200	6150
Retiree family members and survivors	1127	1135	1125

Total Retirement Pay	7289	7335	7275
Total Beneficiaries (active duty, retirees, survivors)	13768	14059	14101

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.


Identification code 075–0379–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
13.0	Benefits for former personnel	471	486	501
25.6	Medical care	122	121	128

99.9	Total new obligations, unexpired accounts	593	607	629


Identification code 075–0170–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Medicare eligible accruals	28	33	30

0900	Total new obligations (object class 12.2)	28	33	30

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	28	33	30
1930	Total budgetary resources available	28	33	30

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	28	33	30
3020	Outlays (gross)	–28	–33	–30

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	28	33	30
	Outlays, gross:
4010	Outlays from new discretionary authority	28	33	30
4180	Budget authority, net (total)	28	33	30
4190	Outlays, net (total)	28	33	30

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).


Identification code 075–9913–0–1–551		2017 actual	2018 est.	2019 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)


Identification code 075–9941–0–4–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0801	Program Support Center	1,176	1,395	1,333
0802	OS activities	441	454	470

0900	Total new obligations, unexpired accounts	1,617	1,849	1,803

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	181	201	295
1021	Recoveries of prior year unpaid obligations	76	181	181

1050	Unobligated balance (total)	257	382	476
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,485	1,762	1,508
1701	Change in uncollected payments, Federal sources	76

1750	Spending auth from offsetting collections, disc (total)	1,561	1,762	1,508
1930	Total budgetary resources available	1,818	2,144	1,984
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	201	295	181

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	909	1,011	300
3010	New obligations, unexpired accounts	1,617	1,849	1,803
3020	Outlays (gross)	–1,439	–2,379	–1,508
3040	Recoveries of prior year unpaid obligations, unexpired	–76	–181	–181

3050	Unpaid obligations, end of year	1,011	300	414
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–460	–536	–536
3070	Change in uncollected pymts, Fed sources, unexpired	–76

3090	Uncollected pymts, Fed sources, end of year	–536	–536	–536
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	449	475	–236
3200	Obligated balance, end of year	475	–236	–122

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,561	1,762	1,508
	Outlays, gross:
4010	Outlays from new discretionary authority	857	1,762	1,508
4011	Outlays from discretionary balances	582	617

4020	Outlays, gross (total)	1,439	2,379	1,508
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1,178	–1,762	–1,508
4033	Non-Federal sources	–307

4040	Offsets against gross budget authority and outlays (total)	–1,485	–1,762	–1,508
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–76
4080	Outlays, net (discretionary)	–46	617
4180	Budget authority, net (total)
4190	Outlays, net (total)	–46	617

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.


Identification code 075–9941–0–4–551		2017 actual	2018 est.	2019 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	93	104	105
11.3	Other than full-time permanent	4	5	4
11.5	Other personnel compensation	3	3	3
11.7	Military personnel	6	7	7
11.8	Special personal services payments	9	8	9

11.9	Total personnel compensation	115	127	128
12.1	Civilian personnel benefits	31	33	34
12.2	Military personnel benefits	3	2	2
21.0	Travel and transportation of persons	2	4	2
22.0	Transportation of things	2	5	5
23.1	Rental payments to GSA	19	20	21
23.3	Communications, utilities, and miscellaneous charges	8	12	12
24.0	Printing and reproduction	5	6	6
25.1	Advisory and assistance services	122	165	172
25.2	Other services from non-Federal sources	1,102	1,165	1,147
25.3	Other goods and services from Federal sources	87	109	90
25.4	Operation and maintenance of facilities	10	20	14
25.6	Medical care	23	35	36
25.7	Operation and maintenance of equipment	45	66	66
26.0	Supplies and materials	39	75	63
31.0	Equipment	4	5	5

99.9	Total new obligations, unexpired accounts	1,617	1,849	1,803


Identification code 075–9941–0–4–551		2017 actual	2018 est.	2019 est.

2001	Reimbursable civilian full-time equivalent employment	930	930	930
2101	Reimbursable military average strength employment	71	71	71
3101	Allocation account military average strength employment	1,603	1,788	1,901

Trust Funds


Identification code 075–9971–0–7–551		2017 actual	2018 est.	2019 est.

0100	Balance, start of year			5
	Receipts:
	Current law:
1130	Contributions, Indian Health Facilities	14	48	48
1130	Contributions, N.I.H., Unconditional Gift Fund	6	3	3
1130	Centers for Disease Control, Gifts and Donations	20	15	15
1130	Contributions, N.I.H., Conditional Gift Fund	47	27	27
1130	Contributions to the Indian Health Service Gift Fund		1	1
1140	Interest, Miscellaneous Trust Funds	1	1	1

1199	Total current law receipts	88	95	95

1999	Total receipts	88	95	95

2000	Total: Balances and receipts	88	95	100
	Appropriations:
	Current law:
2101	Miscellaneous Trust Funds	–88	–90	–84

5099	Balance, end of year		5	16


Identification code 075–9971–0–7–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0002	Gifts	79	110	110
0003	Contributions, Indian Health Facilities	13	9	9

0900	Total new obligations, unexpired accounts	92	119	119

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	198	199	239
1021	Recoveries of prior year unpaid obligations	5	8	8
1033	Recoveries of prior year paid obligations		61	61

1050	Unobligated balance (total)	203	268	308
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	88	90	84
1930	Total budgetary resources available	291	358	392
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	199	239	273

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	61	72	41
3010	New obligations, unexpired accounts	92	119	119
3020	Outlays (gross)	–76	–142	–142
3040	Recoveries of prior year unpaid obligations, unexpired	–5	–8	–8

3050	Unpaid obligations, end of year	72	41	10
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	61	72	41
3200	Obligated balance, end of year	72	41	10

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	88	90	84
	Outlays, gross:
4100	Outlays from new mandatory authority	20	9	8
4101	Outlays from mandatory balances	56	133	134

4110	Outlays, gross (total)	76	142	142
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–61	–61
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts		61	61

4160	Budget authority, net (mandatory)	88	90	84
4170	Outlays, net (mandatory)	76	81	81
4180	Budget authority, net (total)	88	90	84
4190	Outlays, net (total)	76	81	81

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	21	34	34
5001	Total investments, EOY: Federal securities: Par value	34	34	34

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.


Identification code 075–9971–0–7–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	3	3	3
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	4	4	4
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	2	2	2
25.1	Advisory and assistance services	4	6	6
25.2	Other services from non-Federal sources	17	25	25
25.3	Other goods and services from Federal sources	7	7	7
25.5	Research and development contracts	5	5	5
25.6	Medical care	3	3	3
26.0	Supplies and materials	7	7	7
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	41	58	58

99.9	Total new obligations, unexpired accounts	92	119	119


Identification code 075–9971–0–7–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	35	35	35

Federal Funds

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, $80,000,000: 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.


Identification code 075–0128–0–1–551		2017 actual	2018 est.	2019 est.

	Obligations by program activity:
0001	Office of Inspector General (Direct)	81	81	80
0801	Office of Inspector General HCFAC Trust Fund	206	217	232
0802	Office of Inspector General (Direct Reimbursable)	16	21	21
0803	Office of Inspector General HCFAC Discretionary	86	88	87

0899	Total reimbursable obligations	308	326	340

0900	Total new obligations, unexpired accounts	389	407	420

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	34	41	20
1001	Discretionary unobligated balance brought fwd, Oct 1	1	7
1011	Unobligated balance transfer from other acct [075–0140]	1
1021	Recoveries of prior year unpaid obligations	13

1050	Unobligated balance (total)	48	41	20
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	80	80	80
1121	Appropriations transferred from other acct [075–9911]	2	1

1160	Appropriation, discretionary (total)	82	81	80
	Spending authority from offsetting collections, discretionary:
1700	Collected	96	103	109
1701	Change in uncollected payments, Federal sources	2

1750	Spending auth from offsetting collections, disc (total)	98	103	109
	Spending authority from offsetting collections, mandatory:
1800	Collected	209	202	220
1801	Change in uncollected payments, Federal sources	–7
1802	Offsetting collections (previously unavailable)	1
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–1

1850	Spending auth from offsetting collections, mand (total)	202	202	220
1900	Budget authority (total)	382	386	409
1930	Total budgetary resources available	430	427	429
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	41	20	9

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	67	78	104
3010	New obligations, unexpired accounts	389	407	420
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–363	–381	–413
3040	Recoveries of prior year unpaid obligations, unexpired	–13
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	78	104	111
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–130	–114	–114
3070	Change in uncollected pymts, Fed sources, unexpired	5
3071	Change in uncollected pymts, Fed sources, expired	11

3090	Uncollected pymts, Fed sources, end of year	–114	–114	–114
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–63	–36	–10
3200	Obligated balance, end of year	–36	–10	–3

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	180	184	189
	Outlays, gross:
4010	Outlays from new discretionary authority	151	168	172
4011	Outlays from discretionary balances	22	19	17

4020	Outlays, gross (total)	173	187	189
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–107	–103	–109
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2
4052	Offsetting collections credited to expired accounts	11

4060	Additional offsets against budget authority only (total)	9

4070	Budget authority, net (discretionary)	82	81	80
4080	Outlays, net (discretionary)	66	84	80
	Mandatory:
4090	Budget authority, gross	202	202	220
	Outlays, gross:
4100	Outlays from new mandatory authority	136	184	200
4101	Outlays from mandatory balances	54	10	24

4110	Outlays, gross (total)	190	194	224
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–199	–191	–208
4123	Non-Federal sources	–10	–11	–12

4130	Offsets against gross budget authority and outlays (total)	–209	–202	–220
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	7
4170	Outlays, net (mandatory)	–19	–8	4
4180	Budget authority, net (total)	82	81	80
4190	Outlays, net (total)	47	76	84

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	1	1	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	1	1	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.


Identification code 075–0128–0–1–551		2017 actual	2018 est.	2019 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	40	40	40
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1	1	1

11.9	Total personnel compensation	42	42	42
12.1	Civilian personnel benefits	16	16	16
21.0	Travel and transportation of persons	2	1	2
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	4	5	5
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.2	Other services from non-Federal sources	1	1	2
25.3	Other goods and services from Federal sources	8	8	7
25.4	Operation and maintenance of facilities	1	1	1
31.0	Equipment	5	5	5

99.0	Direct obligations	81	81	82
99.0	Reimbursable obligations	308	326	338

99.9	Total new obligations, unexpired accounts	389	407	420


Identification code 075–0128–0–1–551		2017 actual	2018 est.	2019 est.

1001	Direct civilian full-time equivalent employment	355	347	347
2001	Reimbursable civilian full-time equivalent employment	1,253	1,285	1,303


		2017 actual	2018 est.	2019 est.

Offsetting receipts from the public:
075–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	106	90	90
075–267403	Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies	127	15
075–275830	Downward Reestimates of Subsidies, Health Centers	1
075–310700	Federal Share of Child Support Collections	633	621	608
075–310700	Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO			11
075–322000	All Other General Fund Proprietary Receipts Including Budget Clearing Accounts	57	34	34
General Fund Offsetting receipts from the public		924	760	743


Intragovernmental payments:
075–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	87

General Fund Intragovernmental payments		87

(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.

(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.

(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.

(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.

(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 —

(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 —

(f) No effect on other laws.—This section does not affect other laws about reimbursable agreements.

(1) by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE.—A covered entity shall permit"

"(ii) USE OF SAVINGS.—A covered entity shall permit the Secretary to audit at the Secretary's expense the records of the entity to determine how net income from purchases under this section are used by the covered entity.

"(iii) RECORDS RETENTION.— Covered entities shall retain such records and provide such records and reports as deemed necessary by the Secretary for carrying out this subparagraph.".

(b) by adding at the end the following new subsection: "(f) REGULATIONS.—The Secretary may promulgate such regulations as the Secretary determines necessary or appropriate to carry out the provisions of this section.".

(b) NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL.—A State or tribal organization which elects to make a transfer under subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless the Secretary determines that such transfer is not consistent with the objectives of the OAA.

(c) RULES OF CONSTRUCTION.—No transfer of grant funds by a State or tribal organization under this section shall be construed—

(1) as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight by the Secretary; or

(2) to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such funds.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and expenses

Buildings and facilities

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

FDA Working Capital Fund

Payment to the FDA Innovation Account, CURES Act

FDA Innovation, CURES Act

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

Primary health care

Health workforce

maternal and child health

Ryan white HIV/AIDS program

health care systems

Rural health

Family Planning

program management

Health Resources and Services

(Legislative proposal, subject to PAYGO)

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Maternal, Infant, and Early Childhood Home Visiting Programs

(Legislative proposal, subject to PAYGO)

Health Center Guaranteed Loan Financing Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

Vaccine injury compensation program trust fund

Indian Health Service

Federal Funds

Indian health services

Indian Health Services

(Legislative proposal, subject to PAYGO)

Contract support costs

Indian health facilities

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

Administrative provisions—indian health service

Centers for Disease Control and Prevention

Federal Funds

Immunization and respiratory diseases

HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention

Emerging and zoonotic infectious diseases

Chronic disease prevention and health promotion

Birth defects, developmental disabilities, disabilities and health

Public Health Scientific Services

Environmental health

Injury prevention and control

National Institute for Occupational Safety and Health

Energy employees occupational illness compensation program

Global health

public health preparedness and response

cdc-wide activities and program support

buildings and facilities

CDC Working Capital Fund

Toxic substances and environmental public health

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

national cancer institute

national heart, lung, and blood institute

national institute of dental and craniofacial research

national institute of diabetes and digestive and kidney diseases

national institute of neurological disorders and stroke

national institute of allergy and infectious diseases

national institute of general medical sciences

eunice kennedy shriver national institute of child health and human development

national eye institute

national institute of environmental health sciences

National institute of environmental health sciences

national institute on aging

national institute of arthritis and musculoskeletal and skin diseases

national institute on deafness and other communication disorders

national institute of nursing research

national institute on alcohol abuse and alcoholism

national institute on drug abuse

national institute of mental health