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; $5,833,942,000: Provided, That of the amount provided under this heading, $1,062,367,000 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; $219,527,000 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; $511,682,000 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; $39,618,000 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; $30,524,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j-12, and shall be credited to this account and remain available until expended; $18,700,000 shall be derived from generic new animal drug user fees authorized by 21 U.S.C. 379j-21, 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, biosimilar biological product user fees, animal drug user fees, and generic animal drug user fees that exceed the respective fiscal year 2020 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, biosimilar biological product, animal drug, and generic animal drug assessments for fiscal year 2020, including any such fees collected prior to fiscal year 2020 but credited for fiscal year 2020, shall be subject to the fiscal year 2020 limitations: Provided further, That the Secretary may accept payment during fiscal year 2020 of user fees specified under this heading and authorized for fiscal year 2021, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2021 for which the Secretary accepts payment in fiscal year 2020 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 2019 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, 2019 (Division C of P.L. 115–245, as amended). The amounts included for 2019 reflect the annualized level provided by the continuing resolution.


Identification code 075–9911–0–1–554		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	1	1	2
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, FDA	1	3	3

2000	Total: Balances and receipts	2	4	5
	Appropriations:
	Current law:
2101	Salaries and Expenses	–1	–2	–2

5099	Balance, end of year	1	2	3


Identification code 075–9911–0–1–554		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Foods	1,041	1,042	1,083
0002	Human Drugs	496	496	716
0003	Devices and Radiological Health	330	330	424
0004	National Center for Toxicological Research	63	63	67
0005	FDA Other Activities (FDA Headquaters)	194	196	180
0006	FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)	115	115	144
0007	FDA GSA Rental Payments	170	170	172
0008	FDA Buildings and Facilities	15	12	12
0009	Cooperative Research and Development (CRADA)	2	2	2
0010	Animal Drugs and Feed	172	173	192
0011	Biologics	215	215	262
0012	Food and Drug Safety (no-year)	1
0014	Zika Activities	1
0015	CURES Activities		60	75
0016	Emerging Health Threats	4
0017	Opioids - IMF	13	94

0799	Total direct obligations	2,832	2,968	3,329
0801	FDA Reimbursable program (User fees)	2,488	2,535	2,656
0802	FDA Reimbursable program (Federal sources)	37

0899	Total reimbursable obligations	2,525	2,535	2,656

0900	Total new obligations, unexpired accounts	5,357	5,503	5,985

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	927	926	910
1001	Discretionary unobligated balance brought fwd, Oct 1	927	926
1021	Recoveries of prior year unpaid obligations	54

1050	Unobligated balance (total)	981	926	910
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,913	2,906	3,251
1120	Appropriations transferred to other accts [075–0128]	–2	–2
1120	Appropriations transferred to other acct [075–4613]		–5	–5
1121	Appropriations transferred from other acct [075–5629]		60	75

1160	Appropriation, discretionary (total)	2,911	2,959	3,321
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1	2	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,932	2,526	2,650
1700	Collected	12	31
1701	Change in uncollected payments, Federal sources	31	–31
1702	Offsetting collections (previously unavailable)	197
1710	Spending authority from offsetting collections transferred to other accounts [075–4613]	–5
1725	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–772

1750	Spending auth from offsetting collections, disc (total)	2,395	2,526	2,650
	Spending authority from offsetting collections, mandatory:
1800	Collected	1
1900	Budget authority (total)	5,308	5,487	5,973
1930	Total budgetary resources available	6,289	6,413	6,883
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	926	910	898

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,723	2,978	3,178
3010	New obligations, unexpired accounts	5,357	5,503	5,985
3011	Obligations ("upward adjustments"), expired accounts	32
3020	Outlays (gross)	–5,001	–5,303	–5,483
3040	Recoveries of prior year unpaid obligations, unexpired	–54
3041	Recoveries of prior year unpaid obligations, expired	–79

3050	Unpaid obligations, end of year	2,978	3,178	3,680
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–65	–70	–39
3070	Change in uncollected pymts, Fed sources, unexpired	–31	31
3071	Change in uncollected pymts, Fed sources, expired	26

3090	Uncollected pymts, Fed sources, end of year	–70	–39	–39
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,658	2,908	3,139
3200	Obligated balance, end of year	2,908	3,139	3,641

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5,306	5,485	5,971
	Outlays, gross:
4010	Outlays from new discretionary authority	2,908	4,404	4,760
4011	Outlays from discretionary balances	2,091	895	721

4020	Outlays, gross (total)	4,999	5,299	5,481
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–33	–31
4033	Non-Federal sources:	–2,933	–2,526	–2,650

4040	Offsets against gross budget authority and outlays (total)	–2,966	–2,557	–2,650
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–31	31
4052	Offsetting collections credited to expired accounts	22

4060	Additional offsets against budget authority only (total)	–9	31

4070	Budget authority, net (discretionary)	2,331	2,959	3,321
4080	Outlays, net (discretionary)	2,033	2,742	2,831
	Mandatory:
4090	Budget authority, gross	2	2	2
	Outlays, gross:
4100	Outlays from new mandatory authority		2	2
4101	Outlays from mandatory balances	2	2

4110	Outlays, gross (total)	2	4	2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources:	–1
4180	Budget authority, net (total)	2,332	2,961	3,323
4190	Outlays, net (total)	2,034	2,746	2,833

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	229	804	804
5092	Unexpired unavailable balance, EOY: Offsetting collections	804	804	804

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 advance 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 2020 Budget includes $6.1 billion in total resources for FDA. The Budget invests in priority activities including: modernizing food safety, strengthening foodborne illness response, helping fight the opioid crisis, promoting the development of innovative medical products, investing in blood pathogen reduction technology, and supporting the preparedness infrastructure.


Identification code 075–9911–0–1–554		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	931	940	964
11.3	Other than full-time permanent	85	86	89
11.5	Other personnel compensation	42	44	45
11.7	Military personnel	58	60	62
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	1,117	1,131	1,161
12.1	Civilian personnel benefits	351	354	363
12.2	Military personnel benefits	31	32	33
21.0	Travel and transportation of persons	56	60	75
22.0	Transportation of things	3	4	5
23.1	Rental payments to GSA	170	170	172
23.2	Rental payments to others	3	3	4
23.3	Communications, utilities, and miscellaneous charges	21	23	28
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	54	58	72
25.2	Other services from non-Federal sources	407	455	569
25.3	Other goods and services from Federal sources	159	170	213
25.4	Operation and maintenance of facilities	95	102	128
25.5	Research and development contracts	28	30	37
25.7	Operation and maintenance of equipment	63	68	85
26.0	Supplies and materials	47	50	63
31.0	Equipment	47	52	65
32.0	Land and structures	3	4	4
41.0	Grants, subsidies, and contributions	173	198	247
42.0	Insurance claims and indemnities	1	1	2

99.0	Direct obligations	2,832	2,968	3,329
99.0	Reimbursable obligations	2,525	2,535	2,656

99.9	Total new obligations, unexpired accounts	5,357	5,503	5,985


Identification code 075–9911–0–1–554		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	9,220	9,215	9,454
1101	Direct military average strength employment	668	668	668
2001	Reimbursable civilian full-time equivalent employment	6,602	7,191	7,355
2101	Reimbursable military average strength employment	479	479	479
3001	Allocation account civilian full-time equivalent employment	43	43	43
3101	Allocation account military average strength employment	1	1	1

Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for innovative food products activities and over-the-counter monograph drug activities: Provided, That fees of $28,000,000 for innovative food products shall be credited to this account and remain available until expended; $28,400,000 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 innovative food products and over-the-counter monograph drug user fees that exceed the respective fiscal year 2020 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from innovative food products and over-the-counter monograph drug reviews for fiscal year 2020 received during fiscal year 2020, including any such fees assessed prior to fiscal year 2020 but credited for fiscal year 2020, shall be subject to the fiscal year 2020 limitations: Provided further, That the Secretary may accept payment during fiscal year 2020 of user fees specified in this paragraph and authorized for fiscal year 2021, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2021 for which the Secretary accepts payment in fiscal year 2020 shall not be included in amounts in this paragraph.

In addition, contingent upon the enactment of authorizing legislation establishing fees under 21 U.S.C. 387s with respect to products deemed under 21 U.S.C. 387a(b) but not specified in 21 U.S.C. 387s(b)(2)(B), the Secretary shall assess and collect such fees: Provided, That $100,000,000 shall be derived from such fees, which shall be credited to this account and remain available until expended, in addition to amounts otherwise derived from fees authorized under 21 U.S.C. 387s.


Identification code 075–9911–2–1–554		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	FDA Reimbursable program (Tobacco)			156

0899	Total reimbursable obligations			156

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			156
1900	Budget authority (total)			156
1930	Total budgetary resources available			156

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			156
3020	Outlays (gross)			–156

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			156
	Outlays, gross:
4010	Outlays from new discretionary authority			156
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources:			–156

4040	Offsets against gross budget authority and outlays (total)			–156
4180	Budget authority, net (total)
4190	Outlays, net (total)

The FY 2020 Budget proposes reforms to the Over-the-Counter Monograph program and includes a total of $28 million in new over-the-counter drug fees. The Budget proposes a new user fee program to support innovative food activities totaling $28 million. The Budget also includes a legislative proposal to increase the user fee collected in support of the tobacco program by $100 million and adds electronic nicotine delivery system manufacturers and importers as entities subject to the user fees.


Identification code 075–9911–2–1–554		2018 actual	2019 est.	2020 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent			5
11.3	Other than full-time permanent			1
11.5	Other personnel compensation			1

11.9	Total personnel compensation			7
12.1	Civilian personnel benefits			2
21.0	Travel and transportation of persons			3
25.1	Advisory and assistance services			12
25.2	Other services from non-Federal sources			91
25.3	Other goods and services from Federal sources			41

99.0	Reimbursable obligations			156

99.9	Total new obligations, unexpired accounts			156


Identification code 075–9911–2–1–554		2018 actual	2019 est.	2020 est.

2001	Reimbursable civilian full-time equivalent employment			52


Identification code 075–4613–0–4–554		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Direct program activity			15

0900	Total new obligations, unexpired accounts (object class 25.3)			15

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		5	10
	Budget authority:
	Appropriations, discretionary:
1121	Appropriations transferred from other acct [075–9911]		5	5
	Spending authority from offsetting collections, discretionary:
1711	Spending authority from offsetting collections transferred from other accounts [075–9911]	5
1900	Budget authority (total)	5	5	5
1930	Total budgetary resources available	5	10	15
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	5	10

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			15
3020	Outlays (gross)			–3

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

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5	5	5
	Outlays, gross:
4011	Outlays from discretionary balances			3
4180	Budget authority, net (total)	5	5	5
4190	Outlays, net (total)			3


Identification code 075–0148–0–1–554		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Direct program activity	60	60	75

0900	Total new obligations, unexpired accounts (object class 94.0)	60	60	75

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	60	60	75
1930	Total budgetary resources available	60	60	75

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	60	60	75
3020	Outlays (gross)	–60	–60	–75

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	60	60	75
	Outlays, gross:
4100	Outlays from new mandatory authority	60	60	75
4180	Budget authority, net (total)	60	60	75
4190	Outlays, net (total)	60	60	75

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", $75,000,000, 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		2018 actual	2019 est.	2020 est.

0100	Balance, start of year			10
	Receipts:
	Current law:
1140	General Fund Payment, FDA Innovation, CURES Act	60	70	75

2000	Total: Balances and receipts	60	70	85
	Appropriations:
	Current law:
2101	FDA Innovation, Cures Act	–60	–60	–75

5099	Balance, end of year		10	10


Identification code 075–5629–0–2–554		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	New Obligations for CURES Activities	41

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	8	27	27
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	60	60	75
1120	Appropriations transferred to other acct [075–9911]		–60	–75

1160	Appropriation, discretionary (total)	60
1930	Total budgetary resources available	68	27	27
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	27	27	27

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	8	26
3010	New obligations, unexpired accounts	41
3020	Outlays (gross)	–23	–26

3050	Unpaid obligations, end of year	26
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	8	26
3200	Obligated balance, end of year	26

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	60
	Outlays, gross:
4010	Outlays from new discretionary authority	15
4011	Outlays from discretionary balances	8	26

4020	Outlays, gross (total)	23	26
4180	Budget authority, net (total)	60
4190	Outlays, net (total)	23	26

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	10
11.3	Other than full-time permanent	2
11.5	Other personnel compensation	1

11.9	Total personnel compensation	13
12.1	Civilian personnel benefits	4
25.2	Other services from non-Federal sources	12
31.0	Equipment	1
41.0	Grants, subsidies, and contributions	11

99.9	Total new obligations, unexpired accounts	41


Identification code 075–5629–0–2–554		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	100


Identification code 075–4309–0–3–554		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	Revolving Fund for Certification and Other Services (Reimbursable)	10	10	11

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4	3	3
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	9	10	10
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	11
1900	Budget authority (total)	9	10	11
1930	Total budgetary resources available	13	13	14
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	3	3

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3	4
3010	New obligations, unexpired accounts	10	10	11
3020	Outlays (gross)	–9	–14	–11

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	9	10	11
	Outlays, gross:
4100	Outlays from new mandatory authority	6	10	11
4101	Outlays from mandatory balances	3	4

4110	Outlays, gross (total)	9	14	11
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–9	–10	–10
4180	Budget authority, net (total)			1
4190	Outlays, net (total)		4	1

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	1	1	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	1	1

FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs, medical devices, and cosmetics. These services are financed wholly by fees paid by the industries affected.


Identification code 075–4309–0–3–554		2018 actual	2019 est.	2020 est.

	Reimbursable obligations:
11.1	Personnel compensation: Full-time permanent	4	4	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
25.4	Operation and maintenance of facilities	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	11


Identification code 075–4309–0–3–554		2018 actual	2019 est.	2020 est.

2001	Reimbursable civilian full-time equivalent employment	36	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, $1,626,522,000 : 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 $120,000,000 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 .

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921 of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $304,714,000: Provided, That sections 751 and 762(k) of the PHS Act and the proportional funding amounts in paragraphs (1) through (4) of section 756(f) 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 section and subpart: Provided further, That $105,000,000 shall remain available until expended for the purposes of providing primary health services, assigning National Health Service Corps ("NHSC") members to expand the delivery of substance use disorder treatment services, notwithstanding the assignment priorities and limitations under sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of the PHS Act, and making payments under the NHSC Loan Repayment Program under section 338B of such Act: Provided further, That for purposes of the previous proviso, section 331(a)(3)(D) of the PHS Act shall be applied as if the term "primary health services" includes clinical substance use disorder treatment services, including those provided by masters level, licensed substance use disorder treatment counselors.

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, and title V of the Social Security Act, $783,200,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $92,593,000 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, $2,388,781,000 ; of which $1,970,881,000 shall remain available to the Secretary through September 30, 2022, for parts A and B of title XXVI of the PHS Act, 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; and of which $70,000,000, to remain available until expended, shall be available to the Secretary for carrying out a program of grants and contracts under title XXVI or section 311(c) of such Act focused on ending the nationwide epidemic, with any grants issued under such section 311(c) administered in conjunction with title XXVI of the PHS Act, including the limitation on administrative expenses.

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, $111,018,000 : 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 for 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 appropriation and 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 sections 711 and 1820 of the Social Security Act, $188,645,000 .

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0005	Primary Health Care (Health Centers, Free Clinics)	1,668	1,626	1,626
0010	Primary Health Care (Mandatory)	3,894	4,016
0015	Health Workforce	915	1,139	305
0020	Health Workforce (Mandatory)	464	439
0025	Maternal and Child Health	883	927	783
0030	Maternal and Child Health (Mandatory)	6	6
0035	Ryan White HIV/AIDS	2,355	2,326	2,389
0040	Health Care Systems	111	115	111
0045	Rural Health	200	374	189
0050	Family Planning	286	286	286
0055	HRSA Program Management	155	155	152

0091	Direct program activities, subtotal	10,937	11,409	5,841

0300	Total direct programs	10,937	11,409	5,841
	Credit program obligations:
0702	Loan guarantee subsidy			2

0799	Total direct obligations	10,937	11,409	5,843
0801	Health Resources and Services (Reimbursable)	65	63	82

0899	Total reimbursable obligations	65	63	82

0900	Total new obligations, unexpired accounts	11,002	11,472	5,925

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	309	454	315
1001	Discretionary unobligated balance brought fwd, Oct 1	167	335
1010	Unobligated balance transfer to other accts [075–1503]	–17
1010	Unobligated balance transfer to other accts [015–5606]	–5	–5	–5
1021	Recoveries of prior year unpaid obligations	61

1050	Unobligated balance (total)	348	449	310
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,737	6,844	5,841
1120	Appropriations transferred to other acct [075–1503]	–16
1121	Appropriations transferred from other acct [075–0140]	60

1160	Appropriation, discretionary (total)	6,781	6,844	5,841
	Appropriations, mandatory:
1200	Appropriation	4,268	4,443
	Spending authority from offsetting collections, discretionary:
1700	Collected	20	30	49
1701	Change in uncollected payments, Federal sources	10

1750	Spending auth from offsetting collections, disc (total)	30	30	49
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	32	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)	32	21	21
1900	Budget authority (total)	11,111	11,338	5,911
1930	Total budgetary resources available	11,459	11,787	6,221
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	454	315	296

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,627	7,968	8,613
3010	New obligations, unexpired accounts	11,002	11,472	5,925
3011	Obligations ("upward adjustments"), expired accounts	26
3020	Outlays (gross)	–10,519	–10,827	–9,281
3040	Recoveries of prior year unpaid obligations, unexpired	–61
3041	Recoveries of prior year unpaid obligations, expired	–107

3050	Unpaid obligations, end of year	7,968	8,613	5,257
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–16	–16	–16
3070	Change in uncollected pymts, Fed sources, unexpired	–10
3071	Change in uncollected pymts, Fed sources, expired	10

3090	Uncollected pymts, Fed sources, end of year	–16	–16	–16
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,611	7,952	8,597
3200	Obligated balance, end of year	7,952	8,597	5,241

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,811	6,874	5,890
	Outlays, gross:
4010	Outlays from new discretionary authority	2,088	2,233	1,878
4011	Outlays from discretionary balances	4,121	4,150	4,893

4020	Outlays, gross (total)	6,209	6,383	6,771
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–11	–12	–12
4033	Non-Federal sources	–26	–18	–18
4033	Non-Federal sources			–19

4040	Offsets against gross budget authority and outlays (total)	–37	–30	–49
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10
4052	Offsetting collections credited to expired accounts	17

4060	Additional offsets against budget authority only (total)	7

4070	Budget authority, net (discretionary)	6,781	6,844	5,841
4080	Outlays, net (discretionary)	6,172	6,353	6,722
	Mandatory:
4090	Budget authority, gross	4,300	4,464	21
	Outlays, gross:
4100	Outlays from new mandatory authority	1,907	1,958	21
4101	Outlays from mandatory balances	2,403	2,486	2,489

4110	Outlays, gross (total)	4,310	4,444	2,510
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–32	–20	–20
4180	Budget authority, net (total)	11,049	11,288	5,842
4190	Outlays, net (total)	10,450	10,777	9,212

	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


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	11,049	11,288	5,842
	Outlays	10,450	10,777	9,212
Legislative proposal, subject to PAYGO:
	Budget Authority			4,443
	Outlays			1,937
Total:
	Budget Authority	11,049	11,288	10,285
	Outlays	10,450	10,777	11,149

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


Identification code 075–0350–0–1–550		2018 actual	2019 est.	2020 est.

	Guaranteed loan levels supportable by subsidy budget authority:
215001	Health centers: Facilities renovation loan guarantee levels	7	3	60

215999	Total loan guarantee levels	7	3	60
	Guaranteed loan subsidy (in percent):
232001	Health centers: Facilities renovation loan guarantee levels	2.69	2.71	2.57

232999	Weighted average subsidy rate	2.69	2.71	2.57
	Guaranteed loan subsidy budget authority:
233001	Health centers: Facilities renovation loan guarantee levels			2

233999	Total subsidy budget authority			2
	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 program's 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 2017–2018 data reported in the Annual Operating Report.


Program	Account Balance


HPSL	424,598,650
NSL	195,287,497
PCL	225,828,416
LDS	181,920,522

Total	1,027,635,085


Identification code 075–0350–0–1–550		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	197	201	152
11.3	Other than full-time permanent	6	6	5
11.5	Other personnel compensation	5	5	3
11.7	Military personnel	21	21	16

11.9	Total personnel compensation	229	233	176
12.1	Civilian personnel benefits	65	65	50
12.2	Military personnel benefits	11	11	9
21.0	Travel and transportation of persons	3	3	3
23.1	Rental payments to GSA	30	30	16
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	5	5	5
25.1	Advisory and assistance services	16	16	11
25.2	Other services from non-Federal sources	251	258	188
25.3	Other goods and services from Federal sources	295	415	155
25.4	Operation and maintenance of facilities	1	1	1
25.6	Medical care	3	3	2
25.7	Operation and maintenance of equipment	7	6	4
26.0	Supplies and materials	1	1	1
31.0	Equipment	4	4	4
41.0	Grants, subsidies, and contributions	9,905	10,248	5,108
42.0	Insurance claims and indemnities	110	109	109

99.0	Direct obligations	10,937	11,409	5,843
99.0	Reimbursable obligations	65	63	82

99.9	Total new obligations, unexpired accounts	11,002	11,472	5,925


Identification code 075–0350–0–1–550		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	1,788	1,810	1,404
1101	Direct military average strength employment	201	201	154
2001	Reimbursable civilian full-time equivalent employment	51	51	67
2101	Reimbursable military average strength employment	2	2	2


Identification code 075–0350–4–1–550		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0010	Primary Health Care (Mandatory)			4,000
0020	Health Workforce (Mandatory)			437
0030	Maternal and Child Health (Mandatory)			6

0300	Total direct programs			4,443

0900	Total new obligations, unexpired accounts			4,443

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			4,443
1900	Budget authority (total)			4,443
1930	Total budgetary resources available			4,443

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			4,443
3020	Outlays (gross)			–1,937

3050	Unpaid obligations, end of year			2,506
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			2,506

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			4,443
	Outlays, gross:
4100	Outlays from new mandatory authority			1,937
4180	Budget authority, net (total)			4,443
4190	Outlays, net (total)			1,937

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent			45
11.3	Other than full-time permanent			1
11.5	Other personnel compensation			1
11.7	Military personnel			5

11.9	Total personnel compensation			52
12.1	Civilian personnel benefits			15
12.2	Military personnel benefits			3
23.1	Rental payments to GSA			8
23.3	Communications, utilities, and miscellaneous charges			2
25.2	Other services from non-Federal sources			34
25.3	Other goods and services from Federal sources			114
41.0	Grants, subsidies, and contributions			4,215

99.9	Total new obligations, unexpired accounts			4,443


Identification code 075–0350–4–1–550		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment			364
1101	Direct military average strength employment			36


Identification code 075–0320–0–1–551		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	31	33	33
1033	Recoveries of prior year paid obligations	2

1050	Unobligated balance (total)	33	33	33
1930	Total budgetary resources available	33	33	33
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	33	33	33

	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		2018 actual	2019 est.	2020 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		2018 actual	2019 est.	2020 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		2018 actual	2019 est.	2020 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	411	404	400

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	14	20	16
1021	Recoveries of prior year unpaid obligations	17

1050	Unobligated balance (total)	31	20	16
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	400	400	400
1930	Total budgetary resources available	431	420	416
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	20	16	16

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	720	748	769
3010	New obligations, unexpired accounts	411	404	400
3020	Outlays (gross)	–366	–383	–393
3040	Recoveries of prior year unpaid obligations, unexpired	–17

3050	Unpaid obligations, end of year	748	769	776
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	720	748	769
3200	Obligated balance, end of year	748	769	776

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	400	400	400
	Outlays, gross:
4100	Outlays from new mandatory authority	4	16	16
4101	Outlays from mandatory balances	362	367	377

4110	Outlays, gross (total)	366	383	393
4180	Budget authority, net (total)	400	400	400
4190	Outlays, net (total)	366	383	393

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		2018 actual	2019 est.	2020 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent	5	5	5

11.9	Total personnel compensation	5	5	5
12.1	Civilian personnel benefits	2	2	2
25.1	Advisory and assistance services	11	11	11
41.0	Grants, subsidies, and contributions	393	386	382

99.9	Total new obligations, unexpired accounts	411	404	400


Identification code 075–0321–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	39	39	39
1101	Direct military average strength employment	3	3	3


Identification code 075–4442–0–3–551		2018 actual	2019 est.	2020 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 075–4442–0–3–551		2018 actual	2019 est.	2020 est.

	Position with respect to appropriations act limitation on commitments:
2111	Guaranteed loan commitments from current-year authority	889
2121	Limitation available from carry-forward	6	888	885
2143	Uncommitted limitation carried forward	–888	–885	–825

2150	Total guaranteed loan commitments	7	3	60
2199	Guaranteed amount of guaranteed loan commitments	6	2	48

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	69	60	52
2231	Disbursements of new guaranteed loans	7	3	60
2251	Repayments and prepayments	–16	–10	–10
	Adjustments:
2263	Terminations for default that result in claim payments		–1	–1
2264	Other adjustments, net

2290	Outstanding, end of year	60	52	101

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	45	39	78

Public Law 104–299, Public Law 104–208, and Public Law 115–141 authorize Health Resources and Services Administration (HRSA) to guarantee up to $1 billion 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		2017 actual	2018 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	2	1

1999	Total assets	2	1
	LIABILITIES:
2204	Non-Federal liabilities: Liabilities for loan guarantees	2	1
	NET POSITION:
3300	Cumulative results of operations

4999	Total liabilities and net position	2	1


Identification code 075–9931–0–3–551		2018 actual	2019 est.	2020 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	5	5	5

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		2017 actual	2018 actual

	ASSETS:
1601	Direct loans, gross	5	5

1999	Total assets	5	5
	LIABILITIES:
2201	Non-Federal liabilities: Accounts payable	5	5
	NET POSITION:
3100	Unexpended appropriations
3300	Cumulative results of operations

3999	Total net position

4999	Total liabilities and net position	5	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 $11,200,000 shall be available from the Trust Fund to the Secretary.


Identification code 075–8175–0–7–551		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	3,619	3,684	3,812
0198	Reconciliation adjustment	5

0199	Balance, start of year	3,624	3,684	3,812
	Receipts:
	Current law:
1110	Deposits, Vaccine Injury Compensation Trust Fund	309	305	310
1140	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	10	130	146

1199	Total current law receipts	319	435	456

1999	Total receipts	319	435	456

2000	Total: Balances and receipts	3,943	4,119	4,268
	Appropriations:
	Current law:
2101	Vaccine Injury Compensation Program Trust Fund	–27	–27	–33
2101	Vaccine Injury Compensation Program Trust Fund	–227	–280	–286

2199	Total current law appropriations	–254	–307	–319

2999	Total appropriations	–254	–307	–319
4030	Vaccine Injury Compensation Program Trust Fund	5
5098	Reconciliation adjustment	–10

5099	Balance, end of year	3,684	3,812	3,949


Identification code 075–8175–0–7–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	227	280	286
0103	Claims processing (Claims Court)	8	8	9
0104	Claims processing (HRSA)	9	9	11
0105	Claims processing (Dept. of Justice)	10	10	13

0191	Direct program activities, subtotal	27	27	33

0900	Total new obligations, unexpired accounts	254	307	319

	Budgetary resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	1
1033	Recoveries of prior year paid obligations	4
1035	Unobligated balance of appropriations withdrawn	–5
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	27	27	33
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	227	280	286
1900	Budget authority (total)	254	307	319
1930	Total budgetary resources available	254	307	319

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	11	18
3010	New obligations, unexpired accounts	254	307	319
3020	Outlays (gross)	–246	–325	–319
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	11	18
3200	Obligated balance, end of year	18

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	27	27	33
	Outlays, gross:
4010	Outlays from new discretionary authority	15	27	33
4011	Outlays from discretionary balances	4

4020	Outlays, gross (total)	19	27	33
	Mandatory:
4090	Budget authority, gross	227	280	286
	Outlays, gross:
4100	Outlays from new mandatory authority	227	280	286
4101	Outlays from mandatory balances		18

4110	Outlays, gross (total)		298	286
	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)	227	280	286
4170	Outlays, net (mandatory)	223	298	286
4180	Budget authority, net (total)	254	307	319
4190	Outlays, net (total)	242	325	319

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	3,595	3,750	3,905
5001	Total investments, EOY: Federal securities: Par value	3,750	3,905	4,075

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	3
12.1	Civilian personnel benefits	1	1	1
25.3	Other goods and services from Federal sources	4	22	29
42.0	Insurance claims and indemnities	247	282	286

99.9	Total new obligations, unexpired accounts	254	307	319


Identification code 075–8175–0–7–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	14	14	20
1101	Direct military average strength employment	4	4	4

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, $4,286,541,000, 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$968,177,000 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, for the Zero Suicide Initiative, for Aftercare Pilot Program at Youth Regional Treatment Centers, for transformation and modernization costs of the IHS Electronic Health Record system, for an initiative to improve the recruitment and retention of health care providers and certain other critical professions, for national quality and oversight activities, for initiatives to treat or reduce the transmission of Hepatitis-C and HIV-AIDs or both in high priority areas, 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Clinical services	3,603	3,615	3,997
0002	Preventive health	170	171	118
0003	Urban health	49	49	49
0004	Indian health professions	49	49	44
0005	Tribal management	2	2
0006	Direct operations	72	72	74
0007	Self-governance	6	6	5
0009	Diabetes funds	150	150

0799	Total direct obligations	4,101	4,114	4,287
0801	Indian Health Services (Reimbursable)	1,610	1,634	1,634

0900	Total new obligations, unexpired accounts	5,711	5,748	5,921

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,006	1,220	1,222
1001	Discretionary unobligated balance brought fwd, Oct 1	1,006	1,006
1021	Recoveries of prior year unpaid obligations	185

1050	Unobligated balance (total)	1,191	1,220	1,222
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,952	3,966	4,287
	Appropriations, mandatory:
1200	Appropriation	150	150
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,647	1,634	1,634
1701	Change in uncollected payments, Federal sources	7

1750	Spending auth from offsetting collections, disc (total)	1,654	1,634	1,634
1900	Budget authority (total)	5,756	5,750	5,921
1930	Total budgetary resources available	6,947	6,970	7,143
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–16
1941	Unexpired unobligated balance, end of year	1,220	1,222	1,222

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,034	1,139	553
3010	New obligations, unexpired accounts	5,711	5,748	5,921
3011	Obligations ("upward adjustments"), expired accounts	34
3020	Outlays (gross)	–5,431	–6,334	–5,796
3040	Recoveries of prior year unpaid obligations, unexpired	–185
3041	Recoveries of prior year unpaid obligations, expired	–24

3050	Unpaid obligations, end of year	1,139	553	678
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–100	–106	–106
3070	Change in uncollected pymts, Fed sources, unexpired	–7
3071	Change in uncollected pymts, Fed sources, expired	1

3090	Uncollected pymts, Fed sources, end of year	–106	–106	–106
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	934	1,033	447
3200	Obligated balance, end of year	1,033	447	572

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5,606	5,600	5,921
	Outlays, gross:
4010	Outlays from new discretionary authority	4,423	4,886	5,149
4011	Outlays from discretionary balances	862	1,298	641

4020	Outlays, gross (total)	5,285	6,184	5,790
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–441	–441	–441
4033	Non-Federal sources	–1,210	–1,193	–1,193

4040	Offsets against gross budget authority and outlays (total)	–1,651	–1,634	–1,634
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–7
4052	Offsetting collections credited to expired accounts	4

4060	Additional offsets against budget authority only (total)	–3

4070	Budget authority, net (discretionary)	3,952	3,966	4,287
4080	Outlays, net (discretionary)	3,634	4,550	4,156
	Mandatory:
4090	Budget authority, gross	150	150
	Outlays, gross:
4100	Outlays from new mandatory authority	47	144
4101	Outlays from mandatory balances	99	6	6

4110	Outlays, gross (total)	146	150	6
4180	Budget authority, net (total)	4,102	4,116	4,287
4190	Outlays, net (total)	3,780	4,700	4,162


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	4,102	4,116	4,287
	Outlays	3,780	4,700	4,162
Legislative proposal, subject to PAYGO:
	Budget Authority			150
	Outlays			144
Total:
	Budget Authority	4,102	4,116	4,437
	Outlays	3,780	4,700	4,306

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. More than $2.5. billion, primarily through self-determination contracts and compacts, will be administered by tribal governments in 2020.


Identification code 075–0390–0–1–551		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	420	421	450
11.3	Other than full-time permanent	18	18	19
11.5	Other personnel compensation	66	66	69
11.7	Military personnel	54	54	57

11.9	Total personnel compensation	558	559	595
12.1	Civilian personnel benefits	167	168	186
12.2	Military personnel benefits	24	24	25
13.0	Benefits for former personnel	12	12	13
21.0	Travel and transportation of persons			1
21.0	Patient travel	45	45	45
22.0	Transportation of things	6	6	5
23.1	Rental payments to GSA	15	15	16
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	17	17	18
25.1	Advisory and assistance services	6	6	6
25.2	Other services from non-Federal sources	153	154	184
25.3	Other goods and services from Federal sources	88	88	93
25.4	Operation and maintenance of facilities	2	2
25.6	Medical care	360	361	361
25.7	Operation and maintenance of equipment	19	19	19
25.8	Subsistence and support of persons	8	8	8
26.0	Supplies and materials	97	97	119
31.0	Equipment	7	7	7
32.0	Land and structures	1	1	1
41.0	Grants, subsidies, and contributions	2,505	2,514	2,573
42.0	Insurance claims and indemnities	10	10	11

99.0	Direct obligations	4,101	4,114	4,287
99.0	Reimbursable obligations	1,610	1,634	1,634

99.9	Total new obligations, unexpired accounts	5,711	5,748	5,921


Identification code 075–0390–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	6,676	6,676	6,785
1101	Direct military average strength employment	922	922	922
2001	Reimbursable civilian full-time equivalent employment	5,701	5,701	5,701
2101	Reimbursable military average strength employment	785	785	785


Identification code 075–0390–4–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0009	Diabetes funds			150

0799	Total direct obligations			150

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

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			150
3020	Outlays (gross)			–144

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			150
	Outlays, gross:
4100	Outlays from new mandatory authority			144
4180	Budget authority, net (total)			150
4190	Outlays, net (total)			144

The Budget proposes to extend the Special Diabetes Program for Indians through fiscal year 2021.


Identification code 075–0390–4–1–551		2018 actual	2019 est.	2020 est.

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

99.9	Total new obligations, unexpired accounts			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 2020, 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Contract Support Costs	763	822	855

0900	Total new obligations, unexpired accounts (object class 25.3)	763	822	855

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	763	822	855
1930	Total budgetary resources available	763	822	855

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	48	63	3
3010	New obligations, unexpired accounts	763	822	855
3011	Obligations ("upward adjustments"), expired accounts	20
3020	Outlays (gross)	–754	–882	–855
3041	Recoveries of prior year unpaid obligations, expired	–14

3050	Unpaid obligations, end of year	63	3	3
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	48	63	3
3200	Obligated balance, end of year	63	3	3

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	763	822	855
	Outlays, gross:
4010	Outlays from new discretionary authority	723	822	855
4011	Outlays from discretionary balances	31	60

4020	Outlays, gross (total)	754	882	855
4180	Budget authority, net (total)	763	822	855
4190	Outlays, net (total)	754	882	855

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 $855 million in contract support costs funds will be provided to tribal governments and tribal organizations in 2020.

For construction, repair, maintenance, improvement, demolition, 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, $803,026,000, 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.


Identification code 075–0391–0–1–551		2018 actual	2019 est.	2020 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Maintenance	168	168	169
0002	Sanitation Facilities Construction	192	192	193
0003	Facilities and environmental health	251	251	251
0004	Equipment	24	24	24

0100	Total direct program	635	635	637

0799	Total direct obligations	635	635	637
0801	Indian Health Facilities (Reimbursable)	9	9	9

0900	Total new obligations, unexpired accounts	644	644	646

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	309	620	912
1001	Discretionary unobligated balance brought fwd, Oct 1	309	620
1021	Recoveries of prior year unpaid obligations	11

1050	Unobligated balance (total)	320	620	912
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	868	868	803
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	8	9	9
	Spending authority from offsetting collections, discretionary:
1700	Collected	59	59	59
1701	Change in uncollected payments, Federal sources	9

1750	Spending auth from offsetting collections, disc (total)	68	59	59
1900	Budget authority (total)	944	936	871
1930	Total budgetary resources available	1,264	1,556	1,783
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	620	912	1,137

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	574	679	488
3010	New obligations, unexpired accounts	644	644	646
3020	Outlays (gross)	–528	–835	–868
3040	Recoveries of prior year unpaid obligations, unexpired	–11

3050	Unpaid obligations, end of year	679	488	266
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–9	–18	–18
3070	Change in uncollected pymts, Fed sources, unexpired	–9

3090	Uncollected pymts, Fed sources, end of year	–18	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	565	661	470
3200	Obligated balance, end of year	661	470	248

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	936	927	862
	Outlays, gross:
4010	Outlays from new discretionary authority	326	319	300
4011	Outlays from discretionary balances	195	507	559

4020	Outlays, gross (total)	521	826	859
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–59	–59	–59

4040	Offsets against gross budget authority and outlays (total)	–59	–59	–59
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–9

4070	Budget authority, net (discretionary)	868	868	803
4080	Outlays, net (discretionary)	462	767	800
	Mandatory:
4090	Budget authority, gross	8	9	9
	Outlays, gross:
4100	Outlays from new mandatory authority	3	9	9
4101	Outlays from mandatory balances	4

4110	Outlays, gross (total)	7	9	9
4180	Budget authority, net (total)	876	877	812
4190	Outlays, net (total)	469	776	809

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. More than $340 million, primarily through self-determination contracts and compacts, will be administered by tribal governments in 2020.


Identification code 075–0391–0–1–551		2018 actual	2019 est.	2020 est.

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

11.9	Total personnel compensation	78	78	78
12.1	Civilian personnel benefits	18	18	18
12.2	Military personnel benefits	8	8	8
21.0	Travel and transportation of persons	3	3	3
22.0	Transportation of things	4	4	4
23.1	Rental payments to GSA	1	1	1
23.3	Communications, utilities, and miscellaneous charges	15	15	15
25.1	Advisory and assistance services	2	2	2
25.2	Other services from non-Federal sources	163	163	165
25.3	Other goods and services from Federal sources	1	1	1
25.4	Operation and maintenance of facilities	24	24	24
25.7	Operation and maintenance of equipment	4	4	4
25.8	Subsistence and support of persons	64	64	64
26.0	Supplies and materials	11	11	11
31.0	Equipment	8	8	8
32.0	Land and structures	6	6	6
41.0	Grants, subsidies, and contributions	225	225	225

99.0	Direct obligations	635	635	637
99.0	Reimbursable obligations	9	9	9

99.9	Total new obligations, unexpired accounts	644	644	646


Identification code 075–0391–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	1,010	1,010	1,015
1101	Direct military average strength employment	151	151	151
2001	Reimbursable civilian full-time equivalent employment	40	40	40

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, $577,386,000.

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, $1,318,056,000, of which $140,000,000 shall remain available through September 30, 2021.

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, $372,472,000: Provided, That of the amounts made available under this heading 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, $347,145,000: Provided, That such amounts and any amounts transferred to this account shall be 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 this program, the Director may 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 made available under this heading 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, $112,000,000.

For carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics, and workforce development, $45,000,000: Provided, That in addition to amounts provided herein, $423,000,000 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, $628,839,000.

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, $190,000,000.

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 titles II, III, and XVII of the PHS Act with respect to global health, $456,984,000, of which: (1) $69,547,000 shall remain available through September 30, 2021 for international HIV/AIDS; and (2) $99,762,000 shall be available for global public health protection: 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, $825,000,000: Provided, That the Director of the Centers for Disease Control and Prevention (referred to in this title as "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, $155,000,000, of which up to $10,000,000 may be transferred to the reserve of the Working Capital Fund authorized under this heading in division F of Public Law 112–74: 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 of the amounts made available under this heading, $50,000,000 shall be transferred to and merged with the Infectious Diseases Rapid Response Reserve Fund established by section 231 of division B of Public Law 115–245: Provided further, That any funds made available by this Act to the Centers for Disease Control and Prevention may be used to support the purchase, hire, maintenance, and operation of an 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, 2021.


Identification code 075–0943–0–1–999		2018 actual	2019 est.	2020 est.

0100	Balance, start of year			1
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, Centers for Disease Control	1	2	2

2000	Total: Balances and receipts	1	2	3
	Appropriations:
	Current law:
2101	CDC-wide Activities and Program Support	–1	–1	–1

5099	Balance, end of year		1	2


Identification code 075–0943–0–1–999		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Birth Defects, Developmental Disabilities, Disability and Health (0958)	140	156	112
0002	CDC-Wide Activities and Program Support (0943)	564	327	105
0004	Chronic Disease Prevention and Health Promotion (0948)	1,166	1,188	951
0005	Emerging and Zoonotic Infectious Diseases (0949)	611	620	509
0006	Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)	52	51	55
0007	Environmental Health (0947)	218	209	157
0008	Global Health (0955)	442	489	457
0012	HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)	1,122	1,132	1,318
0013	Immunization and Respiratory Diseases (0951)	769	798	727
0015	Injury Prevention and Control (0952)	593	649	629
0016	Occupational Safety and Health (0953)	334	336	190
0019	Public Health Preparedness and Response (0956)	1,168	858	825
0020	Public Health Scientific Services (0959)	488	496	468
0021	Cooperative Research and Development Agreements (CRADA) (5146)	1	1	1

0799	Total direct obligations	7,668	7,310	6,504
0802	CDC-Wide Activities and Program Support (Reimbursable)	269	297	331

0809	Reimbursable program activities, subtotal	269	297	331

0900	Total new obligations, unexpired accounts	7,937	7,607	6,835

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	469	933	467
1001	Discretionary unobligated balance brought fwd, Oct 1	334	664
1010	Unobligated balance transfer to other accts [075–0960]	–1
1010	Unobligated balance transfer to other accts [075–9915]	–3
1010	Unobligated balance transfer to other accts [075–0140]		–406
1010	Unobligated balance transfer to other accts [075–0140]		–23
1012	Unobligated balance transfers between expired and unexpired accounts	7
1021	Recoveries of prior year unpaid obligations	148
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	621	504	467
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	7,135	7,058	5,185
1120	Appropriations transferred to other acct [075–1503]	–17
1120	Appropriations transferred to other acct [075–0960]	–6
1120	Appropriations transferred to other acct [075–0140]		–604
1120	Appropriations transferred to other acct [075–0945]		–50	–50

1160	Appropriation, discretionary (total)	7,112	6,404	5,135
	Appropriations, mandatory:
1200	Appropriation (075–0954 - EEOICPA)	55	55	55
1200	Appropriation (Childhood Obesity 075–0943)	30
1201	Appropriation (075–5146 CRADA)	1	1	1
1221	Appropriations transferred from other acct PPHF [075–0116]	801	805	894
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–5

1260	Appropriations, mandatory (total)	882	861	950
	Spending authority from offsetting collections, discretionary:
1700	Collected	267	301	331
1701	Change in uncollected payments, Federal sources	–7

1750	Spending auth from offsetting collections, disc (total)	260	301	331
	Spending authority from offsetting collections, mandatory:
1800	Collected	4	4	4
1900	Budget authority (total)	8,258	7,570	6,420
1930	Total budgetary resources available	8,879	8,074	6,887
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–9
1941	Unexpired unobligated balance, end of year	933	467	52

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,137	6,935	7,135
3010	New obligations, unexpired accounts	7,937	7,607	6,835
3011	Obligations ("upward adjustments"), expired accounts	48
3020	Outlays (gross)	–7,884	–7,407	–7,637
3040	Recoveries of prior year unpaid obligations, unexpired	–148
3041	Recoveries of prior year unpaid obligations, expired	–155

3050	Unpaid obligations, end of year	6,935	7,135	6,333
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–190	–127	–127
3070	Change in uncollected pymts, Fed sources, unexpired	7
3071	Change in uncollected pymts, Fed sources, expired	56

3090	Uncollected pymts, Fed sources, end of year	–127	–127	–127
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,947	6,808	7,008
3200	Obligated balance, end of year	6,808	7,008	6,206

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	7,372	6,705	5,466
	Outlays, gross:
4010	Outlays from new discretionary authority	2,629	2,860	2,368
4011	Outlays from discretionary balances	4,364	3,772	4,397

4020	Outlays, gross (total)	6,993	6,632	6,765
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–310	–301	–331
4033	Non-Federal sources	–20

4040	Offsets against gross budget authority and outlays (total)	–330	–301	–331
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	7
4052	Offsetting collections credited to expired accounts	63

4060	Additional offsets against budget authority only (total)	70

4070	Budget authority, net (discretionary)	7,112	6,404	5,135
4080	Outlays, net (discretionary)	6,663	6,331	6,434
	Mandatory:
4090	Budget authority, gross	886	865	954
	Outlays, gross:
4100	Outlays from new mandatory authority	147	206	224
4101	Outlays from mandatory balances	744	569	648

4110	Outlays, gross (total)	891	775	872
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–5	–4	–4
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	1

4160	Budget authority, net (mandatory)	882	861	950
4170	Outlays, net (mandatory)	886	771	868
4180	Budget authority, net (total)	7,994	7,265	6,085
4190	Outlays, net (total)	7,549	7,102	7,302

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 2020 Budget provides $140 million for CDC to begin a new initiative to end the HIV epidemic in America. The FY 2020 Budget maintains the proposal to establish a new block grant, proposed at $500 million, to increase flexibility for States to address their population's unique public health needs. The FY 2020 Budget provides $100 million for global health security activities to protect Americans through partnerships and other activities that support public health capacity improvements in countries at risk for uncontrolled outbreaks of infectious diseases.


Identification code 075–0943–0–1–999		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	770	642	642
11.3	Other than full-time permanent	115	100	100
11.5	Other personnel compensation	40	34	34
11.7	Military personnel	76	70	72
11.8	Special personal services payments	8	7	7

11.9	Total personnel compensation	1,009	853	855
12.1	Civilian personnel benefits	309	255	255
12.2	Military personnel benefits	46	47	49
13.0	Benefits for former personnel	1	1	1
21.0	Travel and transportation of persons	55	50	50
22.0	Transportation of things	12	13	14
23.1	Rental payments to GSA	7	6	6
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	9	18	19
24.0	Printing and reproduction	2	3	3
25.1	Advisory and assistance services	814	625	737
25.2	Other services from non-Federal sources	180	155	183
25.3	Other goods and services from Federal sources	883	855	315
25.4	Operation and maintenance of facilities	12	22	25
25.5	Research and development contracts	38	24	28
25.6	Medical care	28	37	44
25.7	Operation and maintenance of equipment	41	44	52
26.0	Supplies and materials	260	401	406
31.0	Equipment	70	52	52
32.0	Land and structures	1	1	1
41.0	Grants, subsidies, and contributions	3,889	3,846	3,407
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	7,668	7,310	6,504
99.0	Reimbursable obligations	269	297	331

99.9	Total new obligations, unexpired accounts	7,937	7,607	6,835


Identification code 075–0943–0–1–999		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	8,970	8,784	8,808
1101	Direct military average strength employment	820	810	808
2001	Reimbursable civilian full-time equivalent employment	187	178	178
2101	Reimbursable military average strength employment	31	5	5

For any cost related to the acquisition of real property, equipment, construction, installation, demolition, and renovation of facilities, $30,000,000, which shall remain available until September 30, 2024 .


Identification code 075–0960–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	CDC Buildings and Facilities (0960)	25	25	25

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	7	499	504
1011	Unobligated balance transfer from other acct [075–0125]	240
1011	Unobligated balance transfer from other acct [075–0943]	1

1050	Unobligated balance (total)	248	499	504
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	270	30	30
1121	Appropriations transferred from other acct [075–0943]	6

1160	Appropriation, discretionary (total)	276	30	30
1930	Total budgetary resources available	524	529	534
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	499	504	509

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	10	27	25
3010	New obligations, unexpired accounts	25	25	25
3020	Outlays (gross)	–8	–27	–43

3050	Unpaid obligations, end of year	27	25	7
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	10	27	25
3200	Obligated balance, end of year	27	25	7

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	276	30	30
	Outlays, gross:
4010	Outlays from new discretionary authority	1	12	12
4011	Outlays from discretionary balances	7	15	31

4020	Outlays, gross (total)	8	27	43
4180	Budget authority, net (total)	276	30	30
4190	Outlays, net (total)	8	27	43


Identification code 075–0960–0–1–551		2018 actual	2019 est.	2020 est.

	Direct obligations:
25.1	Advisory and assistance services	1	1	1
25.4	Operation and maintenance of facilities	11	11	11
32.0	Land and structures	13	13	13

99.9	Total new obligations, unexpired accounts	25	25	25


Identification code 075–4553–0–4–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	CDC Working Capital Fund (Reimbursable)	576	569	569

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	54	48	55
1021	Recoveries of prior year unpaid obligations	6

1050	Unobligated balance (total)	60	48	55
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	564	576	532
1900	Budget authority (total)	564	576	532
1930	Total budgetary resources available	624	624	587
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	48	55	18

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	195	199	207
3010	New obligations, unexpired accounts	576	569	569
3020	Outlays (gross)	–566	–561	–545
3040	Recoveries of prior year unpaid obligations, unexpired	–6

3050	Unpaid obligations, end of year	199	207	231
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2	–2	–2

3090	Uncollected pymts, Fed sources, end of year	–2	–2	–2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	193	197	205
3200	Obligated balance, end of year	197	205	229

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	564	576	532
	Outlays, gross:
4010	Outlays from new discretionary authority	399	380	351
4011	Outlays from discretionary balances	167	181	194

4020	Outlays, gross (total)	566	561	545
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–564	–576	–532
4180	Budget authority, net (total)
4190	Outlays, net (total)	2	–15	13

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		2018 actual	2019 est.	2020 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	77	77	77
25.3	Other goods and services from Federal sources	68	68	68
25.4	Operation and maintenance of facilities	10	10	10
25.7	Operation and maintenance of equipment	57	52	52
26.0	Supplies and materials	1	1	1
31.0	Equipment	12	12	12
32.0	Land and structures	52	50	50

99.9	Total new obligations, unexpired accounts	576	569	569


Identification code 075–4553–0–4–551		2018 actual	2019 est.	2020 est.

2001	Reimbursable civilian full-time equivalent employment	1,268	1,551	1,551
2101	Reimbursable military average strength employment	21	79	79


Identification code 075–0945–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Direct program activity			50

0900	Total new obligations, unexpired accounts (object class 41.0)			50

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			50
	Budget authority:
	Appropriations, discretionary:
1121	Appropriations transferred from other acct [075–0943]		50	50
1930	Total budgetary resources available		50	100
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		50	50

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			50
3020	Outlays (gross)			–50

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		50	50
	Outlays, gross:
4011	Outlays from discretionary balances			50
4180	Budget authority, net (total)		50	50
4190	Outlays, net (total)			50

The FY 2020 Budget provides $50 million for the Infectious Diseases Rapid Response Reserve Fund within the Centers for Disease Control and Prevention. This Fund will provide the ability to respond efficiently and rapidly to emerging infectious disease threats or outbreaks.

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 2020, and existing profiles may be updated as necessary.


Identification code 075–0944–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Agency for Toxic Substances and Disease Registry, Toxic Substance (Direct)	87	75	62
0801	Agency for Toxic Substances and Disease Registry, Toxic Substance (Reimbursable)	16

0900	Total new obligations, unexpired accounts	103	75	62

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	23	21	24
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	75	75	62
1121	Appropriations transferred from other acct [097–0100]	10

1160	Appropriation, discretionary (total)	85	75	62
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	3	3
1701	Change in uncollected payments, Federal sources	13

1750	Spending auth from offsetting collections, disc (total)	16	3	3
1900	Budget authority (total)	101	78	65
1930	Total budgetary resources available	124	99	89
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	21	24	27

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	41	64	42
3010	New obligations, unexpired accounts	103	75	62
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–79	–97	–71
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	64	42	33
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–4	–15	–15
3070	Change in uncollected pymts, Fed sources, unexpired	–13
3071	Change in uncollected pymts, Fed sources, expired	2

3090	Uncollected pymts, Fed sources, end of year	–15	–15	–15
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	37	49	27
3200	Obligated balance, end of year	49	27	18

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	101	78	65
	Outlays, gross:
4010	Outlays from new discretionary authority	51	51	42
4011	Outlays from discretionary balances	25	46	29

4020	Outlays, gross (total)	76	97	71
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–5	–3	–3

4040	Offsets against gross budget authority and outlays (total)	–5	–3	–3
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–13
4052	Offsetting collections credited to expired accounts	2

4060	Additional offsets against budget authority only (total)	–11

4070	Budget authority, net (discretionary)	85	75	62
4080	Outlays, net (discretionary)	71	94	68
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3
4180	Budget authority, net (total)	85	75	62
4190	Outlays, net (total)	74	94	68


Identification code 075–0944–0–1–551		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	21	20	16
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	27	26	22
12.1	Civilian personnel benefits	8	7	6
12.2	Military personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1
25.1	Advisory and assistance services	3	7	9
25.2	Other services from non-Federal sources	5	5	3
25.3	Other goods and services from Federal sources	22	14	14
25.7	Operation and maintenance of equipment	1	1	1
26.0	Supplies and materials	1
31.0	Equipment	2		1
41.0	Grants, subsidies, and contributions	16	13	5

99.0	Direct obligations	87	75	62
99.0	Reimbursable obligations	16

99.9	Total new obligations, unexpired accounts	103	75	62


Identification code 075–0944–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	214	212	212
1101	Direct military average strength employment	33	33	33
2001	Reimbursable civilian full-time equivalent employment		2	2


Identification code 075–0946–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	World Trade Center Health Program—Federal Share (CDC/NIOSH)	432	517	541
0002	World Trade Center Health Program—NYC	48	57	60

0900	Total new obligations, unexpired accounts	480	574	601

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	869	872	812
1012	Unobligated balance transfers between expired and unexpired accounts	25	25	25
1021	Recoveries of prior year unpaid obligations	25
1033	Recoveries of prior year paid obligations	11

1050	Unobligated balance (total)	930	897	837
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (WTC (CDC Direct))	347	440	487
1200	Appropriation (WTC—NYC DHSS—CDC)	39	49	54

1260	Appropriations, mandatory (total)	386	489	541
	Spending authority from offsetting collections, mandatory:
1800	Collected	36
1900	Budget authority (total)	422	489	541
1930	Total budgetary resources available	1,352	1,386	1,378
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	872	812	777

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	186	225	412
3010	New obligations, unexpired accounts	480	574	601
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–393	–387	–401
3040	Recoveries of prior year unpaid obligations, unexpired	–25
3041	Recoveries of prior year unpaid obligations, expired	–25

3050	Unpaid obligations, end of year	225	412	612
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	186	225	412
3200	Obligated balance, end of year	225	412	612

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	422	489	541
	Outlays, gross:
4100	Outlays from new mandatory authority		225	249
4101	Outlays from mandatory balances	393	162	152

4110	Outlays, gross (total)	393	387	401
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–50
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	3
4143	Recoveries of prior year paid obligations, unexpired accounts	11

4150	Additional offsets against budget authority only (total)	14

4160	Budget authority, net (mandatory)	386	489	541
4170	Outlays, net (mandatory)	343	387	401
4180	Budget authority, net (total)	386	489	541
4190	Outlays, net (total)	343	387	401

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 2019 and 2020 in the Budget reflect estimated Federal obligations for the WTC Health Program.


Identification code 075–0946–0–1–551		2018 actual	2019 est.	2020 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	35	39	39
25.2	Other services from non-Federal sources	128	157	179
25.3	Other goods and services from Federal sources	10	4	4
31.0	Equipment	4	1	1
41.0	Grants, subsidies, and contributions	23	27	27
42.0	Insurance claims and indemnities	274	340	345

99.9	Total new obligations, unexpired accounts	480	574	601


Identification code 075–0946–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	30	32	32
1101	Direct military average strength employment	9	7	7

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, $5,051,737,000, of which up to $30,000,000 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, $3,002,696,000.

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $397,493,000.

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,746,493,000.

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,956,031,000.

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $4,754,379,000.

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $2,472,838,000, of which $741,000,000 shall be from funds available under section 241 of the PHS Act: Provided, That not less than $311,236,000 is provided for the Institutional Development Awards program.

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $1,296,732,000.

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $685,644,000.

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $666,854,000.

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, $66,581,000.

For carrying out section 301 and title IV of the PHS Act with respect to aging, $2,654,144,000.

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $520,829,000.

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $408,358,000.

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, $140,301,000.

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $452,419,000.

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $1,296,379,000.

For carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,560,422,000.

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, $495,448,000.

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $335,986,000.

For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $126,081,000.

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, $270,870,000.

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), $67,235,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $380,463,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2021: Provided further, That in fiscal year 2020, 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, $694,112,000: Provided, That up to 10 percent of the amounts made 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, $1,756,544,000: 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 $157,065,000 shall be for the Environmental Influences on Child Health Outcomes study: Provided further, That $520,367,000 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 of, 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, 2024.

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 2020: 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.


Identification code 075–9915–0–1–999		2018 actual	2019 est.	2020 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, NIH	45	42	42

2000	Total: Balances and receipts	45	42	42
	Appropriations:
	Current law:
2101	National Institutes of Health	–45	–42	–42

5099	Balance, end of year


Identification code 075–9915–0–1–999		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	National Cancer Institute (0849)	5,951	6,170	5,248
0002	National Heart, Lung, and Blood Institute (0872)	3,374	3,487	3,003
0003	National Institute of Dental and Craniofacial Research (0873)	447	462	397
0004	National Institute of Diabetes and Digestive and Kidney Disease (0884)	1,963	2,030	1,746
0005	National Institute of Neurological Disorders and Stroke (0886)	1,949	2,469	2,027
0006	National Institute of Allergy and Infectious Diseases (0885)	5,263	5,528	4,755
0007	National Institute of General Medical Sciences (0851)	1,858	1,726	1,732
0008	National Institute of Child Health and Human Development (0844)	1,450	1,514	1,297
0009	National Eye Institute (0887)	770	797	686
0010	National Institute of Environmental Health Sciences (0862)	830	852	733
0011	National Institute on Aging (0843)	2,571	3,082	2,655
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)	585	605	521
0013	National Institute on Deafness and Other Communication Disorder (0890)	459	474	408
0014	National Institute of Mental Health (0892)	1,754	1,870	1,630
0015	National Institute on Drug Abuse (0893)	1,161	1,633	1,296
0016	National Institute on Alcohol Abuse and Alcoholism (0894)	508	526	452
0017	National Institute of Nursing Research (0889)	158	163	140
0018	National Human Genome Research Institute (0891)	557	576	495
0019	National Institute of Biomedical Imaging and Bioengineering (0898)	377	389	336
0021	National Center for Complementary and Integrative Health (0896)	142	146	126
0022	National Institute on Minority Health and Health Disparities (0897)	304	315	271
0023	John E. Fogarty International Center (0819)	76	78	67
0024	National Library of Medicine (0807)	427	442	380
0025	NIH Office of the Director (0846)	1,806	1,922	1,769
0026	NIH Buildings and facilities (0838)	169	200	200
0027	NIH Cooperative Research and Development Agreements	37	42	42
0028	National Center for Advancing Translational Sciences (0875)	754	813	694
0029	National Institute for Research on Safety and Quality			256
0031	Type 1 Diabetes	26	274	150

0799	Total direct obligations	35,726	38,585	33,512
0801	NIH Reimbursable - Other	3,958	4,408	3,730
0802	NIH Royalties	146	145	145

0809	Reimbursable program activities, subtotal	4,104	4,553	3,875

0899	Total reimbursable obligations	4,104	4,553	3,875

0900	Total new obligations, unexpired accounts	39,830	43,138	37,387

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	992	1,476	782
1001	Discretionary unobligated balance brought fwd, Oct 1	992	1,277
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	6
1021	Recoveries of prior year unpaid obligations	88
1033	Recoveries of prior year paid obligations	9

1050	Unobligated balance (total)	1,098	1,476	804
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	35,792	37,290	32,972
1120	Appropriations transferred to other acct [075–1503]	–87
1120	Appropriations transferred to other acct [075–0128]		–5
1121	Appropriations transferred from other acct [075–5628]	386	515	335
1121	Appropriations transferred from other acct [075–5736]		13	13

1160	Appropriation, discretionary (total)	36,091	37,813	33,320
	Appropriations, mandatory:
1200	Appropriation	150	150
1201	Appropriation (special or trust fund)	45	42	42

1260	Appropriations, mandatory (total)	195	192	42
	Spending authority from offsetting collections, discretionary:
1700	Collected	3,784	4,439	4,439
1701	Change in uncollected payments, Federal sources	137

1750	Spending auth from offsetting collections, disc (total)	3,921	4,439	4,439
	Spending authority from offsetting collections, mandatory:
1800	Collected	4
1900	Budget authority (total)	40,211	42,444	37,801
1930	Total budgetary resources available	41,309	43,920	38,605
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	1,476	782	1,218

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	34,682	37,408	40,758
3001	Adjustments to unpaid obligations, brought forward, Oct 1	–10
3010	New obligations, unexpired accounts	39,830	43,138	37,387
3011	Obligations ("upward adjustments"), expired accounts	493
3020	Outlays (gross)	–36,720	–39,788	–40,881
3040	Recoveries of prior year unpaid obligations, unexpired	–88
3041	Recoveries of prior year unpaid obligations, expired	–779

3050	Unpaid obligations, end of year	37,408	40,758	37,264
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–671	–565	–565
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	51
3070	Change in uncollected pymts, Fed sources, unexpired	–137
3071	Change in uncollected pymts, Fed sources, expired	192

3090	Uncollected pymts, Fed sources, end of year	–565	–565	–565
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	34,052	36,843	40,193
3200	Obligated balance, end of year	36,843	40,193	36,699

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	40,012	42,252	37,759
	Outlays, gross:
4010	Outlays from new discretionary authority	11,786	14,161	12,961
4011	Outlays from discretionary balances	24,748	25,489	27,729

4020	Outlays, gross (total)	36,534	39,650	40,690
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,654	–4,439	–4,439
4033	Non-Federal sources	–366

4040	Offsets against gross budget authority and outlays (total)	–4,020	–4,439	–4,439
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–137
4052	Offsetting collections credited to expired accounts	227
4053	Recoveries of prior year paid obligations, unexpired accounts	9

4060	Additional offsets against budget authority only (total)	99

4070	Budget authority, net (discretionary)	36,091	37,813	33,320
4080	Outlays, net (discretionary)	32,514	35,211	36,251
	Mandatory:
4090	Budget authority, gross	199	192	42
	Outlays, gross:
4100	Outlays from new mandatory authority	17	44	10
4101	Outlays from mandatory balances	169	94	181

4110	Outlays, gross (total)	186	138	191
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–4
4180	Budget authority, net (total)	36,286	38,005	33,362
4190	Outlays, net (total)	32,696	35,349	36,442


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	36,286	38,005	33,362
	Outlays	32,696	35,349	36,442
Legislative proposal, subject to PAYGO:
	Budget Authority			150
	Outlays			35
Total:
	Budget Authority	36,286	38,005	33,512
	Outlays	32,696	35,349	36,477

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 2020 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. Detailed information is available through the Department of Health and Human Services.


Identification code 075–9915–0–1–999		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	985	1,015	1,044
11.3	Other than full-time permanent	515	527	531
11.5	Other personnel compensation	48	49	50
11.7	Military personnel	18	19	20
11.8	Special personal services payments	194	197	189

11.9	Total personnel compensation	1,760	1,807	1,834
12.1	Civilian personnel benefits	514	529	546
12.2	Military personnel benefits	12	12	13
13.0	Benefits for former personnel			2
21.0	Travel and transportation of persons	54	56	43
22.0	Transportation of things	5	6	5
23.1	Rental payments to GSA	23	21	18
23.2	Rental payments to others	1	1
23.3	Communications, utilities, and miscellaneous charges	38	36	25
25.1	Advisory and assistance services	264	268	194
25.2	Other services from non-Federal sources	1,327	1,393	974
25.3	Other goods and services from Federal sources	3,374	3,519	3,214
25.4	Operation and maintenance of facilities	213	282	268
25.5	Research and development contracts	1,577	1,663	1,467
25.6	Medical care	29	29	25
25.7	Operation and maintenance of equipment	143	146	120
25.8	Subsistence and support of persons	2	2	2
26.0	Supplies and materials	240	247	191
31.0	Equipment	192	204	159
41.0	Grants, subsidies, and contributions	25,958	28,364	24,412

99.0	Direct obligations	35,726	38,585	33,512
99.0	Reimbursable obligations	4,104	4,553	3,875

99.9	Total new obligations, unexpired accounts	39,830	43,138	37,387


Identification code 075–9915–0–1–999		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	12,799	13,193	13,412
1101	Direct military average strength employment	172	177	181
2001	Reimbursable civilian full-time equivalent employment	4,435	4,572	4,573
2101	Reimbursable military average strength employment	96	99	99


Identification code 075–9915–4–1–999		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Type 1 Diabetes			150

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

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

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			150
3020	Outlays (gross)			–35

3050	Unpaid obligations, end of year			115
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			115

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			150
	Outlays, gross:
4100	Outlays from new mandatory authority			35
4180	Budget authority, net (total)			150
4190	Outlays, net (total)			35

The Budget proposes to extend the Special Diabetes Program for Type 1 Diabetes through fiscal year 2021.


Identification code 075–0147–0–1–552		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Payment to NIH Innovation (object class 94.0)	496	711	492

0900	Total new obligations, unexpired accounts (object class 94.0)	496	711	492

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	496	711	492
1930	Total budgetary resources available	496	711	492

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	496	711	492
3020	Outlays (gross)	–496	–711	–492

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	496	711	492
	Outlays, gross:
4100	Outlays from new mandatory authority	496	711	492
4180	Budget authority, net (total)	496	711	492
4190	Outlays, net (total)	496	711	492

This account, and a related special fund 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 NIH in this Act, $492,000,000, to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act, are to be derived from amounts transferred under section 1001(b)(2)(A) of such Act, and may be transferred by the Director of the National Institutes of Health to other accounts of the National Institutes of Health solely for the purposes provided in such Act: Provided further, That upon a determination by the Director that funds transferred pursuant to the previous proviso are not necessary for the purposes provided, such amounts may be transferred back to the 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		2018 actual	2019 est.	2020 est.

0100	Balance, start of year
	Receipts:
	Current law:
1140	General Fund Payment, NIH Innovation, CURES Act	496	711	492

2000	Total: Balances and receipts	496	711	492
	Appropriations:
	Current law:
2101	NIH Innovation, Cures Act	–496	–711	–492

5099	Balance, end of year


Identification code 075–5628–0–2–552		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	CURES obligations	102	244	157

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	40	48
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	496	711	492
1120	Appropriations transferred to other acct [075–9915]	–386	–515	–335

1160	Appropriation, discretionary (total)	110	196	157
1930	Total budgetary resources available	150	244	157
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	48

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	12	94	233
3010	New obligations, unexpired accounts	102	244	157
3020	Outlays (gross)	–20	–105	–175

3050	Unpaid obligations, end of year	94	233	215
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	12	94	233
3200	Obligated balance, end of year	94	233	215

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	110	196	157
	Outlays, gross:
4010	Outlays from new discretionary authority	12	39	33
4011	Outlays from discretionary balances	8	66	142

4020	Outlays, gross (total)	20	105	175
4180	Budget authority, net (total)	110	196	157
4190	Outlays, net (total)	20	105	175

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. Amounts appropriated into the NIH Innovation Account are either transferred to the individual institutes and centers or obligated directly in the NIH Innovation Account.


Identification code 075–5628–0–2–552		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	3	6	7
11.3	Other than full-time permanent	1	2	2

11.9	Total personnel compensation	4	8	9
12.1	Civilian personnel benefits	1	2	3
25.3	Other goods and services from Federal sources	1
25.5	Research and development contracts	2	1
41.0	Grants, subsidies, and contributions	94	233	145

99.9	Total new obligations, unexpired accounts	102	244	157


Identification code 075–5628–0–2–552		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	30	59	73
1101	Direct military average strength employment		1	1


Identification code 075–5736–0–2–552		2018 actual	2019 est.	2020 est.

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

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

5099	Balance, end of year


Identification code 075–5736–0–2–552		2018 actual	2019 est.	2020 est.

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

This special fund was created by the Gabriella Miller Kids First Research Act, enacted on April 3, 2014. This fund receives transfers from the Presidential Election Campaign Fund, which are then appropriated to the NIH Common Fund to support pediatric research.

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, $1,485,047,000: 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 $150,000,000 shall be available until September 30, 2022 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93: 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 available 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 and the SUPPORT for Patients and Communities Act, $3,708,767,000: Provided, That $1,500,000,000 shall be for State Opioid Response Grants for carrying out activities pertaining to opioids undertaken by the State agency responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the PHS Act (42 U.S.C. 300x-21 et seq.): Provided further, That of such amount $50,000,000 shall be made available to Indian Tribes or tribal organizations: Provided further, That 15 percent of the remaining amount shall be for the States with the highest mortality rate related to opioid use disorders: Provided further, That of the amounts provided for State Opioid Response Grants not more than 2 percent shall be available for Federal administrative expenses, training, technical assistance, and evaluation: Provided further, That of the amount not reserved by the previous three provisos, the Secretary shall make allocations to States, territories, and the District of Columbia according to a formula using national survey results that the Secretary determines are the most objective and reliable measure of drug use and drug-related deaths: Provided further, That prevention and treatment activities funded through such grants may include education, treatment (including the provision of medication), behavioral health services for individuals in treatment programs, referral to treatment services, recovery support, and medical screening associated with such treatment: Provided further, That each State, as well as the District of Columbia, shall receive not less than $4,000,000: Provided further, 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 of the funds made available under this heading, $4,000,000 shall be available to carry out section 3203 of the SUPPORT for Patients and Communities Act: Provided further, That none of the funds provided for section 1921 of the PHS Act or State Opioid Response Grants 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 National Narcotics Leadership Act of 1988, as amended, $244,090,000, of which $2,000,000 shall be made available as directed by section 4 of Public Law 107–82, as amended by Public Law 115–271, 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 and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, $97,004,000: Provided, That in addition to amounts provided herein, $42,453,000 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, 2021: 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".


Identification code 075–1362–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0006	Mental Health	1,454	1,525	1,485
0007	Substance Abuse Treatment	3,683	3,738	3,708
0008	Substance Abuse Prevention	248	205	244
0009	Health Surveillance and Program Support	129	129	98
0011	SAMHSA Prevention Fund	12	12

0100	Total, direct program	5,526	5,609	5,535

0799	Total direct obligations	5,526	5,609	5,535
0802	SAMHSA Reimbursables	146	148	30
0810	SAMHSA Reimbursable: PHS Evaluation	134	134	143

0899	Total reimbursable obligations	280	282	173

0900	Total new obligations, unexpired accounts	5,806	5,891	5,708

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	19	19
1001	Discretionary unobligated balance brought fwd, Oct 1	1	6
1020	Adjustment of unobligated bal brought forward, Oct 1	10

1050	Unobligated balance (total)	12	19	19
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	5,013	5,597	5,535
1120	Appropriations transferred to other acct [075–1503]	–6
1121	Appropriations transferred from other acct [075–5627]	500
1121	Appropriations transferred from other acct [075–0140]	20

1160	Appropriation, discretionary (total)	5,527	5,597	5,535
	Appropriations, mandatory:
1221	Appropriations transferred from the Prevention and Public Health Fund [075–0116]	12	12
	Spending authority from offsetting collections, discretionary:
1700	Collected	163	282	173
1701	Change in uncollected payments, Federal sources	115

1750	Spending auth from offsetting collections, disc (total)	278	282	173
1900	Budget authority (total)	5,817	5,891	5,708
1930	Total budgetary resources available	5,829	5,910	5,727
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–4
1941	Unexpired unobligated balance, end of year	19	19	19

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4,506	6,127	6,824
3010	New obligations, unexpired accounts	5,806	5,891	5,708
3011	Obligations ("upward adjustments"), expired accounts	24
3020	Outlays (gross)	–4,085	–5,194	–5,857
3041	Recoveries of prior year unpaid obligations, expired	–124

3050	Unpaid obligations, end of year	6,127	6,824	6,675
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–143	–165	–165
3070	Change in uncollected pymts, Fed sources, unexpired	–115
3071	Change in uncollected pymts, Fed sources, expired	93

3090	Uncollected pymts, Fed sources, end of year	–165	–165	–165
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4,363	5,962	6,659
3200	Obligated balance, end of year	5,962	6,659	6,510

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5,805	5,879	5,708
	Outlays, gross:
4010	Outlays from new discretionary authority	1,155	1,636	1,593
4011	Outlays from discretionary balances	2,913	3,553	4,258

4020	Outlays, gross (total)	4,068	5,189	5,851
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–250	–280	–171
4033	Non-Federal sources	–2	–2	–2

4040	Offsets against gross budget authority and outlays (total)	–252	–282	–173
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–115
4052	Offsetting collections credited to expired accounts	89

4060	Additional offsets against budget authority only (total)	–26

4070	Budget authority, net (discretionary)	5,527	5,597	5,535
4080	Outlays, net (discretionary)	3,816	4,907	5,678
	Mandatory:
4090	Budget authority, gross	12	12
	Outlays, gross:
4100	Outlays from new mandatory authority		4
4101	Outlays from mandatory balances	17	1	6

4110	Outlays, gross (total)	17	5	6
4180	Budget authority, net (total)	5,539	5,609	5,535
4190	Outlays, net (total)	3,833	4,912	5,684

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	47	48	49
11.3	Other than full-time permanent	2	3	2
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	3	3	3

11.9	Total personnel compensation	53	55	55
12.1	Civilian personnel benefits	15	16	17
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	1	1
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	32	33	34
25.2	Other services from non-Federal sources	132	146	146
25.3	Other goods and services from Federal sources	36	40	37
25.4	Operation and maintenance of facilities	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	5,244	5,306	5,232

99.0	Direct obligations	5,526	5,610	5,535
99.0	Reimbursable obligations	280	281	173

99.9	Total new obligations, unexpired accounts	5,806	5,891	5,708


Identification code 075–1362–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	424	474	479
1101	Direct military average strength employment	31	31	31
2001	Reimbursable civilian full-time equivalent employment	101	101	91
2101	Reimbursable military average strength employment	5	5	5

Federal Funds


Identification code 075–1700–0–1–552		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Research on Health Costs, Quality and Outcomes	192	197
0002	Medical Expenditure Panel Survey	70	70
0003	AHRQ Program Support	71	71

0799	Total direct obligations	333	338
0803	Research on Health Costs, Quality and Outcomes (Reimbursable)	26	26

0899	Total reimbursable obligations	26	26

0900	Total new obligations, unexpired accounts	359	364

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	22	21	22
1001	Discretionary unobligated balance brought fwd, Oct 1	1	1
1010	Unobligated balance transfer to other accts [075–9915]			–22
1021	Recoveries of prior year unpaid obligations	1	1

1050	Unobligated balance (total)	23	22
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	334	338
1120	Appropriations transferred to other acct [075–1503]	–1

1160	Appropriation, discretionary (total)	333	338
	Spending authority from offsetting collections, discretionary:
1700	Collected	1	1
1701	Change in uncollected payments, Federal sources	17	17

1750	Spending auth from offsetting collections, disc (total)	18	18
	Spending authority from offsetting collections, mandatory:
1800	Collected	6	8
1900	Budget authority (total)	357	364
1930	Total budgetary resources available	380	386
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	21	22

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	346	335	432
3010	New obligations, unexpired accounts	359	364
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–358	–266	–299
3040	Recoveries of prior year unpaid obligations, unexpired	–1	–1
3041	Recoveries of prior year unpaid obligations, expired	–12

3050	Unpaid obligations, end of year	335	432	133
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–52	–35	–18
3070	Change in uncollected pymts, Fed sources, unexpired	–17	–17
3071	Change in uncollected pymts, Fed sources, expired	34	34

3090	Uncollected pymts, Fed sources, end of year	–35	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	294	300	414
3200	Obligated balance, end of year	300	414	115

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	351	356
	Outlays, gross:
4010	Outlays from new discretionary authority	130	136
4011	Outlays from discretionary balances	222	114	299

4020	Outlays, gross (total)	352	250	299
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–28	–28

4040	Offsets against gross budget authority and outlays (total)	–28	–28
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–17	–17
4052	Offsetting collections credited to expired accounts	27	27

4060	Additional offsets against budget authority only (total)	10	10

4070	Budget authority, net (discretionary)	333	338
4080	Outlays, net (discretionary)	324	222	299
	Mandatory:
4090	Budget authority, gross	6	8
	Outlays, gross:
4100	Outlays from new mandatory authority		8
4101	Outlays from mandatory balances	6	8

4110	Outlays, gross (total)		16
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–6	–8
4180	Budget authority, net (total)	333	338
4190	Outlays, net (total)	324	230	299

The FY 2020 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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	30	31
11.3	Other than full-time permanent	4	4
11.5	Other personnel compensation	1
11.7	Military personnel	1	1

11.9	Total personnel compensation	36	36
12.1	Civilian personnel benefits	11	11
23.1	Rental payments to GSA	3	3
25.2	Other services from non-Federal sources	10	11
25.3	Other goods and services from Federal sources	21	21
25.5	Research and development contracts	142	144
31.0	Equipment	1	2
41.0	Grants, subsidies, and contributions	109	110

99.0	Direct obligations	333	338
99.0	Reimbursable obligations	26	26

99.9	Total new obligations, unexpired accounts	359	364


Identification code 075–1700–0–1–552		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	263	270
1101	Direct military average strength employment	6	6
2001	Reimbursable civilian full-time equivalent employment	4	1
3001	Allocation account civilian full-time equivalent employment	8	7

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $273,188,478,000, to remain available until expended.

In addition, for carrying out such titles after May 31, 2020, for the last quarter of fiscal year 2020 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 2021, $139,903,075,000, 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments	414,870	420,268	438,844
0002	State and local administration	22,133	21,861	22,527
0003	Vaccines for Children	4,389	4,176	4,761

0799	Total direct obligations	441,392	446,305	466,132

0900	Total new obligations, unexpired accounts (object class 41.0)	441,392	446,305	466,132

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	310	15,402	16,784
1021	Recoveries of prior year unpaid obligations	29,936	35,570	37,100
1033	Recoveries of prior year paid obligations	15,114

1050	Unobligated balance (total)	45,360	50,972	53,884
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	284,798	276,236	273,188
	Advance appropriations, mandatory:
1270	Advance appropriation	125,219	134,848	137,932
	Spending authority from offsetting collections, mandatory:
1800	Collected	1,087	1,033	1,128
1801	Change in uncollected payments, Federal sources	330

1850	Spending auth from offsetting collections, mand (total)	1,417	1,033	1,128
1900	Budget authority (total)	411,434	412,117	412,248
1930	Total budgetary resources available	456,794	463,089	466,132
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	15,402	16,784

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	39,981	46,079	37,100
3010	New obligations, unexpired accounts	441,392	446,305	466,132
3020	Outlays (gross)	–405,358	–419,714	–427,114
3040	Recoveries of prior year unpaid obligations, unexpired	–29,936	–35,570	–37,100

3050	Unpaid obligations, end of year	46,079	37,100	39,018
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–393	–723	–723
3070	Change in uncollected pymts, Fed sources, unexpired	–330

3090	Uncollected pymts, Fed sources, end of year	–723	–723	–723
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	39,588	45,356	36,377
3200	Obligated balance, end of year	45,356	36,377	38,295

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	411,434	412,117	412,248
	Outlays, gross:
4100	Outlays from new mandatory authority	404,451	404,672	410,329
4101	Outlays from mandatory balances	907	15,042	16,785

4110	Outlays, gross (total)	405,358	419,714	427,114
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,087	–1,033	–1,128
4123	Non-Federal sources	–15,114

4130	Offsets against gross budget authority and outlays (total)	–16,201	–1,033	–1,128
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–330
4143	Recoveries of prior year paid obligations, unexpired accounts	15,114

4150	Additional offsets against budget authority only (total)	14,784

4160	Budget authority, net (mandatory)	410,017	411,084	411,120
4170	Outlays, net (mandatory)	389,157	418,681	425,986
4180	Budget authority, net (total)	410,017	411,084	411,120
4190	Outlays, net (total)	389,157	418,681	425,986


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	410,017	411,084	411,120
	Outlays	389,157	418,681	425,986
Legislative proposal, subject to PAYGO:
	Budget Authority			–7,835
	Outlays			–7,835
Total:
	Budget Authority	410,017	411,084	403,285
	Outlays	389,157	418,681	418,151

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	2018	2019	2020

Vaccine Purchase	4,191	3,964	4,467
Vaccine Stockpile	25	24	98
Ordering, Distribution, and Operations	122	136	142
Vaccine Management Contract Support	0	0	0
Evaluation Activities	51	52	54

Total Obligations	4,389	4,176	4,761


Identification code 075–0512–4–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments			–7,835

0799	Total direct obligations			–7,835

0900	Total new obligations, unexpired accounts (object class 41.0)			–7,835

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–7,835
1900	Budget authority (total)			–7,835
1930	Total budgetary resources available			–7,835

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–7,835
3020	Outlays (gross)			7,835

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–7,835
	Outlays, gross:
4100	Outlays from new mandatory authority			–7,835
4180	Budget authority, net (total)			–7,835
4190	Outlays, net (total)			–7,835


Identification code 075–0516–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0012	Medicaid integrity program	84	102	90
0018	Money follows the person (MFP) demonstration		112	76
0019	MFP evaluations and technical support		1
0021	Katrina Relief	2
0023	Grants to improve outreach and enrollment	1	58
0028	Demo to increase substance use provider under the Medicaid Program		51	1

0799	Total direct obligations	87	324	167

0900	Total new obligations, unexpired accounts	87	324	167

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	244	368	293
1021	Recoveries of prior year unpaid obligations	1
1033	Recoveries of prior year paid obligations	10

1050	Unobligated balance (total)	255	368	293
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	206	254	90
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–6	–5

1260	Appropriations, mandatory (total)	200	249	90
1900	Budget authority (total)	200	249	90
1930	Total budgetary resources available	455	617	383
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	368	293	216

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,297	901	749
3010	New obligations, unexpired accounts	87	324	167
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–482	–476	–610
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	901	749	306
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,297	901	749
3200	Obligated balance, end of year	901	749	306

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	200	249	90
	Outlays, gross:
4100	Outlays from new mandatory authority	20	39	15
4101	Outlays from mandatory balances	462	437	595

4110	Outlays, gross (total)	482	476	610
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–10
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	10

4160	Budget authority, net (mandatory)	200	249	90
4170	Outlays, net (mandatory)	472	476	610
4180	Budget authority, net (total)	200	249	90
4190	Outlays, net (total)	472	476	610

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). The account also includes funding for grant programs enacted in the HEALTHY KIDS Act (P.L. 115–120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123), the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115–271), and the Medicaid Extenders Act of 2019 (P.L. 116–3).


Identification code 075–0516–0–1–551		2018 actual	2019 est.	2020 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent - Medicaid Integrity Program	19	27	27

11.9	Total personnel compensation		27	27
12.1	Civilian personnel benefits - Medicaid Integrity Program	9	13	13
41.0	Grants, subsidies, and contributions - Medicaid Integrity Program	56	62	50
41.0	Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations		112	76
41.0	Grants, subsidies, and contributions - MFP evaluations and technical support		1
41.0	Grants, subsidies, and contributions - Grants to improve outreach and enrollment	1	58
41.0	Grants, subsidies, and contributions - Katrina Relief	2
41.0	Grants, subsidies, and contributions - Demo to increase substance use provider capacity under Medicaid		51	1

99.0	Direct obligations	87	324	167

99.9	Total new obligations, unexpired accounts	87	324	167


Identification code 075–0516–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	188	200	200
1101	Direct military average strength employment		5	5

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, $410,796,100,000.

In addition, for making adjustments to the allocation of administrative expenses incurred in prior fiscal years pursuant to section 201(g) of the Social Security Act, such sums as may be necessary: Provided, That such amounts shall not be available for obligation until the Office of Management and Budget approves a justification of the adjustments to the allocation of administrative expenses between the Social Security Administration, Railroad Retirement Board, and the CMS Trust Funds.

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)	249,921	284,288	296,515
0002	Part D benefits (Rx Drug)	69,563	92,070	98,431
0003	Part D Federal administration (Rx Drug)	422	642	861
0004	General Fund Transfers to HI	1,543	1,332	1,323
0006	Federal Bureau of Investigation (HCFAC)	135	135	138
0007	Federal payments from taxation of OASDI benefits (HI)	24,192	23,882	26,472
0008	Criminal fines (HCFAC)	2	88	36
0009	Civil penalties and damages (HCFAC—DOJ and CMS administration)	16	52	52
0010	Asset Forfeiture	22	31	32
0011	State Low Income Determinations	3	4	5

0900	Total new obligations, unexpired accounts	345,819	402,524	423,865

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)	327,124	378,336	397,135
1200	Appropriation (indefinite, permanent)	24,723	23,882	26,472
1200	Appropriation (HCFAC for FBI)	135	135	138
1200	Appropriation (indefinite for HCFAC)	307	171	120

1260	Appropriations, mandatory (total)	352,289	402,524	423,865
1930	Total budgetary resources available	352,289	402,524	423,865
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6,470

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	18,743	10,525	54,052
3010	New obligations, unexpired accounts	345,819	402,524	423,865
3020	Outlays (gross)	–348,189	–358,997	–401,440
3041	Recoveries of prior year unpaid obligations, expired	–5,848

3050	Unpaid obligations, end of year	10,525	54,052	76,477
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	18,743	10,525	54,052
3200	Obligated balance, end of year	10,525	54,052	76,477

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	352,289	402,524	423,865
	Outlays, gross:
4100	Outlays from new mandatory authority	339,880	348,473	360,406
4101	Outlays from mandatory balances	8,309	10,524	41,034

4110	Outlays, gross (total)	348,189	358,997	401,440
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–3,980
4123	Non-Federal sources	–228

4130	Offsets against gross budget authority and outlays (total)	–4,208
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	4,208

4160	Budget authority, net (mandatory)	352,289	402,524	423,865
4170	Outlays, net (mandatory)	343,981	358,997	401,440
4180	Budget authority, net (total)	352,289	402,524	423,865
4190	Outlays, net (total)	343,981	358,997	401,440


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	352,289	402,524	423,865
	Outlays	343,981	358,997	401,440
Legislative proposal, not subject to PAYGO:
	Budget Authority			–7,786
	Outlays			–7,786
Total:
	Budget Authority	352,289	402,524	416,079
	Outlays	343,981	358,997	393,654

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions	343,722	400,542	421,676
42.0	Insurance claims and indemnities (HI Uninsured Federal)	132	127	102
94.0	Financial transfers (Federal admin)	1,965	1,855	2,087

99.9	Total new obligations, unexpired accounts	345,819	402,524	423,865


Identification code 075–0580–2–1–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)			–7,696
0002	Part D benefits (Rx Drug)			–90

0900	Total new obligations, unexpired accounts (object class 41.0)			–7,786

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)			–7,786
1930	Total budgetary resources available			–7,786

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–7,786
3020	Outlays (gross)			7,786

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–7,786
	Outlays, gross:
4100	Outlays from new mandatory authority			–7,786
4180	Budget authority, net (total)			–7,786
4190	Outlays, net (total)			–7,786


Identification code 075–0519–0–1–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	QIO contracts	478	445	226
0002	QIO support contracts	157	875	444

0900	Total new obligations, unexpired accounts	635	1,320	670

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	172	1,320	670
1801	Change in uncollected payments, Federal sources	607

1850	Spending auth from offsetting collections, mand (total)	779	1,320	670
1930	Total budgetary resources available	779	1,320	670
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–144

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,188	867	867
3010	New obligations, unexpired accounts	635	1,320	670
3020	Outlays (gross)	–934	–1,320	–670
3041	Recoveries of prior year unpaid obligations, expired	–22

3050	Unpaid obligations, end of year	867	867	867
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,982	–1,616	–1,616
3070	Change in uncollected pymts, Fed sources, unexpired	–607
3071	Change in uncollected pymts, Fed sources, expired	973

3090	Uncollected pymts, Fed sources, end of year	–1,616	–1,616	–1,616
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–794	–749	–749
3200	Obligated balance, end of year	–749	–749	–749

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	779	1,320	670
	Outlays, gross:
4100	Outlays from new mandatory authority	167	720	416
4101	Outlays from mandatory balances	767	600	254

4110	Outlays, gross (total)	934	1,320	670
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,040	–1,320	–670
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–607
4142	Offsetting collections credited to expired accounts	868

4150	Additional offsets against budget authority only (total)	261
4170	Outlays, net (mandatory)	–106
4180	Budget authority, net (total)
4190	Outlays, net (total)	–106

	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 (P.L. 97–248), 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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	27	29	58
11.7	Military personnel		1	1

11.9	Total personnel compensation		30	59
12.1	Civilian personnel benefits	9	9	9
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.2	Other services from non-Federal sources	598	1,280	601

99.9	Total new obligations, unexpired accounts	635	1,320	670


Identification code 075–0519–0–1–571		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	236	220	168
1101	Direct military average strength employment		10	10

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 & Medicaid Services, not to exceed $3,579,427,000, 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 2020 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: Provided further, That of the funds made available under this heading, $442,192,000, to remain available until September 30, 2021, shall be available for the Survey and Certification Program.


Identification code 075–0511–0–1–550		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Program operations	3,106	2,886	2,446
0002	Federal administration	749	733	748
0003	State survey and certification	409	403	447
0004	Research, demonstrations, and evaluation projects	20	20
0007	ARRA Medicare/Medicaid HIT	37	36	23

0100	Total direct program	4,321	4,078	3,664

0799	Total direct obligations	4,321	4,078	3,664
0801	Clinical laboratory improvement amendments	62	35	40
0802	Sale of data	18	21	20
0803	Coordination of benefits	32	35	35
0804	Medicare advantage/Prescription drug plan	58	88	89
0805	Provider enrollment	10	31	32
0806	Recovery audit contractors	90	80	85
0808	Marketplace User Fees	1,272	1,422	1,235
0810	Risk Adjustment Administrative Expenses	32	49	39
0813	Other reimbursable program activity	13

0899	Total reimbursable obligations	1,587	1,761	1,575

0900	Total new obligations, unexpired accounts	5,908	5,839	5,239

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	–9,240	3,123	3,838
1020	Adjustment of unobligated bal brought forward, Oct 1	–162
1021	Recoveries of prior year unpaid obligations	12,330
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	2,929	3,123	3,838
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3	3	3
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,832	4,035	3,629
1701	Change in uncollected payments, Federal sources	2,204

1750	Spending auth from offsetting collections, disc (total)	4,036	4,035	3,629
	Spending authority from offsetting collections, mandatory:
1800	Collected	2,232	2,560	2,491
1801	Change in uncollected payments, Federal sources	–88
1802	Offsetting collections (previously unavailable)	101	116
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–145	–160

1850	Spending auth from offsetting collections, mand (total)	2,100	2,516	2,491
1900	Budget authority (total)	6,139	6,554	6,123
1930	Total budgetary resources available	9,068	9,677	9,961
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–37
1941	Unexpired unobligated balance, end of year	3,123	3,838	4,722

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	16,606	4,599	4,568
3001	Adjustments to unpaid obligations, brought forward, Oct 1	25
3010	New obligations, unexpired accounts	5,908	5,839	5,239
3011	Obligations ("upward adjustments"), expired accounts	164
3020	Outlays (gross)	–5,553	–5,870	–6,691
3040	Recoveries of prior year unpaid obligations, unexpired	–12,330
3041	Recoveries of prior year unpaid obligations, expired	–221

3050	Unpaid obligations, end of year	4,599	4,568	3,116
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–6,082	–5,839	–5,839
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	–10
3070	Change in uncollected pymts, Fed sources, unexpired	–2,116
3071	Change in uncollected pymts, Fed sources, expired	2,369

3090	Uncollected pymts, Fed sources, end of year	–5,839	–5,839	–5,839
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	10,539	–1,240	–1,271
3200	Obligated balance, end of year	–1,240	–1,271	–2,723

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,036	4,035	3,629
	Outlays, gross:
4010	Outlays from new discretionary authority	1,774	2,042	1,840
4011	Outlays from discretionary balances	2,249	1,192	1,991

4020	Outlays, gross (total)	4,023	3,234	3,831
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–4,056	–3,985	–3,579
4033	Non-Federal sources	–54	–50	–50

4040	Offsets against gross budget authority and outlays (total)	–4,110	–4,035	–3,629
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2,204
4052	Offsetting collections credited to expired accounts	2,278

4060	Additional offsets against budget authority only (total)	74
4080	Outlays, net (discretionary)	–87	–801	202
	Mandatory:
4090	Budget authority, gross	2,103	2,519	2,494
	Outlays, gross:
4100	Outlays from new mandatory authority	172	1,399	1,283
4101	Outlays from mandatory balances	1,358	1,237	1,577

4110	Outlays, gross (total)	1,530	2,636	2,860
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–314	–159	–36
4123	Non-Federal sources	–1,935	–2,401	–2,455

4130	Offsets against gross budget authority and outlays (total)	–2,249	–2,560	–2,491
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	88
4142	Offsetting collections credited to expired accounts	16
4143	Recoveries of prior year paid obligations, unexpired accounts	1

4150	Additional offsets against budget authority only (total)	105

4160	Budget authority, net (mandatory)	–41	–41	3
4170	Outlays, net (mandatory)	–719	76	369
4180	Budget authority, net (total)	–41	–41	3
4190	Outlays, net (total)	–806	–725	571

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	476	515	559
5091	Expiring unavailable balance: Offsetting collections	–5
5092	Unexpired unavailable balance, EOY: Offsetting collections	515	559	559
5093	Expired unavailable balance, SOY: Offsetting collections	1	6	6
5095	Expired unavailable balance, EOY: Offsetting collections	1	6	6


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	–41	–41	3
	Outlays	–806	–725	571
Legislative proposal, subject to PAYGO:
	Budget Authority			12
	Outlays			2
Total:
	Budget Authority	–41	–41	15
	Outlays	–806	–725	573

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.


Identification code 075–0511–0–1–550		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	473	489	490
11.3	Other than full-time permanent	11	11	15
11.5	Other personnel compensation	8	8	9
11.7	Military personnel	15	15	15

11.9	Total personnel compensation	507	523	529
12.1	Civilian personnel benefits	157	154	157
12.2	Military personnel benefits	8	8	8
21.0	Travel and transportation of persons	5	5	5
22.0	Transportation of things	2	2	2
23.1	Rental payments to GSA	23	23	23
23.3	Communications, utilities, and miscellaneous charges	73	73	73
24.0	Printing and reproduction	63	63	63
25.2	Other services from non-Federal sources	3,030	2,765	2,298
25.6	Medical care	394	403	447
26.0	Supplies and materials	2	2	2
31.0	Equipment	4	4	4
41.0	Grants, subsidies, and contributions	33	33	33
42.0	Insurance claims and indemnities	20	20	20

99.0	Direct obligations	4,321	4,078	3,664
99.0	Reimbursable obligations	1,587	1,761	1,575

99.9	Total new obligations, unexpired accounts	5,908	5,839	5,239


Identification code 075–0511–0–1–550		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	4,206	4,167	4,195
1001	Direct civilian full-time equivalent employment	149	142	142
1101	Direct military average strength employment	135	146	146
2001	Reimbursable civilian full-time equivalent employment	252	300	380


Identification code 075–0511–4–1–550		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Program operations			12

0100	Total direct program			12

0799	Total direct obligations			12
0801	ACL SHIPs			13

0899	Total reimbursable obligations			13

0900	Total new obligations, unexpired accounts			25

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			12
	Spending authority from offsetting collections, mandatory:
1800	Collected			13
1900	Budget authority (total)			25
1930	Total budgetary resources available			25

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			25
3020	Outlays (gross)			–15

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			25
	Outlays, gross:
4100	Outlays from new mandatory authority			15
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–13
4180	Budget authority, net (total)			12
4190	Outlays, net (total)			2

This display includes the effects of proposals related to mandatory funding for the State Health Insurance Assistance Program, resources to implement HHS's legislative proposals in the FY 2020 Budget, and the National Medicare and You Education Program user fee increase.


Identification code 075–0511–4–1–550		2018 actual	2019 est.	2020 est.

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

99.0	Direct obligations			12
99.0	Reimbursable obligations			13

99.9	Total new obligations, unexpired accounts			25


Identification code 075–0514–4–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Direct program activity			15,290

0900	Total new obligations, unexpired accounts (object class 41.0)			15,290

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			15,290
1930	Total budgetary resources available			15,290

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			15,290
3020	Outlays (gross)			–15,290

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			15,290
	Outlays, gross:
4100	Outlays from new mandatory authority			15,290
4180	Budget authority, net (total)			15,290
4190	Outlays, net (total)			15,290

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Grants to states and US territories	17,310	17,881	18,366
0002	CHIP Redistribution Funds	171
0003	Child health quality	8	22	21

0900	Total new obligations, unexpired accounts (object class 41.0)	17,489	17,903	18,387

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6,442	8,251	10,887
1011	Unobligated balance transfer from other acct [075–5551]			4,632
1012	Unobligated balance transfers between expired and unexpired accounts	101
1020	Adjustment of unobligated bal brought forward, Oct 1	–170
1021	Recoveries of prior year unpaid obligations	2,041

1050	Unobligated balance (total)	8,414	8,251	15,519
	Budget authority:
	Appropriations, discretionary:
1130	Appropriations permanently reduced			–15,352
	Appropriations, mandatory:
1200	Appropriation	21,590	22,600	23,700
1221	Appropriations transferred from other acct [075–5551]			5,604
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–3,645	–2,061

1260	Appropriations, mandatory (total)	17,945	20,539	29,304
1900	Budget authority (total)	17,945	20,539	13,952
1930	Total budgetary resources available	26,359	28,790	29,471
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–619
1941	Unexpired unobligated balance, end of year	8,251	10,887	11,084

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,803	5,789	5,258
3010	New obligations, unexpired accounts	17,489	17,903	18,387
3020	Outlays (gross)	–17,282	–18,434	–16,882
3040	Recoveries of prior year unpaid obligations, unexpired	–2,041
3041	Recoveries of prior year unpaid obligations, expired	–180

3050	Unpaid obligations, end of year	5,789	5,258	6,763
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,803	5,789	5,258
3200	Obligated balance, end of year	5,789	5,258	6,763

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–15,352
	Mandatory:
4090	Budget authority, gross	17,945	20,539	29,304
	Outlays, gross:
4100	Outlays from new mandatory authority	11,703	12,301	11,653
4101	Outlays from mandatory balances	5,579	6,133	5,229

4110	Outlays, gross (total)	17,282	18,434	16,882
4180	Budget authority, net (total)	17,945	20,539	13,952
4190	Outlays, net (total)	17,282	18,434	16,882

The Balanced Budget Act of 1997 (P.L. 105–33) 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, 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) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended CHIP funding through fiscal year 2015 and 2017, respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123) extended CHIP funding through fiscal year 2023 and 2027, respectively.


Identification code 075–0522–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Administration	320	420	397
0002	Innovation Activities	611	602	1,003

0900	Total new obligations, unexpired accounts	931	1,022	1,400

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,483	2,619	1,597
1021	Recoveries of prior year unpaid obligations	66
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	3,550	2,619	1,597
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			10,000
1930	Total budgetary resources available	3,550	2,619	11,597
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,619	1,597	10,197

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,376	1,228	1,161
3010	New obligations, unexpired accounts	931	1,022	1,400
3020	Outlays (gross)	–1,013	–1,089	–1,226
3040	Recoveries of prior year unpaid obligations, unexpired	–66

3050	Unpaid obligations, end of year	1,228	1,161	1,335
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,376	1,228	1,161
3200	Obligated balance, end of year	1,228	1,161	1,335

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			10,000
	Outlays, gross:
4100	Outlays from new mandatory authority			413
4101	Outlays from mandatory balances	1,013	1,089	813

4110	Outlays, gross (total)	1,013	1,089	1,226
	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)			10,000
4170	Outlays, net (mandatory)	1,012	1,089	1,226
4180	Budget authority, net (total)			10,000
4190	Outlays, net (total)	1,012	1,089	1,226

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 for fiscal years 2011 through 2019 and each subsequent 10-year fiscal period (beginning with the 10-year fiscal period beginning with fiscal year 2020).


Identification code 075–0522–0–1–551		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	62	60	67
11.7	Military personnel		3	3

11.9	Total personnel compensation		63	70
12.1	Civilian personnel benefits	20	20	21
12.2	Military personnel benefits		1	1
23.3	Communications, utilities, and miscellaneous charges	3	3	3
25.2	Other services from non-Federal sources	512	418	777
41.0	Grants, subsidies, and contributions	310	448	457
42.0	Insurance claims and indemnities	24	69	71

99.9	Total new obligations, unexpired accounts	931	1,022	1,400


Identification code 075–0522–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	540	578	578
1101	Direct military average strength employment		22	22


Identification code 075–5551–0–2–551		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	570	3,132	5,604
0198	Rounding adjustment	2
0198	Earnings on investment adjustment		–4

0199	Balance, start of year	572	3,128	5,604
	Receipts:
	Current law:
1140	Interest, Child Enrollment Contingency Fund	27	246	156

2000	Total: Balances and receipts	599	3,374	5,760
	Appropriations:
	Current law:
2101	Child Enrollment Contingency Fund	–27	–246	–156
2103	Child Enrollment Contingency Fund	–572	–3,128	–5,604
2134	Child Enrollment Contingency Fund	2,562	3,262

2199	Total current law appropriations	1,963	–112	–5,760

2999	Total appropriations	1,963	–112	–5,760
4030	Child Enrollment Contingency Fund	570	2,342

5099	Balance, end of year	3,132	5,604


Identification code 075–5551–0–2–551		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	573	2,338	4,632
1010	Unobligated balance transfer to other accts [075–0515]			–4,632
1020	Adjustment of unobligated bal brought forward, Oct 1	–2	4
1035	Unobligated balance precluded from obligation (limitation on obligations)	–570	–2,342

1050	Unobligated balance (total)	1
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced			–4,396
	Appropriations, mandatory:
1200	Appropriation	4,300	4,520	4,740
1201	Appropriation (special or trust fund)	27	246	156
1203	Appropriation (previously unavailable)	572	3,128	5,604
1220	Appropriations transferred to other acct [075–0515]			–5,604
1234	Appropriations precluded from obligation	–2,562	–3,262

1260	Appropriations, mandatory (total)	2,337	4,632	4,896
1900	Budget authority (total)	2,337	4,632	500
1930	Total budgetary resources available	2,338	4,632	500
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,338	4,632	500

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	200	200
3020	Outlays (gross)		–200

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

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–4,396
	Mandatory:
4090	Budget authority, gross	2,337	4,632	4,896
	Outlays, gross:
4101	Outlays from mandatory balances		200
4180	Budget authority, net (total)	2,337	4,632	500
4190	Outlays, net (total)		200

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	1,145		10,236
5001	Total investments, EOY: Federal securities: Par value		10,236	500

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) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended the Contingency Fund through fiscal years 2015 and 2017, respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123) extended the Contingency Fund through FY 2023 and FY 2027, respectively.

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

The Budget proposes to repeal the Child Enrollment Contingency Fund, because few states can meet the restrictive eligibility criteria to qualify for a payment, and when States do qualify, funds do not need to be spent on children's health. Instead, the Budget proposes funding for a restructured Shortfall Fund, which will be a more accessible safety net for States.


Identification code 075–0508–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	Incentive payments to hospitals	60	20	15

0900	Total new obligations, unexpired accounts (object class 42.0)	60	20	15

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	7
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected from the HI Trust Fund	71	20	15
1801	Change in uncollected payments, Federal sources	–10
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–8

1850	Spending auth from offsetting collections, mand (total)	53	20	15
1930	Total budgetary resources available	60	20	15

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	18	25
3010	New obligations, unexpired accounts	60	20	15
3020	Outlays (gross)	–53	–45	–15

3050	Unpaid obligations, end of year	25
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–171	–161	–161
3070	Change in uncollected pymts, Fed sources, unexpired	10

3090	Uncollected pymts, Fed sources, end of year	–161	–161	–161
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–153	–136	–161
3200	Obligated balance, end of year	–136	–161	–161

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	53	20	15
	Outlays, gross:
4100	Outlays from new mandatory authority	35	20	15
4101	Outlays from mandatory balances	18	25

4110	Outlays, gross (total)	53	45	15
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–71	–20	–15
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	10

4160	Budget authority, net (mandatory)	–8
4170	Outlays, net (mandatory)	–18	25
4180	Budget authority, net (total)	–8
4190	Outlays, net (total)	–18	25

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	133	141	141
5092	Unexpired unavailable balance, EOY: Offsetting collections	141	141	141


Identification code 075–0112–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Premium rate review grants	9		19

0900	Total new obligations, unexpired accounts (object class 41.0)	9		19

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3	4	19
1012	Unobligated balance transfers between expired and unexpired accounts	10
1021	Recoveries of prior year unpaid obligations		15

1050	Unobligated balance (total)	13	19	19
1930	Total budgetary resources available	13	19	19
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	4	19

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	69	53	5
3010	New obligations, unexpired accounts	9		19
3020	Outlays (gross)	–19	–33	–4
3040	Recoveries of prior year unpaid obligations, unexpired		–15
3041	Recoveries of prior year unpaid obligations, expired	–6

3050	Unpaid obligations, end of year	53	5	20
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	69	53	5
3200	Obligated balance, end of year	53	5	20

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	19	33	4
4180	Budget authority, net (total)
4190	Outlays, net (total)	19	33	4

The Patient Protection and Affordable Care Act (P.L. 111–148) added section 2794 to 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Pre-Existing Condition Insurance Plan Program (Direct)	87
0002	Administration		81	60

0799	Total direct obligations	87	81	60

0900	Total new obligations, unexpired accounts (object class 25.2)	87	81	60

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	332	246	165
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	333	246	165
1930	Total budgetary resources available	333	246	165
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	246	165	105

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	38	69	94
3010	New obligations, unexpired accounts	87	81	60
3020	Outlays (gross)	–55	–56	–43
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	69	94	111
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	38	69	94
3200	Obligated balance, end of year	69	94	111

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	55	56	43
4180	Budget authority, net (total)
4190	Outlays, net (total)	55	56	43

This account funded 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 paid for remaining costs that exceeded 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 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		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	26	26	26
1930	Total budgetary resources available	26	26	26
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	26	26	26

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	11	11
3020	Outlays (gross)		–11

3050	Unpaid obligations, end of year	11
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	11	11
3200	Obligated balance, end of year	11

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		11
4180	Budget authority, net (total)
4190	Outlays, net (total)		11

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0002	Administration	12

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	13
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–1

1260	Appropriations, mandatory (total)	12
1930	Total budgetary resources available	12

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	147	8	1
3010	New obligations, unexpired accounts	12
3020	Outlays (gross)	–48	–7
3041	Recoveries of prior year unpaid obligations, expired	–103

3050	Unpaid obligations, end of year	8	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	147	8	1
3200	Obligated balance, end of year	8	1	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	12
	Outlays, gross:
4100	Outlays from new mandatory authority	7
4101	Outlays from mandatory balances	41	7

4110	Outlays, gross (total)	48	7
4180	Budget authority, net (total)	12
4190	Outlays, net (total)	48	7

This program provided funding for Planning and Establishment Grants to States for their activities to implement Health Insurance Exchanges. The Exchanges facilitated the purchase of qualified health plans in the individual market and allowed 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		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3
25.2	Other services from non-Federal sources	9

99.9	Total new obligations, unexpired accounts	12


Identification code 075–0115–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	24


Identification code 075–0126–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Cost Sharing Reductions		6,263	6,601
0002	Basic Health Program		1,312	1,374

0900	Total new obligations, unexpired accounts (object class 41.0)		7,575	7,975

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		8,076	7,975
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–501

1260	Appropriations, mandatory (total)		7,575	7,975
1930	Total budgetary resources available		7,575	7,975

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		7,575	7,975
3020	Outlays (gross)		–7,575	–7,975

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		7,575	7,975
	Outlays, gross:
4100	Outlays from new mandatory authority		7,575	7,975
4180	Budget authority, net (total)		7,575	7,975
4190	Outlays, net (total)		7,575	7,975


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority		7,575	7,975
	Outlays		7,575	7,975
Legislative proposal, subject to PAYGO:
	Budget Authority		–6,301	479
	Outlays		–6,301	479
Total:
	Budget Authority		1,274	8,454
	Outlays		1,274	8,454

Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers. The FY 2020 Budget requests a mandatory appropriation for Cost Sharing Reduction (CSR) payments. The classification of CSRs as an entitlement pursuant to BBEDCA does not determine legal entitlement to a payment or benefit or availability of funding.


Identification code 075–0126–4–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Cost Sharing Reductions		–5,070	397
0002	Basic Health Program		–1,231	82

0900	Total new obligations, unexpired accounts (object class 41.0)		–6,301	479

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		–6,802
1200	Appropriation		501	479

1260	Appropriations, mandatory (total)		–6,301	479
1930	Total budgetary resources available		–6,301	479

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		–6,301	479
3020	Outlays (gross)		6,301	–479

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–6,301	479
	Outlays, gross:
4100	Outlays from new mandatory authority		–6,301	479
4180	Budget authority, net (total)		–6,301	479
4190	Outlays, net (total)		–6,301	479

This proposal would fully fund cost-sharing reduction (CSR) payments through calendar year 2020 only for those qualified health plans that did not increase their premium rates to account for the non-payment of CSRs.


Identification code 075–5733–0–2–551		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	371	311	297
	Receipts:
	Current law:
1110	Receipts, Risk Adjustment Program	4,705	4,786	4,022

2000	Total: Balances and receipts	5,076	5,097	4,319
	Appropriations:
	Current law:
2101	Risk Adjustment Program Payments	–4,705	–4,786	–4,022
2103	Risk Adjustment Program Payments	–371	–311	–297
2132	Risk Adjustment Program Payments	311	297

2199	Total current law appropriations	–4,765	–4,800	–4,319

2999	Total appropriations	–4,765	–4,800	–4,319

5099	Balance, end of year	311	297


Identification code 075–5733–0–2–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Risk Adjustment Program Payments (Direct)	3,875	4,800	4,319

0900	Total new obligations, unexpired accounts (object class 41.0)	3,875	4,800	4,319

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,336	2,226	2,226
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	4,705	4,786	4,022
1203	Appropriation (previously unavailable)	371	311	297
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–311	–297

1260	Appropriations, mandatory (total)	4,765	4,800	4,319
1930	Total budgetary resources available	6,101	7,026	6,545
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,226	2,226	2,226

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	915	2,191
3010	New obligations, unexpired accounts	3,875	4,800	4,319
3020	Outlays (gross)	–2,599	–6,991	–4,319

3050	Unpaid obligations, end of year	2,191
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	915	2,191
3200	Obligated balance, end of year	2,191

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,765	4,800	4,319
	Outlays, gross:
4100	Outlays from new mandatory authority	348	4,800	4,319
4101	Outlays from mandatory balances	2,251	2,191

4110	Outlays, gross (total)	2,599	6,991	4,319
4180	Budget authority, net (total)	4,765	4,800	4,319
4190	Outlays, net (total)	2,599	6,991	4,319

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		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	285	25
0198	Rounding adjustment	1

0199	Balance, start of year	286	25
	Receipts:
	Current law:
1110	Contributions, Transitional Reinsurance Program	383

2000	Total: Balances and receipts	669	25
	Appropriations:
	Current law:
2101	Transitional Reinsurance Program	–383
2103	Transitional Reinsurance Program	–286	–25
2132	Transitional Reinsurance Program	25

2199	Total current law appropriations	–644	–25

2999	Total appropriations	–644	–25

5099	Balance, end of year	25


Identification code 075–5735–0–2–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Transitional reinsurance payments	428	241

0900	Total new obligations, unexpired accounts (object class 41.0)	428	241

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		216
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	383
1203	Appropriation (previously unavailable)	286	25
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–25

1260	Appropriations, mandatory (total)	644	25
1930	Total budgetary resources available	644	241
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	216

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	248	10	10
3010	New obligations, unexpired accounts	428	241
3020	Outlays (gross)	–666	–241

3050	Unpaid obligations, end of year	10	10	10
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	248	10	10
3200	Obligated balance, end of year	10	10	10

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	644	25
	Outlays, gross:
4100	Outlays from new mandatory authority	419	25
4101	Outlays from mandatory balances	247	216

4110	Outlays, gross (total)	666	241
4180	Budget authority, net (total)	644	25
4190	Outlays, net (total)	666	241

Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a transitional 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 assessed contributing entities a per enrollee fee to fund the reinsurance program and made 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 were made in the year following the plan year for which they were applicable. Reinsurance collections ended in FY 2018 and outlays in subsequent fiscal years reflect remaining payments, refunds, and allowable administrative activities.


Identification code 075–0524–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
	Credit program obligations:
0705	Reestimates of direct loan subsidy	124	4
0706	Interest on reestimates of direct loan subsidy	11
0709	Administrative expenses		1

0900	Total new obligations, unexpired accounts (object class 41.0)	135	5

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

1050	Unobligated balance (total)	1	1
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	135	4
1930	Total budgetary resources available	136	5
	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	4	2	1
3010	New obligations, unexpired accounts	135	5
3020	Outlays (gross)	–136	–6
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	2	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4	2	1
3200	Obligated balance, end of year	2	1	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	135	4
	Outlays, gross:
4100	Outlays from new mandatory authority	135	4
4101	Outlays from mandatory balances	1	2

4110	Outlays, gross (total)	136	6
4180	Budget authority, net (total)	135	4
4190	Outlays, net (total)	136	6

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


Identification code 075–0524–0–1–551		2018 actual	2019 est.	2020 est.

	Direct loan reestimates:
135001	Startup Loans	17	5
135002	Solvency Loans	117

135999	Total direct loan reestimates	134	5

	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 075–0118–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
	Credit program obligations:
0705	Reestimates of direct loan subsidy	226	231
0706	Interest on reestimates of direct loan subsidy	33	28
0709	Administrative expenses		1

0900	Total new obligations, unexpired accounts (object class 41.0)	259	260

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

1050	Unobligated balance (total)	1	1
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	259	259
1900	Budget authority (total)	259	259
1930	Total budgetary resources available	260	260
	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	4	2
3010	New obligations, unexpired accounts	259	260
3020	Outlays (gross)	–260	–262
3040	Recoveries of prior year unpaid obligations, unexpired	–1

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	259	259
	Outlays, gross:
4100	Outlays from new mandatory authority	259	259
4101	Outlays from mandatory balances	1	3

4110	Outlays, gross (total)	260	262
4180	Budget authority, net (total)	259	259
4190	Outlays, net (total)	260	262

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


Identification code 075–0118–0–1–551		2018 actual	2019 est.	2020 est.

	Direct loan reestimates:
135002	Startup Loans	–8	116
135003	Solvency Loans	252	143

135999	Total direct loan reestimates	244	259

	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 awarded loans to qualified nonprofit issuers to fund start-up costs and reserves, which enabled qualified issuers to meet state solvency requirements. The Secretary issued the final round of loans in December 2014.


Identification code 075–4418–0–3–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
	Credit program obligations:
0713	Payment of interest to Treasury	13	7	7
0742	Downward reestimates paid to receipt accounts	14
0743	Interest on downward reestimates	1

0900	Total new obligations, unexpired accounts	28	7	7

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	143	22	24
1020	Adjustment of unobligated bal brought forward, Oct 1	–127
1021	Recoveries of prior year unpaid obligations	3
1023	Unobligated balances applied to repay debt	–4

1050	Unobligated balance (total)	15	22	24
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	22	2	2
	Spending authority from offsetting collections, mandatory:
1800	Collected	265	301	565
1801	Change in uncollected payments, Federal sources	–1
1825	Spending authority from offsetting collections applied to repay debt	–251	–294	–565

1850	Spending auth from offsetting collections, mand (total)	13	7
1900	Budget authority (total)	35	9	2
1930	Total budgetary resources available	50	31	26
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	22	24	19

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3
3010	New obligations, unexpired accounts	28	7	7
3020	Outlays (gross)	–28	–7	–7
3040	Recoveries of prior year unpaid obligations, unexpired	–3
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1
3070	Change in uncollected pymts, Fed sources, unexpired	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	35	9	2
	Financing disbursements:
4110	Outlays, gross (total)	28	7	7
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources	–259	–259
4122	Interest on uninvested funds	–6	–5	–5
4123	Non-Federal sources		–37	–560

4130	Offsets against gross budget authority and outlays (total)	–265	–301	–565
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired	1

4160	Budget authority, net (mandatory)	–229	–292	–563
4170	Outlays, net (mandatory)	–237	–294	–558
4180	Budget authority, net (total)	–229	–292	–563
4190	Outlays, net (total)	–237	–294	–558


Identification code 075–4418–0–3–551		2018 actual	2019 est.	2020 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	1,893	1,893	1,858
1251	Repayments: Repayments and prepayments		–35	–11
1263	Write-offs for default: Direct loans			–582

1290	Outstanding, end of year	1,893	1,858	1,265


Identification code 075–4418–0–3–551		2017 actual	2018 actual

	ASSETS:
	Federal assets:
1101	Fund balances with Treasury	16	9
	Investments in U.S. securities:
1106	Receivables, net		259
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross	1,893	1,893
1402	Interest receivable	20	25
1405	Allowance for subsidy cost (-)	–1,278	–1,778

1499	Net present value of assets related to direct loans	635	140

1999	Total assets	651	408
	LIABILITIES:
2103	Federal liabilities: Debt	651	408
	NET POSITION:
3300	Cumulative results of operations

4999	Total liabilities and net position	651	408


Identification code 075–4482–0–3–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
	Credit program obligations:
0713	Payment of interest to Treasury	4	1	1

0900	Total new obligations, unexpired accounts	4	1	1

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	34	9	12
1020	Adjustment of unobligated bal brought forward, Oct 1	–24
1021	Recoveries of prior year unpaid obligations	3
1023	Unobligated balances applied to repay debt	–4

1050	Unobligated balance (total)	9	9	12
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	1	2	1
	Spending authority from offsetting collections, mandatory:
1800	Collected	137	5	164
1801	Change in uncollected payments, Federal sources	–1
1825	Spending authority from offsetting collections applied to repay debt	–133	–3	–164

1850	Spending auth from offsetting collections, mand (total)	3	2
1900	Budget authority (total)	4	4	1
1930	Total budgetary resources available	13	13	13
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	9	12	12

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3
3010	New obligations, unexpired accounts	4	1	1
3020	Outlays (gross)	–4	–1	–1
3040	Recoveries of prior year unpaid obligations, unexpired	–3
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	1
3070	Change in uncollected pymts, Fed sources, unexpired	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	4	4	1
	Financing disbursements:
4110	Outlays, gross (total)	4	1	1
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources	–134	–5
4122	Interest on uninvested funds	–3		–164

4130	Offsets against gross budget authority and outlays (total)	–137	–5	–164
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired	1

4160	Budget authority, net (mandatory)	–132	–1	–163
4170	Outlays, net (mandatory)	–133	–4	–163
4180	Budget authority, net (total)	–132	–1	–163
4190	Outlays, net (total)	–133	–4	–163


Identification code 075–4482–0–3–551		2018 actual	2019 est.	2020 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	480	480	480
1263	Write-offs for default: Direct loans			–139

1290	Outstanding, end of year	480	480	341


Identification code 075–4482–0–3–551		2017 actual	2018 actual

	ASSETS:
	Federal assets:
1101	Fund balances with Treasury	9	5
	Investments in U.S. securities:
1106	Receivables, net		5
1206	Non-Federal assets: Receivables, net	4
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross	480	480
1402	Interest receivable		5
1405	Allowance for subsidy cost (-)	–291	–429

1499	Net present value of assets related to direct loans	189	56

1999	Total assets	202	66
	LIABILITIES:
	Federal liabilities:
2103	Debt		65
2104	Resources payable to Treasury	202
2207	Non-Federal liabilities: Other

2999	Total liabilities	202	65
	NET POSITION:
3300	Cumulative results of operations		1

4999	Total liabilities and net position	202	66

Trust Funds


Identification code 075–8005–0–7–571		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	160,218	164,161	156,887
	Receipts:
	Current law:
1110	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	241,572	256,909	268,244
1110	FHI Trust Fund, Receipts from Railroad Retirement Board	571	593	607
1110	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	18,516	18,751	20,087
1110	FHI Trust Fund, Civil Penalties and Damages	507	614	575
1130	FHI Trust Fund, Other Proprietary Interest from the Public		2	2
1130	FHI Trust Fund, Basic Premium, Medicare Advantage	393	462	502
1130	FHI Trust Fund, Medicare Refunds	6,051	6,100	6,150
1130	Affordable Care Act Medicare Shared Savings Models (HI)	17	118	3
1130	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,533	3,931	4,194
1140	FHI Trust Fund, Federal Employer Contributions (FICA)	3,839	3,816	3,821
1140	FHI Trust Fund, Postal Service Employer Contributions (FICA)	639	660	675
1140	FHI Trust Fund, Interest Received by Trust Funds	7,328	7,039	6,640
1140	FHI Trust Fund, Taxation on OASDI Benefits	24,192	23,882	26,472
1140	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	135	135	138
1140	FHI Trust Fund, Transfers from General Fund (criminal Fines)	2	88	36
1140	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	49	52	52
1140	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	22	31	32
1140	FHI Trust Fund, Interest Payments by Railroad Retirement Board	26	26	28
1140	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	1,498	1,307	1,316

1199	Total current law receipts	308,890	324,516	339,574
	Proposed:
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–8
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–5
1230	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible			–223
1240	FHI Trust Fund, Interest Received by Trust Funds		14	301
1240	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)			2

1299	Total proposed receipts		14	67

1999	Total receipts	308,890	324,530	339,641

2000	Total: Balances and receipts	469,108	488,691	496,528
	Appropriations:
	Current law:
2101	Federal Hospital Insurance Trust Fund	–3,247	–3,039	–2,878
2101	Federal Hospital Insurance Trust Fund	–303,458	–319,485	–334,568
2101	Health Care Fraud and Abuse Control Account	–745	–765	–792
2101	Health Care Fraud and Abuse Control Account	–1,348	–1,354	–1,229
2103	Federal Hospital Insurance Trust Fund		–7,210	–12,886
2132	Federal Hospital Insurance Trust Fund	8
2132	Health Care Fraud and Abuse Control Account	50	49
2134	Federal Hospital Insurance Trust Fund	3,996

2199	Total current law appropriations	–304,744	–331,804	–352,353
	Proposed:
2201	Federal Hospital Insurance Trust Fund		–14	–301
2201	Federal Hospital Insurance Trust Fund			230
2234	Federal Hospital Insurance Trust Fund		14	301
2234	Federal Hospital Insurance Trust Fund			15,455

2299	Total proposed appropriations			15,685

2999	Total appropriations	–304,744	–331,804	–336,668
3098	Federal Hospital Insurance Trust Fund	–203

5099	Balance, end of year	164,161	156,887	159,860


Identification code 075–8005–0–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Benefit payments, HI	298,824	325,232	346,847
0002	HIT Incentive Payments	44	20	15
0003	Administration, HI	3,536	3,297	2,868
0004	Quality improvement organizations, HI	522	891	452

0799	Total direct obligations	302,926	329,440	350,182

0900	Total new obligations, unexpired accounts	302,926	329,440	350,182

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			294
1021	Recoveries of prior year unpaid obligations	4
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	203
1033	Recoveries of prior year paid obligations	18

1050	Unobligated balance (total)	225		294
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	3,247	3,039	2,878
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	303,458	319,485	334,568
1203	Appropriation (previously unavailable)		7,210	12,886
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)	–8
1234	Appropriations precluded from obligation	–3,996

1260	Appropriations, mandatory (total)	299,454	326,695	347,454
1900	Budget authority (total)	302,701	329,734	350,332
1930	Total budgetary resources available	302,926	329,734	350,626
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		294	444

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	35,193	36,685	36,823
3001	Adjustments to unpaid obligations, brought forward, Oct 1		5
3010	New obligations, unexpired accounts	302,926	329,440	350,182
3020	Outlays (gross)	–301,430	–329,307	–350,596
3040	Recoveries of prior year unpaid obligations, unexpired	–4

3050	Unpaid obligations, end of year	36,685	36,823	36,409
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	35,193	36,690	36,823
3200	Obligated balance, end of year	36,685	36,823	36,409

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,247	3,039	2,878
	Outlays, gross:
4010	Outlays from new discretionary authority	2,014	1,898	1,850
4011	Outlays from discretionary balances	981	746	1,182

4020	Outlays, gross (total)	2,995	2,644	3,032
	Mandatory:
4090	Budget authority, gross	299,454	326,695	347,454
	Outlays, gross:
4100	Outlays from new mandatory authority	267,704	293,886	315,282
4101	Outlays from mandatory balances	30,731	32,777	32,282

4110	Outlays, gross (total)	298,435	326,663	347,564
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–18
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	18

4160	Budget authority, net (mandatory)	299,454	326,695	347,454
4170	Outlays, net (mandatory)	298,417	326,663	347,564
4180	Budget authority, net (total)	302,701	329,734	350,332
4190	Outlays, net (total)	301,412	329,307	350,596

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	197,835	202,805	195,595
5001	Total investments, EOY: Federal securities: Par value	202,805	195,595	182,709


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	302,701	329,734	350,332
	Outlays	301,412	329,307	350,596
Legislative proposal, subject to PAYGO:
	Budget Authority			–15,685
	Outlays			–15,685
Total:
	Budget Authority	302,701	329,734	334,647
	Outlays	301,412	329,307	334,911

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


Identification code 075–8005–0–7–571		2018 actual	2019 est.	2020 est.

	Unexpended balance, start of year:
0100	Balance, start of year	197,520	203,227	196,153

0999	Total balance, start of year	197,520	203,227	196,153
	Cash income during the year:
	Current law:
	Receipts:
1110	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	241,572	256,909	268,244
1110	FHI Trust Fund, Receipts from Railroad Retirement Board	571	593	607
1110	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	18,516	18,751	20,087
1110	FHI Trust Fund, Civil Penalties and Damages	507	614	575
1130	FHI Trust Fund, Basic Premium, Medicare Advantage	393	462	502
1130	FHI Trust Fund, Medicare Refunds	6,051	6,100	6,150
1130	Affordable Care Act Medicare Shared Savings Models (HI)	17	118	3
1130	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,533	3,931	4,194
1130	Federal Hospital Insurance Trust Fund	18
1150	FHI Trust Fund, Interest Received by Trust Funds	7,328	7,039	6,640
1150	FHI Trust Fund, Other Proprietary Interest from the Public		2	2
1150	FHI Trust Fund, Interest Payments by Railroad Retirement Board	26	26	28
1160	FHI Trust Fund, Federal Employer Contributions (FICA)	3,839	3,816	3,821
1160	FHI Trust Fund, Postal Service Employer Contributions (FICA)	639	660	675
1160	FHI Trust Fund, Taxation on OASDI Benefits	24,192	23,882	26,472
1160	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	135	135	138
1160	FHI Trust Fund, Transfers from General Fund (criminal Fines)	2	88	36
1160	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	49	52	52
1160	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	22	31	32
1160	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	1,498	1,307	1,316

1199	Income under present law	308,908	324,516	339,574
	Proposed:
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–8
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–5
	Offsetting receipts (proprietary):
1230	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible			–223
1250	FHI Trust Fund, Interest Received by Trust Funds		14	301
	Offsetting governmental receipts:
1260	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)			2

1299	Income proposed		14	67

1999	Total cash income	308,908	324,530	339,641
	Cash outgo during year:
	Current law:
2100	Federal Hospital Insurance Trust Fund [009–38–8005–0]	–301,430	–329,307	–350,596
2100	Health Care Fraud and Abuse Control Account [009–38–8393–0]	–1,771	–2,297	–1,909

2199	Outgo under current law	–303,201	–331,604	–352,505
	Proposed:
2200	Federal Hospital Insurance Trust Fund			15,685

2299	Outgo under proposed legislation			15,685

2999	Total cash outgo (-)	–303,201	–331,604	–336,820
	Surplus or deficit:
3110	Excluding interest	–1,647	–14,155	–4,150
3120	Interest	7,354	7,081	6,971

3199	Subtotal, surplus or deficit	5,707	–7,074	2,821

3999	Total change in fund balance	5,707	–7,074	2,821
	Unexpended balance, end of year:
4100	Uninvested balance (net), end of year	422	558	16,265
4200	Federal Hospital Insurance Trust Fund	202,805	195,595	182,709

4999	Total balance, end of year	203,227	196,153	198,974


Identification code 075–8005–0–7–571		2018 actual	2019 est.	2020 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activities	522	891	452
42.0	Insurance claims and indemnities (benefits)	298,868	325,232	346,862
94.0	Financial transfers	3,536	3,317	2,868

99.9	Total new obligations, unexpired accounts	302,926	329,440	350,182


Identification code 075–8005–0–7–571		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	1	2	2


Identification code 075–8005–2–7–571		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		14	301
1234	Appropriations precluded from obligation		–14	–301
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–8005–4–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Benefit payments, HI			–15,703
0003	Administration, HI			18

0799	Total direct obligations			–15,685

0900	Total new obligations, unexpired accounts			–15,685

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–230
1234	Appropriations precluded from obligation			–15,455

1260	Appropriations, mandatory (total)			–15,685
1900	Budget authority (total)			–15,685
1930	Total budgetary resources available			–15,685

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–15,685
3020	Outlays (gross)			15,685

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–15,685
	Outlays, gross:
4100	Outlays from new mandatory authority			–15,685
4180	Budget authority, net (total)			–15,685
4190	Outlays, net (total)			–15,685

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 075–8005–4–7–571		2018 actual	2019 est.	2020 est.

	Direct obligations:
42.0	Insurance claims and indemnities (benefits)			–15,703
94.0	Financial transfers			18

99.9	Total new obligations, unexpired accounts			–15,685

In addition to amounts otherwise available for program integrity and program management, $792,000,000, to remain available through September 30, 2021, 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 $614,000,000 shall be for the Centers for Medicare & Medicaid Services program integrity activities, of which $98,000,000 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 $80,000,000 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 2020 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 $475,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That amounts made available under this heading and amounts made available for fiscal year 2020 in section 1817(k)(3)(A) of the Social Security Act shall also be available for the Senior Medicare Patrol program to combat health care fraud and abuse.


Identification code 075–8393–0–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Medicare integrity program	864	898	939
0002	FBI fraud and abuse control	135	138	151
0003	Other fraud and abuse control	282	294	320
0005	Undistributed Savings, HCFAC and SSA		–26	–181

0091	Total Mandatory	1,281	1,304	1,229
0101	CMS discretionary	576	599	614
0102	Other discretionary	160	166	178

0191	Total Discretionary	736	765	792

0900	Total new obligations, unexpired accounts	2,017	2,069	2,021

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	430	471	472
1001	Discretionary unobligated balance brought fwd, Oct 1	198	201
1021	Recoveries of prior year unpaid obligations	23

1050	Unobligated balance (total)	453	471	472
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	745	765	792
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1,348	1,354	1,229
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–50	–49

1260	Appropriations, mandatory (total)	1,298	1,305	1,229
1900	Budget authority (total)	2,043	2,070	2,021
1930	Total budgetary resources available	2,496	2,541	2,493
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8
1941	Unexpired unobligated balance, end of year	471	472	472
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	8
1952	Expired unobligated balance, start of year	28	32	32
1953	Expired unobligated balance, end of year	24	32	32

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,764	1,970	1,742
3010	New obligations, unexpired accounts	2,017	2,069	2,021
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–1,771	–2,297	–1,909
3040	Recoveries of prior year unpaid obligations, unexpired	–23
3041	Recoveries of prior year unpaid obligations, expired	–19

3050	Unpaid obligations, end of year	1,970	1,742	1,854
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,764	1,970	1,742
3200	Obligated balance, end of year	1,970	1,742	1,854

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	745	765	792
	Outlays, gross:
4010	Outlays from new discretionary authority	148	306	317
4011	Outlays from discretionary balances	503	124	268

4020	Outlays, gross (total)	651	430	585
	Mandatory:
4090	Budget authority, gross	1,298	1,305	1,229
	Outlays, gross:
4100	Outlays from new mandatory authority	355	665	525
4101	Outlays from mandatory balances	765	1,202	799

4110	Outlays, gross (total)	1,120	1,867	1,324
4180	Budget authority, net (total)	2,043	2,070	2,021
4190	Outlays, net (total)	1,771	2,297	1,909

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent (CMS)	38	42	42
11.7	Military personnel		2	2

11.9	Total personnel compensation		44	44
12.1	Civilian personnel benefits (CMS)	10	10	10
12.2	Military personnel benefits		1	1
23.3	Communications, utilities, and miscellaneous charges	10	11	11
25.2	Other services (CMS/Medicaid)	89
25.3	Other purchases of goods and services from Government accounts (HHS/DOJ)	135	140	147
25.3	Other purchases of goods and services from Government accounts (HHS/OIG)	285	294	319
25.3	Other purchases of goods and services from Government accounts (HHS/OGC)	7	7	8
25.3	Other goods and services from Federal sources (HHS/CMS)	9	13	15
25.3	Other goods and services from Government accounts (HHS/FDA)	6	6	7
25.6	Medical care (CMS)	1,293	1,431	1,489
92.0	Undistributed		–26	–181
94.0	Financial transfers (FBI)	135	138	151

99.9	Total new obligations, unexpired accounts	2,017	2,069	2,021


Identification code 075–8393–0–7–571		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	387	409	409
1101	Direct military average strength employment		17	17


Identification code 075–8004–0–7–571		2018 actual	2019 est.	2020 est.

0100	Balance, start of year	47,105	67,416	74,724
0198	Rounding adjustment	130

0199	Balance, start of year	47,235	67,416	74,724
	Receipts:
	Current law:
1110	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	4,095	4,709	2,800
1130	Other Proprietary Interest from the Public, FSMI Fund		3	3
1130	Premiums Collected for Medicare Prescription Drug Account, FSMI	5,254	5,341	6,051
1130	Payments from States, Medicare Prescription Drug Account, FSMI	11,670	12,142	13,035
1130	Basic Premium, Medicare Advantage, FSMI Trust Fund	476	517	568
1130	Medicare Refunds, SMI	4,827	4,877	4,927
1130	Affordable Care Act Medicare Shared Savings Models, SMI	18	68	3
1130	Premiums Collected for the Aged, FSMI Fund	77,305	84,634	91,149
1130	Premiums Collected for the Disabled, FSMI Fund	13,107	12,696	13,082
1140	Federal Contributions, FSMI Fund	245,714	265,753	285,481
1140	Interest Received by Trust Fund, FSMI Fund	2,322	1,014	1,375
1140	Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI		3	5
1140	Interest, Medicare Prescription Drug Account, FSMI	57	26	19
1140	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	655	642	662
1140	Federal Contributions for Benefits, Prescription Drug Account, SMI	71,750	67,107	87,246
1140	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	2	1	1

1199	Total current law receipts	437,252	459,533	506,407
	Proposed:
1230	Premiums Collected for Medicare Prescription Drug Account, FSMI			–10
1230	Payments from States, Medicare Prescription Drug Account, FSMI			–10
1230	Premiums Collected for the Aged, FSMI Fund			–2,246
1230	Premiums Collected for the Disabled, FSMI Fund			–322
1240	Federal Contributions, FSMI Fund			–7,696
1240	Federal Contributions for Benefits, Prescription Drug Account, SMI			–80

1299	Total proposed receipts			–10,364

1999	Total receipts	437,252	459,533	496,043

2000	Total: Balances and receipts	484,487	526,949	570,767
	Appropriations:
	Current law:
2101	Federal Supplementary Medical Insurance Trust Fund	–2,933	–3,006	–2,525
2101	Federal Supplementary Medical Insurance Trust Fund	–345,486	–371,229	–397,476
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–421	–633	–858
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–88,420	–84,665	–105,548
2134	Federal Supplementary Medical Insurance Trust Fund	19,912	7,308	3,463

2199	Total current law appropriations	–417,348	–452,225	–502,944
	Proposed:
2201	Federal Supplementary Medical Insurance Trust Fund			7,776
2201	Federal Supplementary Medical Insurance Trust Fund			2,478
2201	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund			100
2203	Federal Supplementary Medical Insurance Trust Fund			–7,776
2234	Federal Supplementary Medical Insurance Trust Fund			7,767

2299	Total proposed appropriations			10,345

2999	Total appropriations	–417,348	–452,225	–492,599
3098	Federal Supplementary Medical Insurance Trust Fund	–312
5098	Reconciliation adjustment	589

5099	Balance, end of year	67,416	74,724	78,168


Identification code 075–8004–0–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Benefit payments, SMI	323,097	360,873	391,252
0002	Transfer to Medicaid for payment of SMI premiums	1,087	1,030	1,123
0003	HIT Incentive Payments	16
0004	Administration, SMI	3,027	3,223	2,573
0005	Quality Improvement Organizations, SMI	252	429	218

0799	Total direct obligations	327,479	365,555	395,166

0900	Total new obligations, unexpired accounts	327,479	365,555	395,166

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1	1
1001	Discretionary unobligated balance brought fwd, Oct 1		1
1021	Recoveries of prior year unpaid obligations	30
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	312
1033	Recoveries of prior year paid obligations	3

1050	Unobligated balance (total)	345	1	1
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	2,933	3,006	2,525
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	345,486	371,229	397,476
1234	Appropriations precluded from obligation	–19,912	–7,308	–3,463
1236	Appropriations applied to repay debt	–1,372	–1,372	–1,372

1260	Appropriations, mandatory (total)	324,202	362,549	392,641
1900	Budget authority (total)	327,135	365,555	395,166
1930	Total budgetary resources available	327,480	365,556	395,167
	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	26,304	27,918	28,124
3001	Adjustments to unpaid obligations, brought forward, Oct 1		5
3010	New obligations, unexpired accounts	327,479	365,555	395,166
3020	Outlays (gross)	–325,835	–365,354	–395,323
3040	Recoveries of prior year unpaid obligations, unexpired	–30

3050	Unpaid obligations, end of year	27,918	28,124	27,967
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	26,304	27,923	28,124
3200	Obligated balance, end of year	27,918	28,124	27,967

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,933	3,006	2,525
	Outlays, gross:
4010	Outlays from new discretionary authority	1,700	1,988	1,739
4011	Outlays from discretionary balances	1,078	797	836

4020	Outlays, gross (total)	2,778	2,785	2,575
	Mandatory:
4090	Budget authority, gross	324,202	362,549	392,641
	Outlays, gross:
4100	Outlays from new mandatory authority	298,989	336,985	362,544
4101	Outlays from mandatory balances	24,068	25,584	30,204

4110	Outlays, gross (total)	323,057	362,569	392,748
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	3

4160	Budget authority, net (mandatory)	324,202	362,549	392,641
4170	Outlays, net (mandatory)	323,054	362,569	392,748
4180	Budget authority, net (total)	327,135	365,555	395,166
4190	Outlays, net (total)	325,832	365,354	395,323

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	70,589	98,197	104,990
5001	Total investments, EOY: Federal securities: Par value	98,197	104,990	109,728
5080	Outstanding debt, SOY	–6,396	–5,024	–3,652
5081	Outstanding debt, EOY	–5,024	–3,652	–2,280


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	327,135	365,555	395,166
	Outlays	325,832	365,354	395,323
Legislative proposal, subject to PAYGO:
	Budget Authority			–10,245
	Outlays			–10,245
Total:
	Budget Authority	327,135	365,555	384,921
	Outlays	325,832	365,354	385,078

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.


Identification code 075–8004–0–7–571		2018 actual	2019 est.	2020 est.

	Unexpended balance, start of year:
0100	Balance, start of year	68,008	96,946	106,000

0999	Total balance, start of year	68,008	96,946	106,000
	Cash income during the year:
	Current law:
	Receipts:
1110	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	4,095	4,709	2,800
1130	Premiums Collected for Medicare Prescription Drug Account, FSMI	5,254	5,341	6,051
1130	Payments from States, Medicare Prescription Drug Account, FSMI	11,670	12,142	13,035
1130	Basic Premium, Medicare Advantage, FSMI Trust Fund	476	517	568
1130	Medicare Refunds, SMI	4,827	4,877	4,927
1130	Affordable Care Act Medicare Shared Savings Models, SMI	18	68	3
1130	Premiums Collected for the Aged, FSMI Fund	77,305	84,634	91,149
1130	Premiums Collected for the Disabled, FSMI Fund	13,107	12,696	13,082
1130	Federal Supplementary Medical Insurance Trust Fund	3
1130	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	1
1150	Interest Received by Trust Fund, FSMI Fund	2,322	1,014	1,375
1150	Other Proprietary Interest from the Public, FSMI Fund		3	3
1150	Interest, Medicare Prescription Drug Account, FSMI	57	26	19
1160	Federal Contributions, FSMI Fund	245,714	265,753	285,481
1160	Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI		3	5
1160	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	655	642	662
1160	Federal Contributions for Benefits, Prescription Drug Account, SMI	71,750	67,107	87,246
1160	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	2	1	1

1199	Income under present law	437,256	459,533	506,407
	Proposed:
	Offsetting receipts (proprietary):
1230	Premiums Collected for Medicare Prescription Drug Account, FSMI			–10
1230	Payments from States, Medicare Prescription Drug Account, FSMI			–10
1230	Premiums Collected for the Aged, FSMI Fund			–2,246
1230	Premiums Collected for the Disabled, FSMI Fund			–322
	Offsetting governmental receipts:
1260	Federal Contributions, FSMI Fund			–7,696
1260	Federal Contributions for Benefits, Prescription Drug Account, SMI			–80

1299	Income proposed			–10,364

1999	Total cash income	437,256	459,533	496,043
	Cash outgo during year:
	Current law:
2100	Federal Supplementary Medical Insurance Trust Fund [009–38–8004–0]	–325,835	–365,354	–395,323
2100	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009–38–8308–0]	–82,488	–85,125	–106,035

2199	Outgo under current law	–408,323	–450,479	–501,358
	Proposed:
2200	Federal Supplementary Medical Insurance Trust Fund			10,245
2200	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund			100

2299	Outgo under proposed legislation			10,345

2999	Total cash outgo (-)	–408,323	–450,479	–491,013
	Surplus or deficit:
3110	Excluding interest	26,554	8,011	3,633
3120	Interest	2,379	1,043	1,397

3199	Subtotal, surplus or deficit	28,933	9,054	5,030
3298	Reconciliation adjustment	5

3299	Total adjustments	5

3999	Total change in fund balance	28,938	9,054	5,030
	Unexpended balance, end of year:
4100	Uninvested balance (net), end of year	–1,251	1,010	1,302
4200	Federal Supplementary Medical Insurance Trust Fund	98,197	104,990	109,728

4999	Total balance, end of year	96,946	106,000	111,030


Identification code 075–8004–0–7–571		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
41.0	Payment for Quality Improvement Organization (QIO) activity	252	429	218
42.0	Insurance claims and indemnities	323,097	360,873	391,252
94.0	Financial transfers	4,129	4,252	3,695

99.0	Direct obligations	327,479	365,555	395,166

99.9	Total new obligations, unexpired accounts	327,479	365,555	395,166


Identification code 075–8004–0–7–571		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	7	8	8


Identification code 075–8004–2–7–571		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–7,776
1203	Appropriation (previously unavailable)			7,776
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–8004–4–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Benefit payments, SMI			–10,265
0004	Administration, SMI			20

0799	Total direct obligations			–10,245

0900	Total new obligations, unexpired accounts			–10,245

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–2,478
1234	Appropriations precluded from obligation			–7,767

1260	Appropriations, mandatory (total)			–10,245
1900	Budget authority (total)			–10,245
1930	Total budgetary resources available			–10,245

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–10,245
3020	Outlays (gross)			10,245

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–10,245
	Outlays, gross:
4100	Outlays from new mandatory authority			–10,245
4180	Budget authority, net (total)			–10,245
4190	Outlays, net (total)			–10,245

In addition, the Budget includes a package of targeted Medicare proposals designed to improve drug pricing and payment, eliminate wasteful Federal spending and spending on government-imposed provider burdens, address fraud and abuse, and reform the Medicare appeals process.


Identification code 075–8004–4–7–571		2018 actual	2019 est.	2020 est.

	Direct obligations:
42.0	Insurance claims and indemnities			–10,265
94.0	Financial transfers			20

99.0	Direct obligations			–10,245

99.9	Total new obligations, unexpired accounts			–10,245


Identification code 075–8308–0–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Prescription Drug Benefits	81,103	84,656	105,544
0002	Administrative Costs	422	642	861

0799	Total direct obligations	81,525	85,298	106,405

0900	Total new obligations, unexpired accounts	81,525	85,298	106,405

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	421	633	858
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	88,420	84,665	105,548
	Spending authority from offsetting collections, mandatory:
1801	Change in uncollected payments, Federal sources	–7,316
1900	Budget authority (total)	81,525	85,298	106,406
1930	Total budgetary resources available	81,525	85,298	106,406
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year			1
	Special and non-revolving trust funds:
1952	Expired unobligated balance, start of year	3

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	8,404	7,466	7,639
3001	Adjustments to unpaid obligations, brought forward, Oct 1	27
3010	New obligations, unexpired accounts	81,525	85,298	106,405
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–82,488	–85,125	–106,035
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	7,466	7,639	8,009
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–7,541	–225	–225
3070	Change in uncollected pymts, Fed sources, unexpired	7,316

3090	Uncollected pymts, Fed sources, end of year	–225	–225	–225
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	890	7,241	7,414
3200	Obligated balance, end of year	7,241	7,414	7,784

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	421	633	858
	Outlays, gross:
4010	Outlays from new discretionary authority	218	330	331
4011	Outlays from discretionary balances	217	131	147

4020	Outlays, gross (total)	435	461	478
	Mandatory:
4090	Budget authority, gross	81,104	84,665	105,548
	Outlays, gross:
4100	Outlays from new mandatory authority	74,420	77,619	95,548
4101	Outlays from mandatory balances	7,633	7,045	10,009

4110	Outlays, gross (total)	82,053	84,664	105,557
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–1
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	7,316
4142	Offsetting collections credited to expired accounts	1

4150	Additional offsets against budget authority only (total)	7,317

4160	Budget authority, net (mandatory)	88,420	84,665	105,548
4170	Outlays, net (mandatory)	82,052	84,664	105,557
4180	Budget authority, net (total)	88,841	85,298	106,406
4190	Outlays, net (total)	82,487	85,125	106,035


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	88,841	85,298	106,406
	Outlays	82,487	85,125	106,035
Legislative proposal, subject to PAYGO:
	Budget Authority			–100
	Outlays			–100
Total:
	Budget Authority	88,841	85,298	106,306
	Outlays	82,487	85,125	105,935

Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug benefit.


Identification code 075–8308–0–7–571		2018 actual	2019 est.	2020 est.

	Direct obligations:
25.2	Other services from non-Federal sources	422	642	861
42.0	Insurance claims and indemnities	81,103	84,656	105,544

99.0	Direct obligations	81,525	85,298	106,405

99.9	Total new obligations, unexpired accounts	81,525	85,298	106,405


Identification code 075–8308–0–7–571		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	4	4	4


Identification code 075–8308–4–7–571		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Prescription Drug Benefits			–100

0799	Total direct obligations			–100

0900	Total new obligations, unexpired accounts (object class 42.0)			–100

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–100
1900	Budget authority (total)			–100
1930	Total budgetary resources available			–100

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–100
3020	Outlays (gross)			100

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–100
	Outlays, gross:
4100	Outlays from new mandatory authority			–100
4180	Budget authority, net (total)			–100
4190	Outlays, net (total)			–100

The Budget includes a package of proposals designed to modernize the Part D benefit by realigning incentives and enhancing benefit management.

Federal Funds


Identification code 075–1552–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	State family assistance grant	16,433	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	141	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	16,714	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
1900	Budget authority (total)		16,737	16,739
1930	Total budgetary resources available	16,737	16,737	16,739
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–23	–15	–15

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,772	8,070	8,256
3010	New obligations, unexpired accounts	16,714	16,722	16,724
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–16,415	–16,536	–16,219
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	8,070	8,256	8,761
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,772	8,070	8,256
3200	Obligated balance, end of year	8,070	8,256	8,761

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	16,737	16,737	16,739
	Outlays, gross:
4100	Outlays from new mandatory authority	11,018	11,495	11,497
4101	Outlays from mandatory balances	5,397	5,041	4,722

4110	Outlays, gross (total)	16,415	16,536	16,219
4180	Budget authority, net (total)	16,737	16,737	16,739
4190	Outlays, net (total)	16,415	16,536	16,219


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	16,737	16,737	16,739
	Outlays	16,415	16,536	16,219
Legislative proposal, subject to PAYGO:
	Budget Authority			–1,502
	Outlays			–1,077
Total:
	Budget Authority	16,737	16,737	15,237
	Outlays	16,415	16,536	15,142

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 TANF Extension Act of 2019 (P.L. 116–4) authorized TANF through June 30, 2019. 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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	8	10	9
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1

11.9	Total personnel compensation	10	11	10
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	68	67	68
25.3	Other goods and services from Federal sources	4	20	20
25.7	Operation and maintenance of equipment		1	1
41.0	Grants, subsidies, and contributions	16,628	16,619	16,621

99.9	Total new obligations, unexpired accounts	16,714	16,722	16,724


Identification code 075–1552–0–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	105	104	97


Identification code 075–1552–4–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	State family assistance grant			–1,594
0002	Territories - family assistance grants			–8
0012	Promoting Opportunity and Economic Mobility Demonstrations			100

0900	Total new obligations, unexpired accounts			–1,502

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–1,502
1930	Total budgetary resources available			–1,502

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–1,502
3020	Outlays (gross)			1,077

3050	Unpaid obligations, end of year			–425
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			–425

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1,502
	Outlays, gross:
4100	Outlays from new mandatory authority			–1,077
4180	Budget authority, net (total)			–1,502
4190	Outlays, net (total)			–1,077


Identification code 075–1552–4–1–609		2018 actual	2019 est.	2020 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent			1

11.9	Total personnel compensation			1
25.1	Advisory and assistance services			29
41.0	Grants, subsidies, and contributions			–1,532

99.9	Total new obligations, unexpired accounts			–1,502


Identification code 075–1552–4–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment			7


Identification code 075–1522–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Contingency Fund for State Welfare Programs	608	608	608

0900	Total new obligations, unexpired accounts (object class 41.0)	608	608	608

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	608	608	608
1930	Total budgetary resources available	608	608	608

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	113	55	66
3010	New obligations, unexpired accounts	608	608	608
3020	Outlays (gross)	–666	–597	–608

3050	Unpaid obligations, end of year	55	66	66
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	113	55	66
3200	Obligated balance, end of year	55	66	66

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	608	608	608
	Outlays, gross:
4100	Outlays from new mandatory authority	574	545	545
4101	Outlays from mandatory balances	92	52	63

4110	Outlays, gross (total)	666	597	608
4180	Budget authority, net (total)	608	608	608
4190	Outlays, net (total)	666	597	608


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	608	608	608
	Outlays	666	597	608
Legislative proposal, subject to PAYGO:
	Budget Authority			–608
	Outlays			–545
Total:
	Budget Authority	608	608
	Outlays	666	597	63


Identification code 075–1522–4–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Contingency Fund for State Welfare Programs			–608

0900	Total new obligations, unexpired accounts (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, $2,890,000,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2021, $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, 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	State child support administrative costs	3,793	3,924	3,969
0002	Child support incentive payments	577	574	598
0003	Access and visitation grants	10	10	10

0091	Subtotal, child support enforcement	4,380	4,508	4,577
0102	Payments to territories	33	33	33
0103	Repatriation	3	1	1

0191	Subtotal, other payments	36	34	34

0799	Total direct obligations	4,416	4,542	4,611
0801	Offset obligations (CSE grants to States)	13	13	1

0900	Total new obligations, unexpired accounts	4,429	4,555	4,612

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	35	141	121
1021	Recoveries of prior year unpaid obligations	159	200	200
1029	Other balances withdrawn to Treasury	–32

1050	Unobligated balance (total)	162	341	321
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	2,995	2,922	2,890
	Advance appropriations, mandatory:
1270	Advance appropriation	1,400	1,400	1,400
	Spending authority from offsetting collections, mandatory:
1800	Collected	13	13	1
1900	Budget authority (total)	4,408	4,335	4,291
1930	Total budgetary resources available	4,570	4,676	4,612
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	141	121

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,263	1,383	1,490
3010	New obligations, unexpired accounts	4,429	4,555	4,612
3020	Outlays (gross)	–4,150	–4,248	–4,308
3040	Recoveries of prior year unpaid obligations, unexpired	–159	–200	–200

3050	Unpaid obligations, end of year	1,383	1,490	1,594
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,263	1,383	1,490
3200	Obligated balance, end of year	1,383	1,490	1,594

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,408	4,335	4,291
	Outlays, gross:
4100	Outlays from new mandatory authority	3,754	3,774	3,807
4101	Outlays from mandatory balances	396	474	501

4110	Outlays, gross (total)	4,150	4,248	4,308
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–13	–13	–1
4180	Budget authority, net (total)	4,395	4,322	4,290
4190	Outlays, net (total)	4,137	4,235	4,307


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	4,395	4,322	4,290
	Outlays	4,137	4,235	4,307
Legislative proposal, subject to PAYGO:
	Budget Authority			50
	Outlays			49
Total:
	Budget Authority	4,395	4,322	4,340
	Outlays	4,137	4,235	4,356

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		2018 actual	2019 est.	2020 est.

41.0	Direct obligations: Grants, subsidies, and contributions	4,416	4,542	4,611
99.0	Reimbursable obligations	13	13	1

99.9	Total new obligations, unexpired accounts	4,429	4,555	4,612


Identification code 075–1501–4–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	State child support administrative costs			49

0091	Subtotal, child support enforcement			49
0103	Repatriation			1

0191	Subtotal, other payments			1

0799	Total direct obligations			50

0900	Total new obligations, unexpired accounts			50

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			50
1900	Budget authority (total)			50
1930	Total budgetary resources available			50

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			50
3020	Outlays (gross)			–49

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			50
	Outlays, gross:
4100	Outlays from new mandatory authority			49
4180	Budget authority, net (total)			50
4190	Outlays, net (total)			49


Identification code 075–1501–4–1–609		2018 actual	2019 est.	2020 est.

	Direct obligations:
25.1	Advisory and assistance services			120
41.0	Grants, subsidies, and contributions			–70

99.0	Direct obligations			50

99.9	Total new obligations, unexpired accounts			50


Identification code 075–1502–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	LIHEAP Block Grant	3,641	3,690

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	1	1
1012	Unobligated balance transfers between expired and unexpired accounts	1

1050	Unobligated balance (total)	2	1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,640	3,690
1930	Total budgetary resources available	3,642	3,691	1
	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	1,421	1,631	1,629
3010	New obligations, unexpired accounts	3,641	3,690
3020	Outlays (gross)	–3,425	–3,692	–1,396
3041	Recoveries of prior year unpaid obligations, expired	–6

3050	Unpaid obligations, end of year	1,631	1,629	233
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,421	1,631	1,629
3200	Obligated balance, end of year	1,631	1,629	233

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,640	3,690
	Outlays, gross:
4010	Outlays from new discretionary authority	2,248	2,362
4011	Outlays from discretionary balances	1,177	1,330	1,396

4020	Outlays, gross (total)	3,425	3,692	1,396
4180	Budget authority, net (total)	3,640	3,690
4190	Outlays, net (total)	3,425	3,692	1,396

The Budget proposes to eliminate funding for the Low Income Home Energy Assistance Program.


Identification code 075–1502–0–1–609		2018 actual	2019 est.	2020 est.

	Direct obligations:
25.1	Advisory and assistance services	3	3
41.0	Grants, subsidies, and contributions	3,638	3,687

99.9	Total new obligations, unexpired accounts	3,641	3,690

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, $1,804,066,000, of which $1,773,066,000 shall remain available through September 30, 2022 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 such Act: 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 "20 percent" for "3 percent": Provided further, That funds made available under this heading shall be available to pay or reimburse other Federal agencies for the costs of construction, improvements to property, and other activities, including structure removal, if such activities are necessary for the purposes of carrying out such sections 462 and 235: Provided further, That such Federal agencies may retain and use such payments and reimbursements to cover costs described in the preceding proviso.


Identification code 075–1503–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Refugee and entrant assistance	503	561	470
0002	Assistance for treatment of torture victims	11	14	14
0003	Unaccompanied Children	1,721	1,303	1,303
0005	Trafficking Victims program	24	27	17

0799	Total direct obligations	2,259	1,905	1,804
0801	Reimbursable program activity	190

0900	Total new obligations, unexpired accounts	2,449	1,905	1,804

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	190	40	40
1011	Unobligated balance transfer from other acct [075–0350]	17
1021	Recoveries of prior year unpaid obligations	52

1050	Unobligated balance (total)	259	40	40
	Budget authority:
	Appropriations, discretionary:
1100	Base Appropriation	1,865	1,905	1,804
1121	Appropriations transferred from other acct [075–0350]	16
1121	Appropriations transferred from other acct [075–1536]	30
1121	Appropriations transferred from other acct [075–1700]	1
1121	Appropriations transferred from other acct [075–0142]	5
1121	Appropriations transferred from other acct [075–1362]	6
1121	Appropriations transferred from other acct [075–0943]	17
1121	Appropriations transferred from other acct [075–9912]	1
1121	Appropriations transferred from other acct [075–9915]	87
1121	Appropriations transferred from other acct [075–1515]	13

1160	Appropriation, discretionary (total)	2,041	1,905	1,804
	Spending authority from offsetting collections, discretionary:
1700	Collected	10	180
1701	Change in uncollected payments, Federal sources	180	–180

1750	Spending auth from offsetting collections, disc (total)	190
1900	Budget authority (total)	2,231	1,905	1,804
1930	Total budgetary resources available	2,490	1,945	1,844
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	40	40	40

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,002	1,721	1,185
3010	New obligations, unexpired accounts	2,449	1,905	1,804
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–1,661	–2,441	–2,115
3040	Recoveries of prior year unpaid obligations, unexpired	–52
3041	Recoveries of prior year unpaid obligations, expired	–19

3050	Unpaid obligations, end of year	1,721	1,185	874
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1		–180
3070	Change in uncollected pymts, Fed sources, unexpired	–180	180

3090	Uncollected pymts, Fed sources, end of year	–180
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,002	1,541	1,185
3200	Obligated balance, end of year	1,541	1,185	874

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,231	1,905	1,804
	Outlays, gross:
4010	Outlays from new discretionary authority	983	1,238	1,173
4011	Outlays from discretionary balances	678	1,203	942

4020	Outlays, gross (total)	1,661	2,441	2,115
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–10	–180
4033	Non-Federal sources	–2

4040	Offsets against gross budget authority and outlays (total)	–12	–180
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–180	180
4052	Offsetting collections credited to expired accounts	2

4060	Additional offsets against budget authority only (total)	–178	180

4070	Budget authority, net (discretionary)	2,041	1,905	1,804
4080	Outlays, net (discretionary)	1,649	2,261	2,115
4180	Budget authority, net (total)	2,041	1,905	1,804
4190	Outlays, net (total)	1,649	2,261	2,115


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	2,041	1,905	1,804
	Outlays	1,649	2,261	2,115
Legislative proposal, subject to PAYGO:
	Budget Authority			738
	Outlays			480
Total:
	Budget Authority	2,041	1,905	2,542
	Outlays	1,649	2,261	2,595

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	10	17	17
11.7	Military personnel	1	2	2

11.9	Total personnel compensation	11	19	19
12.1	Civilian personnel benefits	3	5	5
12.2	Military personnel benefits	1	1	1
23.1	Rental payments to GSA	5	8	8
25.1	Advisory and assistance services	275	275	265
25.3	Other goods and services from Federal sources	63	60	50
25.4	Operation and maintenance of facilities	2	1	1
41.0	Grants, subsidies, and contributions	1,899	1,536	1,455

99.0	Direct obligations	2,259	1,905	1,804
99.0	Reimbursable obligations	190

99.9	Total new obligations, unexpired accounts	2,449	1,905	1,804


Identification code 075–1503–0–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	85	154	154
1101	Direct military average strength employment	11	11	11


Identification code 075–1503–4–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0009	UAC Contingency Fund, mandatory			738

0900	Total new obligations, unexpired accounts (object class 41.0)			738

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			738
1930	Total budgetary resources available			738

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			738
3020	Outlays (gross)			–480

3050	Unpaid obligations, end of year			258
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			258

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			738
	Outlays, gross:
4100	Outlays from new mandatory authority			480
4180	Budget authority, net (total)			738
4190	Outlays, net (total)			480

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Grants to States and Tribes	382	389	363
0002	Research, training and technical assistance	8	10	10
0003	State court improvement activities	32	32	32
0004	Family Connection Grants			2
0005	Personal Responsibility Education (PREP)	73	74	31
0006	Sexual Risk Abstinence Education (SRAE)	64	75
0007	Family Rec. & Reunification		2	3

0900	Total new obligations, unexpired accounts	559	582	441

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	28	39	46
1012	Unobligated balance transfers between expired and unexpired accounts	1
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	30	39	46
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	100	100	60
	Appropriations, mandatory:
1200	Appropriation	503	510	345
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–23	–21

1260	Appropriations, mandatory (total)	480	489	345
1900	Budget authority (total)	580	589	405
1930	Total budgetary resources available	610	628	451
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–12
1941	Unexpired unobligated balance, end of year	39	46	10

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	593	657	680
3010	New obligations, unexpired accounts	559	582	441
3020	Outlays (gross)	–481	–559	–569
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–13

3050	Unpaid obligations, end of year	657	680	552
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	593	657	680
3200	Obligated balance, end of year	657	680	552

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	100	100	60
	Outlays, gross:
4010	Outlays from new discretionary authority	16	28	17
4011	Outlays from discretionary balances	40	63	67

4020	Outlays, gross (total)	56	91	84
	Mandatory:
4090	Budget authority, gross	480	489	345
	Outlays, gross:
4100	Outlays from new mandatory authority	81	98	100
4101	Outlays from mandatory balances	344	370	385

4110	Outlays, gross (total)	425	468	485
4180	Budget authority, net (total)	580	589	405
4190	Outlays, net (total)	481	559	569


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	580	589	405
	Outlays	481	559	569
Legislative proposal, subject to PAYGO:
	Budget Authority			220
	Outlays			25
Total:
	Budget Authority	580	589	625
	Outlays	481	559	594

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, to increase funding for the Court Improvement Program, and a one-year reauthorization of Sexual Risk Avoidance Education and the Personal Responsibility Education Program (PREP).


Identification code 075–1512–0–1–506		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	2	2
25.1	Advisory and assistance services	26	28	16
25.2	Other services from non-Federal sources	1
25.3	Other goods and services from Federal sources	3	3	3
41.0	Grants, subsidies, and contributions	528	549	420

99.9	Total new obligations, unexpired accounts	559	582	441


Identification code 075–1512–0–1–506		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	10	21	21


Identification code 075–1512–4–1–506		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Grants to States and Tribes			40
0003	State court improvement activities			30
0005	Personal Responsibility Education (PREP)			75
0006	Sexual Risk Abstinence Education (SRAE)			75

0900	Total new obligations, unexpired accounts			220

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			220
1930	Total budgetary resources available			220

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			220
3020	Outlays (gross)			–25

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			220
	Outlays, gross:
4100	Outlays from new mandatory authority			25
4180	Budget authority, net (total)			220
4190	Outlays, net (total)			25


Identification code 075–1512–4–1–506		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			2
25.1	Advisory and assistance services			23
25.3	Other goods and services from Federal sources			3
41.0	Grants, subsidies, and contributions			192

99.9	Total new obligations, unexpired accounts			220


Identification code 075–1512–4–1–506		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment			14


Identification code 075–1550–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Mandatory child care	1,178	1,178	1,178
0002	Matching child care	1,710	1,651	1,651
0003	Child Care Training and technical assistance	15	15	15
0004	Child care tribal grants	58	58	58
0005	Child Care Research	4	15	15

0900	Total new obligations, unexpired accounts	2,965	2,917	2,917

	Budgetary resources:
	Unobligated balance:
1012	Unobligated balance transfers between expired and unexpired accounts	48
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	2,917	2,917	2,917
1930	Total budgetary resources available	2,965	2,917	2,917

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,061	1,614	1,712
3010	New obligations, unexpired accounts	2,965	2,917	2,917
3011	Obligations ("upward adjustments"), expired accounts	9
3020	Outlays (gross)	–2,359	–2,819	–3,296
3041	Recoveries of prior year unpaid obligations, expired	–62

3050	Unpaid obligations, end of year	1,614	1,712	1,333
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,061	1,614	1,712
3200	Obligated balance, end of year	1,614	1,712	1,333

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	2,917	2,917	2,917
	Outlays, gross:
4100	Outlays from new mandatory authority	1,596	2,167	2,167
4101	Outlays from mandatory balances	763	652	1,129

4110	Outlays, gross (total)	2,359	2,819	3,296
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–1
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	1

4160	Budget authority, net (mandatory)	2,917	2,917	2,917
4170	Outlays, net (mandatory)	2,358	2,819	3,296
4180	Budget authority, net (total)	2,917	2,917	2,917
4190	Outlays, net (total)	2,358	2,819	3,296


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	2,917	2,917	2,917
	Outlays	2,358	2,819	3,296
Legislative proposal, subject to PAYGO:
	Budget Authority			1,295
	Outlays			266
Total:
	Budget Authority	2,917	2,917	4,212
	Outlays	2,358	2,819	3,562

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 TANF Extension Act of 2019 (P.L. 116–4). 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. The Budget also proposes a $1 billion one-time fund to build the supply of child care for underserved populations and to stimulate employer investment.


Identification code 075–1550–0–1–609		2018 actual	2019 est.	2020 est.

	Direct obligations:
21.0	Travel and transportation of persons	1
23.1	Rental payments to GSA	1
25.1	Advisory and assistance services	5	16	16
25.2	Other services from non-Federal sources	11
25.3	Other goods and services from Federal sources	1	2	2
41.0	Grants, subsidies, and contributions	2,946	2,899	2,899

99.9	Total new obligations, unexpired accounts	2,965	2,917	2,917


Identification code 075–1550–4–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Mandatory child care			1,000
0002	Matching child care			295

0900	Total new obligations, unexpired accounts (object class 41.0)			1,295

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			1,295
1930	Total budgetary resources available			1,295

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			1,295
3020	Outlays (gross)			–266

3050	Unpaid obligations, end of year			1,029
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			1,029

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			1,295
	Outlays, gross:
4100	Outlays from new mandatory authority			266
4180	Budget authority, net (total)			1,295
4190	Outlays, net (total)			266

For carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $5,276,000,000 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 in addition to the amounts required to be reserved by the Secretary under section 658O(a)(2)(A) of such Act, $156,780,000 shall be for Indian tribes and tribal organizations: Provided further, That none of the funds provided under this heading may be used to implement the national toll-free hotline authorized by section 658L(b) of the CCDBG Act.


Identification code 075–1515–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Child Care Block grant payments to States	5,194	5,250	5,250
0004	Child Care Research and evaluation fund	19	26	26

0900	Total new obligations, unexpired accounts	5,213	5,276	5,276

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	5,226	5,276	5,276
1120	Appropriations transferred to other acct [075–1503]	–13

1160	Appropriation, discretionary (total)	5,213	5,276	5,276
1930	Total budgetary resources available	5,213	5,276	5,276

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,122	2,792	3,264
3010	New obligations, unexpired accounts	5,213	5,276	5,276
3011	Obligations ("upward adjustments"), expired accounts	20
3020	Outlays (gross)	–3,540	–4,804	–5,013
3041	Recoveries of prior year unpaid obligations, expired	–23

3050	Unpaid obligations, end of year	2,792	3,264	3,527
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,122	2,792	3,264
3200	Obligated balance, end of year	2,792	3,264	3,527

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5,213	5,276	5,276
	Outlays, gross:
4010	Outlays from new discretionary authority	2,732	3,007	3,007
4011	Outlays from discretionary balances	808	1,797	2,006

4020	Outlays, gross (total)	3,540	4,804	5,013
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources	–1

4040	Offsets against gross budget authority and outlays (total)	–1
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts	1

4070	Budget authority, net (discretionary)	5,213	5,276	5,276
4080	Outlays, net (discretionary)	3,539	4,804	5,013
4180	Budget authority, net (total)	5,213	5,276	5,276
4190	Outlays, net (total)	3,539	4,804	5,013

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
12.1	Civilian personnel benefits	1	1	1
25.1	Advisory and assistance services	101	48	47
25.3	Other goods and services from Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	5,108	5,224	5,225

99.9	Total new obligations, unexpired accounts	5,213	5,276	5,276


Identification code 075–1515–0–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	16	16	16


Identification code 075–1534–0–1–506		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Social Services Block Grant	1,588	1,595	1,700
0002	Health Profession Opportunity Grants	84	85

0900	Total new obligations, unexpired accounts	1,672	1,680	1,700

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	30	29	29
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,785	1,785	1,700
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–113	–105

1260	Appropriations, mandatory (total)	1,672	1,680	1,700
1930	Total budgetary resources available	1,702	1,709	1,729
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	29	29	29

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	467	544	605
3010	New obligations, unexpired accounts	1,672	1,680	1,700
3020	Outlays (gross)	–1,587	–1,619	–1,844
3041	Recoveries of prior year unpaid obligations, expired	–8

3050	Unpaid obligations, end of year	544	605	461
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	467	544	605
3200	Obligated balance, end of year	544	605	461

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,672	1,680	1,700
	Outlays, gross:
4100	Outlays from new mandatory authority	1,227	1,279	1,360
4101	Outlays from mandatory balances	360	340	484

4110	Outlays, gross (total)	1,587	1,619	1,844
4180	Budget authority, net (total)	1,672	1,680	1,700
4190	Outlays, net (total)	1,587	1,619	1,844


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	1,672	1,680	1,700
	Outlays	1,587	1,619	1,844
Legislative proposal, subject to PAYGO:
	Budget Authority			–1,615
	Outlays			–1,357
Total:
	Budget Authority	1,672	1,680	85
	Outlays	1,587	1,619	487

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 2020, for current grantees only.


Identification code 075–1534–0–1–506		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1
25.1	Advisory and assistance services	11	11
41.0	Grants, subsidies, and contributions	1,660	1,668	1,700

99.9	Total new obligations, unexpired accounts	1,672	1,680	1,700


Identification code 075–1534–0–1–506		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	7	8


Identification code 075–1534–4–1–506		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Social Services Block Grant			–1,700
0002	Health Profession Opportunity Grants			85

0900	Total new obligations, unexpired accounts			–1,615

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–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)			1,357

3050	Unpaid obligations, end of year			–258
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			–258

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1,615
	Outlays, gross:
4100	Outlays from new mandatory authority			–1,357
4180	Budget authority, net (total)			–1,615
4190	Outlays, net (total)			–1,357


Identification code 075–1534–4–1–506		2018 actual	2019 est.	2020 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		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment			7

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), and 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, $11,187,485,000, of which $37,943,000, to remain available through September 30, 2021, 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, 2020: Provided, That $10,063,095,000 shall be for making payments under the Head Start Act, including for Early Head Start-Child Care Partnerships, and of which, notwithstanding section 640 of such Act,

$25,000,000 shall be available for allocation by the Secretary to supplement activities described in paragraphs (7)(B) and (9) of section 641(c) of 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, and such funds 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 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 $164,500,000 shall be for carrying out section 303(a) of the Family Violence Prevention and Services Act, of which $5,000,000 shall be allocated notwithstanding section 303(a)(2) of such Act for carrying out section 309 of such Act: Provided further, That the percentages specified in section 112(a)(2) of the Child Abuse Prevention and Treatment Act shall not apply to funds appropriated under this heading: 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0101	Head Start	9,556	10,422	10,063
0102	Preschool Development Grants	256	491
0103	Runaway and homeless youth (basic centers)	54	54	48
0104	Transitional living	55	56	54
0106	Education grants to reduce sexual abuse of runaway youth	17	17	17
0109	Child abuse State grants	85	85	85
0110	Child abuse discretionary activities	33	33	33
0111	Community-based child abuse prevention	40	40	40
0112	Child welfare services	269	269	269
0113	Child welfare training, research, or demonstration projects	18	18	18
0114	Adoption opportunities	39	39	39
0116	Adoption and Legal Guardianship Incentives	75	75	38
0117	Independent living education and training vouchers	43	43	43
0124	Native American programs	52	55	52
0125	Social services and income maintenance research	7	7	7
0128	ACF Federal administration	205	205	205
0131	Disaster human services case management	2	2	2

0191	Direct program activities, subtotal	10,806	11,911	11,013
0301	Community services block grant	715	725
0303	Rural community facilities	20	20
0304	Community economic development	8	9
0308	Domestic violence hotline	9	10	10
0309	Family violence prevention and services	159	164	165

0391	Direct program activities, subtotal	911	928	175

0400	Total, direct program	11,717	12,839	11,188

0799	Total direct obligations	11,717	12,839	11,188
0801	Children and Families Services Programs (Reimbursable)	60	20	20

0809	Reimbursable program activities, subtotal	60	20	20

0900	Total new obligations, unexpired accounts	11,777	12,859	11,208

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	330	1,251	655
1001	Discretionary unobligated balance brought fwd, Oct 1	330	1,251
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	12,672	12,239	11,187
1120	Appropriations transferred to other accts [075–1503]	–30

1160	Appropriation, discretionary (total)	12,642	12,239	11,187
	Spending authority from offsetting collections, discretionary:
1700	Collected	40	22	22
1701	Change in uncollected payments, Federal sources	17

1750	Spending auth from offsetting collections, disc (total)	57	22	22
	Spending authority from offsetting collections, mandatory:
1800	Collected	1	1	1
1801	Change in uncollected payments, Federal sources	1	1	1

1850	Spending auth from offsetting collections, mand (total)	2	2	2
1900	Budget authority (total)	12,701	12,263	11,211
1930	Total budgetary resources available	13,031	13,514	11,866
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	1,251	655	658

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	8,269	8,886	10,495
3010	New obligations, unexpired accounts	11,777	12,859	11,208
3011	Obligations ("upward adjustments"), expired accounts	13
3020	Outlays (gross)	–11,060	–11,250	–11,552
3041	Recoveries of prior year unpaid obligations, expired	–113

3050	Unpaid obligations, end of year	8,886	10,495	10,151
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–4	–20	–21
3070	Change in uncollected pymts, Fed sources, unexpired	–18	–1	–1
3071	Change in uncollected pymts, Fed sources, expired	2

3090	Uncollected pymts, Fed sources, end of year	–20	–21	–22
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	8,265	8,866	10,474
3200	Obligated balance, end of year	8,866	10,474	10,129

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	12,699	12,261	11,209
	Outlays, gross:
4010	Outlays from new discretionary authority	4,230	3,988	3,567
4011	Outlays from discretionary balances	6,829	7,262	7,985

4020	Outlays, gross (total)	11,059	11,250	11,552
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–40	–22	–22

4040	Offsets against gross budget authority and outlays (total)	–40	–22	–22
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–17

4060	Additional offsets against budget authority only (total)	–17

4070	Budget authority, net (discretionary)	12,642	12,239	11,187
4080	Outlays, net (discretionary)	11,019	11,228	11,530
	Mandatory:
4090	Budget authority, gross	2	2	2
	Outlays, gross:
4100	Outlays from new mandatory authority	1
	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	–1	–1
4142	Offsetting collections credited to expired accounts	1	1	1
4170	Outlays, net (mandatory)	–1	–2	–2
4180	Budget authority, net (total)	12,642	12,239	11,187
4190	Outlays, net (total)	11,018	11,226	11,528

The request totals $11.2 billion, including almost $10.1 billion for Head Start. This request discontinues funding for the Community Services Block Grant, Rural Community Facilities, Community Economic Development, and Preschool Development Grants.


Identification code 075–1536–0–1–506		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	109	120	120
11.3	Other than full-time permanent	3	3	3
11.5	Other personnel compensation	2	2	2
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	115	126	126
12.1	Civilian personnel benefits	36	38	38
21.0	Travel and transportation of persons	3	4	4
23.1	Rental payments to GSA	17	17	16
23.3	Communications, utilities, and miscellaneous charges	2	2	2
25.1	Advisory and assistance services	238	261	264
25.2	Other services from non-Federal sources	9	15	17
25.3	Other goods and services from Federal sources	46	48	50
25.4	Operation and maintenance of facilities	2	3	3
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	11,248	12,324	10,667

99.0	Direct obligations	11,717	12,839	11,188
99.0	Reimbursable obligations	60	20	20

99.9	Total new obligations, unexpired accounts	11,777	12,859	11,208


Identification code 075–1536–0–1–506		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	1,028	1,140	1,114
1101	Direct military average strength employment	6	6	6
2001	Reimbursable civilian full-time equivalent employment	9	10	10


Identification code 075–1553–0–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Training and technical assistance	14	18	12
0002	Federal parent locator service	25	28	25

0799	Total direct obligations	39	46	37
0801	Federal Parent Locator Service reimbursable	22	28	29

0899	Total reimbursable obligations	22	28	29

0900	Total new obligations, unexpired accounts	61	74	66

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	12	11
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	15	11
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	37	37	37
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–2	–2

1260	Appropriations, mandatory (total)	35	35	37
	Spending authority from offsetting collections, mandatory:
1800	Collected	22	28	28
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	28	29
1900	Budget authority (total)	57	63	66
1930	Total budgetary resources available	72	74	66
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	11

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	30	25	28
3010	New obligations, unexpired accounts	61	74	66
3020	Outlays (gross)	–63	–71	–65
3040	Recoveries of prior year unpaid obligations, unexpired	–3

3050	Unpaid obligations, end of year	25	28	29
	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	24	19	22
3200	Obligated balance, end of year	19	22	23

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	57	63	66
	Outlays, gross:
4100	Outlays from new mandatory authority	35	42	42
4101	Outlays from mandatory balances	28	29	23

4110	Outlays, gross (total)	63	71	65
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–8	–9	–9
4123	Non-Federal sources	–14	–19	–19

4130	Offsets against gross budget authority and outlays (total)	–22	–28	–28

4160	Budget authority, net (mandatory)	35	35	38
4170	Outlays, net (mandatory)	41	43	37
4180	Budget authority, net (total)	35	35	38
4190	Outlays, net (total)	41	43	37

	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). The Budget includes a set of proposals that would require changes to statute to provide additional access to the National Directory of New Hires for evidence building and program integrity purposes, while ensuring privacy and security safeguards.


Identification code 075–1553–0–1–609		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	8	9	9
12.1	Civilian personnel benefits	2	3	3
21.0	Travel and transportation of persons	1	1
23.1	Rental payments to GSA	4	3	3
25.1	Advisory and assistance services		2	3
25.2	Other services from non-Federal sources	11	11	8
25.3	Other goods and services from Federal sources	8	12	7
25.4	Operation and maintenance of facilities	1
25.7	Operation and maintenance of equipment	4	5	4

99.0	Direct obligations	39	46	37
99.0	Reimbursable obligations	22	28	29

99.9	Total new obligations, unexpired accounts	61	74	66


Identification code 075–1553–0–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	62	68	68

For carrying out, except as otherwise provided, title IV-E of the Social Security Act, $5,745,000,000.

For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year 2021, $3,000,000,000.

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Foster care	5,054	5,113	5,253
0002	Independent living	140	140	143
0004	Adoption assistance	2,785	2,842	2,931
0005	Guardianship	155	202	217
0006	Technical Assistance and Implementation Services for Tribal Programs	3	3	3
0007	Prevention Services Technical Assistance	1	1	1

0900	Total new obligations, unexpired accounts	8,138	8,301	8,548

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5,639	5,602	5,748
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–1	–1

1260	Appropriations, mandatory (total)	5,638	5,601	5,748
	Advance appropriations, mandatory:
1270	Advance appropriation	2,500	2,700	2,800
1900	Budget authority (total)	8,138	8,301	8,548
1930	Total budgetary resources available	8,138	8,301	8,548

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,611	1,213	1,638
3010	New obligations, unexpired accounts	8,138	8,301	8,548
3011	Obligations ("upward adjustments"), expired accounts	82
3020	Outlays (gross)	–8,581	–7,876	–8,404
3041	Recoveries of prior year unpaid obligations, expired	–37

3050	Unpaid obligations, end of year	1,213	1,638	1,782
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,611	1,213	1,638
3200	Obligated balance, end of year	1,213	1,638	1,782

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8,138	8,301	8,548
	Outlays, gross:
4100	Outlays from new mandatory authority	7,425	7,002	7,504
4101	Outlays from mandatory balances	1,156	874	900

4110	Outlays, gross (total)	8,581	7,876	8,404
4180	Budget authority, net (total)	8,138	8,301	8,548
4190	Outlays, net (total)	8,581	7,876	8,404


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	8,138	8,301	8,548
	Outlays	8,581	7,876	8,404
Legislative proposal, subject to PAYGO:
	Budget Authority			31
	Outlays			31
Total:
	Budget Authority	8,138	8,301	8,579
	Outlays	8,581	7,876	8,435

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 202,900 children per month are estimated to be served in FY 2020.

Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 523,000 children per month are estimated to be served in FY 2020.

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 38,400 children per month are estimated to be served in FY 2020.

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, and to allow states to pay salaries to foster parents who can care for children with complex needs. Additionally, the Budget includes the interaction effects from the proposal to eliminate SSBG funding, which increases costs in the Foster Care and Permanency account due to State agencies shifting eligible expenses previously funded by SSBG to Foster Care and Permanency.


Identification code 075–1545–0–1–609		2018 actual	2019 est.	2020 est.

	Direct obligations:
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	32	30	32
25.2	Other services from non-Federal sources		1
41.0	Grants, subsidies, and contributions	8,104	8,268	8,514

99.9	Total new obligations, unexpired accounts	8,138	8,301	8,548


Identification code 075–1545–0–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	3	3	3


Identification code 075–1545–4–1–609		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Foster care			12
0004	Adoption assistance			11
0005	Guardianship			1
0007	Prevention Services Technical Assistance			7

0900	Total new obligations, unexpired accounts			31

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			31
1900	Budget authority (total)			31
1930	Total budgetary resources available			31

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			31
3020	Outlays (gross)			–31

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			31
	Outlays, gross:
4100	Outlays from new mandatory authority			31
4180	Budget authority, net (total)			31
4190	Outlays, net (total)			31


Identification code 075–1545–4–1–609		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			1
25.1	Advisory and assistance services			6
41.0	Grants, subsidies, and contributions			24

99.9	Total new obligations, unexpired accounts			31


Identification code 075–1545–4–1–609		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment			10

Federal Funds

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), the RAISE Family Caregivers Act, the Supporting Grandparents Raising Grandchildren Act, titles III and XXIX of the PHS Act, sections 1252 and 1253 of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, title XX-B of the Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and 5 of subtitle D of title II of the Help America Vote Act of 2002, the Assistive Technology Act of 1998, titles II and VII (and section 14 with respect to such titles) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals with disabilities, $1,996,556,000, together with $36,115,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to carry out section 4360 of the Omnibus Budget Reconciliation Act of 1990: 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0101	Aging Services Programs	1,606	1,606	1,575
0102	ACL Program Administration	40	41	39
0103	Integrated Aging and Disability Services Programs	43	43	41
0104	Disability Services Programs	316	321	251
0105	National Institute on Disability, Independent Living & Rehab Research	105	109	90

0300	Total, direct program	2,110	2,120	1,996

0799	Total direct obligations	2,110	2,120	1,996
0801	ACL Reimbursable Programs	95	94	56

0900	Total new obligations, unexpired accounts	2,205	2,214	2,052

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	9	36
1001	Discretionary unobligated balance brought fwd, Oct 1	4	3
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	8	9	36
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,095	2,120	1,997
1120	Appropriations transferred to other accts [012–3507]	–3
1120	Appropriations transferred to other acct [075–1503]	–5

1160	Appropriation, discretionary (total)	2,087	2,120	1,997
	Appropriations, mandatory:
1221	PPHF Appropriations transferred from other accounts [075–0116]	28	28
	Spending authority from offsetting collections, discretionary:
1700	Collected		68	55
1701	Change in uncollected payments, Federal sources	68

1750	Spending auth from offsetting collections, disc (total)	68	68	55
	Spending authority from offsetting collections, mandatory:
1800	Collected	54	52
1801	Change in uncollected payments, Federal sources	–30	–27

1850	Spending auth from offsetting collections, mand (total)	24	25
1900	Budget authority (total)	2,207	2,241	2,052
1930	Total budgetary resources available	2,215	2,250	2,088
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	9	36	36

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,270	1,468	1,339
3010	New obligations, unexpired accounts	2,205	2,214	2,052
3011	Obligations ("upward adjustments"), expired accounts	3
3020	Outlays (gross)	–1,999	–2,343	–2,313
3040	Recoveries of prior year unpaid obligations, unexpired	–3
3041	Recoveries of prior year unpaid obligations, expired	–8

3050	Unpaid obligations, end of year	1,468	1,339	1,078
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–154	–189	–162
3070	Change in uncollected pymts, Fed sources, unexpired	–38	27
3071	Change in uncollected pymts, Fed sources, expired	3

3090	Uncollected pymts, Fed sources, end of year	–189	–162	–162
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,116	1,279	1,177
3200	Obligated balance, end of year	1,279	1,177	916

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,155	2,188	2,052
	Outlays, gross:
4010	Outlays from new discretionary authority	1,000	1,307	1,229
4011	Outlays from discretionary balances	950	1,001	1,037

4020	Outlays, gross (total)	1,950	2,308	2,266
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–2	–68	–55
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–68
4052	Offsetting collections credited to expired accounts	2

4060	Additional offsets against budget authority only (total)	–66

4070	Budget authority, net (discretionary)	2,087	2,120	1,997
4080	Outlays, net (discretionary)	1,948	2,240	2,211
	Mandatory:
4090	Budget authority, gross	52	53
	Outlays, gross:
4100	Outlays from new mandatory authority	1	6
4101	Outlays from mandatory balances	48	29	47

4110	Outlays, gross (total)	49	35	47
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–55	–52
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	30	27
4142	Offsetting collections credited to expired accounts	1

4150	Additional offsets against budget authority only (total)	31	27

4160	Budget authority, net (mandatory)	28	28
4170	Outlays, net (mandatory)	–6	–17	47
4180	Budget authority, net (total)	2,115	2,148	1,997
4190	Outlays, net (total)	1,942	2,223	2,258


		2018 actual	2019 est.	2020 est.

Enacted/requested:
	Budget Authority	2,115	2,148	1,997
	Outlays	1,942	2,223	2,258
Legislative proposal, subject to PAYGO:
	Outlays			–20
Total:
	Budget Authority	2,115	2,148	1,997
	Outlays	1,942	2,223	2,238

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	21	22	21
12.1	Civilian personnel benefits	7	7	6
23.1	Rental payments to GSA	5	5	4
25.1	Advisory and assistance services	41	41	38
41.0	Grants, subsidies, and contributions	2,036	2,045	1,927

99.0	Direct obligations	2,110	2,120	1,996
99.0	Reimbursable obligations	95	94	56

99.9	Total new obligations, unexpired accounts	2,205	2,214	2,052


Identification code 075–0142–0–1–506		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	173	182	173
2001	Reimbursable civilian full-time equivalent employment	15	16	12


Identification code 075–0142–4–1–506		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	ACL Reimbursable Programs			25

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected			25
1900	Budget authority (total)			25
1930	Total budgetary resources available			25

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			25
3020	Outlays (gross)			–5

3050	Unpaid obligations, end of year			20
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			20

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			25
	Outlays, gross:
4100	Outlays from new mandatory authority			5
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–25
4180	Budget authority, net (total)
4190	Outlays, net (total)			–20

This legislative proposal extends funding for Medicare enrollment assistance programs through 2021.


Identification code 075–0142–4–1–506		2018 actual	2019 est.	2020 est.

	Reimbursable obligations:
25.1	Advisory and assistance services			3
41.0	Grants, subsidies, and contributions			22

99.0	Reimbursable obligations			25

99.9	Total new obligations, unexpired accounts			25


Identification code 075–0142–4–1–506		2018 actual	2019 est.	2020 est.

2001	Reimbursable civilian full-time equivalent employment			4

Federal Funds

For necessary expenses, not otherwise provided, for general departmental management, including 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, $339,909,000, together with $68,840,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation activities, outreach and media campaign initiatives to prevent opioid misuse, and other activities authorized for such funds in this title, as determined by the Secretary: Provided, That of this amount, $53,900,000 shall be for minority AIDS prevention and treatment activities .


Identification code 075–9912–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	General Departmental Management	470	481	340
0801	GDM Collected (Reimbursable)	157	191	191
0802	HCFAC (Mandatory)	7	10	10
0803	PHS Evaluation (Collected)	62	65	69
0804	MACRA (Mandatory)	5	5	5

0899	Total reimbursable obligations	231	271	275

0900	Total new obligations, unexpired accounts	701	752	615

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	11	12	12
1001	Discretionary unobligated balance brought fwd, Oct 1	11	11
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	471	481	340
1120	Appropriations transferred to other accts [075–1503]	–1

1160	Appropriation, discretionary (total)	470	481	340
	Spending authority from offsetting collections, discretionary:
1700	Collected	62	256	260
1701	Change in uncollected payments, Federal sources	158

1750	Spending auth from offsetting collections, disc (total)	220	256	260
	Spending authority from offsetting collections, mandatory:
1800	Collected	14	15	15
1801	Change in uncollected payments, Federal sources	–2

1850	Spending auth from offsetting collections, mand (total)	12	15	15
1900	Budget authority (total)	702	752	615
1930	Total budgetary resources available	713	764	627
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	12	12	12

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	466	492	534
3010	New obligations, unexpired accounts	701	752	615
3011	Obligations ("upward adjustments"), expired accounts	11
3020	Outlays (gross)	–662	–710	–690
3041	Recoveries of prior year unpaid obligations, expired	–24

3050	Unpaid obligations, end of year	492	534	459
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–295	–318	–318
3070	Change in uncollected pymts, Fed sources, unexpired	–156
3071	Change in uncollected pymts, Fed sources, expired	133

3090	Uncollected pymts, Fed sources, end of year	–318	–318	–318
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	171	174	216
3200	Obligated balance, end of year	174	216	141

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	690	737	600
	Outlays, gross:
4010	Outlays from new discretionary authority	336	353	293
4011	Outlays from discretionary balances	315	337	382

4020	Outlays, gross (total)	651	690	675
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–179	–256	–260

4040	Offsets against gross budget authority and outlays (total)	–179	–256	–260
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–158
4052	Offsetting collections credited to expired accounts	117

4060	Additional offsets against budget authority only (total)	–41

4070	Budget authority, net (discretionary)	470	481	340
4080	Outlays, net (discretionary)	472	434	415
	Mandatory:
4090	Budget authority, gross	12	15	15
	Outlays, gross:
4100	Outlays from new mandatory authority	7	15	15
4101	Outlays from mandatory balances	4	5

4110	Outlays, gross (total)	11	20	15
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:	–21	–15	–15
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	2
4142	Offsetting collections credited to expired accounts	7

4150	Additional offsets against budget authority only (total)	9
4170	Outlays, net (mandatory)	–10	5
4180	Budget authority, net (total)	470	481	340
4190	Outlays, net (total)	462	439	415

Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation for 2020. The actual allocation is 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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	90	84	96
11.3	Other than full-time permanent	5	4	5
11.5	Other personnel compensation	2	2	2
11.7	Military personnel	2	1	2

11.9	Total personnel compensation	99	91	105
12.1	Civilian personnel benefits	28	25	30
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	17	17
23.3	Communications, utilities, and miscellaneous charges	2	2	2
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	23	23	14
25.2	Other services from non-Federal sources	59	72	28
25.3	Other goods and services from Federal sources	76	85	89
25.4	Operation and maintenance of facilities	6	6	5
25.7	Operation and maintenance of equipment	4	4	4
26.0	Supplies and materials	1	1	1
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	148	148	38

99.0	Direct obligations	470	481	340
99.0	Reimbursable obligations	231	271	275

99.9	Total new obligations, unexpired accounts	701	752	615


Identification code 075–9912–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	867	868	978
1101	Direct military average strength employment	11	12	12
2001	Reimbursable civilian full-time equivalent employment	473	470	606
2101	Reimbursable military average strength employment	24	24	22


Identification code 075–9912–4–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0805	DAB (Mandatory Proposal & User Fee Collection)			2

0899	Total reimbursable obligations			2

0900	Total new obligations, unexpired accounts (object class 25.3)			2

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected			2
1930	Total budgetary resources available			2

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			2
	Outlays, gross:
4100	Outlays from new mandatory authority			2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:			–2
4180	Budget authority, net (total)
4190	Outlays, net (total)

This legislative proposal provides the Departmental Appeals Board (DAB) mandatory resources in user fees to address the Medicare appeals backlog.


Identification code 075–0146–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Opioid Funding	500

0900	Total new obligations, unexpired accounts (object class 94.0)	500

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	500
1930	Total budgetary resources available	500

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	500
3020	Outlays (gross)	–500

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	500
	Outlays, gross:
4100	Outlays from new mandatory authority	500
4180	Budget authority, net (total)	500
4190	Outlays, net (total)	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		2018 actual	2019 est.	2020 est.

0100	Balance, start of year
	Receipts:
	Current law:
1140	General Fund Payment, State Response to the Opioid Abuse Crisis, CURES Act	500

2000	Total: Balances and receipts	500
	Appropriations:
	Current law:
2101	State Response to the Opioid Abuse Crisis, Cures Act	–500

5099	Balance, end of year


Identification code 075–5627–0–2–551		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	500
1120	Appropriations transferred to other acct [075–1362]	–500
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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Office for Civil Rights (Direct)	39	39	30
0801	Office for Civil Rights (Reimbursable)	10	14	24

0900	Total new obligations, unexpired accounts	49	53	54

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	35	33	44
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	39	39	30
	Spending authority from offsetting collections, mandatory:
1800	Collected	7	26	15
1802	Offsetting collections (previously unavailable)	2
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–1	–1

1850	Spending auth from offsetting collections, mand (total)	8	25	15
1900	Budget authority (total)	47	64	45
1930	Total budgetary resources available	82	97	89
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	33	44	35

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	17	24	25
3010	New obligations, unexpired accounts	49	53	54
3020	Outlays (gross)	–42	–52	–58

3050	Unpaid obligations, end of year	24	25	21
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	17	24	25
3200	Obligated balance, end of year	24	25	21

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	39	39	30
	Outlays, gross:
4010	Outlays from new discretionary authority	32	31	24
4011	Outlays from discretionary balances	7	8	8

4020	Outlays, gross (total)	39	39	32
	Mandatory:
4090	Budget authority, gross	8	25	15
	Outlays, gross:
4100	Outlays from new mandatory authority		2	1
4101	Outlays from mandatory balances	3	11	25

4110	Outlays, gross (total)	3	13	26
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–7	–26	–15
4180	Budget authority, net (total)	40	38	30
4190	Outlays, net (total)	35	26	43

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	1		1
5092	Unexpired unavailable balance, EOY: Offsetting collections		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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	14	16	15
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	15	17	16
12.1	Civilian personnel benefits	5	6	5
21.0	Travel and transportation of persons	1	1
23.1	Rental payments to GSA	4	4	1
25.2	Other services from non-Federal sources	3	1	2
25.3	Other goods and services from Federal sources	9	9	6
25.4	Operation and maintenance of facilities	1
31.0	Equipment	1	1

99.0	Direct obligations	39	39	30
99.0	Reimbursable obligations	10	14	24

99.9	Total new obligations, unexpired accounts	49	53	54


Identification code 075–0135–0–1–751		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	135	147	139
1101	Direct military average strength employment	1	1	1
2001	Reimbursable civilian full-time equivalent employment	2	2	2

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, $43,000,000.


Identification code 075–0130–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Health information technology (IT)	60	60	43

0799	Total direct obligations	60	60	43
0801	Office of the National Coordinator for Health IT (ONC): Reimbursable	17	15	16

0899	Total reimbursable obligations	17	15	16

0900	Total new obligations, unexpired accounts	77	75	59

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	60	60	43
	Spending authority from offsetting collections, discretionary:
1700	Collected	4	15	15
1701	Change in uncollected payments, Federal sources	12

1750	Spending auth from offsetting collections, disc (total)	16	15	15
1900	Budget authority (total)	76	75	58
1930	Total budgetary resources available	78	76	59
	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	66	68	17
3010	New obligations, unexpired accounts	77	75	59
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–71	–126	–63
3041	Recoveries of prior year unpaid obligations, expired	–5

3050	Unpaid obligations, end of year	68	17	13
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–22	–19	–19
3070	Change in uncollected pymts, Fed sources, unexpired	–12
3071	Change in uncollected pymts, Fed sources, expired	15

3090	Uncollected pymts, Fed sources, end of year	–19	–19	–19
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	44	49	–2
3200	Obligated balance, end of year	49	–2	–6

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	76	75	58
	Outlays, gross:
4010	Outlays from new discretionary authority	43	64	50
4011	Outlays from discretionary balances	28	62	13

4020	Outlays, gross (total)	71	126	63
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–17	–15	–15

4040	Offsets against gross budget authority and outlays (total)	–17	–15	–15
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–12
4052	Offsetting collections credited to expired accounts	13

4060	Additional offsets against budget authority only (total)	1

4070	Budget authority, net (discretionary)	60	60	43
4080	Outlays, net (discretionary)	54	111	48
4180	Budget authority, net (total)	60	60	43
4190	Outlays, net (total)	54	111	48

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		2018 actual	2019 est.	2020 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	6	6
23.1	Rental payments to GSA	2	2	2
25.2	Other services from non-Federal sources	16	17	7
25.3	Other goods and services from Federal sources	10	10	8
41.0	Grants, subsidies, and contributions	4	4

99.0	Direct obligations	59	59	43
99.0	Reimbursable obligations	16	16	16
99.5	Adjustment for rounding	2

99.9	Total new obligations, unexpired accounts	77	75	59


Identification code 075–0130–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	174	162	162
1101	Direct military average strength employment	2	2	2

For expenses necessary for the Office of Medicare Hearings and Appeals, $182,381,000 shall remain available until September 30, 2021, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.


Identification code 075–0139–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Office of Medicare Hearings and Appeals (Direct)	146	175	182

0799	Total direct obligations	146	175	182

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		36	36
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	93	175	182
1701	Change in uncollected payments, Federal sources	89

1750	Spending auth from offsetting collections, disc (total)	182	175	182
1900	Budget authority (total)	182	175	182
1930	Total budgetary resources available	182	211	218
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	36	36	36

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	27	56	3
3010	New obligations, unexpired accounts	146	175	182
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–117	–228	–182
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	56	3	3
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–38	–106	–106
3070	Change in uncollected pymts, Fed sources, unexpired	–89
3071	Change in uncollected pymts, Fed sources, expired	21

3090	Uncollected pymts, Fed sources, end of year	–106	–106	–106
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–11	–50	–103
3200	Obligated balance, end of year	–50	–103	–103

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	182	175	182
	Outlays, gross:
4010	Outlays from new discretionary authority	100	175	182
4011	Outlays from discretionary balances	17

4020	Outlays, gross (total)	117	175	182
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–114	–175	–182
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–89
4052	Offsetting collections credited to expired accounts	21

4060	Additional offsets against budget authority only (total)	–68
4080	Outlays, net (discretionary)	3
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		53
4180	Budget authority, net (total)
4190	Outlays, net (total)	3	53

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	61	87	105
11.5	Other personnel compensation			1

11.9	Total personnel compensation	61	87	106
12.1	Civilian personnel benefits	20	29	33
22.0	Transportation of things		2	1
23.1	Rental payments to GSA	7	8	10
23.3	Communications, utilities, and miscellaneous charges	4	8	8
25.2	Other services from non-Federal sources	12	13	9
25.3	Other goods and services from Federal sources	13	16	10
25.4	Operation and maintenance of facilities	24	5	1
25.7	Operation and maintenance of equipment	1	1	2
26.0	Supplies and materials	2	2	1
31.0	Equipment	2	4	1

99.0	Direct obligations	146	175	182

99.9	Total new obligations, unexpired accounts	146	175	182


Identification code 075–0139–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	664	950	1,375


Identification code 075–0139–4–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	Reimbursable program activity			4

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

This legislative proposal provides the Office of Medicare Hearings and Appeals (OMHA) mandatory resources to address the Medicare appeals backlog. The 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.

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, $1,051,591,000, of which $561,700,000 shall remain available through September 30, 2021, 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, 2022: Provided further, That $20,000,000 of the amounts made available to the National Disaster Medical System shall remain available through September 30, 2021, for activities related to the Pediatric Disaster Care Program: Provided further, That $5,000,000 of the amounts made available for policy and planning shall remain available until expended, for implementation activities related to the National Biodefense Strategy.

For expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act), $735,000,000, to remain available until expended.

For expenses necessary to carry out section 319F-2(a) of the PHS Act, $620,000,000, to remain available until expended.

For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic, $260,000,000; of which $225,000,000 shall be available until expended, for activities including the development and purchase of vaccine, antivirals, necessary medical supplies, diagnostics, and other surveillance tools: Provided, That notwithstanding section 496(b) of the PHS Act, 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Public Health and Social Services Emergency Fund	1,991	2,631	2,667

0100	Direct program activities, subtotal	1,991	2,631	2,667
0801	Reimbursable program (FEMA)	188	162	162
0802	Reimbursable program activity (OPP)	2	2	2

0899	Total reimbursable obligations	190	164	164

0900	Total new obligations, unexpired accounts	2,181	2,795	2,831

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	124	437	858
1010	Unobligated balance transfer to other accts [075–0343]	–2	–2	–3
1011	Unobligated balance transfer from other acct [075–0943]		429
1021	Recoveries of prior year unpaid obligations	274

1050	Unobligated balance (total)	396	864	855
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,115	2,021	2,667
1120	Appropriations transferred to other acct [075–0360]	–60
1120	Appropriations transferred to other acct [075–0128]	–2
1120	Appropriations transferred to other acct [075–1362]	–20
1121	Appropriations transferred from other acct [075–0943]		604

1160	Appropriation, discretionary (total)	2,033	2,625	2,667
	Spending authority from offsetting collections, discretionary:
1700	Collected	52	82	82
1701	Change in uncollected payments, Federal sources	139	82	82

1750	Spending auth from offsetting collections, disc (total)	191	164	164
1900	Budget authority (total)	2,224	2,789	2,831
1930	Total budgetary resources available	2,620	3,653	3,686
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	437	858	855

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4,745	4,478	4,365
3010	New obligations, unexpired accounts	2,181	2,795	2,831
3011	Obligations ("upward adjustments"), expired accounts	58
3020	Outlays (gross)	–2,054	–2,908	–2,943
3040	Recoveries of prior year unpaid obligations, unexpired	–274
3041	Recoveries of prior year unpaid obligations, expired	–178

3050	Unpaid obligations, end of year	4,478	4,365	4,253
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–107	–198	–280
3070	Change in uncollected pymts, Fed sources, unexpired	–139	–82	–82
3071	Change in uncollected pymts, Fed sources, expired	48

3090	Uncollected pymts, Fed sources, end of year	–198	–280	–362
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4,638	4,280	4,085
3200	Obligated balance, end of year	4,280	4,085	3,891

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,224	2,789	2,831
	Outlays, gross:
4010	Outlays from new discretionary authority	512	594	623
4011	Outlays from discretionary balances	1,542	2,314	2,320

4020	Outlays, gross (total)	2,054	2,908	2,943
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–84	–82	–82

4040	Offsets against gross budget authority and outlays (total)	–84	–82	–82
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–139	–82	–82
4052	Offsetting collections credited to expired accounts	32

4060	Additional offsets against budget authority only (total)	–107	–82	–82

4070	Budget authority, net (discretionary)	2,033	2,625	2,667
4080	Outlays, net (discretionary)	1,970	2,826	2,861
4180	Budget authority, net (total)	2,033	2,625	2,667
4190	Outlays, net (total)	1,970	2,826	2,861

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 and National Biodefense Strategy implementation. The PHSSEF continues to support the advanced development, procurement, and stockpiling of biodefense and pandemic influenza countermeasures.

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	98	139	140
11.7	Military personnel	7	9	9

11.9	Total personnel compensation	105	148	149
12.1	Civilian personnel benefits	44	53	53
12.2	Military personnel benefits	3	4	4
21.0	Travel and transportation of persons	7	9	9
22.0	Transportation of things		1	1
23.1	Rental payments to GSA	9	11	11
23.2	Rental payments to others	14	17	17
23.3	Communications, utilities, and miscellaneous charges	2	2	2
25.1	Advisory and assistance services	733	776	805
25.2	Other services from non-Federal sources	34	32	32
25.3	Other goods and services from Federal sources	115	122	122
25.4	Operation and maintenance of facilities	4	8	8
25.5	Research and development contracts	557	637	637
25.7	Operation and maintenance of equipment	81	75	77
26.0	Supplies and materials	2	409	403
31.0	Equipment	1	16	16
41.0	Grants, subsidies, and contributions	280	311	321

99.0	Direct obligations	1,991	2,631	2,667
99.0	Reimbursable obligations	190	164	164

99.9	Total new obligations, unexpired accounts	2,181	2,795	2,831


Identification code 075–0140–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	658	933	943
1101	Direct military average strength employment	74	74	74


Identification code 075–0145–0–1–552		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	AHRQ	68	58
0002	Office of the Secretary	17	48	15
0003	NIRSQ			41

0900	Total new obligations, unexpired accounts	85	106	56

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	88	127	171
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	89	127	171
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	123	150
1930	Total budgetary resources available	212	277	171
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	127	171	115

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	123	119	183
3010	New obligations, unexpired accounts	85	106	56
3020	Outlays (gross)	–88	–42	–77
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	119	183	162
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	123	119	183
3200	Obligated balance, end of year	119	183	162

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	123	150
	Outlays, gross:
4100	Outlays from new mandatory authority		4
4101	Outlays from mandatory balances	88	38	77

4110	Outlays, gross (total)	88	42	77
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–123	–150
4180	Budget authority, net (total)
4190	Outlays, net (total)	–35	–108	77

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 was 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 2020 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. In FY 2020, this institute will continue to obligate remaining resources available until expended. The PCORTF terminates at the end of FY 2019, and the Budget does not propose to extend it.


Identification code 075–0145–0–1–552		2018 actual	2019 est.	2020 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3	3	3
25.1	Advisory and assistance services	7
25.3	Other goods and services from Federal sources	22	71	37
41.0	Grants, subsidies, and contributions	53	32	16

99.9	Total new obligations, unexpired accounts	85	106	56


Identification code 075–0145–0–1–552		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	5	5	5


Identification code 075–0125–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Nonrecurring Expenses Fund Projects	131	806	130

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	565	1,116	520
1010	Unobligated balance transfer to other accts [075–0960]	–240
1012	Unobligated balance transfers between expired and unexpired accounts	909	610	600
1021	Recoveries of prior year unpaid obligations	13

1050	Unobligated balance (total)	1,247	1,726	1,120
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced		–400	–400
1930	Total budgetary resources available	1,247	1,326	720
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,116	520	590

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	668	544	1,443
3010	New obligations, unexpired accounts	131	806	130
3020	Outlays (gross)	–242	93	201
3040	Recoveries of prior year unpaid obligations, unexpired	–13

3050	Unpaid obligations, end of year	544	1,443	1,774
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	668	544	1,443
3200	Obligated balance, end of year	544	1,443	1,774

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–400	–400
	Outlays, gross:
4010	Outlays from new discretionary authority		–400	–400
4011	Outlays from discretionary balances	242	307	199

4020	Outlays, gross (total)	242	–93	–201
4180	Budget authority, net (total)		–400	–400
4190	Outlays, net (total)	242	–93	–201

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
23.1	Rental payments to GSA	15	93	15
25.1	Advisory and assistance services	3	18	3
25.2	Other services from non-Federal sources	47	292	46
25.3	Other goods and services from Federal sources	13	81	13
25.4	Operation and maintenance of facilities	3	19	3
25.5	Research and development contracts	4	24	4
25.7	Operation and maintenance of equipment	17	105	17
31.0	Equipment	26	161	26
32.0	Land and structures	2	12	2

99.0	Direct obligations	130	805	129
99.5	Adjustment for rounding	1	1	1

99.9	Total new obligations, unexpired accounts	131	806	130


Identification code 075–0125–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	4	4	4


Identification code 075–0119–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Health Insurance Reform Implementation Fund (Direct)	5

0900	Total new obligations, unexpired accounts (object class 25.2)	5

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6	1	1
1930	Total budgetary resources available	6	1	1
	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	18	23	21
3010	New obligations, unexpired accounts	5
3020	Outlays (gross)		–2	–2

3050	Unpaid obligations, end of year	23	21	19
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	18	23	21
3200	Obligated balance, end of year	23	21	19

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		2	2
4180	Budget authority, net (total)
4190	Outlays, net (total)		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		2018 actual	2019 est.	2020 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		6	6
1012	Unobligated balance transfers between expired and unexpired accounts	6

1050	Unobligated balance (total)	6	6	6
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	900	900	950
1220	Appropriations transferred to other accts [075–0142]	–28	–28
1220	Appropriations transferred to other accts [075–0943]	–801	–805	–894
1220	Appropriations transferred to other accts [075–1362]	–12	–12
1230	Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]	–59	–55	–56
1930	Total budgetary resources available	6	6	6
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	6	6	6
4180	Budget authority, net (total)
4190	Outlays, net (total)

The Prevention and Public Health Fund supports prevention and public health activities. In FY 2020, $894 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Pregnancy Assistance Fund (Direct)	23	23

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			2
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	25	25
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–2

1260	Appropriations, mandatory (total)	23	25
1930	Total budgetary resources available	23	25	2
	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	29	23
3010	New obligations, unexpired accounts	23	23
3020	Outlays (gross)	–21	–29	–9
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	29	23	14
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	28	29	23
3200	Obligated balance, end of year	29	23	14

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	23	25
	Outlays, gross:
4101	Outlays from mandatory balances	21	29	9
4180	Budget authority, net (total)	23	25
4190	Outlays, net (total)	21	29	9

This appropriation funds competitive grants to States to assist pregnant and parenting teens and women. Annual funding for this program expires at the end of FY 2019. The Budget does request an extension of this program.


Identification code 075–0117–0–1–551		2018 actual	2019 est.	2020 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	1	1
41.0	Grants, subsidies, and contributions	22	22

99.9	Total new obligations, unexpired accounts	23	23


Identification code 075–0117–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	2	2


Identification code 075–3902–0–1–552		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	Section 241 Evaluation Transactions Account (Reimbursable)	512	516	528

0809	Reimbursable program activities, subtotal	512	516	528

0900	Total new obligations, unexpired accounts (object class 25.3)	512	516	528

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	74	516	528
1701	Change in uncollected payments, Federal sources	438

1750	Spending auth from offsetting collections, disc (total)	512	516	528
1930	Total budgetary resources available	512	516	528

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	559	634
3010	New obligations, unexpired accounts	512	516	528
3020	Outlays (gross)	–437	–1,150	–528

3050	Unpaid obligations, end of year	634
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–556	–630	–630
3070	Change in uncollected pymts, Fed sources, unexpired	–438
3071	Change in uncollected pymts, Fed sources, expired	364

3090	Uncollected pymts, Fed sources, end of year	–630	–630	–630
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3	4	–630
3200	Obligated balance, end of year	4	–630	–630

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	512	516	528
	Outlays, gross:
4010	Outlays from new discretionary authority	74	516	528
4011	Outlays from discretionary balances	363	634

4020	Outlays, gross (total)	437	1,150	528
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–438	–516	–528

4040	Offsets against gross budget authority and outlays (total)	–438	–516	–528
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–438
4052	Offsetting collections credited to expired accounts	364

4060	Additional offsets against budget authority only (total)	–74
4080	Outlays, net (discretionary)	–1	634
4180	Budget authority, net (total)
4190	Outlays, net (total)	–1	634

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 the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year.


Identification code 075–0379–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Retirement payments	462	476	491
0002	Survivors' benefits	30	31	32
0003	Medical care	115	100	101

0900	Total new obligations, unexpired accounts	607	607	624

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	607	607	624
1930	Total budgetary resources available	607	607	624

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	62	102	35
3010	New obligations, unexpired accounts	607	607	624
3011	Obligations ("upward adjustments"), expired accounts	12
3020	Outlays (gross)	–556	–674	–623
3041	Recoveries of prior year unpaid obligations, expired	–23

3050	Unpaid obligations, end of year	102	35	36
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	62	102	35
3200	Obligated balance, end of year	102	35	36

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	607	607	624
	Outlays, gross:
4100	Outlays from new mandatory authority	535	577	593
4101	Outlays from mandatory balances	21	97	30

4110	Outlays, gross (total)	556	674	623
4180	Budget authority, net (total)	607	607	624
4190	Outlays, net (total)	556	674	623

The number of beneficiaries using the Commissioned Corps system is estimated as follows:


	2018	2019	2020

Active Duty:
HHS	4,781	4,876	4,859
DOJ, BOP	787	787	787
Homeland Security	471	400	400
EPA	55	55	53
All Other	280	294	312

Total Active Duty	6,374	6,412	6,411

Retirees & Survivors:
Retirees	6,200	6,150	6,300
Retiree family members and survivors	1,135	1,125	1,100

Total Retirement Pay	7,335	7,275	7,400
Total Beneficiaries (active duty, retirees, survivors)	13,709	13,687	13,811

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
13.0	Benefits for former personnel	492	507	523
25.6	Medical care	115	100	101

99.9	Total new obligations, unexpired accounts	607	607	624

The Budget includes a mandatory proposal, effective FY 2021, which shifts the U.S. Public Health Service Commissioned Corps retirement pay and survivor benefit costs from mandatory to discretionary.


Identification code 075–0170–0–1–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Medicare eligible accruals	32	29	30

0900	Total new obligations, unexpired accounts (object class 12.2)	32	29	30

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	32	29	30
1900	Budget authority (total)	32	29	30
1930	Total budgetary resources available	32	29	30

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	32	29	30
3020	Outlays (gross)	–32	–29	–30

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	32	29	30
	Outlays, gross:
4010	Outlays from new discretionary authority	32	29	30
4180	Budget authority, net (total)	32	29	30
4190	Outlays, net (total)	32	29	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).

Beginning FY 2021, this account would support the unfunded liability of U.S. Public Health Service Commissioned Corps retirement pay and survivor benefits costs.


Identification code 075–9913–0–1–551		2018 actual	2019 est.	2020 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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0801	Program Support Center	1,447	1,641	1,659
0802	OS activities	449	532	539

0900	Total new obligations, unexpired accounts	1,896	2,173	2,198

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	200	206
1021	Recoveries of prior year unpaid obligations	53		250

1050	Unobligated balance (total)	253	206	250
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,711	1,967	1,948
1701	Change in uncollected payments, Federal sources	138

1750	Spending auth from offsetting collections, disc (total)	1,849	1,967	1,948
1930	Total budgetary resources available	2,102	2,173	2,198
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	206

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,011	1,264	442
3010	New obligations, unexpired accounts	1,896	2,173	2,198
3020	Outlays (gross)	–1,590	–2,995	–1,948
3040	Recoveries of prior year unpaid obligations, unexpired	–53		–250

3050	Unpaid obligations, end of year	1,264	442	442
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–536	–674	–674
3070	Change in uncollected pymts, Fed sources, unexpired	–138

3090	Uncollected pymts, Fed sources, end of year	–674	–674	–674
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	475	590	–232
3200	Obligated balance, end of year	590	–232	–232

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,849	1,967	1,948
	Outlays, gross:
4010	Outlays from new discretionary authority	901	1,967	1,948
4011	Outlays from discretionary balances	689	1,028

4020	Outlays, gross (total)	1,590	2,995	1,948
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1,142	–1,967	–1,948
4033	Non-Federal sources	–569

4040	Offsets against gross budget authority and outlays (total)	–1,711	–1,967	–1,948
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–138
4080	Outlays, net (discretionary)	–121	1,028
4180	Budget authority, net (total)
4190	Outlays, net (total)	–121	1,028

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		2018 actual	2019 est.	2020 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	99	114	117
11.3	Other than full-time permanent	3	3	3
11.5	Other personnel compensation	3	3	3
11.7	Military personnel	6	7	8
11.8	Special personal services payments	10	11	11

11.9	Total personnel compensation	121	138	142
12.1	Civilian personnel benefits	32	37	38
12.2	Military personnel benefits	3	2	3
21.0	Travel and transportation of persons	3	2	2
22.0	Transportation of things	2	3	3
23.1	Rental payments to GSA	19	17	18
23.3	Communications, utilities, and miscellaneous charges	7	9	9
24.0	Printing and reproduction	10	6	6
25.1	Advisory and assistance services	218	182	196
25.2	Other services from non-Federal sources	1,278	1,555	1,557
25.3	Other goods and services from Federal sources	67	70	72
25.4	Operation and maintenance of facilities	12	14	14
25.6	Medical care	23	33	32
25.7	Operation and maintenance of equipment	57	49	51
25.8	Subsistence and support of persons	1
26.0	Supplies and materials	41	51	50
31.0	Equipment	2	5	5

99.9	Total new obligations, unexpired accounts	1,896	2,173	2,198


Identification code 075–9941–0–4–551		2018 actual	2019 est.	2020 est.

2001	Reimbursable civilian full-time equivalent employment	923	923	923
2101	Reimbursable military average strength employment	75	75	75
3101	Allocation account military average strength employment	1,517	1,481	1,499

Trust Funds

Beginning FY 2021, this account would fund the U.S. Public Health Service Commissioned Corps retirement pay and survivor benefit payments.


Identification code 075–9971–0–7–551		2018 actual	2019 est.	2020 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Contributions, Indian Health Facilities	36	48	48
1130	Contributions, N.I.H., Unconditional Gift Fund	5	3	3
1130	Centers for Disease Control, Gifts and Donations	27	15	15
1130	Contributions, N.I.H., Conditional Gift Fund	43	27	27
1130	Contributions to the Indian Health Service Gift Fund		1	1
1140	Interest, Miscellaneous Trust Funds	1	1	1
1198	Rounding adjustment	–1

1199	Total current law receipts	111	95	95

1999	Total receipts	111	95	95

2000	Total: Balances and receipts	111	95	95
	Appropriations:
	Current law:
2101	Miscellaneous Trust Funds	–111	–95	–95

5099	Balance, end of year


Identification code 075–9971–0–7–551		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0002	Gifts	72	72	72
0003	Contributions, Indian Health Facilities	36	36	36

0900	Total new obligations, unexpired accounts	108	108	108

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	198	188	244
1020	Adjustment of unobligated bal brought forward, Oct 1	–17
1021	Recoveries of prior year unpaid obligations	4	8	8
1033	Recoveries of prior year paid obligations		61	61

1050	Unobligated balance (total)	185	257	313
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	111	95	95
1930	Total budgetary resources available	296	352	408
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	188	244	300

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	72	99	50
3001	Adjustments to unpaid obligations, brought forward, Oct 1	17
3010	New obligations, unexpired accounts	108	108	108
3020	Outlays (gross)	–94	–149	–149
3040	Recoveries of prior year unpaid obligations, unexpired	–4	–8	–8

3050	Unpaid obligations, end of year	99	50	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	89	99	50
3200	Obligated balance, end of year	99	50	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	111	95	95
	Outlays, gross:
4100	Outlays from new mandatory authority	24	15	15
4101	Outlays from mandatory balances	70	134	134

4110	Outlays, gross (total)	94	149	149
	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)	111	95	95
4170	Outlays, net (mandatory)	94	88	88
4180	Budget authority, net (total)	111	95	95
4190	Outlays, net (total)	94	88	88

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	34	37	37
5001	Total investments, EOY: Federal securities: Par value	37	37	37

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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	4	4	4
11.3	Other than full-time permanent	1	1	1
11.8	Special personal services payments	4	4	4

11.9	Total personnel compensation	9	9	9
12.1	Civilian personnel benefits	2	2	2
21.0	Travel and transportation of persons	3	3	3
25.1	Advisory and assistance services	5	5	5
25.2	Other services from non-Federal sources	27	27	27
25.3	Other goods and services from Federal sources	2	2	2
25.5	Research and development contracts	3	3	3
25.6	Medical care	1	1	1
25.8	Subsistence and support of persons	21	21	21
26.0	Supplies and materials	7	7	7
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	27	27	27

99.9	Total new obligations, unexpired accounts	108	108	108


Identification code 075–9971–0–7–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	60	60	60

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		2018 actual	2019 est.	2020 est.

	Obligations by program activity:
0001	Office of Inspector General (Direct)	82	86	80
0801	Office of Inspector General HCFAC Trust Fund	213	233	222
0802	Office of Inspector General (Direct Reimbursable)	15	21	21
0803	Office of Inspector General HCFAC Discretionary	88	91	98

0899	Total reimbursable obligations	316	345	341

0900	Total new obligations, unexpired accounts	398	431	421

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	41	42	14
1001	Discretionary unobligated balance brought fwd, Oct 1	1	3
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	44	42	14
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	80	80	80
1121	Appropriations transferred from other acct [075–9911]	2	2
1121	Appropriations transferred from other acct [075–0140]	2
1121	Appropriations transferred from other acct [075–9915]		5

1160	Appropriation, discretionary (total)	84	87	80
	Spending authority from offsetting collections, discretionary:
1700	Collected	92	108	111
1701	Change in uncollected payments, Federal sources	7

1750	Spending auth from offsetting collections, disc (total)	99	108	111
	Spending authority from offsetting collections, mandatory:
1800	Collected	192	208	225
1801	Change in uncollected payments, Federal sources	21
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)	213	208	226
1900	Budget authority (total)	396	403	417
1930	Total budgetary resources available	440	445	431
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	42	14	10

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	78	97	89
3010	New obligations, unexpired accounts	398	431	421
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–376	–439	–419
3040	Recoveries of prior year unpaid obligations, unexpired	–3
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	97	89	91
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–114	–134	–134
3070	Change in uncollected pymts, Fed sources, unexpired	–28
3071	Change in uncollected pymts, Fed sources, expired	8

3090	Uncollected pymts, Fed sources, end of year	–134	–134	–134
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–36	–37	–45
3200	Obligated balance, end of year	–37	–45	–43

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	183	195	191
	Outlays, gross:
4010	Outlays from new discretionary authority	153	177	174
4011	Outlays from discretionary balances	27	23	19

4020	Outlays, gross (total)	180	200	193
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–100	–108	–111
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–7
4052	Offsetting collections credited to expired accounts	8

4060	Additional offsets against budget authority only (total)	1

4070	Budget authority, net (discretionary)	84	87	80
4080	Outlays, net (discretionary)	80	92	82
	Mandatory:
4090	Budget authority, gross	213	208	226
	Outlays, gross:
4100	Outlays from new mandatory authority	135	189	206
4101	Outlays from mandatory balances	61	50	20

4110	Outlays, gross (total)	196	239	226
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–179	–196	–213
4123	Non-Federal sources	–13	–12	–12

4130	Offsets against gross budget authority and outlays (total)	–192	–208	–225
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–21

4160	Budget authority, net (mandatory)			1
4170	Outlays, net (mandatory)	4	31	1
4180	Budget authority, net (total)	84	87	81
4190	Outlays, net (total)	84	123	83

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	1	1	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	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		2018 actual	2019 est.	2020 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	40	40	42
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	44
12.1	Civilian personnel benefits	16	16	16
21.0	Travel and transportation of persons	2	2	2
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	5	5	6
23.3	Communications, utilities, and miscellaneous charges	3	3	3
25.2	Other services from non-Federal sources	6	11	1
25.3	Other goods and services from Federal sources	2	2	2
25.4	Operation and maintenance of facilities	1	1	1
25.7	Operation and maintenance of equipment	1		1
31.0	Equipment	3	3	3

99.0	Direct obligations	82	86	80
99.0	Reimbursable obligations	316	345	341

99.9	Total new obligations, unexpired accounts	398	431	421


Identification code 075–0128–0–1–551		2018 actual	2019 est.	2020 est.

1001	Direct civilian full-time equivalent employment	335	344	349
2001	Reimbursable civilian full-time equivalent employment	1,266	1,306	1,321


		2018 actual	2019 est.	2020 est.

Offsetting receipts from the public:
075–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	114	90	90
075–267403	Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies	15
075–275830	Downward Reestimates of Subsidies, Health Centers		1
075–310700	Federal Share of Child Support Collections	609	596	585
075–310700	Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO			10
075–322000	All Other General Fund Proprietary Receipts Including Budget Clearing Accounts	1,083	34	34
General Fund Offsetting receipts from the public		1,821	721	719


Intragovernmental payments:
075–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	–729

General Fund Intragovernmental payments		–729

(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) such reference to such current recommendations were a reference to the recommendations of such Task Force with respect to breast cancer screening, mammography, and prevention last issued before 2009; and

(2) such recommendations last issued before 2009 applied to any screening mammography modality under section 1861(jj) of the Social Security Act (42 U.S.C. 1395x(jj)).

(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 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" and;

"(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.

(b) The accounts referred to in subsection (a) are: ''Low Income Home Energy Assistance'', ''Refugee and Entrant Assistance'', ''Payments to States for the Child Care and Development Block Grant'', and ''Children and Families Services Programs''.

(3) by adding the following new paragraph: "(3) HEALTH PROFESSIONAL.—For purposes of this section, the term 'health professional' includes information technology specialists and data surveillance specialists."; and

(b) in subsection (c), by striking "1995 through 2002" and inserting "thereafter".

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

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)

Special Diabetes Program for Indians

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

(including transfer of funds)

CDC Working Capital Fund

Infectious Diseases Rapid Response Reserve 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