WPC  -&Y[l=S~i - zђd,`/ 0gN0UNO00/1 0b512222222 0r23494?4 0|E455 0+5EV!8 0c#8 1 u8 0w8 0Mr9N: 0: 0&K; 0[< 0< 0= 0v> 0Q? 1@@@@@ 1 A 1(B 0BDDD vDEEUNEmEsEyEE 0;EFFGTH D+IEIKIUNQI@III 0INMK8OK AM A7$NNoy _O D3Z B` [ 0K([ vs[ D3[ B7\NS\U\ B]\ D3z\\ ?] vY]N]]@]o ]p zj!w 0;'w 0;bx B7y Cyyyyzz z vzN({*{@2{o(H{ D3 B" D3? Br D3 B¤ D/ߤ D3 B*A D3k B*p(ȥ/ $^ vN D3 B* D3 B* D3F By D5 D-@o) AQ 0Dp */),* v,@F-oo.\-p.[NVX v@ C$ C> CX Cr C C C Cڍ C C C'(ow Bp L DCR BaN@΢op/! vWMMMNlG v@Oo ep @o @o:p:!>xxp xłM˂ 0ς@o(p(0 0 0N 0@ 0_ 1CMN 0 0bMj 0Lnp O v@co ypn vNN@oKp5KO5  ;Eך vi@ߛo p     @oѯph@o=)1pY)n@-o7-pSE@g\o?<}\p[<    !@+o .Ap).N  w1  1N11 2 v2@3oy +3p <  9F  CF@MFNcF@eFo({Fp(o  ŗ  ϗpٗI vۘ@Qogp R  Y  c 0Xm@ūom۫pH    N v 0;A@8  N  Y  cNmo{ o@o>pq#@<>o/R>NIn\Kno v9p  p  pMppmp@4oIJpe@o% 0G 0\NMнp#%b@o      vN p &@)oK?pg)()o)uC@iFoFp lV  uf  f@fofpbw@Ao2Wp 3H@Uo/ k v     v$pK @oN  M M  N!M! 0! v"N # #4#I#p#@FA vA@NBodBp SQ@^`o$t`p$@ocpN@o_&p{&     0X N N N   v @ o($ p!()?  Jg  Tg N^g M`g Bdg Bg g g  `'8HHS Title 1Mark TOC, Cond EOP 5, Impact, 22.5 pt, centered, bold  X/XXXgJe` eXX/@*   X/XXXgJe` eXX/d d m:HHS Body TxtTimes New Roman, 12 pt, flush left, single spaced XgJXXXgJXgJXXXgJ  XgJXXXgJXgJXXXgJ   L8HHS Table 1Same asTitle 1 - use with tables - has bold horiz line  XJ,XXXe). eXXJ,@*   AZ') HxdE#HxAe e ee).& % ee  lP K:HHS bullet 3Level 3 bulleted HeadingL 8(*-/0123 x#)LXFXXXF= XXF2 o3  XFX =0    L 8(*-/0123 x#)LXFXXXF= XXF (;3$2#  0  .3  0  3#37=CIQYag1.a.i.(1)(a)(i)1)a)(O;$0  2#  a  .3  0` (#(#OD j8HHS Title 2times, bold, small caps, 12 pt, left, bold, upper/loweXXXX  XXXX XXXXXXXX (b$0  0` (#(#2#   .3  0 ` (#` (#bSG Ȋ8HHS Title 3Third Level indented0  XXXXXXXX  XXXXXXXX (xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#(*-/0123hCG_cgkosw{Bullet ListBullet ListLevel 1Level 2Level 3Level 4Level 5(*-/0123x Egkosw{Shaded BoxShaded Check Boxoooooooo(*-/0123hCEIMQUY]aAutoList1i)1)a)lB :HHS bullet 4Level 4 bulleted HeadingL 4(*-/0123Ch#)LXI[XXXI[0  2C3  0(#(# L 4(*-/0123Ch#)LXI[XXXI[ c:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT(hH  Z6Times New Roman Regular(3n$ q!X  X0XXXX0XXX080XXdd8  -X,XX-(#(#   Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5'dxd(hH  Z 6Times New Roman RegularX*OLE*<D:QuickFormat1X  L 4(*-/0123Ch#)LX  L 4(*-/0123Ch#)L BioterrorismmarginalizedcaregiversCaregiverbioterroristbioterrorismpremarketCCDBG SSDIgenomics bioinformatics RPGs ADAP ASPA CII subspecialtiesAFFORDABILITYEpogenglycemiccaregiverAffordabilityamericaHIPAA MIPHCFAC7l[K I&mage <=8C HKKKK7l[K&OLE 2.0 Box <=8C HKKKKC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptWPCYY!*     `''  ' `' `-   !p !K% !p Arial-  2 N1998 2 1999 2 20002 !Request  ArialT-2 CActual  - !+&C-2 Enacted  - !:&-2 Request - !<&-2   +/- Enacted   - !P& - Arial-Ka2 =<Budget Authority............................................  2 = Ki2 =-$297,438K2 =x$312,210K2 =$335,233KX2 =+$23,023 ^i2 PAOutlays.......................................................... 2 P ^i2 P-$293,921^2 Px$314,860^2 P$333,074^X2 P+$18,214 i2 vAFTE /1........................................................... 2 v i2 vE3,9422 v4,2672 v4,282X 2 vH15 Arial-2 Q1/ In FY 2000, 50 FTEs are being paid from the Public Health and Social Services        I2 , Emergency Fund for millennium compliance.    -"Systemn-'-- `-   !^ !& !a--'- `'ZZZZ'dxd d( $ Figure  1  cC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT^n^n'dxd3+0 d d d   daaaa'dxdC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptSmallTabletC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT ij*OLE*WPCdd!!!!<     `' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New Roman4-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?:$359,5292 ?$379,2782 ?$403,647LX2 ?#+$24,369`j2 SBOutlays........................................................... 2 S 2 S:$350,5582 S$375,5252 S$400,320`X2 S#+$24,795l2 zCFTE................................................................ 2 z 2 zH57,6712 z60,1252 z61,847X2 z1+1,722-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>B >s    `' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New Roman4-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?:$359,5292 ?$379,2782 ?$403,647LX2 ?#+$24,369`j2 SBOutlays........................................................... 2 S 2 S:$350,5582 S$375,5252 S$400,320`X2 S#+$24,795l2 zCFTE................................................................ 2 z 2 zH57,6712 z60,1252 z61,847X2 z1+1,722-'(3n$ q!X  X0XXXX0XXX080XXdd8  -X,XX-(#(#  (3n$ q!X  X0XXXX0XXX080XXdd8  -X,XX-(#(#  3+0 d d ddd !C:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptLargeTableC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT z*OLE*WPC  ! X( +   ' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' -   !Times New Roman-  2 _1998 2 1999 2 20002 MRequest Times New Roman4--"Systemn-'-- *- 2 TActual - !+(T---2 Enacted - !6(---2 Request - !8(---2 = +/- Enacted  - !L(=----'-- Times New Roman0- 32 AFood and Drug Administration:    e%c2 V =Program Level................................................   2 V% ez2 VN$1,062e2 V$1,134e,2 V$1,350e2 V[+$216 z%l2 k CBA................................................................. 2 k% zz 2 kb924z 2 k982z,2 k1,142z 2 kc+160 &j2 BOutlays........................................................... 2 & z 2 b837 2 981,2 1,111 2 c+130 K2 -Health Resources and Services Administration:     %l2 CBA................................................................. 2 % z2 V3,7212 4,363,2 4,291 2 n-72&j2 BOutlays........................................................... 2 & z2 V3,4592 4,006,2 4,274 2 c+268 (2 Indian Health Service:  "%l2  CBA................................................................. 2 % "z2 V2,129"2 2,272",2 2,442" 2 c+170 7&j2 ( BOutlays........................................................... 2 (& 7z2 (V2,14672 (2,2377,2 (2,3387 2 (c+101 H2 R+Centers for Disease Control and Prevention:    v%l2 g CBA................................................................. 2 g% vz2 gV2,387v2 g2,646v,2 g2,823v 2 gc+177 &j2 | BOutlays........................................................... 2 |& z2 |V2,4092 |2,441,2 |2,654 2 |c+213 42 National Institutes of Health:  %l2  CBA................................................................. 2 % z2 N13,6592 15,640,2 15,960 2 c+320 &j2  BOutlays........................................................... 2 & z2 N12,4832 14,019,2 15,4532 W+1,434 H2 +Substance Abuse and Mental Health Services:    %l2  CBA................................................................. 2 % z2 V2,1982 2,488,2 2,627 2 c+139 3&j2 $ BOutlays........................................................... 2 $& 3z2 $V2,23532 $2,3313,2 $2,5193 2 $c+188 H2 N+Agency for Health Care Policy and Research:     r%c2 c =Program Level................................................   2 c% rz 2 cb147r 2 c171r, 2 c206r 2 ck+35 %l2 x CBA................................................................. 2 x% z 2 xj90 2 x100, 2 x27 2 xn-73&j2  BOutlays........................................................... 2 & z 2 j77 2 101, 2 90 2 n-11?2 %Health Care Financing Administration:     %l2  CBA................................................................. 2 % z2 F297,4382 312,210,2 335,2332 O+23,023 &j2  BOutlays........................................................... 2 & z2 F293,9212 314,860,2 333,0742 O+18,214 -'||||'dxdP Pd~~~~'dxd d'dxd d||' dxd'dxd&0 d d'dxd&P d dWPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbCı^(bC$359,5292 $379,278,2 $403,6472 G+$24,369 &j2  BOutlays........................................................... 2 & z2 >$350,5582 $375,525,2 $400,3202 G+$24,795 %a2  <Full-time Equivalents.......................................   2 % z2 N57,6712 60,125,2 61,8472 W+1,722 --'--  3 2 Z1/ FY 1999 and FY 2000 include funds appropriated as part of the Public Health and Social      --'-- 4 2 _Services Emergency Fund. This does not include the President's January 1999 request to transfer     |2 N an additional $93 million in FY 1999 Y2K emergency supplemental funds to HHS.       -'mlYC<<CLevel 1Level 2Level 3Level 4Level 5($$   1  WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbCA)bCT    4' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' 4' 4-   !4Times New Roman4-  2 _1998 2 1999 2 20002 MRequest Times New Roman--"Systemn-'-- *- 2 TActual - !+(T---2 Enacted - !6(---2 Request - !8(---2 = +/- Enacted  - !L(=----'-- 4Times New Roman4- E2 A)Administration for Children and Families:     e%l2 V CBA................................................................. 2 V% ez2 VN36,581e2 V37,699e,2 V38,060e 2 Vc+361 z&j2 k BOutlays........................................................... 2 k& zz2 kN32,589z2 k33,890z,2 k37,949z2 kW+4,059 +2 Administration on Aging:   %l2 CBA................................................................. 2 % z 2 b871 2 882,2 1,048 2 c+166 &j2 BOutlays........................................................... 2 & z 2 b834 2 864, 2 971 2 c+107 C2 (Departmental Management/Civil Rights /1:      %l2 CBA................................................................. 2 %  z 2 b211  2 593 , 2 614  2 k+21 "&j2  BOutlays........................................................... 2 & "z 2 b200" 2 442", 2 534" 2 k+92 12 =Office of Inspector General:  a%l2 R CBA................................................................. 2 R% az 2 Rb118a 2 R129a, 2 R152a 2 Rk+23 v&j2 g BOutlays........................................................... 2 g& vz 2 gb127v 2 g128v, 2 g152v 2 gk+24 ?2 %Health Care Access for the Uninsured:    %l2  CBA................................................................. 2 % z 2 r0 2 0, 2 25 2 k+25 &j2  BOutlays........................................................... 2 & z 2 r0 2 0, 2 $4 2 s+4 =2 $Program Support Center Entitlements:       %l2  CBA................................................................. 2 %  z 2 b244  2 255 , 2 268  2 k+13 &j2  BOutlays........................................................... 2 & z 2 b283 2 205, 2 262 2 k+57 2 9 Receipts: ]%l2 N CBA................................................................. 2 N% ]z2 NP-1,042] 2 N-980],2 N-1,065] 2 Nn-85r&j2 c BOutlays........................................................... 2 c& rz2 cP-1,042r 2 c-980r,2 c-1,065r 2 cn-852  Total, HHS:  %l2  CBA................................................................. 2 % z2 >$359,5292 $379,278,2 $403,6472 G+$24,369 &j2  BOutlays........................................................... 2 & z2 >$350,5582 $375,525,2 $400,3202 G+$24,795 %a2  <Full-time Equivalents.......................................   2 % z2 N57,6712 60,125,2 61,8472 W+1,722 --'--  3 2 Z1/ FY 1999 and FY 2000 include funds appropriated as part of the Public Health and Social      --'-- 4 2 _Services Emergency Fund. This does not include the President's January 1999 request to transfer     |2 N an additional $93 million in FY 1999 Y2K emergency supplemental funds to HHS.       -' HLPASMB User  Fn&XBXXXXBXXXB-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC  !  .    ''  ' ' -   !Times New Roman4-  2 _1998 2 1999 2 20002 MRequest Times New Roman4--"Systemn-'-- *- 2 TActual - !+(T---2 Enacted - !6(---2 Request - !8(---2 = +/- Enacted  - !L(=----'-- Times New Roman4- 32 AMandatory Programs (Outlays):   e&g2 V @Medicare........................................................2 V& ez2 V>$190,893e2 V$202,942e,2 V$214,656e2 VG+$11,714 z%g2 k @Medicaid........................................................2 k% zz2 kF101,234z2 k108,534z,2 k114,660z2 kW+6,126 &L2 .Temporary Assistance for Needy Families.......      2 & z2 N13,2862 13,071,2 14,0902 W+1,019 (Q2 1Foster Care and Adoption Assistance..............    2 ( z2 V4,4512 4,939,2 5,491 2 c+552 &Z2 7Social Services Block Grant............................    2 & z2 V2,4412 2,050,2 2,445 2 c+395 %[2 8Children's Health Insurance.............................  2 % z 2 r52 1,437,2 1,936 2 c+499 &g2 @Child Care......................................................  2 & z2 V2,0282 2,302,2 3,6602 W+1,358 'Z2 7Family Support Payments................................     2 ' z2 V2,1712 2,738,2 2,941 2 c+203  &`2 ;Other Mandatory............................................ 2 &  z 2 b879  2 904 , 2 990  2 k+86 "(]2  9Receipts/Financing Offsets...............................   2 ( Times New Romanx-"z2 P-1,042- !*$P-" 2 -980- !$-",2 -1,065- !*$-" 2 n-85- !$n--7%L2 (.Subtotal, Mandatory (Outlays).................  2 (% 7z2 (>$316,34672 ($337,9377,2 ($359,80472 (G+$21,867 -12 RDiscretionary Programs (BA):    v(W2 g 5Food and Drug Administration.........................    2 g( vz 2 gZ$924v 2 g$982v,2 g$1,142v2 g[+$160 &K2 | -Health Resources and Services Administration.     2 |& z2 |V3,6122 |4,115,2 |4,148 2 |k+33 %`2  ;Indian Health Service......................................  2 % z2 V2,0992 2,242,2 2,412 2 c+170 'N2  /Centers for Disease Control and Prevention.....    2 ' z2 V2,3842 2,643,2 2,820 2 c+177 '^2  :National Institutes of Health.............................  2 ' z2 N13,6322 15,613,2 15,933 2 c+320 'I2  ,Substance Abuse and Mental Health Services..    2 ' z2 V2,1482 2,488,2 2,627 2 c+139 'K2  -Agency for Health Care Policy and Research...     2 ' z 2 j90 2 100, 2 27 2 n-73 %R2  2Health Care Financing Administration..............     2 %  z2 V1,789 2 1,947 ,2 1,822  2 f-125&R2  2Administration for Children and Families..........     2 & z2 V8,3542 8,672,2 9,433 2 c+761 3%]2 $ 9Administration on Aging..................................   2 $% 3z 2 $b8713 2 $8823,2 $1,0483 2 $c+166 H%^2 9 :Office of the Secretary /1................................  2 9% -Hz 2 9b243- !Jb-H 2 9622- !J-H, 2 9671- !J-H 2 9k+49 - !Jk--]'Q2 N1Subtotal, Discretionary (BA)....................   2 N' ]z2 NF$36,146]2 N$40,305],2 N$42,083]2 NO+$1,778 r%L2 c.Subtotal, Discretionary (Outlays)............   2 c% rz2 cF$34,212r2 c$37,588r,2 c$40,516r2 cO+$2,928 %W2 5Total, HHS Outlays...................................   2 % z2 >$350,5582 $375,525,2 $400,3202 G+$24,795 ---'-- 3 2 Z1/ FY 1999 and FY 2000 include funds appropriated as part of the Public Health and Social      --'--  2 _Services Emergency Fund. This does not include the President's January 1999 request to transfer     |2 N an additional $93 million in FY 1999 Y2K emergency supplemental funds to HHS.       -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbCı&.bC$190,893e2 V$202,942e,2 V$214,656e2 VG+$11,714 z%g2 k @Medicaid........................................................2 k% zz2 kF101,234z2 k108,534z,2 k114,660z2 kW+6,126 &L2 .Temporary Assistance for Needy Families.......      2 & z2 N13,2862 13,071,2 14,0902 W+1,019 (Q2 1Foster Care and Adoption Assistance..............    2 ( z2 V4,4512 4,939,2 5,491 2 c+552 &Z2 7Social Services Block Grant............................    2 & z2 V2,4412 2,050,2 2,445 2 c+395 %[2 8Children's Health Insurance.............................  2 % z 2 r52 1,437,2 1,936 2 c+499 &g2 @Child Care......................................................  2 & z2 V2,0282 2,302,2 3,6602 W+1,358 'Z2 7Family Support Payments................................     2 ' z2 V2,1712 2,738,2 2,941 2 c+203  &`2 ;Other Mandatory............................................ 2 &  z 2 b879  2 904 , 2 990  2 k+86 "(]2  9Receipts/Financing Offsets...............................   2 ( Times New Romanx-"z2 P-1,042- !*$P-" 2 -980- !$-",2 -1,065- !*$-" 2 n-85- !$n--7%L2 (.Subtotal, Mandatory (Outlays).................  2 (% 7z2 (>$316,34672 ($337,9377,2 ($359,80472 (G+$21,867 -12 RDiscretionary Programs (BA):    v(W2 g 5Food and Drug Administration.........................    2 g( vz 2 gZ$924v 2 g$982v,2 g$1,142v2 g[+$160 &K2 | -Health Resources and Services Administration.     2 |& z2 |V3,6122 |4,115,2 |4,148 2 |k+33 %`2  ;Indian Health Service......................................  2 % z2 V2,0992 2,242,2 2,412 2 c+170 'N2  /Centers for Disease Control and Prevention.....    2 ' z2 V2,3842 2,643,2 2,820 2 c+177 '^2  :National Institutes of Health.............................  2 ' z2 N13,6322 15,613,2 15,933 2 c+320 'I2  ,Substance Abuse and Mental Health Services..    2 ' z2 V2,1482 2,488,2 2,627 2 c+139 'K2  -Agency for Health Care Policy and Research...     2 ' z 2 j90 2 100, 2 27 2 n-73 %R2  2Health Care Financing Administration..............     2 %  z2 V1,789 2 1,947 ,2 1,822  2 f-125&R2  2Administration for Children and Families..........     2 & z2 V8,3542 8,672,2 9,433 2 c+761 3%]2 $ 9Administration on Aging..................................   2 $% 3z 2 $b8713 2 $8823,2 $1,0483 2 $c+166 H%^2 9 :Office of the Secretary /1................................  2 9% -Hz 2 9b243- !Jb-H 2 9622- !J-H, 2 9671- !J-H 2 9k+49 - !Jk--]'Q2 N1Subtotal, Discretionary (BA)....................   2 N' ]z2 NF$36,146]2 N$40,305],2 N$42,083]2 NO+$1,778 r%L2 c.Subtotal, Discretionary (Outlays)............   2 c% rz2 cF$34,212r2 c$37,588r,2 c$40,516r2 cO+$2,928 %W2 5Total, HHS Outlays...................................   2 % z2 >$350,5582 $375,525,2 $400,3202 G+$24,795 ---'-- 3 2 Z1/ FY 1999 and FY 2000 include funds appropriated as part of the Public Health and Social      --'--  2 _Services Emergency Fund. This does not include the President's January 1999 request to transfer     |2 N an additional $93 million in FY 1999 Y2K emergency supplemental funds to HHS.       -' bioterrorismfoodborneinspectional HHSToolBartable.RunFDAMApremarket JAMAreengineerbiologicsPDUFA DHHSbioweaponsbioterroristlicensure MQSAreauthorized PBOC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt"#C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*d ddd(d2d>!>(  l   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanx-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?R$925 2 ?$9822 ?$1,142LX2 ?4+$160`c2 S=Program Level................................................   2 S 2 SH$1,0622 S$1,1342 S$1,350`X2 S4+$216tj2 gBOutlays........................................................... 2 g 2 gR$837 2 g$9812 g$1,111tX2 g4+$130l2 CFTE................................................................ 2  2 O8,9042 8,9442 9,653 2 H709-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>L. > l   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanx-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?R$925 2 ?$9822 ?$1,142LX2 ?4+$160`c2 S=Program Level................................................   2 S 2 SH$1,0622 S$1,1342 S$1,350`X2 S4+$216tj2 gBOutlays........................................................... 2 g 2 gR$837 2 g$9812 g$1,111tX2 g4+$130l2 CFTE................................................................ 2  2 O8,9042 8,9442 9,653 2 H709-'$7Cyan Matdxd]Cyan MatE d d d d d%  HRSAunderserved HHSmammograms STDsBurdicktelehealthDatabankantiretro ADAP*OLE*WPC  !  T7   3''  ' 3' 3-   !DTimes New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- 3Times New Roman4- (2 $Salaries and Expenses:2 5-42 5YFoods.................................................................................... 2 5g$204 2 5$232 2 5$276A 2 5l+$442 F-42 FYDrugs.................................................................................... 2 Fm449 2 F459 2 F507R 2 Fr+482 W-/2 WPMedical Devices................................................................. 2 Wm157 2 W160 2 W186c 2 Wr+262 h-&2 h=National Center for Toxicological Research................... 2 hs31 2 h32 2 h%34t 2 hx+22 y-22 yVTobacco............................................................................... 2 ys34 2 y34 2 y%68 2 yr+342 -12 SOther Activities................................................................... 2 s88 2 87 2 %87 2 02 -(2 AOther Rent & Rent Related Activities............................. 2 s26 2 26 2 %26 2 02 -+2 GSeafood Inspection--Transfer...........................................Times New Roman4- 2 y0- !y- 2 0- !- 2 %16- ! %- 2 r+16- !r--2 -(2 ASubtotal, Salaries and Expenses.................................. 2 c$9892 $1,0292 $1,2002 b+$171-2 --2 KGSA Rental Payments........................................................ 2 m$46 2 $88 2 $100 2 l+$122 -.2 NBuildings and Facilities...................................................... 2 s21 2 11 2 %32 2 r+202 -02 QCertification Fund............................................................... 2 y4 2 4 2 +4 2 02 -02 QExport Certification............................................................. 2 y2 2 1 2 +1 2 02 -'2 ?Bioterrorism (Funds from other Sources)........................- 2 y0- ! y- 2 0- ! - 2 %13- ! %- 2 r+13- ! r--2 $-,2 $ITotal, Program Level.....................................................2 $Y$1,0622 $$1,1342 $ $1,35002 $b+$216-2 5Less User Fees: 2 F Current Law: 2 W-22 WVPDUFA................................................................................. 2 Wg$117 2 W$132 2 W$145c 2 Wl+$132 h-22 hVMQSA.................................................................................. 2 hs14 2 h15 2 h%15t 2 h02 y-02 yQCertification Fund............................................................... 2 yy4 2 y4 2 y+4 2 y02 -02 QExport Certification............................................................. 2 y2 2 1 2 +1 2 02 -+2 GSeafood Inspection--Transfer........................................... 2 y0 2 0 2 %13 2 r+132  Proposed Law: 2 -42 YFoods.................................................................................... 2 y0 2 0 2 %10 2 r+102 -/2 PMedical Devices.................................................................- 2 y0- !y- 2 0- !- 2 +7- !+- 2 x+7- ! x--2 --2 KSubtotal, User Fees........................................................ 2 c$137 2 $152 2 $195 2 i+$43-2 -$2 :Less Funds from Other Sources: Bioterrorism..............- 2 y0- !y- 2 0- !- 2 %13- ! %- 2 r+13- !r--2 -+2 GTotal, Budget Authority................................................ 2 c$925 2 $9822  $1,142 2 m$160-2 #-72 #_FTE............................................................................................/{2 #`8,904/`2 #6 2 #` /2 #8,944/$2 # 2 # /-2 #9,653/2 # 2 # / 2 #s709/s$2 #: 2 #s -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbCbC+: T7   3''  ' 3' 3-   !DTimes New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- 3Times New Roman4- (2 $Salaries and Expenses:2 5-42 5YFoods.................................................................................... 2 5g$204 2 5$232 2 5$276A 2 5l+$442 F-42 FYDrugs.................................................................................... 2 Fm449 2 F459 2 F507R 2 Fr+482 W-/2 WPMedical Devices................................................................. 2 Wm157 2 W160 2 W186c 2 Wr+262 h-&2 h=National Center for Toxicological Research................... 2 hs31 2 h32 2 h%34t 2 hx+22 y-22 yVTobacco............................................................................... 2 ys34 2 y34 2 y%68 2 yr+342 -12 SOther Activities................................................................... 2 s88 2 87 2 %87 2 02 -(2 AOther Rent & Rent Related Activities............................. 2 s26 2 26 2 %26 2 02 -+2 GSeafood Inspection--Transfer...........................................Times New Roman4- 2 y0- !y- 2 0- !- 2 %16- ! %- 2 r+16- !r--2 -(2 ASubtotal, Salaries and Expenses.................................. 2 c$9892 $1,0292 $1,2002 b+$171-2 --2 KGSA Rental Payments........................................................ 2 m$46 2 $88 2 $100 2 l+$122 -.2 NBuildings and Facilities...................................................... 2 s21 2 11 2 %32 2 r+202 -02 QCertification Fund............................................................... 2 y4 2 4 2 +4 2 02 -02 QExport Certification............................................................. 2 y2 2 1 2 +1 2 02 -'2 ?Bioterrorism (Funds from other Sources)........................- 2 y0- ! y- 2 0- ! - 2 %13- ! %- 2 r+13- ! r--2 $-,2 $ITotal, Program Level.....................................................2 $Y$1,0622 $$1,1342 $ $1,35002 $b+$216-2 5Less User Fees: 2 F Current Law: 2 W-22 WVPDUFA................................................................................. 2 Wg$117 2 W$132 2 W$145c 2 Wl+$132 h-22 hVMQSA.................................................................................. 2 hs14 2 h15 2 h%15t 2 h02 y-02 yQCertification Fund............................................................... 2 yy4 2 y4 2 y+4 2 y02 -02 QExport Certification............................................................. 2 y2 2 1 2 +1 2 02 -+2 GSeafood Inspection--Transfer........................................... 2 y0 2 0 2 %13 2 r+132  Proposed Law: 2 -42 YFoods.................................................................................... 2 y0 2 0 2 %10 2 r+102 -/2 PMedical Devices.................................................................- 2 y0- !y- 2 0- !- 2 +7- !+- 2 x+7- ! x--2 --2 KSubtotal, User Fees........................................................ 2 c$137 2 $152 2 $195 2 i+$43-2 -$2 :Less Funds from Other Sources: Bioterrorism..............- 2 y0- !y- 2 0- !- 2 %13- ! %- 2 r+13- !r--2 -+2 GTotal, Budget Authority................................................ 2 c$925 2 $9822  $1,142 2 m$160-2 #-72 #_FTE............................................................................................/{2 #`8,904/`2 #6 2 #` /2 #8,944/$2 # 2 # /-2 #9,653/2 # 2 # / 2 #s709/s$2 #: 2 #s -'" HLPASMB User  Fn&XBXXXXBXXXB-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.C:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT FQHCs FQHCtable.RunToolBar IHS HCFAC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC!8  l   `''  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New Romane-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?H$3,6122 ?$4,1152 ?$4,148LX 2 ?;+$33`c2 S=Program Level................................................   2 S 2 SH$3,6242 S$4,1302 S$4,172`X 2 S;+$42tj2 gBOutlays........................................................... 2 g 2 gH$3,2892 g$3,7862 g$4,063tX2 g4+$277l2 CFTE................................................................ 2  2 O1,8692 1,9422 1,931 2 J-11-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>|> > l   `''  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New Romane-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?H$3,6122 ?$4,1152 ?$4,148LX 2 ?;+$33`c2 S=Program Level................................................   2 S 2 SH$3,6242 S$4,1302 S$4,172`X 2 S;+$42tj2 gBOutlays........................................................... 2 g 2 gH$3,2892 g$3,7862 g$4,063tX2 g4+$277l2 CFTE................................................................ 2  2 O1,8692 1,9422 1,931 2 J-11-'&'*OLE*WPC55  !   m   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New RomanL-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Arial-J`2 =;Budget Authority...........................................  2 = Jj2 =C$2,099J2 =$2,242J2 =$2,412JY2 =5+$170[a2 N<Program Level...............................................  2 N [j2 NJ2,460[2 N2,652[2 N2,822[Y 2 N<+170lf2 _?Outlays........................................................ 2 _ lj2 _J2,128l2 _2,219l2 _2,301lY 2 _C+82m2 DFTE................................................................. j2 C14,5162 14,7502 15,040Y 2 <+290-'*OLE*WPC!2:    ''  ' ' -   !Times New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman}-A( x2 5KRyan White Activities......................................................  2 5( A{2 5Z$1,149A2 5$1,411A-2 5 $1,511A2 5f+$100R)p2 FFConsolidated Health Centers........................................... 2 F) R{ 2 Fi825R 2 F925R- 2 F945R 2 Fr+20c'2 WPFamily Planning................................................................. 2 W' c{ 2 Wi203c 2 W215c- 2 W240c 2 Wr+25t'{2 hMMCH Block Grant..............................................................  2 h' t{ 2 hi678t 2 h695t- 2 h695t 2 h0'2 ySHealthy Start...................................................................... 2 y' { 2 yo96 2 y105- 2 y105 2 y0)c2 =Universal Newborn Hearing Screening..........................    2 ) { 2 u0 2 0- 2 '4 2 x+4){2 MCritical Care Programs....................................................... 2 ) { 2 o16 2 20- 2 !22 2 x+212 Health Professions Programs:  '{2 MTraining for Diversity....................................................... 2 ' { 2 o89 2 93- 2 109 2 r+16(m2 DCommunity-Based Linkages............................................ 2 ( { 2 o51 2 54- 2 !37 2 u-17'f2 ?Primary Care Medicine and Dentistry............................   2 ' { 2 o77 2 80- 2 '0 2 u-80'a2 <Public Health Workforce Development.........................    2 ' { 2 u9 2 9- 2 '0 2 {-9 'd2 >Workforce Information and Analysis............................   2 '  { 2 u1  2 1 - 2 '1  2 0)g2 @Nursing Workforce Development...................................    2 ) { 2 o63 2 65- 2 !65 2 0/(s2 #HChildren's Hospitals GME................................................  2 #( Times New Roman4-/{ 2 #u0- !0u-/ 2 #0- !0-/- 2 #!40- ! 0!-/ 2 #r+40- !0r--@(~2 4OSubtotal, HP................................................................... 2 4( @{ 2 4_$290@ 2 4$302@- 2 4$252@ 2 4l-$50-Q)x2 EKRural Health/Telehealth.................................................... 2 E) Q{ 2 Eo44Q 2 E76Q- 2 E!76Q 2 E0b)f2 V?Hansen's Disease Services Programs.............................   2 V) b{ 2 Vo22b 2 V24b- 2 V!19b 2 V{-5s)c2 g=Organ Transplantation/Bone Marrow............................   2 g) s{ 2 go18s 2 g28s- 2 g!28s 2 g0)W2 x5Black Lung/Facilities/Nurse Loan/Comm Scholor........  2 x) { 2 xu7 2 x7- 2 x'7 2 x0'p2 FNational Health Service Corp..........................................  2 ' { 2 i115 2 116- 2 116 2 0)u2 IProgram Management.......................................................   2 ) { 2 i121 2 126- 2 128 2 x+2'o2 ENational Practitioner Databank.......................................  2 ' { 2 o12 2 12- 2 !16 2 x+4(o2 EHealth Integ. & Prot. Databank.......................................   2 ( { 2 u0 2 3- 2 '8 2 x+5'|2 NHealth Care Facilities........................................................ 2 ' -{ 2 o28- ! o- 2 65- ! -- 2 '0- !'- 2 u-65- !u--'g2 @Subtotal, Disc. Program Level...................................  2 ' {2 U$3,6242 $4,130-2 $4,172 2 i+$42-C2 (Less Funds Allocated From Other Sources:   --'--  ( y2 LDatabank User Fees..........................................................  2 ( Times New Roman}- { 2 k-12- ! o-  2 -15- ! - - 2 -24- ! !-  2 {-9- ! ---'-- -( o2 ETotal, Discretionary BA .............................................  2 ( {2 U$3,6122 $4,115-2 $4,148 2 i+$33-.(v2 "JAbstinence Education...................................................... 2 "( .{ 2 "o50. 2 "50.- 2 "!50. 2 "0?)g2 3@Medical Facilities Guar & Loan Fund.............................  2 3) ?{ 2 3u6? 2 31?- 2 3'1? 2 30P)o2 DEHEAL Liquidating Account.............................................   2 D) P{ 2 Do30P 2 D37P- 2 D!32P 2 D{-5a'm2 UDVaccine Injury Compensation......................................... 2 U' -a{ 2 Uu0- !bu-a 2 U100- !b-a- 2 U'0- !b'-a 2 Uo-100- !bo--r)g2 f@Total, HRSA Program Level ......................................   2 f) r{2 fU$3,698r2 f$4,303r-2 f$4,231r 2 fl-$72-'2 ]FTE..........................................................................................2 ' {2 `1,8692 1,942-2 1,931 2 u-11-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbCe8:bCD    ''  ' ' -   !Times New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman}-A( x2 5KRyan White Activities......................................................  2 5( A{2 5Z$1,149A2 5$1,411A-2 5 $1,511A2 5f+$100R)p2 FFConsolidated Health Centers........................................... 2 F) R{ 2 Fi825R 2 F925R- 2 F945R 2 Fr+20c'2 WPFamily Planning................................................................. 2 W' c{ 2 Wi203c 2 W215c- 2 W240c 2 Wr+25t'{2 hMMCH Block Grant..............................................................  2 h' t{ 2 hi678t 2 h695t- 2 h695t 2 h0'2 ySHealthy Start...................................................................... 2 y' { 2 yo96 2 y105- 2 y105 2 y0)c2 =Universal Newborn Hearing Screening..........................    2 ) { 2 u0 2 0- 2 '4 2 x+4){2 MCritical Care Programs....................................................... 2 ) { 2 o16 2 20- 2 !22 2 x+212 Health Professions Programs:  '{2 MTraining for Diversity....................................................... 2 ' { 2 o89 2 93- 2 109 2 r+16(m2 DCommunity-Based Linkages............................................ 2 ( { 2 o51 2 54- 2 !37 2 u-17'f2 ?Primary Care Medicine and Dentistry............................   2 ' { 2 o77 2 80- 2 '0 2 u-80'a2 <Public Health Workforce Development.........................    2 ' { 2 u9 2 9- 2 '0 2 {-9 'd2 >Workforce Information and Analysis............................   2 '  { 2 u1  2 1 - 2 '1  2 0)g2 @Nursing Workforce Development...................................    2 ) { 2 o63 2 65- 2 !65 2 0/(s2 #HChildren's Hospitals GME................................................  2 #( Times New Roman4-/{ 2 #u0- !0u-/ 2 #0- !0-/- 2 #!40- ! 0!-/ 2 #r+40- !0r--@(~2 4OSubtotal, HP................................................................... 2 4( @{ 2 4_$290@ 2 4$302@- 2 4$252@ 2 4l-$50-Q)x2 EKRural Health/Telehealth.................................................... 2 E) Q{ 2 Eo44Q 2 E76Q- 2 E!76Q 2 E0b)f2 V?Hansen's Disease Services Programs.............................   2 V) b{ 2 Vo22b 2 V24b- 2 V!19b 2 V{-5s)c2 g=Organ Transplantation/Bone Marrow............................   2 g) s{ 2 go18s 2 g28s- 2 g!28s 2 g0)W2 x5Black Lung/Facilities/Nurse Loan/Comm Scholor........  2 x) { 2 xu7 2 x7- 2 x'7 2 x0'p2 FNational Health Service Corp..........................................  2 ' { 2 i115 2 116- 2 116 2 0)u2 IProgram Management.......................................................   2 ) { 2 i121 2 126- 2 128 2 x+2'o2 ENational Practitioner Databank.......................................  2 ' { 2 o12 2 12- 2 !16 2 x+4(o2 EHealth Integ. & Prot. Databank.......................................   2 ( { 2 u0 2 3- 2 '8 2 x+5'|2 NHealth Care Facilities........................................................ 2 ' -{ 2 o28- ! o- 2 65- ! -- 2 '0- !'- 2 u-65- !u--'g2 @Subtotal, Disc. Program Level...................................  2 ' {2 U$3,6242 $4,130-2 $4,172 2 i+$42-C2 (Less Funds Allocated From Other Sources:   --'--  ( y2 LDatabank User Fees..........................................................  2 ( Times New Roman}- { 2 k-12- ! o-  2 -15- ! - - 2 -24- ! !-  2 {-9- ! ---'-- -( o2 ETotal, Discretionary BA .............................................  2 ( {2 U$3,6122 $4,115-2 $4,148 2 i+$33-.(v2 "JAbstinence Education...................................................... 2 "( .{ 2 "o50. 2 "50.- 2 "!50. 2 "0?)g2 3@Medical Facilities Guar & Loan Fund.............................  2 3) ?{ 2 3u6? 2 31?- 2 3'1? 2 30P)o2 DEHEAL Liquidating Account.............................................   2 D) P{ 2 Do30P 2 D37P- 2 D!32P 2 D{-5a'm2 UDVaccine Injury Compensation......................................... 2 U' -a{ 2 Uu0- !bu-a 2 U100- !b-a- 2 U'0- !b'-a 2 Uo-100- !bo--r)g2 f@Total, HRSA Program Level ......................................   2 f) r{2 fU$3,698r2 f$4,303r-2 f$4,231r 2 fl-$72-'2 ]FTE..........................................................................................2 ' {2 `1,8692 1,942-2 1,931 2 u-11-'()WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICT> >K m   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New RomanL-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Arial-J`2 =;Budget Authority...........................................  2 = Jj2 =C$2,099J2 =$2,242J2 =$2,412JY2 =5+$170[a2 N<Program Level...............................................  2 N [j2 NJ2,460[2 N2,652[2 N2,822[Y 2 N<+170lf2 _?Outlays........................................................ 2 _ lj2 _J2,128l2 _2,219l2 _2,301lY 2 _C+82m2 DFTE................................................................. j2 C14,5162 14,7502 15,040Y 2 <+290-'*+<==@:QuickFormat2X  X  *OLE*WPC  ! F( "    2''  ' 2' 2-   !CTimes New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- 2Times New Roman}- 2 5 SERVICES:R)2 FRClinical Services.................................................................2 F) R{2 FZ$1,804R2 F$1,917R-2 F $2,018R2 Ff+$101Times New Roman4-c&f2 W?Contract Health Services non-add..............................  2 W& 2 Wh373 2 W386 2 W410 2 Wp+24 -t(~2 hOPreventive Health.............................................................. 2 h( t{ 2 ho83t 2 h87t- 2 h!92t 2 hx+5)v2 yJContract Support Costs....................................................2 y) { 2 yi169 2 y204- 2 y239 2 yr+35)W2 5Self Governance and Tribal Management Grants.........  2 ) { 2 o11 2 12- 2 !12 2 0(2 RUrban Health......................................................................  2 ( { 2 o25 2 26- 2 !29 2 x+3(^2 :Direct Operations/Indian Health Professions...............   2 ( { 2 o76 2 79- 2 !80 2 x+1){2 MDiabetes Funding /1.......................................................... 2 ) Times New Roman4-{ 2 o30- ! o- 2 30- ! -- 2 !30- ! !- 2 0- !--(x2 KSubtotal, Services.........................................................2 ( {2 U$2,1982 $2,355-2 $2,5002 b+$145-2  FACILITIES:  )c2 =Environmental Health & Facility Support......................   2 )  { 2 c$102  2 $108 - 2 $120  2 l+$12'c2 =Sanitation & Health Facility Construction....................  2 ' { 2 i103 2 130- 2 135 2 x+5/(W2 #5Maintenance & Improvement and Equipment..............     2 #( -/{ 2 #o57- ! 0o-/ 2 #59- ! 0-/- 2 #!67- ! 0!-/ 2 #x+8- ! 0x--@)y2 4LSubtotal, Facilities........................................................2 4) @{ 2 4_$262@ 2 4$297@- 2 4$322@ 2 4i+$25b'r2 VGTotal, Program Level .................................................. 2 V' b{2 VU$2,460b2 V$2,652b-2 V$2,822b2 Vb+$170-2 xReimbursements:  'p2 FHealth Insurance Collections.......................................... 2 ' 2 c-$3262 -$3752 -$375 2 }$0(|2 NDiabetes Funding.............................................................. 2 ( 2 o-30 2 -30 2 !-30 2 0(y2 LRental of Staff Quarters.................................................... 2 ( - 2 u-5- ! u- 2 -5- ! - 2 '-5- ! '- 2 0- !--)j2 BSubtotal, Reimbursements..........................................   2 ) 2 _-$3612 -$4102 -$410 2 {$0)p2 FTotal, Budget Authority ..............................................  2 ) {2 U$2,0992 $2,242-2 $2,4122 b+$170- '2 ]FTE..........................................................................................2 '  {2 Z14,516 2 14,750 -2  15,040  2 l+290y2 "L1/These mandatory funds are appropriated in the Balanced Budget Act of 1997.  --'-- 2-   "- "- !-2- !#-2- !1-- !-11- !1--'- 2'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICTbCL(bC: "    2''  ' 2' 2-   !CTimes New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- 2Times New Roman}- 2 5 SERVICES:R)2 FRClinical Services.................................................................2 F) R{2 FZ$1,804R2 F$1,917R-2 F $2,018R2 Ff+$101Times New Roman4-c&f2 W?Contract Health Services non-add..............................  2 W& 2 Wh373 2 W386 2 W410 2 Wp+24 -t(~2 hOPreventive Health.............................................................. 2 h( t{ 2 ho83t 2 h87t- 2 h!92t 2 hx+5)v2 yJContract Support Costs....................................................2 y) { 2 yi169 2 y204- 2 y239 2 yr+35)W2 5Self Governance and Tribal Management Grants.........  2 ) { 2 o11 2 12- 2 !12 2 0(2 RUrban Health......................................................................  2 ( { 2 o25 2 26- 2 !29 2 x+3(^2 :Direct Operations/Indian Health Professions...............   2 ( { 2 o76 2 79- 2 !80 2 x+1){2 MDiabetes Funding /1.......................................................... 2 ) Times New Roman4-{ 2 o30- ! o- 2 30- ! -- 2 !30- ! !- 2 0- !--(x2 KSubtotal, Services.........................................................2 ( {2 U$2,1982 $2,355-2 $2,5002 b+$145-2  FACILITIES:  )c2 =Environmental Health & Facility Support......................   2 )  { 2 c$102  2 $108 - 2 $120  2 l+$12'c2 =Sanitation & Health Facility Construction....................  2 ' { 2 i103 2 130- 2 135 2 x+5/(W2 #5Maintenance & Improvement and Equipment..............     2 #( -/{ 2 #o57- ! 0o-/ 2 #59- ! 0-/- 2 #!67- ! 0!-/ 2 #x+8- ! 0x--@)y2 4LSubtotal, Facilities........................................................2 4) @{ 2 4_$262@ 2 4$297@- 2 4$322@ 2 4i+$25b'r2 VGTotal, Program Level .................................................. 2 V' b{2 VU$2,460b2 V$2,652b-2 V$2,822b2 Vb+$170-2 xReimbursements:  'p2 FHealth Insurance Collections.......................................... 2 ' 2 c-$3262 -$3752 -$375 2 }$0(|2 NDiabetes Funding.............................................................. 2 ( 2 o-30 2 -30 2 !-30 2 0(y2 LRental of Staff Quarters.................................................... 2 ( - 2 u-5- ! u- 2 -5- ! - 2 '-5- ! '- 2 0- !--)j2 BSubtotal, Reimbursements..........................................   2 ) 2 _-$3612 -$4102 -$410 2 {$0)p2 FTotal, Budget Authority ..............................................  2 ) {2 U$2,0992 $2,242-2 $2,4122 b+$170- '2 ]FTE..........................................................................................2 '  {2 Z14,516 2 14,750 -2  15,040  2 l+290y2 "L1/These mandatory funds are appropriated in the Balanced Budget Act of 1997.  --'-- 2-   "- "- !-2- !#-2- !1-- !-11- !1--'- 2',-<TT@Ex:QuickFormat3XXXXXXXX XXXXXXXX >$Large Circle0  2b$Square0 <TT@U4:QuickFormat4X"XXXX"XXX" X"XXXX"XXX" (*-/0123xRIcgkosw{Large BulletLarge Bullet<TT@s:QuickFormat5X"XXXX"XXX" X"XXXX"XXX" <77D:QuickFormat6XXX  XXX   >c$"Small Circle"0 WPWin 6.0/OLE 1.0 Prefix Information Marker5 METAFILEPICT> 0 >    `''  ' `' `-   !p !K% !p Arial-  2 N1998 2 1999 2 20002 !Request  ArialT-2 CActual  - !+&C-2 Enacted  - !:&-2 Request - !<&-2   +/- Enacted   - !P& - Arial-Ka2 =<Budget Authority............................................  2 = Ki2 =-$297,438K2 =x$312,210K2 =$335,233KX2 =+$23,023 ^i2 PAOutlays.......................................................... 2 P ^i2 P-$293,921^2 Px$314,860^2 P$333,074^X2 P+$18,214 i2 vAFTE /1........................................................... 2 v i2 vE3,9422 v4,2672 v4,282X 2 vH15 Arial-2 Q1/ In FY 2000, 50 FTEs are being paid from the Public Health and Social Services        I2 , Emergency Fund for millennium compliance.    -"Systemn-'-- `-   !^ !& !a--'- `'C:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt./C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC  xx!x     p' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' p' p-   !`H-  ! o ! oTimes New Roman-  2 N1998 2 1999 2 20002 &Request Times New Roman-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?H$2,3842 ?$2,6432 ?$2,820LX2 ?4+$178`c2 S=Program Level................................................   2 S 2 SH$2,5212 S$2,9152 S$3,116`X2 S4+$201tj2 gBOutlays........................................................... 2 g 2 gH$2,4092 g$2,4382 g$2,651tX2 g4+$213l2 CFTE................................................................ 2  2 O7,0932 7,5222 7,631 2 @+109-'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICT~@| ~@    p' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' p' p-   !`H-  ! o ! oTimes New Roman-  2 N1998 2 1999 2 20002 &Request Times New Roman-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?H$2,3842 ?$2,6432 ?$2,820LX2 ?4+$178`c2 S=Program Level................................................   2 S 2 SH$2,5212 S$2,9152 S$3,116`X2 S4+$201tj2 gBOutlays........................................................... 2 g 2 gH$2,4092 g$2,4382 g$2,651tX2 g4+$213l2 CFTE................................................................ 2  2 O7,0932 7,5222 7,631 2 @+109-'01C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT genomics bioinformaticsbiomaterials RPGspredoctoralNCCAMToolBartable.Run *OLE*WPC2 2 !2 J d%    S' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' S' S-   ! !0 !C !# !0ATimes New Roman-  2 c1998 2 1999 2 20002 ZRequest Times New Roman--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- STimes New Roman- H2 $+Centers for Disease Control and Prevention: A)~2 5 OInfectious Diseases............................................................ 2 5) A{ 2 5c$113A 2 5$138A- 2 5$182A 2 5l+$44Times New Roman-R%`2 F ; Emerging Infectious Diseases (non-add)..................  2 F% 2 Fo59 2 F79 2 F104 2 Fp+25 c$u2 W I Food Safety (non-add).................................................2 W$ 2 Wo15 2 W20 2 W!30 2 Wp+10 -t'g2 h @Heart Disease and Health Promotion..............................    2 h' t{ 2 ho74t 2 h128t- 2 h155t 2 hr+27-$x2 y K Tobacco (non-add).......................................................2 y$ 2 yo28 2 y74 2 y101 2 yp+27 -)2 RImmunization/1.................................................................... 2 ) { 2 i430 2 449- 2 526 2 r+77(c2 =Race and Health Demonstration Projects.......................   2 ( { 2 u0 2 10- 2 !35 2 r+25)p2 FSexually Transmitted Diseases.........................................  2 ) { 2 i112 2 124- 2 131 2 x+7'2 THIV/AIDS............................................................................   2 ' { 2 i625 2 657- 2 667 2 r+10'f2 ?Diabetes and Other Chronic Diseases............................   2 ' { 2 o60 2 80- 2 !80 2 0(u2 IBreast and Cervical Cancer...............................................2 ( { 2 i143 2 159- 2 159 2 0'm2 DOccupational Safety and Health......................................  2 ' { 2 i187 2 200- 2 212 2 r+12 (2  ZInjury....................................................................................2 (  { 2 o56  2 64 - 2 !76  2 r+13-%c2  = Violence Against Women (non-add)..........................  2 % 2 v0 2 0 2 !11 2 p+11 -/)2 # SHealth Statistics.................................................................. 2 #) /{ 2 #o85/ 2 #95/- 2 #110/ 2 #r+15-@&p2 4 F 1% Evaluation (non-add)............................................ 2 4& 2 4o59 2 468 2 4110 2 4p+42 -Q({2 E MPrevention Research..........................................................2 E( Q{ 2 Eu0Q 2 E15Q- 2 E!15Q 2 E0b'p2 V FPreventive Health Block Grant......................................... 2 V' b{ 2 Vi194b 2 V195b- 2 V165b 2 Vu-30-s$o2 g E Crime Bill/ Rape Prevention.......................................  2 g$ 2 go45 2 g45 2 g!45s 2 g{0-'2 x STuberculosis.......................................................................2 x' { 2 xi118 2 x120- 2 x120 2 x0)2  QCancer Registries................................................................2 ) { 2 o24 2 24- 2 !24 2 0'g2  @Environmental Disease Prevention/1..............................  2 ' { 2 o54 2 67- 2 !67 2 0'r2  GChildhood Lead Poisoning...............................................2 ' { 2 o38 2 38- 2 !38 2 0)~2  OPrevention Centers.............................................................2 ) { 2 u8 2 14- 2 !14 2 0)2  PEpidemic Services............................................................... 2 ) { 2 o67 2 86- 2 !85 2 {-1'{2  MBuildings and Facilities.....................................................2 ' { 2 o22 2 18- 2 !40 2 r+22'~2  OOffice of the Director.........................................................  2 ' { 2 o34 2 31- 2 !30 2 {-1- &p2  F 1% Evaluation (non-add)............................................ 2 & 2 s.7 2 .7 2 (0  2 w-1-'v2  JBioterrorism/2 (PHSSEF)...................................................  2 ' { 2 u0 2 124- 2 118 2 {-6.)d2 " >EPA Superfund Allocation (ATSDR)..............................    2 ") .{ 2 "o74. 2 "76.- 2 "!64. 2 "u-12?)a2 3 <Mandatory Budget Authority (Diabetes).......................   2 3) ?{ 2 3u3? 2 33?- 2 3'3? 2 30P(2 D VUser Fees............................................................................. 2 D( Times New Roman%-P{ 2 Du1- !Qu-P 2 D1- !Q-P- 2 D'1- !Q'-P 2 D0- !Q--a)r2 UGSubtotal , Program Level............................................... 2 U) a{2 UU$2,521a2 U$2,915a-2 U$3,116a2 Ub+$201-E2 w)Less Funds Allocated from Other Sources :   )y2  LBioterrorism (PHSSEF).......................................................  2 ) { 2 u0 2 124- 2 118 2 x+6'o2  E1% Evaluation (Health Statistics)....................................  2 ' { 2 o59 2 68- 2 110 2 u-41)d2  >EPA Superfund Allocation (ATSDR)..............................    2 ) { 2 o74 2 76- 2 !64 2 r+12)a2  <Mandatory Budget Authority (Diabetes).......................   2 ) { 2 u3 2 3- 2 '3 2 0(2  VUser Fees............................................................................. 2 ( -{ 2 u1- !u- 2 1- !-- 2 '1- !'- 2 0- !--)s2 HTotal, Budget Authority.................................................  2 ) {2 U$2,3842 $2,643-2 $2,820 2 i$178- '2 ]FTE..........................................................................................2 '  {2 `7,093 2 7,522 -2 7,631  2 l+1092 !f1/FY 1999 Enacted reflects a comparable transfer from the Public Health and Social Services Emergency     2 2[Fund of $28 million for polio and measles and $5 million for the environmental health lab.     j2 CB2/ Includes $1.85 M in FY 1999 for Nuclear Weapons Radiation Study   -'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICTbCJbCW d%    S' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' S' S-   ! !0 !C !# !0ATimes New Roman-  2 c1998 2 1999 2 20002 ZRequest Times New Roman--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- STimes New Roman- H2 $+Centers for Disease Control and Prevention: A)~2 5 OInfectious Diseases............................................................ 2 5) A{ 2 5c$113A 2 5$138A- 2 5$182A 2 5l+$44Times New Roman-R%`2 F ; Emerging Infectious Diseases (non-add)..................  2 F% 2 Fo59 2 F79 2 F104 2 Fp+25 c$u2 W I Food Safety (non-add).................................................2 W$ 2 Wo15 2 W20 2 W!30 2 Wp+10 -t'g2 h @Heart Disease and Health Promotion..............................    2 h' t{ 2 ho74t 2 h128t- 2 h155t 2 hr+27-$x2 y K Tobacco (non-add).......................................................2 y$ 2 yo28 2 y74 2 y101 2 yp+27 -)2 RImmunization/1.................................................................... 2 ) { 2 i430 2 449- 2 526 2 r+77(c2 =Race and Health Demonstration Projects.......................   2 ( { 2 u0 2 10- 2 !35 2 r+25)p2 FSexually Transmitted Diseases.........................................  2 ) { 2 i112 2 124- 2 131 2 x+7'2 THIV/AIDS............................................................................   2 ' { 2 i625 2 657- 2 667 2 r+10'f2 ?Diabetes and Other Chronic Diseases............................   2 ' { 2 o60 2 80- 2 !80 2 0(u2 IBreast and Cervical Cancer...............................................2 ( { 2 i143 2 159- 2 159 2 0'm2 DOccupational Safety and Health......................................  2 ' { 2 i187 2 200- 2 212 2 r+12 (2  ZInjury....................................................................................2 (  { 2 o56  2 64 - 2 !76  2 r+13-%c2  = Violence Against Women (non-add)..........................  2 % 2 v0 2 0 2 !11 2 p+11 -/)2 # SHealth Statistics.................................................................. 2 #) /{ 2 #o85/ 2 #95/- 2 #110/ 2 #r+15-@&p2 4 F 1% Evaluation (non-add)............................................ 2 4& 2 4o59 2 468 2 4110 2 4p+42 -Q({2 E MPrevention Research..........................................................2 E( Q{ 2 Eu0Q 2 E15Q- 2 E!15Q 2 E0b'p2 V FPreventive Health Block Grant......................................... 2 V' b{ 2 Vi194b 2 V195b- 2 V165b 2 Vu-30-s$o2 g E Crime Bill/ Rape Prevention.......................................  2 g$ 2 go45 2 g45 2 g!45s 2 g{0-'2 x STuberculosis.......................................................................2 x' { 2 xi118 2 x120- 2 x120 2 x0)2  QCancer Registries................................................................2 ) { 2 o24 2 24- 2 !24 2 0'g2  @Environmental Disease Prevention/1..............................  2 ' { 2 o54 2 67- 2 !67 2 0'r2  GChildhood Lead Poisoning...............................................2 ' { 2 o38 2 38- 2 !38 2 0)~2  OPrevention Centers.............................................................2 ) { 2 u8 2 14- 2 !14 2 0)2  PEpidemic Services............................................................... 2 ) { 2 o67 2 86- 2 !85 2 {-1'{2  MBuildings and Facilities.....................................................2 ' { 2 o22 2 18- 2 !40 2 r+22'~2  OOffice of the Director.........................................................  2 ' { 2 o34 2 31- 2 !30 2 {-1- &p2  F 1% Evaluation (non-add)............................................ 2 & 2 s.7 2 .7 2 (0  2 w-1-'v2  JBioterrorism/2 (PHSSEF)...................................................  2 ' { 2 u0 2 124- 2 118 2 {-6.)d2 " >EPA Superfund Allocation (ATSDR)..............................    2 ") .{ 2 "o74. 2 "76.- 2 "!64. 2 "u-12?)a2 3 <Mandatory Budget Authority (Diabetes).......................   2 3) ?{ 2 3u3? 2 33?- 2 3'3? 2 30P(2 D VUser Fees............................................................................. 2 D( Times New Roman%-P{ 2 Du1- !Qu-P 2 D1- !Q-P- 2 D'1- !Q'-P 2 D0- !Q--a)r2 UGSubtotal , Program Level............................................... 2 U) a{2 UU$2,521a2 U$2,915a-2 U$3,116a2 Ub+$201-E2 w)Less Funds Allocated from Other Sources :   )y2  LBioterrorism (PHSSEF).......................................................  2 ) { 2 u0 2 124- 2 118 2 x+6'o2  E1% Evaluation (Health Statistics)....................................  2 ' { 2 o59 2 68- 2 110 2 u-41)d2  >EPA Superfund Allocation (ATSDR)..............................    2 ) { 2 o74 2 76- 2 !64 2 r+12)a2  <Mandatory Budget Authority (Diabetes).......................   2 ) { 2 u3 2 3- 2 '3 2 0(2  VUser Fees............................................................................. 2 ( -{ 2 u1- !u- 2 1- !-- 2 '1- !'- 2 0- !--)s2 HTotal, Budget Authority.................................................  2 ) {2 U$2,3842 $2,643-2 $2,820 2 i$178- '2 ]FTE..........................................................................................2 '  {2 `7,093 2 7,522 -2 7,631  2 l+1092 !f1/FY 1999 Enacted reflects a comparable transfer from the Public Health and Social Services Emergency     2 2[Fund of $28 million for polio and measles and $5 million for the environmental health lab.     j2 CB2/ Includes $1.85 M in FY 1999 for Nuclear Weapons Radiation Study   -'2 C:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC!|  l   `''  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New Roman-2 DActual - 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Mgmt. & Support    2 3.4% ----'--- 9-------'---   !2 Research Training 2 3.2% ----'--- 9-------'---  2  R&D Contracts  2 6.4% ----'--- 9--------'--- 5 !2 7Research Project 2 OGrants2 O57.1% ----'--- 9-------'--- pb@ 2 eB All Other 2 tL8.7% ----'--- 9---'--- 9 "-H-  -- -4- "- --- - --- -' 9 '  '*OLE*WPCa a !a ;    ''  ' ' -   !Times New RomanL-  2 c1998 2 1999 2 20002 ZRequest Times New Roman--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman0- 2 $ Institutes:A'x2 5 KNational Cancer Institute.................................................. 2 5' A{2 5Z$2,306A2 5$2,668A-2 5 $2,733A 2 5l+$65R'd2 F >National Heart, Lung, and Blood Institute.....................  2 F' R{2 F`1,508R2 F1,719R-2 F1,760R 2 Fr+41c*X2 W 6National Institute of Dental and Craniofacial Research  c{ 2 Wi201c 2 W220c- 2 W226c 2 Wx+5t'U2 h 4Natl Inst. of Diabetes & Digestive & Kidney Disease.       2 h' t{ 2 hi858t 2 h979t-2 h1,003t 2 hr+23'W2 y 5National Institute of Neurological Disorders & Stroke    2 y' { 2 yi749 2 y870- 2 y891 2 yr+21'Z2 7National Institute of Allergy & Infectious Diseases....    2 ' { 2 i656 2 771- 2 789 2 r+18)`2 ;National Institute of General Medical Sciences.............  2 ) {2 `1,0332 1,166-2 1,194 2 r+28)W2 5Natl Inst. of Child Health and Human Development.....      2 ) { 2 i607 2 678- 2 694 2 r+16(|2 NNational Eye Institute........................................................ 2 ( { 2 i346 2 387- 2 396 2 x+9(X2 6National Institute of Environmental Health Sciences...   2 ( { 2 i335 2 382- 2 391 2 x+9)u2 INational Institute on Aging..............................................  2 ) { 2 i518 2 598- 2 613 2 r+14'X2 6Natl Inst. Of Arthritis & Musculoskeletal & Skin Dis..       2 ' { 2 i269 2 303- 2 310 2 x+7 (T2  3Natl Inst. On Deafness & Communication Disorders...      2 (  { 2 i199  2 230 - 2 235  2 x+6)m2  DNational Institute of Mental Health.................................   2 ) { 2 i642 2 741- 2 759 2 r+18/(l2 # CNational Institute on Drug Abuse...................................   2 #( /{ 2 #i365/ 2 #419/- 2 #429/ 2 #r+10@)T2 4 3National Institute on Alcohol Abuse and Alcoholism.     2 4) @{ 2 4i212@ 2 4243@- 2 4249@ 2 4x+6Q(g2 E @National Institute for Nursing Research.........................  2 E( Q{ 2 Eo58Q 2 E64Q- 2 E!65Q 2 Ex+2b']2 V 9National Human Genome Research Institute.................    2 V' b{ 2 Vi219b 2 V265b- 2 V272b 2 Vx+6s(d2 g >National Center for Research Resources........................ 2 g( s{ 2 gi370s 2 g459s- 2 g470s 2 gr+11'U2 x 4Natl Center for Complementary & Alternative Med.....      2 x' { 2 xo20 2 x49- 2 x!50 2 xx+1's2  HFogarty International Center............................................2 ' { 2 o18 2 23- 2 !23 2 x+1)s2  HNational Library of Medicine............................................  2 ) { 2 i157 2 177- 2 181 2 x+4'~2  OOffice of the Director.........................................................  2 ' { 2 i181 2 213- 2 218 2 x+5)u2  IOffice of AIDS Research 1/...............................................   2 ) {2 `1,6032 1,798-2 1,834 2 r+35)~2  OBuildings & Facilities......................................................... 2 ) { 2 i195 2 191- 2 108 2 u-83)r2  GB&F Advanced Funding...................................................  2 ) { 2 u0 2 0- 2 !40 2 r+40)g2  @EPA Superfund Allocation (NIEHS)................................    2 ) { 2 o58 2 60- 2 !49 2 u-12 )`2  ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 )  { 2 o10  2 10 - 2 !10  2 0'{2  MDiabetes Research 2/......................................................... 2 ' Times New Roman-{ 2 o27- ! o- 2 27- ! -- 2 !27- ! !- 2 0- !--.)r2 "GSubtotal, Program Level................................................ 2 ") .{2 "N$13,717.2 "$15,709.-2 "$16,018.2 "b+$309-C2 D(Less Funds Allocated from Other Sources:   a)g2 U @EPA Superfund Allocation (NIEHS)................................    2 U) a{ 2 Ue-$58a 2 U-$60a- 2 U-$49a 2 Ul+$12r)`2 f ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 f) r{ 2 fk-10r 2 f-10r- 2 f-10r 2 f0'{2 w MDiabetes Research 2/......................................................... 2 w' -{ 2 wk-27- !k- 2 w-27- !-- 2 w-27- !- 2 w0- !--(o2 ESubtotal, Budget Authority...........................................  2 ( {2 N$13,6222 $15,613-2 $15,9332 b+$320-'2 ]FTE..........................................................................................2 ' {2 Z15,1592 16,217-2  16,618 2 l+4012 i1/ FY 1999 figure includes $6.1 million of facilities funds related to the new Vaccine Research Facility.  u2 I2/ These funds were pre-appropriated in the Balanced Budget Act of 1997.   -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbC;bCP    ''  ' ' -   !Times New RomanL-  2 c1998 2 1999 2 20002 ZRequest Times New Roman--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman0- 2 $ Institutes:A'x2 5 KNational Cancer Institute.................................................. 2 5' A{2 5Z$2,306A2 5$2,668A-2 5 $2,733A 2 5l+$65R'd2 F >National Heart, Lung, and Blood Institute.....................  2 F' R{2 F`1,508R2 F1,719R-2 F1,760R 2 Fr+41c*X2 W 6National Institute of Dental and Craniofacial Research  c{ 2 Wi201c 2 W220c- 2 W226c 2 Wx+5t'U2 h 4Natl Inst. of Diabetes & Digestive & Kidney Disease.       2 h' t{ 2 hi858t 2 h979t-2 h1,003t 2 hr+23'W2 y 5National Institute of Neurological Disorders & Stroke    2 y' { 2 yi749 2 y870- 2 y891 2 yr+21'Z2 7National Institute of Allergy & Infectious Diseases....    2 ' { 2 i656 2 771- 2 789 2 r+18)`2 ;National Institute of General Medical Sciences.............  2 ) {2 `1,0332 1,166-2 1,194 2 r+28)W2 5Natl Inst. of Child Health and Human Development.....      2 ) { 2 i607 2 678- 2 694 2 r+16(|2 NNational Eye Institute........................................................ 2 ( { 2 i346 2 387- 2 396 2 x+9(X2 6National Institute of Environmental Health Sciences...   2 ( { 2 i335 2 382- 2 391 2 x+9)u2 INational Institute on Aging..............................................  2 ) { 2 i518 2 598- 2 613 2 r+14'X2 6Natl Inst. Of Arthritis & Musculoskeletal & Skin Dis..       2 ' { 2 i269 2 303- 2 310 2 x+7 (T2  3Natl Inst. On Deafness & Communication Disorders...      2 (  { 2 i199  2 230 - 2 235  2 x+6)m2  DNational Institute of Mental Health.................................   2 ) { 2 i642 2 741- 2 759 2 r+18/(l2 # CNational Institute on Drug Abuse...................................   2 #( /{ 2 #i365/ 2 #419/- 2 #429/ 2 #r+10@)T2 4 3National Institute on Alcohol Abuse and Alcoholism.     2 4) @{ 2 4i212@ 2 4243@- 2 4249@ 2 4x+6Q(g2 E @National Institute for Nursing Research.........................  2 E( Q{ 2 Eo58Q 2 E64Q- 2 E!65Q 2 Ex+2b']2 V 9National Human Genome Research Institute.................    2 V' b{ 2 Vi219b 2 V265b- 2 V272b 2 Vx+6s(d2 g >National Center for Research Resources........................ 2 g( s{ 2 gi370s 2 g459s- 2 g470s 2 gr+11'U2 x 4Natl Center for Complementary & Alternative Med.....      2 x' { 2 xo20 2 x49- 2 x!50 2 xx+1's2  HFogarty International Center............................................2 ' { 2 o18 2 23- 2 !23 2 x+1)s2  HNational Library of Medicine............................................  2 ) { 2 i157 2 177- 2 181 2 x+4'~2  OOffice of the Director.........................................................  2 ' { 2 i181 2 213- 2 218 2 x+5)u2  IOffice of AIDS Research 1/...............................................   2 ) {2 `1,6032 1,798-2 1,834 2 r+35)~2  OBuildings & Facilities......................................................... 2 ) { 2 i195 2 191- 2 108 2 u-83)r2  GB&F Advanced Funding...................................................  2 ) { 2 u0 2 0- 2 !40 2 r+40)g2  @EPA Superfund Allocation (NIEHS)................................    2 ) { 2 o58 2 60- 2 !49 2 u-12 )`2  ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 )  { 2 o10  2 10 - 2 !10  2 0'{2  MDiabetes Research 2/......................................................... 2 ' Times New Roman-{ 2 o27- ! o- 2 27- ! -- 2 !27- ! !- 2 0- !--.)r2 "GSubtotal, Program Level................................................ 2 ") .{2 "N$13,717.2 "$15,709.-2 "$16,018.2 "b+$309-C2 D(Less Funds Allocated from Other Sources:   a)g2 U @EPA Superfund Allocation (NIEHS)................................    2 U) a{ 2 Ue-$58a 2 U-$60a- 2 U-$49a 2 Ul+$12r)`2 f ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 f) r{ 2 fk-10r 2 f-10r- 2 f-10r 2 f0'{2 w MDiabetes Research 2/......................................................... 2 w' -{ 2 wk-27- !k- 2 w-27- !-- 2 w-27- !- 2 w0- !--(o2 ESubtotal, Budget Authority...........................................  2 ( {2 N$13,6222 $15,613-2 $15,9332 b+$320-'2 ]FTE..........................................................................................2 ' {2 Z15,1592 16,217-2  16,618 2 l+4012 i1/ FY 1999 figure includes $6.1 million of facilities funds related to the new Vaccine Research Facility.  u2 I2/ These funds were pre-appropriated in the Balanced Budget Act of 1997.   -'  *OLE*WPC((!(-    ''  ' ' -   !Times New RomanL-  2 c1998 2 1999 2 20002 ZRequest Times New Romanl7--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman0- 2 5 Mechanism:  R'x2 F KResearch Project Grants....................................................2 F' R{2 FZ$7,530R2 F$8,560R-2 F $8,778R2 Ff+$218Times New Roman`-c$r2 W G[No. of Non-Competing].................................................    2 W$ 2 WL[19,526]2 W[20,473]2 W[22,344]2 WT[+1,871] t%r2 h G[No. of New/Competing].................................................     2 h% 2 hS[7,519]2 h[9,171]2 h[7,617]2 hY[-1,554]$y2 y L[Total No. of Grants].......................................................  2 y$ 2 yL[27,045]2 y[29,644]2 y[29,961]2 y^[+317] -'{2 MSBIR/STTR Grants.............................................................2 ' { 2 i269 2 310- 2 317 2 x+7)2 PResearch Centers................................................................2 ) {2 `1,1682 1,323-2 1,348 2 r+25'~2 OResearch Training..............................................................2 ' { 2 i428 2 511- 2 512 2 x+1'2 PR&D Contracts................................................................... 2 ' { 2 i8042 1,019-2 1,016 2 {-3'|2 NIntramural Research........................................................... 2 ' {2 `1,4342 1,561-2 1,619 2 r+58 '2  QOther Research................................................................... 2 '  { 2 i904 2 1,156 -2 1,204  2 r+48(d2  >Research Management and Support...............................  2 ( { 2 i497 2 536- 2 542 2 x+6/)s2 # HNational Library of Medicine............................................  2 #) /{ 2 #i161/ 2 #181/- 2 #186/ 2 #x+4Q'~2 E OOffice of the Director.........................................................  2 E' Q{ 2 Ei221Q 2 E257Q- 2 E263Q 2 Ex+6b'{2 V MBuildings and Facilities.....................................................2 V' b{ 2 Vi207b 2 V198b- 2 V108b 2 Vu-89s)r2 g GB&F Advanced Funding...................................................  2 g) s{ 2 gu0s 2 g0s- 2 g!40s 2 gr+40)g2 x @EPA Superfund Allocation (NIEHS)................................    2 x) { 2 xo58 2 x60- 2 x!49 2 xu-12)`2  ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 ) { 2 o10 2 10- 2 !10 2 0'{2  MDiabetes Research 1/......................................................... 2 ' Times New Roman-{ 2 o27- ! o- 2 27- ! -- 2 !27- ! !- 2 0- !--)r2 GSubtotal, Program Level................................................ 2 ) {2 N$13,7172 $15,709-2 $16,0182 b+$309-C2 (Less Funds Allocated from Other Sources:   )g2  @EPA Superfund Allocation (NIEHS)................................    2 ) { 2 e-$58 2 -$60- 2 -$49 2 l+$12)`2  ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 ) { 2 k-10 2 -10- 2 -10 2 0 '{2  MDiabetes Research 1/......................................................... 2 ' - { 2 k-27- ! k-  2 -27- ! - - 2 -27- ! -  2 0- ! --(o2 ESubtotal, Budget Authority...........................................  2 ( {2 N$13,6222 $15,613-2 $15,9332 b+$320-?'2 3]FTE..........................................................................................2 3' ?{2 3Z15,159?2 316,217?-2 3 16,618? 2 3l+401u2 fI1/ These funds were pre-appropriated in the Balanced Budget Act of 1997.   -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbC-bC]F    ''  ' ' -   !Times New RomanL-  2 c1998 2 1999 2 20002 ZRequest Times New Romanl7--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman0- 2 5 Mechanism:  R'x2 F KResearch Project Grants....................................................2 F' R{2 FZ$7,530R2 F$8,560R-2 F $8,778R2 Ff+$218Times New Roman`-c$r2 W G[No. of Non-Competing].................................................    2 W$ 2 WL[19,526]2 W[20,473]2 W[22,344]2 WT[+1,871] t%r2 h G[No. of New/Competing].................................................     2 h% 2 hS[7,519]2 h[9,171]2 h[7,617]2 hY[-1,554]$y2 y L[Total No. of Grants].......................................................  2 y$ 2 yL[27,045]2 y[29,644]2 y[29,961]2 y^[+317] -'{2 MSBIR/STTR Grants.............................................................2 ' { 2 i269 2 310- 2 317 2 x+7)2 PResearch Centers................................................................2 ) {2 `1,1682 1,323-2 1,348 2 r+25'~2 OResearch Training..............................................................2 ' { 2 i428 2 511- 2 512 2 x+1'2 PR&D Contracts................................................................... 2 ' { 2 i8042 1,019-2 1,016 2 {-3'|2 NIntramural Research........................................................... 2 ' {2 `1,4342 1,561-2 1,619 2 r+58 '2  QOther Research................................................................... 2 '  { 2 i904 2 1,156 -2 1,204  2 r+48(d2  >Research Management and Support...............................  2 ( { 2 i497 2 536- 2 542 2 x+6/)s2 # HNational Library of Medicine............................................  2 #) /{ 2 #i161/ 2 #181/- 2 #186/ 2 #x+4Q'~2 E OOffice of the Director.........................................................  2 E' Q{ 2 Ei221Q 2 E257Q- 2 E263Q 2 Ex+6b'{2 V MBuildings and Facilities.....................................................2 V' b{ 2 Vi207b 2 V198b- 2 V108b 2 Vu-89s)r2 g GB&F Advanced Funding...................................................  2 g) s{ 2 gu0s 2 g0s- 2 g!40s 2 gr+40)g2 x @EPA Superfund Allocation (NIEHS)................................    2 x) { 2 xo58 2 x60- 2 x!49 2 xu-12)`2  ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 ) { 2 o10 2 10- 2 !10 2 0'{2  MDiabetes Research 1/......................................................... 2 ' Times New Roman-{ 2 o27- ! o- 2 27- ! -- 2 !27- ! !- 2 0- !--)r2 GSubtotal, Program Level................................................ 2 ) {2 N$13,7172 $15,709-2 $16,0182 b+$309-C2 (Less Funds Allocated from Other Sources:   )g2  @EPA Superfund Allocation (NIEHS)................................    2 ) { 2 e-$58 2 -$60- 2 -$49 2 l+$12)`2  ;ONDCP Forfeiture Fund Transfer (NIDA)......................   2 ) { 2 k-10 2 -10- 2 -10 2 0 '{2  MDiabetes Research 1/......................................................... 2 ' - { 2 k-27- ! k-  2 -27- ! - - 2 -27- ! -  2 0- ! --(o2 ESubtotal, Budget Authority...........................................  2 ( {2 N$13,6222 $15,613-2 $15,9332 b+$320-?'2 3]FTE..........................................................................................2 3' ?{2 3Z15,159?2 316,217?-2 3 16,618? 2 3l+401u2 fI1/ These funds were pre-appropriated in the Balanced Budget Act of 1997.   -'   ToolBartable.Run CSAP CSATMHPPBG CMHSNHSDAC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt-C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT!"*OLE*WPC!*  l   `''  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New RomanM-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?H$2,1482 ?$2,4882 ?$2,627LX2 ?4+$139`c2 S=Program Level................................................   2 S 2 SH$2,1982 S$2,4882 S$2,627`X2 S4+$139tj2 gBOutlays........................................................... 2 g 2 gH$2,2352 g$2,3312 g$2,519tX2 g4+$188l2 CFTE................................................................ 2  2 Y551 2 576 2 567 2 Q-9-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>|0 > l   `''  ' `' `-   !`Times New Roman-  2 N1998 2 1999 2 20002 &Request Times New RomanM-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? 2 ?H$2,1482 ?$2,4882 ?$2,627LX2 ?4+$139`c2 S=Program Level................................................   2 S 2 SH$2,1982 S$2,4882 S$2,627`X2 S4+$139tj2 gBOutlays........................................................... 2 g 2 gH$2,2352 g$2,3312 g$2,519tX2 g4+$188l2 CFTE................................................................ 2  2 Y551 2 576 2 567 2 Q-9-'   D*OLE*()*OLE*WPC!H( #    C''  ' C' C-   !C !]B/Times New Roman<-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- CTimes New Roman- 2 5Mental Health:  R)s2 FHMental Health Block Grant...............................................  2 F) R{ 2 Fc$275R 2 F$289R- 2 F$359R 2 Fl+$70c(i2 WAPATH Homeless Formula Grant......................................     2 W( c{ 2 Wo23c 2 W26c- 2 W!31c 2 Wx+5t([2 h8Knowledge Development and Application...................     2 h( t{ 2 ho58t 2 h98t- 2 h!98t 2 h0)l2 yCChildren's Mental Health Services..................................  2 y) { 2 yo73 2 y78- 2 y!78 2 y0(r2 GProtection and Advocacy................................................ 2 ( Times New Roman-{ 2 o22- ! o- 2 23- ! -- 2 !23- ! !- 2 0- !--(p2 FSubtotal, Mental Health...............................................  2 ( { 2 _$451 2 $514- 2 $589 2 p+75-2 Substance Abuse: )o2 ETargeted Capacity Expansion..........................................2 ) { 2 i$92 2 $134- 2 $189 2 r+55Times New Roman-&m2 D Substance Abuse Treatment........................................ 2 & 2 o25 2 55 2 110 2 k+55 %l2 C Substance Abuse Prevention......................................2 % 2 o67 2 79 2 !79 2 {0- 'l2 CSubstance Abuse Block Grant........................................ 2 '  {2 `1,360 2 1,585 -2 1,615  2 r+30([2 8Knowledge Development and Application...................     2 ( { 2 i215 2 195- 2 169 2 u-26-/&m2 #D Substance Abuse Treatment........................................ 2 #& 2 #h131 2 #117 2 #117 2 #0@%l2 4C Substance Abuse Prevention......................................2 4% 2 4o84 2 479 2 4!53 2 4u-26-Q'~2 EOHigh Risk Youth................................................................ 2 E' Q{ 2 Eu6Q 2 E7Q- 2 E'7Q 2 E0b(l2 VCNational Data Collection Activities................................   2 V( -b{ 2 Vo18- ! co-b 2 V0- !c-b- 2 V'0- !c'-b 2 V0- !c--s)l2 gCSubtotal, Substance Abuse.......................................... 2 g) s{2 gU$1,691s2 g$1,921s-2 g$1,980s 2 gi+$59-)u2 IProgram Management.......................................................   2 ) -{ 2 o56- ! o- 2 53- ! -- 2 !58- ! !- 2 x+5- ! x--'r2 GTotal, Program Level................................................... 2 ' {2 U$2,1982 $2,488-2 $2,6272 b+$139-'X2 6Less Funds Allocated from Other Sources:..............   2 ' -%U2 4 Advance Appropriation to P.L. 104-121 /1.........2 % Times New Roman0-x 2 f-50- !f- 2 0- !-* 2 #0- !#- 2 {0- !{--(o2 ETotal Discretionary BA...............................................  2 ( {2 U$2,1482 $2,488-2 $2,6272 b+$139- '2 ]FTE..........................................................................................2 ' 2 m551 2 576 2 567  2 {-9a2 3</1 The additional $50 million was provided only in FY 1998.  -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbC.N(bC; #    C''  ' C' C-   !C !]B/Times New Roman<-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- CTimes New Roman- 2 5Mental Health:  R)s2 FHMental Health Block Grant...............................................  2 F) R{ 2 Fc$275R 2 F$289R- 2 F$359R 2 Fl+$70c(i2 WAPATH Homeless Formula Grant......................................     2 W( c{ 2 Wo23c 2 W26c- 2 W!31c 2 Wx+5t([2 h8Knowledge Development and Application...................     2 h( t{ 2 ho58t 2 h98t- 2 h!98t 2 h0)l2 yCChildren's Mental Health Services..................................  2 y) { 2 yo73 2 y78- 2 y!78 2 y0(r2 GProtection and Advocacy................................................ 2 ( Times New Roman-{ 2 o22- ! o- 2 23- ! -- 2 !23- ! !- 2 0- !--(p2 FSubtotal, Mental Health...............................................  2 ( { 2 _$451 2 $514- 2 $589 2 p+75-2 Substance Abuse: )o2 ETargeted Capacity Expansion..........................................2 ) { 2 i$92 2 $134- 2 $189 2 r+55Times New Roman-&m2 D Substance Abuse Treatment........................................ 2 & 2 o25 2 55 2 110 2 k+55 %l2 C Substance Abuse Prevention......................................2 % 2 o67 2 79 2 !79 2 {0- 'l2 CSubstance Abuse Block Grant........................................ 2 '  {2 `1,360 2 1,585 -2 1,615  2 r+30([2 8Knowledge Development and Application...................     2 ( { 2 i215 2 195- 2 169 2 u-26-/&m2 #D Substance Abuse Treatment........................................ 2 #& 2 #h131 2 #117 2 #117 2 #0@%l2 4C Substance Abuse Prevention......................................2 4% 2 4o84 2 479 2 4!53 2 4u-26-Q'~2 EOHigh Risk Youth................................................................ 2 E' Q{ 2 Eu6Q 2 E7Q- 2 E'7Q 2 E0b(l2 VCNational Data Collection Activities................................   2 V( -b{ 2 Vo18- ! co-b 2 V0- !c-b- 2 V'0- !c'-b 2 V0- !c--s)l2 gCSubtotal, Substance Abuse.......................................... 2 g) s{2 gU$1,691s2 g$1,921s-2 g$1,980s 2 gi+$59-)u2 IProgram Management.......................................................   2 ) -{ 2 o56- ! o- 2 53- ! -- 2 !58- ! !- 2 x+5- ! x--'r2 GTotal, Program Level................................................... 2 ' {2 U$2,1982 $2,488-2 $2,6272 b+$139-'X2 6Less Funds Allocated from Other Sources:..............   2 ' -%U2 4 Advance Appropriation to P.L. 104-121 /1.........2 % Times New Roman0-x 2 f-50- !f- 2 0- !-* 2 #0- !#- 2 {0- !{--(o2 ETotal Discretionary BA...............................................  2 ( {2 U$2,1482 $2,488-2 $2,6272 b+$139- '2 ]FTE..........................................................................................2 ' 2 m551 2 576 2 567  2 {-9a2 3</1 The additional $50 million was provided only in FY 1998.  -'    ToolBartable.RunAHCPR EPCsCAHPS MEPSC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt<c:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT01*OLE*WPC! Ml   `''  ' `' `Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New RomanL-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Program Level................................................   2 ? 2 ?R$147 2 ?$171 2 ?$206LX 2 ?;+$35`c2 S=Budget Authority.............................................  2 S 2 SY$90 2 S$100 2 S$27`X 2 S>-$73tj2 gBOutlays........................................................... 2 g 2 gY$77 2 g$101 2 g$90tX 2 g>-$11l2 CFTE................................................................ 2  2 Y260 2 275 2 285X 2 B+10'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>|> Ml   `''  ' `' `Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New RomanL-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Program Level................................................   2 ? 2 ?R$147 2 ?$171 2 ?$206LX 2 ?;+$35`c2 S=Budget Authority.............................................  2 S 2 SY$90 2 S$100 2 S$27`X 2 S>-$73tj2 gBOutlays........................................................... 2 g 2 gY$77 2 g$101 2 g$90tX 2 g>-$11l2 CFTE................................................................ 2  2 Y260 2 275 2 285X 2 B+10'   (_$0    867*OLE*WPC!    ''  ' ' Times New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4-"Systemn-'- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M---'- Times New Roman}-A( U2 54Research on Health Costs, Quality, and Outcomes.....    2 5( A{ 2 5c$108A 2 5$141A- 2 5$168A 2 5l+$27R(f2 F?Medical Expenditures Panel Surveys............................. 2 F( R{ 2 Fi$36R 2 F$28R- 2 F$36R 2 Fr+$8c)~2 WOProgram Support................................................................ 2 W) Times New Roman4-c{ 2 Wo$2- ! do-c 2 W$2- ! d-c- 2 W!$2- ! d!-c 2 Wy$0- ! dy--t)r2 hGSubtotal, program level................................................ 2 h) t{ 2 h_$146t 2 h$171t- 2 h$206t 2 hi+$35(`2 ;Less Transfers: PHS Inter-agency.......................... 2 ( -{ 2 e-$56- !e- 2 -$71- !--2 -$179- !-2 i-$108- !i--'2 QTotal , BA....................................................................... 2 ' { 2 f$90 2 $100- 2 $27 2 l-$73-'2 ]FTE..........................................................................................2 ' { 2 i267 2 275- 2 285 2 r+10[2 81/ FY 1999 numbers do not include $420,000 in Y2K funds.  'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbC$bC2    ''  ' ' Times New Roman4-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4-"Systemn-'- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M---'- Times New Roman}-A( U2 54Research on Health Costs, Quality, and Outcomes.....    2 5( A{ 2 5c$108A 2 5$141A- 2 5$168A 2 5l+$27R(f2 F?Medical Expenditures Panel Surveys............................. 2 F( R{ 2 Fi$36R 2 F$28R- 2 F$36R 2 Fr+$8c)~2 WOProgram Support................................................................ 2 W) Times New Roman4-c{ 2 Wo$2- ! do-c 2 W$2- ! d-c- 2 W!$2- ! d!-c 2 Wy$0- ! dy--t)r2 hGSubtotal, program level................................................ 2 h) t{ 2 h_$146t 2 h$171t- 2 h$206t 2 hi+$35(`2 ;Less Transfers: PHS Inter-agency.......................... 2 ( -{ 2 e-$56- !e- 2 -$71- !--2 -$179- !-2 i-$108- !i--'2 QTotal , BA....................................................................... 2 ' { 2 f$90 2 $100- 2 $27 2 l-$73-'2 ]FTE..........................................................................................2 ' { 2 i267 2 275- 2 285 2 r+10[2 81/ FY 1999 numbers do not include $420,000 in Y2K funds.  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Li2 ?5$297,438L2 ?$312,210L2 ?$335,233LX2 ?#+$23,023`j2 SBOutlays........................................................... 2 S `i2 S5$293,921`2 S$314,860`2 S$333,074`X2 S#+$18,214j2 zBFTE /1............................................................ 2 z i2 zJ3,9422 z4,2672 z4,282X 2 zJ15Arial-2 Q1/ In FY 2000, 50 FTEs are being paid from the Public Health and Social Services        I2 , Emergency Fund for millennium compliance.    -"Systemn-'-- `-   !^ !&--'- `'FG*OLE*WPC@@>>>>!>>f3f51f)%+-.PS,ym8GawT0H |coLd;K23yhh4VVE E 3 3!3!3!3"33L333KEEVJVhhIybaz;-Loy,E 0Txw+C8mvCu3f51f)%+-.h/"/!/!/!/ / / ///4////I///J///K///L//"351)%+-.,ym8GawT0H |coLd;K23yhh4VVE E 3 3!3!3!3"3"3"3#3j#E#E$Vk$V$h%hl%y% &m&&'T''(U(;(L(o<)))#*p* *0 +TW+w++%,r,,8 -m?--- .Z.Q.. /Z/$/X//B0u0=0q01B1!v1g112C2]]2222e3*3^37w3~33 3P34+4#E4i_4x44<444 4g444K455/5v555Z555> 5 5 4"!4i!4!4!4M"4"4"4 #4f#x4#_4$E4J$+4$4$3%3c%3%3%w36&^3|&*3&3&2>'2'2']2'C2E(2z(1(1(v1;)B1p)1)0)0*u0T*B0*/*/+/8+Z/m+ /+.+.+Z.., .c,-,-,?-, --,6-r,Y-%,-+-+-W+- +.*=.p*`.#*r.).).<).(.(.U(!/(3/'D/T'V/'h/&y/m&/ &/%/l%/%/$/k$/$/#/j#/#/"/"/"/!/!/!/ / / ///4//")%+-  / B1)%+-  B1_4351)%+-.( //3y/h/h/y/b///351)%+-.//3y/h/"/)%+- 7M7)%+- 7/351)%+-. xQuQ(x351)%+-.xQ"x)%+-  W W )%+-  W QB 3߿35331`h/V/2D/3/!/K...d..r.c`.=..|-H---aY-6--,G,,c,y.,,+++xm++8++*x*DT**))]p)*;)((z(vE(C'''>'&\&B|&6&%%c%%t$[$AJ$'$#f# #""M"!t!ti!Z"!Z @ @> @@'Z'''v'/@@@K@ZZgt t<i#'AP[ t~7eB\]Cvg!*q]=DXx$+xt$AXZ= qs!?g    ]X ?   e  q 7W ~$   P   # ip W = <#    g   K   / v   Z   > "! i! ! ! M" " "# #= f#W #p $ J$ $ $ % c% %$ %W 6&q |& & & >' '? 'X ' E( z( ( (?;)sp))) *ZT***+A8+tm+++(+u.,c,,C,v,-6-CY---+-x-.=.E`.r..,.y..-.z!/3/D/aV/h/)%+-.h/V/2D/3/!/K...d..r.c`.=..|-H---aY-6--,G,,c,y.,,+++xm++8++*x*DT**))]p)*;)((z(vE(C'''>'&\&B|&6&%%c%%t$[$AJ$'$#f# #""M"!t!ti!Z"!Z @ @> @@'Z'''v'/@@@K@ZZgt t<i#'AP[ t~7eB\]Cvg!*q]=DXx$+xt$AXZ= qs!?g    ]X ?   e  q 7W ~$   P   # ip W = <#    g   K   / v   Z   > "! i! ! ! M" " "# #= f#W #p $ J$ $ $ % c% %$ %W 6&q |& & & >' '? 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"- "--'-- ,--'-- , Arials-----"Systemn-'---     2 CHIP----'--- ,-----'---  2 2 6Medicare   ----'--- ,-----'--- QV& 2 /Administration   ----'--- ,-----'--- F 2 Medicaid  ----'--- ,---'--- - - -4- "- H>- -- - -  Arial- - FB- -  2 B$213.6  ' o-- -- 2- -- - - -- -   2 $1.9  ' o-- -- ,_ - -- - - *Z - -  2 $114.7  ' o-- -- WK- -- - - XO- -   2 ZO$2.9  ' o--  - ' o '  '  ESRD SMI oldsEpogen EPOorthotics HHSToolBartable.Run BBA PSO PPOcapitatedHCFACHIPAA MIP HCFA ORT PROsnoncoverageEMTALAC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt\C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT  WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT'^'^c@     o'' , ' ' ,' 1f - "- - -  $!%)-.! "-P_%- "- $c.1369<>ADGJLORTWZ]_bdgjloqtvy{~}zwtroligd.- $-26:>BFJNRVZ^bfjnquy|   #%(+.1369<>ADGJLORTWZ]]_bdgjloqtvy{~.- "-M3 - "- M3M3$ 3f - 3f$. 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"- "--'-- ,--'-- , Arials-----"Systemn-'---     2 CHIP----'--- ,-----'---  2 2 6Medicare   ----'--- ,-----'--- QV& 2 /Administration   ----'--- ,-----'--- F 2 Medicaid  ----'--- ,---'--- - - -4- "- H>- -- - -  Arial- - FB- -  2 B$213.6  ' o-- -- 2- -- - - -- -   2 $1.9  ' o-- -- ,_ - -- - - *Z - -  2 $114.7  ' o-- -- WK- -- - - XO- -   2 ZO$2.9  ' o--  - ' o '  'ST*OLE*WPC11!1 |y   g''  ' g' gTimes New Roman<-  2 e1998 2 1999 2 2000 2 |+/-Times New Roman.-?2 5%Beneficiaries Enrolled (in Millions): R+y2 FLHospital Insurance (HI) ....................................................  2 F+ 2 Fl38.6 2 F39.0 2 F39.4 2 F|0.4c)`2 W;Supplementary Medical Insurance (SMI)......................   2 W) 2 Wl36.6 2 W36.9 2 W37.2 2 W|0.3'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTC`C  |y   g''  ' g' gTimes New Roman<-  2 e1998 2 1999 2 2000 2 |+/-Times New Roman.-?2 5%Beneficiaries Enrolled (in Millions): R+y2 FLHospital Insurance (HI) ....................................................  2 F+ 2 Fl38.6 2 F39.0 2 F39.4 2 F|0.4c)`2 W;Supplementary Medical Insurance (SMI)......................   2 W) 2 Wl36.6 2 W36.9 2 W37.2 2 W|0.3'V]*OLE*WPC!$ [   :''  ' :' :-   !Times New Roman<-}  2 a1998 2 1999/ 2 20002 _Request Times New Roman4--"Systemn-'-- 3#- 2 $]Actual - !$1]---2 $Enacted- !*1---2 $Request - !,1---2 $O +/- Enacted- !<1O----'-- :Times New RomanG- 2 N Current Law: k)2 _YHI Benefits ............................................................................. 2 _) k}2 _P$134,320k2 _$130,990k/2 _$136,116k2 __+$5,126|*2 pWSMI Benefits .......................................................................... 2 p* Times New Roman4-|}2 p\75,782- !!}\-|2 p91,012- !!}-|/2 p100,521- !'}-|2 p_+$9,509- !(}_--*l2 CSubtotal, Medicare Benefits........................................  2 * }2 I$210,1022 $222,002/2 $236,6372 S+$14,635-)2 TAdministration /2...................................................................  2 ) }2 \$2,5872 $2,998/2 $3,1182 h+$120*]2 9HCFAC /3 (including Medicare Integrity Program)..........    2 * } 2 k522 2 760/ 2 744 2 q-$16)o2 EPeer Review Organizations (PROs) ....................................   2 ) } 2 k222 2 368/ 2 295 2 q-$73*2 PTransfers to Medicaid........................................................... 2 * -} 2 w0- !w- 2 60- ! -/ 2 #90- ! #- 2 n+$30- !n--)j2 BTotal Outlays, Current Law........................................  2 ) }2 I$213,4332 $226,188/2 $240,8842 S+$14,696-)2 YPremiums ................................................................................  2 ) -}2 \20,751- !!\-\2 8 - !$8-2 \ - !\-2 21,299- !!-!2  - !3-2  - !-/2 22,969- !!- 2  - !!-2   - ! -2 l1,670- !l-l2 < - !0<-2 l - !l--7*f2 +?Total Net Outlays, Current Law.................................   2 +* 7}2 +I$192,68272 +$204,8897/2 +$217,91572 +S+$13,026-(2 MProposed Legislation::j*2 ^SMedicare Benefits.................................................................. 2 ^* 2 ^u$0 2 ^$02 ^-$1,2432 ^f-$1,243{+2 oQProposed User Fees............................................................... 2 o+ 2 o{0 2 o0 2 o-1942 oo-$194)2 YPremiums ................................................................................  2 ) 2 {0 2 0 2 -0 2 $0-+p2 FTotal Medicare Savings ............................................... 2 + 2 s$0 2 $02  -$1,4372 a-$1,437)d2 >Total, Net Outlays, Proposed Law .............................  2 ) }2 B +$192,6822  +$204,889/2  +$216,4782 S+$11,589-F2 */ 1 Numbers may not add due to rounding.   x2 K/ 2 Includes Administration payments to SSA and other non-HCFA agencies.      r2 G/ 3 Health Care Fraud and Abuse Control, includes FBI, excludes OIG.   -'X>p0LibsterYo yo : WV 6Plain Texttimes new romanXXXXXXXX  TANF QIs FPL FFPToolBartable.Runpartum SSDI IMDTaskforce CNMIJeffords ACFC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptWPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTC$C: [   :''  ' :' :-   !Times New Roman<-}  2 a1998 2 1999/ 2 20002 _Request Times New Roman4--"Systemn-'-- 3#- 2 $]Actual - !$1]---2 $Enacted- !*1---2 $Request - !,1---2 $O +/- Enacted- !<1O----'-- :Times New RomanG- 2 N Current Law: k)2 _YHI Benefits ............................................................................. 2 _) k}2 _P$134,320k2 _$130,990k/2 _$136,116k2 __+$5,126|*2 pWSMI Benefits .......................................................................... 2 p* Times New Roman4-|}2 p\75,782- !!}\-|2 p91,012- !!}-|/2 p100,521- !'}-|2 p_+$9,509- !(}_--*l2 CSubtotal, Medicare Benefits........................................  2 * }2 I$210,1022 $222,002/2 $236,6372 S+$14,635-)2 TAdministration /2...................................................................  2 ) }2 \$2,5872 $2,998/2 $3,1182 h+$120*]2 9HCFAC /3 (including Medicare Integrity Program)..........    2 * } 2 k522 2 760/ 2 744 2 q-$16)o2 EPeer Review Organizations (PROs) ....................................   2 ) } 2 k222 2 368/ 2 295 2 q-$73*2 PTransfers to Medicaid........................................................... 2 * -} 2 w0- !w- 2 60- ! -/ 2 #90- ! #- 2 n+$30- !n--)j2 BTotal Outlays, Current Law........................................  2 ) }2 I$213,4332 $226,188/2 $240,8842 S+$14,696-)2 YPremiums ................................................................................  2 ) -}2 \20,751- !!\-\2 8 - !$8-2 \ - !\-2 21,299- !!-!2  - !3-2  - !-/2 22,969- !!- 2  - !!-2   - ! -2 l1,670- !l-l2 < - !0<-2 l - !l--7*f2 +?Total Net Outlays, Current Law.................................   2 +* 7}2 +I$192,68272 +$204,8897/2 +$217,91572 +S+$13,026-(2 MProposed Legislation::j*2 ^SMedicare Benefits.................................................................. 2 ^* 2 ^u$0 2 ^$02 ^-$1,2432 ^f-$1,243{+2 oQProposed User Fees............................................................... 2 o+ 2 o{0 2 o0 2 o-1942 oo-$194)2 YPremiums ................................................................................  2 ) 2 {0 2 0 2 -0 2 $0-+p2 FTotal Medicare Savings ............................................... 2 + 2 s$0 2 $02  -$1,4372 a-$1,437)d2 >Total, Net Outlays, Proposed Law .............................  2 ) }2 B +$192,6822  +$204,889/2  +$216,4782 S+$11,589-F2 */ 1 Numbers may not add due to rounding.   x2 K/ 2 Includes Administration payments to SSA and other non-HCFA agencies.      r2 G/ 3 Health Care Fraud and Abuse Control, includes FBI, excludes OIG.   -'_e*OLE*WPC::F F !F      6''  ' 6' 6-   !6Times New Roman4-  2 e1998- !e- 2 1999- !- 2 2000- !-Times New Roman4-2  Enrollment: - !< -Times New Roman}-0*|2 $NAged 65 and Over .............................................................  2 $* 0}2 $b4,20002 $4,3000/2 $4,300A+~2 5OBlind and Disabled............................................................. 2 5+ A}2 5b6,400A2 56,500A/2 56,700R)2 FQNeedy Adults ....................................................................  2 F) R}2 Fb6,200R2 F6,200R/2 F6,300c+2 WQNeedy Children................................................................... 2 W+ -c}2 W\16,100- !!d\-c2 W16,200- !!d-c/2 W16,500- !!d-Times New Roman4-*2 yVTotal.................................................................................2 y* }2 yW32,9002 y33,200/2 y 33,800-'  jC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT  HCFAHIPAA BBA$reconsiderations ARUs FTEbeniestelemedicine"recertification ESRD QIESunprocessable EOMBEOMBsyears.This CLIA xx.xPHSSEF HHS DHHS x.x NMEPMedicare.GovinternetToolBartable.Run HMOs PPOsWPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT{: {:(    6''  ' 6' 6-   !6Times New Roman4-  2 e1998- !e- 2 1999- !- 2 2000- !-Times New Roman4-2  Enrollment: - !< -Times New Roman}-0*|2 $NAged 65 and Over .............................................................  2 $* 0}2 $b4,20002 $4,3000/2 $4,300A+~2 5OBlind and Disabled............................................................. 2 5+ A}2 5b6,400A2 56,500A/2 56,700R)2 FQNeedy Adults ....................................................................  2 F) R}2 Fb6,200R2 F6,200R/2 F6,300c+2 WQNeedy Children................................................................... 2 W+ -c}2 W\16,100- !!d\-c2 W16,200- !!d-c/2 W16,500- !!d-Times New Roman4-*2 yVTotal.................................................................................2 y* }2 yW32,9002 y33,200/2 y 33,800-'gh*OLE*WPCmmEE!E }    f''  ' f' f-   !DTimes New Roman4-  2 e1998 2 1999 2 20002 _Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- fTimes New Roman4- 2 5 Current Law - !DB-Times New Roman}-R)2 FVBenefits \1...........................................................................2 F) R}2 FV$96,409R2 F$102,793R/2 F$108,803R2 F_+$6,009c+|2 WNState Administration .........................................................  2 W+ -c}2 Wb4,825- !db-c2 W5,740- !d-c/2 W6,018- !d-c2 Wh+$278- !dh--)c2 y=Total Net Outlays, Current Law \2 ...........................   2 y) }2 yI$101,2342 y$108,534/2 y$114,8212 yZ+$6,287-'2 Proposed Legislation:- !t--*2 WSavings ...............................................................................2 * } 2 w0 2 0/ 2 -310 2 q-310*2 YCosts....................................................................................2 * -} 2 w0- !w- 2 0- !-/ 2 149- !- 2 n+149- !n--*i2 ASubtotal, Proposed Legislation ..................................2 * } 2 o$0 2 $0/2 -$1612 g-$161+c2 =Total Net Outlays, Proposed Law \3...........................  2 + }2 I$101,2342 $108,534/2 $114,6602 Z+$6,126-L2 ./1 Includes Vaccine for Children Outlays.  2 #a/2 Starting in FY 2000, these numbers do not include the Medicaid outlays associated with CHIP.    I2 4,/3 Numbers may not add due to rounding.    -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTCC$ }    f''  ' f' f-   !DTimes New Roman4-  2 e1998 2 1999 2 20002 _Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- fTimes New Roman4- 2 5 Current Law - !DB-Times New Roman}-R)2 FVBenefits \1...........................................................................2 F) R}2 FV$96,409R2 F$102,793R/2 F$108,803R2 F_+$6,009c+|2 WNState Administration .........................................................  2 W+ -c}2 Wb4,825- !db-c2 W5,740- !d-c/2 W6,018- !d-c2 Wh+$278- !dh--)c2 y=Total Net Outlays, Current Law \2 ...........................   2 y) }2 yI$101,2342 y$108,534/2 y$114,8212 yZ+$6,287-'2 Proposed Legislation:- !t--*2 WSavings ...............................................................................2 * } 2 w0 2 0/ 2 -310 2 q-310*2 YCosts....................................................................................2 * -} 2 w0- !w- 2 0- !-/ 2 149- !- 2 n+149- !n--*i2 ASubtotal, Proposed Legislation ..................................2 * } 2 o$0 2 $0/2 -$1612 g-$161+c2 =Total Net Outlays, Proposed Law \3...........................  2 + }2 I$101,2342 $108,534/2 $114,6602 Z+$6,126-L2 ./1 Includes Vaccine for Children Outlays.  2 #a/2 Starting in FY 2000, these numbers do not include the Medicaid outlays associated with CHIP.    I2 4,/3 Numbers may not add due to rounding.    -'l4,HLPLibbieC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptWPC@@>>>>!>>z     `''  ' ` "--  M "--'-- L--'-- GMMH- "- MMMM F$!44433322110//--++--//011223334444H- $xeffghijklmnprsuwxz|}~|zzxvutrqponmlkjjihhgfffeeeeeeeeeefffghhijjklmnopqr t uvxzz|~ !#%&()*+,-//01123334444433322100/--+e "-])]#h - "- - $eeeee "-LLe33H- "- 3333$ dddddddddffH- ff$ ddddddddeed "-PVdfH- "- ff.$hhgffeeeddddeeeffghhhH- $ hhgffeeeddh "-U[fKKKH- "- KKKKKKj$3~|{ywvtsqpnmlkjihhijklmnpqstvwy{|~H- :$~|{ywvtsqpnmlkjih "- k qxM3H- "- M3M3$+*)(&%#"                              "#%&()*++3fH- 3f$B+*)(&%#"    + "-U U --'-- 3fL Impact------"Systemn-'--- 3f:^E  02 HPRESIDENT'S BUDGET FOR HHS      2 FY 2000  ----'--- L---'--- L Univers (W1)--------'---  l 2  Discretionary 2 210.1% ----'--- L-------'--- Q 2  Children's  2  Mandatory  2 "3.5% ----'--- L------'--- qbI) 2 L+ Medicare 2 ]353.6% ----'--- L-----'--- on) 2 q+ Other 0.6%  ----'--- L-----'--- V 2  TANF 3.5%  ----'--- L-------'--- q9 2 ;Medicaid 2 C28.6% ----'--- L---'--- `- -' ` '  '  Fn&XBXXXXBXXXB-X,XX-  __Excel_spreadsheet_Ԁwillgointhisposition.To_importthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange_.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.no*OLE*WPC!    ''  ' ' -   !Times New Roman4-  2 e1998 2 1999 2 20002 \Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- -A* i2 5A Total Outlays3, Current Law ....................................  2 5* A} 2 5o$5A2 5$1,437A/2 5 $1,900A2 5d+$463Times New Roman}-(2 WProposed Legislation::t*~2 hOChild Health Costs............................................................. 2 h* t} 2 hq$0t 2 h$0t/ 2 h$36-t 2 hk+$36+~2 OTotal Outlays,................................................................. 2 + } 2 o$52 $1,437/2 $1,9362 d+$499-@2 &/1 Numbers may not add due to rounding   2 p/2 Since Child Health is appropriated through 2007 in the enacting legislation, the total outlays request under  |2 Ncurrent law for Child Health represent an estimate of program spending in 1999    2 g/3 Because States have the option to expand childrens health insurance coverage through a State grant 2 jprogram, Medicaid, or a combination of the two, outlays are split between the Childrens Health Insurance       %2 Program and Medicaid  -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTCC2    ''  ' ' -   !Times New Roman4-  2 e1998 2 1999 2 20002 \Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- -A* i2 5A Total Outlays3, Current Law ....................................  2 5* A} 2 5o$5A2 5$1,437A/2 5 $1,900A2 5d+$463Times New Roman}-(2 WProposed Legislation::t*~2 hOChild Health Costs............................................................. 2 h* t} 2 hq$0t 2 h$0t/ 2 h$36-t 2 hk+$36+~2 OTotal Outlays,................................................................. 2 + } 2 o$52 $1,437/2 $1,9362 d+$499-@2 &/1 Numbers may not add due to rounding   2 p/2 Since Child Health is appropriated through 2007 in the enacting legislation, the total outlays request under  |2 Ncurrent law for Child Health represent an estimate of program spending in 1999    2 g/3 Because States have the option to expand childrens health insurance coverage through a State grant 2 jprogram, Medicaid, or a combination of the two, outlays are split between the Childrens Health Insurance       %2 Program and Medicaid  -'  st*OLE*WPC!t 9 [   ''  ' ' -   ! MS Sans Serif--"Systemn-'-- -  *2 NURSING HOME INITIATIVE    --2 FY 2000---'--  MS Sans Serif- 2 MFunding Source MS Sans Serif---'-- "- 2 millions- !!----'-- - 2 ,HCFA: Times New Roman}- MS Sans Serif-2 = Discretionary-YQ2 N1 Medicare Survey and Certification............. Y 2 N18.1j[2 _8 Federal Administration...............................2 _ j 2 _16.9-2 w Mandatory -Q2 1 Medicaid Survey and Certification............. 2   MS Sans Serifn- 2 15.6- !--C2 (Subtotal, HCFA.......................... 2  -2 $50.6-+2 Departmental Management:    -2  Discretionary-T2 3 Office of the General Counsel...................2   2 6.7R2 2 Departmental Appeals Board.....................- 2 2.8- !----'--  92 !Subtotal, Departmental Management    ---'--   2 $9.5-=2 $Total, Nursing Home Initiative......   2  2 $60.1--'-- -   "-  "- !- - !- - ! - - ! - - !- - !--'- 'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT vz  9 [   ''  ' ' -   ! MS Sans Serif--"Systemn-'-- -  *2 NURSING HOME INITIATIVE    --2 FY 2000---'--  MS Sans Serif- 2 MFunding Source MS Sans Serif---'-- "- 2 millions- !!----'-- - 2 ,HCFA: Times New Roman}- MS Sans Serif-2 = Discretionary-YQ2 N1 Medicare Survey and Certification............. Y 2 N18.1j[2 _8 Federal Administration...............................2 _ j 2 _16.9-2 w Mandatory -Q2 1 Medicaid Survey and Certification............. 2   MS Sans Serifn- 2 15.6- !--C2 (Subtotal, HCFA.......................... 2  -2 $50.6-+2 Departmental Management:    -2  Discretionary-T2 3 Office of the General Counsel...................2   2 6.7R2 2 Departmental Appeals Board.....................- 2 2.8- !----'--  92 !Subtotal, Departmental Management    ---'--   2 $9.5-=2 $Total, Nursing Home Initiative......   2  2 $60.1--'-- -   "-  "- !- - !- - ! - - ! - - !- - !--'- 'vw*OLE*WPC  ! 2 P    ''  ' ' -   !Times New Roman4- 2 SFY 19982 FY 19992 FY 20002 _Request Times New Roman4--"Systemn-'-- "- 2 WApprop. - !* W---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman}-A+ 2 5P Medicare Contractors........................................................ 2 5+ 2 5`$1,2162 5$1,2702 5$1,274 2 5$4R)x2 FKSurvey and Certification ..................................................2 F) R} 2 Fk154Rk!2 F8 2 Fk R 2 F171R(2 F 2 F R/ 2 F204R2 F 2 F R 2 F{33R{'2 F< 2 F{ c+y2 WLFederal Administration......................................................  2 W+ c} 2 Wk367ck!2 W8 2 Wk c 2 W456c(2 W 2 W c/ 2 W483c2 W 2 W c 2 W{27c{'2 W< 2 W{ --'-- wgq* 2 eVResearch .............................................................................2 e* Times New Roman4-q} 2 eq52- ! rq-qq$2 e8 - !9r8-2 eq - !rq-q 2 e50- ! r-q+2 e - !Hr-2 e - !r-q/ 2 e#55- ! r#-q#"2 e - !6r-2 e# - !r#-Times New RomanL-q 2 e5q*2 e< - !Kt<-2 e --'-- -* Z2 y7HCFA Discretionary Budget Authority....................     2 y* 2 y[$1,7892 y$1,9472 y $2,016 2 yv$69-+2 YCLIA..................................................................................... 2 + } 2 q43q$2 8 2 q  2 43+2  2  / 2 #43#"2  2 # { 2 w-w$2 > 2 w +i2 ASale of Data/FQHMO applications..................................  2 + q 2 m-m!2 : 2 m  2 2.2  2  / 2 )2)%2  2 ) { 2 w-w$2 > 2 w )m2 DMedicare + Choice Information.......................................  2 ) } 2 q95q$2 8 2 q  2 95+2  2  / 2 1002  2   2 5*2 < 2  -)2 W Subtotal...............................2 ) }2 ^1,927^2 : 2 ^ 2 2,087!2  2  /2 2,1612  2   2 y74y%2 = 2 y -)U2 4Medicare + Choice Information Proposed Increase.....  2 ) q 2 m-k!2 8 2 k  2 -(2  2  / 2 #50#"2  2 #  2 {50{'2 < 2 { +o2 ECLIA User Fees -- Current Law........................................   2 + 2 q-43 2 -43 2 #-43 2 0 )W2 5Sale of Data/FQHMO applications -- Current Law.......   2 ) 2 {0 2 -2 2 )-2 2 0)a2 <Managed Care User Fees -- Current Law.......................   2 ) 2 q-95 2 -95 2 -100 2 -5--'-- 2",+ {2 MProposed User Fees........................................................... 2 + - 2 {0- !-{- 2 0- !-- 2 -244- !--- 2 u-244- !/u---'-- -@* Z2 47Proposed BA (including New User Fees) .................  2 4* 2 4[$1,7892 4$1,9472 4 $1,8222 4k-$125-b)|2 VNProposed Outlays ............................................................. 2 V) -2 V[$1,7892 V$1,9472 V $1,8222 Vk-$125-+2 x]FTE /1.......................................................................................2 x+ }2 xb3,9422 x4,267/2 x4,282 2 x{15{'2 x< 2 x{ 2 o/1 In FY 2000, 50 FTEs are being paid out of the $150 million for the Y2K compliance effort funded out of the    i2 A Public Health and Social Services Emergency Fund (PHSSEF).   --'-- -   "- "- !-3- !V-- !-C- !xC-- !-1- !]1--'- 'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICTCv2C/ P    ''  ' ' -   !Times New Roman4- 2 SFY 19982 FY 19992 FY 20002 _Request Times New Roman4--"Systemn-'-- "- 2 WApprop. - !* W---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman}-A+ 2 5P Medicare Contractors........................................................ 2 5+ 2 5`$1,2162 5$1,2702 5$1,274 2 5$4R)x2 FKSurvey and Certification ..................................................2 F) R} 2 Fk154Rk!2 F8 2 Fk R 2 F171R(2 F 2 F R/ 2 F204R2 F 2 F R 2 F{33R{'2 F< 2 F{ c+y2 WLFederal Administration......................................................  2 W+ c} 2 Wk367ck!2 W8 2 Wk c 2 W456c(2 W 2 W c/ 2 W483c2 W 2 W c 2 W{27c{'2 W< 2 W{ --'-- wgq* 2 eVResearch .............................................................................2 e* Times New Roman4-q} 2 eq52- ! rq-qq$2 e8 - !9r8-2 eq - !rq-q 2 e50- ! r-q+2 e - !Hr-2 e - !r-q/ 2 e#55- ! r#-q#"2 e - !6r-2 e# - !r#-Times New RomanL-q 2 e5q*2 e< - !Kt<-2 e --'-- -* Z2 y7HCFA Discretionary Budget Authority....................     2 y* 2 y[$1,7892 y$1,9472 y $2,016 2 yv$69-+2 YCLIA..................................................................................... 2 + } 2 q43q$2 8 2 q  2 43+2  2  / 2 #43#"2  2 # { 2 w-w$2 > 2 w +i2 ASale of Data/FQHMO applications..................................  2 + q 2 m-m!2 : 2 m  2 2.2  2  / 2 )2)%2  2 ) { 2 w-w$2 > 2 w )m2 DMedicare + Choice Information.......................................  2 ) } 2 q95q$2 8 2 q  2 95+2  2  / 2 1002  2   2 5*2 < 2  -)2 W Subtotal...............................2 ) }2 ^1,927^2 : 2 ^ 2 2,087!2  2  /2 2,1612  2   2 y74y%2 = 2 y -)U2 4Medicare + Choice Information Proposed Increase.....  2 ) q 2 m-k!2 8 2 k  2 -(2  2  / 2 #50#"2  2 #  2 {50{'2 < 2 { +o2 ECLIA User Fees -- Current Law........................................   2 + 2 q-43 2 -43 2 #-43 2 0 )W2 5Sale of Data/FQHMO applications -- Current Law.......   2 ) 2 {0 2 -2 2 )-2 2 0)a2 <Managed Care User Fees -- Current Law.......................   2 ) 2 q-95 2 -95 2 -100 2 -5--'-- 2",+ {2 MProposed User Fees........................................................... 2 + - 2 {0- !-{- 2 0- !-- 2 -244- !--- 2 u-244- !/u---'-- -@* Z2 47Proposed BA (including New User Fees) .................  2 4* 2 4[$1,7892 4$1,9472 4 $1,8222 4k-$125-b)|2 VNProposed Outlays ............................................................. 2 V) -2 V[$1,7892 V$1,9472 V $1,8222 Vk-$125-+2 x]FTE /1.......................................................................................2 x+ }2 xb3,9422 x4,267/2 x4,282 2 x{15{'2 x< 2 x{ 2 o/1 In FY 2000, 50 FTEs are being paid out of the $150 million for the Y2K compliance effort funded out of the    i2 A Public Health and Social Services Emergency Fund (PHSSEF).   --'-- -   "- "- !-3- !V-- !-C- !xC-- !-1- !]1--'- 'y~*OLE*WPCK%K%!K%     ''  ' ' -   !Times New Roman-  2 e1998 2 1999 2 20002 \Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman-R) 2 FUClinical Trials .....................................................................2 F) R} 2 Fw0R 2 F0R/ 2 F#10Times New Roman4-R 2 Ft+10- !St--c*2 WVTotal.................................................................................2 W* c} 2 Wo$0c 2 W$0 2 W$10c 2 Wk+$10H2 x+ /1 Numbers may not add due to rounding   --'-- -   ! ! ! !--'- 'C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT  C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPTWPWin 6.0/OLE 1.0 Prefix Information Marker! METAFILEPICTC C(    ''  ' ' -   !Times New Roman-  2 e1998 2 1999 2 20002 \Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman-R) 2 FUClinical Trials .....................................................................2 F) R} 2 Fw0R 2 F0R/ 2 F#10Times New Roman4-R 2 Ft+10- !St--c*2 WVTotal.................................................................................2 W* c} 2 Wo$0c 2 W$0 2 W$10c 2 Wk+$10H2 x+ /1 Numbers may not add due to rounding   --'-- -   ! ! ! !--'- '*OLE*WPC''  ! n 6   ''  ' ' Times New Roman4-  2 e1998 2 1999 2 20002 \Request Times New Roman4-"Systemn-'- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O---'- Times New Roman- 2 5 Current Law: R+y2 FLMedicare Trust Fund ........................................................ 2 F+ R}2 FP$213,433R2 F$226,188R/2 F$240,884R2 F_+14,696c+2 WVMedicaid ............................................................................. 2 W+ 2 WZ101,2342 W108,5342 W 114,821c2 We+6,287t*2 hYCHIP .................................................................................... 2 h* Times New Roman4-t} 2 hw5- !uw-t2 h1,437- !u-t/2 h1,900- !u-t 2 hn+463- !un--)j2 BTotal Outlays, Current Law........................................  2 ) }2 B +$314,6722  +$336,159/2  +$357,6052 Z+21,446-)2 UPremiums ............................................................................  2 ) }2 R-$20,7512 -$21,299/2 -$22,9692 h-1,670-*f2 ?Total Net Outlays, Current Law.................................   2 * }2 B +$293,9212  +$314,860/2  +$334,6362 S+$19,776-2  Proposed Law: +2 VMedicare ............................................................................. 2 + } 2 q$0 2 $0/2 -$1,2432 b-$1,243 +2 VMedicaid ............................................................................. 2 + 2 {0 2 0 2 -161  2 q-161*2 YCHIP .................................................................................... 2 * 2 {0 2 0 2 '36 2 t+36/+2 #VUser Fees............................................................................. 2 #+ - 2 #{0- !0{- 2 #0- !0- 2 #-194- !0-/ 2 #q-194- !0q--@*2 4ZTotal.....................................................................................2 4* 2 4{0 2 402 4-1562@2 4h-1,562-b+c2 V=Total Net Outlays, Proposed Law /2 ..........................  2 V+ b}2 VI$293,921b2 V$314,860b/2 V$333,074b2 VZ$18,214-@2 x&/1 Numbers may not add due to rounding   2 X/2 Total net outlays equal current law outlays minus the impact of proposed legislation    32  and offsetting receipts.' C:\DATA\WP8\2000pr.wpdwpddd and Final master document for the Press Release duplicate.wpdFYK%K%X<SS:Default ParaS\  `&Times New RomanSS\  `&Times New RomanSC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT   HBIS DOJLIHEAPC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptWPWin 6.0/OLE 1.0 Prefix Information Marker" METAFILEPICTC.> Oi   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Roman4-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New RomanI-!2 +Budget Authority:  - !h:-Times New Roman,-Lg2 ?@Discretionary................................................... 2 ? 2 ?H$8,3542 ?$8,6732 ?$9,432LX2 ?4+$759`i2 SAEntitlement......................................................  2 S -2 SA$28,227- !-bA-2 S$29,027- !-b-2 S$28,627- !-b-`X2 S7-$400- !!b7--ti2 gATotal............................................................ 2 g 2 gA$36,5812 g$37,7002 g$38,059tX2 g4+$359-2 Outlays: - !0--g2 @Discretionary................................................... 2  2 H$7,9192 $8,4782 $8,995X2 4+$517i2 AEntitlement......................................................  2  -2 A$24,670- !-A-2 $25,412- !--2 $28,954- !--X2 *+$3,542- !.*--i2 ATotal............................................................ 2  2 A$32,5892 $33,8902 $37,949X2 *+$4,059-'*OLE*WPC@@>>>>!>>:$  j   7''  ' 7 "--  8 "--'-- 7--'-- 2``` - "- `````` .$iqhpfoeoendmcmclckcjcyczc{c|d|e}e~f~hiiq- j$3iqgpfodndmclckcjchdgefffgeidkcmbpar`u_y_|^^]]\\\\\\\\\]]^^__`abcdefghijiq "-UX] "-& "-- 5B( ||||Ǐ>>>>-$jklm|{zy ---& -$ jklm|{zyj-&-- 5B( |||>|㏏>>>=-$iijkllmj ---& -$ iijkllmji- "-ddy "-&-- 5B( wwwwww^-$krjrjqiqijjk ---& -$ krjrjqiqijjkkr-&-- 5B( wwwwww===^-$krjrjqiqj ---& -$krjrjqiqjkr- "-@@@ - "- @@@@@@"$uusurtptnsmskrkmnprsuuu- $ uusurtptnsmskrjuu "-JMp- "-:$mnnopqrsstuuv~}}|m- "$mnnopqrsstuuvjm "- "-&--KKK 5B( KKKxxxxin= [boot.des- $w~w}wzvyvvuuuuvyz}~ ---& -"$w~w}wzvyvvuuuuvyz}~w-&-- 5B( xxxxin= [boot.des-$w~w}wzvyvvuuuj ---& -$ w~w}wzvyvvuuujw- "-``{ "-&-- 5B( ]UUUUUUUծUUUUUUUl vidc.MSVC=msv- $vvwwwxx ---& -"$vvwwwxxv-&-- 5B( UUUUUUUUUUUUUUUUG=C:\WINDOWS\GIN-$vvwwwxxj ---& -$ vvwwwxxjv- "-- "- :$xxyyyyyyxxxxwx-"$xxyyyyyyxxxxwjx "---'-- 7Times New Roman0-----"Systemn- '--- #  ' F2 )*FY 2000 Discretionary Request $9.4 Billion ---- '--- 7--- '--- 7Small Fonts-- - - - - --- '- -- V:l 2 <n Head Start2 Hx55.9%- --- '- -- 7- - - - --- '- -- rV 2 XOther 2 d4.5%- --- '- -- 7- - - - - - --- '- -- K 2 Refugee 2  Resettlement 2 $4.6%- --- '- -- 7- - - - - --- '- --  2 Community 2 Services 2 5.5%- --- '- -- 7- - - - - - --- '- -- ~C 2 VChild 2 EWelfare/Child 2 SAbuse 2 U4.02%- --- '- -- 7- - - - - - --- '- -- ]^5 2 `7 Violence 2 l9Against 2 x9Women  2 @1.2%- --- '- -- 7- - - - --- '- -- y 2 {LIHEAP2 11.7%- --- '- -- 7- - - - - - --- '- -- | 2 Child Care 2 ~ Block Grant2 12.6%- --- '- -- 7--- '- -- 7--' 7 '  'WPWin 6.0/OLE 1.0 Prefix Information Marker$ METAFILEPICT$ t@$$   j   7''  ' 7 "--  8 "--'-- 7--'-- 2``` - "- `````` .$iqhpfoeoendmcmclckcjcyczc{c|d|e}e~f~hiiq- j$3iqgpfodndmclckcjchdgefffgeidkcmbpar`u_y_|^^]]\\\\\\\\\]]^^__`abcdefghijiq "-UX] "-& "-- 5B( ||||Ǐ>>>>-$jklm|{zy ---& -$ jklm|{zyj-&-- 5B( |||>|㏏>>>=-$iijkllmj ---& -$ iijkllmji- "-ddy "-&-- 5B( wwwwww^-$krjrjqiqijjk ---& -$ krjrjqiqijjkkr-&-- 5B( wwwwww===^-$krjrjqiqj ---& -$krjrjqiqjkr- "-@@@ - "- @@@@@@"$uusurtptnsmskrkmnprsuuu- $ uusurtptnsmskrjuu "-JMp- "-:$mnnopqrsstuuv~}}|m- "$mnnopqrsstuuvjm "- "-&--KKK 5B( KKKxxxxin= [boot.des- $w~w}wzvyvvuuuuvyz}~ ---& -"$w~w}wzvyvvuuuuvyz}~w-&-- 5B( xxxxin= [boot.des-$w~w}wzvyvvuuuj ---& -$ w~w}wzvyvvuuujw- "-``{ "-&-- 5B( ]UUUUUUUծUUUUUUUl vidc.MSVC=msv- $vvwwwxx ---& -"$vvwwwxxv-&-- 5B( UUUUUUUUUUUUUUUUG=C:\WINDOWS\GIN-$vvwwwxxj ---& -$ vvwwwxxjv- "-- "- :$xxyyyyyyxxxxwx-"$xxyyyyyyxxxxwjx "---'-- 7Times New Roman0-----"Systemn- '--- #  ' F2 )*FY 2000 Discretionary Request $9.4 Billion ---- '--- 7--- '--- 7Small Fonts-- - - - - --- '- -- V:l 2 <n Head Start2 Hx55.9%- --- '- -- 7- - - - --- '- -- rV 2 XOther 2 d4.5%- --- '- -- 7- - - - - - --- '- -- K 2 Refugee 2  Resettlement 2 $4.6%- --- '- -- 7- - - - - --- '- --  2 Community 2 Services 2 5.5%- --- '- -- 7- - - - - - --- '- -- ~C 2 VChild 2 EWelfare/Child 2 SAbuse 2 U4.02%- --- '- -- 7- - - - - - --- '- -- ]^5 2 `7 Violence 2 l9Against 2 x9Women  2 @1.2%- --- '- -- 7- - - - --- '- -- y 2 {LIHEAP2 11.7%- --- '- -- 7- - - - - - --- '- -- | 2 Child Care 2 ~ Block Grant2 12.6%- --- '- -- 7--- '- -- 7--' 7 '  '*OLE*WPC@@>>>>!>>  F   K''  ' K "--   "--'-- K - $c22cc2 "---'-- .c|c |cccKcK2c2--'-- K "-2c 2c2c--'-- F--'-- 2c--'-- 0c "-3f - 3f $r{{rr$rrr$ooo$^^^$PPP$222--'-- 3f2c--'-- 3fK "-2c cTimes New Roman--`c|`|cc`ccK`Kc2`2c "-cccTimes New Roman4-----"Systemn-'--- 3f  *  F2 ,*Moving Toward One Million Children in 2002    ----'--- K---'--- K----'--- K 2 4600,0002 u4700,0002 \4800,0002 D4900,0002 ++ 1,000,000---'--- K---'--- K  2 f1992 2 1994 2 1996 2 1998 2 2000 2 2002---'--- KTimes New Roman0------'--- )5 Times New Roman-2 Total Enrollment-----'--- K---'--- K--' K '  'WPWin 6.0/OLE 1.0 Prefix Information Marker% METAFILEPICT5"5"A  F   K''  ' K "--   "--'-- K - $c22cc2 "---'-- .c|c |cccKcK2c2--'-- K "-2c 2c2c--'-- F--'-- 2c--'-- 0c "-3f - 3f $r{{rr$rrr$ooo$^^^$PPP$222--'-- 3f2c--'-- 3fK "-2c cTimes New Roman--`c|`|cc`ccK`Kc2`2c "-cccTimes New Roman4-----"Systemn-'--- 3f  *  F2 ,*Moving Toward One Million Children in 2002    ----'--- K---'--- K----'--- K 2 4600,0002 u4700,0002 \4800,0002 D4900,0002 ++ 1,000,000---'--- K---'--- K  2 f1992 2 1994 2 1996 2 1998 2 2000 2 2002---'--- KTimes New Roman0------'--- )5 Times New Roman-2 Total Enrollment-----'--- K---'--- K--' K '  ' *OLE*WPC!& |   ;''  ' ;' ;-   !u; !#ltTimes New Roman --"Systemn-'-- ";-  *2 6DISCRETIONARY PROGRAMS:    -Times New Roman}----'-- "^$-------- 2 31998 -2 /Actual - !$ /------'-- "_-------- 2 t1999 -2 mEnacted- !* m------'-- "-------- 2 2000 -2 Request - !, ------'-- ":------ 2  Request +/- -2 Enacted- !* ----'-- ;Times New Roman8- 2 $!22 $VHead Start............................................................................2 $;$4,3472 $$4,6602 $$5,267042 $+$6072 5!+2 5GViolence Against Women................................................. 2 5J103 2 5105 2 5119A4 2 5!+142 N!&2 N=Child Care & Development Block Grant /1......................2 NA1,0022 N1,0002 N1,173Z4 2 N+1732 _!(2 _AResearch and Evaluation Fund.....................................Times New Roman4- 2 _V0- !lV- 2 _0- !l- 2 _10- ! l-k4 2 _!+10- !l!--||2 pNSubtotal, CCDBG............................................................... 2 p 2 p;$1,0022 p$1,0002 p$1,183|42 p+$1832 !)2 CCommunity Services Block Grant..................................... 2 J490 2 500 2 5004 2 .02 !&2 =Individual Development Accounts.............................. 2 V0 2 10 2 204 2 !+102 !+2 GDiscretionary Programs.................................................- 2 P51- ! P- 2 54- ! - 2 0- !-4 2 $-54- !$--2 !*2 FSubtotal, Community Services.......................................... 2 D$541 2 $564 2 $5204 2 -$442 !(2 BRunaway and Homeless Youth........................................ 2 P58 2 59 2 644 2 '+52 !,2 JDevelopmental Disabilities................................................ 2 J114 2 119 2 1194 2 .02 !+2 HChild Welfare/Child Abuse............................................... 2 J401 2 404 2 4064 2 '+22 !.2 MAdoption Incentives.......................................................... 2 V0 2 20 2 204 2 .02 !/2 ONative Americans............................................................... 2 P35 2 35 2 35%4 2 .02 2!-2 2KSocial Services Research................................................... 2 2P26 2 227 2 26>4 2 2$-212 C!$2 C9Pre-Appropriated Research/Evaluation /2..................- 2 CP12- ! PP- 2 C12- ! P- 2 C21- ! P-O4 2 C'+9- ! P'--`l2 TCSubtotal, Social Services Research.................................2 T 2 TJ$38 2 T$39 2 T$27`4 2 T-$122 m!22 mULIHEAP /1............................................................................2 mA1,1602 m1,1002 m1,100y4 2 m.02 ~!)2 ~DRefugee and Entrant Assistance...................................... 2 ~J423 2 ~436 2 ~4434 2 ~'+72 !-2 LFederal Administration...................................................... 2 J144 2 144 2 1504 2 '+62 !#2 8Pre-Appropriated Federal Administration /3..............- 2 V8- !V- 2 8- !- 2 9- !-4 2 '+1- ! '--2 !*2 ESubtotal, Federal Administration.....................................- 2 D$152- !D- 2 $152- !- 2 $159- !-4 2 !+$7- !!--2 !.2 MTotal, Program Level.........................................................2 6$8,3742 }$8,6932 $9,46242 +$769-C2 (Less Funds Allocated from Other Sources:   2 !$2 9Pre-Appropriated Research/Evaluation /2.................. 2 P12 2 12 2 214 2 '+92 !#2 8Pre-Appropriated Federal Administration /3..............- 2 V8- !V- 2 8- !- 2 9- !-4 2 '+1- ! '--2 !'2 ?Total, Discretionary Budget Authority..........................2 6$8,3542 }$8,6732 $9,432"42 +$759-2 1!32 1WFTE....................................................................................Times New RomanP-2 0=1,5692 01,5302 01,510 2 0%-20-x2 TK/1 FY 1999 Appropriation (P.L. 105-277) provides advanced FY 2000 funding  --'-- t^d l2 eC/2 Authorization for $12 million of these funds expired in FY 2000  --'-- ; =2 v$/3 1%/2% funds (Public Law 104-193)   -'WPWin 6.0/OLE 1.0 Prefix Information Marker& METAFILEPICT;A&;B |   ;''  ' ;' ;-   !u; !#ltTimes New Roman --"Systemn-'-- ";-  *2 6DISCRETIONARY PROGRAMS:    -Times New Roman}----'-- "^$-------- 2 31998 -2 /Actual - !$ /------'-- "_-------- 2 t1999 -2 mEnacted- !* m------'-- "-------- 2 2000 -2 Request - !, ------'-- ":------ 2  Request +/- -2 Enacted- !* ----'-- ;Times New Roman8- 2 $!22 $VHead Start............................................................................2 $;$4,3472 $$4,6602 $$5,267042 $+$6072 5!+2 5GViolence Against Women................................................. 2 5J103 2 5105 2 5119A4 2 5!+142 N!&2 N=Child Care & Development Block Grant /1......................2 NA1,0022 N1,0002 N1,173Z4 2 N+1732 _!(2 _AResearch and Evaluation Fund.....................................Times New Roman4- 2 _V0- !lV- 2 _0- !l- 2 _10- ! l-k4 2 _!+10- !l!--||2 pNSubtotal, CCDBG............................................................... 2 p 2 p;$1,0022 p$1,0002 p$1,183|42 p+$1832 !)2 CCommunity Services Block Grant..................................... 2 J490 2 500 2 5004 2 .02 !&2 =Individual Development Accounts.............................. 2 V0 2 10 2 204 2 !+102 !+2 GDiscretionary Programs.................................................- 2 P51- ! P- 2 54- ! - 2 0- !-4 2 $-54- !$--2 !*2 FSubtotal, Community Services.......................................... 2 D$541 2 $564 2 $5204 2 -$442 !(2 BRunaway and Homeless Youth........................................ 2 P58 2 59 2 644 2 '+52 !,2 JDevelopmental Disabilities................................................ 2 J114 2 119 2 1194 2 .02 !+2 HChild Welfare/Child Abuse............................................... 2 J401 2 404 2 4064 2 '+22 !.2 MAdoption Incentives.......................................................... 2 V0 2 20 2 204 2 .02 !/2 ONative Americans............................................................... 2 P35 2 35 2 35%4 2 .02 2!-2 2KSocial Services Research................................................... 2 2P26 2 227 2 26>4 2 2$-212 C!$2 C9Pre-Appropriated Research/Evaluation /2..................- 2 CP12- ! PP- 2 C12- ! P- 2 C21- ! P-O4 2 C'+9- ! P'--`l2 TCSubtotal, Social Services Research.................................2 T 2 TJ$38 2 T$39 2 T$27`4 2 T-$122 m!22 mULIHEAP /1............................................................................2 mA1,1602 m1,1002 m1,100y4 2 m.02 ~!)2 ~DRefugee and Entrant Assistance...................................... 2 ~J423 2 ~436 2 ~4434 2 ~'+72 !-2 LFederal Administration...................................................... 2 J144 2 144 2 1504 2 '+62 !#2 8Pre-Appropriated Federal Administration /3..............- 2 V8- !V- 2 8- !- 2 9- !-4 2 '+1- ! '--2 !*2 ESubtotal, Federal Administration.....................................- 2 D$152- !D- 2 $152- !- 2 $159- !-4 2 !+$7- !!--2 !.2 MTotal, Program Level.........................................................2 6$8,3742 }$8,6932 $9,46242 +$769-C2 (Less Funds Allocated from Other Sources:   2 !$2 9Pre-Appropriated Research/Evaluation /2.................. 2 P12 2 12 2 214 2 '+92 !#2 8Pre-Appropriated Federal Administration /3..............- 2 V8- !V- 2 8- !- 2 9- !-4 2 '+1- ! '--2 !'2 ?Total, Discretionary Budget Authority..........................2 6$8,3542 }$8,6732 $9,432"42 +$759-2 1!32 1WFTE....................................................................................Times New RomanP-2 0=1,5692 01,5302 01,510 2 0%-20-x2 TK/1 FY 1999 Appropriation (P.L. 105-277) provides advanced FY 2000 funding  --'-- t^d l2 eC/2 Authorization for $12 million of these funds expired in FY 2000  --'-- ; =2 v$/3 1%/2% funds (Public Law 104-193)   -'  (_7$0   8  c:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptc:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC!'     z5''  ' z5' z5-   !5Times New Roman4- 2 1-YEAR 2 5-YEARS 2 PROPOSAL   Times New Roman4--"Systemn-'-- "5- 2 FY 2000- !. ---2 FY 00-04- !2 ----'-- z5- .2 7CHILD SUPPORT ENFORCEMENT:       Times New Roman}-T{2 H\Eliminate Hold Harmless Provision /2........................................................    2 H{ 2 H-$652 H-$279e{m2 YDReduce Match of Paternity Laboratory Tests from 90 to 66 Percent....  2 Y{ e 2 Y-9e. 2 Y-45vy2 jRMandatory Review of Child Support Orders/3........................................   2 jy Times New Roman4-v 2 j0- !w-v. 2 j-25- !w--{2 {VSubtotal, Child Support Enforcement...................................................  2 {{ - 2 {-74. 2 {-349-2  CHILD CARE:   -{2 `Subsidy at Special Match Rate................................................................... 2 { 2 +1,155.2 +7,500z2 hEarly Learning Fund.....................................................................................2 z - 2 +600- !-.2 +3,000- !" --z2 dSubtotal, Child Care................................................................................  2 z -2 +1,755.2 +10,500-2 TANF: -z2 UFreeze Supplemental Grants at FY 1999 Level.......................................... 2 z  2 -83. 2 -241 zu2 IReduce Cap on Transfers to SSBG from 10 to 4.25 Percent /4............... 2 z -  2 -600- !!- . 2 -500- !!--1z2 %gSubtotal, TANF......................................................................................... 2 %z -1 2 %-6831. 2 %-741-!2 GCONTINGENCY FUND:    -dy2 X^Eliminate Budget Authority Cap................................................................  2 Xy d2 X-1,644d.2 X-1,644-02 zINDEPENDENT LIVING PROGRAM:      -{2 bIncrease Authorization Level...................................................................... 2 {  2 +35. 2 +175yl2 CSupport Living Expenses of Youth in Transitional Living Programs... 2 y - 2 +5- ! -. 2 +50- !--y2 jSubtotal, ILP.............................................................................................2 y - 2 +40. 2 +225Times New Roman4---'-- 5w T2 3TOTAL ACF PROPOSED LAW IMPACT......................     2 w 2 -$6062 $7,991--'-- z5- 2 ^/1 Negative numbers are savings, positive numbers are costs. Except where noted, all figures     72  represent Budget Authority. 2 g/2 Elimination of the hold harmless provision results in a $65 million reduction in spending authority    92 &! from offsetting collections. 2 7k/3 This proposal begins in FY 2001 and has additional savings in Medicaid totaling $60 million by FY 2004.   2 Hj Child support totals combine increased administrative costs and savings due to increased collections.  s2 YH/4 This proposal effects outlays, but has no impact on Budget Authority.  --'-- z5-   "- "- !-- !-z- !z-$6- !$-4#4- !#4-5- !4-""6- !5"-6- !5-55- !5-yy6- !5y--'- z5'WPWin 6.0/OLE 1.0 Prefix Information Marker' METAFILEPICTd:z'd:A     z5''  ' z5' z5-   !5Times New Roman4- 2 1-YEAR 2 5-YEARS 2 PROPOSAL   Times New Roman4--"Systemn-'-- "5- 2 FY 2000- !. ---2 FY 00-04- !2 ----'-- z5- .2 7CHILD SUPPORT ENFORCEMENT:       Times New Roman}-T{2 H\Eliminate Hold Harmless Provision /2........................................................    2 H{ 2 H-$652 H-$279e{m2 YDReduce Match of Paternity Laboratory Tests from 90 to 66 Percent....  2 Y{ e 2 Y-9e. 2 Y-45vy2 jRMandatory Review of Child Support Orders/3........................................   2 jy Times New Roman4-v 2 j0- !w-v. 2 j-25- !w--{2 {VSubtotal, Child Support Enforcement...................................................  2 {{ - 2 {-74. 2 {-349-2  CHILD CARE:   -{2 `Subsidy at Special Match Rate................................................................... 2 { 2 +1,155.2 +7,500z2 hEarly Learning Fund.....................................................................................2 z - 2 +600- !-.2 +3,000- !" --z2 dSubtotal, Child Care................................................................................  2 z -2 +1,755.2 +10,500-2 TANF: -z2 UFreeze Supplemental Grants at FY 1999 Level.......................................... 2 z  2 -83. 2 -241 zu2 IReduce Cap on Transfers to SSBG from 10 to 4.25 Percent /4............... 2 z -  2 -600- !!- . 2 -500- !!--1z2 %gSubtotal, TANF......................................................................................... 2 %z -1 2 %-6831. 2 %-741-!2 GCONTINGENCY FUND:    -dy2 X^Eliminate Budget Authority Cap................................................................  2 Xy d2 X-1,644d.2 X-1,644-02 zINDEPENDENT LIVING PROGRAM:      -{2 bIncrease Authorization Level...................................................................... 2 {  2 +35. 2 +175yl2 CSupport Living Expenses of Youth in Transitional Living Programs... 2 y - 2 +5- ! -. 2 +50- !--y2 jSubtotal, ILP.............................................................................................2 y - 2 +40. 2 +225Times New Roman4---'-- 5w T2 3TOTAL ACF PROPOSED LAW IMPACT......................     2 w 2 -$6062 $7,991--'-- z5- 2 ^/1 Negative numbers are savings, positive numbers are costs. Except where noted, all figures     72  represent Budget Authority. 2 g/2 Elimination of the hold harmless provision results in a $65 million reduction in spending authority    92 &! from offsetting collections. 2 7k/3 This proposal begins in FY 2001 and has additional savings in Medicaid totaling $60 million by FY 2004.   2 Hj Child support totals combine increased administrative costs and savings due to increased collections.  s2 YH/4 This proposal effects outlays, but has no impact on Budget Authority.  --'-- z5-   "- "- !-- !-z- !z-$6- !$-4#4- !#4-5- !4-""6- !5"-6- !5-55- !5-yy6- !5y--'- z5'  1$ $d2$ $d c:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt  *OLE*WPC1 1 !1 )     ''  ' -   "- "- !-- !-'- -'- -   ! !#Times New Romanl-  2 e1998 2 1999 2 "20002 Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2  Request/2 - !7 ---2 r +/- Enacted- !< r----'-- Times New Roman- 42 5Total Collections Distributed: R+{2 F MNon-TANF Families ...........................................................   2 F+ R}2 FV$11,243R2 F$12,931R:2 F$14,449R2 F+$1,518c)~2 W OTANF/FC families...............................................................  2 W) c} 2 Wk152ck!2 W8 2 Wk c 2 W153c(2 W 2 W c: 2 W(154c(%2 W 2 W( c 2 W+1t)2 h PTANF program....................................................................  2 h) t}2 hb2,433tb2 h8 2 hb t2 h2,446t$2 h 2 h t:2 h2,470t!2 h 2 h t 2 h+24+2 y UFC program........................................................................... 2 y+ } 2 yq32 2 y34: 2 y.36 2 y+2-*2 XTotal...................................................................................2 * }2 P$13,8602 $15,564:2 $17,1092 }+$1,545-12 Distributed to TANF Program:   *2 QNet Federal Share ............................................................... 2 * } 2 e$945 2 $945:2 $1,030 2 $85*f2 ?State Share (includes incentives and hold......................2 * } 2 e1488 2 1501: 2 "1440 2 -61*|2 N harmless payments)...........................................................  2 * -*2 XTotal...................................................................................2 * }2 W$2,4332 $2,446:2 $2,470 2 +$24-62 Administrative Costs (Outlays):   /)2 # TFederal Share ......................................................................2 #) /}2 #\$2,110/2 #$2,593/:2 #$2,840/ 2 #$247@)2 4 VState Share...........................................................................2 4) @} 2 4e1196@ 2 41389@: 2 4"1498@ 2 4+109-Q*2 EWCosts.................................................................................. 2 E* Q}2 EW$3,306Q2 E$3,982Q:2 E$4,338Q2 E+$356-@2 g&Program Saving and Costs (Collections: 2 x minus Costs): *2  TFederal Costs ......................................................................2 * }2 \$1,1652 $1,648:2 $1,8102 +$162*2  TState Savings ......................................................................2 * Times New Roman4- } 2 k292- !k- 2 112- !-: 2 .58- ! .- 2 +170- !--+2 TNet Costs...........................................................................  2 + } 2 a$8732 $1,536:2 $1,8682 +$332-B2 '/1 Numbers may not add due to rounding.   E2 )/2 Numbers include legislative proposals.  --'-- -  -- !-- !-- !-- !-@@- !@-  !w !w !w? ! ! ! !? !V !2 !2 !2? ! ! !? !0- -11- !1-  !2 ! ! ! !--'- 'WPWin 6.0/OLE 1.0 Prefix Information Marker( METAFILEPICT5Gn )5G6     ''  ' -   "- "- !-- !-'- -'- -   ! !#Times New Romanl-  2 e1998 2 1999 2 "20002 Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2  Request/2 - !7 ---2 r +/- Enacted- !< r----'-- Times New Roman- 42 5Total Collections Distributed: R+{2 F MNon-TANF Families ...........................................................   2 F+ R}2 FV$11,243R2 F$12,931R:2 F$14,449R2 F+$1,518c)~2 W OTANF/FC families...............................................................  2 W) c} 2 Wk152ck!2 W8 2 Wk c 2 W153c(2 W 2 W c: 2 W(154c(%2 W 2 W( c 2 W+1t)2 h PTANF program....................................................................  2 h) t}2 hb2,433tb2 h8 2 hb t2 h2,446t$2 h 2 h t:2 h2,470t!2 h 2 h t 2 h+24+2 y UFC program........................................................................... 2 y+ } 2 yq32 2 y34: 2 y.36 2 y+2-*2 XTotal...................................................................................2 * }2 P$13,8602 $15,564:2 $17,1092 }+$1,545-12 Distributed to TANF Program:   *2 QNet Federal Share ............................................................... 2 * } 2 e$945 2 $945:2 $1,030 2 $85*f2 ?State Share (includes incentives and hold......................2 * } 2 e1488 2 1501: 2 "1440 2 -61*|2 N harmless payments)...........................................................  2 * -*2 XTotal...................................................................................2 * }2 W$2,4332 $2,446:2 $2,470 2 +$24-62 Administrative Costs (Outlays):   /)2 # TFederal Share ......................................................................2 #) /}2 #\$2,110/2 #$2,593/:2 #$2,840/ 2 #$247@)2 4 VState Share...........................................................................2 4) @} 2 4e1196@ 2 41389@: 2 4"1498@ 2 4+109-Q*2 EWCosts.................................................................................. 2 E* Q}2 EW$3,306Q2 E$3,982Q:2 E$4,338Q2 E+$356-@2 g&Program Saving and Costs (Collections: 2 x minus Costs): *2  TFederal Costs ......................................................................2 * }2 \$1,1652 $1,648:2 $1,8102 +$162*2  TState Savings ......................................................................2 * Times New Roman4- } 2 k292- !k- 2 112- !-: 2 .58- ! .- 2 +170- !--+2 TNet Costs...........................................................................  2 + } 2 a$8732 $1,536:2 $1,8682 +$332-B2 '/1 Numbers may not add due to rounding.   E2 )/2 Numbers include legislative proposals.  --'-- -  -- !-- !-- !-- !-@@- !@-  !w !w !w? ! ! ! !? !V !2 !2 !2? ! ! !? !0- -11- !1-  !2 ! ! ! !--'- 'C:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC  !  U   [''  ' [' [-   !w !2v !9vZ !hTimes New Roman4-  2 ]1998 2 1999 2 20002 )Request Times New Roman4--"Systemn-'-- "[- 2 UActual - !$ U---2 Enacted- !* ---2  Request /2 - !: ---2  +/- Enacted- !< ----'-- [- 2 $PROGRAM Times New Roman!-R+2 FVTANF /3............................................................................... 2 F+ 2 FR$16,6722 F$17,0532 F$17,003RT 2 F>-$50c+y2 WLContingency Fund /3.........................................................2 W+ 2 W^1,960 2 W02 W-1,644cT2 W5-1,644t+y2 hLChild Care Entitlement /3 ................................................. 2 h+ 2 h^2,0702 h2,1672 h4,122tT2 h2+1,955)a2 y<Child Support Enforcement(obligations) /4................... 2 y) 2 y^2,1532 y2,5832 y2,824T 2 y;+241)i2 AFoster Care/Adoption Assistance .................................  2 ) 2 ^4,3112 4,9222 5,667T 2 ;+745+W2 5Childrens Research & Technical Assist (net BA) /3...   2 + 2 g$53 2 $52 2 $62T 2 A+10)j2 BPromoting Safe and Stable Families................................  2 ) 2 g255 2 275 2 295T 2 A+20*v2 JSocial Service Block Grant................................................2 * 2 ^2,2992 1,9092 2,380T 2 ;+471+m2 DAFDC/EA/JOBS/Related /5, /6.........................................    2 + Times New Roman4-u2 V-1,546- !V- 2 66- ! - 2 -2,074- !-T2 /-$2,140- !%/--+m2 DTotal, Program Level/BA ............................................  2 + u2 H$28,2272 $29,027 2 $28,635T2 4-$392-B2 #'/1 Numbers may not add due to rounding.   E2 4)/2 Numbers include legislative proposals.  72 E /3 Programs are preappropriated. 2 Vm/4 Child Support Enforcement (CSE) spending reflects the legislative proposal to reduce the federal match on   2 gr paternity testing. CSE also has two other legislative proposals to: (1) repeal the hold harmless provision,   2 xq reducing spending authority in offsetting collections by $65,000,000 in FY 2000 and, (2) institute mandatory O2 0 review and adjustment beginning in FY 2001.  u2 I/5 AFDC and related assistance is shown net of child support collections.   2 l/6 The negative budget authority shown for FY 1998 and FY 2000 represents the use of funds carried over from  !2  prior years.--'-- [-   ! !C0 !FY !Z !)C3 !3 !Z--'- ['WPWin 6.0/OLE 1.0 Prefix Information Marker) METAFILEPICTM>M>b1 U   [''  ' [' [-   !w !2v !9vZ !hTimes New Roman4-  2 ]1998 2 1999 2 20002 )Request Times New Roman4--"Systemn-'-- "[- 2 UActual - !$ U---2 Enacted- !* ---2  Request /2 - !: ---2  +/- Enacted- !< ----'-- [- 2 $PROGRAM Times New Roman!-R+2 FVTANF /3............................................................................... 2 F+ 2 FR$16,6722 F$17,0532 F$17,003RT 2 F>-$50c+y2 WLContingency Fund /3.........................................................2 W+ 2 W^1,960 2 W02 W-1,644cT2 W5-1,644t+y2 hLChild Care Entitlement /3 ................................................. 2 h+ 2 h^2,0702 h2,1672 h4,122tT2 h2+1,955)a2 y<Child Support Enforcement(obligations) /4................... 2 y) 2 y^2,1532 y2,5832 y2,824T 2 y;+241)i2 AFoster Care/Adoption Assistance .................................  2 ) 2 ^4,3112 4,9222 5,667T 2 ;+745+W2 5Childrens Research & Technical Assist (net BA) /3...   2 + 2 g$53 2 $52 2 $62T 2 A+10)j2 BPromoting Safe and Stable Families................................  2 ) 2 g255 2 275 2 295T 2 A+20*v2 JSocial Service Block Grant................................................2 * 2 ^2,2992 1,9092 2,380T 2 ;+471+m2 DAFDC/EA/JOBS/Related /5, /6.........................................    2 + Times New Roman4-u2 V-1,546- !V- 2 66- ! - 2 -2,074- !-T2 /-$2,140- !%/--+m2 DTotal, Program Level/BA ............................................  2 + u2 H$28,2272 $29,027 2 $28,635T2 4-$392-B2 #'/1 Numbers may not add due to rounding.   E2 4)/2 Numbers include legislative proposals.  72 E /3 Programs are preappropriated. 2 Vm/4 Child Support Enforcement (CSE) spending reflects the legislative proposal to reduce the federal match on   2 gr paternity testing. CSE also has two other legislative proposals to: (1) repeal the hold harmless provision,   2 xq reducing spending authority in offsetting collections by $65,000,000 in FY 2000 and, (2) institute mandatory O2 0 review and adjustment beginning in FY 2001.  u2 I/5 AFDC and related assistance is shown net of child support collections.   2 l/6 The negative budget authority shown for FY 1998 and FY 2000 represents the use of funds carried over from  !2  prior years.--'-- [-   ! !C0 !FY !Z !)C3 !3 !Z--'- ['  !Table_A ToolBartable.RunC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC!  l   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanl-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? Li 2 ?M$871L 2 ?$882L2 ?$1,048LX2 ?4+$166`c2 S=Program Level................................................   2 S `i 2 ST872` 2 S883`2 S1,050`X 2 S;+167tj2 gBOutlays........................................................... 2 g Arial-tj 2 gU834t 2 g864t 2 g971tY 2 g<+107-l2 CFTE................................................................ 2  i 2 T121 2 134 2 155X 2 B+21-'WPWin 6.0/OLE 1.0 Prefix Information Marker* METAFILEPICT>| > l   `''  ' `' `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanl-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? Li 2 ?M$871L 2 ?$882L2 ?$1,048LX2 ?4+$166`c2 S=Program Level................................................   2 S `i 2 ST872` 2 S883`2 S1,050`X 2 S;+167tj2 gBOutlays........................................................... 2 g Arial-tj 2 gU834t 2 g864t 2 g971tY 2 g<+107-l2 CFTE................................................................ 2  i 2 T121 2 134 2 155X 2 B+21-' " #*OLE*WPC  ! !    ''  ' ' -   !Times New Roman--  2 c1998 2 1999 2 20002 ZRequest Times New Roman0--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman)-A( ^2 5:National Family Caregiver Support Program.................   2 5( A{ 2 5o$0A 2 5$0A- 2 5$125A2 5f+$1252 W Meals: t(u2 hIHome-Delivered Meals.....................................................    2 h( t{ 2 hc$112t 2 h$112t- 2 h$147t 2 hl+$35({2 yMCongregate Meals............................................................. 2 y( Times New Roman-{ 2 yi375- !i- 2 y375- !-- 2 y375- !- 2 y0- !-Times New RomanM-&x2 KSubtotal, Meals............................................................ 2 & -{ 2 _$487 2 $487- 2 $522 2 i+$35-(o2 EHealth Disparities Interventions.....................................  2 ( { 2 o$0 2 $0- 2 !$4 2 r+$4(m2 DSupportive Services & Centers....................................... 2 ( { 2 i310 2 310- 2 310 2 0'^2 :Grants to Indian Tribes & Native Hawaiians................    2 ' { 2 o18 2 18- 2 !18 2 0'{2 MAlzheimer's Disease..........................................................   2 ' { 2 u6 2 6- 2 '6 2 0'u2 IProgram Administration...................................................   2 ' { 2 o15 2 15- 2 !17 2 x+2 (s2 HPreventive Health Services.............................................. 2 (  { 2 o16  2 16 - 2 !16  2 0)r2 GState and Local Innovations............................................2 ) { 2 o10 2 18- 2 !18 2 0/(p2 #FVulnerable Older Americans............................................  2 #( /{ 2 #u9/ 2 #12/- 2 #!12/ 2 #0@(g2 4@Operation Restore Trust (HCFAC).................................   2 4( -@{ 2 4u1- !Au-@ 2 41- !A-@- 2 4'2- !A'-@ 2 4x+1- ! Ax--b'r2 VGTotal, Program Level .................................................. 2 V' b{ 2 V_$872b 2 V$883b-2 V$1,050b 2 Vi$167-%2 x Reimbursements:  (g2 @Operation Restore Trust (HCFAC).................................   2 ( - 2 o-$1- !o- 2 -$1- !- 2 !-$2- !!- 2 y-$1- !y--)j2 BSubtotal, Reimbursements..........................................   2 ) 2 m-$1 2 -$1 2 -$2 2 {$0)p2 FTotal, Budget Authority ..............................................  2 ) { 2 _$871 2 $882-2 $1,048 2 i$166-'2 ]FTE..........................................................................................2 ' { 2 i121 2 134- 2 155 2 r+21-'WPWin 6.0/OLE 1.0 Prefix Information Marker+ METAFILEPICTbC5!bC4    ''  ' ' -   !Times New Roman--  2 c1998 2 1999 2 20002 ZRequest Times New Roman0--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman)-A( ^2 5:National Family Caregiver Support Program.................   2 5( A{ 2 5o$0A 2 5$0A- 2 5$125A2 5f+$1252 W Meals: t(u2 hIHome-Delivered Meals.....................................................    2 h( t{ 2 hc$112t 2 h$112t- 2 h$147t 2 hl+$35({2 yMCongregate Meals............................................................. 2 y( Times New Roman-{ 2 yi375- !i- 2 y375- !-- 2 y375- !- 2 y0- !-Times New RomanM-&x2 KSubtotal, Meals............................................................ 2 & -{ 2 _$487 2 $487- 2 $522 2 i+$35-(o2 EHealth Disparities Interventions.....................................  2 ( { 2 o$0 2 $0- 2 !$4 2 r+$4(m2 DSupportive Services & Centers....................................... 2 ( { 2 i310 2 310- 2 310 2 0'^2 :Grants to Indian Tribes & Native Hawaiians................    2 ' { 2 o18 2 18- 2 !18 2 0'{2 MAlzheimer's Disease..........................................................   2 ' { 2 u6 2 6- 2 '6 2 0'u2 IProgram Administration...................................................   2 ' { 2 o15 2 15- 2 !17 2 x+2 (s2 HPreventive Health Services.............................................. 2 (  { 2 o16  2 16 - 2 !16  2 0)r2 GState and Local Innovations............................................2 ) { 2 o10 2 18- 2 !18 2 0/(p2 #FVulnerable Older Americans............................................  2 #( /{ 2 #u9/ 2 #12/- 2 #!12/ 2 #0@(g2 4@Operation Restore Trust (HCFAC).................................   2 4( -@{ 2 4u1- !Au-@ 2 41- !A-@- 2 4'2- !A'-@ 2 4x+1- ! Ax--b'r2 VGTotal, Program Level .................................................. 2 V' b{ 2 V_$872b 2 V$883b-2 V$1,050b 2 Vi$167-%2 x Reimbursements:  (g2 @Operation Restore Trust (HCFAC).................................   2 ( - 2 o-$1- !o- 2 -$1- !- 2 !-$2- !!- 2 y-$1- !y--)j2 BSubtotal, Reimbursements..........................................   2 ) 2 m-$1 2 -$1 2 -$2 2 {$0)p2 FTotal, Budget Authority ..............................................  2 ) { 2 _$871 2 $882-2 $1,048 2 i$166-'2 ]FTE..........................................................................................2 ' { 2 i121 2 134- 2 155 2 r+21-' $ % ToolBartable.RunC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC!  l   `''  ' `' `-   !pTimes New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Roman-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?R$191 2 ?$199 2 ?$206LX 2 ?B+$7`c2 S=Program Level................................................   2 S 2 SR$212 2 S$231 2 S$282`X 2 S;+$51tj2 gBOutlays........................................................... 2 g 2 gR$181 2 g$200 2 g$211tX 2 g;+$11l2 CFTE................................................................ 2  2 O1,2362 1,3532 1,457X 2 ;+104-'WPWin 6.0/OLE 1.0 Prefix Information Marker, METAFILEPICT>| > l   `''  ' `' `-   !pTimes New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Roman-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?R$191 2 ?$199 2 ?$206LX 2 ?B+$7`c2 S=Program Level................................................   2 S 2 SR$212 2 S$231 2 S$282`X 2 S;+$51tj2 gBOutlays........................................................... 2 g 2 gR$181 2 g$200 2 g$211tX 2 g;+$11l2 CFTE................................................................ 2  2 O1,2362 1,3532 1,457X 2 ;+104-' & '*OLE*WPC&&  !      ''  ' ' -   !D !geTimes New Roman-  2 c1998 2 1999 2 20002 ZRequest Times New Roman}--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman- 92 5!General Departmental Management:    R)y2 FLGDM Staff Divisions.........................................................  2 F) R{ 2 Fc$105R 2 F$110R- 2 F$125R 2 Fl+$15c)v2 WJOPHS Program Offices......................................................    2 W) 2 W t'2 hP Minority Health..............................................................  2 h' t{ 2 ho29t 2 h28t- 2 h!28t 2 h0'|2 yN Women's Health.............................................................   2 y' { 2 yo12 2 y15- 2 y!17 2 yx+2(r2 G Emergency Preparedness.............................................. 2 ( { 2 o10 2 10- 2 !10 2 0'f2 ? Council on Physical Fitness & Sports........................ 2 ' { 2 u1 2 1- 2 '1 2 0)x2 K Adolescent Family Life..................................................  2 ) { 2 o17 2 18- 2 '9 2 {-9(u2 ICongressional Earmarks................................................... 2 ( { 2 u3 2 3- 2 '2 2 {-1-)~2 OTotal, GDM..................................................................... 2 ) { 2 _$177 2 $185- 2 $192 2 w$7- '2 TPolicy Research.....................................................................2 '  { 2 o14  2 14 - 2 !14  2 0-/(i2 #ATotal, DM Budget Authority.......................................   2 #( /{ 2 #_$191/ 2 #$199/- 2 #$206/ 2 #p+$7-Q'l2 ECOne-Percent Evaluation Funds....................................... 2 E' Q{ 2 Eo21Q 2 E22Q- 2 E!21Q 2 E{-1b(2 VTBioterrorism........................................................................ 2 V( b 2 V10b- 2 V!55b 2 Vr+45-)l2 xCTotal, DM Program Level...........................................  2 x) { 2 x_$212 2 x$231- 2 x$282 2 xi+$51-'2 ]FTE..........................................................................................2 ' {2 `1,2362 1,353-2 1,457 2 l+104-'WPWin 6.0/OLE 1.0 Prefix Information Marker- METAFILEPICTbC<bC-     ''  ' ' -   !D !geTimes New Roman-  2 c1998 2 1999 2 20002 ZRequest Times New Roman}--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman- 92 5!General Departmental Management:    R)y2 FLGDM Staff Divisions.........................................................  2 F) R{ 2 Fc$105R 2 F$110R- 2 F$125R 2 Fl+$15c)v2 WJOPHS Program Offices......................................................    2 W) 2 W t'2 hP Minority Health..............................................................  2 h' t{ 2 ho29t 2 h28t- 2 h!28t 2 h0'|2 yN Women's Health.............................................................   2 y' { 2 yo12 2 y15- 2 y!17 2 yx+2(r2 G Emergency Preparedness.............................................. 2 ( { 2 o10 2 10- 2 !10 2 0'f2 ? Council on Physical Fitness & Sports........................ 2 ' { 2 u1 2 1- 2 '1 2 0)x2 K Adolescent Family Life..................................................  2 ) { 2 o17 2 18- 2 '9 2 {-9(u2 ICongressional Earmarks................................................... 2 ( { 2 u3 2 3- 2 '2 2 {-1-)~2 OTotal, GDM..................................................................... 2 ) { 2 _$177 2 $185- 2 $192 2 w$7- '2 TPolicy Research.....................................................................2 '  { 2 o14  2 14 - 2 !14  2 0-/(i2 #ATotal, DM Budget Authority.......................................   2 #( /{ 2 #_$191/ 2 #$199/- 2 #$206/ 2 #p+$7-Q'l2 ECOne-Percent Evaluation Funds....................................... 2 E' Q{ 2 Eo21Q 2 E22Q- 2 E!21Q 2 E{-1b(2 VTBioterrorism........................................................................ 2 V( b 2 V10b- 2 V!55b 2 Vr+45-)l2 xCTotal, DM Program Level...........................................  2 x) { 2 x_$212 2 x$231- 2 x$282 2 xi+$51-'2 ]FTE..........................................................................................2 ' {2 `1,2362 1,353-2 1,457 2 l+104-' ( )  HHSToolBartable.RunC:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt * +c:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT*OLE*WPC! Hl   `''  ' `' `-   !pTimes New Roman^-  2 N1998 2 1999 2 20002 &Request Times New Roman=-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman--Lc2 ?=Budget Authority.............................................  2 ? 2 ?`$0 2 ?$0 2 ?$25LX 2 ?;+$25`c2 S=Program Level................................................   2 S 2 S`$0 2 S$0 2 S$25`X 2 S;+$25tj2 gBOutlays........................................................... 2 g 2 g`$0 2 g$0 2 g$4tX 2 gB+$4l2 CFTE................................................................ 2  2 g0 2 0 2 0-'WPWin 6.0/OLE 1.0 Prefix Information Marker. METAFILEPICT>|> Hl   `''  ' `' `-   !pTimes New Roman^-  2 N1998 2 1999 2 20002 &Request Times New Roman=-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman--Lc2 ?=Budget Authority.............................................  2 ? 2 ?`$0 2 ?$0 2 ?$25LX 2 ?;+$25`c2 S=Program Level................................................   2 S 2 S`$0 2 S$0 2 S$25`X 2 S;+$25tj2 gBOutlays........................................................... 2 g 2 g`$0 2 g$0 2 g$4tX 2 gB+$4l2 CFTE................................................................ 2  2 g0 2 0 2 0-' , -  HHSToolBartable.RunSBJPA TANF AIDsc:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptC:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT . /*OLE*WPC!  l   `''  ' `-   "-` "- !`-- !-'- `-'- `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New RomanM-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?Y$20 2 ?$21 2 ?$22LX 2 ?B+$1`c2 S=Program Level................................................   2 S 2 SY$20 2 S$21 2 S$22`X 2 SB+$1tj2 gBOutlays........................................................... 2 g 2 gY$18 2 g$21 2 g$22tX 2 gB+$1l2 CFTE................................................................ 2  2 Y216 2 225 2 225X 2 Q0-"Systemn-'-- `-   "-- !-%%- !%-pp- !p-- !-- !-__- !_-  "-- !-%%- !%-pp- !p-- !-- !-__- !_-  "-a- !a-a- !a-((a- !a(-<<a- !a<-PPa- !aP-dda- !ad-xxa- !ax-a- !a-a- !a--'- `'WPWin 6.0/OLE 1.0 Prefix Information Marker/ METAFILEPICT>|>  l   `''  ' `-   "-` "- !`-- !-'- `-'- `-   !`Times New Roman4-  2 N1998 2 1999 2 20002 &Request Times New RomanM-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?Y$20 2 ?$21 2 ?$22LX 2 ?B+$1`c2 S=Program Level................................................   2 S 2 SY$20 2 S$21 2 S$22`X 2 SB+$1tj2 gBOutlays........................................................... 2 g 2 gY$18 2 g$21 2 g$22tX 2 gB+$1l2 CFTE................................................................ 2  2 Y216 2 225 2 225X 2 Q0-"Systemn-'-- `-   "-- !-%%- !%-pp- !p-- !-- !-__- !_-  "-- !-%%- !%-pp- !p-- !-- !-__- !_-  "-a- !a-a- !a-((a- !a(-<<a- !a<-PPa- !aP-dda- !ad-xxa- !ax-a- !a-a- !a--'- `' C:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt*OLE*WPCDD!,     p''  ' p' p-   !p -  ! oTimes New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanx-2 DActual - !*&D-2 Enacted - !9&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-La2 ?<Budget Authority 1/.........................................  2 ? 2 ?`$0 2 ?$373 2 ?$386LX 2 ?;+$13`c2 S=Program Level 1/.............................................   2 S 2 S`$0 2 S$397 2 S$430`X 2 S;+$33ti2 gAOutlays 1/....................................................... 2 g 2 g`$1 2 g$221 2 g$301tX 2 g;+$80l2 CFTE................................................................ 2  2 g0 2 0 2 0 2 V0Arial-2 l1/ FY 1999 Enacted reflects a comparable transfer to CDC of $33 million for polio and measles ($28 million)        ]2 9 and the environmental health laboratory ($5 million).  -'WPWin 6.0/OLE 1.0 Prefix Information Marker0 METAFILEPICT~@2 ~@8    p''  ' p' p-   !p -  ! oTimes New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanx-2 DActual - !*&D-2 Enacted - !9&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-La2 ?<Budget Authority 1/.........................................  2 ? 2 ?`$0 2 ?$373 2 ?$386LX 2 ?;+$13`c2 S=Program Level 1/.............................................   2 S 2 S`$0 2 S$397 2 S$430`X 2 S;+$33ti2 gAOutlays 1/....................................................... 2 g 2 g`$1 2 g$221 2 g$301tX 2 g;+$80l2 CFTE................................................................ 2  2 g0 2 0 2 0 2 V0Arial-2 l1/ FY 1999 Enacted reflects a comparable transfer to CDC of $33 million for polio and measles ($28 million)        ]2 9 and the environmental health laboratory ($5 million).  -' 0 1 OIG's OIGc:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wpt c:\COREL\SUITE8\TEMPLATE\CUSTOM~1\PRESSR~1\HHSPRE~1.WPT 2 *OLE*WPC!  l   `''  ' `-   "-` "- !`-- !-'- `-'- `-   !`Times New Roman)-  2 N1998 2 1999 2 20002 &Request Times New Roman0-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?Y$32 2 ?$29 2 ?$32LX 2 ?B+$3`c2 S=Program Level................................................   2 S 2 SR$118 2 S$129 2 S$152`X 2 S;+$23tj2 gBOutlays........................................................... 2 g 2 gR$127 2 g$128 2 g$152tX 2 g;+$24l2 CFTE................................................................ 2  2 O1,1662 1,3052 1,408X 2 ;+103-"Systemn-'-- `-  -- !-- !%-- !p-- !-- !-  "-`- !_-  "-- !_-  "-`- !_-((`- !_(-<<`- !_<-PP`- !_P-dd`- !_d-xx`- !_x-- !-__- !_-  "-- !-%%- !%-pp- !p-- !-- !-__- !_-`a- !`-`a- !`-(`(a- !(`-<`<a- !<`-P`Pa- !P`-d`da- !d`-x`xa- !x`-  "-a- !a-a- !a--'- `'*OLE*WPC  ! |     ''  ' ' -   !" !! !Times New Roman0-  2 c1998 2 1999 2 20002 ZRequest Times New RomanX--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- - 2 5 BIOTERRORISM:    Times New Roman-2 FPHSSEF:  2 F c)a2 W <Centers for Disease Control and Prevention.................. 2 W) c 2 W$124c- 2 W$118c 2 Wu-$6t)o2 hE Office of Emergency Preparedness.................................  2 h) t 2 h10t- 2 h!55t 2 hr+45(r2 yG Food and Drug Administration.......................................   2 y( Times New Roman4- 2 y0- !-- 2 y!13- ! !- 2 yr+13- !r--'`2 ;Subtotal, PHSSEF Budget Authority..........................   2 '  2 $134- 2 $186 2 i+$52-(2 Direct Appropriations:  )a2 <Centers for Disease Control and Prevention ................. 2 ) - 2 !20 2 r+20'y2 L National Institutes of Health...........................................  2 ' -{ 2 o14- ! o- 2 24- ! -- 2 !24- ! !- 2 0- !-- (c2 =Total, Bioterrorism Program Level ...........................   2 (  { 2 f$14  2 $158 - 2 $230  2 i+$72/)y2 #LAIDS/HIV FUNDING............................................................      2 #) / 2 #$50/- 2 #$50/ 2 #w$0Q(U2 E4YEAR 2000 COMPUTER CONVERSION.......................      2 E( Q 2 E$189Q- 2 E$150Q 2 El-$39s(d2 g>Total, PHSSEF Budget Authority................................   2 g( s{ 2 gm$0s 2 g$373s- 2 g$386s 2 gi+$13'u2 ITotal, Program Level..................................................... 2 ' { 2 f$14 2 $397- 2 $430 2 i+$33-'2 ]FTE..........................................................................................2 ' { 2 u0 2 0- 2 '0 2 0-'WPWin 6.0/OLE 1.0 Prefix Information Marker1 METAFILEPICTbCvbC/     ''  ' ' -   !" !! !Times New Roman0-  2 c1998 2 1999 2 20002 ZRequest Times New RomanX--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- - 2 5 BIOTERRORISM:    Times New Roman-2 FPHSSEF:  2 F c)a2 W <Centers for Disease Control and Prevention.................. 2 W) c 2 W$124c- 2 W$118c 2 Wu-$6t)o2 hE Office of Emergency Preparedness.................................  2 h) t 2 h10t- 2 h!55t 2 hr+45(r2 yG Food and Drug Administration.......................................   2 y( Times New Roman4- 2 y0- !-- 2 y!13- ! !- 2 yr+13- !r--'`2 ;Subtotal, PHSSEF Budget Authority..........................   2 '  2 $134- 2 $186 2 i+$52-(2 Direct Appropriations:  )a2 <Centers for Disease Control and Prevention ................. 2 ) - 2 !20 2 r+20'y2 L National Institutes of Health...........................................  2 ' -{ 2 o14- ! o- 2 24- ! -- 2 !24- ! !- 2 0- !-- (c2 =Total, Bioterrorism Program Level ...........................   2 (  { 2 f$14  2 $158 - 2 $230  2 i+$72/)y2 #LAIDS/HIV FUNDING............................................................      2 #) / 2 #$50/- 2 #$50/ 2 #w$0Q(U2 E4YEAR 2000 COMPUTER CONVERSION.......................      2 E( Q 2 E$189Q- 2 E$150Q 2 El-$39s(d2 g>Total, PHSSEF Budget Authority................................   2 g( s{ 2 gm$0s 2 g$373s- 2 g$386s 2 gi+$13'u2 ITotal, Program Level..................................................... 2 ' { 2 f$14 2 $397- 2 $430 2 i+$33-'2 ]FTE..........................................................................................2 ' { 2 u0 2 0- 2 '0 2 0-' E E E D D UEWPWin 6.0/OLE 1.0 Prefix Information Marker2 METAFILEPICT>|>  l   `''  ' `-   "-` "- !`-- !-'- `-'- `-   !`Times New Roman)-  2 N1998 2 1999 2 20002 &Request Times New Roman0-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Budget Authority.............................................  2 ? 2 ?Y$32 2 ?$29 2 ?$32LX 2 ?B+$3`c2 S=Program Level................................................   2 S 2 SR$118 2 S$129 2 S$152`X 2 S;+$23tj2 gBOutlays........................................................... 2 g 2 gR$127 2 g$128 2 g$152tX 2 g;+$24l2 CFTE................................................................ 2  2 O1,1662 1,3052 1,408X 2 ;+103-"Systemn-'-- `-  -- !-- !%-- !p-- !-- !-  "-`- !_-  "-- !_-  "-`- !_-((`- !_(-<<`- !_<-PP`- !_P-dd`- !_d-xx`- !_x-- !-__- !_-  "-- !-%%- !%-pp- !p-- !-- !-__- !_-`a- !`-`a- !`-(`(a- !(`-<`<a- !<`-P`Pa- !P`-d`da- !d`-x`xa- !x`-  "-a- !a-a- !a--'- `' c:\Corel\Suite8\Template\Custom WP Templates\Press Release\HHS Press.wptWPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTI+I+\$     `''  ' ` "--  M "--'-- L--'-- GMMH- "- MMMM F$!44433322110//--++--//011223334444H- $xeffghijklmnprsuwxz|}~|zzxvutrqponmlkjjihhgfffeeeeeeeeeefffghhijjklmnopqr t uvxzz|~ !#%&()*+,-//01123334444433322100/--+e "-])]#h - "- - $eeeee "-LLe33H- "- 3333$ dddddddddffH- ff$ ddddddddeed "-PVdfH- "- ff.$hhgffeeeddddeeeffghhhH- $ hhgffeeeddh "-U[fKKKH- "- KKKKKKj$3~|{ywvtsqpnmlkjihhijklmnpqstvwy{|~H- :$~|{ywvtsqpnmlkjih "- k qxM3H- "- M3M3$+*)(&%#"                              "#%&()*++3fH- 3f$B+*)(&%#"    + "-U U --'-- 3fL Impact------"Systemn-'--- 3f:^E  02 HPRESIDENT'S BUDGET FOR HHS      2 FY 2000  ----'--- L---'--- L Univers (W1)--------'---  l 2  Discretionary 2 210.1% ----'--- L-------'--- Q 2  Children's  2  Mandatory  2 "3.5% ----'--- L------'--- qbI) 2 L+ Medicare 2 ]353.6% ----'--- L-----'--- on) 2 q+ Other 0.6%  ----'--- L-----'--- V 2  TANF 3.5%  ----'--- L-------'--- q9 2 ;Medicaid 2 C28.6% ----'--- L---'--- `- -' ` '  'WPWin 6.0/OLE 1.0 Prefix Information Marker6 METAFILEPICT>2 >S    `''  ' `' `-   !p !K%Times New Roman@-  2 N1998 2 1999 2 20002 &Request Times New RomanP-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lc2 ?=Budget Authority.............................................  2 ? Li2 ?5$297,438L2 ?$312,210L2 ?$335,233LX2 ?#+$23,023`j2 SBOutlays........................................................... 2 S `i2 S5$293,921`2 S$314,860`2 S$333,074`X2 S#+$18,214j2 zBFTE /1............................................................ 2 z i2 zJ3,9422 z4,2672 z4,282X 2 zJ15Arial-2 Q1/ In FY 2000, 50 FTEs are being paid from the Public Health and Social Services        I2 , Emergency Fund for millennium compliance.    -"Systemn-'-- `-   !^ !&--'- `'*OLE*WPC^^!!!!   l   `''  ' `-   "-` "- !`-- !-'- `-'- `-   !x` !pwTimes New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanl-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lg2 ?@Expenses........................................................ 2 ? 2 ?R$259 2 ?$271 2 ?$282LX 2 ?;+$11sl2 fCFTE................................................................ 2 f 2 fO1,0692 f1,0852 f1,085sX 2 fQ0-"Systemn-'-- `-  -- !-- !%-- !p-- !-- !-- !_-  "-- !-__- !_-  "-- !-%%- !%-pp- !p-- !-- !-__- !_-  "-a- !a-  "-`a- !`-(`(a- !(`-<`<a- !<`-P`Pa- !P`-c`ca- !c`-  "-wwa- !aw-a- !a--'- `'WPWin 6.0/OLE 1.0 Prefix Information Marker3 METAFILEPICT>n >  l   `''  ' `-   "-` "- !`-- !-'- `-'- `-   !x` !pwTimes New Roman4-  2 N1998 2 1999 2 20002 &Request Times New Romanl-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lg2 ?@Expenses........................................................ 2 ? 2 ?R$259 2 ?$271 2 ?$282LX 2 ?;+$11sl2 fCFTE................................................................ 2 f 2 fO1,0692 f1,0852 f1,085sX 2 fQ0-"Systemn-'-- `-  -- !-- !%-- !p-- !-- !-- !_-  "-- !-__- !_-  "-- !-%%- !%-pp- !p-- !-- !-__- !_-  "-a- !a-  "-`a- !`-(`(a- !(`-<`<a- !<`-P`Pa- !P`-c`ca- !c`-  "-wwa- !aw-a- !a--'- `' 6HLPASMB User%  Fn&XBXXXXBXXXB-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.*OLE*WPC!     ''  ' -   "- "- !-- !-'- -'- -   !Times New Roman<-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman%- d2 5>Retirement Pay and Medical Benefits for Commissioned Officers:    R'y2 F LRetirement Payments.........................................................  2 F' R{ 2 Fc$150R 2 F$159R- 2 F$172R 2 Fl+$13c(2 W PSurvivor's Benefits.............................................................2 W( c{ 2 Wo11c 2 W12c- 2 W!12c 2 W0t'2 h SMedical Care....................................................................... 2 h' t{ 2 ho28t 2 h29t- 2 h!30t 2 hx+1)|2 y NMilitary Service credits...................................................... 2 y) Times New Roman4- { 2 yu2- !u- 2 y2- !-- 2 y'1- !'- 2 y{-1- ! {--'2 WTotal .................................................................................2 ' { 2 _$191 2 $202- 2 $215 2 i+$13'2 TOutlays............................................................................. 2 ' { 2 _$186 2 $199- 2 $213 2 i+$14--'-- -  -- !-- !/-- !-- !-- !3-  "-- !-  "-- !-  "-- !-- !-- !-  "-- !-//- !/-- !-- !-33- !3-- !-- !-- !-""- !"-33- !3-DD- !D-UU- !U-ff- !f-ww- !w-- !-- !-- !--'- 'WPWin 6.0/OLE 1.0 Prefix Information Marker4 METAFILEPICTbCYbC     ''  ' -   "- "- !-- !-'- -'- -   !Times New Roman<-  2 c1998 2 1999 2 20002 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman%- d2 5>Retirement Pay and Medical Benefits for Commissioned Officers:    R'y2 F LRetirement Payments.........................................................  2 F' R{ 2 Fc$150R 2 F$159R- 2 F$172R 2 Fl+$13c(2 W PSurvivor's Benefits.............................................................2 W( c{ 2 Wo11c 2 W12c- 2 W!12c 2 W0t'2 h SMedical Care....................................................................... 2 h' t{ 2 ho28t 2 h29t- 2 h!30t 2 hx+1)|2 y NMilitary Service credits...................................................... 2 y) Times New Roman4- { 2 yu2- !u- 2 y2- !-- 2 y'1- !'- 2 y{-1- ! {--'2 WTotal .................................................................................2 ' { 2 _$191 2 $202- 2 $215 2 i+$13'2 TOutlays............................................................................. 2 ' { 2 _$186 2 $199- 2 $213 2 i+$14--'-- -  -- !-- !/-- !-- !-- !3-  "-- !-  "-- !-  "-- !-- !-- !-  "-- !-//- !/-- !-- !-33- !3-- !-- !-- !-""- !"-33- !3-DD- !D-UU- !U-ff- !f-ww- !w-- !-- !-- !--'- 'j-&BBarqADMINISTRATION FOR CHILDREN AND FAMILIESADMINISTRATION FOR CHILDREN AND FAMILIES3|x  q!X  XBXXXXBXXXB8BXXdd8  -X,XX-(#(#  _)8BXXdXXd8 X @"RjQXB TableofContents #XBXRj̱# H @   >z  >z?0     MEETINGTHEHEALTHANDHUMANSERVICES4 "O  5  >z?[݌4(#(# Ќ  0  6O  7 ԀCHALLENGESOFTHE21stCENTURY#""J(#.@@+(#(##4 "O  5  16O  7 (#4Ԉ |$ >z  >z0     DEPARTMENTOFHEALTHANDHUMANSERVICES#`"`"I(#.\\1(#(##4 `"O  5  106JO^  7 (#>z݌ \ Ќ  >z  >z+0     HHSBUDGETBYOPERATINGDIVISION#`"`"I(#.***(#(##4 `"O  5  116O  7 (#>z+G݌ <  Ќ  0  HHSBUDGETBYOPERATINGDIVISION,CONTINUED#`"`"I(#.FF7(#(##4 `"O  5  126O  7 (#=Ԉ ,   >z  >z0     COMPOSITIONOFTHEHHSBUDGET#`"`"I(#.  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(#(##45 `"O  5  346.OB  7 (#pԈ L >z  >z0     NATIONALINSTITUTESOFHEALTH#`"`"I(#.'(#(##46 `"O  5  3856}O  7 (#>z݌ , Ќ  0  NIHOVERVIEW(byInstitute/Center)#`"`"I(#.$$.(#(##4; `"O  5  396O  7 (#Ԉ  0  NIHOVERVIEW(byMechanism)#`"`"I(#.'(#(##4< `"O  5  406O  7 (#Ԉ   >z  >z0     SUBSTANCEABUSEAND4= O  5  6O   7 :MENTALHEALTHSERVICESADMINISTRATION#`"`"I(#.~~C(#(##4? `"O  5  416O  7 (#'>z݌  Ќ  0  SAMHSAOVERVIEW#`"`"I(#.x x (#(##4@ `"O  5  446O  7 (#FԈ  >z  >z0     AGENCYFORHEALTHCAREPOLICYANDRESEARCH#`"`"I(#.nn4(#(##4B `"O  5  456`Ot  7 (#>z݌  d  Ќ  0  AHCPROVERVIEW#`"`"I(#. (#(##4C`"O  5  486~O   7(#Ԉ !T! >z  >z;0     HEALTHCAREFINANCINGADMINISTRATION#`"`"I(#..(#(##4D`"O  5  496O   7(#>z;W݌ #4!# Ќ  0  MEDICARE#`"`"I(#. (#(##4E`"O  5  506O   7(#.Ԉ |$$"$ 0  MEDICARETRUSTFUNDOVERVIEW#`"`"I(#.HH((#(##4L`"O  5  546O    7(#6 Ԉ l%#% 0  MEDICAID#`"`"I(#. (#(##4M`"O  5  556 O    7(#*!Ԉ \&$& 0  MEDICAIDOVERVIEW#`"`"I(#.(#(##4P`"O  5  606!O!   7(#'"Ԉ L'$' 0  CHILDRENSHEALTHINSURANCEPROGRAM#`"`"I(#./(#(##4Q`"O  5  616"O #   7(#9#Ԉ <(%( 0  CHILDRENSHEALTHINSURANCEPROGRAMOVERVIEW#`"`"I(#.8(#(##4k`"O  5  636$O&$   7(#T$Ԉ ,)&) 0  PROGRAMMANAGEMENT#`"`"I(#.(#(##4p`"O  5  646%O$%   7(#R%Ԉ *'* 0  PROGRAMMANAGEMENTOVERVIEW#`"`"I(#.'(#(##4q`"O  5  716&O+&   7(#Y&Ԉ  +(+ 0  HCFASUMMARY#`"`"I(#.. . (#(##4r`"O  5  726'O#'   7(#Q'Ԉ +), >z  >z'0     >z''݌ #-+.(#(# #Ќ  ADMINISTRATIONFORCHILDRENANDFAMILIES`"`"I(#.24 `"O  5  736(O(  7(#(Ԉ X 0  ACFOVERVIEW:DISCRETIONARYSPENDING#`"`"I(#.~~0(#(##4s`"O  5  776)O)   7(#)Ԉ H 0  ENTITLEMENTPROGRAMSUMMARY#`"`"I(#.'(#(##4`"O  5  786*O*   7(#+Ԉ 8 0  FY2000PROPOSEDACFLEGISLATION#`"`"I(#.,(#(##4`"O  5  856+O+   7(# ,Ԉ ( 0  CHILDSUPPORTENFORCEMENTOVERVIEW:4O  5  6,O,   7,CollectionsandCosts#`"`"I(#.nnE(#(##4`"O  5  866-O-   7(#-Ԉ  0  ACFOVERVIEW:ENTITLEMENTSPENDING#`"`"I(#..(#(##4`"O  5  876.O.   7(#.Ԉ  >z  >z`/0     ADMINISTRATIONONAGING#`"`"I(#.xx!(#(##4`"O  5  886/O0   7(#.0>z`/|/݌  Ќ  0  AoAOVERVIEW#`"`"I(#. (#(##4`"O  5  9161O1   7(#J1Ԉ   >z  >z10     DEPARTMENTALMANAGEMENT#`"`"I(#.!(#(##4`"O  5  926Q2Oe2   7(#2>z11݌  `  Ќ  0  DEPARTMENTALMANAGEMENTOVERVIEW#`"`"I(#.TT,(#(##4`"O  5  9463O3   7(#3Ԉ  P  >z  >z>40     HEALTHCAREACCESSFORTHEUNINSURED#`"`"I(#.``.(#(##4`"O  5  9564O4   7(#5>z>4Z4݌ 0  Ќ  >z  >z50     OFFICEFORCIVILRIGHTS#`"`"I(#.dd!(#(##4?`"O  5  966D6OX6  7?(#6>z55݌ h Ќ  0   (#(# PUBLICHEALTHANDSOCIALSERVICES4?O  5  6j7O~7  7?7EMERGENCYFUND`"`"I(#.:4?`"O  5  97688OL8  7?(#z8Ԉ H 0  _PHSSEF_ԀOVERVIEW#`"`"I(#. (#(##4?`"O  5  996S9Og9  7?(#9Ԉ 8 >z  >z:0     OFFICEOFINSPECTORGENERAL#!!H(#.%(#(##4?!O  5  1006:O:  7?(#:>z:,:݌  Ќ  >z  >z;0     PROGRAMSUPPORTCENTER#!!H(#.ll (#(##4?!O  5  1036 <O!<  7?(#O<>z;;݌  Ќ  0  PROGRAMSUPPORTCENTERENTITLEMENTSPENDING#!!H(#.BB7(#(##4?!O  5  104   ) ) )  6I=O]=  7?= 3  `'  X2XXXBe/ eXX2  `'{>@pp    %  MEETINGTHEHEALTHANDHUMANSERVICES`'{>> ?  H Ќ̌e e ee/XBX ee   `'  X2XXXBe/ eXX2  `'?@J J     %  ԀCHALLENGESOFTHE21stCENTURY`'?Z@ @   Ќ̌e e ee/XBX ee  +jXBXXXB  XBXXXB   (X(#(#(+jVA  Highlights+jVAA ӌ @ ЌXBXXBXBXXB  m XBXXXBXBXXXB  mB    TheFY2000budgetfortheDepartment   ofHealthandHumanServices(HHS)buildsonPresidentClintonscommitmenttothehealthandwellbeingofourNation.Ourbudgetconfrontsthechallengesofsustaininganagingpopulation.Itprovidesquality,affordablehealthcaretoworkingfamilies,andgivesourchildrenasafeandhealthychildhood.TheFY2000budgetaggressivelyattackshealththreatsanditmobilizesourscientificgeniustomakeAmericaahealthier"andsafer"home.And,itcontinuesourfightagainsthealthcarefraud,waste,andabuse.mB C݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m%F    WithourNationenjoyingunparalleled   economicsuccess,wenowhavetheunprecedentedopportunitytoadvancethehealthstatusandwellbeingofAmericanfamilies.Ourbudgetplan:m%FF݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m#H    m#HH݌̌ XBXXXBXBXXXB  &KL 8(*-/0123 x3)LXBXXXB"XXB  &KWI2 o3  XBX"0     Supportsretirementwithdignity&KWIJ ӌh ЌL )#3x8(*-/0123LXBXXBXBXXB   byexpandingsupportforinformalcare ( givers,improvingoptionsforqualitylongtermhealthcarefortheelderlyanddisabled,   implementinganursinghomequalityinitiative,andmodernizingMedicare;   !! &KL 8(*-/0123 x3)LXBXXXB"XXB  &KL2 o3  XBX"0     PromotesQuality,affordable P# # healthcareforourworkingfamilies&KLM ӌ  ЌL )#3x8(*-/0123LXBXXBXBXXB   byimprovingaccesstohealthinsurance &@$' optionsforAmericans"includingearlyretireesandthosewithdisabilitieswhowanttowork"providingaccesstohealthcareforuninsuredworkers,andimprovingcareprovidedtoracialorethnicminorities,peoplelivingwithAIDS,victimsof domesticviolence,andthementallyill;   (-*. &KL 8(*-/0123 x3)LXBXXXB"XXB  &KP2 o3  XBX"0 D       Adv  ocatesasafeandhealthy @. childhood&KPQ ӌ D(#D(# ЌL )#3x8(*-/0123LXBXXBXBXXB   bymakingchildcaresafe,available,and  1 affordable,enhancingtheChildrensHealthInsuranceProgram(CHIP)andMedicaidoutreach,fundingHeadStartandanapproximately$20billionchildcareproposal,promotingimmunizations,innovativetreatmentsforasthma,andexcellenceinchildrenshospitals,curtailingthreatstohealthsuchasyouthsmoking,andeasingtransitionsfromfostercaretoselfsufficientadulthood;&KL 8(*-/0123 x3)LXBXXXB"XXB  &K8U2 o3  XBX"0 D    Mobilizesourscientificgenius&K8UU ӌ`=D(#D(# ЌL )#3x8(*-/0123LXBXXBXBXXB   bycreatingsuperiorpublichealth  ? surveillance,reinforcingpublichealthregulationandinspection,modernizingtheFoodandDrugAdministration,enhancingfoodsafety,expandinghealthresearch,andreplacingantiquatedlaboratories;and,&KL 8(*-/0123 x3)LXBXXXB"XXB  &KX2 o3  XBX"0 D    ImprovestheFiscalSoundnessand 8F ManagementofHHSPrograms&KX]Y ӌ D(#D(# ЌL )#3x8(*-/0123LXBXXBXBXXB   byincreasingaccountabilityand 8I managementflexibility,andemphasizingperformancemeasurementforallHHSprograms.+jXBXXXB  XBXXXB   +j[  ֔XBTotals#XBX.֔/\#+j[\ ӌ #p!N ЌXBXXBXBXXB  m XBXXXBXBXXXB  m] D   TheFY2000PresidentsBudgetfor l%#P HHStotals$400.3billioninoutlays,anincreaseof$24.8billion,or6.6percent,overthecomparableFY1999amount.ThediscretionaryportionoftheHHSbudgettotals$42.1billioninbudgetauthority,anincreaseof4.4percentovertheFY1999level.m]]݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m_ D   m_`݌,*X Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j`  ֔XBSupportingRetirementwith X Dignity#XBX.֔`a# 4 +j`Ba ӌ p ЌXBXXBXBXXB    TwothirdsofthefivemillionAmericans  withsignificantlimitationsduetoillnessordisabilitywhorequirelongtermcareareolderAmericans.Halfofallcaregiversthemselvesareolderthan65years,andarealsohighlyvulnerabletoadeclineintheirownhealthstatus.Moreover,thenumberofAmericansolderthan65yearswilldoubleoverthenext3decades,from34.3millionto69.4million.Thisrapidagingofthepopulationintensifiestheurgencyfordevelopingqualitylongtermcareoptions.  Ourlongtermcareinitiativeassistscaregiverswhoenhancethelivesofourincreasinglyelderlypopulation.Privateinsurancerarelycoverslongtermcarewhichrequiresmajoroutofpocketexpenses.ThisinitiativeaddressesthedailyneedsofourNationssteadilygrowingelderlypopulationbydirectlyassistingcaregivers,educatingtheelderlyandpeoplewithdisabilitiesaboutlongtermcareissuesandoptions,andpromotingnewpromisingstrategiesforlongtermcare. h   .Ȋ  .Ȋf0  XBXXXBXBXXXB       NationalFamily_Caregiver_ԀSupport , Program.Ȋff ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m@h    HHSproposes$125millioninFY2000   toserveapproximately250,000familiesnationwidewiththisnewprogram.Sevenmillioninformalcaregivershelpdisabledolderpersonsliveintheircommunities.Thisinitiativeprovidesforbasicsupportservicesforcaregivers,suchascounselingandtraining,respitecare,homehealthservices,andreferral.  m@hh݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mj    Theinitiativesupportsfamilieswhocare L'$) forelderlyrelativeswithchronicillnessesordisabilitiesbyenablingStatestocreate onestopshopswhichprovidequalityrespitecare,informationaboutcommunitybasedlongtermcareservices,andcounselingandsupport,includingtrainingforcomplexcareneeds.mjrk݌ -+0 Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mm D   mmn݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋn0 D XBXXXBXBXXXB     LongTermCareInformation H1 Campaign.Ȋnn ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m*p D   Nearly60percentofMedicare H4 beneficiariesareunawarethatMedicaredoesnotcovermostlongtermcareservices.Furthermore,manyareunawarewhichservicesmaybestmeettheirneeds.Ourbudgetproposesa$10millionnationwidecampaigntoprovideall39.8millionMedicarebeneficiarieswithrelevantinformationregardingMedicarecoveredservices,howtoidentifyqualityprivatelongtermcare,andhowtoaccessinformationabouthomeandcommunitybasedcareservices.m*pp݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mSs D   mSss݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋt0 D XBXXXBXBXXXB   ExpansionofHomeandCommunity hB BasedOptions.Ȋtt ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mu D   ThisinitiativegivesStatestheoptionof E expandingMedicaideligibilityforpeoplewithincomesupto300percentoftheSupplementalSecurityIncomelevelwhomeetnursinghomeeligibilityrequirementsbutwanttoliveintheircommunities.Thisinitiativecosts$5millioninFY2000,foratotalof$110millionoverfiveyears.mujv݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mx D   mxx݌̌ XBXXXBXBXXXB  .Ȋ      .Ȋy0 D XBXXXBXBXXXB   NursingHomeQualityInitiative.Ȋyy ӌ0ND(#D(# ЌXBXXBXBXXB    D TheHHSFY2000budgetincludes P $60milliontoimplementthePresident'sNursingHomeInitiativeannouncedinJuly,1998.InFY1999,HHSbeganphasing-inkeyprovisionsoftheinitiative.ThisbudgetrequestallowstheHealthCareFinancingAdministration(HCFA)andothercomponentsoftheDepartmenttofullyimplementallprovisionsofthePresidentsinitiative. D FundingwillbeprovidedforStatesurveysofnursinghomes,Federalsurveyoroversightanddevelopinganationalcriminalabuseregistrytoscreenpotentialnursinghomeemployees.Thesefundswillalsoensureadequatelegalresourcesforthe x- +` OfficeoftheGeneralCounselandtheDepartmentalAppealsBoardtoprovidejudicialhearingsandhandleadministrativeandcourtlitigationinatimelymanner..Ȋ  .Ȋ_~0  XBXXXBXBXXXB   MedicareBuyInforEarly 8 Retirees.Ȋ_~z~ ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    TheFY2000budgetenablesAmericans  aged6265tobuyintoMedicarebypayingafullpremiumandextendstheoptionofcoverageuntilage65forthoseworkerswhosecompaniesterminatedretireehealthcoverage.Thisinitiativecostsanetof$1.3billionoverfiveyears,althoughthesecostsarecompletelyoffsetbyproposedMedicaresavingsintheFY2000budget.m6݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jq  ֔XBPromotingquality,affordable h healthcareforAmericas  workingfamilies#XBX.֔#+jqۂ ӌ  ЌXBXXBXBXXB    ThePresidentsgoalistoexpandaccess < tohealthcareformoreAmericans,includingdisplacedworkers,thedisabled,andpregnantwomenandchildren.Thisbudgetprovidescriticallyneededmentalhealthservices,supportshealthcareforNativeAmericans,andenhancesservicesforvictimsofdomesticviolence.  Furthermore,ourbudgetadvancesopportunitiesforpeoplewithdisabilitiestoreturntoworkwiththisunprecedentedinitiative.ManyAmericanswithdisabilitieswanttowork,butthatworkcanendtheiraccesstoMedicareandMedicaidservices.Thisbudgetincludesseveralproposalsthatcreateoptionstoprovidecontinualhealthcaretothispopulation..Ȋ  .Ȋ0  XBXXXBXBXXXB     IncreasingHealthCareAccessfor t'%* TheUninsured.Ȋ. ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    Ourgoalistoprovidebasiccareatthe )t'- righttimeandtherightplaceforthosewhoneedit.Nearly43millionAmericanslackmedicalcoverage.This$1billioninvestmentspreadover5yearswillimprove -4+1 medicalcareformanyoftheNation'suninsuredadultsbyencouragingcollaborationbetweenprimarycareprovidersandhospitalstoensurethatpatientsreceiveappropriatetreatment.Ultimately,thisinitiativewillprovideapproximately100grantstocommunitiestoassisttheminorganizinganddeliveringhealthcaretotheNation'sgrowingcadreoflow-incomeworkersandotherswholackhealthinsurance.Thisinitiativealsowillhelpcommunitiesacquirebasichealthserviceswhichareofteninshortsupplyfortheuninsured.Itencouragescollaborationsamonglocalhealthdepartments,independentcommunityhealthcenters,publichospitalsandhospitalsaffiliatedwithmedicalschools.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mk D   mk݌̌ XBXXXBXBXXXB  .Ȋ    .Ȋ0 D XBXXXBXBXXXB   MedicareBuyInforDisplaced (D Workers.ȊŎ ӌ D(#D(# ЌXBXXBXBXXB    D TheFY2000budgetallowsdisplaced (G workersoverage55accesstoMedicarebyofferingthosewhoinvoluntarilylosetheirjobsandhealthinsuranceabuyinoption.Thisinitiativecostsanetof$0.1billionoverfiveyears,althoughthesecostsareoffsetbyproposedMedicaresavingsintheFY2000budget..Ȋ    .Ȋ[0 D XBXXXBXBXXXB   ExpandingOpportunitiesForthe x P WorkingDisabled.Ȋ[ ӌ D(#D(# ЌXBXXBXBXXB    D ThePresidentcommits$20millionin  xS FY2000and$857millionoverfiveyearsinMedicareandMedicaidspendingtosupportopportunitiesforpeoplewithdisabilitiestoreturntoworkwithoutlosingtheirhealthcare.TheinitiativeincreasesflexibilityforStatestosethigherincomeandresourcestandardsforMedicaid.ItalsoprovidesincentivegrantstoStatestoexpandMedicaidcoveragefortheworkingdisabledandtobuildthecapacitytoprovidehomeandcommunitybasedservicesinordertoprovideanalternativetoinstitutionalcare.Inaddition,theinitiativewouldallowpeoplewithdisabilitieswholeaveSocial -+a _SecurityDisabilityInsuranceinthenext10yearstogotoworkbutcontinuereceivingfreeMedicarePartAcoverage..Ȋ  .Ȋ0  XBXXXBXBXXXB   EnsuringAccesstoAIDStherapies H (RyanWhite).Ȋ ӌ  ЌXBXXBXBXXB     TheFY2000budgetproposesan  increaseof$100millioninRyanWhitetreatmentactivities.Intotal,theFY2000budgetproposes$1.5billioninFederalspendingforactivitiesauthorizedbytheRyanWhite/CAREAct.Thisrepresentsa7percentincreaseoverFY1999levels..Ȋ  .Ȋ0  XBXXXBXBXXXB   ProvidingCriticalMentalHealth   PreventionandTreatmentServices.Ȋ ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    TheFY2000PresidentsBudget X providesa$70million,or24percent,increasefortheMentalHealthBlockGrant,whichprovidesintegralsupporttoStatesforservicestopeoplewithmentalillness.Inadditiontoincreasingfundingforthisvulnerablepopulation,ourbudgetrequestsa$5million,or19percent,increasefortheProjectsforAssistanceinTransitionfromHomelessness(PATH)program.Thisprogramprovidessupportiveservicestohomelesspersonswithamentalillness.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mG    mGƝ݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ{0  XBXXXBXBXXXB   ReducingRacialDisparitiesin 0 HealthStatus.Ȋ{ ӌ  ЌXBXXBXBXXB     DespiteimprovementsintheNations " overallhealthoutcomes,minoritygroupsstilldisproportionallybeartheburdenofdiseaseandillness.TheFY2000budgetincludes$145millionforhealtheducation,prevention,andtreatmentservicesforminoritypopulationstomitigatethedifferencesinhealthoutcomes.Ofthisamount,$35millionsupportscommunitybasedresearchanddemonstrationprojectstoreducehealthdisparitiesamongracialand ethnicminorities. 0*'- .Ȋ  .Ȋ0 D XBXXXBXBXXXB      ProvidingQualityCaretoNative X- Americans.Ȋ ӌ D(#D(# ЌXBXXBXBXXB    D HHSadvancesthroughthisbudgetour X0 effortstoprovidequalitycaretoNativeAmericans.Asawhole,theysufferagreaterdiseaseburdenthanotherAmericanpopulations.The$170millionincreasefortheIndianHealthService(IHS)inFY2000providesadditionalclinical,preventive,andenvironmentalhealthservices,increasescontractsupportpaymentsforthosetribeswhoprovidetheirownhealthservices,andprovidesforadditionalmaintenanceofIHShospitalsandclinics.ThisinvestmenthelpstribesmeettheiruniquehealthserviceschallengesandreaffirmstheAdministrationsdedicationtoimprovingthehealthstatusofallAmericans..Ȋ  .Ȋ0 D XBXXXBXBXXXB   Curt  ailingViolenceAgainst (A Women.Ȋ6 ӌ D(#D(# ЌXBXXBXBXXB    D TheFY2000budgetincludes (D $27milliontocurtailviolenceagainstwomen.Specifically,thisbudgetinvestsinenhancingservicesandchangingsocialnorms.Over4,200womenaremurderedeachyearbysomeonetheyknowandintimatepartnerscommitoverhalfofthosemurders.HHSproposes$23milliontoprovidecounselingandshelterfordomesticviolencevictimsandenhanceotherservices,andincludes$4milliontoimprovepubliceducationaboutdomesticviolence..Ȋ  .Ȋu0 D XBXXXBXBXXXB   FamilyPlanning.Ȋu ӌ8"QD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   Thisbudgetpromotesfamilyplanning #H!S servicestohelpAmericanwomenpreventover1millionunintendedpregnancieseachyear.ThePresidentsBudgetproposesanadditional$25millionovertheFY1999appropriationtoserve4,600familyplanningclinics.Thisfundingexpandseffortstoreduceunintendedpregnanciesandsexuallytransmitteddiseasesforgroupswithhighunintendedpregnancyrates.Theseefforts willpromoteresponsibilityforhealthy -*] reproductivelifestylesemphasizinghardtoreachpopulations.m-݌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j*  ֔XBAdvocatingaSafeandHealthy H Childhood#XBX.֔#+j* ӌ ` ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    TheFY2000budgetforHHSpromotes \ healthandsecureshealthservicesforourNationschildren.First,itincludesasignificantnewcommitmenttochildcare.ItalsoprovidesStateswithadditionalfundsforchildrenshealthinsuranceoutreach,advancesinnovationsinasthmatreatment,promotesexcellenceinchildrenshospitals,andextendsMedicaideligibilitytofosterchildren.m?݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋʳ0  XBXXXBXBXXXB   MakingChildCareSafe,Reliable, T andAffordable.Ȋʳ ӌ  ЌXBXXBXBXXB     Workingfamiliesdeserveaffordable,  qualitychildcare.TheAdministrationinthisbudgetmeetsthechallengeofmakingqualitychildcaremoreaccessible.Thiscomprehensiveinitiativecomprisesapproximately$20billionoverfiveyearsforHHSandtheDepartmentsofTreasuryandEducation.Theinitiativehelpsworkingfamiliesaccessandpayforchildcare,alongwithhelpingStatesandcommunitiesimprovethesafetyandqualityofcare.m XBXXXBXBXXXB  m    HHSproposesa$7.5billionexpansion t! overfiveyearsoftheChildCareandDevelopmentBlockGrantAct(CCDBG).Theseentitlementfundshelpworkingparentspayforcareand"whencombinedwithchildcarefundsfromwelfarereform"enableStatestoprovidechildcareassistancetoover2.4millionchildrenby2004.Thisrepresentsanincreaseofover1millionchildrenabovethe1997level.FundswillbeallocatedtoStatesbyamatchingformulaanddistributedtofamiliestohelpthempayforchildcare.TheFY2000budgetrequestalsocontains$1.2billionindiscretionarychildcarefundsfortheCCDBGinFY2001.m݌ -+0 Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   ThisbudgetproposesanEarlyLearning X0 Fundtoenhanceearlychildhooddevelopment,andimproveemergentliteracyandschoolreadiness.Thisinitiative,totaling$3billionoverfiveyears,providesmatchedchallengegrantsforStatestodistributetocommunitiesforimprovingearlylearningandthequalityandsafetyofchildcare.mg݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB     CHIPandMedicaidOutreach .Ȋξ ӌ ` :D(#D(# ЌXBXXBXBXXB    D Thisoutreachinitiativeinformschildren  < andtheircaregiversaboutCHIPandMedicaid,andgivesStatesflexibilitytoprovideinnovativeandeffectiveapproachestoincreasingoutreachactivities..Ȋ    .Ȋ0 D XBXXXBXBXXXB   ImprovingAsthma  ԀTreatments.Ȋ ӌHBD(#D(# ЌXBXXBXBXXB    D ThePresidentsBudgetproposes XD $50millionindemonstrationgrantstoStatesfortestinginnovativeasthmadiseasemanagementtechniquesforchildrenenrolledinMedicaid.Thiswouldhelpthosechildrenreceivethemostappropriatecaretocontroltheirasthma.ParticipatingStateswillmeasuretheprogramssuccessinavertingasthmarelatedcrisessuchasdecreasedemergencyroomvisitsandhospitalstaystojudgethesuccessoftheprojectinimprovingasthmaticchildrensqualityoflife..Ȋ  .Ȋn0 D XBXXXBXBXXXB     PromotingEducationalExcellence X R inChildrensHospitals.Ȋn ӌH!SD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   Thebudgetproposes$40millionto "X U supportgraduatemedicaleducationatfreestandingchildrenshospitals.Thesehospitalsplayanessentialroleintheeducationofourphysicians.Theytrain25percentofallpediatriciansandoverhalfofmanypediatricsubspecialties.mq݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mR D   mR݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   EnhancingHeadStart.Ȋ ӌ0*']D(#D(# ЌXBXXBXBXXB    D TheHeadStartprogramensuresthat +@)_ lowincomechildrenstartschoolpreparedtolearn.TheFY2000budgetrequestseeks x- +a _$5.3billion,anincreaseof$607millionoverFY1999,forHeadStarttoserveanadditional42,000children.ThisleveloffundingprovidesHeadStarttoatotalof877,000childrenandtheirfamilies.TheAdministrationthusreinforcesitscommitmenttoenrollingonemillionchildrenby2002.Plansincludeimprovingprogramquality,obtainingsaferequipment,improvingclassroomfacilities,andreducingstaffturnover..Ȋ  .Ȋ/0  XBXXXBXBXXXB   EasingtheTransitionfromFoster   CaretoSelf-SufficientAdulthood.Ȋ/J ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    Oncetheyturn18yearsold,fostercare x  youthsbecomeineligibleformaintenancepayments.Eachyear,approximately16,000youthsageoutoffostercareand9,000youthsrunawayfromthefostercaresystem.Theseteensoftenlacktheresourcesandthesupporttheyneedtobeself-sufficient.ConsistentwiththeDepartment'seffortstomovefamiliesfromwelfaretowork,theFY2000President'sBudgetincludesapackageoflegislativeproposalsaimedatassistingtheseformerfosteryouthsintheirtransitiontolivingalone.Thispackageproposes$50millioninFY2000,and$275millionoverthenextfiveyears.m'݌̌ XBXXXBXBXXXB    Theproposalsincludeincreasingfunds 0 fortheIndependentLivingProgramandtheRunawayandHomelessYouthTransitionalLivingProgram,supportingtheLivingExpensesofYouthsinTransitionalLivingPrograms,andprovidingMedicaidcoverageforemancipatedyouthstoage21..Ȋ  .Ȋ0  XBXXXBXBXXXB   ProtectingChildrenfromTobacco.Ȋ ӌ$8"& ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    TheFY2000budgetcombatssmoking %#( amongyoungpeople.Thisbudgetbuildsongainsmadeinthe1998StateAttorneysGeneralTobaccoSettlementandtakessignificantnewstepstodefendpublichealth.mb݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheHHSFY2000budgetincludes +@). $61millionofadditionalfundsfortobaccorelatedactivities.Ofthisamount, x- +0 $27millionexpandstheCentersforDiseaseControlandPreventions(CDCs)Statebasedtobaccopreventionactivities,and$34millionsupportstheFDAsoutreachandenforcementactivities.mr݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   TheAdministrationagainwillsupport 5 legislationwhichconfirmstheFDAsauthoritytoregulatetobaccoproducts,tohaltadvertisingtargetedatchildren,andtoensurethatcigarettesarenotsoldtominors.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m%݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   PromotingChildhood  P ; Immunizations.Ȋ ӌ D(#D(# ЌXBXXBXBXXB    D Thebudgetproposes$1.1billionfor  > childhoodimmunizations,includingtheVaccinesforChildrenprogramandCDCsdiscretionaryimmunizationprogram.TheNationsurpasseditschildhoodvaccinationgoalsfor1997"90percentormoreofAmericastoddlersreceivedeachbasicchildhoodvaccine"asaresultoftheAdministrationsinitiative.Theincidenceofvaccinepreventablediseasessuchasdiphtheria,tetanus,measlesandpolioareatalltimelows.Expandedfundingwillpermitcontinuedhighlevelsofchildhoodimmunization.TheFY2000budgetalsoincludes$83milliontoeradicatepolio,anincreaseof$17million.  +jXBXXXB  XBXXXB   +j  ֔XBMobilizingOurScientific Q Genius#XBX.֔j#+jL ӌ  R ЌXBXXBXBXXB  m XBXXXBXBXXXB  mq D   InFY2000,ourbudgetrenewsthe "D T Administrationscommitmenttoprotectpublichealthandpromotescientificexpertise.Itfocuseson:mq݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mD D   mD݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋx0 D XBXXXBXBXXXB   ImprovingDiseaseSurveillance.Ȋx ӌL'$YD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   Thisbudgetcallsformajor (\&[ improvementsinpublichealthdiseasesurveillance.Surveillanceactivitiesintheinfectiousdisease,foodsafety,andbioterrorisminitiatives($65million)wouldbecoordinatedintoanew_National d- +` ElectronicDiseaseSurveillanceNetwork.OurNationcurrentlylacksastandardized,nationwidesystemforcollectingandanalyzingepidemiologicalinformationoncommunicablediseaseoutbreaks.Thisnetworkwouldestablishastrongcommunicationlinkbetweenthe_local_medicalcommunityandthepublichealthsectortoprovideanintegratedsurveillancesystem.m?݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   ExpandingFDAResources.Ȋ ӌ P  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    HHSproposestoexpandresources   availabletotheFDAtocomplywiththeNationsdrug,food,andmedicaldevicelawsandimprovetheNationsadverseeventreportingsystem.Thebudgetincreasesof$15.3millionforinjuryreporting,$52.2millionforproductsafetyassurance,and$11millionforpremarketapplicationreviewarenecessaryforFDAtomeetitsstatutoryrequirementsandpublicexpectations.Inaddition,$15.3millioninvestsinpreventingproductrelatedinjuries.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mE    mE݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋy0  XBXXXBXBXXXB     EnsuringFoodSafety.Ȋy ӌ0 ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    TheFY2000budgetenhancesfood @ safety.HHSfundingwouldincreaseby$40millionoverthe1999levelfortheAdministrationsinteragencyfoodsafetyinitiative.TheFDA,CDC,andtheDepartmentofAgriculturewillcontinuetocoordinateeffortstoensureasafernationalfoodsupply.mA݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m-    m-݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋa0  XBXXXBXBXXXB   SupportingResearch.Ȋa| ӌ%"& ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    Thisinitiativecontinuesourwise p&$( investmentsinbiomedicalscienceandhealthcarequalityresearch.Scientificadvancementsfortomorrowhingeonstrategicinvestmentsmadetoday.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheNationalInstitutesforHealth(NIH)  +(- spearheadsworldwideeffortstoadvancehealththroughmedicalscience.Werequest$15.9billionforNIH,anincreaseof -+0 $320million.Atthislevel,NIHwouldfundnearly30,000extramuralresearchprojects.Moreover,theFY2000budgetproposesaprogramlevelincreaseof$35million,or20percent,overFY1999fortheAgencyforHealthCarePolicyandResearch(AHCPR).Theireffortsincludebridgingthegapbetweenscienceandhealthcare,andresearchtoimprovecosteffectivenessandqualityofcare,especiallyamongthediseasesthataffectMedicareandMedicaidcoststhemost.m݌̌ XBXXXBXBXXXB   D Lastly,theAdministrationagain  @ < proposesathreeyeardemonstrationtoencouragehigherparticipationforMedicarebeneficiariesinNIHsponsoredcancerclinicaltrials.Onlythreepercentofcancerpatientsparticipateinclinicaltrials;manyscientistsbelievethatgreaterparticipationinthesetrialscouldimproveresults..Ȋ  .Ȋ0 D XBXXXBXBXXXB   RespondingtoBioterrorism.Ȋ ӌ8ED(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m& D   HHSischargedwiththeresponsibility G toprepareforandrespondtothemedicalandpublichealthconsequencesofabioterroristevent.ThePresidentproposesforFY2000atotalof$230millionforHHStoprepareforpossibleincidentsofbioterrorism.Asglobalthreatstopeacepersist,thepotentialfordomesticterrorisminAmericaremainshigh.Bioterrorismisaperniciousthreatbecauseitcanaffectalargepopulation,goundetectedfordaysorweeks,andcausesecondaryillnessordeathiftheagentiscommunicable.Developingsurveillanceandlaboratorycapacitytocompetentlyandprofessionallyrespondtoabiologicalattackisurgentandoftheutmostimportance.m&݌̌ XBXXXBXBXXXB   D Keyelementsofthisinitiativeinclude &$X $72milliontoimprovedeterrence,surveillanceandcommunications,establishregionallabsforidentifyinganddiagnosingbiologicalandchemicalagents,anddeveloprapidtoxinscreening.Itincludes$52millionforthenationalpharmaceuticalstockpileandprovides$67.7millionfor x- +_ researchandexpeditedregulatoryreviewofimproveddrugsandvaccines.Thebudgetalsoincreasesfundingfor_local_ԀMetropolitanMedicalResponseSystemsto$16.5milliontoprovidefor25_local_Ԁemergencymedicalteamstorespondtoemergenciesinvolvingbiologicalorchemicalweapons.֔XXB+j֔֔  XBX֔   #XBXXB#֔XB+j  ImprovingManagement+j ӌ  p  Ќ֔.֔֔.֔  /XBXXXXgJ֔/+XBXXXXgJXXB+m XBXXXBXBXXXB  m    HHSincludesmorethan300programs l   andrepresentsover20percentofallFederaloutlays,administeringmoregrantdollarsthanallotherFederalagenciescombined.Effectiveperformanceofouragenciesrequiresgoodmanagement.Ourinitiativesinclude:md ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m/     m/  ݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋc 0  XBXXXBXBXXXB   ReformingHCFAManagement.Ȋc ~  ӌ ЌXBXXBXBXXB   m XBXXXBXBXXXB  m     HCFAadministersMedicare,Medicaid, T andCHIP,andoverseesStatehealthinsuranceregulationofindividualandsmallgroupmarkets.Theagencyfacestheimportantchallengeofmodernizingitsadministrativeinfrastructure"coordinatingtheworkofdozensofcontractorsaswellasStateandterritorialgovernments"whileprovidingsuperiorcustomerservicetoalmost70millionbeneficiaries.HCFAisfurtherreformingitsoperationsinordertoadapttothechanginghealthcaremarketandincreaseitsaccountabilityasaprudentpurchaserofhealthcare.m %݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m"    m"݌̌ XBXXXBXBXXXB  .Ȋ  .ȊV0  XBXXXBXBXXXB   CombatingMedicareandMedicaid d# !% Fraud,Abuse,andWaste.ȊVq ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    AsaresultoftheAdministrations %d#( overalleffortsaswellasprioryearjudgments,settlements,andadministrativeimpositions,theFederalgovernmentin1998collected$296millionincasesresultingfromhealthcarefraudandabuse,ofwhich$271millionwasreturnedtotheMedicareTrustFund,and$9millionwasrecoveredastheFederalshareofMedicaid.HCFAsmainfocusonpreventinganddetecting ,.+1 fraudandabuseisthroughtheMedicareIntegrityProgram(MIP)andtheHealthCareFraudandAbuseControl(HCFAC)account.mB݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m; D   UndertheHealthInsurancePortability 5 andAccountabilityActof1996,fundingtocombathealthcarefraud,waste,andabuseincreasesinFY2000forbothMIPandHCFAC.MIPincreases$70millioninFY2000whileHCFACincreases$20million.TheseadditionalfundswillhelptheDepartmentsefforts,withtheassistanceoftheDepartmentofJustice,toprotecttheintegrityoftheMedicaretrustfundsandtheGeneralFund.m;݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m1 D   TheFY2000budgetalsoincludesnew h@ proposalstocombatMedicarefraud,waste,andabuse.Theseincludeeliminatingexcessiveoverpaymentsforthedrug_Epogen_andmarkupsforotheroutpatientdrugs,requiringprivateinsurancecompaniestoprovidesecondarypayerinformationsothatMedicaredoesnotpayforservicesthatshouldbepaidbyanotherinsurer,reducingthemisuseofpartialhospitalizationservices,andexpandingtheuseof CentersofExcellenceasapermanentpartofMedicare.TheseproposalsareexpectedtosavetheMedicaretrustfunds$240millioninFY2000and$2.9billionoverfiveyears.m1݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m  D   Thisbudgetalsoworkstoreduce x O Medicaidfraud.First,StateswouldbeallowedtosuspendorrestricteligibilityforbeneficiarieswhohavebeenconvictedofcertaincrimesinStatecourts.ThesecondproposalwouldpreventdebarredindividualsfromcontinuingtobillMedicaidbyaffiliatingthemselveswithotherproviders.Thisprovisionclosestheloopholebyprohibitingprovidersandproviderorganizationsingoodstandingfromhiringorestablishingaffiliationswithdebarredindividuals.m ݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mT! D   mT!!݌ *P(\ Ќ XBXXXBXBXXXB  .Ȋ  .Ȋ"0  XBXXXBXBXXXB      EnsuringY2KCompliance.Ȋ"" ӌX ЌXBXXBXBXXB   m XBXXXBXBXXXB  m#    SolvingtheYear2000computer h conversionproblemsisoneoftheDepartmentshighestpriorities.HHSisstrivingtomeetthechallengeofensuringmillenniumcomplianceinourinformationsystemsbytheAdministrationsdeadlineofMarch31,1999.AsofDecember31,1998,85percentofHHSmissioncriticalsystemswereYear2000compliant.Weareconfidentthatwewillhaveallofoursystemscompliantbynextyear.Infact,webelievethat100percentofourinternalHHSsystemswillbecompliantbyMarch31,1999.AlthoughafewexternalMedicarecontractorsystemsmaytakeuntilJune1999toreachcompliance,HCFAhasprogressedremarkablyinthelastquarter.InFY2000,HHSestimates$165millionwillbespentonYear2000complianceactivities;$150millionofthisamountwillbeforHCFA.m#r$݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mm(    mm((݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ)0  XBXXXBXBXXXB     MeasuringPerformanceUnder ` GPRA.Ȋ)) ӌ  ЌXBXXBXBXXB   AXBXXXB  TheFY2000HHSPerformancePlan ` containsgoalsandmeasuresforthemorethan300programsHHSadministers.Forexample,toreducethedisproportionatecostofdiabetestotheAmericanIndianandAlaskanNativepopulations,IHSwillincreaseby3percenttheproportionofIHSclientswithdiagnoseddiabeteswhohaveimprovedtheirglycemiccontrol.CDCandtheHHSOfficeofEmergencyPreparednesswillimplementaplandesignedtoensurethereadyavailabilityofanationalpharmaceuticalstockpiletorespondtoterroristuseofpotentialbiologicalorchemicalagents,includingtheabilitytoprotect4millionciviliansfromananthrax attack.#XBXXAXB+# )`'+ +jXBXXXB   XBXXXB   +j.  MeetingtheChallenges+j.. ӌ X+ ЌXBXXBXBXXB  m XBXXXBXBXXXB  mJ/ D   TheHHSFY2000budgetrequestmeets h- thehealthandhumanservicesdemandsofanewcentury.ItaddressestheneedsofourrapidlygrowingpopulationofolderAmericanswhileitprotectshealthandopportunityforourchildren.ItexpandsaccesstoAmericashealthcaresystemanditsupportstheresearchbasethatissoimportantforfuturehealthadvances.Thisbudgetalsomaintainsourcommitmenttoaresultsoriented,customerfocusedDepartmentofHealthandHumanServices.mJ//݌̌ XBXXXBXBXXXB   D Inshort,theFY2000budgetkeepsfaith  9 withtheAdministrationsvisionofa21st  : CenturyAmericawhereeveryfamilycangetaheadandnofamilyisleftbehind.  x< (X( #  X2XXXBe/ eXX2  #ᄬ3@    %  DEPARTMENTOFHEALTHANDHUMANSERVICES#ᄬ34 84  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)% d vVhB2.b~1 , `. @Exxe<v (#(#          (#(#AZ') HxdEHxAm XBXXXBXBXXXB  m7    m78݌ c  Ќ XBXXXBXBXXXB  vV?B2.b~1 p `..@E5ppppmv (#(#                           (#(#  2*'+ #  X2XXXBe/ eXX2  #j<@F F     %  HHSBUDGETBYOPERATINGDIVISION#j<< <  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)% u vVyB2.b~1 ,!d& `h(.@Ex`#x`#e<#v (#(#px ԰                                        (#(#%  AZ') HxdyE*HxA  *(. #  X2XXXBe/ eXX2  #ᄾC@    %  HHSBUDGETBYOPERATINGDIVISION,CONTINUED#ᄾC%D JD  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1^R% `Y%.@ER%R%lnV%v (#(#                                         (#(#AZ')-HxdHE-HxAp   ,'40 #  X2XXXBe/ eXX2  # K@     %  COMPOSITIONOFTHEHHSBUDGET# KK K  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)pV<,(`~1 6!d& `h(.Ex`#x`#J[#p (#(#                                       (#(#AZ'),HxdE,HxA  +s), #  X2XXXBe/ eXX2  # R@- -     %  FOODANDDRUGADMINISTRATION# RR R  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 ,$  `. @Ex x e< v (#(#            (#(#AZ') HxdzEHxA C +jXBXXXB  XBXXXB   (X@(#(#(+j0V  Summary+j0VV ӌ z ЌXBXXBXBXXB  m XBXXXBXBXXXB  mxW    TheFY2000budgetrequestforthe : FoodandDrugAdministration(FDA)is$1,350millioninprogramlevel,including$195millioninindustryspecificuserfees.This18percentincreaseoverFY1999istargetedtothefoodsafetyinitiative($30.0million),theyouthtobaccopreventioninitiative($34.0million),thebioterrorisminitiative($13.4million)andFDAsothercoreactivities($95.5million).mxWW݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m[Z    FDAistheprincipalconsumer B protectionagencyoftheFederalgovernment.FDAscriticalmissionistoprotectthepublichealththroughthepreventionofinjuryorillnessduetounsafeorineffectiveproducts.FDAidentifieshealthproblemsassociatedwithFDAregulatedproductsandassesstheoriginandimpactofthesehealthproblems.FDAmakeseveryefforttopreventproblemsthatwouldexposethepublictohazardsandmonitorsthemarketplacetoensurecompliancewiththelawsandregulations.m[ZZ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m]    m]"^݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j^  FoodanddrugAdministration )b'+ modernizationactof1997+j^A_ ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m'`    TheFoodandDrugAdministration ,). ModernizationActof1997(FDAMA)wassignedintolawbyPresidentClintonin -+0 Novemberof1997.Thiscriticallegislationupdatestheregulationoffood,medicalproductsandcosmetics,andpreparestheFDAforthe21stcentury.Thenewlaw J3 buildsonFDAmodernizationeffortsalreadyunderwaywhichhavereduceddrugandmedicaldeviceapprovaltimestorecordlowswhilemaintainingconsumerprotections.ThisbudgetrequestexpandstheresourcesavailabletoFDAtocarryoutitsmissionandcomplywiththedrug,deviceandfoodlaws.SignificantworkforceincreasesarenecessaryforFDAtoaccomplishthesegoals.m'``݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m-d D   InNovember1998,FDAissuedaPlan > forStatutoryCompliancetotheCongressandtheNation.ThePlanoutlinedtheinnovativeapproachestheAgencywilltaketomeetthecomplexpublichealthchallengesofthenextcentury.Atotalof #J!C $95.5millioninbudgetincreasesarerequestedtoaddressplanprioritiesincludinginjuryreporting,productsafetyassurance,andpremarketreview.m-dd݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mg D   mgg݌̌ XBXXXBXBXXXB  .Ȋ  .ȊHh0 D XBXXXBXBXXXB   InjuryReporting.ȊHhch ӌB)&ID(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mi D   Therequestedincreaseof$15.3million *R(K willbedevotedtothepreventionofmedicalandveterinaryproduct-relatedinjury.Currentestimatesoftheincidenceofdeath z-"+N andinjuryassociatedwithproperuseofmedicalproductsisconsiderable,andisprojectedtogrow.mij݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mk    Arecentarticledescribingtheincidence ( ofadversedrugreactionsinhospitalizedpatientspublishedintheJournalofthe  AmericanMedicalAssociation(JAMA)  estimatedthatin1994,106,000deathsand1.3millionseriousinjuriesoccurred.ItisestimatedthatnearlyonemillionpatientinjuriesanddeathseachyearcanbeattributedtousererrorwithFDAregulatedmedicalproducts.mkml݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mn    FDAwillusetherequestedincreaseto 0  developandmaintainadequatemonitoringprogramstoaidinthetimelyidentificationofneworemerginghealthhazardsassociatedwithFDAregulatedproducts.FDAintendstomoveasrapidlyaspossibletoanintegrated,fullyelectronicadverseeventreportingsystem.FDAisuniquelypositionedtoreceiveandanalyzeadverseeventinformation.Astheregulatoryagencyresponsibleforensuringthesafetyandefficacyofregulatedproducts,FDAsmissionclearlyincludesprotectingtheAmericanpublicfromtheriskofmarketedproducts.mnko݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mr    mrr݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋs0  XBXXXBXBXXXB   ProductSafetyAssurance.Ȋss ӌ0 ЌXBXXBXBXXB   m XBXXXBXBXXXB  mt    The$52.2millionrequestedincreasefor  productsafetyassurancewillbeusedtohelpFDAmeetitsstatutorytimeframesforinspections.Fordrugs,biologics,animaldrugsandmedicaldevices,thegoalistoinspecteachmanufacturereverytwoyears.Forwarehousefacilities,FDAsgoalisaninspectioneveryfouryears.mttu݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mw    ThisfundingwillenabletheAgencyto p&$' focusontechnicalassistancetoenhanceindustrycomplianceandintegratepublichealthregulationwiththeStatesthroughcontracts,partnerships,trainingandinformationsharing.InsteadofthetraditionalapproachofhiringadditionalFDAinspectors,thisincreasedfundingwillbeusedtobuyadditionalinspections -+/ throughcontractswiththeStatesandtoestablishanationaldatabaseofinspectionstatisticsthatwillbeavailableto_local_,StateandFederalhealthofficials.Thisshouldimprovetheinspectionalprogramsofallpartiesbyeliminatingduplicationofeffortandsubstantiallyincreasinginspectionalcoverage.mwx݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m{ D   Twentythreemilliondollarsaretargeted  7 fortheconstructionofFDAfieldlaboratoriesandsupportfacilities.FundswillbeusedtobeginthefirstphaseofconstructingtheLosAngeleslaboratory($20million)andtocontinueconstructiononthefinalphaseoftheArkansasRegionalLaboratoryproject($3million).ThesefacilitiesarevitaltoFDAeffortstoimproveandmodernizethescientific,regulatoryinspectionalcapabilitiesoftheAgency.m{(|݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m~ D   m~7݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   Premarketreview.Ȋ ӌCD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m& D   Therequested$28millionincrease, (E whichincludes$17millioninnewuserfees,forpremarketapplicationreviewwillallowFDAtocontinuetoreengineerandautomateitsreviewprocesses.ItwillhelpFDAprovidemoreproductiveinteractionswithindustrythroughuptodateguidancereview,industryeducationandreviewertraining.Also,FDAwillbebetterabletotargetlaboratorysupportonemergingtechnologiesandprovideontime,sciencebasedinteractiveapplicationreviews.FDAhascomealongway,withthehelpofthePrescriptionDrugUserFeeAct(PDUFA),inimprovingpremarketreviewtimesfornewdrugsandbiologics,butthereisstillmoreworktobedoneinotherproductareas.m&݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m0 D   m0݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jd  FoodSafetyInitiative+jdΆ ӌ `'%W ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   IntheUnitedStates,upto33million (p&Y illnessesand9,000deathsperyearcanbeattributedtofoodrelatedhazards.PersonswithloweredimmunityduetoHIV/AIDS,thoseonmedicationsforcancertreatmentandorgantransplantation,andtheelderly x- +^ andveryyoungareamongthepopulationgroupswithincreasedsusceptibilitytofoodbornehazards.FDAisrequesting$79million,anincreaseof$30million,tofundadvancesinthePresidentsFoodSafetyInitiative.Estimatesoftheannualcostofmedicaltreatmentandlostproductivityfromthesevenmajorfoodbornepathogensvarywidelyfrom$6.6billionto$37.1billion.Thefoodsafetyfundingwillcontinuetheimprovementsthatguaranteeasafefoodsupply.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mŋ    FDAisworkingwiththeCDCandthe  @  DepartmentofAgriculturetoidentifythegreatestpublichealthrisksanddesignstrategiestoreducetheserisks.ThesizeandcomplexityoftheU.S.foodsystemrequiressignificantinvolvementofgovernmentatalllevels.TheFDAhasavariedindustrytoregulateandhasreliedonselectivemonitoring.TherequestedincreaseinfoodsafetyfundingwillallowFDAtoincreaseinspectionalresourcesandbetterdirectthoseresourcestotheareasofgreatestneedthatwillresultinthegreatestbenefittotheAmericanpublic.TheFDAworkforceneedstosignificantlyexpandtoaccomplishthenecessaryactivities.mŋD݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    FDAhasexploredwaystostrengthen @ systemsofsurveillance,inspection,research,riskassessment,andeducation.Atthecenterofthisinitiative,FDAhasthefollowinggoals  :m ݌ X   Ќ XBXXXBXBXXXB  &KL 8(*-/0123 x3)LXBXXXB"XXB  _&‘ ӌ̌L )#3x8(*-/0123L""XBX"          _:L 4(*-/0123Ch3)LXBXXXB  :0  2C3  0   Surveillance:Respondto 8"# increasedoutbreakreporting,andexpandmonitoringforantimicrobialresistance.: ӌ  ЌL )#3h4(*-/0123LXBXXB  :L 4(*-/0123Ch3)LXBXXXB  :J0  2C3  0   Inspections:increase %#' FrequencyofInspectionsforhighriskestablishments,and '%) morethandoubleinspectionsofforeignfoodprocessors.:J ӌ  ЌL )#3h4(*-/0123LXBXXB  :L 4(*-/0123Ch3)LXBXXXB  :0  2C3  0   Education:Focuseffortsat *P(, theretaillevelwhereover1/3 ofoutbreaksoccur.: ӌ,0*. ЌL )#3h4(*-/0123LXBXXB  :L 4(*-/0123Ch3)LXBXXXB  :90 D 2C3  0pD(#D(#   ResearchandRiskAssessment: X.  rapidmethodstoidentifypathogens,andbetterdatabasestobettertargetfoodsafetyresources.:9ޛ ӌ p(#p(# ЌL )#3h4(*-/0123LXBXXB  m XBXXXBXBXXXB  m D   m;݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  YouthTobaccoPrevention+jZ ӌ 4 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m! D   Threethousandyoungpeoplebecome ` 6 regularsmokerseachdayandnearlyonethousandofthemwilldieprematurely.Toreversethistrend,FDAwillincreaseitsresourcesaimedatyouthtobaccopreventionactivities.Therequested$68million,anincreaseof$34million,willcontinueFDAseffortstoenforceretailercardingofyoungpeopleandpromoteunderstandingofthisrule.AttheendofFY1998FDAhadcontractswith43Statesandterritories.FDAhopestohavecontractswithall50StatesandalloftheterritoriesbyFY2000.Itisestimatedthatbetween500,000andonemillionretailersmayselltobaccoproducts.Thus,enforcementoftheFDAfinalruleisamajorjobfortheStatesandtheAgency.m!݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m? D   ݀FDAalsoisresponsibleforoutreachto PG retailersandproductregulation.Tobaccocontrolexpertsindicatethatthecombinationofcompliancechecksandanactiveoutreachprogrammaximizesretailercompliancewiththeaccessrestrictions.Intheabsenceofcomprehensivetobaccolegislation,FDAmustworkespeciallyhardtoreducetheavailabilityandappealoftobaccoproductstochildrenandteenagers.Withalongtermgoalofa50percentdeclineinyoungpeoplesuseoftobaccowithinsevenyearsofimplementationoftheFDAprogram,FDAmustcontinueandstrengthenitscurrentprogram.m?݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   mb݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  BioterrorismInitiative+j ӌ P(%W ЌXBXXBXBXXB  m XBXXXBXBXXXB  mG D   FDArequests$13.4millionaspartof )`'Y thePublicHealthandSocialServicesEmergencyFund.The_DHHS_anti-bioterrorisminitiativeconstitutesaDepartment-widestrategytoplanforand x- +] implementactivitiesthatwilladdresstherangeofissuesandconcernsthatarisefromcounteringaterroristattackinvolvingbioweapons.mGƪ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     _DHHS_Ԁhasthesoleresponsibilityof  preparingforandrespondingtothemedicalandpublichealthconsequencesofabioterroristevent.WithintheDepartment,FDAhastheabilityandresponsibilitytoregulatethedrugandbiologicalproductswhichwillbeusedtotreatandpreventthetoxicityofchemical,biological,radiologicalornuclearsubstances.Thisisparticularlydifficultwhendefinitivestudiesinhumanscannotbeethicallyconductedtodemonstratetheefficacyoftheseproducts.FDAhasdraftedaproposalthatwillallowanimaldatatobeusedtoestablishtheefficacyofthesedrugandvaccineproducts.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    FDArequestsadditionalfundstoensure ( theexpeditiousdevelopmentandlicensureofnewproductssuchasvaccinesforanthraxandbotulinum.Theproposedprogramwouldensuretheavailabilityofexpertsinthisareatoexpeditethelicensingprocessofthesevaccines.ExpeditiousdevelopmentandlicensingofthesevaccinesisaprimarygoaloftheFDAandvitaltoprotectingthehealthoftheNation.mi݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mȳ    mȳG݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  Seafoodinspectionprogram+jf ӌ x  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m/    TheFY2000PresidentsBudget   provides$3millioninappropriatedfundsfortraining,otheradministrativeandtransitionalcoststotransfertheprogramtoFDA.Thistransferincludesasignificantnumberofseafoodinspectors.TheSeafoodInspectionProgram,currentlyunderourDepartmentofCommerce,providesvoluntaryinspectionsandcertificationservicesforfishandfisheryproductsonafeeforservicebasisundertheauthorityoftheAgriculturalMarketingActof1946.Theprogramaddressesissuesofwholesomeness,economicintegrityandqualityintheseafoodindustry.Legislationwillbeproposedtomaketheprograma -+/ performancebasedorganization(PBO)aspartoftheVicePresidentsinitiativetoreinventgovernment.PBOshavegreatermanagerialflexibilitiesthatallowforimprovedorganizationalperformance.m/݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jۺ  UserFees+jۺE ӌ p6 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   TheFY2000budgetrequestforFDA  8 includes$195millioninproposedlawandcurrentlawuserfees,includingseafoodinspectionfees($13million)discussedpreviously.Thisincludes$145millionforthePrescriptionDrugUserFeeAct(PDUFA)and$15millionfortheMammographyQualityStandardsAct(MQSA).PDUFAauthorizesthecollectionofuserfeesforreviewingdrugapplicationsandwasreauthorizedaspartoftheFDAModernizationActof1997.m|݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m  D   Thebudgetalsoincludes$17millionin D newproposedlawuserfees.Thesenewfeeswouldbeusedforthereviewofdirectandindirectfoodadditivepetitionsandtoenhancereviewofmedialdeviceapplications.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m( D   m(݌ `J Ќ XBXXXBXBXXXB  (X@(#  X2XXXBe/ eXX2  #ᄙ@$    % # FDAOVERVIEW#ᄙ 9  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 ,! `.(@ExOxOe<v (#(#px ԰                              (#(#AZ') HxdEz!HxA {!#$   "Z & #  X2XXXBe/ eXX2  #@    % $ HEALTHRESOURCESANDSERVICESADMINISTRATION#8 ]  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 , `.U @Exxe<v (#(#           (#(#AZ') HxdEHxA S  +jXBXXXB  XBXXXB   (X@(#(#(+j  Summary+jg ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    TheFY2000budgetrequestforthe J HealthResourcesandServicesAdministration(HRSA)is$4.2billion,anetincreaseof$42millionoverFY1999.HRSAsmissionistoimproveaccesstoessentialhealthcareformillionsofAmericanswhoaremedicallyunderservedbecausetheyareuninsured,livewherehealthcareisscarce,and/orhaveHIV/AIDSorotherhealthproblems.HRSAassistsinexpandingandenhancinghealthcareforallpregnantwomenandchildren.HRSAalsocontributestowardincreasingthediversityanddistributionofhealthcareprofessionals.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    HRSAprogramsworktowards j  eliminatingthemanybarriersthatlimitaccessandprovidehighqualityprimaryhealthcareservicestolowincomeindividualsandfamilies,manyofwhomareracialandethnicminoritieswithdramaticdisparitiesinhealthstatus.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    BestknownamongHRSAseffortsto %#' provideaccesstoneededhealthcarearetheRyanWhiteComprehensiveAIDSResourcesEmergency(CARE)Actprograms,HealthCenters,theNationalHealthServiceCorps,theMaternalandChildHealthServicesBlockGrant,and healthprofessionstraininggrants.me݌ ,2*. Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +jv  HIV/AIDS!RyanWhite+jv ӌ . ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   Asaresultofthewidespreaduseof J0 combinationantiretroviraltherapy,theAIDSdeathratein1997droppedtoitslowestlevelinnearlyadecade.AIDSDrugAssistancePrograms(ADAP),fundedbyHRSAthroughformulagrantstoStatesundertheRyanWhiteCAREAct,assurethatlowincomeanduninsuredindividualslivingwithHIV/AIDSbenefitfromtheselifesavingtreatments.TheFY2000requestof$1.5billionincludesatotalincreaseof$100million(7percent)forallRyanWhitetreatmentactivities.Ofthetotal$1.5billionrequest,$783millionisforformulagrantstoStates,morethanhalf($496million)isearmarkedforADAP.ADAPisaFederalStatepartnershipthatinFY1998served106,000individualsandenabled42Statestoincreasethenumberofdrugsprovided,consistentwiththeDepartmentsGuidelines $!C fortheUseofAntiRetroviralAgentsinHIVInfectedAdultsandAdolescents.m0݌ %#E Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   EvenaspeoplewithHIV/AIDSare &$F livinglonger,thediseaseisexactingahighertollamongracialandethnicminorities.In1997,47percentofthosenewlydiagnosedwithHIVinfectionwereAfricanAmericanand20percentwereHispanic.Inthefallof1998,HHSannouncedaninitiativetoreducetheburden z-"+M ofHIV/AIDSinracialandethnicminoritycommunities,whereCAREActprogramsarecriticallyimportant.InFY1998,approximately41percentofthoseservedbyRyanWhiteprogramswereAfricanAmericanand25percentwereHispanic.m>݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m;    Tocontinuetoofferpeoplelivingwith  HIV/AIDSthebesthopeofalongerandbetterlife,therequestincludes$130millionforearlyinterventionprograms.Includedinthisamountisanincreasetargetedtominoritycommunitiestoprovidestateoftheartclinicalcaretoanestimated10,000peoplelivingwithHIV/AIDSthroughthe60newEarlyInterventionServiceprogramsthatfirstreceivedplanninggrantsupportinFY1999.Theagencyalsoplanstoprovide60newplanninggrantsinFY2000.m;݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mz    Thebudgetalsocontains$48millionto ( supportgrantsforcoordinatedHIVservicesandaccesstoresearchforchildren,youth,women,andfamilies.Additionally,therequestincludes$20millionforAIDSEducationandTrainingCenters,whichannuallytrainsmorethan70,000healthcareproviderstobetterservepeoplelivingwithHIVdisease.mz݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jP  HealthCenters+jP ӌ 0 ЌXBXXBXBXXB  m XBXXXBXBXXXB  mw    Forlowincomeanduninsured  individualsandfamilies,HRSAs746communityandmigranthealthcenterswith3,000sites,including128healthcareprogramsforthehomelessand20healthcareprogramsforresidentsofpublichousing,provideanessentialhealthcaresafetynet.ThemostrecentdataindicatesthatHRSA-supportedhealthcentersandtheNationalHealthServiceCorpsprovidehighquality,comprehensiveprimaryhealthcareto10.9millionindividuals.(mw݌ @)&* Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    ForFY2000,theHRSArequestfor 0*'+ healthcentersis$945million,a$20millionincrease.Withinthistotalrequest,theagencywillsupporta$70millioninvestmentineliminatinghealthdisparities -+/ amongracialandethnicminorities.Morethantwothirdsofthosewhorelyonhealthcentersforprimarycareareracialandethnicminorities,whoexperiencecertainhealthproblems,includingdiabetes,asthma,hypertension,andcertaincancersatmuchhigherratesthanwhites.m<݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Theinitiativetoeliminatedisparities 6 willbuildonhealthcentersrecordofsuccessinimprovingthehealthofracialandethnicminorities.Examplesofthisrecordinclude:my݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   ݀mv݌  @ ; Ќ XBXXXBXBXXXB  L 4(*-/0123Ch3)L:L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   AfricanAmericansand 0 < HispanicswhoreceivecareforhypertensionatHRSA-supportedhealthcentersarethreetimesaslikelytoreportbloodpressureundercontrolthantheirpeers.:2 ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :;0 D 2C3  0pD(#D(#   Healthcenterpatientswho D arediabeticaretwiceaslikelytohavenecessarybloodtestsonschedule.:; ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   Minoritywomenreceiving pH carefromhealthcentershavesignificantlyhigherratesofuptodate_mammograms_Ԁand @K paptests.:? ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :@0 D 2C3  0pD(#D(#   Healthcenterpatientsinsured x M throughMedicaidaremorelikelytohavemuchlowerratesofhospitalizationforconditionsthatcanbetreatedinanoutpatientsettingthanotherMedicaidbeneficiaries.:@ ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m6 D   Tofurtherreduceracialandethnic %#U disparitiesinhealth,HRSAhealthcentersinFY1999and2000willmountaggressiveeffortstocombatdiabetesandotherdiseasesthatparticularlyaffectminorities.m6݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mS D   mS݌ *P(Z Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j  FamilyPlanning+j ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Accesstofamilyplanningservices h reducestheincidenceofunintendedpregnancyandimprovespregnancyspacing,contributingtohealthierstartsforchildrenandhealthierreproductivelifestyles.Accesstofamilyplanningservicesisofparticularimportanceforlowincomewomenandadolescentswhoareathighriskforunintendedpregnancyandsexuallytransmitteddiseases,includingHIV.TheFY2000PresidentsbudgetfortheTitleXFamilyPlanningprogramis$240million,$25millionovertheFY1999appropriation.From1991to1996therewasa6percentdeclineinfirstbirthstoteenagers,whiletherateofsecondbirthsforteenswasdownby21percent.Inaddition,from19911997,birthratestononHispanicwhiteteensandblackteenshavedroppedby16percentand23percentrespectively.mM݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mF    Whiletherehasbeenadeclinein ( unintendedpregnancy,itremainsdisturbinglyhighinthevulnerablepopulationsservedbyTitleX.ThisproposedspendingincreaseinFY2000willallowtheTitleXprogramtoprovidefamilyplanningservicestoanadditional500,000persons,foratotalof5millionpersonsandexpanditseffortsinreducingunintendedpregnanciesand_STDs_Ԁforgroupswithhighunintendedpregnancyrates.TitleXwillalsoexpanditseffortstopromoteresponsibilityforhealthyreproductivelifestyleswithemphasisonhardtoreachpopulationssuchasmales,substanceabusersandthehomeless,andcontinuetodevelopculturallyandlinguisticallyappropriateeducationandcommunicationactivities.mF݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     m  ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j   ServicesToMothersandChildren+j #  ӌ @)&* ЌXBXXBXBXXB  m XBXXXBXBXXXB  m     AmajorservicepopulationofallHRSA *P(, programsarelowincomeanduninsuredwomenandchildren.Becauseadequatehealthcareduringpregnancyandchildhood x- +/ iskeytothefuturehealthoftheNation,HRSAalsosupportsprogramsespeciallytargetedtoimprovinghealthcareforallwomenandchildren,includingchildrenwithspecialhealthcareneeds.TheFY2000requestfortheseprogramsis$804million,a$4millionincrease.Thetotalincludes$695millionfortheMaternalandChildHealthServicesBlockGrant,aFederalStatepartnershipthatbuildscommunitybasedsystemsofcarethatrespondto_local_Ԁneedsand$105millionforHealthyStart,aninitiativethathelpscommunitieswithhighratesofinfantmortalitytodevelopinnovativemodelsofmaternalandinfanthealthcare.m q݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   TheFY2000requestincludes$4million X? tosupportanewprogramthatwillpromotenewbornhearingscreening.StateswillreceivegrantstodevelopandexpandStatewidenewbornhearingscreeningandinterventionprogramsandtolinkthemwithothercommunitydiagnosticandsupportservices.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Therequestalsoincludesthethirdyear G ofthe$50millionannualmandatoryappropriationforabstinenceeducation.mu݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m1݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  CriticalCarePrograms+jP ӌ @K ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   TheFY2000requestincludesatotalof M $22million,anincreaseof$2milliontosupportacomprehensiveapproachtoemergencycare.Thisisaparticularprobleminruralandremoteregionsnotuniversallypreparedtorespondtoallhealthemergencies.ThisprogramconsolidatesandexpandsHRSAsemergencycareeffortstomeettheNationscriticalcareneeds.Theprogramwillstrengthenemergencymedicalservicesforchildren,emergencymedicalservicesystems,servicesforvictimsoftraumaticbraininjuriesandtheirfamilies,andimprovethequalityofservicesforvictimsofaccidentalpoisoning.Theinitiativewilltrainandequipemergencypersonneltocopewiththesespecialpopulationsandsituations.m݌ -+^ Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mK    mK݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  HealthProfessions+j ӌ H ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Federalassistancehelpsassurethatthe X Nationshealthcareprofessionsworkforceisdiverseanddistributedtomeettheneedsofitscitizens.HRSAshealthprofessionstrainingprogramsincreasethenumberofunder-representedracialandethnicminoritiesinthehealthprofessionsandencouragehealthprofessionalstopracticeintheNations3,000-plusmedicallyunderservedcommunities.MinorityprovidersaremorelikelybothtoservetheNationsincreasinglydiversepopulationandtocareforunderservedpeople.m) ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m #    TheFY2000requestcontinuesHRSA  effortstoachieveabetterbalancedhealthcareworkforce.Therequestincludes$252million,a$50millionreduction.WithinthisoverallfundinglevelHRSAwillfocusresourcesonprogramswhichwillhelpdisadvantagedstudentsandreflectstheAdministrationsgoalstomoveawayfrombroadbased,categoricalprograms.Withinthisisa$16millionincreasefortheCentersofExcellenceandtheHealthCareersOpportunityprograms,bothofwhichhaverecordsofsuccessinrecruitingandretainingpromisingracialandethnicminoritystudentsinhealthprofessionstraining.Reductionswillbetakeninbroadbasedcategoricalprogramsthataddressexpandingthesupplyofprimarycare,publichealth,andotherdisciplines.m ##݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mX'    Inaddition,therequestincludes "X # $40millionforanewChildrensHospitalsGraduateMedicalEducationprogramthatwillprovidetemporaryfinancialassistanceforgraduatemedicaleducationatfreestandingchildrenshospitals.Thesehospitalstrain25percentofallpediatriciansandthemajorityofpediatricspecialists.mX''݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m)    m)x*݌ 0*'+ Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +jA+  OtherHRSAPrograms+jA++ ӌ X+ ЌXBXXBXBXXB  m XBXXXBXBXXXB  mw, D   Thisbudgetproposes$374millionfor h- allremainingHRSAprograms,includingruralhealthand_telehealth_,RuralHospitalFlexibilityGrants,Hansensdiseaseservices,BlackLungclinics,organdonationandtransplantationprograms,theNationalBoneMarrowDonorRegistry,NursingLoanRepayment,PaymenttoHawaii,theNationalHealthServiceCorps,andHRSAsinternalprogrammanagement.FundsarenotrequestedforFederalclaimsrelatedtotheadministrationofvaccinesbeforeOctober1,1988.InFY1999,$100millionwasappropriatedtoaddressalloutstandingclaimsandremainsavailableuntilexpended.Fundsarealsonotrequestedforonetimeconstructionandrenovationprojectsforwhich$65millionwasappropriatedinFY1999.mw,,݌̌ XBXXXBXBXXXB    `D  (X(#   X2XXXBe/ eXX2  #/1@66$    % * HRSAOVERVIEW#/11 1  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 ,!! `../@Exxe<v (#(#                                   (#(#AZ') HxdE*&HxA +&#&   r&$' #  X2XXXBe/ eXX2  #7@      % + INDIANHEALTHSERVICE#798 ^8  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB 2.b~1 ,w `.k @Exjxje< v (#(#          (#(#AZ') Gxd%EGxA c  +jXBXXXB  XBXXXB   (X@(#(#(+j;  Summary+j;5< ӌ   ЌXBXXBXBXXB  m XBXXXBXBXXXB  m<    TheIndianHealthService(IHS) Y proposesanFY2000budgetof$2.8billion,anincreaseof$170millionoverFY1999.This8percentincreaseinbudgetauthorityisacontinuingdemonstrationofFederalcommitmenttoprovidingqualityhealthcaretoAmericanIndiansandAlaskaNatives.m<j=݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mR?    The$2.8billiontotalbudgetalso  includesMedicare,Medicaid,andprivatehealthinsurancecollectionsprovidedfortreatmentofIndianpeople(estimatedat$375millioninFY2000).ArecentagreementwiththeHealthCareFinancingAdministrationwillincreaseMedicareandMedicaidcollectionsby$82millionforservicesprovidedbetweenFY1998andFY2000.mR??݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mB    ݀The8percentincreaseproposedforIHS I!" istheresultofahighlysuccessfulconsultationprocessconductedwithIndianpeople.ThisprocessbeganwithbudgetworkshopsconductedwithtribalrepresentativesinalltwelveIHSregionsandculminatedinmeetingsbetweentribalandurbanIndianleadersandhighrankingofficialsfrombothHHSandOMB.DuringthesediscussionstheneedtoexpandaccessinthefaceofagrowingpopulationofeligibleIndianpeopleinordertoreducethegapinhealthdisparitiesbetweenIndianpeopleandotherAmericanswas y-!+/ highlighted.Forexample,themortalityratesfortuberculosis,chronicliverdiseaseandcirrhosis,andaccidents,areallmorethanthreetimesashighforIndianpeopleastheyarefornonIndians.mBB݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m]F D   m]FF݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jG  AgencyDescription+jGG ӌ 95 ЌXBXXBXBXXB  m XBXXXBXBXXXB  mH D   IHSandtribesprovidemedicalcareto 7 anestimated1.5millionAmericanIndiansandAlaskaNativeswhoaremembersofsome560Federallyrecognizedtribes.Thismedicalanddentalcareisprovidedthroughanetworkof49hospitals,209outpatientfacilitiesand285healthstationsandschoolhealthclinicslocatedprimarilyinOklahoma,theNorthernPlains,alongthePacificCoast,Alaska,andtheSouthwest.Thisnetworkincludestheprovisionofmentalhealthandalcohol/substanceabusepreventionandtreatmentservicesandthepurchaseofmedicalcarefromtheprivatesector(i.e.,ContractHealthServices).mH;I݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mrL D   IHSalsodevotesasignificantportionof  %"F itsbudgettoprovidingpreventivehealthcareincludingtheconstructionofsanitationsystems.WhilethebulkofIHSservicesareprovidedinareasonornearreservations,IHSalsoprovidesgrantstosupporttheoperationof34urbanhealthprogramsincitieswithsubstantialnumbersofIndianpeople.mrLL݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mO D   mOO݌ y-!+O Ќ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j_P  Clinical,Preventive,and X EnvironmentalHealth+j_PP ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mQ    TheFY2000budgetincludes X $2.2billionforclinical,preventive,andenvironmentalhealthactivities,anincreaseof$118million,or6percent.mQ&R݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mS    mST݌̌ XBXXXBXBXXXB  .Ȋ  .ȊT0  XBXXXBXBXXXB   PopulationIncreases.ȊTT ӌ`  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mU    Thebudgetcontainsanadditional  p  $33milliontomaintainaccesstohealthcareastheIndianpopulationincreases.Since1990,thepopulationeligibleforservicehasincreasedby25percent.Withinthesefunds,$24millionisfortheContractHealthServicesprogramwhichpurchaseshealthcarefromtheprivatesector.PercapitafundinghasnotkeptpacewithmedicalinflationoverthatpastseveralyearslimitingIHSscapacitytopayformorethanthemostserioustypesofinjuriesandillnesses.TheincreasewillallowIHStoprovide2,000additionalhospitaldaysand13,000additionalvisitstodoctorsanddentists.Alsoincludedisanincreaseof$9milliontostaffnewlyopenedoutpatientfacilitiesatHopi,AZ,andLameDeer,MT,andforthenewlyopenedhospitalatTalihina,OK.mUuV݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mfZ    mfZZ݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ[0  XBXXXBXBXXXB   HealthInitiatives.Ȋ[[ ӌ0 ЌXBXXBXBXXB   m XBXXXBXBXXXB  m\    Thebudgetcontainsa$31million   increasetoprovideadditionalservicesinseveralkeyareaswhichhavebeenselectedthroughconsultationsbetweenIHSandtribalrepresentatives.Theseareasincludedentalandmentalhealth($13million),environmentalhealthandinjuryprevention($8million),andalcohol/substanceabuseprevention&treatment($1million).Thebudgetalsoincludesanadditional$6millionforwomenshealthproblems(e.g.,breast&cervicalcancer,violence,agingissues)and$3milliontoincreaseoutreachactivitiesincludinghomevisits.Thefundingincreaseforoutreachactivitiesrepresentsashiftinemphasistowardsmorehighlytrainedoutreachworkers.A$10millionincreaseis -+0 includedforpublichealthnurses.Communityhealthrepresentativesarefundedatareducedlevel.m\U]݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mja D   mjaa݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋb0 D XBXXXBXBXXXB   Increasingequityamongtribes.Ȋbb ӌ4D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mc D   About60percentoftheIHSbudgetis (6 usedtooperatehospitalsandoutpatientclinicsinexistinglocations.Thislargeinvestmentinfixedhealthfacilitiesmakesitdifficulttoaddressinequitiesinhealthservicelevelsavailabletodifferenttribes.Thebudgetincludesanincreaseof$11milliondollarstoincreaseequityamongtribesbyprovidingadditionalservicestothosetribeswiththehighestlevelsofneed.mced݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mf D   mfXg݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ h0 D XBXXXBXBXXXB   OperatingExpenses/Information xA Technology.Ȋ h(h ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mmi D   Thebudgetalsocontainsanincreaseof (D $43millionforincreasedstaffandleasecostsandtopurchaseadditionalinformationtechnologyandtelecommunicationsequipment.mmii݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m`k D   m`kk݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jl  MedicaidRateincrease+jll ӌ pJ ЌXBXXBXBXXB  m XBXXXBXBXXXB  mm D   IHSandHCFAcontinuetheir 0L cooperativeefforttoensurethatIHShospitalsandclinicsreceiveMedicareandMedicaidreimbursementonthesamebasisasotherMedicareandMedicaidproviders.Basedonanextensivereviewofhospitalbasedcostdata,IHSMedicaidinpatientrateswillriseby40percentbetween1997and1999whileMedicaidoutpatientrateswillincreaseby13percent.IHSestimatesthatthesenewrateswillresultincollectionstotaling$375millioninFY2000.Theseratechangeswillresultinanadditional$82millionbecomingavailableforservicessuchashiringofadditionalstaff,stafftraining,purchasingadditionalequipment&supplies,andmakingimprovementsto existingspace.mmBn݌  +(] Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +jq  TribalContractSupportCosts+jqjr ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  m6s    TheFY2000budgetincludes h $239millionforContractSupportCosts(CSC),anincreaseof$35million,or17percent,overFY1999.CSCareadditionalcostswhichtribesincurwhentheytakeovertheoperationof_local_ԀhealthprogramsfromtheIHS.Tribalorganizationscurrentlyoperate12ofthehospitalsand385oftheotherhealthfacilitiesthroughcontractswithIHSauthorizedbytheIndianSelfDeterminationAct.InFY2000,tribeswillreceiveapproximately42percentofIHSstotalbudget,toprovidehealthservicestotheirmembers.m6ss݌̌ XBXXXBXBXXXBXBXXXB  m XBXXXBXBXXXB  mv    Recentgrowthinthenumberoftribes x wishingtocontractwithIHShasexceededtheamountoffundsavailableforthispurpose,resultinginabacklogofunfundedCSCfornewcontractsofapproximately$65million.Congressaddressedthissituationbyprovidinganincreaseof$35millionforCSCinFY1999.Atthesametime,CongressalsoimposedamoratoriumonnewcontractingtoallowCSCfundingtocatchupwiththedemand.IHSiscurrentlyworkingwithtribesonanequitablewaytodistributetheadditionalfundsinbothyears.mviw݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mOz    Withtheadditionalfundsincludedinthe  FY2000budget,IHSwillalsobeabletoprovidesupportforthenewcontractsanticipatedforFY2000.IHSwillcontinuetoconsultwithtribesoverlongtermsolutionstomeetingtheirCSCneedsaspartofitsoverallmissiontoraisethehealthofIndianpeopletothehighestpossiblelevel.mOzz݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m|    m|h}݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j~  UrbanHealth+j~~ ӌ `'%( ЌXBXXBXBXXB  m XBXXXBXBXXXB  mB    TheFY2000budgetincludes (p&* $29millionforthisactivity,anincreaseof$3millionor11percentcomparedtoFY1999.AdditionalfundingwillprovidehealthcareforIndianpeoplelivinginurbanareas,specificallythroughtheupgradingof x- +/ urbanprograminformationsystemswhichwillimprovetheseprogramsabilitytoaccessnon-IHSfunds.Forexample,urbanhealthgranteesareeligibletobecomeFederallyQualifiedHealthCenters(FQHCs)and25percentareabletoprovideallofthecoreFQHCservices.mB݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   @  < m!݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  SanitationandFacility  7 Construction+jS ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m& D   TheFY2000budgetincludesatotalof 0 : $135millionforsanitationandfacilityconstruction.Anincreaseof$5millionisrequested,including$3milliontoprovideadditionalsanitationforIndianhomesaswellastocleanupopendumps,and$2milliontoincreasetheamountofhealthfacilityconstructionabovetheFY1999level.m&݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Withintherequest,IHSwillfundatotal HC of$43millionforfacilityconstructioninFY2000.IHSwillcontinueconstructionoftwoArizonafacilities,theFortDefianceHospital(Navajotribe)andtheParkerOutpatientFacility(ColoradoRivertribes).TheHopiOutpatientClinic(alsoinArizona)wasfullyfundedinFY1999.IHSalsoproposes$4milliontocompletethedesignsoftwooutpatientfacilities,RedMesainArizonaandPawneeinOklahoma,and$3millionforadditionalmodulardentalunits.m=݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j8  Maintenanceand !hQ Improvement/Equipment+j8 ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mw D   TheFY2000budgetproposesatotalof $!T $67million,anincreaseof$8million,formaintenanceandimprovementsforIHSfacilitiesandtopurchaseadditionalmedicalequipmentforIHSfacilities.Additionalfundswillbeusedfordeferredmaintenance&improvementprojects(e.g.,newheating,ventilation,andairconditioningsystemstoimproveairquality)andtopurchaseambulances.mw݌ ,0*] Ќ XBXXXBXBXXXB  (X@(#  X2XXXBe/ eXX2  #ᄕ@$    % 2 IHSOVERVIEW#ᄕ !  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 ,!} `.h(@ExCxCe< v (#(#                              (#(#  AZ') HxdEz!HxA {!#!   "Z # #  X2XXXBe/ eXX2  #ᄮ@    % 3 CENTERSFORDISEASECONTROLANDPREVENTION#ᄮ :  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)pV<,(`~1 , `. Exxe<e p (#(#          (#(#AZ') Hxd EHxA S  +jXBXXXB  XBXXXB   (X@(#(#(+j揚  Summary+j揚! ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  mכ    TheFY2000budgetrequestsatotalof J $3.1billionfortheCentersforDiseaseControlandPrevention(CDC),anincreaseof$201million,orsevenpercent,overtheFY1999level.Thisincludes$118millioninfundsprovidedthroughthePublicHealthandSocialServicesEmergencyFund(_PHSSEF_)forCDCactivitiesrelatedtobioterrorism.mכV݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    CDCistheleadingpublichealthagency b responsibleforpromotinghealthandqualityoflifebypreventingandcontrollingdisease,injuryanddisability.CDCworkswithStates,_local_Ԁpublichealthagencies,andpartnersthroughouttheNationandtheworldtoaccomplishthismission.Together,theymonitorhealth,detectandinvestigatediseaseoutbreaksandotherhealthproblems,conductresearch,developandadvocatesoundhealthpolicies,implementpreventionstrategies,promotehealthybehaviors,fostersafeandhealthyenvironments,andprovidepublichealthleadershipandtraining.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mT    mTӢ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j戣  RespondingtoBioterroristThreats+j戣 ӌ (r&* ЌXBXXBXBXXB  m XBXXXBXBXXXB  mä    +XBXXXXXXB+Thebudgetincludes$118millioninthe 2*', _PHSSEF_,alongwith$20millionininfectiousdiseases,forCDCsresponsetothethreatofchemicalandbiologicalterrorism.Ofthisamount,$40millionwill -+0 supportdiseasesurveillanceactivitieswhichareaddressedunderInfectiousDiseases.#XBXXXBl#Bioterroristattacksarelikelytobe j2 surreptitiousandsymptomswillfrequentlyresemblelessseriousdiseasesatfirst.Publichealthofficersmustbeabletoobtain,analyze,andsharesurveillanceinformationrapidlyiftheyaretopreventwidespreaddeath,disabilityandsocietaldisruptioncausedbyterroristattacks.! XBXXXB!mäB݌ R9 Ќ XBXXXBXBXXXB  /XBXXXXgJXXB~/+XBXXXXgJXXB+m XBXXXBXBXXXB  m D   Fundingalsowillsupportthefollowing B: activities:m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :G0 D 2C3  0pD(#D(#   Expandingepidemiological = capacitywhichwillbetterprepareStatestodetectandrespondtodiseaseoutbreakscausedbybioterrorism.:G ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :Ʈ0 D 2C3  0pD(#D(#   Expandinglaboratory !jB capacitythatwillensurealethalbiologicalagentreleasedanywhereinthecountrycanbequicklyidentified.:Ʈk ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :B0 D 2C3  0pD(#D(#   Developingarapidtoxic b' %H screenthatcanquicklyidentifyupto150potentialchemicalthreatsreleasedinaterroristattack.:B ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   Creatingandmaintaininga ,)M civilianpharmaceuticalstockpilethatwouldbeusedin -+Op(#p(# theeventofabioterroristattack.:] ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  mE    mEĶ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jy  InfectiousDiseases+jy ӌ ( ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Thebudgetincludes$182millionfor 8 infectiousdiseases,anincreaseof$44million,or32percent,overtheFY1999level.m$݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mi    ݀mi݌ P   Ќ XBXXXBXBXXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   FoodSafetyInitiative.Ȋͻ ӌ@   ЌXBXXBXBXXB   m XBXXXBXBXXXBXBXXXB  m    Foodbornediseasesareestimatedto  P  cause9,000deathsand6.5to33millionillnessesintheUnitedStateseachyear.RecentdiseaseoutbreaksofEcoli0157:H7,andvariousstrainsofSalmonellademonstratetheneedforexpandedinvestmentinfoodsafety.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXBXBXXXB  m_    Thebudgetproposes$29.5millionfor 8 foodsafety,anincreaseof$10million,or51percent,abovetheFY1999level.ThesefundswillsupportactivitiesundertheFoodSafetyInitiativeinwhichCDCparticipateswithFDAandUSDA.CDCwillexpand_PulseNet_,thenationalnetworkofpublichealthlabsthatperformDNA fingerprintingofdiseasecausingbacteria.Thenumberoflabsusing_PulseNet_ԀtoidentifyEcoli0157:H7willexpandfrom29to40.Anincreaseof33newlabs,foratotalof40,willhavetheabilitytoidentifynewstrainsofSalmonella.m_݌ h  Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m]    m]݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   EmergingInfectiousDiseases.Ȋ ӌH!" ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    Dramaticincreasesininternational "X $ commerceandtravel,changesintheenvironment,andincreasingstressesonourpublichealthinfrastructurehavecontributedtoboththeemergenceandtherapidtransmissionofdrugresistantandnewandresurgentbacteria,fungi,parasites,andviruses.Therecognitioninlate1997ofH5N1influenzainHongKonghighlightsthepotentialfornewdiseasestoemerge.mV݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Emerginginfectiousdiseasescontribute ,). substantiallytotheburdenofdiseasebornebytheAmericanpublic.Forexample,the -+0 lasttwoinfluenzapandemics,withmorethan70,000deathsoccurringin1957and28,000in1968,totaledanestimated$32billionindirectandindirectcosts.m4݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m/ D   Thebudgetproposesatotalof 4 $94.1millionforemerginginfectiousdiseases,anincreaseof$15million,or19percentabovetheFY1999level.Ofthisamount,$5millionwouldfundplanningandeducationactivitiesforHepatitisC,and$10millionwouldfundemerginginfectiousdiseasesurveillance,whichwillenhancetheabilityofStateand_local_ԀpublichealthofficialstorespondtomultiStateoutbreaksofdiseasesandtoshareinformation,bothamongthemselvesandwithCDCofficials,aboutemerginginfectiousdiseaseemergenciesandtrends.m/݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   mB݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   ImprovedSurveillance.Ȋ ӌ(CD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m6 D   Diseasesurveillanceisanintegralpartof 8E manyofCDCsprograms!especiallyitsInfectiousDiseaseprogramandResponsetoBioterroristThreats.  m6݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m" D   Thebudgetproposesamajor PI improvementinthecoordinationofpublichealthsurveillanceandcommunication.Surveillanceactivitiesinbioterrorism($40million)emerginginfectiousdiseases($15million)andfoodsafety($10million)wouldbecombinedtosupporttheNationalElectronicDiseaseSurveillanceNetworkInitiative(NEDSNI).ThisinitiativewillintegrateCDCssurveillanceactivitiesintoaNationalsystemthatwillcollectandanalyzeepidemiologicalinformationontheoccurrenceofcommunicablediseases.Inaddition,thenetworkwillestablishalinkbetweenthepublichealthandmedicalcommunitiesforobtainingsurveillanceinformationelectronically.m"݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m  D   m ݌ @)&Z Ќ XBXXXBXBXXXB  .Ȋ  .Ȋi0  XBXXXBXBXXXB        LaboratoryCapacity.Ȋi ӌX ЌXBXXBXBXXB   /XBXXXXFXXBm/+XBXXXXFXXB+m XBXXXBXBXXXBXBXXXB  m     ݀TheFY2000budgetalsoincludes h $32milliontobedirectedtoconstructionprojectsattwoinfectiousdiseaselaboratorysites.With$22millionofthesefundsCDCwillcompletetheconstructionofalaboratorydedicatedtomeasles,foodbornediseases,_rotavirus_ԀandtheAntibioticResistanceUnitsoftheHospitalInfectionsProgram.Theremaining$10millionwillfundtheconstructionofseveralsupportlaboratoriesthatwillreplacefacilitiesconstructedduringthe1940s.(Fundingfortheseprojectsisincludedunderthelineitem, BuildingsandFacilities.)m ݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB/+XBXXXXgJXXB+m XBXXXBXBXXXB  mC    mC݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jw  AdolescentSmokingandHealth+jw ӌ x ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Smokingistheleadingpreventable 8 causeofdeathintheUnitedStates.Thehealthravagescausedbytobaccousecontinuetoescalateeachyear,especiallyamongteens,asonemillionyoungpeoplebecomeregularsmokers.Studiesshowthatover80percentofadultsmokersbecameregularsmokersbeforetheageof18.Preventingthenextgenerationofyoungpeoplefrominitiatingthishabitwillsignificantlyimprovehealthforfuturegenerationsandreducehealthcarecosts.m,݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    ThemultibillionsettlementStateshave x  madewiththetobaccoindustryprovidesahistoricopportunitytoprotectgenerationsofteenagersfromthenegativehealtheffectsofsmoking.Thebudgetincludes$101millionforCDCsupportofStatetobaccocontrol,anincreaseof$27million,or36percent,abovetheFY1999level.Withthesefunds,CDCwillprovideStatesthecapacitytoconductscience-basedtobaccocontrolprogramsproventobeeffectiveinreducingteen-smoking.mT݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    InFY2000,CDCstwoanti-smoking )`'+ initiativesforStates,theAmericanStopSmokingInterventionStudy(ASSIST"transferredfromtheNationalInstitutesofHealth),andInitiativestoMobilizeforthe x- +/ PreventionandControlofTobaccoUse(IMPACT),willbecombinedintotheNationalTobaccoControlProgram(NTCP).TheNTCPwillbuildonthefoundationlaidbytheIMPACTprogramandtheresearchfindingsoftheASSISTprogram,aswellasthelessonslearnedinStateswithtobaccousepreventionprograms.ThegrantstoStateswillincreaseby29percent,from$51millioninFY1999to$66millioninFY2000.Supportwillbeexpandedforthefollowingactivities:m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  ::0 D 2C3  0pD(#D(#   Educationaland 0 < communicationsprogramstodepictthehazardsoftobaccouseandreducethedemandfortobaccoproducts;:: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m D   m)݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   School-basedpreventionand (B cessationprograms;: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :90 D 2C3  0pD(#D(#   Stateand_local_Ԁeffortsto E protectnonsmokers,especiallychildren,fromexposuretoenvironmentaltobaccosmoke;:9 ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m D   mA݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   Trainingandtechnical @K assistancefor_local_communitiestoimplementtobaccopreventionstrategies;and,: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  mv D   mv݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   Datacollectionand 8"Q evaluationofprogramimpact.:O ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m D   mR݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  ChildhoodImmunization+jq ӌ %"T ЌXBXXBXBXXB  m XBXXXBXBXXXB  m6 D   TheChildhoodImmunizationInitiative p&$V (CII)hasbeenamajorAdministrationpriorityforoversixyears.Deliveryofsafeandeffectivevaccinesisthemostcost-effectivemethodofpreventingillness.ThisinvestmenthasenabledtheNationtocontinuetoexceedthegoalofatleast90percentof2-year-oldchildrenreceivingthemostcriticalvaccines.Accordingtothe -+^ NationalImmunizationSurvey,vaccinationratesasofJune1998includethefollowing:m6݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mb    mb݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   95percentof2-year-oldshad ( receivedthreeofthefourdosesofadiphtheria,tetanus,pertussisvaccine(DTaP);:; ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m    ݀m݌  Ќ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :I0  2C3  0   91percenthadreceivedthree   ormoredosesofpoliovaccine;:I ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m~     ݀m~  ݌  `  Ќ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  : 0  2C3  0   91percenthadreceiveda  P  measlesvaccine.: l  ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m     In1998,vaccine-preventabledisease x  levelscontinuedtobeat,ornear,recordlowlevelsaccordingtothefollowingprovisionalcasenumbers:m i ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    mA݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   89casesofmeaslescompared ( toover27,000casesin1990.: ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :)0  2C3  0   Onecaseofdiphtheriaand34  casesoftetanuswerereportedin1998.0 :) ӌ   ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   260casesofHaemophilus ` influenzaesince1991.:( ӌP ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m    m7݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Thegoalfortheyear2000istoensure 0 thatatleast90percentofalltwo-year-oldsreceivethefullseriesofvaccinesandavaccinationsystemisbuiltthatwillsustainandfurtherimprovehighcoveragelevels.mk݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     TheFY2000immunizationbudgetis 8"" $1.1billion.Totalfundingincludes$545millioninentitlementfundingfortheVaccinesforChildren(VFC)program,throughwhichMedicaidpaysforvaccinesforuninsuredMedicaideligiblechildrenandNativeAmericans.VFCfundingis$21millionlessthaninFY1999,asthenewChildrensHealthInsuranceProgramisreducingthenumberofuninsuredchildren.m ݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB/+XBXXXXgJXXB+m XBXXXBXBXXXB  mF    Thediscretionarycomponentofthe +@), immunizationbudgetis$526million,$77millionmorethaninFY1999.Ofthis x- +. increase,$60millionwillbeusedtopurchasevaccinestoimmunizeunderinsuredchildrenthroughthepublichealthsystem.ThisincreaseisneededtoprovideallthevaccinesnowrecommendedbytheNationalAdvisoryCommitteeonImmunizationPractices(ACIP).Theseincludevaccinesfor_rotavirus_Ԁ(theleadingcauseofseverediarrheaininfants),andcatchupvaccinationsforhepatitisBandtheseconddoseofMMRforadolescentswhohavenotpreviouslyreceivedthecompleteseries.mF݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m! D   TherequestforFY2000alsoincludes  @ : $99millionforglobalpolioandmeasleseradication,anincreaseof$17millionoverFY1999.Whileworld-widepoliocaseswerereduced85percentbetween1988and1998,amajorinternationalincreaseineffortwillbeneededtoreachtheWorldHealthOrganizationsgoaltoeliminatepoliointheyear2000.m!!݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m# D   m#C$݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j$  DemonstrationstoReduceHealth D DisparitiesinMinorityPopulations+j$b% ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mU& D   Raceandethnicitycorrelatewith PG persistent,andoftengrowing,healthdisparitiesamongU.S.populations.Thisincreasingproblemdemandsnationalattention.InresponsetothePresidentsInitiativeonRace,HHSiscommittedtodevelopingacomprehensivestrategytoreducehealthdisparitiesamongethnicandminoritygroups.mU&&݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m( D   CDCbudgetincludes$35millionto !hP continueandexpandnewresearch/demonstrationprojectsincommunitiesacrossthecountrywhichaddresssixidentifiedareasofhealthdisparities:infantmortality,cancer,heartdisease,diabetes,HIVinfections,andchildandadultimmunizations.Thesecommunitieswillbeabletoapplythesefundstoaddresshealthproblemsthattheyperceiveastheirgreatestneeds.m(j)݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m+ D   m+U,݌ ,)[ Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j-  HIV/AIDSand_STDs_+j-- ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  ms.    Thebudgetincludes$667millionfor h HIV/AIDS,a$10millionincreaseoverFY1999.Thisincreasewillinitiatea KnowYourHIVStatuscampaign.Thisinitiativewilltargetminoritypopulations.ms..݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m0    Thebudgetincludes$131millionfor p _STD_Ԁpreventionandcontrol,a$7millionincrease.TherelationshipbetweenHIVandother_STDs_Ԁhasbeenwelldocumentedinworldwidestudieswhichconcludethatpresenceofanother_STD_ԀincreasesbytwotofivetimestheriskthatanexposedpersonwilldevelopHIV.Asaresult,preventingandtreating_STDs_ԀdecreasesthelikelihoodofHIVtransmission.m01݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m3    m3V4݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j5  NationalInstituteforOccupational h SafetyandHealth(NIOSH)+j5{5 ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mg6    NIOSHestablishesanddisseminates  scientificandpublichealthinformationnecessarytoensuresafeandhealthfulworkingconditionsformillionsofAmericanworkingmenandwomen.Researchwillcontinuetoincludeoccupationallungdisease,musculoskeletalinjuries,cancers,traumaticinjuries,reproductivedisorders,neurotoxicdisorders,cardiovasculardisease,noiseinducedhearingloss,dermatologicconditions,andprotectiveequipment.Theseeffortswillhelptoaddresssolutionstooccupationaldiseaseandworkplacesafetyconcernsinthosefieldswherethedangersarethegreatest.CDCsbudgetincludes$212millionforNIOSH,anincreaseof$12millionovertheFY1999level.ThisincreasewillsupporttheNationalOccupationalResearchAgenda(NORA),NIOSHsresearchprogramdevelopedcooperativelywithacademiccentersandindustry.mg66݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m;    m;;݌ )`'+ Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +jd<  Violenceagainstwomen+jd<< ӌ X+ ЌXBXXBXBXXB  m XBXXXBXBXXXB  m= D   Nearly2millionAmericanwomen h- experienceddomesticorsexualviolencein1996.Thebudgetincludesatotalof$75million,anincreaseof$11millionabovetheFY1999level,forCDCtosupporttheDepartmentsInitiativetocombatViolenceAgainstWomen(VAW).CDChasakeyroleinensuringthattheDepartmentsresponsetoVAW!includingbothpreventionandservicedelivery!issupportedbyscience.CDCwilluseitsapproachofimprovingpublichealthpreventiontoworkwithStateandcommunitypartnerstohelpincreasetheeffectivenessofVAWpractitioners.Specifically,CDCanditspartnerswilluseascientificapproachtoevaluateservicesandbringinnewpartners,suchasbusinessesandeducationalinstitutions,toimproveservicedeliveryandprovidepreventionopportunities.m=>݌̌ XBXXXBXBXXXB  /XBXXXXXXB/+XBXXXXXXB++jXBXXXB  XBXXXB   +joB  InjuryPrevention+joBB ӌ D ЌXBXXBXBXXB  m XBXXXBXBXXXB  mC D   InadditiontofundsforViolenceAgainst @F Women,thebudgetincludes$65.5millionforinjuryprevention,anincreaseof$2million,orthreepercent,abovetheFY1999level.FundswillsupporttheSafeUSAinitiativewhichwillcollectandanalyzeinformationonthenumberofinjuriesinthenationandhowtheyarecaused.Withthisinformation,CDCwillhelpcommunitiesidentifytheirinjuryproblems,spendtheirresourceswisely,andknowiftheireffortsaremakingadifference.mCD݌̌ XBXXXBXBXXXB  /XBXXXXgJXXBDB/+XBXXXXgJXXB++jXBXXXB  XBXXXB   +j'G  HealthStatistics+j'GG ӌ p&$S ЌXBXXBXBXXB  m XBXXXBXBXXXB  mQH D   Thebudgetincludes$110million,an '%U increaseof$15millionovertheFY1999level,forexpandedsupportofHHShealthsurveyanddatacollectionefforts.InFY2000theentirerequestforNCHSwillbeprovidedthroughinter-agencyfundstransfers.Majorstatisticalsystemsoperated x- +[ byNCHStrackchangeinhealthandhealthcare,plan,target,andassesstheeffectivenessofpublichealthprograms,andidentifyhealthproblems,riskfactors,anddiseasepatternsintheUnitedStates.ThesefundswillbeusedtoexpandtheNationalVitalStatisticsprogram($1million),theNationalHealthInterviewSurveys($3million),theNationalHealthandNutritionExaminationSurvey(NHANES;$1million),andstartnewtargetedsurveys($3.5million).$6millionwouldbeusedtostrengthenCDCsintramuralstatisticalprogram.mQHH݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mL    mLnM݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j#N  PreventiveHealthBlockGrant+j#NN ӌ h ЌXBXXBXBXXBXBXXB  m XBXXXBXBXXXBXBXXXB  mxO    ThePreventiveHealthBlockGrant x wouldbefundedat$120million(plus$45millioninCrimeBillfunding),whichis$30millionbelowtheFY1999level.ThegrantprovidesStateswithfundsforpreventivehealthservices,notcoveredbyothergrants,toreducepreventablemorbidityandmortalityandimprovequalityoflifeforallAmericans.ThefundsareallocatedtotheStates,theDistrictofColumbia,Territories,andeligibleIndianTribesandTribalOrganizationsthatapply./XBXXXXgJXXBF/+XBXXXXgJXXB+ mxOP݌   Ќ XBXXBXBXXB  /XBXXXXXXBlR/+XBXXXXXXB++jXBXXXB  XBXXXB   +jS  AgencyforToxicSubstancesDisease x  Research(_ATSDR_)+jST ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m U    _ATSDR_ԀisfundedthroughSuperfund,  x" whichismanagedbytheEnvironmentalProtectionAgency._ATSDR_ԀperformspublichealthactivitiesrelatedtoSuperfundToxicWastesites.Theseincludehealthconsultations,epidemiologicalsurveillance,profilesofthehealtheffectsofhazardoussubstances,andeducationofhealthcareprovidersnearSuperfundsites.EPAsbudgetproposes$64millionfor_ATSDR_ԀinFY2000,adecreaseof$12million.m UU݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mmX    mmXX݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mY    m^_݌̌ XBXXXBXBXXXB  /XBXXXXgJXXBrS/+XBXXXXgJXXB+ -*/ mY Z݌ ,).  -*/  XBXXXBXBXXXB   X. (X@(  -+. /XBXXXXXXB[/+XBXXXXXXB+#  X2XXXBe/ eXX2  #\@$    % 8 CDCOVERVIEW#\\] ]  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  vVB 2.b~1M& `#.@E&&}m"<' v@ (dollarsinmillions) (#(#                                          (#(#AZ') Hxd%E,HxA  ,c*- #  X2XXXBe/ eXX2  #p 7"(#7"(#(#(#   @7"  @7" $!#7"(#7"(# #  X2XXXBe/ eXX2  #9@\ \     % A NIHOVERVIEW(byInstitute/Center)#9 ű  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 ,!' `'.@Ex$x$e<)%v (#(#                                         (#(#  AZ') Hxd%E+HxA +s),   ,)- #   X2XXXBe/ eXX2  #ᄥ@     % B NIHOVERVIEW(byMechanism)#ᄥ ;  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB2.b~1 ,!" `-/@Exxe<e v (#(#                                    (#(#AZ') Hxd%E'HxA '$'   b' %( `'  X2XXXBe/ eXX2  `'r@* * !    % N SUBSTANCEABUSEAND`'rٿ   X Ќ̌e e ee/XBX ee   #  X2XXXBe/ eXX2  #@VV    % O MENTALHEALTHSERVICESADMINISTRATION#? d   AZ') HxdEHxAe e ee/XBX eeԌ  Ќ  @ (dollarsinmillions) (#(#           (#(#vV B2.b~1 , `.U @E?xxev߰AZ') HxdERHxA S +jXBXXXB  XBXXXB   (X@(#(#(+j  Summary+jh ӌ 2 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    TheFY2000budgetrequestforthe  SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)is$2.6billion,anetincreaseof$139millionor5.6percentovertheFY1999enactedlevel.TheSAMHSAbudgetfocusesonenhancingmentalhealthandsubstanceabuseservicesthroughcapacitybuildingprogramssuchastheMentalHealthBlockGrant,theProjectsforAssistanceinTransitionfromHomelessness,theTargetedTreatmentCapacityExpansion,andtheSubstanceAbusePreventionandTreatmentBlockGrantprograms.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mv    TheSubstanceAbuseandMentalHealth "# ServicesAdministrationprovidesnationalleadershiptoensurethatknowledge,basedonscienceandstate-of-the-artpractice,iseffectivelyusedforthepreventionandtreatmentofaddictiveandmentaldisorders.Further,SAMHSAstrivestoimproveaccessandreducebarrierstohighquality,effectiveprogramsandservicesforindividualswhosufferfrom,orareatriskfor,thesedisorders,aswellasfortheirfamiliesandcommunities.ThroughitsCenters"MentalHealthServices(CMHS),SubstanceAbusePrevention(CSAP),andSubstance B.+0 AbuseTreatment(CSAT)"SAMHSAsupportsaportfolioofprogramstodevelop,test,andtransfernewmethodsandmodelsfortreatingsubstanceabuseandmentalhealthdisordersandpreventingsubstanceabuse.TheFY2000SAMHSAbudgetsupportstheseeffortsthroughitsKnowledgeDevelopmentandApplicationactivities.mv݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m_ D   Lastfall,CSATfundedthreenew  8 activitiesdesignedtoimprovetreatmentservicesforyouth.Newgrantswereawardedtoidentifyeffectivetreatmentregimensforsubstanceabusingadolescentsthatwereusefulforreplicationinothercommunitieswithpriorityforthoseprogramsthatprovidetreatmentforadolescentheroinusers.Thesecondareafunded,inconjunctionwiththeNationalInstituteonAlcoholAbuseandAlcoholism,wasresearchtodevelopefficacioustreatmentforadolescentalcoholabusersandalcoholics.Forthethird,CSATbeganamultisitestudyoftheimpactofmanagedcareonadolescenttreatmentservicesinthepublicsector.Thisstudywillfocusonserviceuseandoutcomesoftreatmentforadolescentsundermanagedcareandfeeforservicemedicalplans.m_݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m=݌ -r+L Ќ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  MentalHealth+jq ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  m-    Eachyearapproximately44million h Americanadultsexperiencesomeformofmentaldisorder,ofthese,10millionareseriousmentalillnesses.Further,anestimated3.5to4millionchildrenandadolescentsbetweentheagesof9through17experienceaseriousemotionaldisturbance.Itisestimatedthatfewerthanoneinfourofthesepersonsreceivestreatmentforthedisorder.m-݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Toincreaseaccesstomentalhealth   services,SAMHSAseeksatotalof$359millionfortheMentalHealthBlockGrant(MHBG),anincreaseof$70million,or24percentoverFY1999.TheMHBGprogramassistsStatesincreatingcomprehensive,communitybasedsystemsofcareforadultswithaseriousmentalillnessandchildrenwithasevereemotionaldisturbance.Thesefundsplayanintegralroleinreducinghospitalizations.Theavailabilityofcosteffectivecommunitybasedsystemsiscriticaltoaddresstheneedsofpersonswhoarenolongerinstitutionalized.Inaddition,thebudgetseeksanadditional$5million,19percent,fortheProjectsforAssistanceinTransitionfromHomelessness(PATH)program.PATH,aStateformulagrantprogram,providesfundsforoutreach;screeninganddiagnostictreatment;habilitationandrehabilitation;communitymentalhealthservices;alcoholordrugtreatment;stafftraining,linkagestoprimarycare;andsupportiveservices.ThenumberofcontactsmadethroughPATHwillincreasebyapproximately13,000andwillimprovethequantityofservicesprovidedtoenrolledPATHclientssuchaslinkagestohealth,educationandjobservices,providecasemanagementandmatchclientswithappropriatehousing.mt݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m,    TheFY2000budgetwillcontinuethe 0*'+ #XBXXXB\#NXBXXXBnew$40millionprogramCMHSinitiatedin  +(, FY1999#XBXXNXB2#NXBXXXBtosupportthedeliveryand ,)- improvementofmentalhealthservicesinournationsschools.Thisambitious -+/ programisdesignedasacomprehensive,interagencycollaborativeapproachlinking_local_ԀandStatementalhealthserviceproviderswithschools.Schooldistrictswillimplementawiderangeofearlychildhooddevelopment,earlyinterventionandprevention,andmentalhealthtreatmentservicesthatappeartohavethegreatestlikelihoodofpreventingviolenceamongchildren.#XBXXNXB#m,݌  p8 Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   mI݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  ClosingthePublicSubstanceAbuse  P : TreatmentGap+jh ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mG D   Nationwide,therecontinuestobeagreat  = needforadditionalcapacitytotreatchronicusersofillegaldrugs.TheOfficeofNationalDrugControlPolicyestimatesthat2.4millionpersonscouldpotentiallybenefitfromtreatmentservicesandareunabletoobtainthem.A1996surveyshowedthatforeverydollarspentontreatment,$5.60isreturnedinpublicsavingsfromreduceduseofwelfare,foodstamps,Medicaidfunds,crime,andreducedimprisonment.TheSAMHSArequestwillsupportsubstanceabusetreatmentforanadditional20,000personsthroughFederalfunds.TheFY2000budgetincludesatotalofnearly$2billionforsubstanceabuseactivities.mG݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m) D   TheFY2000totalbudgetforthe M TargetedTreatmentCapacityExpansionprogramof$110millionisanincreaseof$55millionoverFY1999.TheTargetedCapacityExpansionprogramaddressesthetreatmentgapbysupportingrapidandstrategicresponsestothedemandforalcoholanddrugtreatmentservices,withaspecialfocusonemergingdrugproblems.Thegoaloftheprogramistocreateorexpandintegratedcreativeandcommunity-basedresponsestotargeted,well-documentedsubstanceabusecapacityproblems,andallowcommunitiestomeet theneedsofspecialpopulations.m)݌  +([ Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m       Thisbudgetalsoseeksatotalof X $1.6billion,anincreaseof$30millioninFY2000,plusadvancedappropriationsof$100millioninFY2001fortheSubstanceAbusePreventionandTreatmentBlockGrant.TheBlockGrant,thecornerstoneofStatessubstanceabuseprograms,providessupportforover7,000communitybasedtreatmentorganizationsacrosstheU.S.Inaddition,theBlockGrant!throughitssetaside!willcontinuetosupporttheexpandedNationalHouseholdSurveyonDrugAbuse(NHSDA).NHSDAwillprovideestimatesoftheprevalenceofalcohol,drugandtobaccouseinthe50StatesandtheDistrictofColumbia.In1999,SAMHSAwillintroducecomputerassistedsurveymethodstotheNHSDAinordertoimprovetheprecisionofthesurveydata.mT݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m5    m5݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +ji  Substanceabuseprevention+ji ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    SAMHSAs1997NationalHousehold ( SurveyonDrugAbuse(NHSDA)estimatesthat13.9millionAmericansusedanillicitdruginthepastmonth.Adolescentuseofalcohol,tobacco,marijuanaandotherillicitdrugscontinuesatunacceptablelevels.Moreover,theU.S.Censusprojectsasignificantincreaseinthenumberof12to20-year-oldsoverthenext15years.Thisprojectionsignalsacontinuingneedtoenhanceandbuildonthosepreventionprogramsthatworkandtoencouragedevelopmentofnewandmoreeffectiveprogramsinthefuture.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheSAMHSAbudgetseeksatotalof #H!$ $139millionforKnowledgeDevelopmentandApplication,TargetedCapacityExpansionandHighRiskYouthprogramstocontinuebuildingaknowledgebaseinsubstanceabusepreventionandtopromotewidedisseminationandadoptionofbestpracticesinthefield.Inaddition,theCSAPTargetedCapacityExpansionprograms,includingtheStateIncentiveGrants,will continuetofocusonaddressingspecificand -*. immediatepreventionservicecapacityneedswithinstatesandcommunities.m݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m~ D   m~݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  Programmanagement+j ӌ (1 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   Thebudgetincludesanincreaseof 83 $5millionforProgramManagementactivitiestosupportSAMHSAasitaddressesimportantissuessuchaschildrensmentalhealth,therelationshipbetweendrugabuseandthechangingdemographicsoftheAIDSepidemic,andrespondingtorapidlyemergingsubstanceabusetreatmentgaps.m\݌̌ XBXXXBXBXXXB    ; (X@(#  X2XXXBe/ eXX2  #ᄥ@RR#    % ` SAMHSAOVERVIEW#ᄥ  E  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vV'B2.b~1 ,!Z `.)@Exxe<v (#(#                               (#(#AZ') HxdzEj"HxA k" "   "Z # #  X2XXXBe/ eXX2  #@    % a AGENCYFORHEALTHCAREPOLICYANDRESEARCH#K p  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vV/B2.b~1 , `.U @Exxe<v (#(#           (#(#AZ') HxdEHxA C +jXBXXXB  XBXXXB   (X@(#(#(+j   Summary+j y  ӌ z ЌXBXXBXBXXB  m XBXXXBXBXXXB  m/     TheFY2000requestfortheAgencyfor : HealthCarePolicyandResearch(AHCPR)providesaprogramlevelof$206million,anincreaseof$35million,or21percent,overFY1999.Thisincludes$27millionindirectappropriationsand$179millionininter-agencytransfers.TheBudgetreflectsamajorcommitmenttoensurethattheknowledgegainedthroughhealthcareresearchistranslatedintomeasurableimprovementsintheAmericanhealthcaresystem.TheFY2000budgetwill:m/  ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mZ    mZ݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   Expandworktotranslatethe j  findingsofcompletedresearchintoeverydaymedicalpractice;:3 ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   startnewresearchforfuture *# $ healthcarequalityimprovementsinpriorityareas,especiallyamongthediseasesthathavethegreatestimpactonMedicareandMedicaidcosts;: ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   improvethedecision-support )b'+ toolsandinformationavailabletomedicalproviders,consumers,andpolicymakers;and,:+ ӌz-"+/ ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   includeaspecialfocuson z/ closingthehealthcaregapsaffectingracialandethnicminorities.: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  mR D   mR݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   AHCPRpromotesthecreationanduse *4 ofsciencebasedinformation,oftenthroughpartnershipswithmedicalsocieties,managedcareproviders,andhealthcarepayers.Forexample,itsupports12Evidence-basedPracticeCenters(EPCs).Eachcenterfocusesonamedicalproblemthatiscommonorexpensive(especiallyforMedicaidandMedicare),assessingthecurrentscienceonwhatworksbestforthatmedicalproblem.Eachcenterhasamajorpartner"suchastheAmericanAcademyofPediatricsoramajorinsurer"whowillimplementthecentersfindings.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Otherexamplesofpartnershipsinclude #J!B theNationalGuidelineClearinghouse(jointlymaintainedwiththeAmericanMedicalAssociationandtheAmericanAssociationofHealthPlans),andtheConsumerAssessmentsofHealthPlansStudy(CAHPS).TheNationalCommitteeforQualityAssurance(whichaccreditsmanagedcareplans)recentlyadoptedCAHPStohelpconsumersandemployeebenefitprogrammanagersselectcarebasedonquality,notjustprice.Ninetymillion -+M consumerswillbenefitfromCAHPSin1999.m݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j^!  Healthcosts,quality,andoutcomes+j^!! ӌ ( ЌXBXXBXBXXB  m XBXXXBXBXXXB  m"    ResearchonHealthCosts,Qualityand 8 Outcomesisfundedat$168millioninFY2000,anincreaseof+$27million.ThisresearchfocusesheavilyonillnesseswithhighMedicareandMedicaidcosts,andwillenableHHStoimplementthescientificrecommendationsofthePresidentsAdvisoryCommissiononConsumerProtectionandQualityintheHealthCareIndustry.m"#݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mP%    mP%%݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ&0  XBXXXBXBXXXB   Chronicdiseases.Ȋ&& ӌ ЌXBXXBXBXXB   m XBXXXBXBXXXB  m'    AHCPRwilldirect$9millionto H conductresearchonchronicdiseases,withspecialemphasesonasthmaanddiabetes(including$2.5millioninMEPS).m'=(݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m)    First,AHCPRsinvestmentinresearch  onpharmaceuticalsandtheestablishmentofthenewCentersforEducationandResearchonTherapeuticswillincludestudiesontheeffectiveness,costeffectivenessandqualityofprescribingpracticesforchronicillnesses.m)*݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m+    Second,AHCPRwilldevelopnewways P tomeasurethequalityofcareforchronicillnesses,helpfourmoreStatesimplementthosethatareavailablenowthroughtheHealthcareCostandUtilizationProject,andcollectandanalyzedataonthequalityandcostofcare.m+j,݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m>.    Third,AHCPRwillestablish 8"# cooperativeprojectswithoneormorehealthcarenetworksfocusingonwaystoimplementcurrentmedicalknowledgeonwaystopreventthecomplicationsofchronicillnessesandreducerelatedhospitalizations.m>..݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  ms0    ms00݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ10  XBXXXBXBXXXB   Reducingracialandethnichealth (p&* disparities.Ȋ11 ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m 3    AHCPRwilldirect$10millionin  +(- researchoneliminatinghealthdisparitiesforminoritypopulations.Manyoftheseresultfromprovider,patient,andorganizational -+0 factorsthathindertheappropriateuseofmedicalscience.AHCPRsplansinclude:m 33݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :c50 D 2C3  0pD(#D(#   Researchonfactorsaffecting 82 minorityhealthoutcomes! (3 $4.5million:c56 ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :70 D 2C3  0pD(#D(#   Improvedinformationonthe 5 qualityofcare!$1.6million:7\8 ӌ6p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :90 D 2C3  0pD(#D(#   Partnershipswithhealth 7 deliverysitestotranslateresearchintopractice!$4  p9 million.:9: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m\< D   m\<<݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ=0 D XBXXXBXBXXXB   Long-termcare.Ȋ== ӌ @ <D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m> D   Measuringthequalityoflong-termcare  > isuniquelydifficult.AHCPRplanstouse$1.5milliontodevelopbetterwaystomeasurethisquality,andconductresearchimportanttoMedicaidrecipients.m>G?݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m@ D   m@UA݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ B0 D XBXXXBXBXXXB   Violenceagainstwomen.Ȋ B%B ӌHDD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mJC D   Somehealthcaresystemshave F implementedinnovativeapproachestoprevent,screenandtreatdomesticviolence,butthereislittleresearchthatassessestheirvalue.AHCPRwillworkwithhealthplans,clinicians,andresearcherstosupportuptothreelongitudinalstudiesoftheoutcomesandeffectivenessofthesemedicalinterventions.This$1millionresearcheffortispartofabroaderDepartmentalinitiativetocurtailviolenceagainstwomen.mJCC݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mXF D   mXFF݌̌ XBXXXBXBXXXB  .Ȋ  .ȊG0 D XBXXXBXBXXXB   Measuringtheimpactofchangesin H!R thehealthcaremarketplace.ȊGG ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mI D   Changesinthewayhealthcareisbought #H!U andsoldhashadamajorimpactonthehealthcaretheaverageAmericanreceives.Managedcare,competition,andvaluebasedpurchasingarethreeofthemoreimportantchanges.Atleast$2millioninresearchwillbedirectedtoprovidetimelyinformationontheseeffectstoconsumersanddecision-makers.mII݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mK D   mK-L݌ ,)^ Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +jL  MedicalExpenditu  rePanelSurveys+jLkM ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  mFN    AHCPRsMedicalExpendituresPanel h Surveys(MEPS)arefundedat$36millioninFY2000,anincreaseof$8million.MEPSprovidesdetailed,nationaldataonthehealthcareservicesAmericansuse,howmuchtheycost,andwhopays.Thisincreasewillprovidepolicymakersmoreinformationonthequalityandcostofcareforchronicdiseases,includingcardiovasculardiseaseanddiabetes.Forexample,policymakerswillgetbetterinformationonuseofmedicinesthatreducesubsequenthospitalstays.Thisinformationcanhelptargethealthimprovementseffortsbyhealthplans,theStateandFederalgovernments,andthemedicalcommunity.Targetedsamplesizeincreasesinthehouseholdsurveywillprovidebetterinformationforracialandethnicpopulations.Thisinformationwillhelptargeteffortstoreducehealthdisparities,andtrackprogressofvarioushealthservices.mFNN݌̌ XBXXXBXBXXXB   `  X (X@(vVOB2.b~1 wxZ  `.@Ex x fl v (#(# @ #  X2XXXBe/ eXX2  # T@#    % p AHCPROVERVIEW# TT T  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vV5B2.b~1 ,!  `.@Ex x e<X v (#(#                (#(#AZ') Hxd%EZHxA [   J #  X2XXXBe/ eXX2  #ᄧX@    % q HEALTHCAREFINANCINGADMINISTRATION#ᄧXY 3Y  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vV%B2.b~0]  `.l@Exx_ x_ - v (#(#           (#(#AZ')H`d EH`A+jXBXXXB  XBXXXB   (X@(#(#(+j\  Summary+j\!] ӌ 3 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m]    TheFY2000budgetrequestforthe  HealthCareFinancingAdministration(HCFA)is$333.1billiontocoverMedicareandMedicaid,theChildrensHealthInsuranceProgram(CHIP),theHealthCareFraudandAbuseControlProgram(HCFAC),Stateinsuranceenforcement,andHCFAsoperatingcosts(seechartforthedistributionofspending).Thisbudgetreflectsanincreaseof$18.2billionoverFY1999.SpendingfortheMedicare,Medicaid,andCHIPprogramsrepresent82.7percentofthetotalHHSbudgetforFY2000.m]V^݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  vVEB 2.b~0 3  `..@E2  S`2N Lvm)a    ThePresidentsFY2000budget    includesseverallegislativeproposalsforHCFA.Majorinitiativeswillenablethousandsofpeopleaged5565tobuyintoMedicare,andalsoprovideassistancefordisabledMedicareandMedicaidbeneficiarieswhoreturntowork.Thisbudgetproposesseveralnewendeavorstocontinuethefightagainstwaste,fraud,andabuseintheMedicareprogram.InadditionMedicarepaymentreformswilltightenpaymentsforcertainservices.NewuserfeelegislationinHCFAsdiscretionarybudgetwillenableHCFAtomeetthenewworkloaddemandswhilemoreeffectivelyadministeringtheprogram.m)ab݌ #.+/ Ќ XBXXXBXBXXXB   D Stateswillbegiventheoptiontoextend 3/ Medicaidcoverageforcertaingroups,suchasqualifiedalienchildrenandpregnantwomen.ToserveMedicaidbeneficiariesbetter,thebudgetoffersmorechoicestoMedicaidlongtermcarerecipientsandprovidesgrantstotheStatestoretrainprovidersinasthmamanagementtechniques.Medicaidwillmoreefficientlytargetspendingthroughcostallocationandchangesindrugreimbursementlaws.Finally,thebudgetproposesincreasedCHIPmoneytoprovidemoreequitablefundingforchildrenshealthcareintheU.S.territoriesandincreasedspendingonCHIPoutreachactivities.   x  C> vVHBB2.b~0|$  `..@E|$ \1$3% v@qq0  HCFAFY2000NetOutlays  !@ "k"  @1 Total=$333.1Billion "B  &o$G (X@(`'  X2XXXBe/ eXX2  `'i@&    % { MEDICARE`'ij -j  X Ќ̌e e ee/XBX ee  +jXBXXXB  XBXXXB   (X@(#(#(+jj  Summary+jjyk ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m/l    XBXXXB 6,X,` XX,X6MedicareistheFederalhealthinsurance X programforpeopleage65orolderandpeopleunderage65whoaredisabledorsufferfromendstagerenaldisease(ESRD).InFY2000,theprogramwillserveapproximately39.8millioneligibleindividuals.Medicareconsistsofthreeparts:m/ll݌̌ XBXXXBXBXXXB  /XBXXXXI[XXBl/+XBXXXXI[XXB+:L 4(*-/0123Chh4(*-/0123LXBXXXB  :Io0  2C3  0   ݀PartA"HospitalInsurance @  (HI)Paysforinpatienthospitalcare,someskillednursingfacilitycare,homehealthcarerelatedtoahospitalstay,andhospicecare.TheHIprogramisfundedthroughtheHITrustFund.TheTrustFundreceivesmostofitsincomefromtheHIpayrolltax(2.9percentofpayroll,splitbetweenemployersandemployees).:Ioo ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :r0  2C3  0   ݀PartB"Supplementary p MedicalInsurance(SMI)PartBcoverageisoptional.However,94percentofthoseenrolledinPartAenrollinPartB.PartBpaysformedicallynecessaryphysicianservices,outpatienthospitalservices,treatmentforESRD,laboratoryservices,durablemedicalequipment,homehealthcare,andcertainothermedicalservicesandsupplies.TheSMIprogramisfundedthroughtheSMITrustFund.Enrolleespayabout25percentofPartBcosts,andtheremainingincomecomesfrom generalrevenue.:rGs ӌP-*- ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :v0 D 2C3  0pD(#D(#   PartC"TheMedicare+Choice -  Program,whichisavailabletomostbeneficiaries,offersbeneficiariestheoptionofreceivingtheirMedicarebenefitsthroughprivateorganizationssuchasmanagedcareplans.Currentlyabout16percentofbeneficiarieshavechosentoenrollinaMedicare+Choiceplan.:v\w ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  /XBXXXXI[XXBo/+XBXXXXI[XXB+ Legislativeproposals /XBXXXXI[XXBz/+XBXXXXI[XXB+/XXXXXI[XX/u/+XBXXXXI[XXB+  : /XBXXXXgJXXB{/+XBXXXXgJXXB+m XBXXXBXBXXXB  m{ D   InMedicare,theFY2000budget < includesproposalsto:extendMedicarecoveragetopopulationgroupsatriskoflosinghealthcoverage,combatfraud,wasteandabuseintheprogram,andensureMedicarepaymentforproviderservicesisappropriateandcostefficient.m{|݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m} D   Thetwoinitiativesdesignedtoassist 8C vulnerablepopulationgroupsareaMedicarebuyinforearlyretireesanddisplacedworkersandextendedMedicarecoverageforworkingdisabledbeneficiaries.Together,theseproposalscost$1.7billionoverfiveyears.Thecostsassociatedwiththeseproposalswillbeoffsetbysavingsinitiativesproposedinthisbudget.m}n~݌̌ XBXXXBXBXXXB  @  < .Ȋ  .Ȋ0 D XBXXXBXBXXXB   MedicareBuyin.ȊԀ ӌ#!MD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  6hXpX,X,` X6m    AmajorinitiativeinthisBudgetprovides X%#O theopportunityforcertainindividualsbetweentheagesof5565tobuyintoMedicare.Theseindividualsareamongthemostdifficulttoinsure,havelessaccesstohealthcare,andaretwiceaslikelyas4554yearoldstohavehealthproblems.Thethreeinitiativesthatconstitutethisproposalwill:m݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mڄ    mڄY݌ ,*W Ќ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :#0  2C3  0   EnableAmericansages6265to X  buyintoMedicare,bypayingafullpremium;:#Ȇ ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :p0  2C3  0   Providevulnerabledisplaced ( workersover55accesstoMedicarebyofferingthosewhohaveinvoluntarilylosttheirjobsandtheirhealthinsuranceasimilarbuyin   option;:p ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :(0  2C3  0   ProvideAmericansover55,  `  whosecompaniesterminatetheirretireehealthcoverage,anewinsuranceoption,byextending COBRA x  continuationcoverageuntilage65.:(͋ ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  .Ȋ  .Ȋߍ0  XBXXXBXBXXXB   WorkingDisabledProposal.Ȋߍ ӌ8 ЌXBXXBXBXXB   m XBXXXBXBXXXB  m"    AnothermajorinitiativeintheFY2000 H BudgetextendsMedicarecoverageforthosedisabledindividualswhoreturntowork.Currently,disabledindividualswhoreturntoworkmustpaythefullPartApremiumafter39monthsinordertocontinueinMedicare.ThisproposalprovideslifetimecoverageunderPartAifadisabledpersonwholosesSocialSecuritybecauseoftheirabilitytoworkenrollsduringthefirst10yearsafterenactment,therebyremovingasignificantdisincentivetoworkinherentinthe/XBXXXXgJXXBr{/+XBXXXXgJXXB+current  system.m"݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB/+XBXXXXgJXXB+m XBXXXBXBXXXB  mB    mB݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋv0  XBXXXBXBXXXB   FightingFraud,Waste,andAbuse.Ȋv ӌ!h" ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    Inthecontinuingefforttoensurethatthe (# $ MedicareprogrameffectivelymanagesMedicaredollars,thebudgetproposesthefollowinginitiatives,totalingabout$2.9billionoverfiveyears:m?݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB/+XBXXXXgJXXB+/XBXXXXI[XXB/+XBXXXXI[XXB+:L 4(*-/0123Chh4(*-/0123LXBXXXB  :|0  2C3  0   Eliminatethephysicianmark @)&+ upforoutpatientdrugsbylimitingMedicarepaymentto83percentoftheaverage wholesaleprice;:|! ӌ-*/ ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0p(#(#   Reducemisuseofpartial X/  hospitalizationservicesby:prohibitingprovidersfromfurnishingpartialhospitalizationservicesinabeneficiaryshomeorother 4 inpatientorresidentialsetting,allowingtheSecretarytoestablishmorestringentstandardsforcommunitymentalhealthcenters,andimposingcivilmonetarypenaltieswhenaphysicianfalselycertifiestheneedfortheseservices;: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0p(#(#   Requireprivateinsurance h> companiestoprovideMedicareSecondaryPayerinformation;:K ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0p(#(#   ReduceMedicares 8A reimbursementratefor_Epogen_Ԁ(EPO)by$1tobetterreflectcurrentmarketprices,and;: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :v0  2C3  0p(#(#   MaketheCentersof F Excellenceprogram,whichwassuccessfullytestedasademonstration,apermanentpartoftheMedicareprogram.:v ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   PaymentReforms.Ȋ ӌ0L(#(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m,    DespitetheslowdowninMedicare N growthoverrecentyears,thereisstillevidencetosuggestthatMedicarepaystoomuchforsomeservicesandhasnotbenefittedfromcostefficienciesthathaveoccurredinthemarketplace.InanefforttoensureMedicarecontinuestopayappropriatelyforservicesfurnishedtobeneficiaries,thebudgetincludessavingsproposalstotaling$7.5billionoverfiveyearsto:m,݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0p(#(#   Notupdatethehospital *P([ paymentratesforthetwelve monthsofFY2000;: ӌ ,0*]p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :a0  2C3  0   Reducefrom55to45the X  percentageMedicarepayshospitalsforbaddebtandextendthispolicytoprovidersbeyondhospitals;:a ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   Reducethelabfeeschedule  ceilingfrom74to72percent;and;: ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   LimitMedicarepaymentfor   orthoticsandprostheticstothenationalmedian.: ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m]    m]ܳ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j摴  ManagedCareOptions+j摴 ӌ  @  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Medicareoffersbeneficiariesavarietyof   coverageoptions.Beneficiariesmaychoosetoremaininthetraditionalfeeforserviceprogramorjoinamanagedcareplan.Infeeforservice,beneficiarieschoosefromalmostanydoctor,hospital,orhealthcareprovider.Inmanagedcare,beneficiariesreceivevirtuallyallcarefromtheplansdoctorsandhealthcareproviders.m=݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheBalancedBudgetActof1997(BBA) p expandedthetypesofplansavailabletobeneficiariesincludingprovidersponsoredorganizations(PSO)andpreferredproviderorganizations(PPO).m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Currently,morethan6millionorabout   16percentofbeneficiaries,areenrolledinamanagedcareplan.Enrollmentinmanagedcarehasgrowndramaticallyoverthelastfiveyears.WhilesomemanagedcareorganizationshaverecentlydecidedtodisenrollfromtheMedicareprogram,theoverallgrowthtrendhasnotbeengreatlyaffected.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m&    Medicarepaysasetmonthlyamount,or $8"% _capitated_Ԁamount,tomanagedcareplansforeachbeneficiaryenrolled.Managedcareplanshavebeenattractivetobeneficiariesbecausetheygenerallycovermoreservicesandhavefeweroutofpocketcoststhanfeeforservice.m&݌ XBXXXBXBXXXB  /XBXXXXgJXXBQ/+XBXXXXgJXXB+  +(, /XBXXXXXXBտ/+XBXXXXXXB++jXBXXXB   XBXXXB   +jo  MedicareSpendingGrowth+jo ӌ X, ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Undercurrentlaw,Medicarebenefit h. outlaysareprojectedtoincreasefrom$236.6billioninFY2000to$296billioninFY2004.Theprogramisexpectedtogrowat5.8percentperyearduringthisperiod.PartAbenefitoutlaysareprojectedtogrowfrom$136.1billioninFY2000to$170.4billioninFY2004,alsoatanaverageannualgrowthrateof5.8percent.PartBbenefitoutlayswillgrowfrom$100.5billioninFY2000to$125.6billion&  inFY2004.ThePartBaverageannualgrowthrateduringtheprojectionperiodis5.7percent.')m)݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m3    m3݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jg  HealthCareFraudandAbuse x= ControlProgram(HCFAC)+jg ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m    TitleIIoftheHealthInsurancePortability (@ andAccountabilityActof1996(HIPAA)establishestheHCFACProgramtocombathealthcarefraud,waste,andabuse.IncludedwithinthisoverarchingprogramistheMedicareIntegrityProgram(MIP)andtheHCFACAccount.ThroughtheeffortsofHCFAanditspartners,theseprogramsreturnmultipledollarstotheMedicareTrustFundsforeachdollarspentfightingfraud,waste,andabuse.HIPAAestablishedastableandreliablefundingsourcefortheseeffortsandtheSecretarysOperationRestoreTrust(_ORT_)initiativehasguidedtheDepartmentsefforts.Followingasuccessfuldemonstrationphase,the_ORT_initiativehasgonenationwideandMIPandHCFACAccountspendinghavebeenattheheartofthisneweffort.m2݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m>    TheMedicareIntegrityProgramwas %#S establishedfromtheMedicarepaymentsafeguardprogramunderHCFAsdiscretionaryProgramManagementbudget.Thebaseoftheprogramconsistsofactivitiessuchasfinancialauditsofprovidercostreports,medicalandutilizationreviews,andtheidentificationofMedicarebeneficiarieswhohaveotherinsuranceplans x- +[ withprimaryresponsibilityforpayingclaims.Fundsarealsoearmarkedtosupporteffortsindetectingandinvestigatingprogramfraudandabuse.HCFAwillalsofundprovidereducationandtrainingactivitiesassociatedwithantifraudactivitiesandauditsofmanagedcareplans.m>݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    InFY2000,HIPAAauthorizes  $630millionforMIP,a$70millionincreaseoverFY1999.Withinthislevel,HCFAwillcontinueitspolicyoffundingactivitiesthatwillstopunnecessarypaymentsbeforetheyleavethetrustfundsthroughprepaymentreviewandprovidereducation.TheseactionsshouldhelplowerthepaymenterrorratecitedinrecentChiefFinancialOfficersreports.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheMedicareHospitalInsuranceTrust H FundalsofundstheHCFACAccount.ThisAccountfundsmuchofthehealthcareinvestigationalandprosecutorialactivitiesoftheHHSOfficeofInspectorGeneralandtheDepartmentofJustice.TheHCFACAccountwillincrease$20millioninFY2000overFY1999to$158million.mk݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jr  PeerReviewOrganizations+jr ӌ p ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    PeerReviewOrganizations(PROs)were 0 establishedinTitleIXoftheSocialSecurityAct,PartB,toservethefollowingfunctions:m$݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mp    mp݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   Improvethequalityofcare  forbeneficiariesbyensuringprofessionallyrecognizedstandardsofcarearemet.:I ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  : 0  2C3  0   Protectprogramintegrityby "X # ensuringthatMedicareonlypaysforitemsthatarereasonableandmedicallynecessary.:  ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :v0  2C3  0   Protectbeneficiariesby `'%(   addressingindividualbeneficiaryscomplaints, @)&* hospitalissuednoticesofnoncoverageandEMTALA(dumping)violations.:v ӌ   L 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m*    m*݌ -*. Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mr    Currently,HCFAisnegotiatingthesixth X.  roundofcontractswithPROs.ThelatestcontractswillfocusonNationalHealthImprovementInitiatives,aprogramtopreventpaymenterrors,andthecontinuedmaintenanceoftheClinicalDataAbstractionCenters. m݌ 4 Ќ XBXXXBXBXXXB  m݌ XBXXXBXBXXXB  m݌ XBXXXBXBXXXB   m݌  4     XBXXXBXBXXXB   mr݌  4   XBXXXBXBXXXB  (X@(  X  #  X2XXXBe/ eXX2  #S@* *     % | MEDICARETRUSTFUNDOVERVIEW#S   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @(beneficiariesinmillions)vVRB2.b~1 J)!. `.b@ExxeK`v (#(#      (#(#(#(#K(#AZ') HxdzE HxA   ` * " @TT(Dollarsinmillions)/1vVUB2.b~1 O)! `.(@Exxef&v (#(#                             (#(#AZ') HxdzEq,HxA r,*-   ,a*. `'  X2XXXBe/ eXX2  `'A@  &    %  MEDICAID`'A   X Ќ̌e e ee/XBX ee  +jXBXXXB  XBXXXB   (X@(#(#(+j  Summary+j ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  ? ,, X%XhXpX?m    MedicaidisajointlyfundedFederal- X Stateprogramthatprovidesmedicalassistancetocertaingroupsoflow-incomepeopleandotherswithspecialhealthcareneeds.InFY2000,itwillcoverapproximately33.8millionindividualsincludingchildren,theaged,blind,and/ordisabledandpeoplewhoareeligibletoreceivefederallyassistedincomemaintenancepayments.Undercurrentlaw,theFederalshareofMedicaidoutlaysisexpectedtobeabout$115billioninFY2000.Thisisa$6billion(6percent)increaseoverprojectedFY1999spending.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  LegislativeProposals+j! ӌ h ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Thereareapproximately11.5million x uninsuredchildrenunderage18inthecountry,ofwhomapproximately4millionareeligibleforMedicaid,butnotenrolled.MillionsofotherchildrenareeligibleforhealthcareunderChildrensHealthInsuranceProgram(CHIP).md݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m>    Stateswillbegiventheoptiontoextend ` coverageforcertaingroups,suchasolderfosterchildrenandimmigrantswholostcoverageduetowelfarereform.TheywillalsobegivenmoreflexibilitytouseadministrativefundsthatweremadeavailabletoStatesatenhancedmatchunderthewelfarereformlawtoidentifypeoplewhoareeligiblefor,butnotenrolledin,MedicaidandCHIP.TheseproposalsareexpectedtoincreaseFederalspendingbyabout$1billionoverfiveyears.m>݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mm    InFY2000,thebudgetincludes (H&( $50millioningrantstoStatestoretrainprovidersinasthmamanagementtechniques.mm݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m*    Overfiveyears,thebudgetproposesto p+)+ improvechoicesinlongtermcareoptionsandtoassistthedisabledinreturningtowork.m*݌ @.+. Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m  D   TheFY2000budgetalsocontains . MedicaidproposalsthatwillsavetheFederalgovernment$1.3billion(net)overthenextfiveyears.Thisreductionreflects$1.2billioninsavingsfromchangesinadministrativecostallocation(netofMedicaidsavingsandrelatedTANFincreases)combinedwith$125millioninsavingsfromchangesindrugreimbursementlaws.Thesesavingsproposalspartiallyoffsetthenewspendingproposals.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ60 D XBXXXBXBXXXB   Wp  IncreaseandExpandtheUseofthe 0: OutreachFundWp:  .Ȋ6Q ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   PermitStatestoexpandtheuseofa 0= special$500millionMedicaidfund(authorizedbythewelfarereformstatute)nowaimedatoutreachforchildrenlosingwelfare,tofundoutreachtootherchildreneligibleforMedicaidandtonewchildreneligibleforCHIP.Thisproposalwouldalsoremovethe2000sunset.mb݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mb  D   mb  ݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ 0 D XBXXXBXBXXXB   Wp  Extendedcoverageforchildren F formerlyinfostercareWp" /:  .Ȋ   ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mH  D   PermitStatestoextendMedicaid PI coveragetolowincomechildrenuptoage21whowereinfostercarebutwholeftthatsystematage18.ThisvulnerablepopulationwouldbeassuredofaccesstohealthcareunderMedicaidastheycontinuetoprepareforadulthood.mH  ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   Wp  HealthCareforPregnant %x#Q ImmigrantsWpYates:  .Ȋ ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mm D   GiveStatestheoptiontoextend ((%T MedicaidtopregnantqualifiedalienswhoenteredthecountryafterAugust22,1996.CoveragewouldbeidenticaltothatprovidedtootherpregnantMedicaidbeneficiaries.Thisproposalensuresthatthechildrentowhomthesewomengivebirth, -p+Z whowillbeU.S.citizens,willgetthebestpossiblestartinlife.mm݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m%    m%݌̌ XBXXXBXBXXXB  .Ȋ  .ȊY0  XBXXXBXBXXXB     Wp  MedicaidforImmigrantswith ( RestoredSSIWporki:  .ȊYt ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m     RestoreSSIforqualifiedaliens, ( regardlessofage,whoenteredthecountryafterAugust22,1996,whobecomedisabledatanytimeaftertheyentered,andwhohavebeenhereatleastfiveyears.Undercurrentlaw,theseindividualsarebarredfromSSIunderrestrictionsimposedbythewelfarereformlawenactedin1996.InmostStates,restoringSSIwouldmeanrestoringMedicaidbecausetheireligibilitywasbasedonreceiptofSSI.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     m ݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ=0  XBXXXBXBXXXB   Wp  StateOptiontoCoverLegal h ImmigrantChildrenunderMedicaidand/orCHIPWpX:  .Ȋ=X ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    GiveStatestheoptiontoextend  MedicaidandChildrensHealthInsuranceProgram(CHIP)coveragetoqualifiedalienchildrenwhoenteredthecountryafterAugust22,1996.ThesechildrenlosteligibilityforMedicaidcoverageduetochangesinFederallawunderwelfarereform.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  me     me  ݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ!0  XBXXXBXBXXXB   SimplifyingTransitionalMedicaid.Ȋ!! ӌx  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m"    Thisbudgetproposestosimplifyand ! improvetransitionalMedicaidprogramstohelptheworkingpoorwhoseincomemakesthemineligibleforthetraditionalMedicaidprogram.ByeliminatingburdensomereportingrequirementsthisproposalwouldhelpbeneficiariesretaintemporaryhealthinsurancethroughMedicaiduntiltheycanaffordprivatehealthinsurance.m"c#݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m%    m%&݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ&0  XBXXXBXBXXXB   Wp  AsthmaDiseaseManagement @)&+ InitiativeWpT'X:  .Ȋ&& ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mi(    GivesStatesincentivestotrainproviders +@). ineffectivediseasemanagementtechniques.Thisproposalwouldprovide$50million,on x- +0 acompetitivebasis,toselectedStateMedicaidprogramstotestandevaluatetheeffectivenessofinnovativediseasemanagementapproachestoidentifyandtreatpediatricasthma.TheseeffortsareintendedtoprovideanincentiveformoreeffectiveuseofongoingMedicaidfundsforoutreach,casemanagement,andtreatmentbenefitstoreducecostlyasthmarelatedmedicalcrises(suchasemergencyroomvisitsandhospitalstays)andtoimprovequalityoflife(suchasschoolattendance)forchildrenwithasthmaandtheirfamilies.mi((݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  ma, D   ma,,݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ-0 D XBXXXBXBXXXB   Wp      MedicaidBuy-InforWorking x > Disabled(Jeffords/Kennedy)Wp!.:  .Ȋ-- ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m_/ D   ProvidesincentivesunderbothMedicaid xA andMedicareforpersonswithdisabilitiestoworkwithoutlosingtheirhealthcarecoverage.InMedicaid,itbuildsonthecurrentoptioncreatedbytheBalancedBudgetActof1997(BBA).Underthecurrentoption,StatesmayexpandMedicaideligibilitytoworkerswithdisabilitieswithearnedincomeupto250percentofpoverty,andtheymayrequiretheseindividualstopayaState-establishedpremiumtoqualify.TheproposalexpandsthisMedicaidbuy-inoptionintwoways:byallowingStatestocoverpeoplewithdisabilitieswithearnedincomeabove250percentofpoverty,andbyliftingorrelaxingcurrentlimitsonassetsandonunearnedincome.m_//݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mc3 D   Threehundredmilliondollarsover !hR 5yearswillbeallocatedforademonstrationprogramthatwillallowparticipatingStatestoprovideMedicaidtoindividualswithhealthconditionsthatcanreasonablybeexpectedtodeveloptoalevelofseveritythatwouldqualifythemforSSIorSSDIinthefuture.mc33݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m5 D   Onehundredfiftymilliondollarsover @)&Z 5yearswillbemadeavailabletoStatestotakeadvantageofoneorbothoftheneweligibilityoptions.ThesenewgrantfundscanbeusedbyStatesto:developinfrastructurestosupportindividualswith -+_ disabilitiessotheycanwork;buildcapacitytoprovidehomeandcommunitybasedservicestopeopleofallageswithdisabilities;helptransitioncurrentnursinghomeresidentstothecommunityiftheysochooseandcandososafely;andforoutreachcampaignstoconnectindividualswithdisabilitiestoservices.m5Z6݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mk9    mk99݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ:0  XBXXXBXBXXXB   PermitHigherIncomeEligibility  p  StandardforPeopleNeedingInstitutionalLevelofCareWp  Wp;:  .Ȋ:: ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mt<    Stateswouldhavetheoptiontoextend   Medicaidtoindividualswithincomesupto300percentofSSI($1500permonthin1999)iftheStatedeterminesthemtoneedaninstitutionallevelofcareandiftheyreceiveservicesundertheplan.Stateswouldbepermittedtotargetthiseligibilityoptiontoindividualsreceivingspecifickindsoflongtermcareservices,forexample,personalcareservices.Undercurrentlaw,anindividualmayonlyqualifyforMedicaidunderthehigherincomeleveliftheyenteranursinghomeoriftheyareservedunderaStateshomeandcommunitybasedwaiverprogramforlongtermcare.Thisproposalallowsforequitybetweensettings,andensuresthatindividualshavearealchoiceandarenot,ineffect,forcedintoenteringanursinghome.mt<<݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m@    m@QA݌̌ XBXXXBXBXXXB  .Ȋ  .ȊB0  XBXXXBXBXXXB   Wp  IncreaseBBADSHAllotmentfor  x! theDistrictofColumbiaWpBtyt:  .ȊB!B ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mC    Thisproposalprovidesforaoneyear (# $ increaseof$9milliontotheDSHcapfortheDistrictinFY2000.ThisisthecostofrecalculatingtheFFPfortheoriginalbaseyearnumberforDC($23million)toreflecttheincreaseinFMAPfortheDistrictfrom50percentto70percent.mC9D݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m)F    m)FF݌ )`'+ Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +jqG  Medicaidsavingsproposals+jqGG ӌ X+ ЌXBXXBXBXXB  .Ȋ  .ȊH0 D XBXXXBXBXXXB   Wp  ChildSupportEnforcementWp:Ityt:  .ȊHH ӌh-D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m7J D   SeeACFEntitlementsectionfor (/ description.m7JJ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mK D   mK*L݌̌ XBXXXBXBXXXB  .Ȋ  .ȊL0 D XBXXXBXBXXXB   Wp  RebatesfromGenericDrug 2 ManufacturersWpkMhis:  .ȊLL ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mN D   Currently,brandnamedrug P 5 manufacturersmustpayanadditionaldollarfordollarrebatetotheMedicaidprogramiftheyincreasethepriceoftheirdrugsinexcessofincreasesintheconsumerpriceindexurban(CPIU).Genericdrugmanufacturersarenotsubjecttothisrequirementinthedrugrebateprogrambecauseitwasbelievedthatgenericdrugpriceswouldnotrisefasterthaninflation.RecentpriceincreasesingenericdrugshavedemonstratedtheneedfortheCPIUadjustmentforgenericaswellasbrandnamedrugs.mNO݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mQ D   mQ_R݌̌ XBXXXBXBXXXB  .Ȋ  .ȊS0 D XBXXXBXBXXXB   Wp    CostAllocationWpS:  .ȊS/S ӌ`DD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mT D   Thisproposaladdressesprojected pF FederalcostincreasesintheMedicaidprogramarisingfromchangesinthewayStateschargecoststotheFederalgovernmenttoadministertheFoodStamp,Medicaid,andTemporaryAssistanceforNeedyFamilies(TANF)programs.SimilartotheAgriculturalResearchbillpassedlastyear,thislegislationwoulddirecttheSecretarytoreduceeachStatesMedicaidgrantawardbytheamountofadministrativecostschargedtoAFDCineachStatesTANFbaseyearthatcouldhavelegitimatelybeenchargedtoMedicaid.ThisproposaldoesnotpreventStatesfromusingfundsfromtheirTANFblockgrantstocovertheshortfall.mTU݌ XBXXXBXBXXXB   )`'W +jXBXXXB   XBXXXB   +jX  Background+jXY ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  mY    Medicaidisavoluntaryprogram, h initiatedandadministeredbyStates.StateexpendituresformedicalassistancearematchedbytheFederalgovernmentusingaformulabasedonpercapitaincomeineachStaterelativetothenationalaverage.MatchingratesforFY2000areprojectedtorangefrom50to77percentformedicalassistancepayments.TheFederalmatchingrateonaverageisapproximately57percent.mYLZ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m\    Historically,mostindividuals'eligibility   forMedicaidhasbeenbasedonqualifyingunderthecashassistanceprogramsofAidtoFamilieswithDependentChildren(AFDC)orSupplementalSecurityIncome(SSI).WithpassageofthenewTemporaryAssistanceforNeedyFamilies(TANF)program,whichreplacedAFDC,eligibilityforMedicaidandcashassistancearedelinked.MedicaideligibilityremainstiedtoAFDCprogramrulesinplaceonJuly16,1996.Allthosewhoqualifyunderthe1996AFDCrulesandmostSSIrecipients,commonlyreferredtoasthe"categoricallyeligible,"werecoveredunderStateMedicaidprograms.StateshavetheoptiontocoversomeindividualsnoteligibleunderAFDCorSSIrules(e.g.,peoplewithhigherincomesininstitutions,lowincomepregnantwomenandchildren,andaged,blind,anddisabledpeoplebelowthepovertyline).Statesmayalsocover"medicallyneedy"individuals.Suchindividualsmeetthecategoricaleligibilitycriteria,buthavetoomuchincomeortoomanyresourcestomeetthefinancialcriteria.m\4]݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m$b    Medicaidcoverschildrenundertheage %(#& ofsixandpregnantwomenwhosefamilyincomedoesnotexceed133percentoftheFederalpovertylevel.Medicaidcoverageofchildrenaged6through18,bornafterSeptember30,1983,whosefamilyincomedoesnotexceed100percentoftheFederalpovertylevel,isbeingphasedin.By2002, allchildrenundertheageof19livingbelow -*. thepovertylevelwillbeeligibleforMedicaid.m$bb݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m@e D   Inaddition,MedicaidpaysMedicare 80 premiumsandcostsharingforMedicareforcertainlowincomeseniorsanddisabledindividuals.m@ee݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m g D   UnderBBA,twonewMedicaid 4 eligibilitygroupsconsistingoflowincomeMedicarebeneficiarieswerecreated,QualifiedIndividuals(QIs)1and2.QI1sareMedicarebeneficiarieswithincomesfrom120to135percentofthepovertylevel.ThisgroupiseligibleforafullsubsidyoftheirPartBpremiums.QI2sareMedicarebeneficiarieswithincomesfromatleast135to175percentofthepovertylevel.ThisgroupiseligibleforapartialsubsidyoftheirPartBpremiums.m gg݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m3j D   Generally,Statesarerequiredtoprovide 8@ acoreof13mandatoryservicestoeligiblecategoricallyneedyrecipients.ThosemandatoryMedicaidservicesincludeinpatientandoutpatienthospitalcare,healthscreening,diagnosis,andtreatmenttochildren,familyplanning,physicianservices,andnursingfacilityservicestoindividualsover21.Statesmayalsoelecttocoveranyofover30specifiedoptionalservices,whichincludeprescriptiondrugs,clinicservices,dental,eyeglasses,andservicesprovidedinintermediatecarefacilitiesforthementallyretarded.m3jj݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mm D   FederalMedicaidoutlaysrose X N dramaticallyfromFY1989throughFY1992,ata25percentaverageannualrate.However,outlaygrowthslowedtolessthan12percentinFY1993,followedby8percentgrowthinFY1994.InFY1997,Medicaidgrowthwas3.9percent.InFY1998,Medicaidgrowthwas5.9percent.Thesearethelowestgrowthratessincetheearly1980s.ThedeclineintherateofMedicaidincreasesisduetomanyfactors,includinglegislativechanges(suchaslimitsonproviderspecifictaxesanddonations), decreasesintheprojectedgrowthofSSI ,0*[ caseloads,higheremployment,andStateeffortstocontrolcosts.mmD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   TheFY2000budgetproposestoallow @ statestouseupto3percentoftheirCHIPbenefitspendingamountforoutreachactivitiesandremovesoutreachexpendituresfromthe10percentadministrativecapunderCHIP.ThisproposalmakesfundsavailabletoStatesforoutreachinFY20012003.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  ml D   ml݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   CHIPfortheTerritoriesof pH AmericanSamoaandtheCommonwealthoftheNorthernMarianaIslands(CNMI):.Ȋ ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m= D   ThisproposalwouldgranttoAmerican  PM SamoaandCNMIrelieffromsomeTitleXXIrequirementsthatareinconsistentwiththeirexistingMedicaidprograms.TheincreaseintheseterritoriesflexibilitywillenablethemtouseCHIPandexpandhealthinsurancecoveragetoeligiblechildren.m=݌̌ XBXXXBXBXXXB    +jXBXXXB  XBXXXB   +j浵  Background+j浵 ӌ (H&V ЌXBXXBXBXXB  m XBXXXBXBXXXB  mض D   TheChildrensHealthInsurance *'X ProgramisavoluntaryprogramcarriedoutbytheStates.Stateshaveahighdegreeofflexibilityindesigningtheirprograms.TheycanimplementCHIPbyeither:1) -p+\ creatinganew,nonMedicaidTitleXXIseparateStateprogram,2)expandingMedicaid,or3)developingacombinationofbothapproaches.Generally,uninsuredchildreninfamiliesatorbelow200percentofthepovertylevelwhoarenoteligibleforMedicaidareeligibleforCHIP.mضW݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Underthenewprogram,Stateshave  flexibilityinchoosingwhatbenefitstoprovidechildren.BenefitsunderTitleXXIStateprogramsmustbeidenticaltoa benchmarkplan,orthebenefitsmustbeactuariallyequivalenttoabenchmarkplanwithincertainparameters.Benchmarkplansinclude:theFederalEmployeesHealthBenefitsPackagestandardBlueCross/BlueShieldpreferredprovideroption,awidelyavailableStateemployeeplan,ortheHMOcoverageplanwiththelargestcommercialenrollmentintheState.MedicaidexpansionsunderTitleXXImustprovidetheMedicaidpackage.Finally,costsharingforparticipatingchildrenunderTitleXXIisallowed,butlimited.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    StatesreceiveFederalreimbursementfor  expendituresunderTitleXXIbasedonanenhancedMedicaidmatchingratewhichrangesfrom65to85percent.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Stateallotmentsarecappedandare @ basedonaformuladescribedwithintheCHIPstatute.StatesmusthaveanapprovedchildhealthplanbytheendoftheFY1999toreceivetheirFY1998andFY1999allotment.mn݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     Statesmusttakestepstoensurethat 8"" TitleXXIfundsarenotusedtocoverchildrenwhowouldotherwisereceiveemployersponsoredinsuranceorMedicaid.Thestatuteincludesseveralprovisionsaimedatpreventingsuchsubstitution.m ݌ &$' Ќ XBXXXBXBXXXB   X' (X@(  (p&' #  X2XXXBe/ eXX2  #ᄹ@    %  CHILDRENSHEALTHINSURANCEPROGRAMOVERVIEW#ᄹ  E  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVmB2.b~1 M)!  `.@Ex x e]M v (#(#               (#(#AZ') Hxd%EZHxA [   : `'  X2XXXBe/ eXX2  `'F@ !    %  PROGRAMMANAGEMENT`'F   X Ќ̌e e ee/XBX ee  +jXBXXXB  XBXXXB   (X@(#(#(+j  Summary+j( ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    HCFA'sFY2000ProgramManagement X appropriationrequestis$2,016.1million,a$69millionincreaseovertheFY1999appropriation.Thisappropriationleveldoesnotinclude$150millionformillenniumcomplianceactivitiesfundedseparatelythroughPublicHealthandSocialServicesEmergencyFund(_PHSSEF_).m]݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m}    TheBudgetalsoincludesproposeduser   feestotaling$194.5million.Theenactmentoftheseuserfeeswouldoffsettheappropriationbytheamountoftheproposal.Tofacilitatethisprocess,theAdministrationhasincluded triggerlanguageintheBudget.Ifafeeisenacted,theappropriationwouldbereducedautomaticallybytheamountofthenewfeesexpected.Iftheuserfeesareenacted,HCFAsbudgetauthorityrequestwouldbe$1,822million.m}݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheProgramManagementaccount  providesresourcesforadministeringtheMedicare,Medicaid,andChildrensHealthInsuranceProgram,aswellasenforcingStateinsurancerequirements.TheProgramManagementaccountprovidesthestaffandresourcesnecessarytoadministertheseprograms,totaling$347billion.HCFAimplementsstatutorychangesandcoordinatestheworkofcontractors,Stateagencies,andtheproviderandbeneficiarycommunitiestoensurethesmoothoperationoftheseprograms.HCFAalsosafeguardstheintegrityoftheMedicareTrustFundsandtheGeneralFund.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m-    Whileworkloadshavecontinuedto ((%' increaseeveryyear,theProgramManagementbudgetdecreasedinconstantdollarsby11percentfromFY1994toFY1998.ThisrequiredHCFAtofindmorecosteffectivemethodstoaccomplishitsmissionandgoalsasestablishedinits -p+- strategicplan.Thishasbeenespeciallydifficultsincetheresponsibilitiesoftheagencyweregreatlyexpandedinthatsametimeperiod.WiththepassageoftheHealthInsurancePortabilityandAccountabilityActof1996(HIPAA)andtheBalancedBudgetActof1997(BBA),HCFAmustnowimplementanumberofnewprograms,suchastheChildrensHealthInsuranceProgram,newmanagedcareoptions,andenforcementofStateinsurancerequirementsunderHIPAA.IntheFY1999appropriation,CongressprovidedHCFAitstotalrequestedlevelofProgramManagementfundingaswellasanadditional$4millionforthenewNursingHomeInitiativeandtheopportunitytoaugmentHCFAsY2Kcomplianceefforts.Theseadditionalresourceshavefacilitatedimprovedprogrammanagement.m-݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m&݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  Millenniumcompliance+jE ӌ XA ЌXBXXBXBXXB  m XBXXXBXBXXXB  m  D   TheHHSFY2000budgetrequest C includes$150millionforHCFAmillenniumcompliance,fundedseparatelyaspartofthePublicHealthandSocialServicesEmergencyFund(_PHSSEF_).The$150millionfromthe_PHSSEF_Ԁwillbeusedtocontinuerenovationandtestingofnonmissioncriticalsystems,converttemporarycodingsolutionstopermanentcodingsolutions,continueoutreacheffortstotheprovidercommunityandtheStates,andcontinuecontingencyplanning.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m_ D   m_݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  Nursinghomequalityinitiative+j ӌ H&#P ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   TheDepartment'sFY2000budget 'X%R includesatotalof$60.1millionindiscretionaryandmandatoryresourcestoimplementthePresident'sNursingHomeInitiativeannouncedlastJuly,includingmoneyforHCFA,theOfficeoftheGeneralCounsel,andDepartmentalAppealsBoard.InFY1999,HHSbegantophase-inkey @.+Y provisionsoftheinitiative,suchas:strengtheningthedefinitionofapoorperformingnursinghome,conductingmorefrequentsurveysofrepeatoffenders,staggeringsurveystart-times,andperformingfocusedsurveyreviewsofnursinghomeeffortstoreducetheincidenceofbedsores,malnutrition,anddehydration.TheFY2000requestwillallowHCFAandothercomponentsoftheDepartmenttofullyimplementallprovisionsoftheinitiative.mJ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Themajorityofthe$60.1millionforthe  P  initiative--$50.6million--residesinHCFA'sbudgetrequest.Thisincludes$35millionindiscretionaryprogrammanagementfundsto:strengthenStatesurveyorinspectionandenforcementefforts,establishanationalpatientabuseregistry,andimproveFederaloversightofStatesurveyorefforts.HCFA'sbudgetalsoincludes$15.6millioninmandatoryMedicaidfundstosupplementStateinspectionandenforcementactivitiesinduallycertifiedandMedicaidonlynursinghomes.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mq    Theremaining$9.5millionwillensure p adequatelegalresourcesfortheOfficeoftheGeneralCounselandDepartmentalAppealsBoardtoprovidejudicialhearingsandhandleadministrativeandcourtlitigationinatimelymanner.mq݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB//XBXXXXgJXXBD/m XBXXXBXBXXXB  m    m݌̌ XBXXXBXBXXXB  @   h  +XBXXXXgJXXB++XBXXXXgJXXB+vVrB2.b~1 E `|-.@E EyEyLq  v  +           -*2 XBXXXB  XBXXXB   +jK  HCFAManagementReform+jK ӌ X2 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   HCFA,incooperationwiththe h4 DepartmentofHealthandHumanServices(_DHHS_)andtheOfficeofManagementandBudget(OMB),hasbegunthedevelopmentofamanagementreforminitiativethatwillincreaseHCFAsflexibilitytooperateasaprudentpurchaserofhighqualityhealthcareserviceswhilealsoincreasingaccountability.ThisinitiativefollowsuponHCFAsrecentreorganizationandincludescomponentsthatwouldincreaseprogramandmanagementflexibilityandincreaseaccountabilitytoconstituencies.m0݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m" D   HCFAsvitalcorefunctions!  A modernizingMedicare,detectingfraudandabuse,providingbeneficiaryandprovidereducation,implementinglegislativechanges,processingclaims,providingincreasedbeneficiarychoices,andmanagingFederal/StateMedicaidandCHIPprograms!continuetoexpand.Tomeettheseexpandingchallenges,itisnecessarytomovetowardastableandreliablefundingsourceforHCFAProgramManagementactivities.AsHCFAandHHSachievereformandaccomplishsomeoftheobjectivesnotedabove,theAdministrationwillconsiderlegislativeproposalstoincreasethestabilityofHCFAsfunding.m"݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m`݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  ImplementingtheBalancedBudget R Actof1997(BBA)andtheHealthInsurancePortabilityandAccountabilityActof1996(HIPAA)+j ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m D   #XBXXXB#XBXXXBHCFAhasfullyimplementedmorethan $!W halfofthe335individualBBAprovisionsaffectingHCFAprogramsandmadesubstantialprogressonmanyoftheremainingprovisions.WhileworkingontheBBA,HCFAissimultaneouslymeetingtheYear2000computerchallenge.Asrecommendedbyindependentconsultants,HCFAhasmadethedifficultchoicetopostponeafewBBAprovisionsthatwouldhavejeopardizedHCFA'sY2Kactivity.m+݌ x- +a Ќ XBXXXBXBXXXB  /XBXXXXgJXXBx/+XBXXXXgJXXB+m XBXXXBXBXXXB  mK    InFY2000,HCFAwillcontinueto X workonthedevelopmentofnewpaymentmethods,includingprospectivepaymentforhomehealthagencies,inpatientrehabilitationfacilities,andoutpatienthospitalcare,andriskadjustmentforMedicare+Choiceplans.HCFAwillalsolaunchthenewcompetitivebiddingdemonstrationfordurablemedicalequipment.ThePresident'sbudgetalsoincludesarequesttoincreasetheauthorizationoftheMedicare+Choiceinformationcampaignbyanadditional$50millionto$150million.HCFA'splanstoeducatebeneficiariesabouttheirchoicesincludenationaldistributionofanewMedicarehandbookandholding_local_ԀhealthinformationfairstoassistbeneficiariesduringtheNovember1999openenrollmentseason.mK݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB /+XBXXXXgJXXB+m XBXXXBXBXXXB  m    HCFAwillalsoimplementanumberof  HIPAAactivitiesinFY2000.HCFAwillcontinueitsworkindevelopingindustrywidestandardsforcertainadministrativeandfinancialhealthcaretransactionsoutlinedinHIPAAsadministrativesimplificationprovisions.HCFAisalsochargedwithoverseeingand,incaseswhereStatesdonotimplementinsuranceprotections,enforcinginsurancereformprovisions.TheFY2000requestprovidesfundingfortheseactivities.mx݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  Informationtechnology+j ӌ  x! ЌXBXXBXBXXB  m XBXXXBXBXXXB  mF    HCFAisdevelopinganewarchitecture 8"# foritsinformationtechnologyneedsandacapitalassetsplantoguideitssystemsformation.mF݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     Meanwhile,HCFAmustimproveits %#' informationtechnologycapabilitiesinFY2000tosupportBBAandHIPAAactivities.Theagencymustimprovesystemsecurity,redesignitsmanagedcaresystemtosupportthenewMedicare+Choiceprogram,andcollectencounterdatafrommanagedcareplansasrequiredbytheBBA.m  ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     m  ݌ x- +/ Ќ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j   MedicareContractors+j E ӌ X/ ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   Bylaw,theMedicareprogramis h1 administeredthroughprivateorganizationsthatarereferredtoascontractors.Contractors'responsibilitiesincludeprocessingclaimsandmakingbenefitpayments,performingcertainfunctionstoensuretheappropriatenessofMedicarepaymentsandtoprotecttheMedicareTrustFunds,developingmanagementimprovementscalledproductivityinvestments,andrespondingtotheneedsofitsmanycustomersandstakeholders,Medicarebeneficiaries,andtheprovidercommunity.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mK D   TheMedicareContractorprogramlevel ? budgetwillincrease$4million,from$1,270millioninFY1999to$1,274millioninFY2000.Thethreekeycontractoractivitiesareclaimsprocessing,beneficiaryandproviderservices,andproductivityinvestments.mK݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   TheFY2000contractorbudgetalso pF proposes$93millioninuserfeesallowingtheSecretaryto:assessa$1feeonanyclaimnotsubmittedelectronically,assessa @I feeforduplicateorunprocessableclaimssubmittedbyproviders,andcharge  K providersandsuppliersafeetocoverthecostsofinitiallyenrollingandrenewingenrollment&  ԀintheMedicareprogram.'m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Approximately64percentofthe O FY2000contractorprogramlevelrequest,or$809million,hasbeendesignatedforclaimsprocessing,an8percentdecreasefromFY1999.Overthelasteightyears,HCFA'ssuccessincontrollingprocessingcostshasresultedinreducedunitcostsofprocessingclaims,allowingtheagencytoprocessanexpected925millionclaimsinFY2000withinstatutorilylimitedprocessingtimes.Thisworkloadlevelrepresentsa1.1percentdecreaseoverFY2000estimatesandisattributabletobeneficiariestakingadvantageofMedicare+ChoiceoptionsofferedunderBBA.HCFAanticipatesthatincreased -+^ managedcareenrollmentwillcontinuetoslowthegrowthinclaimsandbillings.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Beneficiaryandproviderservices 8 comprise23percentoftheMedicareContractorsFY2000programlevelrequest,or$294million.ThisamountwillmaintainfundingfortheMedicarebeneficiarytollfreetelephonelines,timelyhearingsandreconsiderations,promptresponsestoproviderandbeneficiaryinquiries,providereducationandtraining,andMedicareparticipatingphysiciansactivities.HCFAwillcontinueitsinnovativeuseofaudioresponseunits(ARUs)fortelephoneinquiries,aswellascontinuingitsuseofthetelephonetoconducthearingreviewsandreconsiderations.TheseactivitiesdemonstrateHCFA'seffortstowardmorecosteffectivemanagementandagreatercommitmenttoprovidingbettercustomerservice.Withincreasedactivityintheareaoffraudandabuse,HCFAexpectsactivityinbeneficiarycommunicationsandinhearingsandappealswillalsoincreasesharply.m?݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     Thebudgetrequestallocates p $104millionforproductivityinvestments.Productivityinvestmentsenhancethecost-effectivenessandqualityofcontractoroperationsandarepartofthelong-termreformofMedicareadministration.Productivityinvestmentcostsincludeexpandingthenewcustomerorientedtollfreesystem,greaterstandardizationofcontractorsystems,andredesigningthemanagedcareprocessingsystem.Alsowithinproductivityinvestmentsarethenonrenewalcostsassociatedwithcontractorswholeavetheprogram.m  !݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m#    m#n$݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j#%  FederalAdministration+j#%% ӌ '%( ЌXBXXBXBXXB  m XBXXXBXBXXXB  mR&    ForFY2000,thePresident'sbudget @)&* requests$482.5millionforHCFA'sFederaladministrativecosts.Thisisanincreaseof$26.7millionovertheFY1999budget.Thisrequestsupportsastaffinglevelof4,282FTE,anincreaseof15FTEover1999 -+/ levels.Thistotalincludes50FTEdedicatedtoY2Kactivities.FundingfortheY2KFTEwillcomefromthePublicHealthandSocialServicesEmergencyFund.ThefundinglevelwillalsosupporttheextensivedataprocessingrequirementsfortheMedicareandMedicaidprograms,aswellasnecessarymaintenanceandenhancementofHCFAsmanyautomateddatasystems.mR&&݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m* D   AlsoincludedintheFY2000Federal  p8 administrationbudgetisa$36.7millionuserfeeauthorizingtheSecretarytocollectinitialregistrationandannualrenewalfeesfromMedicare+Choicemanagedcareplans.Withthisfundinglevel,HCFAwillcarryoutitsmanynewHIPAAandBBAactivities.AnincreasingnumberofStateshavechosennottoperformallorpartoftheirinsuranceenforcementdutiesunderHIPAA.m**݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m- D   UnderHIPAA,HCFAisresponsiblefor C performingthesedutiesonbehalfoftheStateswithinitsdiscretionaryadministrativebudget.Similarly,FederalAdministrationdollarsmustfundnewBBAactivitiessuchasreviewingnewmanagedcareplansunderMedicare+ChoiceaswellasadministeringtheChildrensHealthInsuranceProgram.ThePresidentsbudgetalsoincludes$16.9millioninnewresourcesfortheNursingHomeQualityInitiative,$10milliontoestablishanationalpatientabuseregistryand$6.9milliontoimproveFederaloversightofStatesurveyorefforts.m--݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m0 D   m01݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m1 D   m1F2݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j2  Research,Demonstrationsand $!S Evaluation+j2e3 ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m;4 D   TheFY2000budgetrequests p&$V $55.0millionfortheResearch,DemonstrationsandEvaluationprogram,whichis$5millionmorethentheenactedlevelinFY1999.HCFA'sresearchprogramsupportsresearchanddemonstrationprojectstodevelopandimplementnewhealthcarefinancingpoliciesandtoevaluatetheimpactofHCFA'sprogramson -+^ itsbeneficiaries,providers,States,andourothercustomersandpartners.InformationfromHCFA'sresearchprogramisusedbyCongress,theExecutiveBranch,andStatestoimprovetheefficiency,quality,andeffectivenessoftheMedicare,Medicaid,andCHIPprograms.m;44݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m7    Basicresearchfundswillalsobeusedto  supportDepartmentalthemesincluding,SupportingLongTermCarethroughthestudyofMedicaidwaiversforhomeandcommunitybasedcare,ProtectingVulnerablePopulationsbydesigningastudytolookatbarrierstocareamongvulnerablepopulations,andWorkingforourNationsChildrenbydevelopingdatasetstotracktheeffectsofwelfarereformandtheChildrensHealthInsuranceProgram.m7y8݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m:    Inadditiontobasicresearch,thisbudget 8 fullyfundstheMedicareCurrentBeneficiarySurvey,whichhasrecentlybeenexpandedtoincludeMedicare+Choicebeneficiaries.Finally,thebudgetincludes$12millionforresearchactivitiesassociatedwiththeBalancedBudgetActof1997.m:y;݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jf=  SurveyandCertification+jf== ӌ 0 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m>    Ensuringthesafetyandqualityofcare @ providedbyhealthfacilitiesisoneofHCFA'smostcriticalresponsibilities.HCFAcontractswithStateagenciestoinspecthealthfacilitiesprovidingservicestoMedicareandMedicaidbeneficiariestoensurecompliancewithFederalhealth,safety,andprogramstandards.m>?݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mA    HCFA'sFY2000budgetproposes $!% $204.3milliontofunditssurveyandcertificationactivities,a19.5percentincreaseovertheFY1999appropriatedlevel.Includedinthistotalis$18.1milliontoimplementkeyportionsofthePresidentsNursingHomeInitiativeannouncedlastJuly.Withthismoney,HCFAwilleliminatethegraceperiodfornursinghomesfoundguiltyofasecondoffensethatcausesactualharmtoresidents;conductmore x- +/ frequentinspectionsofnursinghomeswithrepeatviolations;andconductmorefocusedreviewsofanursinghomesabilitytopreventbedsores,dehydration,andmalnutritionduringtheannualsurveyprocess.mAA݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mE D   TheFY2000budgetalsoproposestwo 5 surveyandcertificationuserfeestotaling$65million.Undertheseproposals,theSecretaryorStateswouldbeallowedtochargeuserfeestocoverthefullcostoffacilitiesinitialsurveys($10million)and33percentofthecostsforrecertificationsurveys($55million)inFY2000.Thelatterproposalwilleventuallyresultin100percentuserfeerecoverybyFY2002.mEE݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mG D   Another$179.1millionofthetotal X? surveyandcertificationrequestwillfunddirectsurveyactivities,suchas:annualinspectionsofnursinghomesandthecontinued36monthrecertificationcycleforhomehealthagencies,asrequiredbylaw;anda15percentrecertificationcyclefornonlongtermcarefacilities(e.g.,ESRDfacilities,hospices,ruralhealthclinics,andambulatorysurgicalcenters).mGtH݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mJ D   Theremaining$7.0millioninthe `I FY2000surveyandcertificationrequestwillfundbasesupportcontractactivities,mostnotablythedevelopmentoftheQualityImprovementandEvaluationSystem(QIES).QIESisaninformationsystemcontainingqualityoutcomedatathatsurveyorscanusetobettertargetonsiteinspectionsofpoorperformingproviders.mJWK݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mM D   mMN݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jN  LegislationSupportingthe $!S DiscretionaryBudget+jN#O ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mP D   ThePresident'sFY2000Budget p&$V includesanumberofuserfeesaswellasacontractingreformpackagetoassistHCFAinenteringthe21stCenturyasamore @)&Y efficientandcosteffectiveorganization.mPP݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m*R D   m*RR݌ XBXXXBXBXXXB  .Ȋ  .ȊhS0 D XBXXXBXBXXXB     PaperClaimUserFee:.ȊhSS ӌ ,)\D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mT    AllowstheSecretarytoassessa$1fee X  onanyclaimnotsubmittedelectronically.ThisfeecouldbewaivedatthediscretionoftheSecretaryduetocompellingcircumstances.DuetoY2Kactivities,thisuserfeecouldnotbeinstitutedpriortothesecondhalfofthefiscalyear($55million).mT2U݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m-W    m-WW݌̌ XBXXXBXBXXXB  .Ȋ  .ȊaX0  XBXXXBXBXXXB   DuplicateClaimUserFee:.ȊaX|X ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mY    AllowstheSecretarytoassessafeefor @   duplicateorunprocessableclaimssubmittedbyproviders.DuetoY2Kactivities,thisuserfeecouldnotbeinstitutedpriortothesecondhalfofthefiscalyear($17.8million).mY#Z݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m[    m[G\݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ\0  XBXXXBXBXXXB   ProviderRegistrationFee:.Ȋ\] ӌx ЌXBXXBXBXXB   m XBXXXBXBXXXB  m@^    ݀AuthorizestheSecretarytocollectfees 8 fromprovidersandsuppliers(notmanagedcareplans)tocoverthecostsassociatedwithinitialregistrationsandsubsequentrenewalstotheMedicareprogram($20million).m@^^݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m_`    m_``݌̌ XBXXXBXBXXXB    .Ȋ  .Ȋa0  XBXXXBXBXXXB   Medicare+ChoiceOrganization  UserFee:.Ȋaa ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mb    AuthorizestheSecretarytocollectfees 0 fromMedicare+ChoicesmanagedcareplanstocoverthecostsassociatedwithinitialregistrationsandannualrenewalstotheMedicareprogram($36.7million).mbyc݌̌ XBXXXBXBXXXB  .Ȋ  _. e ӌ̌XBXXXBXBXXXB      _.Ȋ  | lH!.Ȋe0  XBXXXBXBXXXB   SurveyandCertificationUser  l# Fees:.Ȋe*f ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mhg    AuthorizestheSecretarytoimposeor # & requiretheStatetoimposeauserfeeforinitialcertificationsurveysandforrecertificationsurveys.Theinitialsurveyuserfeewillcoverthetotalcostofthesurvey,startinginFY2000($10million).Therecertificationsurveyfeewillonlycover33percentofcostsinFY2000,butwillincreasetocover66percentofcostsinFY2001,and100percentofcostsbyFY2002($55million).mhgg݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mgj    mgjj݌ l-+1 Ќ XBXXXBXBXXXB  .Ȋ  ||X.Ȋk0 D XBXXXBXBXXXB   ContractingReform:.Ȋkk ӌ|1D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  <mm D   TheseprovisionsgivetheSecretaryof 3 HealthandHumanServicesincreasedflexibilityincontractingforclaimsprocessing,payment,andotherMedicareintermediaryandcarrierfunctions.TheprovisionbringstheMedicarecontractingauthorityintocloseralignmentwiththegeneralgovernmentcontractingrulescontainedintheFederalAcquisitionRegulation(FAR),whilepreservingcertainessentialflexibilityintheawardingandrenewalofcontractscurrentlyavailabletotheSecretaryunderMedicarelaw.mmm݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   | 4  +jbp  MandatoryLegislativeProposals+jbpp ӌ  B ЌXBXXBXBXXB  .Ȋ  .Ȋq0 D XBXXXBXBXXXB   CancerClinicalTrials.Ȋqq ӌpDD(#D(# ЌXBXXBXBXXB   8m XBXXXBXBXXXB  ms D   Inaddition,theAdministrationis 8F proposingnewmandatorylegislationpermittingpaymentforthecareofbeneficiariesparticipatingincancerclinicaltrialsaspartofathreeyeardemonstration.mss݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m!u D   Thisdemonstrationwillprovide @K informationonthecostofcoverageofthecancerclinicaltrialswhileaffordingaccesstocuttingedgeexperimentaltreatment.BeginninginFY2001,$750millionwouldbeprovidedforthisdemonstration.m!uu݌̌ XBXXXBXBXXXB  .Ȋ  .ȊXw0 D XBXXXBXBXXXB   NursingHomeInitiative.ȊXwsw ӌHSD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mx D   TheAdministrationplanstosubmit XU legislationtoCongressrequiringnursinghomestoconductcriminalbackgroundchecksofemployeesandestablishinganationalregistryofnursinghomeworkersfoundtohaveabusedresidents.Thecosttoconductbackgroundchecksandtoquerythenationalregistrywillbefinancedthroughuserfees.mxy݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m1{ D   HCFAwillalsoseeklegislationtoallow  (%^ moretypesofnursinghomeemployees,withpropertraining,toperformcrucialnutritionandhydrationfunctions.m1{{݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ}0 D XBXXXBXBXXXB   SurveyandCertification.Ȋ}/} ӌ H-*dD(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mW~    ArecentHCFAstudyfoundthatsurvey X unitcostsvarywidelyacrossStatesandthatnoclearsetoffactorscanexplainthisvariation.Thestudyrecommendedfurtherinvestigationintowhatmayaccountforthesevariations.HCFArecognizesthisproblemandplanstosubmitalegislativeproposalthisyeartocorrectit,workinginconsultationwithourpartnersintheStates,regionaloffices,andprovidercommunity.mW~~݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mD    mDÁ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jx  ClinicalLaboratoryImprovement  P  Amendmentsof1988+jx ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mà    TheClinicalLaboratoryImprovement   Amendmentsof1988(CLIA'88)expandedsurveyandcertificationofclinicallaboratoriesfromMedicareparticipatingandinterstatecommercelaboratoriestoallfacilitiestestinghumanspecimensforhealthpurposes.CLIA'88alsointroduceduserfeesforclinicallaboratoriestofinancesurveyandcertificationactivities.UserfeesarecreditedtotheProgramManagementaccountbutareavailableuntilexpendedforCLIAactivities.mÃB݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheCLIAprogramisfullyoperational, @ withabout160,500laboratoriesregisteredwithHCFA;about28percentofthelaboratoriesaresubjecttoroutineinspection(every2years)undertheprogram.Workloadsforeachinspectionperiodincludeathreepercentsamplereviewofthe17,800accreditedlaboratories,andsurveysof29,000nonaccreditedlaboratories.mf݌̌ XBXXXBXBXXXB       4  `     h +jXBXXXB  XBXXXB   +j  NationalMedicareEducation   $!% Program+jZ ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m7    Inthe2000budget,HCFAwillcontinue p&$( tofundactivitiesthatwillhelpbeneficiariesunderstandandassesstheiroptionsundertheMedicare+Choiceprogram.m7݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheNationalMedicareEducation 0*', Program(NMEP)willfundactivitiestoinformbeneficiariesoftheiroptions!includingtraditionalMedicare,HMOs,andPPOs!andprovidecompleteand -+0 comprehensibleinformationabouttheseoptionstofacilitatetheirdecisionmakingprocess.TheBudgetprovidesanadditional$50milliontoimproveandexpandtheNMEP.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   InFY2000,theNMEPwillfundthe 5 followingactivities:mailingstobeneficiarieswithgenericinformationaboutMedicare,plusspecificinformationonplansavailableintheirarea;atollfreetelephoneserviceavailabletoallbeneficiariesstaffedbycustomerservicerepresentativesabletoprovideinformationonavailableplans;www.medicare.gov,theuserfriendly_internet_Ԁsitethatprovidescomparativeinformationonplansbyzipcode;aswellasotherinitiativesinvolvingStateand_local_entities.mc݌̌ XBXXXBXBXXXB   8B (X@(#  X2XXXBe/ eXX2  #ᄽ@     %  PROGRAMMANAGEMENTOVERVIEW#ᄽ$ I  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @r r  ProgramManagement!discretionary k @ (dollarsinmillions)  [ vVuB!2.b~1 J)!O `.!@ExoxoeK!v (#(#                        (#(#AZ') HxdHEHxA s l~&@XXProgramManagement!Mandatory@(obligationsinmillions\1)vVxB2.b~1 )! `. @Eq xaxaK& "v (#(#         (#(#AZ') HxdE'HxA 'v%(   (%) #  X2XXXBe/ eXX2  #@RR$    %  HCFASUMMARY#\   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  /XBXXXXXXB/ +XBXXXXXXB+/XXXXXXX-/ +XBXXXXXXB+@jj(dollarsinmillions)/1 k      4  `     h      %  Q   vVB2.b~1 Ix `.@ExxaK7#v (#(#                       (#(#A|') xdEPxA  C #  X2XXXBe/ eXX2  #ᄒ@  %  ADMINISTRATIONFORCHILDRENANDFAMILIES#ᄒ  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB 2.b~1 ,  `. @Ex x e< $v (#(#              (#(#AZ') GxdzEzGxA {# +jXBXXXB  XBXXXB   (X@(#(#(+jȦ  Summary+jȦZ ӌ Y ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    #XBXXXB'#XBXXXBTheFY2000budgetrequestfor#XBXXXBܨ#the  AdministrationforChildrenandFamiliesXBXXXB   (ACF)totals$38billion,ofwhich$9.4billionisdiscretionarydollarsand$28.6billionisentitlementbudgetauthority.The#XBXXXB}#AdministrationforChildrenand q FamiliesXBXXXBistheDepartmentsleadagencyfor a programsthatpromotetheeconomicandsocialwell-beingoffamilies,children,individuals,andcommunities.Itsprograms,includingHeadStart,familyviolence,childcare,childsupport,fostercareandadoption,andTemporaryAssistanceforNeedyFamilies(TANF),areattheheartoftheFederalefforttostrengthenfamiliesandgiveallchildrenachancetosucceed.#XBXXXB#In )# $ addition,ACFXBXXXBԀhasresponsibilityforarange $!% ofsocialservicesandincomeassistanceprogramswhichsupportlowincomefamiliesacrossthecountry.m݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB/+XBXXXXgJXXB+m XBXXXBXBXXXB  mR    ACFhasworked,overanumberof '%) years,towardoverhaulingthenationswelfaresystem,whichculminatedintheenactmentofthePersonalResponsibilityandWorkOpportunityReconciliationAct(PRWORA).ACFisresponsiblefortheimplementationofthislegislationincluding y-!+/ responsibilityforadministeringtheTemporaryAssistanceforNeedyFamilies,ChildSupportEnforcement,andchildcareprograms. mRѮ݌ )2 Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m` D    m`߱݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j暲  DiscretionaryProgramSummary+j暲  ӌ a 4 ЌXBXXBXBXXB  m XBXXXBXBXXXB  vVB%2.b~1 )  `..@E$) ) V$B %vmֳ D   Thebudgetincludes$9.4billionfor q6 discretionaryprogramsinFY2000.Throughawidearrayofactivities,ACFassistsStatesand_local_Ԁcommunitiesinpromotingopportunitiesforchildrenandtheirfamiliestogrow,learnandthrive.ByprovidingresourcestoStatesandcommunity-basedorganizations,ACFhelpstopromotechilddevelopment,meettheneedsofthedisabled,andsupportotherspecialpopulationsincludingrefugeesandNativeAmericans.mֳ˴݌̌ XBXXXBXBXXXB    A)&H +jXBXXXB   XBXXXB   +j枷  HeadStart+j枷 ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  m˸    InFY2000,thePresidentsBudgetis h seeking$5.3billionforHeadStarttoserveanadditional42,000children.Thisrequest,anincreaseof$607millionoverFY1999,willprovideatotalofover877,000childrenandtheirfamilieswithaHeadStartexperience.Since1993,enrollmentinHeadStarthasgrownby17percent,from713,903childrenin1993to835,000childrenin1999.ThePresidentremainscommittedtoreachingthegoalofenrollingonemillionchildreninHeadStartby2002.m˸J݌̌ XBXXXBXBXXXB  vVB2.b~1 M  `..@EM  a &v ݰ        XBXXXBXBXXXB  m    In1998,theHeadStartprogramwas  reauthorized.ThisbipartisanlegislationstrengthenedAmericaspremierearlychildhooddevelopmentprogramandensuredthatlowincomechildrenstartschoolreadytolearn.Thelawplacesemphasisonfurtherimprovementsinprogramquality,authorizingfundingforactivitiesaimedatreducingclasssize;improvingclassroomfacilities;enhancingstafftraining;improvingschoolreadiness;obtainingsaferandbetterequipment,reducingstaffturnover;andattractingandretainingwelltrainedstaffmembers.P?Q?Fmܽ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Thereauthorizationlegislationhasalso %#* reinforcedourcommitmenttoinfantsandtoddlersbydoublingthesizeoftheEarlyHeadStartprogrambyFY2002.EarlyHeadStartfundsinFY2000willexceed$420million.EarlyHeadStartwasestablishedinFY1995inrecognitionofthemountingevidencethattheearliestyearsarethemostimportanttochildrensgrowthand x- +2 development.InFY2000,thesefundswillsupportnearly45,000infantsandtoddlersandtheirfamilies.ChildrenandfamiliesenrolledinEarlyHeadStartwillreceiveearly,continuous,intensiveandcomprehensivechilddevelopmentandfamilysupportservices.mz݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   mW݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j   ViolenceAgainstWomen+j v ӌ  : ЌXBXXBXBXXB  m XBXXXBXBXXXB  m< D   Violenceagainstwomenisaserious @ < probleminoursocietytodayaffectingfamiliesallacrossthecountry.AccordingtotheDOJ/HHSNationalViolenceAgainst  ? WomenSurvey,25percentofsurveyed  @ womenhavebeenrapedand/orphysicallyassaultedbyanintimatepartnerintheirlifetime!anestimated1.5millionwomenannuallyintheUnitedStates.m<݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   ThePresidentsBudgetincludes XE $119millionforACFsViolenceAgainstWomenprograms,including$102millionfortheGrantsforBatteredWomensSheltersprogram.Thisisanincreaseof$14millionoverFY1999,andpartofabroaderDepartmentalinitiativetocurtailviolenceagainstwomen.Thesefundswillenhancetheservicesprovidedtowomenandtheirfamilies,aswellaschangethesocialnormsthatpermitviolenceagainstwomentooccur.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m- D   TheGrantsforBatteredWomens Q SheltersprogramhelpsStatesandTribesprovideimmediateshelterandrelatedservicestovictimsofabuseandtheirdependentsaswellasdomesticviolenceawarenessactivities.Thesefundswillbeusedtoprovideatotalof40,000(verifying $8"W numberwithACF)survivorsofdomestic %(#X violenceandsexualassaultwithcounseling,shelter,andotherservices.Alsoincludedis$1millionfortheDomesticViolenceHotlineand$15millionfortheSexualAbusePreventionforRunaway,HomelessandStreetYouthprogram.m-݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   mT݌ ,)_ Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j  ChildCare+j ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  mK    Thebudgetrequestcontains$1.2billion h indiscretionarychildcarefundsinFY2001.BecausetheChildCareandDevelopmentBlockGrantisadvanceappropriated,$1.2billionwasalreadyprovidedforFY2000intheFY1999appropriation.Thesefunds,anincreaseof$183millionoverFY1999,willsupportaffordable,qualitychildcareforlowincomeworkingparents.Ofthesefunds,$173millionwillsupportactivitiesthatimprovethequalityofchildcare.Tenmilliondollarswillbesetasideforresearch,demonstrationandevaluationactivities.Recently,ACFsolicitedinputfromover500expertsinthechildcarefieldinshapingitschildcareresearchagenda.mK݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m:    Thesefundsarepartofan X Administrationinitiativetohelpworkingfamiliesfindsafeandaffordablechildcare.TheFY2000budgetincludes$4.1billioninmandatorychildcarefunding.MoreonthechildcareinitiativeandthemandatorychildcarecomponentcanbefoundintheACFentitlementsection.m:݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  CommunityServicesPrograms+j# ӌ @ ЌXBXXBXBXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   CommunityServicesBlockGrant:.Ȋ ӌ ЌXBXXBXBXXB   m XBXXXBXBXXXB  m<    TheCommunityServicesBlockGrant h! programprovidesStates,territories,andIndianTribeswithaflexiblesourceoffundingtohelpreducepoverty,includingservicestoaddressemployment,education,housingassistance,energyandhealthservices.InFY2000,$500millionisrequestedfortheBlockGrant.m<݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    Thebudgetdoesnotincludefundsfor &$) previouslysupporteddiscretionarycommunityservicesprograms,i.e.,CommunityEconomicDevelopment,CommunityFoodandNutrition,NationalYouthSports,andRuralCommunity Facilities.m:݌ ,0*/ Ќ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB      IndividualDevelopmentAccounts:.Ȋ ӌX/D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mf D   TheAssetsforIndependenceAct h1 of1998authorizedfundsforanewprogramtoempowerlowincomeindividualstosaveforahome,postsecondaryeducation,oranewbusiness,atamatchraterangingfrom$0.50to$4.00foreverydollarsaved.InFY2000,$20millionisrequestedforanIndividualDevelopmentAccountsdemonstration,whichisdoubletheFY1999fundinglevel.InFY2000,60nonprofit 0 : organizationswillreceivegrantstoadministeranIDAdemonstration,servingatotalof13,560low-incomeindividuals.mf݌  = Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   ml݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j*  RunawayandHomelessYouth+j* ӌ ? ЌXBXXBXBXXB  m XBXXXBXBXXXB  md D   Thebudgetrequests$64millionforthe HA RunawayandHomelessYouthprogram.Thisprogramprovidesgrantsfortheprovisionofoutreach,temporaryshelter,familyreunification,drugeducationandprevention,andotherservicestorunawayandhomelessyouth.Anadditional$5millionfortheTransitionalLivingprogramwillassistover600runawayandhomelessyouth,includingyouthfromfostercare,inmakingthetransitiontoindependentliving.TransitionalLivingProgramsteachyoungpeopletheskillstheyneedtoliveindependentlywhilemaintainingcontact,asappropriate,withtheirfamilies,andavoidinglong-termdependencyonsocialwelfareservices.Homelessyouthreceiveshelterandservices(includingcounseling,lifeskillstraining,educationaladvancement,andjobattainment)forupto18months.md݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   mi݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  DevelopmentalDisabilities+j ӌ %#V ЌXBXXBXBXXB  m XBXXXBXBXXXB  mT D   TheDevelopmentalDisabilitiesprogram `'%X helpsStatestoensurethatallpersonswithdevelopmentaldisabilitiesareabletoaccessservicesforenhancedindependence,productivity,integration,andinclusioninthecommunity.TheFY2000requestforDevelopmentalDisabilitiesis$119million.Ofthisamount,$4millionisincludedto -+_ providesystemsofsupporttofamiliesofchildrenwithdisabilities.mT݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mR    mR݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  ChildWelfare/ChildAbuse+j ӌ ( ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    InFY2000,ACFisrequesting 8 $406millioninfundingforarangeofprogramsthathelpStatesand_local_communitiesprotectchildrenbystrengtheningfamiliesandpreventingabuse.Ofthis,$27millionisrequestedforAdoptionOpportunities.ThisamountwillsupportgrantstofacilitatetheadoptionprocessandprovidetechnicalassistancetoenableStatestoincreasethenumberofchildrenadopted,especiallychildrenwithspecialneeds. m8݌  Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    ݀mz݌ x Ќ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jF  SocialServicesResearch+jF ӌ h ЌXBXXBXBXXB  m XBXXXBXBXXXB  mw    TheFY2000budgetincludesatotalof ( $27millionforsocialservicesresearch,ofwhich$6millionisdiscretionaryfunding.Researchandevaluationeffortswillcontinuetofocusonmovingfamiliesfromwelfaretowork,promotingresponsibleparenthood,andfosteringchildwell-being.Theresultsofthisresearchprovidecredibleinformationaboutwelfarereformstrategiesandfamilyandchildwell-beingoutcomes.Ofthesefunds,$21millionismandatoryfundingmadeavailablebyPRWORA.mw݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m5݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  LowIncomeHomeEnergyAssistance X ! Program(LIHEAP)+jT ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m5    ThebudgetrequestforLIHEAPis "X $ $1.1billioninFY2001.Becausethisprogramisadvanceappropriated,$1.1billionforFY2000hasalreadybeenprovidedintheFY1999appropriation.Thebudgetalsorequests$300millioninemergencycontingencyfundsinFY2000.TheemergencycontingencyfundsareavailableforreleaseuponrequestofthePresident,dueeithertonaturaldisasterorotheremergency.Thiscanincludeextreme temperaturesorhighfuelprices.m5݌ -*/ Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mq D   LIHEAPprovidesheatingandcooling X/  benefitstoapproximately4.3millionhouseholdseachyear.Oftherecipienthouseholds,approximately34percentincludesanelderlymember,32percentincludeapersonwithadisability,49percentincludeachildunderageeighteen,and22percentofrecipientsdonotreceiveanypublicassistanceatall.Manybeneficiariesareworkinglowincomefamilieswhoareunabletomeettheirheating/coolingcosts.mq݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  RefugeeandEntrantAssistance+j$ ӌ  @ ; ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   ThebudgetrequestfortheRefugeeand  = EntrantsAssistancePrograminFY2000is$443million.Thisrequestwillprovideeightmonthsofbenefitsforanestimated80,000refugeesand20,000Cuban/HaitianentrantsadmissionsinFY2000.Ofthefundsrequested,ACFwillallocate$221milliontoTransitionalandMedicalServices,$160milliontoSocialServices,$49milliontoTargetedAssistance,and$5milliontoPreventiveHealth.TheprogramiscommittedtoensuringthatSocialServicesgrantsemphasizejobplacement,languageskills,communitysupport,andcitizenshiptrainingefforts.TheBudgetalsoincludes$7.5milliontofullyfundthedomestictreatmentactivitiesnewlyauthorizedbytheTortureVictimsReliefAct.mp ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m  D   m  ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jO  FederalAdministration+jO ӌ !hQ ЌXBXXBXBXXB  m XBXXXBXBXXXB   m D   TheFederalAdministrationrequestis (# S $150million,anincreaseof$6million.Thislevelisexpectedtofundapproximately1,510fulltimeequivalentstaff.Thesefundswillbeusedforcriticaltravelandmonitoringactivities.TheywillalsoprovidepartialpaymentfornecessaryinformationtechnologyinvestmentsanddatacollectiononkeyACFprograms,andfundpayandrentincreases.m݌ +@)\ Ќ XBXXXBXBXXXB  (X@(#  X2XXXBe/ eXX2  #ᄺ@    %  ACFOVERVIEW:DISCRETIONARYSPENDING#ᄺ! F  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB'2.b~1 ,  `{).@Exu"xu"e< #'v (#(#                                       (#(#AZ') Hxd E)HxA  )'* `'  X2XXXBe/ eXX2  `'@     %  ENTITLEMENTPROGRAMSUMMARY`', Q  X Ќ̌e e ee/XBX ee  +jXBXXXB  XBXXXB   (X@(#(#(+j  Summary+j ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  mf    TheDepartmentsFY2000ACFBudget X includes$29billioninoutlaysforentitlementprograms.ThistotalincludespreappropriatedfundingfortheTemporaryAssistanceforNeedyFamilies(TANF)programandtheChildCareEntitlementtoStates.TheACFentitlementbudgetalsorequestsfundingforincreasesinChildCare,ChildSupportEnforcement;FosterCare,AdoptionAssistance,andIndependentLiving;PromotingSafeandStableFamilies;and,theSocialServicesBlockGrant.mf݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    InFY2000,ACFcontinuesitseffortsat @ movingfamiliesfromwelfaretowork.ThehistoricChildCareInitiativeallowsACFtosupportworkingfamiliesandthefosteryouthinitiativewillhelptroubledyouthgainindependence.m ݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB'/+XBXXXXgJXXB+/XBXXXXXXB!/+XBXXXXXXB++jXBXXXB  XBXXXB   +jv"  ChildCareEntitlementtoStates/XBXXXXXBK"/+XBXXXXXB++jv"" ӌ H ЌXBXXBXBXXBXBXXB  /XBXXXXgJXXBM#/+XBXXXXgJXXB+m XBXXXBXBXXXB  m$    ThePersonalResponsibilityandWork  OpportunityReconciliationActof1996(referredtoaswelfarereform)amendedtheChildCareandDevelopmentBlockGrantAct(CCDBG)byconsolidatingtheformerchildcareprograms.AllStatesreceivediscretionaryfunds,mandatoryfundsandmatchingfunds.ThesefundshelpStatesprovideforsubsidiestoworkingfamiliesandrequireStatestospendaminiumof4percentofthefundstoimprovethequalityandavailabilityofhealthyandsafechildcareforallfamilies.Additionalamountsofthediscretionaryfundsarealsosetasideforqualityimprovementsandforschoolagecare.m$%݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mD(    ForFY2000,welfarereformauthorized *'* andpreappropriatedentitlementfunds(matchingandmandatory)of$2.4billionforchildcareprogramstoallowStatesmaximumflexibilityindevelopingchild -p+. careprograms.Thesefunds,combinedwith$1.2billionindiscretionarychildcarefunding,willfurthertheAdministrationscommitmenttosupportingworkingfamiliesandmovingfamiliesfromwelfaretowork.mD((݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m<+ D   Thechildcareentitlementportionsof  H3 thefundincludethefollowing:m<++݌̌ XBXXXBXBXXXB  /XBXXXXgJXXBW$/+XBXXXXgJXXB+/XBXXXXI[XXB,/+XBXXXXI[XXB+:L 4(*-/0123Chh4(*-/0123LXBXXXB  :-0 D 2C3  0pD(#D(#   MandatoryChildCare  7 MandatoryfundsareallocatedtogranteesbasedonhistoriclevelsofTitleIV `: Achildcareexpenditures.Twopercentofthetotalappropriation(bothmandatoryanddiscretionary)issetasideforTribes.:-$. ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :s00 D 2C3  0pD(#D(#   MatchingChildCareThisis HA thetotalallocation,lessthemandatorychildcareallocationsandthetwopercenttribalsetaside. E MatchingfundsarematchedattheFY1995Federalmatchingrates(FMAP)andallocatedusingtheatrisk pI childcareformula.:s01 ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :30 D 2C3  0pD(#D(#   TrainingandTechnical !@L AssistanceProgramThese "0 M amountsaresetasidefortrainingandtechnicalassistancetoStatesandTribes.:3;4 ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  /XBXXXXI[XXBT-/+XBXXXXI[XXB+/XBXXXXXXBT6/+XBXXXXXXB++jXBXXXB  XBXXXB   +j6  ChildCareInitiative/XBXXXXXB6/+XBXXXXXB++j6D7 ӌ ((%S ЌXBXXBXBXXBXBXXB  /XBXXXXgJXXB7/+XBXXXXgJXXB+m XBXXXBXBXXXB  m8 D   Studiesindicatethatworkingfamilies )8'U acrossthecountryarestrugglingtofindsafeandaffordablechildcarefortheirchildren.Ofthe10millionchildreninworkingfamilieswithincomesbelow200percentofpoverty,fundsfromtheChildCareand @.+Z DevelopmentBlockGrantActservedonly1.25millionin1997,approximately10percentofthoseeligible.Thechildrenoftheseworkingparentsoftenspendtheirdaysinsettingsthatdonotpromotehealthychilddevelopmentandthequalityofcareisoftenquitepoor.Evenlowqualitycarecanbeextremelyexpensive.Forfamilieswithchildrenbetweenthreeandfive,childcareisthethirdgreatestexpenseafterhousingandfood.m8Z9݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m<    Theproblemisjustassevereforolder  P  children.Expertsestimatethatnearlyfivemillionschoolagechildrenspendtimewithoutadultsupervisionduringatypicalweek.TheAdministrationseekstoaddressthissituationandhelpparentsfindaffordable,highqualitychildcarethatwillsupportandnurturethedevelopmentoftheirchildren.m<m=݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m?    ݀FollowingtheWhiteHouseChildCare  ConferenceinOctoberof1997,theAdministrationproposedacomprehensive,initiativetoimprovechildcareforAmericasworkingfamilies,includingincreasedfundingforchildcareprogramsinseveralDepartments.Inresponsetolastyearsrequestforfundstoimprovequalityandresearchinchildcare,theFY1999appropriationforHHSforwardfunded(forFY2000)anadditional$173millionforimprovementinchildcarequalityand$10milliondedicatedtochildcareresearch.Additionaldetailsontheseprogramscanbefoundinthediscretionarysectionofthebudget.m?@݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jLC  ChildCareLegislativeProposals+jLCC ӌ %(#& ЌXBXXBXBXXB  m XBXXXBXBXXXB  mD    Aswasthecaseinlastyearsbudget,the &$( Presidenthasincludedcomprehensiveincreasesinchildcarefundingtohelpworkingfamilies.BeyondthetaxcreditsandschoolagechildcarefundingintheDepartmentsofTreasuryandEducation, $10.5billionover5yearsinadditional ,0*. fundingistargetedforHHSchildcareprograms.Thisfundingincludes:mDE݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m\G D   m\GG݌̌ XBXXXBXBXXXB  .Ȋ  .ȊH0 D XBXXXBXBXXXB     SubsidyIncrease  :.ȊHH ӌ(1D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mI D   ݀Afiveyear$7.5billionincreaseinthe 83 entitlementfundingforchildcarewhich,whencombinedwithfundsfromwelfarereform,willincreasethenumberofchildrenreceivingchildcaresubsidiesbymorethan1milliontoatotalof2.4millionby2004.mI`J݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ+L0 D XBXXXBXBXXXB   EarlyLearningFund:.Ȋ+LFL ӌ @ ;D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mjM D   Thebudgetincludes$3billionover  = fiveyearsinentitlementfundsforanEarlyLearningFundtoimprovechildcaresafetyandqualityandenhanceearlychildhooddevelopment,emergentliteracy,andschoolreadiness.TheFundwillprovideStateswithdollarsforcommunitylevelchallengegrantstosupportprogramsthatimproveearlylearningandthequalityandsafetyofchildcareforchildrenuptoagefive.mjMM݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mSP D   mSPP݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jQ  TemporaryAssistancetoNeedy PH Families+jQQ ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mR D   Welfarereformdramaticallychangedthe PK nationswelfaresystembyreplacingAFDC,AFDCChildCare,EmergencyAssistanceandJOBSprogramswiththeStateTANFblockgrant,asinglecappedentitlementofapproximately$17billionannually.UnderTANF,recipientsmustengageinworkactivitiestoreceivetime-limitedassistance.Overthepastfiveyears,thenumberoffamiliesonwelfarehasdroppedbyalmost40percent,tounder3millionfamilies.mRES݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mU D   Welfarereformpromotesworkby %#V imposingstringentworkrequirementsuponfamiliesandStates.Adultrecipientsmustbeengagedinworkactivitiesafterreceivingassistancefor24monthsorless,withfewexceptions.Statesmustalsomeetminimumworkparticipationraterequirements;inFY2000,40percentofallfamiliesand90percentoftwoparentfamiliesmustbe x- +^ engagedinworkactivities.Inaddition,TANFistimelimitedsothatfamiliesmaynotreceiveFederalassistanceformorethanfivecumulativeyears,orlessatStateoption.mUUV݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mXY    Tomeettheaboveworkrequirements,  welfarereformgivesStateswideflexibilitytodesignStateTANFprograms.Welfarereformbroadlydefineseligibilitycriteriaasa needy(asdefinedbytheState)familythatincludesorisexpectingachild.StatesarerequiredtoprovideTANFrecipientswithjobskillsassessments,jobpreparation,andjobsearchservices.However,Statesdeterminetheirowneligibilitycriteriaandbenefitlevels,aswellasthetypeofservicesavailabletoTANFrecipients.AllStatesimplementedtheirStateTANFprogramsbytheJuly1,1997deadline.mXYY݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m\    Welfarereformauthorizesand 8 pre-appropriatesabout$17billionannuallytoStatesforthefollowingactivities:m\q]݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB8/+XBXXXXgJXXB+/XBXXXXI[XXB^/+XBXXXXI[XXB+:L 4(*-/0123Chh4(*-/0123LXBXXXB  BXDpX ,, X%XB:`_0  2C3  0   FamilyAssistanceGrantsto p States,TribesandTerritories;:`_G` ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :a0  2C3  0   MatchingGrantsto P Territories;:azb ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :c0  2C3  0   BonustoRewardDecreasein 0 OutofWedlockBirths;:cd ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :f0  2C3  0   SupplementalGrantsfor  PopulationIncreases;:ff ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :Ch0  2C3  0   BonustoRewardHigh  PerformanceStates;:Chh ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :cj0  2C3  0   0`   TribalWorkPrograms;and,:cjk ӌ x!` `  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :l0  2C3  0    0LoansforStateWelfare !h" Programs.:l.m ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  /XBXXXXI[XXB5_/+XBXXXXI[XXB+/XBXXXXXXBn/+XBXXXXXXB++jXBXXXB  XBXXXB     +j{o  TANFLegislativeProposals  Ԁ+j{oo ӌ $8"% ЌXBXXBXBXXB  m XBXXXBXBXXXB  mp    TheFY2000PresidentsBudget %#' includesthefollowingtwoTANFlegislativeproposals.mpDq݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋgr0  XBXXXBXBXXXB     SupplementalGrantsfor 0*', PopulationIncreases:.Ȋgrr ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  ms    Withtherapiddeclineinwelfare ,0*/ caseloads,thebudgetproposestofreezethe x- +0 SupplementalGrantsforPopulationIncreasesattheFY1999level.InFY2000,seventeenStatesareeligibleforthisgrant.TheseStatesqualifybasedonpopulationgrowthand/orlowerthanaverageStatewelfarespendingperlowincomeperson.Thisproposalwillsave$83millioninFY2000,and$241millionoverthenextfiveyears.msUt݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋv0 D XBXXXBXBXXXB   AcceleratebyOneYeartheCap 0 ; ReductiononTransferstoSSBG:.Ȋvv ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  mGx D   Undercurrentlaw,inFY2000,States 0 > maytransferupto10percentofTANFfundstotheSocialServicesBlockGrant(SSBG)program,andinFY2001,thetransfercapisreducedto4.25percent.InlightoftheSSBGproposed(seebelow)increaseof$471millionabovetheFY1999level,thePresidentsBudgetproposestoreducethetransfercapamountto4.25percentbeginninginFY2000,ratherthanFY2001.Thisproposalwillsave$600millioninFY2000.mGxx݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m^{ D   m^{{݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j|  ContingencyFundforStateWelfare `K Programs/XBXXXXXBPo/+XBXXXXXB++j|| ӌ PL ЌXBXXBXBXXB  /XBXXXXgJXXB}/+XBXXXXgJXXB+m XBXXXBXBXXXB  m~ D   Welfarereformestablisheda N ContingencyFundtoassistStatesthat,duetoeconomichardship,needadditionalfundsabovetheirTANFgranttoprovideassistancetoneedyfamilies.StatesareeligibleforthesematchingfundsduringperiodsofhighunemploymentorrisingFoodStampcaseloads.ThetotalamountofContingencyFundspreappropriatedforFYs1997through2001is$1.96billion.m~݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mr D   mr݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB     +j概  ContingencyFundLegislative `'%Y Proposal+j概 ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m D   TheFY2000PresidentsBudget )`'\ proposestoreplacethecurrentcappedContingencyFundwithanewuncappedfundthatcouldmoreeffectivelyrespondtoStateneedsintheeventofanunforeseen x- +` economicdownturn.Thisproposalwouldsave$1.6billioninBudgetAuthorityinFY2000,andwouldhavenoeffectsonoutlays.mn݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j揆  ChildrensResearch/XBXXXXXBs~/+XBXXXXXB+ԀandTechnical  Assistance(CRTA)+j揆 ӌ̌XBXXBXBXXB  /XBXXXXgJXXB\/+XBXXXXgJXXB+m XBXXXBXBXXXB  m    Welfarereformauthorizesand p appropriatesfundsforwelfareresearchandtechnicalassistanceforStates.TheFY2000totalis$62million.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mi    Ofthis,$41millionincludestwochild 0  supportsetasides:onefortrainingandtechnicalassistanceandtheothertoassistinoperatingtheFederalParentLocatorService(FPLS).ThefundsappropriatedfortheseactivitiesareequaltooneandtwopercentrespectivelyoftheamountpaidtotheFederalgovernmentforitsshareofchildsupportcollectionsduringtheprecedingfiscalyear.mi݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m<    Alsoincludedis$21millionin 8 pre-appropriatedmandatoryfundsforthefollowingactivities:$15millionforwelfareresearch,and$6millionforalongitudinalchildwelfarestudy.Thesefundswillalsofocusonwelfareresearchactivitiessuchasstudyingtheeffectsofwelfarereformandidentifyingwaystoimprovethewelfaresystem.m<݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j܏  ChildSupportEnforcement+j܏F ӌ h  ЌXBXXBXBXXB  m XBXXXBXBXXXB  <XDXXDpX<m    TheChildSupportEnforcement(CSE)  x" programisajointFederal,Stateand_local_partnershipthatseekstoensurefinancialandemotionalsupportforchildrenfrombothparentsbylocatingnoncustodialparents,establishingpaternity,andestablishingandenforcingchildsupportorders.Theprogramprovidescriticalsupportforworkingfamiliesandassistsinthetransitiontoselfsufficiency.InFY2000,anestimatedtotalof$4.4billioninFederalandStatedollarswillbespentinordertocollectover$17.6billioninpayments.Thisrepresentsa9percentgainincollectionsoverFY1999andatotalreturnofmorethan$4forevery -+0 $1investedintheadministrationoftheprogram.SincetheinceptionoftheprograminFY1975,over$100billionhasbeencollected.mɑ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mٕ D   TheFederalgovernmentsharesinthe 4 financingofthisprogrambyprovidingincentivepayments,a66percentmatchrateforgeneralStateadministrativecosts,andanenhancedmatchrateforpaternitytestingandspecifiedautomatedsystemsrequirements.TheCSEprogramalsoincludesacappedentitlementof$10millionannuallyforgrantstoStatestofacilitatenoncustodialparents'accessandvisitationoftheirchildren.mٕX݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m͘ D   TheCSEprogramstrengthensfamilies h? byhelpingchildrengetthesupporttheyareowedfromnoncustodialparents.Innon-TANFcases,childsupportcollectionsareforwardedtothecustodialfamily.Bysecuringsupportonaconsistentandcontinuingbasis,non-welfarefamiliesmayavoidtheneedforpublicassistance,thuspotentiallyreducingfuturewelfarespending.ApplicantsforTANFassigntheirrightstosupportpaymentstotheStateasaconditionofreceiptofassistance.TANFchildsupportcollectionsaresharedbetweentheStateandFederalgovernment.m͘L݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mS D   Asnotedabove,aportionoftheFederal 0M shareofchildsupportcollectionsispaidtotheStatesasincentivepayments.Previously,FederalincentivepaymentstoStateswerebasedontheStatescosteffectivenessinoperatingtheprogramandtheamountofpaymentscollected.Followingpassageofthe#XBXXXBg#XBXXXBChildSupportPerformanceand $!T IncentiveActof1998#XBXXXBf#,anewincentives %"U structurewillbeputintoplaceXBXXXBԀusingfive %#V keymeasures:paternityestablishment,supportorderestablishment,collectionsoncurrentsupport,collectionsonpastduesupport,andcosteffectiveness#XBXXXB6#.Thisnew )`'Z systemwillbephasedinstartinginFY2000.mSҜ݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m݌ ,0*] Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j^  ChildSupportLegislativeProposals+j^Ң ӌ X ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    Thebudgetproposesthreelegislative h changesinthechildsupportprogram:(1)reducingthematchrateforpaternityestablishmentlaboratorytests;(2)repealingtheholdharmlessprovision;and,(3)beginninginFY2001,aproposaltoreturntotheprewelfarereformpolicyofmandatoryreviewandadjustmentofchildsupportTANFassistancecases.ThefirsttwoproposalswereincludedintheFY1999PresidentsBudget.m#݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m0݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   AdjustingtheMatchRate:.Ȋ ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m)    Currently,thereisa90percentFederal h matchforlaboratoryteststoestablishpaternity.However,thefinancingstructureforchildsupportisverycomplexwithvariouslevelsofmatchratesandthecostofpaternityestablishmenttestinghasbeendecreasing.Therefore,theAdministrationproposesthatstartinginFY2000,laboratorytestsforpaternityestablishmentbematchedattheregular66percentadministrativematchrate.Thischangesimplifiesthechildsupportfundingstructure,increasesincentivestocontrolcosts,andsavesapproximately$9millioninFY2000and$45millionover5years.m)݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m׬    m׬V݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ 0  XBXXXBXBXXXB   HoldHarmless:.Ȋ & ӌh  ЌXBXXBXBXXB   m XBXXXBXBXXXB  mD    ݀TheAdministrationproposes,starting  x" inFY2000,torepealthe holdharmlessprovisionthatwasputintoplaceinwelfarereform.HoldharmlessensuredthatifStatesdidnotreachtheir1995levelofcollections,theywouldreceiverecoupmentpaymentsfromtheFederalgovernment.ThisprovisionwasputintoplacelargelytoprotectStatesfromanylossresultingfromnewdistributionrules.However,thisprovisionisnotworkingasintended.SinceTANFcollectionsaredecliningforavarietyofreasons,manyStatesarereceivingthesepaymentsbeforedistributionchangeshavetakenplace.Further,thereisnowayto -+0 separateouttheeffectofdistributionchangeswhentheydooccur.Therefore,weproposethatholdharmlessberepealed,savingapproximately$65millioninFY2000and$279millionover5years.mDï݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0 D XBXXXBXBXXXB   ReviewandAdjustment:.Ȋ ӌ5D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m& D   ݀Underwelfarereform,periodicreviews p7 ofchildsupportordersarenolongerrequired.Thisproposalreturnstopre-welfarereformpolicyandrequiresStatestoconductreviewsinTANFassistancecasesatleastevery3yearsandtoadjustappropriately.Thischangewilllikelyhelpfamiliesand/orreducerelianceonFoodStamps,medical,emergencyorotherpublicbenefits.ThisproposalwillstartinFY2001,withsavingsinMedicaidandChildSupporttotalingapproximately$85millionbyFY2004.ChildSupportsavingstotalover$25millionduringthistimeperiod.m&݌̌ XBXXXBXBXXXB  +XBXXXXgJXXB+/XBXXXXXXB/+XBXXXXXXB++jXBXXXB  XBXXXB   +j4  FosterCare,AdoptionAssistanceand H IndependentLivingProgram+j4 ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m D   TheFY2000budgetrequests @K $5.6billioninBudgetAuthorityfortheFosterCare,AdoptionAssistanceandIndependentLivingprograms.Thisrequestrepresentsanincreaseof$706millionovertheFY1999appropriation.About$600millionofthisincreaseisdueto:(1)projectionsthataverageFosterCarepaymentsandcaseloadswillcontinuetogrowinFY2000atarateconsistentwiththepastfiveyears,and(2)prioryearclaimsthatexceededFY1999fundinglevels.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Ofthetotalrequest,$4.5billionwill %(#W provideFosterCarepaymentsonbehalfofabout338,700childreneachmonth.ThisrequestwillalsofundStateadministration,includingchildwelfareinformationsystems,training,andStatedatasystems.m.݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   FortheAdoptionAssistanceprogram,  +(] about$1billionwillprovidepaymentsforfamilieswhoadoptspecialneedschildren.Monthlypaymentsaremadeonbehalfof -+` adoptedchildrenuntiltheir18thbirthday. X Theproposedleveloffundingwillsupportapproximately217,100childreneachmonth.ml݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    m݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j  FosterCareRelatedLegislative  Proposals+j' ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  ?,` XDXXDX?m    Fostercareyouthsbecomeineligiblefor p maintenancepaymentsatage18.Eachyear,approximately16,000youthsageoutoffostercareand9,000youthsleavethefostercaresystembyrunningaway.Theseyouthsoftenlacktheresourcesorsupportsneededtomaintainaselfsufficientlifestyle.ConsistentwiththeDepartmentseffortstomovefamiliesfromwelfaretowork,theFY2000PresidentsBudgetincludesapackageoflegislativeproposalsaimedatassistingtheseformerfosteryouthsinmakingthetransitiontolivingontheirown.Insum,thispackagewouldcost$50millioninFY2000,and$275millionoverthenextfiveyears.Theproposalsinclude:m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m,    m,݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ`0  XBXXXBXBXXXB   IncreaseIndependentLiving ` Program(ILP)Funding:.Ȋ`{ ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    ݀IncreasingtheILPfundinglevelfrom ` $70millionto$105millionwouldallowStatestoprovidebasicskills,employmentandeducationtrainingtoanadditional17,500fosteryouthsaged16through18,andatStateoption,toage21.Thisproposalwillcost$35millioninFY2000,and$175millionoverthenextfiveyears.mG݌̌ XBXXXBXBXXXB  .Ȋ    .ȊW0  XBXXXBXBXXXB   SupporttheLivingExpensesof #H!% YouthsinTransitionalLivingPrograms:.ȊW} ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    ThroughILP,thisproposalwouldgrant &$) $5millionforStatestosupportthelivingexpensesofapproximately1,750youthsparticipatingintransitionallivingprograms.Fundingfortheseactivitieswouldslightlyincreaseby$5millioneachyear,foratotalcostof$50millionoverfouryears.m]݌̌ XBXXXBXBXXXB   x- +0 .Ȋ  .Ȋd0 D XBXXXBXBXXXB   IncreaseRunawayandHomeless   X0 YouthTransitionalLivingProgramFunding:.Ȋd ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   Increasingthefundingforthis H4 discretionarygrantprogramby$5millionwouldallowStatestoprovideservicestoanadditional600runawayorhomelessyouthwhomaynolongerbeeligibleforfostercare.(SeeACFDiscretionarysectionformoredetailsregardingthisprogram.)mn݌̌ XBXXXBXBXXXB  .Ȋ  .ȊP0 D XBXXXBXBXXXB   MedicaidCoveragefor  @ = EmancipatedYouthsupto21:.ȊPk ӌ D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   ݀ThisproposalwouldallowStatesto  @ expandMedicaideligibilitytoyouthsuptoage21whowereeligibleforfostercareatage18.Thisproposalwillcost$5millioninFY2000,and$45millionoverthenextfiveyears.(SeeHCFAMedicaidsectionformoredetailsregardingthisprogram.)m8݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j&  & 8 PromotingSafeandStableFamilies+j& ӌ I ЌXBXXBXBXXB  m XBXXXBXBXXXB  mm D   TheAdoptionandSafeFamiliesActof PK 1997reauthorizesandexpandsthe'8PromotingSafeandStableFamiliesprogram(formerlyknownastheFamilyPreservationandSupportprogram).Therequestincludes$295millioninFY2000forStatesandeligibleIndiantribes.mm݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   ThePromotingSafeandStableFamilies R programsupportsStatechildwelfareagenciesandtribesinproviding:familypreservationservices,familysupportservices,timelimitedfamilyreunificationservices,andadoptionpromotionandsupportservices.mQ݌̌ XBXXXBXBXXXB   D +jXBXXXB  XBXXXB   +j&  SocialServicesBlockGrant+j& ӌ '%[ ЌXBXXBXBXXB  m XBXXXBXBXXXB  mZ D   TheSocialServicesBlockGrant @)&] (SSBG)allowsStatestheflexibilitytoprovideorsupplementsocialservicesattheStateand_local_Ԁlevels.SSBGfundingprovidesdirectsocialservicesandresourcesthatlinkhumanservicedeliverysystems -+b together.ProgramsorservicesmostfrequentlysupportedbySSBGincludechildcare,childwelfare(fostercare,adoptionandprotectiveservices),eldercare,drugabusepreventionandtreatmentactivities,homebasedservices,employmentservices,preventionandinterventionprograms,andservicesforthedisabled.mZ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheFY2000PresidentsBudget   requestsfundingatthefullauthorizationlevelof$2.38billionforthisprogram.Thisisanincreaseof$471millionaboveFY1999levels.TheDepartmenthastakenstepsinthepastyeartoimprovethequalityofprograminformation,andwillcontinuetoworkwithStatestoimprovereportingandaccountabilityforservicesprovidedwiththesefunds.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    mV݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j   AFDCandRelatedPrograms+j u ӌ ( ЌXBXXBXBXXB  m XBXXXBXBXXXB  m=    WelfarereformreplacedtheAidto 8 FamilieswithDependentChildren(AFDC)Benefits,Stateand_local_ԀAdministration,EmergencyAssistance,AFDCChildCare,andJobOpportunitiesandBasicSkillsTraining(JOBS)programswithTANFandtheChildCareEntitlementprograms.m=݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    DuringFY2000,weexpectto   completelyphaseoutfundingfortherepealedprograms.EstimatesforFY1999  and2000representclaimsforexpendituresincurredbeforetheseprogramswererepealed.Theseclaimswillbefundedbycarryoverbalancesfromprioryears.m2݌ !h" Ќ XBXXXBXBXXXB   X" (X@(   #H!" #  X2XXXBe/ eXX2  #ᄋ@i i     %  FY2000PROPOSEDACFLEGISLATION#ᄋ   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @jj(dollarsinmillions/1)vVB(2.b~1 ,?  `).@Ex/"x/"e<"(v (#(#                                       (#(#AZ') HxdE)HxA  )'* `'  X2XXXBe/ eXX2  `'@    %  CHILDSUPPORTENFORCEMENTOVERVIEW:`' !  X Ќ̌e e ee/XBX ee  #  X2XXXBe/ eXX2  #@P P     %   CollectionsandCosts#]    AZ') HxdEHxAe e ee/XBX eeԌ  Ќ  @jj(dollarsinmillions)/1 (#(#                            (#(#vVB 2.b~1E ` /$@EHar)v߰([" 3# AZ') HxdEZ"HxA [" #   #:!% #  X2XXXBe/ eXX2  #@    %  ACFOVERVIEW:ENTITLEMENTSPENDING#j   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @jj(dollarsinmillions)/1vVB2.b~1 ,, `/3%@Ex&x&e<*v (#(#                            (#(#AZ') HxdHE HxA  3  *eddd Xdd Xdd X(#(#,'$,,,,,$,,,,,+  G|2  z! dddG#XBXXXBo#$`XXB#$`$` #$`$` [F1 z"|ddd dd[ U@+ z#dd ddU U@+ z$3dd ddU U@+ z%3dd ddU [|F+ z&3dd ddd[ F<1 z'3|ddd F ' z(3 ' ' z)3 ' ' z*3 ' ' z+3 ' Z|E z,3  dddZ#XBX$`#$`XXB#$`$`F#$`$` [F1!D-|ddd dd[ U@+!D.dd ddU U@+!D/3dd ddU U@+!D03dd ddU [|F+!D13dd ddd[ F<1!D23|ddd F '!D33 ' '!D43 ' '!D53 ' '!D63 ' ^|I!D73  ddd^ d|O4f" 8|ddd dddd F<1f" 93|ddd F 'f" :3 ' 'f" ;3 ' 'f" <3 ' 'f" =3 ' ^|If" >3  ddd^ ^I42# ?|ddd dd^ U@+2# @3dd ddU [|F+2# A3dd ddd[ F<12# B3|ddd F '2# C3 ' '2# D3 ' '2# E3 ' '2# F3 ' XC2# G3  ddX XC.#!Hdd ddX @6+#!I3dd @ '#!J3 ' '#!K3 ' '#!L3 ' XC#!M3  ddX XC.$r"Ndd ddX @6+$r"O3dd @ '$r"P3 ' '$r"Q3 ' '$r"R3 ' Z|E$r"S3  dddZ [F1%>#T|ddd dd[ U@+%>#Udd ddU U@+%>#V3dd ddU U@+%>#W3dd ddU [|F+%>#X3dd ddd[ F<1%>#Y3|ddd F '%>#Z3 ' '%>#[3 ' '%>#\3 ' '%>#]3 ' ^|I%>#^3  ddd^ ^I4b& $_|ddd dd^ [|F+b& $`3dd ddd[ F<1b& $a3|ddd F 'b& $b3 ' 'b& $c3 ' 'b& $d3 ' 'b& $e3 ' ^|Ib& $f3  ddd^ ^I4.'$g|ddd dd^ U@+.'$h3dd ddU [|F+.'$i3dd ddd[ F<1.'$j3|ddd F '.'$k3 ' '.'$l3 ' '.'$m3 ' '.'$n3 ' ^|I.'$o3  ddd^ ^I4'%p|ddd dd^ [|F+'%q3dd ddd[ F<1'%r3|ddd F ''%s3 ' ''%t3 ' ''%u3 ' ''%v3 '#XBX$`y ##XBXXXB #XBXXXB-#!'%w3  -#XBXXXB#  )'x #  X2XXXBe/ eXX2  #)@      %  ADMINISTRATIONONAGING#)   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB+2.b~1 , `.U @Exxe<+v (#(#           (#(#AZ') HxdEHxA S  +jXBXXXB  XBXXXB   (X@(#(#(+j!  Summary+j!! ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m`"    TheFY2000budgetforthe J AdministrationonAging(AoA)is$1.0billion,anincreaseof$167million,or19percent,overFY1999.ThisincreasewillallowtheAgencytobetterrespondtotheincreasinglongevityofourolderpopulation.Thereare45millionAmericans60yearsofageandover.TheCensusBureauprojectsthatby2030thesenumberswillalmostdoubleto88million.m`""݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m*%    Additionalfundsrequestedwillbeused R primarilyforthenewNationalFamily_Caregiver_ԀSupportProgram"avitalpieceoftheAdministrationsLongTermCareinitiativethatwillprovideessentialassistancetofamiliescaringforolderrelatives.Theincreasewillalsobeusedtoservemorehome-deliveredmealsandtoreducethehighlevelsofdisabilityandratesofdiseaseamongminorityelders.m*%%݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m+(    ݀AoAservesolderpersonsandtheir  %"& familiesthroughtheadministrationoftheOlderAmericansActaswellasthroughagingrelatedappliedresearchandeducationprojects.AoAsgoalistoimprovethequalityoflifeforolderAmericans,primarilybyhelpingthemtoremainindependentandproductive.m+((݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m*    m*/+݌ ,2*. Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j+  NationalFamily_Caregiver_ԀSupport . Program+j+l, ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  md- D   AoAisproposinganew$125million :1 NationalFamily_Caregiver_ԀSupportProgramthatwillofferarangeofcriticalservicesforcaregiversincludingrespitecare,information,assistanceinlocatingservices,andhomecareservices.Some3to4millionolderindividualsrelyoncarefromfamilyandclosefriends,enablingthemtoremainathomeinsteadofenteringanursinghomeorotherinstitutionalsetting.Theroleofthe_caregiver_Ԁisdifficult.Halfarethemselvesovertheageof65,themajorityarewomen,andonethirdhavefulltimejobs.Researchshowsthattheirratesofdepressionaresignificantlyhigherthannoncaregiversofthesameage.md--݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m1 D   TheNationalFamily_Caregiver_ԀSupport :"A ProgramreflectstheAdministrationsconvictionthatthenationsmillionsofcaregiversneedhelpandthatsuchhelpwillpaygreatdividends.Recentstudieshavefoundthatrespitecareandotherservicesnotonlyrelieve_caregiver_Ԁstress,butalsodelaynursinghomeentry.SupportforfamiliesofpersonswithAlzheimersdiseasehasdemonstratedthatinstitutionalizationcanbedelayedforaslongasayear.m12݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m4 D   AoAsNationalFamily_Caregiver_ ,2*L SupportProgramisakeycomponentofthe z-"+M AdministrationsLongTermCareproposaltosupportAmericanswithlongtermcareneedsandthemillionsoffamilymemberswhocareforthem.(Otherpartsofthenewinitiativeincludea$1,000taxcreditfordisabledindividualsandcaregivers;anationalcampaigntoeducateMedicarebeneficiariesaboutthatprogramslimitedlongtermcarecoverageandhowbesttoevaluatelongtermcareoptions;andhavingaproposalfortheFederalgovernmenttoofferinsurancetoitsemployeesatgrouprates.Asthenationslargestemployer,themarketleverageoftheFederalgovernmentwillinfluencetheprivatesectortodevelopbetterlongtermcareinsurance).m4]5݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mH9    Aswithmostofitsexistingprograms, X AoAwilldistributefundsviastateformulagrants.Thiswillallowstatestocreate_caregiver_Ԁsupportinfrastructurenetworksthatprovidequalityrespitecare;criticalinformationaboutcommunitylongtermcareservicesthatbestmeetafamiliesneeds;andcounselingandotherassistance.mH99݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m<    m<<݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j4=  NutritionServices+j4== ӌ p ЌXBXXBXBXXB  m XBXXXBXBXXXB  m_>    TheFY2000budgetincludes 0 $522millionforallmeals.Ofthisamount,$147millionisforHomeDeliveredMeals,anincreaseof$35millionoverFY1999.AoAwillsupportthedeliveryofsome146millionmealsinFY2000(a23percentincreaseoverFY1999)andincreasethenumberofhighriskolderadultsserved.LiketheNationalFamily_Caregiver_ԀSupportProgram,theincreaseforhome-deliveredmealswillassistmoreolderpersonstoremainintheirhomesandcommunities.Anationalevaluationindicatedthatformany,theavailabilityofahome-deliveredmealiscrucialtotheirabilitytofunctionathome.Accordingtothissameevaluation,mealpreparationisdifficultorimpossiblefor41percentofprogramrecipientsand77percenthavedifficultywithoneormore dailyactivity.m_>>݌ -*. Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mC D   SupportforCongregateMealsremainsat X.  theFY1999levelof$375million,maintainingcurrentservicelevels;i.e.119millionmealsservedto2.1millionat-riskolderadults.Adequatenutritionisessentialforhealthyagingandthepreventionordelayofchronicdiseaseanddisease-relateddisabilities.Congregatenutritionservicespresentopportunitiesforactivesocialengagementthereductionofisolation,andforencouragingimprovedphysicalandmentalfunctioning.Thebudgetalsoincludes$18millionforgrantstoIndiantribesandNativeHawaiianorganizations,thesameasinFY1999.mCC݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mF D   mF7G݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jG  HealthDisparityInterventions+jGVH ӌ X> ЌXBXXBXBXXB  m XBXXXBXBXXXB  m#I D   TheFY2000budgetrequestsanew$4 h@ millionprogramtoassistinreducinghigherincidenceratesofdisabilityanddiseaseamongminorityelders.AoAwillprovideinterventiongrantstoStateAgenciesonAgingtopartnerwithStatehealthdepartments,_local_ԀhealthassociationsandAreaAgenciesonAgingtotargetthreeareasofconcern:cardiovasculardisease,diabetes,andadultimmunizations.ThesefocusedeffortswillcomplementabroaderemphasisthroughouttheDepartmenttoaddressracialhealthdisparities.Granteeswillimplementpublichealtheducationprogramsanddesignculturallyappropriateinterventionsandoutreacheffortsforminoritycommunities.AoAisuniquelypositionedtoaddresstheseconcernsbecauseitsnetworkofserviceprovidersisindailycontactwithmillionsofolderpersons,20percentofthepeopleservedbycommunityservicesareminorityasare27percentofthoseservedbythemealsprograms.m#II݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mk#XBXXXBԀmjk݌ z" Ќ XBXXXBXBXXXB  /XBXXXXgJXXBkm/+XBXXXXgJXXB+m XBXXXBXBXXXB  mn    /XBXXXXgJXXBYn/+XBXXXXgJXXB+mno݌̌ XBXXXBXBXXXB  /XBXXXXXXB\o/+XBXXXXXXB++jXBXXXB  XBXXXB   +jlp  GeneralDepartmentalManagement+jlpp ӌ Z ! ЌXBXXBXBXXB  m XBXXXBXBXXXB  mq    TheGDMaccountsupportsthose !j# activitiesassociatedwiththeSecretary'srolesaschiefpolicyofficerandgeneralmanageroftheDepartment,throughnineStaffDivisions(STAFFDIVs):theImmediateOfficeoftheSecretary,theDepartmentalAppealsBoard(DAB),andtheOfficesofPublicAffairs,Legislation,PlanningandEvaluation,ManagementandBudget,IntergovernmentalAffairs,GeneralCounsel(OGC),andPublicHealthandScience(OPHS).TheGDMbudgetrequestforFY2000totals$192million,anetincreaseof$7million.mq#r݌ -+0 Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mu D   Thelargestpartofthisincreaseisatotal j0 of$9.5millionforOGCandDAB,aspartofthePresident'sNursingHomeInitiativetoimprovethequalityofnursinghomecareinthiscountry.WorkingwiththeHealthCareFinancingAdministration(HCFA),OGChassignificantlyincreasedthenumberofsanctionsagainstnursinghomesthatviolatepatienthealthandsafetyrules.Asaresultofappealsbythehomesagainstthesesanctions,bothDAB'sjudicialhearingscaseloadandOGC'sadministrativeandcourtlitigationworkloadshaveexpandeddramatically.TherequestedfundingincreasewillensureadequateOGCandDABstafftohandletheseworkloadsinatimelyandefficientmanner,andtodecreasecurrentcaseloadbacklogs.muu݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m;y D   TheOfficeofPublicHealthandScience #J!B (OPHS),thelargestoftheGDMSTAFFDIVs,isheadedbytheAssistantSecretaryforHealth/SurgeonGeneral,whoservesassenioradvisortotheSecretaryonpublichealthandscienceissuesandexercisesmanagementresponsibilityfortenOPHSoperationalprograms,includingthefollowing:m;yy݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m{ D   m{T|݌ ,)K Ќ XBXXXBXBXXXB  .Ȋ  .Ȋ}0  XBXXXBXBXXXB   OfficeofMin   orityHealth.Ȋ}9} ӌX ЌXBXXBXBXXB   m XBXXXBXBXXXB  mw~    Therequestincludes$28millionto h improvediseaseprevention,healthpromotion,andhealthservicedeliveryfordisadvantagedandminorityindividuals.ThisfundingalsosupportsresearchtoimprovethehealthstatusofracialandethnicminoritypopulationsintheUnitedStates,whichcontinuestolagbehindthehealthstatusoftheAmericanpopulationasawhole.mw~~݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m0    m0݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋd0  XBXXXBXBXXXB   OfficeonWomen'sHealth.Ȋd ӌ  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    Therequestof$18millionprovides x  fundingtoadvancewomen'shealthprogramsthroughthepromotionandcoordinationofresearch,servicedelivery,andeducationthroughoutHHSagenciesandoffices,withothergovernmentorganizations,andwithconsumerandhealthprofessionalgroups.Thisrequestincludesa$2million(13percent)increaseovertheFY1999enactedlevel.Theincreasedfundswillprovide:additionalfundingfortheexisting18NationalCentersofExcellenceinWomensHealth;supportforthenewCommunityCentersofExcellenceinWomensHealth;andsupporttocoordinateHHSactivitiesondomesticviolence.m'݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mv    mv݌̌ XBXXXBXBXXXB  .Ȋ  .Ȋ0  XBXXXBXBXXXB   OfficeofEmergencyPreparedness.Ȋň ӌh  ЌXBXXBXBXXB   m XBXXXBXBXXXB  m    ݀Thebudgetrequestof$10millionwill  x" beusedtomanageandcoordinatethehealth,medicalandhealthrelatedsocialservicesthatareprovidedbytheFederalGovernmenttovictimsofcatastrophicdisastersthroughtheFederalResponsePlansEmergencySupportFunction(ESF)#8.UnderESF#8,HHScoordinatesthesupportoftwelveFederalagenciesinthepreparednessfor,responseto,andrecoveryfromnaturalandman-madedisasters.mt݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    ݀AlsoinFY2000,OEPwillcontinueto  +(- carryouttasksfromtheNationalSecurityCounciltoassessandremedyanyshortfallsinthehealthandmedicalconsequence -+0 responsecapabilitiesthatwillbenecessaryintheeventofaterroristuseofaweaponofmassdestruction,whetherchemical,biologicalornuclear.FundingforthesebioterrorismactivitiesareincludedinthePublicHealthandSocialServicesEmergencyFund.mv݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   m~݌̌ XBXXXBXBXXXB  x  .Ȋ  .ȊH0 D XBXXXBXBXXXB   OfficeofPopulationAffairs.ȊHc ӌx 8D(#D(# ЌXBXXBXBXXB   m XBXXXBXBXXXB  m D   Therequestof$9millionprovides  : supportfortheAdolescentFamilyLife(AFL)DemonstrationandResearchprogramauthorizedunderTitleXXofthePublicHealthServiceAct.Throughthesegrants,AFLprovidesfundingforthreeareas:caredemonstrationprojects,preventionprojects,andresearchprojects.Inaddition,OPAadministerstheFamilyPlanningprogramunderTitleXofthePublicHealthServiceAct(thisprogramisfundedthoughtheHealthResourcesandServicesAdministration).m ݌̌ XBXXXBXBXXXB  x +jXBXXXB  XBXXXB   +jܕ  PolicyResearch+jܕF ӌ I ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   TheFY2000budgetrequestforDM (K alsoincludes$14millionforthePolicyResearchaccount,tosupportresearchonissuesofnationalsignificance.PolicyResearchexaminesbroadissuesthatcutacrossagencyandsubjectlines,aswellasnewpolicyapproachesdevelopedoutsidethecontextofexistingprograms.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D     Priorityissuesthatwillbeexaminedare !S thoserelatedtowelfarereform,healthcareinsurancereform,familysupportandindependence,poverty,at-riskchildrenandyouth,aginganddisability,sciencepolicy,andimprovedaccesstohealthcareandsupportservices.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   Aspartofamultiagencyinitiative,the '8%Z Departmentwillexploremeansbywhichdiscriminationinthehealthsectorcanbemanagedandreported.HHSwillseektoimplementaresearchplanfordistinguishingbetweendiscriminatorybehaviorandpracticesandotherdifferencesthatmayaffecthealthcareoutcomes.mg݌  .+a Ќ XBXXXBXBXXXB  (X@( #  X2XXXBe/ eXX2  #ᄻ@44    %  DEPARTMENTALMANAGEMENTOVERVIEW#ᄻ" G  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB.2.b~1 ,!r `.@Exxe<J.v (#(#                        (#(#AZ') Hxd3EHxA    " #  X2XXXBe/ eXX2  #3@    %  HEALTHCAREACCESSFORTHEUNINSURED#3   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)vVB/2.b~1 ! `.U @Exx/v (#(#          (#(#AZ') Hxd%EHxA c  +jXBXXXB  XBXXXB   (X@(#(#(+j  Summary+j ӌ   ЌXBXXBXBXXB  m XBXXXBXBXXXB  m[    Itisestimatedthat43millionpeoplein Z theU.S.lackhealthinsurance.Ofthese,24.6millionareworkingpeople(5.9millionworkparttimeand18.7millionworkfulltime).Theseuninsuredoftenremainoutsideorganizedsystemsofcare.Theyoftenhavecomplexmedicalneedsandinsufficientresourcestoobtaincare.Theymaydefercareornotreceiveneededservicesandareabouthalfaslikelytoreceivearoutinecheckupasinsuredadults.#XBXXXBAp#NXBXXXBԀTheyrely b heavilyonexpensiveemergencyrooms,andbecausetheylackaroutinesourceofcare,oftenmaynotreceiveneededfollowupservices.m[ک݌̌ XBXXNXBXBXXXB  m XBXXXBXBXXXB  mQ    Manyoftheuninsured,especiallythose j  withlowincomes,relyon safetynetproviders"thosehospitals,clinicsandother J!" providerswhoofferasignificantvolumeofhealthcareserviceseitherforfreeorwithreducedfees.Theseprovidershadtoadjusttotherapidgrowthofmanagedcareinbothprivateandpublicinsuranceprograms,butoftenlacktheresourcesrequiredtomakethechangesneededtobecomeefficient,effectiveprovidersofcareinthechanginghealthcareenvironment.mQЭ݌̌ XBXXXBXBXXXB  /XBXXXXgJXXB/+XBXXXXgJXXB+/XXXXXgJXX/+XBXXXXgJXXB+m XBXXXBXBXXXB  mj    Therefore,anewprogramisincludedin *R(, theFY2000budgetat$25million.Thiscompetitivegrantprogramisthecornerstoneofamultiyearinitiativedesignedto z-"+/ increasethecapacityandeffectivenessofthenationshealthcaresafetynet.Fundsinthisinitiativetotal$1billionoverfiveyears.Thegoalistoassurethatmoreuninsuredpeoplereceiveneededcare,thatthecarereceivedisofhigherquality,andthattheuninsuredareservedbyproviderswhoparticipateinintegratedhealthsystems.mj݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mʴ D   Fundswillbeavailableto:(1)assist r7 eligibleproviderstodevelopandexpandintegratedsystemsofcare;and(2)addressservicegapswithinsuchintegratedsystems,withafocusonprimarycare,mentalhealthservicesandsubstanceabuseservices.Theresultwillbethatmoreuninsuredindividualswillhaveaccesstoacontinuumofcoreservices.mʴI݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mw D   DuringFY2000,theprogramsfirst @ year,fundswillbeusedfor1020grantsforinfrastructuredevelopment,primarilyinlocationswhichhavealreadybegunorganizedcommunitybasedeffortstocoordinateservicesprovidedtotheuninsured.Asmallpercentageoffundingmaybedevotedtoservicedeliveryattheseorothersiteswherecoordinatedsystemsarebeingdeveloped.Inthefollowingyears,whenmorefundsareavailable,thepercentageoffundsdevotedtofillingservicegapswithincoordinatedsystemswillincrease,andadditionalnewsiteswillbeselected.mw݌ -*N Ќ XBXXXBXBXXXB  (X@( #  X2XXXBe/ eXX2  #R@     %  OFFICEFORCIVILRIGHTS#R ޻  X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions) (#(#          @  @  @  @  @  @  @  @  @ pV<,(`~1  `.U Exx{0p (#(#AZ') GxdtEGxA S  +jXBXXXB  XBXXXB   (X@(#(#(+j挿  Summary+j挿 ӌ  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    TheFY2000budgetrequestforthe I OfficeofCivilRights(OCR)is$22million,anincreaseof$2millionovertheFY1998levelandanincreaseof$1millionovertheFY1999level.OCRisresponsibleforenforcingcivilrightsstatutesthatprohibitdiscriminationinFederallyassistedhealthcareandsocialservicesprograms.Thesestatutescovernondiscriminationonthebasisofrace,nationalorigin,disability,age,andinlimitedinstances,sexandreligion.OCRcoordinatesimplementationoftheSection504regulationthatprohibitsdiscriminationagainstpersonswithdisabilitiesinprogramsandactivitiesconductedbyHHS.OCRalsocoordinatesgovernmentwideenforcementoftheAgeDiscriminationAct.OCRimplementsthecivilrightsrequirementsundertheinterethnicadoptionprovisionsoftheSmallBusinessJobProtectionActof1996(SBJPA)intendedtopreventracialandnationalorigindiscriminationinfostercareandadoptionplacements.mS݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    OCRenforcesnondiscrimination '%) requirementsbyprocessingandresolvingdiscriminationcomplaints,conductingreviewsandinvestigations,monitoringcorrectiveactionplans,andcarryingoutvoluntarycompliance,outreachandtechnicalassistanceactivities.Eachof y-!+/ OCRscomplianceactivitiesensuresthatindividualsaretreatedinanondiscriminatorymannerbyhealthandhumanservicesprovideragenciesorfacilities.OCRsworkprotectsindividualrightsandsimultaneouslysupportsHHSgoalsforimprovingthehealthandwellbeingofindividuals,familiesandcommunities.mf݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m D   OCRcontinuestoaddressissuessuchas Q8 racediscriminationinaccesstohealthandhumanservicesanddiscriminationagainstpersonswithdisabilities.In1998,OCRcompleted4,899discriminationcomplaintandreviewcases,withnearly43percentofinvestigationsandpostgrantreviewsresultinginchangesinpoliciesandpractices.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m* D   Thisbudgetrequestsupportsan !iA enhancedcomplianceprogramfocusedonimplementingtheadoptionandfostercarenondiscriminationprovisionsoftheSmallBusinessJobProtectionActof1996,ensuringnondiscriminationintheTemporaryAssistancetoNeedyFamilies(TANF)program,andsupportingqualityhealthcarebyensuringaccessforracialandnationaloriginminoritiesandpersonswithdisabilitiestomanagedcareplanservices,childrenshealthprograms,HIV/_AIDs_servicesandhomehealthcareservices.m*݌ -*M Ќ XBXXXBXBXXXB  (X@( `'  X2XXXBe/ eXX2  `'@      %  PUBLICHEALTHANDSOCIALSERVICES`'O t  X Ќ̌e e ee/XBX ee  #  X2XXXBe/ eXX2  #G@#    %   EMERGENCYFUND#G    AZ') HxdEHxAe e ee/XBX eeԌ  Ќ  @ (dollarsinmillions) (#(#             (#(#vVB 2.b~1 ,  `.)@E?x x e 1v߰AZ') HxdE"HxA # +jXBXXXB  XBXXXB   (X@(#(#(+j|  Summary+j| ӌ Z ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    TheFY2000PresidentsBudgetrequest j providesabudgetauthorityof$386millionforthePublicHealthandSocialServicesEmergencyFund(_PHSSEF_).InFY1999,Congressappropriatedatotalof$373million(comparable)tothe_PHSSEF_,composedofearmarksfor:antibioterrorism($134million);AIDSpreventionandtreatmentinminoritycommunities($50million);andYear2000conversionofcomputersystems($189million).AlsoinFY1999,CongressdesignatedthesefundsasanemergencyrequirementasdefinedintheBalanceBudgetandEmergencyDeficitControlActof1985,asamended.mC݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m    TheFY2000PresidentsBudgetisthe %z#' firsttoincludearequestforthe_PHSSEF_Ԁappropriation.Thisrequestassumesthatthefundsarenotrequiredforemergency (J&* purposes,asdefinedintheBalancedBudgetandEmergencyDeficitControlActof1985,asamended.m ݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m:    ݀m:݌ b, *. Ќ XBXXXBXBXXXB  +jXBXXXB   XBXXXB   +j  respondingtobioterrorism+j ӌ Z. ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D   Becauseterrorismisanationwidethreat, j0 programsandactivitiestoaddressandrespondtothisthreatareapartofagovernment-wideeffort.WithintheFederalgovernmentsinitiative,HHShastheresponsibilitytomeetthepublicandmedicalneedsassociatedwithterroristevents.mB݌̌ XBXXXBXBXXXB  <,` XDpX,` XDX<m XBXXXBXBXXXB  mh D   TheFY2000PresidentsBudget R7 requestforthe_PHSSEF_Ԁincludesatotalof$230.4millioninprogramlevelforthecontinuationofHHSantibioterrorismefforts.Thesefundsareintendedto:mh݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  ݀m D   m݌ # < Ќ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  ݀:0 D 2C3  0pD(#D(#   improveandenhancethe #!= nationspublicsurveillance $"> network!bystrengthening %z#? ourdetection,epidemiological,laboratoryandelectroniccommunicationcapacities;: ӌ p(#p(# ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  ݀m D   m&݌ **(D Ќ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0 D 2C3  0pD(#D(#   strengthencapabilitiesto r+)E provideamedicalandpublic healthresponsetochemical R-*Gp(#p(# andbiologicalweaponsattacks;: ӌ   L 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m    m ݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :0  2C3  0   createandmaintaina ( stockpileofpharmaceuticals,vaccinesandothermaterialsforcivilianuseifmassivetreatmentisneeded;and:g ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  mA    mA݌̌ XBXXXBXBXXXB  :L 4(*-/0123Chh4(*-/0123LXBXXXB  :u0  2C3  0   accelerateresearch,  p  developmentandregulatoryreview/approvalofrapiddiagnostics,antibiotics/antiviralsandvaccines.:u ӌ  ЌL 4(*-/0123Chh4(*-/0123LXBXXB  m XBXXXBXBXXXB  m    ݀mg݌ x  Ќ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j1  aidsinminoritycommunities+j1 ӌ h ЌXBXXBXBXXB  m XBXXXBXBXXXB  mf    TheFY2000PresidentsBudgetrequest x forthe_PHSSEF_Ԁalsoincludes$50milliontocontinuetoaddresstheAIDScrisisfacingminoritycommunities.ThesefundsarespecificallytargetedtoaddressHIV/AIDSprevention,treatmentandinfrastructure/capacitydevelopmentneedswithintheAfrican-Americanandotherracialandethicminoritycommunities.mf݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m3    m3݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jg  year2000computerconversion+jg ӌ 0 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m    ݀Finally,theFY2000PresidentsBudget @ requestforthe_PHSSEF_Ԁincludes$150milliontocontinuetheDepartmentseffortstowardsachievingmillenniumcompliance.AchievingYear2000(Y2K)complianceisHHSshighestpriority,andtheDepartmentismakingsubstantialprogressinitssystemcompliance.InitsYear2000work,theDepartmentischairingY2Koutreacheffortsinthehealthcareandhumanservicescommunities,andhasexpandedoutreachactivitiesinthesesectors.TheDepartmentisalsocommittedtoensuringthattheY2Kdateproblemdoesnotdisruptservicesorimpairourmission.m݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mh    mh݌ *P(, Ќ XBXXXBXBXXXB   X, (X@(  ,0*, #  X2XXXBe/ eXX2  # @#    %  _PHSSEF_ԀOVERVIEW# ~     X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)pV<,(`~1 ,!O `. !Exxe<2p (#(#                         (#(#AZ') HxdzEHxA s    #  X2XXXBe/ eXX2  #ᄴ @) )     %  OFFICEOFINSPECTORGENERAL#ᄴ   @   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)pV<,(`~1 Je `.U Exxu3p (#(#          (#(#/XBXXXXXXB?/+XBXXXXXXB++jXBXXXB  XBXXXB   +j   AZ')<dE<A([X@(#(#(Summary+j  ӌ c  ЌXBXXBXBXXB  m XBXXXBXBXXXB  m     ForFY2000,theOfficeofInspector #  General(OIG)requestsadiscretionaryappropriationof$32million,anincreaseof$3millionabovetheFY1999discretionarylevel.TheOIGwillalsoreceivebetween$110and$120millioninFY2000fromtheHealthCareFraudandAbuseControl(HCFAC)AccountforMedicarerelatedfraudandabuseactivities.m ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     TheOIGsstatutorymissionisto: ; improveHHSprogramsandoperationsandprotectthemagainstfraud,wasteandabuse.Byconductingindependentandobjectiveaudits,evaluations,andinvestigations,OIGprovidestimely,useful,andreliableinformationandadvicetoHHSofficials,theAdministration,theCongressandthepublic.m 4 ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mM     IntheFY19992000timeframe,theOIG    willfocusonsuchprogramareasas:mM  ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m     m ` ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j   increasingcollectionsinthechild " # supportenforcementprogram+j   ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  mm     OIGwillexpanditsmultiagencytask ;%"& forcestoidentify,investigate,andprosecuteindividualswhowillfullyavoidtheirpaymentoftheirchildsupportobligationsundertheChildSupportRecoveryAct.ThesetaskforceswillbringtogetherStateand_local_Ԁlawenforcementandprosecutors,UnitedStatesAttorneysOffices,theOIG,MarshallServicespersonnel,theFBI,Stateandcountychildsupportofficeresources,andallother -S+/ interestedpartiesfromthe18statescoveredbythetaskforces.mm  ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j   Childsupport+j L  ӌ 3 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m  D   OIGwillexamineawiderangeofchild k5 supportissues,includingclientcooperation,paternityestablishment,reviewandadjustmentofsupportorders,childsupportenforcementcoordinationwithfostercareandwithwelfareoffices,medicalinsurancecoverageunderMedicaidandundermanagedcare,interstatecasecollections,earningsofnoncustodialparents,useoflicenserevocation,wagewithholding,datasystems,incentivefunding,andtheFederalParentLocatorService.m  ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m/  D   m/  ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jc   Safe,availableandaffordableChild CB care+jc   ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m  D   OIGwillexaminesubsidysystemsfor !E childcare,focusingonissuessuchashealthandsafety,licensingstandardsandfraudandabusepotential.OIGwillalsoassessthesuccessoftechnicalassistanceprovidedtoStatesonchildcareissues.m % ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m!  D   m! b" ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j#   Tanfprogram+j# #  ӌ (+&L ЌXBXXBXBXXB  m XBXXXBXBXXXB  m<$  D   OIGwillworkwithFederalandState )'N officesintheirimplementationofwelfarereform.OIGwillfocusonreviewinghow Federalandstateofficesareachieving ,c*Q successfuloutcomesandperformanceinwelfareprograms.m<$ $ ݌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m&     m& ' ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j'   postmarketdrugsurveillanceby ( FDA+j' $(  ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m(     AsFDAmorequicklyapprovesnew ( drugs,theOIGwillcontinuetoreviewhowtheagencyiscarryingoutthepostmarketingsurveillanceresponsibilities,toensurethattheover9,000marketeddrugsaresafeandeffective.OIGrevieweffortswillfocusontwocriticalareas:(1)ensuringthatFDAisadequatelydealingwiththeproblemsofadversedrugreactions,whichwasrecentlyreportinginmedicalliteratureasaleadingcauseofdeathintheU.S.and(2)monitoringFDAstatutorycompliancetoinspectdrugmanufacturersevery2years.m( v) ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j`,   NIHcontrolsovertechnology  transfer+j`, ,  ӌ̌XBXXBXBXXB  m XBXXXBXBXXXB  m-     OIGwilldeterminewhethergranteesare p complyingwiththeprovisionsofthe_Bayh_ԄDoleActregardingthedisclosure,reporting,andlicensingofinventionsdevelopedunderFederallysponsoredprojects.TheOIGwillalsodeterminewhethertheGovernmentisusingroyaltyfreelicensesforinventionswhenmakingpurchasesunderFederalprograms.m- . ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m`0     m`0 0 ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j1   Preventyouthsubstanceabuse+j1 1  ӌ  x" ЌXBXXBXBXXB  m XBXXXBXBXXXB  m2     OIGwillupdateits1991studyonyouth 8"$ useofalcohol, YouthandAlcohol:ANationalSurvey!DrinkingHabits,Access,AttitudesandKnowledge,toidentifychangesinyouthpatternsofalcoholuseand/orabuse.OIGwillalsoexamineHHSpreventionandcessationprogramsspecificallyaimedatyouth.m2 I3 ݌ XBXXXBXBXXXB   )`', +jXBXXXB   XBXXXB   +jk5   Foodsafety+jk5 5  ӌ X, ЌXBXXBXBXXB  m XBXXXBXBXXXB  m6  D   OIGwillexamineFDAseffortsto h. developanintegratedfoodsafetyinspectionsystemwiththeStatestoensureappropriateinspectionscoverage,includingthedevelopmentofshareddatasystems.OIGwillalsoidentifyanddescribeexistingmodelsofequivalencywhichFDAcoulduseasitdevelopsequivalencyagreementswithourinternationaltradingpartnersforimportingandexportingfoodproducts.m6 7 ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mx9  D   mx9 9 ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j:   elderlyprotection+j: ;  ӌ  9 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m;  D   OIGwillconductreviewstodetermine x ; theadequacyofservicesandprogramsforinvestigatingelderlyabuse.OIGwillidentifyinnovativemethodstostrengthenprogramstoprotectelderlypersons.m; V< ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m=  D   m= c> ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j?   publichealthfraud+j? ?  ӌ A ЌXBXXBXBXXB  m XBXXXBXBXXXB  mD@  D   Investigationsoffraudinpublichealth (C programsarediverse,complex,andoftencriticaltoprotectingthehealthoftheAmericanpeople.Theseinvestigationswilladdressgrantandcontractfraud,researchfraud,andotherallegationsofwrongdoing.Thisareaisofparticularinterestinviewofexpectedincreasesinprogramgrantfunding.mD@ @ ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jB   EDPauditing+jB QC  ӌ X N ЌXBXXBXBXXB  m XBXXXBXBXXXB  m D  D   OIGwillcontinuetoassistthe !hP DepartmentinassessingtheprogramsinmakingallmissioncriticalsystemsYear2000(Y2K)compliant,includingreviewingcontingencyplanning.m D D ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jF   Financialstatements+jF oF  ӌ '%W ЌXBXXBXBXXB  m XBXXXBXBXXXB  m2G  D   OIGwillperformauditsforthepurpose @)&Y ofexpressingopinionsonthefinancialstatementsofcertainreportingentitiesintheDepartment,asidentifiedundertheCFOActof1990andtheGovernmentManagementReformActof1994.m2G G ݌ -+^ Ќ XBXXXBXBXXXB  m XBXXXBXBXXXB  mtI     mtI I ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mJ     TheOIGhasstrengtheneditspartnerships H withotherFederalAgencies,suchastheDepartmentofJusticeandtheInternalRevenueService.Also,includedintheserelationshipsareStateGovernments,ombudsmen,andtheprivatesectorincluding_local_Ԁagingorganizations,allofwhomareworkingtowardsimilargoals.OIGcontinuestoformpartnershipswiththehealthcareindustrytopublicize bestpractices,promotevoluntarycomplianceplans,establishanadverseactiondatabank,andconsultonbroadprogramintegritystrategies.Thismultidisciplinaryapproachwillcontinuetoenhancetheofficesabilitytocarryoutitsmission.mJ 'K ݌ X Ќ XBXXXBXBXXXB  s#s#Ks# ( ([X@  (   8 #  X2XXXBe/ eXX2  #/O @     %  PROGRAMSUPPORTCENTER#/O O  O   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)pV<4,(`~1 q `. Exxe4p (#(#         (#(#AZ')ku GdTEku GAp     +jXBXXXB  XBXXXB   (X@(#(#(+jR   Summary+jR S  ӌ ' ЌXBXXBXBXXB  m XBXXXBXBXXXB  mAT     TheProgramSupportCenter(PSC) # becameoperationalinFY1996andwasformedbycombiningadministrativeactivitiesformerlylocatedintheOfficeoftheSecretary(OS),andfundedbytheOSWorkingCapitalFund(WCF),withactivitiesfromtheformerOfficeoftheAssistantSecretaryforHealth(OASH),andfundedbythePublicHealthService(PHS)ServiceandSupplyFund(SSF).TheformationofthePSCresultedfromtheDepartmentsREGOIIanalysiswithagoaloffurtherstreamliningandminimizingduplicationoffunctionsintheprovisionofcosteffectiveadministrativeservicestocomponentsoftheDepartmentandotherFederalagenciesonaserviceforfeebasis.Servicesareprovidedinthreebroadareas:humanresources,financialmanagement,andadministrativeoperations.mAT T ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  mX     mX #Y ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +jY   humanresourcesservice+jY BZ  ӌ #?+' ЌXBXXBXBXXB  m XBXXXBXBXXXB  m[     TheFY2000estimatedexpensesforthe ;%,) HumanResourcesService(HRS)are$42million,whichisthesameastheFY1999level.HRSprovidesafullrangeofpersonnelmanagementservicesincludingpersonnelandpayrollsystemssupport;personneloperationsservicesforcivilianandcommissionedpersonnel;trainingandcareerdevelopment;employeeandlaborrelations;andadministrationoftheBoard -52 forCorrectionsofPHSCommissionedCorpspersonnelrecords.m[ [ ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m1^  D   m1^ ^ ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +je_   financialmanagementservice+je_ _  ӌ 5 ЌXBXXBXBXXB  m XBXXXBXBXXXB  m`  D   TheFY2000estimatedexpensesforthe _7 FinancialManagementService(FMS)are$44million,anincreaseof$1millionabovetheFY1999level.FMSsupportsthefinancialoperationsof_HHS_ԀandotherdepartmentsthroughtheprovisionofpaymentmanagementservicesforDepartmentalandotherFederalgrantandprogramactivities;accountingandfiscalservices;debtmanagementservices;andthereview,negotiationandapprovalofrates,includingindirectcostrates,researchpatientcarerates,andfringebenefitrates.m` a ݌̌ XBXXXBXBXXXB  m XBXXXBXBXXXB  m d  D   m d d ݌̌ XBXXXBXBXXXB  +jXBXXXB  XBXXXB   +j@e   administrationoperationsservice+j@e e  ӌ  'E ЌXBXXBXBXXB  m XBXXXBXBXXXB  mzf  D   TheFY2000estimatedexpensesforthe {!(G AdministrativeOperationsServices(AOS)are$196million,anincreaseof$10millionabovetheFY1999level.AOSsupportstheadministrativemanagementfunctionswithintheDepartmentintheareasofpropertyandmaterialmanagement,andsupportservicesrangingfromcommercialgraphicstomaildistributionandtelecommunicationsservices.TheTelecommunicationsImprovementProjectconsolidatestelephoneservicesunderonecontractwithsubstantialsavingsintelephonebillstoagencieslocatedinMaryland.mzf f ݌ -5T Ќ XBXXXBXBXXXB  (X@( #  X2XXXBe/ eXX2  #>j @    %  PROGRAMSUPPORTCENTERENTITLEMENTSPENDING#>j j  j   X AZ') HxdE#HxAe e ee/XBX eeԌ $ Ќ  @ (dollarsinmillions)pV<,(`~1 ,! `.M Exxe<5p (#(#           (#(#AZ') HxdEzHxA {# +jXBXXXB  XBXXXB   (X@(#(#(+j>n   summary+j>n n  ӌ Z ЌXBXXBXBXXB  m XBXXXBXBXXXB  mo     Thisappropriationprovidesfor  retirementpaymentstoPublicHealthService(PHS)CommissionedOfficersandpaymenttosurvivorsofdeceasedretiredofficers.Thisaccountalsofundstheprovisionofmedicalcaretoactivedutyandretiredmembersandtodependentsofactiveduty,retiredanddeceasedmembersofthePHSCommissionedCorps.Inaddition,thisaccountincludesamountstobepaidtotheSocialSecurityAdministration(SSA)formilitaryservicecreditswhichareearnedbyactivedutyCommissionedOfficersfornonwageincome.mo p ݌ J!" Ќ XBXXXBXBXXXB   Z" (X@(#XBXXXB] #