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OVERVIEW
OF BUDGET REQUEST
INTRODUCTION AND MISSION
The Health Resources and Services Administration
(HRSA), an Agency of the U.S. Department of Health
and Human Services (DHHS), is the principal Federal
Agency charged with increasing access to basic health
care for those who are medically underserved. Health
care in the United States is among the finest in the
world, but it is not available to everyone. At a time
when the Nation enjoys unprecedented prosperity, millions
of families still face barriers to quality health
care because of their income, lack of insurance, geographic
isolation, or language and cultural barriers. In the
report, America’s Health Care Safety Net, the
Institute of Medicine concluded that the Nation’s
health care safety net, while intact for the short
term, is endangered over the longer term by shrinking
resources (including available practitioners) and
expanding responsibility. Assuring a safety net for
individuals and families who live outside the economic
and medical mainstream is a key HRSA role.
HRSA’s mission, as articulated in its Strategic
Plan for 2005-2010, is to provide the national leadership,
program resources and services needed to improve access
to culturally competent, quality health care for uninsured,
underserved, vulnerable, and special needs populations.
HRSA programs and services target, for example:
-
The 47 million Americans who lack health insurance
- many of whom are racial and ethnic minorities,
-
Over 50 million underserved Americans who live in
rural and poor urban neighborhoods where health
care services are scarce,
-
African American infants who still are 2.4 times
as likely as white infants to die before their first
birthday,
-
The more than 1 million people living with HIV/AIDS,
both in and out of care,
Over 94,000 Americans who are waiting for an organ
transplant.
As
the Nation’s access agency, HRSA envisions optimal
health care for all, supported by a health care system
that assures access to comprehensive, culturally competent,
quality care.
OVERVIEW OF BUDGET REQUEST
The FY 2009 President’s Budget request for HRSA
is $5,864,511,000 a decrease of $991,681,000 below
the FY 2008 enacted level. Consistent with the Secretary’s
policy guidance, this budget request continues support
for the Administration’s priority initiatives
and reflects the goals and objectives in the Department’s
Strategic Plan. The FY 2009 request also continues
support for the President’s High Poverty goal
to place health centers in high poverty areas that
currently lack a health center site.
The FY 2009 President's Budget request for HRSA is
$5,864,511,000 a decrease of $991,681,000 below the
FY 2008 enacted level. Consistent with the Secretarys
policy guidance, this budget request continues support
for the Administration's priority initiatives and
reflects the goals and, objectives in the Department's
Strategic Plan. The FY 2009 request also continues
support for the Presidents High Poverty goal to place
health centers in high poverty areas that currently
lack a health center site.
Program increases:
Health Centers Presidential Goal (+$26 million).
The Presidents Health Center Initiative, which began
in Fiscal Year 2002, has achieved its goal of significantly
impacting over 1,200 communities through new or expanded
access points. The request includes $26,000,000 for
the Presidents High Poverty goal to fund up to 40
new access point grants in high poverty areas around
the Nation without a Health Center site.
Health Centers Tort Claims (+$.8 million).
This increase will support claims to be paid in fiscal
year 2009.
Hansen
;s Disease Center/ Buildings and Facilities/ Payment
to Hawaii (+.4 million).
These programs will continue goals of increasing
quality of care and improving health outcomes for
Hansens Disease patients.
Nurse Loan Repayment and Scholarship Program
(+$13.2 million)
This request supports an increase of $13.2 million
for the Loan Repayment and Scholarship Program. The
increase will support a commitment from nurses and
nursing students to work in shortage facilities. The
FY 2009 budget request will support 622 loan repayment
awards for RNs agreeing to work in health care facilities
with a critical shortage of nurses and an estimated
212 scholarships.
HIV/AIDS (+$1.1 million)
The FY 2009 request is a net increase of $1.1 million
above the enacted level. This funding will continue
to support over 2,300 providers that help half a million
individuals living with HIV/AIDS obtain access to
life-sustaining care and services. The FY 2009 Request
includes an increase of $14,239,000 to support current
Part B program activities and includes an increase
of $6,046,000 to AIDS Drug Assistance Program that
provides life-saving medications for an additional
148 people living with HIV over the FY 2008 target.
Healthcare Systems (+$3.5 million)
An additional $3.1 million is requested for the Cord
Blood Stem Cell Bank and the budget requests an increase
of
$.4 million for the Organ Transplantation program
to continue support at the FY 2008 enacted level.
The FY 2009 funds for Cord Blood will allow for continued
collections by the second and third cohort of banks.
Parklawn Replacement (+$36 million).
This request includes $36.062 million to support HHS
wide build-out costs for the Parklawn Replacement
Prospectus.
Telehealth (+$.1million)
The funds requested will allow a new competition of
the current Telehealth Network Grant Program that
supports consortia of health providers to deploy telehealth
technologies.
Program Decreases:
National Health Service Corps (NHSC) (-$2.5
million)
The $14 million decrease in the Field line is a reflection
of the increased efficiencies and economies of scale
experienced by the program. The $11.5 million increase
in the Recruitment Line will focus on the recruitment
of dentists into the NHSC: $1 million of this additional
funding will support four new dental student scholars
who will be available to serve in future years as
they complete their training. The remaining $10.5
million will support new loan repayment contracts
for 210 dentists over and above the 716 new loan repayment
contracts that are projected to be made in this year
Faculty Loan Repayment/Minority Faculty Fellowship
($-1.3 million)
Funding is reduced by $1.3 million. This budget focuses
on activities that fund the placement of nurses and
other health professionals in areas that face shortages
and provide direct care.
Health Professions (-$252.1 million)
This is a net decrease of $252.1 million. Funding
has been reduced for activities that have demonstrated
no impact on the placement of health professionals
in underserved areas and invest resources to activities
that have proven to be effective. Funding has been
eliminated for the Health Professions Training for
Diversity programs, the Training in Primary Care Medicine
and Dentistry program, the Interdisciplinary, Community-Based
Linkages and Public Health programs, and the Preventative
Medicine and Dental Public Health Programs. Other
sources of funding through partnerships are available
to meet anticipated needs as the PART rated the training
grants as ineffective. The FY 2009 Budget supports
expanding direct health care services in high need
areas. It is anticipated that programs will be supported
through State, local resources or private foundations
in the future. The budget request also eliminates
funding for the Advanced Education Nursing Program.
Children's Hospitals Graduate Medical Education
(-$301.6 million)
Funding has been eliminated for these payments as
many childrens hospitals already receive payments
from other public and private sources and are more
likely to have positive profit margins than other
hospitals.
Maternal and Child Health (-$40.4 million)
The budget request eliminates funding for the Traumatic
Brain Injury, Universal Newborn Hearing and Emergency
Medical Services for Children. These activities may
be addressed more efficiently by a more flexible MCH
Block Grant Program.
Healthcare Systems (-$17.3 million)
Funding is reduced for C.W. Bill Young Cell
Transplantation Program by $.8 million, and the Poison
Control Centers by $16.5 million. The FY 2009 Budget
for the C.W. Bill Young Cell Transplantation Program
will enable continued recruitment of new donors and
continued facilitation of unrelated blood stem cell
transplantation, and the budget for Poison Control
Centers will assist centers in their efforts to achieve
financial stability, increase access to services,
and achieve certification. Ninety-five percent of
poison control center are now certified, up from 78
percent in 2001.
Patient Navigator (-$2.9 million)
Funding for this program has been eliminated in FY
2009. This budget focuses on activities that fund
the placement of more doctors, nurses, and other health
care professions in regions of the country that face
shortages.
Office of Rural Health (-$150.1 million)
This is a net decrease of $150.1 million. The majority
of these programs were eliminated due to the investment
in rural provisions within the Medicare Modernization
Act of 2003.
Public Health Improvement (-$304.5 million)
Funding for these programs has been eliminated in
FY 2009. The FY 2009 budget supports providing direct
services and placing clinicians in areas with the
greatest need.
HEALTH RESOURCES AND SERVICES ADMINISTRATION FY 2009
APT (Dollars in Thousands)
Programs
|
FY
2007 Actual |
FY
2008
Enacted |
FY
2009
Request 1 |
Change
from
FY 2008 |
DISCRETIONARY
PROGRAMS: |
PRIMARY
CARE: |
Health Centers |
1,943,484 |
2,021,737 |
$2,047,737 |
+26,000
|
Health Center Tort Claims |
44,555 |
43,285 |
44,055 |
+770 |
Total, Health Centers |
1,988,039
|
2,065,022 |
2,091,792 |
+26,770 |
Free Clinics Medical Malpractice |
41
|
40 |
40 |
- |
Hansen's Disease Center |
15,972
|
15,693 |
16,109 |
+416 |
Payment to Hawaii |
1,996 |
1,961 |
1,976 |
+15 |
Buildings and Facilities |
220 |
157 |
100 |
-57 |
Total,
Bureau of Primary Health Care |
2,006,268 |
2,082,873 |
2,110,017
|
+27,144
|
CLINICIAN
RECRUITMENT & SERVICE: |
National
Health Service Corps Field |
40,443
|
39,736 |
25,729 |
-14,007
|
National Health Service Corps Recruitment |
85,230
|
83,741 |
95,230 |
+11,489
|
Nurse
Loan Repayment and Scholarship Program |
31,055 |
30,512 |
43,744 |
+13,232 |
Loan
Repayment/Faculty Fellowships |
1,289
|
1,266 |
- |
-1,266
|
Total,
Clinician Recruitment & Service |
158,017 |
155,255
|
164,703 |
+9,448 |
HEALTH PROFESSIONS: |
Health
Professions Training for Diversity: |
Centers
of Excellence |
11,880
|
12,773
|
- |
-12,773 |
Scholarships for Disadvantaged Students |
46,657 |
45,842 |
- |
-45,842
|
Health
Careers Opportunity Program |
3,960 |
9,825 |
- |
-9,825 |
Subtotal,
Health Professions Training for Diversity |
62,497
|
68,440 |
- |
-68,440 |
Training
in Primary Care Medicine and Dentistry |
48,851 |
47,998
|
- |
-47,998
|
Interdisciplinary,
Community-Based Linkages: |
Area
Health Education Centers |
28,681
|
28,180 |
- |
-28,180 |
Geriatric Programs |
31,548 |
30,997 |
- |
-30,997 |
Allied
Health and Other Disciplines |
3,960
|
8,803 |
- |
-8,803 |
Subtotal,
Interdisciplinary, Community-Based Linkages |
64,189
|
67,980 |
- |
-67,980 |
Public
Health Workforce Development: |
Public
Health/Preventive Medicine; Dental PH Programs |
7,920
|
8,273 |
- |
-8,273 |
Subtotal,
Public Health Workforce Development |
7,920
|
8,273 |
- |
-8,273
|
Nursing
Workforce Development: |
Advanced
Education Nursing |
57,061 |
61,875 |
- |
-61,875
|
Nursing
Workforce Diversity |
16,107 |
15,826 |
16,107 |
+281 |
Nurse
Education, Practice and Retention |
37,291 |
36,640 |
37,291 |
+651 |
Nurse
Faculty Loan Program |
4,773 |
7,860 |
9,319 |
+1,459 |
Comprehensive
Geriatric Education |
3,392 |
3,333 |
3,392 |
+59 |
Subtotal,
Nursing Workforce Development |
118,624
|
125,534 |
66,109 |
-59,425 |
Patient
Navigator Outreach & Chronic Disease
Prevention |
- |
2,948
|
- |
-2,948 |
Children's
Hospitals Graduate Medical Education Program |
297,009 |
301,646 |
- |
-301,646
|
Total, Bureau of Health Professions |
599,090 |
622,819 |
66,109
|
-556,710 |
National
Practitioner Data Bank (User Fees) |
16,200 |
18,570
|
18,900 |
+330 |
Healthcare
Integrity and Protection Data Bank (User
Fees) |
3,825
|
3,758
|
- |
-3,758
|
HEALTH RESOURCES AND SERVICES ADMINISTRATION
FY 2009 APT (Dollars in Thousands)
Programs
|
FY
2007 Actual |
FY
2008 Enacted |
FY
2009 Request |
Change
from
FY 2008 |
MATERNAL
& CHILD HEALTH: |
Maternal
and Child Health Block Grant |
693,000 |
666,155
|
- |
- |
Autism
and Other Developmental Disorders |
- |
36,354 |
666,155 |
- |
Traumatic
Brain Injury |
8,910
|
8,754 |
36,354 |
-8,754
|
Sickle
Cell Service Demonstrations |
2,180 |
2,653 |
2,184 |
-469 |
Universal
Newborn Hearing |
9,804 |
11,790 |
- |
-11,790 |
Emergency
Medical Services for Children |
19,800
|
19,454 |
- |
-19,454 |
Healthy
Start
|
101,518 |
99,744 |
99,744 |
- |
Family
to Family Health Information Centers |
3,000 |
4,000 |
5,000 |
+1,000 |
Total,
Maternal and Child Health Bureau |
838,212
|
848,904 |
809,437
|
-39,467 |
HIV/AIDS:
|
Emergency
Relief - Part A |
603,993 |
627,149 |
619,424 |
-7,725 |
Comprehensive
Care - Part B |
1,195,500 |
1,195,248 |
1,209,487 |
+14,239 |
AIDS
Drug Assistance Program
(Non-Add) |
789,546 |
808,500
|
814,546 |
+6,046 |
Early
Intervention - Part C |
193,721 |
198,754 |
198,754 |
- |
Children,
Youth, Women & Families - Part D
|
71,794 |
73,690 |
73,690
|
- |
Education
and Training Centers - Part F |
34,701 |
34,094 |
28,700 |
-5,394 |
Dental
Services Part F |
13,086 |
12,857 |
12,857 |
- |
SPNS
Evaluation Funding |
25,000
|
25,000
|
25,000 |
- |
Total,
HIV/AIDS Bureau |
2,137,795 |
2,166,792
|
2,167,912 |
+1,120 |
HEALTHCARE
SYSTEMS: |
Organ
Transplantation |
23,049 |
22,646 |
23,049 |
+403 |
Cord
Blood Stem Cell Bank |
3,963 |
8,843 |
11,966 |
+3,123 |
C.W.
Bill Young Cell Transplantation Program |
25,168 |
23,517 |
22,701
|
-816 |
Poison
Control Centers |
23,000 |
26,528 |
10,000 |
-16,528 |
340b
Drug Pricing Program/Office of Pharmacy Affairs
|
- |
- |
- |
- |
Trauma/Emergency
Medical Services
|
- |
- |
- |
- |
State
Health Access Grants |
- |
- |
- |
- |
Total,
Healthcare Systems Bureau |
75,180 |
81,534 |
67,716 |
-13,818 |
RURAL
HEALTH: |
Rural
Health Policy Development |
8,737 |
8,584 |
8,737 |
+153 |
Rural
Health Outreach Grants |
38,885
|
48,031 |
|
-48,031 |
Rural & Community Access to Emergency Devices |
1,487 |
1,461 |
- |
-1,461 |
Rural
Hospital Flexibility Grants |
63,538 |
37,865
|
- |
-37,865 |
Delta
Health Initiative |
- |
24,563 |
8,141 |
-24,563 |
State
Offices of Rural Health |
8,141 |
7,999 |
- |
+142 |
Denali
Project |
39,283
|
38,597 |
- |
-38,597 |
Radiogenic
Diseases |
1,919 |
1,884 |
1,904 |
+20 |
Black
Lung |
5,891 |
5,788 |
5,886 |
+98 |
Total,
Office of Rural Health Policy |
167,881 |
174,772
|
24,668 |
-150,104 |
Public
Health Improvement (Facilities and Other Projects) |
- |
304,475 |
36,062 |
-304,475 |
Parklawn
Replacement |
- |
-6,700 |
6,819 |
+36,062 |
Telehealth |
6,819 |
141,087 |
141,087 |
+119 |
Program Management |
146,283 |
299,981 |
299,981 |
- |
Family
Planning |
283,146 |
|
|
- |
Undistributed Reductions |
|
- |
- |
- |
HEALTH RESOURCES AND SERVICES ADMINISTRATION FY 2009
APT
(Dollars in Thousands)
Programs
|
FY
2007
Actual |
FY
2008 Enacted |
FY
2009
Request |
Change
from
FY 2008 |
Total,
Discretionary Appropriation |
6,390,691 |
6,856,192 |
5,864,511 |
-991,681 |
SPNS
Evaluation Funding |
25,000 |
25,000 |
25,000
|
- |
National
Practitioner Data Bank (User Fees) |
16,200
|
18,570
|
18,900
|
+330
|
Healthcare
Integrity and Protection Data Bank (User Fees) |
3,825 |
3,758
|
|
-3,758
|
Total,
HRS Discretionary Program Level |
6,435,716
|
6,903,520
|
5,908,411
|
-995,109 |
HEAL
Direct Operations |
2,898
|
2,847
|
2,906 |
+59 |
Vaccine
Direct Operations |
3,982
|
5,404 |
4,528
|
-876
|
Total,
HRSA Discretionary Program Level |
6,442,596 |
6,911,771
|
5,915,845
|
-995,926
|
SPNS
Evaluation Funding |
-25,000 |
-25,000 |
-25,000 |
-
|
National
Practitioner Data Bank (User Fees) |
-16,200 |
-18,570 |
-18,900 |
-330 |
Healthcare
Integrity and Protection Data Bank (User Fees)
|
-3,825 |
-3,758
|
- |
+3,758
|
Total,
HRSA Discretionary B. A |
6,397,571 |
6,864,443
|
5,871,945 |
-992,498
|
MANDATORY
PROGRAMS: |
Family
to Family Health Information Centers |
3,000
|
4,000
|
5,000 |
+1,000
|
Total,
HRSA Mandatory B.A |
3,000
|
4,000
|
5,000
|
+1,000
|
Total,
Discretionary Programs, B.A. |
6,397,571 |
6,84,443 |
5,871,945 |
-992,248 |
Total,
Mandatory Programs, B.A. |
3,000 |
4,000 |
5,000 |
+1000 |
Total,
B.A. |
6,4000,571 |
6,868,443 |
5,876,945 |
-001,498 |
1 The
FY 2009 Budget proposes a $5 million rescission for
the Health Centers Gurantee Loan Program and a $100
million rescission for the Health Professions Student
Loan Program.
|