FY 2009 Budget Justification

HRSA - U.S Department of Health and Human Services, Health Resources and Service Administration

U.S. Department of Health & Human Services

FY 2009 Budget Justification

Black Lung

	FY 2007 Actual	FY 2008 Enacted	FY 2009 Estimate	FY 2009 +/- FY 2008
BA	$5,891,000	$5,788,000	$5,886,000	+$98,000

Authorizing Legislation - Federal Mine, Health, and Safety Act of 1977, Section 427(a).

FY 2009 Authorization	$10,000,000
Allocation Method	Competitive Grants

Program Description and Accomplishments
The Black Lung program was established in 1980 and provides funds through project grants to public and private entities, including faith-based and community-based organizations, for the purpose of establishing and operating clinics that provide for the outreach and education, diagnosis, treatment, rehabilitation, and benefits counseling of active and retired coal miners and others with occupation-related respiratory and pulmonary impairments. Other patients include steel mill workers, agricultural workers, and others with occupationally-related respiratory and pulmonary disease. As persons with respiratory and pulmonary disease age, their disease severity progresses, and their need for health care services increases along with the cost of those services.

In FY 2006, the program supported services to 11,444 miners through 19,165 encounters. This is an increase over the target of 10,862 miners served. The number of medical encounters, however, fell short of the target of 20,983. The drop in encounters is due to increased costs per encounter due to rising medical costs. The baseline for miners served for this program is 10,790 miners served and 20,844 medical encounters and was set in 2005.

The Black Lung Program received a PART review in 2006 and was rated as Ineffective. The review noted that the program lacked evaluations and performance data to assess the program’s effectiveness and that the program lacked mechanisms to effectively target resources. As a result of the review the program is examining the feasibility of conducting an independent evaluation of the program, establishing baselines and targets for its new long-term performance measure, and collecting data on the location of miners to better target resources and further enhance outreach.

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

FY 2004	$5,963,000
FY 2005	$5,951,000
FY 2006	$5,887,000
FY 2007	$5,891,000
FY 2008	$5,788,000

Budget Request
The FY 2009 request of $5,886,000 is a $98,000 increase from the FY 2008 Enacted level. This will continue support for the Black Lung Clinic Program and provide enough funding to support authorized program activities. The 2009 budget will focus on improving outreach activities designed to identify miners in need of screening and services. The 2009 target is to serve 11,575 miners.

#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	FY 2006		FY 2007		FY 2008 Target	FY 2009 Target	Out-Year Target
#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	Target	Actual	Target	Actual	FY 2008 Target	FY 2009 Target	Out-Year Target
Long-Term Objective: Expand the capacity of the health care safety net
33.1	Increase the percent of miners that show functional improvement following completion of a pulmonary rehabilitation program. (Developmental)									TBD

#	Key Outputs	FY 2004 Actual	FY 2005 Actual	FY 2006		FY 2007		FY 2008 Target/Est.	FY 2009 Target/Est.	Out-Year Target/Est.
#	Key Outputs	FY 2004 Actual	FY 2005 Actual	Target	Actual	Target	Actual	FY 2008 Target/Est.	FY 2009 Target/Est.	Out-Year Target/Est.
Long-Term Objective: Expand the capacity of the health care safety net
33.I.A.1	Increase the number of miners served each year.	NA	10,790 baseline	10,862	11,444	10,933	Aug-08	11,550 a	11,575	NA
33.I.A.2	Increase the number of medical encounters from Black Lung each year.	NA	20,844 baseline	20,983	19,165	21,121	Aug-08	21,269	21,375	NA
Efficiency Measure
33.E	Increase the number of medical encounters per $1 million in federal funding.	2,600	3,570 baseline	3,590	3,333	3,610	Apr-08	3,630	3,650	NA
Other Outputs
	Number of Black Lung grants	15	15		15		15	15	15	NA
	Appropriated Amount ($ Million)	5.963	5.951		5.887		5.891	5.788	5.886

Notes:
a The target previously published in the FY 2008 Congressional Justification for the number of miners served has been increased to reflect recent performance.