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[House Document 111-139]
[From the U.S. Government Publishing Office]

111th Congress, 2d Session - - - - - - - - - - - House Document 111-139
 
REQUEST FOR FY 2011 BUDGET AMENDMENTS

                               __________

                             COMMUNICATION

                                  from

                    THE PRESIDENT OF THE UNITED STATES

                              transmitting

 A REQUEST FOR BUDGET AMENDMENTS FOR FISCAL YEAR 2011 PROPOSALS IN THE 
FISCAL YEAR 2011 BUDGET FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

 September 16, 2010.--Referred to the Committee on Appropriations and 
                         ordered to be printed

                                           The White House,
                                   Washington, DC, August 20, 2010.
Hon. Nancy Pelosi,
Speaker of the House of Representatives,
Washington, DC.
    Dear Madam Speaker: I ask the Congress to consider the 
enclosed Fiscal Year (FY) 2011 budget amendments for the 
Department of Health and Human Services. Overall, the 
discretionary budget authority proposed in my FY 2011 Budget 
would not be increased by these proposed requests.
    Included are proposed increases for healthcare workforce 
enhancement activities; HIV/AIDS treatment and prevention; 
State health insurance consumer assistance programs; and 
existing State high-risk health insurance pools. Also included 
are requests for necessary changes to appropriations language 
that support the Public Health Emergency Medical Countermeasure 
Enterprise Review described in the report issued by the 
Secretary of Health and Human Services on August 19, 2010.
    The details of these amendments are set forth in the 
enclosed letter from the Acting Deputy Director of the Office 
of Management and Budget.
            Sincerely,
                                                      Barack Obama.
    Enclosure.
                 Estimate No. 10, 111th Cong. 2nd Sess.

                 Executive Office of the President,
                           Office of Management and Budget,
                                   Washington, DC, August 20, 2010.
The President,
The White House.
    Submitted for your consideration are amendments to your FY 
2011 Budget for the Department of Health and Human Services. 
These requests include proposed increases to accounts that 
would be fully offset by proposed reductions of funding from 
lower-priority Federal programs and excess funds. Overall, the 
discretionary budget totals would not be increased by these 
proposed amendments.
    This request would provide $400 million in additional funds 
for the following accounts, as described below and in more 
detail in the enclosures:
     $250 million increase to the Health Resources and 
Services account for health workforce training enhancements.
     $30 million increase to the Health Resources and 
Services account for State AIDS Drug Assistance Programs with 
waiting lists and other signs of distress.
     $35 million increase to the Disease Control, 
Research, and Training account for domestic HIV/AIDS prevention 
and research.
     $55 million increase to the Centers for Medicare 
and Medicaid Services (CMS) Program Management account for 
State high-risk health insurance pools.
     $30 million increase to the Health Insurance 
Consumer Information account.
    These requested increases would be fully offset by reducing 
funding from other Federal programs and excess funds, as 
described below and in more detail in the enclosures:
     $184 million decrease in the Centers for Disease 
Control and Prevention's (CDC's) Disease Control, Research, and 
Training account for Public Health Emergency Preparedness 
grants.
     $103 million decrease in budget authority for 
CDC's occupational safety and health activities; this is fully 
offset by a corresponding increase in Public Health Service Act 
Evaluation Funds to support these activities.
     $103 million decrease in the National Institutes 
of Health's Buildings and Facilities account.
     $10 million decrease in the CMS Program Management 
account for research, demonstrations, and evaluation projects.
    In addition, the request would decrease Public Health 
Service Act Evaluation Funds for Patient-Centered Health 
Research within the Agency for Healthcare Research and Quality; 
authorize the transfer of $200 million from prior BioShield 
Special Reserve Fund (SRF) to the Department of Defense to 
establish a Technical Center of Excellence for Advanced 
Development and Manufacturing; authorize the creation of and 
$200 million in resources to support a strategic investor 
entity with BioShield SRF balances; and provide authority to 
use pandemic influenza appropriations to promote regulatory 
science.

                             RECOMMENDATION

    I have reviewed these requests and am satisfied that they 
are necessary at this time. Therefore, I join the Secretary of 
Health and Human Services in recommending that you transmit the 
proposals to the Congress.
            Sincerely,
                                       Robert L. Nabors II,
                                            Acting Deputy Director.
    Enclosures.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     HEALTH RESOURCES AND SERVICES

House Doc. 111-91 Page: 16
FY 2011 Budget Appendix Page: 464
FY 2011 Pending Request: $7,601,658,000
Proposed Amendment: $280,000,000
FY 2011 Revised Request: $7,881,658,000

(In the appropriations language under the above heading delete 
``$7,601,658,000'' and substitute $7,881,658,000; delete 
``$1,962,865,000'' and substitute $1,992,865,000; delete 
``$855,000,000'' and substitute $885,000,000; and add the 
following new proviso before the concluding period:)

: Provided further, That of the funds provided under this 
heading, $30,000,000 shall be available for AIDS drug 
assistance under section 311 of the Public Health Service Act 
and shall be provided to those States that received funds for 
this purpose in fiscal year 2010 pursuant to sections 311 and 
2620 of such Act
    This amendment would provide an additional $250 million for 
Health Professions programs to help the health professions 
training infrastructure expand and sustain training efforts and 
address the expected demand for primary care providers and the 
geriatric health professions workforce. Also, it provides an 
additional $30 million for States with AIDS Drug Assistance 
Program waiting lists or other signs of distress.
    The $280 million proposed increase in FY 2011 would be 
fully offset by proposed decreases to other accounts, as 
described in the accompanying amendments.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

               Centers for Disease Control and Prevention

                DISEASE CONTROL, RESEARCH, AND TRAINING

FY 2011 Budget Appendix Pages: 472-473
FY 2011 Pending Request: $6,265,806,000
Proposed Amendment: -$252,209,000
Revised Request: $6,013,597,000

(In the appropriations language under the above heading, delete 
``$6,265,806,000'' and substitute $6,013,597,000; and in the 
third proviso, delete ``$91,724,000'' and substitute 
$194,514,000, insert opening and closing brackets around 
``activities within the National Occupational Research 
Agenda'', and add related to occupational safety and health 
immediately after the newly inserted closing bracket.)
    This amendment would decrease the total budget authority 
for the Centers for Disease Control and Prevention (CDC) by 
$252 million by decreasing funding for the Public Health 
Emergency Preparedness (PHEP) grants ($184 million); increasing 
funding for Domestic HIV/AIDS Prevention and Research to 
support the implementation of the National HIV/AIDS Strategy 
($35 million); and decreasing budget authority funding for 
occupational safety and health ($103 million). While the 
amendment decreases budget authority funding for occupational 
safety and health, this is fully offset by a $103 million 
increase in Public Health Service (PHS) Act Evaluation Funds 
(under section 241 of the PHS Act) to support these activities.
    The $184 million decrease for PHEP grants included in this 
amendment would be balanced out by pandemic influenza grants 
that States were permitted to carry over for an additional 
budget year, beyond the original expiration date of July 31, 
2010. CDC will make appropriate adjustments in the FY 2011 PHEP 
formula grant awards to account for individual States' carry-
over resources.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

                     National Institutes of Health

                        BUILDINGS AND FACILITIES

FY 2011 Budget Appendix Page: 477
FY 2011 Pending Request: $125,581,000
Proposed Amendment: -$102,791,000
Revised Request: $22,790,000

(In the appropriations language under the above heading, delete 
``$125,581,000'' and substitute $22,790,000.)
    This amendment would decrease funding for the Building and 
Facilities (B&F) account by $103 million. Due to dramatic 
reductions in facilities construction costs, the National 
Institutes of Health will be able to finance all of its B&F 
projects funded under the American Recovery and Reinvestment 
Act (ARRA) of 2009 for about $139 million, or 28 percent, less 
than originally projected. NIH is able to construct additional 
B&F projects with ARRA funds and plans to use this as the 
source for facilities construction and repair and improvement 
projects. Additionally, based on historic spending patterns and 
current estimates, NIH is likely to carry over unobligated 
balances from prior-year B&F (no-year) appropriated amounts.
    The $103 million proposed decrease in FY 2011 would offset 
proposed increases to the Health Resources and Services 
Administration and the Centers for Medicare and Medicaid 
Services, as described in the accompanying amendments.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

               Agency for Healthcare Research and Quality

                    HEALTHCARE RESEARCH AND QUALITY

FY 2011 Budget Appendix Page: 479
FY 2011 Pending Request: $610,912,000
Proposed Amendment: -$102,790,000
Revised Request: $508,122,000

(In the appropriations language under the above heading, delete 
``$610,912,000'' and substitute $508,122,000.)
    This amendment would decrease funding for Patient-Centered 
Health Research within the Agency for Healthcare Research and 
Quality (AHRQ) by $103 million. This would offset the proposed 
increase in the use of Public Health Service (PHS) Act 
Evaluation Funds (under section 241 of the PHS Act), in the 
Centers for Disease Control and Prevention. Patient-Centered 
Health Research at AHRQ is similar to research that will be 
funded by the new Patient-Centered Outcomes Research Institute 
established in the Affordable Care Act (Public Law 111-148). 
The amendment would decrease discretionary funding for AHRQ 
research, since it can be accomplished with Affordable Care Act 
mandatory funds instead. The Budget proposed funding AHRQ 
entirely using PHS Act Evaluation Funds, as in past years.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

               Centers for Medicare and Medicaid Services

                           PROGRAM MANAGEMENT

FY 2011 Budget Appendix Page: 483
FY 2011 Pending Request: $3,601,147,000
Proposed Amendment: $45,000,000
Revised Request: $3,646,147,000

(In the appropriations language under the above heading delete 
``$3,601,147,000'' and substitute $3,646,147,000; remove the 
opening and closing brackets around the fourth proviso and, in 
the fourth proviso, insert opening and closing brackets around 
``as authorized by the State High Risk Pool Funding Extension 
Act of 2006'' and add under section 2745 of the Public Health 
Service Act immediately after the newly inserted closing 
bracket.)
    This amendment would provide an additional $45 million for 
the Centers for Medicare and Medicaid Services (CMS). It 
includes a $55 million increase for high-risk health insurance 
pool grants, which would allow CMS to continue supporting 
existing State-operated high-risk health insurance pool 
programs. In addition, the amendment would decrease funding for 
research, demonstrations, and evaluation projects within the 
CMS Program Management account by $10 million. The Affordable 
Care Act (Public Law 111-148) included $10 billion from FY 2011 
to FY 2019 for the Center for Medicare and Medicaid Innovation 
(CMI), of which at least $25 million is for designing, 
implementing, and evaluating various models in each year. CMI 
is charged with testing innovative payment and service delivery 
models to reduce program expenditures while preserving or 
enhancing quality of care. As such, many activities that were 
previously funded under the research, demonstrations, and 
evaluations projects in the CMS Program Management account can 
be implemented through CMI.
    The $45 million proposed increase in FY 2011 would be fully 
offset by proposed decreases to other accounts, as described in 
the accompanying amendments.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

                        Departmental Management

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

FY 2011 Budget Appendix Page: 505
FY 2011 Pending Request: - - -
Proposed Amendment: Language
Revised Request: - - -

(In the appropriations language under the above heading, insert 
the following new paragraphs at the end of the section:)

Funds provided under this heading in Public Laws 111-8 and 111-
117 and available for expenses necessary to prepare for and 
respond to an influenza pandemic may also be used for research 
to advance regulatory science to improve the ability to 
determine safety, quality, and performance of medical 
countermeasures against chemical, biological, radiological, and 
nuclear agents including influenza virus.

Of remaining balances of funds appropriated under the heading 
`Biodefense Countermeasures' in Public Law 108-90, and 
transferred to this account by Division D, title II of Public 
Law 111-117. $200,000,000 shall be available to the Secretary 
for the purpose of funding a strategic investment corporation 
established pursuant to section 319L of the Public Health 
Service Act (42 U.S.C. 247d-7e) to foster innovation in the 
development of medical countermeasures; and, in addition, not 
to exceed $200,000,000 of such remaining balances may be 
transferred by the Secretary to ``Research, Development, Test 
and Evaluation, Defense-Wide, Department of Defense'' for the 
purpose of developing medical countermeasures against chemical, 
biological, radiological, and nuclear threats and emerging 
infectious diseases: Provided, That this transfer authority is 
in addition to any other transfer authority available to the 
Secretary.
    This amendment would make available balances from prior 
pandemic influenza appropriations to support research to 
modernize regulatory science and enhance the safety, quality, 
and performance of medical countermeasures against chemical, 
biological, radiological, and nuclear threats and emerging 
infectious diseases.
    This amendment would allow the Secretary of Health and 
Human Services (HHS) to transfer up to $200 million from prior 
BioShield Special Reserve Fund balances to the Department of 
Defense to establish a Technical Center of Excellence for 
Advanced Development and Manufacturing, which would improve the 
capability to more rapidly and efficiently develop medical 
countermeasures against chemical, biological, radiological, and 
nuclear threats and emerging infectious diseases.
    In addition, this amendment would create a new strategic 
investment corporation with up to $200 million by transferring 
funds from the BioShield Special Reserve Fund within HHS. Funds 
would support investments in the private sector with specific 
focus on disruptive technologies including novel antimicrobials 
and multi-use platform technologies for diagnostics and medical 
countermeasures.
    The overall budget authority requested in the FY 2011 
Budget would not be increased by this amendment.
                DEPARTMENT OF HEALTH AND HUMAN SERVICES

                        Departmental Management

                 HEALTH INSURANCE CONSUMER INFORMATION

FY 2011 Budget Appendix Page: 507
FY 2011 Pending Request: - - -
Proposed Amendment: $30,000,000
Revised Request: $30,000,000

(In the appropriations language under the above Bureau, insert 
the above new heading and the following new language just after 
the Bodoni dash and immediately before the heading ``Program 
Support Center'':)

For expenses necessary for Health Insurance Consumer 
Information, including grants to States to enable such States 
(or the Exchanges operating in such States) to establish, 
expand, and provide support for offices of health insurance 
consumer assistance or health insurance ombudsman programs as 
authorized by section 2793 of the Public Health Service Act (42 
U.S.C. 300gg-93), $30,000,000.
    This amendment would provide $30 million for the Health 
Insurance Consumer Information account. The funding would allow 
the Office of Consumer Information and Insurance Oversight and 
States to continue supporting health insurance consumer 
assistance or ombudsman programs in FY 2011.
    The $30 million proposed increase in FY 2011 would be fully 
offset by proposed reductions to other accounts, as described 
in the accompanying amendments.

                                  
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