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UN2 /  @ o p~ %S lx @ o# p? /\% % P' ( @( om) pt/ @5 o $6 08AZ 0T_Z  Z p'$Z /~  @ o[с pw, / Ҏ @֑ o;! pW!' /~  @ o p @ o p UN [ UN ;) UNd @ o p! /%&@!)oM 7)pi 6/CD@GUN@IIUN5JJUN*KxKUNLmLUNnM%MUNNl/OUNPPUNiRRRRRRRRRRRRRRRRRB\SUNTTUNUKVUNOWWUNPYPYUNZ<[UN\; ]UNE^@^UN`!aUNabUNb cUNcdUNe%OeUNtflf/.h]hUNk^ Okw@[k4kkk mkHP LaserJet 5Si,,,,,,0(hH  Z6Times New Roman RegularX($X  XXXXXXXX8XXdXXd8  -X,XX-(#(#c:\COREL\SUITE8\TEMPLATE\CUSTOM~1\WP8US.WPTc:\Corel\Suite8\Template\Custom WP Templates\wp8US.wpt*J %AZ$Impact Regular(9 Z 6Times New Roman Regular,  AZ"Arial Regular\  `&Times New Roman v mG" XXXX XXXX-X,XX-  _ Allhighrisk  facilitieswillbeinspectedatleastonceperyear,withfollowupinspectionswherequality    assurance  processesneedimprovement.  8 mG"LXXXXLXXXX-X,XX-  _ Tocarryoutits  mission,CDCneedsmodern,securelaboratoryfacilities.MuchofCDCslabspaceisovercrowdedandoutdated. (hH  Z6Times New Roman Regular _ 1in4women  withoutinsurancecoveragehadforgonetreatmentneededcomparedto1in17forthoseinsured. W:\press\2001bpm\dhhs1.wpdW:\press\2001bpm\dhhs3.wpdW:\press\2001bpm\dhhs7.wpdW:\press\2001bpm\dhhs5.wpdL>`'8HHS Title 1Mark TOC, Cond EOP 5, Impact, 22.5 pt, centered, bold  X/XXXgJe` eXX/@*   X/XXXgJe` eXX/W:\press\2001ddp\FDA1.wpdW:\press\2001ddp\hrsa1.wpdW:\press\2001ddp\CDC1.wpdW:\press\2001ddp\NIH1.wpdW:\press\2001ddp\SAMHSA1.wpdW:\press\2001ddp\AHRQ-1.wpdd d m:HHS Body TxtTimes New Roman, 12 pt, flush left, single spaced XgJXXXgJXgJXXXgJ  XgJXXXgJXgJXXXgJW:\press\2001hbis\hcfa1.wpdW:\press\2001hbis\HCFA2.WPDW:\press\2001hbis\hcfa3.wpdL8HHS Table 1Same asTitle 1 - use with tables - has bold horiz line  XJ,XXXe). eXXJ,@*   AZ') HxdE#HxAe e ee).& % ee%W:\PRESS\2001HBIS\HCFA3X~1.WPDW:\press\2001hbis\hcfa3x-schip.wpdlP 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(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#(*-/0123hCG_cgkosw{Bullet ListBullet ListW:\press\2001hbis\hcfa4.wpdW:\press\2001ddp\acf1.wpdLevel 1Level 2Level 3Level 4Level 5(*-/0123x Egkosw{Shaded BoxShaded Check Boxooooooool< :HHS bullet 4Level 4 bulleted HeadingL 4(*-/0123Ch3)LXXXX0  2C3  0(#(# L 4(*-/0123Ch3)LXXXXW:\press\2001hbis\acf3.wpdW:\press\2001hbis\acf4.wpdW:\press\2001ddp\aoa1.wpdW:\press\2001ddp\DM1.wpdW:\press\2001ddp\PHSSEF1.wpdW:\press\2001piom\ocr1.wpdW:\press\2001piom\oig1.wpdW:\press\2001piom\psc1.wpdEW:\PRESS\2001BPM\OVERVI~5.WPDHW:\press\2001bpm\overview 5.wpd(3G$ Y:!X  XXXXXXXX8XXdXXd8  -X,XX-(#(#  'dxd(hH  Z6Times New Roman Regular v mG"XXXXXXXX-X,XX-  _ Allhighrisk  facilitieswillbeinspectedatleastonceperyear,withfollowupinspectionswherequality    assurance  processesneedimprovement. LargeTable  mG"XXXXXXXX-X,XX-  _ 5,500deaths  relatedtoAIDSoccurintheSubSaharanregionofAfricaeachday. ab*OLE*7l[K&OLE 2.0 Box <=8C HKKKKX\*OLE*WPC44  !      2' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' 2' 2-   !cTimes New Roman-  2 ,1999 2 y2000 2 20012 Request Times New Roman4--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- 2Times New Roman-R i2 FABudget Authority................................................. 2 F RD2 F$365,417R2 Fd$394,820R2 F$427,462R+2 F+$32,642cv2 WJOutlays................................................................... 2 W cD2 W$359,690c2 Wd$387,331c2 W$421,387c+2 W+$34,056{2 yMFTE..........................................................................2 y D2 y#58,9302 yp61,6542 y63,157+2 y +1,503-'ZZZZ'dxd d( $ Figure  1  WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT::(    2' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' 2' 2-   !cTimes New Roman-  2 ,1999 2 y2000 2 20012 Request Times New Roman4--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- 2Times New Roman-R i2 FABudget Authority................................................. 2 F RD2 F$365,417R2 Fd$394,820R2 F$427,462R+2 F+$32,642cv2 WJOutlays................................................................... 2 W cD2 W$359,690c2 Wd$387,331c2 W$421,387c+2 W+$34,056{2 yMFTE..........................................................................2 y D2 y#58,9302 yp61,6542 y63,157+2 y +1,503-'^ +%HLPASMB User% V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_ԀthecorrectpositioninthisdocumentBottomHorizLine 8 mG"cXXXXcXXXX-X,XX-  _ Tocarryoutits  mission,CDCneedsmodern,securelaboratoryfacilities.MuchofCDCslabspaceisovercrowdedandoutdated. WPCw w !w ( f   2' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' 2' 2-   !cTimes New Roman-  2 ,1999 2 y2000 2 20012 Request Times New Roman5--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- 2Times New RomanE- I2 F,Administration for Children and Families /1:   cd2 W >Budget Authority.............................................. 2 W cD2 W#38,682c2 Wp36,360c2 W42,913c+2 W +6,553tr2 h GOutlays................................................................ 2 h tD2 h#34,493t2 hp37,093t2 h40,916t+2 h +3,823+2 Administration on Aging:   d2 >Budget Authority.............................................. 2  D 2 2882 2 9332 1,084+ 2 +151r2 GOutlays................................................................ 2  D 2 2879 2 8862 1,020+ 2 +134C2 (Departmental Management/Civil Rights /2:    d2 >Budget Authority.............................................. 2  D 2 2751 2 665 2 535+ 2 -130r2 GOutlays................................................................ 2  D 2 2320 2 645 2 516+ 2 -12912 Office of Inspector General: /d2 # >Budget Authority.............................................. 2 # /D 2 #2129/ 2 #151/ 2 #164/+ 2 #+13@r2 4 GOutlays................................................................ 2 4 @D 2 42134@ 2 4143@ 2 4165@+ 2 4+22*2 VProgram Support Center: sd2 g >Budget Authority.............................................. 2 g sD 2 g2254s 2 g267s 2 g272s+ 2 g+5r2 x GOutlays................................................................ 2 x D 2 x2307 2 x270 2 x272+ 2 x+2H2 +Allowances - Repeal of Delayed Obligations:    d2  >Budget Authority.............................................. 2  D 2 >0 2 0 2 0+ 2 %0r2  GOutlays................................................................ 2  D 2 >0 2 499 2 -499+ 2 -9982  Receipts:d2  >Budget Authority.............................................. 2  D 2 .-893 2 {-876 2 -897+ 2 -21 r2  GOutlays................................................................ 2   D 2 .-893  2 {-876  2 -897 + 2 -2192 "!Total, Health and Human Services:   ?d2 3 >Budget Authority.............................................. 2 3 ?D2 3$365,417?2 3d$394,820?2 3$427,462?+2 3+$32,642Pr2 D GOutlays................................................................ 2 D PD2 D$359,690P2 Dd$387,331P2 D$421,387P+2 D+$34,056aa2 U <Full-Time Equivalents....................................... 2 U aD2 U#58,930a2 Up61,654a2 U63,157a+2 U +1,5032 wg/1 FY 2001 includes $1 billion program increase for Head Start and $1.4 billion advance appropriation   U2 4for FY 2001 made in the FY 2000 Appropriations bill.  2 U/2 Includes appropriations for the Public Health and Social Services Emergency Fund.  -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT:(:]F f   2' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' 2' 2-   !cTimes New Roman-  2 ,1999 2 y2000 2 20012 Request Times New Roman5--"Systemn-'-- "2- 2 $Actual - 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Repeal of Delayed Obligations:    d2  >Budget Authority.............................................. 2  D 2 >0 2 0 2 0+ 2 %0r2  GOutlays................................................................ 2  D 2 >0 2 499 2 -499+ 2 -9982  Receipts:d2  >Budget Authority.............................................. 2  D 2 .-893 2 {-876 2 -897+ 2 -21 r2  GOutlays................................................................ 2   D 2 .-893  2 {-876  2 -897 + 2 -2192 "!Total, Health and Human Services:   ?d2 3 >Budget Authority.............................................. 2 3 ?D2 3$365,417?2 3d$394,820?2 3$427,462?+2 3+$32,642Pr2 D GOutlays................................................................ 2 D PD2 D$359,690P2 Dd$387,331P2 D$421,387P+2 D+$34,056aa2 U <Full-Time Equivalents....................................... 2 U aD2 U#58,930a2 Up61,654a2 U63,157a+2 U +1,5032 wg/1 FY 2001 includes $1 billion program increase for Head Start and $1.4 billion advance appropriation   U2 4for FY 2001 made in the FY 2000 Appropriations bill.  2 U/2 Includes appropriations for the Public Health and Social Services Emergency Fund.  -'(hH  Z6Times New Roman Regularei*OLE*WPC!@$ p   v2''  ' v2' v2-   !cTimes New Roman4-  2 ,1999 2 y2000 2 20012 Request Times New Roman4--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- v2Times New Roman4- 32 FFood and Drug Administration:   ci2 WAProgram Level.................................................... 2 W cD2 W#$1,145c2 Wp$1,228c2 W$1,391c+2 W +$163tc2 h=Budget Authority............................................. 2 h tD 2 h2981t2 hv1,050t2 h1,188t+ 2 h+138p2 yFOutlays............................................................... 2 y D 2 y29522 yv1,0472 y1,192+ 2 y+145K2 -Health Resources and Services Administration:   c2 =Budget Authority............................................. 2  D2 )4,3512 v4,7732 4,962+ 2 +189p2 FOutlays............................................................... 2  D2 )3,8572 v4,5502 4,850+ 2 +300(2 Indian Health Service: c2 =Budget Authority............................................. 2  D2 )2,2702 v2,4212 2,650+ 2 +229 p2 FOutlays............................................................... 2   D2 )2,193 2 v2,376 2 2,623 + 2 +247H2 #+Centers for Disease Control and Prevention: @c2 4=Budget Authority............................................. 2 4 @D2 4)2,642@2 4v3,040@2 43,242@+ 2 4+202Qp2 EFOutlays............................................................... 2 E QD2 E)2,459Q2 Ev2,763Q2 E3,030Q+ 2 E+26742 gNational Institutes of Health:  c2 x=Budget Authority............................................. 2 x D2 x#15,6342 xp17,8402 x18,840+2 x +1,000p2 FOutlays............................................................... 2  D2 #13,7952 p15,5442 17,852+2  +2,308H2 +Substance Abuse and Mental Health Services:   c2 =Budget Authority............................................. 2  D2 )2,4872 v2,6522 2,823+ 2 +171p2 FOutlays............................................................... 2  D2 )2,2142 v2,4512 2,648+ 2 +197H2 +Agency for Healthcare Research and Quality:    i2 AProgram Level.................................................... 2   D 2 2171  2 204  2 250 + 2 +46c2 =Budget Authority............................................. 2  D 2 2100 2 110 2 0+ 2 -110.p2 "FOutlays............................................................... 2 " .D 2 "879. 2 "120. 2 "92.+ 2 "-28?2 D%Health Care Financing Administration:   ac2 U=Budget Authority............................................. 2 U aD2 U297,147a2 Uj325,434a2 U349,686a+2 U+24,252rp2 fFOutlays............................................................... 2 f rD2 f298,901r2 fj319,820r2 f347,607r+2 f+27,787-'gh*OLE*WPC@@>>>>!>>!     !' 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"--  " "--'-- !--'-- MM - "- MMMM B$!$'),/1469<>ACFHKMPRUWY\^`cegjlnprtvvxz|~~{yvtqnkhfc`]ZWTQNKHEB?<88<?BEHKNQTWZ]`cfhknqtvy{~~|zwuspnkifda_\ZWTROMJGEB?=:75 - $ "%(,/258<?BEHKNQTWZ]`ccfhknqtvy{~  !$'),/1469<>ACFHKMPRUWY\^`ccegjlnprtvxz|~~{yvtqnkhfc`]ZWTQNKHEB?<8 "-@@ - "- - X$*prtuwy{}p "-33 - "-ff - ff"$`abcdfghjkmop` "-==gf - "- - ($V WWXXYYZZZ[\]^_`V  "-9DZf - "- - $V V V V V  "-'8'C VM3 - "- M3M3$852/,(%" ~|zxv}t{rypwnultjrgpeocm`k^j\hYhYgWfUdRcPbMaK`H_F^C]A\>[<Z9Z6Y4Y1X/X,W)W'V$V!VVVVV5V7V:V=V?VBWEWGXJXMYOYRZTZW[Z\\]_^a_d`faibkcndpfsguhwhwjzk|m~oprtuwy{} "%(,/25883f - 3f$o852/,(%" ~|zxv}t{rypwnultjrgpeocm`k^j\hYgWfUdRcPbMaK`H_F^C]A\>[<Z9Z6Y4Y1X/X,W)W'V$V!VVVVVVVV 8 "-44--'-- 3f!Times New Roman4------"Systemn-'--- 3fVA  02 EPRESIDENT'S BUDGET FOR HHS  2 1FY 2001 ----'--- !---'--- !Times New Roman4--------'--- P[ 2 _Medicaid 2 q"29.6% ----'--- !------'--- <9 2 Other  2 (0.5% ----'--- !-------'--- :  2 TANF  2 3.8% ----'--- !---------'--- ^ 2 " Children's 2  Mandatory  2 /3.4% ----'--- !-------'---  2 Medicare 2 51.9% ----'--- !-------'--- dc 2 he Discretionary 2 zy10.8% ----'--- !---'--- !--' ! '  'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTS8!S8-1     !' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ! "--  " "--'-- !--'-- MM - "- MMMM B$!$'),/1469<>ACFHKMPRUWY\^`cegjlnprtvvxz|~~{yvtqnkhfc`]ZWTQNKHEB?<88<?BEHKNQTWZ]`cfhknqtvy{~~|zwuspnkifda_\ZWTROMJGEB?=:75 - $ "%(,/258<?BEHKNQTWZ]`ccfhknqtvy{~  !$'),/1469<>ACFHKMPRUWY\^`ccegjlnprtvxz|~~{yvtqnkhfc`]ZWTQNKHEB?<8 "-@@ - "- - X$*prtuwy{}p "-33 - "-ff - ff"$`abcdfghjkmop` "-==gf - "- - ($V WWXXYYZZZ[\]^_`V  "-9DZf - "- - $V V V V V  "-'8'C VM3 - "- M3M3$852/,(%" ~|zxv}t{rypwnultjrgpeocm`k^j\hYhYgWfUdRcPbMaK`H_F^C]A\>[<Z9Z6Y4Y1X/X,W)W'V$V!VVVVV5V7V:V=V?VBWEWGXJXMYOYRZTZW[Z\\]_^a_d`faibkcndpfsguhwhwjzk|m~oprtuwy{} "%(,/25883f - 3f$o852/,(%" ~|zxv}t{rypwnultjrgpeocm`k^j\hYgWfUdRcPbMaK`H_F^C]A\>[<Z9Z6Y4Y1X/X,W)W'V$V!VVVVVVVV 8 "-44--'-- 3f!Times New Roman4------"Systemn-'--- 3fVA  02 EPRESIDENT'S BUDGET FOR HHS  2 1FY 2001 ----'--- !---'--- !Times New Roman4--------'--- P[ 2 _Medicaid 2 q"29.6% ----'--- !------'--- <9 2 Other  2 (0.5% ----'--- !-------'--- :  2 TANF  2 3.8% ----'--- !---------'--- ^ 2 " Children's 2  Mandatory  2 /3.4% ----'--- !-------'---  2 Medicare 2 51.9% ----'--- !-------'--- dc 2 he Discretionary 2 zy10.8% ----'--- !---'--- !--' ! '  'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT:F$:A p   v2''  ' v2' v2-   !cTimes New Roman4-  2 ,1999 2 y2000 2 20012 Request Times New Roman4--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- v2Times New Roman4- 32 FFood and Drug Administration:   ci2 WAProgram Level.................................................... 2 W cD2 W#$1,145c2 Wp$1,228c2 W$1,391c+2 W +$163tc2 h=Budget Authority............................................. 2 h tD 2 h2981t2 hv1,050t2 h1,188t+ 2 h+138p2 yFOutlays............................................................... 2 y D 2 y29522 yv1,0472 y1,192+ 2 y+145K2 -Health Resources and Services Administration:   c2 =Budget Authority............................................. 2  D2 )4,3512 v4,7732 4,962+ 2 +189p2 FOutlays............................................................... 2  D2 )3,8572 v4,5502 4,850+ 2 +300(2 Indian Health Service: c2 =Budget Authority............................................. 2  D2 )2,2702 v2,4212 2,650+ 2 +229 p2 FOutlays............................................................... 2   D2 )2,193 2 v2,376 2 2,623 + 2 +247H2 #+Centers for Disease Control and Prevention: @c2 4=Budget Authority............................................. 2 4 @D2 4)2,642@2 4v3,040@2 43,242@+ 2 4+202Qp2 EFOutlays............................................................... 2 E QD2 E)2,459Q2 Ev2,763Q2 E3,030Q+ 2 E+26742 gNational Institutes of Health:  c2 x=Budget Authority............................................. 2 x D2 x#15,6342 xp17,8402 x18,840+2 x +1,000p2 FOutlays............................................................... 2  D2 #13,7952 p15,5442 17,852+2  +2,308H2 +Substance Abuse and Mental Health Services:   c2 =Budget Authority............................................. 2  D2 )2,4872 v2,6522 2,823+ 2 +171p2 FOutlays............................................................... 2  D2 )2,2142 v2,4512 2,648+ 2 +197H2 +Agency for Healthcare Research and Quality:    i2 AProgram Level.................................................... 2   D 2 2171  2 204  2 250 + 2 +46c2 =Budget Authority............................................. 2  D 2 2100 2 110 2 0+ 2 -110.p2 "FOutlays............................................................... 2 " .D 2 "879. 2 "120. 2 "92.+ 2 "-28?2 D%Health Care Financing Administration:   ac2 U=Budget Authority............................................. 2 U aD2 U297,147a2 Uj325,434a2 U349,686a+2 U+24,252rp2 fFOutlays............................................................... 2 f rD2 f298,901r2 fj319,820r2 f347,607r+2 f+27,787-'k 7HLPASMB User% V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument(3G$ Y:!X  XXXXXXXX8XXdXXd8  -X,XX-(#(#  (3G$ Y:!X  XXXXXXXX8XXdXXd8  -X,XX-(#(#    mG"wXXXXwXXXX-X,XX-  _ 5,500deaths  relatedtoAIDSoccurintheSubSaharanregionofAfricaeachday. pq*OLE*WPCxx!xP1    vE' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' vE' vE-   !vTimes New Roman-  2 )1999 2 v2000 2 20012 Request Times New Roman9--"Systemn-'-- "E- 2 %Actual - !$ %---2 oEnacted- !* o---2 Request - !, ---2  +/- Enacted- !< ----'-- vETimes New Roman- 32 FMandatory Programs (Outlays):   c y2 W LMedicare.................................................................... 2 W  cW2 W*$188,349c2 Ww$200,410c2 W$218,760c>2 W+$18,350t y2 h LMedicaid.................................................................... 2 h  tW2 h0108,042t2 h}116,117t2 h124,838t>2 h+8,721 Q2 y 1Temporary Assistance for Needy Families..........    2 y  W2 y614,1612 y14,9962 y15,828> 2 y%+832W2 5Foster Care & Adoption Assistance....................   2  W2 <4,7072 5,4952 6,294> 2 %+799c2 =Child Support Enforcement.................................... 2  W2 <2,7562 3,0532 3,091> 2 ++38 y2 LChild Care..................................................................2  W2 <2,2542 2,4202 2,958> 2 %+538^2 :State Children's Health Insurance......................... 2  W 2 E5652 1,3002 2,117> 2 %+817 f2 ?Social Services Block Grant....................................2  W2 <1,9932 1,6232 1,998> 2 %+375 a2 <Other Mandatory Programs....................................   2  W 2 E881 2 9882 1,011> 2 ++23 d2 >Receipts/Financing Offsets.................................... 2  Times New Roman-W 2 A-893- !A- 2 -876- !- 2 -897- !-> 2 .-21- !.--2 $2 9Subtotal, Mandatory (Outlays)............................ W2 #$322,815 2 p$345,526 2 $375,998 >2  +$30,472-12 #Discretionary Programs (BA):   @ `2 4 ;Food & Drug Administration.................................    2 4  @W 2 4?$981@2 4$1,050@2 4$1,188@>2 4+$138Q N2 E /Health Resources & Services Administration.....    2 E  QW2 E<4,113Q2 E4,645Q2 E4,788Q> 2 E%+143bl2 V CIndian Health Service.............................................. 2 V bW2 V<2,240b2 V2,391b2 V2,620b> 2 V%+229s T2 g 3Centers for Disease Control & Prevention...........  2 g  sW2 g<2,639s2 g3,037s2 g3,239s> 2 g%+202 f2 x ?National Institutes of Health..................................  2 x  W2 x615,6072 x17,8132 x18,813>2 x+1,000 L2  .Substance Abuse & Mental Health Services......    2   W2 <2,4872 2,6522 2,823> 2 %+171O2  0Agency for Healthcare Research & Quality........    2  W 2 E100 2 110 2 0> 2 (-110W2  5Health Care Financing Administration.................   2  W2 <1,9452 1,9932 1,866> 2 (-127 W2  5Administration for Children & Families /1............    2   W2 <9,0152 8,4652 11,638>2 +3,173 f2  ?Administration on Aging........................................   2   W 2 E882 2 9332 1,084> 2 %+151 m2  DOffice of the Secretary............................................. 2   W 2 E266 2 282 2 304> 2 ++22 Q2  1Public Health & Social Services Emergency........   2   -W 2 E514- !E- 2 414- !- 2 265- !-> 2 (-149- !(--2 %2 ;Subtotal, Discretionary (BA)............................... W2 *$40,789 2 w$43,785 2 $48,628 >2 +$4,8432 #2 7Subtotal, Discretionary (Outlays)......................W2 *$36,8752 w$41,8052 $45,389>2 +$3,5842 3(2 3ATotal HHS Outlays................................................?W2 3#$359,690?2 3p$387,331?2 3$421,387?>2 3 +$34,056-2 Ug/1 FY 2001 includes $1 billion program increase for Head Start and $1.4 billion advance appropriation   U2 f4for FY 2001 made in the FY 2000 Appropriations bill.  -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT<V1<A    vE' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' vE' vE-   !vTimes New Roman-  2 )1999 2 v2000 2 20012 Request Times New Roman9--"Systemn-'-- "E- 2 %Actual - !$ %---2 oEnacted- !* o---2 Request - !, ---2  +/- Enacted- !< ----'-- vETimes New Roman- 32 FMandatory Programs (Outlays):   c y2 W LMedicare.................................................................... 2 W  cW2 W*$188,349c2 Ww$200,410c2 W$218,760c>2 W+$18,350t y2 h LMedicaid.................................................................... 2 h  tW2 h0108,042t2 h}116,117t2 h124,838t>2 h+8,721 Q2 y 1Temporary Assistance for Needy Families..........    2 y  W2 y614,1612 y14,9962 y15,828> 2 y%+832W2 5Foster Care & Adoption Assistance....................   2  W2 <4,7072 5,4952 6,294> 2 %+799c2 =Child Support Enforcement.................................... 2  W2 <2,7562 3,0532 3,091> 2 ++38 y2 LChild Care..................................................................2  W2 <2,2542 2,4202 2,958> 2 %+538^2 :State Children's Health Insurance......................... 2  W 2 E5652 1,3002 2,117> 2 %+817 f2 ?Social Services Block Grant....................................2  W2 <1,9932 1,6232 1,998> 2 %+375 a2 <Other Mandatory Programs....................................   2  W 2 E881 2 9882 1,011> 2 ++23 d2 >Receipts/Financing Offsets.................................... 2  Times New Roman-W 2 A-893- !A- 2 -876- !- 2 -897- !-> 2 .-21- !.--2 $2 9Subtotal, Mandatory (Outlays)............................ W2 #$322,815 2 p$345,526 2 $375,998 >2  +$30,472-12 #Discretionary Programs (BA):   @ `2 4 ;Food & Drug Administration.................................    2 4  @W 2 4?$981@2 4$1,050@2 4$1,188@>2 4+$138Q N2 E /Health Resources & Services Administration.....    2 E  QW2 E<4,113Q2 E4,645Q2 E4,788Q> 2 E%+143bl2 V CIndian Health Service.............................................. 2 V bW2 V<2,240b2 V2,391b2 V2,620b> 2 V%+229s T2 g 3Centers for Disease Control & Prevention...........  2 g  sW2 g<2,639s2 g3,037s2 g3,239s> 2 g%+202 f2 x ?National Institutes of Health..................................  2 x  W2 x615,6072 x17,8132 x18,813>2 x+1,000 L2  .Substance Abuse & Mental Health Services......    2   W2 <2,4872 2,6522 2,823> 2 %+171O2  0Agency for Healthcare Research & Quality........    2  W 2 E100 2 110 2 0> 2 (-110W2  5Health Care Financing Administration.................   2  W2 <1,9452 1,9932 1,866> 2 (-127 W2  5Administration for Children & Families /1............    2   W2 <9,0152 8,4652 11,638>2 +3,173 f2  ?Administration on Aging........................................   2   W 2 E882 2 9332 1,084> 2 %+151 m2  DOffice of the Secretary............................................. 2   W 2 E266 2 282 2 304> 2 ++22 Q2  1Public Health & Social Services Emergency........   2   -W 2 E514- !E- 2 414- !- 2 265- !-> 2 (-149- !(--2 %2 ;Subtotal, Discretionary (BA)............................... W2 *$40,789 2 w$43,785 2 $48,628 >2 +$4,8432 #2 7Subtotal, Discretionary (Outlays)......................W2 *$36,8752 w$41,8052 $45,389>2 +$3,5842 3(2 3ATotal HHS Outlays................................................?W2 3#$359,690?2 3p$387,331?2 3$421,387?>2 3 +$34,056-2 Ug/1 FY 2001 includes $1 billion program increase for Head Start and $1.4 billion advance appropriation   U2 f4for FY 2001 made in the FY 2000 Appropriations bill.  -'   t  HLPASMB User% 6 FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHS_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument   xy*OLE*(hH  Z6Times New Roman RegularWPCw#w#!w#N  &   ~<' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ~<' ~<-   !<Times New Roman)-  2 *1999 2 u2000 2 20012 Request Times New Roman0-2 Actual - !+(-2 _Enacted - !6(_-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman-PU2 A4Program Level.......................................   2 A 2 A$1,1452 Ai$1,2282 A$1,391P42 A +$163 y^2 j:FTE....................................................... 2 j 2 j&8,9102 jq9,0092 j9,510y4 2 j+501 -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT;T ;  &   ~<' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ~<' ~<-   !<Times New Roman)-  2 *1999 2 u2000 2 20012 Request Times New Roman0-2 Actual - !+(-2 _Enacted - !6(_-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman-PU2 A4Program Level.......................................   2 A 2 A$1,1452 Ai$1,2282 A$1,391P42 A +$163 y^2 j:FTE....................................................... 2 j 2 j&8,9102 jq9,0092 j9,510y4 2 j+501 -' v mG"XXXXXXXX-X,XX-  _ Allhighrisk  facilitieswillbeinspectedatleastonceperyear,withfollowupinspectionswherequality    assurance  processesneedimprovement. ~*OLE*} 7HLPASMB User% V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_ԀthecorrectpositioninthisdocumentWPCg g !g l 5 0   l''  ' l' l-   !lTimes New Roman,-  2 (1999 2 f2000 2 20012 Request Times New Roman--"Systemn-'-- "- 2  Actual - !$ ---2 XEnacted- !* X---2 Request - !, ---2  +/- Enacted- !< ----'-- lTimes New RomanM- (2 $Salaries and Expenses:2 5-2 5KFoods...................................................................... 2 5,$235 2 5j$267 2 5$316A 2 5+$492 F$2 F9Seafood Inspection (Transfer)............................ 2 F813 2 Fv13 2 F13R 2 F02 W-2 WLDrugs....................................................................... 2 W2288 2 Wp309 2 W330c 2 W+212 h,2 hJBiologics................................................................. 2 h2125 2 hp133 2 h153t 2 h+212 y%2 y<Animal Drugs and Feeds...................................... 2 y843 2 yv49 2 y63 2 y+142 )2 CMedical Devices.................................................... 2 2160 2 p169 2 192 2 +242 2 0National Center for Toxicological Research...... 2 832 2 v34 2 38 2 +42 ,2 ITobacco.................................................................. 2 834 2 v34 2 39 2 +52 *2 EOther Activities..................................................... 2 884 2 v78 2 78 2 02 !2 4Other Rent & Rent Related Activities................Times New Roman4- 2 826- ! 8- 2 v26- ! v- 2 26- ! - 2 0- !--2 !2 3Subtotal, Salaries and Expenses....................2 $1,0412 \$1,1122 $1,2482 +$137-2 &2 >GSA Rental Payments........................................... 2 2$88 2 j$100 2 $105 2 +$52 '2 @Buildings and Facilities........................................ 2 811 2 v11 2 31 2 +202 )2 DCertification Fund.................................................. 2 >4 2 |4 2 4# 2 02 ()2 (DExport Certification................................................ 2 (>1 2 (|1 2 (24 2 (+1Times New Roman4-2 9%2 9<Bioterrorism (non-add)......................................Times New Roman\- 2 9;0- !F;- 2 9y8- !Fy- 2 912- !F-E 2 9+4 - !F--2 O%2 O;Total, Program Level.......................................2 O$1,1452 O\$1,2282 O$1,391[2 O+$163-2 cLess User Fees: 2 t Current Law: 2 2 .Prescription Drug User Fee Act (PDUFA)........ 2 ,$132 2 j$145 2 $149 2 +$4--'--  2 2 (Mammography Quality Standards Act (MQSA)--'-- l  2 814 2 v15 2 15 2 02 )2 DCertification Fund.................................................. 2 >4 2 |4 2 4 2 02 )2 DExport Certification................................................ 2 >1 2 |1 2 2 2 +12 $2 9Seafood Inspection--Transfer............................. 2 813 2 v13 2 13 2 02  Proposed Law: 2 -2 KFoods...................................................................... 2 >0 2 |0 2 14 2 +142 )2 CMedical Devices....................................................- 2 >0- ! >- 2 |0- ! |- 2 6- ! - 2 +6- ! --2 &2 >Subtotal, User Fees...........................................- 2 ($164- !(- 2 f$178- !f- 2 $203- !- 2 +$25- !--2 )$2 ):Total, Budget Authority................................... 2 )($9812 )\$1,0502 )$1,18852 )+$138-2 K02 KQFTE..............................................................................W@2 K%8,910W%2 K 2 K% W~2 Kc9,009Wc2 KN 2 Kc W2 K9,510W2 K 2 K W 2 K+501-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT55r55@ 5 0   l''  ' l' l-   !lTimes New Roman,-  2 (1999 2 f2000 2 20012 Request Times New Roman--"Systemn-'-- "- 2  Actual - !$ ---2 XEnacted- !* X---2 Request - !, ---2  +/- Enacted- !< ----'-- lTimes New RomanM- (2 $Salaries and Expenses:2 5-2 5KFoods...................................................................... 2 5,$235 2 5j$267 2 5$316A 2 5+$492 F$2 F9Seafood Inspection (Transfer)............................ 2 F813 2 Fv13 2 F13R 2 F02 W-2 WLDrugs....................................................................... 2 W2288 2 Wp309 2 W330c 2 W+212 h,2 hJBiologics................................................................. 2 h2125 2 hp133 2 h153t 2 h+212 y%2 y<Animal Drugs and Feeds...................................... 2 y843 2 yv49 2 y63 2 y+142 )2 CMedical Devices.................................................... 2 2160 2 p169 2 192 2 +242 2 0National Center for Toxicological Research...... 2 832 2 v34 2 38 2 +42 ,2 ITobacco.................................................................. 2 834 2 v34 2 39 2 +52 *2 EOther Activities..................................................... 2 884 2 v78 2 78 2 02 !2 4Other Rent & Rent Related Activities................Times New Roman4- 2 826- ! 8- 2 v26- ! v- 2 26- ! - 2 0- !--2 !2 3Subtotal, Salaries and Expenses....................2 $1,0412 \$1,1122 $1,2482 +$137-2 &2 >GSA Rental Payments........................................... 2 2$88 2 j$100 2 $105 2 +$52 '2 @Buildings and Facilities........................................ 2 811 2 v11 2 31 2 +202 )2 DCertification Fund.................................................. 2 >4 2 |4 2 4# 2 02 ()2 (DExport Certification................................................ 2 (>1 2 (|1 2 (24 2 (+1Times New Roman4-2 9%2 9<Bioterrorism (non-add)......................................Times New Roman\- 2 9;0- !F;- 2 9y8- !Fy- 2 912- !F-E 2 9+4 - !F--2 O%2 O;Total, Program Level.......................................2 O$1,1452 O\$1,2282 O$1,391[2 O+$163-2 cLess User Fees: 2 t Current Law: 2 2 .Prescription Drug User Fee Act (PDUFA)........ 2 ,$132 2 j$145 2 $149 2 +$4--'--  2 2 (Mammography Quality Standards Act (MQSA)--'-- l  2 814 2 v15 2 15 2 02 )2 DCertification Fund.................................................. 2 >4 2 |4 2 4 2 02 )2 DExport Certification................................................ 2 >1 2 |1 2 2 2 +12 $2 9Seafood Inspection--Transfer............................. 2 813 2 v13 2 13 2 02  Proposed Law: 2 -2 KFoods...................................................................... 2 >0 2 |0 2 14 2 +142 )2 CMedical Devices....................................................- 2 >0- ! >- 2 |0- ! |- 2 6- ! - 2 +6- ! --2 &2 >Subtotal, User Fees...........................................- 2 ($164- !(- 2 f$178- !f- 2 $203- !- 2 +$25- !--2 )$2 ):Total, Budget Authority................................... 2 )($9812 )\$1,0502 )$1,18852 )+$138-2 K02 KQFTE..............................................................................W@2 K%8,910W%2 K 2 K% W~2 Kc9,009Wc2 KN 2 Kc W2 K9,510W2 K 2 K W 2 K+501-' _ 1in4women  withoutinsurancecoveragehadforgonetreatmentneededcomparedto1in17forthoseinsured.  mG"XXXXXXXX-X,XX-  _ Thenationhasa  rareopportunitytoeliminatesyphilisintheU.S. (hH  Z6Times New Roman Regular*OLE*WPCf%f%!f%  o   `' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' `' `-   !?% !i%Times New Roman(-  2 N1999 2 2000 2 20012 %Request Times New Roman@-2 CActual - !+(C-2 Enacted - !6(-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman-Pc2 A=Program Level................................................   2 A Times New Roman,-2 CH$4,1802 C$4,7142 C$4,859-PX2 A/+$145 zl2 kCFTE................................................................ 2 k -2 mO2,0142 m2,1522 m2,089-zX 2 kB-63-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT> >  o   `' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' `' `-   !?% !i%Times New Roman(-  2 N1999 2 2000 2 20012 %Request Times New Roman@-2 CActual - !+(C-2 Enacted - !6(-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman-Pc2 A=Program Level................................................   2 A Times New Roman,-2 CH$4,1802 C$4,7142 C$4,859-PX2 A/+$145 zl2 kCFTE................................................................ 2 k -2 mO2,0142 m2,1522 m2,089-zX 2 kB-63-'  mG"XXXXXXXX-X,XX-  _ :XX  @@MMNumberof_Mammogram_ԀandPapSmearScreening@@  Among_NBCCEDP_ԀParticipants#XX:# &0 d d(hH  Z6Times New Roman Regular F mG"XXXXXXXX-X,XX-  _ EveryNIH  Institute,Center,andprogrammaticunitwillparticipateindevelopingaTransNIHStrategicPlanforResearchonHealthDisparities. (hH  Z6Times New Roman RegularSmallTable v mG"XXXXXXXX-X,XX-  _ Oneofthehighest  researchprioritiesremainsthesearchforasafeandeffectivevaccinetopreventinfection.NIHfundingforAIDSvaccineresearchwillincreaseby12percentinFY2001. (hH  Z6Times New Roman Regular 1 mG"XXXXXXXX-X,XX-  _ 60percentofpeople  withlifetimehistoriesofatleastonementalillnessneitherseeknorobtainhelpfortheirillness.  HLPASMB User%  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.(hH  Z6Times New Roman Regular 6 mG"XXXXXXXX-X,XX-  _ Wehavethefinesthealthcare  systemintheworld...buttoomanyfamilieshavebeenthevictimsofmedicalerrorsthatareavoidable...thatareunacceptable. &t%XXԀ   ,  X  , #XX%&t[#:XXPresidentWilliamJ.Clinton#XX:#(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _3*OLE*WPC!6A     ''  ' ' -   !7 !286 !g !%8{ !8 !Y; !8 !  !8Times New RomanY-  2 k1999 2 2000 2 20012 bRequest Times New Roman4--"Systemn-'-- %- 2 cActual - !$!c---2 Enacted- !*!---2  Request - !,! ---2 U +/- Enacted- !<!U----'-- Times New Roman4-D0 i2 8AHealth Care Access for the Uninsured.............................   2 80 D 2 8}0D 2 8$25D5 2 8$125D2 8n+$100U1u2 IICommunity Health Centers.................................................  2 I1 U 2 Iq925U2 I1,019U52 I1,069U 2 Iz+50+2 Z Ryan White Programs:  w0|2 kN Emergency Relief- Title I................................................... 2 k0 w 2 kq505w 2 k547w5 2 k#587w 2 kz+401v2 |J Comprehensive Care- Title II............................................ 2 |1  2 |q738 2 |8245 2 |#864 2 |z+40Times New Roman4-,[2 8 AIDS Drug Assistance Program (Non-add)...............    2 , - 2 q461 2 5285 2 #554 2 z+260|2 N Early Intervention- Title III...............................................2 0  2 w94 2 1385 2 #171 2 z+33/v2 J Pediatric HIV/AIDS- Title IV............................................   2 /  2 w46 2 515 2 )60 2 +90p2 F Education and Training Centers......................................2 0  2 w20 2 275 2 )29 2 +212 T Dental Services................................................................... 2 1 Times New Roman4- 2 }8- !}- 2 8- !-5 2 /9- !/- 2 +1- ! --1v2 J Subtotal, Ryan White.....................................................  2 1 2 ]$1,4112 $1,59552 $1,7202 j+$125-02 PMCH Block Grant.................................................................  2 0  2 q805 2 7995 2 #799 2 0/f2 ?Universal Newborn Hearing Screening............................    2 /  2 }0 2 35 2 /3 2 0!0o2 EEMS for Children, Poison Control..................................... 2 0 ! 2 w15! 2 20!5 2 )17! 2 -320{2 &MOrgan Transplantation........................................................ 2 &0 2 2 &w102 2 &1025 2 &)152 2 &+5C0m2 7DRicky Ray Hemophilia Relief Fund....................................  2 70 C 2 775C5 2 7#100C 2 7z+25T02 HSFamily Planning.................................................................... 2 H0 T 2 Hq215T 2 H239T5 2 H#274T 2 Hz+3562 Y Health Professions Programs:  v1x2 jK Children's Hospitals GME................................................  2 j1 v 2 j}0v 2 j40v5 2 j)80v 2 jz+4002 {P Training for Diversity....................................................... 2 {0  2 {w93 2 {935 2 {#103 2 {z+101y2 L Other Health Professions.................................................  2 1 - 2 q209- !q- 2 209- !-5 2 #115- !#- 2 }-94- !}--12 RSubtotal, HP...................................................................... 2 1  2 g$302 2 $3425 2 $298 2 t-$44-/{2 MRural Health/Telehealth...................................................... 2 /  2 w75 2 945 2 )75 2 }-19/i2 AHansen's Disease Services Programs...............................   2 /  2 w24 2 225 2 )19 2 -31[2 8Bone Marrow/Black Lung/Facilities/Nurse Loan............   2 1  2 w26 2 265 2 )26 2 00u2 INational Health Service Corp.............................................  2 0  2 q115 2 1175 2 #117 2 0/f2 ?Comprehensive Care for the Uninsured...........................  2 /  2 }0 2 155 2 /0 2 }-150s2 HNational Practitioner Databank..........................................  2 0  2 w16 2 165 2 )17 2 +1 1s2 HHealth Integ. & Prot. Databank..........................................   2 1   2 }1  2 3 5 2 /4  2 +1102 %QHealth Care Facilities........................................................... 2 %0 1 2 %w651 2 %11215 2 %/01 2 %w-112B/x2 6KProgram Management.........................................................   2 6/ B 2 6q125B 2 6132B5 2 6#131B 2 6-1S1{2 GMAbstinence Education......................................................... 2 G1 -S 2 Gw50- ! Tw-S 2 G50- ! T-S5 2 G)50- ! T)-S 2 G0- !T--d/j2 XBTotal, HRSA Program Level.........................................   2 X/ d2 X]$4,180d2 X$4,714d52 X$4,859d2 Xj+$145-C2 l(Less Funds Allocated From Other Sources:   1j2 }BMandatory, Abstinence Education...................................  2 }1  2 }s-50 2 }-505 2 }%-50 2 }01s2 HHealth Integ. & Prot. Databank..........................................   2 1  2 y-1 2 -35 2 +-4 2 -1/f2 ?National Practitioner Databank User Fees.......................   2 / - 2 s-16- !s- 2 -16- !-5 2 %-17- !%- 2 -1- ! --1s2 HTotal, Discretionary BA ................................................  2 1 2 ]$4,1132 $4,64552 $4,7882 j+$143-02 `FTE.............................................................................................2 0 2 h2,014h2 > 2 h 2 2,152$2  2  52 2,0892  2   2 }-63-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT6D 2 h 2 2,152$2  2  52 2,0892  2   2 }-63-'mlYC<<CLevel 1Level 2Level 3Level 4Level 5($$   1   V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument(hH  Z6Times New Roman Regular   *OLE*  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBarorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocumentWPCJ-J-!J- Ec   Z''  ' Z' Z-   !ZTimes New Roman4-  2 1999 2 ,2000 2 2001 2 Request Times New Roman4-2 Actual  - !71-2 Enacted  - !E1-2 Request - !E1-2  +/- Enacted   - !b1-Times New Roman0-cKZ2 R7Program Level..........................................    2 RK c2 R$2,669  cM2 R$2,831  c2 R$3,060  cO2 R+$229 Ic2 }=FTE.......................................................... 2 }I 2 }14,586  M2 }14,673  2 }14,823  O 2 }&+150 -'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICTFF:  Ec   Z''  ' Z' Z-   !ZTimes New Roman4-  2 1999 2 ,2000 2 2001 2 Request Times New Roman4-2 Actual  - !71-2 Enacted  - !E1-2 Request - !E1-2  +/- Enacted   - !b1-Times New Roman0-cKZ2 R7Program Level..........................................    2 RK c2 R$2,669  cM2 R$2,831  c2 R$3,060  cO2 R+$229 Ic2 }=FTE.......................................................... 2 }I 2 }14,586  M2 }14,673  2 }14,823  O 2 }&+150 -'(hH  Z6Times New Roman RegularZZZZ3 ShadowdZd mG"XXXXXXXX-X,XX-  _1*OLE*WPC@@>>>>!>>  $   6''  ' 6 "--  6 "--'-- 6--'-- 1- "-  $[}hs s}[}- $[}[7h-hs[}$hsh- - shs "-}[shs e[\h\ N[EhE 7[-h-  - $ s}[}hs s "-$[}[7h-hs[}$hsh- - shs "-MM - MMMM$vzvc{_{vvz - $izicvcvziz-ss - ssss$vc{_n_icvc Small Fonts--- "-- ^Lc--"Systemn-'--- \Md  2 Of48,880----'--- 1 "-MM - MMMM $zUQvz -  $zUUzz- ss - ssss$UQQUU "- MM - MMMM$zIEvz - $zIIzz-ss - ssss$IEEII "- MM -  MMMM$z>:vz -  $z>>zz-ss - ssss$>::>> "- MM - MMMM$z95vz - $z99zz-ss - ssss$95599-- "- - 4"---'--- 2#  2 %140,926----'--- 1-- "-}[ 7[}[}Xe[eXN[NX7[7X Arial$- 2 vP02 ^550,0002 G/100,0002 0/150,000}[}}[[}{{}}}} 2 _1994 2 1998 2 20012 Projection--'-- 6ArialG- - - --'- - W $2 YADAP Clients Served   - --'- - 6--'- - 6--'- - 6 -   6- -' 6 '  'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICT f   $   6''  ' 6 "--  6 "--'-- 6--'-- 1- "-  $[}hs s}[}- $[}[7h-hs[}$hsh- - shs "-}[shs e[\h\ N[EhE 7[-h-  - $ s}[}hs s "-$[}[7h-hs[}$hsh- - shs "-MM - MMMM$vzvc{_{vvz - $izicvcvziz-ss - ssss$vc{_n_icvc Small Fonts--- "-- ^Lc--"Systemn-'--- \Md  2 Of48,880----'--- 1 "-MM - MMMM $zUQvz -  $zUUzz- ss - ssss$UQQUU "- MM - MMMM$zIEvz - $zIIzz-ss - ssss$IEEII "- MM -  MMMM$z>:vz -  $z>>zz-ss - ssss$>::>> "- MM - MMMM$z95vz - $z99zz-ss - ssss$95599-- "- - 4"---'--- 2#  2 %140,926----'--- 1-- "-}[ 7[}[}Xe[eXN[NX7[7X Arial$- 2 vP02 ^550,0002 G/100,0002 0/150,000}[}}[[}{{}}}} 2 _1994 2 1998 2 20012 Projection--'-- 6ArialG- - - --'- - W $2 YADAP Clients Served   - --'- - 6--'- - 6--'- - 6 -   6- -' 6 '  '*OLE*WPC@@>>>>!>>    o'' N ' o' N "- "-'- ? MMCC-'- N-'- S-'- C-'- A "-- $ZZ$ll$}}--'-- C--'-- N "-C  Arial-MMCC--"Systemn-'--- N---'--- N  2 _25%  2 _30%  2 B_35%  2 _40%  2 _45%  2 8_50% ---'--- N---'--- o--' o '  'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICT'^'^c@    o'' N ' o' N "- "-'- ? MMCC-'- N-'- S-'- C-'- A "-- $ZZ$ll$}}--'-- C--'-- N "-C  Arial-MMCC--"Systemn-'--- N---'--- N  2 _25%  2 _30%  2 B_35%  2 _40%  2 _45%  2 8_50% ---'--- N---'--- o--' o '  ' V mG"XXXXXXXX-X,XX-  _ X XXX X X  FY1993@ZZFY20000 FY2001# X X ص# &%X X  (hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _ X XXX &%X X @##<$1,138 mG"XXXXXXXX-X,XX-  _ X XXX &%X X @$1,051 mG"XXXXXXXX-X,XX-  _ X XXX &%X X @(($525 n mG"XXXXXXXX-X,XX-  _@sXX s IHSsBudgetControlledbyTribes  @KKdollarsinmillions #s #*OLE*WPC]]!]<  C   N'''  ' N'' N'-   !_'Times New Roman!-Times New RomanP---"Systemn-'-- -I -------  2 +1999 -2 #Actua - ! %#-- 2 Cl-----'-- -J------ 2 i2000 -2 [Enacted- !*%[------'-- ------- 2 2001 -2 Request - !,%------'-- -&-------- 2 Request +/- -2 Enacted- !*%----'-- N'Times New Roman4- (2 /Indian Health Service: 2 @ +2 @GClinical Services......................................................2 @&$1,9342 @d$2,0392 @$2,174 2 @ $135Times New Roman4-2 Q 2 Q/Contract Health Services (nod add)............. 2 Q0386 2 Qn407 2 Q448 2 Q +41 -2 b )2 bDPreventive Health................................................... 2 b;87 2 by92 2 b103 2 b+112 s '2 s?Contract Support Costs......................................... 2 s5204 2 ss229 2 s269 2 s+402 +2 GUrban Health........................................................... 2 ;26 2 y28 2 31 2 +32 "2 5Health Professions/Direct Operations................. 2 ;91 2 y93 2 99 2 +62 )2 DDiabetes Grants /1..................................................Times New Roman4- 2 ;30- ! ;- 2 y30- ! y- 2 30- ! -$ 2 0- !--2 2 ,Subtotal, Health Services Program Level.....2 !$2,3722 _$2,5112 $2,706 2 $195--2 Indian Health Facilities: 2 (2 AEnvironmental Health............................................. 2 /$108 2 m$116 2 $130 2 +142  )2 CFacility Construction.............................................. 2 ;41 2 y50 2 65 2 +152  '2 @Sanitation Construction......................................... 2 ;89 2 y92 2 97 2 +5--'-- = - 2 . 2 .-Maintenance & Improvement / Medical Equipment---'-- N'  2 .;59- ! ;;- 2 .y62- ! ;y- 2 .62- ! ;-:$ 2 .0- !;--2 P 2 P-Subtotal, Health Facilities Program Level.... 2 P+$297 2 Pi$320 2 P$354 2 P+$342 r &2 r=Total, Program Level.........................................2 r!$2,6692 r_$2,8312 r$3,0602 r+$229-C2 (Less Funds Allocated From Other Sources:   2  (2 AInsurance Collections............................................ 2 1-394 2 o-405 2 -405$ 2 02  -2 LQuarters.................................................................... 2 =-5 2 {-5 2 -5$ 2 02  -2 KDiabetes...................................................................- 2 7-30- !7- 2 u-30- !u- 2 -30- !-$ 2 0- !--2  %2 ;Total, Budget Authority....................................2 !$2,2402 _$2,3912 $2,6202 +$229-2  12 SFTE................................................................................(C2 "14,586("2  2 " (2 `14,673(`2 Q 2 ` (2 14,823(2  2  2  +1502 >.2 >M/1 These mandatory funds are appropriated in the Balanced Budget Act of 1997.--'-- N'--'- N''WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICT8 B8<  C   N'''  ' N'' N'-   !_'Times New Roman!-Times New RomanP---"Systemn-'-- -I -------  2 +1999 -2 #Actua - ! %#-- 2 Cl-----'-- -J------ 2 i2000 -2 [Enacted- !*%[------'-- ------- 2 2001 -2 Request - !,%------'-- -&-------- 2 Request +/- -2 Enacted- !*%----'-- N'Times New Roman4- (2 /Indian Health Service: 2 @ +2 @GClinical Services......................................................2 @&$1,9342 @d$2,0392 @$2,174 2 @ $135Times New Roman4-2 Q 2 Q/Contract Health Services (nod add)............. 2 Q0386 2 Qn407 2 Q448 2 Q +41 -2 b )2 bDPreventive Health................................................... 2 b;87 2 by92 2 b103 2 b+112 s '2 s?Contract Support Costs......................................... 2 s5204 2 ss229 2 s269 2 s+402 +2 GUrban Health........................................................... 2 ;26 2 y28 2 31 2 +32 "2 5Health Professions/Direct Operations................. 2 ;91 2 y93 2 99 2 +62 )2 DDiabetes Grants /1..................................................Times New Roman4- 2 ;30- ! ;- 2 y30- ! y- 2 30- ! -$ 2 0- !--2 2 ,Subtotal, Health Services Program Level.....2 !$2,3722 _$2,5112 $2,706 2 $195--2 Indian Health Facilities: 2 (2 AEnvironmental Health............................................. 2 /$108 2 m$116 2 $130 2 +142  )2 CFacility Construction.............................................. 2 ;41 2 y50 2 65 2 +152  '2 @Sanitation Construction......................................... 2 ;89 2 y92 2 97 2 +5--'-- = - 2 . 2 .-Maintenance & Improvement / Medical Equipment---'-- N'  2 .;59- ! ;;- 2 .y62- ! ;y- 2 .62- ! ;-:$ 2 .0- !;--2 P 2 P-Subtotal, Health Facilities Program Level.... 2 P+$297 2 Pi$320 2 P$354 2 P+$342 r &2 r=Total, Program Level.........................................2 r!$2,6692 r_$2,8312 r$3,0602 r+$229-C2 (Less Funds Allocated From Other Sources:   2  (2 AInsurance Collections............................................ 2 1-394 2 o-405 2 -405$ 2 02  -2 LQuarters.................................................................... 2 =-5 2 {-5 2 -5$ 2 02  -2 KDiabetes...................................................................- 2 7-30- !7- 2 u-30- !u- 2 -30- !-$ 2 0- !--2  %2 ;Total, Budget Authority....................................2 !$2,2402 _$2,3912 $2,6202 +$229-2  12 SFTE................................................................................(C2 "14,586("2  2 " (2 `14,673(`2 Q 2 ` (2 14,823(2  2  2  +1502 >.2 >M/1 These mandatory funds are appropriated in the Balanced Budget Act of 1997.--'-- N'--'- N'' 8 mG"XLXXXXLXXXL-X,XX-  _ Tocarryoutits  mission,CDCneedsmodern,securelaboratoryfacilities.MuchofCDCslabspaceisovercrowdedandoutdated.   mG"XLXXXXLXXXL-X,XX-  _ 5,500deaths  relatedtoAIDSoccurintheSubSaharanregionofAfricaeachday.  mG"XXXXXXXX-X,XX-  _2(hH  Z6Times New Roman Regular mG"XLXXXXLXXXL-X,XX-  _ Thenationhasa  rareopportunitytoeliminatesyphilisintheU.S. <==@:QuickFormat7X  X    mG"XLXXXXLXXXL-X,XX-  _ XXL  @@MMNumberof_Mammogram_ԀandPapSmearScreening@@  Among_NBCCEDP_ԀParticipants#XLX# *OLE* mG"XXXXXXXX-X,XX-  _ Reachingthe  PresidentsGoalofOneMillionChildrenby2002 .(hH  Z6Times New Roman Regular  mG"XXXXXXXX-X,XX-  _ Some3to4million  olderindividualsrelyoncarefromfamilyandclosefriendstoremainathome. WPCV V !V BE "    9''  ' 9' 9-   !9 !q !  ! ,Times New Roman-  2 g1999 2 2000 2 20012 Request Times New Roman4--"Systemn-'-- "9- 2 _Actual - !$ _---2 Enacted- !* ---2 Request - !, ---2  +/- Enacted- !< ----'-- 9Times New Roman4- H2 /+Centers for Disease Control and Prevention: LM2 @ZInfectious Diseases....................................................................... 2 @M L 2 @g$137L 2 @$176L 2 @$202L& 2 @$26Times New Roman)-]Ip2 QF Emerging Infectious Diseases (non-add).............................  2 QI 2 Qs79 2 Q98 2 Q123 2 Q+25 nK2 bU Food Safety (non-add).............................................................2 bK 2 bs19 2 b29 2 b39 2 b+10 -Mg2 s@Chronic Disease Prevention and Health Promotion.................   2 sM  2 sm299 2 s375 2 s385 2 s+10 -K2 W Tobacco (non-add)...................................................................2 K 2 s74 2 98 2 103 2 +5 -L2 ^Immunization.................................................................................. 2 L  2 m448 2 510 2 530 2 +20 Ls2 HRace and Health Demonstration Projects..................................   2 L  2 s10 2 30 2 35 2 +5 M2 QSexually Transmitted Diseases....................................................  2 M  2 m124 2 136 2 151 2 +15 N2 `HIV/AIDS........................................................................................   2 N  2 m657 2 730 2 795 2 +66 -I2 S Global AIDS (non-add)...........................................................  2 I 2 y-- 2 35 2 61 2 +26 -L2 TBreast and Cervical Cancer..........................................................2 L  2 m159 2 166 2 171 2 +5 N2 POccupational Safety and Health..................................................  2 N  2 m200 2 215 2 220 2 +5 L2 eInjury...............................................................................................2 L  2 s64 2 90 2 95 2 +5 -)Is2 H Violence Against Women (non-add).....................................  2 I 2 z0 2 10) 2 15 2 +5 -:M2 .^Health Statistics............................................................................. 2 .M : 2 .s94: 2 .105: 2 .110 2 .+5 -KJ2 ?Q 1% Evaluation (non-add)....................................................... 2 ?J 2 ?s68 2 ?72 2 ?77 2 ?+5 -\L2 PXPrevention Research.....................................................................2 PL \ 2 Ps15\ 2 P15\ 2 P15 2 P#- mN2 aRPreventive Health Block Grant..................................................... 2 aN m 2 am195m 2 a179m 2 a179 2 a#- -~K2 rZ Rape Prevention........................................................................2 rK 2 rs45 2 r44 2 r44-~& 2 r"-~"2 r 2 r" N2 _Tuberculosis...................................................................................2 N  2 m120 2 128 2 128 2 #- N2 SChildhood Lead Poisoning...........................................................2 N  2 s38 2 38 2 38 2 #- M2 ZPrevention Centers........................................................................2 M  2 s13 2 18 2 15 2 -3 M2 [Epidemic Services.......................................................................... 2 M  2 s86 2 104 2 86 2 -18 N2 YBuildings and Facilities.................................................................2 N  2 s18 2 57 2 127 2 +70 N2 [Office of the Director.....................................................................  2 N  2 s31 2 38 2 36 2 -2 M2 WBioterrorism (PHSSEF)..................................................................  2 M  2 m124 2 155 2 149 2 -6 Mu2 IEPA Superfund Allocation (ATSDR).........................................    2 M  2 s76 2 70 2 64 2 -6 Mr2 GMandatory Budget Authority (Diabetes)..................................   2 M  2 y3 2 3 2 3& 2 "-"2  2 " (L2 aUser Fees........................................................................................ 2 L Times New Roman4-( 2 y2- !)y-( 2 2- !)-( 2 2- !)-Times New Roman--(& 2 "-("2  - !6+-2 " -<M2 0USubtotal , Program Level............................................................. 2 0M <2 0Y$2,912<2 0$3,339<2 0$3,534<&2 0+$195-E2 R)Less Funds Allocated from Other Sources :   oM2 cWBioterrorism (PHSSEF)..................................................................  2 cM 2 cj-124 2 c-155 2 c-149  2 c+6 N2 tQ1% Evaluation (Health Statistics)................................................  2 tN 2 tp-68  2 t-72  2 t-77  2 t-5 Mu2 IEPA Superfund Allocation (ATSDR).........................................    2 M 2 p-76  2 -70  2 -64  2 +6 Mr2 GMandatory Budget Authority (Diabetes)..................................   2 M 2 v-3  2 -3  2 -3 & 2 "-"2  2 " L2 aUser Fees........................................................................................ 2 L - 2 v-2 - !z- 2 -2 - !- 2 -2 - !-& 2 "-"2  - !6-2 " -M2 VTotal, Budget Authority...............................................................  2 M 2 Y$2,6392 $3,0372 $3,239&2 +$202-N2 fFTE...................................................................................................2 N 2 d7,4912 7,9232 8,0612 +138 -'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICT:2HE:M "    9''  ' 9' 9-   !9 !q !  ! ,Times New Roman-  2 g1999 2 2000 2 20012 Request Times New Roman4--"Systemn-'-- "9- 2 _Actual - !$ _---2 Enacted- !* ---2 Request - !, ---2  +/- Enacted- !< ----'-- 9Times New Roman4- H2 /+Centers for Disease Control and Prevention: LM2 @ZInfectious Diseases....................................................................... 2 @M L 2 @g$137L 2 @$176L 2 @$202L& 2 @$26Times New Roman)-]Ip2 QF Emerging Infectious Diseases (non-add).............................  2 QI 2 Qs79 2 Q98 2 Q123 2 Q+25 nK2 bU Food Safety (non-add).............................................................2 bK 2 bs19 2 b29 2 b39 2 b+10 -Mg2 s@Chronic Disease Prevention and Health Promotion.................   2 sM  2 sm299 2 s375 2 s385 2 s+10 -K2 W Tobacco (non-add)...................................................................2 K 2 s74 2 98 2 103 2 +5 -L2 ^Immunization.................................................................................. 2 L  2 m448 2 510 2 530 2 +20 Ls2 HRace and Health Demonstration Projects..................................   2 L  2 s10 2 30 2 35 2 +5 M2 QSexually Transmitted Diseases....................................................  2 M  2 m124 2 136 2 151 2 +15 N2 `HIV/AIDS........................................................................................   2 N  2 m657 2 730 2 795 2 +66 -I2 S Global AIDS (non-add)...........................................................  2 I 2 y-- 2 35 2 61 2 +26 -L2 TBreast and Cervical Cancer..........................................................2 L  2 m159 2 166 2 171 2 +5 N2 POccupational Safety and Health..................................................  2 N  2 m200 2 215 2 220 2 +5 L2 eInjury...............................................................................................2 L  2 s64 2 90 2 95 2 +5 -)Is2 H Violence Against Women (non-add).....................................  2 I 2 z0 2 10) 2 15 2 +5 -:M2 .^Health Statistics............................................................................. 2 .M : 2 .s94: 2 .105: 2 .110 2 .+5 -KJ2 ?Q 1% Evaluation (non-add)....................................................... 2 ?J 2 ?s68 2 ?72 2 ?77 2 ?+5 -\L2 PXPrevention Research.....................................................................2 PL \ 2 Ps15\ 2 P15\ 2 P15 2 P#- mN2 aRPreventive Health Block Grant..................................................... 2 aN m 2 am195m 2 a179m 2 a179 2 a#- -~K2 rZ Rape Prevention........................................................................2 rK 2 rs45 2 r44 2 r44-~& 2 r"-~"2 r 2 r" N2 _Tuberculosis...................................................................................2 N  2 m120 2 128 2 128 2 #- N2 SChildhood Lead Poisoning...........................................................2 N  2 s38 2 38 2 38 2 #- M2 ZPrevention Centers........................................................................2 M  2 s13 2 18 2 15 2 -3 M2 [Epidemic Services.......................................................................... 2 M  2 s86 2 104 2 86 2 -18 N2 YBuildings and Facilities.................................................................2 N  2 s18 2 57 2 127 2 +70 N2 [Office of the Director.....................................................................  2 N  2 s31 2 38 2 36 2 -2 M2 WBioterrorism (PHSSEF)..................................................................  2 M  2 m124 2 155 2 149 2 -6 Mu2 IEPA Superfund Allocation (ATSDR).........................................    2 M  2 s76 2 70 2 64 2 -6 Mr2 GMandatory Budget Authority (Diabetes)..................................   2 M  2 y3 2 3 2 3& 2 "-"2  2 " (L2 aUser Fees........................................................................................ 2 L Times New Roman4-( 2 y2- !)y-( 2 2- !)-( 2 2- !)-Times New Roman--(& 2 "-("2  - !6+-2 " -<M2 0USubtotal , Program Level............................................................. 2 0M <2 0Y$2,912<2 0$3,339<2 0$3,534<&2 0+$195-E2 R)Less Funds Allocated from Other Sources :   oM2 cWBioterrorism (PHSSEF)..................................................................  2 cM 2 cj-124 2 c-155 2 c-149  2 c+6 N2 tQ1% Evaluation (Health Statistics)................................................  2 tN 2 tp-68  2 t-72  2 t-77  2 t-5 Mu2 IEPA Superfund Allocation (ATSDR).........................................    2 M 2 p-76  2 -70  2 -64  2 +6 Mr2 GMandatory Budget Authority (Diabetes)..................................   2 M 2 v-3  2 -3  2 -3 & 2 "-"2  2 " L2 aUser Fees........................................................................................ 2 L - 2 v-2 - !z- 2 -2 - !- 2 -2 - !-& 2 "-"2  - !6-2 " -M2 VTotal, Budget Authority...............................................................  2 M 2 Y$2,6392 $3,0372 $3,239&2 +$202-N2 fFTE...................................................................................................2 N 2 d7,4912 7,9232 8,0612 +138 -' 6 FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHS_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument*OLE*WPC  Z(Z(!Z(  V   'h̻ """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' - 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"-  $ "- "--'-- o o88--'--  "- --'-- --'-- --'--  "- -  $AA$>>>$88$K8K8K3f - 3f$AAA$>>>$888$8KK88K--'-- 3f--'-- 3f "- Times New RomanL-oo88Times New Roman -----"Systemn-'--- 3fPa  02 fPulseNet Public Health Labs      ----'--- ---'--- --- "--  ---'---    2 7----'--- --  M\---'--- ~M\   2 W`20----'--- --  ---'---    2 40----'--- --  Y---'--- Y   2 c40----'--- --  nM:---'--- ~mM:   2 W>+10----'--- --  rL---'--- qL   2 P+5----'--- --  rYL---'--- qYL   2 cP+5----'--- --  k---'--- k   2 o+8----'--- ---'---   2 b0 2 ba10 2 b20 2 b30 2 b*40 2 b50---'--- Times New Romanct----'---  2 _Shigella  2 WcListeria  2 > Salmonella 2 eE coli 0157:H7   ---'--- ---'--- -- 45- "- y--- - -sArial- - -- -- - 2 FY 2000' ---- --- - --- 2 )FY 2001' -- -'  '  'WPWin 6.0/OLE 1.0 Prefix Information MarkerExcel.Sheet.8Lࡱ> $  !"#Root Entry F[mOle 8CompObjfWorkbook (F! WP 7 [14] FMicrosoft Excel WorksheetBiff8Excel.Sheet.89q?Oh+'08@Th  ASMB User  ASMB User Microsoft Excel@z4d A\p ASMB User Ba== <X@"1Arial1Arial1Arial1Arial1.Times New Roman1Arial1Arial1.Times New Roman1.Times New Roman1Arial1.Times New Roman1Arial"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                + ) , *      ` Chart2Sheet1Sheet2Sheet3ZR3  @@  P SalmonellaListeriaShigellaFY 2000FY 2001E coli 0157:H7~ t0r0@#T0:s0}zb0b.b10tbed@q & btbƎ0|b1.0qՁbbe0(Н0&p70v8by7uqywBwBTuqbazp0&bb&0sT0b0sT0q(btqf&S0bt002  A  dMbP?_*+%"??U}  T0bb  e   @ @ 4@$@  D@@  D@@P&$$$>@  A  dMbP?_*+%"??U>@ A  dMbP?_*+%"??U>@ BOlePartOlePres000SummaryInformation(DocumentSummaryInformation8gO     ' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' - 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"-  $ "- "--'-- o o88--'--  "- --'-- --'-- --'--  "- -  $AA$>>>$88$K8K8K3f - 3f$AAA$>>>$888$8KK88K--'-- 3f--'-- 3f "- Times New RomanL-oo88Times New Roman -----"Systemn-'--- 3fPa  02 fPulseNet Public Health Labs      ----'--- ---'--- --- "--  ---'---    2 7----'--- --  M\---'--- ~M\   2 W`20----'--- --  ---'---    2 40----'--- --  Y---'--- Y   2 c40----'--- --  nM:---'--- ~mM:   2 W>+10----'--- --  rL---'--- qL   2 P+5----'--- --  rYL---'--- qYL   2 cP+5----'--- --  k---'--- k   2 o+8----'--- ---'---   2 b0 2 ba10 2 b20 2 b30 2 b*40 2 b50---'--- Times New Romanct----'---  2 _Shigella  2 WcListeria  2 > Salmonella 2 eE coli 0157:H7   ---'--- ---'--- -- 45- "- y--- - -sArial- - -- -- - 2 FY 2000' ---- --- - --- 2 )FY 2001' -- -'  '  'WPC@@>>>>!>>  '   7%''  ' 7% "--   "--'-- 7%- $"99""99"9"9"--'-- 2 --'-- 9"--'-- 7" "-8-  $&88&&$ASSAA$\nn\\$www$$yyy$eee$OOO$EEE--'-- 9"--'-- 7% "-9" "Small Fonts-"""""""vv"aa"MM"99""Times New Roman-Times New RomanF-Small Fonts|(--------"Systemn-'--- 5 /---  '2 2NIH FUNDING HISTORY      -'2 %p(Dollars in billions)----'--- 7%---'--- 7%------'--- sX 2 Z$11.3----'--- 7%-----'--- p 2 r$12.7----'--- 7%-----'--- wg 2 i$13.6----'--- 7%-----'--- cS 2 U$15.6----'--- 7%-----'--- M= 2 ?$17.8----'--- 7%-----'--- W< 2 >$10.9----'--- 7%-----'--- =" 2 $$10.3----'--- 7%-----'--- yr 2 {t$11.9----'--- 7%-----'--- H8 2 :$18.8----'--- 7%---'--- 7%  2 $0 2 $2 2 $4 2 $6 2 $8 2 $10 2 $12 2 p $14 2 [ $16 2 G $18 2 3 $20---'--- 7%---'--- 7%  2 &1993 2 A1994 2 \1995 2 w1996 2 1997 2 1998 2 1999 2 2000 2 2001---'--- 7%Small Fonts-- - 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 $YYppY$GG$$  $::QQ:$rrr$$$$& "-- 5B( ̙>>>|>Ǐ|||--- !p- ---& -$ppp-&-- 5B( ̙>>>|>Ǐ|||-- !6- ---& -$-&-- 5B( ̙>>>|>Ǐ|||-- !- ---& -$-&-- 5B( ̙>>>|>Ǐ|||&-- !- ---& -$oo//-&-- 5B( ̙>>>|>Ǐ|||OT-- !EQ- ---& -$QQggQ-&-- 5B( ̙>>>|>Ǐ|||-'-- !u- ---& -$-&-- 5B( ̙>>>|>Ǐ|||-'-- !W- ---& -$-&-- 5B( ̙>>>|>Ǐ|||2 q-- !- ---& -$---'-- OT--'-- ( "-T TNT--'-- (Times New Roman-----"Systemn-'--- E  2 65,713  ---'--- (-----'--- S 2 \96,495  ---'--- (-----'---  j 2 q45,289  ---'--- (-----'--- o 2 x109,994  ---'--- (-----'--- 5m 2 #170,717  ---'--- (-----'--- mJ~ 2 Q206,406  ---'--- (-----'--- l 2 s225,088  ---'--- (-----'---  2 223,978  ---'--- (-----'--- # 2 235,000  ---'--- (-----'--- vS 2 Z26,897  ---'--- (-----'---   2 136,139  ---'--- (-----'--- W4C 2 ;L185,059  ---'--- (-----'---  2 223,305  ---'--- (-----'---  2 212,733  ---'--- (-----'---  2 230,000  ---'--- (-----'---   2 136,496  ---'--- (Times New Roman4----'--- (  2 --2 -50,000  2 -100,000  2 -150,000  2 -200,000  2 -1250,000  ---'--- (---'--- ( 2 g>FY91/92  2 UFY93 2 UFY94 2 UFY95 2 HUFY96 2 UFY97 2 UFY98 2 . FY99 Est.  ---'--- (- "- -  M---'---  L---'---  L "-  -   2  Mammograms   ---'--- L---'--- L "- &-- 5B( ̙>>>|>Ǐ|||-- ! - -- -& - -2  Pap Smears   ---'---  L---'---  (---'---  o-- ' o '  'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT'^,'^c@  5   o''  ' o' (- "-  $TNTNT "- "--'-- RTLT TT44TTNN--'-- (L "-T TNNT--'-- (--'-- #--'-- OT--'-- PT "- -  $YYppY$GG$$  $::QQ:$rrr$$$$& "-- 5B( ̙>>>|>Ǐ|||--- !p- ---& -$ppp-&-- 5B( ̙>>>|>Ǐ|||-- !6- ---& -$-&-- 5B( ̙>>>|>Ǐ|||-- !- ---& -$-&-- 5B( ̙>>>|>Ǐ|||&-- !- ---& -$oo//-&-- 5B( ̙>>>|>Ǐ|||OT-- !EQ- ---& -$QQggQ-&-- 5B( ̙>>>|>Ǐ|||-'-- !u- ---& -$-&-- 5B( ̙>>>|>Ǐ|||-'-- !W- ---& -$-&-- 5B( ̙>>>|>Ǐ|||2 q-- !- ---& -$---'-- OT--'-- ( "-T TNT--'-- (Times New Roman-----"Systemn-'--- E  2 65,713  ---'--- (-----'--- S 2 \96,495  ---'--- (-----'---  j 2 q45,289  ---'--- (-----'--- o 2 x109,994  ---'--- (-----'--- 5m 2 #170,717  ---'--- (-----'--- mJ~ 2 Q206,406  ---'--- (-----'--- l 2 s225,088  ---'--- (-----'---  2 223,978  ---'--- (-----'--- # 2 235,000  ---'--- (-----'--- vS 2 Z26,897  ---'--- (-----'---   2 136,139  ---'--- (-----'--- W4C 2 ;L185,059  ---'--- (-----'---  2 223,305  ---'--- (-----'---  2 212,733  ---'--- (-----'---  2 230,000  ---'--- (-----'---   2 136,496  ---'--- (Times New Roman4----'--- (  2 --2 -50,000  2 -100,000  2 -150,000  2 -200,000  2 -1250,000  ---'--- (---'--- ( 2 g>FY91/92  2 UFY93 2 UFY94 2 UFY95 2 HUFY96 2 UFY97 2 UFY98 2 . FY99 Est.  ---'--- (- "- -  M---'---  L---'---  L "-  -   2  Mammograms   ---'--- L---'--- L "- &-- 5B( ̙>>>|>Ǐ|||-- ! - -- -& - -2  Pap Smears   ---'---  L---'---  (---'---  o-- ' o '  ' F mG"XLXXXXLXXXL-X,XX-  _ EveryNIH  Institute,Center,andprogrammaticunitwillparticipateindevelopingaTransNIHStrategicPlanforResearchonHealthDisparities.  v mG"XLXXXXLXXXL-X,XX-  _ Oneofthehighest  researchprioritiesremainsthesearchforasafeandeffectivevaccinetopreventinfection.NIHfundingforAIDSvaccineresearchwillincreaseby12percentinFY2001. *OLE* V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument*OLE*WPC+-+-!+- Pd   w''  ' w' w-   !Times New Roman-  2 R1999 2 2000 2  20012 uRequest Times New Roman%-2 GActual - !+(G-2 Enacted - !6(-2 Request - !8(-2 a +/- Enacted  - !L(a-Times New Roman -P [2 A8Budget Authority........................................  2 A  Pm2 A9$15,597P2 A$17,813P;2 A$18,813P2 As+$1,000 r d2 c>FTE........................................................... 2 c  rm2 cA15,329r2 c16,673r;2 c17,070r 2 c+397 -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTGGL  Pd   w''  ' w' w-   !Times New Roman-  2 R1999 2 2000 2  20012 uRequest Times New Roman%-2 GActual - !+(G-2 Enacted - !6(-2 Request - !8(-2 a +/- Enacted  - !L(a-Times New Roman -P [2 A8Budget Authority........................................  2 A  Pm2 A9$15,597P2 A$17,813P;2 A$18,813P2 As+$1,000 r d2 c>FTE........................................................... 2 c  rm2 cA15,329r2 c16,673r;2 c17,070r 2 c+397 -'WPC@@>>>>!>>  B   9''  ' 9 "--  : "--'-- 9--'-- 4 "-8-  B$"h hiiijjj jjjiiiihggffedcba`_^\[ZXWVSRQNMKHGEBA?=:8731/,*($"  ~||{yyxwvuuttssrrrr rrrrrrss"t$t't+u-v "h3f8- 3f:$-v/w3x5y7y;{=|?|C~EGKMNRTVY[\`acfg -v̙8- ̙@$gilmnprtuwxy{|}~ g& "-- f5B( f>>>|>|||ځ ً @T0-,$   ---&8-.$  -ff8- ff$ ~ }"|$ &-- 5B( >>>|>|||uw+_^[-$ |${&y*x,w.u1t3r5p8n:  ---&8-$ |${&y*x,w.u1t3r5p8n: |$-f8- f$n:m<m<l= n:8- $ l=j?iAgBfDdEcG l=&-- 5B( PF0P->$cGaH^K\M[NYOVRTSRUPVMXKYIZG[C]A^?_=`9b7b5c3d/e-f+f)g$g"h  ---&8-@$cGaH^K\M[NYOVRTSRUPVMXKYIZG[C]A^?_=`9b7b5c3d/e-f+f)g$g"h cG---'-- 9Times New Roman0-------"Systemn-'--- Cb  "2 FY 2001 NIH Budget   K2 'e-$18.8 Billion - Percent of Total by Mechanism           ----'--- 9 "-z iuinM|330vUU<mChr<k<\E---'--- 9Times New Roman1-----------'--- qr $2 t Other Res., Cancer  2 Control, NLM,  "2  Extramural Constr.   2 09.4% ----'--- 9--------'--- { !2 !Research Project 2 ;Grants 2 >56.9% ----'--- 9-------'---  2  R&D Contracts   2 6.5% ----'--- 9-------'---  !2 Research Training 2 3.0% ----'--- 9--------'--- J 2  Res. Mgmt. &    2 ,Support 2 :3.3% ----'--- 9-------'--- e2E $2 GBldgs. & Facilities  2 U0.8% ----'--- 9--------'--- k 2 mOffice of the 2 {Director 2 1.6% ----'--- 9--------'---  2  Intramural  2 Research 2 9.7% ----'--- 9-------'--- yYu 2 [wResearch Centers  2 i8.8% ----'--- 9---'--- 9- - -4--- --- - --  - ' 9 '  'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT::%-  B   9''  ' 9 "--  : "--'-- 9--'-- 4 "-8-  B$"h hiiijjj jjjiiiihggffedcba`_^\[ZXWVSRQNMKHGEBA?=:8731/,*($"  ~||{yyxwvuuttssrrrr rrrrrrss"t$t't+u-v "h3f8- 3f:$-v/w3x5y7y;{=|?|C~EGKMNRTVY[\`acfg -v̙8- ̙@$gilmnprtuwxy{|}~ g& "-- f5B( f>>>|>|||ځ ً @T0-,$   ---&8-.$  -ff8- ff$ ~ }"|$ &-- 5B( >>>|>|||uw+_^[-$ |${&y*x,w.u1t3r5p8n:  ---&8-$ |${&y*x,w.u1t3r5p8n: |$-f8- f$n:m<m<l= n:8- $ l=j?iAgBfDdEcG l=&-- 5B( PF0P->$cGaH^K\M[NYOVRTSRUPVMXKYIZG[C]A^?_=`9b7b5c3d/e-f+f)g$g"h  ---&8-@$cGaH^K\M[NYOVRTSRUPVMXKYIZG[C]A^?_=`9b7b5c3d/e-f+f)g$g"h cG---'-- 9Times New Roman0-------"Systemn-'--- Cb  "2 FY 2001 NIH Budget   K2 'e-$18.8 Billion - Percent of Total by Mechanism           ----'--- 9 "-z iuinM|330vUU<mChr<k<\E---'--- 9Times New Roman1-----------'--- qr $2 t Other Res., Cancer  2 Control, NLM,  "2  Extramural Constr.   2 09.4% ----'--- 9--------'--- { !2 !Research Project 2 ;Grants 2 >56.9% ----'--- 9-------'---  2  R&D Contracts   2 6.5% ----'--- 9-------'---  !2 Research Training 2 3.0% ----'--- 9--------'--- J 2  Res. Mgmt. &    2 ,Support 2 :3.3% ----'--- 9-------'--- e2E $2 GBldgs. & Facilities  2 U0.8% ----'--- 9--------'--- k 2 mOffice of the 2 {Director 2 1.6% ----'--- 9--------'---  2  Intramural  2 Research 2 9.7% ----'--- 9-------'--- yYu 2 [wResearch Centers  2 i8.8% ----'--- 9---'--- 9- - -4--- --- - --  - ' 9 '  '(hH  Z6Times New Roman Regular*OLE*WPC@@>>>>!>>& L -   u''  ' u "--   "--'-- u- $1]]f1f1]]1]ff1]1--'-- p--'-- f]1--'-- h[1 "-8-  $1a?a?v1v1a$1~@~@11~$1==11$1EE11$1RR11$1bb 1 1$1ss'1'1$1//E1E1/$1MMb1b1M8- $1avavv1v1a$1~z~z11~$1}}11$1||11$111$1 1 1$1'1'1$1//E1E1/$1MMb1b1M--'-- f]1--'-- u "-]1 f1Times New Roman0-].]1z.z1.1.1.1.1.1+.+1I.I1f.f1Times New Roman%---------"Systemn-'--- 9\ a--  *2 dRESEARCH PROJECT GRANTS   -$2 &(1993-2001 Request)----'--- u---'--- uTimes New Roman4------'--- vf`A 2 cC23,952----'--- u-----'--- g~B 2 D24,050----'--- u-----'--- d? 2 A23,828----'--- u-----'--- lG 2 I24,507----'--- u-----'--- yT 2 V25,638----'--- u-----'---  d 2 f27,073----'--- u-----'--- 'u 2 w28,606----'--- u-----'--- D. 2 131,287----'--- u-----'--- bL 2 O31,524----'--- u-----'--- vt`U  2 Wcrs2 cW6,149----'--- u-----'--- x~Y  2 [v2 [6,474----'--- u-----'--- {\  2 ^y2 ^6,759----'--- u-----'--- z[  2 ]x2 ]6,653----'--- u-----'--- c  2 e2 e7,390----'--- u-----'---  e  2 g2 g7,578----'--- u-----'--- 'p  2 r$2 r8,532----'--- u-----'--- D.u  2 w1A2 1w8,950----'--- u-----'--- bLf  2 hO_2 Oh7,641----'--- u----'--- u  2 e1993 2 1994 2 1995 2 1996 2 1997 2 1998 2 1999 2 32000 2 P2001---'--- u---'--- u-- -4Times New Roman0------- "- ^G--- -  ---- - n--- -  ---- - --- -  ---- - _J--- -  ---- - t_--- -  ---- - m`--- -  ---- - t_--- -  ---- - \G--- -  -Z|H-- 2 INew & Competing    ' u--- - \gGB--- -  -ZcHE-- 2 IFTotal' u--- - \ G--- -  -ZH-- 2 I Non-Competing   ' u-- -' u '  'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTH.t&H.& L -   u''  ' u "--   "--'-- u- $1]]f1f1]]1]ff1]1--'-- p--'-- f]1--'-- h[1 "-8-  $1a?a?v1v1a$1~@~@11~$1==11$1EE11$1RR11$1bb 1 1$1ss'1'1$1//E1E1/$1MMb1b1M8- $1avavv1v1a$1~z~z11~$1}}11$1||11$111$1 1 1$1'1'1$1//E1E1/$1MMb1b1M--'-- f]1--'-- u "-]1 f1Times New Roman0-].]1z.z1.1.1.1.1.1+.+1I.I1f.f1Times New Roman%---------"Systemn-'--- 9\ a--  *2 dRESEARCH PROJECT GRANTS   -$2 &(1993-2001 Request)----'--- u---'--- uTimes New Roman4------'--- vf`A 2 cC23,952----'--- u-----'--- g~B 2 D24,050----'--- u-----'--- d? 2 A23,828----'--- u-----'--- lG 2 I24,507----'--- u-----'--- yT 2 V25,638----'--- u-----'---  d 2 f27,073----'--- u-----'--- 'u 2 w28,606----'--- u-----'--- D. 2 131,287----'--- u-----'--- bL 2 O31,524----'--- u-----'--- vt`U  2 Wcrs2 cW6,149----'--- u-----'--- x~Y  2 [v2 [6,474----'--- u-----'--- {\  2 ^y2 ^6,759----'--- u-----'--- z[  2 ]x2 ]6,653----'--- u-----'--- c  2 e2 e7,390----'--- u-----'---  e  2 g2 g7,578----'--- u-----'--- 'p  2 r$2 r8,532----'--- u-----'--- D.u  2 w1A2 1w8,950----'--- u-----'--- bLf  2 hO_2 Oh7,641----'--- u----'--- u  2 e1993 2 1994 2 1995 2 1996 2 1997 2 1998 2 1999 2 32000 2 P2001---'--- u---'--- u-- -4Times New Roman0------- "- ^G--- -  ---- - n--- -  ---- - --- -  ---- - _J--- -  ---- - t_--- -  ---- - m`--- -  ---- - t_--- -  ---- - \G--- -  -Z|H-- 2 INew & Competing    ' u--- - \gGB--- -  -ZcHE-- 2 IFTotal' u--- - \ G--- -  -ZH-- 2 I Non-Competing   ' u-- -' u '  ' b mG"XXXXXXXX-X,XX-  _ Accordingtothe  SurgeonGeneralsReportonMentalHealth,depressionistheleadingriskfactorforsuicideinolderadultsbutisneitherwellrecognizednortreated. (hH  Z6Times New Roman Regular*OLE**OLE*WPC!: K   ''  ' ' -   !Times New Roman-  2 c1999 2 2000 2 20012 ZRequest Times New Roman--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman- 2 $ Institutes:A'x2 5 KNational Cancer Institute.................................................. 2 5' A{2 5Z$2,657A2 5$3,067A-2 5 $3,250A2 5f+$183R'd2 F >National Heart, Lung, and Blood Institute.....................  2 F' R{2 F`1,710R2 F1,961R-2 F2,070R 2 Fl+109c*X2 W 6National Institute of Dental and Craniofacial Research  c{ 2 Wi220c 2 W249c- 2 W263c 2 Wr+14t'U2 h 4Natl Inst. of Diabetes & Digestive & Kidney Disease.       2 h' t{ 2 hi976t2 h1,119t-2 h1,186t 2 hr+67'W2 y 5National Institute of Neurological Disorders & Stroke    2 y' { 2 yi868 2 y996-2 y1,050 2 yr+54'Z2 7National Institute of Allergy & Infectious Diseases....    2 ' { 2 i768 2 881- 2 935 2 r+54)`2 ;National Institute of General Medical Sciences.............  2 ) {2 `1,1712 1,317-2 1,389 2 r+73)W2 5Natl Inst. of Child Health and Human Development.....      2 ) { 2 i676 2 770- 2 811 2 r+41(|2 NNational Eye Institute........................................................ 2 ( { 2 i385 2 439- 2 463 2 r+24(X2 6National Institute of Environmental Health Sciences...   2 ( { 2 i381 2 435- 2 461 2 r+26)u2 INational Institute on Aging..............................................  2 ) { 2 i598 2 684- 2 722 2 r+38'X2 6Natl Inst. Of Arthritis & Musculoskeletal & Skin Dis..       2 ' { 2 i301 2 344- 2 363 2 r+19 (T2  3Natl Inst. On Deafness & Communication Disorders...      2 (  { 2 i229  2 262 - 2 276  2 r+14)m2  DNational Institute of Mental Health.................................   2 ) { 2 i740 2 846- 2 896 2 r+50/(l2 # CNational Institute on Drug Abuse...................................   2 #( /{ 2 #i419/ 2 #469/- 2 #496/ 2 #r+27@)T2 4 3National Institute on Alcohol Abuse and Alcoholism.     2 4) @{ 2 4i243@ 2 4274@- 2 4289@ 2 4r+15Q(g2 E @National Institute for Nursing Research.........................  2 E( Q{ 2 Eo64Q 2 E82Q- 2 E!85Q 2 Ex+3b']2 V 9National Human Genome Research Institute.................    2 V' b{ 2 Vi280b 2 V332b- 2 V353b 2 Vr+22s(d2 g >National Center for Research Resources........................ 2 g( s{ 2 gi465s 2 g569s- 2 g603s 2 gr+34'U2 x 4Natl Center for Complementary & Alternative Med.....      2 x' { 2 xo50 2 x68- 2 x!71 2 xx+3's2  HFogarty International Center............................................2 ' { 2 o23 2 29- 2 !33 2 x+4)s2  HNational Library of Medicine............................................  2 ) { 2 i178 2 210- 2 225 2 r+15'~2  OOffice of the Director.........................................................  2 ' { 2 i212 2 237- 2 262 2 r+25)u2  IOffice of AIDS Research 1/...............................................   2 ) {2 `1,7932 2,006-2 2,111 2 l+105)~2  OBuildings & Facilities......................................................... 2 ) { 2 i191 2 165- 2 149 2 u-16)g2  @EPA Superfund Allocation (NIEHS)................................    2 ) { 2 o60 2 60- 2 !49 2 u-11)X2  6ONDCP Drug Forfeiture Fund Transfer (NIDA)............    2 ) { 2 o10 2 10- 2 !10 2 0 '{2  MDiabetes Research 2/......................................................... 2 ' Times New Roman0- { 2 o27- ! o-  2 27- ! - - 2 !27- ! !-  2 0- ! --)r2 GSubtotal, Program Level................................................ 2 ) {2 N$15,6932 $17,909-2 $18,8982 b+$989-C2 3(Less Funds Allocated from Other Sources:   P)g2 D @EPA Superfund Allocation (NIEHS)................................    2 D) P{ 2 De-$60P 2 D-$60P- 2 D-$49P 2 Dl+$11a)X2 U 6ONDCP Drug Forfeiture Fund Transfer (NIDA)............    2 U) a{ 2 Uk-10a 2 U-10a- 2 U-10a 2 U0r'{2 f MDiabetes Research 2/......................................................... 2 f' -r{ 2 fk-27- !sk-r 2 f-27- !s-r- 2 f-27- !s-r 2 f0- !s--(o2 wESubtotal, Budget Authority...........................................  2 w( {2 wN$15,5972 w$17,813-2 w$18,8132 wX+$1,000-'2 ]FTE..........................................................................................2 ' {2 Z15,3292 16,673-2  17,070 2 l+3972 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:bCdM K   ''  ' ' -   !Times New Roman-  2 c1999 2 2000 2 20012 ZRequest Times New Roman--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman- 2 $ Institutes:A'x2 5 KNational Cancer Institute.................................................. 2 5' A{2 5Z$2,657A2 5$3,067A-2 5 $3,250A2 5f+$183R'd2 F >National Heart, Lung, and Blood Institute.....................  2 F' R{2 F`1,710R2 F1,961R-2 F2,070R 2 Fl+109c*X2 W 6National Institute of Dental and Craniofacial Research  c{ 2 Wi220c 2 W249c- 2 W263c 2 Wr+14t'U2 h 4Natl Inst. of Diabetes & Digestive & Kidney Disease.       2 h' t{ 2 hi976t2 h1,119t-2 h1,186t 2 hr+67'W2 y 5National Institute of Neurological Disorders & Stroke    2 y' { 2 yi868 2 y996-2 y1,050 2 yr+54'Z2 7National Institute of Allergy & Infectious Diseases....    2 ' { 2 i768 2 881- 2 935 2 r+54)`2 ;National Institute of General Medical Sciences.............  2 ) {2 `1,1712 1,317-2 1,389 2 r+73)W2 5Natl Inst. of Child Health and Human Development.....      2 ) { 2 i676 2 770- 2 811 2 r+41(|2 NNational Eye Institute........................................................ 2 ( { 2 i385 2 439- 2 463 2 r+24(X2 6National Institute of Environmental Health Sciences...   2 ( { 2 i381 2 435- 2 461 2 r+26)u2 INational Institute on Aging..............................................  2 ) { 2 i598 2 684- 2 722 2 r+38'X2 6Natl Inst. Of Arthritis & Musculoskeletal & Skin Dis..       2 ' { 2 i301 2 344- 2 363 2 r+19 (T2  3Natl Inst. On Deafness & Communication Disorders...      2 (  { 2 i229  2 262 - 2 276  2 r+14)m2  DNational Institute of Mental Health.................................   2 ) { 2 i740 2 846- 2 896 2 r+50/(l2 # CNational Institute on Drug Abuse...................................   2 #( /{ 2 #i419/ 2 #469/- 2 #496/ 2 #r+27@)T2 4 3National Institute on Alcohol Abuse and Alcoholism.     2 4) @{ 2 4i243@ 2 4274@- 2 4289@ 2 4r+15Q(g2 E @National Institute for Nursing Research.........................  2 E( Q{ 2 Eo64Q 2 E82Q- 2 E!85Q 2 Ex+3b']2 V 9National Human Genome Research Institute.................    2 V' b{ 2 Vi280b 2 V332b- 2 V353b 2 Vr+22s(d2 g >National Center for Research Resources........................ 2 g( s{ 2 gi465s 2 g569s- 2 g603s 2 gr+34'U2 x 4Natl Center for Complementary & Alternative Med.....      2 x' { 2 xo50 2 x68- 2 x!71 2 xx+3's2  HFogarty International Center............................................2 ' { 2 o23 2 29- 2 !33 2 x+4)s2  HNational Library of Medicine............................................  2 ) { 2 i178 2 210- 2 225 2 r+15'~2  OOffice of the Director.........................................................  2 ' { 2 i212 2 237- 2 262 2 r+25)u2  IOffice of AIDS Research 1/...............................................   2 ) {2 `1,7932 2,006-2 2,111 2 l+105)~2  OBuildings & Facilities......................................................... 2 ) { 2 i191 2 165- 2 149 2 u-16)g2  @EPA Superfund Allocation (NIEHS)................................    2 ) { 2 o60 2 60- 2 !49 2 u-11)X2  6ONDCP Drug Forfeiture Fund Transfer (NIDA)............    2 ) { 2 o10 2 10- 2 !10 2 0 '{2  MDiabetes Research 2/......................................................... 2 ' Times New Roman0- { 2 o27- ! o-  2 27- ! - - 2 !27- ! !-  2 0- ! --)r2 GSubtotal, Program Level................................................ 2 ) {2 N$15,6932 $17,909-2 $18,8982 b+$989-C2 3(Less Funds Allocated from Other Sources:   P)g2 D @EPA Superfund Allocation (NIEHS)................................    2 D) P{ 2 De-$60P 2 D-$60P- 2 D-$49P 2 Dl+$11a)X2 U 6ONDCP Drug Forfeiture Fund Transfer (NIDA)............    2 U) a{ 2 Uk-10a 2 U-10a- 2 U-10a 2 U0r'{2 f MDiabetes Research 2/......................................................... 2 f' -r{ 2 fk-27- !sk-r 2 f-27- !s-r- 2 f-27- !s-r 2 f0- !s--(o2 wESubtotal, Budget Authority...........................................  2 w( {2 wN$15,5972 w$17,813-2 w$18,8132 wX+$1,000-'2 ]FTE..........................................................................................2 ' {2 Z15,3292 16,673-2  17,070 2 l+3972 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.   -'(hH  Z6Times New Roman Regular _ 1in4women  withoutinsurancecoveragehadforgonetreatmentneededcomparedto1in17forthoseinsured. WPC''!'b  0   x`' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' x`' x`-   !x`Times New Roman-  2 N1999 2 2000 2 20012 &Request Times New Roman)-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman0-Lc2 ?=Program Level................................................   2 ? 2 ?H$2,4872 ?$2,6522 ?$2,835LX2 ?4+$183sl2 fCFTE................................................................ 2 f 2 fY632 2 f686 2 f686 2 fV0-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>h >g  0   x`' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' x`' x`-   !x`Times New Roman-  2 N1999 2 2000 2 20012 &Request Times New Roman)-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman0-Lc2 ?=Program Level................................................   2 ? 2 ?H$2,4872 ?$2,6522 ?$2,835LX2 ?4+$183sl2 fCFTE................................................................ 2 f 2 fY632 2 f686 2 f686 2 fV0-' 1 mG"XLXXXXLXXXL-X,XX-  _ 60percentofpeople  withlifetimehistoriesofatleastonementalillnessneitherseeknorobtainhelpfortheirillness. *OLE*WPC!. R   ''  ' ' -   ! !  !  !wTimes New Roman4-  2 c1999 2 2000 2 20012 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman- 2 5 Mechanism:  R'v2 FJResearch Project Grants...................................................2 F' R{2 FZ$8,475R2 F$9,741R-2 F$10,333R2 Ff+$591Times New Roman-c$p2 WF[No. of Non-Competing]................................................    2 W$ 2 WL[20,074]2 W[22,337]2 W[23,883]2 WT[+1,546] t%p2 hF[No. of New/Competing]................................................     2 h% 2 hS[8,532]2 h[8,950]2 h[7,641]2 hY[-1,309]$x2 yK[Total No. of Grants]......................................................  2 y$ 2 yL[28,606]2 y[31,287]2 y[31,524]2 y^[+237] -O2 0Small Business Innovation Research (SBIR)/ Small  --'-- ( R2 2Business Technology Transfer (STTR) Grants.......2 ( { 2 i315 2 362- 2 381 2 r+18--'-- ) ~2 OResearch Centers...............................................................2 ) {2 `1,3852 1,561-2 1,654 2 r+94'|2 NResearch Training.............................................................2 ' { 2 i509 2 550- 2 564 2 r+14'~2 OR&D Contracts.................................................................. 2 ' {2 `1,0222 1,127-2 1,224 2 r+97 '{2 MIntramural Research.......................................................... 2 '  {2 `1,567 2 1,746 -2 1,823  2 r+77'2 POther Research.................................................................. 2 ' {2 `1,1142 1,395-2 1,457 2 r+61,(a2 <Extramural Research Facilities Construction................. 2 ( ,{ 2 o33, 2 76,- 2 !76, 2 {-1=(c2 1=Research Management and Support..............................  2 1( ={ 2 1i541= 2 1591=- 2 1614= 2 1r+23N)r2 BGNational Library of Medicine...........................................  2 B) N{ 2 Bi182N 2 B215N- 2 B230N 2 Br+15p'|2 dNOffice of the Director........................................................  2 d' p{ 2 di256p 2 d282p- 2 d309p 2 dr+27'y2 uLBuildings and Facilities....................................................2 u' { 2 ui197 2 u165- 2 u149 2 uu-16)f2 ?EPA Superfund Allocation (NIEHS)...............................    2 ) { 2 o60 2 60- 2 !49 2 u-11)W2 5ONDCP Drug Forfeiture Fund Transfer (NIDA)...........    2 ) { 2 o10 2 10- 2 !10 2 0'y2 LDiabetes Research 1/........................................................ 2 ' Times New Roman4-{ 2 o27- ! o- 2 27- ! -- 2 !27- ! !- 2 0- !--)o2 ESubtotal, Program Level.............................................. 2 ) {2 N$15,6932 $17,909-2 $18,8982 b+$989-C2 (Less Funds Allocated from Other Sources:   )f2 ?EPA Superfund Allocation (NIEHS)...............................    2 ) { 2 e-$60 2 -$60- 2 -$49 2 r+11 )W2 5ONDCP Drug Forfeiture Fund Transfer (NIDA)...........    2 )  { 2 k-10  2 -10 - 2 -10  2 0'y2 LDiabetes Research 1/........................................................ 2 ' -{ 2 k-27- !k- 2 -27- !-- 2 -27- !- 2 0- !--+(l2 CSubtotal, Budget Authority.........................................  2 ( +{2 N$15,597+2 $17,813+-2 $18,813+2 X+$1,000-M'2 A]FTE..........................................................................................2 A' M{2 AZ15,329M2 A16,673M-2 A 17,070M 2 Al+397u2 tI1/ These funds were pre-appropriated in the Balanced Budget Act of 1997.   -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbCv.bCB R   ''  ' ' -   ! !  !  !wTimes New Roman4-  2 c1999 2 2000 2 20012 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- Times New Roman- 2 5 Mechanism:  R'v2 FJResearch Project Grants...................................................2 F' R{2 FZ$8,475R2 F$9,741R-2 F$10,333R2 Ff+$591Times New Roman-c$p2 WF[No. of Non-Competing]................................................    2 W$ 2 WL[20,074]2 W[22,337]2 W[23,883]2 WT[+1,546] t%p2 hF[No. of New/Competing]................................................     2 h% 2 hS[8,532]2 h[8,950]2 h[7,641]2 hY[-1,309]$x2 yK[Total No. of Grants]......................................................  2 y$ 2 yL[28,606]2 y[31,287]2 y[31,524]2 y^[+237] -O2 0Small Business Innovation Research (SBIR)/ Small  --'-- ( R2 2Business Technology Transfer (STTR) Grants.......2 ( { 2 i315 2 362- 2 381 2 r+18--'-- ) ~2 OResearch Centers...............................................................2 ) {2 `1,3852 1,561-2 1,654 2 r+94'|2 NResearch Training.............................................................2 ' { 2 i509 2 550- 2 564 2 r+14'~2 OR&D Contracts.................................................................. 2 ' {2 `1,0222 1,127-2 1,224 2 r+97 '{2 MIntramural Research.......................................................... 2 '  {2 `1,567 2 1,746 -2 1,823  2 r+77'2 POther Research.................................................................. 2 ' {2 `1,1142 1,395-2 1,457 2 r+61,(a2 <Extramural Research Facilities Construction................. 2 ( ,{ 2 o33, 2 76,- 2 !76, 2 {-1=(c2 1=Research Management and Support..............................  2 1( ={ 2 1i541= 2 1591=- 2 1614= 2 1r+23N)r2 BGNational Library of Medicine...........................................  2 B) N{ 2 Bi182N 2 B215N- 2 B230N 2 Br+15p'|2 dNOffice of the Director........................................................  2 d' p{ 2 di256p 2 d282p- 2 d309p 2 dr+27'y2 uLBuildings and Facilities....................................................2 u' { 2 ui197 2 u165- 2 u149 2 uu-16)f2 ?EPA Superfund Allocation (NIEHS)...............................    2 ) { 2 o60 2 60- 2 !49 2 u-11)W2 5ONDCP Drug Forfeiture Fund Transfer (NIDA)...........    2 ) { 2 o10 2 10- 2 !10 2 0'y2 LDiabetes Research 1/........................................................ 2 ' Times New Roman4-{ 2 o27- ! o- 2 27- ! -- 2 !27- ! !- 2 0- !--)o2 ESubtotal, Program Level.............................................. 2 ) {2 N$15,6932 $17,909-2 $18,8982 b+$989-C2 (Less Funds Allocated from Other Sources:   )f2 ?EPA Superfund Allocation (NIEHS)...............................    2 ) { 2 e-$60 2 -$60- 2 -$49 2 r+11 )W2 5ONDCP Drug Forfeiture Fund Transfer (NIDA)...........    2 )  { 2 k-10  2 -10 - 2 -10  2 0'y2 LDiabetes Research 1/........................................................ 2 ' -{ 2 k-27- !k- 2 -27- !-- 2 -27- !- 2 0- !--+(l2 CSubtotal, Budget Authority.........................................  2 ( +{2 N$15,597+2 $17,813+-2 $18,813+2 X+$1,000-M'2 A]FTE..........................................................................................2 A' M{2 AZ15,329M2 A16,673M-2 A 17,070M 2 Al+397u2 tI1/ These funds were pre-appropriated in the Balanced Budget Act of 1997.   -'*OLE* V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument*OLE*WPCX X !X 8'     !' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' !' !-   !E !]D/ !]U/ !9 !]/ !0 !wTimes New Roman,-  2 c1999 2 2000 2 20012 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- !Times New Roman)- 2 5Mental Health:  2 F-,2 F JMental Health Block Grant................................................. 2 Fg$289 2 F$356 2 F$416 2 Fw$602 W-+2 W GTargeted Capacity Expansion............................................ 2 Wy0 2 W0 2 W%30 2 W}302 h-)2 h CPATH Homeless Formula Grant........................................ 2 hs26 2 h31 2 h%36 2 h52 y-$2 y :Knowledge Development and Application..................... 2 ys96 2 y137 2 y137 2 y02 -*2 EChildren's Mental Health Services.................................... 2 s78 2 83 2 %87 2 42 -,2 IProtection and Advocacy..................................................Times New Roman<- 2 s23- ! s- 2 25- ! - 2 %26- ! %- 2 1- !--(s2 HSubtotal, Mental Health.................................................  2 ( 2 c$512 2 $632 2 $732 2 m$100-2 Substance Abuse: )p2 FTargeted Capacity Expansion...........................................2 ) 2 g$133 2 $194 2 $248 2 w$54(o2 E Substance Abuse Treatment.........................................  2 ( 2 s55 2 114 2 163 2 }49 )o2  E Substance Abuse Prevention........................................ 2 ) 2 s78 2 80 2 %85 2 5'm2  DSubstance Abuse Block Grant......................................... 2 ' 2 g1585 2 1600 2 1631 2 }31/(]2 # 9Knowledge Development and Application....................     2 #( 2 #m193 2 #160 2 #145 2 #y-15Times New Roman$-@&o2 4 E Substance Abuse Treatment......................................... 2 4& - 2 4m115 2 4100 2 4%95 2 4-5-Q%m2 E D Substance Abuse Prevention.......................................2 E% - 2 Es78 2 E60 2 E%50 2 Ey-10b'2 V PHigh Risk Youth................................................................. 2 V' 2 Vy7 2 V7 2 V+7 2 V0s'[2 g 8National Data Collection Activities (1% Set-aside)......    2 g' - 2 gy0- !ty- 2 g0- !t- 2 g%12- ! t%-- 2 g}12-)o2 xESubtotal, Substance Abuse............................................ 2 x) 2 xY$1,9182 x$1,9612 x $2,043 2 xt$82-)v2  JProgram Management........................................................   2 ) -{ 2 o57- ! o- 2 59- ! -- 2 !60- ! !- 2 x+1- ! x--'u2 ITotal, Program Level..................................................... 2 ' 2 Y$2,4872 $2,6522  $2,835 2 m$183-C2 (Less Funds Allocated from Other Sources:   -%~2 O 1% Set-aside................................................................ 2 % - 2 y0- !y- 2 0- !- 2 !-12- !!- 2 y-12- !y--(r2 GTotal Discretionary BA.................................................  2 ( 2 Y$2,4872 $2,6522  $2,823 2 m$171-'2 ]FTE..........................................................................................2 ' 2 m632 2 686 2 686 2 0-'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTbC>'bCS8     !' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' !' !-   !E !]D/ !]U/ !9 !]/ !0 !wTimes New Roman,-  2 c1999 2 2000 2 20012 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- !Times New Roman)- 2 5Mental Health:  2 F-,2 F JMental Health Block Grant................................................. 2 Fg$289 2 F$356 2 F$416 2 Fw$602 W-+2 W GTargeted Capacity Expansion............................................ 2 Wy0 2 W0 2 W%30 2 W}302 h-)2 h CPATH Homeless Formula Grant........................................ 2 hs26 2 h31 2 h%36 2 h52 y-$2 y :Knowledge Development and Application..................... 2 ys96 2 y137 2 y137 2 y02 -*2 EChildren's Mental Health Services.................................... 2 s78 2 83 2 %87 2 42 -,2 IProtection and Advocacy..................................................Times New Roman<- 2 s23- ! s- 2 25- ! - 2 %26- ! %- 2 1- !--(s2 HSubtotal, Mental Health.................................................  2 ( 2 c$512 2 $632 2 $732 2 m$100-2 Substance Abuse: )p2 FTargeted Capacity Expansion...........................................2 ) 2 g$133 2 $194 2 $248 2 w$54(o2 E Substance Abuse Treatment.........................................  2 ( 2 s55 2 114 2 163 2 }49 )o2  E Substance Abuse Prevention........................................ 2 ) 2 s78 2 80 2 %85 2 5'm2  DSubstance Abuse Block Grant......................................... 2 ' 2 g1585 2 1600 2 1631 2 }31/(]2 # 9Knowledge Development and Application....................     2 #( 2 #m193 2 #160 2 #145 2 #y-15Times New Roman$-@&o2 4 E Substance Abuse Treatment......................................... 2 4& - 2 4m115 2 4100 2 4%95 2 4-5-Q%m2 E D Substance Abuse Prevention.......................................2 E% - 2 Es78 2 E60 2 E%50 2 Ey-10b'2 V PHigh Risk Youth................................................................. 2 V' 2 Vy7 2 V7 2 V+7 2 V0s'[2 g 8National Data Collection Activities (1% Set-aside)......    2 g' - 2 gy0- !ty- 2 g0- !t- 2 g%12- ! t%-- 2 g}12-)o2 xESubtotal, Substance Abuse............................................ 2 x) 2 xY$1,9182 x$1,9612 x $2,043 2 xt$82-)v2  JProgram Management........................................................   2 ) -{ 2 o57- ! o- 2 59- ! -- 2 !60- ! !- 2 x+1- ! x--'u2 ITotal, Program Level..................................................... 2 ' 2 Y$2,4872 $2,6522  $2,835 2 m$183-C2 (Less Funds Allocated from Other Sources:   -%~2 O 1% Set-aside................................................................ 2 % - 2 y0- !y- 2 0- !- 2 !-12- !!- 2 y-12- !y--(r2 GTotal Discretionary BA.................................................  2 ( 2 Y$2,4872 $2,6522  $2,823 2 m$171-'2 ]FTE..........................................................................................2 ' 2 m632 2 686 2 686 2 0-'WPC''!'~ >   x`''  ' x`' x`Times New Roman,-  2 R1999 2 2000 2 20012 1Request Times New Roman0-2 JActual - !$ J-2 Enacted- !* -2 Request - !, -2 ! +/- Enacted- !< !-Times New Roman-A~2 5OBudget Authority............................................................... 2 5 2 5A$297,1472 5$325,4342 5$349,686AY2 5++$24,252R2 FWOutlays................................................................................ 2 F 2 FA$298,9012 F$319,8202 F$347,607RY2 F++$27,787t2 hZFTE.......................................................................................2 h 2 hS4,2192 h4,3632 h4,435tY 2 hF+72'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>>g  >   x`''  ' x`' x`Times New Roman,-  2 R1999 2 2000 2 20012 1Request Times New Roman0-2 JActual - !$ J-2 Enacted- !* -2 Request - !, -2 ! +/- Enacted- !< !-Times New Roman-A~2 5OBudget Authority............................................................... 2 5 2 5A$297,1472 5$325,4342 5$349,686AY2 5++$24,252R2 FWOutlays................................................................................ 2 F 2 FA$298,9012 F$319,8202 F$347,607RY2 F++$27,787t2 hZFTE.......................................................................................2 h 2 hS4,2192 h4,3632 h4,435tY 2 hF+72'   *OLE*  *OLE**OLE*WPCW%W%!W% X   _''  ' _' _Times New Roman4-  2 &1999 2 2000 2 20012 $Request Times New Roman,-2 Actual - !+(-2 oEnacted - !6(o-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman4-PO2 A0Program Level...................................   2 A PA 2 A!$171P 2 A$204P 2 A$250PW 2 A6+$46 zX2 k6FTE................................................... 2 k zA 2 k)253z 2 k285z 2 k294zW 2 kF+9 'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICT>>  X   _''  ' _' _Times New Roman4-  2 &1999 2 2000 2 20012 $Request Times New Roman,-2 Actual - !+(-2 oEnacted - !6(o-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman4-PO2 A0Program Level...................................   2 A PA 2 A!$171P 2 A$204P 2 A$250PW 2 A6+$46 zX2 k6FTE................................................... 2 k zA 2 k)253z 2 k285z 2 k294zW 2 kF+9 'WPC@@>>>>!>>351)%+-. 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Evh "-a'aG3M38- "- M3M3$ &%%#3f8- 3f$Ev "-.3.$%f8- "- ff$      }yuplhdd_[WRNJEA=840+'#       |zwusspnljhfdba_]\ZYXVUTSRQQPOONNMM~M{MyMvMMMMMNNOOPQQRSTUVXYZ\]_abdfhjlnpssuwz|  !#%&(*,-/0235689:<=>?@ABCDEFF G HHIIJ#J'K+K0K4K8L=LALELJLNLRLWK[K_KdKdKhJlJpIuIyH}HGFFEDCBA@?>=<:9865320/-,*(&8- $     }yuplhd_[WRNJEA=840+'#       |zwuspnljhfdba_]\ZYYXVUTSRQQPOONNMM~M{MyMvMsMpMmMkNhNeObO_P]QZQWRTSRTOULVJXGYDZB\?]<_:a7b5d2f0h-j+l(n&p#s!uwz|     #'+048=AEJNRWEv "-BBX "--'-- `--'-- ` Arial-----"Systemn-'--- D3  2 "7SCHIP----'--- `-----'--- X- 2 6Medicare   ----'--- `-----'--- v 2 Administration   ----'--- `-----'--- . 2 2Medicaid  ----'--- `---'--- `- - -4'  - "- 0t- -- - - .o ArialT- -  2 $216.1  ' `-- -- - -- - - - -   2 $2.1  ' `-- -- 3- -- - - .- -  2 $124.9  ' `-- -- m?1- -- - - k@5- -   2 B5$4.5  ' `-- ' `  - ' o '  '  "HLPLibbie  FG&XXXXXXXX-X,XX-  __Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_table.Run_ԀthemacroagainandpauseforasecondbetweenthetwoEnters. 6 mG"XLXXXXLXXXL-X,XX-  _ Wehavethefinesthealthcare  systemintheworld...buttoomanyfamilieshavebeenthevictimsofmedicalerrorsthatareavoidable...thatareunacceptable. &%XXLԀ   ,  X  , #XLX%&[#XXLPresidentWilliamJ.Clinton#XLX#*OLE*WPCKK!    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~{yv  !#%&(*,-/ 023568!9$:(<,=0>4?8@<A@BDCHDMEQFUFYG]HbHfIjInJsJwK{KKKLLLLLLLKKKKKJJIIHHGFFEDCBA@?>=<: 986532 0$/'-+,.*2(5&58- $52.+'$       {wsnjfb]YUQMHD @ < 8 4 0,($! ~{yvspmkheb_]ZWTROLJGDB?<:7520-+(&#!    !$(,048<@DHMQUY]bfjnsw{v5 "-;>;M "--'-- _`--'-- _` Arial-----"Systemn-'--- F   2 $CHIP----'--- _`-----'--- Q?& 2 /Medicare   ----'--- _`-----'--- nZ 2 w^Administration   ----'--- _`-----'--- # 2 Medicaid  ----'--- _`---'--- _`- - -4'  - "- 0t- -- - - .o Ariala- -  2 $213.6  ' _`-- -- - -- - - - -   2 $1.9  ' _`-- -- 3- -- - - .- -  2 $114.7  ' _`-- -- m?- -- - - k@#- -   2 B#$2.9  ' _`-- ' `  - ' o '  ' mG"XLXXXXLXXXL-X,XX-  _3 mG"XLXXXXLXXXL-X,XX-  _1 mG"XLXXXXLXXXL-X,XX-  _2   *OLE*WPCm m !m L+     ''  ' ' -   !Times New Roman- 2 1-YEAR 2 P5-YEARS -2 )jMEDICARE REFORM PROPOSALS     Times New Roman--"Systemn-'-- :(- 2 )FY 2001 - !79---2 )SFY 01-05 - !<9S----'-- - "2 PSAVINGS PROPOSALS:    Times New Roman-?2 e%Provider Payment Changes (thru 2005):    Times New Romanl-s2 y HReduce Hospital Update by 0.8 Percent (Urban) & 0.4 Percent (Rural).....        2 y ( 2 y!02 yf-4,3002 WReduce PPS-Exempt Hospital Updates.....................................................      2  ( 2 !0 2 p-8402 TReduce PPS Capital Payments by 2.1 Percent..........................................      2  ( 2 !0 2 p-630~2 OReduce PPS-Exempt Capital Payments by 15 Percent...............................        2  ( 2 !0 2 p-160v2 JReduce Laboratory Payment Update by CPI Minus 1 Percent...................        2  ( 2 !0 2 p-180~2 OReduce Ambulance Update by CPI Minus 1 Percent.................................      2  ( 2 !0 2 w-10p2 FReduce DME, PEN, and P&O Updates by CPI Minus 1 Percent...............        2  Times New Roman-( 2 !0- !!- 2 p-250- !p--2 XSubtotal, Provider Payment Changes......................................................    2  ( 2 !02 f-6,370-42 -Fee-for-Service Modernization:  -N2 A `Medicare PPO Option.............................................................................   2 A N( 2 A!0N2 Af-1,700b2 U cCenters of Excellence..............................................................................  2 U b( 2 U!0b2 Uf-1,185v2 i `Disease Management..............................................................................   2 i v( 2 i!0v 2 i02 } bCompetitive Acquisition...........................................................................   2 } ( 2 }!0 2 }p-1002  cContracting Reform.................................................................................   2  -( 2 !0- !!- 2 p-200- !p--2 ^Subtotal, FFS Modernization................................................................... 2  ( 2 !02 f-3,185-'2 Cost-Sharing Changes:  -2  VReinstate Cost-Sharing for Laboratory Services........................................   2  ( 2 !02 f-2,4002  ^Index Part B Deductible to CPI................................................................    2  -( 2 !0- !!- 2 p-300- !p--2 \Subtotal, Cost Sharing Changes..............................................................  2  ( 2 !02 f-2,700-12 1Competitive Defined Benefit:    ->( 2 1!0>2 1f-1,800-2 Y Interactions:Times New Roman-f( 2 Y +175- !g  !i -f2 Yc+3,005- !'gc !'ic--z2 lSSubtotal, Medicare Reform Savings..................................................  2 l z( 2 l+175 z2 lY-11,0502 COST PROPOSALS:    -2  \Prescription Drug Benefit (net impact)......................................................    2  ( 2 !02 \+28,7802  WEliminate Cost-Sharing for Preventive Services.........................................    2  ( 2 !02 c+1,0002  dMedicare Buy-In.....................................................................................  2  -( 2 !0- !! !!- 2 m+980- !m !m--2 TSubtotal, Medicare Reform Costs.....................................................   2  ( 2  02 U+30,760 2 _Total Medicare Reform..........................................................................   2  ( 2 +175 2 U+19,710 -'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTDR+DR     ''  ' ' -   !Times New Roman- 2 1-YEAR 2 P5-YEARS -2 )jMEDICARE REFORM PROPOSALS     Times New Roman--"Systemn-'-- :(- 2 )FY 2001 - !79---2 )SFY 01-05 - !<9S----'-- - "2 PSAVINGS PROPOSALS:    Times New Roman-?2 e%Provider Payment Changes (thru 2005):    Times New Romanl-s2 y HReduce Hospital Update by 0.8 Percent (Urban) & 0.4 Percent (Rural).....        2 y ( 2 y!02 yf-4,3002 WReduce PPS-Exempt Hospital Updates.....................................................      2  ( 2 !0 2 p-8402 TReduce PPS Capital Payments by 2.1 Percent..........................................      2  ( 2 !0 2 p-630~2 OReduce PPS-Exempt Capital Payments by 15 Percent...............................        2  ( 2 !0 2 p-160v2 JReduce Laboratory Payment Update by CPI Minus 1 Percent...................        2  ( 2 !0 2 p-180~2 OReduce Ambulance Update by CPI Minus 1 Percent.................................      2  ( 2 !0 2 w-10p2 FReduce DME, PEN, and P&O Updates by CPI Minus 1 Percent...............        2  Times New Roman-( 2 !0- !!- 2 p-250- !p--2 XSubtotal, Provider Payment Changes......................................................    2  ( 2 !02 f-6,370-42 -Fee-for-Service Modernization:  -N2 A `Medicare PPO Option.............................................................................   2 A N( 2 A!0N2 Af-1,700b2 U cCenters of Excellence..............................................................................  2 U b( 2 U!0b2 Uf-1,185v2 i `Disease Management..............................................................................   2 i v( 2 i!0v 2 i02 } bCompetitive Acquisition...........................................................................   2 } ( 2 }!0 2 }p-1002  cContracting Reform.................................................................................   2  -( 2 !0- !!- 2 p-200- !p--2 ^Subtotal, FFS Modernization................................................................... 2  ( 2 !02 f-3,185-'2 Cost-Sharing Changes:  -2  VReinstate Cost-Sharing for Laboratory Services........................................   2  ( 2 !02 f-2,4002  ^Index Part B Deductible to CPI................................................................    2  -( 2 !0- !!- 2 p-300- !p--2 \Subtotal, Cost Sharing Changes..............................................................  2  ( 2 !02 f-2,700-12 1Competitive Defined Benefit:    ->( 2 1!0>2 1f-1,800-2 Y Interactions:Times New Roman-f( 2 Y +175- !g  !i -f2 Yc+3,005- !'gc !'ic--z2 lSSubtotal, Medicare Reform Savings..................................................  2 l z( 2 l+175 z2 lY-11,0502 COST PROPOSALS:    -2  \Prescription Drug Benefit (net impact)......................................................    2  ( 2 !02 \+28,7802  WEliminate Cost-Sharing for Preventive Services.........................................    2  ( 2 !02 c+1,0002  dMedicare Buy-In.....................................................................................  2  -( 2 !0- !! !!- 2 m+980- !m !m--2 TSubtotal, Medicare Reform Costs.....................................................   2  ( 2  02 U+30,760 2 _Total Medicare Reform..........................................................................   2  ( 2 +175 2 U+19,710 -'*OLE*WPC!'     x''  ' x' x-   !xTimes New Roman- 2 *1-YEAR 2 }5-YEARS =2 &W$OTHER MEDICARE LEGISLATIVE PROPOSALS        Times New Roman8--"Systemn-'-- 7%- 2 &*FY 2001 - !76*---2 &FY 01-05 - !<6----'-- x- "2 LSAVINGS PROPOSALS:    Times New Roman4-72 ` Fighting Fraud, Waste and Abuse:    Times New Roman4-2 tdReduce EPO Payment by 10 Percent....................................................................     2 t \ 2 tI-65 2 t-4002 fRequire Insurers to Provide MSP Data..................................................................     2  \ 2 I-40 2 -8002 dReduce Misuse of Partial Hospitalization Benefit....................................................     2  \ 2 I-30 2 -2502 bClarify Scope of and Eligibilty for Partial Hospitaliztion Benefit................................     2  \ 2 I-50 2 -4302 aEliminate Physician Mark-Up of Outpatient Drugs..................................................       2  Times New Romanhq-\ 2 B-130- !B-2 -1,190- !$--2 kSubtotal, Fraud & Abuse....................................................................................  2  \ 2 B-3152 -3,070-:2 "Ensuring Medicare Payment is Fair:     -!2 cReduce Medicare Bad Debt Payments .................................................................      2  !\ 2 B-340!2 -2,28052 ([Reduce Lab Payments by 30 Percent for Four Lab Tests.......................................       2 ( 5\ 2 (I-805 2 (-660I2 <]Establish National Payment Limit for Orthotics and Prosthetics...............................        2 < I\ 2 <B-110I 2 <-930]y2 PLEliminate HPSA Bonus Payments for Non-Primary Care Physicians in Urban Areas              ]\ 2 PI-30] 2 P-190q2 dXReturn to 2002 Phase-In for Medicare+Choice Risk Adjustment.............................       2 d q\ 2 dU0q 2 d-8102 x`Shift Timing of One Medicare+Choice Payment.....................................................       2 x \ 2 xU0 2 x02 mSubtotal, Fair Payment.......................................................................................  2  Times New RomanP-\ 2 B-560- !B !B-2 -4,870- !$ !$--2 aSubtotal, Other Medicare Savings................................................................. 2  \ 2 ?-8752 -7,9402 COST PROPOSALS:    -L2 .Improving Coverage for Vulnerable Populations:    -2 ZPermanently Extend Part A Coverage for Working Disabled...................................       2  \ 2 U0 2 +102 _Expand Coverage for Immunosuppressive Drugs....................................................    2  -\ 2 F+10- !F !F- 2 +35- ! !--"2 bSubtotal, Other Medicare Costs....................................................................  2  "\ 2 C+10 " 2 +45 Times New Roman4- G2 8mTotal Other Medicare.........................................................................................  2 8 G\ 2 8?-865G2 8-7,895r2 cTTOTAL 2001 MEDICARE LEGISLATION.....................................................      2 c r\ 2 c?-690r2 c+11,815 --'- - x-  !\ !^ !\ !v--'-  x'WPWin 6.0/OLE 1.0 Prefix Information Marker METAFILEPICTH'HQA     x''  ' x' x-   !xTimes New Roman- 2 *1-YEAR 2 }5-YEARS =2 &W$OTHER MEDICARE LEGISLATIVE PROPOSALS        Times New Roman8--"Systemn-'-- 7%- 2 &*FY 2001 - !76*---2 &FY 01-05 - !<6----'-- x- "2 LSAVINGS PROPOSALS:    Times New Roman4-72 ` Fighting Fraud, Waste and Abuse:    Times New Roman4-2 tdReduce EPO Payment by 10 Percent....................................................................     2 t \ 2 tI-65 2 t-4002 fRequire Insurers to Provide MSP Data..................................................................     2  \ 2 I-40 2 -8002 dReduce Misuse of Partial Hospitalization Benefit....................................................     2  \ 2 I-30 2 -2502 bClarify Scope of and Eligibilty for Partial Hospitaliztion Benefit................................     2  \ 2 I-50 2 -4302 aEliminate Physician Mark-Up of Outpatient Drugs..................................................       2  Times New Romanhq-\ 2 B-130- !B-2 -1,190- !$--2 kSubtotal, Fraud & Abuse....................................................................................  2  \ 2 B-3152 -3,070-:2 "Ensuring Medicare Payment is Fair:     -!2 cReduce Medicare Bad Debt Payments .................................................................      2  !\ 2 B-340!2 -2,28052 ([Reduce Lab Payments by 30 Percent for Four Lab Tests.......................................       2 ( 5\ 2 (I-805 2 (-660I2 <]Establish National Payment Limit for Orthotics and Prosthetics...............................        2 < I\ 2 <B-110I 2 <-930]y2 PLEliminate HPSA Bonus Payments for Non-Primary Care Physicians in Urban Areas              ]\ 2 PI-30] 2 P-190q2 dXReturn to 2002 Phase-In for Medicare+Choice Risk Adjustment.............................       2 d q\ 2 dU0q 2 d-8102 x`Shift Timing of One Medicare+Choice Payment.....................................................       2 x \ 2 xU0 2 x02 mSubtotal, Fair Payment.......................................................................................  2  Times New RomanP-\ 2 B-560- !B !B-2 -4,870- !$ !$--2 aSubtotal, Other Medicare Savings................................................................. 2  \ 2 ?-8752 -7,9402 COST PROPOSALS:    -L2 .Improving Coverage for Vulnerable Populations:    -2 ZPermanently Extend Part A Coverage for Working Disabled...................................       2  \ 2 U0 2 +102 _Expand Coverage for Immunosuppressive Drugs....................................................    2  -\ 2 F+10- !F !F- 2 +35- ! !--"2 bSubtotal, Other Medicare Costs....................................................................  2  "\ 2 C+10 " 2 +45 Times New Roman4- G2 8mTotal Other Medicare.........................................................................................  2 8 G\ 2 8?-865G2 8-7,895r2 cTTOTAL 2001 MEDICARE LEGISLATION.....................................................      2 c r\ 2 c?-690r2 c+11,815 --'- - x-  !\ !^ !\ !v--'-  x'*OLE*WPC*C*C!*C c   M''  ' M' MTimes New Roman-"Systemn-'-   2 i1999- ! i- 2 2000- ! - 2 2001- ! - 2 +/- - !--'- MTimes New Roman--'- * ?2 %Beneficiaries Enrolled (in Millions):  -'- M-'- ;+72 c2 ( =Hospital Insurance (HI) .....................................  2 (2 2 (m38.8 2 (39.3 2 (39.7 2 (0.4-'- M-'- L<H/ O2 9 0Supplementary Medical Insurance (SMI)...........   2 9/ 2 9m36.9 2 937.3 2 937.7 2 90.3-'- M'WPWin 6.0/OLE 1.0 Prefix Information Marker  METAFILEPICTgDgD c   M''  ' M' MTimes New Roman-"Systemn-'-   2 i1999- ! i- 2 2000- ! - 2 2001- ! - 2 +/- - !--'- MTimes New Roman--'- * ?2 %Beneficiaries Enrolled (in Millions):  -'- M-'- ;+72 c2 ( =Hospital Insurance (HI) .....................................  2 (2 2 (m38.8 2 (39.3 2 (39.7 2 (0.4-'- M-'- L<H/ O2 9 0Supplementary Medical Insurance (SMI)...........   2 9/ 2 9m36.9 2 937.3 2 937.7 2 90.3-'- M'#,HLPLibbie J FG&XXXXXXXX-X,XX-  __Excel_spreadsheet_Ԁwillgointhisposition.To_importthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange_.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_table.Run_ԀthemacroagainandpauseforasecondbetweenthetwoEnters.WPC888 8 !8 Z g   5''  ' 5' 5-   !5Times New Roman--"Systemn-'-- 5   2 p1999- ! p- 2 2000- ! - 2 2001- ! ---'-- 5Times New Roman4---'-- "5 2  Enrollment:  - !B ---'-- 5Times New Roman4---'-- 35#/( `2 ";Aged 65 and Over ..........................................  2 "( /2 "l3,800/2 "3,800/-2 "3,900--'-- 5--'-- D54@) c2 3=Blind and Disabled...........................................  2 3) @2 3l6,600@2 36,700@-2 36,800--'-- 5--'-- U5EQ( d2 D>Needy Adults .................................................  2 D( Q2 Dl6,400Q2 D6,500Q-2 D6,600--'-- 5--'-- f5Vb' c2 U=Needy Children...............................................  2 U' -b2 Ue16,100- !&de-b2 U16,400- !&d-b-2 U16,600- !&d---'-- 5Times New Roman4---'-- 5x) g2 w@Total........................................................... 2 w) 2 w_32,9002 w33,400-2 w33,900--'-- 5-'WPWin 6.0/OLE 1.0 Prefix Information Marker$ METAFILEPICTd:`d:( g   5''  ' 5' 5-   !5Times New Roman--"Systemn-'-- 5   2 p1999- ! p- 2 2000- ! - 2 2001- ! ---'-- 5Times New Roman4---'-- "5 2  Enrollment:  - !B ---'-- 5Times New Roman4---'-- 35#/( `2 ";Aged 65 and Over ..........................................  2 "( /2 "l3,800/2 "3,800/-2 "3,900--'-- 5--'-- D54@) c2 3=Blind and Disabled...........................................  2 3) @2 3l6,600@2 36,700@-2 36,800--'-- 5--'-- U5EQ( d2 D>Needy Adults .................................................  2 D( Q2 Dl6,400Q2 D6,500Q-2 D6,600--'-- 5--'-- f5Vb' c2 U=Needy Children...............................................  2 U' -b2 Ue16,100- !&de-b2 U16,400- !&d-b-2 U16,600- !&d---'-- 5Times New Roman4---'-- 5x) g2 w@Total........................................................... 2 w) 2 w_32,9002 w33,400-2 w33,900--'-- 5-'*OLE*#$*OLE*WPC  ! %    ''  ' ' -   !Times New Roman-}  2 a1999 2 2000/ 2 20012 _Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman4- 2 = Current Law: Z)2 NYHI Benefits ............................................................................. 2 N) Z}2 NP$129,107Z2 N$129,216Z/2 N$139,869Z2 NY+$10,653k*2 _WSMI Benefits .......................................................................... 2 _* Times New Roman4-k}2 _\79,187- !!l\-k2 _90,574- !!l-k/2 _100,273- !'l-k2 __+$9,699- !(l_--|*l2 pCSubtotal, Medicare Benefits........................................  2 p* |}2 pI$208,294|2 p$219,790|/2 p$240,142|2 pS+$20,352 2   2 0 -)2 TAdministration /2...................................................................  2 ) }2 \$2,7062 $3,069/2 $3,1822 h+$113*]2 9HCFAC /3 (including Medicare Integrity Program)..........    2 * } 2 k642 2 744/ 2 820 2 n+$76)o2 EPeer Review Organizations (PROs) ....................................   2 ) } 2 k213 2 485/ 2 422 2 q-$63*2 PTransfers to Medicaid........................................................... 2 * -} 2 w0- !w- 2 50- ! -/ 2 #60- ! #- 2 n+$10- !n--)j2 BTotal Outlays, Current Law........................................  2 ) }2 I$211,8552 $224,138/2 $244,6262 S+$20,488-)2 YPremiums ................................................................................  2 ) -2 X(21,561)- !)X-V2 8 - !8-2 V - !V-2 (21,735)- !)-2  - !--2  - !-32 (23,340)- !) - 2  - !-2  - ! -2 h(1,605)- !#h-f2 < - !*<-2 f - !f--&*f2 ?Total Net Outlays, Current Law.................................   2 * &}2 I$190,294&2 $202,403&/2 $221,286&2 S+$22,093-(2 <Proposed Legislation:: 2 <~ Y*2 MSMedicare Benefits.................................................................. 2 M* 2 Mu$0 2 M$02 M-$6902 Mo-$690j){2 ^MProgram Management...........................................................   2 ^) 2 ^u$0 2 ^$0 2 ^$250 2 ^s$250{+2 oQProposed User Fees............................................................... 2 o+ - 2 o{0- !|{- 2 o0- !|- 2 o-220- !|-2 oo-$220- !|o--+p2 FTotal Medicare Savings ............................................... 2 + 2 s$0 2 $02 -$6602 k-$660)d2 >Total, Net Outlays, Proposed Law .............................  2 ) }2 B +$190,2942  +$202,403/2  +$220,6262 S+$18,223-F2 */ 1 Numbers may not add due to rounding.   2 e/ 2 Includes Administration payments to SSA and other non-HCFA agencies, and proprietary receipts.      r2 G/ 3 Health Care Fraud and Abuse Control, includes FBI, excludes OIG.   -'WPWin 6.0/OLE 1.0 Prefix Information Marker! METAFILEPICTC]%C5    ''  ' ' -   !Times New Roman-}  2 a1999 2 2000/ 2 20012 _Request Times New Roman4--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman4- 2 = Current Law: Z)2 NYHI Benefits ............................................................................. 2 N) Z}2 NP$129,107Z2 N$129,216Z/2 N$139,869Z2 NY+$10,653k*2 _WSMI Benefits .......................................................................... 2 _* Times New Roman4-k}2 _\79,187- !!l\-k2 _90,574- !!l-k/2 _100,273- !'l-k2 __+$9,699- !(l_--|*l2 pCSubtotal, Medicare Benefits........................................  2 p* |}2 pI$208,294|2 p$219,790|/2 p$240,142|2 pS+$20,352 2   2 0 -)2 TAdministration /2...................................................................  2 ) }2 \$2,7062 $3,069/2 $3,1822 h+$113*]2 9HCFAC /3 (including Medicare Integrity Program)..........    2 * } 2 k642 2 744/ 2 820 2 n+$76)o2 EPeer Review Organizations (PROs) ....................................   2 ) } 2 k213 2 485/ 2 422 2 q-$63*2 PTransfers to Medicaid........................................................... 2 * -} 2 w0- !w- 2 50- ! -/ 2 #60- ! #- 2 n+$10- !n--)j2 BTotal Outlays, Current Law........................................  2 ) }2 I$211,8552 $224,138/2 $244,6262 S+$20,488-)2 YPremiums ................................................................................  2 ) -2 X(21,561)- !)X-V2 8 - !8-2 V - !V-2 (21,735)- !)-2  - !--2  - !-32 (23,340)- !) - 2  - !-2  - ! -2 h(1,605)- !#h-f2 < - !*<-2 f - !f--&*f2 ?Total Net Outlays, Current Law.................................   2 * &}2 I$190,294&2 $202,403&/2 $221,286&2 S+$22,093-(2 <Proposed Legislation:: 2 <~ Y*2 MSMedicare Benefits.................................................................. 2 M* 2 Mu$0 2 M$02 M-$6902 Mo-$690j){2 ^MProgram Management...........................................................   2 ^) 2 ^u$0 2 ^$0 2 ^$250 2 ^s$250{+2 oQProposed User Fees............................................................... 2 o+ - 2 o{0- !|{- 2 o0- !|- 2 o-220- !|-2 oo-$220- !|o--+p2 FTotal Medicare Savings ............................................... 2 + 2 s$0 2 $02 -$6602 k-$660)d2 >Total, Net Outlays, Proposed Law .............................  2 ) }2 B +$190,2942  +$202,403/2  +$220,6262 S+$18,223-F2 */ 1 Numbers may not add due to rounding.   2 e/ 2 Includes Administration payments to SSA and other non-HCFA agencies, and proprietary receipts.      r2 G/ 3 Health Care Fraud and Abuse Control, includes FBI, excludes OIG.   -'&1 HLPLibbie  FG&XXXXXXXX-X,XX-  __Excel_spreadsheet_Ԁwillgointhisposition.To_importthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange_.SwitchbacktoWordPerfect.UsetheHHS_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.()*OLE*WPCZZ  ! z < s   D2''  ' D2' D2-   !32 !52Times New Roman4-  2 ,1999 2 y2000 2 20012 Request Times New Roman--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- D2Times New Roman- 2 5 Current Law - !DB-Times New Roman)-Ro2 FEBenefits /1..........................................................2 F RD2 F$102,565R2 Fd$109,737R2 F$116,917R+2 F+$7,180ca2 W<State Administration .......................................  2 W -cD2 W)5,478- !d)-c2 Wv6,380- !dv-c2 W7,259- !d-c+ 2 W879- !d--L2 y.Total Net Outlays, Current Law ...............   2 y D2 y$108,0422 y]$116,1172 y$124,175+2 y+$8,058-%2 Proposed Legislation- !q--p2 FSavings ..............................................................2  D 2 >0 2 0 2 -355+ 2 -355s2 HCosts...................................................................2  -D 2 >0- !>- 2 0- !-2 1,018- !-+2 +1,018- !" --O2 0Subtotal, Proposed Legislation .................2  D 2 6$0 2 $02 +$663+2 +$663H2 +Total Net Outlays, Proposed Law /2.........  2  D2 $108,0422 ]$116,1172 $124,838+2 +$8,721-L2 ./1 Includes Vaccine for Children Outlays.  I2 #,/2 Numbers may not add due to rounding.    -'WPWin 6.0/OLE 1.0 Prefix Information Marker% METAFILEPICT::|! < s   D2''  ' D2' D2-   !32 !52Times New Roman4-  2 ,1999 2 y2000 2 20012 Request Times New Roman--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2 Request - !, ---2  +/- Enacted- !< ----'-- D2Times New Roman- 2 5 Current Law - !DB-Times New Roman)-Ro2 FEBenefits /1..........................................................2 F RD2 F$102,565R2 Fd$109,737R2 F$116,917R+2 F+$7,180ca2 W<State Administration .......................................  2 W -cD2 W)5,478- !d)-c2 Wv6,380- !dv-c2 W7,259- !d-c+ 2 W879- !d--L2 y.Total Net Outlays, Current Law ...............   2 y D2 y$108,0422 y]$116,1172 y$124,175+2 y+$8,058-%2 Proposed Legislation- !q--p2 FSavings ..............................................................2  D 2 >0 2 0 2 -355+ 2 -355s2 HCosts...................................................................2  -D 2 >0- !>- 2 0- !-2 1,018- !-+2 +1,018- !" --O2 0Subtotal, Proposed Legislation .................2  D 2 6$0 2 $02 +$663+2 +$663H2 +Total Net Outlays, Proposed Law /2.........  2  D2 $108,0422 ]$116,1172 $124,838+2 +$8,721-L2 ./1 Includes Vaccine for Children Outlays.  I2 #,/2 Numbers may not add due to rounding.    -'+4,HLPLibbie  FG&XXXXXXXX-X,XX-  __Excel_spreadsheet_Ԁwillgointhisposition.To_importthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange_.SwitchbacktoWordPerfect.UsetheHHS_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters./0*OLE*WPCHH!H b i   4''  ' 4' 4-   !4Times New Roman- 2 FY 2001 2 FY 01-05 !2 SAVINGS PROPOSALS   Times New Roman-%2 0 Cost Allocation  2 0-2602 0-2,06342 A Child Support Enforcement  2 A-10 2 A-170+2 R Generic Drug Rebate  2 R-35 2 R-265T2 c3 Provide Beneficiary with New Enforcement Tools     2 c-10 2 c!-50(2 t Publicize the AMP  2 t-20 2 t-400C2 ( Medicaid Interactions with Medicare    2 -20 2 -100=2 $SUBTOTAL: MANDATORY MEDICAID SAVINGS            2 -3552 -3,048-2 COST PROPOSALS  -^2 : Restore Benefits to Immigrant Children/Pregnant Women    2 61 2 670i2 A Restore SSI to Qualified Immigrants (5-year ban, no deeming)    2 0 2 513(2  Asthma Initiative   2 50 2 10062  300% Eligibility Expansion  2 15 2 14012 ' Presumptive Eligibility  2 '15 2 '30592 8! Extend Transitional Medicaid  2 802 81,55002 I Family Care Initiative  2 I6002 I10,200?2 Z% Medicaid and CHIP Age Expansions    2 Z114 2 Z65092 k! Smoking Cessation with Match    2 k12 2 k%6612 | School Lunch Initiative 2 |5 2 |119C2 ( Align Medicaid and CHIP Eligibility    2 1262 1,561"2  Breast Cancer 2 15 2 220E2 ) Interactions Among Medicaid Policies   2 5 2 %95W2 5 Interactions with Medicare Drug Benefit Proposal    2 02 9,331<2 #SUBTOTAL: MANDATORY MEDICAID COSTS          2 1,0182 25,520-+2 TOTAL MANDATORY MEDICAID     2 6632 22,472-"Systemn-'-- 4-  "- "- !-- !-- !-- !-- ! ! !4-4- !3-4- !3-4- !3-4- !3 !3 !3--'- 4'WPWin 6.0/OLE 1.0 Prefix Information Marker" METAFILEPICTJ:J:6 b i   4''  ' 4' 4-   !4Times New Roman- 2 FY 2001 2 FY 01-05 !2 SAVINGS PROPOSALS   Times New Roman-%2 0 Cost Allocation  2 0-2602 0-2,06342 A Child Support Enforcement  2 A-10 2 A-170+2 R Generic Drug Rebate  2 R-35 2 R-265T2 c3 Provide Beneficiary with New Enforcement Tools     2 c-10 2 c!-50(2 t Publicize the AMP  2 t-20 2 t-400C2 ( Medicaid Interactions with Medicare    2 -20 2 -100=2 $SUBTOTAL: MANDATORY MEDICAID SAVINGS            2 -3552 -3,048-2 COST PROPOSALS  -^2 : Restore Benefits to Immigrant Children/Pregnant Women    2 61 2 670i2 A Restore SSI to Qualified Immigrants (5-year ban, no deeming)    2 0 2 513(2  Asthma Initiative   2 50 2 10062  300% Eligibility Expansion  2 15 2 14012 ' Presumptive Eligibility  2 '15 2 '30592 8! Extend Transitional Medicaid  2 802 81,55002 I Family Care Initiative  2 I6002 I10,200?2 Z% Medicaid and CHIP Age Expansions    2 Z114 2 Z65092 k! Smoking Cessation with Match    2 k12 2 k%6612 | School Lunch Initiative 2 |5 2 |119C2 ( Align Medicaid and CHIP Eligibility    2 1262 1,561"2  Breast Cancer 2 15 2 220E2 ) Interactions Among Medicaid Policies   2 5 2 %95W2 5 Interactions with Medicare Drug Benefit Proposal    2 02 9,331<2 #SUBTOTAL: MANDATORY MEDICAID COSTS          2 1,0182 25,520-+2 TOTAL MANDATORY MEDICAID     2 6632 22,472-"Systemn-'-- 4-  "- "- !-- !-- !-- !-- ! ! !4-4- !3-4- !3-4- !3-4- !3 !3 !3--'- 4'23*OLE*WPCZZ  !     D2''  ' D2' D2-   !D2 !5CTimes New Roman0-  2 ,1999 2 y2000 2 20012 Request Times New Roman0--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2  Request /1 - !: ---2  +/- Enacted- !< ----'-- D2Times New Roman4- 2 5 Current Law - !DB-Times New Roman4-RZ2 F7Grants & Demonstrations................................   2 F RD 2 F8$0R 2 F$0R 2 F$16R+ 2 F+$16-tI2 h,Total Net Outlays, Current Law /2..........   2 h tD 2 h6$0t 2 h$0t 2 h$16t+ 2 h+$16-%2 Proposed Legislation- !q--p2 FSavings ..............................................................2  D 2 >0 2 0+ 2 %0s2 HCosts...................................................................2  -D 2 >0- !>- 2 0- !- 2 10- ! -+ 2 +10- !--O2 0Subtotal, Proposed Legislation .................2  D 2 6$0 2 $0 2 +$10+ 2 +$10K2 -Total Net Outlays, Proposed Law .............  2  D 2 6$0 2 $0 2 $26+ 2 +$26-2 d/1 The Ticket to Work and Work Incentives Improvement act was signed into law on December 17, 1999.        v2 J However, the demonstration grants are not appropriated until FY 2001.   2 #j/2 Note that budget authority for this program is higher than the projected outlays. BA is as follows:     .2 4 FY 01, $62 million.  -'WPWin 6.0/OLE 1.0 Prefix Information Marker# METAFILEPICT::|!    D2''  ' D2' D2-   !D2 !5CTimes New Roman0-  2 ,1999 2 y2000 2 20012 Request Times New Roman0--"Systemn-'-- "2- 2 $Actual - !$ $---2 kEnacted- !* k---2  Request /1 - !: ---2  +/- Enacted- !< ----'-- D2Times New Roman4- 2 5 Current Law - !DB-Times New Roman4-RZ2 F7Grants & Demonstrations................................   2 F RD 2 F8$0R 2 F$0R 2 F$16R+ 2 F+$16-tI2 h,Total Net Outlays, Current Law /2..........   2 h tD 2 h6$0t 2 h$0t 2 h$16t+ 2 h+$16-%2 Proposed Legislation- !q--p2 FSavings ..............................................................2  D 2 >0 2 0+ 2 %0s2 HCosts...................................................................2  -D 2 >0- !>- 2 0- !- 2 10- ! -+ 2 +10- !--O2 0Subtotal, Proposed Legislation .................2  D 2 6$0 2 $0 2 +$10+ 2 +$10K2 -Total Net Outlays, Proposed Law .............  2  D 2 6$0 2 $0 2 $26+ 2 +$26-2 d/1 The Ticket to Work and Work Incentives Improvement act was signed into law on December 17, 1999.        v2 J However, the demonstration grants are not appropriated until FY 2001.   2 #j/2 Note that budget authority for this program is higher than the projected outlays. BA is as follows:     .2 4 FY 01, $62 million.  -'54,HLPLibbie  FG&XXXXXXXX-X,XX-  __Excel_spreadsheet_Ԁwillgointhisposition.To_importthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange_.SwitchbacktoWordPerfect.UsetheHHS_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.8  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBarorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument:;*OLE*WPC!     F''  ' F-   "- "- !-F- !F-'- F-'- F-   !F !ETimes New Roman4- 2 AFY 1999 2 FY 2000 2 FY 2001 2 KRequest Times New Roman<--"Systemn-'-- /- 2 FActual - !+-F---2 Estimate  - !;----2 Estimate  - !;----2 A +/- Enacted  - !L-A----'-- FTimes New Roman4- 42 [ Total Outlays, Current Law /1:     j 2 [a$565j2 [$1,300j32 [$1,9052 [h+$605 -'2 Proposed Legislation:  -%]2 9 Total Cost to SCHIP.................................    2 % 2 - 2 -3 2 $2122 h+$212 -2 -"2 $6Total Outlays /2 /3...................................- 2 a$5652 $1,30032 $2,1172 c+$817 @2 &/1 Numbers may not add due to rounding   2 - f Medicaid expansion are not included in the outlay estimates and are part of the Title XIX account.    --'--   2  d/2 The total outlays for SCHIP represent an estimate of program spending in separate SCHIP programs.        --'-- +  2  c/3 Because States have the option to expand SCHIP coverage through expanding Medicaid, outlays for     --'-- F--'-- F-  -- !-  - ! -//- !/-- !-- !-::- !:-- !-  !- -- !-  !G !D !E- -- !-- !-- !-//- !/-DD- !D-YY- !Y-nn- !n-- !-- !-- !-- !-- !-- !-- !-- !-++- !+-@@- !@--'- F'WPWin 6.0/OLE 1.0 Prefix Information Marker& METAFILEPICT$ES$E!     F''  ' F-   "- "- !-F- !F-'- F-'- F-   !F !ETimes New Roman4- 2 AFY 1999 2 FY 2000 2 FY 2001 2 KRequest Times New Roman<--"Systemn-'-- /- 2 FActual - !+-F---2 Estimate  - !;----2 Estimate  - !;----2 A +/- Enacted  - !L-A----'-- FTimes New Roman4- 42 [ Total Outlays, Current Law /1:     j 2 [a$565j2 [$1,300j32 [$1,9052 [h+$605 -'2 Proposed Legislation:  -%]2 9 Total Cost to SCHIP.................................    2 % 2 - 2 -3 2 $2122 h+$212 -2 -"2 $6Total Outlays /2 /3...................................- 2 a$5652 $1,30032 $2,1172 c+$817 @2 &/1 Numbers may not add due to rounding   2 - f Medicaid expansion are not included in the outlay estimates and are part of the Title XIX account.    --'--   2  d/2 The total outlays for SCHIP represent an estimate of program spending in separate SCHIP programs.        --'-- +  2  c/3 Because States have the option to expand SCHIP coverage through expanding Medicaid, outlays for     --'-- F--'-- F-  -- !-  - ! -//- !/-- !-- !-::- !:-- !-  !- -- !-  !G !D !E- -- !-- !-- !-//- !/-DD- !D-YY- !Y-nn- !n-- !-- !-- !-- !-- !-- !-- !-- !-++- !+-@@- !@--'- F'=>*OLE*WPC!  YE   P''  ' P-   "-P "- !P-- !-'- P-'- P-   ! !m !P !Times New Roman4- 2  SCHIP PROPOSALS   2 FY 2001 2 FY 01-05 2  Coster Proposals  Times New Roman4-*2 1  FamilyCare Program     @ 2 1$200@?2 1$3,600C2 F ( Restore SCHIP to immigrant children    U 2 F$2U? 2 F'$25"2 [  Age expansion j 2 [$6j? 2 ['$35E2 p ) Align Medicaid and SCHIP eligibility    2 p$4? 2 p'$4912  School lunch initiative  2 $0? 2 /$6-2 TOTAL SCHIP    2 $212?2 $3,715-"Systemn-'-- P-  -- !-  - ! -mm- !m-- !-FF- !F-  !O- -OO- !O-  ! !O !N- -PQ- !P-PQ- !P-PQ- !P-/P/Q- !/P-DPDQ- !DP-YPYQ- !YP-nPnQ- !nP-PQ- !P-PQ- !P-PQ- !P--'- P'WPWin 6.0/OLE 1.0 Prefix Information Marker' METAFILEPICT*= *={ YE   P''  ' P-   "-P "- !P-- !-'- P-'- P-   ! !m !P !Times New Roman4- 2  SCHIP PROPOSALS   2 FY 2001 2 FY 01-05 2  Coster Proposals  Times New Roman4-*2 1  FamilyCare Program     @ 2 1$200@?2 1$3,600C2 F ( Restore SCHIP to immigrant children    U 2 F$2U? 2 F'$25"2 [  Age expansion j 2 [$6j? 2 ['$35E2 p ) Align Medicaid and SCHIP eligibility    2 p$4? 2 p'$4912  School lunch initiative  2 $0? 2 /$6-2 TOTAL SCHIP    2 $212?2 $3,715-"Systemn-'-- P-  -- !-  - ! -mm- !m-- !-FF- !F-  !O- -OO- !O-  ! !O !N- -PQ- !P-PQ- !P-PQ- !P-/P/Q- !/P-DPDQ- !DP-YPYQ- !YP-nPnQ- !nP-PQ- !P-PQ- !P-PQ- !P--'- P'   BC*OLE*WPC  !  H c   H''  ' H' H-   !H MS Sans Serifn--"Systemn-'--  -  *2 NURSING HOME INITIATIVE    --2 FY 2001---'-- H MS Sans Serif<- 2 MFunding Source MS Sans Serif---'-- *- 2 millions- !!&----'-- H- 2 4HCFA: Times New Roman- MS Sans Seriff-2 E Discretionary-aQ2 V1 Medicare Survey and Certification............. a 2 V29.7r[2 g8 Federal Administration...............................2 g r 2 g6.1c2 x= Research..................................................2 x  2 x2.0-2  Mandatory -Q2 1 Medicaid Survey and Certification............. 2   2 15.9T2 3 Peer Review Organizations.......................2   MS Sans Serif- 2 3.6- !--C2 (Subtotal, HCFA.......................... 2  -2 $57.3-+2 Departmental Management:    -2  Discretionary- T2 3 Office of the General Counsel...................2    2 9.0R2 2 Departmental Appeals Board.....................- 2 4.5- !----'-- .+ 92 !Subtotal, Departmental Management    ---'-- H+ 2 $13.5-D=2 9$Total, Nursing Home Initiative......   2 9 D2 9$70.8--'-- H-   "-  "- ! -  - !- H- !/- H- !/-  - ! - - !- GG- !G--'- H'WPWin 6.0/OLE 1.0 Prefix Information Marker* METAFILEPICT  ! H c   H''  ' H' H-   !H MS Sans Serifn--"Systemn-'--  -  *2 NURSING HOME INITIATIVE    --2 FY 2001---'-- H MS Sans Serif<- 2 MFunding Source MS Sans Serif---'-- *- 2 millions- !!&----'-- H- 2 4HCFA: Times New Roman- MS Sans Seriff-2 E Discretionary-aQ2 V1 Medicare Survey and Certification............. a 2 V29.7r[2 g8 Federal Administration...............................2 g r 2 g6.1c2 x= Research..................................................2 x  2 x2.0-2  Mandatory -Q2 1 Medicaid Survey and Certification............. 2   2 15.9T2 3 Peer Review Organizations.......................2   MS Sans Serif- 2 3.6- !--C2 (Subtotal, HCFA.......................... 2  -2 $57.3-+2 Departmental Management:    -2  Discretionary- T2 3 Office of the General Counsel...................2    2 9.0R2 2 Departmental Appeals Board.....................- 2 4.5- !----'-- .+ 92 !Subtotal, Departmental Management    ---'-- H+ 2 $13.5-D=2 9$Total, Nursing Home Initiative......   2 9 D2 9$70.8--'-- H-   "-  "- ! -  - !- H- !/- H- !/-  - ! - - !- GG- !G--'- H'FG*OLE*WPCW W !W 4 k    ''  ' ' -   !g !2f !Yf5 !wwTimes New Roman0- 2 SFY 19992 FY 20002 FY 20012 _Request Times New Roman--"Systemn-'-- "- 2 WApprop. - !* W---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman$-A+ 2 5P Medicare Contractors........................................................ 2 5+ 2 5`$1,2652 5$1,2442 5$1,301 2 5y$57R)y2 F LSurvey and Certification ...................................................2 F) R} 2 Fk175Rk!2 F8 2 Fk R 2 F205R(2 F 2 F R/ 2 F234R2 F 2 F R 2 F{29R{'2 F< 2 F{ c+{2 W MFederal Administration.......................................................  2 W+ c} 2 Wk455ck!2 W8 2 Wk c 2 W483c(2 W 2 W c/ 2 W496c2 W 2 W c 2 W{13c{'2 W< 2 W{ t*2 h WResearch...............................................................................2 h* t} 2 hq50tq2 hA 2 hq t 2 h62t/ 2 h#55t 2 h}(7)t}'2 h> 2 h} -*]2 y9HCFA Discretionary Budget Authority......................     2 y* 2 y[$1,9452 y$1,9932 y $2,086 2 yv$93-+2 ZCLIA...................................................................................... 2 + } 2 q43q$2 8 2 q  2 43+2  2  / 2 #43#"2  2 #  2 -+x2 KNursing Home Registry......................................................   2 + } 2 y- 2 -/ 2 )4)%2  2 )  2 4*2 < 2  +j2 BSale of Data/FQHMO applications...................................  2 + } 2 w2w'2 8 2 w  2 2.2  2  / 2 )2)%2  2 )  2 -)o2 EMedicare + Choice Information........................................  2 ) } 2 q95q$2 8 2 q  2 95+2  2  / 2 1002  2   2 5*2 < 2  -)2 X Subtotal................................2 ) }2 ^2,085^2 : 2 ^ 2 2,133!2  2  /2 2,2352  2   2 r102r"2 < 2 r -)W2 5Medicare + Choice Information Proposed Increase......  2 ) } 2 y- 2 -(2  2  / 2 #50#"2  2 #  2 {50{'2 < 2 {  +W2  5Medicare + Choice Information Proposed User Fee......   2 +  } 2 y-  2 - (2  2  2 #-50 2 {-50+p2  FCLIA User Fees -- Current Law.........................................   2 + 2 q-43 2 -43 2 #-43 2 0/*l2 # CNursing Home Registry User Fee.....................................    2 #* 2 #}- 2 #- 2 #)-4 2 #-4@)X2 4 6Sale of Data/FQHMO applications -- Current Law........   2 4) 2 4w-2 2 4-2 2 4)-2@ 2 4-Q)c2 E =Managed Care User Fees -- Current Law........................   2 E) 2 Eq-95 2 E-95 2 E-100 2 E-5--'-- eU_+ |2 S NProposed User Fees............................................................ 2 S+ Times New Romanl- 2 S{0- !`{- 2 S0- !`- 2 S-220- !`-Times New Roman- 2 Su-220- !bu---'-- -s* ]2 g9Proposed BA (including New User Fees) ...................  2 g* 2 g[$1,9452 g$1,9932 g $1,866 2 gr-127-)~2  OProposed Outlays .............................................................. 2 ) -2 [$1,9452 $1,9932  $1,8662 k-$127-+2 ]FTE /1.......................................................................................2 + }2 b4,2192 4,363/2 4,435 2 {72{'2 < 2 { 2 t/1 In FY 2000, 50 employees are being paid out of the $150 million for the Y2K compliance effort funded out of the     i2 A Public Health and Social Services Emergency Fund (PHSSEF).   --'-- -   "- "- !-- !-- !4-"- !-Cf- !#C-- !-v- !xv-- !-1- !]1--'- 'WPWin 6.0/OLE 1.0 Prefix Information Marker( METAFILEPICTC4C 3 k    ''  ' ' -   !g !2f !Yf5 !wwTimes New Roman0- 2 SFY 19992 FY 20002 FY 20012 _Request Times New Roman--"Systemn-'-- "- 2 WApprop. - !* W---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- Times New Roman$-A+ 2 5P Medicare Contractors........................................................ 2 5+ 2 5`$1,2652 5$1,2442 5$1,301 2 5y$57R)y2 F LSurvey and Certification ...................................................2 F) R} 2 Fk175Rk!2 F8 2 Fk R 2 F205R(2 F 2 F R/ 2 F234R2 F 2 F R 2 F{29R{'2 F< 2 F{ c+{2 W MFederal Administration.......................................................  2 W+ c} 2 Wk455ck!2 W8 2 Wk c 2 W483c(2 W 2 W c/ 2 W496c2 W 2 W c 2 W{13c{'2 W< 2 W{ t*2 h WResearch...............................................................................2 h* t} 2 hq50tq2 hA 2 hq t 2 h62t/ 2 h#55t 2 h}(7)t}'2 h> 2 h} -*]2 y9HCFA Discretionary Budget Authority......................     2 y* 2 y[$1,9452 y$1,9932 y $2,086 2 yv$93-+2 ZCLIA...................................................................................... 2 + } 2 q43q$2 8 2 q  2 43+2  2  / 2 #43#"2  2 #  2 -+x2 KNursing Home Registry......................................................   2 + } 2 y- 2 -/ 2 )4)%2  2 )  2 4*2 < 2  +j2 BSale of Data/FQHMO applications...................................  2 + } 2 w2w'2 8 2 w  2 2.2  2  / 2 )2)%2  2 )  2 -)o2 EMedicare + Choice Information........................................  2 ) } 2 q95q$2 8 2 q  2 95+2  2  / 2 1002  2   2 5*2 < 2  -)2 X Subtotal................................2 ) }2 ^2,085^2 : 2 ^ 2 2,133!2  2  /2 2,2352  2   2 r102r"2 < 2 r -)W2 5Medicare + Choice Information Proposed Increase......  2 ) } 2 y- 2 -(2  2  / 2 #50#"2  2 #  2 {50{'2 < 2 {  +W2  5Medicare + Choice Information Proposed User Fee......   2 +  } 2 y-  2 - (2  2  2 #-50 2 {-50+p2  FCLIA User Fees -- Current Law.........................................   2 + 2 q-43 2 -43 2 #-43 2 0/*l2 # CNursing Home Registry User Fee.....................................    2 #* 2 #}- 2 #- 2 #)-4 2 #-4@)X2 4 6Sale of Data/FQHMO applications -- Current Law........   2 4) 2 4w-2 2 4-2 2 4)-2@ 2 4-Q)c2 E =Managed Care User Fees -- Current Law........................   2 E) 2 Eq-95 2 E-95 2 E-100 2 E-5--'-- eU_+ |2 S NProposed User Fees............................................................ 2 S+ Times New Romanl- 2 S{0- !`{- 2 S0- !`- 2 S-220- !`-Times New Roman- 2 Su-220- !bu---'-- -s* ]2 g9Proposed BA (including New User Fees) ...................  2 g* 2 g[$1,9452 g$1,9932 g $1,866 2 gr-127-)~2  OProposed Outlays .............................................................. 2 ) -2 [$1,9452 $1,9932  $1,8662 k-$127-+2 ]FTE /1.......................................................................................2 + }2 b4,2192 4,363/2 4,435 2 {72{'2 < 2 { 2 t/1 In FY 2000, 50 employees are being paid out of the $150 million for the Y2K compliance effort funded out of the     i2 A Public Health and Social Services Emergency Fund (PHSSEF).   --'-- -   "- "- !-- !-- !4-"- !-Cf- !#C-- !-v- !xv-- !-1- !]1--'- 'LM*OLE*KHLPLibbie * FG&XXXXXXXX-X,XX-  __Excel_spreadsheet_Ԁwillgointhisposition.To_importthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange_.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.WPC11!1J     g''  ' g' g-   !xTimes New Roman-  2 e1999 2 2000 2 20012 \Request Times New Roman--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- gTimes New Roman-R) 2 FUClinical Trials .....................................................................2 F) R} 2 Fw0R 2 F0R/ 2 F250Times New Roman4-R 2 Fn+250- !Sn--c*2 WVTotal.................................................................................2 W* c} 2 Wo$0c 2 W$0 2 W$250c2 Wd+$250--'-- g-   !i !f !--'- g'WPWin 6.0/OLE 1.0 Prefix Information Marker) METAFILEPICTC`P C     g''  ' g' g-   !xTimes New Roman-  2 e1999 2 2000 2 20012 \Request Times New Roman--"Systemn-'-- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O----'-- gTimes New Roman-R) 2 FUClinical Trials .....................................................................2 F) R} 2 Fw0R 2 F0R/ 2 F250Times New Roman4-R 2 Fn+250- !Sn--c*2 WVTotal.................................................................................2 W* c} 2 Wo$0c 2 W$0 2 W$250c2 Wd+$250--'-- g-   !i !f !--'- g'OP*OLE*WPC  !     ''  ' ' Times New Roman4-  2 e1999 2 2000 2 20012 \Request Times New Roman4-"Systemn-'- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O---'- Times New Roman0- 2 5 Current Law: R+y2 FLMedicare Trust Fund ........................................................ 2 F+ R}2 FP$211,855R2 F$224,138R/2 F$244,626R2 F_+20,488c+2 WVMedicaid ............................................................................. 2 W+ 2 WZ108,0422 W116,1172 W 124,175c2 We+8,058t+2 hXSCHIP................................................................................... 2 h+ t} 2 hk565t2 h1,300t/2 h1,905t 2 hn+605+l2 yCState Grants and Demonstrations....................................  2 y+ Times New Roman4-} 2 yw0- !w- 2 y0- !-/ 2 y#16- ! #- 2 yt+16- !t--)j2 BTotal Outlays, Current Law........................................  2 ) }2 B +$320,4622  +$341,555/2  +$370,7232 Z+29,168-)2 UPremiums ............................................................................  2 ) }2 R-$21,5612 -$21,735/2 -$23,3402 h-1,605-*f2 ?Total Net Outlays, Current Law.................................   2 * }2 B +$298,9012  +$319,820/2  +$347,3832 S+$27,563-2  Proposed Law:  +2 VMedicare ............................................................................. 2 +  } 2 q$0  2 $0 /2 -$690 2 k-$690+2 VMedicaid ............................................................................. 2 + 2 {0 2 0 2 !663 2 n+663/)u2 #IProgram Management.......................................................   2 #) 2 #{0 2 #0 2 #!250@+2 4XSCHIP................................................................................... 2 4+ 2 4{0 2 40 2 4!212@ 2 4n+212Q+l2 ECState Grants and Demonstrations....................................  2 E+ 2 E{0 2 E0 2 E'10Q 2 Et+10b+2 VVUser Fees............................................................................. 2 V+ - 2 V{0- !c{- 2 V0- !c- 2 V-220- !c-b 2 Vq-220- !cq--s*2 gZTotal.....................................................................................2 g* 2 g{0 2 g0 2 g!225s 2 gn+225-+c2 =Total Net Outlays, Proposed Law /2 ..........................  2 + }2 I$298,9012 $319,820/2 $347,6072 Z$27,787-@2 &/1 Numbers may not add due to rounding   2 X/2 Total net outlays equal current law outlays minus the impact of proposed legislation    'WPWin 6.0/OLE 1.0 Prefix Information Marker+ METAFILEPICTCvC/    ''  ' ' Times New Roman4-  2 e1999 2 2000 2 20012 \Request Times New Roman4-"Systemn-'- "- 2 ]Actual - !$ ]---2 Enacted- !* ---2 Request - !, ---2 O +/- Enacted- !< O---'- Times New Roman0- 2 5 Current Law: R+y2 FLMedicare Trust Fund ........................................................ 2 F+ R}2 FP$211,855R2 F$224,138R/2 F$244,626R2 F_+20,488c+2 WVMedicaid ............................................................................. 2 W+ 2 WZ108,0422 W116,1172 W 124,175c2 We+8,058t+2 hXSCHIP................................................................................... 2 h+ t} 2 hk565t2 h1,300t/2 h1,905t 2 hn+605+l2 yCState Grants and Demonstrations....................................  2 y+ Times New Roman4-} 2 yw0- !w- 2 y0- !-/ 2 y#16- ! #- 2 yt+16- !t--)j2 BTotal Outlays, Current Law........................................  2 ) }2 B +$320,4622  +$341,555/2  +$370,7232 Z+29,168-)2 UPremiums ............................................................................  2 ) }2 R-$21,5612 -$21,735/2 -$23,3402 h-1,605-*f2 ?Total Net Outlays, Current Law.................................   2 * }2 B +$298,9012  +$319,820/2  +$347,3832 S+$27,563-2  Proposed Law:  +2 VMedicare ............................................................................. 2 +  } 2 q$0  2 $0 /2 -$690 2 k-$690+2 VMedicaid ............................................................................. 2 + 2 {0 2 0 2 !663 2 n+663/)u2 #IProgram Management.......................................................   2 #) 2 #{0 2 #0 2 #!250@+2 4XSCHIP................................................................................... 2 4+ 2 4{0 2 40 2 4!212@ 2 4n+212Q+l2 ECState Grants and Demonstrations....................................  2 E+ 2 E{0 2 E0 2 E'10Q 2 Et+10b+2 VVUser Fees............................................................................. 2 V+ - 2 V{0- !c{- 2 V0- !c- 2 V-220- !c-b 2 Vq-220- !cq--s*2 gZTotal.....................................................................................2 g* 2 g{0 2 g0 2 g!225s 2 gn+225-+c2 =Total Net Outlays, Proposed Law /2 ..........................  2 + }2 I$298,9012 $319,820/2 $347,6072 Z$27,787-@2 &/1 Numbers may not add due to rounding   2 X/2 Total net outlays equal current law outlays minus the impact of proposed legislation    '   ST*OLE*WPC{{!{t  `   ''  ' ' Times New Roman4-  2 1999 2 H2000 2 20012 Request Times New Roman4-2 Actual - !$ -2 :Enacted- !* :-2 Request - !, -2  +/- Enacted- !< -Times New Roman4-AC2 5(Discretionary Program Level ............  2 5 A2 5$9,022A`2 5?$9,874A2 5$11,668A2 5+$1,794RF2 F*Entitlement Program Level ................  2 F Times New Roman4-R2 F29,667- !!S-R`2 F?27,895- !!S?-R2 F31,275- !!S-R2 F3,380- !S--cF2 W* Total, ACF Program Level ............  2 W c2 W$38,689c`2 W9$37,769c2 W$42,943c2 W+$5,174`2 y;FTE .......................................................2 y 2 y1,509`2 yE1,5002 y1,560 2 y+60'WPWin 6.0/OLE 1.0 Prefix Information Marker, METAFILEPICTn5z n5( `   ''  ' ' Times New Roman4-  2 1999 2 H2000 2 20012 Request Times New Roman4-2 Actual - !$ -2 :Enacted- !* :-2 Request - !, -2  +/- Enacted- !< -Times New Roman4-AC2 5(Discretionary Program Level ............  2 5 A2 5$9,022A`2 5?$9,874A2 5$11,668A2 5+$1,794RF2 F*Entitlement Program Level ................  2 F Times New Roman4-R2 F29,667- !!S-R`2 F?27,895- !!S?-R2 F31,275- !!S-R2 F3,380- !S--cF2 W* Total, ACF Program Level ............  2 W c2 W$38,689c`2 W9$37,769c2 W$42,943c2 W+$5,174`2 y;FTE .......................................................2 y 2 y1,509`2 yE1,5002 y1,560 2 y+60'V V FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_ԀorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboard_contentsat_Ԁthecorrectpositioninthisdocument mG"XLXXXXLXXXL-X,XX-  _ Reachingthe  PresidentsGoalofOneMillionChildrenby2002 .^_*OLE*[\*OLE*WPC@@>>>>!>> E    o' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' ' | "-H-   4n 3fH- 3f xH-  HH-  X,ffH- ff /BH-  <IcOfH- f ,@2g "--'-- fTimes New Roman,-----"Systemn-'--- fa#  H2 .+FY 2001 Discretionary Funding $11.7 billion          ----'---  "- 0% **Cx---'--- Times New RomanI--------'--- S> 2 ]BOther 2 O5%----'--- ---------'--- * 2 4&Refugee   2 W  Resettlement    2 z@4%----'--- ------'--- br 2 | Head Start    2  53%----'--- ---------'--- f 2 Child 2  Abuse/Welfare   2 ?4%----'--- -------'---  2   Child Care 2 ,17%----'--- --------'--- *X 2 b Community  2 Services  2 5%----'--- -------'---  0 2 4LIHEAP 2 J12%----'--- ---'--- --' o '  'WPWin 6.0/OLE 1.0 Prefix Information Marker. METAFILEPICT'^'^c@ E    o' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' ' | "-H-   4n 3fH- 3f xH-  HH-  X,ffH- ff /BH-  <IcOfH- f ,@2g "--'-- fTimes New Roman,-----"Systemn-'--- fa#  H2 .+FY 2001 Discretionary Funding $11.7 billion          ----'---  "- 0% **Cx---'--- Times New RomanI--------'--- S> 2 ]BOther 2 O5%----'--- ---------'--- * 2 4&Refugee   2 W  Resettlement    2 z@4%----'--- ------'--- br 2 | Head Start    2  53%----'--- ---------'--- f 2 Child 2  Abuse/Welfare   2 ?4%----'--- -------'---  2   Child Care 2 ,17%----'--- --------'--- *X 2 b Community  2 Services  2 5%----'--- -------'---  0 2 4LIHEAP 2 J12%----'--- ---'--- --' o '  'WPC  ! +      ''  '  '  -   !  ! !N !: !~ ! !N !=  ! !N !]  !n !n9 ! ~ ! !F9 !N !w  ! !N !h *Times New Roman--"Systemn-'--  -  *2 DISCRETIONARY PROGRAMS:     -Times New Roman,----'--  9------  2 1999-2 Actual- !"------'--  ~:-------- 2 d2000 -2 SEnacted- !)S------'--  -------- 2 2001 -2 Request- !*------'--  ------ !2 Request  2 +/--2 Enacted- !)----'--  Times New Roman)- 2 !,2 !IHead Start /1 /2.......................................................2 !$4,6582 ![$5,2672 !$6,267-2 !+$1,0002 1!2 13Child Care & Development Block Grant /1 /3.........2 11,0002 1a1,1832 12,000= 2 1+8172 A$2 A:Runaway and Homeless Youth................................ 2 A+59 2 Ap64 2 A74M 2 A+102 Q'2 Q?Violence Against Women......................................... 2 Q%105 2 Qj118 2 Q134] 2 Q+162 a*2 aENative Americans..................................................... 2 a+35 2 ap35 2 a44m 2 a+92 w$2 w:Community Services Block Grant............................ 2 w%500 2 wj528 2 w510 2 w-182 "2 6Individual Development Accounts....................... 2 +10 2 p10 2 25 2 +152 ,2 IJOLI..................................................................... 2 15 2 v5 2 5 2 02 &2 >Discretionary Programs........................................Times New Roman- 2 +47- ! +- 2 p50- ! p- 2 0- !- 2 -50- !--2 &2 =Subtotal, Community Services................................. 2 $562 2 d$593 2 $540 2 -$532 '2 @Developmental Disabilities...................................... 2 %119 2 j122 2 122 2 02 )2 CChild Abuse/Welfare................................................ 2 %404 2 j411 2 411 2 02 )2 DAdoption Incentives................................................. 2 +20 2 p42 2 42 2 02 )2 CSocial Services Research........................................... 2 +27 2 p28 2 7 2 -212 !2 3Pre-Appropriated Research/Evaluation...............- 2 10- ! 1- 2 v0- ! v- 2 21- ! - 2 +21- ! --/a2 #<Subtotal, Social Services Research..........................2 # 2 #%$27 2 #j$28 2 #$28/ 2 #$02 9&2 9=LIHEAP Regular Funding /1....................................2 91,1002 9a1,1002 91,100E 2 902 I'2 I@Contingency Fund................................................- 2 I%300- !V%- 2 Ij300- !Vj- 2 I300- !V-U 2 I0- !V--el2 YCSubtotal, LIHEAP...................................................  2 Y 2 Y$1,4002 Y[$1,4002 Y$1,400e 2 Y02 o&2 o=Refugee and Entrant Assistance............................... 2 o%481 2 oj454 2 o432{ 2 o-22Times New Roman -2 !2 3Refugee Carryover Balance (non-add)................ 2 )66 2 n28 2 0 2 0-2 )2 CFederal Administration............................................. 2 %144 2 j148 2 165 2 +172  2 1Pre-Appropriated Federal Administration /4.......- 2 18- !1- 2 v9- !v- 2 9- !- 2 0- !--2 &2 =Subtotal, Federal Administration.............................- 2 $152- !- 2 d$157- !d- 2 $174- !- 2 +$17- !--2 (2 ATotal, Program Level.............................................2 $9,0222 [$9,8742 $11,6682 +$1,794-C2 (Less Funds Allocated from Other Sources:   2  2 2Head Start Advance Appropriation (net)............ 2 102 a1,400 2 0 2 02 !2 3Pre-Appropriated Research/Evaluation............... 2 10 2 v0 2 21 2 +212  2 1Pre-Appropriated Federal Administration /4.......- 2 18- !1- 2 v9- !v- 2 9- !- 2 0- !--2 !2 4Total, Discretionary Budget Authority...............2 $9,0142 [$8,4652 $11,638'2 +$3,173-2 6,2 6IFTE......................................................................2 61,5092 6a1,5002 61,560B 2 660x2 RK/1 P.L. 106-113 (FY 2000 appropriation) provides advanced FY 2001 funding.Times New Roman4-=2 $/4 1%-2% funds (Public Law 104-193)  --------'--  r- 2 ri/3 The budget includes +$817 million for FY 2001 and an advance appropriation of $2 billion for FY 2002. ------'-- q b- 2 bf/2 FY 2001 and FY 2002 funding levels include $1.4 billion advance appropriation for subsequent year.---'--  --'--  --'-  'WPWin 6.0/OLE 1.0 Prefix Information Marker- METAFILEPICTB6+B6D      ''  '  '  -   !  ! !N !: !~ ! !N !=  ! !N !]  !n !n9 ! ~ ! !F9 !N !w  ! !N !h *Times New Roman--"Systemn-'--  -  *2 DISCRETIONARY PROGRAMS:     -Times New Roman,----'--  9------  2 1999-2 Actual- !"------'--  ~:-------- 2 d2000 -2 SEnacted- !)S------'--  -------- 2 2001 -2 Request- !*------'--  ------ !2 Request  2 +/--2 Enacted- !)----'--  Times New Roman)- 2 !,2 !IHead Start /1 /2.......................................................2 !$4,6582 ![$5,2672 !$6,267-2 !+$1,0002 1!2 13Child Care & Development Block Grant /1 /3.........2 11,0002 1a1,1832 12,000= 2 1+8172 A$2 A:Runaway and Homeless Youth................................ 2 A+59 2 Ap64 2 A74M 2 A+102 Q'2 Q?Violence Against Women......................................... 2 Q%105 2 Qj118 2 Q134] 2 Q+162 a*2 aENative Americans..................................................... 2 a+35 2 ap35 2 a44m 2 a+92 w$2 w:Community Services Block Grant............................ 2 w%500 2 wj528 2 w510 2 w-182 "2 6Individual Development Accounts....................... 2 +10 2 p10 2 25 2 +152 ,2 IJOLI..................................................................... 2 15 2 v5 2 5 2 02 &2 >Discretionary Programs........................................Times New Roman- 2 +47- ! +- 2 p50- ! p- 2 0- !- 2 -50- !--2 &2 =Subtotal, Community Services................................. 2 $562 2 d$593 2 $540 2 -$532 '2 @Developmental Disabilities...................................... 2 %119 2 j122 2 122 2 02 )2 CChild Abuse/Welfare................................................ 2 %404 2 j411 2 411 2 02 )2 DAdoption Incentives................................................. 2 +20 2 p42 2 42 2 02 )2 CSocial Services Research........................................... 2 +27 2 p28 2 7 2 -212 !2 3Pre-Appropriated Research/Evaluation...............- 2 10- ! 1- 2 v0- ! v- 2 21- ! - 2 +21- ! --/a2 #<Subtotal, Social Services Research..........................2 # 2 #%$27 2 #j$28 2 #$28/ 2 #$02 9&2 9=LIHEAP Regular Funding /1....................................2 91,1002 9a1,1002 91,100E 2 902 I'2 I@Contingency Fund................................................- 2 I%300- !V%- 2 Ij300- !Vj- 2 I300- !V-U 2 I0- !V--el2 YCSubtotal, LIHEAP...................................................  2 Y 2 Y$1,4002 Y[$1,4002 Y$1,400e 2 Y02 o&2 o=Refugee and Entrant Assistance............................... 2 o%481 2 oj454 2 o432{ 2 o-22Times New Roman -2 !2 3Refugee Carryover Balance (non-add)................ 2 )66 2 n28 2 0 2 0-2 )2 CFederal Administration............................................. 2 %144 2 j148 2 165 2 +172  2 1Pre-Appropriated Federal Administration /4.......- 2 18- !1- 2 v9- !v- 2 9- !- 2 0- !--2 &2 =Subtotal, Federal Administration.............................- 2 $152- !- 2 d$157- !d- 2 $174- !- 2 +$17- !--2 (2 ATotal, Program Level.............................................2 $9,0222 [$9,8742 $11,6682 +$1,794-C2 (Less Funds Allocated from Other Sources:   2  2 2Head Start Advance Appropriation (net)............ 2 102 a1,400 2 0 2 02 !2 3Pre-Appropriated Research/Evaluation............... 2 10 2 v0 2 21 2 +212  2 1Pre-Appropriated Federal Administration /4.......- 2 18- !1- 2 v9- !v- 2 9- !- 2 0- !--2 !2 4Total, Discretionary Budget Authority...............2 $9,0142 [$8,4652 $11,638'2 +$3,173-2 6,2 6IFTE......................................................................2 61,5092 6a1,5002 61,560B 2 660x2 RK/1 P.L. 106-113 (FY 2000 appropriation) provides advanced FY 2001 funding.Times New Roman4-=2 $/4 1%-2% funds (Public Law 104-193)  --------'--  r- 2 ri/3 The budget includes +$817 million for FY 2001 and an advance appropriation of $2 billion for FY 2002. ------'-- q b- 2 bf/2 FY 2001 and FY 2002 funding levels include $1.4 billion advance appropriation for subsequent year.---'--  --'--  --'-  'ab*OLE*WPC@@>>>>!>><     o''  ' o' o - 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  ''   -4 "-- "--' -- --' -- --'-- Times New Roman- Arial-------------"Systemn-'---  "--  ---'--- - $;9 9 ;;99;9  ;9;---'--- ---'---  9;---'---  7; "- -  $UUU$;;;---'---  9;---'---  "-9; ;8;n8n;T8T;989;; -;;  ---'--- ------'--- {lb   2 od1.53----'--- -----'--- <'  2 *14.7----'--- ---'---   2 -0 2 g-5 2 M'10 2 2'15---'--- ----'---  !2 AChildren Served, 2 \FY1998!2 Children Eligible 2 for Federal2 Subsidies---'--- -------'--- (@ Times New Roman- 2 | Children-Times New Roman-2  (in millions)-----'--- ---'--- --' '  '   -'WPWin 6.0/OLE 1.0 Prefix Information Marker2Excel.Sheet.8Vࡱ> ) !"#$%&'(Root Entry FŢ=nOle CompObjbWorkbook.5  FMicrosoft Excel ChartBiff8Excel.Sheet.89qOh+'08@P` xuserfUSERfMicrosoft Excel@[k՜.+,D՜.+,  IBa=f =hy8X1>Arial1>Arial1>Arial1>Arial1.>Times New Roman1.>Times New Roman1.>Times New Roman1>Arial1Y>Arial1>Arial1>Arial1>Arial1>Arial1>Arial1>Arial1.>Times New Roman1>Arial1>Arial1>Arial1.>Times New Roman1>Arial"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_) @*._) "$"#,##0#,###_);\-#,###_);_(0_)                ! # + ) , *  ! x  #x   ` A#|   #| #|  `  q!`   l catstub_column_aColumn_b-d_stubunderlinetotalorsubtotal_column_aChart1Sheet1+Sheet2E4Sheet3bZ  3  @@   TANFOther Child Care Child SupportSSBGFoster Care/Adopt. Assist. 'Children Eligible for Federal SubsidiesFC/AAChildren Served, FY1998 l  \b(t}-'~-,,bdbeb\b  bVe~@@1pcT0*@1?Н0? be@)bT0 2~b~~bNe@)bT0bip0bbM MMbhbS0ba00ApApzm0$0b 00Ԣ0bbb0bbab0bd4bFollowed Hyperlinkl~npnb0tbbpbe~4)~be~ee~4*~?~bT0? ?bebT0~@b ze~4~~b@Db֜z0Tbd{0BT0dbxbb}0(1T0bbbbz0bbbb04bb 0b4bE 0x  I" foFl Su??3` m ` m ` ! ` ! ?3d23 M NM4 3QQ ;Q ;Q3_4E4D$% M 3O&Q4$% M 3O&Q4FA k3O6 3 b#M&43*.@#M&4% pM Z3O I&Q 2Children (in millions)'4523 M  43d" 3_ M NM  MM< 444%  _Mj3O(&Q'4% #Mj3O&Q'4% M`3O&Q'44e9Children Served, FY1998W'Children Eligible for Federal Subsidiese{Gz?ffffff-@e> ffff  I  MbP?_*+%"??U} T00bbbb~ D@ TANF @'A Child Care~ @ Child Support~ 8@FC/AA~ @ SSBG~ @Other!x@ 71~  @!Children Served, FY1998~  c@0'Children Eligible for Federal Subsidies~ @b2%( 73D,(  v  <NMM?<]   IM2HP LaserJet 5Si HBISy\ odXX@XXEXCELCourier NewL (X7.LPT2HP5SI"dXX??3` m ` m  ` &S3dt 23 M NM4 3Q:  2001Qi ;Q ;Q3_ O   MM< 43_ O   MM< 4E4D$% M 3O&Q4$% M 3O& Q4FAO 3OmOY 3" $% XM 3OQ '43_ M NM  MM< 444% MP3OQ'4% ?3XM3O(!$&Q '4% 3XM3O0%$&Q '4% ` 1XM3O803&Q '4% 3 v3XM3O8 $&Q '4% E 3XM3O=$&Q '4% 3XM3O #$&Q '4% XM3O&Q '44eee ~v  <NMM?` Z] p  IMHP LaserJet 5Si/5Si MX7@dXX7@XXEXCELCourier New (X LPT1HP5SI"dXX??3` m  ` m ` ! ` ! @п3d23 M NM4 3QQ ;Q ;Q3_4E4D$% M 3O&Q4$% M 3O& Q4FA# 3O+D 3 b#M&43*.@#M&4% -tM Z3O I&Q 2Children (in millions)'4523 M  43d" 3_ M NM  MM< 444% M3O&Q'4% gtM3O&Q'4%  tM3O(&Q'44eee >@   I  MbP?_*+%" ??mUT00bb~ D@ TANF @'AOther!x@ 71 Child Support~ 8@$Foster Care/Adopt. Assist. ~ @ Child Care~ @ SSBG~ @x27(6% ( r', p  6NMM?]`  I"??3`  ` m ` m  3d23 M NM4 3Q:  2001Q ;Q ;Q3_4E4D $% M 3O& Q4$% M 3O& Q4FA&T 3O~& T 3" 3O% M3O& Q44$% M 3OQ '43_ M NM  MM< 444% Mc3OQ'44eee >@  I  MbP?_*+%"??U>@ BOlePartOlePres000 @SummaryInformation(DocumentSummaryInformation8m   -   ''   -4 "-- "--' -- --' -- --'-- Times New Roman- Arial-------------"Systemn-'---  "--  ---'--- - $;9 9 ;;99;9  ;9;---'--- ---'---  9;---'---  7; "- -  $UUU$;;;---'---  9;---'---  "-9; ;8;n8n;T8T;989;; -;;  ---'--- ------'--- {lb   2 od1.53----'--- -----'--- <'  2 *14.7----'--- ---'---   2 -0 2 g-5 2 M'10 2 2'15---'--- ----'---  !2 AChildren Served, 2 \FY1998!2 Children Eligible 2 for Federal2 Subsidies---'--- -------'--- (@ Times New Roman- 2 | Children-Times New Roman-2  (in millions)-----'--- ---'--- --' '  '   -'@ PXd lt| 11 Sheet1Sheet2Sheet3Chart1  WorksheetsCharts 6> _PID_GUIDAN{4FC45781-D71C-11D3-82CD-8EC1CE1BD219} METAFILEPICT m   -   ''   -4 "-- "--' -- --' -- --'-- Times New Roman- Arial-------------"Systemn-'---  "--  ---'--- - $;9 9 ;;99;9  ;9;---'--- ---'---  9;---'---  7; "- -  $UUU$;;;---'---  9;---'---  "-9; ;8;n8n;T8T;989;; -;;  ---'--- ------'--- {lb   2 od1.53----'--- -----'--- <'  2 *14.7----'--- ---'---   2 -0 2 g-5 2 M'10 2 2'15---'--- ----'---  !2 AChildren Served, 2 \FY1998!2 Children Eligible 2 for Federal2 Subsidies---'--- -------'--- (@ Times New Roman- 2 | Children-Times New Roman-2  (in millions)-----'--- ---'--- --' '  '   -'  mG"{XXXX{XXXX-X,XX-  _ {:XX  @@MMNumberof_Mammogram_ԀandPapSmearScreening@@  Among_NBCCEDP_ԀParticipants#{XX:# mn*OLE*WPC? ? !? * Q    b''  ' b' b-   !90 !8 !0ITimes New Roman4--"Systemn-'-- b-  2 FY 2001- !*---2 FY 01-05- !.----'-- bTimes New Roman%- .2 CHILD SUPPORT ENFORCEMENT:        f2 /? Optional $100 (or $50 above) Pass-through & Disregard /2 :   ; 2 /+5;) 2 /+97I2 B, Optional Simplified Distribution /2 /3:   N 2 B0N) 2 B+39662 U Remove Cap from Incentives:  a 2 U0a) 2 U#0c2 h= Automated Data Match and Attachment of Gambling Proceeds:       t 2 h-8t) 2 h-189T2 {3 Reduce Threshold for Passport Denial to $2,500:  2 {-1) 2 {-942  SSA Benefit Match (OASDI):     2 -11) 2 -67o2 E Booting Vehicles for Non-custodial Parents Owing at Least $1,000:   2 -3) 2 -96p2 F Reduce Match for Paternity Laboratory Tests from 90 to 66 Percent:   2 -8) 2 -41Q2 1 Mandatory Review of Child Support Orders /4:   - 2 +24- !-) 2 -232- !-Times New Roman5-2 VSubtotal, Child Support Enforcement /5...............................................  2   2 -2) 2 -141-2  CHILD CARE:   +2  Early Learning Fund:- 2 +600- !-)2 +3,000- !"--!2 fSubtotal, Child Care..................................................................................  2  ! 2 +600!)2 +3,000-2 4TANF: O2 E0 Freeze Supplemental Grants at FY 1998 Level: Q 2 E-240Q) 2 E-240--'-- eU u2 VI Allow TANF to Offset Reduction to Medicaid Administrative Payments/6:        ---'-- bb  2 V+208- !c-b) 2 V+353- !c--s2 giSubtotal, TANF........................................................................................... 2 g s 2 g-32s) 2 g +113-2 SSBG:^2 : Increase Authorization Level by $75 million in FY2001:  - 2 +75- !-) 2 +75- !--2 iSubtotal, SSBG........................................................................................... 2   2 +75) 2 +75-72  Foster Care/Adoption Assistance:  -2  Tribal Child Welfare: - 2 +5- ! -) 2 +5- ! --2 iSubtotal, FC/AA..........................................................................................  2   2 +5) 2 +5Times New Roman4---'-- b W2 5TOTAL ACF PROPOSED LAW IMPACT........................     2  2 $6462 $3,052--'-- b- 2 )^/1 Negative numbers are savings, positive numbers are costs. Except where noted, all figures     12 : represent Budget Authority. U2 K4/2 Includes savings from reductions in Food Stamps.   <2 \#/3 This proposal begins in FY 2002.2 ml/4 The savings from this proposal include savings to the Medicaid program totaling $170 million by FY 2005.     --'-- /} 2 ~f Child support totals combine increased administrative costs and savings due to increased collections.  --'-- b v2 J/5 The budget also includes two additional child support proposals on work  2 ^ requirements for non-custodial parents and exclusion of doctors with child support arrearages  d2 > from Medicare. These proposals are discussed in the chapter.  r2 G/6 This proposal has outlay effects, but no impact on budget authority. --'-- b-   "-9 "- !9-(- !(-I- !I-Il- !#I-//- !/-0- !/-c- !b-c- !b-kk- !k-c- !b--'- b'WPWin 6.0/OLE 1.0 Prefix Information Marker0 METAFILEPICT ?b* ?J Q    b''  ' b' b-   !90 !8 !0ITimes New Roman4--"Systemn-'-- b-  2 FY 2001- !*---2 FY 01-05- !.----'-- bTimes New Roman%- .2 CHILD SUPPORT ENFORCEMENT:        f2 /? Optional $100 (or $50 above) Pass-through & Disregard /2 :   ; 2 /+5;) 2 /+97I2 B, Optional Simplified Distribution /2 /3:   N 2 B0N) 2 B+39662 U Remove Cap from Incentives:  a 2 U0a) 2 U#0c2 h= Automated Data Match and Attachment of Gambling Proceeds:       t 2 h-8t) 2 h-189T2 {3 Reduce Threshold for Passport Denial to $2,500:  2 {-1) 2 {-942  SSA Benefit Match (OASDI):     2 -11) 2 -67o2 E Booting Vehicles for Non-custodial Parents Owing at Least $1,000:   2 -3) 2 -96p2 F Reduce Match for Paternity Laboratory Tests from 90 to 66 Percent:   2 -8) 2 -41Q2 1 Mandatory Review of Child Support Orders /4:   - 2 +24- !-) 2 -232- !-Times New Roman5-2 VSubtotal, Child Support Enforcement /5...............................................  2   2 -2) 2 -141-2  CHILD CARE:   +2  Early Learning Fund:- 2 +600- !-)2 +3,000- !"--!2 fSubtotal, Child Care..................................................................................  2  ! 2 +600!)2 +3,000-2 4TANF: O2 E0 Freeze Supplemental Grants at FY 1998 Level: Q 2 E-240Q) 2 E-240--'-- eU u2 VI Allow TANF to Offset Reduction to Medicaid Administrative Payments/6:        ---'-- bb  2 V+208- !c-b) 2 V+353- !c--s2 giSubtotal, TANF........................................................................................... 2 g s 2 g-32s) 2 g +113-2 SSBG:^2 : Increase Authorization Level by $75 million in FY2001:  - 2 +75- !-) 2 +75- !--2 iSubtotal, SSBG........................................................................................... 2   2 +75) 2 +75-72  Foster Care/Adoption Assistance:  -2  Tribal Child Welfare: - 2 +5- ! -) 2 +5- ! --2 iSubtotal, FC/AA..........................................................................................  2   2 +5) 2 +5Times New Roman4---'-- b W2 5TOTAL ACF PROPOSED LAW IMPACT........................     2  2 $6462 $3,052--'-- b- 2 )^/1 Negative numbers are savings, positive numbers are costs. Except where noted, all figures     12 : represent Budget Authority. U2 K4/2 Includes savings from reductions in Food Stamps.   <2 \#/3 This proposal begins in FY 2002.2 ml/4 The savings from this proposal include savings to the Medicaid program totaling $170 million by FY 2005.     --'-- /} 2 ~f Child support totals combine increased administrative costs and savings due to increased collections.  --'-- b v2 J/5 The budget also includes two additional child support proposals on work  2 ^ requirements for non-custodial parents and exclusion of doctors with child support arrearages  d2 > from Medicare. These proposals are discussed in the chapter.  r2 G/6 This proposal has outlay effects, but no impact on budget authority. --'-- b-   "-9 "- !9-(- !(-I- !I-Il- !#I-//- !/-0- !/-c- !b-c- !b-kk- !k-c- !b--'- b'p HLPASMB User  FG&XXXXXXXX-X,XX-  __Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.r +HLPLibbie  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_table.Run_ԀthemacroagainandpauseforasecondbetweenthetwoEnters.tu*OLE*WPC    ! 1     ''  ' -   "- "- !-- !-'- -'- -   ! !Times New Roman4-  2 a1999 2 2000 2 20012 rRequest Times New Roman--"Systemn-'-- &- 2 VActual - !+&V---2 Enacted - !6&---2  Request /2 - !H&---2 b +/- Enacted  - !L&b----'-- Times New Roman4---'-- H8 42 5Total Collections Distributed:   --'-- Y* [2 J8Non-TANF Families ......................................    2 J* Y|2 JH$12,984Y2 J$14,687Y92 J$16,153Y2 Jt+$1,466 --'-- n^j( ^2 [:TANF/FC families..........................................   2 [( j| 2 [d106jd2 [< 2 [d j 2 [90j2 [ 2 [ j9 2 [!109j!2 [ 2 [! j 2 [+19 --'-- --'-- o{' ^2 l:TANF program..............................................  2 l' {|2 lX2,337{X2 l< 2 lX {2 l2,238{2 l 2 l {92 l2,335{2 l 2 l { 2 l+97 --'-- --'-- * d2 }>FC program....................................................  2 }* | 2 }l35 2 }379 2 })38 2 }+1 --'-- ---'-- * g2 @Total........................................................... 2 * |2 H$15,4622 $17,05292 $18,6352 t+$1,583 --'-- ---'--  12 Distributed to TANF Program:    --'-- --'-- ' `2 ;Net Federal Share .........................................   2 ' | 2 \$868 2 $8519 2 $872 2 $21--'-- --'-- ( R2 2State Share (includes incentives and hold.........  2 ( | 2 \1469 2 13879 2 1463 2 +76 --'-- --'-- ) `2 ; harmless payments)........................................  2 ) --'-- ---'-- * g2 @Total........................................................... 2 * |2 P$2,3372 $2,23892 $2,335 2 +$97 --'-- ---'-- ) 62 Administrative Costs (Outlays):    --'-- --'-- :*6( d2 '>Federal Share ................................................  2 '( 6|2 'P$2,63562 '$2,832692 ' $3,0516 2 '$219--'-- --'-- K;G) g2 8@State Share.....................................................  2 8) G| 2 8\1392G 2 81568G9 2 81680G 2 8+112 --'-- ---'-- \LX) f2 I?Costs.......................................................... 2 I) X|2 IP$4,027X2 I$4,400X92 I $4,731X2 I+$331 --'-- ---'-- ~n @2 k&Program Saving and Costs (Collections:     --'-- --'--  2 | minus Costs):  --'-- --'-- ( d2 >Federal Costs ................................................  2 ( |2 P$1,7672 $1,98192  $2,1792 +$198 --'-- --'-- ' `2 ;State Savings/Costs........................................   2 ' 2 _($77) 2 $1819 2 $217Times New Roman0-  2 +36 - !---'- - -* a2 <Net Costs...................................................  2 * |2 P$1,6902 $2,16292  $2,3962 +$234 ---'--  2 S/1 Numbers may not add due to rounding. Costs are positive, savings are (negative).    --'--  E2 )/2 Numbers reflect legislative proposals.  --'-- -  -- !-- !-- !-- !-@@- !@-  ! ! !? ! ! ! !? !V !: !: !:? !0- -11- !1-  ! !: ! !--'- 'WPWin 6.0/OLE 1.0 Prefix Information Marker3 METAFILEPICT5G15G4     ''  ' -   "- "- !-- !-'- -'- -   ! !Times New Roman4-  2 a1999 2 2000 2 20012 rRequest Times New Roman--"Systemn-'-- &- 2 VActual - !+&V---2 Enacted - !6&---2  Request /2 - !H&---2 b +/- Enacted  - !L&b----'-- Times New Roman4---'-- H8 42 5Total Collections Distributed:   --'-- Y* [2 J8Non-TANF Families ......................................    2 J* Y|2 JH$12,984Y2 J$14,687Y92 J$16,153Y2 Jt+$1,466 --'-- n^j( ^2 [:TANF/FC families..........................................   2 [( j| 2 [d106jd2 [< 2 [d j 2 [90j2 [ 2 [ j9 2 [!109j!2 [ 2 [! j 2 [+19 --'-- --'-- o{' ^2 l:TANF program..............................................  2 l' {|2 lX2,337{X2 l< 2 lX {2 l2,238{2 l 2 l {92 l2,335{2 l 2 l { 2 l+97 --'-- --'-- * d2 }>FC program....................................................  2 }* | 2 }l35 2 }379 2 })38 2 }+1 --'-- ---'-- * g2 @Total........................................................... 2 * |2 H$15,4622 $17,05292 $18,6352 t+$1,583 --'-- ---'--  12 Distributed to TANF Program:    --'-- --'-- ' `2 ;Net Federal Share .........................................   2 ' | 2 \$868 2 $8519 2 $872 2 $21--'-- --'-- ( R2 2State Share (includes incentives and hold.........  2 ( | 2 \1469 2 13879 2 1463 2 +76 --'-- --'-- ) `2 ; harmless payments)........................................  2 ) --'-- ---'-- * g2 @Total........................................................... 2 * |2 P$2,3372 $2,23892 $2,335 2 +$97 --'-- ---'-- ) 62 Administrative Costs (Outlays):    --'-- --'-- :*6( d2 '>Federal Share ................................................  2 '( 6|2 'P$2,63562 '$2,832692 ' $3,0516 2 '$219--'-- --'-- K;G) g2 8@State Share.....................................................  2 8) G| 2 8\1392G 2 81568G9 2 81680G 2 8+112 --'-- ---'-- \LX) f2 I?Costs.......................................................... 2 I) X|2 IP$4,027X2 I$4,400X92 I $4,731X2 I+$331 --'-- ---'-- ~n @2 k&Program Saving and Costs (Collections:     --'-- --'--  2 | minus Costs):  --'-- --'-- ( d2 >Federal Costs ................................................  2 ( |2 P$1,7672 $1,98192  $2,1792 +$198 --'-- --'-- ' `2 ;State Savings/Costs........................................   2 ' 2 _($77) 2 $1819 2 $217Times New Roman0-  2 +36 - !---'- - -* a2 <Net Costs...................................................  2 * |2 P$1,6902 $2,16292  $2,3962 +$234 ---'--  2 S/1 Numbers may not add due to rounding. Costs are positive, savings are (negative).    --'--  E2 )/2 Numbers reflect legislative proposals.  --'-- -  -- !-- !-- !-- !-@@- !@-  ! ! !? ! ! ! !? !V !: !: !:? !0- -11- !1-  ! !: ! !--'- 'wx*OLE*WPC  ! z <    [''  ' [' [-   !Times New Roman--  2 ]1999 2 2000 2 20012 )Request Times New Roman--"Systemn-'-- "[- 2 UActual - !$ U---2 Enacted- !* ---2  Request /2 - !: ---2  +/- Enacted- !< ----'-- [- 2 $PROGRAM Times New Roman-R)2 FTTANF /3/4........................................................................... 2 F) Ru2 FN$17,693R2 F$16,689R 2 F$16,439RT2 F8-$250c)v2 WJChild Care Entitlement /3/5.............................................. 2 W) cu2 WZ2,167c2 W2,367c 2 W3,167cT 2 W;+800t+d2 h>Child Support Enforcement(obligations) ....................... 2 h+ tu2 hZ2,523t2 h2,828t 2 h3,100tT 2 h;+272)i2 yAFoster Care/Adoption Assistance .................................  2 y) u2 yZ4,9222 y5,662 2 y6,401T 2 y;+739+W2 5Childrens Research & Technical Assist (net BA) /3...   2 + u 2 i52 2 39  2 59T 2 A+20)j2 BPromoting Safe and Stable Families................................  2 ) u 2 c275 2 295  2 305T 2 A+10*v2 JSocial Service Block Grant................................................2 * u2 Z1,9092 1,775 2 1,775T 2 N0*{2 MRepatriation/Territories.....................................................2 * Times New Roman4-u 2 i16- ! i- 2 24- ! -  2 24- ! -T 2 N0- !N--+m2 DTotal, Program Level/BA ............................................  2 + u2 H$29,6672 $27,895 2 $31,275T2 '+$3,380-2 U/1 Numbers do not add due to rounding and the effect of AFDC/EA/JOBS/Related programs       a2 #<having excess prior year BA as the account was closed out.   E2 4)/2 Numbers include legislative proposals.  F2 E*/3 Majority of funding is preappropriated. 2 VU/4 FY1999 actuals include funding for supplemental grants and High Performance Bonus.   2 gl/5 The $800 million increase includes $200 million in funds pre-approrpiated in PRWORA and the $600 million      %2 xEarly Learning Fund.--'-- [-   !FY ! !Y !Z !+C1 !+1 !Z--'- ['WPWin 6.0/OLE 1.0 Prefix Information Marker4 METAFILEPICTM>M>, <    [''  ' [' [-   !Times New Roman--  2 ]1999 2 2000 2 20012 )Request Times New Roman--"Systemn-'-- "[- 2 UActual - !$ U---2 Enacted- !* ---2  Request /2 - !: ---2  +/- Enacted- !< ----'-- [- 2 $PROGRAM Times New Roman-R)2 FTTANF /3/4........................................................................... 2 F) Ru2 FN$17,693R2 F$16,689R 2 F$16,439RT2 F8-$250c)v2 WJChild Care Entitlement /3/5.............................................. 2 W) cu2 WZ2,167c2 W2,367c 2 W3,167cT 2 W;+800t+d2 h>Child Support Enforcement(obligations) ....................... 2 h+ tu2 hZ2,523t2 h2,828t 2 h3,100tT 2 h;+272)i2 yAFoster Care/Adoption Assistance .................................  2 y) u2 yZ4,9222 y5,662 2 y6,401T 2 y;+739+W2 5Childrens Research & Technical Assist (net BA) /3...   2 + u 2 i52 2 39  2 59T 2 A+20)j2 BPromoting Safe and Stable Families................................  2 ) u 2 c275 2 295  2 305T 2 A+10*v2 JSocial Service Block Grant................................................2 * u2 Z1,9092 1,775 2 1,775T 2 N0*{2 MRepatriation/Territories.....................................................2 * Times New Roman4-u 2 i16- ! i- 2 24- ! -  2 24- ! -T 2 N0- !N--+m2 DTotal, Program Level/BA ............................................  2 + u2 H$29,6672 $27,895 2 $31,275T2 '+$3,380-2 U/1 Numbers do not add due to rounding and the effect of AFDC/EA/JOBS/Related programs       a2 #<having excess prior year BA as the account was closed out.   E2 4)/2 Numbers include legislative proposals.  F2 E*/3 Majority of funding is preappropriated. 2 VU/4 FY1999 actuals include funding for supplemental grants and High Performance Bonus.   2 gl/5 The $800 million increase includes $200 million in funds pre-approrpiated in PRWORA and the $600 million      %2 xEarly Learning Fund.--'-- [-   !FY ! !Y !Z !+C1 !+1 !Z--'- ['z  HLPLibbie  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_table.Run_ԀthemacroagainandpauseforasecondbetweenthetwoEnters.(hH  Z6Times New Roman Regular} 3HLPASMB User%  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBarorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument*OLE*WPC+-+-!+-j 4d   w''  ' w' w-   !wTimes New Roman4-  2 R1999 2 2000 2  20012 uRequest Times New Roman-2 GActual - !+(G-2 Enacted - !6(-2 Request - !8(-2 a +/- Enacted  - !L(a-Times New Roman0-P[2 A8Program Level...........................................   2 A Pm 2 AM$883P 2 A$934P;2 A$1,085P2 A+$151 r d2 c>FTE........................................................... 2 c  rm 2 cU120r 2 c147r; 2 c#167r 2 c+20 -'WPWin 6.0/OLE 1.0 Prefix Information Marker6 METAFILEPICTGpGL  4d   w''  ' w' w-   !wTimes New Roman4-  2 R1999 2 2000 2  20012 uRequest Times New Roman-2 GActual - !+(G-2 Enacted - !6(-2 Request - !8(-2 a +/- Enacted  - !L(a-Times New Roman0-P[2 A8Program Level...........................................   2 A Pm 2 AM$883P 2 A$934P;2 A$1,085P2 A+$151 r d2 c>FTE........................................................... 2 c  rm 2 cU120r 2 c147r; 2 c#167r 2 c+20 -'  mG"XLXXXXLXXXL-X,XX-  _ Some3to4million  olderindividualsrelyoncarefromfamilyandclosefriendstoremainathome.  b mG"XLXXXXLXXXL-X,XX-  _ Accordingtothe  SurgeonGeneralsReportonMentalHealth,depressionistheleadingriskfactorforsuicideinolderadultsbutisneitherwellrecognizednortreated. *OLE*WPC11  !   C   |''  ' |' |-   !Times New Roman4-Times New Roman4---"Systemn-'-- *F--------  2 d1999 -2 YActual - !+(Y------'-- *-------- 2 2000 -2 Enacted - !6(------'-- *-------- 2 2001 -2 Request - !8(------'-- *{ ------- 2 A Request -2 1 +/-Enacted  - !H(1----'-- |Times New Roman)- +2 ,Administration on Aging:   2 AC(2 AASupportive Services.............................................. 2 Ad$310 2 A$310 2 A$4502 AP+$140 Times New Roman4-2 VC"2 V5Care Giver Activities (non add)...................... 2 Vy0 2 V0 2 V125 2 VS+125 -2 kC%2 k<Grants for Native Americans................................. 2 kt19 2 k19 2 k 24 2 kh+5 2 C&2 >State and Local Innovations................................... 2 t18 2 31 2 36 2 h+5 2 C(2 BNutrition Programs................................................ 2 l486 2 522 2 522y 2 q02 C)2 CPreventive Health.................................................. 2 t16 2 16 2 16y 2 q02 C#2 8Alzheimer's Disease/Vulnerable Elderly.................. 2 t18 2 19 2 19y 2 q02 C&2 =Program Management........................................... 2 t15 2 16 2 17 2 h+1 2 C'2 ?Operation Restore Trust........................................Times New Roman1- 2 |1- !|- 2 1- !- 2 1- !-y 2 q0- !q--2 C%2 <Total, Program level........................................ 2 d$883 2 $9342 $1,0852 P+$151 -C2 .(Less Funds Allocated From Other Sources:       2 NC'2 N?Operation Restore Trust........................................- 2 Nn-$1- !_n- 2 N-$1- !_- 2 N-$1- !_-]y 2 Ni$0- !_i--2 cC$2 c9Total, Budget Authority.................................. 2 cd$882 2 c$9332 c$1,0842 cP+$151 -2 C-2 LFTE......................................................................... 2 g120g2 O 2 g  2 1472  2   2 1672  2  2 `+20 -'WPWin 6.0/OLE 1.0 Prefix Information Marker5 METAFILEPICTAA+  C   |''  ' |' |-   !Times New Roman4-Times New Roman4---"Systemn-'-- *F--------  2 d1999 -2 YActual - !+(Y------'-- *-------- 2 2000 -2 Enacted - !6(------'-- *-------- 2 2001 -2 Request - !8(------'-- *{ ------- 2 A Request -2 1 +/-Enacted  - !H(1----'-- |Times New Roman)- +2 ,Administration on Aging:   2 AC(2 AASupportive Services.............................................. 2 Ad$310 2 A$310 2 A$4502 AP+$140 Times New Roman4-2 VC"2 V5Care Giver Activities (non add)...................... 2 Vy0 2 V0 2 V125 2 VS+125 -2 kC%2 k<Grants for Native Americans................................. 2 kt19 2 k19 2 k 24 2 kh+5 2 C&2 >State and Local Innovations................................... 2 t18 2 31 2 36 2 h+5 2 C(2 BNutrition Programs................................................ 2 l486 2 522 2 522y 2 q02 C)2 CPreventive Health.................................................. 2 t16 2 16 2 16y 2 q02 C#2 8Alzheimer's Disease/Vulnerable Elderly.................. 2 t18 2 19 2 19y 2 q02 C&2 =Program Management........................................... 2 t15 2 16 2 17 2 h+1 2 C'2 ?Operation Restore Trust........................................Times New Roman1- 2 |1- !|- 2 1- !- 2 1- !-y 2 q0- !q--2 C%2 <Total, Program level........................................ 2 d$883 2 $9342 $1,0852 P+$151 -C2 .(Less Funds Allocated From Other Sources:       2 NC'2 N?Operation Restore Trust........................................- 2 Nn-$1- !_n- 2 N-$1- !_- 2 N-$1- !_-]y 2 Ni$0- !_i--2 cC$2 c9Total, Budget Authority.................................. 2 cd$882 2 c$9332 c$1,0842 cP+$151 -2 C-2 LFTE......................................................................... 2 g120g2 O 2 g  2 1472  2   2 1672  2  2 `+20 -' (HLPASMB User  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBarorKeystrokestoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument F mG"XXXXXXXX-X,XX-  _ EveryNIH  Institute,Center,andprogrammaticunitwillparticipateindevelopingaTransNIHStrategicPlanforResearchonHealthDisparities.  9 *OLE*WPC%%!% ^   w<''  ' w<' w<-   !wTimes New Roman4-  2 *1999 2 u2000 2 20012 Request Times New Romanl-2 Actual - !+(-2 _Enacted - !6(_-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman,-PU2 A4Program Level.......................................   2 A 2 A*$257 2 Au$307 2 A$330P4 2 A+$23 r^2 c:FTE....................................................... 2 c 2 c&1,3132 cq1,4832 c1,572r4 2 c+89 -'WPWin 6.0/OLE 1.0 Prefix Information Marker7 METAFILEPICT;$;L  ^   w<''  ' w<' w<-   !wTimes New Roman4-  2 *1999 2 u2000 2 20012 Request Times New Romanl-2 Actual - !+(-2 _Enacted - !6(_-2 Request - !8(-2  +/- Enacted  - !L(-Times New Roman,-PU2 A4Program Level.......................................   2 A 2 A*$257 2 Au$307 2 A$330P4 2 A+$23 r^2 c:FTE....................................................... 2 c 2 c&1,3132 cq1,4832 c1,572r4 2 c+89 -'*OLE*WPC  ! #    2''  ' 2' 2-   !E !Yw3 !Y3 !4e !< !1Times New Roman4-  2 c1999 2 2000 2 20012 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- 2Times New Roman4- 92 5!General Departmental Management:    R)y2 FLGDM Staff Divisions.........................................................  2 F) 2 Fg$116 2 F$122 2 F$132R 2 Fl+$10Times New Roman4-c&T2 W3Office of the General Counsel, NHI (non-add).......    2 W& 2 Wv0 2 W7 2 W(9c 2 Wr+2 t&O2 h0Departmental Appeals Board, NHI (non-add).......   2 h& 2 hv1 2 h3 2 h(5t 2 hr+2 -'2 yOPHS Program Offices:    'y2 LMinority Health.............................................................  2 ' 2 s36 2 38 2 %39 2 x+1'v2 JWomen's Health............................................................   2 ' 2 s15 2 15 2 %16 2 x+1(l2 CEmergency Preparedenss............................................. 2 ( 2 s15 2 10 2 %12 2 x+2'`2 ;Council on Physical Fitness & Sports....................... 2 ' 2 y1 2 1 2 +1 2 0)r2 GAdolescent Family Life.................................................  2 ) 2 s18 2 19 2 +8 2 u-11)[2 8US-Mexico Border Health Commission......................    2 ) 2 y1 2 1 2 +1 2 0)y2 LOther Health Activities.....................................................   2 ) 2 y0 2 5 2 +0 2 {-5 'u2 IHealth Informatics Initiative............................................  2 ' 2 y0 2 0 2 %20  2 r+20)y2 L1% Evaluation funds......................................................... 2 ) 2 s22 2 22 2 %21 2 {-1/(2 #TBioterrorism........................................................................ 2 #( 2 #s17 2 #55 2 #%60/ 2 #x+5@'[2 48Health Care Fraud and Abuse Control funds...............  2 4' Times New Roman4- 2 4y2- !Ay- 2 42- !A- 2 4+3- !A+-@ 2 4x+1- ! Ax--b)i2 VATotal, GDM Program Level.........................................  2 V) 2 Vc$243 2 V$290 2 V$313b 2 Vi+$23-'2 xTPolicy Research.....................................................................2 x' { 2 xo14 2 x17- 2 x!17 2 x0-)l2 CTotal, DM Program Level...........................................  2 ) 2 c$257 2 $307 2 $330 2 i+$23-42 Less funds from other sources: )y2 L1% Evaluation funds......................................................... 2 ) 2 s22 2 22 2 %21 2 {-1(2 TBioterrorism........................................................................ 2 ( 2 s17 2 55 2 %60 2 x+5'[2 8Health Care Fraud and Abuse Control funds...............  2 ' - 2 y2- !y- 2 2- !- 2 +3- !+- 2 x+1- ! x--(i2 ATotal, DM Budget Authority.......................................   2 ( 2 c$216 2 $228 2 $246 2 t$18-'(Vm$0   (,!$0  0` (#(#  WPWin 6.0/OLE 1.0 Prefix Information Marker8 METAFILEPICTbC#bC:    2''  ' 2' 2-   !E !Yw3 !Y3 !4e !< !1Times New Roman4-  2 c1999 2 2000 2 20012 ZRequest Times New Roman4--"Systemn-'-- "- 2 [Actual - !$ [---2 Enacted- !* ---2 Request - !, ---2 M +/- Enacted- !< M----'-- 2Times New Roman4- 92 5!General Departmental Management:    R)y2 FLGDM Staff Divisions.........................................................  2 F) 2 Fg$116 2 F$122 2 F$132R 2 Fl+$10Times New Roman4-c&T2 W3Office of the General Counsel, NHI (non-add).......    2 W& 2 Wv0 2 W7 2 W(9c 2 Wr+2 t&O2 h0Departmental Appeals Board, NHI (non-add).......   2 h& 2 hv1 2 h3 2 h(5t 2 hr+2 -'2 yOPHS Program Offices:    'y2 LMinority Health.............................................................  2 ' 2 s36 2 38 2 %39 2 x+1'v2 JWomen's Health............................................................   2 ' 2 s15 2 15 2 %16 2 x+1(l2 CEmergency Preparedenss............................................. 2 ( 2 s15 2 10 2 %12 2 x+2'`2 ;Council on Physical Fitness & Sports....................... 2 ' 2 y1 2 1 2 +1 2 0)r2 GAdolescent Family Life.................................................  2 ) 2 s18 2 19 2 +8 2 u-11)[2 8US-Mexico Border Health Commission......................    2 ) 2 y1 2 1 2 +1 2 0)y2 LOther Health Activities.....................................................   2 ) 2 y0 2 5 2 +0 2 {-5 'u2 IHealth Informatics Initiative............................................  2 ' 2 y0 2 0 2 %20  2 r+20)y2 L1% Evaluation funds......................................................... 2 ) 2 s22 2 22 2 %21 2 {-1/(2 #TBioterrorism........................................................................ 2 #( 2 #s17 2 #55 2 #%60/ 2 #x+5@'[2 48Health Care Fraud and Abuse Control funds...............  2 4' Times New Roman4- 2 4y2- !Ay- 2 42- !A- 2 4+3- !A+-@ 2 4x+1- ! Ax--b)i2 VATotal, GDM Program Level.........................................  2 V) 2 Vc$243 2 V$290 2 V$313b 2 Vi+$23-'2 xTPolicy Research.....................................................................2 x' { 2 xo14 2 x17- 2 x!17 2 x0-)l2 CTotal, DM Program Level...........................................  2 ) 2 c$257 2 $307 2 $330 2 i+$23-42 Less funds from other sources: )y2 L1% Evaluation funds......................................................... 2 ) 2 s22 2 22 2 %21 2 {-1(2 TBioterrorism........................................................................ 2 ( 2 s17 2 55 2 %60 2 x+5'[2 8Health Care Fraud and Abuse Control funds...............  2 ' - 2 y2- !y- 2 2- !- 2 +3- !+- 2 x+1- ! x--(i2 ATotal, DM Budget Authority.......................................   2 ( 2 c$216 2 $228 2 $246 2 t$18-'2HLPASMB User%  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.*OLE*WPC-(-(!-(  ^   wd''  ' wd' wd-   !Times New Roman-  2 :1999 2 2000 2 20012 0Request Times New Roman-2 3Actual - !'(3-2 Enacted - !5(-2 Request - !1(-2  +/- Enacted  - !H(--PU2 A4Program Level ......................................   2 A PU 2 A5$514P 2 A$414P 2 A$265P\2 A6-$149r^2 c:FTE....................................................... 2 c rU 2 cM0r 2 c0r 2 c0r\ 2 cT0-'WPWin 6.0/OLE 1.0 Prefix Information Marker9 METAFILEPICT@?@?L  ^   wd''  ' wd' wd-   !Times New Roman-  2 :1999 2 2000 2 20012 0Request Times New Roman-2 3Actual - !'(3-2 Enacted - !5(-2 Request - !1(-2  +/- Enacted  - !H(--PU2 A4Program Level ......................................   2 A PU 2 A5$514P 2 A$414P 2 A$265P\2 A6-$149r^2 c:FTE....................................................... 2 c rU 2 cM0r 2 c0r 2 c0r\ 2 cT0-' HLPASMB User  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_ HHS_ Ԁ_ ToolBar_ ,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_ table.Run_ ԀthemacroagainandpauseforasecondbetweenthetwoEnters.*OLE*WPC00  !   u   ' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' -   !4 !]3b !YUf !Ywf !Yf ! ! ! ! ! ! ! !42Times New Romanx-  2 1999 2 2000 2 H20012 Request Times New Roman--"Systemn-'-- "- 2 Actual - !$ ---2 Enacted- !* ---2 8Request - !, 8---2  +/- Enacted- !< ----'-- - 2 4 Bioterrorism:  Times New RomanJ-Q\|2 E NCenter for Disease Control and Prevention..................................... 2 E\ 2 E$124 2 E$154 2 EL$149Q 2 E-$5b\2 V SOffice of Emergency Preparedness...................................................  2 V\ 2 V16 2 V55 2 VX60b 2 V+5sZv2 g JAgency for Healthcare Research and Quality................................   2 gZ Times New Roman- 2 g0- !t- 2 g 5- !t - 2 g^0- !t^-s 2 g-5- ! t--Z2 YSubtotal, Bioterrorism ..................................................................  2 Z 2 $140 2 $214 2 H$209 2 -$5[2 hHIV/AIDS................................................................................................    2 [ - 2 $50 2 $50 2 R$50 2 0-[2 TYear 2000 Computer Conversion.......................................................   2 [ - 2 $324 2 $150 2 X$02 -$150-\2 \Tobacco Litigation Support..................................................................2 \ - 2 $0 2 $0 2 X$4 2 +$4-[2 WCritical Infrasturcture Protection..................................................... 2 [ - 2 $0- ! - 2 $0- ! - 2 X$2- ! X- 2 +2- ! -- Zc2 =Total, PHSSEF, Program Level/ Budget Authority 1/2/..........    2 Z 2 $514 2 $414 2 H$2652 -$149-QZ2 EnFTE...........................................................................................................2 EZ Q 2 E0Q 2 E 0Q` 2 EZ0Q 2 E02 x/1 The FY 1999 Actuals reflect a comparable transfer to CDC of $33 million for polio and measles ($28 million) and environmental        ?2 % health laboratory ($5 million). 2 /2 The FY 2000 enacted level reflects a comparable transfer to: CDC of $74 million for the Global Health Initiative ($69 million) and      2  the environmental health laboratory ($5 million); NIH of $20 million for challenge grants; and HSRA of $75 million for the         H2 + Ricky Ray Hemophilia Relief Fund Act.   -'WPWin 6.0/OLE 1.0 Prefix Information Marker: METAFILEPICTK KL1 u   ' """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www45'  ' ' -   !4 !]3b !YUf !Ywf !Yf ! ! ! ! ! ! ! !42Times New Romanx-  2 1999 2 2000 2 H20012 Request Times New Roman--"Systemn-'-- "- 2 Actual - !$ ---2 Enacted- !* ---2 8Request - !, 8---2  +/- Enacted- !< ----'-- - 2 4 Bioterrorism:  Times New RomanJ-Q\|2 E NCenter for Disease Control and Prevention..................................... 2 E\ 2 E$124 2 E$154 2 EL$149Q 2 E-$5b\2 V SOffice of Emergency Preparedness...................................................  2 V\ 2 V16 2 V55 2 VX60b 2 V+5sZv2 g JAgency for Healthcare Research and Quality................................   2 gZ Times New Roman- 2 g0- !t- 2 g 5- !t - 2 g^0- !t^-s 2 g-5- ! t--Z2 YSubtotal, Bioterrorism ..................................................................  2 Z 2 $140 2 $214 2 H$209 2 -$5[2 hHIV/AIDS................................................................................................    2 [ - 2 $50 2 $50 2 R$50 2 0-[2 TYear 2000 Computer Conversion.......................................................   2 [ - 2 $324 2 $150 2 X$02 -$150-\2 \Tobacco Litigation Support..................................................................2 \ - 2 $0 2 $0 2 X$4 2 +$4-[2 WCritical Infrasturcture Protection..................................................... 2 [ - 2 $0- ! - 2 $0- ! - 2 X$2- ! X- 2 +2- ! -- Zc2 =Total, PHSSEF, Program Level/ Budget Authority 1/2/..........    2 Z 2 $514 2 $414 2 H$2652 -$149-QZ2 EnFTE...........................................................................................................2 EZ Q 2 E0Q 2 E 0Q` 2 EZ0Q 2 E02 x/1 The FY 1999 Actuals reflect a comparable transfer to CDC of $33 million for polio and measles ($28 million) and environmental        ?2 % health laboratory ($5 million). 2 /2 The FY 2000 enacted level reflects a comparable transfer to: CDC of $74 million for the Global Health Initiative ($69 million) and      2  the environmental health laboratory ($5 million); NIH of $20 million for challenge grants; and HSRA of $75 million for the         H2 + Ricky Ray Hemophilia Relief Fund Act.   -'8&HLPASMB User  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_HHS_Ԁ_ToolBar_,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_table.Run_ԀthemacroagainandpauseforasecondbetweenthetwoEnters.*OLE*WPC**))!)  U l   r`''  ' r`-   "-` "- !`-r- !r-'- r`-'- r`-   !r`Times New Roman4-  2 N1999 2 2000 2 20012 &Request Times New Roman-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Program Level................................................   2 ? 2 ?Y$21 2 ?$22 2 ?$24LX 2 ?B+$2ml2 `CFTE................................................................ 2 ` 2 `Y210 2 `220 2 `237mX 2 `J17-"Systemn-'-- r`-   "-r- !r-%r%- !r%-prp- !rp-r- !r-r- !r-_r_- !r_-  "-rs- !r-r%s%- !r%-rpsp- !rp-rs- !r-rs- !r-r_s_- !r_-  "-a- !a-a- !a-((a- !a(-<<a- !a<-PPa- !aP-]]a- !a]-qqa- !aq--'- r`'WPWin 6.0/OLE 1.0 Prefix Information Marker; METAFILEPICT>= >  U l   r`''  ' r`-   "-` "- !`-r- !r-'- r`-'- r`-   !r`Times New Roman4-  2 N1999 2 2000 2 20012 &Request Times New Roman-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman,-Lc2 ?=Program Level................................................   2 ? 2 ?Y$21 2 ?$22 2 ?$24LX 2 ?B+$2ml2 `CFTE................................................................ 2 ` 2 `Y210 2 `220 2 `237mX 2 `J17-"Systemn-'-- r`-   "-r- !r-%r%- !r%-prp- !rp-r- !r-r- !r-_r_- !r_-  "-rs- !r-r%s%- !r%-rpsp- !rp-rs- !r-rs- !r-r_s_- !r_-  "-a- !a-a- !a-((a- !a(-<<a- !a<-PPa- !aP-]]a- !a]-qqa- !aq--'- r`'*OLE*WPC33!       ''  '  '  -   ! Times New Roman4-  2 1999 2 62000 2 20012 Request Times New Roman4-2 Actual - !*&-2 !Enacted - !5&!-2 i Request \1 - !G&i-2  +/- Enacted  - !K&-Times New Roman4-LB2 ?'Program Level..........................   2 ? 2 ?$129 2 ?:$151 2 ?$164L 2 ?+$13mK2 `-FTE.......................................... 2 ` 2 `1,2732 `71,4322 `1,539m 2 `+107Times New Roman-2 f/1 Assumes $130 million for Medicare related fraud and abuse activities, the maximum allowed under the        -"Systemn-'--   Q2 1 Health Care Fraud and Abuse Control program.   --'--  --'--  -   "-r "- !r- r - !q - - ! - - ! -(( - ! (-<< - ! <-PP - ! P-]] - ! ]-qq - ! q- - ! --'-  'WPWin 6.0/OLE 1.0 Prefix Information Marker< METAFILEPICT#6 #64      ''  '  '  -   ! Times New Roman4-  2 1999 2 62000 2 20012 Request Times New Roman4-2 Actual - !*&-2 !Enacted - !5&!-2 i Request \1 - !G&i-2  +/- Enacted  - !K&-Times New Roman4-LB2 ?'Program Level..........................   2 ? 2 ?$129 2 ?:$151 2 ?$164L 2 ?+$13mK2 `-FTE.......................................... 2 ` 2 `1,2732 `71,4322 `1,539m 2 `+107Times New Roman-2 f/1 Assumes $130 million for Medicare related fraud and abuse activities, the maximum allowed under the        -"Systemn-'--   Q2 1 Health Care Fraud and Abuse Control program.   --'--  --'--  -   "-r "- !r- r - !q - - ! - - ! -(( - ! (-<< - ! <-PP - ! P-]] - ! ]-qq - ! q- - ! --'-  '(hH  Z6Times New Roman Regular v mG"XXXXXXXX-X,XX-  _ Oneofthehighest  researchprioritiesremainsthesearchforasafeandeffectivevaccinetopreventinfection.NIHfundingforAIDSvaccineresearchwillincreaseby12percentinFY2001. (hH  Z6Times New Roman Regular 1 mG"XXXXXXXX-X,XX-  _ 60percentofpeople  withlifetimehistoriesofatleastonementalillnessneitherseeknorobtainhelpfortheirillness. (hH  Z6Times New Roman Regular*OLE*WPC''!'   l   x`''  ' x`-   "-` "- !`-x- !x-'- x`-'- x`-   !x` !pwTimes New Roman%-  2 N1999 2 2000 2 20012 &Request Times New Roman0-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lg2 ?@Expenses........................................................ 2 ? 2 ?R$270 2 ?$314 2 ?$326LX 2 ?;+$12sl2 fCFTE................................................................ 2 f 2 fO1,0712 f1,1082 f1,114sX 2 fI+6-"Systemn-'-- x`-  -- !-- !%-- !p-- !-- !-- !_-  "-y- !x-_y_- !x_-a- !a-  "-`a- !`-(`(a- !(`-<`<a- !<`-P`Pa- !P`-c`ca- !c`-  "-wwa- !aw--'- x`'WPWin 6.0/OLE 1.0 Prefix Information Marker= METAFILEPICT> >g   l   x`''  ' x`-   "-` "- !`-x- !x-'- x`-'- x`-   !x` !pwTimes New Roman%-  2 N1999 2 2000 2 20012 &Request Times New Roman0-2 DActual - !*&D-2 Enacted - !5&-2 Request - !7&-2  +/- Enacted  - !K&-Times New Roman-Lg2 ?@Expenses........................................................ 2 ? 2 ?R$270 2 ?$314 2 ?$326LX 2 ?;+$12sl2 fCFTE................................................................ 2 f 2 fO1,0712 f1,1082 f1,114sX 2 fI+6-"Systemn-'-- x`-  -- !-- !%-- !p-- !-- !-- !_-  "-y- !x-_y_- !x_-a- !a-  "-`a- !`-(`(a- !(`-<`<a- !<`-P`Pa- !P`-c`ca- !c`-  "-wwa- !aw--'- x`' 6HLPASMB User%  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.Usethe_ HHS_ Ԁ_ ToolBar_ ,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_ table.Run_ ԀthemacroagainandpauseforasecondbetweenthetwoEnters.*OLE*WPCqql"l"!l"  ~   ''  ' ' -   !Times New Roman4-  2 1999 2 2000 2 E20012 Request Times New Roman4-2 Actual - !*&-2 Enacted - !5&-2 .Request - !7&.-2 s +/- Enacted  - !K&s-Times New Roman4-d2 +>Retirement Pay and Medical Benefits for Commissioned Officers:        L~2 ?RRetirement Payments...............................................................    2 ?~ 2 ?$159 2 ?$172 2 ?I$176L 2 ?+$4`~2 SVSurvivor's Benefits................................................................... 2 S~ 2 S$12 2 S$12 2 SP$12` 2 S$0t2 gWMedical Care...........................................................................  2 g 2 g$28 2 g$30 2 gP$31t 2 g+$1~2 {TMilitary Service Credits............................................................  2 {~ Times New Roman!- 2 {$2- !- 2 { $1- ! - 2 {W$1- !W- 2 {$0- !--}2 [ Total................................................................................... 2 } 2 $201 2 $215 2 E$220 2 +$5 -'WPWin 6.0/OLE 1.0 Prefix Information Marker> METAFILEPICTH| H ~   ''  ' ' -   !Times New Roman4-  2 1999 2 2000 2 E20012 Request Times New Roman4-2 Actual - !*&-2 Enacted - !5&-2 .Request - !7&.-2 s +/- Enacted  - !K&s-Times New Roman4-d2 +>Retirement Pay and Medical Benefits for Commissioned Officers:        L~2 ?RRetirement Payments...............................................................    2 ?~ 2 ?$159 2 ?$172 2 ?I$176L 2 ?+$4`~2 SVSurvivor's Benefits................................................................... 2 S~ 2 S$12 2 S$12 2 SP$12` 2 S$0t2 gWMedical Care...........................................................................  2 g 2 g$28 2 g$30 2 gP$31t 2 g+$1~2 {TMilitary Service Credits............................................................  2 {~ Times New Roman!- 2 {$2- !- 2 { $1- ! - 2 {W$1- !W- 2 {$0- !--}2 [ Total................................................................................... 2 } 2 $201 2 $215 2 E$220 2 +$5 -' HLPASMB User  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHS_''ToolBar_'',Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethe_''table.Run_''ԀthemacroagainandpauseforasecondbetweenthetwoEnters. 6 mG"XXXXXXXX-X,XX-  _ Wehavethefinesthealthcare  systemintheworld...buttoomanyfamilieshavebeenthevictimsofmedicalerrorsthatareavoidable...thatareunacceptable. &t%XXԀ   ,  X  , #XX%&t[#:XXPresidentWilliamJ.Clinton#XX:#(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _3(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _1(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _2(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _ Reachingthe  PresidentsGoalofOneMillionChildrenby2002 .(hH  Z6Times New Roman Regular  mG"XXXXXXXX-X,XX-  _ Some3to4million  olderindividualsrelyoncarefromfamilyandclosefriendstoremainathome. (hH  Z6Times New Roman Regular b mG"XXXXXXXX-X,XX-  _ Accordingtothe  SurgeonGeneralsReportonMentalHealth,depressionistheleadingriskfactorforsuicideinolderadultsbutisneitherwellrecognizednortreated. (hH  Z6Times New Roman Regular v mG"XXXXXXXX-X,XX-  _ Allhighrisk  facilitieswillbeinspectedatleastonceperyear,withfollowupinspectionswherequality    assurance  processesneedimprovement. (hH  Z6Times New Roman Regular _ 1in4women  withoutinsurancecoveragehadforgonetreatmentneededcomparedto1in17forthoseinsured.  8 mG"XXXXXXXX-X,XX-  _ Tocarryoutits  mission,CDCneedsmodern,securelaboratoryfacilities.MuchofCDCslabspaceisovercrowdedandoutdated. (hH  Z6Times New Roman Regular  mG"XXXXXXXX-X,XX-  _ 5,500deaths  relatedtoAIDSoccurintheSubSaharanregionofAfricaeachday. (hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _ Thenationhasa  rareopportunitytoeliminatesyphilisintheU.S. (hH  Z6Times New Roman Regular  mG"XXXXXXXX-X,XX-  _ :XX  @@MMNumberof_Mammogram_ԀandPapSmearScreening@@  Among_NBCCEDP_ԀParticipants#XX:# (hH  Z6Times New Roman Regular F mG"XXXXXXXX-X,XX-  _ EveryNIH  Institute,Center,andprogrammaticunitwillparticipateindevelopingaTransNIHStrategicPlanforResearchonHealthDisparities. (hH  Z6Times New Roman Regular v mG"XXXXXXXX-X,XX-  _ Oneofthehighest  researchprioritiesremainsthesearchforasafeandeffectivevaccinetopreventinfection.NIHfundingforAIDSvaccineresearchwillincreaseby12percentinFY2001. (hH  Z6Times New Roman Regular 1 mG"XXXXXXXX-X,XX-  _ 60percentofpeople  withlifetimehistoriesofatleastonementalillnessneitherseeknorobtainhelpfortheirillness. (hH  Z6Times New Roman Regular 6 mG"XXXXXXXX-X,XX-  _ Wehavethefinesthealthcare  systemintheworld...buttoomanyfamilieshavebeenthevictimsofmedicalerrorsthatareavoidable...thatareunacceptable. &t%XXԀ   ,  X  , #XX%&t[#:XXPresidentWilliamJ.Clinton#XX:#(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _3(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _1(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _2(hH  Z6Times New Roman Regular mG"XXXXXXXX-X,XX-  _ Reachingthe  PresidentsGoalofOneMillionChildrenby2002 .(hH  Z6Times New Roman Regular  mG"XXXXXXXX-X,XX-  _ Some3to4million  olderindividualsrelyoncarefromfamilyandclosefriendstoremainathome. (hH  Z6Times New Roman Regular b mG"XXXXXXXX-X,XX-  _ Accordingtothe  SurgeonGeneralsReportonMentalHealth,depressionistheleadingriskfactorforsuicideinolderadultsbutisneitherwellrecognizednortreated.   4HLPASMB User  FG&XXXXXXXX-X,XX-  _Excelspreadsheetwillgointhisposition.ToimportthesheetintoWordPerfect,OpenExcelandcopytheappropriaterange.SwitchbacktoWordPerfect.UsetheHHSToolBar,Keystrokes,orPressReleasemenutoruntheLargeTable(CTRLALTL)orSmallTable(CTRLALTS)macrotoautomaticallypastetheclipboardcontentsatthecorrectpositioninthisdocument.Ifthetablepositionsaboveorbelowboththicklines,deletethetable.RunthemacroagainandpauseforasecondbetweenthetwoEnters.(hH  Z6Times New Roman RegularG(b  EDILUzD(rtyBar:?3|xU !X  XXXXXXXX8XXdd8  -X,XX-(#(#  _% D oX@"TableofContents#XXoE# X    Vm  Vm0     FOCUSINGONTHEHEALTHANDHUMANSERVICEVm݌ (#(# Ќ    CHALLENGESOFTHEFUTURE""J(#.$1 8 Vm  Vm0     DEPARTMENTOFHEALTHANDHUMANSERVICES#`"`"I(#.\\1(#(##12Vm݌ p Ќ  Vm  Vm0     HHSBUDGETBYOPERATINGDIVISION#`"`"I(#.***(#(##13Vm݌ P  Ќ  0  HHSBUDGETBYOPERATINGDIVISION,CONTINUED#`"`"I(#.FF7(#(##14 @   Vm  Vm0     COMPOSITIONOFTHEHHSBUDGET#`"`"I(#.  '(#(##15Vm#݌   Ќ  Vm  Vm0     FOODANDDRUGADMINISTRATION#`"`"I(#.&(#(##16Vm݌   Ќ  0  FDAOVERVIEW#`"`"I(#. (#(##21   Vm  Vm0     HEALTHRESOURCESANDSERVICESADMINISTRATION#`"`"I(#.@@6(#(##22Vm݌ x Ќ  0  HRSAOVERVIEW#`"`"I(#.L L (#(##26 h Vm  Vm&0     INDIANHEALTHSERVICE#`"`"I(#.88(#(##27Vm&B݌ H Ќ  0  IHSOVERVIEW#`"`"I(#.x x (#(##30 8 Vm  Vm? 0     CENTERSFORDISEASECONTROLANDPREVENTION#`"`"I(#.&&4(#(##31Vm? [ ݌ p Ќ  0  CDCOVERVIEW#`"`"I(#. (#(##38 ` Vm  Vmm 0     NATIONALINSTITUTESOFHEALTH#`"`"I(#.'(#(##39Vmm ݌ @ Ќ  0  NIHOVERVIEW(byInstitute/Center)#`"`"I(#.$$.(#(##44 0 0  NIHOVERVIEW(byMechanism)#`"`"I(#.'(#(##45   Vm  Vm 0     SUBSTANCEABUSEANDMENTALHEALTHSERVICESADMINISTRATION#`"`"I(#.~~C(#(##46Vm " ݌  Ќ  0  SAMHSAOVERVIEW#`"`"I(#.x x (#(##50  Vm  VmF 0     AGENCYFORHEALTHCARERESEARCHANDQUALITY#`"`"I(#.4(#(##51VmF b ݌  x  Ќ  0  _AHRQ_ԀOVERVIEW#`"`"I(#.l l (#(##54 !h! Vm  Vm0     HEALTHCAREFINANCINGADMINISTRATION#`"`"I(#..(#(##55Vm݌ #H!# Ќ  0  HCFAFY2001NETOUTLAYS#`"`"I(#.rr$(#(##56 $8"$ 0  MEDICARE#`"`"I(#. (#(##57 %(#% 0  FY2001PROPOSEDMEDICARELEGISLATION#V!V!F(#.dd1(#(##6465 p&$& 0  MEDICARETRUSTFUNDOVERVIEW#`"`"I(#.HH((#(##66 `'%' 0  MEDICAID#`"`"I(#. (#(##67 P(%( 0  MEDICAIDOVERVIEW#`"`"I(#.(#(##74 @)&) 0  MEDICAIDPROPOSALS:COSTSANDSAVINGS#`"`"I(#.1(#(##75 0*'* 0  STATEGRANTSANDDEMONSTRATIONS#V!V!F(#.+(#(##7677  +(+ 0  STATECHILDRENSHEALTHINSURANCEPROGRAM#V!V!F(#.\\6(#(##7882 ,),     PROGRAMMANAGEMENT`"`"I(#.83 -*-   PROGRAMMANAGEMENTOVERVIEW`"`"I(#.'91 -+.   HCFASUMMARY`"`"I(#.. . 92 .,/  /x-0  ADMINISTRATIONFORCHILDRENANDFAMILIES`"`"I(#.293 X 0  ACFOVERVIEW:DISCRETIONARYSPENDING#`"`"I(#.~~0(#(##98 H 0  ENTITLEMENTPROGRAMSUMMARY#`"`"I(#.'(#(##99 8 0  FY2001PROPOSEDACFLEGISLATION#!!H(#.,(#(##107 ( 0  CHILDSUPPORTENFORCEMENTOVERVIEW:#!!H(#.jj/(#(##108  0  ACFOVERVIEW:ENTITLEMENTSPENDING#!!H(#./(#(##109  Vm  Vm]0     ADMINISTRATIONONAGING#!!H(#.xx!(#(##110Vm]y݌  Ќ  0  AOAOVERVIEW#!!H(#. (#(##113   Vm  Vmz0     DEPARTMENTALMANAGEMENT#!!H(#.!(#(##114Vmz݌  `  Ќ  0  DEPARTMENTALMANAGEMENTOVERVIEW#!!H(#.TT,(#(##117  P  Vm  Vm0     PUBLICHEALTHANDSOCIALSERVICESEMERGENCYFUND#!!H(#.:(#(##118Vm݌ 0  Ќ  0  _PHSSEF_ԀOVERVIEW#!!H(#. (#(##120 x  Vm  Vm0     OFFICEFORCIVILRIGHTS#!!H(#.dd!(#(##121Vm ݌ X Ќ  Vm  Vm0     OFFICEOFINSPECTORGENERAL#!!H(#.%(#(##123Vm݌ 8 Ќ  Vm  Vm0     PROGRAMSUPPORTCENTER#!!H(#.ll (#(##125Vm݌  Ќ  0  PROGRAMSUPPORTCENTERENTITLEMENTSPENDING#!!H(#.BB7(#(##127        _CD_`'  X53XXXe eXX53  `'~@VV    FOCUSINGONTHEHEALTHANDHUMANSERVICE`'~    X Ќ̌eq eee XX eeq  `'  X53XXXe eXX53  `'@       CHALLENGESOFTHEFUTURE`'? d   Ќ̌eq eee XX eeq  +jXXXX  XXXX   (X(#(#(+j6   Highlights+j6  ӌ P ЌXXXXXX  m XXXXXXXX  m!    SincetheClintonGoreAdministration   begansevenyearsago,wehaveworkeddiligentlytoimprovethehealthstatusandwelfareofallAmericans.Wehavesoughttobroadenaccesstoaffordable,qualityhealthcare.WehaveenthusiasticallysupportedtheadvanceofscientificresearchandwehaveworkedtoensurethatourNationschildrenhaveasafeandhealthychildhood.m!"݌̌ XXXXXXXX  m XXXXXXXX  mE$    Since1993,wehavewitnessedthe p longesteconomicexpansioninhistoryandeliminatedthebudgetdeficit.Ourchallengeistobuildonthisprosperitybycontinuingoureffortstoexpandhealthcarecoverage,accessandquality,renewsupportforourchildrenandfamilies,supportgreaterscientificadvancement,andcreateahealthierAmerica.mE$$݌̌ XXXXXXXX  m XXXXXXXX  m&    Therefore,ourFY2001budgetwill:m&i'݌  Ќ XXXXXXXX  m XXXXXXXX  mU(    mU((݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &K)2 o3  XX oU0     ExpandHealthCareCoverage&K)M* ӌh ЌL )#3x8(*-/0123LXXXXXX   byacceleratingenrollmentinMedicaidand ( theStateChildrensHealthInsuranceProgram(_SCHIP_),ensuringgreateraccesstoinsuranceforparentsofchildreneligiblefor_SCHIP_ԀandMedicaid,providingaMedicareprescriptiondrugbenefit,modernizingMedicare,makingMedicaremorecompetitiveandefficient,improvingoptionsforqualitylongtermcarefortheelderlyunderMedicaid,andsupportingfamily_caregivers_;m XXXXXXXX  m-    m-{.݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &K0/2 o3  XX oU0       RenewSupportforChildrenand )'* Families&K0// ӌ  ЌL )#3x8(*-/0123LXXXXXX   bymakingchildcareaccessible,affordable, 8,)- andofhighqualityforworkingfamilies;enhancingHeadStart;fundingdemonstrationsforinnovativeasthmatreatmentsforlow-incomechildren, /-1 supportingsubstanceabuseprogramsandgraduatemedicaleducationofpediatricians,andbytakingadditionalstepstoincreasechildsupportcollectionsandtodirectmoreofthesepaymentstolow-incomefamilies;&KL 8(*-/0123 x3)LXXXXoU XX  &Kf32 o3  XX oU0 D    EncourageGreaterScientific  x 7 Advancement&Kf3*4 ӌ D(#D(# ЌL )#3x8(*-/0123LXXXXXX   bycontinuinginvestmentsinbiomedical ( : scienceintheNationalInstitutesofHealth(NIH)andusingsciencetoimprovefoodsafetythroughinvestmentsintheFoodandDrugAdministration(FDA)andtheCentersforDiseaseControlandPrevention(CDC);andbyinvestingintheAgencyforHealthcareResearchandQuality(_AHRQ_)toimprovethequalityofhealthcareandinconjunctionwithFDA,toreducemedicalerrors;and&KL 8(*-/0123 x3)LXXXXoU XX  &K72 o3  XX oU0 D    CreateaHealthierAmerica&K7t8 ӌFD(#D(# ЌL )#3x8(*-/0123LXXXXXX   bystrengtheningsystemsofsurveillanceto XH reducethreatsfromemerginginfectiousdiseasesand_bioterrorism_,andbyinvestinginthepublichealthinfrastructure,supportingmentalhealthprograms,continuingtofightHIV/AIDS,andworkingtoeliminateracialdisparitiesinhealthstatus.+jXXXX  XXXX   +j^;  Totals+j^;; ӌ P# Q ЌXXXXXX  m XXXXXXXX  m}< D   TheFY2001budgetfortheDepartment $`"S ofHealthandHumanServices(HHS)totals$421.4billioninoutlays,anincreaseof$34.1billion,or9percent,overthecomparableFY2000budget.ThediscretionaryportionoftheHHSbudgettotals$48.6billioninbudgetauthority,anincreaseof11percentovertheFY2000level.m}<<݌̌ XXXXXXXX  (-*\( +jXXXX  XXXX   +j"?  ExpandHealthCareCoverage+j"?? ӌ X ЌXXXXXX  m XXXXXXXX  mV@    HHSproposesahealthinsurance h initiativetoexpandaccesstoqualityhealthcareformoreAmericans,includingexpandingMedicarecoverageforolderworkers,expandinghealthinsuranceaccessandoutreachtochildrenandparentsoflow-incomechildren.ItalsorestoresMedicaidbenefitsforlegalimmigrantsandensurescontinuedhealthinsuranceforsingleparentsmovingfromwelfaretowork.mV@@݌̌ XXXXXXXX  m XXXXXXXX  m-C    Over44millionAmericanslackhealth   insurance.Althoughtherearemanycausesofthisproblem,itgenerallyresultsfromthehighcostofinsuranceorlimitedaccesstocoverage.Familyhealthinsurancepremiumscostonaverage$5,700!whichoftenrepresentstoolargeashareoftheincomeforfamiliesofmodestmeanstryingtomakeendsmeet.m-CC݌̌ XXXXXXXX  m XXXXXXXX  mE    Purchasingaffordable,accessible 8 insuranceisalsoaformidablechallengeformanyolderpeople,workersintransitionbetweenjobs,andemployeesofsmallbusinesses,manyofwhomaremovingoffofthewelfarerolls.Yet,thelackofhealthinsurancecanhavedevastatingconsequences.Theuninsuredarethreetimesmorelikelythantheprivatelyinsuredtonotreceiveneededmedicalcare,50to70percentmorelikelytoneedhospitalizationforavoidableconditionslikepneumoniaoruncontrolleddiabetes,andfourtimesmorelikelytorelyonanemergencyroomorhavenoregularsourceofcare.mEUF݌̌ XXXXXXXX  m XXXXXXXX  mzI    Ourbudgetcontainsanumberofother $8"% proposalsthataddresstheproblemsofhealthcareaccess,_affordability_,andqualityformanyAmericans.ItmodernizestheMedicareprogram,extendingthelifeoftheTrustFund,institutingimportantmanagementreforms,andprovidinganewprescriptiondrugbenefitandnewoptionsforlongtermcare.Italsosupportsfamily_caregivers_Ԁoftheelderlyandthedisabled.mzII݌̌ XXXXXXXX  m XXXXXXXX  mL    mLM݌ -+/ Ќ XXXXXXXX  .Ȋ  .ȊM0 D XXXXXXXX     HealthInsuranceInitiative:.ȊMN ӌX/D(#D(# ЌXXXXXX   &KL 8(*-/0123 x3)LXXXXoU XX  &K7O2 o3  XX oU0 D    _FamilyCare_Ԁfor_SCHIP_Ԁand h1 Medicaid  ԀParents&K7OO ӌ D(#D(# ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  mQ D   Thisproposalwouldprovidehigher 4 FederalmatchingpaymentsforstatecoverageofparentsofchildreneligibleforMedicaidortheStateChildrensHealthInsuranceProgram(_SCHIP_).Under_FamilyCare_,parentswouldbecoveredinthesamehealthinsuranceplanastheirchildren.StateswouldusethesamesystemsandfollowmostofthesamerulesastheydoinMedicaidand_SCHIP_Ԁtoday,andtheprogramwouldbeoverseenbythesamestateagency.mQqR݌̌ XXXXXXXX  m XXXXXXXX  m_U D   Statespendingfor_FamilyCare_Ԁwouldbe X@ matchedatthesamehighermatchingrateas_SCHIP_Ԁ(upto15percentagepointshigherthantheMedicaidrate).Toensureadequatefunding,$50billionover10yearswouldbeaddedtothecurrentstate_SCHIP_Ԁallotments.Thisproposalincreasescoveragetofourmillionnewadultsandchildrenoverthenext10years.m_UU݌̌ XXXXXXXX  m XXXXXXXX  mjX D   mjXX݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &KY2 o3  XX oU0 D    AcceleratingEnrollmentin `J Medicaidand_SCHIP_&KYbZ ӌ D(#D(# ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  m2\ D   TheStateChildren'sHealthInsurance M Program(_SCHIP_)helpschildreninfamilieswithincometoohightobeeligibleforMedicaidbuttoolowtoaffordprivateinsurance.Enrollmentin_SCHIP_ԀdoubledtotwomillionchildreninFY1999.However,despitethisencouragingtrend,millionsofchildrenremaineligiblebut_unenrolled_Ԁineither_SCHIP_ԀorMedicaid.m2\\݌̌ XXXXXXXX  m XXXXXXXX  mc_ D   TheFY2001HHSbudgetincludes %(#V proposalsthatwouldgivestatesneededtools,suchasincreasingtheageeligibilityoptions,theschoollunchinitiativeandpresumptiveeligibilityinadditionalsiteslikechildcarereferralcenters,whichprovidecoveragetoanadditional400,000children.mc__݌ XXXXXXXX  m XXXXXXXX  ma D   maZb݌ -*^ Ќ XXXXXXXX  _.Ȋ  .Ȋ4c0  XXXXXXXX      ExpandingHealthInsurance X Options:.Ȋ4cOc ӌ  ЌXXXXXX   &KL 8(*-/0123 x3)LXXXXoU XX  &Kd2 o3  XX oU0     ݀ExpandingAccessto  HealthCare X forImmigrants&Kdfe ӌ  ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  m#g    ThePresidentproposes$6.5billionin  fundingovertenyearstogivestatestheoptionofcoveringqualifiedlegalimmigrants,regardlessofwhentheycametotheUnitedStates.m#gg݌̌ XXXXXXXX  m XXXXXXXX  mi    Theproposalwouldgivestatesthe  `  optiontoinsurechildrenandpregnantwomeninMedicaidandSCHIPregardlessoftheirdateofentry.Itwouldeliminatethe5-yearban,deeming,andaffidavitofsupportprovisionsenactedaspartofwelfarereform.TheproposalwouldalsorequirestatestoprovideMedicaidcoveragetodisabledimmigrantswhowouldbemadeeligibleforSupplementalSecurityIncome(SSI)bytheFY2001budgetsSSIrestorationproposal.Inaddition,parentsofchildrenwhohavebenefitsrestoredcouldbecoveredbytheproposedFamilyCareinitiative.mii݌̌ XXXXXXXX  m XXXXXXXX  ml    ml*m݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &Km2 o3  XX oU0     ImprovingAccesstoCareforthe ` Uninsured&Kmn ӌ  ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  mPp    HHSproposes$125millioninFY2001  toexpandtheinitiativestartedinFY2000thatwillimproveaccesstohealthcareforuninsuredworkers.Americanswhohavenohealthinsurancecoveragemustdependoninstitutionsandindividualhealthprofessionalstoprovideserviceseitherwithoutpaymentoronareducedfeebasistotheuninsured.mPpp݌̌ XXXXXXXX  m XXXXXXXX  mr    Thisinitiativewillimprovemedicalcare %(#' formanyofourNation'suninsuredadultsbyprovidinggrantstoassistcommunitybasedhealthcareproviderstodevelopandexpandintegratedsystemsofcarewithafocusonprimarycare,mentalhealthservices,andsubstanceabuseservices.Thisinitiativewillbecomplementedbyaproposed$50millionincreaseingrantstoCommunityHealthCenters.mrps݌ -+0 Ќ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &Ku2 o3  XX oU0 D    ModernizingMedicare&Kuv ӌX0D(#D(# ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  m(x D   Thisbudgetproposesacomprehensive h2 reformplantomodernizeandstrengthentheMedicareprogramtomeetthehealth,demographic,andfinancingchallengesofthe21stcentury.WeseektomakeMedicare (6 morecompetitiveandefficientbymodernizingMedicaresbenefits.m(xx݌̌ XXXXXXXX  m XXXXXXXX  mz D   ThePresidentsreformplanexpands P 9 accesstopreventivebenefitsbycreatingincentivesforbeneficiariestotakeadvantageofanumberoflifesavingMedicarebenefitssuchascolorectalscreeningandmammograms.TheplanwouldeliminatethecoinsuranceanddeductiblesformanyMedicarecoveredpreventivebenefits.Theplanalsoprovidesforathree-yearsmokingcessationdemonstrationforbeneficiariesandanationwidehealthpromotioneducationcampaigndirectedtowardallAmericansover50.mz{݌̌ XXXXXXXX  m XXXXXXXX  m} D   m}[~݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &K2 o3  XX oU0 D    ݀MedicarePrescriptionDrug `H Benefit&K ӌ D(#D(# ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  mz D   ThecenterpieceofthePresident's `K Medicarereformplanisavoluntaryprescriptiondrugbenefitthatwouldbeaffordableandavailabletoallbeneficiaries.Thedrugbenefitproposalwouldhavenodeductibleandpayhalfofbeneficiaries'prescriptiondrugcostsupto$2,000inFY2003andupto$5,000whenfullyimplementedinFY2009.Thebenefitwouldensureapricediscount,ensurethatlow-incomebeneficiariespaynoorreducedpremiumsandcost-sharing,andprovidefinancialincentivesforemployerstoretainretireehealthcoverage.Thenetcostofthisnewbenefit,includingMedicaid,is$38.1billion($28.8billioninMedicareonly)overfiveyears.mz݌ XXXXXXXX  m XXXXXXXX  mj D   mj݌ *P(\ Ќ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &K2 o3  XX oU0     ݀   MedicareBuyin&Kw ӌX ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  m    Therateofuninsuredisgrowingfastest h amongpeopleages55to65andisexpectedtoincreaseevenfasterinthefuture.Recognizingthis,HHSagainproposesthatpeopleages62through65anddisplacedworkersages55to65beallowedtopaypremiumstobuyintoMedicare.Thisinitiativecosts$980millionoverfiveyears.m݌̌ XXXXXXXX  m XXXXXXXX  m    m"݌̌ XXXXXXXX  .Ȋ  .Ȋ׌0  XXXXXXXX   EnhancingMedicare 0  Management/Fraud,Abuse&ContractorOversight.Ȋ׌ ӌ  ЌXXXXXX   m XXXXXXXX  mN    TheHealthCareFinancing x  Administration(HCFA)administersMedicare,Medicaid,andSCHIP,andoverseesstatehealthinsuranceregulationofindividualandsmallgroupmarkets.HCFAcontinuestofacetheimportantchallengeofmodernizingadministrativeinfrastructure,whileprovidingsuperiorcustomerservicetomorethan70millionbeneficiaries.HCFAanditspartnersalsocontinuetheireffortstopreventanddetecthealthcarefraudandabusethroughtheMedicareIntegrityProgram(MIP)andtheHealthCareFraudandAbuseControl(HCFAC)program.mN͎݌̌ XXXXXXXX  m XXXXXXXX  mđ    Inresponsetorecentrecommendations @ fromtheHHSOfficeoftheInspectorGeneral(OIG)andtheGeneralAccountingOfficeoncontractorfinancialmanagementpracticesandotherissues,HHSproposesacomprehensiveinitiativethatimprovesoversightofMedicarecontractorsresponsibleforclaimsprocessing,beneficiaryandproviderservices,andprogramintegrity.mđC݌̌ XXXXXXXX  m XXXXXXXX  mz    TheHHSbudgetalsoprovidesfundsfor %#' externalreviewsofkeyprogramareas,thedevelopmentofanewfinancialmanagementsystemandnewevaluationprotocols.TheXXXX (p&* requestaddsstafftocontractorstoestablishmorerigorousinternalcontrolpolicies,identifycontrolobjectives,determinetherelevantrisksinachievingthoseobjectives,andreportreliableinformationtoHCFA.#XXXXە#mz݌ x- +/ Ќ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX     NursingHomeInitiative.Ȋŗ ӌX/D(#D(# ЌXXXXXX   m XXXXXXXX  m D   TheHHSFY2001budgetincludes h1 $70.8millionforexpandingimplementationofthePresident'sNursingHomeInitiativeannouncedinJuly1998.InFY1999,HHSbeganphasinginkeyprovisionsoftheinitiative.Thisbudgetrequestallows  HCFAandothercomponentsofHHStofullyimplementallprovisionsofthePresidentsinitiative.mu݌̌ XXXXXXXX  m XXXXXXXX  m D   Sincelaunchingtheinitiative,HCFAhas 0 : madesignificantprogressindraftingstrongernursinghomeenforcementpolicies.πInFY2001,$37.8millionwillbedevotedtostrengtheningstateenforcementeffortsandimprovingFederaloversight,expeditinginvestigationsofnursinghomeresidentcomplaints,andlookingatwaysofmovingindividualsfromnursinghomestocommunitybasedservices.m݌̌ XXXXXXXX  m XXXXXXXX  mp D   Another$19.5millionwillsupplement 8D stateinspectionandenforcementactivitiesinduallycertifiedandMedicaidonlynursinghomes,maintainandupgradetheNursingHomeComparewebsite,andcontinuenationaleducationcampaignstopreventabuse,neglect,andmalnutritioninnursinghomes.mp݌̌ XXXXXXXX  m XXXXXXXX  mߠ D   TheHHSbudgetprovides$13.5million L toensureadequatefundingfortheOfficeoftheGeneralCounselandtheDepartmentalAppealsBoardtoprovidemoretimelyjudicialhearingsandtoreducethebacklogofappealsresultingfromstrongerenforcementactions.mߠ^݌̌ XXXXXXXX  m XXXXXXXX  m- D   HHSwillalsosubmitlegislation #H!S requiringnursinghomestoquerythenursinghomecriminalabuseregistryandconductcriminalbackgroundchecksonnewemployees,activitieswhichwouldbefinancedthroughuserfees.m-݌ XXXXXXXX  m XXXXXXXX  mX D   mXץ݌ @)&Y Ќ XXXXXXXX  .Ȋ  .Ȋ0  XXXXXXXX      LongTermCare.Ȋ ӌX ЌXXXXXX   m XXXXXXXX  m    OverfivemillionAmericanshave h significantlimitationsduetoillnessordisabilityandthusrequirelong-termcare.Approximatelytwo-thirdsofthoserequiringhealthcareareolderAmericans.However,millionsofadultsandagrowingnumberofchildrenhavelong-termcareneedsbecauseofahealthconditionfrombirthorachronicillnessdevelopedlaterinlife.mm݌̌ XXXXXXXX  m XXXXXXXX  m    OurFY2001budgetimprovesequityin 0  Medicaideligibilitybetweenpeopleinhome-andcommunity-basedsettingsandpeoplereceivinginstitutionalcare;supportspartnershipsbetweenMedicaidandtheDepartmentofHousingandUrbanDevelopmenttocoordinatelow-incomehousingandMedicaidservicesfortheelderly;andencouragesthepurchaseofqualityprivatelong-termcareinsurancebyFederalemployees.m(݌̌ XXXXXXXX  m XXXXXXXX  m    m ݌̌ XXXXXXXX  .Ȋ  .Ȋ0  XXXXXXXX     FamilyCaregiverSupport.Ȋڮ ӌp ЌXXXXXX   m XXXXXXXX  m     Thepopulationage85andoveris  expectedtoincreaseby50percentbetween1996and2010.NinetyfivepercentofdisabledolderAmericanswholiveinthecommunitydependoninformalcaregivers,suchasspouses,adultchildren,otherrelativesandfriends,forassistance.WhileMedicaidisvitallyimportantinpayingforinstitutionalizedcare,theprimarylongtermcareprovidersforolderpersonsremainingathomearenotsocialserviceagenciesorgovernmentprograms;theyarefamilies.Studieshavefoundthatcaregivingexactsaheavyemotional,physical,andfinancialtollonfamilies.Assistancetocaregiversisneedednowmorethanever.m ݌̌ XXXXXXXX  m XXXXXXXX  m    Tosupportcaregivers,HHSproposesto '%) increasespendingby$125millioninFY2001.Thisrequestwouldfundquality respiteandothersupportive *P(,    services!teachingcaregiverstomanagewanderingandagitatedbehaviorinlatestateAlzheimersDisease!forapproximately250,000families.me݌̌ XXXXXXXX  m XXXXXXXX  m D   m݌̌ XXXXXXXX  +jXXXX  XXXX   +j潷  RenewSupportforChildrenand 1 Families+j潷' ӌ̌XXXXXX  m XXXXXXXX  m D   TheFY2001HHSbudgetstrengthens ` 4 thefamilybyhelpingAmericansbetterbalancethedemandsofworkandparenthood.Byprovidingaccesstosafe,affordablechildcare,increasingchildsupportcollections,andgettingmoreresourcestofamilies,theClintonGoreAdministrationstandssquarelybehindworkingfamiliesinAmerica.m|݌̌ XXXXXXXX  m XXXXXXXX  m D   m݌̌ XXXXXXXX  .Ȋ  .Ȋż0 D XXXXXXXX     ChildCareInitiative.Ȋż ӌh>D(#D(# ЌXXXXXX   m XXXXXXXX  m D   Federalfundingforchildcarehasmore (@ thandoubledunderthisAdministration,providingchildcareservicesforapproximately1.75millionchildrenfromlowincomeworkingfamiliesinFY1999.Nevertheless,millionsoffamilieswhoareeligibleforassistancewiththeirchildcarecostsdonotreceiveanyhelp;onlyabout10percentofthe15millionlowincomechildrenpotentiallyeligibleforassistanceunderFederaleligibilitycriteriareceivedsubsidies.m݌̌ XXXXXXXX  m XXXXXXXX  m* D   HHSbuildsonthesuccessesofprevious hL budgetsbyproposinganincreaseintheChildCareandDevelopmentBlockGrantof$817million,a70percentincreaseinfundingthatwillprovideadditionalchildcaresubsidiesfornearly150,000neweligiblechildreninFY2001.ThisincreaseraisestheChildCareandDevelopmentBlockGranttoalevelof$2billionindiscretionaryfunds.m*݌̌ XXXXXXXX  m XXXXXXXX  m D   Thesenewfunds,combinedwiththe (p&V childcarefundsprovidedinwelfarereform,willenabletheprogramtoserveover2.2millionchildreninFY2001,anincreaseofnearlyonemillionsinceFY1997.TheblockgrantispartoftheChildCareand x- +[ DevelopmentFund,theprimaryFederalsubsidyprogramthathelpsfamiliespayforchildcare,whichenableslowincomeparentstowork.  ԀToensurethatchildrenhaveaccesstoearlychildhoodprogramsthatpromotetheircognitivedevelopment,theHHSbudgetincludes$3billionoverfiveyearsfortheEarlyLearningFundtohelpimprovechildcarequalityandearlierchildhoodeducationforchildrenunderfiveyearsold.mt݌̌ XXXXXXXX  m XXXXXXXX  m    mz݌̌ XXXXXXXX  .Ȋ  .Ȋ/0  XXXXXXXX   ChildSupportEnforcement.Ȋ/J ӌ @  ЌXXXXXX   m XXXXXXXX  mr    TheHHScampaigntoassurethat   childrenreceivethefinancialsupporttheyneedfrombothparentsisworking.InFY1999,childsupportcollectionsreachedanalltimehighof$15.5billion.OurlegislativeproposalsforFY2001providesupportthroughbetterenforcementtoolsandprogramchangesthatgetmoremoneytofamilies.Thepackageofproposalsincreasescollectionspaidtofamiliesby$1.8billionoverthenextfiveyears.mr݌̌ XXXXXXXX  m XXXXXXXX  ms    Oneimportantproposalbuildsonour P foundationoffamilyfirstdistributionandprovidesstatestheoptiontosimplifytheirrulesfordistributingchildsupporttoasystemwherefamiliesthathaveleftwelfarewillkeepallthechildsupportpaidbythenoncustodialparent,resultinginincreasedpaymentstofamiliesof$815millionoverfiveyears.ms݌̌ XXXXXXXX  m XXXXXXXX  m    Anotherkeyproposaltoincreasefunds !h" tofamilieswouldprovideFederalmatchingfundstostateswhentheypassonchildsupportcollectionstofamiliesonassistance.Paymentstothesefamilieswouldincreaseby$388millionoverfiveyears.OurpackagealsoincludesaproposedseriesofstrongenforcementtechniquesthatsavetheFederalgovernment$361millionoverfiveyearsandincreasepaymentstofamiliesbyover$650millionoverfiveyears.m݌ XXXXXXXX  m XXXXXXXX  m7    m7݌ ,)- Ќ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX      HeadStart.Ȋ ӌX-D(#D(# ЌXXXXXX   m XXXXXXXX  m D   HHShasbeencommittedtobuildinga h/ strongfoundationofsuccessforallofAmericaslowincomechildren.TheHeadStartprogramhasbeenahighlysuccessfulexampleofthatcommitment.EvidenceshowsthatHeadStartproducesimmediategainsforchildrenandfamilies,includingbettercognitivefunctioningandacademicpreparedness,higherselfesteem,andimprovedphysicalhealth.Studiesdemonstratethattheprogramalsoprovideslongtermbenefits,suchasbetterhighschoolattendancerates,lessfrequentretentioningrade,andlessneedforspecialeducation.mG݌̌ XXXXXXXX  m XXXXXXXX  mS D   TheHHSbudgetrequestincludes x> $6.3billionforHeadStart,anincreaseof$1billioninFY2001.ThisincreasewillprovideHeadStartservicestoover70,000additionalchildren,bringingtotalenrollmenttonearly950,000andkeepingusontracktomeetthePresident'sgoalofenrollingonemillionchildrenbyFY2002.mS݌̌ XXXXXXXX  m XXXXXXXX  m D   m_݌̌ XXXXXXXX  .Ȋ    .Ȋ0 D XXXXXXXX   AsthmaInitiativeforLowincome @G Children.Ȋ: ӌ D(#D(# ЌXXXXXX   m XXXXXXXX  m~ D   HHSproposes$50millioneachin @J FY2001andFY2002fordemonstrationgrantstostatesfortestinginnovativeasthmadiseasemanagementtechniquesforchildrenenrolledinMedicaidandSCHIP.Thiswouldhelpthosechildrenreceivethemostappropriatecaretocontroltheirasthma.Participatingstateswillassesstheprogramssuccessinavertingasthma-relatedcrisesthroughmeasuressuchasdecreasedemergencyroomvisitsandhospitalstays.m~݌̌ XXXXXXXX  m XXXXXXXX  m D   m ݌̌ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX     GraduateMedicalEducationfor '%V ChildrensHospitals.Ȋ ӌ(p&WD(#D(# ЌXXXXXX   m XXXXXXXX  m> D   TheHHSbudgetprovidesatotalof 0*'Y $80millionfortheChildrensHospitalsGraduateMedicalEducation(GME),raisingthelevelofsupportfortheNationsfreestandingchildrenshospitals,bymaking -+] suchpaymentsmoreconsistentwithotherteachinghospitals.Thesehospitalstrainover25percentofallU.S.generalpediatricresidentsandthemajorityoftheNationspediatricspecialists.m>݌̌ XXXXXXXX  m XXXXXXXX  m3    m3݌̌ XXXXXXXX  .Ȋ  .Ȋg0  XXXXXXXX     SubstanceAbuse.Ȋg ӌ ЌXXXXXX   m XXXXXXXX  m    Illicitdrugandalcoholuseamong `  Americanyouthsiscontinuingatunacceptablerates.Whiletheseratesremainunacceptablyhigh,wehaveseenaseriesofencouragingreportsthatseemtoindicatealevelingoffandevenpossibledeclineindruguseamongteensafteryearsofdramaticincreases.Accordingtothe1998NationalHouseholdSurveyonDrugAbuse,illicitdruguseamongyouthsaged1217decreasedfrom11.4percentin1997to9.9percentin1998.The1998NationalHouseholdSurveyonDrugAbuseestimatesthatmorethan6.5millionor9.9percentofAmericansaged12andolderusedanillicitdruginthepastyearand19percentofyouthaged1217reporteduseofalcoholinthepreviousmonth.m*݌̌ XXXXXXXX  m XXXXXXXX  m    Nationwide,theneedforservicestotreat @ individualswhouseandareaddictedtoillegaldrugscontinuestooutstriptheavailablecapacity.TheOfficeofNationalDrugControlPolicy(ONDCP)estimatesthatasmanyasfivemillionAmericansareinneedofsubstanceabusetreatmentservices,whilelessthanhalfactuallyreceiveservices.ONDCPestimatesthecosttosocietyofillegaldrugusetobeapproximately$110billioneachyear.m?݌̌ XXXXXXXX  m XXXXXXXX  m    TheFY2001budgetincludesatotalof $8"% $3.3billion,a6.2percentincreaseoverFY2000,forsubstanceabusetreatmentandpreventionservices.mB݌̌ XXXXXXXX  m XXXXXXXX  m    m݌̌ XXXXXXXX  +jXXXX  XXXX   +j  GreaterScientificAdvancement+j9 ӌ @)&* ЌXXXXXX  m XXXXXXXX  m    Tomorrowsscientificadvancements *P(, dependontodaysinvestmentdecisions.InFY2001,thebudgetcontinuesourcommitmenttoprotectpublichealthand x- +/ promotescientificexpertisebyinvestinginbiomedicalscience,foodsafety,andhealthcarequalityresearch.m݌̌ XXXXXXXX  m XXXXXXXX  mp D   mp݌̌ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX     Supportingresearchatthe 3 NationalInstitutesofHealth(NIH).Ȋ ӌ D(#D(# ЌXXXXXX   m XXXXXXXX  m# D   TheFY2001budgetprovides ` 7 $18.8billionforNIH,anincreaseof$1.0billionor5.6percentoverFY2000,tocontinuetogeneratenewscientificknowledgeanddeveloptreatmentsandnewpreventionstrategiesforthemanydiseasesanddisabilitieswhichaffecttheNationshealth.Totakeadvantageofthemostpromisingareasofresearch,NIHhasidentifiedanumberofareasofscientificemphasisforincreaseinFY2001.Theyincludeexploitinggenomics,reinvigoratingclinicalresearch,harnessingtheexpertiseofallieddisciplines,andreducinghealthdisparitiesathomeandabroad.NIHwillalsoplacerenewedemphasisonresearchtoaddressdomesticandinternationalhealthdisparitiesthatmaybeassociatedwithrace,ethnicity,gender,orsocioeconomicstatusandtofindvaccinesforHIV/AIDS,tuberculosis,andmalaria.m#݌̌ XXXXXXXX  m XXXXXXXX  m D   m8݌̌ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX   UsingSciencetoImproveQuality M andReduceMedicalErrors.Ȋ ӌ D(#D(# ЌXXXXXX   m XXXXXXXX  m] D   Therecentlyreleasedstudybythe X P InstituteofMedicine,ToErrIsHuman H!Q (1999),estimatesthatasmanyas98,000Americansmaydieeachyearasaresultofpreventablemedicalerrors.m]݌̌ XXXXXXXX  m XXXXXXXX  my D   HHSproposesanincreaseof$16million %"U fortheFoodandDrugAdministration(FDA)toreducemedicalerrorsandadverseevents.ReducingmedicalerrorsrequiresFDAtoimproveitsabilitytoevaluateandrespondtotheover400,000adverseevent reportsitreceiveseachyear.my݌ *P([ Ќ XXXXXXXX  m XXXXXXXX  m         Currently,FDAhasinoperationan X AdverseEventReportingSystem(AERS)ineachofitsprogramareas.Thisfundingwillinitiatethedevelopmentofanintegrated,fullyelectronicadverseeventreportingsystemacrosstheprogramareas.mv݌̌ XXXXXXXX  m XXXXXXXX  mM    Thebudgetalsoprovides$20millionfor  theAgencyforHealthcareResearchandQuality(AHRQ)toconductresearchdirectedtowardthereductionofmedicalerrors.AstheleadFederalagencyinhealthcarequality,AHRQwillcollaboratewithprivatesector,nonprofithealthcareorganizations,states,andotherFederalagenciestodevelopnationalsafetygoalsandbestpracticestoeliminatetheoccurrencesofmedicalerrors.mM݌̌ XXXXXXXX  m XXXXXXXX  mC     mC  ݌̌ XXXXXXXX  .Ȋ  .Ȋw 0  XXXXXXXX     Foodsafety.Ȋw   ӌ8 ЌXXXXXX   m XXXXXXXX  m     Everyyearanestimated76million H peoplegetsick,325,000arehospitalized,and5,000dieoffoodborneillness.m 6݌̌ XXXXXXXX  m XXXXXXXX  mq    Toreducetheincidenceofdisease,HHS p wouldprovidea$40millionincreasefortheinteragencyfoodsafetyinitiative.FDA,theCentersforDiseaseControlandPrevention(CDC),andtheDepartmentofAgriculture(USDA)willcontinuetocoordinateeffortstoensureasafernationalfoodsupplyandwithstatesandindustrytodevelopaconsistent,highqualitysetoffoodcodesandstandards.mq݌̌ XXXXXXXX  m XXXXXXXX  mF    Oftheincreasedfundsrequested,CDC  x! willuse$10milliontoenhancefoodsafetybyfurtherexpandingCDCsaward-winningPulseNet,thenationalnetworkofpublichealthlabsthatperformDNA fingerprintingofdisease-causingbacteria.FDAisseekinganadditional$30milliontoinspect100percentofhighriskfoodestablishments,completetheNationalAntimicrobialResistanceMonitoringSystem(NARMS),andcooperatewithUSDA,industry,andstatestoreduceSalmonella.mF݌ XXXXXXXX  m XXXXXXXX  m    m݌ -*. Ќ XXXXXXXX  +jXXXX   XXXX   +j  CreateaHealthierAmerica+j< ӌ X. ЌXXXXXX  m XXXXXXXX  m D   TheFY2001budgetforHHSpromotes h0 healthylivingandprovideshealthservicesformoreAmericans.Whilestrengtheningourpublichealthinfrastructure,thisbudgetaddressesmanyofourgreatestpublichealthchallengesincludingthetrackingofemerginginfectiousdiseasesandbioterroristthreats.AhealthierAmericaalsomeansthatwemustworktopreventHIV/AIDSandunwantedpregnancies,providetreatmentformentalillness,andeliminatehealthdisparitiesamongourracialandethnicminorities.m݌̌ XXXXXXXX  m XXXXXXXX  mK D   mK݌̌ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX     HIV/AIDSPrevention,Treatment, > andResearch.Ȋ ӌ D(#D(# ЌXXXXXX   m XXXXXXXX  m D   TheFY2001budgetproposesa 8A discretionaryincreaseof$316millioninHHSforeffortsthatrespondtotheHIV/AIDScrisis.The$66millionincreaseinfundingatCDCwillbeusedtoencourageindividualsatrisktoavoidbehaviorsthatcanresultinthetransmissionofthedisease.Ofthe$66millionincrease,$40millionwillgotoexpandlocalpreventionefforts,includinginterventionstargetedatminoritypopulationsofwhich$10millionwillgotosupportcommunityinterventions.Theremaining$26millionoftheincreasewillsupportacontinuationoftheglobalAIDSexpansionbegunlastyear.mm݌̌ XXXXXXXX  m XXXXXXXX  m! D   Approximately750,000Americansare H!P livingwithHIVand200250,000ofthemknowtheirstatus,butarenotreceivinghealthcare.TheRyanWhiteProgramprovidesessentialmedicalandrelatedsupportservicesforindividualsandfamilieswithHIVandcurrentlysupports2,630communitybasedprovidersofcare.m!"݌̌ XXXXXXXX  m XXXXXXXX  m$ D     Thebudgetwillinvestanadditional (p&X $125millionintheRyanWhiteProgram,anincreaseofalmost8percentoverlastyearsfundinglevel,toprovideprimarymedicalcareandothercrucialsupportservicesforpeoplelivingwithHIVandAIDS.With x- +] thisincrease,atotalof141,000personswillreceiveAIDSdrugtherapythroughtheAIDSDrugAssistanceProgram(ADAP).ThesedrugshavehelpedtodecreasetheprogressionofHIVtoAIDSaswellasimprovethequalityoflifeforpeoplewithHIV/AIDS.m$$݌̌ XXXXXXXX  m XXXXXXXX  m~'    Theincreaseof$105millionforNIH  continuesaninvestmentthathasledtomanyadvancesagainstthisdisease.NIHwillfocusonthesearchforasafeandeffectivevaccinetopreventinfection.m~''݌̌ XXXXXXXX  m XXXXXXXX  m)    m) *݌̌ XXXXXXXX  .Ȋ  .Ȋ*0  XXXXXXXX     FamilyPlanning.Ȋ** ӌ0  ЌXXXXXX   m XXXXXXXX  m,    HHSproposesanadditional$35million   overtheFY2000appropriationtoserve4,600familyplanningclinicstoprovidefamilyplanningservicestoanadditional500,000women.Theseeffortswillpromoteresponsibilityforhealthyreproductivelifestyles.m,,݌̌ XXXXXXXX  m XXXXXXXX  mK.    mK..݌̌ XXXXXXXX  .Ȋ  .Ȋ/0  XXXXXXXX     Mentalhealth.Ȋ// ӌp ЌXXXXXX   m XXXXXXXX  m0    ݀TherecentlyreleasedSurgeonGenerals  ReportonMentalHealthstatesthat aboutoneinfiveAmericansexperiencesamentaldisorderinthecourseofayear.And60percentofpeoplewithlifetimehistoriesofatleastonementalillnessneitherseeknorobtainhelpfortheirillness,andonly25percentofthoseseekinghelpwillreceivecarefromamentalhealthspecialist.m0@1݌̌ XXXXXXXX  m XXXXXXXX  m3    TheSurgeonGeneralsReportconcludes H!" thatmentaldisordersandconditionsaretreatable.Scientificadvanceshaveresultedinnewknowledgeconcerningthebiologyanddynamicsofmentalillness,andhaveledtonewandeffectivemodelsoftreatment.BuildingontherecommendationsoftheSurgeonGeneralsReport,thebudgetincludesfundingtohelpimprovethelivesofthosewhofacementalillness.m34݌̌ XXXXXXXX  m XXXXXXXX  mw6    TheFY2001budgetprovidesa *P(, $60million,a17percentincrease,forthe MentalHealthBlockGrant,whichprovides ,0*. supporttostatesforservicestopeoplewithmentalillness.mw66݌ XXXXXXXX  m XXXXXXXX  m8 D   Thebudgetrequestalsocontinues 80 fundingof$78millionforprojectsprovidedbytheCongressinFY2000forYouthViolencePreventionactivities.Thisincludes$50millionfortheSafeSchools/HealthyStudentsprogramwhichsupportsactivitiestoincreaseschoolsafety,mentalillnesspreventionandtreatment,andschoolviolencepreventionandearlyinterventionservices.m89݌̌ XXXXXXXX  m XXXXXXXX  m\; D   m\;;݌̌ XXXXXXXX  .Ȋ  .Ȋ<0 D XXXXXXXX     PreventingEmergingInfectious 0 ; DiseasesandResondingtoBioterrorism.Ȋ<< ӌ D(#D(# ЌXXXXXX   m XXXXXXXX  m> D   Asglobalthreatstopeacepersist,the x? needtopreparefordomesticterrorisminAmericaremainshigh.  m>>݌̌ XXXXXXXX  m XXXXXXXX  m? D   T  hePresidentsBudgetproposesan HB increaseofnearly50percentoverlastyearsfundinglevel,tofurtherdevelopanationaldiseasesurveillancesystemthatcanrapidlydetecttheinfectiousdiseasecasesthatsignalthebeginningofanoutbreak.Theincreasedfunding,whichbringstotalfundingto$64million,willensurethatdiseaseoutbreakinformationleadstoimmediatepublichealthaction.m?Q@݌̌ XXXXXXXX  m XXXXXXXX  mB D   HHSisresponsibleforpreparingfor, L andrespondingto,themedicalandpublichealthconsequencesofabioterroristevent.ThePresidentproposesforFY2001atotalof$265millionforHHS.Ofthisamount,$149millionisinCDC,$30millionisfortheOfficeofEmergencyPreparedness,and$30millionisforresearch,tocontinueourpreparationforpossibleactsofbioterrorism.mB=C݌̌ XXXXXXXX  m XXXXXXXX  mE D   Activitiesincludethedevelopmentof p&$U surveillanceandlaboratorycapacitytocompetentlyandprofessionallyrespondtoabiologicalattackoftheutmostnationalimportance.Also,NIHrequests$45millionforbioterrorismresearchactivitiesandFDArequests$12millionforexpeditiousdevelopmentandapprovalofneworimprovedvaccines.mEF݌ -+] Ќ XXXXXXXX  .Ȋ  .Ȋ oureffortsto,inthewordsofPresidentClinton, embraceallAmericansinthistime x@ ofprosperityandtogiveeveryAmericanthechancetosucceedatworkandathome.musv݌ XB Ќ XXXXXXXX  (X(C ( #  X53XXXe eXX53  #x@    DEPARTMENTOFHEALTHANDHUMANSERVICES#x5y Zy  X AZ') HxdE HxAeq eee XX eeqԌ   Ќ  @  (dollarsinmillions)  t % R pVW<,(`~1 8} `.n Exmxmep (#(#       (#(#]x% _ AZ') HxdEHxA  pVf<,(`~1  `..Efxxe^pDFx  . D#  X53XXXe eXX53  #ᄤ}@F F     HHSBUDGETBYOPERATINGDIVISION#ᄤ} ~ 0~  X AZ') HxdE HxAeq eee XX eeqԌ   Ќ  @  (dollarsinmillions)  t pVd<,(`~1 8} `).Ex#"x#"e"p (#(#                          (#(#jxAZ') HxdzE,HxA ,|*< D|  >-*> D#  X53XXXe eXX53  #@    HHSBUDGETBYOPERATINGDIVISION,CONTINUED#d   X AZ') HxdE HxAeq eee XX eeqԌ   Ќ  @  (dollarsinmillions)  t pVT<,(`~1 8}" `&.Ex$x$e%p (#(#                            (#(#sxAZ')-HxdE-HxAD#  <.+> D#  X53XXXe eXX53  #ᄃ@     COMPOSITIONOFTHEHHSBUDGET#ᄃ   X AZ') HxdE HxAeq eee XX eeqԌ   Ќ  @  (dollarsinmillions)  t pVo<,(`~1 8t `g+ /Ex!x!e!p (#(#                         (#(#|xAZ') HxdEk+HxA l+): D{  +~)< D#  X53XXXe eXX53    r@u@#ᄽ@- -     FOODANDDRUGADMINISTRATION#ᄽR w  X AZ') HxdE HxAeq eee XX eeqԌ   Ќ  pVv<,(`~1  `.V E9i`p@  (dollarsinmillions)  t  (#(#      (#(#%  p AZ') HxdEKHxA L  +jXXXX  XXXX   (X@(#(#(+j朔  Summary+j朔. ӌ  ЌXXXXXX  m XXXXXXXX  m    TheFY2001budgetrequestforthe . FoodandDrugAdministrationis$1,391millioninprogramlevel,including$203millioninindustryspecificuserfees.This13percentincreaseoverFY2000istargetedtoAdministrationinitiativesincludingassuringthesafetyofFDAregulatedproducts,FoodSafety,Bioterrorism,andYouthTobaccoPrevention.mc݌̌ XXXXXXXX  m XXXXXXXX  m    FDAisaprincipleconsumerprotection " agencyoftheFederalgovernment.FDAsmissionistoprotectthepublichealththroughpreventionofinjuryorillnessduetounsafeorineffectiveproducts.FDAactivelyidentifieshealthproblemsassociatedwithFDAregulatedproductsandassessestheoriginandimpactofthesehealthproblems.FDAmakeseveryefforttopreventproblemsthatwouldexposethepublictohazardsandmonitorsthemarketplacetoensurecompliancewiththelawsandregulations.m݌̌ XXXXXXXX  m XXXXXXXX  m͛    m͛L݌̌ XXXXXXXX  +jXXXX  XXXX   +j  AssuringSafety:Todayand )&0 Tomorrow+jk ӌ̌XXXXXX  m XXXXXXXX  m>    Assuringthesafetyofthefoodand ^+)3 medicalproductsAmericansusetodayrequiresFDAtocarryoutacontinuumofactivities.First,FDAcommunicates ..+6 extensivelywithindustrypriortothesubmissionofnewproductsforreviewtofacilitateagreaterunderstandingofFDArequirementsandreduceproductdevelopmenttimes.Second,FDAmustreviewnewproductstoensuretheyaresafeandeffective.DoingthisaccuratelyandquicklyrequiresFDAtomaintainahighlevelofscientificexpertise.Third,FDAmusthavestate-of-the-arttrackingsystemstodetectandrespondtomedicalerrorsoradverseeventsrelatedtoproductsinthemarketplacethatmanufacturersdidnotdetectinclinicaltesting.Finally,FDAmustcontinuallymonitorthequalityassuranceprocessesinproductionfacilitiestoensurethatfoodiswholesome,andthemedicalproductsAmericansusearewell-made.FDAmustensureithasboththescientificfacilitiesandtheexpertisetomakepromptandsoundjudgementsonthemyriadofadvancesthatareexpectedfromourNation'sinvestmentinbiomedicalresearch.m>݌̌ XXXXXXXX  m XXXXXXXX  m D   FDAsrequestforassuringsafety &V$M includesimprovementsinpremarketreview($42million),increasedpostmarketsurveillanceefforts($45million).Thepostmarketsurveillancerequestincludestwonewinitiatives,InternetDrugSalesandMedicalErrors.mc݌ XXXXXXXX  m XXXXXXXX  m9 D   m9݌ >-*T r@ r  r  ь XXXXXXXX  .Ȋ  .Ȋŧ0  XXXXXXXX      BringingNewProductstoMarket.Ȋŧ ӌX ЌXXXXXX   m XXXXXXXX  m$    TherearetwocomponentstoFDAs h strategyforpremarketreview.First,FDAiscommittedtoensuringnewproductsaresafe,effectiveandavailableinatimelyfashiontotheAmericanpublic.Second,FDAmustexpanditsscientificexpertisetoensureithastheabilitytoaddresstheincreasingnumberofnewandcomplexproductsthatresultfromourNationsmajorinvestmentinbiomedicalresearch.FDAsbudgetincludes$42milliontoimprovethequalityandtimelinessofpremarketreviewtodayandinthefuturethroughacombinationofefficientreviewstofosterinnovationandincreasedtechnicalexpertise,whilemaintainingFDAshighstandards.m$݌̌ XXXXXXXX  m XXXXXXXX  m     Partofthe$42millioninFDAsbudget h requestisdirectedtoimprovingpremarketreviewoftheproductssubmittedtoFDA.FDAsrequestwillnarrowthegapsbetweenstatutoryperformancerequirementsandwhatFDAcanaccomplish!providingforrapidandefficientreviewofdrugsanddevices.FDAalsoseekstoacceleratetheprocessofgenericdrugreviewthatcouldsignificantlydecreasethecostofmedicalcaretotheAmericanpublic.m ݌   Ќ XXXXXXXX  m XXXXXXXX  mG    ForthelastseveralyearsFDAhas  directeditseffortstoimprovingtimeliness,whilemaintainingthequalityofproductreviews.TheFY2001budgetbeginstheprocessofpreparingFDAforanewageofrapidbiomedicalandpharmaceuticalinnovation.InthenextseveralyearsFDAexpectssubstantiallymorecomplexandnumerousapplicationsforinnovativehealthproductstobesubmittedforpremarketreview.Inordertoassurethatproductsaretrulysafeandeffective,FDAmusthaveaccesstothesamescientificexpertiseas  thosewhosinnovationsFDAisevaluating.FDAhasinvestedfundsinFY2001tobegindevelopingtheexpandedscientificexpertisethatitwillneedtomeettheseincreasingdemands.mGư݌̌ XXXXXXXX  m XXXXXXXX  mj    mj݌ -+/ Ќ XXXXXXXX  3  L#.Ȋ  .Ȋ0 D XXXXXXXX     AssuringtheSafetyofProducts X/ ontheMarket.Ȋ ӌ D(#D(# ЌXXXXXX   ̵ m XXXXXXXX  m D   FDAsincreaseof$45millionfor X2 postmarketsafetyassuranceincludestwonewPresidentialInitiatives:ensuringthesafetyofInternetdrugsales($10million)andreducingmedicalerrorsandadverseevents.($16million).TheseactivitiesaddressnewandemergingissuesforAmericanpublichealth.m݌̌ XXXXXXXX  nm XXXXXXXX  m D   FDAsbudgetalsoincludesanincrease 0 : of$19milliontoincreaseFDAscapacitytomeetpublicandstatutoryexpectationsforinspectionsofproductionfacilitiesandsamplesofdomesticandimportedproducts.FDAcurrentlyinspectsabout50percentofbiologicsfacilities,39percentdevicefacilities,27percentofanimaldrugsandfeedsfacilities,and22percentofdrugsfacilities.m݌̌ XXXXXXXX  m XXXXXXXX  m D   mn݌̌ XXXXXXXX   ).Ȋ  .Ȋ=0 D XXXXXXXX     InternetDrugSales.Ȋ=X ӌ(ED(#D(# ЌXXXXXX   #m XXXXXXXX  m D   Thenumberofpeoplewhousethe G Internetforthepurchaseofmedicalproductsisgrowingrapidly,andmanyconsumers,includingthoseinruralareasorthosewhocannotleavetheirhomes,benefitfromtheconvenienceofthisnewoption.However,unsuspectingconsumersmayfallpreytoflybynightInternetpharmaciesthatsellproductsillegally.Thebudgetincludesa$10millioninitiativetoprotectconsumersfromillegitimateInternetpharmaciesthatinappropriatelyprescribemedications,increasetheriskofdangerousdruginteractions,orsellpotentiallycounterfeitedorcontaminateddrugs.TheAdministrationalsoseekslegislativeauthoritytoenhanceFDAsabilitytoprotectInternetconsumersseparatefromthis$10million.m݌̌ XXXXXXXX  m XXXXXXXX    m D   UnderthePresidentsinitiative,FDA (p&Y willcarryoutapubliceducationcampaignonsafewaystopurchasepharmaceuticalsovertheInternet.FDAwillenablecustomerstoidentifylegitimateInternetpharmacysitesthatoperateconsistentlywith x- +^ u@ u  u  StateandFederallaw.TherewouldalsobenewcivilpenaltiesforillegalInternetsaleofdrugswithoutavalidprescription,andproceduresforrapidFDAinvestigationofpotentiallyillegalsales.FDAwouldusepartofthebudgetincreasetodeveloparapidresponseteamandupgradeFDAscomputertechnologytoidentify,investigate,andprosecuteillegitimateInternetpharmacies.FDAseekstoatleastcutinhalfthecurrentnumberofillicitdomesticsites,andbeginworkonsalesbyforeignInternetsites.m_݌̌ XXXXXXXX  m XXXXXXXX  m    m݌̌ XXXXXXXX  .Ȋ  .Ȋ0  XXXXXXXX   ReducingMedicalErrorsand x  AdverseEvents.Ȋ ӌ  ЌXXXXXX   m XXXXXXXX  m    TheInstituteofMedicinesrecentreport, x ToErrIsHuman(1999)estimatesthatupto h 98,000Americansmaydieeachyearasaresultofpreventablemedicalerrors.FDAsbudgetincludesanincreaseof$13milliontoreducethesemedicalerrors,andanadditional$3milliontoreduceotheradverseevents.m݌̌ XXXXXXXX  m XXXXXXXX  m    ReducingmedicalerrorsrequiresFDA P toimproveitsabilitytoevaluateandrespondtotheover300,000adverseeventreportsitreceiveseachyear.Currently,FDAhasoperationalanAdverseEventReportingSystem(AERS)ineachprogramarea.Theseinclude,MedSuninDevices,ananimaldrugsystemforAnimalDrugsandFeeds,andadietarysupplementssystemforFoods.Thisfundingwillinitiatethedevelopmentofanintegrated,fullyelectronicadverseeventreportingsystemwithineachprogramarea.m6݌̌ XXXXXXXX  m XXXXXXXX  m    Electronicmonitoringandsurveillance %(#& oftheseadverseeventreportswillimproveFDAsabilitytodetectpatternsinthesereportsandfollowuprapidlytoprotecttheAmericanpublicfromfurthererrorsandadverseevents.FDAwillalsoexpand  itspartnershipsandcollaborationwithmedicalandpatientsafetyorganizations,stateandlocalhealthagencies,andindustryorganizations.m{݌ -+/ Ќ XXXXXXXX  +jXXXX  XXXX   +j  FoodSafetyInitiative+jU ӌ X/ ЌXXXXXX  m XXXXXXXX  m D   WhileourNationhasoneoftheworlds h1 safestfoodsuppliesintheworld,muchworkremainstobedone.Everyyearanestimated76,000,000peoplegetsick,325,000arehospitalized,and5,000diefromfoodborneillness.FDAisrequestingnearly$109million,a$30millionincreaseoverFY2000,tofundadvancesthroughthePresidentsFoodSafetyInitiative.m݌̌ XXXXXXXX  m XXXXXXXX  zF62h~j #  p E# P JQ F62h~j #  p E# P JQ PF62h~j #  p E# P JQ  F62h~j #  p E# P JQ m D   Anumberoffactorscontributetoour 0 : needforincreasedvigilance.Consumerdietsaremorevaried.Asaresultofadvancesinfoodpreparation,storage,andtransportation,consumershaveaccesstoawidervarietyofproducts,bothfreshandpackaged.Amuchlargerpercentageofmealsarepreparedandconsumedoutsidethehome.Therehasbeenanincreaseinvulnerablepopulations.Theincreasing Z(#Z(#(#(#proportionofgroupssuchaspregnantwomen,children,theelderly,andtheimmuno-compromisehavenecessitatedgreaterattentiontowardpreventioninthesehigh-riskgroups.Finally,withtheemergenceofnew,morelethalpathogens,newpreventativestrategiesarerequired.  m݌ #H!S Ќ (#(#Z(#Z(# XXXXXXXX  m XXXXXXXX  mh D   mh݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &K2 o3  XX oU0 D      Inspections:cover100percentof %(#U highriskfoodestablishments&` ӌp&$VD(#D(# ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX  m D   Inspections.Thebudgetcontinuesto '%X expandtheresourcesavailabletoFDAtoinspectfoodprocessingfacilities.Allhighriskfacilitieswillbeinspectedatleastonceperyear,withfollowupinspectionswherequalityassuranceprocessesneedimprovement.m݌ x- +^ Ќ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX    &K2 o3  XX oU0     Eggsafety:cooperativeworkwith X USDA,industry,andStatestoreduceSalmonella&K ӌ  ЌL )#3x8(*-/0123LXXXXXX   m XXXXXXXX    m    Eggsafety.Thebudgetincludes H anincreaseof$5millionforanewinitiativetoimproveeggsafety.Americansconsumeanaverageof234eggsperpersonperyear.Anestimated1in20,000eggsintheU.S.foodsupplywillcontainSalmonella P   Enteritidis(SE)bacteria,whichcancause @   illnessifnotcookedthoroughlyoreatenraw.Generally,SEillnesshasdeclined44percentbetween1994and1998,primarilyintheNortheastwhereeggqualityassuranceeffortshavebeenmostintensive.FDA,incooperationwithUSDA,seekstofurtherreduceSEillnessby50percentby2005.m)݌̌ XXXXXXXX  m XXXXXXXX  mo    mo݌̌ XXXXXXXX  &KL 8(*-/0123 x3)LXXXXoU XX  &K2 o3  XX oU0     Surveillance:completethe X NationalAntimicrobialResistanceMonitoringSystem(NARMS) &g ӌ8 ЌL )#3x8(*-/0123LXXXXXXXX      m XXXXXXXX  m    FDAsrequestprovidesforthe  completionoftheNationAntimicrobialResistanceMonitoringSystem(NARMS).TheNARMSsystemisusedtodetectandrespondtooutbreaksoffoodborneillnessbyidentifyingemergingresistanceamongfoodbornepathogens.WorkingwithCDC,FDAwilladdnationalandinternationaldatacollectionsitesandmonitoradditionalpathogens.Thiswillprovideinformationessentialinregulatingtheuseofantibioticsinfoodanimals.m1݌̌ XXXXXXXX  m XXXXXXXX  m    mH݌̌ XXXXXXXX  +jXXXX  XXXX   +j  YouthTobaccoPrevention+jg ӌ (# $ ЌXXXXXX  m XXXXXXXX  m.    FDAisrequesting$39million,an $8"& increaseof$5million,fortheTobaccoProgram.TheProgramseekstopromoteandprotectthehealthofournationsyouthbyreducingthenumberofyoungpeoplewhobegintouseandbecomeaddictedtotobaccoproductseachyear.InFY1999,FDAenteredintocontractstoconductcompliancechecksinall50Statesand3Territories--theDistrictofColumbia,theVirginIslands,andAmericanSamoa.Asa -+0 result,inthefirstquarterofFY2000,compliancecheckswillbeconductedineverystateforthefirsttimesinceFDAbeganenforcingtheruletopreventpurchase  oftobaccoproductsbyunderageusers.Ofthe$5millionrequestedincrease,FDAintendstoallocate$3milliontoincreaseenforcementeffortsand$2milliontoincreasecompliance-basedoutreachefforts.m.݌̌ XXXXXXXX  m XXXXXXXX  m D   mI݌̌ XXXXXXXX  +jXXXX  XXXX   +j  ImprovingFDAsInfrastructure+jh ӌ  ` : ЌXXXXXX  m XXXXXXXX  m8 D   Evaluatingstateoftheartmedicaland  < foodproductsrequirescomparablescientificfacilities.FDAsbudgetincludes$43millionovertwoyears(including$20millioninFY2001)toreplaceFDAsdilapidatedLosAngelesregionallaboratoryfacility.TheLosAngeleslaboratoryperforms23percentofFDAsfoodsanalyseseachyear.m8݌̌ XXXXXXXX  m XXXXXXXX  m D   FDAsbudgetalsoincludesanincrease 8E of$5millioninonetimecoststomovetheCenterforFoodSafetyandAppliedNutritionintoanewfacilityattheUniversityofMarylandinCollegePark.TheGeneralServicesAdministrationwillcompletethisfacilitylateinFY2001.Theincreasewillcovercostsassociatedwithtelecommunicationsequipment,moving,anddecommissioningoftheircurrentfacility.mX݌̌ XXXXXXXX  m XXXXXXXX  m D   FDAsscientificfacilityneedsarealso P addressedintheGeneralServicesAdministrationFY2001budget.Includedis$101millionforFDAsheadquartersconsolidationatWhiteOak,Maryland.Togetherwiththe$35millionincludedinGSAsFY2000appropriation,GSAwillbeabletoconstructconsolidatedlaboratoryandofficespacefortheCenterforDrugEvaluationandResearch(CDER).m;݌̌ XXXXXXXX  m XXXXXXXX  m D   FDAsbudgetalsoincludesanincrease @)&Z of$5millioninrent,reflectingamongotherthingsthenewregionallaboratoryinNewYork.m݌ XXXXXXXX  m XXXXXXXX  mm D   mm݌ -*^ Ќ XXXXXXXX  +jXXXX   XXXX   +j    BioterrorismInitiative+j> ӌ X ЌXXXXXX  m XXXXXXXX  m     TheFY2001budgetincludes h $11.5millionforFDAtocarryoutitsuniqueroleincounteringthethreatofbioterrorism.FDAisresponsibleforensuringthesafetyandefficacyofdrugandbiologicalproductswhichwillbeusedtotreatandpreventthetoxicityofchemicalandbiologicalagents.TheNationalInstitutesofHealth,theCenterforDiseaseControl,theDepartmentofDefense,aswellassomeintheprivatesectorareworkingonnewvaccinesanddrugstoreducethesethreats.However,FDAcannotreviewtheseupcomingdrugsandvaccinesusingconventionalmethods,whicharedesignedfordiseasestowhichAmericansarenormallyexposed.Asaresult,FDAmustdevelopnewprocedurestoevaluatetheefficacyoftheseproducts,andbuildthecapacitytodosotimely.ExpeditiousdevelopmentandlicensingofthesenewvaccinesanddrugsisvitaltoprotectingthehealthoftheNation.m  ݌̌ XXXXXXXX  m XXXXXXXX  m     m _݌̌ XXXXXXXX  +jXXXX  XXXX   +j  UserFees+j~ ӌ @ ЌXXXXXX  m XXXXXXXX  m6    TheFY2001budgetrequestforFDA P includes$203millioninuserfees.Ofthisamount,$19.5millionareproposed,additiveuserfees.Thisincludes$8.4millionforfoodadditivepetitions,$5.8millionformedicaldevices,and$5.3millionforfoodexportcertifications.ThefeesforfoodadditiveswillenableFDAtogreatlyreducereviewtimesfornewproducts.Themedicaldevicefees,tobecollectedon501Kpetitions,willbeusedinparttohelpoffsetthecostofthirdpartyreviews.ThebudgetalsocallsforfoodexporterstocoverFDAcostsforcertifications;druganddevice exportersalreadycoversuchcosts.m6݌ (p&* Ќ XXXXXXXX  m XXXXXXXX  m D      Thebudgetincludes$149millioninthe X* PrescriptionDrugUserFeeAct(PDUFA)fees,anincreaseof$4million.PDUFAauthorizesthecollectionofuserfeesforreviewingdrugapplicationsandwasreauthorizedaspartoftheFDAModernizationActof1997.m݌̌ XXXXXXXX  m XXXXXXXX  mr D   mr݌̌ XXXXXXXX  *  +jXXXX  XXXX   +j  ConsolidatingSeafoodInspections+jD ӌ  2 ЌXXXXXX  m XXXXXXXX  m. D   FDAisresponsibleforensuringthe @ 4 safetyofseafoodAmericansconsume.TheCommerceDepartmentsSeafoodInspectionProgramprovidesvoluntaryinspectionsandcertificationservicesforfishandfisheryproductsonafeeforservicebasisundertheauthorityoftheAgriculturalMarketingActof1946.m.݌̌ XXXXXXXX  m XXXXXXXX  m D   TheAdministrationhasproposed h< legislationtomakethevoluntaryinspectionprogramaperformancebasedorganization(PBO)withinFDAtoprovidegreatermanagerialflexibilitytorespondtoindustryrequestsandneeds.EstablishingthisPBOwithinFDAwillenablecompanieswhousetheirservicestoworkwithasinglesetofinspectors;now,theyareinspectedby bothCommerceandFDA.m*݌ 0E Ќ XXXXXXXX  (X(#   X53XXXe eXX53  #@$    FDAOVERVIEW#D i  X AZ') HxdE#HxAeq eee XX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV{<!,(`~0  `) /EvYxf"xf"+"pAZ') ,HxdE ,HxAD  [ D#  X53XXXe eXX53  #"@    HEALTHRESOURCESANDSERVICESADMINISTRATION#"" "  X AZ') HxdE#HxAeq eee XX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<,(`~1 gf `. Ex\x\ewp (#(#        (#(#AZ') b HxdE HxA+jXXXX  XXXX   (X@(#(#(+j%  Summary+j%& ӌ c  ЌXXXXXX  m XXXXXXXX  m9'    TheFY2001budgetrequestforthe #  HealthResourcesandServicesAdministrationis$4.9billion,anetincreaseof$145millionoverFY2000.HRSAistheleadagencywhichhasresponsibilityforensuringaccesstohealthcarethroughawiderangeofprogramsforthosewhoareuninsured,liveinmedicallyunderservedareas,orhavespecialhealthcareneedssuchaspeoplelivingwithHIV/AIDs.m9''݌̌ XXXXXXXX  m XXXXXXXX  m *    m **݌̌ XXXXXXXX  +jXXXX  XXXX   +jA+  ProvidingAccesstoHealthCarefor s theUninsured+jA++ ӌ̌XXXXXX  m XXXXXXXX  C3/hzs p E> v.  C3/hzs p E> v.  C3/hzs p E> v.  C3/hzs p E> v.  m,    Currentlythereareover44million s individualswithouthealthinsurancein , , America(24.6millionoftheseareworkingpeople).Thisnumberisincreasingatarateof100,000permonth.Astudyfoundthat1in4womenwithout insurance  (%) coveragehad , , forgonetreatmentneededcomparedto1in17forthoseinsured.Lackofadequatehealthcareposesasgreatarisktothepublichealthassmoking,alcoholism,andobesity.m,J/݌̌ XXXXXXXX  m XXXXXXXX  m 2    TheFY2001requestmovesforwardon -S+/ avarietyofactivitiestobetterensureaccesstoqualityhealthcare.Theseeffortsincludestrengtheningtheinfrastructureofthehealthcaresafetynetandexpandingthecapacityofcommunityhealthcenterstoservetheuninsured.OfthefundsrequestedforFY2001,HRSAwilldirectatotalof$1.2billiontotheseefforts.m 22݌̌ XXXXXXXX  m XXXXXXXX  m4 D   m4C5݌̌ XXXXXXXX  .Ȋ  .Ȋ50 D XXXXXXXX   HealthCareAccessForthe +8 Uninsured.Ȋ56 ӌ D(#D(# ЌXXXXXX    m XXXXXXXX  m7 D   m77݌ XXXXXXXX  Manyoftheuninsuredrelyonsafetynet +; providers"hospitals,clinicsandotherproviderswhoofferasignificantvolumeofhealthcareservicesforfreeorforreducedfees"fortheirhealthcare.Individualsreceivingsafetynetservicesandtheprovidersthemselvesfacemanychallengessuchasunevendistributionofuninsuredindividuals,fragmentationofservices,insufficientnumbersofspecifictypesofproviders,rapidgrowthofmanagedcare,andagrowingneedformentalhealthandsubstanceabuseservices.m XXXXXXXX  m: D   Toaddressthesechallenges,thebudget %[#H provides$125million,a$100millionincrease,forthesecondyearofthenewHealthCareAccessfortheUninsuredprogram.Projectswillfocusontheneedforcommunitiestobecomemoreefficient,effectiveprovidersofcare,abletocompeteintodayshealthcareenvironment,andtomeettheunderlyingneedforservicesprimarycare,mentalheathandsubstance #.+Q abuseatthecommunitylevel.Therequestwillsupportthecontinuationof10to20grantsbegunin2000andsupportanadditional40to60communitiesin2001.Grantswillsupportdevelopmentorenhancementofnetworkstoprovidemorecomprehensivecaretolowincomeuninsuredindividuals;assistancewiththeestablishmentoffinancialsystems,patienttrackingandothercomputersystems,andtelecommunicationsystemsnecessarytomanagepatientneeds;andfinancingtoaddressservicegapsidentifiedatthelocallevel.m:U;݌̌ XXXXXXXX  m XXXXXXXX  m?    m?`@݌̌ XXXXXXXX  .Ȋ  .ȊA0  XXXXXXXX   CommunityHealthCenters.ȊA0A ӌh ЌXXXXXX   m XXXXXXXX  mWB    TheCommunityHealthCentersprovide x highquality,communitybased,culturallycompetentcaretoapproximately9millionpatientsinruralandinnercityareas.Thecareprovidedbyhealthcentershasbeenproventoreducehospitalizationsandemergencyroomuse,reduceannualMedicaidcosts,andhelppreventmoreexpensivechronicdiseaseanddisability.MedicaidpatientsservedbyHealthCentersare22percentlesslikelytobehospitalizedthanMedicaidbeneficiarieswhoobtaincareelsewhere.mWBB݌̌ XXXXXXXX  m XXXXXXXX  mE    ForFY2001,theHRSArequestfor  healthcentersis$1.1billion,a$50millionincreaseovertheFY2000appropriation.Thesefundswillincreasethenumberofhealthcenterpatientsby100,000andsitesby22foratotalof3,205sites.Inaddition,fundswillsupporthealthcenteruserswhoseinsurancestatushaschanged.Thenumberofuninsuredservedbyhealthcentershasincreasedbynearly60percentsince1990.ThesechangesaretheresultofmarketpressuresincludingthelossofMedicaideligibilityandthelossofprivatecoverage.mEF݌ XXXXXXXX  m XXXXXXXX  mI    mII݌ 0*'+ Ќ XXXXXXXX  +jXXXX   XXXX   +j[J      RyanWhite+j[JJ ӌ X+ ЌXXXXXX  m XXXXXXXX  mK D   Approximately750,000Americansare h- livingwithHIV,ofthese200,000250,000knowtheirstatusandarenotincare.ThroughtheRyanWhiteCareAct,thethirdlargestpublicprogramofHIV/AIDSservicesintheU.S.,essentialmedicalandrelatedsupportservicesforindividualsandfamilieswithHIVwillbeexpanded.Thisinfrastructurecurrentlysupports2,630communitybasedprovidersofcare.ThebudgetrequestforRyanWhiteincludes$1.7billion,anincreaseof$125millionforallRyanWhiteactivities.Inaddition,thisincreasewillallowanadditional2,900personstoreceiveAIDSdrugtherapythroughtheAIDSDrugAssistanceProgram(ADAP).ThesedrugshavehelpedtodecreasetheprogressionofHIVtoAIDSaswellasimprovethequalityoflifeforpeoplewithHIV/AIDS.ThenumberofclientsservedthroughADAPhasincreased114percentfrom19941998.mKL݌̌ XXXXXXXX  m XXXXXXXX  vVB2.b~1   `..@E    vYP (#(#            (#(# D   mYPNQ݌̌ XXXXXXXX  m XXXXXXXX  mnS D   InFY2001theRyanWhite $8"P authorizationexpiresandtheprogramwillfocusonidentifyingnewmethodsofbringingandprovidingmedicalservicesandtherapiestoindividualswithHIVdiseasewhoarenotinthecaresystem;providingqualityservicesthroughtheestablishmentofaccountableservicenetworks;andincreasingtheservicecapacityofunderservedcommunities.Thisisparticularlyimportanttominorities.Inthe -+Z mostrecentyearminoritymenaccountfor70percentofnewcasesandamongwomen82percentwereminorities.mnSS݌̌ XXXXXXXX  m XXXXXXXX  mV    mVdW݌̌ XXXXXXXX    +jXXXX  XXXX   +j$X  PersonsWithSpecialNeeds+j$XX ӌ  ЌXXXXXX  m XXXXXXXX  mWY    HRSAprogramssupportsystemsofcare ( forpopulationswhohavespecialhealthcareneedsincludingprogramsformothersandchildren,organtransplantation,andtheRickyRayHemophiliaReliefFund.mWYY݌̌ XXXXXXXX  m XXXXXXXX  mf[    mf[[݌̌ XXXXXXXX  .Ȋ  .Ȋ\0  XXXXXXXX   MaternalandChildHealth.Ȋ\\ ӌ  ЌXXXXXX   m XXXXXXXX  m]    Thebudgetrequestincludes 0  $869milliontoimprovethehealthofmothersandchildren.Ofthistotal,$799millionisfortheMaternalandChildHealth(MCH)BlockGrant.Thislevelincludesanewsetasideof$90millionasHRSAproposestoincorporatetheHealthyStartinitiativeanditsactivitiesimprovingperinatalhealthanddecreasingfactorswhichcontributetoinfantmortalityintotheMaternalandChildHealthBlockGrant.Bymergingthesetwoprograms,theintentistomorefullydisseminatethelessonslearnedfromthedemonstrationprogramintothecurrentStateMCHprograms.Currently,over24millionmothersandchildrenareservedthroughtheblockgrant.m]\^݌̌ XXXXXXXX  m XXXXXXXX  ma    TheFY2001requestalsoincludes x  $3milliontocontinuethesecondyearoftheUniversalNewbornHearingScreeningprogramand$1.5millionforthesecondyearoffundingtoimproveaccesstoqualitypoisoncontrolservices.Atotalof$15millionisincludedforEmergencyMedicalServicesforChildren.Eachoftheseprogramsplacesemphasisonreachingouttoaddresscriticalproblemsfacedbychildrenandfamilies.maVb݌̌ XXXXXXXX  m XXXXXXXX  md    Therequestalsoincludesthe$50million (p&* annualmandatoryappropriationforabstinenceeducation.Thisprogram providesgrantsto59Statesandterritoriesto +@)-    providementoring,counseling,andadultsupervisiontopromoteabstinencewithafocusongroupsmostlikelytobearchildrenoutofwedlock.mdEe݌̌ XXXXXXXX  m XXXXXXXX  mpg D   mpgg݌̌ XXXXXXXX  .Ȋ  .Ȋh0 D XXXXXXXX     OrganTransplantation.Ȋhh ӌ2D(#D(# ЌXXXXXX   m XXXXXXXX  mi D   Over5,000peopledieeachyearwaiting p4 fororgantransplantsandmorethan66,000peoplearecurrentlywaitingforanorgantransplant.Therequestof$15million,anincreaseof$5million,wouldbroadensupportfortheNationalOrganandTissueDonationInitiativeandexpandactivitiestoincreaseorgandonation.Muchofthefocusinthecomingyearwillbeonreplicatingprojectswhichhavebeenprovensuccessfulandincreasingthenumberofgrantees.OngoingprojectsincludeeffortstousetheInternetfornotifyingfamiliesofanindividualsdesiretodonate;increasingminoritydonations;XXXXtestingdonoreducation 8B strategiesintheworkplace,atendoflifeplanningsessions,andwithdriverslicenserenewals#XXXX m#;andfinallyimprovingtheability `E ofhealthprofessionalstohandleendoflifediscussionsandcare.Forthefirsttimeinrecentyears,thenumberofdonorsfrom1997to1998increasedby6percent.mimj݌̌ XXXXXXXX  m XXXXXXXX  mLo D   mLoo݌̌ XXXXXXXX  .Ȋ  .Ȋp0 D XXXXXXXX     RickyRayHemophiliaReliefFund.Ȋpp ӌKD(#D(# ЌXXXXXX   m XXXXXXXX  mq D   Therequestalsoincludes$100million hM tofundthesecondyearoftheRickyRayHemophiliaprogramandwillprovidecompensationto950personsorfamiliesofpersonswithhemophiliawhohaveHIV/AIDSasaresultofbloodtransfusions.Aspecialtrustfundhasbeenestablished.HRSAiscurrentlyputtinginplacetheadministrativeapparatustoreviewclaimsforcompensation!focusingonmedicalandlegalreviews.mqTr݌ XXXXXXXX  m XXXXXXXX  mt D   mtLu݌ )`'X Ќ XXXXXXXX  +jXXXX   XXXX   +jv    FamilyPlanning+jvv ӌ X ЌXXXXXX  m XXXXXXXX  mSw    Formanyofthe4.5millionindividuals, h primarilywomen,whousefamilyplanningclinics,theseclinicsarethesolepointofcontactwiththehealthcaresystem.Theseclinicsprovideaccesstosuchreproductivehealthcareandpreventativeservicesascounseling,routinegynecologicalcare,hypertensionscreening,screeningandreferralsforbreastandcervicalcancerandsubstanceabuse.TheFY2001requestfortheTitleXFamilyPlanningprogramis$274million,$35millionovertheFY2000appropriation.mSww݌̌ XXXXXXXX  m XXXXXXXX  mz    Thisproposedspendingincreasein   FY2001willallowtheTitleXprogramtoprovidefamilyplanningservicestoanadditional500,000women.ThisincreasewillalsoallowtheTitleXprogramtoincreaseHIV/AIDSpreventionactivities.Asof1998,womenaccountfor24percentofallnewAIDScases,upfrom7percentin1985.Inaddition,TitleXwillexpanditseffortstoreachhardtoreachpopulationssuchasmales,substanceabusers,andhomeless;promoteeffectivepartnershipswithcommunitybasedorganizations,anddevelopculturallyandlinguisticallyappropriateinformationeducationandcommunicationactivities.mz{݌̌ XXXXXXXX  m XXXXXXXX  m^~    m^~~݌̌ XXXXXXXX  +jXXXX  XXXX   +j  HealthProfessions+j ӌ   ЌXXXXXX  m XXXXXXXX  m    TheFY2001budgetincludes H!" $80millionfortheChildrensHospitalsGraduateMedicalEducation(GME),doublingthefundingavailableinFY2000.ThesefundswillraisethelevelofGMEsupportforapproximately60freestandingChildrensHospitalstobemoreconsistentwithotherteachinghospitals.Thesehospitalstrainover25percentofallU.S.generalpediatricresidentsandthemajorityofpediatricspecialists.m<݌̌ XXXXXXXX  m XXXXXXXX  m    TheFY2001requestfortheremaining +@)- healthprofessionsprogramswillworktoensureadiverseworkforcethatisadequately x- +/ distributed.Therequestis$218million,an$84millionreduction.WithinthisoverallfundinglevelHRSAwillfocusresourcesonprogramswhichwillhelpdisadvantagedstudentsandreflectstheAdministrationsgoaltomoveawayfrombroadbasedcategoricalprograms.Withinthislevelthereisa$10milliontotalincreasefortheCentersofExcellenceandtheHealthCareersOpportunityprograms,bothofwhichhavesuccessinincreasingdiversitybyrecruitingandretainingpromisingracialandethnicminoritystudentsinhealthprofessionstraining.Reductionswillbetakeninbroadbasedcategoricalprogramsthataddressexpandingthesupplyofprimarycareandspecialtydisciplines.m4݌̌ XXXXXXXX  m XXXXXXXX  mL D   mLˈ݌̌ XXXXXXXX  +jXXXX  XXXX   +j怉  RuralHealth/Telehealth + ӌ 8A ЌXXXXXX     m XXXXXXXX  m D   Thebudgetincludes$75millionfor HC ruralhealthandtelehealthactivities,$18millionbelowtheFY2000level.Thislevelincludes$6.8milliontosupportagovernmentwideMississippiDeltainitiativetosupport219countiesrecognizedbytheCongressionalcreationoftheLowerMississippiDeltaDevelopmentCommissionin1988.Thisinitiativewillenhancehealthcareinaregionwherethepovertyrateis175percentofthenationalaverageandthepercapitaincomeis38percentbelowthenationalaverage.m݌̌ XXXXXXXX  m XXXXXXXX  mN D   mN͎݌̌ XXXXXXXX  +jXXXX  XXXX   +j悏    OtherHRSAPrograms+j悏 ӌ !hQ ЌXXXXXX  m XXXXXXXX  m D   Thebudgetproposes$294millionforall (# S remainingHRSAprogramsincludingtheNationalHealthServiceCorp,BoneMarrow,HansensDisease,BlackLung,NursingLoanRepayment,andprogrammanagement.Fundsarenotrequestedforonetimehealthfacilityconstructionandrenovationprojectsforwhich$112millionwasappropriatedinFY2000.Inaddition,fundsarenotrequestedfortheonetimeComprehensiveCarefortheUninsuredStatedemonstrationsbeguninFY2000.m8݌ x- +^ Ќ XXXXXXXX  (X@( l7 #  X53XXXe eXX53  #I@66$    HRSAOVERVIEW#I Ք  X AZ') HxdE#HxAeq eee XX eeqԌ $ Ќ  @  (dollarsinmillions)  k AZ'))HxdE)HxAnV:*&`> E!% ` *.E%x!x!e" n_  [ #  X53XXXe eXX53  @#@      INDIANHEALTHSERVICE#k   X AZ') HxdE#HxAeq eee XX eeqԌ $ Ќ  @  (dollarsinmillions)  k  (#(#       (#(#AZ') Gxd%E GxA   pV<,(`~0 Yz! `.ExExEGf p+ݰXXXX  XXXX   (X@(#(#(+j戚  Summary+j戚 ӌ   ЌXXXXXX  m XXXXXXXX  mћ    9,X, XX,X9TheIndianHealthServicesFY2001 y!  budgetrequestis$3.1billion,anincreaseof$229millionoverFY2000.Thebudgetiscomposedof$2.6billioninnewbudgetauthorityand$440millioninreimbursements.Thistenpercentincreaseinbudgetauthority!thelargestrequestedincreaseinovertwodecades!reflectstheimpactoftheDepartmentstribalbudgetconsultationsandacontinuingFederalGovernmentcommitmenttoprovideforthehealthofmembersofFederallyrecognizedTribes.Reimbursementsincludeanestimated$405millioninMedicare,MedicaidandprivatehealthinsurancecollectionsforthetreatmentofIndianpeople.mћP݌̌ XXXXXXXX  m XXXXXXXX  mޟ    mޟ]݌̌ XXXXXXXX  +jXXXX  XXXX   +j  AgencyDescription+j| ӌ Y ! ЌXXXXXX  m XXXXXXXX  m=    IHSprovideshealthcareto1.5million !i# AmericanIndiansandAlaskaNativeswhoaremembersofsome560FederallyrecognizedTribes.Medicalanddentalcareisprovideddirectlythroughanetworkof49hospitals,209healthcentersand285healthstations,satelliteclinics,schoolhealthcentersandAlaskavillageclinics.ThesefacilitiesarelocatedprimarilyinOklahoma,theNorthernPlains,Alaska,theSouthwestandalongthePacificCoast.CareprovidedinIHSfacilitiesissupplementedwithcarepurchasedfromprivatesectorhospitalsandhealthprofessionals.IHSalso -+0 providespreventivehealthservices,throughpublichealthnursesandcommunityhealthrepresentatives,mentalhealthservices,alcohol/substanceabuseprevention/treatmentandprovideswater,wastewaterandsolidwastedisposalsystemsforIndiancommunities.Inmanyareas,healthservicesareprovidedbylocalTribesundercontractwithIHS.InFY2001approximately44percentofIHSsbudgetwillbetriballycontrolled.Fundingisalsoprovidedtourbanhealthgranteesoperatingin41citieswithlargeconcentrationsofIndianpeople.m=݌̌ XXXXXXXX  m XXXXXXXX  m  D   m ݌̌ XXXXXXXX  +jXXXX  XXXX   +j>  Clinical,Preventive,and !? EnvironmentalHealth+j> ӌ̌XXXXXX  m XXXXXXXX  m D   TheFY2001budgetincludes y!B $2.4billionforclinicalpreventiveandenvironmentalhealthactivities,anincreaseof$160million,orsevenpercent.TheadditionalfundswillbeusedprimarilytoaddressagrowingpopulationofIndianeligibles,respondingtospecificdiseases/healthconditionsidentifiedthroughTribalconsultation,andcoverpayandotheroperatingcosts.m݌̌ XXXXXXXX  m XXXXXXXX  mF D   mFŭ݌̌ XXXXXXXX  .Ȋ  .Ȋz0 D XXXXXXXX     PopulationIncreases.Ȋz ӌ(q&MD(#D(# ЌXXXXXX   m XXXXXXXX  mï D   Thebudgetcontainsanadditional 1*'O $53milliontomaintainaccesstohealthcareastheIndianpopulationincreases.Since1990,thepopulationeligibleforserviceshasincreasedby27percent.Withinthistotal, -+S @     $41millionwillbedirectedtotheContractHealthServicesprogramwhichpurchasescarefromtheprivatesector.Percapitafundingforthisprogramhasnotkeptpacewithmedicalinflationoverthepastseveralyears.Asaresult,IHShaslimitedpaymenttoonlythemostserioustypesofinjuriesandillnessesandrestrictedspecialtycareforIndianpeoplesufferingfromchronicdisease.Withtheseadditionalfunds,IHSwillbeabletopurchasesuchservicesaschemotherapy,coronarybypasssurgeryand_retinopathy_Ԁtopreventblindnessasaresultofdiabetes.TheadditionalfundswillalsoallowIHStoprovide1,460additionalhospitaldaysand57,200additionalvisitstodoctorsanddentists.Includedinthisrequestis$12milliontostaffthehealthcenterat_Polacca_,AZ!HopiTribe,andthehospitalat_Talihina_,OK!ChoctawTribe.ThesetwofacilitieswillopeninFY2000andadditionalfundswillpayforthecostofnewstaff.mïB݌̌ XXXXXXXX  m XXXXXXXX  mZ    mZٶ݌̌ XXXXXXXX  .Ȋ  .Ȋ0  XXXXXXXX   ReducingHealthDisparities.Ȋ ӌ ЌXXXXXX   m XXXXXXXX  mӸ    WhileIHShasachieveddramatic @ improvementsinIndianhealthstatusoverthelongrun,overallmortalityratesforIndianpeoplecontinuetoexceedthoseofthegeneralpopulation.Forexample,Indianpeoplehavea249percentgreaterchanceofdyingfromdiabetesanda204percentgreaterchanceofdyingfromaccidents.Thebudgetincludesanincreaseof$35milliontoprovideadditionalservicesinseveralkeyareaswhichhavebeenselectedthroughconsultationbetweenIHSandtribalrepresentatives.Theseareasinclude:diabetes,cancer,heartandinfectiousdisease($7million);domesticcommunityviolenceprevention,elderandmaternal&childhealth($7million);emergencymedicalservicesandinjuryprevention($6million);mentalhealthandalcohol/substanceabuseprevention/treatment($6million)anddentalhealth($3million).Anadditional$6millioninpreventivehealthactivitiesis -+/ requestedinsupportoftheseinitiatives.Thesefundswillimproveanumberofhealthoutcomes,forexample:continuingtoincreasethepercentageofdiabeticswithgood_glycemic_Ԁcontrol!upthreepercentagepointsfromFY1998toFY1999;increasingwaterfluoridationcomplianceintheSouthwest!by26percentsinceFY1999;substantiallyincreasing!by70percentsinceFY1998!thenumberofEmergencydepartmentswhichidentifyandtreatvictimsoffamilyviolenceorneglect.mӸR݌̌ XXXXXXXX  m XXXXXXXX  mͿ D   mͿL݌̌ XXXXXXXX  .Ȋ  .Ȋ0 D XXXXXXXX   IncreasingEquityAmongTribes.Ȋ ӌ0 <D(#D(# ЌXXXXXX   m XXXXXXXX  mI D   AhighpriorityoftheIHSistoprovide  > comparablelevelsofhealthservicestoTribesacrossIndiancountry.About60percentofIHSsbudgetisusedtooperatehospitalsandoutpatientclinicsinexistinglocationsmakingmaintenanceofequityovertimedifficult.AsrequestedintheFY2000budget,Congressaddressedthissituationbyproviding$10milliontothoseTribeswiththelowesthealthservicelevels.AnIHSTribalworkgroupisdevelopingamethodologyfordeterminingwhichTribesshouldreceivefundinginFY2000.ForFY2001,thebudgetincludesafurtherincreaseof$8millionforthoseTribeswiththelowesthealthservicelevels.mI݌̌ XXXXXXXX  m XXXXXXXX  m' D   m'݌̌ XXXXXXXX  .Ȋ  .Ȋ[0 D XXXXXXXX   OperatingExpenses/Information O Technology.Ȋ[v ӌ D(#D(# ЌXXXXXX   m XXXXXXXX  m D   Thebudgetalsoincludesanincreaseof 8"R $64millionforincreasedpaycosts,additionalinformationtechnology(includingtelecommunicationsequipment)andtoincreasetheamountofepidemiologicaldatacomparingTribesindifferentAreas/RegionsoftheUnitedStates.m9݌̌ XXXXXXXX  m XXXXXXXX  m D   m݌̌ XXXXXXXX  +jXXXX  XXXX   +jB    TribalContractSupportCosts+jB ӌ )`'Z ЌXXXXXX  m XXXXXXXX  m D   Thebudgetincludes$269millionfor  +(\ ContractSupportCosts,anincreaseof$40millionor18percentoverFY2000.ContractSupportCostsareadditionalcosts -+_ whichTribesincurwhentheytakeovertheoperationoflocalhealthprogramsfromtheIHS.Tribesandtribalorganizationscurrentlyoperate13hospitalsand385oftheotherhealthfacilitiesthroughcontractswithIHSauthorizedbytheIndianSelf-DeterminationAct.InFY2001thesecontractorswillreceiveapproximately44percentofIHSstotalbudgettoprovidehealthservicestotheirmembers.m݌̌ XXXXXXXX  pV<,(`~1 Ph `..E e  p            G73nz 0  `@E0 0 0 o;+'bzp` `@E`ttxToo;+'bz   `@E  tt8 Tor>.*b~  `@Ett``rG73nzF$ `@E? $$? $m XXXXXXXX  m'    Dueprimarilytorapidgrowthinthe 0  numberofTribeswishingtocontract,thetribalrequestsforContractSupportCostsexceededtheamountprovidedbymr݌̌ XXXXXXXX  >$70milliontribalrequestsexceededthefundsavailable  byamountprovidedby$70millionbytheendofFY1998.Sincethattime,theDepartment,Tribes,andtheCongresshaveworkeddiligentlytoresolvethissituation.Congressprovidedatotalincreaseof$60millionforContractSupportCostsinFY1999andFY2000toaddresstheneedsofbothexistingandnewcontracts.m'݌̌ XXXXXXXX  m XXXXXXXX  m    Theadditional+$40millionincrease p&$, requestedinFY2001willfirstbeusedtofundnewcontracts.IHSestimatesthat$12.5millionwillbeneededfornewcontracts,but,sincecontractingisatribal option,theamountactuallyneededcouldbe  +(1    muchhigher.Totheextentthe$40millionisnotneededfornewcontractsitwillbeusedtoincreaseContractSupportCostsfundingforexistingcontracts.mf݌̌ XXXXXXXX  5m XXXXXXXX  m  D   m ݌̌ XXXXXXXX  +jXXXX  XXXX   +jY  Facilityandsanitationconstruction+jY ӌ 6 ЌXXXXXX  m XXXXXXXX  m D   Thebudgetincludesatotalof p8 $162millionforsanitationandhealthcarefacilityconstruction,anincreaseof$20million,or14percentoverFY2000.Withintherequest,IHSwilldevote$65milliontohealthfacilityconstruction.ThesefundsareforthereplacementoftheFortDefianceHospitalandtodesignitsstaffquarters(NavajoTribe),tocontinueconstructionofthenew_Winnebago_ԀHospital(_Winnebago_ԀandOmahaTribes)andtocompletetheParkerHealthCenter(ColoradoRiverTribes).m݌̌ XXXXXXXX  m XXXXXXXX  m D   Inadditiontoreplacementoflarge HE facilities,$2.5millionisrequestedforanewgrantprogramtohelpTribesconstructsmalloutpatientfacilities.IHSalsoproposesatotalof$2milliontodesignthereplacementPawneeHealthCenterand$1millionformodulardentalunitsinvariouslocations.m݌̌ XXXXXXXX   5 m XXXXXXXX  m D   Thebudgetincludesatotalof 0L $97million,ora$5millionincrease,tobuildsanitationsystemswhichprovidewater,wastewater,andsolidwastedisposalsystemsforIndianhomesandcommunities.TheadditionalfundswillallowIHStoserve60neworlikenewhomesand420existinghomes.m@݌̌ XXXXXXXX  m XXXXXXXX  m- D   m-݌̌ XXXXXXXX  +jXXXX  XXXX   +ja  OtherIHSPrograms+ja ӌ #H!U ЌXXXXXX  m XXXXXXXX  m D   Thebudgetincludes$31million,an %"W increaseof$3million,fortheUrbanHealthprogram,or11percentoverFY2000.FundswillbeusedtoreducehealthdisparitiesforIndianpeoplelivinginurbanareas.Anadditional$6millionisrequestedtobringmorehealthprofessionalsintotheAgencyandforadditionalincreasedpaycosts.m ݌ ,0*_ Ќ XXXXXXXX   (X@(`'  X53XXXe eXX53  AZ')kAHxdEkAHxA`'@      INDIANHEALTHSERVICE`'Z   X Ќ̌eq eee XX eeq  8(pV<,(`~1 } `+.Ex x >Z4!p@  (dollarsinmillions) AZ')\(TxdE\(TxA߈  ( _D#  Xu=XXXLe&eXXu=  #a@    CENTERSFORDISEASECONTROLANDPREVENTION#a   X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<,(`~0 6!f `. E@xxe~p (#(#        (#(#AZ') HxdzE HxA  s  +jXLXXXL  XLXXXL   (X(#(#(+jM  Summary+jM ӌ   ЌXLXXLXLXXL  ) m XLXXXLXLXXXL  m    TheFY2001budgetrequestsatotalof Z $3.5billionfortheCentersforDiseaseControlandPrevention(CDC),anincreaseof$201million,orsixpercent,overFY2000.TheFY2001budgetforCDCincludes$149millioninfundsprovidedthroughthePublicHealthandSocialServicesEmergencyFund(PHSSEF)foractivitiesrelatedtobioterrorism.mB݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mh    CDCistheleadpublichealthagencyfor r promotinghealthandqualityoflifebypreventingandcontrollingdisease,injuryanddisability.CDCworkswithStates,localpublichealthagencies,andpartnersthroughouttheNationandtheworldtoaccomplishthismission.Together,theymonitorhealth,detectandinvestigatediseaseoutbreaksandotherhealthproblems,conductresearch,developandadvocatesoundhealthpolicies,implementpreventionstrategies,promotehealthybehaviors,fostersafeandhealthyenvironments,andprovidepublichealthleadershipandtraining.mh݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mt݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j)  XLXXLXLXXL  Modern,SecureLaboratoriesXLXXLXLXXL  +j) ӌ '%) ЌXLXXLXLXXL   m XLXXXLXLXXXL  mw    ThelaboratoriesatCDCarereliedupon B)&+ worldwidetohelpcontroldiseaseoutbreaksandpreventillnessandinjury.Forexample,CDClabshouseoneofthetwoofficial referencesamplesofsmallpox.mw݌ -*/ Ќ /(#/(#(#(# XLXXXLXLXXXL  F62h~?_G- p E QG-X T F62h~?_G- p E QG-X T  F62h~?_G- p E QG-X T `F62h~?_G- p E QG-X T TheFY2001  /   budgetincludes$127million,anincreaseof$70million,fordesignandconstructionprojectsatthreelaboratorysites.First, (#(#/(#/(#CDCwilluse$86millionofthesefundstobeginconstructionofalaboratorythatincludesfacilitiesdedicatedtothemosthighlyinfectiousandlethalpathogenshandledatCDC.ThisnewbuildingwillincludeaBiosafetyLevel4laboratoryforresearchondiseasesthatneedtobehighlycontainedsuchasEbola,hantavirusandCongoCrimeanhemorrhagicfever.Alsoincludedattheplannedfacilitywillbelabstosupportworkoninfectiousdiseaseagentsthatcouldpotentiallybeusedbyterrorists.ThebudgetcommitsfundsinFY2002andFY2003tocompleteconstructionofthislaboratoryproject.m XLXXXLXLXXXL  m@  D   Second,thebudgetincludes$20million b' %H tocompletetheEdwardR.Roybalinfectiousdiseaselaboratory.Thisbuildingwillbeusedforresearchonmeasles,foodbornediseases,rotavirusandantibioticresistancepathogens.m@  ݌ ,)M Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m       Third,$8millionwillfundthedesign X andbeginconstructionofenvironmentalhealthlabs,andcompletesupportlaboratoriesthatwillreplacefacilitiesconstructedduringthe1940's.Theremaining$13millionwillfundsecurityandinfrastructureimprovementsandannualrepairstoexistingfacilities.Thesecurityimprovementsincludeacentralizedsecuritycontrolroom,additionallighting,securitycameras,andanewtranshipmentcenter.Thefundingfortheseprojectsisincludedunderthelineitem, BuildingsandFacilities.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m|݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j1  RespondingtoBioterroristThreats+j1 ӌ x  ЌXLXXLXLXXL  c m XLXXXLXLXXXL  m    Thebudgetincludes$149million,a  decreaseof$6millioninthePHSSEF,forCDCbioterrorismpreparedness.ThedecreasereflectsthecompletionofprojectsbeguninFY2000.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Bioterroristattacksarelikelytobe 8 covertandsymptomswillfrequentlyresemblelessseriousdiseasesatfirst.Stateandlocalpublichealthofficersmustbeabletoobtain,analyze,andsharesurveillanceinformationrapidly,andmountcontrolmeasuresquicklyiftheyaretopreventwidespreadillness,death,disabilityandsocietaldisruptioncausedbyterroristattacks.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  pV<,(`~0 3  `..E 3 3 n ; pmV    Thebudgetincludes$78millionto   expandStateandlocalbioterrorismpreparedness,includingepidemiologicalandlaboratoryenhancements,detectionofoutbreaksandelectroniccommunications.Fundswillalsosupportlaboratoryregulationofhazardousbiologicalandchemicalagents.mVE݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mF    Fundstotaling$18million,anincrease p&$' of$3millionoverFY2000,willupgradecapacityatCDC,includingcontinueddevelopmentofarapidtoxicscreenthatcanquicklyidentifyupto150chemicalthreats,additionaltrainingfortheEpidemicIntelligenceServiceandincreasedbiological labcapacity.mF݌-*. Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D      Theremaining$52millionwillbeused X. tocontinuedevelopmentoftheNationalPharmaceuticalStockpilethatwillbeused  intheeventofabioterroristattack.Whencompleted,thestockpilewillrespondtothreatsposedbysmallpox,anthrax,plague,botulism,tularemiaandhazardouschemicalagents.me݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m|! D   m|!!݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j"  InfectiousDiseases+j"# ӌ  p7 ЌXLXXLXLXXL  m XLXXXLXLXXXL  m# D   Thebudgetincludes$202millionto 0 9 fightinfectiousdiseases,anincreaseof$26million,or15percent,overFY2000.m#[$݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m% D   m%&݌̌ XLXXXLXLXXXL  .Ȋ   .Ȋ&0 D XLXXXLXLXXXL   FoodSafetyInitiative.Ȋ&' ӌ =D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m=( D   Foodbornediseasesareestimatedto X? cause5,000deathsand76millionillnessesintheUnitedStateseachyear.DiseaseoutbreaksofEcoli0157:H7in1999 (B demonstratetheneedforexpandedinvestmentinfoodsafety.m=((݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m|* D   Thebudgetproposes$39millionfor E foodsafety,anincreaseof$10million,or34percent,aboveFY2000.ThesefundswillsupportactivitiesundertheFoodSafetyInitiativeinwhichCDCparticipateswithFDAandUSDA.CDCwillfurtherexpandtheawardwinningPulseNet,thenationalnetworkofpublichealthlabsthatperformDNA fingerprintingofdiseasecausingbacteria.Expansionsinclude|**݌ hN Ќ (#(#              !x- +] ! XLXXXLXLXXXL  Ecoli0157:H7andSalmonella(5more X States),ListeriaMonocytogene(10more H States),ShigellaSonnei(8moreStates). 8 .Ȋ  .Ȋ00  XLXXXLXLXXXL   '   EmergingInfectiousDiseases.Ȋ0 0 ӌH ЌXLXXLXLXXL   m XLXXXLXLXXXL  m1    Dramaticincreasesininternational  commerceandtravel,changesintheenvironment,andincreasingstressesonourpublichealthinfrastructurehavecontributedtoboththeemergenceandtherapidtransmissionofdrugresistantandnewbacteria,fungi,parasites,andviruses.TheoutbreakofWestNileencephalitisintheNewYorkareahighlightsthepotentialfornewdiseasethreatstoerupt.m12݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m[4    Emerginginfectiousdiseasescontribute h substantiallytotheburdenofdiseasebornebytheAmericanpublic.Forexample,1999provisionalestimatesofthedirectcostofinfluenzaandpneumoniatotal$19billion,withnearly95,000deathsin1998,rankingfifthamongallcausesofdeathduetoillness.m[44݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m6    Thebudgetproposesatotalof  $123millionforemerginginfectiousdiseases,anincreaseof$25million,or25percentabovetheFY2000level.Ofthisincrease,$20millionwouldsupportthedevelopmentofanationalelectronicdiseasesurveillancenetwork,whichwillenhancetheabilityofStateandlocalpublichealthofficialstorespondtomultiStateoutbreaksofdiseasesandtoshareinformation,bothamongthemselvesandwithCDC,aboutemerginginfectiousdiseaseemergenciesandtrends.Theremaining$5millionininfectiousdiseaseswouldfunddemonstrationprojectsinsurveillance,counseling,testing,referralandeducationactivitiestocombatHepatitisCinfections.m6T7݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m:    m:P;݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j<    HIV/AIDSandSTDs+j<o< ӌ (p&* ЌXLXXLXLXXL  0 m XLXXXLXLXXXL  mh=    Thebudgetincludes$795millionfor 0*', HIV/AIDS,anincreaseof$66million,orninepercentoverFY2000.Thisincreaseisfocusedintwoareas!domesticpreventionandglobalAIDS.mh==݌ -+0 Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m|? D   Thebudgetincludesa$40million X0 increasetoexpandlocalpreventionefforts,includinginterventionstargetedtowardminoritypopulations,andthe KnowYourStatuscampaign.Anadditional$10millionwouldberedirectedfromotherHIV/AIDSactivitiestosupportcommunityplanninginterventions.m|??݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  F62h~`L p ELP b F62h~`L p ELP b SF62h~`L p ELP b nF62h~`L p ELP b mA D   TocombatglobalAIDS,thebudget  8 contains$61million,anincreaseof$26millionincrease,or74percent,aboveFY2000.Itisestimatedthatcurrentlythere (#(#are22millionadultsand1millionchildrenlivingwithHIV/AIDSintheSubSaharanregionofAfrica.mAD݌̌ (#(# XLXXXLXLXXXL  m XLXXXLXLXXXL  mF D   mFJG݌̌ XLXXXLXLXXXL  .Ȋ  .ȊG0 D XLXXXLXLXXXL     EliminatingSyphilis.ȊGH ӌFD(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mHI D   Thebudgetincludes$151millionfor `H STDpreventionandcontrol,anincreaseof$15million,or11percentoverFY2000.ThisincreasewillexpandtherecentlyannouncedNationalSyphilisEliminationmHII݌̌ XLXXXLXLXXXL  T= m XLXXXLXLXXXL  F62h~ p EPK2b F62h~ p EPK2b cF62h~ p EPK2b F62h~ p EPK2b mK D   Initiative.Halfofallnewcasesof M  (#(#(#(#syphilisintheUnitedStatesareconcentratedinonly28counties(1percentofallU.S.counties).Thisinitiativewillincludea (#(#(#(#specialemphasisonminoritypopulationswhereratesin1998wereasmuchas34timeshigherthanforwhiteAmericans.mKQN݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m}P D   m}PP݌ P(%Y Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jQ     ChildhoodImmunization+jQ0R ӌ X ЌXLXXLXLXXL  m XLXXXLXLXXXL  m S    TheChildhoodImmunizationInitiative h (CII)hasbeenamajorAdministrationpriority.Deliveryofsafeandeffectivevaccinesisthemostcost-effectivemethodofpreventingillness.ThisinvestmenthasenabledtheNationtocontinuetoexceedthegoalofatleast90percentof2-year-oldchildrenreceivingthemostcriticalvaccines.m SS݌ P   Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  mU    Thegoalfortheyear2000istoensure @   thatatleast90percentofalltwo-year-oldsreceivethefullseriesofvaccinesandthata   vaccinationsystemisbuiltthatwillsustainandfurtherimprovehighcoveragelevels.mUCV݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m X    TheFY2001immunizationbudgetis   $999million.Thisincludes$530milliontobeappropriatedtoCDC,and$469millioninMedicaidfundsfortheVaccinesforChildren(VFC)program.m XX݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m Z    Thediscretionaryrequestfor H immunizationsinFY2001includesanincreaseof$10millionforthepurchaseofvaccinestoimmunizeunderinsuredchildrenthroughthepublichealthsystem.Alsoincludedis$13millionforvaccinesafety,anincreaseof$5million.Fundswouldbeusedtoenhancesurveillanceofadverseeventsfollowingimmunization,andimprovecommunicationofvaccinesafetyissues.m ZZ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m\    TheFY2001budgetrequests  $91millionforglobalpolioeradication.Ifneeded,additionalfundswillberedirectedtothepolioeffortfromfundsusedtopurchasedomesticvaccines.Whileworld-widepoliocaseswerereducedmorethan85percentbetween1988and1999,amajorinternationalincreaseineffortwillbeneededtoreachtheWorldHealthOrganizationsgoaltoeliminatepolio.m\f]݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m_    m_9`݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ`0  XLXXXLXLXXXL     AdolescentSmokingAndHealth.Ȋ` a ӌ@)&* ЌXLXXLXLXXL   m XLXXXLXLXXXL  m@b    Thebudgetincludes$103millionfor *P(, CDCsupportofStatetobaccocontrol,anincreaseof$5million,or5percent,abovetheFY2000level.Thisamountwillsupport x- +/ nationalprogramsandmediaactivitiesforStates,surveillanceandresearchconductedatCDC,andinternationalcontrolefforts.CDCsactivitieswouldcontinuetoprovideStatesthecapacitytoconductscience-basedtobaccocontrolprogramsproventobeeffectiveinreducingteen-smoking.CDCs  NationalTobaccoControlProgram(NTCP)!previouslytwoanti-smokinginitiativesforStates,theAmericanStopSmokingInterventionStudy(ASSIST!transferredfromtheNationalInstitutesofHealth),andInitiativestoMobilizeforthePreventionandControlofTobaccoUse(IMPACT)!willprovidegrantstoStatestotaling$65million.m@bb݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mf D   mf[g݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋh0 D XLXXXLXLXXXL   EnvironmentalHealth.Ȋh+h ӌH@D(#D(# ЌXLXXLXLXXL   rK m XLXXXLXLXXXL  m|i D   Thebudgetincludes$99millionfor XB environmentaldiseaseprevention,anincreaseof$10million,or11percent,aboveFY2000.ThisincreasewouldsupporttheNationalBiomonitoringProgramwhichmeasuresexposureoftheU.S.populationtotoxicsubstancesknowntocausecancer,birthdefectsandotherdisease.Thisinitiativewilltargetvulnerablepopulationssuchaschildren,womenofchildbearingage,theelderlyandminorities.m|ii݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m{l D   m{ll݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jm    BreastandCervicalCancer N Screening+jmn ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mn D   Thebudgetincludes$171millionforthe H!Q NationalBreastandCervicalCancerEarlyScreeningDetectionProgram(NBCCEDP),anincreaseof$5millionaboveFY2000.Thisincreasewillexpandscreening,diagnostic,andcasemanagementservicestowomenatrisk,especiallyminoritywomen.Sinceitsinceptionin1991,over2millionscreeningtestshavebeenprovidedbytheNBCCEDP,withover6,000casesofbreastcancersandover500casesofinvasivecervicalcancerdiagnosed.Theprogramalsoincludesdemonstrationprojectsthatscreenforheartdiseaseanddiabetesrisk x- +^ factors,andprovidedietaryandphysicalactivityinterventionsforwomendeterminedatrisk.mnvo݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mr    mrss݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j(t  &  DemonstrationstoReduceHealth  DisparitiesinMinorityPopulations+j(tt ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  yA1-lz  `E{{yyA1-lz  `E{{yykA1-lz  `E{{yyA1-lz  `E{{ypV<,(`~0l x `..El xx! pmu    Raceandethnicitycorrelatewith p persistent,andoftengrowing,healthdisparitiesamongU.S.populations.Thisincreasingproblemdemandsnationalattention.InresponsetothePresidents                    InitiativeonRace,HHSiscommittedtodevelopingacomprehensivestrategytoreducehealthdisparitiesamongethnicandminoritygroups.'tmux݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m|    Thebudgetincludes$35millionto "X # continueandexpandnewdemonstrationprojectsincommunitiesacrossthecountrywhichaddresssixidentifiedareasofhealthdisparities:infantmortality,cancer,heartdisease,diabetes,HIVinfections,andchildandadultimmunizations.ThirtytwoprojectswereplannedwithfundsprovidedinFY1999,twentyofwhichcanbeginimplementationwithFY2000funding.The budgetrequestincludesfundstoimplement ,)- anadditional2demonstrationsinFY2001.   Communitieswillbeabletoapplythesefundstoaddresshealthproblemsthattheyperceiveastheirgreatestneeds.FundswillalsosupportplanningprojectsthatfocusonhealthdisparitiesinNativeAmericanpopulations.m|x}݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mF D   mFŁ݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL++jXXXXLXLXXX  XLXXXL   +j楂  NationalInstituteforOccupational  5 SafetyandHealth(NIOSH)+j楂. ӌ̌XLXXLXLXXLXLXXL  /XLXXXXgJXXLz/m XLXXXLXLXXXL  mh D   NIOSHestablishesanddisseminates 0 8 scientificandpublichealthinformationnecessarytoensuresafeandhealthfulworkingconditionsformillionsofAmericanworkingmenandwomen.Researchwillcontinuetoincludeoccupationallungdisease,musculoskeletalinjuries,cancers,traumaticinjuries,reproductivedisorders,neurotoxicdisorders,cardiovasculardisease,noiseinducedhearingloss,dermatologicconditions,andprotectiveequipment.Theseeffortswillhelptoaddresssolutionstooccupationaldiseaseandworkplacesafetyconcernsinthosefieldswherethedangersarethegreatest.CDCsbudgetincludes$220millionforNIOSH,anincreaseof$5millionovertheFY2000level.ThisincreasewillsupporttheNationalOccupationalResearchAgenda(NORA),NIOSHsresearchprogramdevelopedcooperativelywithacademiccentersandindustry.mh݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   m݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jF    Violenceagainstwomen+jF ӌ !hO ЌXLXXLXLXXL  hi m XLXXXLXLXXXL  m D   Nearly2millionAmericanwomen!m-݌ (# Q Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   includingmorethan1millionunderthe $!R ageofeighteen"experienceddomesticorsexualviolencein1996.Thebudgetincludesatotalof$87million,anincreaseof$5millionabovetheFY2000level,forCDCtosupporttheDepartmentsInitiativetocombatViolenceAgainstWomen(VAW).CDChasakeyroleinensuringthattheDepartmentsresponsetoVAW!includingbothpreventionandservicedelivery!issupportedbyscience.CDCwill x- +\ useitsapproachofimprovingpublichealthpreventiontoworkwithStateandcommunitypartnerstohelpincreasetheeffectivenessofVAWpractitioners.Specifically,CDCanditspartnerswilluseascientificapproachtoevaluateservicesandbringinnewpartners,suchasbusinessesandeducationalinstitutions,toimproveservicedeliveryandprovidepreventionopportunities.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m<݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  HealthStatistics+j[ ӌ  P  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    Thebudgetincludes$110million,an   increaseof$5millionovertheFY2000level,forexpandedsupportofHHShealthsurveyanddatacollectionefforts.MajorstatisticalsystemsoperatedbyNCHStrackchangeinhealthandhealthcare,plan,target,andassesstheeffectivenessofpublichealthprograms,andidentifyhealthproblems,riskfactors,anddiseasepatternsintheUnitedStates.ThesefundswillbeusedtoexpandtheNationalVitalStatisticsprogram($750thousand),theNationalHealthInterviewSurveys($750thousand),theNationalHealthCareSurveys($750thousand),andtheNationalHealthandNutritionExaminationSurvey(NHANES;$1.8million).Nearly$1millionwouldbeusedtostrengthenCDCsintramuralstatisticalprogram.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m[    m[ژ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j揙  EpidemicServices+j揙 ӌ  x! ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    Thebudgetincludes$86millionfor 8"# EpidemicServices,adecreaseof$18millionbelowFY2000.TheFY2000levelincludedonetimefundingtoevaluatethecurrentlyadministeredanthraxvaccineanditspotentialforadverseeffects.CDCsepidemicservicesprogramconductsappliedresearchtosolvepublichealthproblemsandachievepreventiongoals.m8݌ XLXXXLXLXXXL   *P(, +jXLXXXL   XLXXXL   +j懝    PreventionCenters+j懝 ӌ X, ЌXLXXLXLXXL  m XLXXXLXLXXXL  mǞ D   CDCsPreventionCentersprogram h. providesgrantstoacademicinstitutionsforappliedresearchdesignedtodevelopinnovativestrategiesindiseasepreventionandhealthpromotion.TheCentersfocusinoneormoreofthefollowingpopulations:childrenandyouth;olderadultsanddisabledpersons;minorities;andruralpopulations.Thebudgetincludes$15millionforPreventionCenters,adecreaseof$3millionbelowFY2000.mǞF݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m¡ D   m¡A݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  OtherActivities+j` ӌ  : ЌXLXXLXLXXL  m XLXXXLXLXXXL  m D   Thebudgetdoesnotcontinue$9million h< infundingforglobalmalariaprevention,and$5millionforpreventionofglobalmicronutrientdeficiency.TheFY2000levelsincludedonetimefundingforprojectsintheseprograms.InFY2000,theglobalmalariapreventionprogramprovideddiagnostic,consultativeandepidemiologicsupportandtrainingtohostcountries.Theglobalmicronutrientdeficiencyprogramestablishedbaselineinformationonnutritionalstatustointernationalpartnersandsupportedproven,costeffectivemethodstodelivernutrients,suchasironandiodine,throughdietarydiversificationandfoodsupplements.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   Inaddition,thebudgetincludesa hL $2milliondecreaseforCDCsOfficeoftheDirector.Thisalsoreflectsonetimefundingforprojectsatacademicresearchcenters.mg݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mݩ D   ProgramsthataremaintainedatFY2000 $!Q fundinglevelsincludepreventionresearch,thePreventiveHealthandHealthServicesBlockGrant,tuberculosis,andchildhoodleadpoisoning.mݩ\݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   me݌ (p&V Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j/     AgencyforToxicSubstancesDisease X Research(ATSDR)+j/ ӌ̌XLXXLXLXXL   m XLXXXLXLXXXL  m    ATSDRisfundedthroughSuperfund, X whichismanagedbytheEnvironmentalProtectionAgency.ATSDRperformspublichealthactivitiesrelatedtoSuperfundToxicWastesites.Theseincludehealthconsultations,epidemiologicalsurveillance,profilesofthehealtheffectsofhazardoussubstances,andeducationofhealthcareprovidersnearSuperfundsites.EPAsbudgetproposed$64millionforATSDR,adecreaseof$6millionbelowFY2000.m>݌̌ XLXXXLXLXXXL      X (X@(   #  Xu=XXXLe&eXXu=  #,@$    CDCOVERVIEW#,   X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k  (#(#                                           (#(#AZ') HxdE-HxA -S+. pV< ,(`~0' `#.E''a_(?(p -+/ D#  Xu=XXXLe&eXXu=  #@     NATIONALINSTITUTESOFHEALTH#~   H AZ') HxdEHxAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions)  [  (#(#       (#(#AZ') HxdE HxA ``(#(#nV: *&`> D" `.ExExEeQn+XLXXXL  XLXXXL   pV<,(`~1d `..E`Swap(XE``(+j樽  Summary+j樽 ӌ c  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m`    TheFY2001budgetrequests #  $18.8billionfortheNationalInstitutesofHealth(NIH),anincreaseof$1.0billion,or5.6percent,overtheFY2000level.m`߿݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mC    ݀NIHistheworldslargestandmost  distinguishedorganizationdedicatedtomaintainingandimprovinghealththroughmedicalscience.AttheendofacenturyinwhichtheaveragelifeexpectancyintheUnitedStatesincreasedbynearly30years,triumphoverdiseaseanddisabilityhasbecomearealisticgoal.  mC݌ s Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheInstitutesandCentersfundedby c  NIHs25appropriationssupportresearchactivitiesthatextendfrombasicresearchexploringthefundamentalworkingsofbiologicalsystems,tostudiesthatexaminediseaseandtreatmentsinclinicalsettings,topreventionandtopopulationbasedanalysesofhealthstatusandneeds.ThemissionsofindividualInstitutesandCentersmayfocusonagivendisease,suchascancer,mentalillness,orinfectiousdiseases;onaparticularorgan,suchastheheart,kidney,oreye;oronastageofdevelopment,suchaschildhoodoroldage.Inotherinstances,amissionmightencompasscrosscuttingneedsandopportunities,suchasthedevelopmentofresearchresourcesorthesequencingofthehumangenome.mg݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     Approximately82percentofthefunds C,)- appropriatedtoNIHflowsouttotheextramuralcommunity,whichsupports #.+/  (#(#                   (#(#researchbymorethan50,000researchersaffiliatedwithsome2,000university,hospital,andotherresearchfacilitiesinall50States,theDistrictofColumbia,PuertoRico,Guam,theVirginIslands,andpointsabroad.Asmallpercentageofthebudget!approximately10percent!supportsacoreprogramofbasicandclinicalresearchactivitiesadministeredandstaffedbyNIHsownphysiciansandscientists.Theremaining8percentprovidesforresearchmanagementandsupport,agency administration,andintramuralfacilities.m ݌ +s)N Ќ XLXXXLXLXXXL  +jXLXXXL   XLXXXL   +j\    ResearchThemes+j\ ӌ X ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    Newadvancesforpreventingand h treatingdisease,neverbeforethoughtpossible,arewithinreach.WiththeincreasesrequestedforFY2001,NIHplanstocontinuetofocusonfourprogrammaticthemes:1)toexploitgenomicsby p acceleratingthehumangenomeproject;expandingworkonmodelanimalsystems;learningtogatherandusecomplexbiologicalinformation;andbuildingbioinformatics;2)toreinvigorateclinical   researchbyrecruiting,training,and   retainingclinicalinvestigators;strengtheningclinicalresearchcenters;supportingclinicaltrials,networks,anddatabases;anddevelopingpartnershipswithmanagedcareorganizations,foundations,industriesandotherFederalagencies;3)to X harnesstheexpertiseofallieddisciplines, H suchaschemistry,engineering,computerscience,mathematics,optics,andphysicsinordertoworkwithmedicalscientistsin,forexample,designingnewdrugs;imagingmolecules,chromosomes,cells,andorgans;developingbiomaterials;andanalyzingbioinformaticsandclinicaldata;and4)to 0 reducehealthdisparitiesathomeandabroad   throughresearch,training,testinginterventions,andbuildinginternationalresearchcapacity.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m.    m.݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jb  ResearchProjectGrants+jb ӌ  x! ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    Thesupportofbasicmedicalresearch 8"# throughcompetitive,peerreviewed,andinvestigatorinitiatedresearchprojectgrants(RPGs)continuestobeoneofNIHshighestfundingpriorities.Thesegrantssupportnewandexperiencedinvestigatorsinbroad-basedresearchprograms.InFY2001,theNIHbudgetprovides$10.3billion,a6.1percentincreaseoverFY2000,tofundanestimated31,524projects,thehighesttotallevelever.Thisrepresentsanadditional237totalgrantsoverFY2000.NIHestimatesitwillsupport x- +/ 7,641newandcompetingRPGsinFY2001.Thisnumberis1,309belowestimatedFY2000levels,largelyasaresultoftherecordhighnumberofcontinuationgrants.ToensurethatNIHcanmaintainahealthynumberofnewawards,especiallyforfirsttimeinvestigators,noncompetingRPGswillbelimitedtoincreasesof2percentonaverageforrecurringcostsandcompetingRPGswillreceiveaveragecostincreasesof2percentoverFY2000.Withthis,theaveragecostofanewandcompetingRPGawardwillrisetoabout$321,500,a26percentincreaseoverFY1998.m݌̌ XLXXXLXLXXXL  pV<?,(`~1  `..Ep (#(#           (#(#+jXLXXXL  XLXXXL   +j  BiomedicalInformationScienceand X U TechnologyInitiative+jj ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mQ D   BeginninginFY2000,NIHis "X X supportinganew,transagency,inter-disciplinaryBiomedicalInformationScienceandTechnologyInitiative(BISTI).Medicalresearchersareamassingenormousamountsofinformationtoday!fromtheHumanGenomeproject,clinicaltrials,statistics,populationgenetics,andimagingresearch!therebycreatinglargerepositoriesofinformation,farsurpassingalloftheinformationcollectedpreviously.Criticaltoeffortstoanalyzeandformbridgesbetweenthesedatabasesistheemergingfieldof -+d bioinformaticsthatbringstogethercrossdisciplinaryexpertiseandtechnologiesinbiology,computerscience,andmathematics.TheBISTIinitiativeencompassesseveralmechanismsofresearchsupport:RPGs,forinterdisciplinarygrantsinbioinformatics;researchcenters,forNationalProgramsofExcellenceinBiomedicalComputingSupport;NationalResearchServiceAwards,tobegintraininganewgenerationofresearcherswithcrossdisciplinaryskills;andtheNationalLibraryofMedicine,todevelopinformaticsandmolecularcomputationalbiologyprojects,aswellasprojectsinintramuralresearch,R&Dcontracts,otherresearchgrants,andresearchsupport.NIHplanstodevote$110millioninFY2000and$147millioninFY2001tothisnewinitiative.mQ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mF݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  EliminatingHealthDisparities+je ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  C3/hz p E C` U r C3/hz p E C` U r C3/hz p E C` U r C3/hz p E C` U r m2    AkeycomponentoftheNationseffort ( toeliminatehealthdisparitiesamongpopulationsintheUnitedStatesismedical S S researchandresearchtraining,andNIHplanstoexpanditssupportoftheseactivities.BeginninginFY2000,everyNIHInstitute,Center,andprogrammaticunitwillparticipateindevelopinga S S TransNIHStrategicPlanforResearchonHealthDisparities.ThisplanwillservetoconnectallthecomponentsofNIHinconstructive,multidisciplinarycollaborationsleadingtoabetterunderstandingofthecausesofhealthdisparities;newandimprovedpreventionstrategies,diagnostics,andtreatmentstoreducehealthdisparities;anexpanded -+/ scientificworkforcecommittedtothisgoal;andenhancedcommunicationofresearchresultstoscientists,healthprofessionals,affectedcommunities,andthepublic.Thisstrategicplanwillbedevelopedthroughanopenprocesswithsubstantialpublicinput,particularlyfromrepresentativesofgroupsexperiencingsignificanthealthdisparities.m2݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   NIHwillestablishtheOfficefor  7 ResearchonMinorityHealth(ORMH)astheCoordinatingCenterwithintheOfficeoftheDirectorwhichwillintegratethevariousresearchresourcesoftheInstitutesandcenterstowardsthegoalofsignificantlyreducinghealthdisparities.Additionally,NIHwillseeklegislativeauthorityfortheCoordinatingCentertoawardgrantsforminorityhealthresearchunderexceptionalcircumstances,whenInstitutesorCentersareunabletofundsuchresearchthathasbeenidentifiedasapriority.NIHseeksanincreaseof$20millionforORMHforthepurposesofincreasingitscurrentinnovativegrantresources,facilitatingtheestablishmentofaCoordinatingCenter,andprovidingexceptionalcircumstancesresearchgrants.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mF D   mF݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jz  HIV/AIDSResearch+jz ӌ @K ЌXLXXLXLXXL  m XLXXXLXLXXXL  m D   TheFY2001budgetrequestsatotalof M $2.1billionforAIDS-relatedresearchinNIH.Thisisanincreaseof$105million,or5.2percentovertheFY2000level.Itrepresentsa97percentincreaseinfundingforNIHAIDS-relatedresearchsinceFY1993.m#݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   InvestmentinHIV/AIDSresearchhas $8"T ledtomanyadvancesagainstthisdisease.Ground-breakingNIHresearchinbasicbiologyhasledtoarevolutionindrugdesignanddiagnosticmethodsthatarebenefittingthefightnotonlyagainstAIDS,butalsoagainstmanyotherlife-threateningdiseases.Thisbasicresearchhasbeenthefoundationforthedevelopmentofanewclassofdrugs,knownasproteaseinhibitors,thatareextendingthelengthandqualityof -+^ lifeformanyHIVinfectedindividuals.ButC3/hz}w p E w @ X R C3/hz}w p E w @ X R C3/hz}w p E w @ X R C3/hz}w p E w @ X R manyproblemsremain.Itiscriticaltodevelopsimpler,lesstoxic,andcheaperdrugregimens.NIHisfocusingresearchonbehavioralandbiomedicalinterventionsto   preventtransmission.Forexample,NIH-sponsoredclinicaltrialsdemonstratedthattheadministrationofAZTtoHIV-infectedpregnantwomenandtotheirinfantsdramaticallyreducedtherateofHIVtransmissionfrom   mothertoinfant.NIHinterventionresearchisalsofocusedonpopulationsatrisk,particularlywomenandminorities.Oneofthehighestresearchprioritiesremainsthesearchforasafeandeffectivevaccinetopreventinfection.NIHfundingforAIDSvaccineresearchwillincreaseby12percentinFY2001.ThisincreaseisinconcertwiththePresidentsvaccineinitiativethatalsocallsforastepupinresearchonmalariaandtuberculosis.mj݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheFY2001Presidentsbudget X   includesallofNIHsAIDS-relatedfundsinasingleappropriationaccountfortheOfficeofAIDSResearch(OAR),consistentwiththeprovisionsoftheNIHRevitalizationActof1993.TheDirectorofOARwilltransferfundstotheInstitutesinaccordancewiththescientificprioritiesoftheannualcomprehensiveplanforAIDSresearchdevelopedbyOARalongwiththeInstitutes.TheAdministrationsupportsaconsolidatedAIDSappropriationwithinNIHasavitalpartofensuringacoordinatedandflexibleresponsetotheAIDSepidemic.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌ x- +. Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  ExtramuralResearchFacilities X. Construction+jB  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m  D   ForFY2001,thebudgetproposesto X1 maintaintheFY2000levelof$73millionforextramuralresearchfacilitiesconstructionprojectsadministeredbytheNationalCenterforResearchResources(NCRR)Thesefundsareawardedonacompetitivebasistopublicandnonprofitprivateentitiestoexpand,remodel,renovate,oralterexistingorconstructnewresearchfacilitiesinordertoexpandtheircapacitytoperformorimprovethequalityoftheirbiomedicalandbehavioralresearch.Ingeneral,theseNIHgrantsarelimitedto50percentofthetotalcostofthefacilityprojects.Twentyfivepercentoftheappropriatedfundsforthisprogramareearmarkedbystatuteforinstitutionsofemergingexcellence.InadditiontoNCRR,theNationalCancerInstituteprovidesabout$3millionayearforextramuralresearchlaboratoryrenovations.m  ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   m6݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j    BuildingsandFacilities+jU ӌ PG ЌXLXXLXLXXL  m XLXXXLXLXXXL  m( D   Atotalof$149millionisrequestedfor `I NIHintramuralbuildingsandfacilities(B&F),adecreaseof$16million,or10percent,belowFY2000.Atotalof$73millionisrequestedovertwoyearsforconstructionofanewNationalNeuroscienceResearchCenteronthemainNIHcampus.Forthisfacility,thebudgetincludes$47millioninFY2001andrequestsadvancedappropriationsof$26millionforFY2002.ThistransNIHcenter,ledbytheNationalInstituteofNeurologicalDisordersandStrokeandtheNationalInstituteofMentalHealth,willbringtogether,inasharedfacility,basicandclinicalneuroscientistsfromacrossNIHwhoarecurrentlyfragmentedbylocationand discipline.Theresultingimproved *P(Z    collaborationsinthenewcenterwillspeedtherateatwhichfundamentaldiscoveriesaretranslatedintoeffectivetherapiesforneurologicalandpsychiatricdisorders.m(݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m#    Thebudgetalsorequests$6millionto  fundtheschematicsanddesigndevelopmentofacentralized,multilevelanimalfacility,orvivarium.ThisfacilitywillconsolidateongoingprogramsinthecurrentsprawlingandagingBuilding14through28complex,aswellasmeetmodernanimalresearchneeds.m#݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheremainingB&Ffundswillbeused  @  forchildcarefacilities,generalmaintenance;repairs;renovations;andessentialsafetyandhealthimprovements.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m{    m{݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j    CentralServicesFinancing + ӌ H ЌXLXXXLXLXXXL       m XLXXXLXLXXXL  pV<,(`~0i `..E=v=!pmR    Followinganindepthreviewofthe X fundingprocessforNIHcentralizedresearchsupportservicesandadministrativeactivities,NIHhasdevelopedanewbusinessmodeldedicatedtoimprovingcosts == ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== ==== -+/== andimprovingthequalityofservicesprovidedbyNIHscentralservicesactivities,suchasinformationtechnologysupport,scientificreview,andotherresearchservicessupport.NIHhasdevelopedanew,lesscomplexfundingformulaforallocatingthecostsoftheseservicestoeachInstitutethatwillgointoeffectinFY2001.TheFY2001budgetrequestincludesaonetimebudgetneutraladjustmentbyInstituteforthisnewcentralservicesassessmentmethod.FY1999andFY2000Institutefundingdatahasbeenmadecomparableforthisadjustment.mRA݌̌ XLXXXLXLXXXL   x =   (X@(#  Xu=XXXLe&eXXu=  #,%@\ \     NIHOVERVIEW(byInstitute/Center)#,%% %  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  pV<,(`~1 b!% `(/Ex"x"z#"p@  (dollarsinmillions)  k  (#(#                                        (#(#AZ').*HxdtE.*HxA )'* #   Xu=XXXLe&eXXu=  #F,@     NIHOVERVIEW(byMechanism)#F,, ,  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<",(`~1 N!  `.i.Exxe^#p (#(#                                 (#(#AZ')Q&HxdEQ&HxAD  ;%"% D`'  Xu=XXXLe&eXXu=  `'3@cc    SUBSTANCEABUSEANDMENTALHEALTH`'33 3  X Ќ̌eq eee&XLX eeq   `'  Xu=XXXLe&eXXu=  `'4@     SERVICESADMINISTRATION`'44 5   Ќ̌eq eee&XLX eeq  @  (dollarsinmillions)  |$ AZ')HxdW EHxA (#(#       (#(#vVB2.b~1 %  `.A @Exx}\s$v߰AZ') TxdETxA   +jXLXXXL  XLXXXL   (X@(#(#(+jJ8    Summary+jJ88 ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m9    TheFY2001budgetrequestforthe / SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)is$2.8billion,anincreaseof$171million,or6.4percent,overtheFY2000enactedlevel.TheSAMHSAbudgetfocusesonenhancingmentalhealthandsubstanceabuseservices,aswellasnarrowingthegapsintreatmentfortheseconditions.m9:݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m=<    SAMHSAsmissionistoimprovethe  qualityandavailabilityofprevention,earlyintervention,treatmentandrehabilitationservicesinordertoreduceillness,death,disability,andcosttosocietyresultingfromsubstanceabuseandmentalillness.SAMHSAaccomplishesitsmissionthroughitsCenters"MentalHealthServices(CMHS),SubstanceAbuseTreatment(CSAT),andSubstanceAbusePrevention(CSAP).m=<<݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m"?    m"??݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jV@  MentalHealth+jV@@ ӌ 7&#' ЌXLXXLXLXXL  $ m XLXXXLXLXXXL  mA    TherecentlyreleasedSurgeonGenerals 'G%) ReportonMentalHealthprovidestheNationwithasoberingpictureoftheprevalenceofmentalillness.Accordingtothereport,1in5Americanswillexperienceaseriousmentaldisorderintheirlifetime.Itisestimatedthatapproximately63millionAmericansexperiencedsometypeofmental /.+0 disorder.OftheseAmericans,5.6millionadultsandover1millionchildrenandadolescentsweredisabledbythemostsevereandpersistentmentalillnesses.mA)B݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  J:6j~$  ` @E$    %J:6j~$  ` @E$    %J:6j~$  ` @E$    %J:6j~$  ` @E$    %mD D   AccordingtotheSurgeonGeneral,the 4 annualcostsofmentalillnessinhealthcaredollarsspentandproductivitylostareover (#(#(#(#$150billion.However,thesocialcoststoindividuals,theirfamilies,andmDG݌̌ XLXXXLXLXXXL  communities O= canneverbequantified.Perhapsthemost (#(#(#(#disturbingofthesefactsisthat60percentofpeoplewithlifetimehistoriesofatleastonementalillnessneitherseeknorobtainhelpfortheirillness,andonly25percentofthoseseekinghelpwillreceivecarefromamentalhealthspecialist.m XLXXXLXLXXXL  mJ D   InresponsetotheSurgeonGenerals 'G%H report,theSubstanceAbuseandMentalHealthServicesAdministrationwillplayamajorroleintheDepartmentalMentalHealthinitiative,addressingtheimprovementsneededinthementalhealthservicessystem.TheSAMHSAFY2001budgetbuildsonandadvancesrecent /.+O discoveriesinmentalhealthtreatmentandpreventionbyproviding$731millionforMentalHealthservices,anincreaseof$100million,or16percent,overFY2000.mJfK݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mN    AprincipalcomponentoftheMental  Healthbudgetrequestis$416millionfortheMentalHealthServicesBlockGrant,anincreaseof$60million,or17percent,overFY2000.ThesefundsprovideStateswithneededresourcestosupportcomprehensivecommunitybasedcareforadultswithseriousmentalillnessesandchildrenwithseriousemotionaldisturbances.InFY1999,theStatesusedBlockGrantfundstoprovideservicestoanestimated150,000individuals.mNN݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m8Q    Thisbudgetalsoincludes$30millionfor h anewTargetedMentalHealthCapacityExpansion(TCE)programtohelpestablishneededprevention,earlyidentification,andinterventionservices.ThenewTCEprogramincludestwocomponents:a$10millionPreventionandEarlyInterventionProgramfocusingonindividualsatriskorintheearlystagesofmentalillness,anda$20millionLocalMentalHealthSystemEnhancementProgramtohelpdevelopservicecapacityinnonmentalhealthsettingswherethemajorityofindividualscomeformentalhealthcare.Examplesofthesesettingsincludeprimarycare,fostercare,HeadStart,thecriminaljusticesystem,andsubstanceabusetreatmentcenters.m8QQ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m=U    TheFY2001budgetrequestcontinues H!! fundingof$78millionforKnowledgeDevelopmentandApplication(KDA)projectsincludedbytheCongressinFY2000forYouthViolencePreventionactivities,and$50millionoftheseresourceswillfundapproximately70secondandthirdyeargrantsfortheSafeSchools/HealthyStudentsprogram.TheSafeSchoolsprojects,whicharejointlyadministeredbytheDepartmentsofJustice,Education,andHHS,supportactivitiestoincreaseschoolsafety,mentalhealthpreventionandtreatment,andschoolviolenceprevention x- +. andearlyinterventionservices.TheremainingfundswillsupportSchoolandCommunityActionGrants.m=UU݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m2Y D   Therequestincludes$87millionfor (1 ChildrensMentalHealthServices,anincreaseof$4millionoverFY2000.Thisprogramseekstoexpandtheservicecapacityatthelocallevelforthosecommunitiesthathavedevelopedtheinfrastructuretooffercollaborativeinteragencysupporttochildrenandtheirfamilies.The$4millionincreasewillalloworganizationstoprovideservicestoanadditional1,700children.m2YY݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m \ D   Thebudgetrequestalsoincludes x < $35million,anincreaseof$5million,forthePATHHomelessFormulaGranttoprovidesupportservicestoindividualswhoarehomelessoratriskofhomelessness.InFY1997,themostrecentyearforwhichdataisavailable,360localagenciesand/orcountiesreceivedfunding,providingservicestoatotalof57,731clients.m \\݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m^ D   m^Q_݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j`  SubstanceAbuse+j`p` ӌ F ЌXLXXLXLXXL  m XLXXXLXLXXXL  m.a D   The1998NationalHouseholdSurveyon @H DrugAbuseestimatesthatmorethan6.5millionAmericansaged12andolderusedanillicitdruginthepastyear.Further,19percentofyouthaged1217reporteduseofalcoholinthepreviousmonth.Theseratesareunacceptable.Moreover,theU.S.Censusprojectsasignificantincreaseinthenumberof12to20yearoldsoverthenext15years.m.aa݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mc D   Nationwide,therecontinuestobeagreat #H!R needtoexpandthecapacitytotreatindividualswhouseandareaddictedtoillegaldrugs.TheOfficeofNationalDrugControlPolicyestimatesthatasmanyas5millionAmericansareinneedofsubstanceabusetreatmentservices.However,lessthanhalfactuallyreceiveservices,leavingatreatmentgapofapproximately2.9millionindividuals.mczd݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mf D   Thetreatmentgapaffectsmorethanjust -*\ thoseinneedoftreatment.ONDCP -+] estimatesthecosttosocietyofillegaldrugusetobeapproximately$110billioneachyear.TheFY2001budgetincludesatotalofmorethan$2billionforsubstanceabusetreatmentandpreventionservices.mfKg݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mIi    mIii݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ}j0  XLXXXLXLXXXL     ReducingTheTreatmentGap.Ȋ}jj ӌ ЌXLXXLXLXXL   m XLXXXLXLXXXL  mk    Efficienttreatmentthatiswidely `  availableisasound,costeffectivemethodofreducingthehealthandsocietalcostsofillegaldrugs.SAMHSAprojectsthat$1.04billionwillbeusedfortreatmentservicesinFY2001.Intotal,thesenewtreatmentfundswillallowStatestoprovidetreatmentservicestoapproximately415,000,anincreaseof16,000individualsoverFY2000.mkKl݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mn    Thebudgetrequestincludes h $1.63billionfortheSubstanceAbusePreventionandTreatmentBlockGrant,anincreaseof$31millionoverFY2000.TheBlockGrantisthecornerstoneofStatessubstanceabuseprograms,andprovidessupportforover10,500communitybasedtreatmentandpreventionorganizations.mno݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mq    Therequestalsoprovides$163million @ forTargetedTreatmentCapacityExpansion,anincreaseof$49million,or43percent,abovetheFY2000enactedlevel.Theneweffortaddressesthetreatmentgapbysupportingrapidandstrategicresponsestothedemandfortreatmentservices,primarilyfocusingonemergingdrugproblems.Thegoaloftheprogramistocreateand/orexpandintegrated,creativeandcommunitybasedresponsestotargetedandwelldocumentedsubstanceabuseproblems.mqq݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mGt    mGtt݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ{u0  XLXXXLXLXXXL     SubstanceAbusePrevention.Ȋ{uu ӌp&$' ЌXLXXLXLXXL   m XLXXXLXLXXXL  mv    Thesetrendsindrugusesignala '%) continuedneedtobuilduponpreventionprogramsthatworkandcontinuethedevelopmentofnewprogramsforfutureuse.mvJw݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mx    Thebudgetseeksatotalof$142million ,0*. forKnowledgeDevelopmentand x- +/ Application,TargetedCapacityExpansion,andHighRiskYouthprogramswithintheCenterforSubstanceAbusePrevention(CSAP).Thesefundssupportmaintaining,expanding,anddisseminatingtheknowledgebaseinsubstanceabuseprevention,whileallowingStatestheflexibilitytotargetneededpreventionservicesquickly,accurately,andefficiently.mx+y݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m{ D   ThroughCSAPsleadership,State  p8 IncentiveGrantshavechangedthenationalstandardforsubstanceabuseprevention.ThesethreeyeargrantsassistStatesincoordinatinganddevelopingstatewidepreventionplansandthenumerousfundingstreamsforpreventionactivities.Todate,21StateIncentiveGrants(SIGs)havebeenfunded,withanadditional4tobefundedinFY2000.Overall,thesefundshavehelpedover1,000communitiesimplementprovenpreventionservicemodels.InFY2001,theCSAPwillprovidefundingforanadditional1416SIGs.m{/|݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m( D   Statesarealsocontinuingtoreducethe F percentofretailerswhounlawfullyselltobaccoproductstominors.TheSynarAmendmentImplementationActivitiesprogramworkswithStatestoreducetherateoftobaccosalestominorstoanoveralllevelatorbelow20percentSeptember20,2002.InFY1998,12Statesreportedviolationratesatorbelow20percent,andweexpectallStatestoachievethe20percentgoalbySeptember20,2002.m(݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m* D   m*݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ^0 D XLXXXLXLXXXL   DataCollection/Program (# R Management.Ȋ^y ӌ D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m D   SAMHSAengagesinanextensive %(#U nationaldatacollectionefforttoevaluateboththeprevalenceoftheseconditionsandtheeffectivenessofitsprogramsattreatingorpreventingthem.m5݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   Themostnotabledatacollectioneffort 0*'Z undertakenbySAMHSAistheNationalHouseholdSurveyonDrugAbuse(NHSDA).TheSurveyiscurrentlytheonlysourceofinformationonsubstanceabuse -+^ problemsandtreatmentinthegeneralpublic,anditsdataareusedtostudytrendsintheuseof,andattitudesconcerning,bothlegalandillicitsubstances.Thesurveyisalsoaninvaluableanduniquesourceofinformationforstudyingthecausesofsubstanceabuse,thedemandfortreatment,andtheeffectivenessofserviceprograms.TheNHSDAprovidesacriticalfoundationforevaluatingthesuccessofFederaleffortstotreatandpreventthischronicdisease.InFY2001,SAMHSAprojectsthisservicewillcost$41million.m7݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheFY2001budget,consistentwiththe 0  recommendationsoftheNationalDrugControlStrategy,alsoincludesanewNationalTreatmentOutcomesMonitoringSystem(NTOMS).NTOMSwillmeasureandassesssubstanceabusetreatmentonanationallevel.NTOMSdatawillreflecttheincreaseordecreaseinaccessibilitytotreatment,thedemandforillegalsubstances,waitingtimetoentertreatmentprograms,andthenumberofchronicsubstanceabusers.Further,NTOMSwillprovidevaluableinformationaboutchangesinthesubstanceabusetreatmentgap.ThetotalcostofNTOMSinFY2001isprojectedtobe$5million.mk݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m      Thebudgetincludes$60millionfor 0 ProgramManagement,anincreaseof$1million.ThisincreasewillallowSAMHSAtoaddressimportantissuessuchasYouthViolence,TargetedTreatmentCapacity,andrespondtotherapidlywideningsubstanceabuseandmentalhealthtreatmentgaps.m݌ $!$ Ќ XLXXXLXLXXXL   X$  A (X@(  %#$ `'  Xu=XXXLe&eXXu=  `'@RR#    SAMHSAOVERVIEW AZ')3TxdtE3TxA -Ԉ X      ̌eq eee&XLX eeq  0@  (dollarsinmillions) 0`0Ԉ ` m XLXXXLXLXXXL  m    mz݌̌ XLXXXLXLXXXL  vVB2.b~1 L `.9'@E1xyxye&vD'AZ')&TxdanE&TxA  x  D#  Xu=XXXLe&eXXu=  @#g@    AGENCYFORHEALTHCARERESEARCHANDQUALITY#gߖ   X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV< ,(`~1 of `. Ex=x=e'p (#(#        (#(#AZ') HxdE HxA   +jXLXXXL  XLXXXL   (X@(#(#(+j-  Summary+j- ӌ   ЌXLXXLXLXXL  m XLXXXLXLXXXL  mu    TheFY2001requestfortheAgencyfor z"  HealthcareResearchandQuality(AHRQ)providesaprogramlevelof$250million,anincreaseof$46million,or22.6percent,overFY2000.ThebudgetreflectsamajorcommitmenttotheimprovementofthequalityofpatientcareprovidedbytheAmericanhealthcaresystem.InFY2001thebudgetwillplaceapriorityon:mu݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m'    m'݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : [0  2C3  0  reducingthenumberofmedical  errors;: [ ӌ  ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : m0  2C3  0  usinghealthinformationsystemsto b improvethequalityandeffectivenessofmedicalcare;: m ӌ  ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  improvingemployeehealthservices 2 foronthejobinjuries.: X ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mڥ    mڥY݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    AHRQaccomplishesitsmissionof Z ! supporting,conducting,anddisseminatingresearchontheavailability,quality,andcostsofservicesthroughpartnershipswithacademicinstitutions,medicalsocieties,managedcareorganizations,andhealthcarepayers.Theagencyusesresearchprojectgrantstocollegesanduniversitiestocapitalizeontheexpertiseofacademicinstitutions.Inaddition,AHRQhasforgedcooperativerelationshipswithmajorhealthcareorganizationstoensurethatresearchfundedbytheagencyisimplementedbythemajorplayersinthehealthsystem.Forexample,AHRQ,inconjunctionwiththe z-"+/ AmericanAcademyofPediatricsandmajorinsurers,hascreatedEvidenceBasedPracticeCenters(EPCs)tofocusoncommonorexpensivemedicalproblems.OtherexamplesofAHRQspartnershipsincludetheNationalGuidelineClearinghouseandtheConsumerAssessmentsofHealthPlans,atooltoassist90millionconsumersandemployerswiththeselectionofhealthcareplans.AHRQwillbefullyfundedthroughinteragencytransfers.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   m݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jĭ  HealthCosts,Quality,And B< Outcomes+jĭ. ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m D   ResearchonHealthCosts,Quality,and B? Outcomesisfundedat$206millioninFY2001,anincreaseof+$41million.Thisresearchfocusesheavilyonillnesseswithhighmedicalandsocialcosts.m݌̌ XLXXXLXLXXXL  P m XLXXXLXLXXXL  m9 D   m9݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋm0 D XLXXXLXLXXXL     MedicalErrors.Ȋm ӌ:"ED(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m D   ArecentreportissuedbytheInstituteon #J!G Medicinedocumentedthealarmingnumberofmedicalerrors,whichcausebetween44,000and98,000deathsperyearintheUnitedStates.ThePresidenthasaskedthem/݌̌ XLXXXLXLXXXL  % QualityInteragencyCoordinationTask R(%L Force(QuIC),inwhichAHRQhasaleadrole,toreviewtheIOMreportanddevelopstrategiesforreducingmedicalerrors.InFY2001,AHRQwilldedicate$20milliontoconductresearchdirectedtowardreductionofmedicalerrors. -+R @6    m XLXXXLXLXXXL  mU      AstheleadFederalagencyinhealthcare X quality,AHRQwillcollaboratewiththeprivatesector,nonprofithealthcareorganizations,andotherfederalagenciestodevelopnationalsafetygoalsandbestpracticestoeliminatetheoccurrencesofmedicalerrors.mUԷ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Onefocuswillbetheapplicationof  informationtechnologiesandcomputerizeddecisionsupportsystemstoidentifyandpreventmedicalerrorsinclinicalpractice.AHRQwillexpandresearchintocausesofmedicalerrorsandmethodsoferrorpreventiontocomplementtechnologicalinnovations.m-݌̌             XLXXXLXLXXXL  m XLXXXLXLXXXL  ml    G73jz  ` @E  6 F%hH 3 (G73jz  ` @E  6 F%hH 3 (G73jz  ` @E  6 F%hH 3 (G73jz  ` @E  6 F%hH 3 (Thetechnologicaladvancementsand ` errorpreventionresearchisintendedtoleadtosignificantimprovementsinthequalityandefficiencyofournationshealthcaresystemandsavethelivesofthousandsofAmericans.ml݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mc݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL     &  EmployeeHealth.Ȋ3 ӌH!! ЌXLXXLXLXXL   m XLXXXLXLXXXL  mi    OurNationseffortstoreduceworkplace "X # injurieshavebeenverysuccessfulovertheyears.However,moreworkisneededtoassistthosewhosufferfromworkrelatedinjuriesorillness.InFY2001,AHRQwilldirect$10millioninresearchtoimprove'H!employeehealthservices.AHRQwillfocusonresearchonimprovingthequalityofthe healthcaredeliverysystemsthroughwhich 0*'+    employeesreceivehealthcareservices;thequalityofthehealthcareworkplaceanditsimpactonthequalityandoutcomesofcare;andtheoutcomesandeffectivenessofclinicalservicesemployeesreceive.mi݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mJ D   mJ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ~0 D XLXXXLXLXXXL     HealthInformationTechnology.Ȋ~ ӌ1D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m D   AHRQwilldedicate$10milliontoward ` 3 thedevelopmentofhealthinformationtechnologyapplications.Theuseofinformationsystemsandcomputerizeddecisionsupportsystemshasthepotentialtoimprovethequality,efficiency,andoutcomesprovidedbythehealthcaresystem.mO݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m- D   Forexample,anIndianaUniversity ; researchprojectdemonstratedthatphysicians,remindedbycomputer,weretwiceaslikelytogivefluvaccinetopatientsathighriskduringthewinter,reducinghospitalizationsanderrorsby10to30percent.Thisworkwillmakeevidencebasedinformationmoreaccessibletohealthcaredecisionmakers.ExpansionofinformationtechnologyapplicationswillalsoenhanceAHRQscapacitytocarryouthealthoutcomesresearchandgeneratenewknowledgeaboutthequalityandeffectivenessofournationshealthcaresystem.m-݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   m1݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0 D XLXXXLXLXXXL       Bioterrorism.Ȋ ӌKD(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m2 D   TheFY2000appropriationincluded H!M $5millioninthePublicHealthandSocialServiceEmergencyFundforresearchonhealthservicesissues. AHRQwillevaluate $!P rapidresponsesystemsandthemosteffectiveclinicalinterventionsforpeopleexposedtochemicalandbiologicalagents.AHRQwillalsobringtogetherrepresentativesofclinicians,hospitals,andemergencydepartmentstoinformcurrentandfutureresearchagendas,withaspecificfocusonprimarycarepracticenetworks.Continuationcostsofupto$3millionareanticipatedforprojectsinitiatedinFY2000.m2݌ x- +Z Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j    MedicalExpenditurePanelSurveys+jT ӌ X ЌXLXXLXLXXL  m XLXXXLXLXXXL  m/    MedicalExpendituresPanelSurveys h (MEPS)arefundedat$40.8millioninFY2001,anincreaseof$4.8million.MEPSprovidesdetailed,nationaldataonthehealthcareservicesAmericansuse,howmuchtheycost,andwhopaysforthem.m/݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  md    & ` EnhancementsintheMEPSbudgetwill `  provideAHRQwithincreasedabilitytoexaminequality,cost,access,anduseofclinicalpreventiveservices.Thisinformationwillleadtobetterunderstandingofhealthdisparitiesandwillprovidecriticaldataforclosingthegapsinmedicalcare.ItwillalsohelptotracktheimpactoncarebyFederalandStateprograms,includingtheChildHealthInsuranceProgram(CHIP).'` ` md݌ x Ќ XLXXXLXLXXXL   X   (X@( X #  Xu=XXXLe&eXXu=  ݀#@00$      AHRQOVERVIEW#l   X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<,(`~1 J!9  `.Ex_ x_ e[ )p (#(#            (#(#AZ') TxdETxA C D    D#  Xu=XXXLe&eXXu=  #ᄘ@    HEALTHCAREFINANCINGADMINISTRATION#ᄘ $  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<,(`~1   `.A EMxxe*p (#(#        (#(#AZ')N HxdtEN HxAp +jXLXXXL  XLXXXL   (X@(#(#(+jh  Summary+jh ӌ c  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    TheFY2001budgetrequestforthe #  HealthCareFinancingAdministration(HCFA)is$347.6billiontofinanceMedicareandMedicaid,theStateChildrensHealthInsuranceProgram(SCHIP),theHealthCareFraudandAbuseControlProgram(HCFAC),Stateinsuranceenforcement,andHCFAsoperatingcosts(seefigure1forthedistributionofspending).Thisbudgetreflectsanincreaseof$27.8billionoverFY2000.SpendingfortheMedicare,Medicaid,andSCHIPprogramsrepresent82percentofthetotalHHSbudgetforFY2001.m/݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  vVB 2.b~0 3  `..@E2  S`2N L+vm     ThePresidentsFY2001budget C includesimportantlegislativeproposalsfortheMedicareprogram.Majorinitiativeswilladdavoluntary,affordableprescriptiondrugbenefitforallbeneficiaries;modernizefeeforserviceMedicare;expandaccesstopreventivebenefits;enablethousandsofpeopleaged5565tobuyintoMedicare;continuethefightagainstMedicarewaste,fraud,andabuse;andensurethatMedicarepaymentisfair.m ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Inaddition,newuserfeelegislationin ';%( HCFAsdiscretionarybudgetwillenableHCFAtomeetnewworkload,suchasimplementingtheBalancedBudgetActandtheBalancedBudgetRefinementAct,whilemoreeffectivelyadministeringMedicare, Medicaid,andSCHIP.m݌ 3-*. Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D      Thebudgetalsoincludesmajornew c . proposalstogreatlyincreasethenumberofinsuredindividuals.TheFamilyCareprogramwillgiveStatestheoptiontoexpandhealthcarecoveragetoparentsofchildreneligibleforMedicaidorSCHIP.Stateswillhaveincreasedflexibilitytouseoutreachfundsandtouselessrestrictiveeligibilitydeterminationmethodsforchildrenandtheirparentswhoareeligiblefor,butnotenrolledin,MedicaidandSCHIP.StateswillalsohavetheoptiontoextendMedicaidandSCHIPcoverageforcertaingroups,includingqualifiedaliens,childrenandpregnantwomen.mo݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m D   ToserveMedicaidbeneficiariesbetter, s= thebudgetoffersmorechoicestolongtermcarebeneficiariesandaddressespublichealthconcernsthroughproposalsfocusingontreatingasthma,coveringsmokingcessationdrugsandtreatingbreastandcervicalcancerforuninsuredwomen.MedicaidwillmoreefficientlytargetspendingthroughchangesindrugreimbursementlawsandreduceadministrativepaymentstoStatesbytheamountsofcommonadministrativecoststhatwereincludedintheirTANFgrants.m(݌  (%I Ќ XLXXXLXLXXXL   (X@(`'  Xu=XXXLe&eXXu=  `'U@     HCFAFY2001NetOutlays`'U   X Ќ̌eq eee&XLX eeq  @44 `!XXLTotal=$347.6Billion#XLX! `#  ~VH84f~1 0 `..@Eb  ?,~y A1-lzc2 `E222-yyA1-lzc2 `E222-yyA1-lzc2 `E222-yyA1-lzc2 `E222-yyA1-lz0 2 `E& 22& 2.yyA1-lz0 2 `E& 22& 2.yyA1-lz0 2 `E& 22& 2.yyA1-lz0 2 `E& 22& 2.yyA1-lz7w2 `E- 22- 2/yyA1-lz7w2 `E- 22- 2/yyA1-lz7w2 `E- 22- 2/yyA1-lz7w2 `E- 22- 2/y --(#(# (#(#-- (#(# (#(# X(#X(#(#(# (#(#X(#X(#0  10(#(#Includesbenefitsonly.Z(#(# 0  20(#(#Includesprogrammanagement,HCFAC,PROs,andotheradministrativefunding.J(#(# 0  30(#(#Includesstategrantsanddemonstrationfunding. Do :(#(# !D`'  Xu=XXXLe&eXXu=  _`'@&    MEDICARE`' )  X Ќ̌eq eee&XLX eeq  +jXLXXXL  XLXXXL   (X@(#(#(+j  Summary+jh ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    XLXXXL 6,X,` X,X, X6MedicareistheFederalhealthinsurance X programforpeopleage65orolderandpeopleunderage65whoaredisabledorsufferfromendstagerenaldisease(ESRD).InFY2001,theprogramwillserveapproximately40.1millioneligibleindividuals.Medicareconsistsofthreeparts:m݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL/m XLXXXLXLXXXL  m+     m+  ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : _ 0  2C3  0  PartA"HospitalInsurance(HI) p  paysforinpatienthospitalcare,someskillednursingfacilitycare,homehealthcarerelatedtoahospitalstay,andhospicecare.TheHIprogramisfundedthroughtheHITrustFund.TheTrustFundreceivesmostofitsincomefromtheHIpayrolltax(2.9percentofpayroll,splitbetweenemployersandemployees).: _   ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m     m *݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  PartB"SupplementaryMedical  Insurance(SMI)PartBcoverageisoptional.However,94percentofthoseenrolledinPartAenrollinPartB.PartBpaysformedicallynecessaryphysicianservices,outpatienthospitalservices,treatmentforESRD,laboratoryservices,durablemedicalequipment,homehealthcare,andcertainothermedicalservicesandsupplies.TheSMIprogramisfundedthroughtheSMITrustFund.Enrolleespay25percentofPartBcosts(or$45.50permonthin2000),withremainingcostscoveredbygeneralrevenue.:  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    mh݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  PartC"TheMedicare+Choice *') Program,whichisavailabletomost beneficiaries,offersbeneficiariesthe+)+ optionofreceivingtheirMedicare   benefitsthroughprivateorganizationssuchasmanagedcareplans.Currentlyabout17percentofbeneficiarieshavechosentoenrollinaMedicare+Choiceplan.:  ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  +jXLXXXL  XLXXXL   +jt  MedicareReform+jt ӌ  ( 2 ЌXLXXLXLXXL  m XLXXXLXLXXXL  m D   ThePresidentsFY2001budget  4 proposesacomprehensivereformplantomodernizeandstrengthentheMedicareprogramtomeetthehealth,demographic,andfinancingchallengesitfacesinthe21stcentury.Thishistoricplanwill:1)makeMedicaremorecompetitiveandefficient;2)modernizeMedicaresbenefits,includingtheprovisionofalongoverdueprescriptiondrugbenefitandcostsharingprotectionsforpreventivebenefits;and3)makeanunprecedentedlongtermfinancingcommitmenttotheprogramthatwouldextendsolvencyoftheHospitalInsuranceTrustFundtoatleast2025.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m: D   @  < m:݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0 D XLXXXLXLXXXL   PrescriptionDrugBenefit . ӌDD(#D(# ЌXLXXXLXLXXXL       m XLXXXLXLXXXL  m7 D   ThecenterpieceofthePresidents PF Medicarereformplanisavoluntaryoutpatientprescriptiondrugbenefitthatwouldbeaffordableandavailabletoallbeneficiaries.Thenetcostofthisnewbenefit,includingFederalMedicaidcosts,is$38.1billion($28.8billioninMedicareonly)overfiveyears.ThePresidentsdrugbenefitproposalwould:m7݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m! D   m!b"݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : #0 D 2C3  0pD(#D(#  Havenodeductibleandpayhalfof 'X%P allbeneficiariesprescriptiondrugcostsupto$2,000inFY2003andupto$5,000whenfullyimplementedin2009;: ## ӌ p(#p(#  L )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m% D   m%%&݌ `,*U Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : &0  2C3  0     Ensurebeneficiariesapricediscount X foreachprescriptionpurchasedsimilartothatofferedbymanyemployersponsoredplans,evenafterthe$5,000limitisreached;: &' ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m)    m)*݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : *0  2C3  0  Cost$26permonthbeginningin  2003and$51permonthwhenfullyphasedinby2009;: *p+ ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m -    m --݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : ?.0  2C3  0  Ensurethatbeneficiarieswith  `  incomesbelow135percentofpovertypaynopremiumsorcost-sharingforthedrugbenefit,andofferpremiumassistancetothosewithincomesbetween135and150percentofpoverty;: ?.. ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m0    m0~1݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 320  2C3  0  Providefinancialincentivesfor 8 employerstoretainretireehealthcoverageiftheyofferprescriptiondrugcoveragethatisatleastequivalenttotheMedicaredrugbenefit;and: 322 ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m4    m4Q5݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 60  2C3  0  Beadministeredprimarilybyprivate p sectorpharmaceuticalbenefitmanagers(PBMs).: 66 ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mE8    mE88݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋy90  XLXXXLXLXXXL   FeeForServiceModernization .y99 ӌ0 ЌXLXXXLXLXXXL       m XLXXXLXLXXXL  m3;    ThePresidentsplangivestraditional  feeforserviceMedicarenewprivatesectorpurchasingandqualitymanagementtoolstoimprovecareandconstraincosts,saving$3.2billionoverfiveyears.Thispackageofmodernizationproposalswould:m3;;݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mt=    mt==݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : >0  2C3  0  CreateanewMedicarepreferred %(#& provideroption(PPO)inwhichbeneficiariespaylesscostsharingwhenusingprovidersinthePPOnetworkandareguaranteedthehighestqualitycarethroughnationalqualitystandards;: >M? ӌ   L )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mxA    mxAA݌ ,)- Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : B0 D 2C3  0pD(#D(#     ExpandthesuccessfulCentersof X- ExcellencedemonstrationasapermanentpartoftheMedicareprogram;: BeC ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m(E D   m(EE݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : \F0 D 2C3  0pD(#D(#  Competitivelypayforvoluntary 2 diseasemanagementservices,suchaspatientassessment,telephoneconsultationsandhomenursingvisits,toimprovecareandachievesavingsforpatientswithaparticulardiagnosis;: \FG ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mI D   mII݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : SJ0 D 2C3  0pD(#D(#  Introducecompetitivebiddingand 0 : pricingnegotiationsinsettingpaymentratesforPartBservices(exceptphysicianservices)toachievesavingsforbeneficiariesandtheMedicareprogram,improveproviderperformance,andstrengthenquality;and: SJJ ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m8M D   m8MM݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : lN0 D 2C3  0pD(#D(#  Reformthecontractingprocessto C allowtheSecretarytousecompetitiontoselectMedicareclaimsprocessingcontractors,chooseentitiesotherthaninsurancecompaniesasfiscalagents,anddeterminewhichfunctionsareperformedunderthesecontracts.: lNO ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  .Ȋ  .ȊWQ0 D XLXXXLXLXXXL   CompetitiveDefinedBenefit.ȊWQrQ ӌhLD(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mR D   Thecompetitivedefinedbenefitproposal  xN complementsmodernizationoftheMedicareprogrambyinjectingpricecompetitionintomanagedcarepayments.Thisproposalwouldstartin2003,afterthenewMedicare+Choiceriskadjustmentsystemisalmostfullyimplemented.Itsaves$1.8billionoverfiveyearsfortheMedicareprogram,includingsignificantsavingsforbeneficiaries.Thecompetitivedefinedbenefitproposal:mRS݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mU D   mU V݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : V0 D 2C3  0pD(#D(#  Basesmanagedcarepaymentson ,)Z competitivelybidprices,notaflatratesetbythegovernment;and: VeW ӌ -+\p(#p(# ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : Y0  2C3  0  Allowsbeneficiarieswhochoosea X lowcostmanagedcareplantokeepupto75percentofthesavings,whichtheycankeeporusetopurchaseextrabenefits.: YY ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m[    m[\݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ\0  XLXXXLXLXXXL   ExpandAccesstoPreventive  Benefits.Ȋ\\ ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m.^    ThePresidentsreformplancreates P   incentivesforbeneficiariestotakeadvantageoflifesavingpreventivebenefitsandestablishesimportanthealthpromotioninitiatives.Specifically,theplanwould:m.^^݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mE`    mE``݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : ya0  2C3  0  Eliminatecoinsuranceand   deductiblesforMedicarecoveredpreventivebenefits,suchascolorectalscreening,mammography,prostatecancerscreening,pelvicexams,bonemassmeasurement,anddiabetesselfmanagement,atacostof$1.0billionoverfiveyears;: yab ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mhd    mhdd݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : e0  2C3  0  Initiateathreeyeardemonstrationto ` providesmokingcessationservicestoMedicarebeneficiaries;and: eAf ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mg    mgoh݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : $i0  2C3  0  Launchanewnationwidehealth   promotioneducationcampaigntargetedtoallAmericansovertheageof50.: $ii ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  myk    mykk݌̌ XLXXLXLXXL  .Ȋ  .Ȋl0  XLXXLXLXXL  RationalizeCostSharingand  x! Medigap.ll ӌ!h" ЌXLXXLXLXXL   m XLXXXLXLXXXL  mpn    ݀Tohelpoffsetthecostofbenefit (# $ improvements,thePresidentsplansaves$2.7billionoverfiveyearsbyrationalizingcurrentcostsharingrequirements.ItalsoproposesimprovementstotheMedigapmarketthatexpandopportunitiesandoptionsforindividualstoenrollinMedigapplans.Toaccomplishthesegoals,theplan:mpnn݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mq     mqq݌ *P(, Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : cr0 D 2C3  0pD(#D(#     Reinstatescostsharingforclinical X, laboratoryservices,includinga20percentcoinsurance,topreventoverutilizationandreducefraud;: crs ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mt D   mtnu݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : #v0 D 2C3  0pD(#D(#  Indexestheannual$100deductible, 1 whichhasbeenfixedsince1991,toinflationstartingin2003;: #vv ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mrx D   mrxx݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : y0 D 2C3  0pD(#D(#  ProvideseasieraccesstoMedigapif  p5 abeneficiaryisinanHMOthatleavesMedicare;: yKz ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m{ D   m{f|݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : }0 D 2C3  0pD(#D(#  ExpandstheMedigapenrollment 0 9 periodforindividualswithdisabilitiesandEndStageRenalDisease(ESRD);: }} ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mr D   mr݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0 D 2C3  0pD(#D(#  Encourageseffortstoaddanew, 8> lowercostMedigapoptionwithlowcopaymentsandauthorizestheSecretarytostudythebenefitsofhavingtraditionalMedicareofferaMedigaplikeplan.: K ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mM D   @  < mM̃݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0 D XLXXXLXLXXXL   MedicareBuyin.Ȋ ӌpED(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  6hXpX,X,` X6m΅    AnotherinitiativeintheAdministrations 0G Medicarereformplanprovidestheopportunityforcertainindividualsbetweentheagesof5565tobuyintoMedicare.Theseindividualsareamongthemostdifficulttoinsure,havelessaccesstohealthcare,andaretwiceaslikelyas4554yearoldstohavehealthproblems.Thethreeinitiativesincludedinthisproposalcost$980millionoverfiveyearsandwill:m΅݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mm݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : "0  2C3  0p(#(#  EnableAmericansages6265tobuy %(#R intoMedicare,bypayingafullpremium;: "NJ ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mY    mY،݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0p(#(#  Providevulnerabledisplaced @)&V workersover55accesstoMedicarebyofferingthosewhohaveinvoluntarilylosttheirjobsandtheirhealthinsuranceasimilarbuyinoption;: 2 ӌ -+[p(#p(# ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : .0  2C3  0  ProvideAmericansover55,whose X companiesterminatetheirretireehealthcoverage,anewinsuranceoptionbyextending COBRAcontinuationcoverageuntilage65.: .Ӑ ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mÒ    mÒB݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TohelppeopleaffordtheMedicarebuy  in,theFY2001budgetalsoproposesanewtaxcreditequalto25percentofpremiumcosts.Thiscreditwouldbeavailabletopeopleages62to64anddisplacedworkersages55to65.mv݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m ݌̌ XLXXXLXLXXXL  .Ȋ  .ȊT0  XLXXXLXLXXXL   ConstrainOutyearGrowth.ȊTo ӌ0  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    ToensurethattheMedicarespending   doesnotsignificantlyincreaseaftermostBalancedBudgetAct(BBA)savingsprovisionsexpirein2002,thePresidentsplanincludesoutyearpoliciesfromFY2003toFY2005thatprotectagainstexcessivegrowthrates,butaremoremodestthanthoseincludedinBBA.Theseproposals,whichsave$6.4billionoverfiveyears,would:m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mT    mTӛ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  Reducetheinpatienthospital @ ProspectivePaymentSystem(PPS)paymentupdateeachyearby0.8percentforurbanhospitalsand0.4percentforruralhospitals;: - ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : H0  2C3  0  SetPPSexempthospitalpayment   updatesinrelationtotheirtargetamountsthrough2005,andapplyPPSupdatereductionswhenthesehospitalsareunderPPS;: H ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mѢ    mѢP݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  ContinuePPSandPPSexempt %(#& hospitalcapitalpaymentreductionsof2.1percentand15percent,respectively;:  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m]    m]ܦ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  Reducelaboratorypaymentupdates 0*'+ bytheConsumerPriceIndex(CPI)minus1percent;: 6 ӌ   L )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m۩    m۩Z݌ -*. Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : #0  2C3  0p(#(#  R   educetheambulancepayment X. updatebyCPIminusonepercent;and: #ȫ ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  me    me݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0p(#(#  Reducepaymentupdatesfordurable 2 medicalequipment,parenteral&enteralnutrition,andprosthetics&orthoticsbyCPIminusonepercent.: > ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   StrengtheningMedicares  p7 Financingforthe21stCentury ., ӌ ` 8(#(# ЌXLXXXLXLXXXL        +XLXXXXI[XXL+m XXXXLXXXXXXXXXXXXXXXXXXXXXXXXXLXXXXLXXXL  m9    Despitethesignificantsavingsexpected  : fromthePresidentsproposalstomodernizeMedicareandmakeitmorecompetitive,mostexpertsrecognizethatadditionalfinancingwillbenecessarytomaintainbasicservicesandqualityovertime.BecauseofthestrongbeliefthattheBabyBoomgenerationshouldnotpassaMedicarefinancingcrisistoitschildren,thePresidentproposesthatasignificantportionofthesurplusbededicatedtostrengtheningtheprogram.Specifically,hisplan:m9݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL/m XLXXXLXLXXXL  m     m݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+: L 4(*-/0123Ch3)LXXXXLXLXXX  : 0  2C3  0p(#(#  Dedicatesnearly$400billionofthe PG surplusovertenyearstoextendthelifeofthePartATrustFunduntilatleast2025andhelpfinanceauniversalprescriptiondrugbenefit./XLXXXXI[XXLڸ/: ɹ ӌKp(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    mz݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+ OtherMedicareLegislative M Proposals /XLXXXXI[XXL// N m XLXXXLXLXXXL  m    TheFY2001Presidentsbudgetincludes !hP additionalproposals,beyondMedicarereform,thatwillimprovecoverageforvulnerablepopulations,combatfraud,wasteandabuse,andencourageappropriateandcostefficientpaymentsforservicesMedicareprovides.+XLXXXXgJXXL+mb݌ `'%V  XLXXXLXLXXXLXLXXXL   P(%W .Ȋ  .Ȋ0  XXXXLXLXXXXLXXXL        ImprovingCoveragefor X VulnerablePopulations.Ȋ ӌ  ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  mn    TheFY2001budgetincludestwo X proposalsthatimprovecoveragepolicyforvulnerableMedicarepopulations.Together,theseproposalscost$45millionoverfiveyears.Theseinitiativeswould:mn ݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL/m XLXXXLXLXXXL  m     me݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+: L 4(*-/0123Ch3)LXXXXLXLXXX  : Q0  2C3  0  ExtendMedicarePartAcoverage P   indefinitelyfordisabledindividualswhoreturntowork,removingthefourandonehalfyeartimelimitrecentlyenactedundertheWorkIncentivesImprovementAct;and: Q ӌ  ЌL )#3h4(*-/0123LXLXXXLXLXXXL  /XLXXXXgJXXL&/m XLXXXLXLXXXL  mr    mr݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+: L 4(*-/0123Ch3)LXXXXLXLXXX  : 0  2C3  0  Permanentlyextendcoverageof  immunosuppressivedrugstotransplantpatientsforatotalof48monthsandrevisespoliciesrecentlyenactedundertheBalancedBudgetRefinementActof1999(BBRA).:  ӌ  ЌL )#3h4(*-/0123LXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    m^݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .Ȋ20  XXXXLXLXXXXLXXXL     FightingFraud,Waste,andAbuse.Ȋ2M ӌ` ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m    Inthecontinuingefforttoensurethatthe p MedicareprogrameffectivelymanagesMedicaredollars,thebudgetproposesthefollowinginitiatives,totalingabout$3.1billionoverfiveyears:mc݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL/+XLXXXXgJXXL+/XLXXXXI[XXL9/: L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  Eliminatethephysicianmarkupfor ! outpatientdrugsbylimitingMedicarepaymentto83percentoftheaveragewholesaleprice;: 9 ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    m~݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 30  2C3  0  Reducemisuseofpartial $8"& hospitalizationservicesby:prohibitingprovidersfromfurnishingpartialhospitalizationservicesinabeneficiaryshomeorotherinpatientorresidentialsetting;allowingtheSecretarytoestablishmorestringentstandardsforcommunitymentalhealthcenters;imposingcivilmonetarypenaltieswhenaphysicianfalselycertifiesthe-+0 needfortheseservices;andclarifyingthescopeofandeligibilityforthebenefitinstatute;: 3 ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m     m ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : ?0  2C3  0p(#(#  Requireprivateinsurancecompanies 4 toprovideMedicareSecondaryPayerinformation;and: ? ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0p(#(#  ReduceMedicaresreimbursement  8 rateforEpogen(EPO)by$1tobetterreflectcurrentmarketprices.: \ ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m     m ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ>0  XLXXXLXLXXXL   EnsuringMedicarePaymentisFair.Ȋ>Y ӌ @ <(#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    DespitetheslowdowninMedicare  > growthoverrecentyears,thereisstillevidencetosuggestthatMedicarepaystoomuchforsomeservicesandhasnotreceivedallthebenefitsofcostefficienciesthathaveoccurredinthemarketplace.InanefforttoensureMedicarecontinuestopayappropriatelyandaccuratelyforservicesfurnishedtobeneficiaries,thebudgetincludessavingsproposalstotaling$4.9billionoverfiveyearsto:m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0p(#(#  Reducefrom55to45thepercentage @J Medicarepayshospitalsforbaddebtandreduceotherproviderbaddebtpaymentsby45percent;: ` ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m*    m*݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : ^0  2C3  0p(#(#  Reducelaboratorypaymentsby O 30percentforfourcommonlabtestswheredatashowMedicareoverpayscomparedtotheprivatesector;: ^ ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    mM݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0p(#(#  Establishanationalpaymentlimit #H!T fororthoticsandprosthetics;:  ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m0    m0݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : d0  2C3  0p(#(#  EliminateHealthProfessional p&$W ShortageArea(HPSA)bonuspaymentsfornonprimarycarephysiciansinurbanareas;: d  ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    m@݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0p(#(#  Returntotheoriginalphase-in  +(\ scheduleforMedicare+Choiceriskadjustmentin2002;and:  ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m:    m:݌ -+_ Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  MoveoneMedicare+Choice X paymentfromthestartofFY2003totheendofFY2002.: ( ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    m?݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  ManagedCareOptions+j^ ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m!    Medicareoffersbeneficiariesavarietyof ( coverageoptions.Beneficiariesmaychoosetoremaininthetraditionalfeeforserviceprogramorjoinamanagedcareplan.Infee-forservice,beneficiarieschoosefromalmostanydoctor,hospital,orhealthcareprovider.Inmanagedcare,beneficiariesreceivevirtuallyallcarefromtheplansdoctorsandhealthcareproviders.m!݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheBBAexpandedthetypesofplans   availabletobeneficiariesincludingprovidersponsoredorganizations(PSO)andpreferredproviderorganizations(PPO).me݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Currently,morethan6millionorabout X 17percentofbeneficiariesareenrolledinamanagedcareplan.Enrollmentinmanagedcarehasgrowndramaticallyoverthelastfiveyears.WhilesomemanagedcareorganizationshaverecentlydecidedtodisenrollfromtheMedicareprogram,thenumberofmanagedcareenrolleeshasnotbeengreatlyaffected.mJ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mu    Medicarepaysasetmonthlyamount,or   capitatedamount,tomanagedcareplansforeachbeneficiaryenrolled.Managedcareplanshavebeenattractivetobeneficiariesbecausetheygenerallycovermoreservicesandhavefeweroutofpocketcoststhanfeeforservice.mu݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mJ ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   MedicareSpendingGrowth+j i  ӌ #H!$ ЌXLXXLXLXXL  m XLXXXLXLXXXL  m0     Undercurrentlaw,Medicarebenefit %"& outlaysareprojectedtoincreasefrom$240.1billioninFY2001to$309.0billioninFY2005.Theprogramisexpectedtogrowat6.5percentperyearduringthisperiod.PartAbenefitoutlaysareprojectedtogrowfrom$139.9billioninFY2001to$178.8billioninFY2005,atanaverageannualgrowthrateof6.3percent.PartBbenefitoutlayswillgrowfrom x- +/ $100.3billioninFY2001to$130.2billion&  inFY2005.ThePartBaverageannualgrowthrateduringtheprojectionperiodis6.8percent.'H m0  ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mI݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  HealthCareFraudandAbuse 4 ControlProgram(HCFAC)+jh ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mJ    TitleIIoftheHealthInsurancePortability ` 7 andAccountabilityActof1996(HIPAA)establishestheHCFACProgramtocombathealthcarefraud,waste,andabuse.IncludedwithinthisoverarchingprogramistheMedicareIntegrityProgram(MIP)andtheHCFACAccount.ThroughtheeffortsofHCFAanditspartners,theseprogramsreturnmanymoredollarstotheMedicareTrustFundsforeachdollarspentfightingfraud,waste,andabuse.HIPAAestablishedastableandreliablefundingsourcefortheseeffortsandtheSecretarysOperationRestoreTrust(ORT)initiativehasguidedtheDepartmentsefforts.Followingasuccessfuldemonstrationphase,theORTinitiativehasgonenationwide.MIPandHCFACAccountspendinghavebeenattheheartofthisneweffort.mJ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheMedicareIntegrityProgramconsists 0J offinancialauditsofprovidercostreports,medicalandutilizationreviews,andtheidentificationofMedicarebeneficiarieswhohaveotherinsuranceplanswithprimaryresponsibilityforpayingclaims.Fundsarealsoearmarkedtosupportdetectionandinvestigationofprogramfraudandabuse.HCFAalsofundsprovidereducationandtrainingactivitiesassociatedwithantifraudactivitiesandauditsofmanagedcareplans.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    InFY2001,HIPAAauthorizes %(#U $680millionforMIP,a$50millionincreaseoverFY2000.Withinthislevel,HCFAwillcontinueitspolicyoffundingactivitiesthatwillstopunnecessarypaymentsbeforetheyleavetheTrustFundsthroughprepaymentreviewandprovidereducation.TheseactionshelplowerthepaymenterrorratecitedinrecentChiefFinancialOfficersreports.m1݌ -+^ _A  ь XLXXXLXLXXXL  m XLXXXLXLXXXL  m    HCFAhastakenfulladvantageofitsnew X contractingauthorityunderMIPanddevelopedasetofoverarchingcontractorstoconcentrateonmorespecializedareasoffraud,waste,andabuseintheMedicareprogram.Thesenewcontractorscomplementeffortsbythecurrentfiscalintermediariesandcarrierstopreventoverpayments,detectimproperpayments,coordinatewithHCFAsmanyprogramintegritypartners,andenforceHCFAsprogramintegrityefforts.m5݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    HIPAAalsocreatedtheHCFAC  @  Account.ThisAccountfundsmuchofthehealthcareinvestigationalandprosecutorialactivitiesoftheHHSOfficeofInspectorGeneralandtheDepartmentofJustice.TheHCFACAccountwillincrease$24millioninFY2001overFY2000,to$182million.mL݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m0!    TheAdministrationshealthcarefraud, ( waste,andabusecontroleffortshavepaidoffhandsomelysincethebeginningtheORTdemonstrationproject.Wehavereturnedmorethan$1.6billiontotheTrustFundsandtheMIPprogramhasprevented$5.3billionfromleavingtheTrustFundoverthelasttwelvemonthperiodthroughitsprepaymentefforts.WehavealsocuttheMedicareoverpaymenterrorrateinhalffromFY1996throughFY1998.ThemostrecentMedicareTrusteesreportcitedourhealthcarefraud,waste,andabusecontroleffortsasacontributingfactorintheslowergrowthoftheMedicareprogram.m0!!݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m$    m$g%݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j&  PeerReviewOrganizations+j&& ӌ (# # ЌXLXXLXLXXL  m XLXXXLXLXXXL  mO'    PeerReviewOrganizations(PROs)were $8"% establishedinTitleIXoftheSocialSecurityAct,PartB,toservethefollowingfunctions:mO''݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m)    m))݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : N*0  2C3  0  Improvethequalityofcarefor P(%) beneficiariesbyensuringthatprofessionallyrecognizedstandardsofcarearemet;: N** ӌ   L )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m,    m,6-݌ ,)- Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : -0  2C3  0p(#(#     Protectprogramintegrityby X- ensuringthatMedicareonlypaysforitemsthatarereasonableandmedicallynecessary;and: -. ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mx0    mx00݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 10  2C3  0p(#(#  Protectbeneficiariesby  addressing 2 individualbeneficiaryscomplaints,hospitalissuednoticesofnoncoverageandEMTALA(dumping)violations.: 1Q2 ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m64    m644݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mj5    InFY2001,PeerReviewOrganizations  P 8 contractsincludeperformancestandardswhichwillbeusedtoprovidebenchmarksformajorinitiatives,including:nationalandlocalhealthimprovementinitiatives;aprogramtopreventpaymenterrors;aprojecttoimprovequalityofcareforMedicare+Choicebeneficiaries;andaninitiativetoreducethedisparitybetweencarereceivedbyminoritiesandallotherbeneficiaries.mj55݌̌ XLXXXLXLXXXL     p  '%U (X@(  -+U #  Xu=XXXLe&eXXu=  #8@    FY2001PROPOSEDMEDICARELEGISLATION#8=9 b9  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<,(`~0`$ `*/E$$aIr%0p "(#"(#(#(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# (#(#"(#"(# AZ') HxdE-HxA -S+. #   Xu=XXXLe&eXXu=  #H@@    FY2001PROPOSEDMEDICARELEGISLATION#H@@ @  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  pV<1,(`~0Q^ `.:*EQ^Q^a1p@  (dollarsinmillions)  k  (#(#                                  (#(#AZ') HxdE (HxA  (%(   ,)- #   Xu=XXXLe&eXXu=  #F@* *     MEDICARETRUSTFUNDOVERVIEW#FpG G  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @ (beneficiariesinmillions)  k pV<,(`~1 EH! `.tExxe[2p (#(#     (#(#px (#(#K(#AZ') HxdzE HxA       (dollarsinmillions) /1  2  J ##(###(#(#(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# ##(###(###(###(# (#(###(###(#  pV"<,(`~07u `.3%E7u7uV 3p߰AZ') HxdE,HxA ,)- !D  Y,*. "D`'  Xu=XXXLe&eXXu=  `'O@  &    MEDICAID`'O P EP  X Ќ̌eq eee&XLX eeq  +jXLXXXL  XLXXXL   (X@(#(#(+jP  Summary+jPQ ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m:R    Medicaidisajointlyfunded, X Federal-Stateprogramthatprovidesmedicalassistancetocertaingroupsoflow-incomepeopleandotherswithspecialhealthcareneeds.InFY2001,itwillcoverapproximately33.9millionindividualsincludingchildren,theaged,blind,and/ordisabledandpeoplewhomeeteligibilitycriteriaundertheoldAFDCprogram.Undercurrentlaw,theFederalshareofMedicaidoutlaysisexpectedtobeabout$125billioninFY2001.Thisisan$9billion(7.5percent)increaseoverprojectedFY2000spending.m:RR݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mU    mU V݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jV  LegislativeProposals+jV?W ӌ h ЌXLXXLXLXXL  m XLXXXLXLXXXL  mX    Thereareapproximately11million x uninsuredchildrenunderage18inthecountry,including4millionwhoareeligibleforMedicaid,butremainuninsured.mXX݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mY    ݀ThePresidentshealthcareproposals 8 willgiveStatestheopportunitytogreatlyincreasethenumberofinsuredthroughseveralmajorinitiatives.TheFamilyCareProgram,$10billioninMedicaidfundingand$3.6billioninSCHIPfundingoverfiveyears,willgiveStatestheoptiontoexpandhealthcarecoveragetoparentsofchildreneligibleforMedicaidortheStateChildrensHealthInsuranceProgram(SCHIP).Thiswillallowparentstoenrollinthesamehealthcareprogramastheirchildrenandgreatlyincreasethelikelihoodthatchildrenwillbeenrolledinhealthinsurance.mYhZ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m]    ݚThebudgetcontainsinitiativesto 'X%' accelerateenrollmentofuninsuredchildreneligibleforMedicaidandSCHIPbygivingStatestheoptiontosharefederallyfundedfreeandreducedpriceschoollunchprogrameligibilityinformationwiththeStateMedicaidagency,andexpandingthesitesthatmaydeterminepresumptiveeligibility. @.+. StateswillalsoberequiredtoapplythesameapplicabilityandeligibilitysimplificationstotheMedicaidprogramasStatesapplytotheSCHIPprogram.m] ^݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m`    Stateswillalsohavetheoptiontoexpand  X2 coveragebyextendingbenefitstoimmigrantswholostcoverageduetowelfarereform,expandingeligibilityforchildrenthroughage20,andextendingtransitionalMedicaid.StateswillhavetheoptiontoextendMedicaidtoindividualswithincomesupto300percentofSSI,givingindividualsachoiceofhomeandcommunitybasedcaresettingsandpreventingindividualsfrombeingforcedintoanursinghome.HHSwillalsoworkwithHUDtofurtherenhanceandexpandhomeandcommunitybasedservices.m`Oa݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m=d    InFY2001,thebudgetwillinclude x@ $77millioninMedicaidspendingtoassistinaddressingpublichealthconcernsthroughproposalsfocusingontreatingasthma,coveringsmokingcessationdrugs,andbreastandcervicalcancertreatmentforuninsuredwomen.Takentogether,theseproposalsareexpectedtoincreaseFederalspendingbyabout$16billionoverfiveyears.Anadditional$9billioninspendingcomesfrominteractionwithMedicareproposals.m=dd݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mNg    TheFY2001budgetalsocontains "L MedicaidproposalsthatwillsavetheFederalGovernmentabout$3billionoverthenextfiveyears.ThesavingsreflectreductionsinMedicaidadministrativecostsfromrecoupmentofsharedadministrativeexpensesthatwereincludedintheTANFblockgrant,changesintheMedicaidrebatelawforgenericdrugsandprovidingtheAverageManufacturersPriceofprescriptiondrugstotheStates.SavingscanalsobeattributedtonewSecretarialenforcement toolsandinteractionswiththeMedicare P-*X program.   Newchildsupportenforcementmeasureswillalsocontribute$170millionoverfiveyearsinsavingstotheprogram.mNgg݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ_k0  XLXXXLXLXXXL     FamilyCareinitiative.Ȋ_kzk ӌ8 ЌXLXXLXLXXL   m XLXXXLXLXXXL  ml    ThisproposalwillallowStatestoreceive  enhancedFederalmatchingfundstoexpandhealthcarecoveragetoparentsofchildreneligibleforMedicaidorSCHIP.Parentswouldbecoveredinthesameprogramastheirchildrentomakehealthcareaseasyandaccessibleaspossible.AdditionalfundingforthisinitiativewouldbeprovidedthroughincreasedallotmentstotheSCHIPprogram.(PleaseseetheSCHIPsectionfordetails.)ml(m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mo    ݀mo#p݌ H Ќ XLXXXLXLXXXL  .Ȋ  .Ȋp0  XLXXXLXLXXXL   RestoreMedicaidtoLegal 8 ImmigrantPregnantwomen.Ȋpq ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mUr    Stateswillhavetheoptiontoextend 8 MedicaidtoqualifiedlegalimmigrantpregnantwomenregardlessoftheirdateofentrytotheUnitedStates,includingthosewhoenteredthecountryafterAugust22,1996.CoveragewouldbethesameasthatprovidedtootherMedicaidbeneficiaries.Thisproposalensuresthattheirchildren,whowillbeUnitedStatescitizens,willgetthebestpossiblestartinlife.mUrr݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m6u    m6uu݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋjv0  XLXXXLXLXXXL   StateOptiontoCoverLegal  x" ImmigrantChildrenunderMedicaidand/orSCHIP.Ȋjvv ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mw    ݀Stateswillbegiventheoptiontoextend $!& MedicaidandSCHIPcoveragetoqualifiedlegalimmigrantchildrenregardlessoftheirdateofentrytotheUnitedStates,includingthosewhoenteredthecountryafterAugust22,1996.  ThesechildrenlosteligibilityforMedicaidcoverageduetochangesinFederallawunderWelfareReform.Thisproposalwouldhelpachievethegoalofprovidingaccesstocomprehensivehealthcareforallvulnerable x- +0 children.ParentsofchildrenwhohavebenefitsrestoredwouldalsobeeligiblethroughtheAdministrationsproposedFamilyCarePrograminitiative.mwix݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m{    m{(|݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ|0  XLXXXLXLXXXL     MedicaidforImmigrantswith 5 RestoredSSI.Ȋ|| ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mG~    ThebudgetproposestorestoreSSIfor ` 8 qualifiedaliens,regardlessofage,whoenteredthecountryonorafterAugust22,1996,whobecamedisabledaftertheyentered,andwhohavebeenresidingintheUnitedStatedforatleastfiveyears.Undercurrentlaw,theseindividualsarebarredfromSSIunderrestrictionsimposedbytheWelfareReformlawenactedin1996.InmostStates,restorationofSSIwouldmeanrestorationofMedicaidbecausetheirMedicaideligibilityisbasedonreceiptofSSI.ThisproposalwillallowlegalimmigrantswhorecentlyenteredthecountryandbecamedisabledafterentrytoreceivethesamebenefitsaslegalimmigrantswhoenteredthecountrybeforeAugust22,1996.mG~~݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mS    mS҂݌̌ XLXXXLXLXXXL  .Ȋ  ݀.Ȋ0  XLXXXLXLXXXL   MedicaidAgeExpansion.Ȋ ӌ@J(#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mȄ    Legislationisbeingproposedgiving PL StatestheoptiontoprovideMedicaidandSCHIPcoveragetochildrenages19and20uptothesamepovertyrelatedincomelevelsastheyuseforyoungerchildren.Undercurrentlaw,StateschoosingtoexpandMedicaidcoveragetoolderchildrenonlydosounderlimitedcircumstances.Ingeneral,theycanonlymakeolderchildreneligibleforMedicaidatlowerAFDCrelatedlevels.TheMedicaidexpansionwouldbematchedatregularMedicaidrates.(SeetheSCHIPsectionfordetailsontherelatedSCHIPproposal.)mȄG݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m<    ݀m<݌ (p&Z Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   ExtendandSimplifyTransitional )`'[ Medicaid.Ȋ ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    Theseproposalsmakepermanentthe ,)^ requirementtoprovideMedicaidforupto12monthstofamiliesintransitionfrom -+` welfaretowork.CurrentlawauthorizesthisrequirementonlythroughFY2001.TheproposalwouldalsosimplifyproceduresbyeliminatingexcessiveMedicaidreportingrequirementsduringthetransitionperiod,thusmakingitmorelikelythatthesefamilieswillremainenrolledintheprogram.Finally,theproposalwouldreplacetherequirementtoprovideMedicaidtofamiliesintransitionfromwelfaretoworkinaStatewhichhaselectedtocoverallfamilieswithincomesbelow185percentofpoverty,agroupthatwouldsubsumevirtuallyallfamiliesintransitionfromwelfaretowork.mf݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     ݀m ݌ x  Ќ XLXXXLXLXXXL  .Ȋ  .ȊW0  XLXXXLXLXXXL     PermitHigherIncomeEligibility h StandardsforPeopleNeedinganInstitutionalLevelofCare.ȊWr ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    ThebudgetgivesStatestheoptionto X extendMedicaidtoindividualswithincomesupto300percentoftheSSIlimit($1,532permonthin2000)whoreceiveMedicaidlongtermcareservicesinthecommunity,iftheStatehasdeterminedthemtoneedaninstitutionallevelofcare.Stateswouldbepermittedtotargetthiseligibilityoptiontoindividualsreceivingspecifickindsoflongtermcareservices,suchaspersonalcareservices.Undercurrentlaw,anindividualmayonlyqualifyforMedicaidunderthehigherincomeleveliftheyenteranursinghome,oriftheyareservedunderaStatesHomeandCommunityBasedwaiverprogramforlongtermcare.Typically,lowerincomeeligibilitylevelsfornonwaiver,noninstitutionalsettingspreventmanyindividualsfromqualifying.Thisproposalallowsforequitybetweensettings,andensuresthatindividualshavearealchoiceandarenot,ineffect,forcedintoenteringanursinghome.ms݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌ @)&* Ќ XLXXXLXLXXXL     .Ȋ  .Ȋ]0  XLXXXLXLXXXL   Provide$100millionincompetitive X* HUDgrantfunds.Ȋ]x ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mǙ    Thisproposal(whichhasnocoststothe X- Medicaidprogram)willprovidefundstoqualifiedlow-incomeelderlyhousingprojects(section202HUDprojects)toconvertthemtoassistedlivingfacilities,aslongasthosefacilitiesprovideMedicaidhomeandcommunity-basedservicesandaccessibleservicesfornon-Medicaidresidents.mǙF݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m\    Thisproposalprovidesaunique  6 opportunityforcooperationbetweenHHSandHUD,andwouldallowresidentsto ageinplacebyfundingtheconversionoftheirhomesintoassistedlivingfacilities.Toensurethatthelow-incomeelderlyhaveaccesstotheoption,onlysitesthatagreetobringMedicaidhomeandcommunity-basedservicesintotheconvertedassistedlivingfacilitieswouldqualifyforthegrants.m\ۜ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mH    mHǟ݌̌ XLXXXLXLXXXL  5@p5.Ȋ  .Ȋ0  XLXXXLXLXXXL   ShareSchoollunchinformation pA option.Ȋ̠ ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m     ݀Thisinitiativewillprovidenewoptions pD tofindandenrolluninsuredchildrenthroughschools.AtStateoption,StateMedicaidagencieswouldbeallowedtoaccesseligibilityinformationforchildrenfromthefederallyfundedfreeandreducedpriceschoollunchprogramunlesstheirparentsoptnottoreleasetheinformation.Theproposalssolepurposeisoutreachandenrollmentofeligiblechildren.m ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Stateswouldalsobeallowedtousethis (# N informationtopresumptivelyenrollpotentiallyeligiblechildreninMedicaidandSCHIPwhiletheirapplicationsareformallyprocessed.mo݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    ݀mr݌ '%S Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ=0  XLXXXLXLXXXL      Expandpresumptiveeligibility.Ȋ=X ӌX ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    TheproposalwillallowStatestoexpand h thetypesofsitesthatperformpresumptiveeligibilitydeterminationstoincludeschildcarereferralcenters,childcarecenters,homelessshelters,agenciesthatdetermineeligibilityforIVDmedicalChildSupport,TANFandSCHIP,andotherentitiesapprovedbytheSecretary.ThisbuildsontheBalancedBudgetActStateoptionthatallowedMedicaidprovidersandthosedeterminingeligibilityforWIC,HeadStart,andChildCareandDevelopmentBlockGrantservicestodeterminepresumptiveeligibilityforchildren.ThisoptioncanhelpStatesprovidecriticalhealthcareservicestochildrenpendingofficialenrollment,andincreasesthelikelihoodthatfamiliescompletetheapplicationprocess.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mϭ    mϭN݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   Alignschipandmedicaidto 8 eliminateenrollmentbarriers.Ȋ ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mr    Tosimplifytheenrollmentprocess,  StateswouldberequiredtousethesameeasyapplicationandincomeverificationprocessforchildreneligibleforMedicaid(inpovertyrelatedeligibilitygroups)astheyuseintheirSCHIPprogram.(SeeSCHIPsectionforrelatedproposals.)mr݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mҲ    ݀mҲQ݌ x  Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   AsthmaDiseaseManagement h  Initiative.Ȋ7 ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mv    ݀Thisproposalwouldprovide$50million !h# foreachofFY2001andFY2002,onacompetitivebasis,toselectedStateMedicaidprogramstotestandevaluatetheeffectivenessofinnovativediseasemanagementapproachestoidentifyandtreatpediatricasthma.TheseeffortsareintendedtoprovideanincentiveformoreeffectiveuseofongoingMedicaidfundsforoutreach,casemanagement,andtreatmentbenefitstoreducecostlyasthmarelatedmedicalcrises(suchasemergencyroomvisitsandhospitalstays)andtoimprovethequalityoflifeforchildrenwithasthmaandtheirfamilies.mv݌ -+0 Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL     Coverageofsmokingcessation X0 drugs.Ȋ: ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    ThebudgetrequiresStatestocover X3 prescriptionandcertainnonprescriptionsmokingcessationdrugsforMedicaidbeneficiaries.CostsforthesedrugswillbematchedattheregularMedicaidmatchingrate.Stateswillhavetheauthoritytodecidewhichnonprescriptiondrugstheywillcover.m݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL     Breastandcervicalcancer 0 ; treatment.Ȋ  ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mW    Thisproposalwouldcreateanew 0 > MedicaideligibilityoptionforStatestocoveruninsuredwomenwhohavebeendiagnosedwithbreastcancerorcervicalcancerthroughtheCDCsearlydetectionprogram.WomencoveredunderthisoptionwouldreceiveafullMedicaidbenefitspackagefortheentiretimetheyrequirecancertreatment.Stateswouldalsohavetheoptiontoallowqualifiedentitiestodeterminesuchwomentobepresumptivelyeligibleforuptotwomonthssothatcancertreatmentcanbeginwithoutdelaywhiletheregularapplicationprocesstakesplace.mW־݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m\݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  Medicaidsavingsproposals+j{ ӌ @M ЌXLXXLXLXXL  .Ȋ  .ȊD0  XLXXXLXLXXXL     reducestatesadministrative O payments.ȊD_ ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    ThisproposaladdressesprojectedFederal X R costincreasesintheMedicaidprogramarisingfromchangesinthewayStateschargeadministrativecoststotheFederalFoodStamp,Medicaid,andTemporaryAssistanceforNeedyFamilies(TANF)programs.SimilartotheAgriculturalResearchlawpassedin1998,thislegislationwoulddirecttheSecretarytoreduceeachStatesMedicaidgrantawardbytheamount ofadministrativecostschargedtoAFDCin )`'\    eachStatesTANFbaseyearthatcouldhavelegitimatelybeenchargedtoMedicaid.ThisproposaldoesnotpreventStatesfromusingfundsfromtheirTANFblockgrantstocovertheadjustment.m-݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    ݀m0݌  Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL     RebatesfromGenericDrug  Manufacturers.Ȋ ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mc    Currently,brandnamedrug P   manufacturersmustpayadollarfordollarrebatetotheMedicaidprogramiftheyincreasethepriceoftheirdrugsinexcessofincreasesintheconsumerpriceindexurban(CPIU).Genericdrugmanufacturerswerenotsubjecttothisrequirementinthedrugrebateprogrambecauseitwasbelievedthatgenericdrugpriceswouldnotrisefasterthaninflation.RecentpriceincreasesingenericdrugshavedemonstratedtheneedfortheCPIUadjustmentforgenericaswellasbrandnamedrugs.mc݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m3݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   makemanufacturerpricespublic p formedicaidcovereddrugs.Ȋ ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mX    ThisproposalwouldallowtheSecretary p tomaketheaveragemanufacturerprice(AMP)forMedicaidcovereddrugsavailabletotheStatessothatStatescanusethisdatatoaccuratelysetMedicaiddrugreimbursementrates.mX݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m~    m~݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   NewSecretarialenforcementtools.Ȋ ӌX ! ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    TheBudgetproposestocreateanew !h# intermediateenforcementtoolthatwouldauthorizetheSecretarytoreduceaStatesFederalmatchingratebyupto0.5percentwhentheStatefailstocomplywithFederalrequirements.ReductionswouldremainineffectuntiltheStatecorrectstheviolationandcomplieswithFederalrules.ThistoolwouldgivetheSecretaryadditionalflexibilitytorespondtoStateviolations.Secretarialenforcementtoolsundercurrentlawdemandboththattheviolationbesubstantialandthefinancialpenaltybeextreme,suchaswithholdingallofFederal -+0 FinancialParticipation(FFP).Thisproposaltoolwouldallowlessextremeenforcementmeasures. m|݌ 82 Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m$    m$݌̌ XLXXXLXLXXXL  .Ȋ  .ȊX0  XLXXXLXLXXXL     & 8 ChildSupportEnforcement.ȊXs ӌ4(#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    SeeACFEntitlementsectionfor (6 description.m1݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m&    '8m&݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jm  Background+jm ӌ P 9 ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    Medicaidisavoluntaryprogram,initiated  ` ; andadministeredbytheStates.StateexpendituresformedicalassistancearematchedbytheFederalgovernmentusingaformulabasedonpercapitaincomeineachStaterelativetothenationalaverage.FederalmatchingratesforFY2001areprojectedtorangefrom50to76percentformedicalassistancepayments. Historically, 8C theFederalmatchingrateonaverageisapproximately57percent.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Historically,eligibilityforMedicaidhas F beenbasedonqualifyingunderthecashassistanceprogramsofAidtoFamilieswithDependentChildren(AFDC)orSupplementalSecurityIncome(SSI).WithpassageoftheTemporaryAssistanceforNeedyFamilies(TANF)programin1996,whichreplacedAFDC,eligibilityforMedicaidandcashassistancewerede-linked.However,MedicaideligibilityremainstiedtoAFDCprogramrulesinplaceasofJuly16,1996.Allthosewhoqualifyunderthe1996AFDCrulesandmostSSIrecipients,commonlyreferredtoasthe"categoricallyeligible,"arecoveredunderStateMedicaidprograms.StateshavetheoptiontocoversomeindividualsnoteligibleunderAFDCorSSIrules(e.g.,peoplewithhigherincomesininstitutions,lowincomepregnantwomenandchildren,andaged,blind,anddisabledpeoplebelowthepovertyline),andmaycoverpeopleathigherincomesthroughtheuseofincomedisregards.Statesmayalsocover"medicallyneedy"individuals.Suchindividualsmeetthecategoricaleligibility x- +_ criteria,buthavetoomuchincomeortoomanyresourcestomeetthefinancialcriteria.m+݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  my    Medicaidcoverspregnantwomenand 8 infantswhosefamilyincomedoesnotexceed185percentoftheFederalpovertylevel.Medicaidcoverageofchildrenages6through18,bornafterSeptember30,1983,whosefamilyincomedoesnotexceed100percentoftheFederalpovertylevel,isbeingphasedin.By2002,allchildrenundertheageof19livingbelowthepovertylevelwillbeeligibleforMedicaid.my݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mW      Inaddition,MedicaidpaysMedicare  @  premiumsandcostsharingforcertainlowincomeseniorsanddisabledindividuals.mW݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m#    UndertheBalancedBudgetAct,twonew h MedicaideligibilitygroupsconsistingoflowincomeMedicarebeneficiarieswerecreated,QualifiedIndividuals(QIs)1and2.QI1sareMedicarebeneficiarieswithincomesfrom120to135percentofthepovertylevel.ThisgroupiseligibleforafullsubsidyoftheirPartBpremiums.QI2sareMedicarebeneficiarieswithincomesfromatleast135to175percentofthepovertylevel.ThisgroupiseligibleforapartialsubsidyoftheirPartBpremiums.m#݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m]    Generally,Statesarerequiredtoprovidea P coreof13mandatoryservicestoeligiblecategoricallyneedyrecipients.ThosemandatoryMedicaidservicesinclude:inpatientandoutpatienthospitalcare,healthscreening,diagnosis,andtreatmenttochildren,familyplanning,physicianservices,andnursingfacilityservicestoindividualsover21.Statesmayalsoelecttocoveranyofover30specifiedoptionalservices,whichincludeprescriptiondrugs,clinicservices,dental,eyeglasses,andservicesprovidedinintermediatecarefacilitiesforthosewithmentalretardation.m]݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    FederalMedicaidoutlaysrose (p&) dramaticallyfromFY1989throughFY1992,ata25percentaverageannualrate.dHowever,outlaygrowthslowedtolessthan12percentinFY1993andcontinuedtodeclineto3.9percentin1997.dTheslowin x- +. therateofMedicaidincreasesisduetomanyfactors,includinglegislativechanges(suchaslimitsonproviderspecifictaxesanddonations),decreasesintheprojectedgrowthofSSIcaseloads,higheremployment,andStateeffortstocontrolcosts.dIn1999,therewasaslightincreaseinthegrowthrate.Medicaidoutlaysgrew6.7percentover1998.dTherecentgrowthin  theMedicaidprogramcanlargelybeattributedtohigherreportedadministrativecosts.Administrativecostsgrew19percentfromFY1999overFY1998,comparedto6.6percentgrowthinbenefitpayments.mo݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m'݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  WaiverActivity+jF ӌ h= ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    Stateshaveconsiderableflexibilityin x? structuringtheMedicaidprogram,includingdeterminingproviderpaymentratesandcertificationstandards,anddevelopingalternativehealthcaredeliveryprograms.Inaddition,waiversofvariousportionsofFederallawarealsoavailabletoStates.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mp    NumerousStateshaverestructured `F eligibilityandcoverageunderMedicaidthroughtheuseofdemonstrationwaiversgrantedunderSection1115oftheSocialSecurityAct.AnumberofStatesareusingSection1115demonstrationwaiverstoreformhealthcarebyexpandingcoveragewithoutincreasingtheamounttheFederalgovernmentwouldspendotherwise.dmp݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m"    Since1993,thisAdministrationhas  xO approved20Section1115demonstrationsinArkansas,Delaware,Florida,Hawaii,Illinois,Kentucky,Maryland,Massachusetts,Minnesota,Missouri,NewJersey,NewMexico,NewYork,Ohio,Oklahoma,Oregon,RhodeIsland,Tennessee,VermontandWisconsin,andiscommittedtoworkingcooperativelywithadditionalStatestosupportinnovativeideas.m"݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    dmp݌ 0*'Y Ќ XLXXXLXLXXXL  +jXLXXXL   XLXXXL   +j@  ChangesinMedicaidduetothe X BalancedBudgetRefinementActof1999(BBRA)+j@ ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m    TheBBRAof1999requiredHCFAto H makeafewchangesintheMedicaidprogram.Amongthechangestotheprogramwere:m.݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  ml     ml  ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ 0  XLXXXLXLXXXL     CostBasedReimbursementof P   FederallyQualifiedHealthCenters(FQHCs).Ȋ   ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m'     TheBalancedBudgetAct(BBA)phased  @  outtheMedicaidrequirementtopayFQHCsandruralhealthclinicsbasedoncost.The2000phaseout!wherepaymentsarebasedonthe95percentofcosts!wouldbeextendedfor2001and2002underBBRA.InFY2003,paymentswillbebasedon90percentandinFY2004on85percentofcosts.TheGAOwillconductastudyoftheimpactofthecostreimbursementphaseout,andwillevaluatedifferentpaymentapproaches.m'  ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m?    m?݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋs0  XLXXXLXLXXXL   Extensionof$500millionfund.Ȋs ӌp ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    Thewelfarereformlawputasidea 0 $500millionfundforStatestooffsetthecostsofsimplifyingtheireligibilitysystemsandconductingoutreach.Fornearly30States,thefundingsunsetsthisyear.TheBBRAeliminatedthesunsetandextendedtheavailabilityofthisfunduntilitisexpended.m;݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m2    m2݌̌ XLXXXLXLXXXL    .Ȋ  .Ȋq0  XLXXXLXLXXXL   Changestodisproportionateshare #H!% hospitals(dsh)payments.Ȋq ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    ݀TheBBRAadjustedtheDSHallotments %#( forWashington,D.C.,Minnesota,NewMexicoandWyomingtocorrectanerrorinthebaseyearusedtocalculatetheallotmentsunderBBA.ma݌ XLXXXLXLXXXL   *P(- +jXLXXXL   XLXXXL   +j  ChangesinMedicaidduetothe X- TickettoWorkandWorkIncentivesImprovementAct(TWWIIA)+jm ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mv    TheTickettoWorkandWorkIncentives H1 ImprovementActof1999expandsStateoptionsunderMedicaidforworkerswithdisabilities.StateshavetwooptionalMedicaidbuyincategoriesthatwould:(1)allowindividualswhowouldbeeligible,exceptforincreasedincome,forSupplementalSecurityIncome(SSI)andthereforeforMedicaid,tobuyintohealthcarecoverage;and/or(2)permitStatestocontinuecoverageforworkingindividualswithdisabilitieswhosemedicalconditionsremainseverebutwhowouldotherwiseloseeligibilityduetomedicalimprovement.mv݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m      TWWIIAalsoallowsStatestoparticipate h? intwoStategrantsanddemonstrationprograms.Thesearedescribedinthenextsection.mu݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL    m p   mX ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j !  ChangesinMedicaidduetothe pD FostercareIndependenceAct+j !w! ӌ̌XLXXLXLXXL    TheFosterCareIndependenceActof pG 1999providedStateswiththeoptionofcontinuingMedicaidcoverageforadolescentsages18to21leavingfoster care. 0K (X(#   Xu=XXXLe&eXXu=  #d#@ "    MEDICAIDOVERVIEW#d## #  X AZ') HxdE HxAeq eee&XLX eeqԌ   Ќ  @ (averageenrolleesinthousands)  t pV!<,(`~1 M `.` E)xcxce4p (#(#      (#(#%px AZ') HxdEKHxA L    `'  Xu=XXXLe&eXXu=  `'?'@]]"    MEDICAIDOUTLAYS`'?'' '  ^  Ќ̌eq eee&XLX eeq  vNpV'<8,(`~1 t `.ExtxtYN 5p@  (outlaysinmillions)  v  (#(#                   (#(#*px AZ')`%HxdjE`%HxA  n&$, #  Xu=XXXLe&eXXu=  #,@QQ    MEDICAIDPROPOSALS:COSTSANDSAVINGS#,k, ,  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  pV.<3,(`~0  `.8,Exx[T6p (#(#                                (#(#AZ')`%HxdjE`%HxA  K$!$ `'  Xu=XXXLe&eXXu=  `'2@    STATEGRANTSANDDEMONSTRATIONS`'2y2 2  X Ќ̌eq eee&XLX eeq  +jXLXXXL  XLXXXL   (X@(#(#(+jb3  TheTickettoWorkandWork  IncentivesImprovementAct(TWWIIA)+jb33 ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m4    TheTickettoWorkandWorkIncentives 8  ImprovementActof1999(TWIIA)expandedStateoptionsunderMedicaidforworkerswithdisabilities.Thesearedescribedabove.m4a5݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m6    InadditiontothetwooptionalMedicaid   categoriescreatedbyTWWIIA,theActalsocreatednewmandatoryhealthgrantstofundbothademonstrationprogramandagrantprogram.m6P7݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m8    Thedemonstrationprogram @ ($250millionover20012006)wouldallowStatestoreceiveFederalfinancialparticipationtodevelopaprogramtoprovideMedicaidequivalentcoveragetoworkerswithhealthconditionswhich,withoutmedicaltreatment,willcausethemtobecomedisabledandqualifyforSSI/SSDI.Thedemonstrationwilldeterminewhetherprovidinghealthcoveragepreventeddeteriorationintheirhealthcondition.m8J9݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m;    TheMedicaidInfrastructureGrant  Program(Section203ofthelegislation) p makes$150millionavailableoverfiveyears(beginninginFY2001)toStatestodesign,establishandoperateStateinfrastructuresthatprovideitemsandservicestopeoplewithdisabilitieswhowork.Fundsmayalso&   beusedtoconductoutreachcampaignstoeducatebeneficiariesabouttheavailabilityofsuchinfrastructures.TheminimumawardtoStatesis$500,000perfiscalyear.m;=<݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m>    m>}?݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j2@  LegislativeProposals+j2@@ ӌ P ' ЌXLXXLXLXXL  .Ȋ  .Ȋ`A0  XLXXXLXLXXXL   HomelessInitiative.Ȋ`A{A ӌ`)(#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mB    Thisproposalprovides$10millionin  + mandatoryfundinginFY2001forcompetitivegrantstoStatestoimprovecoordinationamonghealthandotherprogramsaddressingtheneedsofthehomelesswiththepurposeofincreasing' =homelessenrollmentintheseprograms.GrantswouldbeawardedtofivetosevenStateswithinnovativeplanstoprovideoutreachtohomelesspopulationsandcoordinateactivitiesacrossMedicaid,SCHIP,MentalHealthandSubstanceAbuseBlockGrants,TANF,andFoodStamps.mBC݌ `7 Ќ XLXXXLXLXXXL  5@(#(#X@35 +'    P7 #  Xu=XXXLe&eXXu=  #wF@    STATEGRANTSANDDEMONSTRATIONS #wFF G  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  @  (outlaysinmillions)  k pV1<4,(`~1 8}  `.Exx[[7p (#(#                    (#(#4px AZ') HxdzEHxA  "D =  R $D`'  Xu=XXXLe&eXXu=  `'3L@    STATECHILDRENSHEALTHINSURANCEPROGRAM`'3LL L  X Ќ̌eq eee&XLX eeq  (X@(#(#(+jXLXXXL  XLXXXL   +jM  Summary+jM#N ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  mN    ThebipartisanBalancedBudgetActof X 1997createdtheStateChildrensHealthInsuranceProgram(SCHIP)underTitleXXIoftheSocialSecurityAct.Thisprogrammakesanunprecedentedinvestmentinimprovingthequalityoflifeformillionsofuninsuredchildren.mNXO݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m.Q    In1998,therewereanestimated   11millionchildren"oneinseven"whowereuninsured.ThemajorityofthesechildrenliveinfamiliesthatearntoomuchtoqualifyforMedicaid,butnotenoughtopurchaseprivateinsurance.TheSCHIPprogramtargetsthesechildrenandhelpsthemobtainhealthinsurance.m.QQ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mS    mS1T݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jT  ImplementationStatus+jTPU ӌ X ЌXLXXLXLXXL  m XLXXXLXLXXXL  mV    ThenumberofStatesenrollingchildren h underapprovedplanshasgrownsinceFY1998.AsofSeptember1999,SCHIPplanswereapprovedforall50States,theDistrictofColumbia,andfiveTerritories.Stateshavereceivedapprovalfor24Medicaidexpansionprograms,15separateprograms,and17combinationprograms.AsofJanuary2000,37Stateplanamendmentsreceivedapproval,andanother18amendmentsareunderreview.WiththeexceptionofHawaii,Washington,andWyoming,asoftheendofFiscalYear1999,53programswereinoperationservingnearlytwomillionchildren.mVV݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mY    ThescopeofcoverageunderSCHIPis %x#% increasing.ManyStatesinitiallyadoptedmodestexpansionsofcoverageunderSCHIP,butsincethenproposedfurtherexpansionsofcoverage.BytheendofFiscalYear1999,30StatesSCHIPplanscoverchildreninfamilieswithincomesup to200percentoftheFederalpovertylevel.mY&Z݌ `,*, Ќ XLXXXLXLXXXL     Ofthe30,fiveStatescoverchildrenin , familieswithincomesupto300percentofpoverty;oneStatecoversupto350percentofpoverty.m XLXXXLXLXXXL  m ]    m ]]݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j>^  ChangestoSCHIPduetoThe  2 BalancedBudgetRefinementActof1999(BBRA)+j>^^ ӌ̌XLXXLXLXXL  .Ȋ  .Ȋ_0  XLXXXLXLXXXL   StabilizedtheSCHIPallotments.Ȋ__ ӌ` 6(#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m`    BBRAincludedanewallotmentformula p 8 tostabilizeStatesannualSCHIPallotmentsinfourways:1)itbasestheallotmentsmoreonthenumberoflowincomechildren(below200percentoftheFPL)ratherthanthenumberofuninsuredchildrenbecausethedataforlowincomechildrenaremorestable;2)itsetsfloorssothatallotmentscannotdecreasebymorethan10percentfromStatespreviousyearsallotmentsordecreasebymorethan30percentoftheFY1999allotments;3)itsetsceilingsonallotmentssonoStatesallotmentcanincreasebymorethan45percentoveraStatesFY1999allotment,and4)itusesdatafromthethreemostrecentcalendaryearsinsteadofthethreemostrecentfiscalyears.ThenewformulaiseffectiveforFiscalYear2000allotmentsandbeyond.Priortothischange,Stateallotmentscouldfluctuatesignificantlyfromyeartoyear.m`ia݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  me    me0f݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋf0  XLXXXLXLXXXL   Additionalbudgetauthorityfor h$"N CommonwealthsandTerritories.Ȋfg ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mXh    FortheperiodfromFY2000through &h$Q FY2007,CommonwealthsandTerritoriesreceiveatotalof$249millionfortheirSCHIPprograms.Priortothischange,CommonwealthsandTerritoriesreceivedonly0.25percent(about$11millionperyearfor5Territories)ofeachyearstotalannualSCHIPallotment.mXhh݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mj    mjQk݌ @.+Y Ќ XLXXXLXLXXXL  & 8 .Ȋ  .Ȋ'l0  XLXXXLXLXXXL   Improveddatacollectionand X evaluationoftheSCHIPprogram.Ȋ'lBl ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mm    AlsoeffectiveuponenactmentofBBRA X onNovember29,1999arethefollowing:'8Xlmmn݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mAo    mAoo݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : up0  2C3  0  Provides$10milliontothe ( DepartmentofCommerce(beginninginFY2000)toincreasethesamplesizeoftheCurrentPopulationSurvey(CPS)toprovidereliablestatelevelestimatesofthenumberofuninsuredchildrenbyincome,ageandrace.: upq ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mTs    mTss݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : t0  2C3  0  Provides$10million(inFY2000,   availablethroughFY2002)totheSecretaryforaFederalevaluationoftheSCHIPprogramusingasampleof10States.ThisreportisduetoCongressonDecember31,2001.: t-u ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mBw    mBww݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : vx0  2C3  0  DirectstheInspectorGeneralto ( audit,andtheGAOtoreporttoCongress,everythreeyearsonStatecompliancewiththerequirementthatSCHIPapplicantsthatarefoundtobeeligibleforMedicaidareenrolledinMedicaidandprogressmadeinreducingthenumberofuninsured.: vxy ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mx{    mx{{݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : |0  2C3  0  Requiresthatalldatarelatingto  childreninSCHIPandMedicaidbecoordinatedwiththedatarequirementsintheMaternalandChildHealthBlockgrant.: |Q} ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m3    m3݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : g0  2C3  0  DirectstheSecretary,throughthe $8"% AssistantSecretaryforPlanningandEvaluation(ASPE)toestablishadataclearinghouseonFederalhealthprogramsandchildren'shealth.: g  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL     +j5  OutreachActivity+j5 ӌ 0*'+ ЌXLXXLXLXXL  m XLXXXLXLXXXL  mj    Outreachcontinuestobeapriorityto +@)- ensurethatasmanyeligiblechildrenaspossibleareenrolledinSCHIP.The x- +/ Administrationiscommittedtoprovidingleadershiptosustainandenhanceongoingoutreachefforts.mj݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    InaFebruary1998Executive (2 Memorandum,PresidentClintondirected11FederaldepartmentsandagenciestoformanInteragencyTaskforceonchildrenshealthoutreachtodevelopwaystoeducatefamiliesandenrollchildreninbothMedicaidandSCHIP.InOctober1999,theTaskforcereleaseditsannualInteragencyReportonchildren'shealthinsuranceoutreach.m ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mV    InFebruary1999,theAdministration,  @ ; alongwiththeNationalGovernorsAssociation,launchedanationwidechildrenshealthoutreachinitiativecalledthe InsureKidsNowcampaign,whichincludesradiospotstopromotethenationaltoll-freetelephonenumber,posters,outreachkits,andaFallback-to-schoolcampaign.mVՊ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    InOctober1999,attheannualmeetingof C theAmericanAcademyofPediatrics,thePresidentannouncedthatover$9millioninprivate/publicresearchfundswillbededicatedtoidentifyingeffectivechildren'shealthinsurancestrategies.HealsochargedCabinetSecretariestodevelopstrategiestoinstitutionalizeschool-basedoutreach,andtodistributeanewguidanceforStatesandschoolsonfundingoptionsforschoolbasedoutreach.ml݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mn݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j#  SCHIPProposedRule+j# ӌ X O ЌXLXXLXLXXL  m XLXXXLXLXXXL  mO    TheSCHIPNoticeofProposed !hQ Rulemaking(NPRM),publishedintheFederalRegisteronNovember8,1999,codifiestheSCHIPguidancedocumentstotheStates.Indevelopingtheproposedrule,HCFAconsultedwiththeStates,Congressionalstaff,theNationalGovernorsAssociation,andnumerousadvocacygroups.mOΒ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mє    TheSCHIPNPRMcontainsstrong 0*'Z patientprotectionssuchasaccesstohealthcarespecialistsandaccesstoemergencyserviceswhenandwheretheneedarises.TheNPRMalsoaddressesissuessuchas -+^ ensuringthatchildrenareenrolledintheprogramforwhichtheyareeligible,ensuringthatcost-sharingbenominal,andrequiringameaningfulbenefitpackageinStatescreatingaseparateSCHIPprogram.ThecommentperiodontheproposedruleclosedonJanuary7,2000.TheDepartmentiscarefullyreviewingcommentsandplanstoissuethefinalrulethisyear.mєP݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mb    mb݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   &  +j料  LegislativeProposals+j料  ӌ  `  ЌXLXXLXLXXL  .Ȋ  .ȊК0  XLXXXLXLXXXL   FamilyCareProgram.ȊК ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m     ' TheFamilyCareProgramproposalbuilds 0  onStatessuccessinimplementingtheirSCHIPprogramsbyexpandingthecoverageforparentsofchildreneligibleforMedicaidandSCHIP.Researchindicatesthatchildrenaremorelikelytobeenrolledinhealthinsuranceiftheirparentsarealsoenrolled.m ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    UnderFamilyCare,Stateswouldreceive  anenhancedmatchforcoveringparentsinthesameprogram(eitherMedicaidorSCHIP)astheirchildren.Tobeeligiblefortheenhancedmatchingrateforthecostsofcoveringparents,Stateswouldhavetocoverchildren,uptoage19,upto200percentoftheFederalpovertylevelwithoutwaitinglists,andinitiateorexpandcoverageforlowincomeparentsaboveeligibilitylevelsinplaceasofJanuary1,2000.Statesmustcoverlowerincomeparentsbeforetheycoverparentswithhigherincomes.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    In2006,Statesarerequiredtocover 8"# parentsupto100%FPLatanenhancedmatchingrateeveniftheyhavenotexpandedcoverageforchildrenupto200percentoftheFPL.Also,StateswouldgetanenhancedmatchforallchildreninfamilieswithincomesabovethemandatoryMedicaidlevelsaswellasforparentsabove100percentoftheFPL.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    FamilyCarewouldalsopermitStatesto *P(, poolallotmentswithemployercontributionstowardthepurchaseofprivatecoverage.FamiliesthatareeligibleforFamilyCare x- +/ willbeabletoaccesstheiremployershealthplanaslongasthathealthplanmeetsFamilyCarestandards,andtheemployercontributesatleasthalfthepremiumcost.m"݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mQ    Topayforthecostofcoveringparents, 3 theSCHIPallotmentswouldbeincreasedbeginninginFY2002.Anadditional$50billioninallotmentswouldbemadeavailableoverthenexttenyears.(SeeMedicaidsectiononrelatedproposal.)mQЧ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  .Ȋ  & H .Ȋ0  XLXXXLXLXXXL   RestoreSCHIPtolegalimmigrant  P : childrenandpregnantwomen.Ȋ ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m8    ThePresidentsBudgetwouldgive'H ժStates  = theoptiontoinsurelegalimmigrantchildrenandpregnantwomeninMedicaidandSCHIPregardlessoftheirdateofentry.Itwouldeliminatethecurrentfive-yearban,deeming,andaffidavitofsupportprovisions.TheproposalwouldalsorequireStatestoprovideMedicaidcoveragetodisabledimmigrantswhowouldbemadeeligibleforSSIbytheFY2001budgetsSSIrestorationproposal.ParentsofchildrenwhohavebenefitsrestoredwouldbecoveredbytheproposedFamilyCareProgram.(SeeMedicaidsectiononrelatedproposal.)m8݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mۯ    mۯZ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   AligningMedicaidandSCHIP M eligibilityrules.Ȋ* ӌ (#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  mr    Stateswouldberequiredtomaketheir X P MedicaidandSCHIPeligibilityrulesbeequallysimple.WeencourageStatestousethisopportunitytosimplifyandstreamlineeligibilityacrossbothMedicaidandSCHIPprograms.TheproposalrequiresthatbothMedicaidandSCHIPeligibilityrulesconforminthreeareas:(1)theuseofthesameassetstest;(2)simplifyingeligibilityrequirements,suchasusingamailinapplication;and(3)conductingeligibilityredeterminationsnomorefrequentlythanonceayear.(SeeMedicaidsectiononrelatedproposal.)mr݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    mk݌ x- +^ Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ50  XLXXXLXLXXXL   Expandpresumptiveeligibility X option.Ȋ5P ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    Thisproposalwouldexpandthetypeof X qualifiedentitiesthatcandeterminechildrentobepresumptivelyeligibleforMedicaidandSCHIP.Theadditionalpresumptiveeligibilitysitescouldincludeschools,childcarecenters,homelessshelters,agenciesthatdetermineeligibilityforMedicaid,TANF,andSCHIP.(SeeMedicaidsectionfordetailsonrelatedproposal.)m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mJ    mJɻ݌̌ XLXXXLXLXXXL  & 8 .Ȋ  .Ȋ0  XLXXXLXLXXXL   MedicaidandSCHIPageexpansion.Ȋ ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mԽ    ThisproposalwouldgiveStatesthe x  optiontoprovideMedicaidtochildrenaged19and20uptothesamepoverty-related'8~incomelevelsastheyuseforyoungerchildren.StatesthatchoosethisMedicaidoptionwouldalsobepermittedtoincludechildrenaged19and20intheirSCHIPprograms.(SeeMedicaidsectiononrelatedproposal.)mԽS݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ0  XLXXXLXLXXXL   Shareschoollunchinformation  option.Ȋ ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    ThisproposalwouldallowState 0 MedicaidandSCHIPagenciestoaccesseligibilityinformationforchildrenfromthefederallyfundedfreeandreducedpriceschoollunchprogramunlesstheirparentsoptnottoreleasetheinformation.ConfidentialitysafeguardswillensurethattheinformationobtainedwillnotbeusedforanypurposeotherthanoutreachandenrollmentinMedicaidandSCHIP.(SeeMedicaidsectiononrelatedproposal.)m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jC  Background+jC ӌ p&$( ЌXLXXLXLXXL  m XLXXXLXLXXXL  mf    TheStateChildrensHealthInsurance '%* Program(SCHIP)isapartnershipbetweentheFederalandStategovernmentsthatwillhelpprovidechildrenwiththehealthcoveragetheyneedtogrowuphealthy.TheBalancedBudgetActof1997createdSCHIPunderTitleXXIoftheSocial x- +0 SecurityAct.SCHIPwasdesignedtoreachchildrenwhosefamilieshaveincomestoohightoqualifyforMedicaidbuttoolowtoaffordprivatehealthinsurance.mf݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m{    TitleXXIappropriatedalmost$40billion 4 totheprogramovertenyears,beginninginFY1998throughFY2007.StateswithanapprovedSCHIPplanareeligibletoreceiveanenhancedFederalmatchingratedrawnfromacappedallotment.StatesreceiveFederalreimbursementforexpendituresunderTitleXXIbasedontheenhancedMedicaidmatchingratewhichrangesfrom65to85percent.m{݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mF    Stateshaveahighdegreeofflexibilityin x > designingtheirprograms.TheycanimplementSCHIPby:1)expandingMedicaid,2)creatinganew,nonMedicaidTitleXXIseparateStateprogram,or3)acombinationofbothapproaches.mF݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mu    Generally,uninsuredchildrenages0to D 18yearsoldinfamiliesatorbelow200percentoftheFederalpovertylevelwhoarenoteligibleforMedicaidareeligibleforSCHIP.mu݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  ml    ml݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m݌ `J Ќ XLXXXLXLXXXL  5@(#(#X@M5`'  Xu=XXXLe&eXXu=  NF `'@    STATECHILDRENSHEALTHINSURANCEPROGRAM`'   X Ќ̌eq eee&XLX eeq  l#  Xu=XXXLe&eXXu=  #ᄾ@&    d ld OVERVIEW#ᄾ% J   AZ') HxdEHxAeq eee&XLX eeqԌ x Ќ  @  (dollarsinmillions)   7 (#(#                 (#(#pV<<,(`~0   `..EGx6 x6 a 8ppV9<,(`~1 O! `.EFxxen9p߰ (#(#           (#(#AZ') $HxdxE $HxA$D^9  %#& 5D`'  Xu=XXXLe&eXXu=  `'@ !    PROGRAMMANAGEMENT`'B g  X Ќ̌eq eee&XLX eeq  +jXLXXXL  XLXXXL   (X@(#(#(+j  Summary+j ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  @Pmf    HCFA'sFY2001Programmanagement X appropriationrequestis$2,086million,a$93millionincreaseovertheFY2000appropriation.ThisappropriationleveldoesnotincludefundingfortheNationalMedicareEducationProgram(NMEP)orothercurrentuserfees.mf݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheBudgetalsoincludesproposeduser   feestotaling$220million.Ifenacted,theappropriationwouldbereducedbytheamountoftheseuserfees.Tofacilitatethisprocess,theAdministrationhasincluded triggerlanguageintheBudget.Ifafeeisenacted,theappropriationwouldbereducedautomaticallybytheamountofthenewfeesexpected.Ifalltheuserfeesareenacted,HCFAsbudgetauthorityrequestwouldbe$1,866million.mA݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheProgramManagementaccount 8 providesresourcesforadministeringtheMedicare,Medicaid,andStateChildrensHealthInsuranceProgram,aswellasenforcingStateinsurancerequirements.TheProgramManagementaccountprovidesthestaffandresourcesnecessarytoadministertheseprograms,totaling$343billion.HCFAimplementsstatutorychangesandcoordinatestheworkofcontractors,Stateagencies,andtheproviderandbeneficiarycommunitiestoensurethesmoothoperationoftheseprograms.HCFAalsosafeguardstheintegrityoftheMedicareTrustFundsandtheGeneralFund.mP݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  ml    WhileHCFAscorefunctions!e.g., H&#% modernizingMedicare,processingclaims,etc.!arevitalandcontinuetoexpand,HCFAsProgramManagementbudgethasnotkeptpacewithworkloadssinceFY1994.Inconstantdollars,HCFAsFY2000appropriationremainsbelowFY1994spendinglevels.ThishasrequiredHCFAtofindmorecosteffectivemethods -p+- toaccomplishitsmissionandgoalsasestablishedinitsstrategicplan.Thishasbeenespeciallydifficultsincetheresponsibilitiesoftheagencyweregreatlyexpandedinthatsametimeperiod.BecauseofthepassageoftheHealthInsurancePortabilityandAccountabilityActof1996(HIPAA),theBalancedBudgetActof1997(BBA),andtheBalancedBudgetRefinementActof1999(BBRA),HCFAnowhastheresponsibilitytoimplementanumberofnewprograms.TheseprogramsincludetheStateChildrensHealthInsuranceProgram,newmanagedcareoptions,enforcementofStateinsurancerequirementsunderHIPAAaswellasanumberofdemonstrations,studies,andsystemschanges.IntheFY2000appropriation,CongressprovidedHCFAitstotalrequestedlevelofProgramManagementfundingasamended.Theseadditionalresourceshavefacilitatedimprovedprogrammanagement.ml݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m&݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  Nursinghomequalityinitiative+jE ӌ pE ЌXLXXLXLXXL  m XLXXXLXLXXXL  m    TheDepartment'sFY2001budget G includesatotalof$70.8millionindiscretionaryandmandatoryresourcestoimplementthePresident'sNursingHomeInitiativeannouncedinJuly1998,includingmoneyforHCFA,theOfficeoftheGeneralCounsel,andDepartmentalAppealsBoard.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mo    SincelaunchingtheInitiativeoverayear h$"N ago,HCFAhasmadesignificantprogressinimplementingstrongerenforcementpolicies.Forinstance:Statesmustimposeimmediatesanctionsonnursinghomesfoundtohavecausedactualharmtoaresidentontwoconsecutivesurveys;surveyorsarerequiredtoinvestigateallcomplaintsallegingactualharmtoaresidentwithintendays;Statesstaggerthestarttimesoftheirannualsurveys,withatleast10percentbegunon -p+X weekendsoroffhours;Statesmorefrequentlyinspectnursinghomeswithrepeatedseriousviolations;andnewinspectionprotocolsallowsurveyorstobetterdetectandpreventbedsores,malnutrition,andresidentabuse.TheFY2001requestwillallowHCFAandothercomponentsoftheDepartmenttoexpandimplementationofthisimportantPresidentialInitiative.mo݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    Themajorityofthe$70.8millionforthe  `  initiative--$57.3million--residesinHCFA'sbudgetrequest.Thisincludes$37.8millionindiscretionaryprogrammanagementfundsto:strengthenStatesurveyorinspectionandenforcementefforts;expediteinvestigationsofresidentcomplaints;improveFederaloversightofStatesurveyorefforts;andconductdemonstrationsonmethodstomoveresidentsfromnursinghomestocommunitybasedservices.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    ݀HCFA'sbudgetalsoincludes$19.5  millioninmandatoryresources.About$15.9millioninMedicaidmatchingfundswillsupplementStateinspectionandenforcementactivitiesinduallycertifiedandMedicaidonlynursinghomes.Theother$3.6millionisPeerReviewOrganizationfundingthatwillbeusedtomaintainandupgradetheNursingHomeComparewebsiteandcontinuenationaleducationcampaignstopreventabuse,neglect,andmalnutritioninnursinghomes.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m0    Theremaining$13.5millionwillensure 8"" adequatelegalresourcesfortheOfficeoftheGeneralCounselandDepartmentalAppealsBoardtoprovidejudicialhearingsandadministrativeandcourtlitigationinatimelymanner,andreducethebacklogofappealsresultingfromstrongerenforcementactionsbeingtakenundertheInitiative.m0݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    AspartoftheInitiative,the )`'* AdministrationalsoplanstosubmitlegislationtoCongressrequiringnursinghomestoquerythenursinghomecriminalabuseregistryandconductcriminal x- +. backgroundchecksonnewemployeestodeterminewhethernursinghomeworkershaveahistoryofabusingresidents.Thecostsfortheseactivitieswillbefinancedthroughuserfees.ThePresidentsbudgetprojectsthatHHSwillcollect$4.3millioninfeestoquerytheabuseregistry,andthattheDepartmentofJusticeandStateswillcollect$41.1millioninfeestoconductcriminalbackgroundchecks.mE݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mu    mu݌̌ XLXXXLXLXXXL  vVAB2.b~1 E `c(.@E ]] :v (#(#            (#(# XLXXXLXLXXXL  m    m ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   HCFAsMedicareContractor x R OversightInitiative+j (  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m     HCFA,incooperationwiththe  xU DepartmentandtheDepartmentsOfficeoftheInspectorGeneral(OIG),hasbegunimprovingoversightofitsMedicarecontractorsresponsibleforclaimsprocessing,beneficiaryandproviderservices,andprogramintegrity.ThisinitiativefollowsuponrecentOIGandGeneralAccountingOrganizationreportsoncontractorpracticesandthelackofsufficientoversight.m  ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     ThisInitiativewillbecomprehensive,  +(` encompassingprogramoperations,financialmanagement,monitoringofelectronicdataprocessing,andestablishinganintegrated -+c generalledgerforallcontractortransactions.m d݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    TheFY2001requestincludesfundingfor H externalreviewsofkeyprogramareas,thedevelopmentofanewmanagementinformationsystem,newevaluationprotocols,andadditionalstafftoperformfinancialmanagementoversightfunctions.Inaddition,XLXXXLthisrequestaddsstaffto  contractorsthatwillestablishtheinternalcontrolenvironment,identifycontrolobjectives,determinetherelevantrisksinachievingthoseobjectives,andreportreliableinformationtoHCFA.#XLXXXL#m݌  @  Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m    m!݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j  ImplementingtheBalancedBudget x  Actof1997(BBA)andtheHealthInsurancePortabilityandAccountabilityActof1996(HIPAA)+j@ ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mm    XLXXXLHCFAhasfullyimplemented70percent X ofthe335individualBBAprovisionsaffectingHCFAprogramsandmadesubstantialprogressonmanyoftheremainingprovisions.WithY2Kcompliancenolongeraconcern,HCFAwillresumeworkontheremainingBBAprovisionsaswellasthenewprovisionsoftheBalancedBudgetRefinementActof1999(BBRA).mm݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL/m XLXXXLXLXXXL  m}    InFY2001,HCFAwillcontinuetowork  onthedevelopmentandimplementationofnewpaymentmethods,includingprospectivepaymentforhomehealthagencies,inpatientrehabilitationfacilities,andoutpatienthospitalcare,andriskadjustmentforMedicare+Choiceplans.HCFAwillalsolaunchthenewcompetitivebiddingdemonstrationfordurablemedicalequipment.ThePresident'sbudgetalsoincludesarequesttoincreasetheauthorizationoftheMedicare+Choiceinformationcampaignto$150million.HCFA'splanstoeducatebeneficiariesabouttheirchoicesthroughthenationaldistributionofthe2000MedicareandYou  +(, handbook,thewww.medicare.govwebsite, ,)- StateHealthInsuranceAssistanceProgram(SHIP)activities,andLocalhealth -+/ informationfairstoassistbeneficiariesduringtheopenenrollmentseason.m}݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+m XXXXLXLXXXXLXXXL  mo    HCFAwillalsoimplementanumberof 81 HIPAAactivitiesinFY2001.HCFAwillcontinueitsworkindevelopingindustrywidestandardsforcertainadministrativeandfinancialhealthcaretransactionsoutlinedinHIPAAsadministrativesimplificationprovisions.HCFAisalsochargedwithoverseeingand,incaseswhereStatesdonotimplementinsuranceprotections,enforcinginsurancereformprovisions.TheFY2001requestprovidesfundingfortheseactivities.mo ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j!  Informationtechnology+j!T" ӌ  > ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m8#    HCFAhasdevelopedanewarchitecture X@ foritsinformationtechnologyneedsandacapitalassetsplantoguideitssystemsformation.m8##݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mC%    Meanwhile,HCFAmustmaintainits D informationtechnologycapabilitiesinFY2001tosupportBBAandHIPAAactivities.Theagencymustimprovesystemsecurity,continuetoredesignitsmanagedcaresystemtosupportthenewMedicare+Choiceprogram,andcollectencounterdatafrommanagedcareplansasrequiredbytheBBA.mC%%݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m (    m ((݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j)  MedicareContractors+j)* ӌ x N ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m*    TheMedicareContractorprogramlevel P budgetwillincrease$57million,from$1,244millioninFY2000to$1,301.3millioninFY2001./XLXXXXgJXXLD/+XLXXXXgJXXL+ԀBylaw,the "X S Medicareprogramisadministeredthroughprivateorganizations.Responsibilitiesofthesecontractorsinclude:processingclaimsandmakingbenefitpayments,performingcertainfunctionstoensuretheappropriatenessofMedicarepaymentsandtoprotecttheMedicareTrustFunds,developingmanagementimprovementscalledproductivityinvestments,andrespondingtotheneedsofitsmanycustomersandstakeholders,Medicarebeneficiaries,andtheprovidercommunity.m*+݌ -+_ @PX    ь XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m/    TheFY2001contractorbudgetalso X proposes$136millioninuserfeesallowingtheSecretaryto:assessa$1feeonanyclaimnotsubmittedelectronically,assessa ( feeforduplicateorunprocessableclaimssubmittedbyproviders,andcharge  providersandsuppliersafeetocoverthecostsofinitiallyenrollingandrenewingenrollment&  ԀintheMedicareprogram.' 1m/!0݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m2    Approximately62percentoftheFY2001  p  contractorprogramlevelrequest,or$812million,hasbeendesignatedforclaimsprocessing,an0.4percentincreaseoverFY2000.From1995throughFY1998,HCFA'ssuccessincontrollingprocessingcostshasresultedinreducedunitcostsofprocessingclaims.HCFAexpectsunitcostratestoincreaseslightlyinFY2001asthefactorsthatwereresponsibleforpastyearefficiencies,suchasuseofelectronicclaimsandconsolidatingclaimsprocessingsystems,reachoptimallevels.HCFAexpectsthatitsclaimsprocessingworkloadwillincrease3.5percentinFY2001,from887.7millionclaimsinFY2000to918.4claimsinFY2001.TheslowerthanusualgrowthinMedicarefeeforserviceclaims/XLXXXXgJXXL{,/Ԁis ` attributabletobeneficiariestakingadvantageofMedicare+ChoiceoptionsofferedunderBBA.HCFAanticipatesthatincreasedmanagedcareenrollmentwillcontinuetoslowthegrowthinclaimsandbillings.m2e3݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+m XXXXLXLXXXXLXXXL  m]8    Beneficiaryandproviderservices X   comprise23percentoftheMedicareContractorsFY2001programlevelrequest,or$300million,thesamelevelastheFY2000appropriation.ThefeeforserviceportionoftheNationalMedicareEducationProgramisfundedfromthisallotment.TheFY2001amountincludesnofundingfortheonetimeLongTermCarenationaleducationcampaignfundedinFY2000.However,thisamountwillmaintainfundingfortheMedicarebeneficiarytollfreetelephonelines,timelyhearingsandreconsiderations,promptresponsestoproviderandbeneficiaryinquiries,provider x- +. educationandtraining,andMedicareparticipatingphysiciansactivities.HCFAwillcontinueitsinnovativeuseofaudioresponseunits(ARUs)fortelephoneinquiries,aswellascontinuingitsuseofthetelephonetoconducthearingreviewsandreconsiderations.Theseactivitiesreduceprogramadministrativecostswhileprovidingbettercustomerservice.Increasedactivityintheareaoffraudandabuseisexpectedtoincreasebeneficiarycommunicationsandhearingsandappealsactivity.m]88݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m?>    Thebudgetrequestallocates$149million 0 ; forproductivityinvestments.Productivityinvestmentsenhancethecost-effectivenessandqualityofcontractoroperationsandarepartofthelong-termreformofMedicareadministration.Productivityinvestmentcostsincludeexpandingthenewcustomerorientedtollfreetelephonesystem,greaterstandardizationofcontractorsystems,andredesigningthemanagedcareprocessingsystem.InFY2001,HCFAwillresumemovingitsremainingcontractorstooneofitsthreestandardclaimsprocessingsystems.WorkonmigratingcontractorstothestandardsystemsforPartA,PartBanddurablemedicalequipmentwassuspendedwhiletheagencyproceededwiththeimportantworkofmakingallMedicaresystemsmillenniumcompliant.m?>>݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mB    mBiC݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j=D  FederalAdministration+j=DD ӌ H!O ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mE    ForFY2001,thePresident'sbudget "X Q requests$495.9millionforHCFA'sFederaladministrativecosts.Thisisanincreaseof$13millionovertheFY2000budget.Thisdirectappropriationrequestsupportsastaffinglevelof4,353FTE,anincreaseof120FTEoverFY2000levels,thenewFTEareneededtocontinuethePresidentsNursingHomeQualityInitiativeandstrengthenoversightofMedicarecontractors.ItalsosupportstheextensivedataprocessingrequirementsfortheMedicareandMedicaidprograms,aswellas -+] necessarymaintenanceandenhancementofHCFAsmanyautomateddatasystems.mEHF݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mI    AlsoincludedintheFY2001budgetis 8 legislationauthorizingtheSecretarytocollectinitialregistrationandannualrenewalfeesfromMedicare+Choicemanagedcareplans.Thesefeesareestimatedtogeneraterevenuesof$36.7milliontofinancenewresponsibilitiesunderHIPAA,BBA,andBBRA.mIEJ݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL28/m XLXXXLXLXXXL  mL    Forinstance,anincreasingnumberof  `  StateshavechosennottoperformallorpartoftheirHIPAAinsuranceenforcementduties.+XLXXXXgJXXL+UnderHIPAA,HCFAisresponsible 0  forperformingthesedutiesonbehalfoftheStateswithinitsdiscretionaryadministrativebudget.Similarly,FederalAdministrationdollarsmustfundnewBBAandBBRAactivitiessuchasreviewingnewmanagedcareplansunderMedicare+ChoiceaswellasadministeringtheChildrensHealthInsuranceProgram.mLM݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXLM/m XLXXXLXLXXXL  m5P    ThePresidentsbudgetalsoincludes$6.1  millioninresourcesfortheNursingHomeQualityInitiativetostrengthenFederaloversightandtrainingofStatesurveyors.m5PP݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m'R    m'RR݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j[S  Research,Demonstrationsand P Evaluation+j[SS ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mT    TheFY2001budgetrequests  $55.0millionfortheResearch,DemonstrationsandEvaluationprogram,whichis$6.8millionlessthanthelevelenactedinFY2000.HCFA'sresearchprogramsupportsresearchanddemonstrationprojectstodevelopandimplementnewhealthcarefinancingpoliciesandtoevaluatetheimpactofHCFA'sprogramsonitsbeneficiaries,providers,States,othercustomersandpartners.InformationfromHCFA'sresearchprogramisusedbyCongress,theExecutiveBranch,andStatestoimprovetheefficiency,quality,andeffectivenessofthe Medicare,Medicaid,andSCHIPprograms.mTU݌ ,)- Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m^X       Basicresearchfundswillalsobeusedto X- conductevaluationsoftheMedicare+ChoiceProgram,theSCHIPProgram,MedicaidStateReform,andtheBeneficiaryInformationCampaign.TheNursingHomeTransitionGrantProgram,amajordepartmentalinitiativetomovepeopleoutofnursinghomesandintocommunitybasedalternatives,willbeimplementedandevaluated.Additionally,HCFAisplanningprojectsintheareasofMentalHealthandAsthmaaspartofwiderdepartmentalinitiatives.m^XX݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m[    Inadditiontobasicresearch,thisbudget 0 : fundstheMedicareCurrentBeneficiarySurvey,whichcontinuestobeacriticalsourceofdataonhealthcareusageandhealthstatusofMedicarebeneficiaries.m["\݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m]    m]5^݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j^  SurveyandCertification+j^T_ ӌ (@ ЌXLXXLXLXXL  m XLXXXLXLXXXL  m`    Ensuringthesafetyandqualityofcare 8B providedbyhealthfacilitiesisoneofHCFA'smostcriticalresponsibilities.HCFAcontractswithStateagenciestoinspecthealthfacilitiesprovidingservicestoMedicareandMedicaidbeneficiariesandensurecompliancewithFederalhealth,safety,andprogramstandards.m``݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mb    HCFA'sFY2001budgetproposes$234 J milliontofunditssurveyandcertificationactivities,a14.4percentincreaseovertheFY2000appropriatedlevel.Includedinthistotalis$29.7milliontocontinueimplementingactivitiesassociatedwiththePresidentsNursingHomeInitiative,suchas:imposingimmediatesanctionsonnursinghomesfoundguiltyofasecondoffensethatcausesactualharmtoresidents;conductingmorefrequentinspectionsofnursinghomeswithrepeatviolations;andconductingmorefocusedreviewsofanursinghomeseffortstopreventbedsores,dehydration,andmalnutrition.HCFAwillalsoinvestmoremoneytoexpediteinvestigationofresidentcomplaintswithinthetendaytimeframeannouncedlastMarch.mbc݌ -+\ Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  mf      TheFY2001budgetalsoproposestwo X surveyandcertificationuserfeestotaling$63million.Undertheseproposals,theSecretaryorStateswouldbeallowedtochargeuserfeestocoverthefullcostoffacilitiesinitialsurveys($13million)and33percentofthecostsforrecertificationsurveys($50million)inFY2001.Thelatterproposalwilleventuallyresultin100percentuserfeerecoverybyFY2003.mfgg݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mi    Another$182.3millionofthetotal  `  surveyandcertificationrequestwillfunddirectsurveyactivities,suchas:annualinspectionsofnursinghomes,surveysofhomehealthagenciesonceeverytwoyears,anda15percentrecertificationcycleforothernonlongtermcarefacilities(e.g.,hospices,ruralhealthclinics,andambulatorysurgicalcenters).Inaddition,thisfundinglevelwillallowHCFAtodecreasethesurveyintervalsforESRDfacilitiesandnonaccreditedhospitalsfromonceeverysixtoonceeverythreeyears.mi_j݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mCm    Theremaining$22.1millioninthe  FY2001surveyandcertificationrequestwillfundbasesupportcontractactivities,mostnotably:operationoftheQualityImprovementandEvaluationSystem(QIES),whichcontainsqualityoutcomedatathatsurveyorscanusetobettertargetonsiteinspectionsofpoorperformingproviders;enhancementstotheOSCARdatasystem,whichcontainsinformationonnursinghomesurveyresultsandoutcomes;improvedFederalandStatesurveyortraining;andsupportservicesforsurveyingpsychiatrichospitals.mCmm݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mp    TheFY2001budgetalsoproposesto %"% achieveasavingsof$10millioninsurveycostsbybasingspendingprojectionsonpriceratherthancost.Forthefirsttime,surveyandcertificationbudgetestimatesareestimatedfroma bottomupapproachbasedonactualStateexpendituresversusa topdownapproachthatusesanationalspendingtargetdistributedamongStates.Thismovementtowardapricebasedbudget x- +. methodologywillallowHCFAtobeginreducingvariationsinStatesurveyunitcostsandholdingStatesmoreaccountabletostrongerpriceandperformancemeasures.mp'q݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mVt    Finally,tohelpfinanceHCFAssurvey 2 andcertificationactivities,theFY2001budgetproposestwosurveyandcertificationuserfeestotaling$63million.Undertheseproposals,theSecretaryorStateswouldbeallowedtochargeuserfeestocoverthefullcostoffacilitiesinitialsurveys($13million)and33percentofthecostsforrecertificationsurveys($50million)inFY2001.Thelatterproposalwilleventuallyresultin100percentuserfeerecoverybyFY2003.mVtt݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+m XXXXLXLXXXXLXXXL  mw    mwOx݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXXXLw/+jXLXXXL  XLXXXL   +jRy  NationalMedicareEducation   H? Program+jRyy ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mz    Inthe2001budget,HCFAwillcontinue HB tofundactivitiesthatwillhelpbeneficiariesunderstandandassesstheiroptionsundertheMedicareprogram,includingMedicare+Choice.mz{݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+m XXXXLXXXXXXXXXXXXXXXXXXXXXXXXXLXXXXLXXXLXLXXXL  m|    TheNationalMedicareEducation PG Program(NMEP)willfundactivitiestoinformbeneficiariesoftheiroptions!includingtraditionalMedicare,HMOs,andPPO!andprovidecompleteandcomprehensibleinformationabouttheseoptionstofacilitatetheirdecisionmakingprocess.ThePresidentsbudgetprovidesupto$150millioninuserfees,subjecttoannualappropriations,toimproveandexpandNMEPactivitiesrelatedtoMedicare+Choice.m|5~݌̌ XLXXXLXLXXXLXLXXXLXLXXXLXLXXXLXLXXXLXLXXXLXLXXXLXLXXXLXLXXXL  m XXXXLXXXXXXXXXXXXXXXXXXXXXXXXXLXXXXLXXXLXLXXXL  m    InFY2001,theNMEPwillfundthe $8"S followingactivities:mailingstobeneficiarieswithgeneralinformationaboutMedicare,plusspecificinformationonplansavailableintheirarea;atollfreetelephoneservicestaffedbycustomerservice representativesabletoprovideinformation 0*'Y onavailableplans;medicare.gov,the X    user-friendlyinternetsitethatprovidescomparativeinformationonplansbyzipcode;aswellasotherinitiativesinvolvingStateandLocalentities.#XLXXXL|#XLXXXL m+݌  Ќ XLXXLXLXXLXLXXL  /XLXXXXgJXL/m XLXXLXLXXL  mȆ    mȆG݌̌ XLXXLXLXXL  +jXLXXXL  XLXXXL   +j  ClinicalLaboratoryImprovement  Amendmentsof1988+jl ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mM    TheClinicalLaboratoryImprovement P   Amendmentsof1988(CLIA'88)expandedsurveyandcertificationofclinicallaboratoriesfromMedicareparticipatingandinterstatecommercelaboratoriestoallfacilitiestestinghumanspecimensforhealthpurposes.CLIA'88alsointroduceduserfeesforclinicallaboratoriestofinancesurveyandcertificationactivities.UserfeesarecreditedtotheProgramManagementaccountbutareavailableuntilexpendedforCLIAactivities.EffectiveJanuary31,2000theprocessofCLIAtestcategorizationwilltransferfromCDCtoFDA.Thetransferwillallowlaboratorydevicemanufacturerstoonlysubmitapplicationstooneagencyforbothapprovalandcategorization.mM̉݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+m XXXXLXXXXXXXXXLXXXXLXXXL  m    TheCLIAprogramisfullyoperational, @ withabout171,000laboratoriesregisteredwithHCFA;about26percentofthelaboratoriesaresubjecttoroutineinspection(every2years)undertheprogram.Workloadsforeachinspectionperiodincludea3percentsamplereviewofthe17,400accreditedlaboratories,andsurveysof26,000nonaccreditedlaboratories.#XLXXXL[#XLXXXLmb݌ !h" Ќ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL+/m XLXXXLXLXXXL  m7    m7݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL++jXXXXLXLXXX  XLXXXL   +j斒  LegislationSupportingthe #H!$ DiscretionaryBudget+j斒 ӌ̌XLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m    ThePresident'sFY2001Budgetincludes %#' anumberuserfeeproposals,aswellasacontractingreformpackagetoassistHCFAinbecomingamoreefficientandcost (p&* effectiveorganization.m݌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    m݌ *P(, Ќ XLXXXLXLXXXLXLXXXL  .Ȋ  .Ȋ0  XXXXLXLXXXXLXXXL        PaperClaimUserFee:.Ȋ! ӌX,(#(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m    AllowstheSecretarytoassessa$1feeon h. anyclaimnotsubmittedelectronically.ThisfeecouldbewaivedatthediscretionoftheSecretaryduetocompellingcircumstances($83million).mA݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    m݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .ȊY0  XXXXLXLXXXXLXXXL     DuplicateClaimUserFee:.ȊYt ӌ` 4(#(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m    AllowstheSecretarytoassessafeefor  p6 duplicateorunprocessableclaimssubmittedbyproviders($53million).m݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXLk/m XLXXXLXLXXXL  m     m ݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+.Ȋ  .Ȋi0  XXXXLXLXXXXLXXXL   Medicare+ChoiceOrganization 0 : UserFee:.Ȋi ӌ (#(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m    AuthorizestheSecretarytocollectfees = fromMedicare+ChoicemanagedcareplanstocoverthecostsassociatedwithinitialregistrationsandannualrenewalstotheMedicareprogram($21million).m݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL>/m XLXXXLXLXXXL  m|    m|݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+.Ȋ  .Ȋۧ0  XXXXLXLXXXXLXXXL   SurveyandCertificationUserFees:.Ȋۧ ӌ(C(#(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  mf    AuthorizestheSecretarytoimposeor E requiretheStatetoimposeauserfeeforinitialcertificationsurveysandforrecertificationsurveys.Theinitialsurveyuserfeewillcoverthetotalcostofthesurvey,startinginFY2001($13million).Therecertificationsurveyfeewillonlycover33percentofcostsinFY2001,butwillincreasetocover66percentofcostsinFY2002,and100percentofcostsbyFY2003($50million).mf݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXXXL/.Ȋ  .ȊӬ0  XLXXXLXLXXXL   Medicare+ChoiceUserFee:.ȊӬ ӌ#H!R(#(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    AuthorizestheSecretarytoassessupto %"T $150millioninuserfeesonMedicaremanagedcareorganizationsforthe operationoftheMedicare+Choice '%W InformationCampaign,apartofthe   NationalMedicareEducationProgram(NMEP).TheBBRAloweredtheuserfeefromupto$100millionto$19millioninFY2001basedonaformulainstatute.Atthe$19millionlevel,operationoftheNMEPwouldeffectivelycease.m݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m.    m.݌̌ XLXXXLXLXXXL    +XLXXXXgJXXL+.Ȋ  .Ȋ0  XXXXLXLXXXXLXXXL   ContractingReform:.Ȋ ӌ  ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m    KeyprovisionsofthePresidents @   MedicarereformplangivetheSecretaryofHealthandHumanServicesincreasedflexibilityincontractingforclaimsprocessing,payment,andotherMedicareintermediaryandcarrierfunctions.TheprovisionsbringMedicarecontractingauthorityintocloseralignmentwiththegeneralgovernmentcontractingrulescontainedintheFederalAcquisitionRegulation(FAR),whilepreservingcertainessentialflexibilityintheawardingandrenewalofcontractscurrentlyavailabletotheSecretaryunderMedicarelaw.m݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXLm/m XLXXXLXLXXXL  m    mo݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ$0  XLXXXLXLXXXL     ProviderReEnrollmenttothe P MedicareIntegrityProgram(MIP).Ȋ$? ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  m    Shiftsthisactivityandtheoverpayment P collectionfunctionfromtheProgramManagementdiscretionarybudgettothemandatorybudgetMIPaccount.AsaneligiblefunctionunderMIP,thesefraudrelatedactivitieswillenjoyastablefundingsource.TheProgramManagementfundingusedforthispurposewillfundadditionalcontractorFTEsthatwillestablishandimplementfinancialmanagementcontrolsundertheAdministrationsMedicarecontractoroversightinitiative.m"݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+.Ȋ  .Ȋ0  XXXXLXXXXXXXXXLXXXXLXXXL   NursingHomeInitiative:.Ȋ ӌP(%* ЌXLXXLXLXXLXLXXL   /XLXXXXgJXXLɽ/m XLXXXLXLXXXL  m    AspartoftheInitiative,the )`', Administrationproposesrequiringnursinghomestoquerythenursinghomecriminalabuseregistryandconductcriminalbackgroundchecksonnewemployees.The x- +0 costsfortheseactivitieswillbefinancedthroughuserfees.ThePresidentsbudgetprojectsthatHHSwillcollect$4.3millioninfeestoquerytheabuseregistry,andthattheDepartmentofJusticeandStateswillcollect$41.1millioninfeestoconductcriminalbackgroundchecks.Thelegislationwillalsoallowmoretrainednursinghomeemployeestohelpfeedresidentsatmealtimes.m`݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+m XXXXLXLXXXXLXXXL  m    mS݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j'  /XLXXXXgJXL/+XLXXXXgJXL+  MandatoryLegislativeProposals+j' ӌ  P ; ЌXLXXLXLXXLXLXXL  .Ȋ  .Ȋ0  XXXXLXLXXXXLXXXL   CancerClinicalTrials.Ȋ ӌ =(#(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m    Inaddition,theAdministrationis x ? proposingnewmandatorylegislationpermittingpaymentforthecareofbeneficiariesparticipatingincancerclinicaltrialsaspartofathreeyeardemonstration.m݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    Thisdemonstrationwillprovide (D informationonthecostofcoverageofthecancerclinicaltrialswhileaffordingaccesstocuttingedgeexperimentaltreatment.BeginninginFY2001,$750million(overthreeyears)wouldbeprovidedforthisdemonstration.mn݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXL/+XLXXXXgJXXL+    M 5@(#(#X@5#  XXXXLXu=XXXe&eXXu=  #+@     PROGRAMMANAGEMENTOVERVIEW#+   X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  @{ {  ProgramManagementdiscretionary  k @  (dollarsinmillions)  [  (#(#                            (#(#AZ') HxdHE HxA  3  pVD<,(`~00 `.#E00zj;p߰@  ProgramManagementMandatory !j" @(obligationsinmillions/1) %#(#%#(#(#(# %#(#%#(#%#(#%#(# %#(#%#(#%#(#%#(# %#(#%#(#%#(#%#(# %#(#%#(#%#(#%#(# %#(#%#(#%#(#%#(# (#(#%#(#%#(#/XLXXXXgJXXL/+XLXXXXgJXXL+      `     h      p     Jp AZ') HxdEA)HxA B)&* pVH<5,(`~0 !)!. `.bEb$xx#a<p  )1'+ /XLXXXXXXL/#  Xu=XXXLe&eXXu=  #@RR$    HCFASUMMARY#T y  X AZ') HxdE#HxAeq eee&XLX eeqԌ $ Ќ  +XLXXXXXXL+@BB (dollarsinmillions)/1  k pVN<G,(`~0*\ `.!E*\*\8=p "(#"(#(#(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# (#(#"(#"(#AZ') HxdEHxA/XLXXXXXXL/+XLXXXXXXL+5G  C 6D#  XXXXLXu=XXXe&eXXu=  Q@9,X, XhXpX9#ᄌ@  ADMINISTRATIONFORCHILDRENANDFAMILIES#ᄌ\  X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  @  (dollarsinmillions) k  pVR<,(`~1sY+ `.o EsY+Y+(>p #(##(#(#(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# (#(##(##(#UxAZ') HxdE HxA+jXXXXLXLXXX  XLXXXL   (X@(#(#(+j  Summary+j ӌ C ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m    TheFY2001budgetrequestforthe  AdministrationforChildrenandFamilies(ACF)totals$42.9billion,anincreaseof$5.2billion,or14percent,overFY2000.Ofthesefunds,$11.7billionisdiscretionaryprogramleveland$31.3billionisentitlementbudgetauthority.m&݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m!    TheAdministrationforChildrenand ; FamiliesistheDepartment'sleadagencyforprogramsthatpromotetheeconomicandsocialwell-beingoffamilies,children,individuals,andcommunities.Itsprograms,includingHeadStart,childcare,childsupport,familyviolence,fostercareandadoption,andTemporaryAssistanceforNeedyFamilies(TANF),areattheheartoftheFederalefforttostrengthenfamiliesandgiveallchildrenachancetosucceed.m!݌̌ XLXXXLXLXXXLXLXXXL   +jXXXXLXLXXX  XLXXXL   +j    DiscretionaryProgramSummary+j& ӌ #{!$ ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m    TheFY2001discretionarybudget ;%"& requestfortheAdministrationforChildrenandFamilies(ACF)is$11.7billion,anincreaseof$1.8billion,or18percent,overFY2000.m݌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mX    mX݌ )'+ Ќ XLXXXLXLXXXLXLXXXL  .Ȋ     vVZB2.b~102|0  `..@E0|0 |0  ?v. (#(#          (#(#0 D XLXXXLXLXXXL   HeadStart.Ȋ ӌS?D(#D(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  WI95jz-% p @E@#%"x"@I95jz-% p @E@#%"x"@I95jz-% p @E@#%"x"@I95jz-% p @EP"%"!@m D   ThePresident'sBudgetrequestincludes  A $6.3billionforHeadStart,a19percent (#(#(#(#increaseovertheFY2000appropriation.This$1billionincreasewillprovideHeadStartservicestoover70,000additionalchildren,bringingtotalenrollmenttonearly950,000-- (#(#(#(#wellonthewaytoreachingthePresident'sgoalofenrollingonemillionchildrenby 2002.m݌ 3-*O Ќ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    Inaddition,asignificantshareofthe X  FY2001fundsavailableforexpansionwillbereservedforgranteestoaddressunservedandunderservedpopulations,includingrecentimmigrantsandlimitedEnglishproficient(LEP)populations.Programsservingmigrantandseasonalfarmworkerswillreceivetheirfullshareofcost-of-livingandqualityimprovementfundsaswellasadditionalexpansionfunds.m&݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    vV`B2.b~1< H'  `..@E<H' H' A AvResearchfindingscontinuetosupport  `  theimportanceofHeadStartinthelivesoflow-incomechildren.PreliminaryfindingsfromtheHeadStartFamilyandChildExperiencesSurvey(FACES)revealthatHeadStartclassroomqualityisgood,andthatHeadStartchildrenshowgrowthinvocabulary,mathandsocialskillsovertheHeadStartyear.FurtherresearchisplannedtoexploretheimpactofHeadStart.Lastyear,anadvisorypanelwasconvenedtoproviderecommendations;acontractwillbeawardedthisyear.mJ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m    M ݌̌                  XLXXXLXLXXXL  .Ȋ  .Ȋ 0  XXXXLXLXXXXLXXXL   QualityHeadStartServices.Ȋ   ӌ'%( ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m`     AsAmerica'spremierearlychildhood @)&* educationprogram,HeadStartensuresthatlow-incomechildrenstartschoolreadytolearn.Since1993,HeadStartenrollmenthasincreasedby23percent.TheFY2001requestreflectsnotonlyacommitmentto -+/ increasingHeadStartenrollment,butalsoadedicationtocontinuedimprovementsinprogramquality.The1998reauthorizationactcallsfordedicating47.5percentoftheincreaserequestedthisyear,or$418million,tosupportactivitiesaimedatreducingclasssize,improvingclassroomfacilities,enhancingstafftraining,improvingschoolreadiness,obtainingsaferandbetterequipment,andattractingandretainingwell-trainedstaffmembers.m`  ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m  D   m T ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .Ȋ( 0 D XXXXLXLXXXXLXXXL   EarlyHeadStart.Ȋ( C  ӌ @ ;D(#D(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m  D   In1995,EarlyHeadStartwas  = establishedtoservechildrenageszerotothreeinrecognitionthattheearliestyearsarecriticaltochildren'sgrowthanddevelopment.InFY2001,fundingforEarlyHeadStartwillbe$564million,or9percentofthetotalHeadStartappropriation.Withthesefunds,54,000childrenageszerotothreeandtheirfamilieswillreceiveearly,continuous,intensiveandcomprehensivechilddevelopmentandfamilysupportservices.TheFY2001requestsupportsanincreaseof10,000children.m > ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m4  D   m4  ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j   ChildCare+j /  ӌ  K ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m  D   Arecentreport, AccesstoChildCare 0M forLow-IncomeWorkingFamilies,foundthatonly10percentofthe14.7millionchildreneligibleforchildcaresubsidiesunderFederalguidelinesreceivethem.Reliable,high-qualitychildcareisessentialbothtoparents'continuedemploymentandtochildren'shealthandintellectualdevelopment.Recognizingtheneedtoincreasetheavailabilityandqualityofaffordablechildcare,theFY2001budgetincludes$2billionforthediscretionaryChildCareandDevelopmentBlockGrant(CCDBG),anincreaseof$817million.Withthefundsrequested,nearly150,000additionalchildrenwillreceivechildcaresubsidies,significantlyexpandingaccesstohigh-qualitychildcare.m  ݌ x- +^ Ќ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m|     Theaforementionedreportonaccessto X childcarefoundthatafamilyofthreewithanincomeof$15,000wouldpaybetween24percentand45percentoftheirincomeonchildcarewithoutassistance.IfthissamefamilyreceivedaCCDBG-fundedchildcaresubsidy,theywouldonlyneedtospendbetween1percentand7percentoftheirincomeonchildcare.Clearly,forparentsstrugglingtoleavewelfareortostayoffofwelfare,childcaresubsidiescanbecriticaltotheirabilitytomakeendsmeet.m|  ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m     m  ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .Ȋm 0  XXXXLXLXXXXLXXXL   ImprovingQuality.Ȋm   ӌ0  ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m     Researchshowsthatqualitychildcare   programshaveapositiveeffectonchildrenscognitiveperformance,languagedevelopment,socialadjustment,andoverallbehavior.ThefundsrequestedforFY2001willsupportcontinuingimprovementsinchildcarequality.ThePresident'sBudgetdedicates$223milliontoimprovethequalityofchildcare.ThesefundsareinadditiontotheamountsStatesarecurrentlyrequiredtospend.Alsoincludedis$19milliontosupportschool-agechildcareandresourceandreferralactivities.m  ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m     ThePresident'sBudgetalsoincludes   $600millioninmandatoryfundstoestablishanewEarlyLearningFund.TheEarlyLearningFundisacriticalinvestmentinouryoungestandmostvulnerablechildren.MoreonthisinitiativecanbefoundintheACFentitlementsection.m "! ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m#     m# # ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .Ȋ$ 0  XXXXLXLXXXXLXXXL   StrengtheningResearch.Ȋ$ $  ӌ#H!$ ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m &     InFY2000,ACFfunded$10millionof %"& newchildcareresearch,demonstrationandevaluationactivities.Includedintherequestis$10milliontocontinuetheseresearcheffortsinFY2001.Withthesefunds,ACFwillcontinuetodevelopthecapacityfor ongoingresearchanddatacollection,partner *P(, withStatestostrengthenthecapacityfor   cross-cuttingresearchonissuesaffectingwelfarerecipientsandlow-incomeworkingfamilies,andencouragefield-initiatedresearchonchildcare.m & & ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m)  D   m) O* ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j#+     RunawayandHomelessYouth+j#+ +  ӌ 2 ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m,  D   Thebudgetincludesarequestof ` 4 $74million,anincreaseof$10million.AspartoftheDepartmentalMentalHealthInitiative,thesefundswillsupportcentersandStatecollaborationeffortstoprovideearliermentalhealth-orientedservicestoyouthat-riskofbecomingrunawaysand/orhomeless.Currently,thereareover350centersacrossthecountrybeingsupportedthroughthisgrantprogram.m, =- ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m/  D   m/ T0 ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j(1   FamilyViolence+j(1 1  ӌ X? ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m2  D   AspartoftheDepartmentsviolence A againstwomeninitiative,thebudgetincludes$134million,anincreaseof$16million,forFamilyViolenceprograms.Thesefundswillenhancetheservicesprovidedtowomenandtheirfamilies.m2 ,3 ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m5  D   Oftheamountrequested,$117millionis `G fortheGrantsforBatteredWomen'sSheltersprogram,anincreaseof$16million.ThesegrantshelpStatesandTribesprovideimmediateshelterandrelatedservicestovictimsofabuseandtheirdependentsaswellasdomesticviolenceawarenessactivities.Therequestedfundingincreasewillbeusedtoexpandservices,particularlytounderservedpopulations.m5 5 ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m8  D     Thesefundswillalsobeusedtoincrease $!Q supportfortheNationalDomesticViolenceHotline,forwhich$2millionisrequested.Inaddition,atotalof$15millionisincludedfortheSexualAbusePreventionforRunaway,HomelessandStreetYouthprogram.m8 8 ݌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m:  D   m: T; ݌ *P(X Ќ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX   XLXXXL   +j=<   NativeAmericanPrograms+j=< <  ӌ X ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m=     Thebudgetincludesarequestof h $44millionfortheprogramsoftheAdministrationforNativeAmericans,anincreaseof$9million,or25percentoverFY2000.ThisproposedincreasereflectstheinterestsandconcernsexpressedtotheDepartmentduringTribalbudgetconsultations.m= T> ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mY@     Fundsareawardedcompetitively, @   primarilyforSocialandEconomicDevelopmentStrategiesgrants,whichleadtoselfsufficiencyforindividuals,TribesandNativeAmericancommunities.GrantsarealsoprovidedforNativeLanguagepreservationandthedevelopmentoftribalenvironmentalregulations.Inawardinggrants,specialattentionwillbegiventoenergydevelopmentandcreationoftribalcodesandordinances.mY@ @ ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mC     mC !D ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +jD   CommunityServicesPrograms+jD ~E  ӌ ( ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mgF     Thebudgetprovides$540millionfor  CommunityServicesprograms,adecreaseof$53million.mgF G ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mJH     mJH H ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .ȊI 0  XXXXLXLXXXXLXXXL   CommunityServicesBlockGrant.ȊI I  ӌP ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  mBK     TheCommunityServicesBlockGrant  programprovidesStates,territories,andIndiantribeswithaflexiblesourceoffundingtohelpreducepoverty,includingservicestoaddressemployment,education,housingassistance,energyandhealthservices.InFY2001,$510millionisrequestedfortheBlockGrant.mBK K ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mM     mM N ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .ȊoO 0  XXXXLXLXXXXLXXXL   IndividualDevelopmentAccounts %(#' (IDAs).ȊoO O  ӌ  ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m Q     FY1999wasthefirstyearoffundingfor '%* anewprogramtoempowerlow-incomeindividualstosaveforahome,post-secondaryeducation,oranewbusiness.InFY1999,over10,000individualshadtheopportunitytoopenIDAsasaresultofthesefunds.m Q Q ݌ x- +0 Ќ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mS  D   ThePresident'sBudgetincludes X0 $25millionforIDAs,morethandoublingthesizeoftheprogram.Thesefundswillsupport110non-profitorganizationsadministeringIDAdemonstrations,servinganadditional20,500low-incomeindividuals.mS ?T ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mV  D   mV V ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .ȊW 0 D XXXXLXLXXXXLXXXL     JobOpportunitiesforLow-Income  8 IndividualsProgram(JOLI).ȊW W  ӌ D(#D(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  mBY  D   Thebudgetalsoincludesarequestof 0 ; $5millionfortheJobOpportunitiesforLow-Income(JOLI)program.TheJOLIprogramprovidesvitalsupporttohelplow-incomefamilies,includingmanyleavingTANF,tosucceedandadvanceatwork.Fundsareusedtohelprevitalizelow-incomecommunitiesandtocreatejobopportunitiesforpoorfamilies,andarecriticalinlinkingorganizationsengagedincommunitydevelopmenttothewelfarereformandworkingfamiliesagenda.mBY Y ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m\  D   m\ =] ݌̌ XLXXXLXLXXXLXLXXXL  .Ȋ  .Ȋ^ 0 D XXXXLXLXXXXLXXXL     OtherCommunityServices `H Programs.Ȋ^ ,^  ӌ D(#D(# ЌXLXXLXLXXLXLXXL   m XXXXLXLXXXXLXXXL  m_  D   Thebudgetdoesnotfundthe `K CommunityEconomicDevelopment,RuralCommunityFacilities,NeighborhoodInnovativeProjects,NationalYouthSportsorCommunityFoodandNutritionprograms.m_ O` ݌̌ XLXXXLXLXXXLXLXXXL   +jXXXXLXLXXX  XLXXXL   +j"b     DevelopmentalDisabilities+j"b b  ӌ H!R ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mc  D   TheDevelopmentalDisabilitiesprogram "X T helpsStatestoensurethatallpersonswithdevelopmentaldisabilitiesareabletoaccessservicesforenhancedindependence,productivity,integration,andinclusioninthecommunity.TheFY2001requestforDevelopmentalDisabilitiesis$122million,thesamelevelasinFY2000.mc ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   ChildCareEntitlementLegislative 4 Proposal+j ]  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m7  D   Inadditiontothediscretionaryincrease ` 7 requestdiscussedpreviously,akeycomponentofthePresidentsChildCareInitiativeisfundingforanewEarlyLearningFund.m7 ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m/  D   m/ ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋc 0 D XLXXXLXLXXXL     EarlyLearningFund:.Ȋc ~  ӌ =D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m  D   Thebudgetincludes$3billionover h? fiveyearsinentitlementfundsforanEarlyLearningFundtofosterearlychildhooddevelopment,emergentliteracy,andschoolreadinessandtoimprovechildcaresafetyandquality.Recentresearchfoundthatalmosthalfoftheinfantsandtoddlersinchildcarecenterswereincarethatlackedbasicsanitaryandsafetyconditions.Otherstudiesindicatethatchildreninhigherqualitychildcareprogramsdevelopstrongerlanguage,readingandmathskillsandfewerbehaviorproblemsthanchildreninmediocreorpoorqualityprograms.Thebetterthechildcareprogram,themorelikelythechildistoenterschoolreadytolearn.TheFundwillprovideStateswithdollarsforcommunitylevelchallengegrantstosupportprogramsthatimproveearlylearningandthequalityandsafetyofchildcareforchildrenuptoagefive.m , ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m`  D   m` ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   TemporaryAssistancetoNeedy %"U Families+j  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m  D   TheTANFblockgrant,asinglecapped `'%X entitlementofapproximately$17billionannually,providesfundstoStatestodesigncreativeprogramstohelpfamiliestransitionfromwelfaretoselfsufficiency.UnderTANF,recipientsmustengageinworkactivitiestoreceivetime-limitedassistance.Overthepastfiveyears,thenumberof -+_ familiesonwelfarehasdroppedbyover40percent,tounder2.5millionfamilies!morethan1.3millionadultsonwelfarewenttoworkbetween1997to1998.Notonlyaretheseadultsworking,theirincomeisrisingastimegoeson,acriticalcomponentofstayingoffofwelfare.Ourmostrecentdataindicateanaverageearningsincreaseof23percentforformerwelfarerecipientsfromtheirfirstquarterofemploymenttotheirthirdquarter.m R ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mE     Welfarereformauthorizesand  P  pre-appropriatesabout$17billionannuallytoStatesforthefollowingactivities:mE ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m } ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 2 0  2C3  0  FamilyAssistanceGrantstoStates, h TribesandTerritories;: 2  ӌ  ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : Y 0  2C3  0  MatchingGrantstoTerritories;: Y  ӌH ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : X 0  2C3  0  BonustoRewardDecreaseinOut 8 ofWedlockBirths;: X  ӌ  ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : w 0  2C3  0  SupplementalGrantsforPopulation  Increases;: w   ӌ  ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  BonustoRewardHighPerformance  States;: 5  ӌ  ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0  04  TribalWorkPrograms;and,: I  ӌ44 ЌL )#3h4(*-/0123LXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 0  2C3  0   0LoansforStateWelfarePrograms.: c  ӌp ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m     Uptoacombined30percentofTANF P fundsmaybetransferredtoeithertheChildCareandDevelopmentBlockGrantortheSocialServicesBlockGrant(SSBG).StartinginFY2001,transferstoSSBGarelimitedto4.25percentofTANFfunds.StatesaretransferringlargeamountsoftheirTANFfundstotheChildCareandDevelopmentBlockGrant,inresponsetotheincreasedneedsinthisprogram.m c ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m 8 ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL     +j   TANFLegislativeProposals  Ԁ+j b  ӌ %#& ЌXLXXLXLXXL  m XLXXXLXLXXXL  m7     TheFY2001PresidentsBudget `'%( includesthefollowingTANFlegislativeproposal.m7 ݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m \ ݌ 0*'+ Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ% 0 D XLXXXLXLXXXL        SupplementalGrantsfor X+ PopulationIncreases:.Ȋ% @  ӌ D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m  D   Withtherapiddeclineinwelfare X. caseloads,thebudgetproposestolimittheSupplementalGrantsforPopulationIncreasesattheFY1998level.SeventeenStatesareeligibleforthisgrant,basedonpopulationgrowthand/orlowerthanaverageStatewelfarespendingperlowincomeperson.Thisproposalwillsave$240millioninBudgetAuthorityinFY2001.m ( ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mX  D     mX ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   ChildrensResearch+XLXXXXXL+ԀandTechnical  9 Assistance(CRTA)+j   ӌ̌XLXXLXLXXLXLXXLXLXXLXLXXL  /XLXXXXgJXXL5 /m XLXXXLXLXXXL  m  D   Welfarereformauthorizesand X< appropriatesfundsforwelfareresearchandtechnicalassistanceforStates.TheFY2001totalis$58.6million.m  ݌̌ XLXXXLXLXXXL   D Includedinthistotalis$21millionin @ pre-appropriatedmandatoryfundsforthefollowingactivities:$15millionforwelfareresearch,and$6millionforalongitudinalchildwelfarestudy.Thesefundswillalsosupportwelfareresearchontheeffectsofwelfarereformandonwaystoimprovethewelfaresystem.m XLXXXLXLXXXL  m  D   Theremaining$38millioninthisfund I includestwochildsupportsetasides:onefortrainingandtechnicalassistanceandtheothertoassistinoperatingtheFederalParentLocatorService(FPLS).Thefundsappropriatedfortheseactivitiesareequaltooneand2percentrespectivelyoftheamountpaidtotheFederalgovernmentforitsshareofchildsupportcollectionsduringtheprecedingfiscalyear.m S ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m  D   m 6 ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   ChildSupportEnforcement+j U  ӌ `'%T ЌXLXXLXLXXL  m XLXXXLXLXXXL  m  D   TheChildSupportEnforcement(CSE) (p&V programisajointFederal,StateandLocalpartnershipthatseekstoensurefinancialandemotionalsupportforchildrenfrombothparentsbylocatingnoncustodialparents,establishingpaternity,andestablishingand x- +[ enforcingchildsupportorders.Theprogramprovidescriticalsupportforworkingfamiliesandassistsinthetransitiontoselfsufficiency.InFY2001,anestimatedtotalof$4.7billioninFederalandStatedollarswillbespentinordertocollect$19billioninpayments.Thisrepresentsa9percentgainincollectionsoverFY2000andatotalreturnofmorethan$4forevery$1investedintheadministrationoftheprogram.SincetheinceptionoftheprograminFY1975,over$100billionhasbeencollected.Successintheprogramalsoincludesanewrecordamountof$1.3billioncollectedinoverduechildsupportfromFederalincometaxrefunds.Inaddition,theNationalDirectoryofNewHireshashelpedlocatemorethan2.8milliondelinquentparentsandpaternityestablishmentroseto1.45millionin1998,amorethanthreefoldincreasefrom516,000in1992.m ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     TheFederalgovernmentsharesinthe  financingofthisprogrambyprovidingincentivepayments,a66percentmatchrateforgeneralStateadministrativecosts,andanenhancedmatchrateforpaternitytestingandspecifiedautomatedsystemsrequirements.TheCSEprogramalsoincludesacappedentitlementof$10millionannuallyforgrantstoStatestofacilitatenoncustodialparents'accesstoandvisitationoftheirchildren.m p ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     TheCSEprogramstrengthensfamilies X   byhelpingchildrengetthesupporttheyareowedfromnoncustodialparents.Innon-TANFcases,childsupportcollectionsareforwardedtothecustodialfamily.Bysecuringsupportonaconsistentandcontinuingbasis,familiesmayavoidtheneedforpublicassistance,thuspotentiallyreducingfuturewelfare,FoodStamp,andMedicaidspending.ApplicantsforTANFassigntheirrightstosupportpaymentstothe Stateasaconditionofreceiptofassistance. *P(+    ChildsupportcollectionsonbehalfoffamiliesreceivingTANFandsomecollectionsonbehalfofformerTANFrecipientsaresharedbetweentheStateandFederalgovernment.m h ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m   D   Asnotedabove,aportionoftheFederal 0 shareofchildsupportcollectionsispaidtotheStatesasincentivepayments.Previously,FederalincentivepaymentstoStateswerebasedontheStatescosteffectivenessinoperatingtheprogramandtheamountofpaymentscollected.FollowingpassageoftheXLXXXLChildSupportPerformanceand  @ 7 IncentiveActof1998#XLXXXL #,anewincentives 0 8 structurewasputintoplaceXLXXXLԀusingfivekey x 9 measures:paternityestablishment,supportorderestablishment,collectionsoncurrentsupport,collectionsonpastduesupport,andcosteffectiveness#XLXXXL #.Thisnewsystemisbeing 8= phasedinstartinginFY2000.m   ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m  D   m  ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   ChildSupportLegislativeProposals+j 9  ӌ @ ЌXLXXLXLXXL  m XLXXXLXLXXXL  m   D   TheFederalgovernmenthasastrong pB interestinseeingthatanation-widechildsupportsystemiseffective.Overthelasttwoyears,theAdministrationtooktheleadinbringingstakeholderstogethertoexaminethecurrentfinancingstructureoftheChildSupportprogram.Inadditiontoholdingdiscussionmeetingsacrossthecountry,weconductedresearchandanalysisonthefundingoftheprogram.Manyoftheproposalsinthisyear'sbudgetwereanoutgrowthofourconsultationsoverthepasttwoyears.m   ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mT  D   ThebudgetproposesChildSupport #H!O legislationwithvariouschangesthatfocusonincreasingpaymentstofamiliesandmakingthechildsupportsystemworkbetter.mT  ݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mI  D   mI  ݌ P(%T Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j        ProgrammaticChangestoGetMore X MoneytoFamilies:+j   ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m     Thebudgetincludesfourproposalsto X simplifythechildsupportsystemand/orgetmoremoneytofamilies.m ~ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m 0 ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  :  0  2C3  0  Optio  nalPass-through&Disregard: p TheproposalprovidesFederalmatchingfundsfornewStatepoliciesthatpass-throughchildsupportcollectionstofamiliesanddisregardthesefundswhendeterminingassistancelevelsforTANFfamilies.Underthisproposal,theFederalgovernmentwouldshareinthecostofamountsaboveaState'scurrentpass-throughanddisregardpolicydistributedtoTANFfamiliesanddisregarded,uptothegreaterof$100permonthor$50overcurrentStateefforts.Increasedcollectionstofamilies:$388millionoverfiveyears.Federalcost:$97millionoverfiveyears.:    ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m7     m7  ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : k 0  2C3  0  OptionalSimplifiedDistribution: @ ThisproposalallowsStatestoadoptsimplifiedrulesfordistributingchildsupportcollections.Underthesimplifiedformula,collectionsreceivedonbehalfoffamiliesreceivingTANFbenefitswouldberetainedbytheFederalandStategovernmentsasreimbursementforassistance(asundercurrentlaw)andchildsupportcollectedonbehalfoffamilieswhonolongerreceiveassistancewouldbepaidtothefamilies.ThepolicywouldbeimplementedstartinginFY2002.Increasedcollectionstofamilies:$815millionoverfiveyears.Federalcost:$396millionoverfiveyears.: k   ӌ   L )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m"     m" I# ݌ ,)- Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : $ 0 D 2C3  0pD(#D(#     Technicalfixtoremovenationalcap X- fromincentives:ThisproposalisarevenueneutraltechnicalimprovementtotheincentivesystemenactedintheChildSupportPerformanceandIncentivesActof1998.ThetechnicalchangeimprovesthemethodologyforawardingincentivepaymentstoStatesbycreatingaperStatemaximumlevelofincentives,eliminatingStatetoStatecompetitionfornationallycappedfunds.: $ $  ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m'  D   m' 0( ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : ( 0 D 2C3  0pD(#D(#  ReviewandAdjustmentofChild h< SupportOrders:Thisproposal,previouslyproposedintheFY2000Budget,requiresStatestoreviewandadjustchildsupportordersforTANFfamilieseverythreeyears.Benefitsincludeincreasingthenumberofchildrenwithprivatehealthinsuranceandincreasingcollectionstofamilies,therebyreducingfamiliesrelianceonpublicbenefitprograms.Federalsavings:$232millionoverfiveyears.: ( )  ӌ p(#p(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m,  D   m, , ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j-   BetterEnforcementToGetMore 0J MoneytoFamilies+j- .  ӌ̌XLXXLXLXXL  Thebudgetincludesfournewmeasuresto M increasechildsupportcollectionsfromparentswhoowepast-duechildsupport.: L 4(*-/0123Ch3)LXLXXXL  : / 0 D 2C3  0pD(#D(#  AutomatedDataMatchand (# Q AttachmentofGamblingProceeds:Thisproposalprovidesfortheinterceptoflargegamblingwinningsofnon-custodialparentswithchildsupportarrears.Increasedcollectionstofamilies:$348millionoverfiveyears.Federalsavings:$189millionoverfiveyears.: / /0  ӌ p(#p(#  L )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m2  D   m2 #3 ݌ +@)Z Ќ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 3 0  2C3  0     ReductionofThresholdforPassport X Denialto$2,500:Theproposaldeniespassportstodelinquentnon-custodialparentswithmorethan$2,500inchildsupportarrears,loweringthethresholdfrom$5,000undercurrentlaw.Increasedcollectionstofamilies:$36millionoverfiveyears.Federalsavings:$9millionoverfiveyears.: 3 4  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m:7     m:7 7 ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : n8 0  2C3  0  SSABenefitMatch:Inorderto  P  collectpastduesupport,thisproposaloffsetsOldAge,Survivor,andDisabilitySocialSecuritybenefits.Increasedcollectionstofamilies:$102millionoverfiveyears.Federalsavings:$67millionoverfiveyears.: n8 9  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mU;     mU; ; ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : < 0  2C3  0  BootingVehiclesofNon-Custodial  ParentsOwingatLeast$1,000inChildSupport:AddsvehiclebootingtothesetofenforcementtoolsavailabletoStatestoencouragenon-custodialparentstoenterintopaymentofchildsupportarrears.Increasedcollectionstofamilies:$183millionoverfiveyears.Federalsavings:$96millionoverfiveyears.: < .=  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m?     m? Q@ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mA     Twoadditionalimportantproposalsare h included:1)aproposaltoprovideSecretarialdiscretiontoexcludedoctorswithchildsupportarrearagesfromparticipationinMedicareand2)aproposedStaterequirementtohaveproceduresinplacetorequireindividualswhooweoverduechildsupporttopayorengageinworkactivities.Thebudgetalsore-proposestoeliminatetheenhancedmatchforpaternityestablishment,conformingtheFederalmatchrateforpaternitytestingto theloweroverallchildsupport *P(+ administrativematchrate(ashiftfrom   90percentto66percent).Asummarychartcanbefoundattheendofthissectiondetailingcostsandsavingsassociatedwitheachlegislativeproposal.mA A ݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL+/XLXXXXXXLCE /+jXLXXXL  XLXXXL   +jE   FosterCare,AdoptionAssistance 1 andIndependentLivingProgram+jE F  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mF  D   TheFY2001budgetrequests P 4 $6.4billioninBudgetAuthorityfortheFosterCare,AdoptionAssistanceandIndependentLivingprograms.Thisrequestrepresentsanincreaseof$739millionovertheFY2001appropriation.mF uG ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mI  D   Ofthetotalrequest,$5.1billionwill  : provideFosterCarepaymentsonbehalfofabout341,700childreneachmonth.ThisrequestwillalsofundStateadministration,includingchildwelfareinformationsystems,training,andStatedatasystems.mI I ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mWK  D   FortheAdoptionAssistanceprogram, 8@ about$1.2billionwillprovidepaymentsforfamilieswhoadoptspecialneedschildren.Monthlypaymentsaremadeonbehalfofadoptedchildrenuntiltheir18thbirthday. PD Theproposedleveloffundingwillsupportapproximately256,400childreneachmonth.mWK K ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mM  D   Thebudgetincludes$140millionto  G fundtheIndependentLivingProgram.mM _N ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mqO  D   mqO O ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jP   TheFosterCareIndependenceAct J of1999+jP Q  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  mQ  D   Thisact,enactedinNovember1999, H!M increasedtheIndependentLivingProgramlevelfrom$70millionto$140million.SeveralprovisionsfromtheFY2000PresidentsBudgetwereincluded,suchas:increasingfunding,allowingStatestousefundstopayforroomandboardforformerfosteryouths,andallowingStatestoexpandMedicaideligibilitytoyouthsuptoage21whowereeligibleforfostercareatage18.mQ fR ݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mT  D   mT ]U ݌ *P(W Ќ XLXXXLXLXXXL  +jXLXXXL   XLXXXL   +j'V   FosterCareRelatedLegislative X Proposals+j'V V  ӌ̌XLXXLXLXXL  .Ȋ  .ȊuW 0  XLXXXLXLXXXL   IndependentLivingProgram(ILP) X SupplementalAppropriationforFY2000:.ȊuW W  ӌ  ЌXLXXLXLXXL   m XLXXXLXLXXXL  mX     OnthesamedaytheFosterCare  IndependenceActof1999waspassed,Congressappropriated$105millionforILPforFY2000,aswasoriginallyrequestedintheFY2000PresidentsBudget.TheFY2001budgetincludesasupplementalrequestfor$35millionforFY2000tobringtheappropriationuptothelevelStatesareentitledtounderthisnewstatute.mX rY ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m[     m[ "\ ݌̌ XLXXXLXLXXXL  .Ȋ    .Ȋ\ 0  XLXXXLXLXXXL   TribalChildWelfare.Ȋ\ \  ӌX ЌXLXXLXLXXL   m XLXXXLXLXXXL  m!^     Thebudgetwillinclude$5millionin h FosterCareandAdoptionAssistanceforatwotieredapproachtolookingatTribalchildwelfareprograms. XLXXXLHHSplansto 8 conductacomprehensiveassessmentofIndianchildwelfareprograms,focusingontheirstrengthsandthechallengestheyfaceinprovidingtheservices,protectionsandproceduralrequirementsassociatedwiththeFederalfostercareprogram.Inaddition,weproposetomakegrantstoalimitednumberoftribestoenablethemtostrengthenthecapacityoftheirtribalchildwelfareprogramsbyaddressingissuessuchasstafftrainingandretention,licensingoffostercarehomes,conductingcriminalbackgroundchecksofprospectivefosterandadoptiveparents,operatingcasereviewsystems,anddevelopingautomateddatacollectionsystems.Webelievethattheseeffortswillenableustodevelopimprovedtechnicalassistancetotribes,betterassessfuturepolicydirections,anddevelopmodelsforstrengtheningtribalchildwelfareprogramsonalargerscale.m!^ ^ ݌ XLXX XLXLXXXLXLXXXL  /XLXXXXgJXXLp_ /m XLXXXLXLXXXL  mc     mc xd ݌ 0*', Ќ XLXXXLXLXXXL  +XLXXXXgJXXL++jXXXXLXLXXX   XLXXXL   +jle   PromotingSafeandStableFamilies+jle e  ӌ X, ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mf  D   TheAdoptionandSafeFamiliesActof h. 1997reauthorizedandexpandedthePromotingSafeandStableFamiliesprogram(formerlyknownastheFamilyPreservationandSupportprogram).TheFY2001requestincludes$305million,a$10millionincreaseoverFY2000,forStatesandeligibleIndiantribes.mf g ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mi  D   ThePromotingSafeandStableFamilies @ 6 programsupportsStatechildwelfareagenciesandtribesinproviding:familypreservationservices,familysupportservices,timelimitedfamilyreunificationservices,andadoptionpromotionandsupportservices.mi Aj ݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXLAe /m XLXXXLXLXXXL  mWl  D    p mWl l ݌̌ XLXXXLXLXXXL  +XLXXXXgJXXL++jXXXXLXLXXX  XLXXXL   +jm   SocialServicesBlockGrant+jm Kn  ӌ h> ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m4o  D   TheSocialServicesBlockGrant (@ (SSBG)allowsStatestheflexibilitytoprovideorsupplementsocialservicesattheStateandLocallevels.SSBGfundingprovidesdirectsocialservicesandresourcesthatlinkhumanservicedeliverysystemstogether.ProgramsorservicesmostfrequentlysupportedbySSBGincludechildcare,childwelfare(fostercare,adoptionandprotectiveservices),eldercare,drugabusepreventionandtreatmentactivities,homebasedservices,employmentservices,preventionandinterventionprograms,andservicesforthedisabled.m4o o ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mr  D   mr s ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j]t   SSBGLegislativeproposal+j]t t  ӌ 8"O ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mu  D   TheFY2001PresidentsBudget #H!Q requestsfundingat$75millionabovetheauthorizationlevelsetintheTransportationEquityActforthe21stCenturyof p&$T $1.7billionforthisprogram.ThisincreasewouldmaintainSSBGattheFY2000levelof$1.775billionstabilizingfundingforthesecriticallyimportantprograms.Ofthisamount,$25millionwillbeavailabletosupportsecondchancehomesforteenparentsandtheirchildrenwhocannotliveathomeorwithotherrelatives.mu kv ݌ -+\ Ќ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +jgy   AFDCandRelatedPrograms+jgy y  ӌ X ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mz     WelfarereformreplacedtheAidto h FamilieswithDependentChildren(AFDC)Benefits,StateandLocalAdministration,EmergencyAssistance,AFDCChildCare,andJobOpportunitiesandBasicSkillsTraining(JOBS)programswithTANFandtheChildCareEntitlementprograms.mz u{ ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  mk}     DuringFY2001,weexpectto P   completelyphaseoutfundingfortherepealedprograms.EstimatesforFYs1999  and2000representclaimsforexpendituresincurredbeforetheseprogramswererepealed.Theseclaimswillbefundedbycarryoverbalancesfromprioryears.mk} ~ ݌̌ XLXXXLXLXXXLXLXXXL     `   X 5@(#(#X@ٗ 5  h #  XXXXLXu=XXXe&eXXu=  #ᄪ @     FY2001PROPOSEDACFLEGISLATION#ᄪ 0  U   X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  @BB (dollarsinmillions/1)  k pVl< ,(`~0hS% `'/EhS%hS%eP%Ep (#(#                                         (#(#op AZ') /HxdE /HxA;D   -S+. <D`'  XXXXLXu=XXXe&eXXu=  `'Ԉ @    ݀CHILDSUPPORTENFORCEMENTOVERVIEW:AZ')HxdEHxA`'Ԉ Z     X Ќ̌eq eee&eq e eeqXLX eeq  #  XXXXLXu=XXXe&eXXu=  #ᄨ @P P      CollectionsandCosts#ᄨ .  S    AZ') HxdEHxAeq eee&eq e eeqXLX eeqԌ  Ќ  @BB (dollarsinmillions) /1  qp (pVs<,(`~1 "  `."E xx8p :Fp (#(#                          (#(#AZ')H`dEZ"H`A/XLXXXXgJXXLm /+XLXXXXgJXXL+  [" # #  XXXXLXu=XXXe&eXXu=  #= @ss    ACFOVERVIEW:ENTITLEMENTSPENDING#= Ñ     X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  @* @BB(dollarsinmillions) /1 [ pVv< ,(`~1N `. !Ea>(8Gp (#(#                        (#(#yp AZ') HxdHEHxA<Gs   S =D#  XXXXLXu=XXXe&eXXu=  9,X, X,X, X9#ᄢ @      ADMINISTRATIONONAGING#ᄢ a     X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  @  (dollarsinmillions)  k  (#(#       (#(#|AZ') GxdE GxA   pV~<B,(`~0 Uz! `.ExAxAYbHp߰+jXXXXLXLXXX  XLXXXL   (X@(#(#(+j՛   Summary+j՛  ӌ   ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  9,X,` X,X, X9m[     TheFY2001budgetrequestforthe y!  AdministrationonAging(AoA)is$1.1billion,anincreaseof$151million,or16percentoverFY2000.TheincreasewillallowtheAgencytorespondtotheneedsofournationsgrowingolderpopulation.Since1900,thenumberofAmericanssixtyfiveandolderhasgrownfrom3millionto34million.TheCensusBureaupredictsthatthisnumberwillincreaseto70millionby2030whenthelastmembersofthe BabyBoomgenerationreachestheageofsixty-five.m[ 2 ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m     AoAsgoalistoimprovethequalityof Q lifeforallolderAmericansbyhelpingthemtoremainindependentandproductive.ThroughtheOlderAmericansAct,fundsaredistributed!primarilybyformula!throughanationwidenetworkofState,TribalandAreaAgenciesonAging,tosome27,000localserviceproviders.AoAfundsalsosupportserviceanddeliverysysteminnovationstomoreeffectivelyassistolderpersonsandtheirfamilies.m ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m`     m` ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +jҥ   FosteringIndependence+jҥ [  ӌ &$( ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m?     TitleIIIoftheOlderAmericansAct Q(%* providesforthedevelopmentofsystemsofsupportiveserviceswhichofferacontinuumofcaretoenableolderindividualstomaintainmaximumindependenceinahomeenvironment.AoAisproposingtoincreasefundingforSupportiveServicesby -+0 $140million,45percentaboveFY2000.Oftheadditional$140millionrequested,$125millionisfortheprovision,throughSubtitleD,ofsupportiveserviceswhichwillassistfamilieswhocareforolderrelativesand$15million,throughSubtitleB,isforcoreSupportiveServices.m? ݧ ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m  D   m ݌̌ (#(#(#(# XLXXXLXLXXXLXLXXXL  Some3to 98 4millionolderindividualsrelyoncarefromfamilyandclosefriendstoremainathome.F62h~71< p E"PPb IF62h~71< p E"PPb IF62h~71< p E"PPb IF62h~71< p E"PPb I 6  If 1> formalserviceswere !? usedinstead, (#(#(#(#theywouldcostbetween$45billionand$75billionannually.m XXXXLXLXXXXLXXXL  m8  D   Halfofallcaregiversarethemselves C overtheageof65.Themajorityarewomen,andonethirdofallcaregivershavefulltimejobs.Researchshowsthattheirratesofdepressionaresignificantlyhigherthannoncaregiversofthesameage.Withthe$125millionrequested,AoAestimatesthatqualityrespitecareandothersupportiveservices!teachingcaregiverstomanagewanderingandagitatedbehaviorinlatestateAlzheimersDisease!couldbeprovidedto250,000families.m8 ְ ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m  D   The$15millionrequestedforcore !+(O SupportiveServices!SubtitleB!willsupport:informationandreferral;transportationandescortservices;chore, -+R homemakerandpersonalcareservices;andtheprovisionofadultdaycare.Withtheadditionalfundsrequested,AoAexpectstoprovidemorethansixmillionadditionalrides,2millionadditionalhoursofhomemakerandpersonalcareservicesand845,000additionalhoursofadultdaycare.m H ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m     m ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +jt   StateandLocal   Innovations"Mentalhealth  p  Services+jt  ӌ̌XLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  L<8j~71o< p @Eo @ 8RJL<8j~71o< p @Eo @ 8RJL<8j~71o< p @Eo @ 8RJL<8j~71o< p @Eo @ 8RJm     Olderpeoplecommitsuicide50percent     moreoftenthanthoseundersixty-five.AccordingtotheSurgeonGeneralsReportonMentalHealth,depressionistheleadingriskfactorforsuicideinolderadultsbutisneitherwellrecognizednortreated.m  ݌̌ XLXXXLXLXXXLXLXXXL  }  m XXXXLXLXXXXLXXXL  ݀mC     AoAis @ requestinganincreaseof   $5millionaspartofaDepartmentwideMentalHealthInitiative.FundswillbeusedtotraintheAgingNetworktobeabletodetect,refer,andprovidesupportivelinkagesandotherservicestoassistpersonstoreceivehelpfromprofessionalsinthementalhealthsystem.Additionally,fundswillbeusedtoworkwiththementalhealthsystemonthedestigmatizationofmentalillnessamongolderadults.FundingformentalhealthisrequestedthroughtheStateandLocalInnovationsprogram.mC ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  ݀m     m ݌ P(%) Ќ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL   +j   GrantsForNativeAmericans+j  ӌ @)&* ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m     Thebudgetincludesanadditional *P(, $5million,or26percent,toprovidemealsandsupportiveservicesforNativeAmericans.Tribalorganizations,and x- +/ organizationsservingNativeHawaiians,areeligibletoreceivefundsdirectlyfromAoAunderTitleVIoftheOlderAmericansAct.BecausetheyreceivelessfundingfromState,Tribalandprivatesources,andsmallercontributionsfromthosetheyserve,theseorganizationsaresignificantlymoredependentonAoAfortheirfunds.AoAprovides73percentoffundingforTribalgranteehomedeliveredmeals.Theadditional$5millionwillallowgranteestorespondtoagrowingpopulationofNativeAmericanelders.Tribalgranteesreporta20percentincreaseinthenumberofelderseligibleforservicesbetween1996and1999.Theadditionalfundingwillincreasethenumberofmealsservedby307,000foratotalof3.1millionmeals.m ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m  D   m ݌̌ XLXXXLXLXXXLXLXXXL  +jXXXXLXLXXX  XLXXXL     +j|   NutritionPrograms+j|   ӌ (B ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m  D   Thebudgetincludesarequestof 8D $522millionforcongregateandhomedeliveredmeals,thesameleveloffundingasinFY2000.Thenutritionprogramshavebeenshowntobeeffectiveinimprovingthenutritionalstatus,andtherebytheoverallhealth,oftheirparticipants.Participantsintheseprogramshavecharacteristicsplacingthematincreasednutritionalandhealthrisk.Comparedwitheligiblenonparticipants,theyareolder,poorer,morelikelytolivealoneandmorelikelytobemembersofracialorethnicminoritygroups.SinceFY1997,fundingfornutritionprogramshasincreasedby11percent.FY2001fundingwillallowthepurchaseof279millionmeals,anincreaseof43millionoverthenumberofmealsservedinFY1997,themostrecentyearforwhichdataisavailable.m ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m  D   m 5 ݌̌ XLXXXLXLXXXLXLXXXL  /  +jXXXXLXLXXX  XLXXXL   +j7   OtherAoAPrograms+j7  ӌ P(%X ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  m  D   Thebudgetrequestalsoincludes )`'Z $16millionforPreventiveHealthServices,$13millionforVulnerableOlderAmericans,and$6millionfortheAlzheimersDiseaseprogramwhichwas x- +^ transferredfromtheHealthResourcesandServicesAdministrationinFY1999.TheseactivitiesareallfundedattheirFY2000levels.m > ݌̌ XLXXXLXLXXXLXLXXXL  m XXXXLXLXXXXLXXXL  m{     Atotalof$17millionisrequestedfor  ProgramAdministration,anincreaseof$1millionoverFY2000.TheadditionalfundswillallowAoAtohireadditionalstafftoincreaseitsabilitytodisseminateinformation,especiallythroughtheNationalAgingInformationCenter;providebettertechnicalassistancetoStates;andimprovedataanalysisforperformancemeasures.Theincreasewillalsosupportincreasedpaycostsforexistingstaffandfundadditionaladministrativeandsupportservices.AoAwillalsoexpandthenumberofprogramstafffundedthroughtheOperationRestoreTrustprograminordertofulfillincreasedresponsibilitiesindetectinghealthcarefraudandabuseagainstseniors.m{  ݌  Ќ XLXXXLXLXXXLXLXXXL   X 5@(#(#X@^ 5 #     #  XXXXLXu=XXXe&eXXu=  #h @$    AOAOVERVIEW#h     X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  @  (dollarsinmillions)  k pV<K,(`~1    `.Eexx[[OKp (#(#                      (#(#xAZ') TxdETxA=Sk    >D#  XXXXLXu=XXXe&eXXu=  _J9,X,X,X,` X9#e @Y Y     DEPARTMENTALMANAGEMENT#e 5  Z   X AZ') HxdE#HxAeq eee&eq e eeqXLX eeqԌ $ Ќ  pV<D,(`~0 6~{ `. ExVxVLp@  (dollarsinmillions)  k m XXXXLXLXXXXLXXXL  m=     = ݌̌ (#(#        (#(# XLXXXLXLXXXL  AZ') HxdzE HxA  s  +jXXXXLXLXXX  XLXXXL   (X@(#(#(+j   Summary+j  ӌ   ЌXLXXLXLXXLXLXXL  m XXXXLXLXXXXLXXXL  mh     DepartmentalManagement(DM) j consolidatesactivitiesfundedundertwoappropriationaccountsintheOfficeoftheSecretary:GeneralDepartmentalManagement(GDM)andPolicyResearch.TheFY2001budgetrequestprovidesaprogramlevelof$330millionforDepartmentalManagement,includinganappropriationof$246million,intra-agencytransfersof$21millioninonepercentevaluationfunds,$60millioninbioterrorismfundsand$3millioninhealthcarefraudandabusefunds.#XLXXXL #XLXXXLԀmh  ݌ R Ќ XLXXXLXLXXXLXLXXXL  /XLXXXXgJXXLL /m XLXXXLXLXXXL  mY     +XLXXXXgJXXL+mY ݌̌ XLXXXLXLXXXLXLXXXL  /XLXXXXXXL /+jXLXXXL  XLXXXL   ?  +j   GeneralDepartmentalManagement+j  ӌ 2 ЌXLXXLXLXXL  m XLXXXLXLXXXL  ml     TheGDMaccountsupportsthose   activitiesassociatedwiththeSecretary'srolesaschiefpolicyofficerandgeneralmanageroftheDepartmentinadministering,andoverseeingtheorganization,programsandactivitiesoftheDepartment.TheseactivitiesarecarriedoutthroughnineStaffDivisions(STAFFDIVs),includingtheImmediateOfficeoftheSecretary,theDepartmentalAppealsBoard(DAB),andtheOfficesofPublicAffairs,Legislation,PlanningandEvaluation,ManagementandBudget,IntergovernmentalAffairs,General Counsel(OGC),andPublicHealthand "+(-    Science(OPHS).TheGDMbudgetrequestforFY2001totals$313million,anincreaseof$23million(8percent)fromtheFY2000enactedlevel.ml ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m  D   TheFY2001budgetrequestincludesa j1 totalof$13.5millionforOGCsandDABseffortsunderthePresident'sNursingHomeInitiative(NHI),toimprovethequalityofnursinghomecareinthiscountry.WorkingwiththeHealthCareFinancingAdministration,OGCwillusetheaddedfundstoprovidelitigationsupportforaincreasenumberofsanctionsagainstnursinghomesthatviolatepatienthealthandsafetyrules.Asaresultofappealsbythenursinghomesagainstsuchsanctions,bothDAB'sjudicialhearingscaseloadandOGC'sadministrativeandcourtlitigationworkloadswillcontinuetoexpanddramatically.TherequestedfundingincreasewillensureadequateOGCandDABstafftohandletheseworkloadsinatimelyandefficientmanner,andtodecreasecurrentcaseloadbacklogs.m , ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m  D   OPHS,thelargestGDMSTAFFDIV,is %*#E headedbytheAssistantSecretaryforHealth/SurgeonGeneral,whoservesassenioradvisortotheSecretaryonpublic  healthandscienceissues.TheASH/SGalsoexercisesmanagementresponsibilityfortenOPHSoperationalprograms,includingthefollowing:m ݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m  D   m  ݌ -*M Ќ XLXXXLXLXXXL  .Ȋ  .Ȋ 0  XLXXXLXLXXXL      OfficeofMinorityHealth.Ȋ  ӌX ЌXLXXLXLXXL   m XLXXXLXLXXXL  m:     Therequestincludes$39millionto h improvediseaseprevention,healthpromotion,andhealthservicedeliveryfordisadvantagedandminorityindividuals.ThisfundingalsosupportsresearchtoimprovethehealthstatusofracialandethnicminoritypopulationsintheUnitedStates,whichcontinuestolagbehindthehealthstatusoftheAmericanpopulationasawhole.InadditionthesefundswillsupportactivitiesaimedatreducingtheriskofacquiringortransmittingHIV/AIDS,andatincreasingaccesstoservicesandtreatment.m: ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m  ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ 0  XLXXXLXLXXXL   OfficeonWomen'sHealth.Ȋ   ӌ ЌXLXXLXLXXL   m XLXXXLXLXXXL  m     Therequestof$16millionprovides H fundingtoadvancewomen'shealthprogramsthroughthepromotionandcoordinationofresearch,servicedelivery,andeducationthroughoutHHSagenciesandoffices,withothergovernmentorganizations,andwithconsumerandhealthprofessionalgroups.Thisrequestincludesa$1million(6percent)increaseovertheFY2000enactedlevel.m  ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m Q ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ 0  XLXXXLXLXXXL     OfficeofEmergencyPreparedness.Ȋ !  ӌ@ ЌXLXXLXLXXL   m XLXXXLXLXXXL  m[     Thebudgetrequestof$12millionwill  beusedtomanageandcoordinatethehealth,medicalandhealthrelatedsocialservicesthatareprovidedbytheFederalgovernmenttovictimsofcatastrophicdisastersthroughtheFederalResponsePlansEmergencySupportFunction(ESF)#8.UnderESF#8,HHScoordinatesthesupportoftwelve  Federalagenciesinthepreparednessfor,responseto,andrecoveryfromnaturalandman-madedisasters.m[ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mg     AlsoinFY2001,OEPwillcontinueto P(%* carryouttasksfromtheNationalSecurityCounciltoassessandremedyanyshortfallsinthehealthandmedicalconsequenceresponsecapabilitiesthatwillbenecessaryintheeventofaterroristuseofaweaponofmassdestruction,whetherchemical, -+0 biologicalornuclear.FundingforthesebioterrorismactivitiesareincludedinthePublicHealthandSocialServicesEmergencyFund.mg ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mm  D   mm  ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ 0 D XLXXXLXLXXXL     OfficeofPopulationAffairs.Ȋ   ӌ5D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m  D   Therequestof$8millionprovides p7 supportfortheAdolescentFamilyLife(AFL)DemonstrationandResearchprogramauthorizedunderTitleXXofthePublicHealthServiceAct.Throughthesegrants,AFLprovidesfundingforthreeareas:caredemonstrationprojects,preventionprojects,andresearchprojects.Inaddition,OPAadministerstheFamilyPlanningprogramunderTitleXofthePublicHealthServiceAct(thisprogramisfundedthroughtheHealthResourcesandServicesAdministration).m q ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m*  D   m*  ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ^ 0 D XLXXXLXLXXXL     OfficeofDiseasePreventionand 8E HealthPromotion.Ȋ^ y  ӌ D(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m  D   Thebudgetrequestof$8million H includesanincreaseof$4million(100percent)overtheFY2000enactedlevel.ThesefundswillsupporttheimplementationoftheSecretarysinitiativetopromotehealthandpreventdiseaseanddisabilitythroughHealthyPeople2010.m P ݌̌ XLXXXLXLXXXL    m XLXXXLXLXXXL  mX  D   mX  ݌̌ XLXXXLXLXXXL  .Ȋ  .Ȋ 0 D XLXXXLXLXXXL     HealthInformaticsInitiative.Ȋ   ӌhPD(#D(# ЌXLXXLXLXXL   m XLXXXLXLXXXL  m  D   TheGDMrequestalsoincludes  xR $20milliontoimplementanewHealthInformaticsInitiative.ThisInitiativeencompassesapowerfulsetofcrosscuttingandagencyspecificinvestmentsininformationsystemsandhealthdata,aimedatstrengtheningtheinformationbasefordecisionmaking.TheInitiativeensuresthatHHSswealthofhealthinformationandinformationsystemsresourcesarecoordinatedandprioritized,enablingHHStoenhanceitsroleasaleaderinthedevelopment,use,anddisseminationofhealthinformation.TheInitiativeincludesHHSeffortsaimedat:m ] ݌ -+` _Jv9X  ь XLXXXLXLXXXL  m XLXXXLXLXXXL  m!     m! '" ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  D  : " 0  2C3  0  developing,adoptingand ) implementingnationaldatastandards;: " #  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m4%     m4% % ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : h& 0  2C3  0  assuringsecureandconfidential  electronictransmissionofhealthinformationwithinthepublichealthandhealthcaredeliverysystems;: h& '  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m(     m( \) ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : * 0  2C3  0  strengtheninghealthinformation  `  confidentialityprotection;: * *  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m:,     m:, , ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : n- 0  2C3  0  enhancingthecapacityoffederal, i0  Stateandlocalpartnerstoparticipateinthenextgenerationofhealthinformationsystems;: n- .  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m/     m/ [0 ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 1 0  2C3  0  developingimprovedmethodsand  tools;: 1 1  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m"3     m"3 3 ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : V4 0  2C3  0  providingpublicaccesstorelevant  healthdataandinformation;and: V4 4  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m6     m6 7 ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : 7 0  2C3  0  investigatingthepotentialusesof  informationtechnologyinreducingdeathsandinjuriescausedbymedicalerrors.: 7 _8  ӌ  ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m:     m: : ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mN;       TheInitiativesultimategoalisto i0 improvepatientcareandhealthoutcomesthroughtheefficientandeffectiveuseofdataandinformation.mN; ; ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m2=     m2= = ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jf>   PolicyResearch+jf> >  ӌ #" ЌXLXXLXLXXL  m XLXXXLXLXXXL  m?     TheFY2001budgetrequestforDM $H!$ alsoincludes$17millionforthePolicyResearchaccount,tosupportresearchonissuesofnationalsignificance.PolicyResearchexaminesbroadissuesthatcutacrossagencyandsubjectlines,aswellasnewpolicyapproachesdevelopedoutside thecontextofexistingprograms.m? @ ݌ +'+ Ќ XLXXXLXLXXXL  m XLXXXLXLXXXL  m0B  D   Pri   orityissuesthatwillbeexaminedare 9+ thoserelatedtowelfarereform,healthcareinsurancereform,familysupportandindependence,poverty,at-riskchildrenandyouth,aginganddisability,sciencepolicy,andimprovedaccesstohealthcareandsupportservices.m0B B ݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mD  D   mD #E ݌  2 Ќ XLXXXLXLXXXL  e #  5@(#(#Xek 5#   Xu=XXXLe&eXXu=  #^F @    DEPARTMENTALMANAGEMENTOVERVIEW#^F F  F   9 AZ') HxdEeHAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions) L  pV< ,(`~1 J!} `.h(Ee<YMp efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efefpe AZ')k#Hd= Ek#HA>D   l!3  ?D`'  Xu=XXXLe&eXXu=  `'L @    PUBLICHEALTHANDSOCIALSERVICESAZ')bTxdEbTxA`'L fM  M   9 Ќ̌eq eee&XLX eeq  `'  Xu=XXXLe&eXXu=  `'N @#    |ԀEMERGENCYFUND`'N N  O   | Ќ̌eq eee&XLX eeq  !M pV<K,(`~1s  `. Es  (n"Np@ (dollarsinmillions) p_  !  efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efefAZ')QTdEQTA+jXLXXXL  XLXXXL   +j#R   (X@e(#e(#(Summary+j#R R  ӌ a( ЌXLXXLXLXXL  m XLXXXLXLXXXL  mkS     TheFY2001PresidentsBudgetrequest  provides$265millioninthePublicHealthandSocialServicesEmergencyFund(PHSSEF).mkS S ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m5U     ThePHSSEFFY2001budgetrequestof P $265millionincludes:$209millionforavarietyofactivitiesintheDepartmentsCounteringBioterrorisminitiative;$50milliontocontinuetoaddresstheAIDScrisisfacingminoritycommunities;$4millionfortobaccolitigationsupportattheDepartmentofJustice(DoJ);and$2millionforcriticalinfrastructureprotectionactivities.m5U U ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mW     mW }X ݌̌ XLXXXLXLXXXL  F  +jXLXXXL  XLXXXL   +j`Y   CounteringBioterrorism+j`Y Y  ӌ !! ЌXLXXLXLXXL  m XLXXXLXLXXXL  mZ     Becauseterrorismisanation-widethreat, A# # programsandactivitiestoaddressandrespondtothisthreatareapartofagovernment-wideeffort.HHShastheresponsibilitytomeetthepublicandmedicalneedsassociatedwithterroristevents.mZ [ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m\     TheFY2001requestforthePHSSEF (%) includesatotalof$209millionforthecontinuationofHHSantibioterrorismefforts.Thesefundsareintendedto:m\ J] ݌̌ XLXXXLXLXXXL    .*/ : L 4(*-/0123Ch3)LXLXXXL  : ^ 0  2C3  0J(#(#  ݀improveandenhancethenations a(/ publicsurveillancenetwork!bystrengtheningourdetection,epidemiological,laboratoryandelectroniccommunicationcapacities;: ^ e_  ӌ J(#J(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mTa     mTa a ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : b 0  2C3  0J(#(#  ݀strengthencapabilitiestoprovidea 5 medicalandpublichealthresponsetochemicalandbiologicalweaponsattacks;: b -c  ӌ J(#J(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  md     md he ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : f 0  2C3  0J(#(#  createandmaintainastockpileof x: pharmaceuticals,vaccinesandothermaterialsforcivilianuseifmassivetreatmentisneeded;and: f f  ӌ J(#J(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mh     mh i ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Ch3)LXLXXXL  : i 0  2C3  0J(#(#  accelerateresearch,developmentand a!(? regulatoryreview/approvalofrapiddiagnostics,antibiotics/antiviralsandvaccines.: i ij  ӌ J(#J(# ЌL )#3h4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m+l     m+l l ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m_m     ThefundsinthePHSSEFareallocatedto &"D theOfficeofEmergencyPreparednessandtheCentersforDiseaseControlandPrevention.InadditiontothefundsrequestedforBioterrorisminthisaccount,theNationalInstitutesofHealthhasrequested$45millionforresearchactivitiesinFY2001andtheFoodandDrugAdministrationisrequesting$12millionfor -X*L XLXXXLexpeditiousdevelopmentandlicensureof 9 new/improvedvaccinesforanthraxandbotulinum.#XLXXXLo #Ԁm_m m ݌  Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jp   AidsinMinorityCommunities+jp Uq  ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m r     TheFY2001requestincludes a( $50millionspecificallytargetedtoaddressHIV/AIDSprevention,treatmentandinfrastructure/capacitydevelopmentneedswithintheAfrican-Americanandotherracialandethicminoritycommunities.ThesefundsallowtheDepartmenttocontinuetoinvestininitiativesthatwillcreateasoundfoundationtoachieveadurableandsustainableresponsetoreducetheburdenofHIV/AIDSinracialandethnicminoritypopulations.FundsfromthePHSSEFareallocatedtoleadhealthagenciestocomplementongoingefforts.m r r ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mu     mu v ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jv   Year2000ComputerConversion+jv -w  ӌ H ЌXLXXLXLXXL  m XLXXXLXLXXXL  mw     TheFY2001budgetrequestsnofunds  forY2Kactivities.AllfundsremainingfromFY1999andallfundsprovidedinFY2000willenabletheDepartmenttocompleteitsY2Krelatedactivitieswithnoadditionalfundingrequirements.mw xx ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m-z     m-z z ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +ja{   TobaccoLitigationSupport+ja{ {  ӌ y@ ЌXLXXLXLXXL  m XLXXXLXLXXXL  m|     TheFY2001requestincludes$4million  fortobaccolitigationsupport.ThesefundswillprovidelitigationsupporttotheDepartmentofJusticeforresearch,documentmanagementinsuitsagainstUStobaccocompaniesseekingcompensationforthecostoftobaccorelatedillnessbornebyFederalhealthprograms.m| } ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     ݀m  ݌ a&(#' Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j\     CriticalInfrastructureProtection+j\ ƀ  ӌ Q'$( ЌXLXXLXLXXL  m XLXXXLXLXXXL  m     Finally,theFY2001PresidentsBudget (%* requestforthePHSSEFincludes$2millionforactivitiesassociatedwiththepublichealthinfrastructuresuchas:m " ݌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m  ݌ y,@). Ќ XLXXXLXLXXXL  L 4(*-/0123Ch3)L: L 4(*-/0123Chh4(*-/0123LXLXXXL  &   : ' 0  2C3  0J(#(#  developingahospitalandhealthcare 9. systemthatlinkstotransportation,publicsafetyandemergencymedicalsystemsforuseduringtransportationincidents,naturaldisasters,heatwaves,terroristeventsandmedicalemergencies;'9̅ Ԁ: '  ӌ J(#J(# ЌL 4(*-/0123Chh4(*-/0123LXLXXXL  m XLXXXLXLXXXL  m&     m& ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Chh4(*-/0123LXLXXXL  : Z 0  2C3  0J(#(#  assistingpublicsafetyandhealth  6 officialsintheassessment,mitigation,andprotectionofthreatstowatersystems;and: Z  ӌ J(#J(# ЌL 4(*-/0123Chh4(*-/0123LXLXXXL  m XLXXXLXLXXXL  mË     mË B ݌̌ XLXXXLXLXXXL  : L 4(*-/0123Chh4(*-/0123LXLXXXL  : 0  2C3  0J(#(#  developingweaponsofmass i0 ; destruction(WMD)agentandWMDmasscasualtysurvivablefacilities.:  ӌ J(#J(# ЌL 4(*-/0123Chh4(*-/0123LXLXXXL   9> 5@e(#e(#X@eR 5#  Xu=XXXLe&eXXu=  #ᄎ @zz#    PHSSEFOVERVIEW#ᄎ     9 AZ') HxdEeHAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions)  L pV<,(`~1 F$, `.Ee//<YOp efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efefpe AZ') HxdzEeHA  ?D4    @D#  Xu=XXXLe&eXXu=  #ᄁ @     OFFICEFORCIVILRIGHTS#ᄁ     9 AZ') HxdEeHAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions)  L pV<,(`~0 w `.U E:eYPp efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efefpe          A  m     u AZ') GxdtEeGA S  +jXLXXXL  XLXXXL   (X@e(#e(#(+j   Summary+j  ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  mE     TheFY2001budgetrequestforthe * OfficeofCivilRights(OCR)is$24million,anincreaseof$2millionovertheFY2000level.OCRisresponsibleforenforcingcivilrightsstatutesthatprohibitdiscriminationinFederallyassistedhealthcareandsocialservicesprograms.Thesestatutesprohibitnondiscriminationonthebasisofrace,nationalorigin,disability,age,andinlimitedinstances,sexandreligion.mE ě ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m4     Amongthemostsignificantissuesthat Q OCRaddressesaretheeffectsofdiscriminationonracialdisparitiesinhealthcare;implementationoftheSupremeCourts1999decisionintheOlmsteadcase J   concerningtheprovisionofservicesinthemostintegratedsettingtopersonswithdisabilities;nondiscriminatoryimplementationofTemporaryAssistancetoNeedyFamilies(TANF)andwelfaretoworkprograms;assessmentoftheeffectsofmanagedcareonservicestominorityanddisabilitycommunities,andremovalofdiscriminatorybarrierstoaccessforimmigrantpopulations.m4 ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mۡ     OCRalsoimplementsinterethnic *a'+ adoptioncivilrightsrequirementsintendedtopreventracialandnationalorigindiscriminationinfostercareandadoption j-1*. placements.Inaddition,OCRcoordinatesimplementationoftheregulationthatprohibitsdiscriminationagainstpersonswithdisabilitiesinprogramsandactivitiesconductedbyHHS.OCRalsocoordinatesgovernmentwideenforcementoftheAgeDiscriminationAct.mۡ Z ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mݤ     OCRenforcesnondiscrimination R5 requirementsbyprocessingandresolvingdiscriminationcomplaints,conductingreviewsandinvestigations,monitoringcorrectiveactionplans,andcarryingoutvoluntarycompliance,outreachandtechnicalassistanceactivities.EachofOCRscomplianceactivitiesensuresthatindividualsaretreatedinanondiscriminatorymannerbyhealthandhumanservicesprovideragenciesorfacilities.OCRsworkprotectsindividualrightsandsimultaneouslysupportsHHSgoalsforimprovingthehealthandwellbeingofindividuals,familiesandcommunities.mݤ \ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  my     ThemajorityofOCRsFY2001budget b&)#D increaseisintendedtoensurethatcivilrightsandnondiscriminatoryaccesstohealthcareandservicesareanintegralpartoftheDepartmentsinitiativetoeliminateracialdisparitiesinhealthcare.Thisbudgetrequestsupportsasignificantqualityaccessimprovementinitiativedesignedtoeliminateracialdisparitiesandimprovethequalityof -*L healthcareforracialandethnicminorities.TherequestwillenableexpansionofaninitiativeundertakeninNassauCounty,NewYorktofiveadditionalregions.TheinitiativeusesTitleVIoftheCivilRightsActof1964todeterminethepotentialroleofracialdiscriminationintheapparentracialdisparitiesinaccesstoandqualityofhealthcare.InFY2001,OCRwillexpandasmallLosAngelesfieldofficetobeopenedinlateFY2000.LosAngelesisbyfarthelargestU.S.metropolitanareainwhichOCRdoesnotcurrentlyhaveaphysicalpresence.Throughthisoffice,OCRwillbeabletoserveaverydiversepopulationbyaddressingtheprioritycivilrightsissuesnotedabove.my ݌ 9 Ќ XLXXXLXLXXXL   9 5@e(#e(#X@eg 5 LY  @D*}    AD#  Xu=XXXLe&eXXu=  #/ @      OFFICEOFINSPECTORGENERAL#/     9 AZ') HxdEeHAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions)  L nV:R*&`> (e  `.Eea  Y Qn efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efefAZ')<dE[<A \# +jXLXXXL  XLXXXL   +j{   ([X@e(#e(#(Summary+j{  ӌ N ЌXLXXLXLXXL  m XLXXXLXLXXXL  mô     ForFY2001,theOfficeofInspector  General(OIG)requestsadiscretionaryappropriationof$34million,anincreaseof$3millionabovetheFY2000discretionarylevel.TheOIGwillalsoreceivebetween$120and$130millioninFY2001fromtheHealthCareFraudandAbuseControl(HCFAC)AccountforMedicarerelatedfraudandabuseactivities.mô B ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mg     TheOIGsstatutorymissionisto: _& improveHHSprogramsandoperationsandprotectthemagainstfraud,wasteandabuse.Byconductingindependentandobjectiveaudits,evaluations,andinvestigations,OIGprovidestimely,useful,andreliableinformationandadvicetoHHSofficials,theAdministration,theCongressandthepublic.mg ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     IntheFY20002001period,theOIGwill %"& focusonthefollowingprogrampriorities:m ~ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m  ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jμ   IncreasingCollectionsIntheChild (v%) SupportEnforcementProgram+jμ 8  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m&     OIGwillexpanditsmultiagencytask +', forcestoidentify,investigate,andprosecuteindividualswhowillfullyavoidtheirpaymentoftheirchildsupportobligationsunderthe -*/ ChildSupportRecoveryAct.ThesetaskforceswillbringtogetherStateandlocallawenforcementandprosecutors,UnitedStatesAttorneysOffices,theOIG,MarshallServicespersonnel,theFBI,Stateandcountychildsupportpersonnel,andallotherinterestedpartiesfromthe18statescoveredbythetaskforces.AsofDecember1999,OIGhasopened860childsupportcasesnationwide,whichhaveresultedin173convictions,andcourtorderedrestitutionofover$11.2millioninpaymentstocustodialparents.m& ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m:  D   m: ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jn   ChildSupport+jn  ӌ !n= ЌXLXXLXLXXL  m XLXXXLXLXXXL  m  D   OIGwillexamineawiderangeofchild #? supportissues,includingreviewingtheoperationoftheexpandedFederalParentLocatorService,theperformanceandeffectivenessofthenewNationalDirectoryofNewHires,andtheFederalCaseRegistryofchildsupportorders.Inaddition,OIGwilllookattheeffectivenessoftheUniformInterstateProtocolincollectingchildsupportacrossStatelines.OIGreviewswillalsoexaminemethodsforincreasingchildsupportcollections.m  ݌ _-&*J Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j     Safe,AvailableandAffordableChild 9 Care+j =  ӌ̌XLXXLXLXXL  m XLXXXLXLXXXL  m!     OIGwillexaminesubsidysystemsfor X childcare,focusingonissuessuchashealthandsafety,licensingstandardsandfraudandabusepotential.Attentionwillfocusonimprovingqualityofcareprovidedtochildrenandlowincomeworkingfamilies.OIGwillidentifyopportunitiestopreventabuseofdisabledchildrenininstitutions,nursinghomes,andgrouphomes.m! ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m Z ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   TANFProgram+j y  ӌ   ЌXLXXLXLXXL  m XLXXXLXLXXXL  m4     OIGwillworkwithFederalandState Y  officesintheirimplementationofwelfarereform.OIGwillfocusonreviewinghowFederalandstateofficesareachievingsuccessfuloutcomesandperformanceinwelfareprograms.m4 ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mU     mU ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   FosterCare+j  ӌ  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m     OIGwillperformnewinvestigativeaudit Q worktoreviewStateseffortstoidentify,investigateandprecludeabuseandneglectinfostercare.OIGwillexamineStateseffortstoensureidentificationandinvestigationofchildabuseandneglect,theStatesperformanceofbackgroundchecksonpersonshavingcontactwithchildreninfostercare,Statesmaintenanceandsharinginformationfromthechildabuseandneglectcentralregistry,andsharingofinformationwhenfosterandadoptiveparentsmovefromoneagencytoanother.m , ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +jO   PublicHealthFraud+jO  ӌ q%8"& ЌXLXXLXLXXL  m XLXXXLXLXXXL  m{     Investigationsoffraudinpublichealth &#( programsarediverse,complex,andoftencriticaltoprotectingthehealthoftheAmericanpeople.Theseinvestigationswilladdressgrantandcontractfraud,researchfraud,andotherallegationsofwrongdoing.Thisareaisofparticularinterestinviewofexpectedincreasesinprogramgrantfunding.m{ ݌ i-0*/ Ќ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j1   FinancialStatements+j1  ӌ 9/ ЌXLXXLXLXXL  m XLXXXLXLXXXL  m^  D   OIGwillperformauditsforthepurpose h1 ofexpressingopinionsonthefinancialstatementsofcertainreportingentitiesintheDepartment,asidentifiedundertheCFOActof1990andtheGovernmentManagementReformActof1994.m^ ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m  D   TheOIGhasstrengthenedits A 7 partnershipswithotherFederalAgencies,suchastheDepartmentofJusticeandtheInternalRevenueService.Also,includedintheserelationshipsareStateGovernments,ombudsmen,andtheprivatesectorincludinglocalagingorganizations,allofwhomareworkingtowardsimilargoals.OIGcontinuestoformpartnershipswiththehealthcareindustrytopublicize bestpractices,promotevoluntarycomplianceplans,establishanadverseactiondatabank,andconsultonbroadprogramintegritystrategies.Thismultidisciplinaryapproachwillcontinuetoenhancetheofficesabilitytocarryoutitsmission.m ݌ QF Ќ XLXXXLXLXXXL  5@e(#e(#[X@e 5   A  BD#  Xu=XXXLe&eXXu=  #( @     PROGRAMSUPPORTCENTER#(     9 AZ') HxdEeHAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions) L  efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efef p_ AZ') GxdtEe GA   pV<,(`~0 Z  `.A EQHYRp߰+jXLXXXL  XLXXXL   (X@e(#e(#(+j   Summary+j  ӌ   ЌXLXXLXLXXL  m XLXXXLXLXXXL  mG     TheProgramSupportCenter(PSC) J becameoperationalinFY1996andwasformedbycombiningadministrativeactivitiesformerlylocatedintheOfficeoftheSecretary(OS),andfundedbytheOSWorkingCapitalFund(WCF),withactivitiesfromtheformerOfficeoftheAssistantSecretaryforHealth(OASH),andfundedbythePublicHealthService(PHS)ServiceandSupplyFund(SSF).TheformationofthePSCresultedfromtheDepartmentsREGOIIanalysiswithagoaloffurtherstreamliningandminimizingduplicationoffunctionsintheprovisionofcosteffectiveadministrativeservicestocomponentsoftheDepartmentandotherFederalagenciesonaserviceforfeebasis.Servicesareprovidedinthreebroadareas:humanresources,financialmanagement,andadministrativeoperations.mG ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  m     m ) ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   HumanResourcesService+j H  ӌ $!% ЌXLXXLXLXXL  m XLXXXLXLXXXL  m     TheFY2001estimatedexpensesforthe b&)#' HumanResourcesService(HRS)are$44million,anincreaseof$1millionabovetheFY2000level.HRSprovidesafullrangeof personnelmanagementservicesincluding "*&+ personnelandpayrollsystemssupport;   personneloperationsservicesforcivilianandcommissionedpersonnel;trainingandcareerdevelopment;employeeandlaborrelations;andadministrationoftheBoardforCorrectionsofPHSCommissionedCorpspersonnelrecords.m ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  ma     ma ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   FinancialManagementService+j  ӌ b)3 ЌXLXXLXLXXL  m XLXXXLXLXXXL  m     TheFY2001estimatedexpensesforthe 5 FinancialManagementService(FMS)are$47million,anincreaseof$2millionabovetheFY2000level.FMSsupportsthefinancialoperationsofHHSandotherdepartmentsthroughtheprovisionofpaymentmanagementservicesforDepartmentalandotherFederalgrantandprogramactivitiessuchastheDepartmentsofState,InteriorandTreasury;accountingandfiscalservices;debtmanagementservices;andthereview,negotiationandapprovalofrates,includingindirectcostrates,researchpatientcarerates,andfringebenefitrates.m I ݌̌ XLXXXLXLXXXL  m XLXXXLXLXXXL  mT     mT ݌̌ XLXXXLXLXXXL  +jXLXXXL  XLXXXL   +j   AdministrationOperationsService+j  ӌ '$E ЌXLXXLXLXXL  m XLXXXLXLXXXL  m     TheFY2001estimatedexpensesforthe 2)%G AdministrativeOperationsServices(AOS) are$235million,anincreaseof$13million +'I abovetheFY2000level.AOSsupportsthe   administrativemanagementfunctionswithintheDepartmentintheareasofpropertyandmaterialmanagement,andsupportservicesrangingfromcommercialgraphicstomaildistributionandtelecommunicationsservices.TheTelecommunicationsImprovementProjectconsolidatestelephoneservicesunderonecontractwithsubstantialsavingsintelephonebillstoagencieslocatedinMaryland.m A ݌  `  Ќ XLXXXLXLXXXL     9  5@e(#e(#X@ei 5_  y@  #  Xu=XXXLe&eXXu=  # @    PROGRAMSUPPORTCENTERENTITLEMENTSPENDING#     9 AZ') HxdEeHAeq eee&XLX eeqԌ  Ќ  @  (dollarsinmillions)  L vVBQ2.b~1 |# `. @E'mYSv efefe(#e(# efefefef efefefef efefefef efefefef efefefef efefefef efefefef efefefef e(#e(#efefAZ')kZHdEkZHAp_ +jXLXXXL  XLXXXL   (X@e(#e(#(+j3   Summary+j3   ӌ c  ЌXLXXLXLXXL  m XLXXXLXLXXXL  m{     Thisappropriationprovidesfor   retirementpaymentstoPublicHealthService(PHS)CommissionedOfficersandpaymenttosurvivorsofdeceasedretiredofficers.Thisaccountalsofundstheprovisionofmedicalcaretoactivedutyandretiredmembersandtodependentsofactiveduty, k retiredanddeceasedmembersofthePHSCommissionedCorps.Inaddition,thisaccountincludesamountstobepaidtotheSocialSecurityAdministration(SSA)formilitaryservicecreditswhichareearnedbyactivedutyCommissionedOfficersfornonwageincome.m{  ݌ < Ќ XLXXXLXLXXXL  5@e(#e(#X@e 5BDw BDU