DEPARTMENT OF HEALTH AND HUMAN SERVICES Department of Health and Human Services Department of Health and Human Services General Fund Proprietary Interest Receipts, not Otherwise Classified Health Education Assistance Loans, Downward Reestimates of Subsidies Downward Reestimates of Subsidies, Health Centers Federal Share of Child Support Collections Legislative proposal, subject to PAYGO All Other General Fund Proprietary Receipts Including Budget Clearing Accounts Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts Rent and Charges for Quarters, Indian Health Service Cooperative Research and Development Agreements, NIH Cooperative Research and Development Agreements, Centers for Disease Control Cooperative Research and Development Agreements, FDA Interest, Child Enrollment Contingency Fund Reinsurance and Risk Adjustment Program Collections Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI Federal Contributions, FSMI Fund Amounts included in the adjusted baseline Legislative proposal, not subject to PAYGO Interest Received by Trust Fund, FSMI Fund Amounts included in the adjusted baseline Legislative proposal, not subject to PAYGO Other Proprietary Interest from the Public, FSMI Fund Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI Premiums Collected for Medicare Prescription Drug Account, FSMI Amounts included in the adjusted baseline Legislative proposal, subject to PAYGO Payments from States, Medicare Prescription Drug Account, FSMI Amounts included in the adjusted baseline Legislative proposal, subject to PAYGO Interest, Medicare Prescription Drug Account, FSMI Basic Premium, Medicare Advantage, FSMI Trust Fund Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI Federal Contributions for Benefits, Prescription Drug Account, SMI Amounts included in the adjusted baseline Legislative proposal, not subject to PAYGO Premiums Collected for the Aged, FSMI Fund Amounts included in the adjusted baseline Legislative proposal, subject to PAYGO Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund Premiums Collected for the Disabled, FSMI Fund Amounts included in the adjusted baseline Legislative proposal, subject to PAYGO FHI Trust Fund, Transfers from General Fund (FICA Taxes) Amounts included in the adjusted baseline Legislative proposal, not subject to PAYGO Legislative proposal, subject to PAYGO FHI Trust Fund, Receipts from Railroad Retirement Board FHI Trust Fund, Transfers from General Fund (SECA Taxes) FHI Trust Fund, Federal Employer Contributions (FICA) FHI Trust Fund, Postal Service Employer Contributions (FICA) FHI Trust Fund, Interest Received by Trust Funds Legislative proposal, not subject to PAYGO FHI Trust Fund, Other Proprietary Interest from the Public FHI Trust Fund, Taxation on OASDI Benefits FHI Trust Fund, Basic Premium, Medicare Advantage FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account FHI Trust Fund, Transfers from General Fund (criminal Fines) FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties) FHI Trust Fund, Transfers from General Fund (asset Forfeitures) FHI Trust Fund, Civil Penalties and Damages FHI Trust Fund, Interest Payments by Railroad Retirement Board FHI Trust Fund, Medicare Refunds FHI Trust Fund, Payments from the General Fund (uninsured and Program Management) FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible Legislative proposal, subject to PAYGO Contributions, Indian Health Facilities Deposits, Vaccine Injury Compensation Trust Fund Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund Contributions, N.I.H., Unconditional Gift Fund Centers for Disease Control, Gifts and Donations Contributions, N.I.H., Conditional Gift Fund Contributions, PHS Conditional Gift Fund Contributions to the Indian Health Service Gift Fund Deposits, Patients Benefit Fund, N.I.H. Gifts and Contributions, Miscellaneous Trust Funds Interest, Miscellaneous Trust Funds Legislative proposal, subject to PAYGO Food and Drug Administration Salaries and ExpensesFor necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; $3,788,336,000 $3,083,408,000: Provided, That, of the amount provided under this heading, $702,172,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h shall be credited to this account and remain available until expended, and shall not include any fees pursuant to 21 U.S.C. 379h(a)(2) and (a)(3) assessed for fiscal year 2013 but collected in fiscal year 2012; $57,605,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain available until expended; $21,768,000 $30,530,000 shall be derived from animal drug user fees authorized by section 740 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-12), and shall be credited to this account and remain available until expended; $5,706,000 $7,595,000 shall be derived from animal generic drug user fees authorized by section 741 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-21), and shall be credited to this account and shall remain available until expended; $477,000,000 $505,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s and shall be credited to this account and remain available until expended; $12,364,000 $12,925,000 shall be derived from food and feed recall fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; $14,700,000 $15,367,000 shall be derived from food reinspection fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; and amounts derived from voluntary qualified importer program fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended: Provided further, That, in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug animal drug user fees and animal generic drug user fees that exceed the respective fiscal year 2012 2013 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device, animal drug , and animal generic drug, and tobacco product assessments for fiscal year 2012 2013 received during fiscal year 2012 2013, including any such fees assessed prior to fiscal year 2012 2013 but credited for fiscal year 2012 2013, shall be subject to the fiscal year 2012 2013 limitations: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C. 9701: Provided further, That of the total amount appropriated: (1) $882,747,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs; (2) $978,705,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs, of which no less than $52,947,000 shall be available for the Office of Generic Drugs; (3) $329,136,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $166,365,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $356,909,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $60,039,000 shall be for the National Center for Toxicological Research; (7) $454,751,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $131,639,000 shall be for Rent and Related activities, of which $43,981,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) not to exceed $205,472,000 shall be for payments to the General Services Administration for rent; and (10) $222,573,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs, the Office of Foods, the Office of Medical and Tobacco Products, the Office of Global and Regulatory Policy, the Office of Operations, the Office of the Chief Scientist, and central services for these offices: the Secretary may, prior to the due date for such fees, accept payment of animal drug user fees and animal generic drug user fees authorized for fiscal year 2014, and that amounts of such fees assessed for fiscal year 2014 for which the Secretary accepts payment in fiscal year 2013 shall not be included in amounts provided under this heading: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner: Provided further, That funds may be transferred from one specified activity to another with the prior approval of the Committees on Appropriations of both Houses of Congress.In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381, and priority review user fees authorized by 21 U.S.C. 360n may be credited to this account, to remain available until expended. For plans, construction, repair, improvement, extension, alteration, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided, $8,788,000 $5,320,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2012.)[In millions of dollars]201120122013
Distribution of discretionary budget authority by account:
Salaries and expenses244724972511
Buildings and facilities1095
Distribution of discretionary outlays by account:
Salaries and expenses197525632491
Buildings and facilities984
The Food and Drug Administration (FDA) is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our Nation's food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines more effective, safer, and more affordable; and helping to provide the public accurate, science-based information about medicines and foods to improve their health. FDA decisions affect Americans on a daily basis. The Budget includes funding for counterterrorism activities that specifically relate to the protection of products or therapies regulated by the FDA (such as drugs, vaccines, foods, and animal feed), and the availability of medical products for public health preparedness in the event of an attack. Specifically, the Budget requests funding for food protection, drug safety, medical device review and safety, developing medical countermeasures, and headquarters consolidation in White Oak, Maryland. Special and Trust Fund Receipts(in millions of dollars)Identification code 75–9911–0–1–5542011 actual2012 est.2013 est.
0100Balance, start of year1
Receipts:
0220Cooperative Research and Development Agreements, FDA133
0400Total: Balances and collections134
Appropriations:
0500Salaries and Expenses–1–2–2
0799Balance, end of year12
Program and Financing(in millions of dollars)Identification code 75–9911–0–1–5542011 actual2012 est.2013 est.
Obligations by program activity:
0001Foods8361,004992
0002Drugs829690683
0003Devices and radiological products322322319
0004National Center for Toxicological Research616060
0005Other activities149154163
0006Other rent and rent related activities99106127
0007Rental payments151161169
0008Buildings and facilities1395
0009CRADAs233
0799Total direct obligations2,4622,5092,521
0801Reimbursable program9191,321675
0900Total new obligations3,3813,8303,196
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1587582814
1020Adjustment of unobligated bal brought forward, Oct 1–293
1050Unobligated balance (total)294582814
Budget authority:
Appropriations, discretionary:
1100Appropriation2,4622,5062,517
1130Appropriations permanently reduced–5
1160Appropriation, discretionary (total)2,4572,5062,517
Appropriations, mandatory:
1201Appropriation (special or trust fund)122
1260Appropriations, mandatory (total)122
Spending authority from offsetting collections, discretionary:
1700Collected1,2391,554675
1701Change in uncollected payments, Federal sources26
1702Offsetting collections (previously unavailable)386333333
1725Spending authority from offsetting collections precluded from obligation (limitation on obligations)–440–333–333
1750Spending auth from offsetting collections, disc (total)1,2111,554675
1900Budget authority (total)3,6694,0623,194
1930Total budgetary resources available3,9634,6444,008
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year582814812
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1,3631,4601,163
3010Uncollected pymts, Fed sources, brought forward, Oct 1–52–46–46
3020Obligated balance, start of year (net)1,3111,4141,117
3030Obligations incurred, unexpired accounts3,3813,8303,196
3031Obligations incurred, expired accounts9
3040Outlays (gross)–3,253–4,127–3,173
3050Change in uncollected pymts, Fed sources, unexpired–26
3051Change in uncollected pymts, Fed sources, expired32
3081Recoveries of prior year unpaid obligations, expired–40
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)1,4601,1631,186
3091Uncollected pymts, Fed sources, end of year–46–46–46
3100Obligated balance, end of year (net)1,4141,1171,140
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross3,6684,0603,192
Outlays, gross:
4010Outlays from new discretionary authority2,3983,1582,286
4011Outlays from discretionary balances854967885
4020Outlays, gross (total)3,2524,1253,171
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–81–67–67
4033Non-Federal sources–1,187–1,487–608
4040Offsets against gross budget authority and outlays (total)–1,268–1,554–675
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–26
4052Offsetting collections credited to expired accounts29
4060Additional offsets against budget authority only (total)3
4070Budget authority, net (discretionary)2,4032,5062,517
4080Outlays, net (discretionary)1,9842,5712,496
Mandatory:
4090Budget authority, gross122
Outlays, gross:
4100Outlays from new mandatory authority122
4180Budget authority, net (total)2,4042,5082,519
4190Outlays, net (total)1,9852,5732,498
Memorandum (non-add) entries:
5090Unavailable balance, SOY: Offsetting collections65119119
5091Unavailable balance, EOY: Offsetting collections119119119
Object Classification(in millions of dollars)Identification code 75–9911–0–1–5542011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent749760764
11.3Other than full-time permanent105106107
11.5Other personnel compensation596060
11.7Military personnel585961
11.8Special personal services payments111
11.9Total personnel compensation972986993
12.1Civilian personnel benefits260264265
12.2Military personnel benefits293031
13.0Benefits for former personnel2
21.0Travel and transportation of persons505151
22.0Transportation of things555
23.1Rental payments to GSA151161169
23.2Rental payments to others222
23.3Communications, utilities, and miscellaneous charges565757
24.0Printing and reproduction222
25.1Advisory and assistance services424343
25.2Other services from non-Federal sources423434430
25.3Other goods and services from Federal sources113114113
25.4Operation and maintenance of facilities106107107
25.5Research and development contracts343434
25.7Operation and maintenance of equipment313131
26.0Supplies and materials464646
31.0Equipment575757
32.0Land and structures666
41.0Grants, subsidies, and contributions757777
42.0Insurance claims and indemnities22
99.0Direct obligations2,4622,5092,521
99.0Reimbursable obligations9191,321675
99.9Total new obligations3,3813,8303,196
Employment SummaryIdentification code 75–9911–0–1–5542011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment9,1039,3357,584
1101Direct military average strength employment692692492
2001Reimbursable civilian full-time equivalent employment3,1913,3002,621
2101Reimbursable military average strength employment243243172
3001Allocation account civilian full-time equivalent employment656754
3101Allocation account military average strength employment111
Legislative proposal, not subject to PAYGO Salaries and ExpensesContingent upon the enactment of legislation authorizing user fees with respect to biosimilar biological products and human generic drugs, such fees shall be credited to this account and remain available until expended: Provided, That, with respect to such fees authorized for fiscal year 2014, the Secretary may, prior to the due date for such fees, accept payment of such fees and such payments shall be credited to this account for fiscal year 2014. In addition, contingent upon the enactment of legislation authorizing user fees with respect to food inspections and food facility registrations, food contact notification activities, reinspection of medical product facilities, cosmetic activities, and international express courier import activities, such fees shall be credited to this account and remain available until expended. In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for prescription drug review activities and medical device review activities: Provided, That fees of $712,808,000, for prescription drug reviews, shall be credited to this account and remain available until expended; and $69,700,000, for medical device reviews, shall be credited to this account and remain available until expended: Provided further, That, in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees and medical device user fees that exceed the respective fiscal year 2013 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug reviews and medical device reviews for fiscal year 2013 received during fiscal year 2013, including any such fees assessed prior to fiscal year 2013 but credited for fiscal year 2013, shall be subject to the fiscal year 2013 limitations: Provided further, That the Secretary may, prior to the due date for such fees, accept payment of prescription drug user fees and medical device user fees authorized for fiscal year 2014, and that amounts of such fees assessed for fiscal year 2014 for which the Secretary accepts payment in fiscal year 2013 shall not be included in amounts provided under this heading. The 2013 Budget includes a number of new and current user fees. Legislation will be proposed to allow FDA to collect fees to support human generic drug review as well as for the evaluation of biosimilar biological product applications. The additional resources, estimated at $299 million for the human generic drug program, would enable FDA to reduce review times and respond to the growing number of generic drug applications. The fees collected for biosimilars would ensure sound funding for the review of biosimilar applications including the development-phase FDA consultation and review work. The Budget also proposes user fees to support activities related to cosmetics and food contact notification activities. In addition, the Budget reproposes user fees to support inspection-related activities at domestic courier facilities and reinspections at medical product facilities. Lastly, the Budget includes a total of $712 million in prescription drug user fees and $70 million in medical device user fees. The FDA transmitted proposed legislation to reauthorize PDUFA and establish new generic drug and biosimilar user fees to Congress on January 13, 2012. The proposed legislation authorizes the collection and spending of these fees subject to appropriations. Program and Financing(in millions of dollars)Identification code 75–9911–2–1–5542011 actual2012 est.2013 est.
Obligations by program activity:
0801PDUFA713
0802MDUFMA70
0803Generic Drug User Fee299
0804Biosimilar User Fees20
0805Reinspection (Drugs)15
0806Food Inspection and Registration Fee220
0807International Courier User Fee6
0808Cosmetic and Food Contact Notification User Fee5
0810Cosmetic User Fee19
0900Total new obligations1,367
Budgetary Resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700Collected1,367
1750Spending auth from offsetting collections, disc (total)1,367
1930Total budgetary resources available1,367
Change in obligated balance:
3030Obligations incurred, unexpired accounts1,367
3040Outlays (gross)–1,367
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross1,367
Outlays, gross:
4010Outlays from new discretionary authority1,367
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033Non-Federal sources–1,367
Object Classification(in millions of dollars)Identification code 75–9911–2–1–5542011 actual2012 est.2013 est.
99.9Total new obligations1,367
Employment SummaryIdentification code 75–9911–2–1–5542011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment2,648
1101Direct military average strength employment200
2001Reimbursable civilian full-time equivalent employment928
2101Reimbursable military average strength employment71
3001Allocation account civilian full-time equivalent employment19
3101Allocation account military average strength employment
Revolving Fund for Certification and Other Services FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs, medical devices, and cosmetics (21 U.S.C. 346a, 356, 357, 376). These services are financed wholly by fees paid by the industries affected.Program and Financing(in millions of dollars)Identification code 75–4309–0–3–5542011 actual2012 est.2013 est.
Obligations by program activity:
0801Reimbursable program888
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1222
Budget authority:
Spending authority from offsetting collections, mandatory:
1800Collected888
1850Spending auth from offsetting collections, mand (total)888
1930Total budgetary resources available101010
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year222
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)332
3030Obligations incurred, unexpired accounts888
3040Outlays (gross)–8–9–9
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)321
3100Obligated balance, end of year (net)321
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross888
Outlays, gross:
4100Outlays from new mandatory authority888
4101Outlays from mandatory balances11
4110Outlays, gross (total)899
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123Non-Federal sources–8–8–8
4190Outlays, net (total)11
Object Classification(in millions of dollars)Identification code 75–4309–0–3–5542011 actual2012 est.2013 est.
Reimbursable obligations:
11.1Personnel compensation: Full-time permanent444
12.1Civilian personnel benefits111
23.1Rental payments to GSA111
25.2Other services from non-Federal sources111
26.0Supplies and materials111
99.9Total new obligations888
Employment SummaryIdentification code 75–4309–0–3–5542011 actual2012 est.2013 est.
2001Reimbursable civilian full-time equivalent employment373738
Health Resources and Services Administration Health Resources and Services Health Resources and ServicesFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect to primary health care and the Native Hawaiian Health Care Act of 1988, $1,598,957,000 $1,579,975,000, of which $129,000 $127,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center: Provided, That no more than $40,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act, including associated administrative expenses and relevant evaluations: Provided further, That no more than $95,073,000 $94,893,000 shall be available until expended for carrying out the provisions of Public Law 104–73 and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS'') pertaining to administrative claims made under such law. For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $734,402,000 $522,187,000: Provided, That sections 747(c)(2), 751(j)(2) 340G-1(b) and (d), and the proportional funding amounts in paragraphs (1) through (4) of section 756(e) of the PHS Act shall not apply to funds made available under this heading: Provided further, That for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of Health and Human Services (referred to in this title as "Secretary'') may waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act: Provided further, That in addition to fees authorized by section 427(b) of the Health Care Quality Improvement Act of 1986, fees shall be collected for the full disclosure of information under such Act sufficient to recover the full costs of operating the National Practitioner Data Bank and shall remain available until expended to carry out that Act: Provided further, That fees collected for the full disclosure of information under the "Health Care Fraud and Abuse Data Collection Program'', authorized by section 1128E(d)(2) of the Social Security Act, shall be sufficient to recover the full costs of operating the program, and shall remain available until expended to carry out that Act: Provided further, That fees collected for the disclosure of information under the information reporting requirement program authorized by section 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the program and shall remain available until expended to carry out that Act: Provided further, That funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments to awards made under such sections: Provided further, That, in addition to amounts appropriated under this heading, $35,000,000 shall be available under section 241 of the PHS Act to carry out titles VII and VIII of the PHS Act: Provided further, That, of the amount appropriated under this heading, $88,000,000 shall be for payments to children's hospitals pursuant to section 340E of the PHS Act, all of which shall be for payments for direct graduate medical education as described in section 340E(c). Maternal and Child HealthFor carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social Security Act, and section 712 of the American Jobs Creation Act of 2004, $863,607,000 $854,807,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $79,586,000 $78,641,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and $10,400,000 $10,276,000 shall be available for projects described in paragraphs (A) through (F) of section 501(a)(3) of such Act. Ryan White Hiv/Aids ProgramFor carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,326,665,000 $2,446,772,000, of which $1,995,670,000 $2,093,599,000 shall remain available to the Secretary of Health and Human Services through September 30, 2014, for parts A and B of title XXVI of the PHS Act, and of which : Provided, That of the funds available for parts A and B of title XXVI of the PHS Act, not less than $900,000,000 $1,000,000,000 shall be for State AIDS Drug Assistance Programs under the authority of pursuant to section 2616 or 311(c) of such Act: Provided further, That in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out parts A, B, C, and D of title XXVI of the PHS Act to fund Special Projects of National Significance under section 2691. For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, $83,526,000 $82,534,000: Provided, That the Secretary may collect a fee of 0.1 percent of each purchase of 340B drugs from entities participating in the Drug Pricing Program pursuant to section 340B of the PHS Act to pay for the operating costs of such program: Provided further, That fees pursuant to the 340B Drug Pricing Program shall be collected by manufacturers at the time of sale, and shall be credited to this account, to remain available until expended. For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health and Safety Act, the Cardiac Arrest Survival Act of 2000, and sections 711 and 1820 of the Social Security Act, $139,832,000 $122,232,000, of which $41,118,000 $26,200,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program: Provided, That, of the funds made available under this heading for Medicare rural hospital flexibility grants, $15,000,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for grants under section 1820(g)(6) available for the purchase and implementation of telehealth services, including pilots and demonstrations on the use of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs electronic health record system: Provided further, That notwithstanding section 338J(k) of the PHS Act, $10,055,000 $10,036,000 shall be available for State Offices of Rural Health. For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $297,400,000 $296,838,000: Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office. For program support in the Health Resources and Services Administration, $161,815,000 $162,517,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings "Primary Health Care'', "Health Workforce'', "Maternal and Child Health'', "Ryan White HIV/AIDS Program'', "Health Care Systems'', and "Rural Health'': Provided further, That the Administrator may transfer funds between any of the accounts of HRSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.) Resources displayed here support categorical grants and contracts managed by Health Resources and Services Administration (HRSA). These activities include support for Federally Qualified Health Centers, treatment and care for those living with HIV/AIDS, health professions training, maternal and child health care services, promotion of organ and bone marrow donation, and the medical malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program. The FY 2013 Budget proposes a new user fee for this program to improve administration and oversight of this activity.HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL), Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans the programs revolving account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If the programs revolving account has excess funds that will not be used to provide new loans, these excess funds are returned to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects Academic Year 2010–2011 data reported in the Annual Operating Report.Health Professions Revolving Loan ProgramsFederal Capital Contribution ProgramAccount Balance
HPSL$370,561,960
NSL$168,761,018
PCL$249,867,755
LDS$129,792,459
Total$918,984,192
Program and Financing(in millions of dollars)Identification code 75–0350–0–1–5502011 actual2012 est.2013 est.
Obligations by program activity:
0010Health Centers1,4811,4671,467
0012National Health Service Corps Recruitment25
0013Hansen's Disease Center161616
0014Payment to Hawaii for the Treatment of Hansen's Disease222
0015Black Lung Clinics777
0016Nursing Education Loan Repayment and Scholarships938383
0017Health Professions405376345
0018Maternal and Child Health Block Grant656639640
0019Healthy Start104103103
0020Poison Control Centers221919
0021EMS for Children212121
0022Universal Newborn Hearing Screening191919
0023HIV/AIDS2,3102,3752,447
0024Organ Transplantation252424
0025Bone Marrow Donor Registry232323
0026Rural Health Policy Development101010
0027Rural Health Outreach Grants565656
0028Rural Health Flexibility Grants414126
0030Telehealth121212
0031Program Management162160162
0032Family Planning298294297
0033Loan Repayment/Faculty Fellowship111
0035Health Centers Tort Claim Fund8911395
0036Heritable Disorders101010
0038Childrens' GME26826588
0041State Offices of Rural Health101010
0043Radiogenic Diseases222
0044Traumatic Brain Injury101010
0045Autism and Other Developmental Disorders484747
0046Cord Blood Stem Cell Bank121212
0047Free Clinics Medical Malpractice12
0048Sickle Cell555
0049Drug Pricing Program444
0050Family to Family Health Information Centers ACA55
0052Health Center Loan Subsidy1
0067Prevention Fund207510
0071ARRA74
0072Infrastructure to Expand Access to Care ACA100
0073Health Centers ACA9981,1501,200
0074Health Centers Construction ACA742758
0075National Health Service Corps ACA289296300
0076School Based Health Centers ACA981587
0077GME Payments THC ACA41843
0079Rural Health AED1
0080Pediatric Loan Repayment5
0300Total direct programs8,5798,5467,708
0799Total direct obligations8,5798,5467,708
0801Reimbursable program626672
0802Reimbursable program: PHS evaluation222560
0899Total reimbursable obligations8491132
0900Total new obligations8,6638,6377,840
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 12721,060345
1021Recoveries of prior year unpaid obligations3
1050Unobligated balance (total)2751,060345
Budget authority:
Appropriations, discretionary:
1100Appropriation6,2756,2076,068
1121Appropriations transferred from other accts [75–9915]9
1121Appropriations transferred from other accts [75–1362]1
1121Appropriations transferred from other accts [75–0943]1
1130Appropriations permanently reduced–13
1143Approp permanently reduced (Sec 527, HR 2055)–12
1160Appropriation, discretionary (total)6,2626,2066,068
Appropriations, mandatory:
1200Appropriation3,0751,5501,850
1221Appropriations transferred from other accts [75–0116]207510
1260Appropriations, mandatory (total)3,0951,6251,860
Spending authority from offsetting collections, discretionary:
1700Collected5475116
1701Change in uncollected payments, Federal sources24
1750Spending auth from offsetting collections, disc (total)7875116
Spending authority from offsetting collections, mandatory:
1800Offsetting collections (cash)(HPSL&NSL)161616
1850Spending auth from offsetting collections, mand (total)161616
1900Budget authority (total)9,4517,9228,060
1930Total budgetary resources available9,7268,9828,405
Memorandum (non-add) entries:
1940Unobligated balance expiring–3
1941Unexpired unobligated balance, end of year1,060345565
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)6,8646,8376,598
3010Uncollected pymts, Fed sources, brought forward, Oct 1–50–42–42
3020Obligated balance, start of year (net)6,8146,7956,556
3030Obligations incurred, unexpired accounts8,6638,6377,840
3031Obligations incurred, expired accounts1
3040Outlays (gross)–8,582–8,876–8,168
3050Change in uncollected pymts, Fed sources, unexpired–24
3051Change in uncollected pymts, Fed sources, expired32
3080Recoveries of prior year unpaid obligations, unexpired–3
3081Recoveries of prior year unpaid obligations, expired–106
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)6,8376,5986,270
3091Uncollected pymts, Fed sources, end of year–42–42–42
3100Obligated balance, end of year (net)6,7956,5566,228
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross6,3406,2816,184
Outlays, gross:
4010Outlays from new discretionary authority2,5892,5212,508
4011Outlays from discretionary balances5,1204,1393,821
4020Outlays, gross (total)7,7096,6606,329
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–52–52–82
4033Non-Federal sources–28–23–34
4040Offsets against gross budget authority and outlays (total)–80–75–116
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–24
4052Offsetting collections credited to expired accounts26
4060Additional offsets against budget authority only (total)2
4070Budget authority, net (discretionary)6,2626,2066,068
4080Outlays, net (discretionary)7,6296,5856,213
Mandatory:
4090Budget authority, gross3,1111,6411,876
Outlays, gross:
4100Outlays from new mandatory authority818863870
4101Outlays from mandatory balances551,353969
4110Outlays, gross (total)8732,2161,839
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123Non-Federal sources–16–16–16
4180Budget authority, net (total)9,3577,8317,928
4190Outlays, net (total)8,4868,7858,036
Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program(in millions of dollars)Identification code 75–0350–0–1–5502011 actual2012 est.2013 est.
Guaranteed loan levels supportable by subsidy budget authority:
215001Health centers: Facilities renovation loan guarantee levels3288
215002Health centers: Managed care network development loan guarantee21
215003Health centers: Managed care plan loan guarantee levels53
215999Total loan guarantee levels321512
Guaranteed loan subsidy (in percent):
232001Health centers: Facilities renovation loan guarantee levels2.722.672.16
232002Health centers: Managed care network development loan guarantee0.009.629.73
232003Health centers: Managed care plan loan guarantee levels0.005.765.79
232999Weighted average subsidy rate2.724.633.70
Guaranteed loan subsidy budget authority:
233001Health centers: Facilities renovation loan guarantee levels1
233999Total subsidy budget authority1
Guaranteed loan subsidy outlays:
234001Health centers: Facilities renovation loan guarantee levels1
234999Total subsidy outlays1
Object Classification(in millions of dollars)Identification code 75–0350–0–1–5502011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent148147151
11.3Other than full-time permanent566
11.5Other personnel compensation444
11.7Military personnel192020
11.8Special personal services payments1
11.9Total personnel compensation177177181
12.1Civilian personnel benefits454244
12.2Military personnel benefits81111
21.0Travel and transportation of persons444
23.1Rental payments to GSA252525
23.2Rental payments to others122
23.3Communications, utilities, and miscellaneous charges211
24.0Printing and reproduction111
25.1Advisory and assistance services383838
25.2Other services from non-Federal sources180156156
25.3Other goods and services from Federal sources182197197
25.4Operation and maintenance of facilities211
25.6Medical care333
25.7Operation and maintenance of equipment131414
26.0Supplies and materials111
31.0Equipment444
41.0Grants, subsidies, and contributions7,8107,7806,936
42.0Insurance claims and indemnities838989
99.0Direct obligations8,5798,5467,708
99.0Reimbursable obligations8491132
99.9Total new obligations8,6638,6377,840
Employment SummaryIdentification code 75–0350–0–1–5502011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment1,5391,5281,505
1101Direct military average strength employment202202202
2001Reimbursable civilian full-time equivalent employment767682
2101Reimbursable military average strength employment666
Vaccine Injury Compensation The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203, and serves as a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine related injury or death occurring before October 1, 1988 are financed from the General Fund and are reflected in this account. Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be adjudicated, no appropriation is requested in 2012 to cover payment of pre-1988 claims. By statute, no new claims are accepted for this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988 are reflected in the Vaccine Injury Compensation Program trust fund account.Program and Financing(in millions of dollars)Identification code 75–0320–0–1–5512011 actual2012 est.2013 est.
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1121212
1930Total budgetary resources available121212
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year121212
Covered Countermeasure Process Fund The Covered Countermeasure Process Fund is established pursuant to the PHS Act, as amended by Division C of Public Law 109–148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section 319F-3(b) of the Public Health Service Act. Additionally, authority is provided to address any unexpected claims that may arise under the Smallpox Emergency Personal Protection Act of 2003.Program and Financing(in millions of dollars)Identification code 75–0343–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Claims21
0103Admin Expense334
0900Total new obligations355
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 12
1011Unobligated balance transfer from other accts [75–0140]535
1050Unobligated balance (total)555
1930Total budgetary resources available555
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year2
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)27
3030Obligations incurred, unexpired accounts355
3040Outlays (gross)–1
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)2712
3100Obligated balance, end of year (net)2712
Budget authority and outlays, net:
Discretionary:
Outlays, gross:
4011Outlays from discretionary balances1
4190Outlays, net (total)1
Object Classification(in millions of dollars)Identification code 75–0343–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent111
25.3Other goods and services from Federal sources222
42.0Insurance claims and indemnities22
99.9Total new obligations355
Employment SummaryIdentification code 75–0343–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment444
1101Direct military average strength employment111
Maternal, Infant, and Early Childhood Home Visiting Programs P.L. 111–148 provides resources to Maternal, Infant and Early Childhood Home Visiting Program through FY 2014 to provide comprehensive services for at risk communities. These activities are administered by HRSA.Program and Financing(in millions of dollars)Identification code 75–0321–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0010Maternal, Infant, and Early Childhood Home Visiting Programs250350400
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation250350400
1260Appropriations, mandatory (total)250350400
1930Total budgetary resources available250350400
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)99313577
3030Obligations incurred, unexpired accounts250350400
3040Outlays (gross)–36–86–359
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)313577618
3100Obligated balance, end of year (net)313577618
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross250350400
Outlays, gross:
4100Outlays from new mandatory authority172528
4101Outlays from mandatory balances1961331
4110Outlays, gross (total)3686359
4180Budget authority, net (total)250350400
4190Outlays, net (total)3686359
Object Classification(in millions of dollars)Identification code 75–0321–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent222
12.1Civilian personnel benefits111
25.1Advisory and assistance services151515
41.0Grants, subsidies, and contributions232332382
99.9Total new obligations250350400
Employment SummaryIdentification code 75–0321–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment161616
1101Direct military average strength employment333
Health Center Guaranteed Loan Financing Account P.L. 104–299 and P.L. 104–208 authorize Health Resources and Services Administration (HRSA) to guarantee up to $160 million in private loans to health centers for the costs of developing and operating managed care networks or plans and for the construction, renovation and modernization of medical facilities. As required by the Federal Credit Reform Act of 1990, this financing account records all cash flows to and from the Government resulting from the Health Center Loan Guarantee program. The program account for this activity is displayed in the Health Resources and Services account (75–0350) as a line in the program and financing schedule. Program and Financing(in millions of dollars)Identification code 75–4442–0–3–5512011 actual2012 est.2013 est.
Obligations by program activity:
Credit program obligations:
0711Default claim payments on principal11
0900Total new obligations11
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1232
Financing authority:
Spending authority from offsetting collections, mandatory:
1800Collected1
1850Spending auth from offsetting collections, mand (total)1
1930Total budgetary resources available332
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year321
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1
3030Obligations incurred, unexpired accounts11
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)12
3100Obligated balance, end of year (net)12
Financing authority and disbursements, net:
Mandatory:
4090Financing authority, gross1
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120Federal sources–1
4190Financing disbursements, net (total)–1
Status of Guaranteed Loans(in millions of dollars)Identification code 75–4442–0–3–5512011 actual2012 est.2013 est.
Position with respect to appropriations act limitation on commitments:
2121Limitation available from carry-forward602813
2143Uncommitted limitation carried forward–28–13
2150Total guaranteed loan commitments321513
2199Guaranteed amount of guaranteed loan commitments261310
Cumulative balance of guaranteed loans outstanding:
2210Outstanding, start of year658082
2231Disbursements of new guaranteed loans251310
2251Repayments and prepayments–10–10–10
2263Adjustments: Terminations for default that result in claim payments–1–1
2290Outstanding, end of year808281
Memorandum:
2299Guaranteed amount of guaranteed loans outstanding, end of year726968
Balance Sheet(in millions of dollars)Identification code 75–4442–0–3–5512010 actual2011 actual
ASSETS:
1101Federal assets: Fund balances with Treasury43
1999Total assets43
LIABILITIES:
2204Non-Federal liabilities: Liabilities for loan guarantees43
4999Total liabilities and net position43
Health Education Assistance Loans Program Account Health Education Assistance Loans Program AccountSuch sums as may be necessary to carry out the purpose of the program, as authorized by title VII of the PHS Act.In addition, For for administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, $2,841,000 $2,807,000. (Department of Health and Human Services Appropriations Act, 2012.) In FY 2013 the Department of Education will assume responsibility for the program. Legislative language that would effect this transfer is included under General Provisions. The authority to administer, service, collect, and enforce the program as well as the functions, assets, and liabilities of the Secretary of Health and Human Services will be permanently transferred to the Secretary of Education.Program and Financing(in millions of dollars)Identification code 75–0340–0–1–5522011 actual2012 est.2013 est.
Obligations by program activity:
Credit program obligations:
0707Reestimates of loan guarantee subsidy13
0708Interest on reestimates of loan guarantee subsidy14
0709Administrative expenses23
0900Total new obligations293
Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100Appropriation333
1120Appropriations transferred to other accts [91–0202]–3
1160Appropriation, discretionary (total)33
Appropriations, mandatory:
1200Appropriation26
1260Appropriations, mandatory (total)26
1900Budget authority (total)293
1930Total budgetary resources available293
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)222
3030Obligations incurred, unexpired accounts293
3040Outlays (gross)–29–3
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)222
3100Obligated balance, end of year (net)222
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross33
Outlays, gross:
4010Outlays from new discretionary authority23
4011Outlays from discretionary balances1
4020Outlays, gross (total)33
Mandatory:
4090Budget authority, gross26
Outlays, gross:
4100Outlays from new mandatory authority26
4180Budget authority, net (total)293
4190Outlays, net (total)293
Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program(in millions of dollars)Identification code 75–0340–0–1–5522011 actual2012 est.2013 est.
Guaranteed loan upward reestimates:
235001HEAL Loan guarantee26
235999Total upward reestimate budget authority26
Guaranteed loan downward reestimates:
237001HEAL Loan guarantee–12
237999Total downward reestimate subsidy budget authority–12
Administrative expense data:
3510Budget authority33
3590Outlays from new authority3
Object Classification(in millions of dollars)Identification code 75–0340–0–1–5522011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent23
25.3Other goods and services from Federal sources1
41.0Grants, subsidies, and contributions26
99.9Total new obligations293
Employment SummaryIdentification code 75–0340–0–1–5522011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment1313
Health Education Assistance Loans Financing Account Program and Financing(in millions of dollars)Identification code 75–4304–0–3–5522011 actual2012 est.2013 est.
Obligations by program activity:
Credit program obligations:
0711Default claim payments on principal1514
0742Downward reestimate paid to receipt account5
0743Interest on downward reestimates7
0900Total new obligations1526
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1497052
1010Unobligated balance transfer to other accts [91–4300]–52
1050Unobligated balance (total)4970
Financing authority:
Spending authority from offsetting collections, mandatory:
1800Collected368
1850Spending auth from offsetting collections, mand (total)368
1900Financing authority(total)368
1930Total budgetary resources available8578
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year7052
Change in obligated balance:
3030Obligations incurred, unexpired accounts1526
3040Financing disbursements (gross)–15–26
Financing authority and disbursements, net:
Mandatory:
4090Financing authority, gross368
Financing disbursements:
4110Financing disbursements, gross1526
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120Federal sources - upward reestimates and interest–26
4122Interest on uninvested funds–4–4
4123Recoveries of defaulted loans–6–4
4130Offsets against gross financing auth and disbursements (total)–36–8
4170Financing disbursements, net (mandatory)–2118
4190Financing disbursements, net (total)–2118
Status of Guaranteed Loans(in millions of dollars)Identification code 75–4304–0–3–5522011 actual2012 est.2013 est.
Cumulative balance of guaranteed loans outstanding:
2210Outstanding, start of year627526499
2251Repayments and prepayments–86–13
Adjustments:
2261Terminations for default that result in loans receivable–14–10
2263Terminations for default that result in claim payments–1–4
2264Other adjustments, net–499
2290Outstanding, end of year526499
Memorandum:
2299Guaranteed amount of guaranteed loans outstanding, end of year526499
Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310Outstanding, start of year171175181
2331Disbursements for guaranteed loan claims1410
2351Repayments of loans receivable–6–4
2361Write-offs of loans receivable–1
2364Other adjustments, net–3–181
2390Outstanding, end of year175181
Balance Sheet(in millions of dollars)Identification code 75–4304–0–3–5522010 actual2011 actual
ASSETS:
1101Federal assets: Fund balances with Treasury4970
Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501Defaulted guaranteed loans receivable, gross171175
1505Allowance for subsidy cost (-)–126–126
1599Net present value of assets related to defaulted guaranteed loans4549
1999Total assets94119
LIABILITIES:
2204Non-Federal liabilities: Liabilities for loan guarantees94119
4999Total liabilities and net position94119
Health Education Assistance Loans Liquidating Account Program and Financing(in millions of dollars)Identification code 75–4305–0–3–5522011 actual2012 est.2013 est.
Obligations by program activity:
Credit program obligations:
0711Default claim payments on principal32
0900Total new obligations (object class 33.0)32
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation11
1260Appropriations, mandatory (total)11
Spending authority from offsetting collections, mandatory:
1800Collected910
1820Capital transfer of spending authority from offsetting collections to general fund–7–9
1850Spending auth from offsetting collections, mand (total)21
1900Budget authority (total)32
1930Total budgetary resources available32
Change in obligated balance:
3030Obligations incurred, unexpired accounts32
3040Outlays (gross)–3–2
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross32
Outlays, gross:
4100Outlays from new mandatory authority32
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123Non-Federal sources–9–10
4180Budget authority, net (total)–6–8
4190Outlays, net (total)–6–8
Status of Guaranteed Loans(in millions of dollars)Identification code 75–4305–0–3–5522011 actual2012 est.2013 est.
Cumulative balance of guaranteed loans outstanding:
2210Outstanding, start of year1038369
2251Repayments and prepayments–17–12
Adjustments:
2261Terminations for default that result in loans receivable–3–2
2264Other adjustments, net–69
2290Outstanding, end of year8369
Memorandum:
2299Guaranteed amount of guaranteed loans outstanding, end of year8368
Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310Outstanding, start of year379362346
2331Disbursements for guaranteed loan claims33
2351Repayments of loans receivable–9–8
2361Write-offs of loans receivable–21–21
2364Other adjustments, net1010–346
2390Outstanding, end of year362346
Balance Sheet(in millions of dollars)Identification code 75–4305–0–3–5522010 actual2011 actual
ASSETS:
1101Federal assets: Fund balances with Treasury11
1701Defaulted guaranteed loans, gross379362
1703Allowance for estimated uncollectible loans and interest (-)–250–238
1799Value of assets related to loan guarantees129124
1999Total assets130125
LIABILITIES:
2104Federal liabilities: Resources payable to Treasury122119
2204Non-Federal liabilities: Liabilities for loan guarantees86
2999Total liabilities130125
4999Total liabilities and net position130125
Medical Facilities Guarantee and Loan Fund Titles VI and XVI of the Public Health Service Act established a loan and loan guarantee fund for medical facilities with a maximum amount allowable for the Government's liability. Direct loans were made available for public facilities and guaranteed loans for private, nonprofit facilities. Funds under this authority were established in the amount of $50 million for use in fulfilling guarantees in event of default, $30 million as a revolving fund for direct loans and an amount for interest subsidy payments on guaranteed loans. Program and Financing(in millions of dollars)Identification code 75–9931–0–3–5512011 actual2012 est.2013 est.
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)111
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)111
3100Obligated balance, end of year (net)111
Status of Direct Loans(in millions of dollars)Identification code 75–9931–0–3–5512011 actual2012 est.2013 est.
Cumulative balance of direct loans outstanding:
1210Outstanding, start of year777
1251Repayments: Repayments and prepayments
1290Outstanding, end of year777
Balance Sheet(in millions of dollars)Identification code 75–9931–0–3–5512010 actual2011 actual
ASSETS:
1601Direct loans, gross77
1999Total assets77
LIABILITIES:
2201Non-Federal liabilities: Accounts payable77
4999Total liabilities and net position77
Vaccine Injury Compensation Program Trust Fund Vaccine Injury Compensation Program Trust FundFor payments from the Vaccine Injury Compensation Program Trust Fund ("Trust Fund''), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $6,489,000 $6,477,000 shall be available from the Trust Fund to the Secretary. (Department of Health and Human Services Appropriations Act, 2012.)The Vaccine Injury Compensation Program was established pursuant to P.L. 99–660 and P.L. 100–203 and serves as a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims for vaccine-related injury or death occurring after October 1, 1988.Special and Trust Fund Receipts(in millions of dollars)Identification code 75–8175–0–7–5512011 actual2012 est.2013 est.
0100Balance, start of year2,9603,1153,205
Adjustments:
0190Adjustment - rounding–1
0199Balance, start of year2,9593,1153,205
Receipts:
0200Deposits, Vaccine Injury Compensation Trust Fund278274283
0240Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund1267074
0299Total receipts and collections404344357
0400Total: Balances and collections3,3633,4593,562
Appropriations:
0500Vaccine Injury Compensation Program Trust Fund–19–19–19
0501Vaccine Injury Compensation Program Trust Fund–229–235–242
0599Total appropriations–248–254–261
0799Balance, end of year3,1153,2053,301
Program and Financing(in millions of dollars)Identification code 75–8175–0–7–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Compensation: Claims for post - FY 1989 injuries231235242
0103Claims processing (Claims Court)555
0104Claims processing (HRSA)666
0105Claims processing (Dept. of Justice)688
0191Total, administrative expenses171919
0799Total direct obligations248254261
0801Reimbursable program activity (claims)3
0900Total new obligations251254261
Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1101Appropriation (special or trust fund)191919
1160Appropriation, discretionary (total)191919
Appropriations, mandatory:
1201Appropriation (special or trust fund)229235242
1260Appropriations, mandatory (total)229235242
Spending authority from offsetting collections, mandatory:
1800Collected3
1850Spending auth from offsetting collections, mand (total)3
1900Budget authority (total)251254261
1930Total budgetary resources available251254261
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)16199
3030Obligations incurred, unexpired accounts251254261
3040Outlays (gross)–248–264–269
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)1991
3100Obligated balance, end of year (net)1991
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross191919
Outlays, gross:
4010Outlays from new discretionary authority1919
4011Outlays from discretionary balances13108
4020Outlays, gross (total)132927
Mandatory:
4090Budget authority, gross232235242
Outlays, gross:
4100Outlays from new mandatory authority232235242
4101Outlays from mandatory balances3
4110Outlays, gross (total)235235242
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–3
4180Budget authority, net (total)248254261
4190Outlays, net (total)245264269
Memorandum (non-add) entries:
5000Total investments, SOY: Federal securities: Par value2,9393,1083,452
5001Total investments, EOY: Federal securities: Par value3,1083,4523,809
Object Classification(in millions of dollars)Identification code 75–8175–0–7–5512011 actual2012 est.2013 est.
Direct obligations:
25.3Other goods and services from Federal sources171919
42.0Insurance claims and indemnities231235242
99.0Direct obligations248254261
99.0Reimbursable obligations3
99.9Total new obligations251254261
Indian Health ServiceFor expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service, $3,872,377,000, $3,978,974,000, together with payments received during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b for services furnished by the Indian Health Service: Provided, That funds made available to tribes and tribal organizations through contracts, grant agreements, or any other agreements or compacts authorized by the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed to be obligated at the time of the grant or contract award and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That $844,927,000 $897,562,000 for contract medical care, including $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: Provided further, That of the funding provided for information technology activities and, notwithstanding any other provision of law, $4,000,000 shall be allocated at the discretion of the Director of the Indian Health Service: Provided further, That of the funds provided, up to $36,000,000 shall remain available until expended for implementation of the loan repayment program under section 108 of the Indian Health Care Improvement Act: Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a): Provided further, That notwithstanding any other provision of law, the amounts made available within this account for the methamphetamine and suicide prevention and treatment initiative and for the domestic violence prevention initiative shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 fiscal years, provided the total obligation is recorded in the year the funds are appropriated: Provided further, That the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health Care Improvement Act shall remain available until expended for the purpose of achieving compliance with the applicable conditions and requirements of titles XVIII and XIX of the Social Security Act, except for those related to the planning, design, or construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall remain available until expended: Provided further, That amounts received by tribes and tribal organizations under title IV of the Indian Health Care Improvement Act shall be reported and accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That, notwithstanding any other provision of law, of the amounts provided herein, not to exceed $472,193,000 $476,446,000 shall be for payments to tribes and tribal organizations for contract or grant support costs associated with contracts, grants, self-governance compacts, or annual funding agreements between the Indian Health Service and a tribe or tribal organization pursuant to the Indian Self-Determination Act of 1975, as amended, prior to or during fiscal year 2012, of which not to exceed $10,000,000 may be used for contract support costs associated with new or expanded self-determination contracts, grants, self-governance compacts, or annual funding agreements: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.653 billion primarily through self determination contracts and compacts, will be administered by tribal governments in 2012.Program and Financing(in millions of dollars)Identification code 75–0390–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Clinical services2,9873,0843,187
0002Preventive health144147151
0003Urban health434343
0004Indian health professions414141
0005Tribal management333
0006Direct operations697273
0007Self-governance666
0008Contract support costs398471476
0009Diabetes funds121150150
0799Total direct obligations3,8124,0174,130
0801Reimbursable program1,1251,1321,132
0900Total new obligations4,9375,1495,262
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1434744776
1021Recoveries of prior year unpaid obligations179
1050Unobligated balance (total)613744776
Budget authority:
Appropriations, discretionary:
1100Appropriation3,6733,8723,979
1120Transferred to other accounts [75–0390]–43
1121Transferred from other accounts [75–0390]43
1130Appropriations permanently reduced–7
1141Approp permanently reduced (Sec 436, HR 2055)–6
1160Appropriation, discretionary (total)3,6663,8663,979
Appropriations, mandatory:
1200Appropriation150150150
1260Appropriations, mandatory (total)150150150
Spending authority from offsetting collections, discretionary:
1700Collected1,1551,1651,165
1701Change in uncollected payments, Federal sources103
1750Spending auth from offsetting collections, disc (total)1,2581,1651,165
1900Budget authority (total)5,0745,1815,294
1930Total budgetary resources available5,6875,9256,070
Memorandum (non-add) entries:
1940Unobligated balance expiring–6
1941Unexpired unobligated balance, end of year744776808
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1,076866459
3010Uncollected pymts, Fed sources, brought forward, Oct 1–233–331–331
3020Obligated balance, start of year (net)843535128
3030Obligations incurred, unexpired accounts4,9375,1495,262
3031Obligations incurred, expired accounts22
3040Outlays (gross)–4,973–5,556–5,482
3050Change in uncollected pymts, Fed sources, unexpired–103
3051Change in uncollected pymts, Fed sources, expired5
3080Recoveries of prior year unpaid obligations, unexpired–179
3081Recoveries of prior year unpaid obligations, expired–17
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)866459239
3091Uncollected pymts, Fed sources, end of year–331–331–331
3100Obligated balance, end of year (net)535128–92
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross4,9245,0315,144
Outlays, gross:
4010Outlays from new discretionary authority4,0784,3354,428
4011Outlays from discretionary balances8391,068898
4020Outlays, gross (total)4,9175,4035,326
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–366–368–368
4033Non-Federal sources–792–797–797
4040Offsets against gross budget authority and outlays (total)–1,158–1,165–1,165
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–103
4052Offsetting collections credited to expired accounts3
4060Additional offsets against budget authority only (total)–100
4070Budget authority, net (discretionary)3,6663,8663,979
4080Outlays, net (discretionary)3,7594,2384,161
Mandatory:
4090Budget authority, gross150150150
Outlays, gross:
4100Outlays from new mandatory authority56144144
4101Outlays from mandatory balances912
4110Outlays, gross (total)56153156
4180Budget authority, net (total)3,8164,0164,129
4190Outlays, net (total)3,8154,3914,317
Object Classification(in millions of dollars)Identification code 75–0390–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent388390396
11.3Other than full-time permanent212121
11.5Other personnel compensation575858
11.7Military personnel787982
11.9Total personnel compensation544548557
12.1Civilian personnel benefits136137139
12.2Military personnel benefits343436
13.0Benefits for former personnel101010
21.0Travel and transportation of persons121113
21.0Patient travel303030
22.0Transportation of things777
23.1Rental payments to GSA121213
23.2Rental payments to others111
23.3Communications, utilities, and miscellaneous charges111112
24.0Printing and reproduction1
25.1Advisory and assistance services131010
25.2Other services from non-Federal sources80102114
25.3Other goods and services from Federal sources626263
25.4Operation and maintenance of facilities44
25.6Medical care342459499
25.7Operation and maintenance of equipment121212
25.8Subsistence and support of persons333
26.0Supplies and materials136142146
31.0Equipment141414
32.0Land and structures11
41.0Grants, subsidies, and contributions2,3512,4062,446
42.0Insurance claims and indemnities11
99.0Direct obligations3,8124,0174,130
99.0Reimbursable obligations1,1251,1321,132
99.9Total new obligations4,9375,1495,262
Employment SummaryIdentification code 75–0390–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment6,9827,1277,249
1101Direct military average strength employment1,0901,1031,112
2001Reimbursable civilian full-time equivalent employment5,3495,3565,362
2101Reimbursable military average strength employment835828822
Indian Health FacilitiesFor construction, repair, maintenance, improvement, and equipment of health and related auxiliary facilities, including quarters for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act with respect to environmental health and facilities support activities of the Indian Health Service, $441,052,000 $443,502,000, to remain available until expended: Provided, That notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation or expansion of health facilities for the benefit of an Indian tribe or tribes may be used to purchase land on which such facilities will be located: Provided further, That not to exceed $500,000 shall be used by the Indian Health Service to purchase TRANSAM equipment from the Department of Defense for distribution to the Indian Health Service and tribal facilities: Provided further, That none of the funds appropriated to the Indian Health Service may be used for sanitation facilities construction for new homes funded with grants by the housing programs of the United States Department of Housing and Urban Development: Provided further, That not to exceed $2,700,000 from this account and the "Indian Health Services'' account shall be used by the Indian Health Service to obtain ambulances for the Indian Health Service and tribal facilities in conjunction with an existing interagency agreement between the Indian Health Service and the General Services Administration: Provided further, That not to exceed $500,000 shall be placed in a Demolition Fund, to remain available until expended, and be used by the Indian Health Service for the demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service.Special and Trust Fund Receipts(in millions of dollars)Identification code 75–0391–0–1–5512011 actual2012 est.2013 est.
0100Balance, start of year
Receipts:
0220Rent and Charges for Quarters, Indian Health Service888
0400Total: Balances and collections888
Appropriations:
0500Indian Health Facilities–8–8–8
0799Balance, end of year
Program and Financing(in millions of dollars)Identification code 75–0391–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Sanitation and health facilities154165161
0002Maintenance545455
0003Facilities and environmental health193199205
0004Equipment232323
0100Total direct program424441444
0799Total direct obligations424441444
0801Reimbursable program183183183
0900Total new obligations607624627
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1181215243
1021Recoveries of prior year unpaid obligations25
1050Unobligated balance (total)206215243
Budget authority:
Appropriations, discretionary:
1100Appropriation405441444
1130Appropriations permanently reduced–1
1141Approp permanently reduced (Sec 436, HR 2055)–1
1160Appropriation, discretionary (total)404440444
Appropriations, mandatory:
1201Appropriation (special or trust fund)888
1260Appropriations, mandatory (total)888
Spending authority from offsetting collections, discretionary:
1700Collected1911916
1701Change in uncollected payments, Federal sources1313
1750Spending auth from offsetting collections, disc (total)2042046
1900Budget authority (total)616652458
1930Total budgetary resources available822867701
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year21524374
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)550580432
3010Uncollected pymts, Fed sources, brought forward, Oct 1–8–21–34
3020Obligated balance, start of year (net)542559398
3030Obligations incurred, unexpired accounts607624627
3040Outlays (gross)–552–772–411
3050Change in uncollected pymts, Fed sources, unexpired–13–13
3080Recoveries of prior year unpaid obligations, unexpired–25
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)580432648
3091Uncollected pymts, Fed sources, end of year–21–34–34
3100Obligated balance, end of year (net)559398614
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross608644450
Outlays, gross:
4010Outlays from new discretionary authority260336139
4011Outlays from discretionary balances287428264
4020Outlays, gross (total)547764403
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–190–190–6
4033Non-Federal sources–1–1
4040Offsets against gross budget authority and outlays (total)–191–191–6
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–13–13
4070Budget authority, net (discretionary)404440444
4080Outlays, net (discretionary)356573397
Mandatory:
4090Budget authority, gross888
Outlays, gross:
4100Outlays from new mandatory authority388
4101Outlays from mandatory balances2
4110Outlays, gross (total)588
4180Budget authority, net (total)412448452
4190Outlays, net (total)361581405
Object Classification(in millions of dollars)Identification code 75–0391–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent474951
11.3Other than full-time permanent444
11.5Other personnel compensation333
11.7Military personnel222324
11.9Total personnel compensation767982
12.1Civilian personnel benefits151616
12.2Military personnel benefits888
21.0Travel and transportation of persons333
22.0Transportation of things333
23.1Rental payments to GSA222
23.3Communications, utilities, and miscellaneous charges141616
25.1Advisory and assistance services222
25.2Other services from non-Federal sources645555
25.3Other goods and services from Federal sources112
25.4Operation and maintenance of facilities678
25.7Operation and maintenance of equipment334
25.8Subsistence and support of persons111111
26.0Supplies and materials788
31.0Equipment899
32.0Land and structures231717
41.0Grants, subsidies, and contributions178201198
99.0Direct obligations424441444
99.0Reimbursable obligations183183183
99.9Total new obligations607624627
Employment SummaryIdentification code 75–0391–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment1,0361,0081,011
1101Direct military average strength employment168167169
2001Reimbursable civilian full-time equivalent employment252525
ADMINISTRATIVE PROVISIONS Administrative Provisions—Indian Health ServiceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C. 3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C. 5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public Law 93–638, as amended: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance: Provided further, That the appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)Centers for Disease Control and Prevention CDC-Wide Activities and Program Support CDC-Wide Activities and Program SupportImmunization and Respiratory DiseasesFor carrying out titles II, III, VII, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, $579,375,000 $583,855,000: Provided, That in addition to amounts provided herein, $12,864,000 $13,765,000 shall be available from amounts available under section 241 of the PHS Act to carry out the National Immunization Surveys. HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis PreventionFor carrying out titles II, III, VII, XVII, XXIII, and XXVI of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, $1,105,995,000 $1,145,678,000: Provided, That Centers for Disease Control and Prevention and State grant recipients may transfer up to ten percent of funds appropriated for Centers for Disease Control and Prevention HIV/AIDS, sexually transmitted disease, hepatitis, and tuberculosis activities to address the overlapping epidemics of these diseases by improving program collaboration and providing integrated services in accordance with priorities identified by the Centers for Disease Control and Prevention: Provided further, That with respect to the previous proviso, grantees shall submit a plan in writing to the Centers for Disease Control and Prevention and obtain the approval of the Centers for Disease Control and Prevention to transfer such funds. Emerging and Zoonotic Infectious DiseasesFor carrying out titles II, III, VII, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, $253,919,000 $279,477,000, of which $1,000,000 shall remain available until expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under federal or state quarantine laws. Chronic Disease Prevention and Health PromotionFor carrying out titles II, III, VII, XI, XV, XVII, and XIX of the PHS Act and section 4201 of the Patient Protection and Affordable Care Act, with respect to chronic disease prevention and health promotion, $760,700,000 $608,019,000: Provided, That, in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out the Prevention Research Centers: Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for not less than up to 21 States, tribes, or tribal organizations. Birth Defects, Developmental Disabilities, Disabilities and HealthFor carrying out titles II, III, VII, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, $138,072,000 $18,476,000. Public Health Scientific ServicesFor carrying out titles II and III of the PHS Act with respect to health statistics, surveillance, informatics, and workforce development, $144,795,000 $35,695,000: Provided, That in addition to amounts provided herein, $247,769,000 $379,374,000 shall be available from amounts available under section 241 of the PHS Act to carry out Public Health Scientific Services. For carrying out titles II, III, VII, and XVII of the PHS Act with respect to environmental health, $105,598,000 $103,672,000. Injury Prevention and ControlFor carrying out titles II, III, VII, and XVII of the PHS Act with respect to injury prevention and control, $138,480,000 $137,754,000: Provided, That funds appropriated under this heading may be used to fund evaluation, research, and pilot programs for sexual violence prevention programs. National Institute for Occupational Safety and HealthFor carrying out titles II, III, VII, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22 of the Occupational Safety and Health Act, with respect to occupational safety and health, $182,903,000: Provided, That in addition to amounts provided herein, $110,724,000 $249,364,000 shall be available from amounts available under section 241 of the PHS Act. Energy Employees Occupational Illness Compensation ProgramFor necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain available until expended, of which $4,500,000 shall be for use by or in support of the Advisory Board on Radiation and Worker Health ("Board'') to carry out its statutory responsibilities, including obtaining audits, technical assistance, and other support from the Board's audit contractor with regard to radiation dose estimation and reconstruction efforts, site profiles, procedures, and review of Special Exposure Cohort petitions and evaluation reports: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of division B, title I of Public Law 106–554. For carrying out titles II, III, VII and XVII of the PHS Act with respect to global health, $349,547,000 $362,889,000, of which $118,023,000 $117,156,000 for international HIV/AIDS shall remain available through September 30, 2013 2014: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries. Public Health Preparedness and ResponseFor carrying out titles II, III, VII, and XVII of the PHS Act with respect to public health preparedness and response, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, $1,306,906,000 $1,228,360,000, of which $509,486,000 $439,444,000 shall remain available until expended for the Strategic National Stockpile under pursuant to section 319F-2 of the PHS Act. CDC-Wide Activities and Program SupportFor carrying out titles II, III, VII, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program support that supplement activities funded under the headings "Immunization and Respiratory Diseases'', "HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention'', "Emerging and Zoonotic Infectious Diseases'', "Chronic Disease Prevention and Health Promotion'', "Birth Defects, Developmental Disabilities, Disabilities and Health'', "Environmental Health'', "Injury Prevention and Control'', "National Institute for Occupational Safety and Health'', "Employees Occupational Illness Compensation Program Act'', "Global Health'', "Public Health Preparedness and Response'', and "Public Health Scientific Services'', and for carrying out section 4001 of the Patient Protection and Affordable Care Act, $621,445,000 $487,648,000 of which $30,000,000 $368,529,000 shall be available until September 30, 2013 2014, for business services, of which $25,000,000 shall be available until September 30, 2016, for equipment, construction and renovation of facilities, and of which $80,000,000 shall be for the Preventive Health and Health Services Block Grant Program: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading and in all other accounts of the Centers for Disease Control and Prevention (referred to in this title as "CDC''): Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase, hire, maintenance, and operation of aircraft for use and support of the activities of CDC: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities, or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service, or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program shall be available through September 30, 2013 2014: Provided further, That of the funds made available under this heading, up to $1,000 per eligible employee of CDC shall be made available until expended for Individual Learning Accounts: Provided further, That CDC may establish a Working Capital Fund, with the authorities equivalent to those provided in 42 U.S.C. 231, to improve the provision of supplies and service Provided further, That the Director may transfer funds between any of the accounts of CDC with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve the health, safety, and protection of all Americans. These activities include immunization, HIV prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion, occupational safety and health, injury prevention and control, environmental health, global health, programs that reduce the occurrence of birth defects and developmental disabilities, and CDC-Wide Activities and Program Support. CDC also supports bioterrorism, emergency response, and pandemic influenza preparedness activities. The CDC Stockpile activities include resources directed at enhancing preparedness. The Budget will finance a portion of these ongoing activities through unobligated balances available from P.L. 111–32, the Supplemental Appropriations Act of 2009. P.L. 111–32 appropriated $7.65 billion to the Public Health and Social Services Emergency Fund for pandemic influenza preparedness and response activities. Special and Trust Fund Receipts(in millions of dollars)Identification code 75–0943–0–1–9992011 actual2012 est.2013 est.
0100Balance, start of year
Receipts:
0220Cooperative Research and Development Agreements, Centers for Disease Control222
0400Total: Balances and collections222
Appropriations:
0500CDC-Wide Activities and Program Support–2–2–2
0799Balance, end of year
Program and Financing(in millions of dollars)Identification code 75–0943–0–1–9992011 actual2012 est.2013 est.
Obligations by program activity:
0001Birth Defects, Developmental Disabilities, Disability and Health (BA & Prevention Fund)136137125
0002Buildings and Facilities5825
0003Business Services Support361395369
0004Chronic Disease Prevention and Health Promotion813756608
0005Emerging and Zoonotic Infectious Diseases252252280
0006Energy Employee Illness Occupational Compensation Program Act (EEOICPA)575555
0007Environmental Health134105104
0008Global Health365348363
0009Pandemic Influenza Supplemental (H1N1)18
0010Healthcare Reform Prevention and Public Health Fund, Other Activities611805796
0011Health Reform - Chronic Disease Prevention and Health Promotion7
0012HIV/AIDS, Viral Hepatitis, STD and TB Prevention1,0751,1001,146
0013Immunization and Respiratory Diseases478576584
0014Individual Learning Accounts (ILAs)7
0015Injury Prevention and Control143138138
0016Occupational Safety and Health230182
0017Preventive Health & Health Services Block Grants8079
0018Public Health Leadership & Support120119119
0019Public Health Preparedness & Response1,3211,3001,228
0020Public Health Scientific Services14714435
0799Total direct obligations6,4136,5165,950
0802Other Reimbursable Programs622749749
0809Reimbursable program activities, subtotal622749749
0900Total new obligations7,0357,2656,699
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1283192161
1021Recoveries of prior year unpaid obligations204
1050Unobligated balance (total)303196161
Budget authority:
Appropriations, discretionary:
1100Appropriation5,6605,6684,992
1120Appropriations transferred to other accts [75–0350]–1
1130Appropriations permanently reduced–11
1143Approp permanently reduced (Sec 527, HR 2055)–11
1160Appropriation, discretionary (total)5,6495,6564,992
Appropriations, mandatory:
1200Appropriation555555
1201Appropriation (special or trust fund)222
1221Appropriations transferred from other accts [75–0116]611805903
1260Appropriations, mandatory (total)668862960
Spending authority from offsetting collections, discretionary:
1700Collected310712712
1701Change in uncollected payments, Federal sources300
1750Spending auth from offsetting collections, disc (total)610712712
1900Budget authority (total)6,9277,2306,664
1930Total budgetary resources available7,2307,4266,825
Memorandum (non-add) entries:
1940Unobligated balance expiring–3
1941Unexpired unobligated balance, end of year192161126
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)6,8506,4516,487
3010Uncollected pymts, Fed sources, brought forward, Oct 1–486–468–468
3020Obligated balance, start of year (net)6,3645,9836,019
3030Obligations incurred, unexpired accounts7,0357,2656,699
3031Obligations incurred, expired accounts31
3040Outlays (gross)–7,277–7,225–6,866
3050Change in uncollected pymts, Fed sources, unexpired–300
3051Change in uncollected pymts, Fed sources, expired318
3080Recoveries of prior year unpaid obligations, unexpired–20–4
3081Recoveries of prior year unpaid obligations, expired–168
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)6,4516,4876,320
3091Uncollected pymts, Fed sources, end of year–468–468–468
3100Obligated balance, end of year (net)5,9836,0195,852
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross6,2596,3685,704
Outlays, gross:
4010Outlays from new discretionary authority2,5502,4532,124
4011Outlays from discretionary balances4,5194,4413,975
4020Outlays, gross (total)7,0696,8946,099
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–606–703–703
4033Non-Federal sources–13–9–9
4040Offsets against gross budget authority and outlays (total)–619–712–712
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–300
4052Offsetting collections credited to expired accounts309
4060Additional offsets against budget authority only (total)9
4070Budget authority, net (discretionary)5,6495,6564,992
4080Outlays, net (discretionary)6,4506,1825,387
Mandatory:
4090Budget authority, gross668862960
Outlays, gross:
4100Outlays from new mandatory authority120320353
4101Outlays from mandatory balances8811414
4110Outlays, gross (total)208331767
4180Budget authority, net (total)6,3176,5185,952
4190Outlays, net (total)6,6586,5136,154
Object Classification(in millions of dollars)Identification code 75–0943–0–1–9992011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent674801723
11.3Other than full-time permanent8110090
11.5Other personnel compensation384338
11.7Military personnel627166
11.8Special personal services payments111
11.9Total personnel compensation8561,016918
12.1Civilian personnel benefits231273247
12.2Military personnel benefits445047
21.0Travel and transportation of persons494940
22.0Transportation of things171615
23.1Rental payments to GSA105251
23.2Rental payments to others111
23.3Communications, utilities, and miscellaneous charges383633
24.0Printing and reproduction565
25.1Advisory and assistance services581498439
25.2Other services from non-Federal sources237211189
25.3Other goods and services from Federal sources396390364
25.4Operation and maintenance of facilities745046
25.5Research and development contracts516862
25.6Medical care32927
25.7Operation and maintenance of equipment333532
25.8Subsistence and support of persons (Includes 1259)313330
26.0Supplies and materials560518518
31.0Equipment585555
32.0Land and structures4198
41.0Grants, subsidies, and contributions3,0973,1212,823
99.0Direct obligations6,4136,5165,950
99.0Reimbursable obligations622749749
99.9Total new obligations7,0357,2656,699
Employment SummaryIdentification code 75–0943–0–1–9992011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment8,4328,3798,370
1101Direct military average strength employment814771771
2001Reimbursable civilian full-time equivalent employment1,0771,0821,081
2101Reimbursable military average strength employment388181
The Consolidated Appropriations Bill, 2012 (P.L. 112–74, Division F) provided authorities equivalent to those provided in 42 U.S.C 231 for CDC to begin creating a Working Capital Fund. The Working Capital Fund will be used by CDC to achieve greater cost efficiencies across the administrative operations of the agency. Toxic Substances and Environmental Public Health, Agency for Toxic Substances and Disease Registry Agency for Toxic Substances and Disease Registrytoxic substances and environmental public healthFor necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended; section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA), as amended; and section 3019 of the Solid Waste Disposal Act, as amended, $76,337,000 $76,300,000, of which up to $1,000 per eligible employee of the Agency for Toxic Substances and Disease Registry shall remain available until expended for Individual Learning Accounts: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA, the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation, biomedical testing, clinical evaluations, medical monitoring, and referral to accredited healthcare providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological profiles pursuant to section 104(I) of CERCLA during fiscal year 2012 2013, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)The Agency for Toxic Substances and Disease Registry (ATSDR) is authorized under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). ATSDR assesses health hazards at specific hazardous waste sites helping to prevent or reduce exposure and illnesses that result, and increasing knowledge and understanding of the health effects that may result from exposure to hazardous substances.Program and Financing(in millions of dollars)Identification code 75–0944–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Direct program767676
0002Direct program - health reform3
0799Total direct obligations797676
0801Reimbursable program101010
0900Total new obligations898686
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1232121
Budget authority:
Appropriations, discretionary:
1100Appropriation777676
1160Appropriation, discretionary (total)777676
Spending authority from offsetting collections, discretionary:
1700Collected3310
1701Change in uncollected payments, Federal sources77
1750Spending auth from offsetting collections, disc (total)101010
1900Budget authority (total)878686
1930Total budgetary resources available110107107
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year212121
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)434714
3010Uncollected pymts, Fed sources, brought forward, Oct 1–13–13–20
3020Obligated balance, start of year (net)3034–6
3030Obligations incurred, unexpired accounts898686
3040Outlays (gross)–81–119–95
3050Change in uncollected pymts, Fed sources, unexpired–7–7
3051Change in uncollected pymts, Fed sources, expired7
3081Recoveries of prior year unpaid obligations, expired–4
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)47145
3091Uncollected pymts, Fed sources, end of year–13–20–20
3100Obligated balance, end of year (net)34–6–15
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross878686
Outlays, gross:
4010Outlays from new discretionary authority558484
4011Outlays from discretionary balances26263
4020Outlays, gross (total)8111087
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–10–3–10
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–7–7
4052Offsetting collections credited to expired accounts7
4060Additional offsets against budget authority only (total)–7
4070Budget authority, net (discretionary)777676
4080Outlays, net (discretionary)7110777
Mandatory:
Outlays, gross:
4101Outlays from mandatory balances98
4180Budget authority, net (total)777676
4190Outlays, net (total)7111685
Object Classification(in millions of dollars)Identification code 75–0944–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent232222
11.3Other than full-time permanent111
11.5Other personnel compensation111
11.7Military personnel444
11.9Total personnel compensation292828
12.1Civilian personnel benefits777
12.2Military personnel benefits222
25.1Advisory and assistance services544
25.2Other services from non-Federal sources777
25.3Other goods and services from Federal sources111111
26.0Supplies and materials11
31.0Equipment11
41.0Grants, subsidies, and contributions181515
99.0Direct obligations797676
99.0Reimbursable obligations101010
99.9Total new obligations898686
Employment SummaryIdentification code 75–0944–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment259258258
1101Direct military average strength employment393939
2001Reimbursable civilian full-time equivalent employment131313
World Trade Center Health Program Fund HHS along with CDC began implementing provisions of The James Zadroga 9/11 Health and Compensation Act of 2010 (P.L.111–347) on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the Program Administrator for the WTC Health Program. The WTC Health Program provides quality care for WTC-related health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks. The amounts included for FY 2012 and FY 2013 Budget reflect estimated Federal obligations for the WTC Health Program. Program and Financing(in millions of dollars)Identification code 75–0946–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Federal Share71174171
0002NYC81919
0900Total new obligations79193190
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation (WTC (CDC Direct))79174171
1200Appropriation (WTC—NYC DHSS—CDC)1919
1260Appropriations, mandatory (total)79193190
1930Total budgetary resources available79193190
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)68131
3030Obligations incurred, unexpired accounts79193190
3040Outlays (gross)–11–130–161
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)68131160
3100Obligated balance, end of year (net)68131160
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross79193190
Outlays, gross:
4100Outlays from new mandatory authority116564
4101Outlays from mandatory balances6597
4110Outlays, gross (total)11130161
4180Budget authority, net (total)79193190
4190Outlays, net (total)11130161
Object Classification(in millions of dollars)Identification code 75–0946–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
25.1Advisory and assistance services82019
25.2Other services from non-Federal sources338079
25.3Other goods and services from Federal sources21010
25.6Medical care347978
41.0Grants, subsidies, and contributions244
99.9Total new obligations79193190
National Institutes of Health National Institutes of Health National Cancer InstituteFor carrying out section 301 and title IV of the PHS Act with respect to cancer, $5,081,788,000 $5,068,864,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research and Development Center in Frederick, Maryland. (Department of Health and Human Services Appropriations Act, 2012.)National Heart, Lung, and Blood InstituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, $3,084,851,000 $3,076,067,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Dental and Craniofacial ResearchFor carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $411,488,000 $408,212,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Diabetes and Digestive and Kidney DiseasesFor carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,800,447,000 $1,792,107,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Neurological Disorders and StrokeFor carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,629,445,000 $1,624,707,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Allergy and Infectious DiseasesFor carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $4,499,215,000 $4,495,307,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of General Medical SciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $2,434,637,000: Provided, That not less than $276,480,000 is provided for the Institutional Development Awards program $2,378,835,000. (Department of Health and Human Services Appropriations Act, 2012.)Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentFor carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $1,323,900,000 $1,320,600,000. (Department of Health and Human Services Appropriations Act, 2012.)For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $704,043,000 $693,015,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Environmental Health SciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $686,869,000 $684,030,000. (Department of Health and Human Services Appropriations Act, 2012.)For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended, and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $79,054,000 $78,928,000. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)National Institute on AgingFor carrying out section 301 and title IV of the PHS Act with respect to aging, $1,105,530,000 $1,102,650,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Arthritis and Musculoskeletal and Skin DiseasesFor carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $536,801,000 $535,610,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute on Deafness and Other Communication DisordersFor carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $417,061,000 $417,297,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Nursing ResearchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, $145,043,000 $144,153,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute on Alcohol Abuse and AlcoholismFor carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $460,389,000 $457,104,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute on Drug AbuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $1,055,362,000 $1,054,001,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Mental HealthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,483,068,000 $1,479,204,000. (Department of Health and Human Services Appropriations Act, 2012.)National Human Genome Research InstituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, $513,844,000 $511,370,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute of Biomedical Imaging and BioengineeringFor carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $338,998,000 $336,896,000. (Department of Health and Human Services Appropriations Act, 2012.)National Center for Complementary and Alternative MedicineFor carrying out section 301 and title IV of the PHS Act with respect to complementary and alternative medicine, $128,299,000 $127,930,000. (Department of Health and Human Services Appropriations Act, 2012.)National Institute on Minority Health and Health DisparitiesFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, $276,963,000 $279,389,000. (Department of Health and Human Services Appropriations Act, 2012.)John E. Fogarty International CenterFor carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), $69,754,000 $69,758,000. (Department of Health and Human Services Appropriations Act, 2012.)National Library of MedicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications, $338,278,000 $372,651,000, of which $4,000,000 shall be available until September 30, 2013 2014, for improvement of information systems: Provided, That in fiscal year 2012 2013, the National Library of Medicine may enter into personal services contracts for the provision of services in facilities owned, operated, or constructed under the jurisdiction of the National Institutes of Health (referred to in this title as "NIH''): Provided further, That in addition to amounts provided herein, $8,200,000 shall be available from amounts available under section 241 of the PHS Act to carry out the purposes of the National Information Center on Health Services Research and Health Care Technology established under section 478A of the PHS Act and related health services. (Department of Health and Human Services Appropriations Act, 2012.)National Center for Advancing Translational SciencesFor carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $576,456,000 $639,033,000: Provided, That up to $10,000,000 $50,000,000 shall be available to implement section 402C of the PHS Act, relating to the Cures Acceleration Network: Provided further, That funds appropriated may be used to support the reorganization and activities required to eliminate the National Center for Research Resources: Provided further, That the Director of the NIH shall ensure that, of all funds made available to Institute, Center, and Office of the Director accounts within "Department of Health and Human Services, National Institutes of Health'', at least $487,767,000 is provided to the Clinical and Translational Sciences Awards program. (Department of Health and Human Services Appropriations Act, 2012.)For carrying out the responsibilities of the Office of the Director, NIH, $1,461,880,000 $1,429,161,000, of which up to $25,000,000 shall be used to carry out section 213 of this Act: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That NIH is authorized to collect third-party payments for the cost of clinical services that are incurred in NIH research facilities and that such payments shall be credited to the NIH Management Fund: Provided further, That all funds credited to the NIH Management Fund shall remain available for one fiscal year after the fiscal year in which they are deposited: Provided further, That $193,880,000 shall be available for continuation of the National Children's Study: Provided further, That $545,962,000 $544,930,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act: Provided further, That the Director may direct up to 1 percent of the total made available in this or any other Act to all National Institutes of Health appropriations to activities that the Director may so designate: Provided further, That no such appropriation shall be decreased by more than 1 percent by any such transfers and that the Congress is promptly notified of the transfer. (Department of Health and Human Services Appropriations Act, 2012.)For the study of, construction of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, $125,581,000 $125,308,000, to remain available until September 30, 2016 expended. (Department of Health and Human Services Appropriations Act, 2012.)DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT(in millions of dollars)2011201212013
Distribution of budget authority by account:
National Cancer Institute5,0595,0715,069
National Heart, Lung, and Blood Institute3,0703,0783,076
National Institute of Dental and Craniofacial Research409411408
National Institute of Diabetes and Digestive and Kidney Diseases1,9421,9471,942
National Institute of Neurological Disorder and Stroke1,6221,6261,625
National Institute of Allergy and Infectious Diseases4,77624,48924,495
National Institute of General Medical Sciences2,0342,4292,379
Eunice Kennedy Shriver National Institute of Child Health and Human Development1,3181,3211,321
National Eye Institute701703693
National Institute of Environmental Health Sciences763764763
National Institute on Aging1,1001,1031,103
National Institute of Arthritis and Musculoskeletal and Skin Diseases534536536
National Institute on Deafness and Other Communication Disorders415416417
National Institute of Mental Health1,4771,4801,479
National Institute on Drug Abuse1,0501,0531,054
National Institute on Alcohol Abuse and Alcoholism458459457
National Institute of Nursing Research144145144
National Center for Research Resources1,26500
National Human Genome Research Institute511513511
National Institute of Biomedical Imaging and Bioengineering314338337
National Institute on Minority Health and Health Disparities210276279
National Center for Complementary and Alternative Medicine119128128
National Center for Advancing Translational Sciences0575639
John E. Fogarty International Center697070
National Library of Medicine337338373
Office of the Director1,1671,4591,429
Buildings and Facilities50125125
ARRA Funds000
Subtotal30,91430,85230,852
Cooperative Research and Development Agreements121717
Total Budget Authority, NIH30,92630,86930,869
1Funding provided in the Consolidated Appropriations Act, 2012, reflects a reorganization of the National Institutes of Health that created the new National Center for Advancing Translational Sciences (NCATS) and abolished the National Center for Research Resources (NCRR). The translational functions of NCRR were moved to NCATS, and the remaining non-translational functions were moved to the National Institute of General Medical Sciences, the National Institute of Biomedical Imaging and Bioengineering, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of the Director.2The Department of Defense and Full-Year Continuing Appropriations Act, 2011, included $297,300,000 in the National Institute of Allergy and Infectious Diseases for transfer to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis. The Consolidated Appropriations Act, 2012, did not include such a transfer.
(in millions of dollars)201120122013
Distribution of outlays by account:
National Cancer Institute5,0964,7045,018
National Heart, Lung, and Blood Institute3,0883,0343,045
National Institute of Dental and Craniofacial Research410425415
National Institute of Diabetes and Digestive and Kidney Diseases1,9051,8931,960
National Institute of Neurological Disorders and Stroke1,5801,6711,641
National Institute of Allergy and Infectious Diseases4,4674,1354,526
National Institute of General Medical Sciences1,9852,1362,060
Eunice Kennedy Shriver National Institute of Child Health and Human Development1,2741,3471,335
National Eye Institute693680709
National Institute of Environmental Health Sciences769770773
National Institute on Aging1,0991,0531,135
National Institute of Arthritis and Musculoskeletal and Skin Diseases532512540
National Institute on Deafness and Other Communication Disorders407422420
National Institute of Mental Health1,4921,4521,496
National Institute on Drug Abuse1,0699761,054
National Institute on Alcohol Abuse and Alcoholism457463463
National Institute of Nursing Research145131146
National Center for Research Resources1,2177881,268
National Human Genome Research Institute506495520
National Institute of Biomedical Imaging and Bioengineering309307320
National Institute on Minority Health and Health Disparities211202216
National Center for Complementary and Alternative Medicine131106133
National Center for Advancing Translational Sciences092453
John E. Fogarty International Center716871
National Library of Medicine334315363
Office of the Director1,1961,4231,193
Buildings and Facilities115146113
ARRA Funds3,8441,8641,095
Subtotal Outlays34,40231,61032,481
Cooperative Research and Development Agreements171717
Total Outlays, NIH34,41931,62732,498
This program funds biomedical research and research training. These accounts will continue to be appropriated separately, and are displayed in a consolidated format to improve the readability of the presentation. Detailed information is available through the Department of Health and Human Services.Special and Trust Fund Receipts(in millions of dollars)Identification code 75–9915–0–1–5522011 actual2012 est.2013 est.
0100Balance, start of year
Receipts:
0220Cooperative Research and Development Agreements, NIH171717
0400Total: Balances and collections171717
Appropriations:
0500National Institutes of Health–17–17–17
0799Balance, end of year
Program and Financing(in millions of dollars)Identification code 75–9915–0–1–5522011 actual2012 est.2013 est.
Obligations by program activity:
0001National Cancer Institute (0849)5,0595,0715,069
0002National Heart, Lung, and Blood Institute (0872)3,0703,0783,076
0003National Institute of Dental and Craniofacial Research (0873)409411408
0004National Institute of Diabetes and Digestive and Kidney Disease (0884)1,7921,7971,792
0005National Institute of Neurological Disorders and Stroke (0886)1,6221,6261,625
0006National Institute of Allergy and Infectious Diseases (0885)4,4784,4894,495
0007National Institute of General Medical Sciences (0851)2,0342,4292,379
0008National Institute of Child Health and Human Development (0844)1,3181,3211,321
0009National Eye Institute (0887)701703693
0010National Institute of Environmental Health Sciences (0862)763764763
0011National Institute on Aging (0843)1,1001,1031,103
0012National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)534536536
0013National Institute on Deafness and Other Communication Disorder (0890)415416417
0014National Institute of Mental Health (0892)1,4771,4801,479
0015National Institute on Drug Abuse (0893)1,0501,0531,054
0016National Institute on Alcohol Abuse and Alcoholism (0894)458459457
0017National Institute of Nursing Research (0889)144145144
0018National Human Genome Research Institute (0891)511513511
0019National Institute of Biomedical Imaging and Bioengineering (0898)314338337
0020National Center for Research Resources (0848)1,258
0021National Center for Complementary and Alternative Medicine (0896)128128128
0022National Institute on Minority Health and Health Disparities (0897)210276279
0023John E. Fogarty International Center (0819)697070
0024National Library of Medicine (0807)337338373
0025Office of the Director (0846)1,1671,4591,429
0026Buildings and facilities (0838)62125125
0027Cooperative Research and Development Agreements121717
0028National Center for Advancing Translational Sciences (0875)575639
0031Type 1 Diabetes150150150
0799Total direct obligations30,64230,87030,869
0801Reimbursable program activity3,1903,2013,294
0802Royalties888888
0809Reimbursable program activities, subtotal3,2783,2893,382
0899Total reimbursable obligations3,2783,2893,382
0900Total new obligations33,92034,15934,251
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1345376375
1020Adjustment of unobligated bal brought forward, Oct 1–6
1021Recoveries of prior year unpaid obligations46
1050Unobligated balance (total)385376375
Budget authority:
Appropriations, discretionary:
1100Appropriation30,82830,76930,702
1120Transferred to other accounts [72–1028]–297
1120Appropriations transferred to other accts [75–0350]–9
1121Transferred from other accounts [75–9912]1
1130Appropriations permanently reduced–62
1143Approp permanently reduced (Sec 527, HR 2055)–58
1160Appropriation, discretionary (total)30,47030,70230,702
Appropriations, mandatory:
1200Appropriation150150150
1201Appropriation (special or trust fund)171717
1260Appropriations, mandatory (total)167167167
Spending authority from offsetting collections, discretionary:
1700Collected2,7343,2893,382
1701Change in uncollected payments, Federal sources544
1750Spending auth from offsetting collections, disc (total)3,2783,2893,382
1900Budget authority (total)33,91534,15834,251
1930Total budgetary resources available34,30034,53434,626
Memorandum (non-add) entries:
1940Unobligated balance expiring–4
1941Unexpired unobligated balance, end of year376375375
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)39,71235,62234,908
3010Uncollected pymts, Fed sources, brought forward, Oct 1–1,247–1,151–1,151
3011Adjustments to uncollected pymts, Fed sources, brought forward, Oct 16
3020Obligated balance, start of year (net)38,47134,47133,757
3030Obligations incurred, unexpired accounts33,92034,15934,251
3031Obligations incurred, expired accounts857
3040Outlays (gross)–37,715–34,873–33,863
3050Change in uncollected pymts, Fed sources, unexpired–544
3051Change in uncollected pymts, Fed sources, expired634
3080Recoveries of prior year unpaid obligations, unexpired–46
3081Recoveries of prior year unpaid obligations, expired–1,106
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)35,62234,90835,296
3091Uncollected pymts, Fed sources, end of year–1,151–1,151–1,151
3100Obligated balance, end of year (net)34,47133,75734,145
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross33,74833,99134,084
Outlays, gross:
4010Outlays from new discretionary authority10,75111,15011,243
4011Outlays from discretionary balances26,69523,55622,453
4020Outlays, gross (total)37,44634,70633,696
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–3,246–3,289–3,382
4033Non-Federal sources–99
4040Offsets against gross budget authority and outlays (total)–3,345–3,289–3,382
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–544
4052Offsetting collections credited to expired accounts611
4060Additional offsets against budget authority only (total)67
4070Budget authority, net (discretionary)30,47030,70230,702
4080Outlays, net (discretionary)34,10131,41730,314
Mandatory:
4090Budget authority, gross167167167
Outlays, gross:
4100Outlays from new mandatory authority15353
4101Outlays from mandatory balances268114114
4110Outlays, gross (total)269167167
4180Budget authority, net (total)30,63730,86930,869
4190Outlays, net (total)34,37031,58430,481
Object Classification(in millions of dollars)Identification code 75–9915–0–1–5522011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent878885889
11.3Other than full-time permanent477483494
11.5Other personnel compensation444343
11.7Military personnel222223
11.8Special personal services payments166170169
11.9Total personnel compensation1,5871,6031,618
12.1Civilian personnel benefits403409412
12.2Military personnel benefits161616
21.0Travel and transportation of persons565554
22.0Transportation of things565
23.1Rental payments to GSA111
23.2Rental payments to others111
23.3Communications, utilities, and miscellaneous charges262726
24.0Printing and reproduction847
25.1Advisory and assistance services112117132
25.2Other services from non-Federal sources714718725
25.3Other goods and services from Federal sources3,0543,0563,246
25.4Operation and maintenance of facilities1268377
25.5Research and development contracts2,1172,1571,968
25.6Medical care181817
25.7Operation and maintenance of equipment838582
25.8Subsistence and support of persons2
26.0Supplies and materials194204196
31.0Equipment120125119
32.0Land and structures126125
41.0Grants, subsidies, and contributions21,99922,05922,042
99.0Direct obligations30,64230,87030,869
99.0Reimbursable obligations3,2783,2893,382
99.9Total new obligations33,92034,15934,251
Employment SummaryIdentification code 75–9915–0–1–5522011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment13,29213,29213,157
1101Direct military average strength employment238238238
2001Reimbursable civilian full-time equivalent employment4,9504,9504,899
2101Reimbursable military average strength employment898989
Substance Abuse and Mental Health Services Administration Susbstance Abuse and Mental Health Services Administration Mental HealthFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for Individuals with Mental Illness Act, $934,853,000 $902,856,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, $21,039,000 $21,039,000 shall be available under section 241 of the PHS Act to carry out subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1920(b) activities shall not exceed 5 percent of the amounts appropriated for subpart I of part B of title XIX: Provided further, That section 520E(b)(2) of the PHS Act shall not apply to funds appropriated under this Act for fiscal year 2012: Provided further, That of the amount appropriated under this heading, $45,800,000 shall be for the National Child Traumatic Stress Initiative as described in section 582 of the PHS Act 2013. Substance Abuse TreatmentFor carrying out titles III, V, and XIX of the PHS Act with respect to substance abuse treatment and section 1922(a) of the PHS Act with respect to substance abuse prevention, $2,123,993,000 $1,711,045,000: Provided, That in addition to amounts provided herein, the following amounts shall be available under section 241 of the PHS Act: (1) $79,200,000 $71,724,000 shall be available under section 241 of the PHS Act to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX; and (2) $2,000,000 to evaluate substance abuse treatment programs: Provided further, That no funds shall be available for the National All Schedules Prescription Reporting system section 1922(a)(1) of the PHS Act shall not apply to amounts provided herein. Substance Abuse PreventionFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention, $186,361,000 $463,378,000. Health Surveillance and Program SupportFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'' in carrying out titles III, V, and XIX of the PHS Act and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, $109,106,000 $74,229,000: Provided, That in addition to amounts provided herein, $27,428,000 $71,995,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug abuse and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities: Provided further, That, in addition, fees may be collected for the costs associated with additional publications, data, data tabulations, and data analysis completed under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation and shall remain available until expended for such purposes: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'': Provided further, That the Administrator may transfer funds between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective substance abuse prevention, addiction treatment, and mental health services for people at risk for or experiencing substance abuse or mental illness. SAMHSA builds partnerships with states, communities, tribal and private not-for-profit organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities. The Consolidated Appropriations Act of 2012 (P.L. 112–74) restructured the appropriation accounts for SAMHSA, which is continued in FY 2013.Program and Financing(in millions of dollars)Identification code 75–1362–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0002Mental Health Block Grant420
0003Substance Abuse Block Grant1,442
0004State Prevention Grants475
0005Program Management120
0006Mental Health933903
0007Substance Abuse Treatment1,7751,711
0008Substance Abuse Prevention530464
0009Health Surveillance and Program Support10974
0010Children's Mental Health118
0011PATH Homeless State Grants65
0012Protection and Advocacy36
0013Innovation and Emerging Issues680
0014Public Education and Support14
0022Performance and Quality Information Systems38
0023Regulatory and Oversight Functions53
0100Total, direct program3,4613,3473,152
0799Total direct obligations3,4613,3473,152
0802Reimbursable program: PHS Evaluation256255292
0900Total new obligations3,7173,6023,444
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 188
Budget authority:
Appropriations, discretionary:
1100Appropriation3,3863,3543,152
1120Appropriations transferred to other accts [75–0350]–1
1130Appropriations permanently reduced–7
1143Approp permanently reduced (Sec 527, HR 2055)–6
1160Appropriation, discretionary (total)3,3793,3473,152
Appropriations, mandatory:
1221Appropriations transferred from the Prevention and Public Health Fund [75–0116]8888105
1260Appropriations, mandatory (total)8888105
Spending authority from offsetting collections, discretionary:
1700Collected144255292
1700Collected2
1701Change in uncollected payments, Federal sources106
1750Spending auth from offsetting collections, disc (total)250255294
1900Budget authority (total)3,7173,6903,551
1930Total budgetary resources available3,7173,6903,639
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year88195
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)2,8282,9642,877
3010Uncollected pymts, Fed sources, brought forward, Oct 1–151–239–239
3020Obligated balance, start of year (net)2,6772,7252,638
3030Obligations incurred, unexpired accounts3,7173,6023,444
3040Outlays (gross)–3,557–3,689–3,699
3050Change in uncollected pymts, Fed sources, unexpired–106
3051Change in uncollected pymts, Fed sources, expired18
3081Recoveries of prior year unpaid obligations, expired–24
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)2,9642,8772,622
3091Uncollected pymts, Fed sources, end of year–239–239–239
3100Obligated balance, end of year (net)2,7252,6382,383
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross3,6293,6023,446
Outlays, gross:
4010Outlays from new discretionary authority1,4651,5941,555
4011Outlays from discretionary balances2,0832,0422,047
4020Outlays, gross (total)3,5483,6363,602
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–144–255–292
4033Non-Federal sources–2
4040Offsets against gross budget authority and outlays (total)–144–255–294
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–106
4070Budget authority, net (discretionary)3,3793,3473,152
4080Outlays, net (discretionary)3,4043,3813,308
Mandatory:
4090Budget authority, gross8888105
Outlays, gross:
4100Outlays from new mandatory authority11
4101Outlays from mandatory balances95296
4110Outlays, gross (total)95397
4180Budget authority, net (total)3,4673,4353,257
4190Outlays, net (total)3,4133,4343,405
Object Classification(in millions of dollars)Identification code 75–1362–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent474646
11.3Other than full-time permanent222
11.5Other personnel compensation111
11.7Military personnel444
11.9Total personnel compensation545353
12.1Civilian personnel benefits121212
12.2Military personnel benefits222
21.0Travel and transportation of persons122
23.1Rental payments to GSA777
23.3Communications, utilities, and miscellaneous charges111
24.0Printing and reproduction333
25.1Advisory and assistance services292617
25.2Other services from non-Federal sources229201130
25.3Other goods and services from Federal sources879058
25.7Operation and maintenance of equipment111
41.0Grants, subsidies, and contributions3,0342,9482,865
42.0Insurance claims and indemnities111
99.0Direct obligations3,4613,3473,152
99.0Reimbursable obligations256255292
99.9Total new obligations3,7173,6023,444
Employment SummaryIdentification code 75–1362–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment472496496
1101Direct military average strength employment525454
2001Reimbursable civilian full-time equivalent employment192020
2101Reimbursable military average strength employment444
Agency for Healthcare Research and Quality Healthcare Research and Quality Healthcare Research and QualityFor carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, $369,053,000 $334,357,000 shall be available from amounts available under section 241 of the PHS Act, notwithstanding subsection 947(c) of such Act: Provided, That in addition, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this appropriation and shall remain available until September 30, 2013 expended. (Department of Health and Human Services Appropriations Act, 2012.)This activity supports the development of scientific evidence and tools to improve the quality, safety, and effectiveness of all aspects of the health care system, and initiatives to disseminate and translate scientific findings into health care practice. Program and Financing(in millions of dollars)Identification code 75–1700–0–1–5522011 actual2012 est.2013 est.
Obligations by program activity:
0003Prevention and Public Health Fund121212
0801Reimbursable program171717
0802Reimbursable program: PHS evaluation371369334
0899Total reimbursable obligations388386351
0900Total new obligations400398363
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1644
Budget authority:
Appropriations, mandatory:
1221Appropriations transferred from other accts [75–0116]121212
1260Appropriations, mandatory (total)121212
Spending authority from offsetting collections, discretionary:
1700Collected159386351
1701Change in uncollected payments, Federal sources227
1750Spending auth from offsetting collections, disc (total)386386351
1900Budget authority (total)398398363
1930Total budgetary resources available404402367
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year444
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1,165988324
3010Uncollected pymts, Fed sources, brought forward, Oct 1–451–382–382
3020Obligated balance, start of year (net)714606–58
3030Obligations incurred, unexpired accounts400398363
3031Obligations incurred, expired accounts2
3040Outlays (gross)–566–1,062–533
3050Change in uncollected pymts, Fed sources, unexpired–227
3051Change in uncollected pymts, Fed sources, expired296
3081Recoveries of prior year unpaid obligations, expired–13
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)988324154
3091Uncollected pymts, Fed sources, end of year–382–382–382
3100Obligated balance, end of year (net)606–58–228
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross386386351
Outlays, gross:
4010Outlays from new discretionary authority126386351
4011Outlays from discretionary balances435673175
4020Outlays, gross (total)5611,059526
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–451–768–388
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–227
4052Offsetting collections credited to expired accounts29238237
4060Additional offsets against budget authority only (total)6538237
4080Outlays, net (discretionary)110291138
Mandatory:
4090Budget authority, gross121212
Outlays, gross:
4100Outlays from new mandatory authority1
4101Outlays from mandatory balances437
4110Outlays, gross (total)537
4180Budget authority, net (total)121212
4190Outlays, net (total)115294145
Object Classification(in millions of dollars)Identification code 75–1700–0–1–5522011 actual2012 est.2013 est.
Direct obligations:
25.5Research and development contracts888
41.0Grants, subsidies, and contributions444
99.0Direct obligations121212
99.0Reimbursable obligations388386351
99.9Total new obligations400398363
Employment SummaryIdentification code 75–1700–0–1–5522011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment333
2001Reimbursable civilian full-time equivalent employment300300300
2101Reimbursable military average strength employment101010
Centers for Medicare and Medicaid Services Grants to States for Medicaid Grants to States for MedicaidFor carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $184,279,110,000 $178,791,197,000, to remain available until expended.For making, after May 31, 2012 2013, payments to States under title XIX or in the case of section 1928 on behalf of States under title XIX of the Social Security Act for the last quarter of fiscal year 2012 2013 for unanticipated costs incurred for the current fiscal year, such sums as may be necessary.For making payments to States or in the case of section 1928 on behalf of States under title XIX of the Social Security Act for the first quarter of fiscal year 2013, $90,614,082,000 2014, $106,335,631,000, to remain available until expended.Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter. (Department of Health and Human Services Appropriations Act, 2012.)Medicaid assists States in providing medical care to their low-income populations by granting Federal matching payments under title XIX of the Social Security Act to States with approved plans.Medicaid estimates assume budget authority for expenses that are incurred but not reported (IBNR).Authorized as part of Title XIX, Vaccines for Children (VFC) finances the purchase of vaccines for low-income, eligible children. VFC is administered by the Centers for Disease Control and Prevention and is funded entirely by the Federal Government.Vaccines for Children(in millions of dollars)Obligations201120122013
Vaccine Purchase3,6633,7033,972
Vaccine Stockpile138137137
Ordering, Distribution, and Operations108126119
Vaccine Management Contract Support421
Evaluation Activities404142
Total Obligations3,9534,0094,271
Program and Financing(in millions of dollars)Identification code 75–0512–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Medicaid vendor payments276,980245,689263,693
0002State and local administration14,08314,88514,735
0003Vaccines for Children3,9534,0094,271
0004Incurred by providers but not yet reported1171,3601,360
0799Total direct obligations295,133265,943284,059
0801Medicare Part B premiums703320
0900Total new obligations295,836266,263284,059
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 117,00840814,654
1021Recoveries of prior year unpaid obligations20,0399,465
1050Unobligated balance (total)37,0479,87314,654
Budget authority:
Appropriations, mandatory:
1200Appropriation Medicaid184,279178,791
1200Appropriation Medicaid, Indefinite171,576
1260Appropriations, mandatory (total)171,576184,279178,791
Advance appropriations, mandatory:
1270Advance appropriation86,78986,44590,614
1280Advanced appropriation, mandatory (total)86,78986,44590,614
Spending authority from offsetting collections, mandatory:
1800Collected832320
1850Spending auth from offsetting collections, mand (total)832320
1900Budget authority (total)259,197271,044269,405
1930Total budgetary resources available296,244280,917284,059
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year40814,654
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)28,39128,39229,751
3030Obligations incurred, unexpired accounts295,836266,263284,059
3040Outlays (gross)–275,796–255,439–282,699
3080Recoveries of prior year unpaid obligations, unexpired–20,039–9,465
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)28,39229,75131,111
3100Obligated balance, end of year (net)28,39229,75131,111
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross259,197271,044269,405
Outlays, gross:
4100Outlays from new mandatory authority259,197237,457267,961
4101Outlays from mandatory balances16,59917,98214,738
4110Outlays, gross (total)275,796255,439282,699
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–703–320
4123Non-Federal sources–129
4130Offsets against gross budget authority and outlays (total)–832–320
4160Budget authority, net (mandatory)258,365270,724269,405
4170Outlays, net (mandatory)274,964255,119282,699
4180Budget authority, net (total)258,365270,724269,405
4190Outlays, net (total)274,964255,119282,699
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority258,365270,724269,405
Outlays274,964255,119282,699
Amounts included in the adjusted baseline:
Budget Authority–11–70
Outlays–11–70
Legislative proposal, not subject to PAYGO:
Budget Authority–215–695
Outlays–215–695
Legislative proposal, subject to PAYGO:
Budget Authority370885
Outlays370885
Total:
Budget Authority258,365270,868269,525
Outlays274,964255,263282,819
Object Classification(in millions of dollars)Identification code 75–0512–0–1–5512011 actual2012 est.2013 est.
41.0Direct obligations: Grants, subsidies, and contributions295,133265,943284,059
99.0Reimbursable obligations703320
99.9Total new obligations295,836266,263284,059
Amounts included in the adjusted baseline Please see the narratives in the Limitation on Administrative Expenses and Health Care Fraud and Abuse Control accounts for a description of the program integrity estimates reflected here.Program and Financing(in millions of dollars)Identification code 75–0512–7–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Medicaid vendor payments–11–70
0900Total new obligations (object class 41.0)–11–70
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation–11–70
1260Appropriations, mandatory (total)–11–70
1930Total budgetary resources available–11–70
Change in obligated balance:
3030Obligations incurred, unexpired accounts–11–70
3040Outlays (gross)1170
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–11–70
Outlays, gross:
4100Outlays from new mandatory authority–11–70
4180Budget authority, net (total)–11–70
4190Outlays, net (total)–11–70
Legislative proposal, not subject to PAYGO This schedule reflects the offsetting collections from Medicare Part B for the extension of the Qualified Individual (QI) program.Program and Financing(in millions of dollars)Identification code 75–0512–2–1–5512011 actual2012 est.2013 est.
Budget authority and outlays, net:
Mandatory:
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–215–695
4180Budget authority, net (total)–215–695
4190Outlays, net (total)–215–695
Legislative proposal, subject to PAYGO This schedule reflects the Administration's Medicaid proposals.Program and Financing(in millions of dollars)Identification code 75–0512–4–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Program Integrity–151
0003Other Proposals155341
0799Total direct obligations155190
0801Medicare Part B premiums215695
0900Total new obligations370885
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation Medicaid155190
1260Appropriations, mandatory (total)155190
Spending authority from offsetting collections, mandatory:
1800Collected215695
1850Spending auth from offsetting collections, mand (total)215695
1900Budget authority (total)370885
1930Total budgetary resources available370885
Change in obligated balance:
3030Obligations incurred, unexpired accounts370885
3040Outlays (gross)–370–885
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross370885
Outlays, gross:
4100Outlays from new mandatory authority370885
4180Budget authority, net (total)370885
4190Outlays, net (total)370885
Object Classification(in millions of dollars)Identification code 75–0512–4–1–5512011 actual2012 est.2013 est.
41.0Direct obligations: Grants, subsidies, and contributions155190
99.0Reimbursable obligations215695
99.9Total new obligations370885
State Grants and Demonstrations State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170), the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), and the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152).The Budget includes an unobligated balance of $125 million for activities authorized by Section 204 of the Ticket to Work and Work Incentives Improvement Act. Thus, pursuant to 31 U.S.C. 1555, any remaining balance (whether obligated or unobligated) will be withdrawn and returned to the Treasury two years after there has been no disbursement made against the appropriation.Program and Financing(in millions of dollars)Identification code 75–0516–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0010Ticket to Work grants75
0011Emergency health services for undocumented aliens882218
0012Medicaid integrity program779680
0015Partnerships for long-term care3
0017Psychiatric residential treatment demonstration148
0018Money follows the person (MFP) demonstration298410403
0019MFP evaluations and technical support111
0023Grants to improve outreach and enrollment43734
0024Application of Prospective Payment System3
0025Medicaid emergency psychiatric demonstration12324
0026Incentives for prevention of chronic diseases in Medicaid182922
0799Total direct obligations752591582
0801Reimbursable program activity6
0900Total new obligations758591582
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 11,2061,3041,241
1021Recoveries of prior year unpaid obligations47
1050Unobligated balance (total)1,2531,3041,241
Budget authority:
Appropriations, mandatory:
1200Appropriation (Ticket to Work)47
1200Appropriation (Expansion of long-term care partnerships)3
1200Appropriation (Psychiatric residential treatment demonstration)57
1200Appropriation (Money follows the person (MFP) demonstration)449449449
1200Appropriation (MFP research & evaluation)111
1200Appropriation (Medicaid integrity program)767880
1200Appropriation (Medicaid Emergency Psychiatric Demo)75
1200Appropriation (Incentives for Prevention of Chronic Diseases in Medicaid)100
1260Appropriations, mandatory (total)808528530
Spending authority from offsetting collections, mandatory:
1800Collected6
1850Spending auth from offsetting collections, mand (total)6
1900Budget authority (total)814528530
1930Total budgetary resources available2,0671,8321,771
Memorandum (non-add) entries:
1940Unobligated balance expiring–5
1941Unexpired unobligated balance, end of year1,3041,2411,189
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)738881868
3030Obligations incurred, unexpired accounts758591582
3040Outlays (gross)–568–604–474
3080Recoveries of prior year unpaid obligations, unexpired–47
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)881868976
3100Obligated balance, end of year (net)881868976
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross814528530
Outlays, gross:
4100Outlays from new mandatory authority577980
4101Outlays from mandatory balances511525394
4110Outlays, gross (total)568604474
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–6
4180Budget authority, net (total)808528530
4190Outlays, net (total)562604474
Object Classification(in millions of dollars)Identification code 75–0516–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent - Medicaid Integrity Program999
12.1Civilian personnel benefits - Medicaid Integrity Program666
41.0Grants, subsidies, and contributions - Ticket to Work75
41.0Grants, subsidies, and contributions - Emergency services for undocumented aliens882218
41.0Grants, subsidies, and contributions - Medicaid Integrity Program628165
41.0Grants, subsidies, and contributions - Partnership for long-term care3
41.0Grants, subsidies, and contributions - Psychiatric residential treatment demonstration148
41.0Grants, subsidies, and contributions - Money follows the person (MFP) demonstration298410403
41.0Grants, subsidies, and contributions - MFP evaluations and technical support111
41.0Grants, subsidies, and contributions - Grants to improve outreach and enrollment43734
41.0Grants, subsidies, and contributions - Application of Prospective Payment System13
41.0Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration182324
41.0Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid2922
99.0Direct obligations752591582
99.0Reimbursable obligations6
99.9Total new obligations758591582
Employment SummaryIdentification code 75–0516–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment81100102
Payments to Health Care Trust Funds Payments to Health Care Trust FundsFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the Social Security Act, $230,741,378,000 $251,359,000,000.In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security Act that were not anticipated in budget estimates, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2012.)Payments are made to the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds from the general fund of the Treasury to finance Medicare's medical and drug benefits for beneficiaries and certain other qualified individuals. Program and Financing(in millions of dollars)Identification code 75–0580–0–1–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Federal contribution to match premiums (SMI)168,849167,184189,520
0002Part D benefits (Rx Drug)55,92947,28260,744
0003Part D Federal administration (Rx Drug)373405424
0004General Fund Transfers to HI489603671
0006Federal Bureau of Investigation (HCFAC)128132135
0007Federal payments from taxation of OASDI benefits (HI)15,14318,44320,811
0008Criminal fines (HCFAC)1,1961,0451,127
0009Civil monetary penalties and damages (HCFAC - DOJ and CMS administration)182020
0010Asset Forfeiture22
0900Total new obligations242,147235,114273,452
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation (definite, annual)229,464230,741251,359
1200Appropriation (indefinite, permanent)15,14318,44320,811
1200Appropriation (HCFAC for FBI)128132135
1200Appropriation (indefinite for HCFAC)1,2361,0651,147
1260Appropriations, mandatory (total)245,971250,381273,452
1930Total budgetary resources available245,971250,381273,452
Memorandum (non-add) entries:
1940Unobligated balance expiring–3,824–15,267
Change in obligated balance:
3030Obligations incurred, unexpired accounts242,147235,114273,452
3031Obligations incurred, expired accounts46
3040Outlays (gross)–242,193–235,114–273,452
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross245,971250,381273,452
Outlays, gross:
4100Outlays from new mandatory authority242,147235,114273,452
4101Outlays from mandatory balances46
4110Outlays, gross (total)242,193235,114273,452
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–19
Additional offsets against gross budget authority only:
4142Offsetting collections credited to expired accounts19
4160Budget authority, net (mandatory)245,971250,381273,452
4170Outlays, net (mandatory)242,174235,114273,452
4180Budget authority, net (total)245,971250,381273,452
4190Outlays, net (total)242,174235,114273,452
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority245,971250,381273,452
Outlays242,174235,114273,452
Amounts included in the adjusted baseline:
Budget Authority4,514
Outlays4,514
Legislative proposal, not subject to PAYGO:
Budget Authority–4,565
Outlays–4,565
Increased funding for BBEDCA program integrity adjustments:
Outlays114
Total:
Budget Authority245,971250,381273,401
Outlays242,174235,228273,401
Object Classification(in millions of dollars)Identification code 75–0580–0–1–5712011 actual2012 est.2013 est.
Direct obligations:
41.0Grants, subsidies, and contributions241,139234,106272,357
42.0Insurance claims and indemnities275262228
94.0Financial transfers (Federal admin)733746867
99.9Total new obligations242,147235,114273,452
Amounts included in the adjusted baseline Program and Financing(in millions of dollars)Identification code 75–0580–7–1–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Federal contribution to match premiums (SMI)4,514
0900Total new obligations (object class 41.0)4,514
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation (definite annuall)4,514
1260Appropriations, mandatory (total)4,514
1930Total budgetary resources available4,514
Change in obligated balance:
3030Obligations incurred, unexpired accounts4,514
3040Outlays (gross)–4,514
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross4,514
Outlays, gross:
4100Outlays from new mandatory authority4,514
4180Budget authority, net (total)4,514
4190Outlays, net (total)4,514
Legislative proposal, not subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–0580–2–1–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Federal contribution to match premiums (SMI)–15
0002Part D benefits (Rx Drug)–4,550
0900Total new obligations (object class 41.0)–4,565
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation (definite, annual)–4,565
1260Appropriations, mandatory (total)–4,565
1930Total budgetary resources available–4,565
Change in obligated balance:
3030Obligations incurred, unexpired accounts–4,565
3040Outlays (gross)4,565
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–4,565
Outlays, gross:
4100Outlays from new mandatory authority–4,565
4180Budget authority, net (total)–4,565
4190Outlays, net (total)–4,565
Quality Improvements Organizations Program and Financing(in millions of dollars)Identification code 75–0519–0–1–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001QIO contracts612315270
0002QIO support contracts244125108
0900Total new obligations856440378
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1387
Budget authority:
Spending authority from offsetting collections, mandatory:
1800Collected20827528
1801Change in uncollected payments, Federal sources999
1850Spending auth from offsetting collections, mand (total)1,019827528
1930Total budgetary resources available1,019827915
Memorandum (non-add) entries:
1940Unobligated balance expiring–163
1941Unexpired unobligated balance, end of year387537
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)824437
3010Uncollected pymts, Fed sources, brought forward, Oct 1–999–999
3020Obligated balance, start of year (net)–175–562
3030Obligations incurred, unexpired accounts856440378
3040Outlays (gross)–32–827–528
3050Change in uncollected pymts, Fed sources, unexpired–999
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)824437287
3091Uncollected pymts, Fed sources, end of year–999–999–999
3100Obligated balance, end of year (net)–175–562–712
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross1,019827528
Outlays, gross:
4100Outlays from new mandatory authority326656
4101Outlays from mandatory balances761472
4110Outlays, gross (total)32827528
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–20–827–528
Additional offsets against gross budget authority only:
4140Change in uncollected pymts, Fed sources, unexpired–999
4170Outlays, net (mandatory)12
4190Outlays, net (total)12
Object Classification(in millions of dollars)Identification code 75–0519–0–1–5712011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent2828
25.2Other services from non-Federal sources848404342
25.3Other goods and services from Federal sources888
99.9Total new obligations856440378
Employment SummaryIdentification code 75–0519–0–1–5712011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment164164
Program ManagementFor carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for Medicare and Medicaid Services, not to exceed $3,879,476,000, $4,820,808,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353 of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary pursuant to section 302 of the Tax Relief and Health Care Act of 2006; and such sums as may be collected from authorized user fees and the sale of data, which shall be credited to this account and remain available until September 30, 2017 expended: Provided, That all funds derived in accordance with 31 U.S.C. 9701 from organizations established under title XIII of the PHS Act shall be credited to and available for carrying out the purposes of this appropriation: Provided further, That $34,000,000, $11,150,000, to remain available through September 30, 2013 2014, shall be for contract costs for the Healthcare Integrated General Ledger Accounting System: Provided further, That the Secretary is directed to collect fees in fiscal year 2012 2013 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act: Provided further, That $44,000,000 shall be available for the State high-risk health insurance pool program as authorized by the State High Risk Pool Funding Extension Act of 2006. (Department of Health and Human Services Appropriations Act, 2012.)Program management activities include funding for program operations, survey and certification, State high-risk pools, Clinical Laboratory Improvement Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts and other administrative costs.Program and Financing(in millions of dollars)Identification code 75–0511–0–1–5502011 actual2012 est.2013 est.
Obligations by program activity:
0001Program operations2,5922,9223,641
0002Federal administration687960870
0003State survey and certification390444408
0004Research, demonstrations, and evaluation projects4863259
0006High-risk pool grants554422
0007ARRA Medicare/Medicaid HIT160195193
0008Consumer Assistance Grants272
0100Total direct program3,9595,1995,193
0799Total direct obligations3,9595,1995,193
0801Clinical laboratory improvement amendments534343
0802Sale of data1277
0803Coordination of benefits344835
0804Medicare advantage/Prescription drug plan347070
0805Provider enrollment7272
0806Recovery audit contractors130310310
0807Other reimbursable program activity18
0809Reimbursable program activities, subtotal281550537
0899Total reimbursable obligations281550537
0900Total new obligations4,2405,7495,730
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 18501,349339
1021Recoveries of prior year unpaid obligations11
1050Unobligated balance (total)8611,349339
Budget authority:
Appropriations, mandatory:
1200Appropriation403253253
1260Appropriations, mandatory (total)403253253
Spending authority from offsetting collections, discretionary:
1700Collected1,9654,3065,286
1701Change in uncollected payments, Federal sources1,805
1750Spending auth from offsetting collections, disc (total)3,7704,3065,286
Spending authority from offsetting collections, mandatory:
1800Collected71180101
1801Change in uncollected payments, Federal sources547
1850Spending auth from offsetting collections, mand (total)618180101
1900Budget authority (total)4,7914,7395,640
1930Total budgetary resources available5,6526,0885,979
Memorandum (non-add) entries:
1940Unobligated balance expiring–63
1941Unexpired unobligated balance, end of year1,349339249
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)2,4802,8252,587
3010Uncollected pymts, Fed sources, brought forward, Oct 1–2,867–3,623–3,623
3020Obligated balance, start of year (net)–387–798–1,036
3030Obligations incurred, unexpired accounts4,2405,7495,730
3031Obligations incurred, expired accounts90
3040Outlays (gross)–3,786–5,987–5,755
3050Change in uncollected pymts, Fed sources, unexpired–2,352
3051Change in uncollected pymts, Fed sources, expired1,596
3080Recoveries of prior year unpaid obligations, unexpired–11
3081Recoveries of prior year unpaid obligations, expired–188
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)2,8252,5872,562
3091Uncollected pymts, Fed sources, end of year–3,623–3,623–3,623
3100Obligated balance, end of year (net)–798–1,036–1,061
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross3,7704,3065,286
Outlays, gross:
4010Outlays from new discretionary authority1,8134,3065,286
4011Outlays from discretionary balances1,605
4020Outlays, gross (total)3,4184,3065,286
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030Federal sources–3,154–3,828–4,821
4033Non-Federal sources–313–478–465
4040Offsets against gross budget authority and outlays (total)–3,467–4,306–5,286
Additional offsets against gross budget authority only:
4050Change in uncollected pymts, Fed sources, unexpired–1,805
4052Offsetting collections credited to expired accounts1,502
4060Additional offsets against budget authority only (total)–303
4080Outlays, net (discretionary)–49
Mandatory:
4090Budget authority, gross1,021433354
Outlays, gross:
4100Outlays from new mandatory authority73275213
4101Outlays from mandatory balances2951,406256
4110Outlays, gross (total)3681,681469
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–83–108–29
4123Non-Federal sources–5–72–72
4130Offsets against gross budget authority and outlays (total)–88–180–101
Additional offsets against gross budget authority only:
4140Change in uncollected pymts, Fed sources, unexpired–547
4142Offsetting collections credited to expired accounts17
4150Additional offsets against budget authority only (total)–530
4160Budget authority, net (mandatory)403253253
4170Outlays, net (mandatory)2801,501368
4180Budget authority, net (total)403253253
4190Outlays, net (total)2311,501368
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority403253253
Outlays2311,501368
Legislative proposal, subject to PAYGO:
Budget Authority400
Outlays100
Total:
Budget Authority403253653
Outlays2311,501468
Object Classification(in millions of dollars)Identification code 75–0511–0–1–5502011 actual2012 est.2013 est.
Direct obligations:
Personnel compensation:
11.1Full-time permanent418474493
11.3Other than full-time permanent141111
11.5Other personnel compensation988
11.7Military personnel91010
11.9Total personnel compensation450503522
12.1Civilian personnel benefits120122131
12.2Military personnel benefits455
21.0Travel and transportation of persons91612
22.0Transportation of things1
23.1Rental payments to GSA152425
23.3Communications, utilities, and miscellaneous charges55
24.0Printing and reproduction3544
25.1Advisory and assistance services16
25.2Other services from non-Federal sources1,6072,2712,904
25.3Other goods and services from Federal sources77117
25.5Research and development contracts3266982
25.6Medical care1,2281,3061,387
25.7Operation and maintenance of equipment132
26.0Supplies and materials1311
31.0Equipment8
32.0Land and structures1111
41.0Grants, subsidies, and contributions157256102
99.0Direct obligations3,9595,1995,193
99.0Reimbursable obligations281550537
99.9Total new obligations4,2405,7495,730
Employment SummaryIdentification code 75–0511–0–1–5502011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment4,0864,5914,726
1001Direct civilian full-time equivalent employment143535
1101Direct military average strength employment107107107
2001Reimbursable civilian full-time equivalent employment105123124
Legislative proposal, subject to PAYGO The budget includes a package of proposals that improve Medicaid's finances, Medicare's sustainability, and slow the growth of Part D net expenditures. To achieve the reforms proposed, HHS will need to implement significant administrative changes to its systems and processes.Program and Financing(in millions of dollars)Identification code 75–0511–4–1–5502011 actual2012 est.2013 est.
Obligations by program activity:
0001Program operations400
0100Total direct program400
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation400
1260Appropriations, mandatory (total)400
1930Total budgetary resources available400
Change in obligated balance:
3030Obligations incurred, unexpired accounts400
3040Outlays (gross)–100
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)300
3100Obligated balance, end of year (net)300
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross400
Outlays, gross:
4100Outlays from new mandatory authority100
4180Budget authority, net (total)400
4190Outlays, net (total)100
Object Classification(in millions of dollars)Identification code 75–0511–4–1–5502011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent2
12.1Civilian personnel benefits1
25.2Other services from non-Federal sources397
99.9Total new obligations400
Employment SummaryIdentification code 75–0511–4–1–5502011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment20
Children's Health Insurance Fund The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income families. States are able to use Title XXI funds for obtaining health benefit coverage for uninsured children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3) reauthorized the CHIP program through FY 2013 and made some modifications to the program including increased funding for States and territories, bonus payments for States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding for CHIP, providing appropriations through FY 2015.Program and Financing(in millions of dollars)Identification code 75–0515–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Grants to States and U.S. territories8,4798,9149,700
0002Performance bonus payments217296380
0003Child health quality improvement445147
0900Total new obligations (object class 41.0)8,7409,26110,127
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 14,3307,5276,925
1012Unobligated balance transfers between expired and unexpired accounts1,917
1021Recoveries of prior year unpaid obligations16
1050Unobligated balance (total)6,2637,5276,925
Budget authority:
Appropriations, discretionary:
1131Unobligated balance of appropriations permanently reduced–6,706
1160Appropriation, discretionary (total)–6,706
Appropriations, mandatory:
1200Appropriation13,50414,98217,406
1200Appropriation4545
1230Appropriations and/or unobligated balance of appropriations permanently reduced–3,500–6,368
1260Appropriations, mandatory (total)10,0048,65917,451
1900Budget authority (total)10,0048,65910,745
1930Total budgetary resources available16,26716,18617,670
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year7,5276,9257,543
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)8,1957,1076,590
3030Obligations incurred, unexpired accounts8,7409,26110,127
3031Obligations incurred, expired accounts46
3040Outlays (gross)–8,629–9,778–10,027
3080Recoveries of prior year unpaid obligations, unexpired–16
3081Recoveries of prior year unpaid obligations, expired–1,229
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)7,1076,5906,690
3100Obligated balance, end of year (net)7,1076,5906,690
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross–6,706
Mandatory:
4090Budget authority, gross10,0048,65917,451
Outlays, gross:
4100Outlays from new mandatory authority2,7184,4454,045
4101Outlays from mandatory balances5,9115,3335,982
4110Outlays, gross (total)8,6299,77810,027
4180Budget authority, net (total)10,0048,65910,745
4190Outlays, net (total)8,6299,77810,027
Center for Medicare and Medicaid Innovation Program and Financing(in millions of dollars)Identification code 75–0522–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Administration43112155
0002Innovation Activities521,5811,207
0900Total new obligations951,6931,362
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 159,9108,217
Budget authority:
Appropriations, mandatory:
1200Appropriation10,000
1260Appropriations, mandatory (total)10,000
1930Total budgetary resources available10,0059,9108,217
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year9,9108,2176,855
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)841,044
3030Obligations incurred, unexpired accounts951,6931,362
3040Outlays (gross)–11–733–1,090
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)841,0441,316
3100Obligated balance, end of year (net)841,0441,316
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross10,000
Outlays, gross:
4100Outlays from new mandatory authority11
4101Outlays from mandatory balances7331,090
4110Outlays, gross (total)117331,090
4180Budget authority, net (total)10,000
4190Outlays, net (total)117331,090
Object Classification(in millions of dollars)Identification code 75–0522–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent51111
12.1Civilian personnel benefits133
25.2Other services from non-Federal sources771,5811,207
25.3Other goods and services from Federal sources898141
31.0Equipment4
99.9Total new obligations951,6931,362
Employment SummaryIdentification code 75–0522–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment68204265
Child Enrollment Contingency Fund The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 established the Child Enrollment Contingency Fund under Title XXI. Beginning in FY 2009, a State may qualify for a contingency fund payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 extended the contingency fund through FY 2015.The fund received an initial appropriation equal to 20 percent of the FY 2009 national allotment ($2.1 billion). In fiscal years 2010 through 2015, the statute appropriates the amount necessary to make payments to eligible States, but not to exceed 20 percent of the total annual appropriation for CHIP allotments to States. Any amounts in excess of this aggregate cap will be made available for CHIP performance bonus payments. The contingency fund is invested in interest bearing securities of the United States, and the income derived from these investments constitutes a part of the fund. Special and Trust Fund Receipts(in millions of dollars)Identification code 75–5551–0–2–5512011 actual2012 est.2013 est.
0100Balance, start of year
Receipts:
0240Interest, Child Enrollment Contingency Fund8713
0400Total: Balances and collections8713
Appropriations:
0500Child Enrollment Contingency Fund–8–7–13
0799Balance, end of year
Program and Financing(in millions of dollars)Identification code 75–5551–0–2–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Grants to States and US Territories29100200
0900Total new obligations (object class 41.0)29100200
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 12,1152,0942,001
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)8713
1260Appropriations, mandatory (total)8713
1930Total budgetary resources available2,1232,1012,014
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year2,0942,0011,814
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)25
3030Obligations incurred, unexpired accounts29100200
3040Outlays (gross)–4–125–200
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)25
3100Obligated balance, end of year (net)25
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross8713
Outlays, gross:
4100Outlays from new mandatory authority4
4101Outlays from mandatory balances125200
4110Outlays, gross (total)4125200
4180Budget authority, net (total)8713
4190Outlays, net (total)4125200
Memorandum (non-add) entries:
5000Total investments, SOY: Federal securities: Par value2,1192,0932,001
5001Total investments, EOY: Federal securities: Par value2,0932,0011,814
Medicare Health Information Technology Incentive Payments, Recovery Act Program and Financing(in millions of dollars)Identification code 75–0508–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0801Incentive payments to hospitals356950860
0802Incentive payments to eligible professionals97690930
0900Total new obligations (object class 42.0)4531,6401,790
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 11,6581,658
Budget authority:
Spending authority from offsetting collections, mandatory:
1800Collected from the HI Trust Fund227950860
1800Collected from the SMI Trust Fund45690930
1801Change in uncollected payments, Federal sources1,839
1850Spending auth from offsetting collections, mand (total)2,1111,6401,790
1930Total budgetary resources available2,1113,2983,448
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year1,6581,6581,658
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)9191
3010Uncollected pymts, Fed sources, brought forward, Oct 1–1,839–1,839
3020Obligated balance, start of year (net)–1,748–1,748
3030Obligations incurred, unexpired accounts4531,6401,790
3040Outlays (gross)–362–1,640–1,790
3050Change in uncollected pymts, Fed sources, unexpired–1,839
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)919191
3091Uncollected pymts, Fed sources, end of year–1,839–1,839–1,839
3100Obligated balance, end of year (net)–1,748–1,748–1,748
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross2,1111,6401,790
Outlays, gross:
4100Outlays from new mandatory authority3621,6401,790
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–272–1,640–1,790
Additional offsets against gross budget authority only:
4140Change in uncollected pymts, Fed sources, unexpired–1,839
4170Outlays, net (mandatory)90
4190Outlays, net (total)90
The Affordable Care Act (P.L. 111–148) amends Section 2794 of the Public Health Service Act and provides that the Secretary shall carry out a program to award grants to States for a five year period beginning in fiscal year 2010. The Grants to States for Health Insurance Premium Review program provides funding to help States develop or enhance their current rate review activities. The program provides $250,000,000 over the five year period beginning with fiscal year 2010. States may receive no less than $1,000,000 and no more than $5,000,000 in any one grant year. Grant recipients are required to submit data to the Secretary on health insurance rate trends. Program and Financing(in millions of dollars)Identification code 75–0112–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Premium rate review grants1146328
0900Total new obligations (object class 41.0)1146328
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 12049130
1021Recoveries of prior year unpaid obligations12
1050Unobligated balance (total)2059330
1930Total budgetary resources available2059330
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year91302
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)46147128
3030Obligations incurred, unexpired accounts1146328
3040Outlays (gross)–12–80–80
3080Recoveries of prior year unpaid obligations, unexpired–1–2
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)14712876
3100Obligated balance, end of year (net)14712876
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101Outlays from mandatory balances128080
4190Outlays, net (total)128080
Pre-Existing Condition Insurance Plan Program This account funds the Pre-Existing Condition Insurance Plan Program (PCIP), which makes health insurance available to people who have been unable to get insurance due to a pre-existing condition. Enrollees pay monthly premiums similar to those charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions. The funding for this program, including operating costs, was provided in the FY 2010 appropriation by the Affordable Care Act (P.L. 111–148).Program and Financing(in millions of dollars)Identification code 75–0113–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Direct program activity8171,4631,525
0801Premiums from Fallback States277291
0900Total new obligations8441,5351,616
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 14,7783,9612,498
Budget authority:
Spending authority from offsetting collections, mandatory:
1800Collected277291
1850Spending auth from offsetting collections, mand (total)277291
1900Budget authority (total)277291
1930Total budgetary resources available4,8054,0332,589
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year3,9612,498973
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)218633531
3030Obligations incurred, unexpired accounts8441,5351,616
3040Outlays (gross)–429–1,637–2,146
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)6335311
3100Obligated balance, end of year (net)6335311
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross277291
Outlays, gross:
4100Outlays from new mandatory authority277291
4101Outlays from mandatory balances4021,5652,055
4110Outlays, gross (total)4291,6372,146
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123Non-Federal sources–27–72–91
4190Outlays, net (total)4021,5652,055
Object Classification(in millions of dollars)Identification code 75–0113–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent222
25.2Other services from non-Federal sources52931
41.0Grants, subsidies, and contributions8101,4321,492
99.0Direct obligations8171,4631,525
99.0Reimbursable obligations277291
99.9Total new obligations8441,5351,616
Employment SummaryIdentification code 75–0113–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment131416
Early Retiree Reinsurance Program The Affordable Care Act (P.L. 111–148) authorized and appropriated $5 billion for the Early Retiree Reinsurance Program (ERRP). ERRP provides reimbursement to participating sponsors of certified plans that provide health benefits to early retirees (age 55 and older and not eligible for Medicare), their spouses, and surviving spouses and dependents. Reimbursement is equal to 80 percent of the actual cost of health expenses paid for an individual (net of price concessions) between a cost threshold of $15,000 and cost limit of $90,000 beginning in 2010. The cost threshold and cost limit are adjusted for inflation each year based on the Medical Care Component of the consumer price index for all urban consumers. Reimbursements to sponsors shall be used to reduce the sponsor's health benefit or premium costs, provide premium and cost sharing relief to plan participants, or both. Program and Financing(in millions of dollars)Identification code 75–0114–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Subsidies for early retirees2,9441,936
0002Administration222925
0900Total new obligations2,9661,96525
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 14,3741,99833
1021Recoveries of prior year unpaid obligations590
1050Unobligated balance (total)4,9641,99833
1930Total budgetary resources available4,9641,99833
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year1,998338
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)6252618
3030Obligations incurred, unexpired accounts2,9661,96525
3040Outlays (gross)–2,975–1,973–28
3080Recoveries of prior year unpaid obligations, unexpired–590
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)261815
3100Obligated balance, end of year (net)261815
Budget authority and outlays, net:
Mandatory:
Outlays, gross:
4101Outlays from mandatory balances2,9751,97328
4190Outlays, net (total)2,9751,97328
Object Classification(in millions of dollars)Identification code 75–0114–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent11
25.2Other services from non-Federal sources222723
42.0Insurance claims and indemnities2,9441,936
99.0Direct obligations2,9661,96424
99.5Below reporting threshold11
99.9Total new obligations2,9661,96525
Employment SummaryIdentification code 75–0114–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment21010
Affordable Insurance Exchange Grants The American Health Benefit Exchange Program, commonly known as the Affordable Insurance Exchanges, provides funding for Planning and Establishment Grants to States to for their activities to implement Exchanges. The Exchanges will facilitate the purchase of qualified health plans in the individual market and provide for the establishment of a Small Business Health Options Program to allow small businesses to offer qualified health plans to their employees. Section 1311 of the Patient Protection and Affordable Care Act (P.L. 111–148) provides amounts necessary to enable the Secretary to award grants to States beginning no later than March 23, 2011, and allows for renewal grants through January 1, 2015.Program and Financing(in millions of dollars)Identification code 75–0115–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
0001Planning and establishment grants4671,092820
0002Administration114848
0900Total new obligations4781,140868
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation4781,140868
1260Appropriations, mandatory (total)4781,140868
1930Total budgetary resources available4781,140868
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)49503737
3030Obligations incurred, unexpired accounts4781,140868
3040Outlays (gross)–24–906–1,087
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)503737518
3100Obligated balance, end of year (net)503737518
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross4781,140868
Outlays, gross:
4100Outlays from new mandatory authority9580444
4101Outlays from mandatory balances15326643
4110Outlays, gross (total)249061,087
4180Budget authority, net (total)4781,140868
4190Outlays, net (total)249061,087
Object Classification(in millions of dollars)Identification code 75–0115–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent466
12.1Civilian personnel benefits122
25.2Other services from non-Federal sources54040
25.3Other goods and services from Federal sources1
41.0Grants, subsidies, and contributions4671,092820
99.9Total new obligations4781,140868
Employment SummaryIdentification code 75–0115–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment286363
Reduced Cost Sharing for Individuals Enrolling in Qualified Health Plans Reinsurance and Risk Adjustment Program Payments Consumer Operated and Oriented Plan Program Account The Consumer Operated and Oriented Plan (CO-OP) Program was authorized in Section 1322 of the Affordable Care Act (P.L. 111–148). The CO-OP Program fosters the creation of qualified nonprofit health insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section 1322. $3.4 billion has been appropriated to carry out Section 1322 of the Affordable Care Act. As required by the Federal Credit Reform Act of 1990, this account records, for this program, the subsidy costs associated with CO-OP Program grants and loans, as well as administrative expenses of this program. The subsidy amounts are estimated on a present value basis; the administrative expenses are estimated on a cash basis. Program and Financing(in millions of dollars)Identification code 75–0118–0–1–5512011 actual2012 est.2013 est.
Obligations by program activity:
Credit program obligations:
0701Direct loan subsidy2,431699
0709Administrative expenses31515
0900Total new obligations32,446714
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 16,0003,797951
Budget authority:
Appropriations, mandatory:
1230Appropriations and/or unobligated balance of appropriations permanently reduced–2,200–400
1260Appropriations, mandatory (total)–2,200–400
1930Total budgetary resources available3,8003,397951
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year3,797951237
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)32,356
3030Obligations incurred, unexpired accounts32,446714
3040Outlays (gross)–93–803
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)32,3562,267
3100Obligated balance, end of year (net)32,3562,267
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–2,200–400
Outlays, gross:
4101Outlays from mandatory balances93803
4180Budget authority, net (total)–2,200–400
4190Outlays, net (total)93803
Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program(in millions of dollars)Identification code 75–0118–0–1–5512011 actual2012 est.2013 est.
Direct loan levels supportable by subsidy budget authority:
115002Startup Loans675195
115003Solvency4,9501,430
115999Total direct loan levels5,6251,625
Direct loan subsidy (in percent):
132002Startup Loans0.0037.5137.66
132003Solvency0.0043.9943.78
132999Weighted average subsidy rate0.0043.2143.05
Direct loan subsidy budget authority:
133002Startup Loans25373
133003Solvency2,178626
133999Total subsidy budget authority2,431699
Direct loan subsidy outlays:
134002Startup Loans84168
134003Solvency614
134999Total subsidy outlays84782
Direct loan downward reestimates:
Administrative expense data:
3510Budget authority31515
3580Outlays from balances921
Object Classification(in millions of dollars)Identification code 75–0118–0–1–5512011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent22
12.1Civilian personnel benefits11
25.2Other services from non-Federal sources31212
41.0Grants, subsidies, and contributions2,431699
99.9Total new obligations32,446714
Employment SummaryIdentification code 75–0118–0–1–5512011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment11919
Consumer Operated and Oriented Plan Financing Account As required by the Federal Credit Reform Act of 1990, this non-budgetary account records all cash flows to and from the Government resulting from direct loans obligated in 1992 and beyond (including modifications of direct loans that resulted from obligations in any year). The amounts in this account are a means of financing and are not included in the budget totals.Program and Financing(in millions of dollars)Identification code 75–4418–0–3–5512011 actual2012 est.2013 est.
Obligations by program activity:
Credit program obligations:
0710Direct loan obligations5,6251,625
0713Payment of interest to Treasury222
0900Total new obligations5,6271,647
Budgetary Resources:
Financing authority:
Borrowing authority, mandatory:
1400Borrowing authority3,196948
1440Borrowing authority, mandatory (total)3,196948
Spending authority from offsetting collections, mandatory:
1800Collected84782
1801Change in uncollected payments, Federal sources2,347–83
1850Spending auth from offsetting collections, mand (total)2,431699
1900Financing authority(total)5,6271,647
1930Total budgetary resources available5,6271,647
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)5,400
3010Uncollected pymts, Fed sources, brought forward, Oct 1–2,347
3020Obligated balance, start of year (net)3,053
3030Obligations incurred, unexpired accounts5,6271,647
3040Financing disbursements (gross)–227–1,866
3050Change in uncollected pymts, Fed sources, unexpired–2,34783
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)5,4005,181
3091Uncollected pymts, Fed sources, end of year–2,347–2,264
3100Obligated balance, end of year (net)3,0532,917
Financing authority and disbursements, net:
Mandatory:
4090Financing authority, gross5,6271,647
Financing disbursements:
4110Financing disbursements, gross2271,866
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120Federal sources–84–782
Additional offsets against financing authority only (total):
4140Change in uncollected pymts, Fed sources, unexpired–2,34783
4160Financing authority, net (mandatory)3,196948
4170Financing disbursements, net (mandatory)1431,084
4180Financing authority, net (total)3,196948
4190Financing disbursements, net (total)1431,084
Status of Direct Loans(in millions of dollars)Identification code 75–4418–0–3–5512011 actual2012 est.2013 est.
Position with respect to appropriations act limitation on obligations:
1131Direct loan obligations exempt from limitation5,6251,625
1150Total direct loan obligations5,6251,625
Cumulative balance of direct loans outstanding:
1210Outstanding, start of year226
1231Disbursements: Direct loan disbursements2251,844
1251Repayments: Repayments and prepayments
1261Adjustments: Capitalized interest14
1263Write-offs for default: Direct loans
1290Outstanding, end of year2262,074
Federal Hospital Insurance Trust Fund The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible disabled people.The status of the trust fund is as follows. In addition, the Budget includes a package of proposals that improve Medicare's sustainability by promoting high-quality, efficient care; aligning payments with the costs of providing care; encouraging beneficiaries to seek high-value services; and reducing the Federal subsidy of Medicare costs for those beneficiaries who can most afford them.Special and Trust Fund Receipts(in millions of dollars)Identification code 75–8005–0–7–5712011 actual2012 est.2013 est.
0100Balance, start of year255,722212,203193,121
Adjustments:
0191Adjustment - to correct for prior budget entry–1,254
0199Balance, start of year254,468212,203193,121
Receipts:
0200FHI Trust Fund, Transfers from General Fund (FICA Taxes)175,094188,041198,016
0201FHI Trust Fund, Transfers from General Fund (FICA Taxes)1886
0202FHI Trust Fund, Transfers from General Fund (FICA Taxes)–72
0203FHI Trust Fund, Receipts from Railroad Retirement Board452499519
0204FHI Trust Fund, Transfers from General Fund (SECA Taxes)12,94413,98915,394
0205FHI Trust Fund, Civil Penalties and Damages578630675
0220FHI Trust Fund, Other Proprietary Interest from the Public22
0221FHI Trust Fund, Basic Premium, Medicare Advantage222222225
0222FHI Trust Fund, Medicare Refunds5,1765,7005,800
0223FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible3,2733,4463,550
0224FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible2
0240FHI Trust Fund, Federal Employer Contributions (FICA)3,3843,5163,649
0241FHI Trust Fund, Postal Service Employer Contributions (FICA)641583590
0242FHI Trust Fund, Interest Received by Trust Funds12,87711,30410,019
0243FHI Trust Fund, Interest Received by Trust Funds223
0244FHI Trust Fund, Taxation on OASDI Benefits15,14318,44320,811
0245FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account128131134
0246FHI Trust Fund, Transfers from General Fund (criminal Fines)1,1961,0451,126
0247FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)16212
0248FHI Trust Fund, Transfers from General Fund (asset Forfeitures)22
0249FHI Trust Fund, Interest Payments by Railroad Retirement Board252626
0250FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)490604672
0251FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)114
0299Total receipts and collections231,661248,336261,249
0400Total: Balances and collections486,129460,539454,370
Appropriations:
0500Federal Hospital Insurance Trust Fund–2,299–2,185–2,327
0501Federal Hospital Insurance Trust Fund27
0502Federal Hospital Insurance Trust Fund5
0503Federal Hospital Insurance Trust Fund–227,694–244,229–256,999
0504Federal Hospital Insurance Trust Fund–42,424–19,619–24,346
0505Federal Hospital Insurance Trust Fund5
0506Federal Hospital Insurance Trust Fund–2–23
0507Federal Hospital Insurance Trust Fund223
0508Federal Hospital Insurance Trust Fund–18–88
0509Federal Hospital Insurance Trust Fund181,108
0510Federal Hospital Insurance Trust Fund1
0511Federal Hospital Insurance Trust Fund72
0512Federal Hospital Insurance Trust Fund–972
0513Health Care Fraud and Abuse Control Account–310–311–610
0514Health Care Fraud and Abuse Control Account1
0515Health Care Fraud and Abuse Control Account–1,422–1,224–1,167
0516Health Care Fraud and Abuse Control Account–272
0517Health Care Fraud and Abuse Control Account1
0518Health Care Fraud and Abuse Control Account414551
0599Total appropriations–274,117–267,418–284,778
0610Federal Hospital Insurance Trust Fund2
0611Health Care Fraud and Abuse Control Account23
0620Federal Hospital Insurance Trust Fund142
0795Adjustment - for expired accounts, trust fund receipts returned24
0799Balance, end of year212,203193,121169,592
Program and Financing(in millions of dollars)Identification code 75–8005–0–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Benefit payments, HI267,607262,334279,982
0002HIT Incentive Payments1,621950860
0003Administration, HI2,6812,3922,528
0004Quality improvement organizations, HI833352302
0799Total direct obligations272,742266,028283,672
0812Reimbursable program activity1,811
0900Total new obligations274,553266,028283,672
Budgetary Resources:
Unobligated balance:
1021Recoveries of prior year unpaid obligations501
1026Adjustment for change in allocation of trust fund limitation or foreign exchange valuation–142
1029Other balances withdrawn–2
1050Unobligated balance (total)357
Budget authority:
Appropriations, discretionary:
1101Appropriation (special or trust fund)2,2992,1852,327
1132Appropriations temporarily reduced–27
1144Approp temporarily reduced (Sec 527, HR 2055)–5
1160Appropriation, discretionary (total)2,2722,1802,327
Appropriations, mandatory:
1201Appropriation (special or trust fund)227,694244,229256,999
1203Appropriation (previously unavailable)42,42419,61924,346
1235Appropriations precluded from obligation–5
1260Appropriations, mandatory (total)270,113263,848281,345
Spending authority from offsetting collections, mandatory:
1800Collected1,811
1850Spending auth from offsetting collections, mand (total)1,811
1900Budget authority (total)274,196266,028283,672
1930Total budgetary resources available274,553266,028283,672
Memorandum (non-add) entries:
Special and non-revolving trust funds:
1950Other balances withdrawn2
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)23,42332,19531,887
3010Uncollected pymts, Fed sources, brought forward, Oct 1–1–1–1
3020Obligated balance, start of year (net)23,42232,19431,886
3030Obligations incurred, unexpired accounts274,553266,028283,672
3040Outlays (gross)–265,280–266,336–283,733
3080Recoveries of prior year unpaid obligations, unexpired–501
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)32,19531,88731,826
3091Uncollected pymts, Fed sources, end of year–1–1–1
3100Obligated balance, end of year (net)32,19431,88631,825
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross2,2722,1802,327
Outlays, gross:
4010Outlays from new discretionary authority1,6631,7341,801
4011Outlays from discretionary balances737405394
4020Outlays, gross (total)2,4002,1392,195
Mandatory:
4090Budget authority, gross271,924263,848281,345
Outlays, gross:
4100Outlays from new mandatory authority241,076237,514256,088
4101Outlays from mandatory balances21,80426,68325,450
4110Outlays, gross (total)262,880264,197281,538
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–1,811
4180Budget authority, net (total)272,385266,028283,672
4190Outlays, net (total)263,469266,336283,733
Memorandum (non-add) entries:
5000Total investments, SOY: Federal securities: Par value279,475245,939226,320
5001Total investments, EOY: Federal securities: Par value245,939226,320201,974
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority272,385266,028283,672
Outlays263,469266,336283,733
Amounts included in the adjusted baseline:
Budget Authority900
Outlays900
Legislative proposal, subject to PAYGO:
Budget Authority–1,020
Outlays–1,020
Increased funding for BBEDCA program integrity adjustments:
Budget Authority–1
Outlays–1
Total:
Budget Authority272,385266,027283,552
Outlays263,469266,335283,613
Status of Funds(in millions of dollars)Identification code 75–8005–0–7–5712011 actual2012 est.2013 est.
Unexpended balance, start of year:
0100Balance, start of year280,119245,698226,314
Adjustments:
0190Adjustment - to correct for prior budget entry–1,254
0199Total balance, start of year278,865245,698226,314
Cash income during the year:
Current law:
Receipts:
1200FHI Trust Fund, Transfers from General Fund (FICA Taxes)175,094188,041198,016
1202FHI Trust Fund, Transfers from General Fund (FICA Taxes)–72
1203FHI Trust Fund, Receipts from Railroad Retirement Board452499519
1204FHI Trust Fund, Transfers from General Fund (SECA Taxes)12,94413,98915,394
1205FHI Trust Fund, Civil Penalties and Damages578630675
Offsetting receipts (proprietary):
1220FHI Trust Fund, Other Proprietary Interest from the Public22
1221FHI Trust Fund, Basic Premium, Medicare Advantage222222225
1222FHI Trust Fund, Medicare Refunds5,1765,7005,800
1223FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible3,2733,4463,550
Offsetting receipts (intragovernmental):
1240FHI Trust Fund, Federal Employer Contributions (FICA)3,3843,5163,649
1241FHI Trust Fund, Postal Service Employer Contributions (FICA)641583590
1242FHI Trust Fund, Interest Received by Trust Funds12,87711,30410,019
1244FHI Trust Fund, Taxation on OASDI Benefits15,14318,44320,811
1245FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account128131134
1246FHI Trust Fund, Transfers from General Fund (criminal Fines)1,1961,0451,126
1247FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)16212
1248FHI Trust Fund, Transfers from General Fund (asset Forfeitures)22
1249FHI Trust Fund, Interest Payments by Railroad Retirement Board252626
1250FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)490604672
Offsetting collections:
1280Federal Hospital Insurance Trust Fund1,811
1299Income under present law233,472248,202261,138
Proposed legislation:
Receipts:
2201FHI Trust Fund, Transfers from General Fund (FICA Taxes)1886
Offsetting receipts (proprietary receipts):
2224FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible2
Offsetting receipts (intragovernmental):
2243FHI Trust Fund, Interest Received by Trust Funds223
2251FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)114
2299Income under proposed legislation134111
3299Total cash income233,472248,336261,249
Cash outgo during year:
Current law:
4500Federal Hospital Insurance Trust Fund–265,280–266,336–283,733
4500Health Care Fraud and Abuse Control Account–900
4500Federal Hospital Insurance Trust Fund–1,359–1,527–1,928
4500Health Care Fraud and Abuse Control Account413551
4599Outgo under current law (-)–266,639–267,450–286,010
Proposed legislation:
5500Health Care Fraud and Abuse Control Account–271
5500Federal Hospital Insurance Trust Fund1
5500Federal Hospital Insurance Trust Fund1,020
5599Outgo under proposed legislation (-)–2701,020
6599Total cash outgo (-)–266,639–267,720–284,990
Unexpended balance, end of year:
8700Uninvested balance (net), end of year–241–6599
8701Federal Hospital Insurance Trust Fund245,939226,320201,974
8799Total balance, end of year245,698226,314202,573
Object Classification(in millions of dollars)Identification code 75–8005–0–7–5712011 actual2012 est.2013 est.
Direct obligations:
41.0Payment for Quality Improvement Organization (QIO) activities833352302
42.0Insurance claims and indemnities (benefits)267,607263,284280,842
94.0Financial transfers4,3022,3922,528
99.0Direct obligations272,742266,028283,672
42.0Allocation Account - reimbursable: Insurance claims and indemnities1,811
99.9Total new obligations274,553266,028283,672
Amounts included in the adjusted baseline Program and Financing(in millions of dollars)Identification code 75–8005–7–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Benefit payments, HI900
0900Total new obligations (object class 42.0)900
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)–72
1203Appropriation (previously unavailable)972
1260Appropriations, mandatory (total)900
1900Budget authority (total)900
1930Total budgetary resources available900
Change in obligated balance:
3030Obligations incurred, unexpired accounts900
3040Outlays (gross)–900
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross900
Outlays, gross:
4100Outlays from new mandatory authority900
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4180Budget authority, net (total)900
4190Outlays, net (total)900
Legislative proposal, not subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–8005–2–7–5712011 actual2012 est.2013 est.
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)223
1203Appropriation (previously unavailable)–2–23
Legislative proposal, subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–8005–4–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Benefit payments, HI–1,020
0900Total new obligations (object class 42.0)–1,020
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)1888
1203Appropriation (previously unavailable)–18–1,108
1260Appropriations, mandatory (total)–1,020
1930Total budgetary resources available–1,020
Change in obligated balance:
3030Obligations incurred, unexpired accounts–1,020
3040Outlays (gross)1,020
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–1,020
Outlays, gross:
4100Outlays from new mandatory authority–1,020
4180Budget authority, net (total)–1,020
4190Outlays, net (total)–1,020
Health Care Fraud and Abuse Control Account Health Care Fraud and Abuse Control AccountIn addition to amounts otherwise available for program integrity and program management, $310,377,000 $610,000,000, to remain available through September 30, 2013 2014, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act, of which $219,879,000 $409,697,693 shall be for the Medicare Integrity Program at the Centers for Medicare and Medicaid Services Program Integrity Activities, including administrative costs, to conduct oversight activities for the Medicare program including, but not limited to, Medicare Advantage under Part C and the Medicare Prescription Drug Program under Part D of the authorized in title XVIII of the Social Security Act and for activities described in section 1893(b) of such Act and for Medicaid and Children's Health Insurance Program ("CHIP") program integrity activities, of which $29,730,000 $102,499,971 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act, of which $31,038,000 shall be for the Medicaid and Children's Health Insurance Program ("CHIP'') program integrity activities, and of which $29,730,000 $97,802,336 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act: Provided, That of the amount provided under this heading, $311,000,000 is provided to meet the terms of section 251(b)(2)(C)(ii) of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and $299,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year 2012 2013 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and CHIP programs for the funds provided by this appropriation. (Department of Health and Human Services Appropriations Act, 2012.)P.L. 104–191 established the Health Care Fraud and Abuse Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds, from the Trust Fund to the HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services (HHS), the Department of Justice, and other agencies.The Budget includes a discretionary request for efforts to safeguard Medicare, Medicaid, and CHIP that will supplement the mandatory funds made available by P.L. 104–191 and subsequent Acts. The 2013 discretionary investment is a part of a multi-year fraud and abuse plan specified for 2012 through 2021 in the Balanced Budget and Emergency Deficit Control Act (BBEDCA) of 1985, as amended by the Budget Control Act of 2011. In 2013, the BBEDCA exempts up to $299 million from the new discretionary caps. This exemption is only permissible if the base level of $311 million is fully funded and the use of these funds is clearly restricted to the specified purposes. This Budget assumes that in each year both the base level and the cap adjustments are funded at the maximum levels allowed by section 251(b)(2)(C) of BBEDCA. See additional discussion in the Budget Process chapter in the Analytical Perspectives volume.The HCFAC entities will develop a comprehensive plan for Medicare, Medicaid, and CHIP program integrity activities. The plan will indicate how program integrity appropriations from all sources will be allocated to address program integrity priorities. These priorities include fraud prevention, reducing the improper payment rate, identifying and recouping excessive payments, pinpointing potential weaknesses in program integrity oversight, and establishing new processes and safeguards to correct programmatic vulnerabilities. Program and Financing(in millions of dollars)Identification code 75–8393–0–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Medicare integrity program822863866
0002FBI fraud and abuse control135132135
0003Other fraud and abuse control299295296
0004Predictive Modeling27
0091Total Mandatory1,2831,2901,297
0101CMS discretionary BASE229250410
0102Other discretionary BASE8860200
0191Total Discretionary317310610
0900Total new obligations1,6001,6001,907
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 165241175
1021Recoveries of prior year unpaid obligations46
1050Unobligated balance (total)111241175
Budget authority:
Appropriations, discretionary:
1101Appropriation (special or trust fund)310311610
1144Approp temporarily reduced (Sec 527, HR 2055)–1
1160Appropriation, discretionary (total)310310610
Appropriations, mandatory:
1201Appropriation (special or trust fund)1,4221,2241,167
1260Appropriations, mandatory (total)1,4221,2241,167
1900Budget authority (total)1,7321,5341,777
1930Total budgetary resources available1,8431,7751,952
Memorandum (non-add) entries:
1940Unobligated balance expiring–2
1941Unexpired unobligated balance, end of year24117545
Special and non-revolving trust funds:
1951Unobligated balance expiring2
1952Expired unobligated balance, start of year364141
1953Expired unobligated balance, end of year394141
1954Unobligated balance canceling23
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)8731,0181,091
3030Obligations incurred, unexpired accounts1,6001,6001,907
3031Obligations incurred, expired accounts6
3040Outlays (gross)–1,359–1,527–1,928
3080Recoveries of prior year unpaid obligations, unexpired–46
3081Recoveries of prior year unpaid obligations, expired–56
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)1,0181,0911,070
3100Obligated balance, end of year (net)1,0181,0911,070
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross310310610
Outlays, gross:
4010Outlays from new discretionary authority44310610
4011Outlays from discretionary balances178
4020Outlays, gross (total)222310610
Mandatory:
4090Budget authority, gross1,4221,2241,167
Outlays, gross:
4100Outlays from new mandatory authority747831764
4101Outlays from mandatory balances390386554
4110Outlays, gross (total)1,1371,2171,318
4180Budget authority, net (total)1,7321,5341,777
4190Outlays, net (total)1,3591,5271,928
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority1,7321,5341,777
Outlays1,3591,5271,928
Amounts included in the adjusted baseline:
Budget Authority–414–551
Outlays–413–551
Increased funding for BBEDCA program integrity adjustments:
Budget Authority271
Outlays271
Total:
Budget Authority1,7321,3911,226
Outlays1,3591,3851,377
Object Classification(in millions of dollars)Identification code 75–8393–0–7–5712011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent (CMS)113838
12.1Civilian personnel benefits (CMS)288
23.3Communications, utilities, and miscellaneous charges288
25.1Advisory and assistance services (predictive modeling)27
25.2Other services (CMS/Medicaid)174547
25.3Other purchases of goods and services from Government accounts (HHS/DOJ)10991159
25.3Other purchases of goods and services from Government accounts (HHS/OIG)244226299
25.3Other purchases of goods and services from Government accounts (HHS/AoA)413
25.3Other purchases of goods and services from Government accounts (HHS/OGC)99
25.3Other goods and services from Federal sources (HHS/CMS)222
25.3Other goods and services from Government accounts (HHS/FDA)42
25.3Other goods and services from Government accounts (HHS/ASPA)1
25.6Medical care (CMS)1,0331,0261,211
94.0Financial transfers (FBI)135132135
99.9Total new obligations1,6001,6001,907
Employment SummaryIdentification code 75–8393–0–7–5712011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment162325360
Amounts included in the adjusted baseline The Balanced Budget and Emergency Deficit Control Act (BBEDCA) of 1985, as amended, exempts up to $299 million in 2013 from the discretionary caps enacted in the Act. Funding the discretionary cap up to the adjustment level permitted by the BBEDCA is estimated to achieve an additional $450 million in savings.Program and Financing(in millions of dollars)Identification code 75–8393–7–7–5712011 actual2012 est.2013 est.
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 1–414
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)–414–551
1260Appropriations, mandatory (total)–414–551
1900Budget authority (total)–414–551
1930Total budgetary resources available–414–965
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year–414–965
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)413
3040Outlays (gross)413551
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)413964
3100Obligated balance, end of year (net)413964
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–414–551
Outlays, gross:
4100Outlays from new mandatory authority–413–551
4180Budget authority, net (total)–414–551
4190Outlays, net (total)–413–551
Federal Supplementary Medical Insurance Trust Fund The Supplementary Medical Insurance (SMI) program is a voluntary program that affords protection against the costs of physician and certain other medical services. The program also covers treatment of end-stage renal disease for eligible enrollees. SMI costs are generally financed by premium payments from enrollees and contributions from the general revenues. The status of the trust fund is as follows. In addition, the Budget includes a package of proposals that improve Medicare's sustainability by promoting high-quality, efficient care; aligning payments with the costs of providing care; encouraging beneficiaries to seek high-value services; and reducing the Federal subsidy of Medicare costs for those beneficiaries who can most afford them. Special and Trust Fund Receipts(in millions of dollars)Identification code 75–8004–0–7–5712011 actual2012 est.2013 est.
0100Balance, start of year45,63042,93037,621
Receipts:
0200Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI1,8762,9442,800
0220Other Proprietary Interest from the Public, FSMI Fund233
0221Premiums Collected for Medicare Prescription Drug Account, FSMI2,6313,1264,004
0222Premiums Collected for Medicare Prescription Drug Account, FSMI78
0223Payments from States, Medicare Prescription Drug Account, FSMI6,5368,0478,795
0224Payments from States, Medicare Prescription Drug Account, FSMI190
0225Basic Premium, Medicare Advantage, FSMI Trust Fund197211215
0226Medicare Refunds, SMI4,6374,3004,400
0227Premiums Collected for the Aged, FSMI Fund47,27748,97753,326
0228Premiums Collected for the Aged, FSMI Fund1,409
0229Manufacturer Rebates5,870
0230Premiums Collected for the Disabled, FSMI Fund9,7509,36710,243
0231Premiums Collected for the Disabled, FSMI Fund270
0240Federal Contributions, FSMI Fund168,849167,184189,520
0241Federal Contributions, FSMI Fund–15
0242Federal Contributions, FSMI Fund4,514
0243Interest Received by Trust Fund, FSMI Fund3,2213,2883,535
0244Interest Received by Trust Fund, FSMI Fund–342–974
0245Interest, Medicare Prescription Drug Account, FSMI10910
0246Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI400405424
0247Federal Contributions for Benefits, Prescription Drug Account, SMI55,92947,28260,744
0248Federal Contributions for Benefits, Prescription Drug Account, SMI–4,550
0249Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund111
0299Total receipts and collections301,316294,802344,812
0400Total: Balances and collections346,946337,732382,433
Appropriations:
0500Federal Supplementary Medical Insurance Trust Fund–3,051–3,432–4,175
0501Federal Supplementary Medical Insurance Trust Fund32
0502Federal Supplementary Medical Insurance Trust Fund6
0503Federal Supplementary Medical Insurance Trust Fund–230,483–233,528–259,914
0504Federal Supplementary Medical Insurance Trust Fund–2,802
0505Federal Supplementary Medical Insurance Trust Fund4,48522,770
0506Federal Supplementary Medical Insurance Trust Fund4,565
0507Federal Supplementary Medical Insurance Trust Fund–215–5,260
0508Federal Supplementary Medical Insurance Trust Fund–4,550
0509Federal Supplementary Medical Insurance Trust Fund4,580
0510Federal Supplementary Medical Insurance Trust Fund342–5,220
0511Federal Supplementary Medical Insurance Trust Fund–9,579–21,205
0512Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund–402–397–418
0513Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund1
0514Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund–67,454–57,794–73,512
0515Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund–1,588
0599Total appropriations–304,160–300,111–343,927
0610Federal Supplementary Medical Insurance Trust Fund1
0620Federal Supplementary Medical Insurance Trust Fund150
0795Adjustment - for expired accounts, trust fund receipts withdrawn–7
0799Balance, end of year42,93037,62138,506
Program and Financing(in millions of dollars)Identification code 75–8004–0–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Benefit payments, SMI231,760227,880236,075
0002Transfer to Medicaid for payment of SMI premiums703320
0003HIT Incentive Payments490690930
0004Administration, SMI3,3613,4914,238
0005Quality Improvement Organizations, SMI1868876
0799Total direct obligations236,500232,469241,319
0801Reimbursable program activity11
0900Total new obligations236,511232,469241,319
Budgetary Resources:
Unobligated balance:
1021Recoveries of prior year unpaid obligations347
1026Adjustment for change in allocation of trust fund limitation or foreign exchange valuation–150
1029Other balances withdrawn–1
1050Unobligated balance (total)196
Budget authority:
Appropriations, discretionary:
1101Appropriation (special or trust fund)3,0513,4324,175
1132Appropriations temporarily reduced–32
1144Approp temporarily reduced (Sec 527, HR 2055)–6
1160Appropriation, discretionary (total)3,0193,4264,175
Appropriations, mandatory:
1201Appropriation (special or trust fund)230,483233,528259,914
1203Appropriation (previously unavailable)2,802
1235Appropriations precluded from obligation–4,485–22,770
1260Appropriations, mandatory (total)233,285229,043237,144
Spending authority from offsetting collections, mandatory:
1800Collected11
1850Spending auth from offsetting collections, mand (total)11
1900Budget authority (total)236,315232,469241,319
1930Total budgetary resources available236,511232,469241,319
Memorandum (non-add) entries:
Special and non-revolving trust funds:
1950Other balances withdrawn1
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)22,18424,06324,023
3030Obligations incurred, unexpired accounts236,511232,469241,319
3040Outlays (gross)–234,285–232,509–241,007
3080Recoveries of prior year unpaid obligations, unexpired–347
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)24,06324,02324,335
3100Obligated balance, end of year (net)24,06324,02324,335
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross3,0193,4264,175
Outlays, gross:
4010Outlays from new discretionary authority1,7042,3262,728
4011Outlays from discretionary balances1,0079941,033
4020Outlays, gross (total)2,7113,3203,761
Mandatory:
4090Budget authority, gross233,296229,043237,144
Outlays, gross:
4100Outlays from new mandatory authority209,811207,468214,076
4101Outlays from mandatory balances21,76321,72123,170
4110Outlays, gross (total)231,574229,189237,246
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–11
4180Budget authority, net (total)236,304232,469241,319
4190Outlays, net (total)234,274232,509241,007
Memorandum (non-add) entries:
5000Total investments, SOY: Federal securities: Par value70,98270,44666,500
5001Total investments, EOY: Federal securities: Par value70,44666,50067,635
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority236,304232,469241,319
Outlays234,274232,509241,007
Amounts included in the adjusted baseline:
Budget Authority9,23726,425
Outlays9,23726,425
Legislative proposal, not subject to PAYGO:
Budget Authority215695
Outlays215695
Legislative proposal, subject to PAYGO:
Budget Authority–30
Outlays–30
Total:
Budget Authority236,304241,921268,409
Outlays234,274241,961268,097
Status of Funds(in millions of dollars)Identification code 75–8004–0–7–5712011 actual2012 est.2013 est.
Unexpended balance, start of year:
0100Balance, start of year71,97772,78067,422
Adjustments:
0190Adjustment - rounding–1
0199Total balance, start of year71,97672,78067,422
Cash income during the year:
Current law:
Receipts:
1200Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI1,8762,9442,800
Offsetting receipts (proprietary):
1220Other Proprietary Interest from the Public, FSMI Fund233
1221Premiums Collected for Medicare Prescription Drug Account, FSMI2,6313,1264,004
1223Payments from States, Medicare Prescription Drug Account, FSMI6,5368,0478,795
1225Basic Premium, Medicare Advantage, FSMI Trust Fund197211215
1226Medicare Refunds, SMI4,6374,3004,400
1227Premiums Collected for the Aged, FSMI Fund47,27748,97753,326
1228Premiums Collected for the Aged, FSMI Fund1,409
1230Premiums Collected for the Disabled, FSMI Fund9,7509,36710,243
1231Premiums Collected for the Disabled, FSMI Fund270
Offsetting receipts (intragovernmental):
1240Federal Contributions, FSMI Fund168,849167,184189,520
1242Federal Contributions, FSMI Fund4,514
1243Interest Received by Trust Fund, FSMI Fund3,2213,2883,535
1244Interest Received by Trust Fund, FSMI Fund–342–974
1245Interest, Medicare Prescription Drug Account, FSMI10910
1246Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI400405424
1247Federal Contributions for Benefits, Prescription Drug Account, SMI55,92947,28260,744
1249Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund111
Offsetting collections:
1280Federal Supplementary Medical Insurance Trust Fund11
1281Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund1,612
1299Income under present law302,939294,802343,239
Proposed legislation:
Offsetting receipts (proprietary receipts):
2222Premiums Collected for Medicare Prescription Drug Account, FSMI78
2224Payments from States, Medicare Prescription Drug Account, FSMI190
2229Manufacturer Rebates5,870
Offsetting receipts (intragovernmental):
2241Federal Contributions, FSMI Fund–15
2248Federal Contributions for Benefits, Prescription Drug Account, SMI–4,550
2299Income under proposed legislation1,573
3299Total cash income302,939294,802344,812
Cash outgo during year:
Current law:
4500Federal Supplementary Medical Insurance Trust Fund–234,285–232,509–241,007
4500Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund–9,237–26,425
4500Federal Supplementary Medical Insurance Trust Fund–67,850–58,199–73,930
4599Outgo under current law (-)–302,135–299,945–341,362
Proposed legislation:
5500Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund–1,588
5500Federal Supplementary Medical Insurance Trust Fund–215–695
5500Federal Supplementary Medical Insurance Trust Fund30
5599Outgo under proposed legislation (-)–215–2,253
6599Total cash outgo (-)–302,135–300,160–343,615
Unexpended balance, end of year:
8700Uninvested balance (net), end of year2,334922984
8701Federal Supplementary Medical Insurance Trust Fund70,44666,50067,635
8799Total balance, end of year72,78067,42268,619
Object Classification(in millions of dollars)Identification code 75–8004–0–7–5712011 actual2012 est.2013 est.
Direct obligations:
41.0Payment for Quality Improvement Organization (QIO) activity1868876
42.0Insurance claims and indemnities232,953228,890237,005
94.0Financial transfers3,3613,4914,238
99.0Direct obligations236,500232,469241,319
42.0Allocation Account - reimbursable: Insurance claims and indemnities11
99.9Total new obligations236,511232,469241,319
Amounts included in the adjusted baseline Program and Financing(in millions of dollars)Identification code 75–8004–7–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Benefits9,23726,425
0900Total new obligations (object class 42.0)9,23726,425
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)–3425,220
1235Appropriations precluded from obligation9,57921,205
1260Appropriations, mandatory (total)9,23726,425
1900Budget authority (total)9,23726,425
1930Total budgetary resources available9,23726,425
Change in obligated balance:
3030Obligations incurred, unexpired accounts9,23726,425
3040Outlays (gross)–9,237–26,425
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross9,23726,425
Outlays, gross:
4100Outlays from new mandatory authority9,23726,425
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4180Budget authority, net (total)9,23726,425
4190Outlays, net (total)9,23726,425
Legislative proposal, not subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–8004–2–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0002Transfer to Medicaid for payment of SMI premiums215695
0900Total new obligations (object class 42.0)215695
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)–4,565
1235Appropriations precluded from obligation2155,260
1260Appropriations, mandatory (total)215695
1900Budget authority (total)215695
1930Total budgetary resources available215695
Change in obligated balance:
3030Obligations incurred, unexpired accounts215695
3040Outlays (gross)–215–695
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross215695
Outlays, gross:
4100Outlays from new mandatory authority215695
4180Budget authority, net (total)215695
4190Outlays, net (total)215695
Legislative proposal, subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–8004–4–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Benefit payments, SMI–30
0900Total new obligations (object class 42.0)–30
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)4,550
1235Appropriations precluded from obligation–4,580
1260Appropriations, mandatory (total)–30
1900Budget authority (total)–30
1930Total budgetary resources available–30
Change in obligated balance:
3030Obligations incurred, unexpired accounts–30
3040Outlays (gross)30
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–30
Outlays, gross:
4100Outlays from new mandatory authority–30
4180Budget authority, net (total)–30
4190Outlays, net (total)–30
Transitional Drug Assistance, Federal Supplementary Medical Insurance Trust Fund Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug benefit. The Budget includes a package of proposals that slow the growth of Part D net expenditures by allowing Medicare to benefit from the same rebates that Medicaid receives for drugs provided to low-income beneficiaries and by increasing the availability of generic drugs. Program and Financing(in millions of dollars)Identification code 75–8308–0–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Prescription Drug Benefits67,67357,78973,507
0002Administrative Costs268401423
0799Total direct obligations67,94158,19073,930
0801Reimbursable program (Prescription Drug Benefits)1,612
0900Total new obligations69,55358,19073,930
Budgetary Resources:
Unobligated balance:
1021Recoveries of prior year unpaid obligations221
1050Unobligated balance (total)221
Budget authority:
Appropriations, discretionary:
1101Appropriation (special or trust fund)402397418
1144Approp temporarily reduced (Sec 527, HR 2055)–1
1160Appropriation, discretionary (total)402396418
Appropriations, mandatory:
1201Appropriation (special or trust fund)67,45457,79473,512
1260Appropriations, mandatory (total)67,45457,79473,512
Spending authority from offsetting collections, mandatory:
1800Collected1,612
1850Spending auth from offsetting collections, mand (total)1,612
1900Budget authority (total)69,46858,19073,930
1930Total budgetary resources available69,68958,19073,930
Memorandum (non-add) entries:
1940Unobligated balance expiring–136
Special and non-revolving trust funds:
1951Unobligated balance expiring136
1952Expired unobligated balance, start of year536572571
1953Expired unobligated balance, end of year436571571
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)3,6265,2165,207
3030Obligations incurred, unexpired accounts69,55358,19073,930
3031Obligations incurred, expired accounts151
3040Outlays (gross)–67,850–58,199–73,930
3080Recoveries of prior year unpaid obligations, unexpired–221
3081Recoveries of prior year unpaid obligations, expired–43
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)5,2165,2075,207
3100Obligated balance, end of year (net)5,2165,2075,207
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross402396418
Outlays, gross:
4010Outlays from new discretionary authority254310321
4011Outlays from discretionary balances1448178
4020Outlays, gross (total)398391399
Mandatory:
4090Budget authority, gross69,06657,79473,512
Outlays, gross:
4100Outlays from new mandatory authority65,84052,95569,912
4101Outlays from mandatory balances1,6124,8533,619
4110Outlays, gross (total)67,45257,80873,531
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120Federal sources–1,612
4180Budget authority, net (total)67,85658,19073,930
4190Outlays, net (total)66,23858,19973,930
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority67,85658,19073,930
Outlays66,23858,19973,930
Legislative proposal, subject to PAYGO:
Budget Authority1,588
Outlays1,588
Total:
Budget Authority67,85658,19075,518
Outlays66,23858,19975,518
Object Classification(in millions of dollars)Identification code 75–8308–0–7–5712011 actual2012 est.2013 est.
Direct obligations:
25.2Other services from non-Federal sources268401423
42.0Insurance claims and indemnities67,67357,78973,507
99.0Direct obligations67,94158,19073,930
42.0Allocation Account - reimbursable: Insurance claims and indemnities1,612
99.9Total new obligations69,55358,19073,930
Amounts included in the adjusted baseline Legislative proposal, subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–8308–4–7–5712011 actual2012 est.2013 est.
Obligations by program activity:
0001Prescription Drug Benefits1,588
0900Total new obligations (object class 25.2)1,588
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1201Appropriation (special or trust fund)1,588
1260Appropriations, mandatory (total)1,588
1930Total budgetary resources available1,588
Change in obligated balance:
3030Obligations incurred, unexpired accounts1,588
3040Outlays (gross)–1,588
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross1,588
Outlays, gross:
4100Outlays from new mandatory authority1,588
4180Budget authority, net (total)1,588
4190Outlays, net (total)1,588
Allocations Received from Other Accounts Note.—Obligations incurred under allocations from other accounts are included in the schedule of the parent appropriation as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."Administration for Children and Families Temporary Assistance for Needy Families This account provides funding for the Temporary Assistance for Needy Families block grant and related activities authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171), the Claims Resolution Act of 2010 (P.L. 111–291), the Short Term TANF Extension Act (P.L. 112–35), and the Temporary Payroll Tax Cut Continuation Act of 2011 (P.L. 112–78)Program and Financing(in millions of dollars)Identification code 75–1552–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001State family assistance grant16,49116,48816,488
0002Territories - family assistance grants777878
0004Supplemental Grants 2011211
0006Tribal work programs588
0009Healthy marriage and responsible fatherhood grants150150150
0900Total new obligations16,93416,72416,724
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation16,95016,73916,739
1260Appropriations, mandatory (total)16,95016,73916,739
1930Total budgetary resources available16,95016,73916,739
Memorandum (non-add) entries:
1940Unobligated balance expiring–16–15–15
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)4,7764,5944,780
3030Obligations incurred, unexpired accounts16,93416,72416,724
3040Outlays (gross)–17,116–16,538–17,017
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)4,5944,7804,487
3100Obligated balance, end of year (net)4,5944,7804,487
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross16,95016,73916,739
Outlays, gross:
4100Outlays from new mandatory authority14,03913,37713,378
4101Outlays from mandatory balances3,0773,1613,639
4110Outlays, gross (total)17,11616,53817,017
4180Budget authority, net (total)16,95016,73916,739
4190Outlays, net (total)17,11616,53817,017
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority16,95016,73916,739
Outlays17,11616,53817,017
Legislative proposal, subject to PAYGO:
Budget Authority319
Outlays289
Total:
Budget Authority16,95016,73917,058
Outlays17,11616,53817,306
Object Classification(in millions of dollars)Identification code 75–1552–0–1–6092011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent222
12.1Civilian personnel benefits11
21.0Travel and transportation of persons11
23.1Rental payments to GSA11
25.1Advisory and assistance services232121
25.3Other goods and services from Federal sources333
41.0Grants, subsidies, and contributions16,90616,69516,695
99.9Total new obligations16,93416,72416,724
Employment SummaryIdentification code 75–1552–0–1–6092011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment181818
Legislative proposal, subject to PAYGO The Budget proposes to permanently fund the TANF Supplemental Grants for Population Increases by redirecting TANF Contingency Fund resources to support these grants.Program and Financing(in millions of dollars)Identification code 75–1552–4–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0004Supplemental Grants319
0900Total new obligations (object class 41.0)319
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation319
1260Appropriations, mandatory (total)319
1930Total budgetary resources available319
Change in obligated balance:
3030Obligations incurred, unexpired accounts319
3040Outlays (gross)–289
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)30
3100Obligated balance, end of year (net)30
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross319
Outlays, gross:
4100Outlays from new mandatory authority289
4180Budget authority, net (total)319
4190Outlays, net (total)289
This account provides funding for the TANF Contingency Fund authorized by section 403(b) of the Social Security Act that currently provides money to qualifying States (but not Territories or Tribes) during an economic downturn.Program and Financing(in millions of dollars)Identification code 75–1522–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001Contingency fund334612612
0900Total new obligations (object class 41.0)334612612
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation506612612
1230Appropriations and/or unobligated balance of appropriations permanently reduced–172
1260Appropriations, mandatory (total)334612612
1930Total budgetary resources available334612612
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)2,454832127
3030Obligations incurred, unexpired accounts334612612
3040Outlays (gross)–1,956–1,317–682
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)83212757
3100Obligated balance, end of year (net)83212757
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross334612612
Outlays, gross:
4100Outlays from new mandatory authority249555555
4101Outlays from mandatory balances1,707762127
4110Outlays, gross (total)1,9561,317682
4180Budget authority, net (total)334612612
4190Outlays, net (total)1,9561,317682
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority334612612
Outlays1,9561,317682
Legislative proposal, subject to PAYGO:
Budget Authority–319
Outlays–289
Total:
Budget Authority334612293
Outlays1,9561,317393
Legislative proposal, subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–1522–4–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001Contingency fund–319
0900Total new obligations (object class 41.0)–319
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation–319
1260Appropriations, mandatory (total)–319
1930Total budgetary resources available–319
Change in obligated balance:
3030Obligations incurred, unexpired accounts–319
3040Outlays (gross)289
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)–30
3100Obligated balance, end of year (net)–30
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross–319
Outlays, gross:
4100Outlays from new mandatory authority–289
4180Budget authority, net (total)–319
4190Outlays, net (total)–289
Payments to States for Child Support Enforcement and Family Support Programs Payments to States for Child Support Enforcement and Family Support ProgramsFor making payments to States or other non-Federal entities under titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960, $2,305,035,000 $2,756,485,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2013 2014, $1,100,000,000, to remain available until expended.For making payments to each State for carrying out the program of Aid to Families with Dependent Children under title IV-A of the Social Security Act before the effective date of the program of Temporary Assistance for Needy Families with respect to such State, such sums as may be necessary: Provided, That the sum of the amounts available to a State with respect to expenditures under such title IV-A in fiscal year 1997 under this appropriation and under such title IV-A as amended by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 shall not exceed the limitations under section 116(b) of such Act.For making, after May 31 of the current fiscal year, payments to States or other non-Federal entities under titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal year, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2012.)This account provides for payments to States for child support enforcement and other family support programs, including access and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt account. This request proposes a Child Support and Fatherhood Initiative, a comprehensive set of proposals which promotes using child support payments in the best interest of the child; supports noncustodial parents becoming and staying involved in their children's lives; and improves establishment and enforcement procedures by closing loopholes and improving federal processes. Program and Financing(in millions of dollars)Identification code 75–1501–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001State child support administrative costs4,1613,7783,572
0002Child support incentive payments466526540
0003Access and visitation grants101010
0091Subtotal, child support enforcement4,6374,3144,122
0102Payments to territories303333
0103Repatriation111
0191Subtotal, other payments313434
0799Total direct obligations4,6684,3484,156
0801Offset obligations (CSE grants to States)333
0900Total new obligations4,6714,3514,159
Budgetary Resources:
Unobligated balance:
1021Recoveries of prior year unpaid obligations509300300
1050Unobligated balance (total)509300300
Budget authority:
Appropriations, mandatory:
1200Appropriation3,0592,8482,756
1260Appropriations, mandatory (total)3,0592,8482,756
Advance appropriations, mandatory:
1270Advance appropriation1,1001,2001,100
1280Advanced appropriation, mandatory (total)1,1001,2001,100
Spending authority from offsetting collections, mandatory:
1800Collected333
1850Spending auth from offsetting collections, mand (total)333
1900Budget authority (total)4,1624,0513,859
1930Total budgetary resources available4,6714,3514,159
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1,1301,1071,286
3030Obligations incurred, unexpired accounts4,6714,3514,159
3040Outlays (gross)–4,185–3,872–3,865
3080Recoveries of prior year unpaid obligations, unexpired–509–300–300
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)1,1071,2861,280
3100Obligated balance, end of year (net)1,1071,2861,280
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross4,1624,0513,859
Outlays, gross:
4100Outlays from new mandatory authority3,3183,0012,895
4101Outlays from mandatory balances867871970
4110Outlays, gross (total)4,1853,8723,865
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123Non-Federal sources–3–3–3
4180Budget authority, net (total)4,1594,0483,856
4190Outlays, net (total)4,1823,8693,862
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority4,1594,0483,856
Outlays4,1823,8693,862
Legislative proposal, subject to PAYGO:
Budget Authority11
Outlays11
Total:
Budget Authority4,1594,0483,867
Outlays4,1823,8693,873
Object Classification(in millions of dollars)Identification code 75–1501–0–1–6092011 actual2012 est.2013 est.
41.0Direct obligations: Grants, subsidies, and contributions4,6684,3484,156
99.0Reimbursable obligations333
99.9Total new obligations4,6714,3514,159
Legislative proposal, subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–1501–4–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001State child support administrative costs11
0900Total new obligations (object class 41.0)11
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation11
1260Appropriations, mandatory (total)11
1900Budget authority (total)11
1930Total budgetary resources available11
Change in obligated balance:
3030Obligations incurred, unexpired accounts11
3040Outlays (gross)–11
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross11
Outlays, gross:
4100Outlays from new mandatory authority11
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4180Budget authority, net (total)11
4190Outlays, net (total)11
Low Income Home Energy Assistance Low Income Home Energy AssistanceFor making payments under subsections (b), and (d), and (e) of section 2602 of the Low Income Home Energy Assistance Act of 1981, $3,478,246,000 $3,020,000,000, of which $2,820,000,000 shall be for payments under subsections (b) and (d) of such section; and of which $200,000,000 shall be for making payments under subsection (e) of such section, to be made notwithstanding the designation requirements of such subsection: Provided, That all but $497,000,000 $403,000,000 of such funds the amount provided in this section for subsections (b) and (d) shall be allocated as though the total appropriation for such payments for fiscal year 2012 2013 was less than $1,975,000,000: Provided further, That notwithstanding section 2609A(a), of the amounts appropriated under section 2602(b), not more than $3,000,000 of such amounts may be reserved by the Secretary for technical assistance, training, and monitoring of program activities for compliance with internal controls, policies and procedures. (Department of Health and Human Services Appropriations Act, 2012.)This program makes grants to States and Indian Tribes to aid low-income households with high energy costs through payments to eligible households, energy suppliers, and weatherization providers. Obligation estimates for the contingency fund assume that all funds will be released in response to expected high prices for home delivered fuels and other weather related events.Program and Financing(in millions of dollars)Identification code 75–1502–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001LIHEAP4,7013,4723,020
0900Total new obligations (object class 41.0)4,7013,4723,020
Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100Appropriation4,7103,4793,020
1130Appropriations permanently reduced–9
1143Approp permanently reduced (Sec 527, HR 2055)–7
1160Appropriation, discretionary (total)4,7013,4723,020
1930Total budgetary resources available4,7013,4723,020
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1,7151,9921,738
3030Obligations incurred, unexpired accounts4,7013,4723,020
3040Outlays (gross)–4,419–3,726–3,338
3081Recoveries of prior year unpaid obligations, expired–5
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)1,9921,7381,420
3100Obligated balance, end of year (net)1,9921,7381,420
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross4,7013,4723,020
Outlays, gross:
4010Outlays from new discretionary authority2,9782,3262,027
4011Outlays from discretionary balances1,4411,4001,311
4020Outlays, gross (total)4,4193,7263,338
4180Budget authority, net (total)4,7013,4723,020
4190Outlays, net (total)4,4193,7263,338
Refugee and Entrant Assistance Refugee and Entrant AssistanceFor necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality Act and section 501 of the Refugee Education Assistance Act of 1980, for carrying out section 462 of the Homeland Security Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, and the Trafficking Victims Protection Act of 2000, for costs associated with the care and placement of unaccompanied alien children, and for carrying out the Torture Victims Relief Act of 1998, $769,789,000 $805,358,000, of which up to $9,794,000 $9,775,000 shall be available to carry out the Trafficking Victims Protection Act of 2000: Provided, That funds appropriated under this heading pursuant to section 414(a) of the Immigration and Nationality Act, section 462 of the Homeland Security Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, and the Trafficking Victims Protection Act of 2000 for fiscal year 2012 2013 shall be available for the costs of assistance provided and other activities to remain available through September 30, 2014 2015. (Department of Health and Human Services Appropriations Act, 2012.)This program provides funds to States and non-governmental organizations for administering the refugee and entrant assistance program. Funds also are provided to assist in the rehabilitation of victims of torture, trafficking victims, and the care and placement of unaccompanied alien children. Program and Financing(in millions of dollars)Identification code 75–1503–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001Refugee and entrant assistance574605619
0002Assistance for treatment of torture victims111111
0003Unaccompanied alien children175175175
0900Total new obligations760791805
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 17723
1021Recoveries of prior year unpaid obligations2
1050Unobligated balance (total)7923
Budget authority:
Appropriations, discretionary:
1100Appropriation731769805
1130Appropriations permanently reduced–2
1131Unobligated balance of appropriations permanently reduced–25
1143Approp permanently reduced (Sec 527, HR 2055)–1
1160Appropriation, discretionary (total)704768805
1930Total budgetary resources available783791805
Memorandum (non-add) entries:
1941Unexpired unobligated balance, end of year23
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)576566699
3030Obligations incurred, unexpired accounts760791805
3040Outlays (gross)–753–658–830
3080Recoveries of prior year unpaid obligations, unexpired–2
3081Recoveries of prior year unpaid obligations, expired–15
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)566699674
3100Obligated balance, end of year (net)566699674
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross704768805
Outlays, gross:
4010Outlays from new discretionary authority347307322
4011Outlays from discretionary balances406351508
4020Outlays, gross (total)753658830
4180Budget authority, net (total)704768805
4190Outlays, net (total)753658830
Object Classification(in millions of dollars)Identification code 75–1503–0–1–6092011 actual2012 est.2013 est.
Direct obligations:
11.1Personnel compensation: Full-time permanent444
12.1Civilian personnel benefits111
23.1Rental payments to GSA222
25.1Advisory and assistance services312929
25.3Other goods and services from Federal sources81616
41.0Grants, subsidies, and contributions714739753
99.9Total new obligations760791805
Employment SummaryIdentification code 75–1503–0–1–6092011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment444444
Supporting Healthy Families and Adolescent Development Promoting Safe and Stable FamiliesFor carrying out section 436 of the Social Security Act, $345,000,000 and, in addition, for carrying out section 437 of such Act, $63,184,000 $63,065,000. (Department of Health and Human Services Appropriations Act, 2012.)This account provides funds for a broad range of child welfare services, including family preservation and family support services. Additionally, this account includes funding for the Personal Responsibility Education Program (PREP) and Abstinence Education which were made available by the Patient Protection and Affordable Care Act (P.L. 111–148). This account also includes a new initiative to prevent pregnancy among youth in foster care.Program and Financing(in millions of dollars)Identification code 75–1512–0–1–5062011 actual2012 est.2013 est.
Obligations by program activity:
0001Grants to States and Tribes388368368
0002Research, training and technical assistance888
0003State court improvement activities323232
0004Family Connection Grants151515
0005PREP7210075
0006Abstinence Education383737
0900Total new obligations553560535
Budgetary Resources:
Unobligated balance:
1000Unobligated balance brought forward, Oct 11925
1021Recoveries of prior year unpaid obligations3
1050Unobligated balance (total)2225
Budget authority:
Appropriations, discretionary:
1100Appropriation636376
1130Appropriations permanently reduced–13
1160Appropriation, discretionary (total)636363
Appropriations, mandatory:
1200Appropriation505485485
1260Appropriations, mandatory (total)505485485
1900Budget authority (total)568548548
1930Total budgetary resources available590573548
Memorandum (non-add) entries:
1940Unobligated balance expiring–12–13
1941Unexpired unobligated balance, end of year2513
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)552614542
3030Obligations incurred, unexpired accounts553560535
3040Outlays (gross)–479–632–542
3080Recoveries of prior year unpaid obligations, unexpired–3
3081Recoveries of prior year unpaid obligations, expired–9
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)614542535
3100Obligated balance, end of year (net)614542535
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross636363
Outlays, gross:
4010Outlays from new discretionary authority211919
4011Outlays from discretionary balances454145
4020Outlays, gross (total)666064
Mandatory:
4090Budget authority, gross505485485
Outlays, gross:
4100Outlays from new mandatory authority104158158
4101Outlays from mandatory balances309414320
4110Outlays, gross (total)413572478
4180Budget authority, net (total)568548548
4190Outlays, net (total)479632542
Object Classification(in millions of dollars)Identification code 75–1512–0–1–5062011 actual2012 est.2013 est.
Direct obligations:
25.1Advisory and assistance services121212
25.3Other goods and services from Federal sources222
41.0Grants, subsidies, and contributions539546521
99.9Total new obligations553560535
Employment SummaryIdentification code 75–1512–0–1–5062011 actual2012 est.2013 est.
1001Direct civilian full-time equivalent employment555
Child Care Entitlement to States This account provides child care subsidies for low-income working families and was established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171), the Claims Resolution Act of 2010 (P.L. 111–291), the Short Term TANF Extension Act (P.L. 112–35), and the Temporary Payroll Tax Cut Continuation Act of 2011 (P.L. 112–78). Program and Financing(in millions of dollars)Identification code 75–1550–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001Mandatory child care1,1781,1781,178
0002Matching child care1,6861,6741,674
0003Training and technical assistance777
0004Child care tribal grants585858
0900Total new obligations2,9292,9172,917
Budgetary Resources:
Unobligated balance:
1012Unobligated balance transfers between expired and unexpired accounts25
Budget authority:
Appropriations, mandatory:
1200Appropriation2,9172,9172,917
1260Appropriations, mandatory (total)2,9172,9172,917
1900Budget authority (total)2,9172,9172,917
1930Total budgetary resources available2,9422,9172,917
Memorandum (non-add) entries:
1940Unobligated balance expiring–13
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)806609658
3030Obligations incurred, unexpired accounts2,9292,9172,917
3040Outlays (gross)–3,100–2,868–2,877
3081Recoveries of prior year unpaid obligations, expired–26
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)609658698
3100Obligated balance, end of year (net)609658698
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross2,9172,9172,917
Outlays, gross:
4100Outlays from new mandatory authority2,3822,3572,357
4101Outlays from mandatory balances718511520
4110Outlays, gross (total)3,1002,8682,877
4180Budget authority, net (total)2,9172,9172,917
4190Outlays, net (total)3,1002,8682,877
Summary of Budget Authority and Outlays(in millions of dollars)2011 actual2012 est.2013 est.
Enacted/requested:
Budget Authority2,9172,9172,917
Outlays3,1002,8682,877
Legislative proposal, subject to PAYGO:
Budget Authority500
Outlays409
Total:
Budget Authority2,9172,9173,417
Outlays3,1002,8683,286
Object Classification(in millions of dollars)Identification code 75–1550–0–1–6092011 actual2012 est.2013 est.
Direct obligations:
25.1Advisory and assistance services11
25.2Other services from non-Federal sources766
41.0Grants, subsidies, and contributions2,9222,9102,910
99.9Total new obligations2,9292,9172,917
Legislative proposal, subject to PAYGO Program and Financing(in millions of dollars)Identification code 75–1550–4–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0002Matching child care480
0003Training and technical assistance10
0004Child care tribal grants10
0900Total new obligations500
Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200Appropriation500
1260Appropriations, mandatory (total)500
1900Budget authority (total)500
1930Total budgetary resources available500
Change in obligated balance:
3030Obligations incurred, unexpired accounts500
3040Outlays (gross)–409
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)91
3100Obligated balance, end of year (net)91
Budget authority and outlays, net:
Mandatory:
4090Budget authority, gross500
Outlays, gross:
4100Outlays from new mandatory authority397
4101Outlays from mandatory balances12
4110Outlays, gross (total)409
4180Budget authority, net (total)500
4190Outlays, net (total)409
Object Classification(in millions of dollars)Identification code 75–1550–4–1–6092011 actual2012 est.2013 est.
Direct obligations:
25.2Other services from non-Federal sources10
41.0Grants, subsidies, and contributions490
99.9Total new obligations500
Payments to States for the Child Care and Development Block Grant Payments to States for the Child Care and Development Block GrantFor carrying out the Child Care and Development Block Grant Act of 1990, $2,282,627,000 $2,303,313,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families: Provided, That $19,433,000 $19,609,000 shall be available for child care resource and referral and school-aged child care activities, of which $1,000,000 shall be available to the Secretary for a competitive grant for the operation of a national toll free hotline and Web site to develop and disseminate child care consumer education information for parents and help parents access child care in their local community: Provided further, That, in addition to the amounts required to be reserved by the States under section 658G, $291,248,000 $293,887,000 shall be reserved by the States for activities authorized under section 658G, of which $106,813,000 $107,781,000 shall be for activities that improve the quality of infant and toddler care: Provided further, That $9,890,000 $9,871,000 shall be for use by the Secretary for child care research, demonstration, and evaluation activities.In addition, $300,000,000, for grants to States to improve the quality of child care and for the Federal costs of carrying out evaluations.(Department of Health and Human Services Appropriations Act, 2012.)This program provides grants to States for child care subsidies for low-income working families and activities to improve child care quality. Program and Financing(in millions of dollars)Identification code 75–1515–0–1–6092011 actual2012 est.2013 est.
Obligations by program activity:
0001Block grant payments to States2,2132,2682,593
0004Research and evaluation fund101010
0900Total new obligations2,2232,2782,603
Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100Appropriation2,2272,2822,603
1130Appropriations permanently reduced–4
1143Approp permanently reduced (Sec 527, HR 2055)–4
1160Appropriation, discretionary (total)2,2232,2782,603
1930Total budgetary resources available2,2232,2782,603
Change in obligated balance:
Obligated balance, start of year (net):
3000Unpaid obligations, brought forward, Oct 1 (gross)1,240478457
3030Obligations incurred, unexpired accounts2,2232,2782,603
3040Outlays (gross)–2,984–2,299–2,461
3081Recoveries of prior year unpaid obligations, expired–1
Obligated balance, end of year (net):
3090Unpaid obligations, end of year (gross)478457599
3100Obligated balance, end of year (net)478457599
Budget authority and outlays, net:
Discretionary:
4000Budget authority, gross2,2232,2782,603
Outlays, gross:
4010Outlays from new discretionary authority1,8251,8452,108
4011Outlays from discretionary balances1,159454353