FY2014 Senate Labor-HHS-Education Bill Summary

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1 (July 19, 2013) Senate Labor-HHS-Education Bill Summary On July 11, the Senate Appropriations Committee passed their Labor-HHS-Education bill that includes funding for state and local public health programs. The bill does not include sequester cuts as required by the Budget Control Act. The full Senate is unlikely to vote on the bill this year. The House has yet to take action in the Appropriations Committee on their version of the bill. It is extremely difficult to compare funding levels over time FY2012 to FY2013 to. The Senate bill includes the FY2013 pre-sequester levels for comparison purposes to their funding recommendations. The Senate bill also rejects CDC s proposal included in the President s budget to create a Working Capital Fund by distributing Business Services Support (BSS) funding to all CDC programs. The President s funding levels for programs across CDC are therefore inflated to reflect the Working Capital Fund amounts. NACCHO has attempted to compare the Senate funding levels (assumes no sequester) to the FY2013 HHS Operations Plan levels (post-sequester). The following chart demonstrates how NACCHO s funding priorities fared in the Senate bill. A full chart is available here and portions of the Committee report that affect public health can be found here. Please contact Eli Briggs, NACCHO Director of Government Affairs, with any questions at NACCHO Priority Public Health Program Funding ($ in millions) HHS Program ($ in millions) FY2012 FY2013 Post- Sequester President s Request* Senate Committee Mark NACCHO Request Prevention and Public Health Fund (PPHF) 1, ,000 1,000 1,000 Public Health Emergency Preparedness Cooperative Agreements (PHEP) ** Community Transformation Grants (PPHF) (280) CDC Food Safety Epidemiology and Lab Capacity Grants (PPHF) 94 Public Health Workforce (PPHF) 67 (25) National Public Health Improvement Initiative(PPHF) Section 317 Immunization Program (PPHF) 620 (190) 90 (32) 57 (16) (22) 528 (91) 94? (25) (15.7) (25) (72) 579 (150) 642

2 HHS Program ($ in millions) FY2012 FY2013 Post- Sequester President s Request* Senate Committee Mark NACCHO Request Preventive Health & Health Serv. Block Grant HRSA Public Health & Preventive Medicine (PPHF) (25) (0) (4.7) (25) ASPR Hospital Preparedness Program OSG Medical Reserve Corps 11.2? *President s budget includes BSS allocation in CDC program funding levels ** President s budget no longer has a separate funding line for PHEP which is rolled up into State and Local Preparedness and Response Capability Prevention and Public Health Fund The Senate bill includes $1 billion for the Prevention and Public Health Fund (PPHF) for. NACCHO has created a chart that includes the Senate allocation. The bill includes language (Section 219) modifying the PPHF reporting requirements for the existing publicly accessible website. Most notably, HHS must include a link to the full text of each FOA, RFP, or other announcement or solicitation of proposals for grants, cooperative agreements, or contracts to be awarded using PPHF funds to be posted no later than the day after the announcement or solicitation is issued. Centers for Disease Control and Prevention The Senate bill includes $6.9 billion, which is an increase of $681 million from The Senate bill maintains the separate Business Service Supports funding line rejecting the proposal in the President s budget. The bill continues the Section 503 lobbying restrictions on the use of federal funds. Programs of interest at CDC are as follows: Immunization and Respiratory Diseases- $738 million, an increase of $60 million. The total includes $150 million from the PPHF. o Section 317 Immunization Program - $579 million, an increase of $51 million from The total includes $150 million from the PPHF, which was increased by $59 million. The Committee report notes that the bill combines the funding amounts for health department 317 vaccine purchase with funding for program implementation and accountability to allow CDC maximum flexibility to increase quality and safety activities as insurance coverage rates change over time.

3 The Committee report rejects the President s request for a $44 million increase for CDC s intramural immunization costs and funds CDC s program implementation costs at the FY2013 level. The Committee report recommends that CDC direct the increased resources to: (1) modernize immunization information systems; (2) prepare public health departments for changes in the healthcare delivery system, including new billing procedures related to privately insured patients; (3) strengthen the evidence base to inform immunization policy; and (4) improve program monitoring, including vaccine-preventable disease surveillance, vaccine coverage assessment, adverse event reporting, and laboratory training. The Committee report addresses CDC new funding formula for states and directly funded cities that was detailed in the President s budget. The report notes that the Committee has some concerns about the administration's plan to change from a vaccine purchase allocation formula that is based strictly on each state's total population to a formula based on Census estimates of each state's uninsured population. The Committee notes that this change would inadvertently penalize uninsured and underinsured individuals in states that are using all available tools to insure their populace. The Committee urges CDC to develop a component in the formula that would provide an incentive to states to administer Section 317-funded vaccines in a way that addresses coverage gaps which cannot be filled with other available federal programs. o Influenza Planning and Response - $159 million, an increase of $8 million from This incorporates core pandemic and seasonal influenza activities. HIV, Viral Hepatitis, STD, and TB Prevention - $1.1 billion, an increase of $55 million from FY2013 and includes $10 million from the PPHF. o HIV Prevention - $785 million, an increase of $40 million from The Senate bill collapses the six HIV funding lines into the following three lines. HIV Prevention by Health Departments - $393 million, an increase of $75 million from National Programs to Identify and Reach High Risk Populations - $632 million. Division of Adolescent and School Health s (DASH s) HIV/STD Prevention Education program - $30 million, an increase of $1.5 million from o Viral Hepatitis Prevention - $30 million, an increase of $1 million from o STD Prevention - $154 million, an increase of $8 million from o TB Prevention - $140 million, an increase of $7 million from o Syringe Exchange The Senate bill (Section 520) lifts the federal funding ban on syringe exchange programs for. Federal funding could be used as long as sites were supported by local health and law enforcement authorities.

4 Emerging and Zoonotic Infectious Diseases $335 million, an increase of $44 million over The total includes $52 million from the PPHF. o Food Safety - $35 million, an increase of $9 million over o Emerging Infectious Diseases/Epidemiology and Laboratory Capacity Grants - $94 million, same as FY2012 with $40 million from the PPHF. o National Healthcare Safety Network - $17 million, an increase of $12 million over o Health Associated Infections - $12 million, same as o Advanced Molecular Detection and Response to Infectious Disease Outbreaks- $20 million in new funding. The Committee Report recommends that CDC use the first year of funding to begin building the science base of this initiative before funding the coordination of States. In starting this initiative, the Committee notes that this is a focused, time-limited effort on a particular genetic sequencing capability that has implications across many of CDC's program areas. Chronic Disease Prevention and Health Promotion $1.2 billion, an increase of $288 million from $485 million provided through the PPHF. o Community Transformation Grants - $290 million, an increase of $144 million from $280 million is funded through the PPHF. The $144 million is for a new round of CTG awards for communities to implement Blue Zone goals and strategies using multi-sector approaches to public health interventions in areas such as transportation, agriculture, and housing. o Racial and Ethnic Approach to Community Health - $44 million, an increase of $2 million. The Committee report directs CDC to implement the model of REACH that existed prior to o Tobacco Prevention and Control - $203 million, an increase of $17 million; $95 million provided through the PPHF. o Million Hearts - $5 million through the PPHF, an increase of $388,000. o Chronic grants to states: Cancer Prevention and Control - $48 million, an increase of $82 million from Safe Motherhood/Infant Health - $44 million, an increase of $2 million. Arthritis - $23 million, same as Coordinated Chronic Disease Funding - Nutrition, Physical Activity, and Obesity - $51 million, an increase of $10 million; $10 million from PPHF. Heart Disease and Stroke Prevention $55 million, an increase of $3 million. School Health - $17 million, an increase of $4 million. Includes $1.7 million from PPHF for a National School Food Marketing Assessment

5 as a follow up observational study from the School Health Policies and Practices Study. Diabetes Prevention and Control - $64 million, an increase of $3 million; $10 million from PPHF. The Committee report commends CDC for the release of the February year FOA that provides funding to states for obesity prevention, health disease and stroke, school health and diabetes. The report acknowledges that states received deep cuts. The increases in are to be directed to increase the base grant component for states. o Obesity Prevention in High-Obesity Regions $5 million in new funding from PPHF for competitive awards to counties with the highest prevalence of obesity to conduct pilot programs that focus on the use of extension and outreach services. Birth Defects, Developmental Disabilities, Disability and Health - $123 million, a cut of $7 million. Public Health and Scientific Services - $450 million, a $6 million increase over $58 million is provided by the PPHF. o Public Health Workforce Development - $52 million, a cut of $6 million; $15.7 million through the PPHF. o Surveillance, Epidemiology, and Public Health Informatics - $252 million, a $5 million increase over $45 million is provided by the PPHF of which $7.4 million is for the Community Preventive Services Task Force/Community Guide and $35 million is for healthcare surveillance. The Committee report directs CDC to develop a plan for public health surveillance that includes advantages and disadvantages, costs, and barriers to integrated surveillance approaches. CDC is directed to consult with state and local health departments on the report. o Health Statistics - $139 million, same as Environmental Health - $153 million, an increase $30 million from $39 million is provided by the PPHF. o Healthy Homes (lead poisoning) - $10 million, an increase of $8 million from The Committee report notes that the funding is sufficient for national surveillance efforts, technical assistance to local health departments, and national leadership on the science of lead poisoning. o Asthma - $25 million, an increase of $2 million from o Environmental Health Tracking Network - $35 million, an increase of $14 million from FY2013, entirely funded through the PPHF. The Committee report notes that the funding is sufficient to continue to support the 23 states and one city that were funding in FY2012. o Chronic Disease Biomarkers - $4.2 million in new funding through the PPHF.

6 Injury Prevention and Control- $165 million, an increase of $35 million from FY2013, $3 million through the PPHF. o Intentional Injury - $113 million, an increase of $25 million from Rape Prevention and Education $39 million, an increase of $2 million from Gun Violence Prevention Research - $10 million in new funding. o Unintentional Injury - $23 million, a cut of$6 million from o National Violent Death Reporting System - $18 million, an increase of $15 million from CDC s Center for Public Health Preparedness and Response - $1.3 billion, an increase of $61 million from o State and Local Preparedness and Response Capability $659 million, an increase of $37 million from Public Health Emergency Preparedness (PHEP) - $644 million, an increase of $36 million from The Committee report notes that the funding is sufficient to return to a minimum state grant level of $5 million. Academic Centers for Public Health Preparedness - $7.9 million, an increase of $402,000 million from o Strategic National Stockpile - $496 million, an increase of $18 million from CDC-Wide Activities and Program Support - $657 million, an increase of $34 million from FY2013, $41 million through PPHF. o Public Health Leadership and Support - $118 million, an increase of $6 million from $41.2 million is provided through the PPHF. Public Health Infrastructure/National Public Health Improvement Initiative - $40 million, an increase of $18 million from FY2013 through the PPHF. National Prevention Strategy - $1 million, same as FY2013 through the PPHF. o Preventive Health and Health Services Block Grant $79 million, an increase of $4 million from Health Resources and Services Administration The Senate bill includes $6.6 billion, an increase of $690 million from Programs of interest at HRSA are as follows: Community Health Centers $3.8 billion, an increase of $800 million. $2.2 billion is mandatory funding from the Affordable Care Act. Public Health and Preventive Medicine Training Programs - $35 million, an increase of $27 million. $25 million is through the PPHF. This includes funding for the Public Health Training Centers. Maternal and Child Health Block Grant $644 million, an increase of $39 million. The Committee report states that state grants should be funded at no less than $555 million. Ryan White AIDS Programs $2.4 billion, an increase of $145 million over

7 o Part A cities - $670 million, an increase of $46 million over o Part B states - $426 million, an increase of $25 million over o Part B AIDS Drug Assistance Program - $943 million, a $57 million increase over Title X Family Planning Program - $327 million, an increase of $49 million over Office of the HHS Secretary Teen Pregnancy Prevention Initiative - $113 million, an increase of $15 million over Public Health and Social Services Emergency Fund Assistant Secretary for Preparedness and Response $1 billion, an increase of $168 million over o Hospital Preparedness - $255 million, a cut of $104 million from The Committee report provides no explanation for the deep cut. o Medical Countermeasure Dispensing - $5 million in new funding. o Biomedical Advanced Research and Development Authority- $415 million in new budget authority in. The bill includes a new provision (Section 222) allowing BARDA to enter into incrementally funded, multiyear contracts for up to 10 years and to repurpose unused termination costs to pay contract invoices. o Project BioShield - $250 million in new budget authority in to replenish the BioShield Special Reserve Fund mandatory funding set to expire at the end of o Medical Reserve Corps - $9 million, a cut of $2 million from FY2012.

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