Substance Abuse and Mental Health Services Administration 54
Agency for Healthcare Research and Quality 59
Centers for Medicare & Medicaid Services 64
Administration for Children and Families 105
Administration on Aging 125
Departmental Management 130
Office for Civil Rights 139
Office of Inspector General 142
Program Support Center 145
Retirement Pay and Medical Benefits for Commissioned Officers 147
ADVANCING THE HEALTH, SAFETY, AND WELL-BEING OF OUR PEOPLE The Department of Health and Human Services enhances the health and well-being of Americans by providing for effective health and human services, and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. The Department of Health and Human Services (HHS) Fiscal Year (FY) 2006 budget enables the Department to provide for the health, safety, and well-being of Americans. FY 2006 outlays will total $642 billion, an increase of $58 billion over FY 2005 spending. The discretionary portion of the HHS budget totals $67 billion in budget authority and $71 billion in program level.
The Department’s budget fosters strong sustained advances in the sciences underlying medicine, in public health, and in social services, and provides effective heath and human services. This budget request builds on the Department's Strategic Plan goals and enables HHS to meet present and future challenges. In FY 2006, resources and efforts will be directed toward:
Improving HHS management, including implementing the President's Management Agenda
The HHS FY 2006 budget will enable the Department to improve the quantity and quality of health care available to Americans by implementing Medicare's prescription drug benefit, completing the President's current Health Center initiative, and launching a new health center effort in the poorest counties. This budget will enable the National Institutes of Health to increase research efforts in developing bioterrorism countermeasures and to fund biomedical research at current levels, will allow the Centers for Disease Control to expand the Strategic National Stockpile, and will support the Food and Drug Administration's efforts to defend the nation's food supply; it will further secure our nation against the threat of bioterrorism.
The Department considered a number of factors in constructing the FY 2006 budget, including the need for spending discipline and program effectiveness to support the Administration's initiative to cut the deficit in half over four years. Specifically, the budget decreases funding for lower-priority programs and one-time projects, consolidates or eliminates programs with duplicative missions, reduces administrative costs, and makes government more efficient.
For example, the budget requests no funding for the Community Services Block Grant and a number of smaller community services programs that were unable to demonstrate results in PART evaluation assessments.
Providing Access to Quality Health Care
Improving Medicare Through the Medicare Modernization Act: Funding for Medicare benefits, which assist 42.7 million elderly and disabled Americans, is estimated to be $394 billion in 2006.
Two of the most important provisions of the Medicare Modernization Act (MMA) are the new voluntary drug benefit, which will begin on January 1, 2006, and the enhanced health plan choices in Medicare Advantage. As a result of these new benefits, beneficiaries will be able to receive voluntary drug coverage as well as new support for their existing drug coverage through Medicare, and access to preferred provider organizations (PPOs), which are the most popular health plan choices for non-Medicare beneficiaries. Beginning in 2006, PPOs will begin to serve beneficiaries on a regional basis thereby promoting competition with other health care programs.
All beneficiaries will continue to have access to affordable care, while those with the lowest incomes and the highest levels of spending on drugs will receive additional assistance. As with current MMA implementation, as new options become available, Medicare will ensure that beneficiaries understand their choices and benefits.
Implementation of the Prescription Drug Benefit Program: Until 2006, the interim Medicare-endorsed prescription drug discount cards and transitional assistance programs will help beneficiaries pay the cost of prescription drugs. Beginning on January 1, 2006, Medicare will help pay for outpatient prescription drugs through private plans. Beneficiaries will have the option of remaining in the traditional fee-for-service program, enrolling separately in private prescription drug plans, or enrolling in integrated Medicare Advantage plans for all Medicare-covered benefits, including drugs. The prescription drug benefit program will be financed through beneficiary premiums (25.5 percent) and general revenue (74.5 percent) and is projected to cost $58.9 billion in 2006.
Promoting Affordable Health Care: The Administration is strongly committed to meeting the needs of the approximately 45 million Americans who are uninsured. For this reason, the Administration proposes a multi-pronged approach to promoting economic opportunity and ownership, including:
Health insurance tax credits to facilitate the private purchase of health insurance and Health Savings Accounts (HSAs);
Grants to States for purchasing pools to help low-income individuals purchase coverage with the health insurance tax credit;
Tax deductions for individuals with a high-deductible health plan and an HSA;
Tax rebates to small employers contributing to employees' HSAs;
Association Health Plans for groups of small businesses, civic groups, and community organizations;
Medical liability law reforms that increase access to high quality and affordable health care; and
A competitive marketplace for health insurance that crosses state lines while maintaining strong consumer protections.
Increasing Coverage through Medicaid and the State Childrens' Health Insurance Program: The Department currently projects that Medicaid will cover over 46 million individuals in FY 2006 at a cost to the Federal Government of $193 billion.
HHS proposes to provide States with additional flexibility in Medicaid to further increase coverage among low-income individuals and families without creating additional costs for the Federal Government. States largely agree that current Medicaid rules and regulations are barriers to effective and efficient management. The proposal builds on the success of the State Childrens' Health Insurance Program (SCHIP) in providing acute care for children and families, as well as current efforts to reduce the number of uninsured individuals.
A modernized Medicaid system will give States greater flexibility without the need for burdensome waiver applications. Principles that are employed in SCHIP and emphasize innovation will be expanded to Medicaid beneficiaries, while long-term care reforms will build on successful programs that use consumer direction and home-based care and community-based care to improve satisfaction and lower costs. A modernized Medicaid system will continue to grow at a robust rate to accommodate increases in health care spending.
The President's Budget includes proposals to extend Medicaid benefits to cover uninsured individuals and to expand benefits to those already on Medicaid, an investment of $7 billion over five years. These proposals include demonstration projects to expand access to community-based care for the disabled and elderly, an extension of transitional medical assistance, and an extension of Medicare premium assistance.
The FY 2006 budget also includes program integrity and cost efficiency proposals that will save an estimated $20 billion over five years in Medicaid fraud, waste, and abuse. Representative proposals include a reduction in allowable provider related taxes, an elimination of inter-governmental transfers that unfairly augment a State's share of Federal Medicaid matching funds, and reform the transfer of assets policy for medically needy eligibles applying for Medicaid long-term care.
SCHIP will spend approximately $5.4 billion in FY 2006. Authorization for the program expires at the end of FY 2007. Due to its success at enrolling millions of low-income uninsured children, the President's Budget seeks to re-authorize the program early, and better target the fund in a more timely manner. Under the proposal, the time States have to spend their SCHIP allotments would change from three years to two years. In total, budget proposals that enhance the SCHIP program will cost $992 million over five years.
Health Information Technology: In April 2004, the President expressed his vision for improving the safety, quality, and cost-effectiveness of health care through rapid implementation of secure and interoperable electronic health records. The FY 2006 budget seeks a total of $125 million to make this vision a reality. The Office of the National Coordinator for Health Information Technology (ONCHIT) will provide strategic direction for development of a national interoperable health care system, and encourage clinicians to connect and collaborate within a national Health IT network. The Agency for Health Care Quality and Research (AHRQ) will continue to accelerate the development, adoption, and diffusion of interoperable information technology in a range of health care settings.
Increasing the Capacity and Number of Health Centers: The budget completes the President's five-year commitment to create 1,200 new or expanded health center sites and serve an additional 6.1 million people by 2006. In FY 2006 alone, more than 2.4 million individuals will receive health care through 578 new or expanded sites in rural areas and underserved urban communities. In addition, the President is establishing a new goal to help every poor county in America in need that lacks a health center and the FY 2006 request funds 40 new health center sites in high-poverty counties.
Increasing Care Available to Native Americans: The budget increases support to 1.8 million members of federally recognized Tribes by $72 million, for a total of $3.8 billion. With these funds, the Indian Health Service will provide high quality health care through 49 hospitals, over 240 outpatient centers, and over 300 health stations and Alaska village clinics. Increases will serve a growing eligible population and meet the rising costs of delivering health care. Resources are included to expand access to care through staffing six newly built health care facilities.
Access to Recovery Drug Treatment Program: Through the Access to Recovery program, HHS will assist States in expanding access to clinical treatment and recovery support services and allow individuals to exercise choice among qualified community provider organizations, including those that are faith-based. The toll of drug abuse on the individual, family, and community is both significant and cumulative. It may lead to lost productivity and educational opportunity, lost lives and to costly social and public health problems including HIV/AIDS, domestic violence, child abuse, and crime. The budget increases support for this initiative by 50 percent for a total of $150 million.
Ryan White: The FY 2006 request provides a total of $2.1 billion for Ryan White programs to ensure a comprehensive approach to provide treatment services to persons living with HIV/AIDS, consistent with the President's reauthorization principles–prioritization, flexibility, and accountability. Over 570,000 people will receive treatment services through Ryan White grant funding in FY 2006.
Enhancing Public Health and Protecting America
Medical Research: Federal investments in biomedical research have fueled major advances in knowledge about life sciences. The FY 2006 budget requests $28.8 billion for the National Institutes of Health (NIH), a net increase of $196 million. The request seeks to capitalize on the resulting opportunities this investment has opened for significant progress in improving the health of the nation by preventing, treating, and curing disease and disability. The budget request enables NIH to continue to implement the Roadmap for Medical Research; enhance collaborations for multidisciplinary neuroscience research; and accelerate efforts to develop and evaluate vaccines against HIV/AIDS. Withing this total, NIH will also increase funding to address critical requirements in biodefense, including a new targeted $50 million research effort to expand the current range of chemical countermeasures.
Preventing Disease: The FY 2006 budget includes targeted efforts to ensure a stable supply of annual influenza vaccine, develop the surge capacity that would be needed in a pandemic, improve low-income children's access to routine immunizations, and improve the response to emerging infectious diseases before they reach the United States.
HHS will invest $439 million in targeted influenza activities in FY 2006, in addition to insurance reimbursement payments through Medicare. The request for the Centers for Disease Control (CDC) will fund a three-pronged approach to ensure an adequate supply of annual vaccine. Within the Vaccines for Children (VFC) program, CDC will allocate $40 million in new budget authority to buy a stockpile of pediatric influenza vaccine to guard against late-season surges in demand. The discretionary Section 317 program will use $30 million to get manufacturers to make additional bulk monovalent vaccine that can be turned into finished vaccine if other producers experience problems, or unusually high demand is anticipated. Finally, CDC will expand routine use vaccine procurements to $104 million, including an increase of $20 million targeted to children not eligible for VFC.
A draft Pandemic Influenza Response and Preparedness Plan was issued in August 2004, which lays out action steps in several areas. In support of this plan, NIH has expanded its research investment to approximately $119 million. The budget also increases to $120 million the Department's investment to develop the year-round domestic surge vaccine production capacity that will be needed in a pandemic, including new cell culture vaccine manufacturing processes.
Global Disease Detection
CDC supports a range of efforts to both track and prevent the international spread of infectious diseases. Although modern advances in vaccinations and technology have conquered some diseases, recent outbreaks of infectious diseases such as severe acute respiratory syndrome (SARS) and avian influenza, are reminders of the ability of microbes to adapt and to move across borders. In FY 2006, CDC will invest an additional $12 million to strengthen Global Disease Detection.
Responding to Major Disasters and Emergencies: The National Response Plan calls on HHS to lead public health and medical services during major disasters and emergencies. In support of this responsibility, the FY 2006 budget includes $70 million in targeted investments for the new Federal Mass Casualty Initiative to improve our medical surge capacity. This includes procurement of portable treatment units through the Strategic National Stockpile, and the tools and infrastructure necessary to mobilize and coordinate medical personnel and volunteers in the event of a major medical emergency. HHS will also invest $1.3 billion in support of on-going work at the Centers for Disease Control and the Health Resources and Services Administration to improve state and local public health and hospital preparedness.
Strategic National Stockpile: HHS has the primary responsibility for ensuring the Nation's citizens have almost immediate access to an adequate supply of the medicines needed to protect them in the event of an attack with weapons of mass destruction, or other major public health emergencies. The Strategic National Stockpile (SNS) includes enough smallpox vaccine to protect every American, and by the end of FY 2006, will have sufficient antibiotics to protect 60 million people from anthrax exposure. The $600 million request includes $50 million to procure portable mass casualty treatment units and $550 million to buy additional medicines, replace those that are losing potency, provide specialized storage, and ensure that medicines and supplies can be made available for use anywhere in the United States within 12 hours.
Safe Food and Safe Drugs: The FY 2006 budget seeks $1.9 billion for the Food and Drug Administration (FDA), a net increase of $81 million above FY 2005. Within the requested increase for FDA, $30 million will be directed to enhancing the agency's national network of food contamination analysis laboratories and support vital research on technologies able to prevent threats to our food supply. Drug safety is also a primary focus, with a $6.5 million (24%) increase dedicated to evaluating and communicating drug safety risks to the public and applying scientific expertise to explore the risks of medical products already on the market. The FY 2006 budget also funds the medical devices program at a level consistent with the intent of the Medical Devices User Fee and Modernization Act of 2002.
Supporting a Compassionate Society
Marriage and Healthy Family Development:
Abstinence education programs are part of a comprehensive and continuing effort of the Administration to help adolescents avoid behaviors that could jeopardize their futures. Last year, HHS integrated abstinence education activities with the youth development efforts at the Administration for Children and Families (ACF), by transferring the Community-Based Abstinence Education program and the Abstinence Education Grants to States to ACF. The FY 2006 budget expands activities to educate adolescents and parents about the health risks associated with early sexual activity and provide them with the tools needed to help adolescents make healthy choice. A total of $206 million, an increase of $39 million, is requested for these activities.
Healthy Marriage / TANF Reauthorization
A high priority in the President's Budget is TANF reauthorization. A key element of the President's plan is its support of healthy marriage and responsible fatherhood. The FY 2006 budget includes $1 billion over five years in federal funds to promote healthy marriage through demonstrations, research, and a matching state program. The budget also proposes $200 million in mandatory funding over five years to support responsible fatherhood.
With matching state funds, a total of $1.7 billion over five years will help advance this central goal of the TANF program.
Faith Based and Community Initiatives:
As part of the larger Faith-Based and Community Initiative, the budget maintains a commitment to strengthen the capacity of faith-based and community organizations.
Compassion Capital Fund
The Compassion Capital Fund advances the efforts of community and charitable organizations, including faith-based organizations, to increase their effectiveness and enhance their ability to provide social services where they are needed. The budget includes $100 million, an increase of $45 million. Among the priorities within the 2006 proposal is an emphasis on supporting anti-gang efforts through community and faith-based organizations.
Mentoring Children of Prisoners
The Mentoring Children of Prisoners program, funded at $50 million, will establish approximately 33,000 new mentoring relationships for children of incarcerated parents or those recently released from prison. Nearly two million children have a parent in a federal or state correctional facility, and research indicates that children with incarcerated parents are more likely than the general population to display a variety of behavioral, emotional, health, and educational problems.
Maternity Group Homes
The budget includes $10 million for Maternity Group Homes, to support community-based, adult-supervised group homes for young mothers and their children. Grantees will provide a range of coordinated services such as child care, education, job training, and counseling and advice on parenting and life skills.
Increasing Care for Children and the Elderly:
Child Support Enforcement
The FY 2006 President's Budget eagerly anticipates congressional action on previously proposed child support enforcement legislation. The President's legislative proposals continue to support healthy, financially strong families by strengthening enforcement tools, enhancing child support automation, and improving collection of medical child support. These proposals offer an impressive $3.4 billion in increased child support collections to families at a total federal cost of $52 million over five years.
Child Welfare Program Option
It is a high priority of HHS to pursue with Congress passage of the Child Welfare Program Option. The Child Welfare Program Option would give States the option to receive their foster care funding as a flexible grant over five years. The flexible option would support a continuum of services to families in crisis and children at risk. This proposal costs $36 million in FY 2006 and it is budget neutral over five years.
The budget requests $6.9 billion for Head Start, which will provide comprehensive child development services to 919,000 children of primarily low-income families. The request includes $45 million to support the President's initiative to improve Head Start by funding nine state pilot projects to coordinate state preschool, child care, and Head Start in a comprehensive system of early childhood programs. Head Start programs help ensure that children are ready to succeed at school by supporting their social and cognitive development.
Services for the Elderly
The budget requests a total of $1.4 billion in the Administration on Aging for programs that serve the most vulnerable elderly Americans, who otherwise lack access to healthy meals, preventive care, and other supports that enable them to remain in their home communities and out of nursing facilities. It also continues investments in program innovations to test new models of home and community-based care.
Implementing the President's Management Agenda & Improving Management
The President's Management Agenda (PMA) provides a framework to improve the management and performance of HHS. HHS has taken significant steps to institutionalize its focus on results and achieve improved program performance that is important to the HHS mission and the American taxpayer.
Budget and Performance Integration: Budget and Performance Integration (BPI) aims to improve program performance and results by ensuring that performance information is used to inform funding and management decisions. For FY 2006, HHS operating divisions produced their first "performance budgets" which combine budget and performance information in a single document. With this new format the Department moves from the traditional approach of presenting separate budget justifications and performance plans to the use of one integrated document to present both budget and performance information. This enhances the availability and use of program and performance information to inform the budget process. The new budget format along with other successes enabled HHS to improve its BPI status rating from red to yellow while maintaining a green progress rating on the PMA scorecard.
The Program Assessment Rating Tool (PART) is an important component of BPI and is used to assess program performance and improve the quality of performance information. Sixty five HHS programs were reviewed in the PART process between FY 2004 and 2006. These programs account for more than 74 percent of HHS budgetary resources. Forty-seven of the
65 programs reviewed received a narrative rating of Adequate, Moderately Effective, or Effective. Additional information on PART results for HHS programs is provided in the individual Operating Division sections as well as in the FY 2006 PART table on page 10.