DEPARTMENT of HEALTH and HUMAN SERVICES Fiscal Year 2012 Health Resources and Services Administration Justification of Estimates for Appropriations Committees MESSAGE FROM THE ADMINISTRATOR I am pleased to present the FY 2012 Congressional Justification for the Health Resources and Services Administration (HRSA). This budget targets critical healthcare needs in underserved areas. It is estimated that in FY 2012 approximately 24.4 million patients will receive access to high quality, comprehensive and cost-effective primary health care through HRSA’s Health Center program. Additional resources are also provided for the Ryan White HIV/AIDS program to enhance prevention and treatment of people impacted by HIV/AIDS. Through the AIDS Drug Assistance Program, requested resources will provide life saving medications to 218,446 people infected with HIV. In July, 2010, the Obama Administration released the National HIV/AIDS Strategy (NHAS) and Implementation Plan for the United States. HRSA has an essential role to play in meeting the NHAS goals and is working across its Bureaus to fulfill the implementation plan activities. The budget also requests funding for other programs that play a key role in driving down costs and expanding healthcare access for the whole family. The FY 2012 budget invests resources to increase the number of doctors, nurses and dentists in areas of the country experiencing shortages of health professionals. This will ensure that qualified clinicians will be available to serve underserved populations in the future. The budget also includes $124 million to improve both access to and quality of health care in rural areas. This will strengthen regional and local partnerships among rural health care providers, expand community-based programs and promote the modernization of the health care infrastructure in rural areas. This budget request supports achievement of the Agency’s four strategic goals, which are to: • Improve Access to Quality Health Care and Services • Strengthen the Health Workforce • Build Healthy Communities • Improve Health Equity Our FY 2012 budget request places a strong emphasis on investing in programs that improve access to health care in underserved areas and allows the Health Resources and Services Administration to take important steps toward achieving health care reform. Mary K. Wakefield Administrator TABLE OF CONTENTS FY 2012 Budget Organization Chart 1 Executive Summary 2 Introduction and Mission 3 Overview of Budget Request 4  Overview of Performance 8 Summary of Performance Targets and Results 12 ARRA Performance Overview 13 All Purpose Table 16  Health Resources and Services Budget Exhibit Appropriation Language 21 Language Analysis 25 Amounts Available for Obligation 29 Summary of Changes 31 Budget Authority by Activity 34 Authorizing Legislation 37 Appropriations History Table 47 Narrative by Activity Primary Health Care 51 Health Centers 51 Community Health Center Fund – Construction 62 School Based Health Centers – Facilities 63 Free Clinics Medical Malpractice 65 National Hansen’s Disease Program 68 National Hansen’s Disease Program - Buildings and Facilities 73 Payment to Hawaii 74 Clinician Recruitment and Services 76 National Health Service Corps 76 Nursing Education Loan Repayment and Scholarship Programs 84 Faculty Loan Repayment Program 88 Health Professions 90 Summary of Request 90 Health Professions Training for Diversity 103 Centers of Excellence 103  Scholarships for Disadvantaged Students 106 Health Careers Opportunity Program 109 Health Care Workforce Assessment 112 Primary Care Training and Enhancement Program 115 Oral Health Training Programs 121 Teaching Health Center Graduate Medical Education Payments 127 Interdisciplinary, Community- Based Linkages 130 Area Health Education Centers (AHEC) Program 130 Geriatric Programs 134 Allied Health and Other Disciplines 141 Mental and Behavioral Health Education and Training 143 Public Health Workforce Development 148 Public Health and Preventive Medicine 148 State Health Care Workforce Development 154 Nursing Workforce Development 157 Advanced Education Nursing 157  Nursing Workforce Diversity 162 Nurse Education, Practice, Quality and Retention Program 166 Nurse Faculty Loan Program 170 Comprehensive Geriatric Education 173 Nurse Managed Health Clinics 176 Patient Navigator Outreach and Chronic Disease Prevention Program 179 Children’s Hospitals Graduate Medical Education Payment Program 182 Teaching Health Centers Development Grants 184 National Practitioner Data Bank 187 Maternal and Child Health 190 Maternal and Child Health Block Grant 190 Autism and Other Developmental Disorders 202 Traumatic Brain Injury 207 Sickle Cell Services Demonstration Program 211 James T. Walsh Universal Newborn Hearing Screening 214 Emergency Medical Services for Children 217 Healthy Start 220 Heritabl e Disorders Program 227 Congenital Conditions 235 Nutrition, Physical Activity and Screen Time Standards 237 Family-To-Family Health Information Centers 239 Maternal, Infant, and Early Childhood Home Visiting Program 242 HIV/AIDS 245 Ryan White HIV/AIDS Overview 245 Em ergency Relief Grants – Part A 255 HIV Care Grants to States – Part B 260 Early Intervention Services – Part C 266 Women, Infants, Children and Youth – Part D 269 AIDS Education and Training Programs – Part F 272 Dental Reimbursem ent Program – Part F 275 Healthcare Systems 278 Organ Transplantation 278 National Cord Blood Inventory 286 C.W. Bill Young Cell Transplantation Program 290 Poison Control Program 295 Office of Pharmacy Affairs/340B Drug Pricing Program 300 Office of Pharmacy Affairs/340B Drug Pricing Program User Fees 305 State Health Access Program 311 Infrastructure to Expand Access to Care 314 Office of Rural Health Policy 316 Summary of the Request 316 Rural Health Policy Development 322 Rural Healthcare Services Outreach, Network and Quality Improvement Grants 325 Rural Access to Emergency Devices 329 Rural Hospital Flexibility Grants 331 Delta Health Initiative 335 State Offices of Rural Health 337 Denali Commission 340 Radiation Exposure Screening and Education Program 342 Black Lung 345 Telehealth 347 Other Programs 351Program Management 357Family Planning 363Public Health Improvements (Facilities and Other Projects) 365Healthy Weight Collaborative Supplementary Tables 368 Budget Authority by Object Class 369 Salaries and Expenses 370 Detail of Full Time Equivalents (FTE) 371 Programs Proposed for Elimination 374 Health Professions Loan Programs 376 Drug Budget 377 Significant Items 379 Health Education Assistance Loans 397 Vaccine Injury Compensation Program 419 Countermeasures Injury Compensation Program 425 OFFICEOFTHEADMINISTRATOR  Administrator MaryK.Wakefield,Ph.D.,R.N.  DeputyAdministrator MarciaK.Brand,Ph.D.  SeniorAdvisor TinaCheatham  ChiefPublicHealthOfficer KyuRhee,M.D.  (RA) Officeof Communications     Director MartinKramer   ( RA6 )  BureauofPrimary HealthCare   AssociateAdministrator JamesMacrae     (RC) MaternalandChild HealthBureau   AssociateAdministrator PetervanDyck    (RM) BureauofHealth Professions   AssociateAdministrator JanetHeinrich    (RP) OfficeofRuralHealth Policy   AssociateAdministrator TomMorris    (RH) HealthcareSystems Bureau   Associate Administrator JoyceSomsak   (RR) HIV/AIDS Bureau   Associate Administrator DeborahParhamHopson   (RV) BureauofClinician Recruitmentand Service  AssociateAdministrator RebeccaSpitzgo    (RU) Officeof Legislation     Director LeslieAtkinson   (RAE) Officeof Operations     ChiefOperatingOfficer ThomasMorford   (RB) OfficeofFederal Assistance Management    Associate Administrator MikeNelson(Acting)  (RJ) OfficeofSpecial HealthAffairs     Director TerryAdirim   (RA1) OfficeofRegional Operations     AssociateAdministrator DennisMalcomson (Acting)  (RE) OfficeofEqual Opportunity,Civil Rights,and Diversity Management  Director M.JuneHorner   (RA2) OfficeofPlanning Analysisand Evaluation    Director RebeccaSlifkin   (RA5) DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration ORGANIZATIONAL CHART 1 2 Executive Summary TAB INTRODUCTION AND MISSION The Health Resources and Services Administration (HRSA), an Agency of the U.S. Department of Health and Human Services (DHHS), is the principal Federal Agency charged with increasing access to basic health care for those who are medically underserved. Health care in the United States is among the finest in the world but it is not accessible to everyone. Millions of families still face barriers to quality health care because of their income, lack of insurance, geographic isolation, or language and cultural barriers. The Patient Protection and Affordable Care Act provides for a substantial expansion of components of the HRSA-supported safety net, including the Health Centers program, the National Health Service Corps, and a variety of health workforce development programs, to address these and other access problems. Assuring a safety net for individuals and families who live outside the economic and medical mainstream remains a key HRSA role. A recent New England Journal of Medicine article 1 concluded that the existing safety net is simply inadequate and is continuing to deteriorate. It further noted that, while implementation of health reforms and other factors will affect the structure, function, and mission of the safety net, the underlying problems that created the need for a safety net in the first place will not be solved in the near future. HRSA’s mission as articulated in its Strategic Plan for 2010-2015 is: To improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs. HRSA supports programs and services that target, for example: • The 50 million Americans who lack health insurance many of whom are racial and ethnic minorities, • Over 50 million underserved Americans who live in rural and poor urban neighborhoods where health care providers and services are scarce, • African American infants who still are 2.4 times as likely as white infants to die before their first birthday, • The more than 1 million people living with HIV/AIDS, both in and out of care, • The more than 100,000 Americans who are waiting for an organ transplant. Focusing on these and other vulnerable, underserved groups, HRSA’s leadership and programs promote the improvements in access, quality and equity that are essential for a healthy nation. 1 America’s Safety Net and Health Care Reform – What Lies Ahead? Irwin Redlener, M.D., and Roy Grant, M.A., Posted by New England Journal of Medicine, December 2, 2009. 3 OVERVIEW OF BUDGET REQUEST The FY 2012 President’s program level request of $9,034,701,000 for the Health Resources and Services Administration (HRSA) is an increase of $977,544,000 from the FY 2010 Actual level. Program Increases: Health Centers (+$1,132.669 million) This request will continue to support more than 1,100 health center grantees that provide comprehensive, culturally competent, quality primary healthcare services through more than 8,000 service delivery sites. This request reflects the projected increase in FTCA program demand, given the recent expansion of the Health Center Program and the significant projected Health Center Program expansion supported by the Affordable Care Act. This funding level also includes $1.2 billion appropriated under the Affordable Care Act for health center service. As a result of the Affordable Care Act funding, the total number of patients served in FY 2012 is projected to reflect an increase of approximately 900,000. National Health Service Corps (NHSC) (+$277.057 million) This request includes $295 million in mandatory funding from the Affordable Care Act. This budget will support a Field Strength of 10,683. This will fund 389 scholars and 2,971 loan repayers. Health Workforce Programs (+$71.294 million) This request includes $255 million in PHS Evaluation Funds for certain health workforce activities, $15 million from the Prevention and Public Health Fund. National Practitioner Data Bank User Fees (+$4.508) This reflects the estimated User Fees for the National Practitioner Data Bank. Autism and other Developmental Disorders (+$7.102 million) $2.6 million of the increase will support LEND interdisciplinary training programs; $2.1 million of the increase will support additional autism intervention research projects examining areas of particular interest to families as outlined in the Interagency Autism Coordinating Committee’s 2010 Strategic Plan for Autism Spectrum Disorder Research; and the remainder will support State demonstration grants, resource centers, a national evaluation, and a quality improvement initiative. Maternal, Infant and Early Childhood Visiting Program (+$250.0 million) This level of funding will provide: $329 million for awards to 56 State grantees and associated program technical assistance; $10.5 million for 18 awards representing American Indian tribes, and $10.5 million for research, evaluation, and corrective action technical assistance for States not meeting benchmarks. 4 HIV/AIDS Early Intervention Part A (+$1.000 million) The FY 2012 Request will support program activities and services for PLWH in the 24 Eligible Metropolitan Areas, 28 Transition Grant Areas, and 4 states. HIV/AIDS Early Intervention Part B (+$82.000 million) The increase will support program activities and includes the provision life-saving medications to persons living with HIV. The number of clients served by ADAPs is predicted to be 218,446. HIV/AIDS Early Intervention Part C (+$5.139 million) The increase will support the provision of comprehensive primary health care in an outpatient setting for people living with HIV disease for an additional 6,467 clients. The FY 2012 Budget Request target for the number of people receiving primary care services under Early Intervention Services programs is 247,133. HIV/AIDS Part D (+$.166 million) This funding level will support primary healthcare and social support services available to 90,000 women, men, transgendered persons, infants, children, youth and adults living with HIV and AIDS and their affected families at programs in 37 States, D.C., Puerto Rico and Virgin Islands. The target for the number of female clients provided comprehensive services through Part D, including appropriate services before or during pregnancy to reduce perinatal transmission is 57,773. HIV/AIDS Education and Training Centers Part F (+.074 million) This funding will help meet the program’s performance goal to, “Maintain the proportion of racial/ethnic minority healthcare providers participating in the AETC intervention programs”. HIV/AIDS Dental Services Part F (+.029 million) These funds will continue to support the reimbursement of applicant institutions, outreach to people with HIV/AIDS who need dental care, and continued efforts to improve service coordination among reimbursement recipients and other community-based health service providers. The FY 2012 Budget Request target for the number of persons for whom a portion of their unreimbursed oral health costs will be reimbursed is 35,474. Cord Blood Stem Cell Bank (+$1.926 million) This funding will support progress toward the statutory goal of building a genetically diverse inventory of at least 150,000 new units of high-quality cord blood for transplantation and will, therefore, increase the number of patients in all population groups who are able to obtain life-saving transplants. C.W. Bill Young Cell Transplantation Program (+$3.077 million) This funding will support progress toward the Program’s ambitious performance target of 2,660,000 adult volunteers from racially/ethnically diverse minority population groups listed on the registry by September 30, 2012. These funds will also be used to support the four major Program. 5 [...]... Online Performance Appendix Performance Management Achieving a high-level of performance in pursuing its goals is a major priority for HRSA, and is one of its Strategic Plan principles Performance management at HRSA involves the active use 10 of performance data to improve its operations and those of grantees Underpinning this is the regular collection, monitoring, analysis, and reporting of performance... of the PHS Act, funds made available under this heading for section 399BB of the PHS Act are for carrying out the program as authorized under section 399BB(a)-(f) of such Act: Provided further, That notwithstanding section 338J(k) of the PHS Act, $10,075,000 shall be available for State Offices of Rural Health: Provided further, That the Secretary may collect a fee of 0.1 percent of each purchase of. .. days of enactment, for increasing supplemental grants for fiscal year 2012 to metropolitan and transitional areas that received grant funding in fiscal year 2011 under subparts I and II of part A of title XXVI of the PHS Act to ensure that an area's total funding under subparts I and II of part A for fiscal year 2011, together with the amount of this additional funding, is not less than 92.4 percent of. .. (-$34.927million) There is no FY 2012 request for this program Denali Project (-$10.0 million) There is no FY 2012 request for this program Public Health Improvements Projects (-$337.300 million) There is no FY 2012 request for this program Investments in Information Technology (IT): Funding for many of the HRSA Programs includes IT funding for the continued development, operations and maintenance of the HRSA Electronic... Act of 1986, the Native Hawaiian Health Care Act of 1988, the Cardiac Arrest Survival Act of 2000, section 712 of the American Jobs Creation Act of 2004, and the Stem Cell Therapeutic and Research Act of 2005, and the Patient Protection and Affordable Care Act, $6,801,262,000, of which $26,200,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for. .. distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office: Provided further, That of the funds available under this heading, $2,037,865,000 shall remain available to the Secretary of HHS through September 30, 2014, for parts A and B of title XXVI of the PHS Act, of which not less than $880,000,000 shall be for State... complexity of information that is needed for effective performance management HRSA is also focusing on its programs’ ability to explain, not just report, performance trends Finally the agency is strengthening its focus on the conduct of evaluations to augment routine performance information These steps are taken to ensure the availability of relevant, practical, timely, and useful data for decision-making... centers Funding for the National Health Service Corps (NHSC) has led to significant efforts to increase the number of loan repayment contracts for service in underserved areas, as well as NHSC Scholarships Under the Health Professions Training program, grants were awarded for a variety of programs, including Scholarships for Disadvantaged Students, Centers of Excellence focused on the training of minority... otherwise authorized: Provided further, 23 That, for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of HHS may waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act: Provided further, That funds provided under section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments... Drug Pricing Program/Office of Pharmacy Affairs (+$3.000 million) This funding will help to support verification of all HRSA-funded entities, ensuring accuracy and integrity of the 340B database over time 340b Drug Pricing Program/Office of Pharmacy Affairs User Fees (+$5.000 million) This reflects the estimates amount of user fees Rural Health Outreach Grants (+$1.361 million) In FY 2012, the program . DEPARTMENT of HEALTH and HUMAN SERVICES Fiscal Year 2012 Health Resources and Services Administration Justification of Estimates for Appropriations. and Mission 3 Overview of Budget Request 4  Overview of Performance 8 Summary of Performance Targets and Results 12 ARRA Performance Overview 13 All