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DEPARTMENTof HEALTHand HUMANSERVICESFiscal Year2019General Departmental ManagementOpioids Epidemic and Serious Mental Illness InitiativeOffice of Medicare Hearings and AppealsOffice for Civil RightsNational Coordinator for Health Information TechnologyHealth Insurance Reform Implementation FundNonrecurring Expenses FundService and Supply FundRetirement Pay & Medical Benefits for Commissioned OfficersHHS General ProvisionsJustification of Estimates forAppropriations Committees
DEPARTMENT OF HEALTH AND HUMAN SERVICESDEPARTMENTAL MANAGEMENTFY 2019FTEGeneral Departmental ManagementBudget Authority1,005 289,545,000129 53,445,0002 25,000,000HCFAC234 10,000,000Proposed Mandatory Funding – Departmental Appeals Board314 2,000,000Proposed User Fee Collections – Departmental Appeals Board6GDM Program Level401,184 1,457,000 381,447,000Office of Medicare Hearings and Appeals705 112,381,000Proposed Mandatory Funding – Office of Medicare Hearings and Appeals200 125,000,000Recovery Audit Collections – Office of Medicare Hearings and Appeals andDepartmental Appeals Board545 10,000,000Proposed User Fee Collections – Office of Medicare Hearings and Appeals6OMHA Program Level0950 3,679,000 251,060,000Office for Civil Rights153 30,904,000Office of the National Coordinator for Health IT164 38,381,0001,001 00 10,000,000,0003,452 10,701,792,000PHS Evaluation Set‐Aside – Public Health Service ActPregnancy Assistance Fund1Service and Supply FundOpioids Epidemic and Serious Mental Illness and Serious EmotionalDisturbance InitiativeTOTAL, Departmental Management1 The Pregnancy Assistance Fund (PAF) is authorized and appropriated by the Patient Protection and Affordable Care Act (ACA) Public Law 111‐148.2 The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation accountfor 2019. Actual allocation will be determined annually.3 The proposed mandatory funding has a legislative proposal in place to transfer funds from the Federal Hospital Insurance and FederalSupplementary Medical Insurance Trust Funds to the Departmental Appeals Board.4 The GDM Program Level does not include either estimated reimbursable budget authority and associated FTE or Pregnancy Assistance Fundand associated FTE, unless otherwise indicated.5 Recovery Audit Collections reflect FY 2018 House and Senate Bills to address Medicare Appeals at OMHA and DAB.6 The proposed user fee collections for OMHA and DAB represent a proposal that creates a post‐adjudication user fee applied to all unfavorableappeals (other than beneficiary appeals) at the 3rd and 4th level of appeals.Page 2
INTRODUCTIONThe FY 2019 Congressional Justification is one of several documents that fulfill the Departmentof Health and Human Services’ (HHS) performance planning and reporting requirements. HHSachieves full compliance with the Government Performance and Results Act of 1993 (GPRA) andOffice of Management and Budget (OMB) Circulars A‐11 and A‐136 through the HHS agencies’FY 2019 Congressional Justifications and Online Performance Appendices, the Agency FinancialReport, and the HHS Citizens’ Report. These documents are available athttp://www.hhs.gov/budget.The FY 2019 Congressional Justifications and accompanying Online Performance Appendicescontain the updated FY 2019 Annual Performance Report and FY 2019 Annual PerformancePlan. The Agency Financial Report provides fiscal and high‐level performance results. TheSummary of Performance and Financial Information summarizes key past and plannedperformance and financial information.Page 3
DEPARTMENT OF HEALTH AND HUMAN SERVICESOFFICE OF THE SECRETARYInspector GeneralDaniel R. LevinsonChief Administrative Law JudgeOffice of Medicare Hearings and AppealsNancy GriswoldAssistant Secretary forAdministrationVacantAssistant Secretary forPreparedness andResponseRobert P. Kadlec, M.D.SecretaryAlex M. Azar IIDirector, Office for Civil RightsRoger SeverinoDeputy SecretaryEric HarganNational Coordinator for Health ITDon Rucker, M.D.Chief of StaffE. Peter UrbanowiczAssistant Secretary forHealthBrett P. Giroir, M.D.Assistant Secretary forPublic AffairsJudy SteckerDirector, Office of GlobalAffairsGarrett GrigsbyAssistant Secretary forLegislationMatthew BassettAssistant Secretaryfor Planning and EvaluationVacantAssistant Secretary forFinancial ResourcesVacantChair, DepartmentalAppeals BoardConstance B. TobiasGeneral CounselRobert CharrowDirector, Office ofIntergovernmental andExternal AffairsVacantPage 5
ORGANIZATIONAL CHART: TEXT VERSIONDepartment of Health and Human Serviceso Alex M. Azar II Deputy Secretary Eric Hargan Chief of Staff E. Peter UrbanowiczThe following offices report directly to the Secretary: Inspector Generalo Daniel R. Levinson Chief Administrative Law Judge of the Office of Medicare Hearings and Appealso Nancy Griswold Director of the Office for Civil Rightso Roger Severino National Coordinator for Health Information Technologyo Don Rucker, M.D. Assistant Secretary for Administrationo Vacant Assistant Secretary for Healtho Brett P. Giroir, M.D. Assistant Secretary for Legislationo Matthew Bassett Assistant Secretary for Planning and Evaluationo Vacant Assistant Secretary for Preparedness and Responseo Robert P. Kadlec, M.D., M.P.H. Assistant Secretary for Public Affairso Judy Stecker Assistant Secretary for Financial Resourceso Vacant General Counselo Robert Charrow Director, Office of Global Affairso Garrett Grigsby Chief of the Departmental Appeals Boardo Constance B. Tobias Director of the Office of Intergovernmental and External Affairso VacantPage 6
DEPARTMENTAL MANAGEMENT OVERVIEWDepartmental Management (DM) is a consolidated display that includes the Office of the Secretary (OS)activities funded under the following accounts: General Departmental Management (appropriation); Office of Medicare Hearings and Appeals (appropriation); Office for Civil Rights (appropriation); Office of the National Coordinator for Health Information Technology (appropriation); Service and Supply Fund (revolving fund); and Opioids Epidemic and Serious Mental Illness and Serious Emotional Disturbance Initiative.The mission of the OS is to provide support and assistance to the Secretary in administering andoverseeing the organization, programs, and activities of the Department of Health and Human Services.The overall FY 2019 President’s Budget request for DM totals 10,701,792,000 in program level funding,including 3,452 full‐time equivalent (FTE) positions, an increase of 9,944,409,000 above the FY 2018Annualized Continuing Resolution (CR) Level.The FY 2019 Budget will support ongoing and critical priorities including the Opioid Epidemic and SeriousMental Illness and Serious Emotional Disturbance, Global Health Security Agenda, the HHS PainManagement Task Force, religious freedom, and the Departmental Appeals Board.The General Departmental Management (GDM) appropriation supports the activities associated withthe Secretary’s responsibilities as chief policy officer and general manager of the Department inadministering and overseeing the organization, programs, and activities of HHS. These activities arecarried out through eleven Staff Divisions (STAFFDIVs), including the Immediate Office of the Secretary,the Departmental Appeals Board, and the Offices of public affairs, legislation, planning and evaluation,financial resources, administration, intergovernmental and external affairs, general counsel, globalaffairs, and the assistant Secretary for Health. The FY 2019 President’s Budget program level request forGDM includes a total of 381,447,000 and 1,184 FTE.The Office of Medicare Hearings and Appeals (OMHA) was created pursuant to the MedicarePrescription Drug, Improvement, and Modernization Act of 2003 (MMA). As mandated by MMA, OMHAopened its doors on July 1, 2005, to hear Medicare appeals at the Administrative Law Judge (ALJ) level,for cases under titles XVIII and XI of the Social Security Act. OMHA is funded from the Medicare HospitalInsurance and Supplemental Medical Insurance Trust Funds. The FY 2019 President’s Budget request forOMHA is 251,060,000 and 950 FTE. Of this amount, 125,000,000 and 200 FTE will be provided throughproposed mandatory funding, 10,000,000 in Recovery Audit collections, and 3,679,000 in proposeduser fee collections. The request will help support critical initiatives intended to improve the Medicareappeals process by allowing the addition of up to 106 ALJ teams. The budget will also allow OMHA toexpand its alternative dispute resolution initiatives by allowing for the addition of attorney adjudicatorsand settlement conference facilitators who will increase the agency’s disposition capacity. The budgetalso proposes additional legislative authorities for OMHA to address the Medicare appeals backlog.The Office for Civil Rights (OCR) is the Department's chief law enforcer and regulator of civil rights,conscience, and religious freedom, and health information privacy and security. The FY 2019 President’sBudget request for OCR is 30,904,000 in budget authority and 153 FTE. The Budget supports OCR’sPage 7
essential programmatic focus as the primary defender of the public’s right to nondiscriminatory accessto, and receipt of, HHS‐funded health and human services, conscience and religious freedomprotections, and access, privacy, and security protections for individually identifiable health information.To carry out these functions, OCR investigates complaints, enforces rights, develops policy, promulgatesregulations, and provides technical assistance and public education to ensure understanding of, andcompliance with, non‐discrimination and health information privacy laws.The Office of the National Coordinator for Health Information Technology (ONC) was established byExecutive Order 13335 on April 27, 2004, and subsequently authorized by the Health InformationTechnology for Economic and Clinical Health Act on February 17, 2009. The FY 2019 President’s Budgetrequest for ONC is 38,381,000 and 164 FTE, to coordinate national efforts related to theimplementation and use of interoperable electronic health information exchange. The Office of theNational Coordinator for Health Information Technology (ONC) leads the Government’s efforts to ensurethat electronic health information is available and can be shared safely and securely to improve thehealth and care of all Americans and their communities. ONC’s work is pivotal to achievinginteroperability, encouraging market competition, advancing patient access to their electronic records,combating information blocking, and bringing innovative easy‐to‐use products into the hands of users.The Service and Supply Fund (SSF), the HHS revolving fund, is composed of two components: theProgram Support Center (PSC) and the Non‐PSC activities. For the FY 2019 President’s Budget requestthe SSF is projecting total revenue of 1,802,732,432 and usage of 1,001 FTE.The FY 2019 Budget proposes a 10 billion historic investment for Combatting Opioid Epidemic andSerious Mental Illness and Serious Emotional Disturbance. This investment supports department‐widecollaboration to address the opioids epidemic and focus on rural and underserved populations throughevidence‐based approaches and establishes a new grant program for Certified Community BehavioralHealth Clinics that provide services to individuals suffering from serious mental illness.Page 8
DEPARTMENTAL MANAGEMENTBUDGET BY APPROPRIATION(Dollars in thousands)FY 2017FinalFY 2018 AnnualizedCRFY 2019 President’sBudgetGeneral DepartmentalManagement459,579457,501289,545PHS Evaluation Funds64,82864,38853,445Pregnancy Assistance Fund123,27523,35025,000HCFAC Funds27,0007,00010,000Proposed Mandatory FundingDepartment Appeals Board3‐‐2,000Proposed User Fee (DAB) 6‐‐1,457Subtotal, GDM Program Level4554,682552,239381,447Office of Medicare Hearings andAppeals107,381106,652112,381Proposed Mandatory Funding‐‐125,000Recovery Audit Collections5‐‐10,000Proposed User Fee (OMHA) 6‐‐3,679Subtotal, OMHA Program Level107,381106,652251,060Office for Civil ,000,000760,998757,38310,701,792DetailsOffice of the NationalCoordinator for HealthInformation TechnologyOpioids & Serious Mental Illness& Serious Emotional DisturbanceInitiativeTotal, DepartmentalManagement1The Pregnancy Assistance Fund (PAF) is authorized and appropriated by the Patient Protection and Affordable Care Act(ACA) Public Law 111‐148.2The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of theallocation account for 2019. Actual allocation will be determined annually.3The proposed mandatory funding has a legislative proposal in place to transfer funds from the Federal HospitalInsurance and Federal Supplementary Medical Insurance Trust Funds to the Departmental Appeals Board (DAB).4The GDM Program Level does not include either estimated reimbursable budget authority and associated FTE orPregnancy Assistance Fund and associated FTE, unless otherwise indicated.5Recovery Audit Collections reflect FY 2018 House and Senate Bills to address Medicare Appeals at OMHA and DAB.6The proposed user fee collections for OMHA and DAB represent a proposal that creates a post‐adjudication user feeapplied to all unfavorable appeals (other than beneficiary appeals) at the 3rd and 4th level of appeals.Page 9
General Departmental Management
TABLE OF CONTENTSAppropriations Language . 3Language Analysis . 4Authorizing Legislation. 5Amounts Available for Obligation . 6Summary of Changes . 7Budget Authority by Activity ‐ Direct . 8Budget Authority by Object Class ‐ Direct . 9Budget Authority by Object Class – Reimbursable . 10Salary and Expenses . 11Appropriation History Table . 12Overview of Performance . 13Overview of Budget Request . 15Narratives by Activity . 16Immediate Office of the Secretary . 16Secretarial Initiatives and Innovations . 21Assistant Secretary for Administration . 22Assistant Secretary for Financial Resources . 27Acquisition Reform . 30Assistant Secretary for Legislation . 31Assistant Secretary for Public Affairs . 33Office of the General Counsel . 35Departmental Appeals Board . 38Office of Global Affairs . 47Office of Intergovernmental and External Affairs . 50Center for Faith‐Based and Neighborhood Partnerships . 52Office of the Assistant Secretary for Health . 54Executive Summary. 54Immediate Office of the Assistant Secretary for Health. 56Office of HIV/AIDS and Infectious Disease Policy . 64Office of Disease Prevention and Health Promotion. 69Page 1
President’s Council on Fitness, Sports and Nutrition . 74Office of Human Research Protections. 77National Vaccine Program Office . 81Office of Adolescent Health . 85Public Health Reports . 87Teen Pregnancy Prevention . 90Office of Minority Health . 91Office on Women’s Health. 105Office of Research Integrity . 113Embryo Adoption Awareness Campaign . 117Sexual Risk Avoidance . 119Minority HIV/AIDS Initiative . 120Rent, Operation, and Maintenance and Related Services. 121Shared Operating Expenses . 122PHS Evaluation Funded Appropriations . 124Assistant Secretary for Planning and Evaluation . 124Health Care Evaluation . 131Assistant Secretary for Financial Resources . 133Office of the Assistant Secretary for Health . 134Teen Pregnancy Prevention . 136Pregnancy Assistance Fund. 137Supporting Exhibits . 140Detail of Positions . 140Detail of Full‐Time Equivalent (FTE) Employment . 141FTEs Funded by the Affordable Care Act . 142Statement of Personnel Resources. 143Rent and Common Expenses . 144Physicians’ Comparability Allowance (PCA). 145Grants.Gov . 147Centrally Managed Projects . 151Significant Items in Conference, House, and Senate Appropriations Committees Report . 154Page 2
APPROPRIATIONS LANGUAGEGENERAL DEPARTMENTAL MANAGEMENTFor necessary expenses, not otherwise provided for general departmental management,including hire of [six] passenger motor vehicles, and for carrying out titles III, XVII, XXI, andsection 229 of the PHS Act, the United States‐Mexico Border Health Commission Act, andresearch studies under section 1110 of the Social Security Act,[ 457,501,000] 289,545,000 together with [ 64,388,000] 53,445,000 from the amountsavailable under section 241 of the PHS Act to carry out national health or human servicesresearch and evaluation activities: [Provided further, That of the funds made availableunder this heading, 10,000,000 shall be for making competitive grants which exclusivelyimplement education in sexual risk avoidance (defined as voluntarily refraining from non‐marital sexual activity): Provided further, That funding for such competitive grants forsexual risk avoidance shall use medically accurate information referenced to peer‐reviewed publications by educational, scientific, governmental, or health organizations;implement an evidence‐based approach integrating research findings with practicalimplementation that aligns with the needs and desired outcomes for the intendedaudience; and teach the benefits associated with self‐regulation, success sequencing forpoverty prevention, healthy relationships, goal setting, and resisting sexual coercion,dating violence, and other youth risk behaviors such as underage drinking or illicit druguse without normalizing teen sexual activity: Provided further, That no more than 10percent of the funding for such competitive grants for sexual risk avoidance shall beavailable for technical assistance and administrative costs of such programs:] Providedfurther, That funds provided in this Act for embryo adoption activities may be used toprovide to individuals adopting embryos, through grants and other mechanisms, medicaland administrative services deemed necessary for such adoptions: Provided further, Thatsuch services shall be provided consistent with 42 CFR 59.5(a)(4).Page 3
LANGUAGE ANALYSISLanguage ProvisionExplanation[That of the funds made available underthis heading, 10,000,000 shall be formaking competitive grants whichexclusively implement education insexual risk avoidance ]The President’s budget does notrequest amounts available forsexual risk avoidance activities inFY 2019.Page 4
AUTHORIZING LEGISLATION(Dollars in Thousands)2018AuthorizedDetailsGeneral Departmental Management:except account below:Reorganization Plan No. 1 of 1953Office of the Assistant Secretary for Health:Public Health Service ActTitle III, Section 301Title, II Section 229 (OWH)Title XVII Section 1701 (ODPHP)Title XVII, Section 1707 (OMH)Title XVII, Section 1708 (OAH)Title XXI, Section 2101 (NVPO)SubtotalTotal GDM 44289,5451) Authorizing legislation under Section 229 of the PHS Act expires September 30, 20142) Authorizing legislation under Section 1701 of the PHS Act expired September 30, 2002. Reauthorization will be proposed.3) Authorizing legislation under Section 1707 of the PHS Act expires September 30, 2016.4) Authorizing legislation under Section 1708 of the PHS Act expired September 30, 2000.5) Authorizing legislation under Section 2101 of the PHS Act expired September 30, 2005. Reauthorization will be proposedPage 5
AMOUNTS AVAILABLE FOR OBLIGATIONFY 2017 FinalFY 2018AnnualizedCRFY 2019President’sBudget 460,629,000 460,629,000 289,545,000‐‐ 3,128,132‐‐ 1,050,000‐‐Subtotal, adjusted budget authority 459,579,000 457,500,868 289,545,000Total Obligations 459,579,000 456,782,983 289,545,000DetailAnnual appropriation1Rescission2Transfer of Funds to ACF12Continuing Appropriations Act, 2018 (Division D of P.L. 115‐56)Consolidated Appropriations Act, 2017 (Division H of P.L. 115‐31)Page 6
SUMMARY OF CHANGES(Dollars in Thousands)Budget Year and Type of AuthorityDollarsFY 2018 Annualized CRTotal Adjusted Budget AuthorityFY 2019 Current RequestTotal Estimated Budget AuthorityNet creasesFY 2018Annualized CR9929921,0051,005 13FY 2019 RequestChange from BaseImmediate Office of the Secretary13,210 90Assistant Secretary for Public Affairs8,351 57Assistant Secretary for Legislation4,072 28ASFR, Financial Systems Integration30,237 206Assistant Secretary for Administration17,339 119Office of Intergovernmental and External Affairs10,553 72Center for Faith Based Neighborhood Partnerships1,290 36Office of the General Counsel30,889 211Departmental Appeals Board10,925 7,075Office of Global Affairs5,985 41Rent15,980 109Shared Operating Services ‐ Enterprise IT, SSF Payments11,466 1,096Office of the Assistant Secretary for Health*34,102 396Embryo Adoption Awareness Campaign993 7Total195,392 9,543*OASH includes increases in the Immediate Office, OHAIDP, ODPHP, PCFSN, OHRP, NVP, and PHRDecreasesFY 2018Annualized 2,109Secretary’s Initiative/InnovationsAcquisition ReformOffice of the Assistant Secretary for Health – OAHTeen Pregnancy PreventionOffice of Minority HealthOffice on Women’s HealthSexual Risk AvoidanceMinority HIV/AIDSTotalTotal ChangesTotal Increase ChangesTotal Decrease ChangesTotalFY 2018AnnualizedCR195,392262,109457,501FY 2018FTE‐‐992FY 2019 RequestChange from ‐14,898‐53,534‐177,499FY 2018 RequestChange from BaseFY 2019 FTEChange from Base9,543‐177,499‐167,956 131,005Page 7
BUDGET AUTHORITY BY ACTIVITY ‐ DIRECTActivity(Dollars in Thousands)FYFY 20172017FinalFTEImmediate Office of the SecretaryFYFY 2018FYFY 20192018 Annualized 2019 ecretarial Initiatives and Innovations‐1,765‐1,986‐1,000Assistant Secretary for Administration11417,45811417,33911417,458Assistant Secretary for Financial ,000Assistant Secretary for Legislation274,100274,072274,100Assistant Secretary for Public Affairs568,408568,351568,408Office of the General Counsel14331,10014330,88914331,100Departmental Appeals Board7011,0007010,92510318,000Office of Global Affairs226,026225,985226,026Office of Intergovernmental and External 55225,154255224,054236116,944Embryo Adoption Awareness Campaign‐998‐993‐1,000HIV‐AIDS in Minority Communities153,777153,534‐‐Shared Operating Expenses‐11,544‐11,466‐12,725Rent, Operations, Maintenance and Related Services‐15,866‐15,980‐16,089Sexual Risk 501 1,005289,545Acquisition ReformCenter for Faith‐Based and Neighborhood PartnershipsOffice of the Assistant Secretary for HealthTotal, Budget AuthorityPage 8
BUDGET AUTHORITY BY OBJECT CLASS – DIRECT(Dollars in Thousands)Object ClassTableDescriptionFY 2018Annualized CRFY 2017 FinalFY 2019President'sBudgetFY 2019 /‐FY 201886,47587,03588,625 1,590Other than full‐time permanent9,6269,6729,732 6011.5Other personnel compensation1,9581,9731,984 1111.7Military personnel2,7422,6792,660‐1911.1Full‐time permanent11.3SubtotalPersonnel Compensation100,802101,359103,001 1,64212.1Civilian personnel benefits28,44828,63229,377 74512.2Military benefits1,2801,2671,278 1113.0Benefits for former personnelTotalPay Costs21.0Travel and transportation of persons22.0‐‐130,530131,258133,656 2,3984,2934,2323,789‐443Transportation of things187187189 223.1Rental payments to GSA15,72415,83115,623‐20823.3Communications, utilities, and misc. charges2,1642,1732,186 1324.0Printing and reproduction811816805‐1125.1Advisory and assistance services22,13721,95115,701‐6,25025.2Other services from non‐Federal sources45,64545,05528,081‐16,97425.3Other goods and services from Federal sources69,04567,10531,023‐36,08225.4Operation and maintenance of facilities5,4845,5365,595 5925.5Research and development contracts‐‐‐‐25.6Medical care‐‐‐‐25.7Operation and maintenance of equipment4,9814,7815,238 45725.8Subsistence and support of persons109109109‐26.0Supplies and materials2,5602,5622,624 6231.0Equipment453454425‐2932.0Land and Structures‐‐‐‐41.0Grants, subsidies, and contributions155,456155,44942.0Insurance claims and indemnities‐44.0Refunds‐‐TotalNon‐Pay Costs329,049326,242155,889 ‐170,354TotalBudget Authority by Object Class459,579457,500289,545 ‐167,95544,499 ‐110,950‐‐‐Page 9
BUDGET AUTHORITY BY OBJECT CLASS – REIMBURSABLE(Dollars in Thousands)Object ClassCodeDescription11.1Full‐time permanent11.3FY 2018AnnualizedCRFY 2017FinalFY 2019President’sBudgetFY 2019 /‐FY 201857,40356,01652,495‐3,520Other than full‐time permanent3,2963,2783,278‐11.5Other personnel compensation788787784‐311.7Military personnel1,6751,6911,691‐SubtotalPersonnel Compensation63,16261,77258,249‐3,52312.1Civilian personnel benefits19,09618,60418,610 612.2Military benefits557557557‐13.0Benefits for former personnel‐‐‐‐TotalPay Costs82,81580,93377,415‐3,51721.0Travel and transportation of persons1,1141,1251,125‐22.0Transportation of things100100100‐23.1Rental payments to GSA6,4116,4946,516 2223.3Communications, utilities,
The Service and Supply Fund (SSF), the HHS revolving fund, is composed of two components: the Program Support Center (PSC) and the Non‐PSC activities. For the FY 2019 President's Budget request the SSF is projecting total revenue of 1,802,732,432 and usage of 1,001 FTE.
