.
The Agency for Healthcare Research and
Quality (AHRQ) Budget: Fact Sheet
Amanda K. Sarata
Specialist in Health Policy
August 4, 2015
Congressional Research Service
7-5700
www.crs.gov
R44136
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The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet
.
T
he Quality (AHRQ) Budget: Fact Sheet
March 15, 2016
(R44136)
The Agency for Healthcare Research and Quality (AHRQ), within the Department of Health
and Human Services (HHS), is the federal agency charged with supporting research
designed to improve the quality of health care, increase the efficiency of its delivery, and
broaden access to health services. In addition, AHRQ is required to disseminate its research
findings to health care providers, payers, and consumers, among others. The agency collects data
on health care expenditures and utilization through the Medical Expenditure Panel Survey
(MEPS) and the Healthcare Cost and Utilization Project (HCUP).
11 Authorized appropriations for
AHRQ expired in 2005; however, it has continued to receive annual funding
.
since that time.
The AHRQ budget has traditionally been organized into
threethe program areas
: (1) of Health Costs,
Quality, and Outcomes (HCQO) Research;
(2) MEPS; and
(3) program support.
Currently,
As of FY2017, HCQO focuses on
fivefour priority areas, including (1) Health Information Technology Research; (2)
Patient Safety; (3) Health Services Research, Data and Dissemination;
and (4) U.S. Preventive Services Task Force(4) Prevention/Care
Management; and (5) Value. For several years, HCQO included a patient-centered health research
(comparative effectiveness research) area, but this area was
first removed in the FY2016 congressional
budget justification and the FY2016 President
’s budget request.
Funding Sources
AHRQ’s budget comprises both discretionary and mandatory funds. Between FY2003 and
FY2014, AHRQ did not receive its own annual discretionary appropriations.2 Instead, the
majority of AHRQ’s funding during this timeframe consisted of transfers of discretionary funds
from the Public Health Service (PHS) evaluation set-aside. This set-aside (sometimes called the
PHS evaluation “tap”) is authorized in Section 241 of the Public Health Service Act (PHSA) and
allows the HHS Secretary, with the approval of congressional appropriators, to redistribute a
portion of eligible PHS agency appropriations across the department to evaluate the
implementation and effectiveness of HHS programs.3 While the PHS evaluation set-aside has
generally been the primary source of AHRQ funding in recent years, this was not the case in
FY2015, when the agency received its own annual discretionary appropriation for the first time in
over a decade, and did not receive any transfer from the PHS evaluation set-aside.
With the passage of the Patient Protection and Affordable Care Act (ACA), AHRQ began
receiving additional transfers from two new mandatory funding streams: (1) the Prevention and
Public Health Fund (PPHF), which is designed to support prevention, wellness, and public health
activities,4 and (2) the Patient-Centered Outcomes Research Trust Fund (PCORTF), which is
designed to support comparative clinical effectiveness research.5 AHRQ received a share of total
PPHF transfers in each of FY2010-FY2014, but received no PPHF transfer in FY2015. The ACA
directly appropriated annual funding to the PCORTF through FY2019 and required the HHS
1
For more information about AHRQ in general, see http://www.ahrq.gov.
Although AHRQ did not receive a discretionary appropriation in the FY2009 Omnibus Appropriations Act (P.L. 1118), the agency did receive $700 million in a one-time supplemental discretionary appropriation from the American
Recovery and Reinvestment Act of 2009 (P.L. 111-5).
3
For more information about the PHS Program Evaluation Set-Aside, see CRS Report R43967, Labor, Health and
Human Services, and Education: FY2015 Appropriations, coordinated by Karen E. Lynch.
4
For more information about PPHF, see Appendix C in CRS Report R43304, Public Health Service Agencies:
Overview and Funding, coordinated by C. Stephen Redhead.
5
For more information about PCORTF, see Appendix D in CRS Report R43304, Public Health Service Agencies:
Overview and Funding, coordinated by C. Stephen Redhead.
2
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The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet
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Secretary to transfer a share of PCORTF funds to AHRQ each year. Funds transferred to AHRQ
from PCORTF are designated by the ACA to carry out PHSA Section 937,6 which requires AHRQ
to disseminate the results of patient-centered outcomes research carried out by the Patient
Centered Outcomes Research Institute (PCORI) and other “government-funded research relevant
to comparative clinical effectiveness research.” AHRQ received PCORTF transfers in each of
FY2011-FY2015 and, under law, is scheduled to continue receiving PCORTF transfers through
's budget request, and continued to be excluded in FY2017 documents. In addition, HCQO had previously included a "Value" category, but that area was removed in the FY2017 President's budget request and in the FY2017 congressional budget justification.
AHRQ's program level had been increasing steadily over the period FY2011-FY2015, with decreases in discretionary funding being more than offset by transfers of ACA mandatory funds. However, in FY2016, the total program level for the agency decreased for the first time since FY2011. Discretionary sources of funding shifted from evaluation set-aside transfers to the agency's own discretionary appropriation in FY2015, and ACA mandatory funds have been a prominent and increasing source of funding for the agency since FY2010.
Funding Sources
AHRQ's budget currently comprises both discretionary and mandatory funds, although it has not always. Between FY2003 and FY2008, agency funding came mostly if not entirely from transfers of discretionary funds from the Public Health Service (PHS) evaluation set-aside. From FY2010 to FY2016, in addition to transfers from the PHS evaluation set-aside, agency funding included mandatory funds, as the agency began receiving transfers from specified ACA trust funds. Also, in FY2015 and FY2016, discretionary funding for the agency shifted from PHS evaluation set-aside funds to the agency's own discretionary appropriation.
Discretionary Funding Sources
Between FY2003 and FY2014, AHRQ did not receive its own annual discretionary appropriations.2 Instead, the majority of AHRQ's funding during this timeframe consisted of transfers of discretionary funds from the PHS evaluation set-aside. This set-aside (sometimes called the PHS evaluation "tap") is authorized in Section 241 of the Public Health Service Act (PHSA) and allows the HHS Secretary, with the approval of congressional appropriators, to redistribute a portion of eligible PHS agency appropriations across the department to evaluate the implementation and effectiveness of HHS programs.3 While the PHS evaluation set-aside has generally been the primary source of AHRQ funding in recent years, this was not the case in FY2015, when the agency received its own annual discretionary appropriation for the first time in over a decade, and did not receive any transfer from the PHS evaluation set-aside. This trend continued in FY2016, when the agency again received its own annual discretionary appropriation but no transfer from the PHS evaluation set-aside.
Mandatory Funding Sources4
With the passage of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), AHRQ began receiving additional transfers from two new mandatory funding streams: (1) the Prevention and Public Health Fund (PPHF), which is designed to support prevention, wellness, and public health activities,5 and (2) the Patient-Centered Outcomes Research Trust Fund (PCORTF), which is designed to support comparative clinical effectiveness research.6 AHRQ received a share of total PPHF transfers in each of FY2010-FY2014, but received no PPHF transfer in FY2015 or FY2016. The ACA directly appropriated annual funding to the PCORTF beginning in FY2011 and through FY2019 and required the HHS Secretary to transfer a share of PCORTF funds to AHRQ each year. Funds transferred to AHRQ from PCORTF are designated by the ACA to carry out PHSA Section 937,7 which requires AHRQ to disseminate the results of patient-centered outcomes research carried out by the Patient Centered Outcomes Research Institute (PCORI) and other "government-funded research relevant to comparative clinical effectiveness research." AHRQ received PCORTF transfers in each of FY2011-FY2016 and, under law, is scheduled to continue receiving PCORTF transfers through FY2019. As illustrated in Figure 1, funding transfers from PPHF and PCORTF
have supplanted, to
some extent, PHS evaluation set-aside dollars
.
; in FY2015 and FY2016, these mandatory funds supplanted a discretionary appropriation.
Figure 1 shows the funding sources for the agency
’'s budget from FY2010 (the first year ACA
funds were available) through
FY2015FY2016. During this time, the agency
’'s budget has increased by
$62 $25 million, as transfers (mostly from PCORTF) have more than offset decreases in PHS
evaluation set-aside dollars evaluation set-aside dollars and discretionary appropriations in later years. However, funding for the agency decreased in FY2016, by $14 million, for the first time since FY2011, despite an increasing transfer from PCORTF. The figure also shows that although the majority of agency funding
came has come from PHS evaluation set-aside dollars (and its own discretionary appropriation in FY2015
),
and FY2016) during this time, funding from PCORTF has also grown considerably over this time period, from $8 million in
FY2011 to $
101106 million in
FY2015.
Figure 1. FY2016.
Figure 1. AHRQ Budget, by Source, FY2010-
FY2015
FY2016
(Dollars in Millions)
500
450
400
350
300
250
200
150
100
50
0
Source: Funding amounts for FY2010 and FY2011 are taken from AHRQ
’'s FY2012 and FY2013 congressional
budget justification documents. Funding amounts for FY2012 and FY2013 are taken from AHRQ
’'s Sequestration
Operating Plan for FY2013. Funding amounts for FY2014
and FY2015 are taken from the FY2016 HHS Budget in
Brief, http://www.hhs.gov/about/budget/budget-in-brief/ahrq/index.html
.
Notes:. Funding amounts for FY2015, FY2016, and the FY2017 President's budget request are taken from the FY2017 HHS Budget in Brief.
Notes: PPHF: Prevention and Public Health Fund; PCORTF: Patient-Centered Outcomes Research Trust Fund;
Eval Tap: PHS Program Evaluation Set-Aside dollars; Disc Approp: annual discretionary appropriation.
6
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Congressional Research Service
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The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet
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FY2016 Budget Request and Funding Status
There are notable differences in proposed funding levels for AHRQ in the FY2016 President’s
budget request and in the full committee-reported Labor-HHS-ED bills (H.R. 3020 and S. 1695).
The request would give the agency a total funding level (i.e., program level) of $479 million
using PHS evaluation set-aside dollars ($88 million), an annual discretionary appropriation ($276
million), and the PCORTF transfer of $116 million.
S. 1695 would appropriate $236 million in discretionary funds for the agency (-$39 million from
the President’s request) and would not require any PHS evaluation set-aside dollars to be
transferred to the agency for FY2016 (-$88 million from the President’s request). The
discretionary appropriation proposed by S. 1695 would be augmented by the $116 million
transfer from PCORTF (per statutory requirements), outside of the appropriations process.
H.R. 3020 would require the termination of the agency as of October 1, 2015. It would rescind all
unobligated agency funds and would allow for the provision of fiscal year continuation funding
for agency grants. The bill would allow for other HHS agencies to carry out certain activities
currently carried out by AHRQ. In addition, it would transfer the U.S. Preventive Services Task
Force (USPSTF, which is currently authorized at PHSA Section 915(a), 42 U.S.C. 299b-4) from
AHRQ to the Assistant Secretary for Health, moving the current authorizing language to PHSA
Section 317 and replacing it with the language as it was prior to amendment by the ACA.7 The
bill would also prohibit any discretionary funds made available by the bill to be used for patientcentered outcomes research; as a result, any such research currently being carried out by AHRQ
would not be funded with discretionary dollars for FY2016, even if the research activities were
transferred to other HHS agencies. In addition, the bill would rescind $100 million from the
PCORTF in FY2016.
AHRQ Funding History
AHRQ’s program level has increased steadily over the past several years, with decreases in
discretionary funding being more than offset by transfers of ACA mandatory funds. Table 1
provides information on the past five years of the agency’s budget, as well as the FY2016
President’s budget request.
7
The prior USPSTF authority, among other things, required the task force to consider cost-effectiveness in its review
of clinical preventive services, and exempted it from requirements of the Federal Advisory Committee Act. ACA
amended the language to retain these provisions, and added a permanent, indefinite authorization of appropriations and
additional requirements for the review process. For more information on USPSTF, see
http://www.uspreventiveservicestaskforce.org/.
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The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet
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Table 1. AHRQ’s Budget, FY2011-FY2016 Request
Dollars in Millions, by Fiscal Year
Program or Activity
Health Costs, Quality, and Outcomes
(HCQO) Research
2011
2012
2013
2014
2015
2016
Req.
266
272
300
304
330
339
Health Information Technology Research
28
26
26
30
28
23
Patient Safety
66
66
67
72
77
76
Patient-Centered Health Researcha
29
41
68
0
0
0
PCORTF Transfer (non-add)
(8)
(24)
(58)
—
—
—
PCORTF Transfer (add)
—
—
—
65
101
116
112
108
111
111
112
112
4
4
4
3
—
—
Health Services Research, Data, and
Dissemination
Value
Prevention/Care Management
28
28
26
23
12
12
(12)
(12)
(6)
(7)
—
—
Medical Expenditure Panel Surveys
(MEPS)
59
59
61
64
65
69
Program Support
68
74
68
69
70
72
Total, Program Level
392
405
429
436
465
479
372
369
365
364
—
88
8
24
58
65
101
116
12
12
6
7
—
—
0
0
0
0
364
276
PPHF Transfer (non-add)
Less Funds From Other Sources
PHS Evaluation Set-Aside
PCORTF Transfers
PPHF Transfers
Total, Discretionary Appropriation
Source: Funding amounts for FY2011 are taken from AHRQ’s FY2013 congressional budget justification
document. Funding amounts for FY2012 and FY2013 are taken from AHRQ’s Sequestration Operating Plan for
FY2013. Funding amounts for FY2014 and FY2015 are taken from the FY2016 HHS Budget in Brief and the
FY2015 congressional budget justification. The funding amounts for the FY2016 President’s Request are taken
from the FY2016 HHS Budget in Brief. All Eval Tap: PHS Program Evaluation Set-Aside dollars; Disc Approp: annual discretionary appropriation.
AHRQ Funding History
AHRQ's program level had been increasing steadily over the past several years, with decreases in discretionary funding being more than offset by transfers of ACA mandatory funds. However, in FY2016, the total program level for the agency decreased for the first time since FY2011, despite an increasing PCORTF transfer. Table 1 provides information on the past five years of the agency's budget, as well as the FY2017 President's budget request.
Table 1. AHRQ's Budget, FY2012-FY2017 Request
Dollars in Millions, by Fiscal Year
|
Program or Activity
|
2012
|
2013
|
2014
|
2015
|
2016
|
2017 Req.
|
|
Health Costs, Quality, and Outcomes (HCQO) Research
|
272
|
300
|
304
|
308
|
291
|
330
|
|
Health Information Technology Research
|
26
|
26
|
30
|
28
|
22
|
23
|
|
Patient Safety
|
66
|
67
|
72
|
77
|
74
|
76
|
Patient-Centered Health Researcha
41
|
68
|
0
|
0
|
0
|
0
|
|
PCORTF Transfer (non-add)
|
(24)
|
(58)
|
—
|
—
|
—
|
—
|
|
PCORTF Transfer (add)
|
—
|
—
|
65
|
79
|
94
|
106
|
|
Health Services Research, Data, and
Dissemination
|
108
|
111
|
111
|
112
|
89
|
113
|
Valueb
4
|
4
|
3
|
—
|
—
|
—
|
Prevention/Care Management (USPSTF)c
28
|
26
|
23
|
12
|
12
|
12
|
|
PPHF Transfer (non-add)
|
(12)
|
(6)
|
(7)
|
—
|
—
|
—
|
|
Medical Expenditure Panel Surveys (MEPS)
|
59
|
61
|
64
|
65
|
66
|
69
|
|
Program Support
|
74
|
68
|
69
|
70
|
71
|
71
|
|
Total, Program Level
|
405
|
429
|
436
|
443
|
428
|
470
|
Less Funds From Other Sources
|
|
PHS Evaluation Set-Aside
|
369
|
365
|
364
|
—
|
—
|
83
|
|
PCORTF Transfers
|
24
|
58
|
65
|
79
|
94
|
106
|
|
PPHF Transfers
|
12
|
6
|
7
|
—
|
—
|
—
|
|
Total, Discretionary Appropriation
|
0
|
0
|
0
|
364
|
334
|
280
|
Source: Funding amounts for FY2012 and FY2013 are taken from AHRQ's Sequestration Operating Plan for FY2013. Funding amounts for FY2014 are taken from the FY2016 HHS Budget in Brief and the FY2015 congressional budget justification. The funding amounts for FY2015, FY2016, and the FY2017 President's budget request are taken from the FY2017 HHS Budget in Brief. All of these documents are available at http://www.hhs.gov/budget/
.
.
Notes: PCORTF: Patient-Centered Outcomes Research Trust Fund; PPHF: Prevention and Public Health Fund;
PHS: Public Health Service. Individual amounts may not add to subtotals or totals due to rounding.
a.
a.
Starting with the FY2016 President
’'s request, the PCORTF transfer was separated from patient-centered
health research within HCQO, and patient-centered health research was removed from HCQO altogether.
However, this table retains this research area within HCQO for comparability purposes across the budget
window. This is the reason FY2014-
FY2016FY2017 request funds are shown as an
“add”"add" to other HCQO funds—
because the source used for those years (the
FY2016FY2017 HHS Budget in Brief) pulls these funds out of HCQO.
Author Contact Information
Amanda K. Sarata
Specialist in Health Policy
asarata@crs.loc.gov, 7-7641
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b.
The category "value" was removed from the FY2017 budget materials (the HHS Budget in Brief as well as the AHRQ congressional budget justification).
c.
The category "prevention/care management" was removed from the FY2017 budget materials, and replaced with "U.S. Preventive Services Task Force."
Author Contact Information
[author name scrubbed], Specialist in Health Policy
([email address scrubbed], [phone number scrubbed])
Footnotes
| 1.
|
For more information about AHRQ in general, see http://www.ahrq.gov.
|
| 2.
|
Although AHRQ did not receive a discretionary appropriation in the FY2009 Omnibus Appropriations Act (P.L. 111-8), the agency did receive $700 million in a one-time supplemental discretionary appropriation from the American Recovery and Reinvestment Act of 2009 (P.L. 111-5).
|
| 3.
|
For more information about the PHS Program Evaluation Set-Aside, see CRS Report R43967, Labor, Health and Human Services, and Education: FY2015 Appropriations, coordinated by [author name scrubbed].
|
4.
|
As noted previously, ARRA made a one-time appropriation of $700 million to the agency in FY2009; however, this is not discussed in this section as this section reflects a discussion of the information in Figure 1, which begins with the ACA transfers in FY2010.
| 5.
|
For more information about PPHF, see Appendix C in CRS Report R43304, Public Health Service Agencies: Overview and Funding (FY2010-FY2016), coordinated by [author name scrubbed] and [author name scrubbed].
|
| 6.
|
For more information about PCORTF, see Appendix D in CRS Report R43304, Public Health Service Agencies: Overview and Funding (FY2010-FY2016), coordinated by [author name scrubbed] and [author name scrubbed].
|
| 7.
|
42 U.S.C. 299b-37.
|