U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress

Changes from March 11, 2021 to August 3, 2021

This page shows textual changes in the document between the two versions indicated in the dates above. Textual matter removed in the later version is indicated with ~~red strikethrough~~ and textual matter added in the later version is indicated with blue.

U.S. Public Health Service: COVID-19
~~March 11~~August 3, 2021 , 2021
Supplemental ~~Funding~~Appropriations in the 116th ~~Congress~~
Kavya Sekar, Coordinator
Congress Analyst in Health Policy Within the Department of Health and Human Services (HHS), eight agencies and two Within the Department of Health and Human Services (HHS), eight agencies and two
~~Analyst in Health Policy~~
~~offices are~~ offices are Agata Bodie designated components of the U.S. Public Health Service (PHS). Some of designated components of the U.S. Public Health Service (PHS). Some of

these agencies and these agencies and Analyst in Health Policy offices—for example, the U.S. Centers for Disease Control and offices—for example, the U.S. Centers for Disease Control and
~~Agata Bodie~~
Prevention (CDC) and the U.S. Prevention (CDC) and the U.S. Food and Drug Administration (FDA)—have played a Food and Drug Administration (FDA)—have played a
~~Analyst in Health Policy~~
major role in the federal response to the Coronavirus Disease 2019 (COVID-19)major role in the federal response to the Coronavirus Disease 2019 (COVID-19)

pandemic. pandemic.
Ada S. Cornell
Senior Research Librarian Senior Research Librarian
PHS agencies are funded primarily by annual discretionary appropriations. As such, PHS agencies are funded primarily by annual discretionary appropriations. As such,
many of
~~many of~~ these agencies have received additional supplemental discretionary these agencies have received additional supplemental discretionary
appropriations for pandemic- Johnathan H. Duff
~~appropriations for pandemic-~~related activities. In addition, one-time appropriations have related activities. In addition, one-time appropriations have
~~Analyst in Health Policy~~
been made to the Public Health and been made to the Public Health and Analyst in Health Policy Social Services Emergency Fund (PHSSEF) Social Services Emergency Fund (PHSSEF)

account, which funds emergency preparedness and account, which funds emergency preparedness and response activities and is often used response activities and is often used
for one-time and pass-through funding to address health for one-time and pass-through funding to address health ~~emergencies. As part of the~~
~~Elayne J. Heisler~~
~~Specialist in Health~~
Elayne J. Heisler emergencies. As part of the federal response to the pandemic, PHSSEF appropriations have been federal response to the pandemic, PHSSEF appropriations have been Specialist in Health used to fund used to fund
~~Services~~
activities such as purchasing medical products and supplies (e.g., vaccines and activities such as purchasing medical products and supplies (e.g., vaccines and ~~syringes)~~
Services syringes) and supporting health care providers. and supporting health care providers.
~~Isaac A. Nicchitta~~
~~Research Assistant~~
This CRS report summarizes COVID-19 supplemental funding for the public health This CRS report summarizes COVID-19 supplemental funding for the public health

~~service~~ service Isaac A. Nicchitta agencies and to PHSSEF in the 116th Congress. It also includes resources to track agencies and to PHSSEF in the 116th Congress. It also includes resources to track
~~COVID-19~~ COVID-19 Research Assistant supplemental spending provided across five supplemental appropriations supplemental spending provided across five supplemental appropriations

measures: measures:
  First Measure: Division A of the Coronavirus Preparedness and Response Division A of the Coronavirus Preparedness and Response ~~Supplemental~~
Supplemental Appropriations Act, 2020 (P.L. 116-123),Appropriations Act, 2020 (P.L. 116-123), enacted on March 6, 2020. enacted on March 6, 2020.
  Second Measure: Division A of the Families First Coronavirus Response Act (FFCRA, P.L. 116-Division A of the Families First Coronavirus Response Act (FFCRA, P.L. 116-
127), 127), enacted on March 18, 2020. enacted on March 18, 2020.
  Third Measure: Division B of the Coronavirus Aid, Relief, and Economic Security Act (CARES Division B of the Coronavirus Aid, Relief, and Economic Security Act (CARES
Act, P.L. Act, P.L. 116-136),116-136), enacted on March 27, 2020. enacted on March 27, 2020.
  Fourth Measure: Division B of the Paycheck Protection Program and Health Care Enhancement Division B of the Paycheck Protection Program and Health Care Enhancement
Act Act (PPPHCEA, P.L. 116-139),(PPPHCEA, P.L. 116-139), enacted on April 24, 2020. enacted on April 24, 2020.
  Fifth Measure: Division M of Consolidated Appropriations Act, 2021 (P.L. 116-260),Division M of Consolidated Appropriations Act, 2021 (P.L. 116-260), enacted on enacted on
December 27, 2020. December 27, 2020.
Across the five measures, a total of $305.6 Across the five measures, a total of $305.6 ~~bil ion~~billion has been provided to the PHS agencies and PHSSEF, much of has been provided to the PHS agencies and PHSSEF, much of
which is which is ~~available~~ available for multiple years or until expended. In some cases, amounts were appropriated to one account for multiple years or until expended. In some cases, amounts were appropriated to one account
with instructions to transfer a portion of the funds to another account or agency. Except as noted, amounts shown with instructions to transfer a portion of the funds to another account or agency. Except as noted, amounts shown
in the tables and figures throughout this report in the tables and figures throughout this report ~~typical y~~typically present funds in the account to which they were present funds in the account to which they were
appropriated, as final data on transfers are appropriated, as final data on transfers are not universally available for all ~~not universal y available for al~~ accounts. The following amounts were accounts. The following amounts were
appropriated to each PHS agency: appropriated to each PHS agency:
  CDC,, the federal government’s lead public health agency,the federal government’s lead public health agency, received a total of $15.3 received a total of $15.3 ~~bil ion~~billion. .
 The  The Agency for Toxic Substances and Disease Registry (ATSDR), which is headed by the CDC (ATSDR), which is headed by the CDC
director director and investigates the public health impact of exposure to hazardous substances, received a and investigates the public health impact of exposure to hazardous substances, received a
total of $12.5 total of $12.5 ~~mil ion~~million. .
  FDA,, which regulates medical products such as vaccines, treatments, and tests,which regulates medical products such as vaccines, treatments, and tests, received a total of received a total of
~~$196 mil ion.~~
~~Congressional Research Service~~

~~U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress~~
$196 million.
 The  The Health Resources and Services Administration (HRSA),, which funds programs and which funds programs and
systems that systems that provide health care services to the uninsured and provide health care services to the uninsured and ~~medical y~~medically underserved, received a underserved, received a
total of $1.3 total of $1.3 ~~bil ion.~~ billion.
 The  The Indian Health Service (IHS), which supports a health care delivery system for , which supports a health care delivery system for ~~Native~~
~~Americans~~American Indians and Alaska Natives, received a total of $1.1 , received a total of $1.1 ~~bil ion.~~billion. Congressional Research Service U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress
 The  The National Institutes of Health (NIH),, the nation’s lead medical and health research agency, the nation’s lead medical and health research agency,
received a received a total of $3.0 total of $3.0 ~~bil ion~~billion..
 The  The Substance Abuse and Mental Health Services Administration (SAMHSA), which funds , which funds
mental mental health and substance abuse prevention and treatment services, received a total of $4.7 health and substance abuse prevention and treatment services, received a total of $4.7
~~bil ion.~~ billion.
PHSSEF received a total of $280 PHSSEF received a total of $280 ~~bil ion~~ billion (including amounts directed as transfers to the above agencies) for a (including amounts directed as transfers to the above agencies) for a
broad set of purposes. broad set of purposes. ~~Some~~Of PHSSEF appropriations, the Provider Relief Fund (PRF)—a fund for reimbursing eligible health care providers for health care-related expenses or lost revenues attributable to the pandemic—accounted for $178 billion (63.6%). Aside from PRF, some of the funded activities are carried out by the Office of the Assistant Secretary for of the funded activities are carried out by the Office of the Assistant Secretary for
Preparedness and Response (ASPR; a component of the Public Health Service). In particular, the account funds Preparedness and Response (ASPR; a component of the Public Health Service). In particular, the account funds
the Biomedical Advanced Research and Development Authority (BARDA)the Biomedical Advanced Research and Development Authority (BARDA) which supports the development and which supports the development and
procurement of medical countermeasures (e.g., vaccines, treatments)procurement of medical countermeasures (e.g., vaccines, treatments)~~, as wel as~~. ASPR also supports the deployment of certain the deployment of certain
operational response assets such as the Strategic National Stockpile and medical workforce assistance to statesoperational response assets such as the Strategic National Stockpile and medical workforce assistance to states .
. Some PHSSEF funding has since been transferred from PHSSEF or administered by other agencies, in addition to Some PHSSEF funding has since been transferred from PHSSEF or administered by other agencies, in addition to
the transfers directed by the laws. HHS transfer authorities the transfers directed by the laws. HHS transfer authorities ~~al ow~~allow for transfers between accounts as specified in for transfers between accounts as specified in
each law. each law.
Some of the supplemental funding has been provided broadly, “to prevent, prepare for and respond to coronavirus, Some of the supplemental funding has been provided broadly, “to prevent, prepare for and respond to coronavirus,
~~domestical y or international y~~domestically or internationally.” Other funding was provided for specific purposes, for example, for testing and .” Other funding was provided for specific purposes, for example, for testing and
vaccine distribution. Further, appropriations in different laws are available for different time periods. This report vaccine distribution. Further, appropriations in different laws are available for different time periods. This report
summarizes appropriations by agency, account, availability, and purpose as directed across the measures. summarizes appropriations by agency, account, availability, and purpose as directed across the measures.

Congressional Research Service Congressional Research Service

U.S. Public Health Service: COVID-19 Supplemental ~~Funding~~Appropriations in the 116th Congress

Introduction
The Coronavirus Disease 2019 (COVID-19) pandemic continues to have a significant impact on The Coronavirus Disease 2019 (COVID-19) pandemic continues to have a significant impact on
communities throughout the United States and around the world. The federal response to this communities throughout the United States and around the world. The federal response to this
crisis has included multiple waves of supplemental appropriations for various agencies, programs, crisis has included multiple waves of supplemental appropriations for various agencies, programs,
and accounts to help prevent, prepare for, and respond to the pandemic. and accounts to help prevent, prepare for, and respond to the pandemic.
Within the Department of Health and Human Services (HHS), eight agencies and two offices are Within the Department of Health and Human Services (HHS), eight agencies and two offices are
designated components of the U.S. Public Health Service (PHS).1 Some of these agencies and designated components of the U.S. Public Health Service (PHS).1 Some of these agencies and
offices—such as the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food offices—such as the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food
and Drug Administration (FDA)—have played a major role in the federal public health response and Drug Administration (FDA)—have played a major role in the federal public health response
to the COVID-19 pandemic. Others have played a role in providing community health support to the COVID-19 pandemic. Others have played a role in providing community health support
services, for example, the Health Resources and Services Administration (HRSA) and the services, for example, the Health Resources and Services Administration (HRSA) and the
Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Abuse and Mental Health Services Administration (SAMHSA).
PHS agencies are primarily funded by annual discretionary appropriations. As such, many of PHS agencies are primarily funded by annual discretionary appropriations. As such, many of
these agencies have received additional supplemental discretionary appropriations for pandemic -these agencies have received additional supplemental discretionary appropriations for pandemic -
related activities. In addition, one-time appropriations have been made to the Public Health and related activities. In addition, one-time appropriations have been made to the Public Health and
Social Services Emergency Fund (PHSSEF) account, which funds emergency preparedness and Social Services Emergency Fund (PHSSEF) account, which funds emergency preparedness and
response activities and is often used for one-time and pass-through funding to address health response activities and is often used for one-time and pass-through funding to address health
emergencies. As part of the federal response to the pandemic, PHSSEF appropriations have been emergencies. As part of the federal response to the pandemic, PHSSEF appropriations have been
made to fund activities such as purchasing medical products and supplies (e.g., vaccines and made to fund activities such as purchasing medical products and supplies (e.g., vaccines and
syringes) and supporting health care providers. Some of these activities are carried out by the syringes) and supporting health care providers. Some of these activities are carried out by the
Office of the Assistant Secretary for Preparedness and Response (ASPR, a PHS component). Office of the Assistant Secretary for Preparedness and Response (ASPR, a PHS component).
PHSSEF appropriations also include a number of transfers to PHS agenciesPHSSEF appropriations also include a number of transfers to PHS agencies, as directed in the as directed in the
response measures. response measures.
This report summarizes coronavirus supplemental funding for the public health service agencies This report summarizes coronavirus supplemental funding for the public health service agencies
and to the PHSSEF in the 116th Congress. It also includes resources for tracking spending. and to the PHSSEF in the 116th Congress. It also includes resources for tracking spending.
Funding has been provided across five supplemental appropriations measures: Funding has been provided across five supplemental appropriations measures:
  First Measure: Division A of the Coronavirus Preparedness and Response Division A of the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020 (P.L. 116-123), enacted on March 6, Supplemental Appropriations Act, 2020 (P.L. 116-123), enacted on March 6,
2020. 2020.
  Second Measure: Division A of the Families First Coronavirus Response Act Division A of the Families First Coronavirus Response Act
(FFCRA, P.L. 116-127), enacted on March 18, 2020. (FFCRA, P.L. 116-127), enacted on March 18, 2020.
  Third Measure: Division B of the Coronavirus Aid, Relief, and Economic Division B of the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act, P.L. 116-136), enacted on March 27, 2020.2 Security Act (CARES Act, P.L. 116-136), enacted on March 27, 2020.2
  Fourth Measure: Division B, of the Paycheck Protection Program and Health Division B, of the Paycheck Protection Program and Health
Care Enhancement Act (PPPHCEA, P.L. 116-139 Care Enhancement Act (PPPHCEA, P.L. 116-139 ), enacted on April 24, 2020. ), enacted on April 24, 2020.

1 T he two HHS offices that are a part of the Public Health Service (PHS) include the Office of the Assistant Secretary 1 T he two HHS offices that are a part of the Public Health Service (PHS) include the Office of the Assistant Secretary
for Preparedness and Response (ASPR) and the Office of Global Affairs (OGA). T he Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Office of Global Affairs (OGA). T he Office of the Assistant Secretary
for Health (OASH) has responsibilities for leadership and coordination of the Public Health Service. Other HHS for Health (OASH) has responsibilities for leadership and coordination of the Public Health Service. Other HHS
operating divisions that are not a part of PHS include the Administration for Children and Families (ACF), the operating divisions that are not a part of PHS include the Administration for Children and Families (ACF), the
Administration for Community Living (ACL), and the Center s for Medicare & Medicaid Services (CMS). See HHS, Administration for Community Living (ACL), and the Center s for Medicare & Medicaid Services (CMS). See HHS,
“HHS Organizational Chart,” https://www.hhs.gov/about/agencies/orgchart/index.html. “HHS Organizational Chart,” https://www.hhs.gov/about/agencies/orgchart/index.html.
2 In addition, Division A of the CARES Act provides the supplemental mandatory funding for HRSA that is included in 2 In addition, Division A of the CARES Act provides the supplemental mandatory funding for HRSA that is included in
the budgetary calculations in this report. Information on this mandatory funding is included to provide a more complete the budgetary calculations in this report. Information on this mandatory funding is included to provide a more complete
account of the additional funding provided to HRSA for pandemic response. account of the additional funding provided to HRSA for pandemic response.
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  Fifth Measure: Division M of Consolidated Appropriations Act, 2021 (P.L. 116- Division M of Consolidated Appropriations Act, 2021 (P.L. 116-
260), enacted on December 27, 2020. 260), enacted on December 27, 2020.
This report provides an overview of each of the PHS agencies This report provides an overview of each of the PHS agencies, as wel as the PHSSEF. The as wel as the PHSSEF. The
funding tables funding tables (Table 1 aand Table 2) display supplemental funding as appropriated to these display supplemental funding as appropriated to these
accounts across the measures. In addition, this report provides an overview of resources for accounts across the measures. In addition, this report provides an overview of resources for
tracking spending; however, it does not provide a comprehensive overview of al ocations, tracking spending; however, it does not provide a comprehensive overview of al ocations,
outlays, and awards because available funding data are incomplete. outlays, and awards because available funding data are incomplete.
American Rescue Plan Act (ARPA; P.L. 117-2) Funding This report focuses on supplemental appropriations in the 116th Congress and therefore does not cover funding to PHS agencies or for public health purposes at HHS in the ARPA enacted in the 117th Congress. For information about related ARPA funding, see CRS Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health Services, and Related Provisions. Understanding PHS COVID-19 Supplemental Appropriations
The above appropriations measures provided additional budgetary resources to PHS accounts to The above appropriations measures provided additional budgetary resources to PHS accounts to
address the pandemic. In these measures, discretionary funding was appropriated to PHS accounts address the pandemic. In these measures, discretionary funding was appropriated to PHS accounts
pursuant to an “emergency requirement” and directed to be used for various pandemic-related pursuant to an “emergency requirement” and directed to be used for various pandemic-related
activities.3 Additional y, the measures directed that certain amounts of appropriations funding be activities.3 Additional y, the measures directed that certain amounts of appropriations funding be
transferred from one account to another. In several instances, these transfers were directed as “not transferred from one account to another. In several instances, these transfers were directed as “not
less than” or “not more than” a certain amount. less than” or “not more than” a certain amount.
In addition, the measures included several authorities that al ow the HHS Secretary to transfer In addition, the measures included several authorities that al ow the HHS Secretary to transfer
certain funds between certain accounts, as specified in each measure. This transfer authority is in certain funds between certain accounts, as specified in each measure. This transfer authority is in
addition to the directed transfers specified in the laws. addition to the directed transfers specified in the laws.
The first measure broadly al owed for HHS to transfer funds among accounts at CDC, NIH, and The first measure broadly al owed for HHS to transfer funds among accounts at CDC, NIH, and
PHSSEF. The third measure al owed for transfers among accounts at CDC, PHSSEF, the PHSSEF. The third measure al owed for transfers among accounts at CDC, PHSSEF, the
Administration for Children and Families (ACF), the Administration for Community Living Administration for Children and Families (ACF), the Administration for Community Living
(ACL), and NIH. The fourth measure al owed for transfers among accounts at CDC, NIH, (ACL), and NIH. The fourth measure al owed for transfers among accounts at CDC, NIH,
PHSSEF, and FDA, but limited the amounts available for such transfers (e.g., it excluded from PHSSEF, and FDA, but limited the amounts available for such transfers (e.g., it excluded from
this authority $75 bil ion provided to the PHSSEF for the “Provider Relief Fund”). The fifth this authority $75 bil ion provided to the PHSSEF for the “Provider Relief Fund”). The fifth
measure al owed for transfers among accounts at CDC, NIH, SAMHSA, ACF, and PHSSEF, but measure al owed for transfers among accounts at CDC, NIH, SAMHSA, ACF, and PHSSEF, but
again limited the amounts available for such transfers (e.g., it excluded from this authority $22.4 again limited the amounts available for such transfers (e.g., it excluded from this authority $22.4
bil ion provided to the PHSSEF for COVID-19 testing, contact tracing, surveil ance, containment, bil ion provided to the PHSSEF for COVID-19 testing, contact tracing, surveil ance, containment,
and mitigation). The acts require HHS to notify the House and the Senate appropriations and mitigation). The acts require HHS to notify the House and the Senate appropriations
committees 10 days in advance of such transfers. committees 10 days in advance of such transfers.
Unless otherwise noted, the budgetary figures in this report do not reflect transfers between accounts pursuant to these authorities. Moreover, in several instances, one agency administers a program funded by appropriations that Moreover, in several instances, one agency administers a program funded by appropriations that
were made to another agency’s or office’s account. were made to another agency’s or office’s account. ~~Unless otherwise noted, the budgetary figures~~
~~in this report do not reflect transfers between accounts pursuant to these authorities, nor do they~~
~~reflect al ocations~~This report acknowledges some such instances, but does not comprehensively reflect al ocations, transfers, and spending of agency and spending of agency appropriations below the level of detail specified in the appropriations below the level of detail specified in the
supplemental appropriations measures. supplemental appropriations measures.
Several of the other divisions in the above measures include either regular discretionary Several of the other divisions in the above measures include either regular discretionary
appropriations to these agencies’ accounts or mandatory appropriations to support ongoing appropriations to these agencies’ accounts or mandatory appropriations to support ongoing
programs and operations. These regular, annual funds are not reflected in this report because they programs and operations. These regular, annual funds are not reflected in this report because they
~~were not appropriated specifical y to address the pandemic. However, this report does include the~~
~~mandatory appropriations for the HRSA Health Centers program that were provided in Division A~~
~~of the third measure, because these funds were specifical y directed as supplemental awards for~~
~~pandemic-related activities at HRSA-funded health centers.~~

3 For further information about the emergency requirements designation, see CRS Report R45778, 3 For further information about the emergency requirements designation, see CRS Report R45778, Exceptions to the
Budget Control Act’s Discretionary Spending Limits. .
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Congress were not appropriated specifical y to address the pandemic. However, this report does include the mandatory appropriations for the HRSA Health Centers program that were provided in Division A of the third measure, because these funds were specifical y directed as supplemental awards for pandemic-related activities at HRSA-funded health centers. A Note About Funding Amounts in This Report
Funding amounts in each section of this report are presented in different ways. The Funding amounts in each section of this report are presented in different ways. The “Agency Overview” section section
discusses agency funding accounting for discusses agency funding accounting for directed transfers to and from the agency accounts in the laws. As a result, transfers to and from the agency accounts in the laws. As a result,
the funding totals based on these CRS calculations differ fromthe funding totals based on these CRS calculations differ from ~~Table 1~~ ~~and Table 2 (in the~~ ~~“Funding Overview”~~
~~section), because those tables~~ Figure 1, Figure 2, Table 1 and Table 2), because those show funds show funds as appropriated in each account and priorin each account and prior to any transfersto any transfers. WebsitesWebsites
that track federalthat track federal spending may include various breakdowns and presentations of funds in these agency accounts spending may include various breakdowns and presentations of funds in these agency accounts
that do not match numbers in this report. that do not match numbers in this report.
In addition, the report does not include an overview of funding by category, such as funding totals for vaccine, In addition, the report does not include an overview of funding by category, such as funding totals for vaccine,
testing, or contact tracing-related purposes. Questions such as “How much funding was appropriated for testing, testing, or contact tracing-related purposes. Questions such as “How much funding was appropriated for testing,
contact tracing, or vaccines?” often defy a clear answer. Several agencies that support related programs and contact tracing, or vaccines?” often defy a clear answer. Several agencies that support related programs and
activities received broad appropriations “to prevent, prepare for, and respond to coronavirus,” or similar broad activities received broad appropriations “to prevent, prepare for, and respond to coronavirus,” or similar broad
language. Agencies general y have discretion to al ocate such funding for specific purposes and may not do so in language. Agencies general y have discretion to al ocate such funding for specific purposes and may not do so in
ways that are easy to categorize. For example, CDC has used its appropriations to award several broad and ways that are easy to categorize. For example, CDC has used its appropriations to award several broad and
flexible grants to states and other jurisdictions that can be used for a variety of purposes, including expanding flexible grants to states and other jurisdictions that can be used for a variety of purposes, including expanding
testing, laboratory, and contact tracing programs, among others. In addition, health care services programs, such testing, laboratory, and contact tracing programs, among others. In addition, health care services programs, such
as those administered by HRSA and IHS, provide many kinds of care, including testing and vaccination services. as those administered by HRSA and IHS, provide many kinds of care, including testing and vaccination services.
Further, categories such as “testing” and “vaccines” may include a wide set of activities—research and Further, categories such as “testing” and “vaccines” may include a wide set of activities—research and
development; regulation; testing and vaccination programs and infrastructure; testing, vaccine, and related supply development; regulation; testing and vaccination programs and infrastructure; testing, vaccine, and related supply
manufacturing; procurement of tests, vaccines, and related supplies; health education programs about testing and manufacturing; procurement of tests, vaccines, and related supplies; health education programs about testing and
vaccination; and the provision and financing of testing and vaccination services, among others. Many accounts at vaccination; and the provision and financing of testing and vaccination services, among others. Many accounts at
PHS agencies and across the federal government may support similar or related activities. PHS agencies and across the federal government may support similar or related activities.
Some sources, such as reports published by the Government Accountability Office (GAO), provideSome sources, such as reports published by the Government Accountability Office (GAO), provide views of views of
funding al ocations by various categories. GAO uses data provided by HHS and the Office of Management and funding al ocations by various categories. GAO uses data provided by HHS and the Office of Management and
Budget (OMB). These reports are inherently subject to categorization choices made by HHS, OMB, and GAO. Budget (OMB). These reports are inherently subject to categorization choices made by HHS, OMB, and GAO.
PHS Agency and PHSSEF Appropriations: A Snapshot
Across the five measures, a total of $305.6 bil ion was provided to the PHS agencies and Across the five measures, a total of $305.6 bil ion was provided to the PHS agencies and
PHSSEF. Much of this funding is available for multiple years or until expended. These measures PHSSEF. Much of this funding is available for multiple years or until expended. These measures
include the following amounts by PHS agency (as appropriated to agency accounts): include the following amounts by PHS agency (as appropriated to agency accounts):
  CDC,, the federal government’s lead public health agency,the federal government’s lead public health agency, received a total of received a total of
$15.3 bil ion. $15.3 bil ion.
 The  The Agency for Toxic Substances and Disease Registry (ATSDR), which is (ATSDR), which is
headed by the CDC director and investigates the public health impact of exposure headed by the CDC director and investigates the public health impact of exposure
to hazardous substances, received a total of $12.5 mil ion. to hazardous substances, received a total of $12.5 mil ion.
  FDA,, which regulates medical products such as vaccines, treatments, and tests,which regulates medical products such as vaccines, treatments, and tests,
received a total of $196 mil ion. received a total of $196 mil ion.
  HRSA, which funds programs and systems that provide health care services to , which funds programs and systems that provide health care services to
the uninsured and medical y underserved, received a total of $1.3 bil ion. the uninsured and medical y underserved, received a total of $1.3 bil ion.
 The  The Indian Health Service (IHS), which supports a health care delivery system , which supports a health care delivery system
for for ~~Native Americans~~American Indians and Alaska Natives, received a total of $1.1 bil ion., received a total of $1.1 bil ion.
 The  The National Institutes of Health (NIH),, the nation’s lead medical and health the nation’s lead medical and health
research agency, received a total of $3.0 bil ion. research agency, received a total of $3.0 bil ion.
  SAMHSA, which, which funds mental health and substance abuse prevention and funds mental health and substance abuse prevention and
treatment services, received a total of $4.7 bil ion. treatment services, received a total of $4.7 bil ion.
Congressional Research Service 3 link to page 27 link to page 29 U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress TheThe PHSSEFPHSSEF received a total of $280 bil ion for a broad set of purposes, including funding received a total of $280 bil ion for a broad set of purposes, including funding
directed as transfers to the above agencies. This funding wasdirected as transfers to the above agencies. This funding was ~~general y~~, in large part, provided for four main provided for four main
purposes: purposes:
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  Medical Countermeasures and Surge Capacity (approximately $53.4 bil ion), (approximately $53.4 bil ion),
including the development, manufacture, and purchase of medical including the development, manufacture, and purchase of medical
countermeasures such as tests, treatments, vaccines, and other medical supplies, countermeasures such as tests, treatments, vaccines, and other medical supplies,
as wel as as wel as for activities related to supporting a surge in demand for health care (e.g., health care supporting a surge in demand for health care (e.g., health care
workforce supports, distribution of medical supplies, and alternative care sites). workforce supports, distribution of medical supplies, and alternative care sites).
  COVID-19 Testing for the Uninsured ($1 bil ion), provided in the second ($1 bil ion), provided in the second
measure. Accounting for a transfer in the fourth measure of not more than $1 measure. Accounting for a transfer in the fourth measure of not more than $1
bil ion of the amount for COVID-19 Testing, Surveil ance, Contact Tracing, bil ion of the amount for COVID-19 Testing, Surveil ance, Contact Tracing,
Containment and Mitigation (last bullet below), a total of not more than $2 Containment and Mitigation (last bullet below), a total of not more than $2
bil ion has been provided for this fund. bil ion has been provided for this fund.
  Provider Relief Fund ($178 bil ion) to reimburse eligible health care providers ($178 bil ion) to reimburse eligible health care providers
for health care-related expenses or lost revenues attributable to the pandemic. for health care-related expenses or lost revenues attributable to the pandemic.
  COVID-19 Testing, Surveillance, Contact Tracing, Containment and
Mitigation ($47.4 bil ion). Much of this funding has been awarded as grants to ($47.4 bil ion). Much of this funding has been awarded as grants to
states and other jurisdictions by CDC, while other amounts have been transferred states and other jurisdictions by CDC, while other amounts have been transferred
to other PHS agencies or used for related purposes, such as purchasing testing-to other PHS agencies or used for related purposes, such as purchasing testing-
related supplies, or transferred to the uninsured fund listed above. related supplies, or transferred to the uninsured fund listed above.
Some of the funded activities are carried out by ASPR, particularly BARDA for medical Some of the funded activities are carried out by ASPR, particularly BARDA for medical
countermeasure development and procurement. Some PHSSEF funding has since been countermeasure development and procurement. Some PHSSEF funding has since been
transferred from PHSSEF and is administered by other agencies (though these transfers were not transferred from PHSSEF and is administered by other agencies (though these transfers were not
explicitly directed in the laws). explicitly directed in the laws).
An eighth PHS agency, the Agency for Healthcare Research and Quality (AHRQ) did not receive An eighth PHS agency, the Agency for Healthcare Research and Quality (AHRQ) did not receive
COVID-19 supplemental appropriations in any of the measures. COVID-19 supplemental appropriations in any of the measures.
Report Roadmap
This report provides an overview of COVID-19 supplemental appropriations to PHS accounts in This report provides an overview of COVID-19 supplemental appropriations to PHS accounts in
three main sections: three main sections:
Agency Overviews. This section provides a high-level overview of each PHS agency and its role This section provides a high-level overview of each PHS agency and its role
in the pandemic response. The discussion includes total supplemental appropriations and in the pandemic response. The discussion includes total supplemental appropriations and
additional budgetary resources made available to each agency for pandemic response, accounting additional budgetary resources made available to each agency for pandemic response, accounting
for both appropriations made to agency accounts and transfers to the agency directed from other for both appropriations made to agency accounts and transfers to the agency directed from other
accounts. The section discusses the purposes for which funds were appropriated, as wel as accounts. The section discusses the purposes for which funds were appropriated, as wel as
programs administered by the agency for which funding was appropriated to another account. programs administered by the agency for which funding was appropriated to another account.
Final y,Final y, the section discusses PHSSEF, the largest account covered in this report, and the major the section discusses PHSSEF, the largest account covered in this report, and the major
categories of its appropriations. categories of its appropriations.
Funding Overview. This section includes two tables of COVID-19 supplemental appropriations This section includes two tables of COVID-19 supplemental appropriations
for PHS agencies for PHS agencies as appropriated,, with information on availability of fundswith information on availability of funds. Table 1 provides a provides a
high-level summary of appropriations by agency and includes information about transfers high-level summary of appropriations by agency and includes information about transfers
specifical y directed to another agency specifical y directed to another agency ~~account~~account. Table 2 provides a more detailed view of these provides a more detailed view of these
appropriations, including overviews of al appropriations for accounts, programs, and specified appropriations, including overviews of al appropriations for accounts, programs, and specified
purposes within an agency, as wel as directed transfers outside of agency accounts. In at least one purposes within an agency, as wel as directed transfers outside of agency accounts. In at least one
Congressional Research Service 4 link to page 9 U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress case, transfers are directed to “other federal agencies” without specifying the specific agency or case, transfers are directed to “other federal agencies” without specifying the specific agency or
account. account.
Resources to Track Spending. This section provides an overview of available resources to track This section provides an overview of available resources to track
spending from PHS accounts, with a discussion of data limitations and relevant caveats for spending from PHS accounts, with a discussion of data limitations and relevant caveats for
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interpreting these sources. The section includes both general federal spending and department and interpreting these sources. The section includes both general federal spending and department and
agency-specific resources. agency-specific resources.
As a general caveat, the PHS agencies are not the only agencies within the federal government As a general caveat, the PHS agencies are not the only agencies within the federal government
that have conducted public health activities for pandemic response. The federal public health that have conducted public health activities for pandemic response. The federal public health
response to the COVID-19 pandemic has been “whole-of-government” and has involved response to the COVID-19 pandemic has been “whole-of-government” and has involved
departments and agencies outside of HHS, such as the Federal Emergency Management Agency departments and agencies outside of HHS, such as the Federal Emergency Management Agency
(FEMA), the Department of Defense (DOD), and others. These entities and their appropriations (FEMA), the Department of Defense (DOD), and others. These entities and their appropriations
are outside the scope of this report. are outside the scope of this report.
Agency Overview
Seven PHS agencies received COVID-19 supplemental appropriations across the five measures. Seven PHS agencies received COVID-19 supplemental appropriations across the five measures.
As shown iAs shown in Figure 1, CDC received the largest amount of appropriations at $15.3 bil ion (59.6% CDC received the largest amount of appropriations at $15.3 bil ion (59.6%
of al PHS agency appropriations), followed by SAMHSA ($4.7 bil ion; 18.3%), NIH ($3.0 of al PHS agency appropriations), followed by SAMHSA ($4.7 bil ion; 18.3%), NIH ($3.0
bil ion; 11.9%), HRSA ($1.3 bil ion; 5.2%), IHS ($1.1 bil ion; 4.3%), FDA ($196.0 mil ion; bil ion; 11.9%), HRSA ($1.3 bil ion; 5.2%), IHS ($1.1 bil ion; 4.3%), FDA ($196.0 mil ion;
0.8%); and ATSDR ($12.5 mil ion; less than 1%). 0.8%); and ATSDR ($12.5 mil ion; less than 1%).
Figure 1. PHS Agencies: COVID-19 Supplemental Appropriations
(Dol ars in mil ions; amounts shown as appropriated) (Dol ars in mil ions; amounts shown as appropriated)

Source: Compiled by CRS from amounts specified in P.L. 116-123 (Compiled by CRS from amounts specified in P.L. 116-123 (~~Title III, Division~~ Division A), P.L. 116-127 (A), P.L. 116-127 (~~Title V,~~
~~Division~~ Division A), P.L. 116-136 (Division A and A), P.L. 116-136 (Division A and ~~Title VIII,~~ Division B),Division B), P.L. 116-139 (P.L. 116-139 (~~Title I, Division~~ Division B), and P.L.B), and P.L. 116-116-
260 (Division260 (Division M). M).
Notes: These amounts reflect discretionary supplemental appropriations to agency accounts, as wel as These amounts reflect discretionary supplemental appropriations to agency accounts, as wel as
additional mandatory appropriations for pandemic response made available to HRSA. These amounts do additional mandatory appropriations for pandemic response made available to HRSA. These amounts do not
reflect transfers directed into and from agency accounts in the laws; therefore these amounts may differ from reflect transfers directed into and from agency accounts in the laws; therefore these amounts may differ from
those in the discussion below about transfers. Other sources that track federal spending, such as those in the discussion below about transfers. Other sources that track federal spending, such as
Congressional Research Service 5 link to page 9 link to page 27 link to page 29 link to page 26 U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress USASpending,gov, may include various breakdowns and presentations of funds in these agency accounts that do USASpending,gov, may include various breakdowns and presentations of funds in these agency accounts that do
not match numbers in this figure. not match numbers in this figure.
This section discusses agency funding accounting for This section discusses agency funding accounting for directed transfers to and from the agency transfers to and from the agency
accounts in the laws. As such, the funding totals based on these calculations differ fraccounts in the laws. As such, the funding totals based on these calculations differ from Figure 1, ,
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as wel aas wel as Table 1 aand Table 2 in the in the “Funding Overview” section, as those figures and tables section, as those figures and tables
show funds show funds as appropriated in each account and prior to any transfersin each account and prior to any transfers.
Centers for Disease Control and Prevention (CDC)
As the nation’s lead public health agency, CDC’s mission is to “to protect America from health, As the nation’s lead public health agency, CDC’s mission is to “to protect America from health,
safety and security threats, both foreign and in the United States.”4 To fulfil its mission, CDC safety and security threats, both foreign and in the United States.”4 To fulfil its mission, CDC
supports various activities related to a wide array of il nesses and injuries, including developing supports various activities related to a wide array of il nesses and injuries, including developing
expertise and best practices in disease prevention and control; conducting and supporting public expertise and best practices in disease prevention and control; conducting and supporting public
health research; supporting health education; developing laboratory capacity; and conducting health research; supporting health education; developing laboratory capacity; and conducting
surveil ance (i.e., data collection), among others. A large portion of CDC’s annual budget is surveil ance (i.e., data collection), among others. A large portion of CDC’s annual budget is
awarded as external financial assistance (typical y in the form of grants)—especial y to state awarded as external financial assistance (typical y in the form of grants)—especial y to state
health departments.5 health departments.5
During the COVID-19 pandemic, CDC has played major roles in supporting the nation’s public During the COVID-19 pandemic, CDC has played major roles in supporting the nation’s public
health response. The agency has produced and disseminated health information on COVID-19, health response. The agency has produced and disseminated health information on COVID-19,
conducted research, awarded funding, and provided technical assistance to public health agencies conducted research, awarded funding, and provided technical assistance to public health agencies
at the state, local, territorial, and tribal level (SLTT). These activities include (1) supporting at the state, local, territorial, and tribal level (SLTT). These activities include (1) supporting
surveil ance, epidemiology, and contact tracing; (2) supporting laboratory testing and diagnostics surveil ance, epidemiology, and contact tracing; (2) supporting laboratory testing and diagnostics
development; (3) coordinating across public health agencies; (4) providing health education and development; (3) coordinating across public health agencies; (4) providing health education and
guidance for a variety of stakeholders; (5) providing travel health advisories and notices; (6) guidance for a variety of stakeholders; (5) providing travel health advisories and notices; (6)
supporting international public health responses to the pandemic; and (7) coordinating, setting supporting international public health responses to the pandemic; and (7) coordinating, setting
requirements, and providing assistance for the COVID-19 vaccination program.6 requirements, and providing assistance for the COVID-19 vaccination program.6
Across four of the five supplemental appropriations measures, CDC received appropriations of Across four of the five supplemental appropriations measures, CDC received appropriations of
nearly $15.3 bil ion to the CDC-Wide Activities and Program Support account, along with an nearly $15.3 bil ion to the CDC-Wide Activities and Program Support account, along with an
additional directed transfer in the fourth measure of not less than $1 bil ion to CDC from additional directed transfer in the fourth measure of not less than $1 bil ion to CDC from
PHSSEF. In addition, the fifth measure directed a transfer of $210 mil ion from CDC to IHS. PHSSEF. In addition, the fifth measure directed a transfer of $210 mil ion from CDC to IHS.
Accounting for transfers, total budgetary resources available to CDC are not less than $16.0 Accounting for transfers, total budgetary resources available to CDC are not less than $16.0
bil ion. In addition, CDC has administered grants funds for testing-related activities initial y bil ion. In addition, CDC has administered grants funds for testing-related activities initial y
appropriated to the PHSSEF account (as explained in the appropriated to the PHSSEF account (as explained in the text box below). below).
In general, appropriations to CDC have been provided for three major purposes: In general, appropriations to CDC have been provided for three major purposes:
Broadly Available Funding. The first and third measures made available a total of $6.5 bil ion to The first and third measures made available a total of $6.5 bil ion to
CDC “to prevent, prepare for, and respond to coronavirus,” including $2.2 bil ion in the first CDC “to prevent, prepare for, and respond to coronavirus,” including $2.2 bil ion in the first
measure and $4.3 bil ion in the third measure, with amounts set aside or transferred for the measure and $4.3 bil ion in the third measure, with amounts set aside or transferred for the
following purposes: following purposes:
  Grants to state, local, territorial, tribal governments, and other tribal health
organizations (SLTT agencies): Not less than $2.45 bil ion total, including not Not less than $2.45 bil ion total, including not
less than $950 mil ion in the first measure and not less than $1.5 bil ion in the less than $950 mil ion in the first measure and not less than $1.5 bil ion in the
third measure. As specified in the laws, the funding was directed “to carry out third measure. As specified in the laws, the funding was directed “to carry out
~~surveil ance, epidemiology, laboratory capacity, infection control, mitigation,~~
~~communications, and other preparedness and response activities.” CDC has since~~
~~awarded the funding through several grant mechanisms and programs (see the~~

4 CDC, “Mission, Role, and Pledge,” https://www.cdc.gov/about/organization/mission.htm. 4 CDC, “Mission, Role, and Pledge,” https://www.cdc.gov/about/organization/mission.htm.
5 CDC, “Office of Financial Assistance: FY2019 Assistance Snapshot,” https://www.cdc.gov/funding/documents/5 CDC, “Office of Financial Assistance: FY2019 Assistance Snapshot,” https://www.cdc.gov/funding/documents/
fy2019/fy-2019-ofr-assistance-snapshot-508.pdf. fy2019/fy-2019-ofr-assistance-snapshot-508.pdf.
6 CDC, “CDC in Action: Working 24/7 to the Stop the T hreat of COVID-19,” https://www.cdc.gov/budget/documents/6 CDC, “CDC in Action: Working 24/7 to the Stop the T hreat of COVID-19,” https://www.cdc.gov/budget/documents/
covid-19/CDC-247-Response-to-COVID-19-fact-sheet.pdf. covid-19/CDC-247-Response-to-COVID-19-fact-sheet.pdf.
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Congress surveil ance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.” CDC has since awarded the funding through several grant mechanisms and programs (see the text box below). The measures specify that, at a minimum, every grantee that below). The measures specify that, at a minimum, every grantee that
received a Public Health and Emergency Preparedness (PHEP) grant for FY2019 received a Public Health and Emergency Preparedness (PHEP) grant for FY2019
must receive no less than 90% of that grant level from the first measure, and no must receive no less than 90% of that grant level from the first measure, and no
less than 100% of that grant level from the third measure.7 A portion of funds in less than 100% of that grant level from the third measure.7 A portion of funds in
each measure is designated for tribal entities (as detailed in each measure is designated for tribal entities (as detailed in “Funding for Tribal
Entities” section). section).
  Global disease detection and emergency response: Not less than $800 mil ion Not less than $800 mil ion
total is for global disease detection and emergency response, including not less total is for global disease detection and emergency response, including not less
than $300 mil ion in the first measure and not less than $500 mil ion in the third than $300 mil ion in the first measure and not less than $500 mil ion in the third
measure. measure.
  Public health data modernization: The third measure set aside not less than The third measure set aside not less than
$500 mil ion of the total appropriation to CDC for “public health data $500 mil ion of the total appropriation to CDC for “public health data
surveil ance and analytics infrastructure modernization.” surveil ance and analytics infrastructure modernization.”
  Transfers to the Infectious Disease Rapid Response Reserve Fund
(IDRRRF): ~~Not less than~~ $600 mil ion total was directed to IDRRRF, including$600 mil ion total was directed to IDRRRF, including
~~not less than~~ $300 mil ion $300 mil ion in the first measure andin the first measure and ~~not less than~~ $300 mil ion $300 mil ion in in
the third measure. The IDRRRF is a reserve account for CDC used for infectious the third measure. The IDRRRF is a reserve account for CDC used for infectious
disease emergenciesdisease emergencies~~, with funding general y available until expended~~.8 .8
Testing-Related Funding. The fourth measure directed a transfer of not less than $1 bil ion from The fourth measure directed a transfer of not less than $1 bil ion from
PHSSEF to CDC for “surveil ance, epidemiology, laboratory capacity expansion, contact tracing, PHSSEF to CDC for “surveil ance, epidemiology, laboratory capacity expansion, contact tracing,
public health data surveil ance and analytics infrastructure modernization, disseminating public health data surveil ance and analytics infrastructure modernization, disseminating
information about testing, and workforce support necessary to expand and improve COVID-19 information about testing, and workforce support necessary to expand and improve COVID-19
testing.” testing.”
In addition, a large portion of the general testing-related funds in the PHSSEF account made In addition, a large portion of the general testing-related funds in the PHSSEF account made
available by the fourth and fifth measures has been administered as CDC grants (see the available by the fourth and fifth measures has been administered as CDC grants (see the text box
below). below).
Vaccine-Related Funding. The fifth measure made available $8.75 bil ion to CDC for “activities The fifth measure made available $8.75 bil ion to CDC for “activities
to plan, prepare for, promote, distribute, administer, monitor, and track coronavirus vaccines to to plan, prepare for, promote, distribute, administer, monitor, and track coronavirus vaccines to
ensure broad-based distribution, access, and vaccine coverage.” Of this total, at least $4.5 bil ion ensure broad-based distribution, access, and vaccine coverage.” Of this total, at least $4.5 bil ion
was for SLTT grants (or cooperative agreements), of which $210 mil ion is to be transferred to was for SLTT grants (or cooperative agreements), of which $210 mil ion is to be transferred to
the Indian Health Service (IHS) and a separate amount of not less than $300 mil ion is for “high-the Indian Health Service (IHS) and a separate amount of not less than $300 mil ion is for “high-
risk and underserved populations, including racial and ethnic minority populations and rural risk and underserved populations, including racial and ethnic minority populations and rural
communities.” communities.”
Public Health Grant Funding for States, Localities, Territories, and Tribes (SLTTs)
CDC has used funding made available to the CDC-Wide Activities and Program Support account, as wel as CDC has used funding made available to the CDC-Wide Activities and Program Support account, as wel as
several appropriations to the PHSSEF account for “COVID-19 Testing, Surveil ance, Contact Tracing, several appropriations to the PHSSEF account for “COVID-19 Testing, Surveil ance, Contact Tracing,
Containment and Mitigation” to support public health grant programs. CDC has primarily awarded this funding Containment and Mitigation” to support public health grant programs. CDC has primarily awarded this funding
using some of its existing grant relationships with states, territories, and a few localities and tribal entities. For using some of its existing grant relationships with states, territories, and a few localities and tribal entities. For
some of the funding for tribes, CDC created new grant mechanisms (as explained in the some of the funding for tribes, CDC created new grant mechanisms (as explained in the “Funding for Tribal
Entities” section). section).
~~According to funding data published by CDC, as of January 8, 2021, CDC has awarded a total of $34.7 bil ion in~~
~~grants to SLTT governments and tribal entities. Of this amount, the three grant mechanisms described below~~

7 T he Public Health Emergency Preparedness (PHEP) cooperative agreement is a grant program that provides annual 7 T he Public Health Emergency Preparedness (PHEP) cooperative agreement is a grant program that provides annual
funding to 62 state, territorial, and local grantees. It is authorized by Public Health Service Act, §319C-1 [42 U.S.C. funding to 62 state, territorial, and local grantees. It is authorized by Public Health Service Act, §319C-1 [42 U.S.C.
§247d–3a]. §247d–3a].
8 42 U.S.C. §247d-4a. 8 42 U.S.C. §247d-4a.
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Congress According to funding data published by CDC, as of January 8, 2021, CDC has awarded a total of $34.7 bil ion in grants to SLTT governments and tribal entities. Of this amount, the three grant mechanisms described below were used to award most of the funding. Although these grant mechanisms were used to award the funding, the were used to award most of the funding. Although these grant mechanisms were used to award the funding, the
exact terms of each grant and the purposes for which the awards can be used vary by funding al ocation: exact terms of each grant and the purposes for which the awards can be used vary by funding al ocation:
 
Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement. The majority of the The majority of the
funds ($30.2 bil ion) have been awarded using the Epidemiology and Laboratory Capacity cooperative funds ($30.2 bil ion) have been awarded using the Epidemiology and Laboratory Capacity cooperative
agreement mechanism, drawing from appropriations in the first, third, fourth, and fifth measures (from agreement mechanism, drawing from appropriations in the first, third, fourth, and fifth measures (from
both CDC and PHSSEF accounts). This program both CDC and PHSSEF accounts). This program ~~general y~~generally awards annual funding to 64 state, local, and awards annual funding to 64 state, local, and
territorial health departments to facilitate capacity for infectious disease control and prevention. For the territorial health departments to facilitate capacity for infectious disease control and prevention. For the
pandemic, ELC has been used as a mechanism to support expanding testing capacity (including by pandemic, ELC has been used as a mechanism to support expanding testing capacity (including by
expanding laboratory capacity and supporting public health department testing programs), surveil ance, expanding laboratory capacity and supporting public health department testing programs), surveil ance,
contact tracing, health communication, and infection control programs in health care and other high-risk contact tracing, health communication, and infection control programs in health care and other high-risk
settings (e.g., long-term care facilities, prisons), among other functions. settings (e.g., long-term care facilities, prisons), among other functions.
 
Immunization Cooperative Agreements (Section 317 Program). CDC has awarded a total of CDC has awarded a total of
$3.3 bil ion using its Immunization Cooperative agreement (“Section 317” program) funding mechanism, $3.3 bil ion using its Immunization Cooperative agreement (“Section 317” program) funding mechanism,
which annual y funds 64 state, territorial, and local jurisdictions for immunization-related programs. which annual y funds 64 state, territorial, and local jurisdictions for immunization-related programs.
These awards, using funds from the third and fifth measures, support planning and implementation of the These awards, using funds from the third and fifth measures, support planning and implementation of the
COVID-19 vaccine program, including supporting distribution efforts, data systems, vaccine safety and COVID-19 vaccine program, including supporting distribution efforts, data systems, vaccine safety and
effectiveness monitoring, and related health education, among other activities. effectiveness monitoring, and related health education, among other activities.
 
Crisis Response Cooperative Agreement. Initial y, CDC used its Crisis Response funding Initial y, CDC used its Crisis Response funding
mechanisms to award a total of $755 mil ion to 65 jurisdictions using funds from the first measure. This mechanisms to award a total of $755 mil ion to 65 jurisdictions using funds from the first measure. This
grant mechanism was designed specifical y to al ow for rapid grant awards to jurisdictions ingrant mechanism was designed specifical y to al ow for rapid grant awards to jurisdictions in the event of the event of
a public health emergency. a public health emergency.
CDC also awarded several other smal er grant awards using its COVID-19 supplemental funds, as outlined in the CDC also awarded several other smal er grant awards using its COVID-19 supplemental funds, as outlined in the
table linked in the source note below. table linked in the source note below.
Sources: Funding Table: CDC COVID-19 State, Tribal, Local, and Territorial (STLT) Funding Update, January 8, Funding Table: CDC COVID-19 State, Tribal, Local, and Territorial (STLT) Funding Update, January 8,
https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/funding-update.pdf. https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/funding-update.pdf.
CDC, “Budget,” https://www.cdc.gov/budget/index.html. This website includes several factsheets on the agency’s CDC, “Budget,” https://www.cdc.gov/budget/index.html. This website includes several factsheets on the agency’s
COVID-19 response funding efforts. COVID-19 response funding efforts.
The Agency for Toxic Substances and Disease Registry (ATSDR), which is headed by the CDC The Agency for Toxic Substances and Disease Registry (ATSDR), which is headed by the CDC
Director, investigates the public health impact of exposure to hazardous substances. The third Director, investigates the public health impact of exposure to hazardous substances. The third
measure made available $12.5 mil ion to ATSDR, designated for two purposes: measure made available $12.5 mil ion to ATSDR, designated for two purposes:
 $7.5 mil ion for the Geospatial Research, Analysis and Services Program “to  $7.5 mil ion for the Geospatial Research, Analysis and Services Program “to
support spatial analysis and Geographic Information System mapping of support spatial analysis and Geographic Information System mapping of
infectious disease hot spots, including cruise ships.” infectious disease hot spots, including cruise ships.”
 $5 mil ion to Pediatric Environmental Health Specialty Units and state health  $5 mil ion to Pediatric Environmental Health Specialty Units and state health
departments “to provide guidance and outreach on safe practices for disinfection departments “to provide guidance and outreach on safe practices for disinfection
for home, school, and daycare facilities.” for home, school, and daycare facilities.”
U.S. Food and Drug Administration (FDA)
FDA regulates the safety of foods (including dietary supplements), cosmetics, and radiation-FDA regulates the safety of foods (including dietary supplements), cosmetics, and radiation-
emitting products; the safety and effectiveness of medical products (e.g., drugs, biologics, and emitting products; the safety and effectiveness of medical products (e.g., drugs, biologics, and
devices); and public health aspects of tobacco products.9 devices); and public health aspects of tobacco products.9
During the pandemic, FDA has engaged in premarket regulatory activities to facilitate the During the pandemic, FDA has engaged in premarket regulatory activities to facilitate the
availability of medical products for the treatment, prevention, mitigation, and diagnosis of availability of medical products for the treatment, prevention, mitigation, and diagnosis of
COVID-19, as wel as postmarket activities such as monitoring of medical product safety and COVID-19, as wel as postmarket activities such as monitoring of medical product safety and
~~supply chain issues.10 With respect to its premarket work, FDA has granted approval or~~

9 CRS Report R44576, 9 CRS Report R44576, The Food and Drug Administration (FDA) Budget: Fact Sheet. .
~~10 CRS Report R46507, FDA’s Role in the Medical Product Supply Chain and Considerations During COVID-19.~~
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Congress supply chain issues.10 With respect to its premarket work, FDA has granted approval, clearance, marketing authorization, or emergency use authorization (EUA) to COVID-19 therapeutics, vaccines, diagnostics, and other emergency use authorization (EUA) to COVID-19 therapeutics, vaccines, diagnostics, and other
medical devices (e.g., respirators and ventilators).11 FDA has issued guidance to facilitate medical devices (e.g., respirators and ventilators).11 FDA has issued guidance to facilitate
COVID-19 vaccine development, clarifying its expectations for licensure and EUA.12 As part of COVID-19 vaccine development, clarifying its expectations for licensure and EUA.12 As part of
its postmarket work, the agency has monitored medical product shortages and issued its postmarket work, the agency has monitored medical product shortages and issued ~~polic ies~~policies of of
enforcement discretion to increase availability of certain medical enforcement discretion to increase availability of certain medical products, including products, including in vitro diagnostics (e.g., tests), hand hand
sanitizer, surgical gowns, and face masks. To further address potential supply chain disruptions, sanitizer, surgical gowns, and face masks. To further address potential supply chain disruptions,
FDA has worked with the pharmaceutical industry and federal partners to accelerate the adoption FDA has worked with the pharmaceutical industry and federal partners to accelerate the adoption
of advanced manufacturing technologies (i.e., technologies that may improve medical product of advanced manufacturing technologies (i.e., technologies that may improve medical product
quality, reduce quality, reduce shortages, and speed time to market).13 shortages, and speed time to market).13
Across four of the five measures, FDA has received a total of $218 mil ion, including $196 Across four of the five measures, FDA has received a total of $218 mil ion, including $196
mil ion to the agencies’ accounts and a directed transfer from the PHSSEF to FDA of $22 mil ion mil ion to the agencies’ accounts and a directed transfer from the PHSSEF to FDA of $22 mil ion
in the fourth measure. This funding was provided in two categories: in the fourth measure. This funding was provided in two categories:
Broadly Available Funding. In the first, third, and fifth measures, funding was made available to In the first, third, and fifth measures, funding was made available to
FDA to “prevent, prepare for, and respond to coronavirus domestical y and international y.” The FDA to “prevent, prepare for, and respond to coronavirus domestical y and international y.” The
supplemental funds were to be used for activities such as pre- and postmarket work on medical supplemental funds were to be used for activities such as pre- and postmarket work on medical
countermeasures (e.g., therapeutics, vaccines, and diagnostics), EUAs, monitoring of medical countermeasures (e.g., therapeutics, vaccines, and diagnostics), EUAs, monitoring of medical
product supply chains, advanced manufacturing, and related administrative activities. In the first product supply chains, advanced manufacturing, and related administrative activities. In the first
and third measures, amounts were not designated for specific activities. and third measures, amounts were not designated for specific activities.
However, the fifth measure specified that FDA was to spend the total supplemental appropriation However, the fifth measure specified that FDA was to spend the total supplemental appropriation
of $55 mil ion as follows: of $55 mil ion as follows:
 $9 mil ion for the development of necessary medical countermeasures and  $9 mil ion for the development of necessary medical countermeasures and
vaccines, vaccines,
 $30.5 mil ion for advanced manufacturing of medical products,  $30.5 mil ion for advanced manufacturing of medical products,
 $1.5 mil ion for the monitoring of medical product supply chains,  $1.5 mil ion for the monitoring of medical product supply chains,
 $7.6 mil ion for other public health research and response investments,  $7.6 mil ion for other public health research and response investments,
 $1.4 mil ion for data management operation tools, and  $1.4 mil ion for data management operation tools, and
 $5 mil ion for after action review activities.  $5 mil ion for after action review activities.
Testing Activities. The fourth measure provided $22 mil ion to FDA, as a transfer from the The fourth measure provided $22 mil ion to FDA, as a transfer from the
PHSSEF account, to support activities associated with “diagnostic, serological, antigen, and other PHSSEF account, to support activities associated with “diagnostic, serological, antigen, and other
tests, and related administrative activities.” tests, and related administrative activities.”

10 CRS Report R46507, FDA’s Role in the Medical Product Supply Chain and Considerations During COVID-19. 11 FDA, Emergency Use Authorization, “ Coronavirus Disease 2019 (COVID-19) EUA Information,” 11 FDA, Emergency Use Authorization, “ Coronavirus Disease 2019 (COVID-19) EUA Information,”
https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-
use-authorization#covid19euas. See also CRS Report R46427, use-authorization#covid19euas. See also CRS Report R46427, Developm ent and Regulation of Medical
Counterm easures for COVID-19 (Vaccines, Diagnostics, and Treatm ents): Frequently Asked Questions. .
12 FDA, “ Development and Licensure of Vaccines to Prevent COVID-19,” Guidance for Industry, June 2020, 12 FDA, “ Development and Licensure of Vaccines to Prevent COVID-19,” Guidance for Industry, June 2020,
https://www.fda.gov/media/139638/download. FDA, “ Emergency Use Authorization for Vaccines to Prevent COVID-https://www.fda.gov/media/139638/download. FDA, “ Emergency Use Authorization for Vaccines to Prevent COVID-
19,” Guidance for Industry, October 2020, https://www.fda.gov/media/142749/download. 19,” Guidance for Industry, October 2020, https://www.fda.gov/media/142749/download.
13 FDA, “ Accelerating the Adoption of Advanced Manufacturing T echnologies to Strengthen Our Public Health 13 FDA, “ Accelerating the Adoption of Advanced Manufacturing T echnologies to Strengthen Our Public Health
Infrastructure,” January 15, 2021, https://www.fda.gov/news-events/fda-voices/accelerating-adoption-advanced-Infrastructure,” January 15, 2021, https://www.fda.gov/news-events/fda-voices/accelerating-adoption-advanced-
manufacturing-technologies-strengthen-our-public-health. See also, FDA, “ Advanced Manufacturing,” updated January manufacturing-technologies-strengthen-our-public-health. See also, FDA, “ Advanced Manufacturing,” updated January
16, 2021, https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/advanced-manufacturing. 16, 2021, https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/advanced-manufacturing.
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Health Resources and Services Administration (HRSA)
HRSA provides health care to individuals who are geographical y isolated, economical y or HRSA provides health care to individuals who are geographical y isolated, economical y or
medical y vulnerable, or both. HRSA programs target specific populations, including pregnant medical y vulnerable, or both. HRSA programs target specific populations, including pregnant
women and their children and individuals with HIV/AIDS. In addition, HRSA supports the health women and their children and individuals with HIV/AIDS. In addition, HRSA supports the health
care workforce; oversees organ, bone marrow, and cord blood donation; and administers the care workforce; oversees organ, bone marrow, and cord blood donation; and administers the
National Vaccine Injury Compensation program. HRSA currently awards funding to more than National Vaccine Injury Compensation program. HRSA currently awards funding to more than
3,000 grantees, including community-based organizations; colleges and universities; hospitals; 3,000 grantees, including community-based organizations; colleges and universities; hospitals;
state, local, and tribal governments; and private entities. These funds support health services state, local, and tribal governments; and private entities. These funds support health services
projects, such as training health care workers and providing specific health services.14 projects, such as training health care workers and providing specific health services.14
COVID-19 prevention, treatment, and response has involved a number of HRSA programs. For COVID-19 prevention, treatment, and response has involved a number of HRSA programs. For
example, the health centers program, HRSA’s largest program, provides grants to support more example, the health centers program, HRSA’s largest program, provides grants to support more
than 12,000 sites in underserved areas that provide primary care to disadvantaged populations than 12,000 sites in underserved areas that provide primary care to disadvantaged populations
regardless of their ability to pay.15 Because of their scope, health centers have been an important regardless of their ability to pay.15 Because of their scope, health centers have been an important
part of COVID-19 response.16 They have provided testing to underserved and largely minority part of COVID-19 response.16 They have provided testing to underserved and largely minority
populations. The Biden Administration has included health centers in its vaccine program populations. The Biden Administration has included health centers in its vaccine program
beginning in February 2021 as a way of reaching underserved populations.17 beginning in February 2021 as a way of reaching underserved populations.17
The Ryan White HIV/AIDS program (Ryan White) provides HIV/AIDS health care and related The Ryan White HIV/AIDS program (Ryan White) provides HIV/AIDS health care and related
health and social support services to individuals with HIV or AIDS. Individuals with HIV/AIDS health and social support services to individuals with HIV or AIDS. Individuals with HIV/AIDS
may be particularly vulnerable to serious COVID-19 infections.18 Ryan White sites have may be particularly vulnerable to serious COVID-19 infections.18 Ryan White sites have
undertaken prevention efforts and increased certain services (e.g., meal delivery) to facilitate undertaken prevention efforts and increased certain services (e.g., meal delivery) to facilitate
program participants’ ability to self-isolate to reduce their risk of infection. program participants’ ability to self-isolate to reduce their risk of infection.
During the pandemic, health care providers have increasingly used telehealth services to reduce During the pandemic, health care providers have increasingly used telehealth services to reduce
the spread of COVID-19 and conserve health care workforce time and supplies (e.g., personal the spread of COVID-19 and conserve health care workforce time and supplies (e.g., personal
protective equipment). HRSA has made long-standing investments in increasing telehealth in protective equipment). HRSA has made long-standing investments in increasing telehealth in
rural areas, which may have less access to technology and infrastructure needed to effectively rural areas, which may have less access to technology and infrastructure needed to effectively
deliver telehealth, and has increased this support during the pandemic.19 deliver telehealth, and has increased this support during the pandemic.19
HRSA received a total of $1.3 HRSA received a total of $1.3 ~~billion~~bil ion in COVID-19 supplemental mandatory funding for its in COVID-19 supplemental mandatory funding for its
Health Centers program in Division A of the CARES Act (P.L. 116-136). In addition, the first, Health Centers program in Division A of the CARES Act (P.L. 116-136). In addition, the first,
third, and fourth measures directed HHS to transfer a combined total of $975 mil ion to HRSA third, and fourth measures directed HHS to transfer a combined total of $975 mil ion to HRSA
from PHSSEF. These transfers are estimated to increase HRSA’s total budgetary resources for from PHSSEF. These transfers are estimated to increase HRSA’s total budgetary resources for
pandemic-related activities to nearly $2.3 bil ion. Moreover, HRSA administers several pandemic pandemic-related activities to nearly $2.3 bil ion. Moreover, HRSA administers several pandemic
response programs funded by the PHSSEF account: (1) the Uninsured Fund for testing, which response programs funded by the PHSSEF account: (1) the Uninsured Fund for testing, which
received funds in two of the measures, (2) the Provider Relief Fund, which received funds in received funds in two of the measures, (2) the Provider Relief Fund, which received funds in

14 See HRSA’s website at http://www.hrsa.gov. 14 See HRSA’s website at http://www.hrsa.gov.
15 See https://data.hrsa.gov/. 15 See https://data.hrsa.gov/.
16 CRS Insight IN11367, 16 CRS Insight IN11367, Federal Health Centers and COVID-19. .
17 “President Biden Announces Community Health Centers Vaccination Program to Launch Next Week 17 “President Biden Announces Community Health Centers Vaccination Program to Launch Next Week ~~and~~a nd Another Another
Increase in States, T ribes, & T erritories’ Vaccine Supply,” press release, February 9, 2021, Increase in States, T ribes, & T erritories’ Vaccine Supply,” press release, February 9, 2021,
https://www.whitehouse.gov/briefing-room/statements-releases/2021/02/09/fact-sheet-president -biden-announces-https://www.whitehouse.gov/briefing-room/statements-releases/2021/02/09/fact-sheet-president -biden-announces-
community-health-centers-vaccination-program-to-launch-next-week-and-another-increase-in-states-tribes-territories-community-health-centers-vaccination-program-to-launch-next-week-and-another-increase-in-states-tribes-territories-
vaccine-supply/, and HRSA, “ Ensuring Equity in COVID-19 Vaccine Distribution,” https://www.hrsa.gov/coronavirus/vaccine-supply/, and HRSA, “ Ensuring Equity in COVID-19 Vaccine Distribution,” https://www.hrsa.gov/coronavirus/
health-center-program. health-center-program.
18 HIV.gov, “Coronavirus (COVID-19) and People with HIV,” press release, December 30, 2020, https://www.hiv.gov/ 18 HIV.gov, “Coronavirus (COVID-19) and People with HIV,” press release, December 30, 2020, https://www.hiv.gov/
hiv-basics/staying-in-hiv-care/other-related-health-issues/coronavirus-covid-19. hiv-basics/staying-in-hiv-care/other-related-health-issues/coronavirus-covid-19.
19 CRS Report R44437, 19 CRS Report R44437, Telehealth and Telemedicine: Description and Issues. .
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three of the measures, and (3) testing programs at rural health clinics, which received funds in one three of the measures, and (3) testing programs at rural health clinics, which received funds in one
of the measures. HRSA funding and programs are described in greater detail below. of the measures. HRSA funding and programs are described in greater detail below.
Health Centers. The Health Centers program received funding in the first, third, and fourth The Health Centers program received funding in the first, third, and fourth
measures. In the first and fourth measures, funding was provided as transfers from the PHSSEF measures. In the first and fourth measures, funding was provided as transfers from the PHSSEF
account, including $100 mil ion in the first measure and $600 mil ion specified for testing-related account, including $100 mil ion in the first measure and $600 mil ion specified for testing-related
activities in the fourth measure. Funding in the fourth measure was specifical y made available to activities in the fourth measure. Funding in the fourth measure was specifical y made available to
federal y qualified health center look-alikes.20 Health centers received $1.3 bil ion as a mandatory federal y qualified health center look-alikes.20 Health centers received $1.3 bil ion as a mandatory
appropriation in the third measure to supplement existing health center grant awards. The law appropriation in the third measure to supplement existing health center grant awards. The law
directed these funds specifical y for supplementary awards to health centers for “the detection of directed these funds specifical y for supplementary awards to health centers for “the detection of
SARS–CoV–2 [the virus that causes COVID-19] or the prevention, diagnosis, and treatment of SARS–CoV–2 [the virus that causes COVID-19] or the prevention, diagnosis, and treatment of
COVID–19.”21 Al told, the Health Centers program has received additional budgetary resources COVID–19.”21 Al told, the Health Centers program has received additional budgetary resources
totaling roughly $2 bil ion. totaling roughly $2 bil ion.
Additional Support for Existing HRSA Programs. The third measure included a transfer of The third measure included a transfer of
$275 mil ion from the PHSSEF to HRSA to support three agency programs: $275 mil ion from the PHSSEF to HRSA to support three agency programs:
 $90 mil ion to supplement grants awarded as part of the Ryan White HIV/AIDS  $90 mil ion to supplement grants awarded as part of the Ryan White HIV/AIDS
program to support pandemic response, program to support pandemic response,
 $5 mil ion transfer to “improve the capacity of poison control centers to respond  $5 mil ion transfer to “improve the capacity of poison control centers to respond
to increased cal s,” and to increased cal s,” and
 $180 mil ion for telehealth and rural health activities, of which not less than $15  $180 mil ion for telehealth and rural health activities, of which not less than $15
mil ion was reserved for Indian Tribes (ITs), Tribal Organizations (TOs), Urban mil ion was reserved for Indian Tribes (ITs), Tribal Organizations (TOs), Urban
Indian health organizations (UIOs), and health service providers to tribes. These Indian health organizations (UIOs), and health service providers to tribes. These
funds were provided to support smal rural hospitals in their pandemic response funds were provided to support smal rural hospitals in their pandemic response
and were awarded to telehealth resource centers to provide technical assistance to and were awarded to telehealth resource centers to provide technical assistance to
rural areas to aid with pandemic response.22 rural areas to aid with pandemic response.22
New Funds that HRSA Administers. The various measures created two new funding streams, The various measures created two new funding streams,
from PHSSEF funds, to support health care providers in responding to the pandemic: from PHSSEF funds, to support health care providers in responding to the pandemic:
  The Uninsured Fund: The Uninsured Fund, which was created to pay for health The Uninsured Fund, which was created to pay for health
care expenses of the uninsured during the pandemic, received a total of not more care expenses of the uninsured during the pandemic, received a total of not more
than $2 bil ion to pay for costs associated with testing the uninsured. The second than $2 bil ion to pay for costs associated with testing the uninsured. The second
measure appropriated $1 bil ion to the PHSSEF to reimburse providers for measure appropriated $1 bil ion to the PHSSEF to reimburse providers for
uninsured testing. Though no administering agency was specified, the language uninsured testing. Though no administering agency was specified, the language
in the second measure stated that reimbursements were to be made in “in in the second measure stated that reimbursements were to be made in “in
coordination with the Assistant Secretary for Preparedness and Response and the coordination with the Assistant Secretary for Preparedness and Response and the
Administrator of the Centers for Medicare & Medicaid Services.” HHS elected to Administrator of the Centers for Medicare & Medicaid Services.” HHS elected to
have HRSA administer these funds as part of the Uninsured Fund.23 Uninsured have HRSA administer these funds as part of the Uninsured Fund.23 Uninsured
testing subsequently received an additional not more than $1 bil ion transfer in testing subsequently received an additional not more than $1 bil ion transfer in
the fourth measure. the fourth measure.

20 CRS Report R46325, 20 CRS Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief. .
21 §3211 of P.L. 116-136. 21 §3211 of P.L. 116-136.
22 HHS, HRSA, “HHS Awards Nearly $165 Million to Combat the COVID-19 Pandemic in Rural Communities,” press 22 HHS, HRSA, “HHS Awards Nearly $165 Million to Combat the COVID-19 Pandemic in Rural Communities,” press
release, April 22, 2020, https://public3.pagefreezer.com/content/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/release, April 22, 2020, https://public3.pagefreezer.com/content/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/
about/news/2020/04/22/hhs-awards-nearly-165-million-to-combat -covid19-pandemic-in-rural-communities.html. about/news/2020/04/22/hhs-awards-nearly-165-million-to-combat -covid19-pandemic-in-rural-communities.html.
23 CRS Insight IN11526, 23 CRS Insight IN11526, COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and
Treatm ent. See also CRS Report R46481, . See also CRS Report R46481, COVID-19 Testing: Frequently Asked Questions. .
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  Provider Relief Fund: The Provider Relief Fund (PRF), which was created to The Provider Relief Fund (PRF), which was created to
reimburse health care providers for lost revenues and increased expenses during reimburse health care providers for lost revenues and increased expenses during
the pandemic, received a total of $178 bil ion across three measures. The third the pandemic, received a total of $178 bil ion across three measures. The third
measure provided the PHSSEF with $100 bil ion “to reimburse, through grants or measure provided the PHSSEF with $100 bil ion “to reimburse, through grants or
other mechanisms, eligible health care providers for health care related expenses other mechanisms, eligible health care providers for health care related expenses
or lost revenues that are attributable to coronavirus.” This fund was later termed or lost revenues that are attributable to coronavirus.” This fund was later termed
the Provider Relief Fund and is administered by HRSA, though the third measure the Provider Relief Fund and is administered by HRSA, though the third measure
did not use this term, nor did it specify an administering agency for the fund.24 did not use this term, nor did it specify an administering agency for the fund.24
Subsequent measures increased PRF to a total of $178 bil ion—with $75 bil ion Subsequent measures increased PRF to a total of $178 bil ion—with $75 bil ion
provided in the fourth measure and $3 bil ion provided in the fifth measure. The provided in the fourth measure and $3 bil ion provided in the fifth measure. The
Trump Administration elected to use an unspecified amount of the third measure Trump Administration elected to use an unspecified amount of the third measure
appropriation to reimburse providers for uninsured treatment, which is appropriation to reimburse providers for uninsured treatment, which is
administered in conjunction with the appropriation for uninsured testing as the administered in conjunction with the appropriation for uninsured testing as the
Uninsured Fund. This fund was subsequently expanded to enable reimbursement Uninsured Fund. This fund was subsequently expanded to enable reimbursement
of costs for vaccination services for the uninsured and underinsured.25 of costs for vaccination services for the uninsured and underinsured.25
In addition to these larger funds, HRSA administers the $225 mil ion transferred from the In addition to these larger funds, HRSA administers the $225 mil ion transferred from the
PHSSEF in the fourth measure for testing at rural health clinics (RHCs)—smal outpatient clinics PHSSEF in the fourth measure for testing at rural health clinics (RHCs)—smal outpatient clinics
located in rural areas. As directed in the law, funds are to be awarded through grants or other located in rural areas. As directed in the law, funds are to be awarded through grants or other
mechanisms “for building or construction of temporary structures, leasing of properties, and mechanisms “for building or construction of temporary structures, leasing of properties, and
retrofitting facilities as necessary to support COVID–19 testing.” Although RHCs are similar to retrofitting facilities as necessary to support COVID–19 testing.” Although RHCs are similar to
health centers, a dedicated grant program for RHCs did not exist prior to the pandemic. As such, health centers, a dedicated grant program for RHCs did not exist prior to the pandemic. As such,
unlike health centers, where grants can be supplemented, RHCs required a new funding process unlike health centers, where grants can be supplemented, RHCs required a new funding process
to receive funds—a process that was undertaken by HRSA.26 The law did not specify which to receive funds—a process that was undertaken by HRSA.26 The law did not specify which
agency is to administer these funds. agency is to administer these funds.
Indian Health Service (IHS)
The Indian Health Service (IHS) provides health care to American Indian and Alaska Native The Indian Health Service (IHS) provides health care to American Indian and Alaska Native
populations. Such health care is provided either directly, by providing funds for Indian Tribes populations. Such health care is provided either directly, by providing funds for Indian Tribes
(ITs) or Tribal Organizations (TOs) to operate health care facilities, or by providing grants to (ITs) or Tribal Organizations (TOs) to operate health care facilities, or by providing grants to
Urban Indian Health Organizations (UIOs) to provide care to American Indians and Alaska Urban Indian Health Organizations (UIOs) to provide care to American Indians and Alaska
Natives in urban areas.27 IHS general y provides services free of charge to approximately 2.6 Natives in urban areas.27 IHS general y provides services free of charge to approximately 2.6
mil ion eligible American Indians and Alaska Natives in 37 states.28 More than two-thirds of IHS mil ion eligible American Indians and Alaska Natives in 37 states.28 More than two-thirds of IHS
facilities are operated by ITs/TOs through contracts or compacts authorized under the Indian Self- facilities are operated by ITs/TOs through contracts or compacts authorized under the Indian Self-
Determination and Education Assistance Act (ISDEAA, P.L. 93-638). ITs/TOs general y contract Determination and Education Assistance Act (ISDEAA, P.L. 93-638). ITs/TOs general y contract

24 CRS Insight IN11438, 24 CRS Insight IN11438, The COVID-19 Health Care Provider Relief Fund. .
25 25 ~~CRS communication with CDC, March 1, 2021.~~
HRSA, COVID-19 Coverage Assistance Fund, https://www.hrsa.gov/covid19-coverage-assistance. 26 HHS, HRSA, “HHS Provides $225 Million for COVID-19 T esting in Rural Communities,” press release, May 20, 26 HHS, HRSA, “HHS Provides $225 Million for COVID-19 T esting in Rural Communities,” press release, May 20,
2020, https://public3.pagefreezer.com/content/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/about/news/2020/05/2020, https://public3.pagefreezer.com/content/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/about/news/2020/05/
20/hhs-provides-225-million-for-covid19-testing-in-rural-communities.html. 20/hhs-provides-225-million-for-covid19-testing-in-rural-communities.html.
27 T he Indian Health Service (IHS) also provides grants to Urban Indian Organizations (UIOs) that operate smaller 27 T he Indian Health Service (IHS) also provides grants to Urban Indian Organizations (UIOs) that operate smaller
health facilities in urban areas. T hese facilities vary in terms of the services available, with some providing health facilities in urban areas. T hese facilities vary in terms of the services available, with some providing
comprehensive services, whereas others provide information comprehensive services, whereas others provide information ~~an d~~and referral services. Outside of the grants they receive, referral services. Outside of the grants they receive,
UIOs are generally not eligible for funds from the overall IHS budget, with some exceptions. SeeUIOs are generally not eligible for funds from the overall IHS budget, with some exceptions. See CRS Report R43330, CRS Report R43330,
The Indian Health Service (IHS): An Overview. .
28 HHS, IHS, 28 HHS, IHS, Fiscal Year 2021 Indian Health Service Justification of Estimates, https://www.ihs.gov/sites/, https://www.ihs.gov/sites/
budgetformulation/themes/responsive2017/display_objects/documents/FY_2021_Final_CJ-IHS.pdf. Facilities operated budgetformulation/themes/responsive2017/display_objects/documents/FY_2021_Final_CJ-IHS.pdf. Facilities operated
by IHS are prohibited to charge for services; facilities operated by Indian T ribes, T ribal Organizations, or UIOs may by IHS are prohibited to charge for services; facilities operated by Indian T ribes, T ribal Organizations, or UIOs may
charge for services. charge for services.
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or compact for services that IHS would have otherwise provided by entering into a funding or compact for services that IHS would have otherwise provided by entering into a funding
agreement that delineates the services funded under the agreement. agreement that delineates the services funded under the agreement.
Funding has been provided to IHS for COVID-19 pandemic response, in part, because of the Funding has been provided to IHS for COVID-19 pandemic response, in part, because of the
agency’s role as a direct health care provider. In that role, the agency directly supports testing, agency’s role as a direct health care provider. In that role, the agency directly supports testing,
treatment, and vaccination services for its service population, which has been disproportional y treatment, and vaccination services for its service population, which has been disproportional y
affected by the pandemic. A number of IHS areas, including the Navajo area, experienced early affected by the pandemic. A number of IHS areas, including the Navajo area, experienced early
and sustained outbreaks of COVID-19 infections. Data show high COVID-19 mortality rates and sustained outbreaks of COVID-19 infections. Data show high COVID-19 mortality rates
among American Indians and Alaska Natives.29 IHS, like other health systems, experienced among American Indians and Alaska Natives.29 IHS, like other health systems, experienced
increased demand for intensive COVID-19 related services, while seeing declining revenue from increased demand for intensive COVID-19 related services, while seeing declining revenue from
cancel ed or delayed routine and elective care.30 In addition to providing health services related to cancel ed or delayed routine and elective care.30 In addition to providing health services related to
COVID-19, IHS supports certain public health and health education activities (similar to those of COVID-19, IHS supports certain public health and health education activities (similar to those of
CDC). CDC).
Across four of the five measures, IHS received $1.1 bil ion in supplemental appropriations to the Across four of the five measures, IHS received $1.1 bil ion in supplemental appropriations to the
agency accounts and a total of not less than $1.8 bil ion in directed transfers and set-asides either agency accounts and a total of not less than $1.8 bil ion in directed transfers and set-asides either
(1) to agency accounts or (2) to be al ocated at the discretion of the IHS Director in other (1) to agency accounts or (2) to be al ocated at the discretion of the IHS Director in other
accounts. In total, accounting for transfers and set-asides, budgetary resources of at least $2.8 accounts. In total, accounting for transfers and set-asides, budgetary resources of at least $2.8
bil ion have been made available either to IHS accounts or at the direction of the IHS Director. In bil ion have been made available either to IHS accounts or at the direction of the IHS Director. In
addition, a total of not less than $320 mil ion has been reserved for tribal entities (i.e., addition, a total of not less than $320 mil ion has been reserved for tribal entities (i.e.,
ITs/TO/UIOs) from funds that were appropriated to other HHS accounts but were not specifical y ITs/TO/UIOs) from funds that were appropriated to other HHS accounts but were not specifical y
directed to IHS. directed to IHS.
Funding has been provided to IHS in three categories: (1) funding for testing, (2) funding for Funding has been provided to IHS in three categories: (1) funding for testing, (2) funding for
health services and infrastructure, and (3) funding for vaccines. In addition, funds have been health services and infrastructure, and (3) funding for vaccines. In addition, funds have been
provided to tribal entities (i.e., ITs/TO/UIOs), but not specifical y to IHS, for public health provided to tribal entities (i.e., ITs/TO/UIOs), but not specifical y to IHS, for public health
activities and telehealth and behavioral health. activities and telehealth and behavioral health.
Funding for Testing. IHS received funding for testing-related activities in the second, fourth, and IHS received funding for testing-related activities in the second, fourth, and
fifth measures. In the second measure, $64 mil ion was provided directly to IHS for COVID-19 fifth measures. In the second measure, $64 mil ion was provided directly to IHS for COVID-19
testing, test administration, and related items and services.31 In the fourth measure, of the not less testing, test administration, and related items and services.31 In the fourth measure, of the not less
than $11 bil ion in that measure set aside for SLTT grants for testing-related activities, not less than $11 bil ion in that measure set aside for SLTT grants for testing-related activities, not less
than $750 mil ion was provided in the PHSSEF account to be al ocated in consultation with the than $750 mil ion was provided in the PHSSEF account to be al ocated in consultation with the
IHS director. The law did not specify that these funds be transferred to IHS; however, HHS IHS director. The law did not specify that these funds be transferred to IHS; however, HHS
eventual y did so.32 The fifth measure directed that $790 mil ion be transferred to IHS from the eventual y did so.32 The fifth measure directed that $790 mil ion be transferred to IHS from the
PHSSEF for testing, contact tracing, surveil ance, and containment, among other purposes. The PHSSEF for testing, contact tracing, surveil ance, and containment, among other purposes. The
law specified that funds were to be al ocated, at the discretion of the IHS Director, to IT/TOs law specified that funds were to be al ocated, at the discretion of the IHS Director, to IT/TOs
through ISDEAA contracts and compacts, and to UIOs through grants or contracts. In total, IHS through ISDEAA contracts and compacts, and to UIOs through grants or contracts. In total, IHS
has been provided not less than $1.6 bil ion for testing-related purposes. has been provided not less than $1.6 bil ion for testing-related purposes.
Funding for Health Services and Infrastructure. The third measure appropriated $1.032 bil ion The third measure appropriated $1.032 bil ion
to the IHS Indian Health Services account. Specifical y, funds were provided to to the IHS Indian Health Services account. Specifical y, funds were provided to

29 Jessica Arrazola et al., 29 Jessica Arrazola et al., COVID-19 Mortality Among American Indian and Alaska Native Persons—14 States,
January–June 2020, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly (69)(49), Atlanta, , Centers for Disease Control and Prevention, Morbidity and Mortality Weekly (69)(49), Atlanta,
GA, December 11, 2020, https://www.cdc.gov/mmwr/volumes/69/wr/mm6949a3.htm?s_cid=mm6949a3_w. GA, December 11, 2020, https://www.cdc.gov/mmwr/volumes/69/wr/mm6949a3.htm?s_cid=mm6949a3_w.
30 See CRS Insight IN11333, 30 See CRS Insight IN11333, COVID-19 and the Indian Health Service. .
31 T he law waived cost sharing for testing provided to Indian Health Service (IHS) beneficiaries who receive services 31 T he law waived cost sharing for testing provided to Indian Health Service (IHS) beneficiaries who receive services
outside of IHS facilities, but authorized payment with IHS funding. For more information, see CRS Report R46316, outside of IHS facilities, but authorized payment with IHS funding. For more information, see CRS Report R46316,
Health Care Provisions in the Fam ilies First Coronavirus Response Act, P.L. 116 -127. .
32 Letter from Michael D. Weahkee, Director, Indian Health Service, to T ribal Leader and Urban Indian Organization 32 Letter from Michael D. Weahkee, Director, Indian Health Service, to T ribal Leader and Urban Indian Organization
Leader:, May 19, 2020, https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/Leader:, May 19, 2020, https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/
2020_Letters/DTLL_DUIOLL_05192020.pdf. 2020_Letters/DTLL_DUIOLL_05192020.pdf.
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respond to coronavirus, domestically or internationally, including for public health support, respond to coronavirus, domestically or internationally, including for public health support,
electronic health record modernization, telehealth and other information technology electronic health record modernization, telehealth and other information technology
upgrades, Purchased/Referred Care, Catastrophic Health Emergency Fund, Urban Indian upgrades, Purchased/Referred Care, Catastrophic Health Emergency Fund, Urban Indian
Organizations, Tribal Epidemiology Centers, Community Health Representatives, and Organizations, Tribal Epidemiology Centers, Community Health Representatives, and
other activities to protect the safety of patients and staff. other activities to protect the safety of patients and staff.
Purchased/Referred Care and the Catastrophic Health Emergency Fund are both mechanisms Purchased/Referred Care and the Catastrophic Health Emergency Fund are both mechanisms
used to pay for care provided to beneficiaries at non-IHS facilities. Tribal Epidemiology Centers used to pay for care provided to beneficiaries at non-IHS facilities. Tribal Epidemiology Centers
(TEC) and Community Health Representatives perform public health activities for the IHS (TEC) and Community Health Representatives perform public health activities for the IHS
system. TECs conduct surveil ance and epidemiology activities for IHS service areas. system. TECs conduct surveil ance and epidemiology activities for IHS service areas.
Community Health Representatives are general y paraprofessionals involved in activities such as Community Health Representatives are general y paraprofessionals involved in activities such as
health education and disease prevention. Further, the law specified that not less than $450 mil ion health education and disease prevention. Further, the law specified that not less than $450 mil ion
was for ITs/TOs to supplement their existing ISDEAA contracts and compacts, and that not more was for ITs/TOs to supplement their existing ISDEAA contracts and compacts, and that not more
than $125 mil ion was for the Indian Health Facilities account and to be al ocated at the discretion than $125 mil ion was for the Indian Health Facilities account and to be al ocated at the discretion
of the IHS Director.33 The Indian Health Facilities account is used for facility and equipment- of the IHS Director.33 The Indian Health Facilities account is used for facility and equipment-
related expenses. related expenses.
Funding for Vaccine Distribution. In the fifth measure, CDC was directed to transfer $210 In the fifth measure, CDC was directed to transfer $210
mil ion to IHS “for activities to plan, prepare for, promote, distribute, administer, monitor, and mil ion to IHS “for activities to plan, prepare for, promote, distribute, administer, monitor, and
track coronavirus vaccines to ensure broad-based distribution, access, and vaccine coverage.” The track coronavirus vaccines to ensure broad-based distribution, access, and vaccine coverage.” The
law specified that these funds were to be al ocated at the discretion of the IHS Director, to IT/TOs law specified that these funds were to be al ocated at the discretion of the IHS Director, to IT/TOs
through ISDEAA contracts and compacts, and to UIOs through grants or contracts. through ISDEAA contracts and compacts, and to UIOs through grants or contracts.
Funding for Tribal Entities
As discussed elsewhere in this report, some of the measures directed that funding in certain As discussed elsewhere in this report, some of the measures directed that funding in certain
accounts (e.g., CDC, SAMHSA) be made available to tribal entities (ITs, TOs, UIOs, and health accounts (e.g., CDC, SAMHSA) be made available to tribal entities (ITs, TOs, UIOs, and health
service providers to tribes); however, the measures did not specify that these funds be transferred service providers to tribes); however, the measures did not specify that these funds be transferred
to IHS. to IHS.
Funding for Public Health Activities. Several CDC appropriations have been directed to tribal Several CDC appropriations have been directed to tribal
entities in the first and third measures. The first and third measure required that not less than $40 entities in the first and third measures. The first and third measure required that not less than $40
mil ion and not less than $125 mil ion, respectively, in CDC funds for SLTT grants be made mil ion and not less than $125 mil ion, respectively, in CDC funds for SLTT grants be made
available to ITs/TOs, UIOs, and health providers to Indian Tribes for “surveil ance, epidemiology, available to ITs/TOs, UIOs, and health providers to Indian Tribes for “surveil ance, epidemiology,
laboratory capacity, and other preparedness and response activities.” CDC awarded much of this laboratory capacity, and other preparedness and response activities.” CDC awarded much of this
funding using new noncompetitive grant mechanisms to tribal nations, consortia, and funding using new noncompetitive grant mechanisms to tribal nations, consortia, and
organizations, as wel as through some of its existing grant relationships with regional tribal organizations, as wel as through some of its existing grant relationships with regional tribal
organizations.34 As noted above, some of the funds provided directly to the Indian Health organizations.34 As noted above, some of the funds provided directly to the Indian Health
Services account in the third measure were to be used for public health activities conducted by Services account in the third measure were to be used for public health activities conducted by
IHS. IHS.
Funding for Telehealth and Behavioral Health. The third and fifth measures included set-aside The third and fifth measures included set-aside
funding for tribal entities in both HRSA and SAMHSA appropriations. For HRSA, the third funding for tribal entities in both HRSA and SAMHSA appropriations. For HRSA, the third
measure specified that of the amount transferred from PHSSEF to HRSA’s Office of Rural Health measure specified that of the amount transferred from PHSSEF to HRSA’s Office of Rural Health
for telehealth and rural health activities, not less than $15 mil ion was to be al ocated to ITs/TOs, for telehealth and rural health activities, not less than $15 mil ion was to be al ocated to ITs/TOs,
UIOS, or health service providers to tribes. These funds were subsequently provided to facilitate UIOS, or health service providers to tribes. These funds were subsequently provided to facilitate

33 For more information about IHS’s budget accounts, see CRS Report R46490, 33 For more information about IHS’s budget accounts, see CRS Report R46490, Indian Health Service (IHS) FY2021
Budget Request and Funding History: In Brief. .
34 CDC, “CDC COVID-19 Funding for T ribes,” https://www.cdc.gov/budget/documents/covid-19/CDC-COVID-19- 34 CDC, “CDC COVID-19 Funding for T ribes,” https://www.cdc.gov/budget/documents/covid-19/CDC-COVID-19-
Funding-for-T ribes-508.pdf. Funding-for-T ribes-508.pdf.
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the ability of ITs/TOs to provide telehealth to their service populations. 35 In addition, SAMHSA the ability of ITs/TOs to provide telehealth to their service populations. 35 In addition, SAMHSA
appropriations included set-asides for tribal entities for behavioral health activities in two of the appropriations included set-asides for tribal entities for behavioral health activities in two of the
measures, specifical y not less than $15 mil ion in the third measure and not less than $125 measures, specifical y not less than $15 mil ion in the third measure and not less than $125
mil ion in the fifth measure. As directed in the measures, these appropriations were to be mil ion in the fifth measure. As directed in the measures, these appropriations were to be
al ocated to ITs/TOs/UIOS and to behavioral health service providers to tribes. al ocated to ITs/TOs/UIOS and to behavioral health service providers to tribes.
National Institutes of Health (NIH)
NIH is the nation’s lead medical and health agency. It supports much of the basic biomedical NIH is the nation’s lead medical and health agency. It supports much of the basic biomedical
research in the United States and some development of new medical products. NIH is made up of research in the United States and some development of new medical products. NIH is made up of
27 institutes and centers (ICs) and the Office of the Director (OD). Of the ICs, 24 ICs and OD 27 institutes and centers (ICs) and the Office of the Director (OD). Of the ICs, 24 ICs and OD
support research programs; each IC has broad responsibilities to support research, scientific support research programs; each IC has broad responsibilities to support research, scientific
training, information dissemination and health and medical science as related to its respective training, information dissemination and health and medical science as related to its respective
mission. In general, about 80% of NIH’s budget supports extramural research through grants, mission. In general, about 80% of NIH’s budget supports extramural research through grants,
contracts, and other awards to research institutions (e.g., universities, medical centers) and 10% contracts, and other awards to research institutions (e.g., universities, medical centers) and 10%
supports intramural research at NIH-operated laboratories and facilities.36 During the pandemic, supports intramural research at NIH-operated laboratories and facilities.36 During the pandemic,
NIH has supported scientific research on the virus and disease, as wel as the development of NIH has supported scientific research on the virus and disease, as wel as the development of
vaccines, therapeutics, and diagnostics. vaccines, therapeutics, and diagnostics. ItNIH has also published and maintained treatment has also published and maintained treatment ~~guidelines~~
guidelines and other health information. and other health information.
Across four of the five measures, NIH received a total of $3.0 bil ion to NIH IC accounts Across four of the five measures, NIH received a total of $3.0 bil ion to NIH IC accounts, along along
with directed transfers from the PHSSEF account to NIH accounts totaling not less than $1.8 with directed transfers from the PHSSEF account to NIH accounts totaling not less than $1.8
bil ion. Accounting for transfers, NIH is to receive a total of at least $4.8 bil ion. This funding bil ion. Accounting for transfers, NIH is to receive a total of at least $4.8 bil ion. This funding
was primarily provided in three categories: was primarily provided in three categories:
Broadly Available Funding. In the first and third measure, funding was made available to In the first and third measure, funding was made available to
several NIH IC accounts “to prevent, prepare for and respond to coronavirus, domestical y and several NIH IC accounts “to prevent, prepare for and respond to coronavirus, domestical y and
international y.” Uses of the funds would be governed by the mission and authority of the ICs international y.” Uses of the funds would be governed by the mission and authority of the ICs
receiving funds. For example, the National Institute of Al ergy and Infectious Diseases (NIAID) receiving funds. For example, the National Institute of Al ergy and Infectious Diseases (NIAID)
supports research, training, and information dissemination related to “al ergic and immunologic supports research, training, and information dissemination related to “al ergic and immunologic
diseases and disorders and infectious diseases, including tropical diseases.”37 The National Heart, diseases and disorders and infectious diseases, including tropical diseases.”37 The National Heart,
Lung, and Blood Institute (NHLBI) supports research, training, and information dissemination Lung, and Blood Institute (NHLBI) supports research, training, and information dissemination
related to “heart, blood vessel, lung, and blood diseases.”38 NIH IC accounts that received broadly related to “heart, blood vessel, lung, and blood diseases.”38 NIH IC accounts that received broadly
available funds and their totals include the following: available funds and their totals include the following:
  NIAID: $1.5 bil ion, including $836 mil ion in the first measure and $706 $1.5 bil ion, including $836 mil ion in the first measure and $706
mil ion in the third measure. Some transfers or set-asides were directed for mil ion in the third measure. Some transfers or set-asides were directed for
specific purposes in the NIAID appropriations. The first measure directed a specific purposes in the NIAID appropriations. The first measure directed a
transfer of not less than $10 mil ion to the National Institute of Environmental transfer of not less than $10 mil ion to the National Institute of Environmental
Health Sciences (NIEHS) for “worker-based training to prevent and reduce Health Sciences (NIEHS) for “worker-based training to prevent and reduce
exposure of hospital employees, emergency first responders, and other workers exposure of hospital employees, emergency first responders, and other workers
who are at risk of exposure to coronavirus through their work duties.” The third who are at risk of exposure to coronavirus through their work duties.” The third
measure set aside not less than $156 mil ion of the total for “the study of, measure set aside not less than $156 mil ion of the total for “the study of,
construction of, demolition of, renovation of, and acquisition of equipment for, construction of, demolition of, renovation of, and acquisition of equipment for,

35 For information on these awards, see HHS, HRSA, “HHS Awards $15 Million to Combat the COVID-19 Pandemic 35 For information on these awards, see HHS, HRSA, “HHS Awards $15 Million to Combat the COVID-19 Pandemic
in Rural T ribal Communities,” press release, May 28, 2020, https://public3.pagefreezer.com/content/HHS.gov/31-12-in Rural T ribal Communities,” press release, May 28, 2020, https://public3.pagefreezer.com/content/HHS.gov/31-12-
2020T 08:51/https://www.hhs.gov/about/news/2020/05/28/hhs-awards-15-million-to-combat -covid19-pandemic-in-2020T 08:51/https://www.hhs.gov/about/news/2020/05/28/hhs-awards-15-million-to-combat -covid19-pandemic-in-
rural-tribal-communities.html. rural-tribal-communities.html.
36 CRS Report R41705, 36 CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues. .
37 Public Health Service Act (PHSA) Section 446, 42 U.S.C. §285f. 37 Public Health Service Act (PHSA) Section 446, 42 U.S.C. §285f.
38 Public Health Service Act (PHSA) Section 419, 42 U.S.C. §285b-1. 38 Public Health Service Act (PHSA) Section 419, 42 U.S.C. §285b-1.
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vaccine and infectious diseases research facilities of or used by NIH, including vaccine and infectious diseases research facilities of or used by NIH, including
the acquisition of real property.” the acquisition of real property.”
  NHLBI: $103.4 mil ion in the third measure.$103.4 mil ion in the third measure.
  National Institute of Biomedical Imaging and Bioengineering (NIBIB): $60 $60
mil ion in the third measure. mil ion in the third measure.
  National Library of Medicine (NLM): $10 mil ion in the third measure. $10 mil ion in the third measure.
  National Center for Advancing Translational Sciences (NCATS): $36 mil ion $36 mil ion
in the third measure. in the third measure.
  Office of the Director (OD): $30 mil ion in the third measure. $30 mil ion in the third measure.
Diagnostic Testing Research and Development (R&D). In the fourth and fifth measure, NIH In the fourth and fifth measure, NIH
received funding for specific purposes related to diagnostic test R&D. This funding was directed received funding for specific purposes related to diagnostic test R&D. This funding was directed
to NIH as “not less than” transfers from the PHSSEF account in the fourth measure, and directly to NIH as “not less than” transfers from the PHSSEF account in the fourth measure, and directly
to the OD account in the fifth measure. These amounts include the following: to the OD account in the fifth measure. These amounts include the following:
  National Cancer Institute (NCI): Transfer of not less than $306 mil ion from Transfer of not less than $306 mil ion from
PHSSEF to NCI “to develop, validate, improve, and implement serological PHSSEF to NCI “to develop, validate, improve, and implement serological
testing and associated technologies.” testing and associated technologies.”
  NIBIB: Transfer of not less than $500 mil ion from PHSSEF to NIBIB “to Transfer of not less than $500 mil ion from PHSSEF to NIBIB “to
accelerate research, development, and implementation of point of care and other accelerate research, development, and implementation of point of care and other
rapid testing related to coronavirus.” rapid testing related to coronavirus.”
  OD: Transfer of not less than $1 bil ion from PHSSEF to OD “to develop, Transfer of not less than $1 bil ion from PHSSEF to OD “to develop,
validate, improve, and implement testing and associated technologies; to validate, improve, and implement testing and associated technologies; to
accelerate research, development, and implementation of point of care and other accelerate research, development, and implementation of point of care and other
rapid testing; and for partnerships with governmental and non-governmental rapid testing; and for partnerships with governmental and non-governmental
entities.” In the fifth measure, not less than $100 mil ion of the $1.25 bil ion total entities.” In the fifth measure, not less than $100 mil ion of the $1.25 bil ion total
provided to the OD account is for “the Rapid Acceleration of Diagnostics.” provided to the OD account is for “the Rapid Acceleration of Diagnostics.”
NIH’s Rapid Acceleration of Diagnostics (RADx) initiative is a prize competition for diagnostics NIH’s Rapid Acceleration of Diagnostics (RADx) initiative is a prize competition for diagnostics
development. As communicated to CRS, the $1.5 bil ion total for NIBIB and OD in the fourth development. As communicated to CRS, the $1.5 bil ion total for NIBIB and OD in the fourth
measure was used to support RADx initial y, with additional funds in the fifth measure as measure was used to support RADx initial y, with additional funds in the fifth measure as
specified above.39 specified above.39
Long-Term Studies of COVID-19. The fifth measure directed $1.15 bil ion of the total $1.25 The fifth measure directed $1.15 bil ion of the total $1.25
bil ion provided to the OD account “for research and clinical trials related to long-term studies of bil ion provided to the OD account “for research and clinical trials related to long-term studies of
COVID-19.” The fifth measure also al ows the total $1.25 bil ion appropriation to OD to be COVID-19.” The fifth measure also al ows the total $1.25 bil ion appropriation to OD to be
transferred to other IC accounts (in addition to other HHS transfer authorities in the law). transferred to other IC accounts (in addition to other HHS transfer authorities in the law).
Substance Abuse and Mental Health Services Administration
(SAMHSA)
SAMHSA is the federal agency primarily responsible for supporting community-based mental SAMHSA is the federal agency primarily responsible for supporting community-based mental
health and substance abuse treatment and prevention services. SAMHSA provides federal funding health and substance abuse treatment and prevention services. SAMHSA provides federal funding
to states, local communities, and private entities by administering block grants and other formula to states, local communities, and private entities by administering block grants and other formula
and discretionary grants. Some grants al ow broad uses of funds, whereas others target specific and discretionary grants. Some grants al ow broad uses of funds, whereas others target specific
behavioral health issues or populations. Through such grants, SAMHSA supports activities that behavioral health issues or populations. Through such grants, SAMHSA supports activities that
include education and training, prevention programs, early intervention activities, treatment include education and training, prevention programs, early intervention activities, treatment

39 CRS communication with NIH, July 24, 2020. 39 CRS communication with NIH, July 24, 2020.
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services, and technical assistance. SAMHSA does not provide mental health or substance abuse services, and technical assistance. SAMHSA does not provide mental health or substance abuse
treatment. Rather, the agency supports states’ efforts in providing community-based behavioral treatment. Rather, the agency supports states’ efforts in providing community-based behavioral
health services. In addition, SAMHSA conducts surveil ance and data collection of national health services. In addition, SAMHSA conducts surveil ance and data collection of national
behavioral health issues, provides statistical and analytic support to grantees, and administers behavioral health issues, provides statistical and analytic support to grantees, and administers
other agency-wide initiatives. other agency-wide initiatives.
SAMHSA has continued to support community-based behavioral health treatment and prevention SAMHSA has continued to support community-based behavioral health treatment and prevention
services throughout the COVID-19 pandemic. Circumstances surrounding the pandemic—services throughout the COVID-19 pandemic. Circumstances surrounding the pandemic—
including lifestyle changes instituted to prevent spread of the virus—appear to have negatively including lifestyle changes instituted to prevent spread of the virus—appear to have negatively
affected the mental health of many Americans.40 Studies show elevated levels of emotional affected the mental health of many Americans.40 Studies show elevated levels of emotional
distress, anxiety, depression, substance use, and drug-related overdoses in 2020 compared with distress, anxiety, depression, substance use, and drug-related overdoses in 2020 compared with
the same time period in previous years.41 On account of these increases, CDC reported that the same time period in previous years.41 On account of these increases, CDC reported that
“support systems to mitigate mental health consequences as the pandemic evolves wil continue “support systems to mitigate mental health consequences as the pandemic evolves wil continue
to be urgently needed.”42 In addition, physical distancing measures and temporary stay-at-home to be urgently needed.”42 In addition, physical distancing measures and temporary stay-at-home
orders associated with the pandemic have required changes to service delivery for mental health orders associated with the pandemic have required changes to service delivery for mental health
and substance use treatment. Many behavioral health service providers have increased their use of and substance use treatment. Many behavioral health service providers have increased their use of
telehealth modalities to deliver treatment.43 Stil , limits on face-to-face service provision and telehealth modalities to deliver treatment.43 Stil , limits on face-to-face service provision and
other economic consequences of the pandemic have led to clinic closures and other reductions to other economic consequences of the pandemic have led to clinic closures and other reductions to
treatment service capacity.44 Emergency financial support for behavioral health activities treatment service capacity.44 Emergency financial support for behavioral health activities
provided in two of the supplemental COVID-19 funding measures may address the high demand provided in two of the supplemental COVID-19 funding measures may address the high demand
for mental health and substance use disorder treatment services and decreased capacity in the for mental health and substance use disorder treatment services and decreased capacity in the
system. system.
SAMHSA received a total of $4.7 bil ion in supplemental appropriations in the third ($425 SAMHSA received a total of $4.7 bil ion in supplemental appropriations in the third ($425
mil ion) and fifth ($4.25 bil ion) measures. Funding was designated for specific purposes as mil ion) and fifth ($4.25 bil ion) measures. Funding was designated for specific purposes as
follows (organized by size of appropriation): follows (organized by size of appropriation):
Block Grant Programs. Of the total $4.25 bil ion in the fifth measure, $1.65 bil ion was Of the total $4.25 bil ion in the fifth measure, $1.65 bil ion was
designated for each of SAMHSA’s two main block grants: the Substance Abuse Prevention and designated for each of SAMHSA’s two main block grants: the Substance Abuse Prevention and
Treatment Block Grant (SABG) and the Community Mental Health Services Block Grant Treatment Block Grant (SABG) and the Community Mental Health Services Block Grant
(MHBG)—SAMHSA’s two largest grant programs. Both block grant programs distribute funds (MHBG)—SAMHSA’s two largest grant programs. Both block grant programs distribute funds
to states (including the District of Columbia and territories) according to a statutory formula.45 to states (including the District of Columbia and territories) according to a statutory formula.45

40 See, for example, Colin Planalp, Giovann Alacron, and Lynn Blewett, 40 See, for example, Colin Planalp, Giovann Alacron, and Lynn Blewett, 90 Percent of U.S. Adults Report Increased
Stress due to Pandem ic, State Health Access Data Assistance Center (SHADAC), Minneapolis, MN, May 26, 2020, , State Health Access Data Assistance Center (SHADAC), Minneapolis, MN, May 26, 2020,
https://www.shadac.org/SHADAC_CO VID19_Stress_AmeriSpeak-Survey. https://www.shadac.org/SHADAC_CO VID19_Stress_AmeriSpeak-Survey.
41 Liz Hamel, Audrey Kearney, Ashley Kirzinger, et al., 41 Liz Hamel, Audrey Kearney, Ashley Kirzinger, et al., Coronavirus: Reopening, Schools, and the Government
Response, Kaiser Family Foundation, KFF Health T racking T racking Poll - July 2020, July 27, 2020, , Kaiser Family Foundation, KFF Health T racking T racking Poll - July 2020, July 27, 2020,
https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-july-2020/. https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-july-2020/.
42 Mark E. Czeisler, Rashon I. Lane, Emiko Petrosky, et al., 42 Mark E. Czeisler, Rashon I. Lane, Emiko Petrosky, et al., Mental Health, Substance Use, and Suicidal Ideation
During the COVID-19 Pandem ic - United States, June 24-30, 2020, Centers for Disease Control and Prevention, , Centers for Disease Control and Prevention,
Morbidity and Mortality Weekly Report (MMWR) vol. 69, no. 32, Atlanta, GA, August 14, 2020, p. 1055. Morbidity and Mortality Weekly Report (MMWR) vol. 69, no. 32, Atlanta, GA, August 14, 2020, p. 1055.
43 Ateev Mehrotra, Michael Chernew, and David Linesky, 43 Ateev Mehrotra, Michael Chernew, and David Linesky, The Impact of the COVID-19 Pandemic on Outpatient Care:
Visits Return to Prepandem ic Levels, but Not for All Providers and Patients, T he Commonwealth Fund, New York, , T he Commonwealth Fund, New York,
NY, October 15, 2020, https://www.commonwealthfund.org/publications/2020/oct/impact-covid-19-pandemic-NY, October 15, 2020, https://www.commonwealthfund.org/publications/2020/oct/impact-covid-19-pandemic-
outpatient -care-visits-return-prepandemic-levels. outpatient -care-visits-return-prepandemic-levels.
44 T he National Council for Behavioral Health, 44 T he National Council for Behavioral Health, Demand for Mental Health and Addiction Services Increasing as
COVID-19 Pandem ic Continues to Threaten Availability of Treatm ent Options, National Council for Behavioral Health , National Council for Behavioral Health
Member Survey Polling Presentation, Washington, DC, September 2020, https://www.thenationalcouncil.org/press-Member Survey Polling Presentation, Washington, DC, September 2020, https://www.thenationalcouncil.org/press-
releases/demand-for-mental-health-and-addiction-services-increasing-as-covid-19-pandemic-continues-to-threaten-releases/demand-for-mental-health-and-addiction-services-increasing-as-covid-19-pandemic-continues-to-threaten-
availability-of-treatment-options/. availability-of-treatment-options/.
45 PHSA T itle XIX. For more information, see CRS Report R46426, 45 PHSA T itle XIX. For more information, see CRS Report R46426, Substance Abuse and Mental Health Services
Adm inistration (SAMHSA): Overview of the Agency and Major Program s. .
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The states, in turn, distribute funds to local government entities and nonprofit organizations for The states, in turn, distribute funds to local government entities and nonprofit organizations for
behavioral health-related treatment and prevention activities in accordance with a required state behavioral health-related treatment and prevention activities in accordance with a required state
plan. The law maintained a 20% set-aside for prevention-related activities. plan. The law maintained a 20% set-aside for prevention-related activities.
Certified Community Behavioral Health Clinic (CCBHC) Expansion Grant Program. A A
total of not less than $850 mil ion was made available to the Certified Community Behavioral total of not less than $850 mil ion was made available to the Certified Community Behavioral
Health Clinic (CCBHC) Expansion grant program. The third measure included not less than $250 Health Clinic (CCBHC) Expansion grant program. The third measure included not less than $250
mil ion of the total appropriation for SAMHSA, and the fifth measure included not less than $600 mil ion of the total appropriation for SAMHSA, and the fifth measure included not less than $600
mil ion. mil ion.
Certified Community Behavioral Health Clinics (CCBHCs)
In 2014, the Protecting Access to Medicare Act of 2014 (P.L. 113-193) created a program to improve community- In 2014, the Protecting Access to Medicare Act of 2014 (P.L. 113-193) created a program to improve community-
based behavioral health services through a demonstration program. Certified community behavioral health clinics based behavioral health services through a demonstration program. Certified community behavioral health clinics
(CCBHCs) are facilities operated by nonprofit organizations or governmental or tribal entities that offer a (CCBHCs) are facilities operated by nonprofit organizations or governmental or tribal entities that offer a
comprehensive range of services, including risk assessment, outpatient mental health and substance use treatment, comprehensive range of services, including risk assessment, outpatient mental health and substance use treatment,
case management, psychiatric rehabilitation services, peer and family supports, 24 -hour crisis management, and case management, psychiatric rehabilitation services, peer and family supports, 24 -hour crisis management, and
primary care medical services, among others.46 To be certified, CCBHCs are required to maintain partnerships primary care medical services, among others.46 To be certified, CCBHCs are required to maintain partnerships
with other health and social service providers. with other health and social service providers.
In 2015, 24 states received planning grants. In 2016, eight states were selected to participate in the initial In 2015, 24 states received planning grants. In 2016, eight states were selected to participate in the initial
demonstration program. These states received an enhanced Medicaid federal medical assistance percentage (i.e., demonstration program. These states received an enhanced Medicaid federal medical assistance percentage (i.e.,
federal matching) rate for CCBHC services, and the CCBHCs in these states received an enhanced payment rate federal matching) rate for CCBHC services, and the CCBHCs in these states received an enhanced payment rate
through a prospective payment system methodology.47 Two additional states were added to the demonstration through a prospective payment system methodology.47 Two additional states were added to the demonstration
program in 2020.48 program in 2020.48
A CCBHC Expansion grant program was authorized as a part of FY2020 appropriations (P.L. 116-94). CCBHC A CCBHC Expansion grant program was authorized as a part of FY2020 appropriations (P.L. 116-94). CCBHC
Expansion Grants provided up to $2 mil ion to facilities that met the certification criteria to increase access and Expansion Grants provided up to $2 mil ion to facilities that met the certification criteria to increase access and
improve the quality of their behavioral health services. (Only CCBHCs in the demonstration program receive the improve the quality of their behavioral health services. (Only CCBHCs in the demonstration program receive the
enhanced Medicaid rate.) In 2020, 33 states were participating in the CCBHC Demonstration and Expansion enhanced Medicaid rate.) In 2020, 33 states were participating in the CCBHC Demonstration and Expansion
Grant programs.49 Grant programs.49
Emergency Substance Abuse or Mental Health Needs. A total of not less than $340 mil ion A total of not less than $340 mil ion
was made available for emergency substance abuse or mental health needs, including not less was made available for emergency substance abuse or mental health needs, including not less
than $100 mil ion in the third measure and not less than $240 mil ion in the fifth measure. These than $100 mil ion in the third measure and not less than $240 mil ion in the fifth measure. These
funds provide crisis intervention services, mental and substance use disorder treatment, and other funds provide crisis intervention services, mental and substance use disorder treatment, and other
related recovery supports for children and adults affected by the COVID-19 pandemic.50 related recovery supports for children and adults affected by the COVID-19 pandemic.50
SAMHSA gave states significant flexibility in how they use these funds to support behavioral SAMHSA gave states significant flexibility in how they use these funds to support behavioral
health-related activities. health-related activities.
Suicide Prevention. A total of not less than $100 mil ion was provided for suicide prevention, A total of not less than $100 mil ion was provided for suicide prevention,
including not less than $50 mil ion in the third measure and not less than $50 mil ion in the fifth including not less than $50 mil ion in the third measure and not less than $50 mil ion in the fifth
measure. measure.

46 §223 of P.L. 113-93, Protecting Access to Medicare Act of 2014. 46 §223 of P.L. 113-93, Protecting Access to Medicare Act of 2014.
47 SAMHSA, 47 SAMHSA, Section 223 Demonstration Program for Certified Community ~~Behavioral~~Behavio ral Health Clinics, Last updated , Last updated
October 11, 2018, https://www.samhsa.gov/section-223. October 11, 2018, https://www.samhsa.gov/section-223.
48 §3814 of P.L. 116-136, the Coronavirus Aid, Relief, and Economic Security Act . 48 §3814 of P.L. 116-136, the Coronavirus Aid, Relief, and Economic Security Act .
49 T he National Council for Behavioral Health, 49 T he National Council for Behavioral Health, CCBHCs: A New Model for Behavioral Health Gaining Momentum in
States, webinar, Washington, DC, January 29, 2021, https://www.thenationalcouncil.org/webinars/ccbhcs-a-new-, webinar, Washington, DC, January 29, 2021, https://www.thenationalcouncil.org/webinars/ccbhcs-a-new-
model-for-behavioral-health-gaining-momentum-in-states. model-for-behavioral-health-gaining-momentum-in-states.
50 Eligibility included territories and tribes/tribal organizations. See Substance Abuse and Mental Health Services 50 Eligibility included territories and tribes/tribal organizations. See Substance Abuse and Mental Health Services
Administration, Administration, Em ergency Grants to Address Mental Health and Substance Use Disorders during COVID -19, ,
Funding Opportunity Announcement FG-20-006, April 1, 2020, https://www.samhsa.gov/grants/grant -announcements/Funding Opportunity Announcement FG-20-006, April 1, 2020, https://www.samhsa.gov/grants/grant -announcements/
fg-20-006. fg-20-006.
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U.S. Public Health Service: COVID-19 Supplemental ~~Funding~~Appropriations in the 116th Congress

Project AWARE. Of the total amount in the fifth measure, $50 mil ion was directed to Of the total amount in the fifth measure, $50 mil ion was directed to
SAMHSA’s Project AWARE program, which supports school-based mental health training and SAMHSA’s Project AWARE program, which supports school-based mental health training and
referral services in elementary and secondary education. referral services in elementary and secondary education.
National Child Traumatic Stress Network. Of the total funding amount in the fifth measure, Of the total funding amount in the fifth measure,
$10 mil ion was designated for the National Child Traumatic Stress Network, which was $10 mil ion was designated for the National Child Traumatic Stress Network, which was
established to improve behavioral health services for children exposed to traumatic events. Grant established to improve behavioral health services for children exposed to traumatic events. Grant
funding supports development and promotion of effective community practices, mostly through funding supports development and promotion of effective community practices, mostly through
information and trainings by a network of centers. information and trainings by a network of centers.
Office of the Secretary
Under the HHS Office of the Secretary (OS), the PHSSEF account is often used for one-time or Under the HHS Office of the Secretary (OS), the PHSSEF account is often used for one-time or
short-term funding, such as emergency supplemental appropriations. PHSSEF receives annual short-term funding, such as emergency supplemental appropriations. PHSSEF receives annual
appropriations for the routine operations of several HHS offices, including the Office of the HHS appropriations for the routine operations of several HHS offices, including the Office of the HHS
Assistant Secretary for Preparedness and Response (ASPR), the lead office at HHS for health Assistant Secretary for Preparedness and Response (ASPR), the lead office at HHS for health
emergency preparedness and response strategy and coordination and a component of the Public emergency preparedness and response strategy and coordination and a component of the Public
Health Service. Health Service.
Public Health and Social Services Emergency Fund
PHSSEF received about $280 bil ion in supplemental funding across the five measures. These PHSSEF received about $280 bil ion in supplemental funding across the five measures. These
funds may support various activities, including health care surge capacity and the development funds may support various activities, including health care surge capacity and the development
and purchase of medical countermeasures (including vaccines), as wel as provider and purchase of medical countermeasures (including vaccines), as wel as provider
reimbursement through the Provider Relief Fund and Uninsured Fund. In general, PHSSEF reimbursement through the Provider Relief Fund and Uninsured Fund. In general, PHSSEF
supplemental funding has been provided for certain activities and programs as shown i supplemental funding has been provided for certain activities and programs as shown in Figure 2.
Figure 2. PHSSEF: Major Categories of COVID-19 Supplemental Appropriations
Dol ars in mil ions; amounts shown as appropriated. Al transfers and set-asides are not shown. Dol ars in mil ions; amounts shown as appropriated. Al transfers and set-asides are not shown.

Sources: Compiled by CRS from amounts specified in P.L. 116-123 (Title III, Division A), P.L. 116-127 (Title V, Compiled by CRS from amounts specified in P.L. 116-123 (Title III, Division A), P.L. 116-127 (Title V,
Division A), P.L. 116-136 (Title VIII, Division B), P.L. 116-139 (Title I, Division B), and P.L. 116-260 (Division M). Division A), P.L. 116-136 (Title VIII, Division B), P.L. 116-139 (Title I, Division B), and P.L. 116-260 (Division M).
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Notes: These amounts reflect discretionary supplemental appropriations to PHSSEF. They These amounts reflect discretionary supplemental appropriations to PHSSEF. They do not reflect reflect
directed transfers out of PHSSEF to other agency accounts or set-aside amounts within the account. PHSSEF directed transfers out of PHSSEF to other agency accounts or set-aside amounts within the account. PHSSEF
appropriations include many transfer and set-aside amounts as detailed below and in the tables in the next appropriations include many transfer and set-aside amounts as detailed below and in the tables in the next
section. Other sources that track federal spending, such as USASpending,gov, may include various breakdowns section. Other sources that track federal spending, such as USASpending,gov, may include various breakdowns
and presentations of funds in these agency accounts that do not match numbers in this figure. and presentations of funds in these agency accounts that do not match numbers in this figure.
*Additional y, a total of not more than $1 bil ion of funding for “COVID-19 Testing, Surveil ance, and Contact *Additional y, a total of not more than $1 bil ion of funding for “COVID-19 Testing, Surveil ance, and Contact
Tracing” in the fourth measure was set aside for Testing for the Uninsured. Tracing” in the fourth measure was set aside for Testing for the Uninsured.
PHSSEF appropriations include four major categories: PHSSEF appropriations include four major categories:
Medical Countermeasures and Surge Capacity. The first, third, and fifth measures each The first, third, and fifth measures each
provided funding to support (1) the development, manufacturing, and, in some cases, federal provided funding to support (1) the development, manufacturing, and, in some cases, federal
purchase of COVID-19 medical countermeasures (e.g., diagnostic tests, treatments, vaccines, and purchase of COVID-19 medical countermeasures (e.g., diagnostic tests, treatments, vaccines, and
medical supplies), and (2) other response activities, such as for health care workforce and surge medical supplies), and (2) other response activities, such as for health care workforce and surge
capacity (e.g., health care workforce supports, distribution of medical supplies, and alternative capacity (e.g., health care workforce supports, distribution of medical supplies, and alternative
care sites). In total, approximately $53.4 bil ion (prior to transfers) has been provided for these care sites). In total, approximately $53.4 bil ion (prior to transfers) has been provided for these
activities. The measures specify that some of these funds are to be transferred elsewhere (e.g., to activities. The measures specify that some of these funds are to be transferred elsewhere (e.g., to
other federal agencies for the care of persons under federal quarantine) or reserved for specific other federal agencies for the care of persons under federal quarantine) or reserved for specific
purposes or activities (e.g., provided to grantees of the Hospital Preparedness Program). purposes or activities (e.g., provided to grantees of the Hospital Preparedness Program). ~~These~~
~~activities~~ In addition, al three measures al ow for optional transfers to the Covered Countermeasures Process Fund, which funds the Countermeasures Injury Compensation Program (CICP).51 Activities funded by the $53.4 bil ion may be carried out by various ASPR components, especial y the Biomedical Advanced may be carried out by various ASPR components, especial y the Biomedical Advanced
Research and Development Authority (BARDA) for countermeasure Research and Development Authority (BARDA) for countermeasure development and development and
procurement.procurement.5152 Two major set-aside categories are described below. Two major set-aside categories are described below.
  BARDA: Under ASPR, BARDA specifical y supports the development of Under ASPR, BARDA specifical y supports the development of
medical countermeasures for health emergencies, such as emerging infectious medical countermeasures for health emergencies, such as emerging infectious
diseases and other threats (i.e., chemical, biological, radiological, and nuclear diseases and other threats (i.e., chemical, biological, radiological, and nuclear
threat agents). A total of not less than $24.2 bil ion has been set aside for threat agents). A total of not less than $24.2 bil ion has been set aside for
BARDA in the third, fourth, and fifth measures. This includesBARDA in the third, fourth, and fifth measures. This includes :  $23.2 bil ion$23.2 bil ion of the of the
total for Medical Countermeasures and Surge Capacity total for Medical Countermeasures and Surge Capacity in the third and fifth in the third and fifth
measures, including not less than $3.5 bil ionmeasures, including not less than $3.5 bil ion in the third measure and $19.7 in the third measure and $19.7
bil ionbil ion in the fifth measure. Funding in the third measure in the fifth measure. Funding in the third measure was designated for was designated for
“necessary expenses of manufacturing, production, and purchase ... of vaccines, “necessary expenses of manufacturing, production, and purchase ... of vaccines,
therapeutics, diagnostics, and smal molecule active pharmaceutical ingredients, therapeutics, diagnostics, and smal molecule active pharmaceutical ingredients,
including the development, translation, and demonstration at scale of innovations including the development, translation, and demonstration at scale of innovations
in manufacturing platforms.” Funding in the fifth measure was designated for in manufacturing platforms.” Funding in the fifth measure was designated for
“necessary expenses of manufacturing, production, and purchase ..“necessary expenses of manufacturing, production, and purchase ... of vaccines, of vaccines,
therapeutics, and ancil ary supplies.” therapeutics, and ancil ary supplies.”  An additionalAn additional set-aside of not less than $1 set-aside of not less than $1
bil ion was directed to BARDAbil ion was directed to BARDA in in the fourth measure from the total for “COVID-the fourth measure from the total for “COVID-
19 Testing, Surveil ance, 19 Testing, Surveil ance, Contact Tracing, Containment, and Mitigation” in that Contact Tracing, Containment, and Mitigation” in that
measure. This transfer was directed for “necessary expenses of advanced measure. This transfer was directed for “necessary expenses of advanced
research, development, manufacturing, production, and purchase of diagnostic, research, development, manufacturing, production, and purchase of diagnostic,
~~serologic, or other~~ serologic, or other 51 T he Countermeasures Injury Compensation Program provides compensation to individuals found to have been injured or killed by a covered medical countermeasure under the Public Readiness and Emergency Preparedness Act declaration. For further information, see CRS Legal Sidebar LSB10443, The PREP Act and COVID-19: Lim iting Liability for Medical Counterm easures. 52 For information on the ASPR activities, see HHS, ASPR, “COVID-19: 2019 Novel Coronavirus Disease,” https://www.phe.gov/emergency/events/COVID19/Pages/default.aspx. Congressional Research Service 20 link to page 14 link to page 14 link to page 11 U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress COVID–19 tests or related supplies, and other activities COVID–19 tests or related supplies, and other activities
related to COVID–19 testing.” related to COVID–19 testing.”
  Strategic National Stockpile (SNS), under ASPR, provides select medicines and under ASPR, provides select medicines and
medical supplies during public health emergencies that overwhelm local medical supplies during public health emergencies that overwhelm local
availability.availability. PHSSEF funding in the first, third, fourth (of the total $25 bil ion for PHSSEF funding in the first, third, fourth (of the total $25 bil ion for
COVID-19 Testing, Contact Tracing and Surveil ance), and fifth measures can be COVID-19 Testing, Contact Tracing and Surveil ance), and fifth measures can be
used for SNS supply purchases. The third and fifth measures used for SNS supply purchases. The third and fifth measures limit the amount that can be al ocated to SNS from those appropriations and specify that a total specify that a total
of not more than $19.25 bil ion may be al ocated for the SNS from the total of not more than $19.25 bil ion may be al ocated for the SNS from the total

~~51 For information on the ASPR activities, see HHS, ASPR, “COVID-19: 2019 Novel Coronavirus Disease,”~~
~~https://www.phe.gov/emergency/events/COVID19/Pages/default.aspx.~~
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appropriations for Medical Countermeasures and Surge Capacity in those laws, appropriations for Medical Countermeasures and Surge Capacity in those laws,
including not more than $16 bil ion in the third measure and not more than $3.25 including not more than $16 bil ion in the third measure and not more than $3.25
bil ion in the fifth measure. bil ion in the fifth measure.
COVID-19 Testing for the Uninsured. The second measure included $1 bil ion to provide The second measure included $1 bil ion to provide
reimbursements for COVID-19 testing and related services for persons who are uninsured. In reimbursements for COVID-19 testing and related services for persons who are uninsured. In
addition, the fourth measure specified that up to $1 bil ion of the amounts appropriated for addition, the fourth measure specified that up to $1 bil ion of the amounts appropriated for
broader COVID-19 testing purposes (discussed below) may be used to cover the costs of testing broader COVID-19 testing purposes (discussed below) may be used to cover the costs of testing
for the uninsured.for the uninsured.5253 (See the (See the “Health Resources and Services Administration ” section for details ” section for details
about HRSA’s administration of this program.) about HRSA’s administration of this program.)
Provider Relief Fund (PRF). The third, fourth, and fifth measures each provided funding for a The third, fourth, and fifth measures each provided funding for a
“Provider Relief Fund” to assist health care providers and facilities affected by the COVID-19 “Provider Relief Fund” to assist health care providers and facilities affected by the COVID-19
pandemic. pandemic.5354 These funds are intended to reimburse eligible health care providers for health care- These funds are intended to reimburse eligible health care providers for health care-
related expenses or lost revenues attributable to the pandemic. The measures define eligible related expenses or lost revenues attributable to the pandemic. The measures define eligible
providers broadly as any that provide “diagnoses, testing, or care for individuals with possible or providers broadly as any that provide “diagnoses, testing, or care for individuals with possible or
actual cases of COVID-19.” In total, $178 bil ion has been appropriated for the PRF.actual cases of COVID-19.” In total, $178 bil ion has been appropriated for the PRF.5455 (See the (See the
“Health Resources and Services Administration ” section for more details about HRSA’s section for more details about HRSA’s
administration of this program.) administration of this program.)
COVID-19 Testing, Surveillance, Contact Tracing, Containment, and Mitigation. As As
specified in the bullets below, the fourth and fifth measures provided $47.4 bil ion to augment specified in the bullets below, the fourth and fifth measures provided $47.4 bil ion to augment
national capacity for COVID-19 containment, including expanded testing capacity and workforce national capacity for COVID-19 containment, including expanded testing capacity and workforce
and technical capacity for disease surveil ance and contact tracing. and technical capacity for disease surveil ance and contact tracing.
 The fourth measure provided $25 bil ion total and directed HHS to reserve some  The fourth measure provided $25 bil ion total and directed HHS to reserve some
of these funds for specific purposes. For example, not less than $11 bil ion is for of these funds for specific purposes. For example, not less than $11 bil ion is for
states, localities, territories, tribes, tribal organizations, urban Indian health states, localities, territories, tribes, tribal organizations, urban Indian health
organizations, and health service providers to tribes. Of this total for SLTT organizations, and health service providers to tribes. Of this total for SLTT
grantees, not less than $2 bil ion was to be al ocated according to the formula that grantees, not less than $2 bil ion was to be al ocated according to the formula that
applied to the PHEP cooperative agreement in 2019,applied to the PHEP cooperative agreement in 2019,5556 and $4.25 bil ion must be and $4.25 bil ion must be
al ocated according to a formula that is based on the relative number of COVID- al ocated according to a formula that is based on the relative number of COVID-
19 cases. In addition, the law specified that certain amounts of these funds are to 19 cases. In addition, the law specified that certain amounts of these funds are to
~~be transferred to other agencies and accounts (e.g., $22 mil ion is to be~~
~~transferred to the FDA to support activities related to diagnostic, serological,~~
~~antigen, and other tests). See Table 2 for a detailed accounting of al transfers~~
~~and set-asides.~~
~~ The fifth measure provided a total of $22.4 bil ion and directed that funds shal~~
~~be for states, localities, territories, and tribal entities, and that funding may be~~
~~awarded as grants or cooperative agreements. Of the total, $790 mil ion was~~
~~designated to be transferred to IHS, and a separate amount of not less than $2.5~~
~~bil ion is for “strategies for improving testing capabilities and other purposes ..~~

52 53 Both measures provide for these payments to be made according to Both measures provide for these payments to be made according to ~~t he~~the National Disaster Medical System (NDMS) National Disaster Medical System (NDMS)
definitive care reimbursement mechanism. As mentioned, this testing program is administered by HRSA. HRSA, definitive care reimbursement mechanism. As mentioned, this testing program is administered by HRSA. HRSA,
“COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting and T reatment of the “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting and T reatment of the
Uninsured,” https://www.hrsa.gov/CovidUninsuredClaim. Uninsured,” https://www.hrsa.gov/CovidUninsuredClaim.
5354 For more information on the Provider Relief Fund, see HHS, “CARES Act Provider Relief Fund” (the name given to For more information on the Provider Relief Fund, see HHS, “CARES Act Provider Relief Fund” (the name given to
this fund by HHS), April 22, 2020, https://www.hhs.gov/provider-relief/index.html. this fund by HHS), April 22, 2020, https://www.hhs.gov/provider-relief/index.html.
5455 For further information about these appropriations, see CRS Report R46325, For further information about these appropriations, see CRS Report R46325, Fourth COVID-19 Relief Package (P.L.
116-139): In Brief, and HHS news releases at https://www.hhs.gov/about/news/index.html. , and HHS news releases at https://www.hhs.gov/about/news/index.html.
5556 See footnot See footnote 7 for explanation of the PHEP program. for explanation of the PHEP program.
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Congress be transferred to other agencies and accounts (e.g., $22 mil ion is to be transferred to the FDA to support activities related to diagnostic, serological, antigen, and other tests). See Table 2 for a detailed accounting of al transfers and set-asides.  The fifth measure provided a total of $22.4 bil ion and directed that funds shal be for states, localities, territories, and tribal entities, and that funding may be awarded as grants or cooperative agreements. Of the total, $790 mil ion was designated to be transferred to IHS, and a separate amount of not less than $2.5 bil ion is for “strategies for improving testing capabilities and other purposes .. in high-risk and underserved populations, including racial and ethnic minority in high-risk and underserved populations, including racial and ethnic minority
populations and rural communities as wel as identifying best practices for states populations and rural communities as wel as identifying best practices for states
and public health officials to use for contact tracing in high-risk and underserved and public health officials to use for contact tracing in high-risk and underserved
populations, including racial and ethnic minority populations and rural populations, including racial and ethnic minority populations and rural
communities.” The funding, except for the transfer to IHS, is to be awarded communities.” The funding, except for the transfer to IHS, is to be awarded
according to the formula that applied to the PHEP cooperative agreement in according to the formula that applied to the PHEP cooperative agreement in
FY2020. FY2020.
CDC has administered several grant awards using these appropriations (as described in the CDC has administered several grant awards using these appropriations (as described in the text
box in the in the “Centers for Disease Control and Prevention (CDC)” section). section).
In addition to the activities specified above, PHSSEF appropriations in the first, third, and fourth In addition to the activities specified above, PHSSEF appropriations in the first, third, and fourth
measures cal ed for some portion of the funds to be transferred to other agencies or accounts for measures cal ed for some portion of the funds to be transferred to other agencies or accounts for
particular activities. For instance, some PHSSEF funds are to be transferred to HRSA for health particular activities. For instance, some PHSSEF funds are to be transferred to HRSA for health
centers, rural health, the Ryan White HIV/AIDS program, and health care systems.centers, rural health, the Ryan White HIV/AIDS program, and health care systems.5657 (See the (See the
“Health Resources and Services Administration (HRSA)” section for more details.) section for more details.)
Funding Overview
The following tables provide overviews of COVID-19 supplemental appropriations for PHS The following tables provide overviews of COVID-19 supplemental appropriations for PHS
agencies agencies as appropriated.
  Table 1 provides a high-level summary of appropriations by agency and includes provides a high-level summary of appropriations by agency and includes
information about transfers specifical y directed to another agency account. It information about transfers specifical y directed to another agency account. It
also provides information on the period of availability for these funds, listed as a also provides information on the period of availability for these funds, listed as a
specified date when they are no longer available for obligation (i.e., “expire”), or specified date when they are no longer available for obligation (i.e., “expire”), or
that they are “no year” funds (i.e., available until expended). that they are “no year” funds (i.e., available until expended).
  Table 2 provides a more detailed view of these appropriations, including provides a more detailed view of these appropriations, including
overviews of al appropriations for accounts, programs, and specified purposes overviews of al appropriations for accounts, programs, and specified purposes
within an agency, as wel as directed transfers outside of agency accounts. It also within an agency, as wel as directed transfers outside of agency accounts. It also
provides information on the availability of the funds for obligation, as above. provides information on the availability of the funds for obligation, as above.
The tables present accounts in the order in which they appear in the five appropriations laws. The tables present accounts in the order in which they appear in the five appropriations laws.
Transfers are listed in their account of origin, not the receiving account. In at least one case, Transfers are listed in their account of origin, not the receiving account. In at least one case,
transfers are directed to “other federal agencies” without specifying the agency or account. transfers are directed to “other federal agencies” without specifying the agency or account.
Several of these transfers are directed as “not less than” (NLT) or “not more than” (NMT). Several of these transfers are directed as “not less than” (NLT) or “not more than” (NMT).

5657 For further background on HRSA and these activities, see, for example, CRS Report R44054, For further background on HRSA and these activities, see, for example, CRS Report R44054, Health Resources and
Services Adm inistration (HRSA) Funding: Fact Sheet; CRS Report R46239, ; CRS Report R46239, Telehealth and Telem edicine: Frequently
Asked Questions; and CRS Insight IN11238, ; and CRS Insight IN11238, Coronavirus Disease 2019 (COVID-19) Poses Challenges for the U.S.
Blood Supply. .
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Table 1. Summary of COVID-19 Supplemental Appropriations to Public Health Service
Al amounts are in U.S. $ mil ions Al amounts are in U.S. $ mil ions
P.L. 116-123
P.L. 116-127
P.L. 116-136
P.L. 116-139
P.L. 116-260
(Division A)
(Division A)
(Division A & B)
(Division B)
(Division M)

Department or Agency,
Avail. Avail. Avail. Avail. Avail.
Program or Account
Amount
~~Avail.~~ Until
Amount
~~Avail.~~ Until
Amount
~~Avail.~~ Until
Amount
Until
Amount
~~Avail.~~ Until
Total
FDA; Salaries and
Expenses 61
expended
—
—
80
expended
—
—
55
expended
196
~~Expenses~~
CDC; CDC-Wide Activities
2,200
Sep. 30, ~~2022~~
—
—
4,300
Sep. 30, ~~2024~~
—
—
8,750
Sep. 30,
15,250
~~Activities~~ and Program Support 2022
2024
~~Support~~2024
Transfer to IHS
—
—
—
—
—
—
—
—
(210)
((as above)

NIH
836
Sep. 30, ~~2024~~
—
—
945
Sep. 30, ~~2024~~
—
—
1,250
Sep. 30,
3,031
2024 2024 2024
SAMHSA; Health
—
—
—
—
425
Sep. 30, ~~2021~~
—
—
4,250
Sep. 30,
4,675
Surveillance and
Program 2021
~~Program~~ 2021 Support
HRSA
—
—
—
—
1,320
Sep. 30, ~~2020~~
—
—
—
—
1,320
2020 PHSSEF; HHS OS
3,400
varies
1,000
expended
127,290
varies
100,000 expended
48,345
varies by
280,035
(including (including
~~appropriati~~
~~contingent of~~
on
~~300)~~
contingent of 300)
NMT Transfer to HHS OIG
(2)
expended
—
—— —
(4)
expended
(6) (as above)
(2)
expended
(14)
Transfers to HRSA (Ryan
—
—
—
—
~~(275)~~
~~Sep. 30, 2022~~
—
—
—
—
~~(275)~~
~~White, Rural~~ White, — — — — (275) Sep. 30, — — — — (275) Rural Health, and
Health Care 2022 Systems)
Provider Relief Fund
— —
— —
— —
~~— (~~— (100,000)
expended
(75,000)
(as above)
(3,000)
expended
(178,000)
Medical Countermeasures and
(3,400)
Sep. 30, ~~2024~~
— —
— —
(27,015)
Sep. 30, ~~2024~~
—
— — —
(22,945)
Sep. 30,
(53,360)
~~and~~ Surge Capacity
2024 2024 2024
CRS-23 CRS-23

link to page 29 link to page 29 ~~link to page 37~~
P.L. 116-123
P.L. 116-127
P.L. 116-136
P.L. 116-139
P.L. 116-260
(Division A)
(Division A)
(Division A & B)
(Division B)
(Division M)

Department or Agency,
Avail. Avail. Avail. Avail. Avail.
Program or Account
Amount
~~Avail.~~ Until
Amount
~~Avail.~~ Until
Amount
~~Avail.~~ Until
Amount
Until
Amount
~~Avail.~~ Until
Total
Transfer to HRSA, Primary
(100)
Sep. 30, ~~2024~~
— —
— —
—
—— —
— —
— —
—
—— —
(100)
Health Care (Health
Centers 2024 Program)
COVID-19 Testing, Surveil ance,
— —
— —
— —
— —
— —
— —
(25,000)
(as above)
(22,400)
Sep. 30,
(47,400)
~~Surveil ance,~~ and Contact Tracing 2022
~~2022~~
~~Tracing~~
NLT for grants to states,
— —
— —
— —
— —
— —
— —
(11,000)
(as above)
— —
— —
(11,000)
localities, territories, and
~~tribal~~ tribal entitiesa
NLT al ocated in
coordination — —
— —
— —
— —
— —
— —
(750)
(as above)
— —
— —
(750)
~~coordination~~ with IHS
Director
NLT transfer to CDC-Wide
—
—
—
—
—
—— — — — — —
(1,000)
(as above)
—
—— —
(1,000)
Activities and Program
Support
NLT transfer to NIH NCI
—
—
—
—
—
—— — — — — —
(306)
(as above)
—
—— —
(306)
NLT transfer to NIH NIBIB
—
—
—
—
—
—— — — — — —
(500)
(as above)
—
—— —
(500)
NLT transfer to NIH OD
—
—
—
—
—
—— — — — — —
(1,000)
(as above)
—
—— —
(1,000)
Transfer to FDA (Salaries and — — — — — —
—
—
—
—
—
—
(22)
(as above)
—
—— —
(22)
~~and~~ Expenses)
Transfer to HRSA (Health
—
—
—
—
—
—
~~(600)~~p— — — — — — (600)
(as above)
—
—— —
(600)
Centers)
Transfer to IHS
— —
— —
— —
— —
— —
— —
—
—— —
(790)
Sep. 30,
(790)
2022
IHS
—
—
64
64 Sep. 30,
1,032
Sep. 30, ~~2021~~
—
—
—
—
~~1,096~~
~~2022~~
~~CRS-24~~

~~link to page 36~~
~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~

~~Department or Agency,~~
~~Avail.~~
~~Program or Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
~~ATSDR; Toxic~~ — — — — 2022 2021 ATSDR; Toxic Substances —
—
—
—
—
13 13 Sep. 30, ~~2021~~
—
—
—
—
13
~~Substances and~~

~~Environmental Public~~
and Environmental Public 2021 Health
Total
6,497
——
1,064
——
135,404
——
100,000
——
62,650
—— 305,615 CRS-24 link to page 36
~~305,615~~
Source: Compiled by CRS from amounts specified in P.L. 116-123 ( Compiled by CRS from amounts specified in P.L. 116-123 (~~Title III, Division~~ Division A), P.L. 116-127 (A), P.L. 116-127 (~~Title V, Division~~ Division A), P.L.A), P.L. 116-136 (Division A and 116-136 (Division A and ~~Title VIII,~~
Division B), P.L. 116-139 Division B), P.L. 116-139 (~~(Title I,~~ Division B), and P.L.Division B), and P.L. 116-260 (Division M). 116-260 (Division M).
Notes: Values are rounded to the nearest mil ion. Due to rounding, some totals may not equal the sum of their separate components. Al funds except for the HRSA Values are rounded to the nearest mil ion. Due to rounding, some totals may not equal the sum of their separate components. Al funds except for the HRSA
health center funds in Division A of P.L. 116-136 are designated as an emergency requirement. Amounts in parenthesis and italics are nonhealth center funds in Division A of P.L. 116-136 are designated as an emergency requirement. Amounts in parenthesis and italics are non -adds. Abbreviations: ATSDR = -adds. Abbreviations: ATSDR =
Agency for Toxic Substances and Disease Registry;Agency for Toxic Substances and Disease Registry; CDC = Centers for Disease Control and Prevention; FDA = Food and Drug Administration; HHS = CDC = Centers for Disease Control and Prevention; FDA = Food and Drug Administration; HHS = ~~Department~~Departmen t of of
Health and Human Services; HRSA = Health Resources and Services Administration; IHS = Indian Health Service; NCI = National Cancer Institute; NIBIB = National Health and Human Services; HRSA = Health Resources and Services Administration; IHS = Indian Health Service; NCI = National Cancer Institute; NIBIB = National
Institute of Biomedical Imaging and Bioengineering; NIH = National Institutes of Health; OD = Office of the Director; OIG = Office of the Inspector General; OS = Institute of Biomedical Imaging and Bioengineering; NIH = National Institutes of Health; OD = Office of the Director; OIG = Office of the Inspector General; OS =
Office of the Secretary; PHSSEF = Public Health and Social Services Emergency Fund; SAMHSA = Substance Abuse and Mental Health Services Administration.Office of the Secretary; PHSSEF = Public Health and Social Services Emergency Fund; SAMHSA = Substance Abuse and Mental Health Services Administration.
a. Unlike the other appropriations in this table, this funding was not specifical y directed to be transferred to another agency account, though the funding has been a. Unlike the other appropriations in this table, this funding was not specifical y directed to be transferred to another agency account, though the funding has been
since administered by CDC and IHS. It is presented here to comprehensively reflect appropriations made available to IHS. since administered by CDC and IHS. It is presented here to comprehensively reflect appropriations made available to IHS.
Table 2. Detailed COVID-19 Supplemental Appropriations to Public Health Service
Al amounts are in U.S. $ Al amounts are in U.S. $ ~~mil ions~~millions
P.L. 116-123
P.L. 116-127
P.L. 116-136
P.L. 116-139
P.L. 116-260
Department or
(Division A)
(Division A)
(Division A & B)
(Division B)
(Division M)
Agency, Program or

Account
Amount
Avail. Until
Amount
Avail. Until
Amount
Avail. Until
Amount
Avail. Until
Amount
Avail. Until
Total
FDA
61 expended
—
—
80 expended
—a
—
55 expended
196
Salaries and Expenses Salaries and Expenses
61 61
(as above) (as above)
—
—
80 80
(as above) (as above)
—
—
55 55
(as above) (as above)
196 196
Medical
—
—
—
—
—
—
—
—
(9)
(as above)
(9)
countermeasures and
vaccines
~~CRS-25~~

~~link to page 36 link to page 36 link to page 36~~
~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~Department or~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~
~~Agency, Program or~~

~~Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
~~Advanced~~Advanced — — — — — — — — (31) (as above) (31) manufacturing for medical products Monitoring of medical — — — — — — — — (2) (as above) (2) product supply chains Public health research
—
—
—
—
—
—
—
—
(318)
(as above)
(~~31)~~
~~manufacturing for~~

~~medical products~~
~~Monitoring of medical~~8) and response Data management
—
—
—
—
—
—
—
—
(21)
(as above)
(2)
~~product supply chains~~
~~Public health research~~
—
—
—
—
—
—
—
—
~~(8)~~
~~(as above)~~
~~(8)~~
~~and response~~
~~Data management~~
—
—
—
—
—
—
—
—
~~(1)~~
~~(as above)~~
~~(1)~~
~~operation tools~~1) operation tools CRS-25 link to page 36 link to page 36 link to page 36 P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139 P.L. 116-260 Department or (Division A) (Division A) (Division A & B) (Division B) (Division M) Agency, Program or Account Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Total
After action review
—
—
—
—
—
—
—
—
(5)
(as above)
(5)
activities
CDC
2,200
Sep. 30,
—
—
4,300
Sep. 30,
—
—
8,750b
Sep. 30,
15,250
2022
2024
2024
CDC-Wide Program CDC-Wide Program
2,200 2,200
(as above) (as above)
— —
— —
4,300 4,300
(as above) (as above)
— —
— —
8,750 8,750
(as above) (as above)
15,250 15,250
Activities and Support Activities and Support
NLT for states,
(950950)c
(as above)
— —
— —
(1,500)d
(as above)
— —
— —
(4,500)
(as above)
(6,950)
territories, localities, or
tribal entities
Transfer to IHS
— —
— —
— —
— —
— —
— —
— —
— —
(210)
(as above)
(210)
NLT for tribes, tribal
(40)
(as above)
— —
— —
(125) (125)
(as above)
— —
— —
— —
— —
(165)
organizations, and
related entities
NLT for high-risk and
— —
— —
— —
— —
— —
— —
— —
— —
(300)
(as above)
(300)
underserved
populations (e.g.,
racial and ethnic
minority populations
and rural
communities)
~~CRS-26~~

~~link to page 37 link to page 37 link to page 37~~
~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~Department or~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~
~~Agency, Program or~~

~~Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
SAMHSA
—
—
—
—
425
Sep. 30,
—
—
4,250e
Sep. 30,
4,675
2021
2021
Health Surveil ance and Health Surveil ance and
— —
— —
— —
— —
425f
(as above) (as above)
— —
— —
4,250e
(as above) (as above)
4,675 4,675
Program Support Program Support
NLT for Certified
— —
— —
— —
— —
(250)
(as above) (as above)
— —
— —
(600)
(as above)
(850)
Community Behavioral
Health Clinics
NLT for suicide
— —
— —
— —
— —
(50)
(as above)
— —
— —
(50)
(as above)
(100)
prevention CRS-27 link to page 36 link to page 36 link to page 36 link to page 37 link to page 36 link to page 36 link to page 36 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139 P.L. 116-260 Department or (Division A) (Division A) (Division A & B) (Division B) (Division M) Agency, Program or Account Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Total NLT for emergency — — — — (100)
~~NLT for emergency~~
—
—
—
—
~~(100)~~
(as above)
— —
— —
(240)
(as above)
(340)
response grants for
substance abuse and
mental health
Substance abuse and
— —
— —
— —
— —
— —
— —
— —
— —
(1,650)
(as above)
(1,650)
prevention treatment
block grant
Community mental
— —
— —
— —
— —
— —
— —
— —
— —
(1,650)
(as above)
(1,650)
health services block
grant
Project AWARE
— —
— —
— —
— —
— —
— —
— —
— —
(50)
(as above)
(50)
National Child
— —
— —
— —
— —
— —
— —
— —
— —
(10)
(as above)
(10)
Traumatic Stress
Network
HRSA
—
—
—
—
1,320
Sep. 30,
—
—
—
—
1,320
2020
Supplemental awards Supplemental awards
— —
— —
— —
— —
(1,320)
(as above) — — — — (1,320) for health centers ~~(as above)~~
—
—
—
—
~~(1,320)~~
~~for health centers~~
~~CRS-28~~

link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37 link to page 37
~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~Department or~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~
~~Agency, Program or~~

~~Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
PHSSEF
3,400
varies
1,000g
varies
127,290h
Sep. 30,
100,000i
expended
48,345j
varies
280,035
(including
2024

contingent
of 300)
HHS OS HHS OS
3,400 3,400 Sep. 30, 2024 Sep. 30, 2024
1,00 1,000g
(as above) (as above)
127,29 127,290h
(as above) (as above)
100,00 100,000i
(as above) (as above)
48,34 48,345j
(as above) (as above)
280,035 280,035
HHS OS, additional
(300)k Sep. 30, 2024
— —
— —
— —
— —
— —
— —
— —
— —
300
contingent amount
NMT Transfer to HHS
(2)l
expended
— —
— —
(4)l
expended
(66)l
(as above)
(2)l
expended
(14)
OIG
Testing for the
— —
— —
(1,000)
(as above)
— —
— —
—m
— —
— —
— —
(1,000)
Uninsured CRS-28 link to page 37 P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139 P.L. 116-260 Department or (Division A) (Division A) (Division A & B) (Division B) (Division M) Agency, Program or Account Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Total
Transfers to HRSA
— —
— —
— —
— —
(275)n Sep. 30, 2022
— —
— —
— —
— —
(275)
(Ryan White, Rural
Health, and Health
Care Systems)
Provider Relief Fund
— —
— —
— —
— —
(100,000)
expended
(75,000)
(as above)
(3,000)
expended
(178,000)
Medical
(3,400) Sep. 30, 2024
— —
— —
(27,015) Sep. 30, 2024
—
—
(22,945) Sep. 30, 2024
(53,360)
Countermeasures and
Surge Capacity
Transfer to HRSA,
(100)
(as above)
— —
— —
— —
— —
— —
— —
— —
— —
(100)
Primary Health Care
(Health Centers
Program)
NMT for Strategic
— —
— —
— —
— —
(16,000)
(as above)
— —
— —
(3,250)
Sep. 30,
2024 (19,250)
National Stockpile
~~2024~~
NLT for Hospital
— —
— —
— —
— —
(250)
(as above)
— —
— —
— —
— —
(250)
Preparedness
Program grantees or
subgrantees
~~CRS-29~~

~~link to page 37~~
~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~Department or~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~
~~Agency, Program or~~

~~Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
NLT for BARDA
— —
— —
— —
— —
(3,500)
(as above)
— —
— —
— —
— —
(3,500)
BARDA
— —
— —
— —
— —
— —
— —
— —
— —
(19,695) Sep. 30, 2024
(19,695)
NMT transfer to
— —
— —
— —
— —
(289)
(as above)
— —
— —
— —
— —
(289)
other federal
agencies for care of
persons under
federal quarantine
National Academies
— —
— —
— —
— —
(2)
(as above)
— —
— —
— —
— —
(2)
Study
COVID-19 Testing,
— —
— —
— —
— —
— —
— —
(25,000)
(as above)
(22,400) Sep. 30, 2022
(47,400)
Surveil ance, and
Contact Tracing CRS-29 link to page 37 link to page 37 link to page 37 P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139 P.L. 116-260 Department or (Division A) (Division A) (Division A & B) (Division B) (Division M) Agency, Program or Account Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Total
NLT for grants to
— —
— —
— —
— —
— —
— —
(11,000)
(as above)
—o
— —
(11,000)
states, localities,
territories, and tribal
entities
NLT al ocated in

(750)
(as above)

(750)
coordination with
IHS Director
NLT transfer to CDC-
— —
— —
— —
— —
— —
— —
(1,000)
(as above)
— —
— —
(1,000)
Wide Activities and
Program Support
NLT transfer to NIH
— —
— —
— —
— —
— —
— —
(306)
(as above)
— —
— —
(306)
NCI
NLT transfer to NIH
— —
— —
— —
— —
— —
— —
(500)
(as above)
— —
— —
(500)
NIBIB
NLT transfer to NIH
— —
— —
— —
— —
— —
— —
(1,000)
(as above)
— —
— —
(1,000)
OD
NLT for BARDA
— —
— —
— —
— —
— —
— —
(1,000)
(as above)
— —
— —
(1,000)
~~CRS-30~~

~~link to page 37 link to page 37 link to page 36 link to page 36~~
~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~Department or~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~
~~Agency, Program or~~

~~Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
~~Transfer to FDA~~
—
—
—
—
—
—
~~(22)~~
~~(as above)~~
—
—
~~(22)~~
~~(Salaries and~~
~~Expenses)~~
~~Transfer to HRSA~~
—
—
—
—
—
—
(600)p
~~(as above)~~
—
—
~~(600)~~
~~(Health Centers)~~
~~Rural Health Clinics~~
—
—
—
—
—
—
~~(225)~~
~~(as above)~~
—
—
~~(225)~~
~~NMT Testing for the~~
—
—
—
—
—
—
(1,000)m
~~(as above)~~
—
—
~~(1,000)~~
~~Uninsured~~
~~Transfer to IHS~~
—
—
—
—
—
—
—
—
~~(790) Sep. 30, 2022~~
~~(790)~~
~~NLT improving~~
—
—
—
—
—
—
—
—
~~(2,500)~~ Transfer to FDA — — — — — — (22) (as above) — — (22) (Salaries and Expenses) Transfer to HRSA — — — — — — (600)p (as above) — — (600) (Health Centers) Rural Health Clinics — — — — — — (225) (as above) — — (225) NMT Testing for the — — — — — — (1,000)m (as above) — — (1,000) Uninsured Transfer to IHS — — — — — — — — (790) Sep. 30, 2022 (790) CRS-30 link to page 36 link to page 36 P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139 P.L. 116-260 Department or (Division A) (Division A) (Division A & B) (Division B) (Division M) Agency, Program or Account Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Total NLT improving — — — — — — — — (2,500) Sep. 30, 2022
(2,500)
testing and contract
tracing for high-risk
and underserved
populations
IHS
—c
—
64
Sep. 30,
1,032
Sep. 30,
—
—
—
—
1,096
2022
2021
Indian Health Services Indian Health Services
—c
— —
64 64
(as above) (as above)
1,032 1,032
(as above) (as above)
— —
— —
— —
— —
1,096 1,096
NMT Electronic health
—
—
—
—
(65)
(as above)
—
—
—
—
(65)
record stabilization and
support
NLT Indian Self-
—
—
—
—
(450)
(as above)
—
—
—
—
(450)
Determination and
Education Assistance
Act programs and tribes
NMT transfer to Indian
—
—
—
—
(125)
(as above)
—
—
—
—
(125)
Health Facilities
ATSDR
—
—
—
—
13
Sep. 30,
—
—
—
—
13
2021

~~CRS-31~~

~~P.L. 116-123~~
~~P.L. 116-127~~
~~P.L. 116-136~~
~~P.L. 116-139~~
~~P.L. 116-260~~
~~Department or~~
~~(Division A)~~
~~(Division A)~~
~~(Division A & B)~~
~~(Division B)~~
~~(Division M)~~
~~Agency, Program or~~

~~Account~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Amount~~
~~Avail. Until~~
~~Total~~
~~Toxic Substances and~~
—
—
—
—
13
~~(as above)~~
—
—
—
—
13
~~Environmental Public~~
~~Health~~
~~Geospatial Research,~~
—
—
—
—
~~(8)~~
~~(as above)~~
—
—
—
—
~~(8)~~
~~Analysis and Services~~
~~Program~~
~~Awards to Pediatric~~
—
—
—
—
~~(5)~~
~~(as above)~~
—
—
—
—
~~(5)~~
~~Environmental Health~~
~~Specialty Units and~~
~~state health~~
~~departments~~
Toxic Substances and — — — — 13 (as above) — — — — 13 Environmental Public Health Geospatial Research, — — — — (8) (as above) — — — — (8) Analysis and Services Program Awards to Pediatric — — — — (5) (as above) — — — — (5) Environmental Health Specialty Units and state health departments CRS-31 P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139 P.L. 116-260 Department or (Division A) (Division A) (Division A & B) (Division B) (Division M) Agency, Program or Account Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Amount Avail. Until Total Total (in $U.S.
6,497
— —
1,064
— —
135,404
— —
100,000
— —
62,650
— —
305,615
millions)
Source: Compiled by CRS from amounts specified in P.L. 116-123 ( Compiled by CRS from amounts specified in P.L. 116-123 (~~Title III, Division~~ Division A), P.L. 116-127 (A), P.L. 116-127 (~~Title V, Division~~ Division A), P.L.A), P.L. 116-136 (Division A and 116-136 (Division A and ~~Title VIII,~~
Division B), P.L. 116-139 Division B), P.L. 116-139 (~~(Title I,~~ Division B), and P.L.Division B), and P.L. 116-260 (Division M). 116-260 (Division M).
Notes: Values are rounded to the nearest mil ion. Due to rounding, some totals may not equal the sum of their separate components. Al funds except for the HRSA Values are rounded to the nearest mil ion. Due to rounding, some totals may not equal the sum of their separate components. Al funds except for the HRSA
health center funds in Division A of P.L. 116-136 are designated as an emergency requirement. Amounts in parenthesis and italics are non-adds.health center funds in Division A of P.L. 116-136 are designated as an emergency requirement. Amounts in parenthesis and italics are non-adds. Abbreviations: ATSDR = Abbreviations: ATSDR =
Agency for Toxic Substances and Disease Registry; BARDA = Biomedical Advanced Research and Development Authority; CDC = Centers for Disease Control and Agency for Toxic Substances and Disease Registry; BARDA = Biomedical Advanced Research and Development Authority; CDC = Centers for Disease Control and
Prevention; FDA = Food and Drug Administration; HHS = Department of Health and Human Services; HRSA = Health Resources and Services Administration; IDRRRF Prevention; FDA = Food and Drug Administration; HHS = Department of Health and Human Services; HRSA = Health Resources and Services Administration; IDRRRF
= Infectious Disease Rapid Response Reserve Fund; IHS = Indian Health Service; NCATS = National Center for Advancing Translational Sciences; NCI = National Cancer = Infectious Disease Rapid Response Reserve Fund; IHS = Indian Health Service; NCATS = National Center for Advancing Translational Sciences; NCI = National Cancer
Institute; NHLBI = National Heart, Lung, and Blood Institute; NIAID = National Institute of Al ergy and Infectious Diseases; NIBIB = National Institute of Biomedical Institute; NHLBI = National Heart, Lung, and Blood Institute; NIAID = National Institute of Al ergy and Infectious Diseases; NIBIB = National Institute of Biomedical
Imaging and Bioengineering; NIEHS = National Institute of Environmental Health Sciences; NIH = National Institutes of Health; NLM = National Library of Medicine; OD Imaging and Bioengineering; NIEHS = National Institute of Environmental Health Sciences; NIH = National Institutes of Health; NLM = National Library of Medicine; OD
= Office of the Director; OIG = Office of the Inspector General; OS = Office of the Secretary; PHSSEF = Public Health and Social Services Emergency Fund; SAMHSA = = Office of the Director; OIG = Office of the Inspector General; OS = Office of the Secretary; PHSSEF = Public Health and Social Services Emergency Fund; SAMHSA =
Substance Abuse and Mental Health Services Administration. Substance Abuse and Mental Health Services Administration.
a. A $22 mil ion transfer was directed from PHSSEF to FDA for “diagnostic, serological, antigen, and other testing, as wel as related administrative activities.” a. A $22 mil ion transfer was directed from PHSSEF to FDA for “diagnostic, serological, antigen, and other testing, as wel as related administrative activities.”
b. This appropriation was directed for vaccine-related activities, specifical y for “activities to plan, prepare for, promote, distribute, administer, monitor, and track b. This appropriation was directed for vaccine-related activities, specifical y for “activities to plan, prepare for, promote, distribute, administer, monitor, and track
coronavirus vaccines to ensure broad-based distribution, access, and vaccine coverage.” coronavirus vaccines to ensure broad-based distribution, access, and vaccine coverage.”
c. Of the total CDC set-aside for states, territories, localities, or tribal entities, not less than $40 mil ion was to be al ocated to tribes, tribal organizations, urban Indian c. Of the total CDC set-aside for states, territories, localities, or tribal entities, not less than $40 mil ion was to be al ocated to tribes, tribal organizations, urban Indian
health organizations, or health service providers to tribes. health organizations, or health service providers to tribes.
d. Of the total appropriated for the CDC set-aside for states, territories, localities, or tribal entities, not less than $125 mil ion was to be al ocated to tribes, trib al d. Of the total appropriated for the CDC set-aside for states, territories, localities, or tribal entities, not less than $125 mil ion was to be al ocated to tribes, trib al
organizations, urban Indian health organizations, or health service providers to tribes. organizations, urban Indian health organizations, or health service providers to tribes.
~~CRS-32~~

e. Of the total appropriated to SAMHSA, not less than $125 mil ion was to be al ocated to tribes, tribal organizations, urban In dian health organizations, or health or e. Of the total appropriated to SAMHSA, not less than $125 mil ion was to be al ocated to tribes, tribal organizations, urban In dian health organizations, or health or
behavioral health service providers to tribes. behavioral health service providers to tribes.
f. f.
Of the total appropriated SAMHSA, not less than $15 mil ion was to be al ocated to tribes, tribal organizations, urban Indian Of the total appropriated SAMHSA, not less than $15 mil ion was to be al ocated to tribes, tribal organizations, urban Indian health organizations, or health or health organizations, or health or
behavioral health service providers to tribes. behavioral health service providers to tribes.
g. To provide reimbursements for COVID-19 testing and related services for persons who are uninsured. g. To provide reimbursements for COVID-19 testing and related services for persons who are uninsured.
h. Provided in distinct appropriations broadly focused on medical countermeasures and surge capacity ($27 bil ion), health care provider reimbursement (the Provider h. Provided in distinct appropriations broadly focused on medical countermeasures and surge capacity ($27 bil ion), health care provider reimbursement (the Provider
Relief Fund, $100 bil ion), and HRSA transfers ($275 mil ion). Of the total appropriated to the PHSSEF, up to $4 mil ion is to be Relief Fund, $100 bil ion), and HRSA transfers ($275 mil ion). Of the total appropriated to the PHSSEF, up to $4 mil ion is to be ~~tra nsferred~~transferred to the HHS OIG. to the HHS OIG.
i. i.
Provided in distinct appropriations broadly focused on health care provider reimbursement (the Provider Provided in distinct appropriations broadly focused on health care provider reimbursement (the Provider ~~R elief~~Relief Fund, $75 bil ion) and COVID-19 testing, Fund, $75 bil ion) and COVID-19 testing,
surveil ance, and contact tracing ($25 bil ion). Of the total appropriated to the PHSSEF, up to $6 mil ion is to be transferred to the HHS OIG. surveil ance, and contact tracing ($25 bil ion). Of the total appropriated to the PHSSEF, up to $6 mil ion is to be transferred to the HHS OIG.
CRS-32 j. j.
Provided in distinct appropriations broadly focused on medical countermeasures and surge capacity ($23 bil ion), testing, surveil ance, and contact tracing ($22 Provided in distinct appropriations broadly focused on medical countermeasures and surge capacity ($23 bil ion), testing, surveil ance, and contact tracing ($22
bil ion), and health care provider reimbursement (the Provider Relief Fund, $3 bil ion). Of the total appropriated to the PHSSEF, up to $2 mil ion is to be transferred bil ion), and health care provider reimbursement (the Provider Relief Fund, $3 bil ion). Of the total appropriated to the PHSSEF, up to $2 mil ion is to be transferred
to the HHS OIG. to the HHS OIG.
k. These funds may be used to purchase medical products (e.g., vaccines, therapeutics, and diagnostics). However, the availability of these appropriations is contingent k. These funds may be used to purchase medical products (e.g., vaccines, therapeutics, and diagnostics). However, the availability of these appropriations is contingent
upon future actions by HHS. Specifical y, HHS must certify to the appropriations committees that funds from the initial $3.1 bil ion in PHHSEF appropriations that upon future actions by HHS. Specifical y, HHS must certify to the appropriations committees that funds from the initial $3.1 bil ion in PHHSEF appropriations that
had been al otted for purchase of such products wil be obligated imminently and that the additional $300 mil ion is necessary to purchase vaccines, therapeutics, or had been al otted for purchase of such products wil be obligated imminently and that the additional $300 mil ion is necessary to purchase vaccines, therapeutics, or
diagnostics to adequately address the public health nee diagnostics to adequately address the public health nee
l. l.
The transfers to the HHS OIG are specified in general provisions (not more than $2 mil ion per Title III, Division A, Section The transfers to the HHS OIG are specified in general provisions (not more than $2 mil ion per Title III, Division A, Section 306 of306 of P.L. 116-123; not more than $4 P.L. 116-123; not more than $4
mil ion per Title VIII, Division B, Section 8113 of P.L. 116-136; not more than $6 mil ion per Title I, Division B, Section 103 of P.L. 116-139; and not more than $2 mil ion per Title VIII, Division B, Section 8113 of P.L. 116-136; not more than $6 mil ion per Title I, Division B, Section 103 of P.L. 116-139; and not more than $2
mil ion per Division M, Section 304 of P.L. 116-260mil ion per Division M, Section 304 of P.L. 116-260 ). The amounts transferred to the HHS OIG may come from any funds appropriated to the PHSSEF in the ). The amounts transferred to the HHS OIG may come from any funds appropriated to the PHSSEF in the
respective appropriations acts. The HHS OIG funds are for oversight of al activities supported with funds appropriated to HHS to prevent, prepare for, and respective appropriations acts. The HHS OIG funds are for oversight of al activities supported with funds appropriated to HHS to prevent, prepare for, and
respond to the COVID-19 pandemic (not just funds appropriated to the PHSSEF). respond to the COVID-19 pandemic (not just funds appropriated to the PHSSEF).
m. P.L. 116-139 did not provide a distinct appropriation for testing for the uninsured, but it specified that up to $1 bil ion out of the $25 bil ion appropriated for m. P.L. 116-139 did not provide a distinct appropriation for testing for the uninsured, but it specified that up to $1 bil ion out of the $25 bil ion appropriated for
COVID-19 testing, surveil ance, and contact tracing may be used for this purpose. COVID-19 testing, surveil ance, and contact tracing may be used for this purpose.
n. Of the total to be transferred to HRSA, $90 mil ion is for the Ryan White HIV/AIDS program, $180 mil ion is n. Of the total to be transferred to HRSA, $90 mil ion is for the Ryan White HIV/AIDS program, $180 mil ion is for rural health programs (of which not less than $15 for rural health programs (of which not less than $15
mil ion is for tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes), and $5 mil ion is for health care systems. mil ion is for tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes), and $5 mil ion is for health care systems.
o. P.L. 116-260 directed that these funds shal be for “states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service o. P.L. 116-260 directed that these funds shal be for “states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service
providers to tribes” and may be awarded as grants or cooperative agreements. providers to tribes” and may be awarded as grants or cooperative agreements.
p. P.L. 116-139 specified that these funds may be awarded to Federal y Qualified Health Centers under Section 330 of the Public Health Service Act and to entities that p. P.L. 116-139 specified that these funds may be awarded to Federal y Qualified Health Centers under Section 330 of the Public Health Service Act and to entities that
are eligible for but not currently receiving such funds (i.e., Federal y Qualified Health Center “look-alikes”). are eligible for but not currently receiving such funds (i.e., Federal y Qualified Health Center “look-alikes”).

CRS-33 CRS-33

U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress

Resources for Tracking PHS Spending
This section provides an overview of federal resources to track Public Health Service spending This section provides an overview of federal resources to track Public Health Service spending
from COVID-19 supplemental legislation. For further information on tracking COVID-19 from COVID-19 supplemental legislation. For further information on tracking COVID-19
spending government-wide, see CRS Report R46491, spending government-wide, see CRS Report R46491, Resources for Tracking Federal COVID-19
Spending. .
USAspending.gov
USAspending.USAspending.~~gov57~~gov58 provides information on federal awards, including grants, contracts, loans, provides information on federal awards, including grants, contracts, loans,
and other assistance. USAspending.gov has a dedicated page for tracking spending from COVID-and other assistance. USAspending.gov has a dedicated page for tracking spending from COVID-
19 supplemental measures (COVID-19 Spending, https://www.usaspending.gov/disaster/covid-19 supplemental measures (COVID-19 Spending, https://www.usaspending.gov/disaster/covid-
19). There is also an advanced search page (https://www.usaspending.gov/search) with the search 19). There is also an advanced search page (https://www.usaspending.gov/search) with the search
option “Disaster Emergency Funding Code,” to limit results by COVID-19 supplemental funding option “Disaster Emergency Funding Code,” to limit results by COVID-19 supplemental funding
law.law.5859 For the COVID-19 supplemental funding, USAspending.gov provides data on For the COVID-19 supplemental funding, USAspending.gov provides data on obligations
(amount promised) and (amount promised) and outlays (amount paid out). Typical y, USAspending.gov provides only (amount paid out). Typical y, USAspending.gov provides only
obligations data. obligations data.
Caveats to the data presented in USAspending.gov are outlined on the “Known Data Limitations” Caveats to the data presented in USAspending.gov are outlined on the “Known Data Limitations”
page (https://www.usaspending.gov/data/data-limitations.pdf). page (https://www.usaspending.gov/data/data-limitations.pdf).5960
Pandemic Response Accountability Committee
The Pandemic Response Accountability Committee (PRAC) website provides visualizations of The Pandemic Response Accountability Committee (PRAC) website provides visualizations of
COVID-19 supplemental appropriations funding data on the “Track the Money” page COVID-19 supplemental appropriations funding data on the “Track the Money” page
(https://www.pandemicoversight.gov/track-the-money). This site uses data from (https://www.pandemicoversight.gov/track-the-money). This site uses data from
USAspending.gov. The “Funding Charts & Graphs” USAspending.gov. The “Funding Charts & Graphs” page (https://www.pandemicoversight.gov/page (https://www.pandemicoversight.gov/
track-the-money/funding-charts-graphs) track-the-money/funding-charts-graphs) ~~under~~ shows payments from the Provider Relief Fund, and “Pandemic Response Funding” shows spending by “Pandemic Response Funding” shows spending by
agency, geography, and program (“assistance agency, geography, and program (“assistance listing”) in interactive charts, graphs, and tables.listing”) in interactive charts, graphs, and tables.
HHS TAGGS HHS TAGGS
The HHS Tracking Accountability in Government Grants SystemThe HHS Tracking Accountability in Government Grants System (HHS TAGGS) has a dedicated (HHS TAGGS) has a dedicated
page for COVID-19 funding (https://taggs.hhs.gov/Coronavirus). This page provides details on page for COVID-19 funding (https://taggs.hhs.gov/Coronavirus). This page provides details on
HHS grant awards underHHS grant awards under ~~the first four~~ COVID supplemental measures. Awards can be filtered by COVID supplemental measures. Awards can be filtered by
HHS operating division (e.g., CDC), program, date, recipient, city, state, and supplemental HHS operating division (e.g., CDC), program, date, recipient, city, state, and supplemental
appropriations law. appropriations law.
Separate tables show data on attested Separate tables show data on attested ~~payments60~~payments61 made under the Provider Relief Fund made under the Provider Relief Fund
(https://taggs.hhs.gov/Coronavirus/Providers), Rural Health Clinic (RHC) COVID-19 Testing (https://taggs.hhs.gov/Coronavirus/Providers), Rural Health Clinic (RHC) COVID-19 Testing
~~Fund (https://taggs.hhs.gov/Coronavirus/RuralHealthClinics), and the Uninsured Relief Fund~~
~~(https://taggs.hhs.gov/Coronavirus/Uninsured).~~

5758 For more information on USAspending.gov, see CRS Report R44027, For more information on USAspending.gov, see CRS Report R44027, Tracking Federal Awards: USAspending.gov
and Other Data Sources, and CRS In Focus IF10231, , and CRS In Focus IF10231, Tracking Federal Awards in States and ~~Congressional~~Con gressional Districts
Using USAspending.gov. .
5859 DEFC Codes are described at USAspending.gov, DEFC Codes are described at USAspending.gov, COVID-19 Spending: Data Sources & Methodology, “Disaster , “Disaster
Emergency Fund Code (DEFC),” https://www.usaspending.gov/disaster/covid-19/data-sources?section=defc. Emergency Fund Code (DEFC),” https://www.usaspending.gov/disaster/covid-19/data-sources?section=defc.
5960 Ibid. Ibid.
6061 For more information about attested payments, see For more information about attested payments, see CARES Act Provider Relief Fund: For Providers, under “Attest to , under “Attest to
Payment” (https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#how-to-attest). Payment” (https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#how-to-attest).
Congressional Research Service Congressional Research Service

34 34

U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress

Fund (https://taggs.hhs.gov/Coronavirus/RuralHealthClinics), and the Uninsured Relief Fund (https://taggs.hhs.gov/Coronavirus/Uninsured). GAO Reports
GAO provides oversight of the federal response to the pandemic and COVID-19-related GAO provides oversight of the federal response to the pandemic and COVID-19-related
spending. Information on COVID-19 supplemental funding is available on the “Coronavirus spending. Information on COVID-19 supplemental funding is available on the “Coronavirus
Oversight” page (https://www.gao.gov/coronavirus/). The following GAO reports in particular Oversight” page (https://www.gao.gov/coronavirus/). The following GAO reports in particular
have detailed information on PHS and COVID-19 related funding: have detailed information on PHS and COVID-19 related funding:
  COVID-19: Opportunities to Improve Federal Response and Recovery Efforts
(GAO-20-625, (GAO-20-625, ~~Jun~~June 25, 2020) 25, 2020)
  COVID-19 Contracting: Observations on Federal Contracting in Response to the
Pandemic (GAO-20-632, (GAO-20-632, ~~Jul~~July 29, 2020) 29, 2020)
  COVID-19: Brief Update on Initial Federal Response to the Pandemic (GAO-20- (GAO-20-
708, 708, ~~Aug~~August 31, 2020) 31, 2020)
  COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted
Actions (GAO-20-701, (GAO-20-701, ~~Sep~~September 21, 2020) 21, 2020)
  COVID-19: Federal Efforts Accelerate Vaccine and Therapeutic Development,
but More Transparency Needed on Emergency Use Authorizations (GAO-21-207, (GAO-21-207,
~~Nov~~November 17, 2020) 17, 2020)
  COVID-19: Urgent Actions Needed to Better Ensure an Effective Federal
Response (GAO-21-191, (GAO-21-191, ~~Nov~~November 30, 2020) 30, 2020)
  COVID-19: Critical Vaccine Distribution, Supply Chain, Program Integrity, and
Other Challenges Require Focused Federal Attention (GAO-21-265, (GAO-21-265, ~~Jan~~January 28, 28,
2021) 2021)
  Operation Warp Speed: Accelerated COVID-19 Vaccine Development Status and
Efforts to Address Manufacturing Challenges (GAO-21-319, (GAO-21-319, ~~Feb~~February 11, 2021)  COVID-19:Sustained Federal Action Is Crucial as Pandemic Enters Its Second Year (GAO-21-387, March 31, 2021)  COVID-19: Efforts to Increase Vaccine Availability and Perspectives on Initial Implementation (GAO-21-443, April 14, 2021)  COVID-19: Continued Attention Needed to Enhance Federal Preparedness, Response, Service Delivery, and Program Integrity (GAO-21-551, July 19, 2021)  COVID-19 Contracting: Actions Needed to Enhance Transparency and Oversight of Selected Awards (GAO-21-501, July 26, 2021) PHS Agency Websites The following PHS agency websites have information on the distribution of COVID-19 supplemental funding:  ASPR. BARDA’s COVID-19 Medical Countermeasure Portfolio (https://www.medicalcountermeasures.gov/app/barda/coronavirus/COVID19.aspx) has information on funding awards for the development and manufacturing of COVID-19 products including diagnostics, vaccines, and therapeutics. ASPR’s COVID-19 Supplemental Funding Overview (https://www.phe.gov/emergency/events/COVID19/HPP/Pages/overview.aspx) Congressional Research Service 35 U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress has a funding table by state for several programs supporting health care system COVID-19 response funded by the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES Act. ~~11, 2021)~~
~~PHS Agency Websites~~
~~The following PHS agency websites have information on the distribution of COVID-19~~
~~supplemental funding:~~
  CDC. The CDC Budget website (https://www.cdc.gov/budget/index.html) The CDC Budget website (https://www.cdc.gov/budget/index.html)
provides CDC COVID-19 State, Tribal, Local, and Territorial (STLT) Funding provides CDC COVID-19 State, Tribal, Local, and Territorial (STLT) Funding
~~Fact Sheet~~ (https://www.cdc.gov/(https://www.cdc.gov/~~coronavirus/2019-ncov/downloads/php/funding-~~
~~update.pdf~~budget/fact-sheets/covid-19/funding/index.html) with information on funding by supplemental measure) with information on funding by supplemental measure ~~and program~~
by , program, and topical area by jurisdiction. Additional information is available on the page “Budget Fact jurisdiction. Additional information is available on the page “Budget Fact
Sheets: Novel Coronavirus (COVID-19)” (https://www.cdc.gov/budget/fact-Sheets: Novel Coronavirus (COVID-19)” (https://www.cdc.gov/budget/fact-
sheets/covid-19/index.html). sheets/covid-19/index.html).
  HRSA. HRSA provides funding information on various pages for programs that HRSA provides funding information on various pages for programs that
received supplemental funding; for example, received supplemental funding; for example, “Primary Health Care Coronavirus “Primary Health Care Coronavirus
Related Grants by State Funding Report” (https://data.hrsa.gov/data/reports/Related Grants by State Funding Report” (https://data.hrsa.gov/data/reports/
datagrid?gridName=COVID19FundingReport); “Coronavirus Disease (COVID-datagrid?gridName=COVID19FundingReport); “Coronavirus Disease (COVID-
19) Frequently Asked Questions – Federal Office of Rural Health Policy” 19) Frequently Asked Questions – Federal Office of Rural Health Policy”
(https://www.hrsa.gov/rural-health/coronavirus/frequently-asked-questions); (https://www.hrsa.gov/rural-health/coronavirus/frequently-asked-questions); “Rural Health Clinic COVID-19 Testing and Mitigation Program Funding Distribution” (https://www.hrsa.gov/coronavirus/rural-health-clinics/testing/funding); and ~~and~~
“Ryan White HIV/AIDS Program: FY 2020 CARES “Ryan White HIV/AIDS Program: FY 2020 CARES Act Awards” Act Awards”
(https://hab.hrsa.gov/coronavirus/cares-FY2020-awards). Relevant information (https://hab.hrsa.gov/coronavirus/cares-FY2020-awards). Relevant information
can also be found on the HHS TAGGS pages for the Provider Relief Fund can also be found on the HHS TAGGS pages for the Provider Relief Fund
(https://taggs.hhs.gov/Coronavirus/Providers), Rural Health Clinic (RHC) (https://taggs.hhs.gov/Coronavirus/Providers), Rural Health Clinic (RHC)
~~Congressional Research Service~~

35

~~U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress~~

COVID-19 Testing Fund (https://taggs.hhs.gov/Coronavirus/RuralHealthClinics), COVID-19 Testing Fund (https://taggs.hhs.gov/Coronavirus/RuralHealthClinics),
and the Uninsured Relief Fund (https://taggs.hhs.gov/Coronavirus/Uninsured). and the Uninsured Relief Fund (https://taggs.hhs.gov/Coronavirus/Uninsured).
  IHS. The IHS website Coronavirus (COVID-19) Resources The IHS website Coronavirus (COVID-19) Resources
(https://www.ihs.gov/coronavirus/resources/ (https://www.ihs.gov/coronavirus/resources/ ~~https://www.ihs.gov/coronavirus/~~
~~faqs-federal-response-in-indian-country/~~) provides details on funding under the ) provides details on funding under the
section “COVID-19 Funding Guidance for Tribes, Tribal Organizations and section “COVID-19 Funding Guidance for Tribes, Tribal Organizations and
Urban Indian Organizations,” including “Guidance on Indian Health Service Urban Indian Organizations,” including “Guidance on Indian Health Service
COVID-19 Funding Distribution for Tribes, Tribal Organizations, and Urban COVID-19 Funding Distribution for Tribes, Tribal Organizations, and Urban
Indian Organizations” (https://www.ihs.gov/sites/coronavirus/themes/Indian Organizations” (https://www.ihs.gov/sites/coronavirus/themes/
responsive2017/display_objects/documents/COVID-responsive2017/display_objects/documents/COVID-
19_Funding_Guidance_Tribes_UrbanIndianOrganizations.pdf) and “19_Funding_Guidance_Tribes_UrbanIndianOrganizations.pdf) and “~~Fiscal Year~~
~~2020~~FY 2020-2021 Coronavirus (COVID-19) Coronavirus (COVID-19) and American Rescue Plan Act Funding ~~Funding~~ Al ocations” (https://www.ihs.gov/sites/Al ocations” (https://www.ihs.gov/sites/
coronavirus/themes/responsive2017/display_objects/coronavirus/themes/responsive2017/display_objects/~~documents/~~
~~FY_2020_COVID19_FundingSummary~~documents/FY-2020-2021-COVID19-ARPA-Funding-Summary.pdf)..pdf).
  NIH. NIH provides details on research projects funded by COVID-19 NIH provides details on research projects funded by COVID-19
supplemental measures, filtered by state and congressional district on the site supplemental measures, filtered by state and congressional district on the site
COVID-19 Research: FundingCOVID-19 Research: Funding (https://covid19.nih.gov/funding). Also, the NIH (https://covid19.nih.gov/funding). Also, the NIH
RePORTER database (https://reporter.nih.gov/) provides details on NIH-funded RePORTER database (https://reporter.nih.gov/) provides details on NIH-funded
projects with more detailed search capabilities. The “Advanced Projects Search”projects with more detailed search capabilities. The “Advanced Projects Search”
page (https://reporter.nih.gov/advanced-search) has an option to add the search page (https://reporter.nih.gov/advanced-search) has an option to add the search
filter “NIH COVID-19 Response,” with choices for “NIH Regular filter “NIH COVID-19 Response,” with choices for “NIH Regular
Appropriations Funding Used for COVID-19 Research,” which al ows users to Appropriations Funding Used for COVID-19 Research,” which al ows users to
limit the search to COVID-19 research funded by regular NIH appropriations, limit the search to COVID-19 research funded by regular NIH appropriations,
COVID-19 supplemental appropriations, or specific supplemental appropriations COVID-19 supplemental appropriations, or specific supplemental appropriations
laws. laws.
Congressional Research Service 36 U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress   SAMHSA. The SAMHSA website Coronavirus (COVID-19) The SAMHSA website Coronavirus (COVID-19)
(https://www.samhsa.gov/coronavirus) under “SAMHSA Resources and (https://www.samhsa.gov/coronavirus) under “SAMHSA Resources and
Information” provides COVID-related grant funding details under “FY 2021 Information” provides COVID-related grant funding details under “FY 2021
SAMHSA COVID-19 Funded Grants” (https://www.samhsa.gov/sites/default/SAMHSA COVID-19 Funded Grants” (https://www.samhsa.gov/sites/default/
files/covid19-programs-funded-samhsa-fy21.pdf) and “FY 2020 SAMHSA files/covid19-programs-funded-samhsa-fy21.pdf) and “FY 2020 SAMHSA
COVID-19 Funded Grants” (https://www.samhsa.gov/sites/default/files/covid19-COVID-19 Funded Grants” (https://www.samhsa.gov/sites/default/files/covid19-
programs-funded-samhsa.pdfprograms-funded-samhsa.pdf). SAM.gov Data Bank: Contract Data Reports  Contract Data Reports (https://sam.gov/reports/awards/static) includes a “COVID-19 Report,” which is a spreadsheet of COVID-19 pandemic-related federal contract awards that have been made since March 13, 2020. Note that this is a very large file. The spreadsheet may be filtered by criteria such as agency, place of performance (including state and congressional district), and Treasury Account Symbol (TAS). ).
Nongovernment Sources
The following sources are examples of unofficial, nongovernment sources that provide tracking The following sources are examples of unofficial, nongovernment sources that provide tracking
and analysis of COVID-19 supplemental funding: and analysis of COVID-19 supplemental funding:
 COVID Money Tracker (Committee for a Responsible Budget),  COVID Money Tracker (Committee for a Responsible Budget),
https://www.covidmoneytracker.org/explore-data/interactive-table https://www.covidmoneytracker.org/explore-data/interactive-table
 COVID-19 Relief Spending Tracker (Project on Government Oversight),  COVID-19 Relief Spending Tracker (Project on Government Oversight),
https://covidtracker.pogo.org/table-view https://covidtracker.pogo.org/table-view
 Coronavirus Disease 2019 (COVID-19)  Coronavirus Disease 2019 (COVID-19) (Federal Funds Information for States, (Federal Funds Information for States,
FFIS), https://ffis.org/COVID-19 (by subscription only) FFIS), https://ffis.org/COVID-19 (by subscription only)

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~~U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress~~

 Coronavirus Contracts: Tracking Federal Purchases to Fight the Coronavirus (ProPublica), https://projects.propublica.org/coronavirus-contracts/
Author Information

Kavya Sekar, Coordinator Kavya Sekar, Coordinator
Johnathan H. Duff Johnathan H. Duff
Analyst in Health Policy Analyst in Health Policy
Analyst in Health Policy Analyst in Health Policy

Agata Bodie Agata Bodie
Elayne J. Heisler Elayne J. Heisler
Analyst in Health Policy Analyst in Health Policy
Specialist in Health Services Specialist in Health Services

Ada S. Cornell Ada S. Cornell
Isaac A. Nicchitta Isaac A. Nicchitta
Senior Research Librarian Senior Research Librarian
Research Assistant Research Assistant

Congressional Research Service 37 U.S. Public Health Service: COVID-19 Supplemental Funding in the 116th Congress Acknowledgments
~~Acknowledgments~~
CRS Visual Information Specialist Jamie Hutchinson provided support for graphics in this report.CRS Visual Information Specialist Jamie Hutchinson provided support for graphics in this report.
CRS Senior Research Librarian Angela Napili contributed to a technical update to this report.
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