ȱ
ȱ
ȱȱȱȱȱ
¢ȱȱȱȱȱŘŖŖşȱ
ǯȱȱǰȱȱ
ȱȱ
ȱ¢ȱ
ȱ ǯȱȱ
¢ȱȱ ¢ȱ
ȱǯȱȱ
ȱȱȱ
ȱȱ¢ȱ
ȱ¢Ȭȱ
¢ȱȱ
ȱȱȱȱ
ȱǯȱȱ
¢ȱȱȱ¢ȱ
ȱǯȱȱ
¢ȱȱȱ
ȱȱ¢ȱ
¢ȱŘŖǰȱŘŖŖşȱ
ȱȱȱ
ŝȬśŝŖŖȱ
ǯǯȱ
ŚŖŗŞŗȱ
ȱȱȱ
Pr
epared for Members and Committees of Congress
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
ȱ
Introduction ..................................................................................................................................... 1
Selected HHS Appropriations.......................................................................................................... 1
Health Information Technology....................................................................................................... 3
Comparative Effectiveness Research .............................................................................................. 3
ȱ
Table 1. Selected Health Funding in the American Recovery and Reinvestment Act of
2009.............................................................................................................................................. 4
ȱ
Author Contact Information ............................................................................................................ 7
Acknowledgments ........................................................................................................................... 7
ȱȱȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
ȱ
The American Recovery and Reinvestment Act (ARRA) of 2009 includes emergency
appropriations for biomedical research, public health, and other health-related programs within
the Department of Health and Human Services (HHS), as well as new authorizing language to
promote health information technology (HIT) and establish a federal interagency advisory panel
to coordinate comparative effectiveness research. The President signed the ARRA bill (H.R. 1)
into law on February 17, 2009 (P.L. 111-5).
This report compares funding provided for selected HHS programs in the ARRA conference
report (H.Rept. 111-16) with the recommendations in the House- and Senate-passed versions of
H.R. 1. It also briefly discusses ARRA’s provisions on HIT and comparative effectiveness
research as they relate to the funding.
ȱ
ȱȱ
The ARRA conference agreement includes the following discretionary appropriations for HHS
health-related programs and activities.
• Community health centers. The conference agreement provides $1.5 billion for
the renovation and repair of health centers and the acquisition of HIT systems,
and an additional $500 million for center grants to increase the number of
uninsured individuals served.
• Health workforce. The conference agreement provides $500 million for training
primary health care providers and helping pay medical school expenses for
students who agree to practice in medically underserved communities through the
National Health Service Corps program.
• HHS buildings and facilities. The conference agreement provides $500 million
to repair and improve National Institutes of Health (NIH) facilities, and $415
million for the Indian Health Service (IHS) for construction and deferred
maintenance projects and the purchase of equipment.
• Biomedical research. The conference agreement provides a total of $9.5 billion
for biomedical research, including $8.2 billion for NIH research grants, $1 billion
to construct and renovate university biomedical and behavioral research facilities,
and $300 million for instrumentation.
• Comparative effectiveness. The conference agreement provides a total of $1.1
billion for research comparing the clinical outcomes, effectiveness, and
appropriateness of items, services, and procedures used to prevent, diagnose and
treat diseases and other health conditions. The Agency for Healthcare Research
and Quality (AHRQ) receives $700 million, of which $400 million is to be
transferred to NIH. An additional $400 million is to be allocated at the discretion
of the HHS Secretary.
• Health information technology. The conference agreement provides $2 billion
for HIT to support the electronic sharing of clinical data among hospitals,
ȱȱȱ
ŗȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
physicians, and other health care stakeholders. An additional $85 million is
provided for HIT activities and telehealth services at Indian health facilities.
• Public health preparedness. The conference agreement provides $50 million for
HHS cyber-security.
• Disease prevention. The conference agreement provides $1 billion for
prevention and wellness programs and activities.
Table 1 provides a more detailed comparison of the funding included in the ARRA conference
agreement with the recommendations in the House- and Senate-passed bills for the above HHS
programs and activities. Unless otherwise noted, all the funds will remain available through the
end of FY2010 (i.e., through September 30, 2010). Each mention of the Secretary in the table
refers to the HHS Secretary. The following acronyms appear in the table:
AHRQ
Agency for Healthcare Research and Quality
CDC
Centers for Disease Control and Prevention
HIT Health
Information
Technology
HRSA
Health Resources and Services Administration
IHS
Indian Health Service
NIH
National Institutes of Health
NCRR
National Center for Research Resources (NIH)
NIST
National Institute of Standards and Technology
ONCHIT
Office of the National Coordinator for Health Information Technology
PHS
Public Health Service
PHSSEF
Public Health and Social Services Emergency Fund
The conference agreement also includes discretionary funding for human services programs
administered by HHS. It provides $100 million to the Administration on Aging (AOA) for senior
nutrition programs authorized under Title III of the Older Americans Act, and gives $5.15 billion
to the Administration for Children and Families (ACF) for the Child Care and Development
Block Grant, the Community Services Block Grant, and Head Start. For more information, see
CRS Report RL33880, Older Americans Act Funding, and CRS Report R40211, Human Services
Provisions of the American Recovery and Reinvestment Act.
ȱȱȱ
Řȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
ȱ ȱ¢ȱ
The economic recovery legislation includes the Health Information Technology for Economic and
Clinical Health (HITECH) Act, which contains three sets of provisions to promote the adoption of
interoperable electronic health records (EHRs) and the development of a national health
information network to permit the secure exchange of electronic health information among
providers. First, the HITECH Act codifies the HHS Office of the National Coordinator for Health
Information Technology (ONCHIT), which was created by Executive Order in 2004.
Second, through a number of mechanisms the Act provides financial incentives for HIT use
among health care practitioners. It establishes several grant programs to provide funding for
investing in HIT infrastructure, purchasing certified EHRs, training, and the dissemination of best
practices. It also authorizes grants to states for low-interest loans to help providers finance HIT.
Beginning in 2011, the HITECH Act authorizes Medicare incentive payments to encourage
doctors and hospitals to adopt and use certified EHRs. Those incentive payments are phased out
over time and replaced by financial penalties for physicians and hospitals that are not using
certified EHRs. The legislation further authorizes a 100% federal match for payments to
Medicaid providers to encourage the adoption and use of certified EHR technology.
Finally, the HITECH Act strengthens the federal health information privacy and security
standards, established under the Health Information Portability and Accountability Act (HIPAA).
For more information, see CRS Report R40161, The Health Information Technology for
Economic and Clinical Health (HITECH) Act.
The ARRA conference agreement instructs the Secretary to use the $2 billion appropriation for
HIT to implement the HITECH Act.
ȱȱȱ
In addition to appropriating funds for comparative effectiveness research, ARRA establishes an
interagency advisory panel to help coordinate and support the research. The Federal Coordinating
Council for Comparative Effectiveness Research, composed of up to 15 senior officials (including
physicians and others with clinical expertise) from federal agencies with health-related programs,
is required to report to the President and Congress annually. The conference agreement includes
language stating that (1) the Council may not mandate coverage, reimbursement, or other policies
for public and private payers of health care, and (2) Council reports and recommendations may
not be construed as mandates or clinical guidelines for payment, coverage, or treatment.
ȱȱȱ
řȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
Table 1. Selected Health Funding in the American Recovery and Reinvestment Act of 2009
($ millions)
Function + Agency/Office
House
Senate
Enacted
Explanation
Community Health Centers
HRSA
1,500
1,870
2,000
The conference agreement provides $1.5 billion for the renovation and repair of health centers and
the acquisition of HIT systems; the remaining $500 million is for center grants. The House bill provided
$1 billion for center renovation and HIT acquisition, and $500 million for centers grants. The Senate
bill provided $1.87 billion for construction, renovation and equipment for health centers.
Health Workforce
HRSA
600
0
500
The conference agreement provides $500 million for PHS Act health workforce programs. Of this
total, $300 million is for the National Health Service Corps ($75 million of which is to remain available
through September 30, 2011), and $200 million is for education and training programs authorized in
Title VII (Health Professions) and Title VIII (Nursing Training) of the PHS Act. Funds may also be used
to develop interstate licensing agreements to promote telemedicine. The House bill provided $600
million for health workforce programs; the Senate bill included no such funding.
HHS Buildings and Facilities
CDC
462
412
0
The House and Senate bills both provided funds to CDC for the acquisition of real property,
equipment, construction, and renovation of facilities, including necessary repairs and improvements to
leased laboratories. The House bill further included a requirement to relocate and consolidate
property and facilities of the National Institute for Occupational Safety and Health (NIOSH). The
conference agreement includes no funding for CDC buildings and facilities.
NIH
500
500
500
The conference agreement provides $500 million for high-priority repair, construction, and
improvement projects for NIH facilities on the Bethesda, MD campus and other agency locations, as
provided in the Senate bill. The House and Senate bills both provided the same amount, but the House
bill allowed funding only for repair and improvement projects.
IHS
550
410
415
The conference agreement provides $415 million for Indian health facilities. Within this amount, $227
million is for health care facilities construction, $100 million is for facilities maintenance and
improvement, $68 million is for sanitation facilities construction, and $20 million is for equipment
(including HIT). The funds are not subject to the annual spending caps for medical equipment. The
House provided $550 million for Indian health facilities construction projects, deferred maintenance,
and the purchase of equipment and related services (including HIT), all to be allocated at the discretion
of the IHS Director. The Senate provided $410 million for the Indian Health Facilities account.
HRSA
88
88
0
The House and Senate bills both provided funds to cover the costs related to moving into a facility and
for the temporary relocation of staff, so as to maintain continuity of business operations during
renovation or replacement of the headquarters for components of the Department of Health and
Human Services. The conference agreement includes no such funding.
ȬŚȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
Function + Agency/Office
House
Senate
Enacted
Explanation
Biomedical/Behavioral Research Facilities (Extramural)
NIH, NCRR
1,500
300
1,300
The conference agreement provides $1.3 billion to NCRR, of which $1 billion is for competitive grants
and contracts under PHS Act Sec. 481A to construct, renovate, or repair existing non-federal research
facilities. It waives various requirements for matching funds and support of regional centers for primate
research, and shortens the time (from 20 years to 10 years) for required future use of the research
facility. It also permits use of $300 million for shared instrumentation and other capital research
equipment. The House bill provided $1.5 billion for awards to renovate or repair existing facilities, and
permitted use of funds for shared instrumentation and other capital research equipment. The Senate
version provided funds only for shared instrumentation and other capital research equipment.
Biomedical Research
NIH
1,500 9,200 8,200
The conference agreement provides $8.2 billion to the Office of the Director for support of additional
scientific research (extramural and intramural). The funds are not subject to small business set-aside
requirements. Of the total, $7.4 billion is to be transferred to the Institutes and Centers of NIH and to
the Common Fund in proportion to regular appropriations (certain accounts are not eligible for these
funds). The remaining $800 million is available at the Director’s discretion, with an emphasis on short-
term (2-year) projects, including $400 million that may be used under the Director's flexible research
authority. The House bill provided $1.5 billion, all for transfer proportionally to the Institutes, Centers,
and Common Fund, with half for FY2009 and half for FY2010. The Senate version provided $9.2 billion,
with $7.85 billion for proportional transfer and $1.35 billion for the Director's discretionary use.
Comparative Effectiveness
AHRQ
700
700
700
The conference agreement provides $700 million to AHRQ for comparative effectiveness research, of
which $400 million is to be transferred to NIH for the same purpose. Funds transferred to NIH may
be allocated to the Institutes, Centers, and Common Fund. AHRQ may not use more than 1% of its
funds for additional FTEs. The House and Senate bills both provided the same amount of funding.
Office of the Secretary
400
400
400
The conference agreement further provides $400 million for comparative effectiveness research to be
allocated at the Secretary’s discretion to: (1) conduct, support, or synthesize research that compares
the clinical outcomes, effectiveness, and appropriateness of preventive, diagnostic, and therapeutic
items, services, and procedures; and (2) encourage the development and use of clinical registries,
clinical data networks, and other forms of electronic health data that can be used to generate or obtain
outcomes data. It specifies using up to $1.5 million for an Institute of Medicine study, to be submitted
to Congress no later than June 30, 2009. The study must include recommendations on the national
priorities for comparative effectiveness research. The Secretary is also instructed to consider any
recommendations submitted by the Federal Coordinating Council for Comparative Effectiveness
Research. The House and Senate bills both provided the same amount of funding.
Ȭśȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
Function + Agency/Office
House
Senate
Enacted
Explanation
Health Information Technology
Office of the Secretary, ONCHIT
2,000
3,000
2,000
The conference agreement provides $2 billion, to remain available until expended, to implement the
HITECH Act and promote the widespread adoption of electronic health records, of which $300
million is to support regional health information exchange networks. It transfers $20 million to NIST
for HIT standards analysis and testing. The House and Senate bills both provided HIT funding.
IHS
0
85
85
The conference agreement provides $85 million for HIT, including telehealth, to be allocated at the
discretion of the IHS Director. The Senate provided the same amount for HIT (and, separately, added
$50 million for contract health care services). The House did not include a specific amount for HIT;
however, funding for Indian health facilities (described earlier in the table) may be used for the
purchase of equipment, including HIT.
Public Health Preparedness
Office of the Secretary, PHSSEF
430
0
0
The House bill provided funds for advanced research and development of countermeasures through
the Biomedical Advanced Research and Development Authority (BARDA; PHS Act Sec. 319L). The
conference agreement includes no such funding.
420
0
0
The House bill provided funds for preparedness for an influenza pandemic, including procurement of
countermeasures and equipment. Funds could be used for construction or renovation of privately
owned facilities for the production of vaccine and other biologics. The conference report includes no
such funding.
50
0
50
The conference agreement provides funds to improve information technology security (i.e., cyber-
security) at HHS. The House bill included similar funding.
Disease Prevention
3,000
0
1,000
The conference agreement provides $1 billion for a Prevention and Wellness Fund to be administered
by the Secretary. Of the total, $300 million is to be transferred to CDC for the immunization
program, $650 million is for evidence-based clinical and community-level prevention and wellness
programs that address chronic disease, and the remaining $50 million is for state activities to reduce
healthcare-associated infections. The House bill provided $3 billion for a Prevention and Wellness
Fund.
Source: Table prepared by the Congressional Research Service using (i) the text of H.R. 1, as passed by the House on January 28, 2009, (ii) the text of Senate Amendment 570 to H.R. 1, as
passed by the Senate on February 10, 2009, and (iii) the text of the H.R. 1 conference report (H.Rept. 111-16).
ȬŜȱ
ȱ
ȱȱȱȱȱ¢ȱȱȱȱȱŘŖŖşȱ
ȱ
ȱȱ ȱ
C. Stephen Redhead, Coordinator
Bernice Reyes-Akinbileje
Specialist in Health Policy
Analyst in Health Resources and Services
credhead@crs.loc.gov, 7-2261
breyes@crs.loc.gov, 7-2260
Kirsten J. Colello
Pamela W. Smith
Analyst in Gerontology
Analyst in Biomedical Policy
kcolello@crs.loc.gov, 7-7839
psmith@crs.loc.gov, 7-7048
Sarah A. Lister
Andrew R. Sommers
Specialist in Public Health and Epidemiology
Analyst in Public Health and Epidemiology
slister@crs.loc.gov, 7-7320
asommers@crs.loc.gov, 7-4624
ȱ
Roger Walke contributed to this report.
ȱȱȱ
ŝȱ