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Selected Health Funding in the American
Recovery and Reinvestment Act of 2009
C. Stephen Redhead, Coordinator
Acting Section Research Manager
Elayne J. Heisler
Analyst in Health Services
Sarah A. Lister
Specialist in Public Health and Epidemiology
Bernice Reyes-Akinbileje
Analyst in Health Resources and Services
Amanda K. Sarata
Specialist in Health Policy and Genetics
Pamela W. Smith
Analyst in Biomedical Policy
Roger Walke
Specialist in American Indian Policy
March 17, 2010
Congressional Research Service
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www.crs.gov
R40181
CRS Report for Congress
P
repared for Members and Committees of Congress
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Summary
The American Recovery and Reinvestment Act of 2009 (ARRA), the economic stimulus
legislation signed into law on February 17, 2009 (P.L. 111-5), included supplemental FY2009
discretionary appropriations for biomedical research, public health, and other health-related
programs within the Department of Health and Human Services (HHS). Generally, the
appropriations are to remain available through September 30, 2010. P.L. 111-5 also incorporated
new authorizing language to promote health information technology (HIT) and established a
federal interagency advisory panel to coordinate comparative effectiveness research.
As enacted, ARRA included $17.15 billion for community health centers, health care workforce
training, biomedical research, comparative effectiveness research, HIT, disease prevention, and
Indian health facilities. This report discusses the health-related programs and activities funded by
ARRA and provides details on how the administering HHS agencies and offices are allocating,
awarding, and spending the funds. It will be regularly updated as new information becomes
available.
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Contents
Introduction ................................................................................................................................ 1
Health Centers ............................................................................................................................ 3
Infrastructure ........................................................................................................................ 3
Patient Services..................................................................................................................... 3
Health Workforce Programs ........................................................................................................ 4
National Health Service Corps .............................................................................................. 4
Health Professions Education and Training............................................................................ 4
Biomedical and Behavioral Research .......................................................................................... 5
Comparative Effectiveness Research ........................................................................................... 6
Health Information Technology................................................................................................... 7
HITECH Act Grants.............................................................................................................. 9
Health Information Technology Extension Program......................................................... 9
State Health Information Exchange Cooperative Agreement Program.............................. 9
Health Information Technology Workforce Development Program ................................ 10
Beacon Community Cooperative Agreement Program ................................................... 10
Strategic Health IT Advanced Research Projects (SHARP) Program.............................. 10
Disease Prevention.................................................................................................................... 11
Immunization Programs ...................................................................................................... 11
Health Care-Associated Infections (HAIs)........................................................................... 11
Evidence-Based Prevention and Wellness Programs ............................................................ 12
Indian Health Care .................................................................................................................... 14
Facilities Funding ............................................................................................................... 14
Health Care Facilities Construction ............................................................................... 14
Facilities Maintenance, Sanitation Construction, and Equipment ................................... 14
Health Information Technology Funding ............................................................................. 16
Figures
Figure 1. ARRA Discretionary Health Funding, by Agency/Office............................................. 17
Tables
Table 1. ARRA Discretionary Health Funding, by Agency/Office ................................................ 2
Table 2. ARRA Evidence-Based Prevention and Wellness Program Funding.............................. 13
Table 3. IHS ARRA Facilities Funding, by Type of Activity ...................................................... 15
Table 4. ARRA Discretionary Health Funding and Comparable Appropriations, by
Activity.................................................................................................................................. 18
Table 5. Obligation of ARRA Discretionary Health Funding...................................................... 20
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Contacts
Author Contact Information ...................................................................................................... 21
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Introduction
The American Recovery and Reinvestment Act of 2009 (ARRA; P.L. 111-5), which the President
signed into law on February 17, 2009, provided $17.15 billion in supplemental FY2009
discretionary appropriations for biomedical research, public health, and other health-related
programs within the Department of Health and Human Services (HHS). ARRA also included new
authorizing language to promote the widespread adoption of electronic health records and other
health information technology (HIT), and established a federal interagency advisory panel to
coordinate comparative effectiveness research.
This report discusses the health-related programs and activities funded by ARRA and provides
details on how the administering HHS agencies and offices are allocating and obligating the
funds. ARRA funds were designated as emergency supplemental appropriations for FY2009.
Unless otherwise specified in the law, the ARRA funds are to remain available for obligation
through the end of FY2010 (i.e., September 30, 2010).
Most of the health-related programs and activities for which ARRA provided supplemental funds
also receive funding in annual appropriations acts through regular procedures. HHS FY2009
appropriations were included in the Omnibus Appropriations Act, 2009 (P.L. 111-8), which was
signed into law on March 11, 2009. The Consolidated Appropriations Act, 2010 (P.L. 111-117),
signed on December 16, 2009, included HHS appropriations for FY2010. For more information,
see CRS Report RL34577, Labor, Health and Human Services, and Education: FY2009
Appropriations; and CRS Report R40730, Labor, Health and Human Services, and Education:
Highlights of FY2010 Budget and Appropriations.
Table 1 summarizes ARRA’s discretionary health funding, by HHS agency and office. Figure 1
shows the percentage distribution of the ARRA funds, by HHS agency and office. Two additional
tables that appear at the end of this report provide more details on the ARRA funding. Table 4
shows the ARRA health funding, by type of activity funded, and includes a comparison of the
amounts provided in ARRA with the regular FY2009 and FY2010 appropriations and the FY2011
budget request. Table 5 shows the obligation of ARRA funds, by type of activity funding, for
FY2009 and FY2010.
As part of its efforts to ensure transparency and accountability in the use of ARRA funds, the
Office of Management and Budget (OMB) issued detailed government-wide guidance for
implementing ARRA and established a website, “Recovery.gov,” which allows the public to track
ARRA spending.1 The guidance required each federal agency to establish a Recovery page on its
existing website, linked to Recovery.gov, on which they must post all agency-specific information
related to ARRA.2
In most cases, ARRA specified that the agency receiving funding had to submit an initial
implementation plan before the funds could be obligated. Those plans are posted on the HHS
Recovery Plans website.3 In addition, ARRA required that a report on the actual obligations,
1 Executive Office of the President, Office of Management and Budget, Initial Implementing Guidance for the
American Recovery and Reinvestment Act of 2009, Memorandum for the Heads of Departments and Agencies M-09-
10, February 18, 2009, http://www.whitehouse.gov/omb/assets/memoranda_fy2009/m09-10.pdf.
2 HHS created a Recovery website at http://www.hhs.gov/recovery.
3 HHS implementation plans are at http://www.hhs.gov/recovery/reports/plans/index.html.
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expenditures, and unobligated balances for each ARRA-funded activity be submitted by
November 1, 2009, and each six months thereafter as long as funding remains available for
obligation or expenditure.
Table 1. ARRA Discretionary Health Funding, by Agency/Office
($ millions)
Agency/Office
Funding
Explanation
Health Resources and Services
2,500
ARRA’s funding for HRSA included $1.5 billion for health
Administration (HRSA)
center renovation and repair, $500 million for health center
operation grants and HIT acquisition, and $500 million for
the National Health Service Corps and other health
workforce programs.
National Institutes of Health (NIH)
10,000
ARRA’s funding for NIH included $8.2 billion for scientific
research; $1.3 billion for non-federal research facility
construction, renovation, and equipment; and $500 million
for NIH buildings and facilities.
Agency for Healthcare Research and
1,100
ARRA provided this funding for comparative effectiveness
Quality (AHRQ)
research. Of the total, $300 million is for AHRQ, $400
million was transferred to NIH, and $400 million is to be
al ocated at the Secretary’s discretion.
Indian Health Service (IHS)
500
ARRA’s funding for IHS included $415 million for Indian
health care and sanitation facility construction, building
maintenance and improvement, and medical equipment
(including HIT); and $85 million for HIT infrastructure
development and deployment, including telehealth.
Office of the HHS Secretary (OS)
Office of the National Coordinator for
2,000
ARRA provided this funding for grants and other activities
Health Information Technology (ONC)
authorized by the HITECH Act.
Public Health and Social Services
50
ARRA provided this funding for HHS cybersecurity.
Emergency Fund (PHSSEF)
Prevention and Wel ness Fund
1,000
ARRA’s funding for prevention and wel ness included $300
million for CDC’s immunization program, $650 million for
prevention and wellness programs, and $50 million for state
programs to reduce health care-associated infections.
TOTAL 17,150
Source: Table prepared by CRS based on the ARRA text (P.L. 111-5).
Each ARRA grant recipient is required to submit to the funding agency a quarterly report that
includes the following information: (1) the total amount of ARRA funds received, (2) the amount
of ARRA funds received that have been expended on projects and activities, and (3) details about
the funded project or activity, including an estimate of the number of jobs created and the number
of jobs retained by the project or activity. ARRA requires that the information submitted by
grantees be posted on the funding agency’s Recovery website.
In addition to funding health-related programs and activities, ARRA included discretionary funds
for human services programs administered by HHS. It provided $100 million to the
Administration on Aging (AoA) for senior nutrition programs authorized under Title III of the
Older Americans Act, and gave $5.15 billion to the Administration for Children and Families
(ACF) for the Child Care and Development Block Grant, the Community Services Block Grant,
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and Head Start. For more information on those funds, see CRS Report RL33880, Older
Americans Act: Funding; and CRS Report R40211, Human Services Provisions of the American
Recovery and Reinvestment Act. Throughout this report, unless otherwise specified, all references
to the Secretary refer to the HHS Secretary.
Health Centers
ARRA provided $2 billion to the Health Resources and Services Administration (HRSA) for
grants to health centers authorized under section 330 of the Public Health Service (PHS) Act. Of
this total, $1.5 billion is for the construction and renovation of health centers and the acquisition
of HIT systems. The remaining $500 million is for operating grants to health centers to increase
the number of underinsured and uninsured patients who receive health care services at these
facilities. The implementation plan for ARRA funding of health center capital projects is available
on the HHS Recovery Plans website.4 For more information on health centers, see CRS Report
RL32046, Federal Health Centers Program.
Infrastructure
HRSA allocated the $1.5 billion for health center infrastructure as follows: $862.5 million for
Capital Improvement Program (CIP) grants to support the construction, repair, and renovation of
over 1,500 health center sites nationwide, including purchasing HIT and expanding the use of
electronic health records (EHRs); $512.5 million for Facility Investment Program (FIP) grants to
expand the capacity of health centers to provide primary and preventive health services; and $125
million for HIT systems/networks grants to support electronic health information exchange.5
Almost 60% of these funds were obligated in FY2009 (see Table 5). There is no regular
appropriation for health center infrastructure. However, some health centers receive facilities and
equipment funds in congressionally directed (i.e., earmarked) spending.6
Patient Services
Of the $500 million ARRA appropriation for health center operations, HRSA allocated $157
million for New Access Point (NAP) grants to support health centers’ new service delivery sites,
and $343 million for Increased Demand for Services (IDS) grants to increase health center
staffing, extend hours of operations, and expand existing health care services. These funds, which
were obligated in FY2009, supplemented the $2.2 billion provided for health centers in FY2009
through regular appropriations (see Table 4 and Table 5).
HRSA awarded NAP competitive grants to establish 126 new health centers located in 39 states,
Puerto Rico, and American Samoa. The award amounts range from $478,000 to $1,300,000. IDS
grants were awarded to 1,128 federally qualified health centers in all 50 states, the District of
4 http://www.hhs.gov/recovery/reports/plans/healthcenterscapital.pdf.
5 Details on each of the grant programs, including the CIP awards, are at http://bphc.hrsa.gov/recovery/.
6 HRSA’s FY2009 appropriations included $310 million in congressionally directed spending for health facilities,
including funding for numerous specified health centers. The agency’s FY2010 appropriations included $338 million in
earmarked funds for health facilities.
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Columbia, Puerto Rico, and the U.S. territories, based on a formula.7 The project period for all
IDS grantees is limited to two years, from March 27, 2009, through March 26, 2011. The IDS
funds are projected to create or retain approximately 6,400 jobs and provide care to an estimated
additional 2.1 million patients, including 1 million uninsured people.8
Health Workforce Programs
ARRA provided $500 million to HRSA for health workforce programs authorized in the PHS Act.
Of this total, $300 million is for the National Health Service Corps (NHSC) recruitment and field
activities (PHS Act Title III), $75 million of which is to remain available through September 30,
2011. The remaining $200 million is for the health professions programs authorized in PHS Act
Title VII (health professions education) and Title VIII (nursing workforce development). Some of
these funds may also be used to develop interstate licensing agreements to promote telemedicine
(PHS Act section 330L).
National Health Service Corps
The NHSC program provides scholarships and student loan repayments for medical students,
nurse practitioners, physician assistants, and others who agree to a period of service as a health
care provider in a federally designated health professional shortage area (HPSA). NHSC
clinicians may fulfill their service commitments in health centers, rural health clinics, public or
nonprofit medical facilities, or within other community-based systems of care. ARRA stipulated
that 80% of the NHSC funds be used for scholarships and loan repayments, and the remaining
20% for field operations, including recruitment, placements and assignments, and HPSA
designations.9 In regular appropriations, the NHSC program received $135 million for FY2009
and $142 million for FY2010 (see Table 4). For more information, see CRS Report R40533,
Health Care Workforce: National Health Service Corps.
Health Professions Education and Training
Health professions programs authorized under Title VII provide grants, scholarships and loans to
students and professionals in medicine and allied health professions. Nursing workforce programs
authorized under Title VIII provide similar types of assistance to nursing students and
professionals. Of the $200 million ARRA appropriation for health workforce programs, $148.4
million has been allocated for programs that target medical and dental professionals in primary
care, nurses, disadvantaged students, and others; $50 million is for equipment grants to enhance
the training of health professionals; and $1.5 million has been applied toward the development of
interstate licensure agreements that promote telemedicine.10 In regular appropriations, Title VII
and Title VIII programs received a total of $392 million for FY2009 and $497 million for
7 Under the formula, each health center received $100,000 (base allocation) + $6.00 per insured patient + $19.00 per
uninsured patient. Patient information is based on the CY2008 Uniform Data System (UDS) data.
8 Details on the allocation and impact of NAP and IDS grants, by state and grantee, are available on the HHS Recovery
website at http://www.hhs.gov/recovery/programs/index.html#Community.
9 More details on the allocation of ARRA funding for the NHSC program are in the implementation plan at
http://www.hhs.gov/recovery/reports/plans/nhsc.pdf.
10 A list of ARRA funding levels for individual health workforce programs is at http://bhpr.hrsa.gov/recovery/.
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FY2010 (see Table 4). For more information, see CRS Report RS22438, Health Workforce
Programs in the Public Health Service Act (PHSA): Appropriations History, FY2001-FY2010.
Biomedical and Behavioral Research
ARRA provided $10.0 billion directly to the National Institutes of Health (NIH) for biomedical
research and extramural research facilities, plus $400 million more through a transfer from
AHRQ for comparative effectiveness research (discussed below). Of the $10.0 billion, the law
provided $8.2 billion to the Office of the Director for broad support of NIH scientific research,
both extramural and intramural. Most of that funding, $7.4 billion, was transferred to the NIH
institutes and centers and the Common Fund in proportion to their regular appropriations. The
remaining $800 million is being used at the Director’s discretion, with an emphasis on short-term
(two-year) projects, including $400 million that may be used under the Director’s flexible
research authority. Also included in the $10.0 billion total was $1 billion to the National Centers
for Research Resources (NCRR) for grants to construct and renovate university research
facilities, as well as $300 million to NCRR for grants for shared instrumentation and other capital
research equipment at extramural research facilities. Finally, the Buildings and Facilities account
received $500 million for construction, repair, and improvement of NIH intramural facilities.
NIH received a program level total of $30.3 billion in regular FY2009 appropriations and $30.9
billion in FY2010 appropriations. The additional funds from ARRA, which are being obligated at
roughly $5 billion in each of the two years, have therefore boosted NIH resources by about one-
sixth each year. The $8.2 billion in ARRA research funding is being used by the institutes and
centers and the Director for a wide variety of competitive grant programs, as is the case with the
regular appropriations. The intent, however, is to “follow the spirit of the ARRA by funding
projects that will stimulate the economy, create or retain jobs, and have the potential for making
scientific progress in 2 years.” The $1 billion for NCRR construction and renovation grants for
extramural research facilities is being spent under a program that has received no regular funding
since FY2005, while the $300 million for shared instrumentation grants is several times larger
than the usual funding for that program (see Table 4).
NIH activities with ARRA funding are being tracked on the NIH Recovery website, which
includes links to news releases, information on current grant funding opportunities, awards
already made, and ARRA-funded job postings at NIH.11 NIH’s ARRA implementation plans for
the various funding categories are available on the HHS Recovery Plans website.12 NIH is
focusing activities on (1) funding new and recently peer-reviewed, highly meritorious research
grant applications that can be accomplished in two years or less; (2) giving targeted supplemental
awards to current grants to push research forward; and (3) supporting a new initiative called the
NIH Challenge Grants in Health and Science Research for research on specific topics that would
benefit from significant two-year jumpstart funds (grants have budgets under $500,000 per year).
Another new program, called Research and Research Infrastructure “Grand Opportunities” (GO)
11 The main site, “NIH and the ARRA,” is at http://www.nih.gov/recovery. The “Recovery Act Grant Information”
page is at http://grants.nih.gov/recovery, including a listing of funding opportunity announcements and searchable
state-by-state data on ARRA-funded awards. ARRA-funded NIH jobs may be searched at http://www.jobs.nih.gov/
recovery.
12 See the section on “Strengthening Scientific Research and Facilities” at http://www.hhs.gov/recovery/reports/plans/
index.html.
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grants, will devote about $200 million to large-scale research projects (budgets over $500,000 per
year) that work in areas of specific knowledge gaps, create new technologies, or develop new
approaches to multi- and interdisciplinary research teams.
On September 30, 2009, President Obama spoke about the nearly $5 billion that NIH had
awarded in ARRA funding in FY2009, supporting over 12,000 grants to research institutions in
every state (see Table 5). A White House press release highlighted examples of research in
cancer, heart disease, and autism, particularly over $1 billion in research applying the technology
produced by the Human Genome Project.13 On February 1, 2010, NIH released actual FY2009
spending in 218 major research, disease, and condition categories, including the amounts
provided under ARRA. Spending estimates for FY2010, FY2010 ARRA (partial), and FY2011
are also available.14
Comparative Effectiveness Research
ARRA provided $1.1 billion to the Agency for Healthcare Research and Quality (AHRQ) for
comparative effectiveness research (CER), also referred to as patient-centered health research.
These funds are to be used to support research that (1) compares the clinical outcomes,
effectiveness, and appropriateness of preventive, diagnostic, and therapeutic items, services, and
procedures; and (2) encourages 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. Of the total amount of funding provided, $300 million is for AHRQ to invest in
CER activities, $400 million was transferred to NIH, and $400 million is to be allocated at the
discretion of the Secretary. ARRA also stipulated that AHRQ could use no more than 1% of the
$300 million under its own discretion for additional FTEs. According to the agency, that amount
(i.e., $3 million) provides sufficient funding to hire approximately 15 FTEs (two-year
appointments).
The $1.1 billion that ARRA provided for CER represents a substantial increase in federal research
funding in this area. In its regular appropriations, AHRQ received $50 million in FY2009 for
CER, and $21 million in FY2010. The agency’s FY2011 budget request includes $286 million for
CER (see Table 4). AHRQ’s research on comparative effectiveness is authorized by Section 1013
of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173)
and is part of the agency’s Effective Health Care Program.
ARRA instructed the Secretary to contract with the Institute of Medicine (IOM) to produce a
report with recommendations on national CER priorities. IOM released its report on June 30,
2009.15 Reflecting broad stakeholder input, the IOM report identified 100 health topics as high-
priority areas for CER. Almost one-quarter of the priority topics address the health care delivery
13 See the press release, “President Obama Announces Recovery Act Funding for Groundbreaking Medical Research,”
and an accompanying fact sheet, at http://www.whitehouse.gov/the_press_office/President-Obama-Announces-
Recovery-Act-Funding-For-GroundingBreaking-Medical-Research/ and http://www.whitehouse.gov/the_press_office/
Fact-Sheet-Recovery-to-Discovery-5-Billion-Recovery-Act-Investment-in-Scientific-Research-and-Jobs/.
14 See the table on “Estimates of Funding for Various Diseases, Conditions, and Disease Categories (RCDC)” at
http://www.report.nih.gov/rcdc/categories.
15 Institute of Medicine, 2009, Initial National Priorities for Comparative Effectiveness Research, Washington, DC:
The National Academies Press, http://www.iom.edu/Reports/2009/ComparativeEffectivenessResearchPriorities.aspx.
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system. They include topics related to dissemination of CER study results; patient decision
making; health behavior and care management; comparing settings of care; and utilization of
surgical, radiological, and medical procedures. The IOM concluded that the country needs a
robust CER infrastructure to sustain the research well into the future, including carrying out the
research recommended in the report and studying new topics identified by future priority setting.
In addition, ARRA established an interagency advisory panel to help coordinate and support
CER. The Federal Coordinating Council for Comparative Effectiveness Research, composed of
senior officials from federal agencies with health-related programs, was instructed to submit an
initial report describing current federal CER activities and providing recommendations for future
research. Thereafter, the council is to prepare an annual report on its activities and include
recommendations on infrastructure needs and coordination of federal CER. Importantly, ARRA
included 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.
The council published its initial report on June 30, 2009.16 The report’s recommendations focused
on (1) the importance of disseminating CER findings to doctors and patients; (2) targeting CER to
the needs of priority populations such as racial and ethnic minorities, and persons with multiple
chronic conditions; (3) researching high-impact health arenas such as medical and assistive
devices, surgical procedures, and behavioral interventions and prevention; and (4) electronic data
networks and exchange.
Three implementation plans for ARRA-funded CER—one for funds to be obligated by AHRQ, a
second for the NIH funds, and a third for the funds to be allocated at the discretion of the
Secretary—are available on the HHS Recovery Plans website.17 While NIH obligated almost half
of its ARRA funds for CER in FY2009, with the remainder to be obligated in FY2010, almost all
of the ARRA funds for CER that are to be obligated by AHRQ or at the discretion of the
Secretary will be awarded in FY2010 (see Table 5). AHRQ has published 11 CER funding
announcements for ARRA funds to date; these announcements are available on AHRQ’s
website.18
Health Information Technology
ARRA provided $2 billion to the HHS Office of the National Coordinator for Health Information
Technology (ONC) to fund activities and grant programs authorized by the Health Information
Technology for Economic and Clinical Health (HITECH) Act, which was incorporated in ARRA.
Of that amount, $300 million is to support regional health information exchange networks. In
addition, the Secretary was instructed to transfer $20 million to the National Institute of Standards
and Technology (NIST) for HIT standards analysis and testing. An implementation plan that
discusses ONC’s administrative and regulatory responsibilities under ARRA is available on the
16 HHS, Federal Coordinating Council for Comparative Effectiveness Research, Report to the President and the
Congress, June 30, 2009, http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf.
17 See the section on “Supporting Comparative Effectiveness Research” at http://www.hhs.gov/recovery/reports/plans/
index.html.
18 AHRQ and the Recovery Act at http://www.ahrq.gov/fund/cefarra.htm.
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HHS Recovery Plans website.19 ONC received $61 million in regular appropriations in both
FY2009 and FY2010 (see Table 4). Details of the allocation and obligation of ARRA funds for
the various HITECH Act grant programs are provided below, following a brief overview of the
HITECH Act.
The HITECH Act is intended to promote the widespread adoption of HIT for the electronic
sharing of clinical data among hospitals, physicians, and other health care providers.20 To that
end, the HITECH Act included the following provisions. First, it codified ONC within the Office
of the HHS Secretary. Created by a presidential executive order in 2004, ONC has played an
important role directing HIT activities both inside and outside the federal government. It has
focused on developing technical standards necessary to achieve interoperability among varying
EHR applications; establishing criteria for certifying that HIT products meet those standards;
ensuring the privacy and security of electronic health information; and helping facilitate the
creation of prototype health information networks. The goal is to develop a national capability to
exchange standards-based health care data in a secure computer environment. The HITECH Act
required the HHS Secretary, by December 31, 2009, to issue a comprehensive set of
interoperability standards and certification criteria for EHRs.21
Second, the HITECH Act established six grant programs to provide funding for investing in HIT
infrastructure, purchasing certified EHRs, training, and disseminating information on best
practices, among other things (see below). Third, the HITECH Act authorized HIT incentive
payments under the Medicare and Medicaid programs. Beginning in 2011, the Medicare program
will begin providing bonus payments to doctors and hospitals that adopt and use certified EHRs
in such a way as to improve the quality and coordination of health care. Those incentive
payments are phased out over time and replaced by financial penalties for physicians and
hospitals that are not using certified EHRs. The HITECH Act also provides for a 100% federal
match for payments to certain qualifying Medicaid providers who acquire and use certified EHR
technology.22
Finally, the HITECH Act included a series of privacy and security provisions that amended and
expanded the current federal standards under the Health Insurance Portability and Accountability
Act (HIPAA). Among other things, it established a breach notification requirement for health
information that is not encrypted, strengthened enforcement of the HIPAA standards, placed new
restrictions on marketing activities by health plans and providers, and created transparency by
allowing patients to request an audit trail showing all disclosures of their electronic health
19 See the section on “Accelerating the Adoption of Health Information Technology” at http://www.hhs.gov/recovery/
reports/plans/index.html.
20 The HITECH Act appears in two ARRA titles. Division A, Title XIII includes the provisions dealing with (1)
ONCHIT, standards and certification; (2) grant, loan, and demonstration programs; and (3) privacy and security.
Division B, Title IV includes the Medicare and Medicaid HIT incentives.
21 See Department of Health and Human Services, Office of the National Coordinator for Health Information
Technology, “Health Information Technology: Initial Set of Standards, Implementation Specification, and Certification
Criteria for Electronic Health Record Technology; Interim Final Rule,” 75 Federal Register 2014-2047, January 13,
2010.
22 In January 2010, the Centers for Medicare and Medicaid Services published a proposed rule for implementing the
EHR incentives program. See Department of Health and Human Services, Centers for Medicare and Medicaid Services,
“Medicare and Medicaid Programs: Electronic Health Record Incentive Program; Proposed Rule,” 75 Federal Register
1844-2011, January 13, 2010.
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information. For more information, see CRS Report R40161, The Health Information Technology
for Economic and Clinical Health (HITECH) Act.
HITECH Act Grants
As noted above, ARRA included $2 billion in supplemental funding for the new HIT grant
programs authorized under the HITECH Act. The allocation of those funds among the various
programs and the status of their obligations are briefly summarized below.
Health Information Technology Extension Program
ONC has allocated $693 million of the ARRA funds for the Health IT Extension Program. Of that
amount, $643 million is for cooperative agreements to support approximately 60 to 65 Regional
Extension Centers (RECs) each serving a defined geographic area. The RECs will offer technical
assistance, training, and other support services to help physicians and other providers in the
adoption and meaningful use of EHR systems. The RECs are expected to support at least 100,000
priority primary care providers in rural and other medically underserved areas. In February 2010,
ONC announced the first cycle of awards providing $375 million to create 32 RECs.23 A second
round of REC awards is anticipated in April 2010.
The remaining $50 million of the funds allocated for the Health IT Extension Program will be
used to establish a national Health Information Technology Research Center (HITRC) to foster
collaboration among the RECs and with other stakeholders to identify and share best practices in
EHR adoption, effective use, and provider support.24
State Health Information Exchange Cooperative Agreement Program
ONC has allocated $564 million for states and qualified state designated entities (SDEs) to
facilitate electronic health information exchange (HIE) through the meaningful use of EHR
systems. Legal, financial, and technical support is necessary to enable consistent, secure,
statewide HIE across health care provider systems. The State HIE Cooperative Agreement
Program will fund efforts at the state level to establish and implement appropriate governance,
policies, and network services within the broader national framework to build capacity for
connectivity between and among providers. States and SDEs will be required to match grant
awards beginning in 2011. The first cycle of state HIE awards, announced in February 2010 along
with the initial round of REC awards, provided a total of $386 million to 34 states (or SDEs), the
District of Columbia, Puerto Rico, and the U.S. territories to develop HIE capability.25 In March
2010, a second round of state HIE awards was announced, providing a total of $162 million to the
remaining 16 states (or SDEs).26
23 The February 12, 2010 press release is at http://www.hhs.gov/news/press/2010pres/02/20100212a.html.
24 More information on the Health IT Extension Program, including a list of REC grantees and an interactive U.S. map
showing the regions covered by the RECs, is available on the ONC website at http://healthit.hhs.gov/programs/REC.
25 The February 12, 2010 press release is at http://www.hhs.gov/news/press/2010pres/02/20100212a.html.
26 The March 15, 2010 press release is at http://www.hhs.gov/news/press/2010pres/03/20100315a.html. More
information on the State HIE Cooperative Agreement Program, including a list of grantees, is available on the ONC
website at http://healthit.hhs.gov/programs/statehie.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Health Information Technology Workforce Development Program
ONC has set aside a total of $120 million for the Health IT Workforce Development Program to
establish and/or expand education programs for training HIT professionals. The funds will be
used to award grants under four separate programs.27 Award announcements are expected soon.
First, the Community College Consortia Program will provide approximately $70 million in
assistance through cooperative agreements with about five institutions of higher education to
create or expand HIT training programs at about 70 community colleges throughout the nation.
Community colleges funded under this initiative will establish intensive, non-degree training
programs that can be completed in six months or less by individuals with appropriate prior
education and/or experience. ONC expects the participating colleges collectively to establish
training programs with the capacity to train at least 10,500 students annually to be part of the HIT
workforce.
Second, the Curriculum Development Centers Program will provide approximately $10 million in
assistance through cooperative agreements with about five non-profit institutions of higher
education to develop curriculum and instructional materials to enhance workforce training
programs primarily at the community college level. Third, the Competency Examination Program
will provide approximately $6 million through a cooperative agreement to an institution of higher
education to support the development and initial administration of a set of HIT competency
examinations. Finally, the University-Based Training Program will provide approximately $32
million in assistance through cooperative agreements with eight or more institutions of higher
education to establish programs for increasing the supply of individuals qualified to serve in
specific HIT professional roles requiring university-level training.
Beacon Community Cooperative Agreement Program
ONC has allocated a total of $235 million for the Beacon Community Program to strengthen the
HIT infrastructure in the United States. Of that amount, $220 will be provided in cooperative
agreements with integrated health systems, consortia of health care providers, or government
entities to build on existing infrastructure to support electronic HIE. The remaining $15 million
will be used to provide technical assistance to the grantees and evaluate the success of the
program. Beacon Community awards are expected to be announced soon.28
Strategic Health IT Advanced Research Projects (SHARP) Program
Finally, ONC has allocated $60 million for the SHARP Program to fund research in areas where
breakthrough advances are needed to address barriers to the widespread adoption of HIT. SHARP
grantees will implement a research program in one of the following areas: (1) developing security
and risk mitigation policies to build public trust in HIT; (2) harnessing HIT to support clinicians’
decision making; (3) developing new applications and platforms for achieving electronic HIE;
27 More information on the Health IT Workforce Development Program is available on the ONC website at
http://healthit.hhs.gov/hitechgrants.
28 More information on the Beacon Community Cooperative Agreement Program is available on the ONC website at
http://healthit.hhs.gov/beacon.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
and (4) enhancing the secondary use of EHR clinical data to improve health care quality. SHARP
awards are expected to be announced soon.29
Disease Prevention
ARRA provided $1 billion to the Secretary for a Prevention and Wellness Fund, for three
specified activities: (1) $300 million to the Centers for Disease Control and Prevention (CDC) for
PHS Act “Section 317” immunization grants; (2) $50 million for state activities to reduce health
care-associated infections (HAIs); and (3) $650 million for evidence-based clinical and
community prevention and wellness programs that address chronic diseases.
Immunization Programs
On April 9, 2009, HHS announced the allocation of $300 million in ARRA funds for the Section
317 immunization program to the existing 64 state, territorial, and municipal public health
department grantees.30 Funds were transferred to CDC, which administers the program, and were
to be distributed as follows: $200 million in specified amounts to each grantee; $50 million for
program operation grants for grantees to deliver vaccines and strengthen their immunization
programs; and $18 million for innovation grants to increase vaccination rates and improve
reimbursement practices. The remaining $32 million would be for immunization information,
communication, education, and evidence development activities. Funds were to be obligated in
both FY2009 and FY2010 (see Table 4 and Table 5).
Health Care-Associated Infections (HAIs)
Of the $50 million in ARRA funds to reduce HAIs, HHS transferred $40 million to CDC for
grants to state health departments to improve hospital infection control practices, and the
remaining $10 million to the Centers for Medicare and Medicaid Services (CMS) for state survey
agency oversight of infection control practices in ambulatory surgical centers (ASCs).
On July 30, 2009, CMS announced that it was awarding $1 million, distributed among 12 states,
for onsite reviews of ASCs to ensure that the facilities are following Medicare health and safety
standards, and that the remaining $9 million would be available for all states in October 2009.31
On September 1, 2009, CDC announced plans to distribute the $40 million to health departments
in 49 states, the District of Columbia, and Puerto Rico, for the following HAI prevention
activities: (1) creating or expanding state and local efforts to implement recommendations in the
HHS HAI action plan; (2) increasing health care facilities’ and health departments’ use of CDC’s
National Healthcare Safety Network, an HAI surveillance system; (3) hiring and training of
29 More information on the SHARP Program is available on the ONC website at http://healthit.hhs.gov/sharp.
30 HHS, “Biden Announces $2.3 Billion in Recovery Act Funds to Help Care for Children, Prevent Disease,” press
release, April 9, 2009, http://www.hhs.gov/news. Grantees are all 50 states (including the District of Columbia), all
territories, and the cities of New York, Chicago, Philadelphia, Houston, and San Antonio. For a state by state list of
ARRA Section 317 awards, go to http://transparency.cit.nih.gov/RecoveryGrants/grant.cfm?grant=vaccines.
31 CMS, “Recovery Act to Fund 12 State Efforts to Improve Care in Ambulatory Surgical Centers,” press release, July
30, 2009. Information regarding states’ use of funds for ASC surveys during FY2010 is available at CMS, ASC-HAI
Initiative, Recovery Act FY2010 Plan Approvals, http://www.cms.hhs.gov/Recovery/Downloads/FY2010ASCHAI.pdf.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
public health staff to promote and lead HAI prevention initiatives; and (4) complementing HAI
investments from other HHS agencies.32 Funds were to be obligated in both FY2009 and FY2010
(see Table 5).
The Administration has noted that ARRA-funded CMS and CDC activities support a broader
national strategy and action plan to reduce HAIs, published by HHS in January 2009.33 Congress
provided funding to HHS for a variety of HAI prevention activities in FY2009 and FY2010
appropriations, and HHS requests additional HAI funding for CDC and AHRQ activities for
FY2011.34 However, except for the ARRA funds, HHS has not generally presented comparable
agency or departmental budget lines for HAI activities.
Evidence-Based Prevention and Wellness Programs35
The majority of the $650 million in ARRA funds for prevention and wellness programs is being
administered by CDC. The agency notes that there are four program components, as presented in
Table 2. For each component, funds are to be used by grantees to deliver evidence-based
prevention strategies and programs for adults and children, utilizing local resources and
strengthening state capacity for chronic disease prevention. Each component is intended to focus
on the following prevention and wellness goals: (1) increase levels of physical activity; (2)
improve nutrition; (3) decrease obesity rates; and (4) decrease smoking prevalence, teen smoking
initiation, and exposure to second-hand smoke. No funds for these activities were obligated in
FY2009. As a result, according to the law, all of these funds must be obligated in FY2010 (see
Table 5).
In its budget request for FY2011, HHS did not provide amounts for comparable activities in
regular appropriations. The CDC National Center for Chronic Disease Prevention and Health
Promotion conducts activities that are somewhat similar. There is a key difference, however,
between CDC’s annual chronic disease prevention appropriations and the ARRA prevention and
wellness funding. Regular appropriations are generally provided for disease-specific activities,36
whereas the ARRA funding was not designated for specific diseases. As noted earlier, ARRA
funding goals instead target disease risk factors—often behavioral or lifestyle-based—that may
predispose to multiple chronic conditions. As a result, ARRA prevention and wellness funding is
not strictly comparable to activities funded through regular appropriations. Health reform
32 CDC, “CDC to Distribute $40 Million in Recovery Act Funding to Help States Fight Healthcare-Associated
Infections,” press release, September 1, 2009, http://www.cdc.gov/media. See also CDC, “Healthcare-Associated
Infections: Recovery Act,” http://www.cdc.gov/HAI/recoveryact/index.html.
33 HHS, HHS Action Plan to Prevent Healthcare-Associated Infections, January 2009, http://www.hhs.gov/ophs/
initiatives/hai/.
34 HHS, “Fiscal Year 2011 Budget In Brief,” February 2009, pp. 33 and 49, http://www.hhs.gov/asrt/ob/docbudget/
2011budgetinbrief.pdf.
35 Unless otherwise noted, information in this section is drawn from CDC, “Recovery Act Communities Putting
Prevention to Work,” as of February 5, 2010, http://www.cdc.gov/chronicdisease/recovery/index.htm. See also HHS
press releases, “HHS Secretary Sebelius Announces Cornerstone Funding of the $650 Million Recovery Act
Community Prevention and Wellness Initiative,” September 17, 2009; and “$120 Million for States Made Available as
Part of Recovery Act Community Prevention and Wellness Initiative,” September 29, 2009, both at
http://www.hhs.gov/news.
36 For example, see the program activities table for Chronic Disease Prevention, Health Promotion, and Genomics in
CDC, FY2011 Justification of Estimates for Congressional Committees, pp. 117-118, http://www.cdc.gov/fmo/topic/
Budget%20Information/index.html.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
proposals pending in the 111th Congress would establish mechanisms to provide annual baseline
funding for similar prevention and wellness activities.37 Also, in its FY2011 budget justification,
CDC requests new appropriations language that would allow state grantees to reprogram up to
10% of funds from all CDC grants to carry out activities “to address one or more of the top six
leading causes of death.” These causes are not defined.38
Table 2. ARRA Evidence-Based Prevention and Wellness Program Funding
($ millions)
Award
Component
Description
Funding
Status
Community Initiative
Competitive grants to small and large
449.4a Applications
due
cities, urban areas, and tribal communities
Dec. 2009.
for community approaches to chronic
Awards not yet
disease prevention; administered by CDC.
announced.
States and Territories Policy and Funding for states and territories for
125.0 Awards
Environmental Change Initiative
policy and environmental changes for
announced Feb.
chronic disease prevention and tobacco
2010.b
cessation; administered by CDC.
States Chronic Disease Self-
Funding for state chronic disease self-
32.5 Funding
Management Initiative
management programs through existing
opportunity not
public health and aging network
yet announced.
partnerships at state and community
levels; administered by CDC and AoA.
National Prevention Media
National media initiative to complement
40.0 Funding
Initiative
state and community efforts; administered
opportunity not
by CDC.
yet announced.
Management and Oversight
Administrative costs.
3.0
Not applicable.
TOTAL
650.0
Sources: Adapted by CRS from CDC, “Recovery Act Communities Putting Prevention to Work,” as of
February 5, 2010, http://www.cdc.gov/chronicdisease/recovery/index.htm; and HHS, FY2011 Justification of
Estimates for Congressional Committees, General Departmental Management, pp. 317-318, http://www.hhs.gov/
asrt/ob/docbudget/2011cj.pdf.
Notes: Numbers do not add due to rounding.
a. Of this amount, $77 million is for technical assistance and evaluation.
b. HHS, “More Than $119 Million Awarded to States and Territories,” press release, February 5, 2010,
http://www.hhs.gov/news.
37 See “Sec. 2301. Prevention and Wellness” in CRS Report R40892, Public Health, Workforce, Quality, and Related
Provisions in H.R. 3962, coordinated by C. Stephen Redhead, and “Sec. 4002. Prevention and Public Health Fund” in
CRS Report R40943, Public Health, Workforce, Quality, and Related Provisions in H.R. 3590, as Passed by the
Senate, coordinated by C. Stephen Redhead and Erin D. Williams.
38 CDC, FY2011 Justification of Estimates for Congressional Committees, pp. 19-20, http://www.cdc.gov/fmo/topic/
Budget%20Information/index.html.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Indian Health Care
ARRA provided a total of $500 million for the Indian Health Service (IHS)—$415 million for
IHS health facilities-related activities, including maintenance and improvement, and $85 million
for HIT activities. Within the health facilities account, IHS received $227 million for health care
facilities construction, $100 million for facilities maintenance and improvement, $68 million for
sanitation facilities construction, and $20 million for equipment (including HIT). The $85 million
IHS received for HIT activities, including funds for telehealth services,39 were included in the
IHS health services account but could also include HIT-related infrastructure activities. These
funds were to be allocated at the discretion of the IHS director. As of January 29, 2010, IHS has
obligated over 65% of these funds; the remaining funds will be obligated by the end of FY2010.40
Table 4 compares ARRA funding with regular IHS FY2009-FY2010 appropriations and FY2011-
requested appropriations for the same activities.
Facilities Funding
IHS constructs, maintains, and operates hospitals, clinics, and health centers throughout Indian
Country, and also funds construction of Indian sanitation facilities.
Health Care Facilities Construction
For health care facilities construction, ARRA required that the $227 million be used to complete
up to two facilities from IHS’s current priority list on which work had already begun. The
facilities chosen are the Norton Sound Regional Hospital in Nome, AK, and the hospital and staff
quarters at Eagle Butte Health Center in South Dakota.41 Both projects are expected to be
completed by the fourth quarter of FY2012. As of January 29, 2010, approximately $150 million
had been obligated, with an estimated 95 jobs created or saved as a result of the construction
projects.42
Facilities Maintenance, Sanitation Construction, and Equipment
Funds for facilities maintenance and improvement, sanitation, construction, and medical
equipment were to be obligated in FY2009 and FY2010. Obligations for FY2009 through January
29, 2010 are included in Table 3. The table also includes information on the scheduled
completion data of projects and estimates on the number of jobs created or saved as of the end of
the first quarter of FY2010 (i.e., end of December 2009). For a list of the IHS construction
39 Telehealth is the use of use of electronic information and telecommunications technologies, such as
videoconferencing and the internet, to support long-distance clinical health care, health education and other health
related activities. See http://www.hrsa.gov/telehealth/.
40 U.S. Indian Health Service, “ARRA Briefing, Senate Committee on Indian Affairs, February 19, 2010,” transmitted
to CRS Feb. 22, 2010; hereinafter, IHS ARRA Briefing.
41 HHS, American Recovery and Reinvestment Act, Strengthening Community Healthcare Services, Indian Health
Service: Health Care Facilities Construction, http://www.hhs.gov/recovery/reports/plans/ihshcfacilities.pdf and
http://www.ihs.gov/publicaffairs/PressReleases/index.cfm?module=view_details&ID=IyggMisK.
42 IHS ARRA Briefing.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
projects and equipment, organized by state and type of project, see the HHS Recovery website,
Tribal Pre-Award Funding by State.43
Table 3. IHS ARRA Facilities Funding, by Type of Activity
($ millions)
Total
Projection
ARRA
Completion
Jobs
Funding Area
Funds
Use
Obligationsa
Date
Created/Savedb
Facilities
100
Funding for 302
66 End
of
FY2010 125
Maintenance
infrastructure projects “to
and
improve the condition,
Improvement
fire-life safety, energy
conservation, and
operational efficiency” of
existing IHS and tribal
health facilities.
Sanitation
68c
Funding for 169 projects
48 4th Quarter of
160
Construction
to provide water supplies,
FY2013
sewage disposal facilities,
solid waste treatment site
development, and
technical assistance to
Indian water and sewer
utility organizations.
Medical
20
Funding for 199 pieces of
10 FY2011d na
Equipment
medical equipment,
Including $5 million for 62
ambulances, and $6.5
million for 19 computed
tomography (CT)
scanners. Equipment was
al ocated to locations
prioritized within or
across IHS’s 12 regions.
Sources: Table prepared by CRS based on HHS, American Recovery and Reinvestment Act, Strengthening
Community Healthcare Services, Indian Health Service: Maintenance & Improvement, http://www.hhs.gov/recovery/
reports/plans/ihsfacilitiesmaintenanceimprovement.pdf; HHS, American Recovery and Reinvestment Act,
Strengthening Community Healthcare Services, Indian Health Service: Sanitation Facilities Construction Program,
http://www.hhs.gov/recovery/reports/plans/ihssanitation.pdf; HHS, American Recovery and Reinvestment Act,
Strengthening Community Healthcare Services, Indian Health Service: Equipment, http://www.hhs.gov/recovery/
reports/plans/ihsequipment.pdf; and U.S. Indian Health Service, “ARRA Briefing, Senate Committee on Indian
Affairs, February 19, 2010,” transmitted to CRS Feb. 22, 2010.
a. As of January 29, 2010.
b. Based on grant recipient reports from the 1st quarter of FY2010 (i.e., end of December 2009).
c. In addition to the ARRA funds directly appropriated to IHS, the Environmental Protection Agency
transferred $90 million for Sanitation Facilities Construction, for a total of $158 million in ARRA funds.
d. IHS estimates that all medical equipment purchasing will be completed within one year of final obligations
(IHS ARRA Briefing.). Because IHS states that all obligations will be completed by September 30, 2010 (i.e.,
by the end of FY2010), al purchasing should be completed by the end of FY2011.
43 http://www.hhs.gov/recovery/programs/ihs/preawardfundingstate.html.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Health Information Technology Funding
IHS has existing HIT operations for both personal health services and public health activities,
funded chiefly through the hospital and health clinics budget in IHS’s health services account.
ARRA directed that the additional $85 million in HIT funds be allocated by the IHS director. IHS
distributed the HIT funds for the development of existing management and EHR software, and to
telehealth infrastructure and development, with 20% allocated to hardware. IHS identified non-
localized HIT projects, with $61.4 million going for EHR development and deployment, $2.45
million for personal health record development, $16.96 million for telehealth and network
infrastructure, and $4.0 million for administration. Of the HIT funds, IHS obligated $53.55
million as of January 29, 2010, with the remainder to be obligated by the end of FY2010.44
Unlike the rest of HHS, IHS received its appropriations under ARRA’s title for Interior and
Environment appropriations (Title VII). The provision for IHS facilities in Title VII excluded IHS
health facilities funds from the Interior and Environment appropriations bill’s usual annual
spending caps for medical equipment, and also excluded them from ARRA’s general provision
requiring payment of prevailing wage rates under the Davis-Bacon Act for construction and repair
projects. (Separate prevailing wage rate requirements apply to IHS construction activities.) ARRA
report language for Title VII allowed agencies covered by the title to expend up to 5% of ARRA
funds for administrative and support costs, but also noted that oversight of IHS activities under
ARRA was to be included in the general oversight of HHS’s ARRA activities funded under
ARRA’s title for HHS appropriations (Title VIII).
Further information on IHS’s ARRA expenditures, by project category, with links to more
detailed implementation plans, is available on the HHS Recovery website.45 For more on IHS
appropriations in FY2009 and FY2010, see CRS Report R40685, Interior, Environment, and
Related Agencies: FY2010 Appropriations. For general information on IHS, see CRS Report
RL33022, Indian Health Service: Health Care Delivery, Status, Funding, and Legislative Issues.
44 IHS ARRA Briefing.
45 http://www.hhs.gov/recovery/programs/ihs/fundingdescription.html.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Figure 1. ARRA Discretionary Health Funding, by Agency/Office
(Total funding = $17.150 billion)
Source: Figure prepared by CRS based on the ARRA text (P.L. 111-5).
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Table 4. ARRA Discretionary Health Funding and Comparable Appropriations, by Activity
($ millions)
FY2009
FY2009
FY2010
FY2011
Activity (Agency/Office)
Actual
ARRA
Enacted
Request
Notes
Health Centers (HRSA)
Construction, renovation, HIT acquisition
0
1,500 0 0
There is no regular appropriation for health center infrastructure.
Some facilities receive facility and equipment funds in congressionally
Patient services
2,190 500 2,190 2,480
directed (i.e., earmarked) spending.
Health Workforce (HRSA)
National Health Service Corps
135 300 142 169
Of the $300 million in ARRA funds for the NHSC, $75 million is to
remain available through the end of FY2011. Of the $200 million in
Health professions
392 200 497 503
ARRA funds for health professions, $1.5 million is being used to
develop interstate licensing agreements to promote telemedicine.
Biomedical/Behavioral Research (NIH)
Total, NIH funding
30,254a
10,000 30,947a
31,947a Of the $10 billion in ARRA funds for NIH, $1.3 billion is for
extramural research infrastructure, including laboratories and shared
Extramural facilities
0
1,000 0 0
equipment; and $500 million is for the construction and renovation of
Shared instrumentation/equipment
64 300 64 66
NIH facilities. The remaining $8.2 billion is for scientific research
activities (extramural and intramural) supported by al the NIH
NIH buildings and facilities
126 500 100 126
institutes and centers.
Comparative Effectiveness (AHRQ, NIH, OS)
Patient-centered health research
50 1,100
21 286
ARRA provided $1.1 billion to AHRQ for comparative effectiveness
research, of which $400 million was transferred to NIH, and $400
million is to be allocated at the Secretary’s discretion.
Health Information Technology (OS)
Office of the National Coordinator
61
2,000 61 78
ARRA provided $2 billion to implement the HITECH Act, of which
$20 million was transferred to NIST for HIT standards analysis and
testing.
Disease Prevention (OS, CDC, CMS, AoA)
Immunization program
560 300 562 579
ARRA provided $1 billion for a Prevention and Wellness Fund to be
administered by the Secretary. Of the total, $300 million was
Prevention and wellness programs
na 650 na na
CRS-18
.
FY2009
FY2009
FY2010
FY2011
Activity (Agency/Office)
Actual
ARRA
Enacted
Request
Notes
Health care-associated infections
na 50 na na
transferred to CDC for the immunization program, $650 million is for
prevention and wellness programs, and the remaining $50 million is
for state activities to reduce HAIs. For the prevention and wel ness
programs and the HAI activities there are no comparable funding
figures in regular appropriations.
Indian Health Care (IHS)
Total, IHS facilitiesb
390 415 395 445
ARRA provided $500 million for Indian health care, of which $415 is
for the construction of IHS facilities, building maintenance and
Health care facilities construction
40 227 29 66
improvement, water and wastewater sanitation projects, and the
Sanitary facilities construction
96 68 96 98
purchase of medical equipment. The remaining $85 million is for HIT
infrastructure development and deployment, including telehealth.
Maintenance and improvement
54 100 54 56
Medical equipment
22 20 23 24
Health information technology
115 85 131 135
Source: Table prepared by CRS based on the HHS FY2011 Budget in Brief, available at http://www.hhs.gov/asrt/ob/docbudget/2011budgetinbrief.pdf, and on the IHS
FY2011 Justification of Estimates for Congressional Committees, available at http://www.ihs.gov/NonMedicalPrograms/BudgetFormulation/documents/
IHS%20FY%202011%20Congressional%20Justification.pdf.
a. Total NIH program level minus funds ($300 million) for transfer to the Global Fund to Fight HIV/AIDS, TB, and Malaria.
b. Totals for regular appropriations include activities that received no ARRA funds and are not shown here.
CRS-19
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Table 5. Obligation of ARRA Discretionary Health Funding
($ millions)
Total
Obligations
ARRA
Activity (Agency/Office)
Funds
FY2009
FY2010
Health Centers (HRSA)
Construction, renovation, HIT acquisition
1,500
889
611
Patient services
500
497
3
Total, Health centers
2,000
1,386
614
Health Workforce (HRSA)
National Health Service Corps
300a
66 159
Health professions
200
67
133
Total, Health workforce
500
133
292
Biomedical/Behavioral Research (NIH)
Scientific research
8,200
4,607
3,593
Extramural facilities 1,000 52
948
Shared instrumentation/equipment
300
53
247
NIH buildings and facilities 500
50
450
Total, Biomedical/behavioral research (excluding CER)
10,000
4,762
5,238
Comparative Effectiveness Research
AHRQ 300
5
295
NIH 400
192
208
HHS-wide 400
2
398
Total, Comparative effectiveness research
1,100
199
901
Health Information Technology (OS)
Office of the National Coordinator
2,000b
1 1,919
Disease Prevention (OS, CDC, CMS, AoA)
Immunization program
300
155
145
Prevention and wel ness programs
650
0
650
Healthcare-associated infections
50
41
9
Total, Disease Prevention
1,000
196
804
Indian Health Care (IHS)
IHS buildings and facilities 415
254
161
Health information technology
85
40
45
Total, Indian health care
500
294
206
Source: Table prepared by CRS based on the HHS FY2011 Budget in Brief, available at http://www.hhs.gov/asrt/
ob/docbudget/2011budgetinbrief.pdf.
a. Of the $300 million for NHSC, $75 million is to remain available through the end of FY2011.
b. Funds are to remain available until expended.
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Selected Health Funding in the American Recovery and Reinvestment Act of 2009
Author Contact Information
C. Stephen Redhead, Coordinator
Amanda K. Sarata
Acting Section Research Manager
Specialist in Health Policy and Genetics
credhead@crs.loc.gov, 7-2261
asarata@crs.loc.gov, 7-7641
Elayne J. Heisler
Pamela W. Smith
Analyst in Health Services
Analyst in Biomedical Policy
eheisler@crs.loc.gov, 7-4453
psmith@crs.loc.gov, 7-7048
Sarah A. Lister
Roger Walke
Specialist in Public Health and Epidemiology
Specialist in American Indian Policy
slister@crs.loc.gov, 7-7320
rwalke@crs.loc.gov, 7-8641
Bernice Reyes-Akinbileje
Analyst in Health Resources and Services
breyes@crs.loc.gov, 7-2260
Congressional Research Service
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