HHS Budget-Justification-Fy2019 PDF

DEPARTMENT
of HEALTH
and HUMAN
SERVICES
Fiscal Year
2019
Health Resources and
Services Administration
Justification of
Estimates for
Appropriations Committees
MESSAGE FROM THE ADMINISTRATOR
I am pleased to present the FY 2019 Congressional Justification for the Health Resources and
Services Administration (HRSA). HRSA is the primary Federal agency for improving access to
health care for people who are geographically isolated, and economically or medically
challenged. The FY 2019 Budget provides $9.6 billion to invest in programs that provide direct
heath care services to individuals who are medically underserved or face barriers to health care.
The Budget also proposes an additional opioid allocation of $550 million to HRSA to address the
opioid epidemic. When accounting for these resources, the total for HRSA is $10.2 billion.
In FY 2019, the Health Center program supports nearly 1,400 health centers grantees, providing
care to approximately 26 million patients. The Budget provides $5.1 billion for the Health Center
Program. These resources will ensure that current health centers can continue to provide essential
health care services to their patient populations.
The Budget prioritizes funding for health workforce activities that provide scholarships and loan
repayment in exchange for service in areas of the United States where there is a shortage of
health professionals. HRSA is requesting $476.6 million for workforce programs. The Budget
requests strategic investments in the National Health Service Corps, Nurse Corps Loan
Repayment and Scholarships programs, Teaching Health Center Graduate Medical Education
program, and Health Care Workforce Assessment. In addition, the Budget proposes to
consolidate Federal graduate medical education spending from Medicare, Medicaid, and the
Children's Hospitals Graduate Medical Education program into a single grant program for
teaching hospitals.
The Budget requests $1.1 billion to improve the health of mothers and children. The Budget
provides $627.7 million for the Maternal and Child Health Block Grant program, which works to
improve the lives of America’s children and families. The Block Grant serves more than 76
million people, including over 57 million children and 3 million pregnant women. These
resources, in conjunction with $103.5 million for the Healthy Start program, and $405 million
for the Maternal, Infant, and Early Childhood Home Visiting Program and the Family-to-Family
Health Information Centers, will allow HRSA to focus on direct access to quality health care and
services for mothers, children and families.
The Budget request also includes $74.9 million to support health care needs in rural areas. The
request provides funding for direct service programs, including the Radiation Exposure
Screening Program, Black Lung Clinics, and Rural Health Outreach Services; as well as for
telehealth activities to promote the modernization of the health care infrastructure in rural areas.
The Budget also includes funding for the Rural Health Policy program to support the Federal
Office of Rural Health Policy’s role to advise the Secretary on rural health issues, conduct and
oversee research on rural health, and provide support for grant programs that enhance health care
delivery in rural communities.
The FY 2019 Budget includes $2.3 billion for the Ryan White program to improve access to care
for persons living with HIV/AIDS. Of this amount, $900.3 million is included for the AIDS
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Drug Assistance Program. Over the last 27 years, the program has developed a comprehensive
system of safety net providers who deliver high quality direct health care and support services.
Viral suppression outcome measures demonstrate the success of the program because 85 percent
of patients receiving medical care are virally suppressed. Furthermore, the AIDS Drug
Assistance Program creates a major public health benefit by also reducing new infections. The
Budget proposes to reauthorize the Ryan White program to make statutory changes to reduce
recipient burden, standardize certain requirements and definitions, and effectively focus
resources for HIV care, treatment, and support based on need, geography, data quality, and
performance.
The FY 2019 Budget includes $116.5 million to support additional healthcare systems programs.
These include programs to support organ and cell transplantation, Poison Control Centers, and
the National Hansen’s Disease Program. In addition, the Budget proposes reforms to the 340B
Drug Pricing Program, which requires drug manufacturers to provide discounts on outpatient
prescription drugs to certain safety net providers. These changes – including requirements to
report on the use of 340B savings, a new user fee for covered entities and general regulatory
authority – would strengthen program integrity and ensure patients benefit from the Program, as
intended.
The Budget includes an initial opioid allocation of $550 million to address substance abuse,
including opioid abuse, and the overdose crisis in highest risk communities. This funding will
allow communities to develop plans to address local needs. This funding is part of the $10
billion proposal to combat the opioid epidemic and address mental health across HHS.
The Health Resources and Services Administration’s FY 2019 Budget supports the
Administration’s commitment to prioritize direct health care services. This request supports the
President’s goal to put American families first while improving the efficiency and effectiveness
of the Federal Government.
George Sigounas, MS, Ph.D.

Administrator
2
Organizational Chart
3
Table of Contents
Organizational Chart.................................................................................................................... 3
Executive Summary ...................................................................................................................... 8

Introduction and Mission ................................................................................................................ 9
Overview of Budget Request ........................................................................................................ 10
Overview of Performance ............................................................................................................. 13
All-Purpose Table ......................................................................................................................... 16
Budget Exhibits ........................................................................................................................... 21

Appropriations Language.............................................................................................................. 22
Language Analysis ........................................................................................................................ 23
Amounts Available for Obligation................................................................................................ 24
Summary of Changes .................................................................................................................... 25
Budget Authority by Activity ....................................................................................................... 29
Authorizing Legislation ................................................................................................................ 33
Appropriations History Table ....................................................................................................... 45
Appropriations Not Authorized by Law ....................................................................................... 48
PRIMARY HEALTH CARE ..................................................................................................... 53

Health Centers ........................................................................................................................... 53
Free Clinics Medical Malpractice ............................................................................................. 64
HEALTH WORKFORCE ......................................................................................................... 68

National Health Service Corps (NHSC).................................................................................... 68
Faculty Loan Repayment Program ............................................................................................ 76
Health Professions Training for Diversity ................................................................................ 78
Centers of Excellence ............................................................................................................ 78
Scholarships for Disadvantaged Students.............................................................................. 81
Health Careers Opportunity Program .................................................................................... 84
Health Care Workforce Assessment ......................................................................................... 87
The National Center for Health Workforce Analysis ............................................................ 87
Primary Care Training and Enhancement Program .................................................................. 90
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Oral Health Training Programs ................................................................................................. 95
Interdisciplinary, Community-Based Linkages....................................................................... 101
Area Health Education Centers Program ............................................................................. 101
Geriatrics Program ............................................................................................................... 105
Behavioral Health Workforce Education and Training ....................................................... 109
Mental and Behavioral Health Education and Training Programs ...................................... 112
Public Health Workforce Development .................................................................................. 115
Public Health and Preventive Medicine Training Grant Programs ..................................... 115
Nursing Workforce Development ........................................................................................... 120
Advanced Nursing Education Programs.............................................................................. 120
Nursing Workforce Diversity .............................................................................................. 124
Nurse Education, Practice, Quality and Retention Programs .............................................. 127
Nurse Faculty Loan Program ............................................................................................... 131
NURSE Corps...................................................................................................................... 134
Children’s Hospitals Graduate Medical Education Payment Program ................................... 138
Teaching Health Center Graduate Medical Education Program ............................................. 141
National Practitioner Data Bank ............................................................................................. 146
Health Workforce Cross-Cutting Performance Measures ....................................................... 149
MATERNAL AND CHILD HEALTH ................................................................................... 152

Maternal and Child Health Block Grant ................................................................................. 152
Autism and Other Developmental Disabilities........................................................................ 165
Sickle Cell Disease Treatment Demonstration Program ......................................................... 169
James T. Walsh Universal Newborn Hearing Screening ........................................................ 171
Emergency Medical Services for Children ............................................................................. 175
Healthy Start ............................................................................................................................ 179
Heritable Disorders in Newborns and Children ...................................................................... 185
Family-To-Family Health Information Centers ...................................................................... 188
Maternal, Infant, and Early Childhood Home Visiting Program ............................................ 191
RYAN WHITE HIV/AIDS ....................................................................................................... 200

Ryan White HIV/AIDS Overview .......................................................................................... 200
RWHAP Part A - Emergency Relief Grants ........................................................................... 203
RWHAP Part B - HIV Care Grants to States .......................................................................... 211
5
RWHAP Part C - Early Intervention Services ........................................................................ 220
RWHAP Part D - Women, Infants, Children and Youth ........................................................ 223
RWHAP Part F - AIDS Education and Training Programs .................................................... 226
RWHAP Part F - Dental Programs ......................................................................................... 229
RWHAP Part F - Special Projects of National Significance ................................................... 232
HEALTHCARE SYSTEMS .................................................................................................... 235

Organ Transplantation ............................................................................................................. 235
National Cord Blood Inventory ............................................................................................... 241
C.W Bill Young Cell Transplantation Program ...................................................................... 246
Poison Control Program .......................................................................................................... 250
Office of Pharmacy Affairs/340B Drug Pricing Program ....................................................... 255
National Hansen’s Disease Program ....................................................................................... 261
National Hansen’s Disease Program – Buildings and Facilities ............................................. 265
Payment to Hawaii .................................................................................................................. 266
FEDERAL OFFICE OF RURAL HEALTH POLICY ......................................................... 268

Rural Health Policy Development........................................................................................... 268
Rural Health Care Services Outreach, Network and Quality Improvement Grants................ 271
Rural Hospital Flexibility Grants ............................................................................................ 276
Radiation Exposure Screening and Education Program ......................................................... 281
Black Lung .............................................................................................................................. 283
Telehealth ................................................................................................................................ 286
Opioids ....................................................................................................................................... 291

Program Management .............................................................................................................. 294
Family Planning ........................................................................................................................ 302
Supplementary Tables .............................................................................................................. 307

Budget Authority by Object Class .............................................................................................. 308
Salaries and Expenses ................................................................................................................. 318
Detail of Full-Time Equivalent Employment ............................................................................. 320
FTEs Funded by P.L. 111-148 and Any Supplementals ............................................................. 325
Programs Proposed for Elimination ............................................................................................ 326
6
Physicians’ Comparability Allowance (PCA) Worksheet .......................................................... 330
Significant Items........................................................................................................................ 331

Vaccine Injury Compensation Program ................................................................................. 353
7
Executive Summary
TAB
8
Introduction and Mission
The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department
of Health and Human Services. The Department’s mission is, in part, to enhance the health and
well-being of Americans by providing effective health and human services. In alignment with
this mission, HRSA is the principal Federal agency charged with increasing access to effective
and efficient basic health care for those individuals and families who are medically underserved
due to barriers (e.g., economic, geographic, linguistic, cultural) they face in obtaining appropriate
and quality care.
HRSA supports programs and services that target, for example:
 Underserved persons who live in rural and poor urban neighborhoods where health care
providers and services are scarce,
 Individuals who lack health insurance--many of whom are racial and ethnic minorities,
 African American infants who still are 2.3 times as likely as white infants to die before
their first birthday,
 The more than 1.1 million people living with HIV infection,
 Persons affected by the critical national problem of opioid abuse and overdose,
 The nearly 115,000 individuals who are waiting for an organ transplant.
By focusing on these and other underserved and at-risk groups, HRSA’s leadership and programs
promote the improvements in health care access and quality that are essential for a healthy
nation.
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Overview of Budget Request
The FY 2019 President’s program level request is $9.6 billion for the Health Resources and
Services Administration (HRSA). This is -$953.3 million below the FY 2018 Annualized
Continuing Resolution (CR) level.
Highlights of the major programs are listed below:
Health Centers and Free Clinics: +$10.1 million; total program $5.1 billion – The Budget
supports nearly 1,400 health centers, providing care to approximately 26 million patients. These
resources will help ensure that current health centers can continue to provide essential primary
health care services to their patient populations. The Budget proposes a shift from mandatory
resources to discretionary resources for this program.
Health Workforce: -$744.4 million; total $476.6 million
 National Health Service Corps (NHSC): total program $310 million. The Budget
proposes a shift from mandatory resources to discretionary resources for this
program. This funding will support a field strength of 8,810 providers in FY 2019.
 NURSE Corps: +$0.6 million; total program $83.1 million. The Budget prioritizes
nursing activities that provide nurse scholarships and nurse loan repayments in
exchange for service in areas of the United States with health workforce shortages.
This funding will allow the program to maintain its efforts to address the anticipated
demand for access to services in Critical Shortage Facilities.
 Children’s Hospital Graduate Medical Education (GME) Program: -$298 million;

total program $0. The Budget proposes to consolidate Federal graduate medical
education spending from Medicare, Medicaid, and the Children's Hospitals Graduate
Medical Education program into a single grant program for teaching hospitals equal
to the sum of Medicare and Medicaid's 2016 payments for graduate medical
education, plus 2016 spending on children's hospitals graduate medical education,
adjusted for inflation. This amount would then grow with inflation minus 1
percentage point each year. HRSA and the Centers for Medicare & Medicaid
Services (CMS) would jointly determine program requirements and the formula for
distribution. Payments would be distributed to hospitals based on the number of
residents at a hospital (up to its existing cap) and the portion of the hospital's inpatient
days accounted for by Medicare and Medicaid patients. The Secretary would have
authority to modify the amounts distributed based on the proportion of residents
training in priority specialties or programs and based on other criteria identified by
the Secretary, including addressing health care professional shortages and educational
priorities. This grant program would be funded out of the general fund of the
Treasury.
 Teaching Health Centers Graduate Medical Education Program: total program $60
million. The Budget includes $60 million for residency training in primary care
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medicine and dentistry in community-based, ambulatory settings. The Budget
proposes a shift from mandatory resources to discretionary resources for this
program.
 Workforce Training Programs: -$447.8 million; total program $4.7 million. The
Budget prioritizes funding for health workforce activities that provide scholarships
and loan repayment to clinicians in exchange for their service in areas of the United
States where there is a shortage of health professionals and eliminates funding for
other health professions and nursing training programs. As the nation’s health care
system continues to change, state and national level analysis of health care workforce
needs will be critical to determining appropriate investments in the health workforce.
To meet this need, the Budget provides $4.7 million for the Health Care Workforce
Assessment program.
Maternal and Child Health (MCH): -$111.7 million; total $1.1 billion –The Budget provides
$627.7 million for the MCH Block Grant program, a decrease of -$9.7 million. The Block Grant
supports services for more than 76 million people, including 57 million children and 3 million
pregnant women. The request also includes $103.5 million, an increase of +$0.7 million, for
Healthy Start program, which serves approximately 69,000 participants annually. The Budget
prioritizes programs that support direct health care services and give states and communities the
flexibility to meet local needs and eliminates funding related to Autism and Developmental
Disorders, Sickle Cell, Universal Newborn Hearing, Heritable Disorders and Emergency
Medical Services for Children.
The FY 2019 Budget includes $400 million in discretionary resources for the Maternal, Infant,
and Early Childhood Home Visiting program. This funding will improve access for at-risk
families to voluntary, evidence-based home visiting services where nurses, social workers, and
other professionals provide support for their children’s health, development, and ability to learn.
The Budget also includes $5 million to extend the Family-to-Family Health Information Centers
Program. The Budget proposes to change the source of funding for these two programs from
mandatory to discretionary.
HIV/AIDS: -$42.9 million; total program $2.3 billion – The Budget provides a comprehensive
system of HIV primary medical care, medications, and essential support services for low-income
people living with HIV. It includes $900.3 million for the AIDS Drug Assistance Programs
(ADAP) to provide access to life saving HIV related medications and health care services to
persons living with HIV in all 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin
Islands, Guam and five Pacific jurisdictions. In an effort to more effectively target resources and
reduce burden, the Budget proposes statutory changes to allow a data driven framework to
distribute funding, and simplify and standardize certain requirements and definitions. The
request eliminates funding for AIDS Educations and Training Centers and does not provide a
direct appropriation for Special Programs of National Significance.
Healthcare Systems: -$3 million in discretionary funding; total programs $116.5 million – The
Budget provides funding to support Poison Control Centers, organ and cell transplantation and
the National Hansen’s Disease Program. The Budget reduces National Hansen’s Disease
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Program funding to focus on direct patient care activities, while reflecting the declining
beneficiary population. The Budget includes resources and proposes broad regulatory authority
to support the 340B Drug Pricing Program, which requires drug manufacturers to provide
discounts on outpatient prescription drugs to certain safety net providers. In addition, the Budget
includes a new user fee on covered entities for the 340B program.
Rural Health: -$80.1 million; total program $74.9 million – The Budget prioritizes funding for
direct service programs, including the Radiation Exposure Screening Program, Black Lung
Clinics, and Rural Health Outreach Services, as well as Telehealth. The allocation includes
funding for the Rural Health Policy program to support the Federal Office of Rural Health
Policy’s role to advise the Secretary on rural health issues, conduct and oversee research on rural
health, and provide support for grant programs that enhance health care delivery in rural
communities. This level eliminates funding for Rural Hospital Flexibility grants and State
Offices of Rural Health.
Funding to Combat the Opioid Epidemic - The Budget includes an initial opioid allocation of
$550 million to address substance abuse, including opioid abuse, and the overdose crisis. This
funding is part of the HHS $10 billion proposal to combat the opioid epidemic and address
mental health.
Program Management: -$1 million; total program $152 million – This request supports program
management activities to effectively and efficiently support HRSA’s operations, including
investments in information technology and cybersecurity.
Vaccine Injury Compensation Program: +$1.5 million; total program $9.2 million – The Budget
requests additional administrative funding to support the significant rise in the number of claims
filed largely due to claims for injuries from the influenza vaccine. The funding will support the
additional costs of medical reviewers dedicated to evaluating the increased claims.
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Overview of Performance
HRSA and its partners work to achieve the vision of “Healthy Communities, Healthy People.”
In pursuing this vision, HRSA’s strategic goals are to: improve access to quality health care and
services, strengthen the health workforce, build healthy communities, improve health equity, and
strengthen program management and operations. The anticipated performance in FY 2019 of
key HRSA programs is highlighted below, categorized by goal to indicate the close alignment of
specific programmatic activities with broader HRSA priorities. The examples illustrate ways
HRSA will continue to help states, communities and organizations provide essential health care
and related services to meet the needs of medically underserved individuals, special needs
populations, and many other Americans.
Highlights of Performance Results and Targets
HRSA Goals: Improve access to quality health care and services; Improve health equity
HRSA programs support the direct delivery of health services and health system improvements
that increase access to health care and help reduce health disparities.
 In 2016, the Health Center Program supported health centers’ provision of affordable,
accessible, quality and cost efficient care to 25.9 million patients. In FY 2019, the
number is projected be 26 million.
 The Health Center Program projects that the low birthweight rate (LBW) among health
center patients will be five percent below the national rate in FY 2019, an ambitious
target given the many factors that predispose these patients to greater risk of LBW and
adverse birth outcomes.
 HRSA expects to help states serve 51 million children through the Maternal and Child
Health (MCH) Block Grant program in FY 2019, providing support to address states’
highest MCH priorities.
 The MCH Block Grant program expects to contribute to the reduction of the national
infant mortality rate from 5.9 per 1,000 in 2015 to 5.5 per 1,000 in 2019 by supporting
state MCH activities to improve the health of mothers, children, and families, particularly
those with low-income or limited availability of care.
 Grantees of the Maternal, Infant, and Early Childhood Home Visiting Program are
expected to make 960,000 home visits to at-risk families in FY 2019, using evidence-
based models of care to address children’s health, development and well-being.
 By supporting the provision of HIV medications and related services to more than
259,500 persons in FY 2019 through the AIDS Drug Assistance Program, HRSA will
continue its contribution to reducing AIDS-related mortality for low-income and
uninsured people living with HIV/AIDS.
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 In FY 2019, the Ryan White HIV Emergency Relief Grants (Part A) and HIV Care
Grants to States (Part B) are projected to support, respectively, 3.6 million visits and 3.4
million visits for health-related care.
 To increase the number of patients from racially and ethnically diverse backgrounds able
to find a suitably matched unrelated adult donor for their blood stem cell transplants, the
C.W. Bill Young Cell Transplantation program projects that it will have more than 4.0
million adult volunteer potential donors of minority race and ethnicity listed on the donor
registry in FY 2019. Approximately 3.5 million were listed on the registry in FY 2016.
 The Organ Transplantation program projects that it will facilitate the transplantation of
nearly 27,000 deceased donor organs in FY 2019.
HRSA Goal: Strengthen the health workforce
HRSA works to improve the health care system by bolstering the healthcare workforce through
the support of provider placement, retention, and training activities.
 In FY 2019, 8,810 primary care and other health practitioners will provide service in
health professional shortage areas in rural, urban, and frontier communities in return for
National Health Service Corps (NHSC) loan repayment or scholarship support.
 HRSA projects that in FY 2019 11,500 healthcare providers will be deemed eligible for
Federal Tort Claims Act malpractice coverage through the Free Clinics Medical
Malpractice program. The program encourages providers to volunteer their time at
sponsoring free clinics, thereby expanding the capacity of the healthcare safety net.
In the ways highlighted above and others, HRSA will continue to help strengthen the Nation’s
healthcare safety net and improve Americans’ health, health care, and quality-of-life.
Performance Management
Performance management is central to the agency’s overall management approach and

performance-related information is routinely used to improve HRSA’s operations and those of its
grantees. At the agency level, HRSA’s performance management process includes setting
priorities and goals that are linked to HRSA’s Strategic Plan, action planning and execution, and
regular monitoring and review with follow-up.
As the key element of the performance management process, priority setting is done each fiscal
year in which annual goals, potentially covering a wide range of areas, and measures or other
indicators of success are established as part of the development of performance plans for Senior
Staff. Senior Staff oversee the planning, development, and implementation of the major actions
that must be accomplished to achieve progress in the defined performance areas.
Regular reviews of performance take place several times a year between Senior Staff and the
Administrator/Deputy Administrator, including during regularly scheduled one-on-one meetings,
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mid-year and year-end Senior Staff performance reviews, and ad hoc meetings to address
emerging issues and problems. Reviews focus on progress, challenges, and possible course
corrections, with particular emphasis on root-causes of performance results.
These aspects of HRSA’s performance management system promote accountability and

transparency, support collaboration in problem solving, and help drive performance
improvement at the HRSA level and among its grantees.
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All-Purpose Table
Health Resources and Services Administration
(Dollars in Thousands)
FY 2017 FY 2018 FY 2019 FY 2019

President's
Budget +/-
Annualized President's
Final FY 2018
CR1 Budget
Program Annualized
CR
PRIMARY CARE:
Health Centers:
Health Centers 1,387,036 1,381,185 4,990,629 +3,609,444
Health Centers Current Law Mandatory 3,510,661 550,000 - -550,000
Health Centers Proposed Law Mandatory - 3,050,000 - -3,050,000
Health Center Tort Claims 99,893 99,215 99,893 +678
Subtotal, Health Centers 4,997,590 5,080,400 5,090,522 +10,122
Free Clinics Medical Malpractice 1,000 993 1,000 +7
Subtotal, Bureau of Primary Health Care (BPHC) 4,998,590 5,081,393 5,091,522 +10,129
Subtotal, Mandatory BPHC (non-add) 3,510,661 3,600,000 - -3,600,000
Subtotal, Discretionary BPHC (non add) 1,487,929 1,481,393 5,091,522 +3,610,129
HEALTH WORKFORCE:
National Health Service Corps (NHSC):
NHSC - - 310,000 +310,000
NHSC Current Law Mandatory 288,610 65,000 - -65,000
NHSC Proposed Law Mandatory - 245,000 - -245,000
Subtotal, NHSC 288,610 310,000 310,000 -
Loan Repayment/Faculty Fellowships 1,187 1,182 - -1,182
Health Professions Training for Diversity:
Centers of Excellence 21,659 21,564 - -21,564
Scholarships for Disadvantaged Students 45,859 45,658 - -45,658
Health Careers Opportunity Program 14,155 14,093 - -14,093
Subtotal, Health Professions Training for Diversity 81,673 81,315 - -81,315
Health Care Workforce Assessment 4,652 4,631 4,663 +32
Primary Care Training and Enhancement 38,830 38,660 - -38,660
Oral Health Training Programs 36,587 36,424 - -36,424
1
Reflects the annualized level of the Continuing Resolution (P.L. 115-96), including any applicable funding anomalies and directed or
permissive transfers (where applicable).
16
FY 2017 FY 2018 FY 2019 FY 2019
President's
Budget +/-
Annualized President's FY 2018
Final
CR1 Budget
Program Annualized
CR
Interdisciplinary, Community-Based Linkages:
Area Health Education Centers 30,177 30,045 - -30,045
Geriatric Programs 38,644 38,474 - -38,474
Behavioral Health Workforce Education and Training 50,000 49,660 - -49,660
Mental and Behavioral Health 9,892 9,849 - -9,849
Subtotal, Interdisciplinary, Community-Based
Linkages 128,713 128,028 - -128,028
Public Health Workforce Development:
Public Health/Preventive Medicine 16,949 16,885 - -16,885
Nursing Workforce Development:
Advanced Nursing Education 64,425 64,142 - -64,142
Nursing Workforce Diversity 15,306 15,239 - -15,239
Nurse Education, Practice and Retention 39,817 39,642 - -39,642
Nurse Faculty Loan Program 26,436 26,320 - -26,320
NURSE Corps Scholarship and Loan Repayment
Program 82,935 82,570 83,135 +565
Subtotal, Nursing Workforce Development 228,919 227,913 83,135 -144,778
Children's Hospital Graduate Medical Education2 299,289 297,963 - -297,963
Teaching Health Center Graduate Medical
Education (THCGME):
THCGME - - 60,000 +60,000
THCGME Current Law Mandatory 55,860 30,000 - -30,000
THCGME Mandatory Proposed Law - 30,000 - -30,000
Subtotal, THCGME 55,860 60,000 60,000 -
National Practitioner Data Bank (User Fees) 18,814 18,000 18,814 +814
Subtotal, Bureau of Health Workforce (BHW) 1,200,083 1,221,001 476,612 -744,389
Subtotal, User Fees BHW (non-add) 18,814 18,000 18,814 +814
Subtotal, Discretionary BHW (non-add) 836,799 833,001 457,798 -375,203
Subtotal, Mandatory BHW (non-add) 344,470 370,000 - -370,000
2
Discretionary funding for CHGME is discontinued in FY 2019. The Budget proposes to consolidate Federal
graduate medical education spending from Medicare, Medicaid, and the Children's Hospitals Graduate Medical
Education program into a single grant program for teaching hospitals.
17
FY 2017 FY 2018 FY 2019 FY 2019
President's
Budget +/-
Final
CR1 Budget
Program Annualized
CR
MATERNAL & CHILD HEALTH:
Maternal and Child Health Block Grant 640,163 637,342 627,700 -9,642
Autism and Other Developmental Disorders 46,985 46,779 - -46,779
Sickle Cell Service Demonstrations 4,444 4,425 - -4,425
James T. Walsh Universal Newborn Hearing Screening 17,775 17,697 - -17,697
Emergency Medical Services for Children 20,113 20,025 - -20,025
Healthy Start 118,251 102,797 103,500 +703
Heritable Disorders 13,850 13,789 - -13,789
Family-to-Family Health Information Centers (F2F
HICs):
F2F HICs - - 5,000 +5,000
F2F HICs Current Law Mandatory 4,655 - - -
F2F HICs Proposed Law Mandatory - 5,000 - -5,000
Subtotal, F2F HICs 4,655 5,000 5,000 -
Maternal, Infant and Early Childhood Home
Visiting Program (MIECHV):
MIECHV - - 400,000 +400,000
MIECHV Current Law Mandatory 372,400 - - -
MIECHV Proposed Law Mandatory - 400,000 - -400,000
Subtotal, MIECHV 372,400 400,000 400,000 -
Subtotal, Maternal and Child Health Bureau
(MCHB) 1,238,636 1,247,854 1,136,200 -111,654
Subtotal, Discretionary MCHB (non-add) 861,581 842,854 1,136,200 293,346
Subtotal, Mandatory MCHB (non-add) 377,055 405,000 - -405,000
HIV/AIDS:
Emergency Relief - Part A 654,296 651,422 655,876 +4,454
Comprehensive Care - Part B 1,311,837 1,306,075 1,315,005 +8,930
AIDS Drug Assistance Program (non-add) 900,313 894,199 900,313 +6,114
Early Intervention - Part C 200,585 199,713 201,079 +1,366
Children, Youth, Women & Families - Part D 74,907 74,578 75,088 +510
AIDS Education and Training Centers - Part F 33,530 33,383 - -33,383
Dental Reimbursement Program Part F 13,090 13,033 13,122 +89
Special Projects of National Significance (SPNS) 24,940 24,830 - -24,830
Subtotal, HIV/AIDS Bureau 2,313,185 2,303,034 2,260,170 -42,864
18
FY 2017 FY 2018 FY 2019 FY 2019
President's
Budget +/-
Final
CR1 Budget
Program Annualized
CR
HEALTHCARE SYSTEMS:
Organ Transplantation 23,492 23,389 23,549 +160
National Cord Blood Inventory 12,239 12,183 12,266 +83
C.W. Bill Young Cell Transplantation Program 22,056 21,959 22,109 +150
Poison Control Centers 18,801 18,718 18,846 +128
340B Drug Pricing Program/Office of Pharmacy Affairs 10,213 10,168 10,238 +70
340B Drug Pricing Program User Fees - - 16,000 +16,000
Hansen's Disease Center 15,169 15,103 11,653 -3,450
Payment to Hawaii 1,853 1,844 1,857 +13
National Hansen's Disease Program - Buildings and
Facilities 122 121 - -121
Subtotal, Healthcare Systems Bureau (HSB) 103,945 103,485 116,518 +13,033
Subtotal, Discretionary HSB (non-add) 103,945 103,485 100,518 -2,967
Subtotal, User Fees HSB (non-add) - - 16,000 +16,000
RURAL HEALTH:
Rural Health Policy Development 9,328 9,287 5,000 -4,287
Rural Health Outreach Grants 65,347 65,055 50,811 -14,244
Rural Hospital Flexibility Grants 43,509 43,313 - -43,313
State Offices of Rural Health 9,977 9,932 - -9,932
Radiation Exposure Screening and Education Program 1,830 1,822 1,834 +12
Black Lung 7,250 7,217 7,266 +49
Telehealth 18,459 18,374 10,000 -8,374
Subtotal, Federal Office of Rural Health Policy 155,700 155,000 74,911 -80,089
PROGRAM MANAGEMENT 153,629 152,954 151,993 -961

FAMILY PLANNING 286,479 284,534 286,479 +1,945
Appropriation Table Match 6,199,247 6,156,255 9,559,591 +3,403,336
Funds Appropriated to Other HRSA Accounts:

Vaccine Injury Compensation:
Vaccine Injury Compensation Trust Fund (HRSA
Claims) 282,000 308,000 308,000 -
VICTF Direct Operations - HRSA 7,750 7,697 9,200 +1,503
Subtotal, Vaccine Injury Compensation 289,750 315,697 317,200 +1,503
19
FY 2017 FY 2018 FY 2019 FY 2019
President's
Budget +/-
Final
CR1 Budget
Program Annualized
CR
Total, HRSA Discretionary Program Level 6,225,811 6,181,952 9,603,605 +3,421,653
Mandatory Programs: 4,232,186 4,375,000 - -4,375,000
Total, HRSA Program Level 10,457,997 10,556,952 9,603,605 -953,347
Less Programs Funded from Other Sources:
User Fees -18,814 -18,000 -34,814 -16,814
Mandatory Programs -4,232,186 -4,375,000 - +4,375,000
Total, HRSA Discretionary Budget Authority 6,206,997 6,163,952 9,568,791 +3,404,839
Additional Opioids Allocation3 - - 550,000 +550,000
Total, HRSA Program Level with Opioids 10,457,997 10,556,952 10,153,605 -403,347
3
This funding is part of the HHS $10 billion proposal to combat the opioid epidemic and address
mental health.
20
Budget Exhibits
TAB
21
Appropriations Language
Appropriations language for this account was not finalized at the time of publication of the
online edition of this congressional justification. The online edition will be updated when the
appropriations language is available. Appropriations language will be included in the printed
copy of the congressional justification.
22
Language Analysis
Appropriations language for this account was not finalized at the time of publication of the
online edition of this congressional justification. The online edition will be updated when the
appropriations language is available. Appropriations language will be included in the printed
copy of the congressional justification.
23
Amounts Available for Obligation4
FY 2017 FY 2018 FY 2019

President's
Final Annualized CR Budget
General Fund Discretionary Appropriation:
Appropriation $6,213,347,000 $6,156,255,000 $9,559,591,000
Real transfer to the Administration for Children
and Families -14,100,000 - -
Subtotal, adjusted general fund discretionary
appropriation 6,199,247,000 6,156,255,000 9,559,591,000
Mandatory Appropriation:5
Family to Family Health Information Centers +5,000,000 +5,000,000 -
Primary Health Care Access:
Community Health Center Fund +3,600,000,000 +3,600,000,000 -
National Health Service Corps +310,000,000 +310,000,000 -
Subtotal Primary Health Care Access +3,910,000,000 +3,910,000,000 -
Maternal, Infant and Early Childhood Home
Visitation +400,000,000 +400,000,000 -
Teaching Health Centers Graduate Medical
Education +60,000,000 +60,000,000 -
Transfer to the Department of Justice -5,000,000 - -5,000,000
Appropriations Permanently Reduced -142,814,000 - -
Subtotal, adjusted mandatory appropriation 4,227,186,000 4,375,000,000 -5,000,000
Offsetting Collections +16,902,000 +19,000,000 +35,000,000
Unobligated balance, start of year +519,437,000 +322,598,000 +223,000,000

Unobligated balance, end of year -322,598,000 -223,000,000 -220,000,000
Recovery of prior year obligations + 84,000,000 - -
Unobligated balance, lapsing -4,497,000 - -
Total obligations $10,719,677,000 $10,649,853,000 $9,592,591,000
4
Excludes the following amounts for reimbursable activities carried out by this account: FY 2017 - $12,178,000
and 26 FTE; FY 2018 - $12,194,000 and 26 FTE; FY 2019 $12,199,000 and 26 FTE.
5
FY 2018 level includes proposed mandatory funding.
24
Summary of Changes
2018 Continuing Resolution $6,156,255,000

(Obligations) ($6,156,255,000)
2019 Estimate $9,559,591,000

(Obligations) ($9,559,591,000)
2018 Mandatory6 $4,375,000,000

(Obligations) ($4,375,000,000)
2019 Mandatory -
(Obligations) -
Net Change -$971,664,000

(Obligations) +$971,664,000
FY 2019 President's
FY 2018 Annualized CR FY 2019 +/- FY 2018
Budget
Budget
FTE Budget Authority FTE Budget Authority FTE
Authority
FTE 2,074 1,993 -81
Pay Cost $ 316,033,636 $ 303,264,411 $-12,769,225
Increases:
A. Built in:
1. January 2019 Civilian Pay Raise 3,712,418 - -3,712,418
2. January 2019 Military Pay Raise 467,598 607,948 +140,350
3. Civilian Annualization of Jan. 2018 1,933,436 1,275,155 -658,281
4. Military Annualization of Jan. 2018 232,384 194,913 -37,471
Subtotal, built-in increases $6,345,836 $2,078,016 -4,267,820
6
25
FY 2019 President's
Budget
Budget
Authority
B. Program:
Discretionary Increases
Health Centers 288 1,381,185,000 522 4,990,629,000 +234 +3,609,444,000
Health Center Tort Claims - 99,215,000 - 99,893,000 - +678,000
Free Clinics Medical Malpractice - 993,000 - 1,000,000 - +7,000
National Health Service Corps - - 225 310,000,000 +225 +310,000,000
Health Workforce Assessment 6 4,631,000 6 4,663,000 - +32,000
NURSE Corps Scholarship and Loan Repayment 32 82,570,000 32 83,135,000 - +565,000
Teaching Health Center Graduate Medical Education - - 8 60,000,000 +8 +60,000,000
Healthy Start 15 102,797,000 15 103,500,000 - +703,000
Family-to-Family Health Information Centers - - 1 5,000,000 +1 +5,000,000
Maternal, Infant and Early Childhood Home Visiting - - 43 400,000,000 +43 +400,000,000
Emergency Relief - Part A 44 651,422,000 44 655,876,000 - +4,454,000
Comprehensive Care - Part B 63 1,306,075,000 63 1,315,005,000 - +8,930,000
Early Intervention - Part C 54 199,713,000 56 201,079,000 +2 +1,366,000
Children, Youth, Women & Families - Part D 10 74,578,000 10 75,088,000 - +510,000
Dental Reimbursement Program Part F 1 13,033,000 1 13,122,000 - +89,000
Organ Transplantation 2 23,389,000 2 23,549,000 - +160,000
National Cord Blood Inventory 4 12,183,000 4 12,266,000 - +83,000
C.W. Bill Young Cell Transplantation Program 7 21,959,000 7 22,109,000 - +150,000
Poison Control Centers 2 18,718,000 2 18,846,000 - +128,000
340B Drug Pricing Program/Office of Pharmacy
22 +70,000
Affairs 10,168,000 22 10,238,000 -
Payment to Hawaii - 1,844,000 - 1,857,000 - +13,000
Radiation Exposure Screening and Education Program 1 1,822,000 1 1,834,000 - +12,000
Black Lung - 7,217,000 - 7,266,000 - +49,000
Family Planning 12 284,534,000 35 286,479,000 +23 +1,945,000
Subtotal Discretionary Program Increases 563 4,298,046,000 1,099 8,702,434,000 +536 +4,404,388,000
Mandatory Increases
Subtotal Mandatory Program Increases - - - - - -
Total Program Increases 563 4,298,046,000 1,099 8,702,434,000 + 536 +4,404,388,000
26
FY 2019 President's
Budget
Budget
Authority
Decreases:
A. Built in:
1. Pay Costs 2,074 316,033,636 1,993 303,264,411 -81 -4,267,820
B. Program:
Discretionary Decreases
Loan Repayment/Faculty Fellowships - 1,182,000 - - - -1,182,000
Centers of Excellence 1 21,564,000 - - -1 -21,564,000
Scholarships for Disadvantaged Students 5 45,658,000 - - -5 -45,658,000
Health Careers Opportunity Program 2 14,093,000 - - -2 -14,093,000
Primary Care Training and Enhancement 6 38,660,000 - - -6 -38,660,000
Oral Health Training Programs 6 36,424,000 - - -6 -36,424,000
Area Health Education Centers 4 30,045,000 - - -4 -30,045,000
Geriatric Programs 6 38,474,000 - - -6 -38,474,000
Behavioral Health Workforce Education and Training 6 49,660,000 - - -6 -49,660,000
Mental and Behavioral Health 2 9,849,000 - - -2 -9,849,000
Public Health/Preventive Medicine 4 16,885,000 - - -4 -16,885,000
Advanced Nursing Education 8 64,142,000 - - -8 -64,142,000
Nursing Workforce Diversity - 15,239,000 - - - -15,239,000
Nurse Education, Practice and Retention 5 39,642,000 - - -5 -39,642,000
Nurse Faculty Loan Program 5 26,320,000 - - -5 -26,320,000
Children's Hospital Graduate Medical Education 17 297,963,000 - - -17 -297,963,000
Maternal and Child Health Block Grant 42 637,342,000 42 627,700,000 - -9,642,000
Autism and Other Developmental Disorders 6 46,779,000 - - -6 -46,779,000
Sickle Cell Service Demonstrations 2 4,425,000 - - -2 -4,425,000
James T. Walsh Universal Newborn Hearing Screening 4 17,697,000 - - -4 -17,697,000
Emergency Medical Services for Children 5 20,025,000 - - -5 -20,025,000
Heritable Disorders 3 13,789,000 - - -3 -13,789,000
AIDS Education and Training Centers - Part F 5 33,383,000 - - -5 -33,383,000
Special Projects of National Significance (SPNS) 2 24,830,000 - - -2 -24,830,000
Hansen's Disease Center 53 15,103,000 53 11,653,000 - -3,450,000
Natl. Hansen's Disease Prog. - Buildings and Facilities - 121,000 - - - -121,000
27
FY 2019 President's
Budget
Budget
Authority
Rural Health Policy Development 1 9,287,000 1 5,000,000 - -4,287,000
Rural Health Outreach Grants 8 65,055,000 8 50,811,000 - -14,244,000
Rural Hospital Flexibility Grants 2 43,313,000 - - -2 -43,313,000
State Offices of Rural Health - 9,932,000 - - - -9,932,000
Telehealth 1 18,374,000 1 10,000,000 - -8,374,000
Program Management 789 152,954,000 789 151,993,000 - -961,000
Subtotal Discretionary Program Decreases 1,000 1,858,209,000 894 857,157,000 -106 -1,001,052,000
Mandatory Decreases
Health Centers 234 3,600,000,000 - - -234 -3,600,000,000
National Health Service Corps 225 310,000,000 - - -225 -310,000,000
Teaching Health Center Graduate Medical Education 8 60,000,000 - - -8 -60,000,000
Family-to-Family Health Information Centers 1 5,000,000 - - -1 -5,000,000
Maternal, Infant and Early Childhood Home Visiting 43 400,000,000 - - -43 -400,000,000
Subtotal Mandatory Program Decreases 511 4,375,000,000 - - -511 -4,375,000,000
Total Program Decreases 1,511 6,233,209,000 894 857,157,000 -617 -5,376,052,000
Net Change Discretionary 1,563 6,156,255,000 1,993 9,559,591,000 +430 +3,403,336,000

Net Change Mandatory 511 4,375,000,000 - - -511 -4,375,000,000
Net Change Discretionary and Mandatory 2,074 10,531,255,000 1,993 9,559,591,000 -81 -971,664,000
28
Budget Authority by Activity
FY 2017 FY 2018 FY 2019
Final
CR Budget
Program
1. PRIMARY CARE:
Health Centers:
Health Centers 1,387,036 1,381,185 4,990,629
Health Centers Mandatory 3,510,661 550,000 -
Health Centers Proposed Mandatory - 3,050,000 -
Health Center Tort Claims 99,893 99,215 99,893
Subtotal, Health Centers 4,997,590 5,080,400 5,090,522
Free Clinics Medical Malpractice 1,000 993 1,000
Subtotal, Bureau of Primary Health Care 4,998,590 5,081,393 5,091,522
2. HEALTH WORKFORCE:

NHSC 310,000
NHSC Mandatory 288,610 65,000 -
NHSC Proposed Mandatory - 245,000 -
Subtotal, NHSC 288,610 310,000 310,000
Loan Repayment/Faculty Fellowships 1,187 1,182 -
Health Professions Training for Diversity:
Centers of Excellence 21,659 21,564 -
Scholarships for Disadvantaged Students 45,859 45,658 -
Health Careers Opportunity Program 14,155 14,093 -
Subtotal, Health Professions Training for Diversity 81,673 81,315 -
Health Care Workforce Assessment 4,652 4,631 4,663
Primary Care Training and Enhancement 38,830 38,660 -
Oral Health Training Programs 36,587 36,424 -
Interdisciplinary, Community-Based Linkages:
Area Health Education Centers 30,177 30,045 -
Geriatric Programs 38,644 38,474 -
Behavioral Health Workforce Education and Training 50,000 49,660 -
Mental and Behavioral Health 9,892 9,849 -
Subtotal, Interdisciplinary, Community-Based Linkages 128,713 128,028 -
29
FY 2017 FY 2018 FY 2019
Final
CR Budget
Program
Public Health Workforce Development:

Public Health/Preventive Medicine 16,949 16,885 -
Advanced Nursing Education 64,425 64,142 -
Nursing Workforce Diversity 15,306 15,239 -
Nurse Education, Practice and Retention 39,817 39,642 -
Nurse Faculty Loan Program 26,436 26,320 -
NURSE Corps Scholarship and Loan Repayment Program 82,935 82,570 83,135
Subtotal, Nursing Workforce Development 228,919 227,913 83,135
Children's Hospital Graduate Medical Education 299,289 297,963 -
Teaching Health Center Graduate Medical Education
(THCGME):
THCGME - - 60,000
THCGME Current Law Mandatory 55,860 30,000 -
THCGME Proposed Mandatory - 30,000 -
Subtotal. THCGME 55,860 60,000 60,000
National Practitioner Data Bank (User Fees) 18,814 18,000 18,814
Subtotal, Bureau of Health Workforce 1,200,083 1,221,001 476,612
3. MATERNAL & CHILD HEALTH:
Maternal and Child Health Block Grant 640,163 637,342 627,700

Autism and Other Developmental Disorders 46,985 46,779 -
Sickle Cell Service Demonstrations 4,444 4,425 -
James T. Walsh Universal Newborn Hearing Screening 17,775 17,697 -
Emergency Medical Services for Children 20,113 20,025 -
Healthy Start 118,251 102,797 103,500
Heritable Disorders 13,850 13,789 -
Family-to-Family Health Information Centers (F2F HICs)
F2F HICs - - 5,000
F2F HICs Current Law Mandatory 4,655 - -
F2F HICs Proposed Mandatory - 5,000 -
Subtotal, F2F HICs 4,655 5,000 5,000
Maternal, Infant and Early Childhood Home Visiting
Program (MIECHV)
MIECHV - - 400,000
MIECHV Current Law Mandatory 372,400 - -
30
FY 2017 FY 2018 FY 2019
Final
CR Budget
Program
MIECHV Proposed Mandatory - 400,000 -

Subtotal, MIECHV 372,400 400,000 400,000
Subtotal, Maternal and Child Health Bureau 1,238,636 1,247,854 1,136,200
4. HIV/AIDS:
Emergency Relief - Part A 654,296 651,422 655,876

Comprehensive Care - Part B 1,311,837 1,306,075 1,315,005
AIDS Drug Assistance Program (non-add) 900,313 894,199 900,313
Early Intervention - Part C 200,585 199,713 201,079
Children, Youth, Women & Families - Part D 74,907 74,578 75,088
AIDS Education and Training Centers - Part F 33,530 33,383 -
Dental Reimbursement Program Part F 13,090 13,033 13,122
Special Projects of National Significance (SPNS) 24,940 24,830 -
Subtotal, HIV/AIDS Bureau 2,313,185 2,303,034 2,260,170
5. HEALTHCARE SYSTEMS:
Organ Transplantation 23,492 23,389 23,549

National Cord Blood Inventory 12,239 12,183 12,266
C.W. Bill Young Cell Transplantation Program 22,056 21,959 22,109
Poison Control Centers 18,801 18,718 18,846
340B Drug Pricing Program/Office of Pharmacy Affairs 10,213 10,168 10,238
340B Drug Pricing Program User Fees - - 16,000
Hansen's Disease Center 15,169 15,103 11,653
Payment to Hawaii 1,853 1,844 1,857
National Hansen's Disease Program - Buildings and Facilities 122 121 -
Subtotal, Healthcare Systems Bureau 103,945 103,485 116,518
6. RURAL HEALTH:
Rural Health Policy Development 9,328 9,287 5,000

Rural Health Outreach Grants 65,347 65,055 50,811
Rural Hospital Flexibility Grants 43,509 43,313 -
State Offices of Rural Health 9,977 9,932 -
Radiation Exposure Screening and Education Program 1,830 1,822 1,834
Black Lung 7,250 7,217 7,266
31
FY 2017 FY 2018 FY 2019
Final
CR Budget
Program
Telehealth 18,459 18,374 10,000

Subtotal, Federal Office of Rural Health Policy 155,700 155,000 74,911
7. PROGRAM MANAGEMENT 153,629 152,954 151,993

8. FAMILY PLANNING 286,479 284,534 286,479
Total, Discretionary Budget Authority 6,199,247 6,156,255 9,559,591

FTE7,8 2,141 2,141 2,060
7
Does not include the Vaccine Injury Compensation program
8
Due to coding error in the Family Planning program, FTE is reporting lower than actual
32
Authorizing Legislation
FY 2018 FY 2018 FY 2019 FY 2019
Amount Annualized CR Amount President’s
Authorized Authorized Budget
PRIMARY HEALTH CARE:
Authorized for Authorized for FY
FY 2018 (and 2019 (and each
each subsequent subsequent year),
year), an amount an amount equal
Health Centers:
equal to the to the previous
Public Health Service (PHS) Act, Section
previous year’s year’s funding
330, as amended by P.L. 111-148, Section 1,381,185,000 4,990,629,000
funding adjusted adjusted for any
5601
for any increase increase in the
in the number of number of
patients served patients served
and the per- and the per-
patient costs patient costs
Health Centers (Mandatory): Expiring
P.L. 111-148, Section 10503; as amended by 3/31/2018
P.L 111-152, Section 2303; as amended by ($550,000,000 for
P.L. 114-10, Section 221 [see 42 USC 254b- the period of the 3,600,000,0009 $0 --
2 stand-alone provision—not in PHS Act], as first and second
amended by P.L. 115-96, Sec. 3101(a)(2)(F) quarters of FY
2018)
$10,000,000 per
Federal Tort Claims Act Coverage for Health $10,000,000 per
fiscal year is
Centers: fiscal year is
authorized under
PHS Act, Section 224, as added by P.L. 102- authorized under
Section 224; 99,215,000 99,893,000
501; as amended by P.L. 103-183; P.L. 104- Section 224;
funding comes
73; P.L. 108-163; and the 21st Century Cures funding comes
from the Health
Act, P.L. 114-255, Section 9025 from the Health
Center line
Center line
Federal Tort Claims Act Coverage for Free $10,000,000 per

Clinics: $10,000,000 per fiscal year is
PHS Act, Section 224, as added to the PHS fiscal year is 993,000 authorized 1,000,000
Act by P.L. 104-191, Section 194; as authorized
amended by P.L. 111-148, Section 10608
BUREAU OF HEALTH WORKFORCE:

NHSC: Authorized for Authorized for FY
PHS Act, Sections 331-338, and 338C-H as FY 2018 (and 2019 (and each
amended by the Health Care Safety Net Act each subsequent subsequent year),
of 2008, P.L. 110-355, Section 3(a)(1) and year), based on based on previous
-- 310,000,000
3(c)-(d); as amended by P.L. 111-148, previous year’s year’s funding,
10501(n)(1)-(3) and (5) funding, subject subject to
to adjustment adjustment
formula formula
9
33
FY 2018 FY 2018 FY 2019 FY 2019
NHSC (Mandatory): Expiring

P.L. 111-148, Section 10503(b)(2), as 3/31/2018
amended by P.L. 114-10, Section 221 [see 42 ($65,000,000 for
USC 254b-2 stand-alone provision—not in the period of the 310,000,00010 $0 --
PHS Act] , as amended by P.L. 115-96, Sec. first and second
3101(b)(3)(F) quarters of FY
2018)
NHSC Scholarship Program:
PHS Act, Sections 338A and 338C-H, as
amended by the Health Care Safety Net Act
of 2008, P.L. 110-355, Section 3(a)(2); as
amended by the Patient Protection and
Affordable Care Act P.L. 111-148, Sections
5207
NHSC Loan Repayment Program:
PHS Act, Sections 338B and 338C-H, as
amended by the Health Care Safety Net Act
of 2008, P.L. 110-355, Section 3(a)(2); as
amended by the Patient Protection and
Affordable Care Act , P.L. 111-148, Sections
5207 and 10501(n)(4)
Students to Service Loan Repayment
Program: Indefinite Indefinite
PHS Act, Section 338B
Expired
State Loan Repayment Program Expired (Note:
(Note: The
(SLRP): The CHC/NHSC
CHC/NHSC Fund
PHS Act, Section 338I(a)-(i), as amended Fund (extended
(extended by
by P.L. 107-251, Section 315; as further by MACRA) was
MACRA) is used
amended by the Health Care Safety Net Act used to make
to make SLRP
of 2008, P.L. 110-355, Section 3(a)(2) SLRP grants
grants)
Loan Repayments and Fellowships
Regarding Faculty Positions (Faculty Loan
Repayment): PHS Act, Section 738(a) and Expired 1,182,000 Expired --
740(b), as amended by P.L. 111-148,
Sections 5402 and 10501(d)
Centers of Excellence:
Section 736, PHS Act, as amended by P.L. SSAN 21,564,000 SSAN --
111-148, Section 5401
Scholarships for Disadvantaged Students:
PHS Act, Section 737, as amended by P.L.
Expired 45,658,000 Expired --
111-148, Section 5402(b), authorization of
appropriations in Section 740(a)
Health Careers Opportunity Program:
111-148, Section 5402, authorization of
appropriation in Section 740(c),
10
34
FY 2018 FY 2018 FY 2019 FY 2019
National Center for Workforce Analysis:
PHS Act, Section 761(b), as amended by Expired 4,631,000 Expired 4,663,000
P.L. 111-148, Section 5103
Primary Care Training and Enhancement:
PHS Act, Section 747, as amended by P.L. Expired 38,660,000 Expired --
111-148, Section 5301
Oral Health Training Programs (Training in Expired (with Expired (with
General, Pediatric, and Public Health provision for provision for
Dentistry): carryover funds 36,424,000 carryover funds --
PHS Act, Section 748, as added by P.L. 111- for no more than for no more than 3
148, Section 5303 3 years) years)
Interdisciplinary, Community-Based
Linkages: Expired (with Expired (with
provision for provision for
Area Health Education Centers: carryover funds 30,045,000 carryover funds --
PHS Act, Section 751, as amended by P.L. for no more than for no more than 3
111-148, Section 5403; as amended by P.L. 3 years) years)
113-128, Section 512(z)(2)
Behavioral Health Workforce Education and $50,000,000 for
Training (BHWET): PHS Act, Sections 755 each of fiscal
49,660,000 $50,000,000 --
and 756; as amended by the 21st Century years 2018
Cures Act, P.L. 114-255, section 9021 through 2022
Education and Training Related to Geriatrics:
111-148, Section 5305
(through FY
2022)
Subsection (a)(1) 21st Century

grants: CURES Act,
$15,000,000 Section
Mental and Behavioral Health Education and 9021Subsection
Training Grants (MBHET): Subsection (a)(2) (a)(1)--
PHS Act, Section 756, as added by P.L. 111- grants: $15,000,000
9,849,000 --
148, Section 5306; as amended by the 21 st $15,000,000 Subsection (a)(2)
Century Cures Act, P.L. 114-255, Section $15,000,000;
9021 Subsection (a)(3) Subsection (a)(3):
grants: $10,000,000;
$10,000,000 Subsection (a)(4):
$10,000,000
Subsection (a)(4)
grants:
$10,000,000
Public Health /Preventive Medicine:
PHS Act, Sections 765-768, as amended by Expired 16,885,000 Expired --
P.L. 111-148, Section 10501
Advanced Education Nursing: Expired 64,142,000 Expired --

111-148, Section 5308
35
FY 2018 FY 2018 FY 2019 FY 2019
Nursing Workforce Diversity
111-148, Sec. 5404
Nurse Education, Practice, Quality and
Retention :
PHS Act, Section 831 and 831A, as amended
by P.L. 111-148, Section 5309
Nurse Faculty Loan Program:

PHS Act, Section 846A, as amended by P.L. Expired 26,320,000 Expired --
111-148, Section 5311
Comprehensive Geriatric Education:

PHS Act, Section 865, as re-designated by Expired -- Expired --
P.L. 111-148, Section 5310(b)
NURSE Corps (formerly Nursing Education

Loan Repayment and Scholarship Programs):
Expired 82,570,000 Expired 83,135,000
107-205, Section 103; and for NURSE Corps
Loan Repayment only, as amended by P.L.
111-148, Section 5310(a)
Children's Hospitals Graduate Medical Direct GME:

Education Program: Direct GME: $100,000,000
PHS Act, Section 340E, as amended by P.L. $100,000,000 (through FY
106-129, section 4; as amended by P.L. 106- Indirect Medical 2018) and Indirect
310, section 2001; as amended by P.L. 108- Education: 297,963,000 Medical --
490; as amended by P.L. 109-307; as $200,000,000 Education:
amended by P.L. 113-98 $200,000,000
(through FY
2018)

Education Program: Expiring on
PHS Act, Section 340H, as added by P.L. 3/31/2018
111-148, Section 5508; as amended by P.L. ($30,000,000 for
114-10, Section 221; as amended by P.L. the period of the
60,000,00011 $0 60,000,000
115-63, Section 301(a) by the Disaster Tax first and second
Relief and Airport and Airway Extension Act quarters of FY
of 2017 (included 3-month THCGME 2018)
funding), as amended by P.L. 115-96 Sec.
3101(c)(2)
11
36
FY 2018 FY 2018 FY 2019 FY 2019
National Practitioner Data Bank: (User

Fees)
Title IV, P.L. 99-660, SSA, Section 1921;
P.L. 100-508, SSA, Section 1128E Not Specified 18,000,000 Not Specified 18,814,000
(also includes: Health Care Integrity and
Protection Data Bank (HIPDB), SSA, Section
1128E)
MATERNAL & CHILD HEALTH:

Maternal and Child Health Block Grant: Indefinite at Indefinite at
637,342,000 627,700,000
Social Security Act, Title V $850,000,000 $850,000,000
Autism Education, Early Detection and
Intervention:
Not Specified Not Specified
PHS Act, Section 399BB, as added by P.L.
(sunset at end of 46,779,000 (sunset at the end --
109-416, Section 2; reauthorized: P.L. 112-
FY 2019) of FY 2019)
32, Section 2; reauthorized: P.L. 113-157,
Section 4
Sickle Cell Service Demonstration Grants:
American Jobs Creation Act of 2004, P.L. Expired 4,425,000 Expired --
108-357, Section 712(c )
Universal Newborn Hearing Screening:
PHS Act, Section 399M, as amended by P.L.
106-310, Section 702; as amended by P.L.
111-337, Section 2
Emergency Medical Services for Children:
PHS Act, Section 1910, as amended by P.L. $20,213,000
105-392, Section 415; as amended by P.L. (through FY 20,025,000 $20,213,000 --
111-148, Section 5603; as amended by P.L. 2019)
113-180, Section 2
Healthy Start:
PHS Act, Section 330H(a)-(d), as amended
Expired 102,797,000 Expired 103,500,000
by P.L. 106-310, Section 1501; as amended
by P.L. 110-339, Section 2
Heritable Disorders: $11,900,000
PHS Act, Section 1109-1112 and 1114, as (Sections 1109-
amended by P.L. 106-310, Section 2601; as $11,900,000
1112);
amended by P.L. 110-204, Section 2; as (Sections 1109-
$8,000,000 13,789,000 --
amended by P.L. 110-237, Section 1; as 1112); $8,000,000
(Section 1113)
amended by P.L. 113-240, Section 10 (see (Section 1113)
(through FY
PHS Act, Section 1117-authorization levels) 2019)
37
FY 2018 FY 2018 FY 2019 FY 2019
Family to Family Health Information
Centers: Social Security Act, Section
501(c)(1)(A), as amended by P.L. 109-171,
Section 6064; reauthorized by P.L. 111-148,
Section 5507(b), as amended by P.L. 112- Expired 5,000,00012 $0 5,000,000
240, Section 624; as amended by P.L. 113-
67, Section 1203; as amended by P.L. 113-
93, Section 207; as amended by P.L. 114-10,
Section 216
Maternal, Infant and Early Childhood

Visiting Program:
Social Security Act, Section 511, as added by
Expired 400,000,00012 $0 400,000,000
P.L. 111-148, Section 2951; as amended by
P.L. 114-10, Section 218
HIV/AIDS:13
Emergency Relief - Part A

PHS Act, Sections 2601-10, as amended by
Expired 651,422,000 Expired 655,876,000
P.L. 106-345; as amended by P.L. 109-415;
as amended by P.L. 111-87
Comprehensive Care - Part B:

Expired 1,306,075,000 Expired 1,315,005,000
P.L. 106-345, as amended by P.L. 109-415,
AIDS Drug Assistance Program (Non-Add)

PHS Act, Sections 2611-31 and 2616, as
Expired 894,199,000 Expired 900,313,000
amended by P.L. 106-345, as amended by
P.L. 109-415, as amended by P.L. 111-87
Early Intervention Services – Part C:

Expired 199,713,000 Expired 201,079,000
12
13The Ryan White Program was authorized through September 30, 2013. The Ryan White HIV/AIDS Treatment
Extension Act of 2009 (P.L. 111-87, October 30, 2009) removed the explicit sunset clause. In the absence of the
sunset clause, the program will continue to operate without a Congressional reauthorization if funds are
appropriated.
38
FY 2018 FY 2018 FY 2019 FY 2019
Coordinated Services and Access to
Research for Women, Infants, Children and
Youth - Part D:
Expired 74,578,000 Expired 75,088,000
106-345, as amended by P.L. 109-415, as
amended by P.L. 111-87
AIDS Education and Training Centers - Part
F:
PHS Act, Section 2692(a), as amended by Expired 33,383,000 Expired --
Dental Reimbursement Program - Part F:

PHS Act, Section 2692(b), as amended by
P.L. 106-345, as amended by P.L.109-415, Expired 13,033,000 Expired 13,122,000
as amended by P.L.111-87
Special Projects of National Significance -

Part F:
HEALTHCARE SYSTEMS:
Organ Transplantation:
42 U.S.C. 273-274g, PHS Act, Sections 371-
378, as amended by P.L. 108-216, Expired 23,389,000 Expired 23,549,000
P.L. 109-129, P.L. 110-144, P.L. 110-413,
and P.L. 113-51
National Cord Blood Inventory:
PHS Act, Section 379; as amended by P.L. $23,000,000
109-129, Section 3; as amended by P.L. 111- (through FY 12,183,000 $23,000,000 12,266,000
264; as amended by P.L. 114-104, Section 3 2020)
C.W. Bill Young Cell Transplantation
Program:
PHS Act, Sections 379-379B, as amended by $30,000,000
P.L. 109-129, Section 3; as amended by P.L. (through FY 21,959,000 $30,000,000 22,109,000
111-264; as amended by P.L. 114-104, 2020)
Section 2
Poison Control: Toll-free number: Toll-free number:

PHS Act, Sections 1271-1274, as amended $700,000 $700,000;
by P.L. 108-194; as amended by P.L. 110-
377; as amended by P.L. 113-77 Media campaign: Media Campaign:
18,718,000 18,846,000
$800,000 $800,000;
Grant program: Grant program:

$28,600,000 $28,600,000
39
FY 2018 FY 2018 FY 2019 FY 2019
340B Drug Pricing Program:
PHS Act, Section 340B, as added by P.L.
102-585, Section 602(a); as amended by P.
L. 103-43, Section 2008(i)(1)(A); as SSAN
amended by P.L. 111-148, Sections 10,168,000 SSAN 10,238,000
indefinitely
2501(f)(1), 7101(a) –(d), 7102; as amended
by P.L. 111-152, Section 2302; as amended
by P.L. 111-309, Section 204(a)(1)
National Hansen's Disease Program:
Not Specified 15,103,000 Not Specified 11,653,000
107-220
Payment to Hawaii:
PHS Act, Section 320(d), as amended by Not Specified 1,844,000 Not Specified 1,857,000
P.L. 105-78, Section 211
National Hansen's Disease - Buildings and

Facilities: Not Specified 122,000 Not Specified --
PHS Act, Section 320
Countermeasures Injury Compensation

Program: PHS Act, Sections 319F-3 and
319F-4, as added by P.L. 109-148, as Not Specified -- Not Specified --
amended by P.L. 113-5 (to Section 319F-3)
RURAL HEALTH:
Rural Health Policy Development:
Social Security Act, Section 711, and PHS Indefinite 9,287,000 Indefinite 5,000,000
Act, Section 301
Rural Health Outreach Network
Development and Small Health Care
Provider Quality Improvement:
PHS Act, Section 330A, as amended by P.L. Expired 65,055,000 Expired 50,811,000
110-355, Section 4
Rural Hospital Flexibility Grants:
SSA, Section 1820(j), as amended by P.L.
105-33, Section 4201(a) and Section 4002(f),
and P.L. 108-173, Section 405(f), as
amended by P.L. 110-275, Section 121; as
amended by P.L. 111-148, Section 3129(a)
State Offices of Rural Health:
PHS Act, Section 338J, as amended by P.L. Expired 9,932,000 Expired --
105-392, Section 301
Radiogenic Diseases (Radiation Exposure
Screening and Education Program):
PHS Act, Section 417C, as amended by P.L. Not Specified 1,822,000 Not Specified 1,834,000
106-245, Section 4, as amended by P.L. 109-
482, Sections 103, 104
40
FY 2018 FY 2018 FY 2019 FY 2019
Black Lung:
Federal Mine Safety and Health Act 1977, Not Specified 7,217,000 $10,000,000 7,266,000
P.L. 91-173, Section 427(a)
Telehealth:
PHS Act, Section 330I, as amended by P.L.
107-251, as amended by P.L. 108-163; as Expired 18,374,000 Expired 10,000,000
OTHER PROGRAMS:
Family Planning:
Expired 284,534,000 Expired 286,479,000
Grants: PHS Act Title X
Program Management Indefinite 152,954,000 Indefinite 151,993,000
Vaccine Injury Compensation Program

(VICP) (funded through the VICP Trust
Fund):
Indefinite 315,697,000 Indefinite 317,200,000
PHS Act, Title XXI, Subtitle 2, Sections
2110-34, as amended by P.L. 114-255,
Section 3093(c).
UNFUNDED AUTHORIZATIONS:
Health Center Demonstration Project for
Individualized Wellness Plans
SSAN -- SSAN --
PHS Act, Section 330(s), as added to PHS
Act by P.L. 111-148, Section 4206
Expired (through Expired (through

School Based Health Centers - Facilities FY 2013 and FY 2013 and
Construction amounts remain -- amounts remain --
P.L. 111-148, Section 4101(a) available until available until
expended) expended)
School Based Health Centers - Operations
PHS Act, Section 399Z-1, as added by P.L. Expired -- Expired --
111-148, Section 4101(b)
Health Information Technology Innovation
Initiative
PHS Act, Section 330(e)(1)(C), (Grants for SSAN -- SSAN --
Operation of Health Center Networks and
Plans), as amended
Health Information Technology Planning
Grants
SSAN -- SSAN --
PHS Act, Section 330(c)(1)(B)-(C), as
amended
41
FY 2018 FY 2018 FY 2019 FY 2019
Electronic Health Record Implementation
Initiative SSAN -- SSAN --
PHS Act, Section 330(e)(1)(C), as amended
Native Hawaiian Health Scholarships:
42 USC 11709, as amended by P.L. 111-148,
SSAN (through SSAN (through
Section 10221 (incorporating Section 202(a) -- --
FY 2019) FY 2019)
of title II of Senate Indian Affairs
Committee-reported S. 1790)
Health Professions Education in Health
Disparities and Cultural Competency
Expired -- Expired --
111-148, Section 5307
Training Opportunities for Direct Care
Workers
PHS Act, Section 747A, as added by P.L.
111-148, Section 5302
Continuing Education Support for Health
Professionals Serving in Underserved
Communities SSAN -- SSAN --
111-148, Section 5403
Geriatric Career Incentive Awards
PHS Act, Section 753(e), as amended by P.L. Expired -- Expired --
111-148, Section 5305(a)
Geriatric Academic Career Awards
PHS Act, Section 753(c), as amended by P.L. Not Specified -- Not Specified --
111-148, Section 5305(b)
Rural Interdisciplinary Training (Burdick)
Not Specified -- Not Specified --
PHS Act, Section 754
Expired (through Expired (through
Grants for Pain Care Education & Training, FY 2012 and FY 2012 and
PHS Act, Section 759, as added by P.L.111- amounts amounts
-- --
148, Section 4305 appropriated appropriated
remain available remain available
until expended) until expended)
Advisory Council on Graduate Medical
Education
111-148, Section 5103
Health Professions Education in Health
Disparities and Cultural Competency
111-148, Section 5307
Minority Faculty Fellowship Program
PHS Act, Section 738 (authorized
appropriation in PHS Act Section 740(b)), as Expired -- Expired --
amended by P.L.111-148, Sections 5402,
10501
42
FY 2018 FY 2018 FY 2019 FY 2019
State Health Care Workforce Development
Grants and Implementation Grants
[stand-alone 42 U.S.C. 294r (not as part of SSAN -- SSAN --
PHS Act)], as added by P.L. 111-148,
Section 5102
Allied Health and Other Disciplines
PHS Act, Section 755 Not Specified -- Not Specified --
Nurse Managed Health Clinics ,
PHS Act, Section 330A-1, as added by P.L. Expired -- Expired --
111-148, Section 5208
Patient Navigator
109-18, Section 2; as amended by P.L. 111-
148, Section 3510
Teaching Health Centers Development
Grants,
SSAN -- SSAN --
111-148, Section 5508
Evaluation of Long Term Effects of Living
Organ Donation,
108-216, Section 7
Congenital Disabilities
PHS Act, Section 399T, as added by P.L.
110-374, Section 3, as renumbered by P.L.
111-148, Section 4003
Pediatric Loan Repayment:
PHS Act, Section 775, as added by P.L. 111- Expired -- Expired --
148, Section 5203
Not Specified Not Specified
(Section 755) (Section 755)
Clinical Training in Interprofessional
Practice: -- --
Expired Expired
PHS Act, Sections 755, 765, 831
(Sections 765 and (Sections 765 and
831) 831)
Rural Access to Emergency Devices:
PHS Act, Section 313 (Public Access
Defibrillation Demo), and P.L. 106-505, Expired -- Expired --
Section 413 (Rural Access to Emergency
Devices)
Training Demonstration Program:
$10,000,000 (for $10,000,000 (for
PHS Act, Section 760, as added by P.L. 114-
each of FY 2018- -- each of FY 2018- --
255, the 21st Century Cures Act, Section
FY 2022) FY 2022)
9022
Pediatric Mental Health Care Access Grants: $9,000,000 (for $9,000,000 (for
PHS Act, Section 330M, as added by P.L. the period of the period of
-- --
114-255, the 21st Century Cures Act, Section fiscal years 2018- fiscal years 2018-
10002 2022) 2022)
43
FY 2018 FY 2018 FY 2019 FY 2019
Screening and Treatment for Maternal
Depression Grants: $5,000,000 (for $5,000,000 (for
PHS Act, Section 317L-1, as added by P.L. each of FY 2018- -- each of FY 2018- --
114-255, the 21st Century Cures Act, Section FY 2022) FY 2022)
10005
Infant and Early Childhood Mental Health
Promotion, Intervention, and Treatment $20,000,000 (for $20,000,000 (for
Grants: the period of the period of
-- --
PHS Act, Section 399Z-2, as added by P.L. fiscal years fiscal years
114-255, the 21st Century Cures Act, Section 2018- 2022) 2018- 2022)
10006
Liability Protections for Health Professional
Volunteers at Community Health Centers:
PHS Act, Section 224(q), as added by P.L. Not Specified -- Not Specified --
114-255, the 21st Century Cures Act, Section
9025
44
Appropriations History Table
Budget
Estimate to House Senate
Congress Allowance Allowance Appropriation
FY 2009
General Fund Appropriation:

Base 5,864,511,000 7,081,668,000 6,943,926,000 7,234,436,000
Mandatory Authority 5,000,000
Advance
Supplemental 2,500,000,000
Rescission of Unobligated Funds
Transfers
Subtotal 5,864,511,000 7,081,668,000 6,943,926,000 9,739,436,000
FY 2010

Base 7,126,700,000 7,306,817,000 7,238,799,000 7,473,522,000
Advance
Supplemental
Rescissions
Transfers 9,472,000
Subtotal 7,126,700,000 7,306,817,000 7,238,799,000 7,482,994,000
FY 2011

Base 7,473,522,000 7,491,063,000 6,274,790,000
Supplemental
Transfers
Across-the-board reductions -12,549,000
American Recovery and
Reinvestment Act 73,600,000
Subtotal 7,473,522,000 7,491,063,000 6,335,841,000
FY 2012

Base 6,801,262,000 6,206,204,000
Advance
Supplemental
Rescissions
Across-the-board reductions -11,730,000
Transfers 11,277,000
Subtotal 6,801,262,000 6,205,751,000
45
Budget
FY 2013

Base 6,067,862,000 6,194,474,000
Advance
Supplemental
Rescissions -12,389,000
Transfers -15,807,000
Sequestration -311,619,000
Subtotal 6,067,862,000 5,854,664,000
FY 2014

Base 6,015,039,000 6,309,896,000 6,054,378,000
Advance
Supplemental
Rescissions
Subtotal 6,015,039,000 6,309,896,000 6,039,180,000
FY 2015

Base 5,292,739,000 6,093,916,000 6,104,784,000
Advance
Supplemental
Rescissions
Transfers
Subtotal 5,292,739,000 6,093,916,000 6,104,784,000
FY 2016

Base 6,217,677,000 5,804,254,000 5,987,562,000 6,139,558,000
Advance
Supplemental
Rescissions
Transfers
Subtotal 6,217,677,000 5,804,254,000 5,987,562,000 6,139,558,000
46
Budget
FY 2017

Base 5,733,481,000 5,917,190,000 6,155,869,000 6,213,347,000
Advance
Supplemental
Rescissions
Subtotal 5,733,481,000 5,917,190,000 6,155,869,000 6,199,247,000
FY 2018

Base 5,538,834,000 5,839,777,000 6,217,794,000 6,156,255,000
Advance
Supplemental
Rescissions
Transfers
Subtotal 5,538,834,000 5,815,727,000 6,217,794,000 6,156,255,000
FY 2019
General Fund Appropriation: 9,559,591,000

Base
Advance
Supplemental
Rescissions
Transfers
Subtotal 9,559,591,000
47
Appropriations Not Authorized by Law14
Appropriations
Last Year of Last Authorization in Last Year of Appropriations
HRSA Program Authorization Level Authorization in FY 2018
Health Centers (Mandatory):
P.L 111-152, Section 2303; as amended by 2017 36,000,000,000 3,510,661,000 3,600,000,00015
P.L. 114-10, Section 221 [see 42 USC 254b-2
stand-alone provision—not in PHS Act]
School-Based Health Centers (facilities
construction) –P.L. 111-148, Section 4101(a) 2013 $50,000,000 47,450,000 --
National Health Service Corps (NHSC)
(Mandatory):
P.L. 111-148, Section 10503(b)(2), as
2017 310,000,000 288,610,000 310,000,000
amended by P.L. 114-10, Section 221 [see 42
USC 254b-2 stand-alone provision—not in
PHS Act]
State Loan Repayment Program (SLRP) –
Public Health Service (PHS) Act, Section
338I(a)-(i), as amended by P.L. 107-251,
Section 315; as amended by P.L. 110-355, Such sums as
2012 -- --
Section 3(a)(2) necessary (SSAN)
Authorization of appropriations:
Section 338I(i)
NHSC – PHS Act, Sections 331-338
Authorization of appropriations (“Field”): 2012 -- -- --
Section 338(a)
NURSE Corps (formerly Nursing Education
Loan Repayment and Scholarship Programs)
107-205, Section 103; and for NURSE Corps
Loan Repayment only, as amended by P.L. 2007 SSAN 31,055,000 82,570,000
111-148, Section 5310(a)
Authorization of appropriations:
Section 846(i)(1)
Loan Repayments and Fellowships Regarding
Faculty Positions (Faculty Loan Repayment) –
PHS Act, Section 738(a) and 740(b), as 2014 5,000,000 1,187,000 1,182,000
amended by P.L. 111-148, Sections 5402 and
10501(d)
Scholarships for Disadvantaged Students –
PHS Act, program authorized by Section 737,
authorization of appropriations in Section 2014 SSAN 44,857,000 45,658,000
740(a), as amended by P.L. 111-148, Section
5402(b)
14
Please note that even where authorizations of appropriations ended in prior fiscal years, authority still exists for
particular activities if the enabling authorities continue to exist and if current appropriations extend to the
programmatic activities.
15
48
Appropriations
Health Careers Opportunity Program –
PHS Act, program authorized by Section 739,
authorization of appropriation in Section 2014 SSAN 14,153,000 14,093,000
740(c), as amended by P.L. 111-148, Section
5402
National Center for Workforce Analysis –
PHS Act, Section 761(b), authorization of
2014 7,500,000 4,651,000 4,631,000
appropriation in Section 760(e)(1)(A), as
Primary Care Training and Enhancement --
PHS Act, Section 747, as amended by P.L. 2014 SSAN 36,831,000 38,660,000
111-148, Section 5301
Oral Health Training Programs (Grants for
Innovative Programs for Dental Health) – $25,000,000 Total
2012 31,928,000 36,424,000
PHS Act, Section 340G (for FY 2008-12)
Area Health Education Centers
2014 125,000,000 30,250,000 30,045,000
113-128, Section 512(z)(2)
 Education and Training Relating to
Geriatrics – PHS Act, Section 753, as
 Geriatric Workforce Development
(authorization of appropriation in Section
753(d) (9)) 2014 10,800,000
33,237,000 38,474,000
 Geriatric Career Incentive Awards 2013 10,000,000
(authorization of appropriation in Section
753(e)(4))
Nursing Workforce Development
 Nurse Retention Grants – PHS Act, 2012 SSAN -- --
Section 831A
 Nurse Education, Practice, and Quality 2016 SSAN 37,913,000 39,642,000
grants – PHS Act, Section 831
 Nurse Faculty Loan Program – PHS Act, 2014 SSAN 24,500,000 26,320,000
Section 846A
 Comprehensive Geriatric Education – PHS 2014 SSAN 4,350,000 --
Act, Section 865
Education (THCGME) Program:
PHS Act, Section 340H, as added by P.L.
2018
(First Quarter 15,000,000 60,000,000 60,000,00016
114-10, Section 221; as amended by P.L. 115-
only)
63, Section 301(a) by the Disaster Tax Relief
and Airport and Airway Extension Act of
2017 (included 3-month THCGME funding)
16
49
Appropriations
Sickle Cell Service Demonstration Grants –
American Jobs Creation Act of 2004, P.L. 2009 10,000,000 4,455,000 4,425,000
108-357, Section 712(c )
Healthy Start –
PHS Act, Section 330H(a)-(d), as amended by Amount authorized
2013 100,746,000 102,797,000
P.L. 106-310, Section 1501; as amended by for the preceding FY
P.L. 110-339, Section 2 increased by formula
Family to Family Health Information Centers:
Social Security Act, Section 501(c)(1)(A), as
amended by P.L. 109-171, Section 6064;
reauthorized by P.L. 111-148, Section
5507(b), as amended by P.L. 112-240, Section 2017 5,000,000 4,655,000 5,000,00017
624; as amended by P.L. 113-67, Section
1203; as amended by P.L. 113-93, Section
207; as amended by P.L. 114-10, Section 216
Maternal, Infant and Early Childhood Visiting
Program:
Social Security Act, Section 511, as added by
P.L. 111-148, Section 2951; as amended by 2017 400,000,000 372,400,000 400,000,00017
P.L. 113-93, Section 209; as amended by P.L.
114-10, Section 218
Emergency Relief - Part A –

P.L. 106-345; as amended by P.L. 109-415; as 2013 789,471,000 649,373,000 651,422,000
Comprehensive Care - Part B –
PHS Act, Sections 2611-31, as amended by 2013
P.L. 106-345, as amended by P.L. 109-415, as 1,562,169,000 1,314,446,000 1,306,075,000
Early Intervention Services – Part C –
PHS Act, Sections 2651-67, as amended by 2013
P.L. 106-345, as amended by P.L. 109-415, as 285,766,000 205,544,000 199,713,000
Coordinated Services and Access to Research
for Women, Infants, Children and Youth -
Part D – 2013
PHS Act, Section 2671, as amended by P.L. 87,273,000 72,395,000 74,578,000
Special Projects of National Significance -
Part F –
PHS Act, Section 2691, as amended by P.L. 2013 25,000,000 25,000,000 24,830,000
17
50
Appropriations
AIDS Education and Training Centers - Part F
– PHS Act, Section 2692(a), as amended by 2013 42,178,000 33,275,000 33,383,000
P.L. 106-345, as amended by P.L. 109-415, as
Dental Reimbursement Program - Part F –
PHS Act, Section 2692(b), as amended by 2013
15,802,000 12,991,000 13,033,000
P.L. 106-345, as amended by P.L.109-415, as
amended by P.L.111-87
Organ Transplantation – Annual
42 U.S.C. 273-274g, PHS Act, Sections 371- appropriations
378, as amended by P.L. 108-216, constitute
P.L. 109-129, P.L. 110-144, P.L. 110-413, and authorizations Section 377—
P.L. 113-51 (Section- 5,000,000
specific Section 377A—
appropriations SSAN 2,767,000 23,389,000
for sections Section 377B—
377, 377A, SSAN
and 377B
expired
September 30,
2009)
Rural Health Outreach Network Development
and Small Health Care Provider Quality
Improvement –
PHS Act, Section 330A, as amended by P.L. 2012 45,000,000 55,553,000 65,055,000
110-355, Section 4
Rural Hospital Flexibility Grants –
SSA, Section 1820(j), as amended by P.L.
105-33, Section 4201(a) and Section 4002(f),,
and P.L. 108-173, Section 405(f), as amended 2012 SSAN 41,040,000 43,313,000
by, P.L. 110-275, Section 121; as amended by
P.L. 111-148, Section 3129(a)
State Offices of Rural Health—

PHS Act, Section 338J, as amended by P.L. 2002 SSAN 4,000,000 9,932,000
105-392, Section 301
Telehealth –
PHS Act, Section 330I, as amended by P.L.
107-251, as amended by P.L. 108-163; as 2006 SSAN 6,814,000 18,374,000
further amended by P.L. 113-55, Section 103
Family Planning Grants –
PHS Act, Title X 1985 158,400,000 142,500,000 284,534,000
51
Primary Health Care
TAB
52
PRIMARY HEALTH CARE
Health Centers
FY 2018 FY 2019 FY 2019
FY 2017 Annualized President’s +/-
Final CR Budget FY 2018
BA $1,387,036,000 $1,381,185,000 $4,990,629,000 +$3,609,444,000
Current Law
$3,510,661,000 $550,000,000 --- -$550,000,000
Mandatory Funding
Proposed Law
--- $3,050,000,000 --- -$3,050,000,000
Mandatory Funding
FTCA Program $99,893,000 $99,215,000 $99,893,000 +$678,000
Total $4,997,590,000 $5,080,400,000 $5,090,522,000 +$10,122,000
FTE 522 522 522 ---
Authorizing Legislation: Public Health Service Act, Section 330, as amended by Public Law
111-148, Section 5601; Public Law 111-148, Section 10503, as amended by Public Law 114-10,
Section 221; Public Health Service Act, Section 224, as added by Public Law 102-501 and
amended by Public Law 104-73; Public Law 114-22.
FY 2019 Authorization: FY 2018 authorization level adjusted by the product of -

(i) one plus the average percentage increase in costs incurred per patient served; and
(ii) one plus the average percentage increase in the total number of patients served.
FY 2019 Community Health Center Fund Authorization..............................................................$0
Allocation Method ....................................................... Competitive grants/cooperative agreements
Program Description and Accomplishments
For more than 50 years, health centers have delivered affordable, accessible, quality, and cost-
effective primary health care to patients regardless of their ability to pay. During that time, health
centers have become an essential primary care provider. Health centers advance a model of
coordinated, comprehensive, and patient-centered primary health care, integrating a wide range
of medical, dental, behavioral, and patient services. Today, nearly 1,400 health centers operate
more than 11,000 service delivery sites that provide care in every U.S. State, the District of
Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.
In 2016, health centers served 25.9 million patients, one in every twelve people living in the
United States, providing approximately 104 million patient visits, at an average cost of $890 per
patient (including Federal and non-Federal sources of funding). In 2016, nearly half of all health
centers served rural areas providing care to 8.6 million patients, about one in 6 people living in
rural areas. Patient services are supported through Federal Health Center grants, Medicaid,
53
Medicare, Children’s Health Insurance Program (CHIP), other third party payments, self-pay
collections, other Federal grants, and State/local/other resources.
Health centers deliver high quality and cost-effective care by using key quality improvement
practices, including health information technology. Approximately 66 percent of health centers
are recognized by national accrediting organizations as Patient Centered Medical Homes– an
advanced model of patient-centered primary care that emphasizes quality and care coordination
through a team‐based approach to care. Despite treating a sicker, poorer, and more diverse
population than other health care providers, health centers exceeded numerous national averages
and benchmarks in 2016 including Healthy People 2020 goals for low birth rate, hypertension
control, and dental sealant services. Overall, 91 percent of health centers met or exceeded
Healthy People 2020 goals for at least one clinical measure in 2016. Health centers also reduce
costs to health systems; the health center model of care has been shown to reduce the use of
costlier providers of care, such as emergency departments and hospitals.
Populations served: Health centers serve a diverse patient population. In 2016:
 People of all ages: Approximately 31 percent of patients were children (age 17 and
younger); over 8 percent were 65 or older. Health centers provided primary care services
for one in ten children nationwide.
 People in poverty: 92 percent of health center patients are individuals or families living
at or below 200 percent of the Federal Poverty Guidelines as compared to approximately
34 percent of the U.S. population as a whole.
 People without and with health insurance: About one in 4 patients were without health
insurance. Those patients that are insured are covered by Medicaid, Medicare, other
public insurance, or private insurance.
 Special Populations: Some health centers receive specific funding to provide primary
care services for certain special populations including individuals and families
experiencing homelessness, agricultural workers, those living in public housing, and
Native Hawaiians. Health centers served over 1.2 million individuals experiencing
homelessness, over 950,000 agricultural workers and their families, almost 2.7 million
residents of public housing and nearly 14,000 Native Hawaiians.
o Health Care for the Homeless Program: Homelessness continues to affect rural as
well as urban and suburban communities in the United States. According to the
Department of Housing and Urban Development’s 2015 Annual Homeless
Assessment Report to Congress, approximately 1.5 million people were homeless.
In 2016, HRSA-funded health centers provided primary care services for over 1.2
million persons experiencing homelessness. The Health Care for the Homeless
Program supports coordinated, comprehensive, integrated primary care including
substance abuse and mental health services for homeless persons in the United
States, serving patients that live on the street, in shelters, or in transitional
housing.
54
o Migrant Health Center Program: HRSA-funded health centers provided primary
care services for over 950,000 migratory and seasonal agricultural workers and
their families. It is estimated that there are approximately 2.8 million migratory
and seasonal agricultural workers in the United States (2016 LSC Agricultural
Worker Population Estimate Update). The Migrant Health Center Program
supports comprehensive, integrated primary care services for agricultural workers
and their families with a particular focus on occupational health and safety.
o Public Housing Primary Care Program: The Public Housing Primary Care
Program increases access for residents of public housing to comprehensive,
integrated primary care services. Health centers deliver care at locations on the
premises of public housing developments or immediately accessible to residents.
HRSA-funded health centers provided primary care services for nearly 2.7 million
residents of public housing. The Public Housing Primary Care Program provides
services that are responsive to identified needs of the residents and in coordination
with public housing authorities.
o Native Hawaiian Health Care Program: The Native Hawaiian Health Care
Program, funded within the Health Center appropriation, improves the health of
Native Hawaiians by making health education, health promotion, and disease
prevention services available through a combination of outreach, referral, and
linkage mechanisms. Services provided include nutrition programs, screening
and control of hypertension and diabetes, immunizations, and basic primary care
services. Native Hawaiian Health Care Systems provided medical and enabling
services to nearly 14,000 people.
Allocation Method: Public and non-profit private entities, including tribal, faith-based and
community-based organizations are eligible to apply for funding under the Health Center
Program. New health center grants are awarded based on a competitive process that includes an
assessment of need and merit. In addition, health centers are required to compete for continued
grant funding to serve their existing service areas at the completion of every project period
(generally every 3 years). New Health Center Program grant opportunities are announced
nationally and applications are reviewed and rated by objective review committees (ORC),
composed of experts who are qualified by training and experience in particular fields related to
the Program.
Funding decisions are made based on ORC assessments, announced funding preferences and
program priorities. In making funding decisions, HRSA applies statutory awarding factors
including funding priority for applications serving a sparsely-populated area; consideration of the
rural and urban distribution of awards (no more than 60 percent and no fewer than 40 percent of
projected patients come from either rural or urban areas); and continued proportionate
distribution of funds to the special populations served under the Health Center Program.
Patient Care: Health centers continue to serve an increasing number of patients. The number of
health center patients served in 2016 was 25.9 million; an increase of 10.9 million, or 73 percent,
above the 15.0 million patients served in 2006. Of the 25.9 million patients served and for those
55
for whom income status is known, 92 percent were at or below 200 percent of the Federal
poverty level and approximately 23 percent were uninsured. Success in increasing the number of
patients served has been due in large part to the development of new health centers, new satellite
sites, and expanded capacity at existing clinics.
Health centers focus on integrating care for their patients across the full range of services – not
just medical but oral health, vision, behavioral health (mental health and substance use disorder
services), and pharmacy. Health centers also deliver crucial services such as case management,
transportation, and health education, which enable target populations to access care. Over 90
percent of health centers provide preventive dental services either directly or via contract. In
2016, health centers provided oral health services to about 5.7 million patients, an increase of 50
percent since 2010. In 2016, almost 1.8 million people received behavioral health services at
health centers, an increase of 43 percent from 2014 to 2016 due to significant Health Center
Program investments in behavioral health services beginning in 2014.
Improving Quality of Care and Health Outcomes: Health centers continue to provide quality
primary and related health care services, improving the health of the Nation’s underserved
communities and populations. HRSA-funded health centers are evaluated on a set of
performance measures emphasizing health outcomes and the value of care delivered. These
measures provide a balanced, comprehensive look at a health center’s services toward common
conditions affecting underserved communities. Performance measures align with national
standards and are commonly used by Medicare, Medicaid, and health insurance/managed care
organizations. Benchmarking health center outcomes to national rates demonstrates how health
center performance compares to the performance of the nation overall.
Timely entry into prenatal care is an indicator of both access to and quality of care. Identifying
maternal disease and risks for complications of pregnancy or birth during the first trimester can
also help improve birth outcomes. Results over the past few years demonstrate improved
performance as the percentage of pregnant health center patients that began prenatal care in the
first trimester grew from 57.8 percent in 2011 to 74.0 percent in 2016, exceeding the target of
67.0 percent.
Appropriate prenatal care management can also have a significant effect on the incidence of low
birth weight (LBW), the risk factor most closely associated with neonatal mortality. Monitoring
birth weight rates is one way to measure quality of care and health outcomes for health center
female patients of childbearing age, approximately 29 percent of the total health center patient
population served in 2016. In 2016, the health center rate was 7.8 percent, approximately 4
percentage points lower than the 2015 national rate of 8.1 percent, and has consistently been
lower than the national rate during the past several years.
Health center patients, including low-income individuals, racial/ethnic minority groups, and
persons who are uninsured, are more likely to suffer from chronic diseases such as hypertension
and diabetes. Clinical evidence indicates that access to appropriate care can improve the health
status of patients with chronic diseases and thus reduce or eliminate health disparities. The
Health Center Program began reporting data from all grantees on the control of hypertension and
diabetes via its Uniform Data System in 2008. In 2016, 62 percent of adult health center patients
56
with diagnosed hypertension had blood pressure under adequate control (less than 140/90)
compared to 53 percent nationally. Additionally in 2016, 68 percent of adult health center
patients with type 1 or 2 diabetes had their most recent hemoglobin A1c (HbA1c) under control
(less than or equal to 9 percent) compared to 55 percent nationally.
HRSA recognizes that there are many opportunities to maintain and improve the quality and
effectiveness of health center care. In FY 2015, HRSA established an annual Health Center
Quality Improvement Fund to recognize the highest clinically-performing health centers
nationwide as well as those health centers that have made significant quality improvement gains
in the past year. Quality Improvement Fund awards are based on uniform clinical performance
measures collected from all health centers, including measures on preventive health,
perinatal/prenatal care, and chronic disease management, and designed to drive improvements in
patient care and outcomes.
Health centers improve health outcomes by emphasizing the care management of patients with
multiple health care needs and the use of key quality improvement practices, including health
information technology. HRSA’s Health Center Program Patient Centered Medical Home
(PCMH) Initiative supports health centers to achieve national PCMH recognition, an advanced
model of primary care using a team-based approach to improve quality through coordination of
care and patient engagement. At the end of FY 2016, two-thirds of HRSA-funded health centers
were recognized as PCMHs. In addition, health centers have advanced quality and
accountability by adopting Health Information Technology (HIT), including the use of certified
Electronic Health Records (EHRs), telehealth and other technologies that advance and enable
quality improvement. Over 98 percent of all health centers reported having an EHR in 2016.
Promoting Efficiency: Health centers provide cost effective, affordable, quality primary health
care services. The Program’s efficiency measure focuses on maximizing the number of health
center patients served per dollar as well as keeping cost increases below average annual national
health care cost growth rate while maintaining access to high quality services. The annual
growth in total cost per patient, reflects the full complement of services (e.g., medical, dental,
mental health, substance abuse, pharmacy, outreach, translation) that make health centers a
“health care home”. In 2014, health center costs grew at a rate of 4.7 percent, compared to a
national rate of 5.3 percent. In 2015, the health center cost growth rate was 5.4 percent,
compared to a national rate of 5.8 percent. In 2016, the health center cost growth rate was 7.9
percent, slightly higher than the national rate of 4.3 percent, due to extensive investments in new
health center services and capital improvement projects.
By keeping increases in the cost per individual served at health centers below than national per
capita health care cost increases, the Program demonstrates that it delivers its high-quality
services at a more cost-effective rate. Success in achieving cost-effectiveness may in part be
related to the multi- and interdisciplinary team-based approach used under the PCMH model of
care that not only increases access and reduces health disparities, but also promotes more
effective care for health center patients with chronic conditions.
External Evaluation: In addition to internal monitoring of health center performance, peer

reviewed literature and major reports continue to document that health centers successfully
57
increase access to care, promote quality and cost-effective care, and improve patient outcomes,
especially for traditionally underserved populations.
 Health center Medicaid patients had lower use and spending than did non-health center
patients across all services, with 22 percent fewer visits and 33 percent lower spending on
specialty care, and 25 percent fewer admissions and 27 percent lower spending on
inpatient care. Total spending was 24 percent lower for health center patients. (Nocon,
Robert S. et al. “Health Care Use and Spending for Medicaid Enrollees in federally
Qualified Health Centers Versus Other Primary Care Settings” American Journal of
Public Health, Nov 2016).
 Health centers provide socially and medically disadvantaged patients with care that
results in lower utilization and maintained or improved preventive care. (Neda
Laiteerapong, James Kirby, Yue Gao, Tzy-Chyi Yu, Ravi Sharma, Robert Nocon, Sang
Mee Lee, Marshall H. Chin, Aviva G. Nathan, Quyen Ngo-Metzger, and Elbert S. Huang;
Health Services Research 2014).
 Health centers provide high-quality primary care and do not exhibit the extent of
disparities that exist in other US health care settings. (Shi L, Lebrun-Harris L,
Parasuraman S, Zhu J, Ngo-Metzger Q “The Quality of Primary Care Experienced by
Health Center Patients” Journal of the American Board of Family Medicine, 2013; 26(6):
768-777).
 Health Centers and look-alikes demonstrated equal or better performance than private
practice primary care providers on select quality measures despite serving patients who
have more chronic disease and socioeconomic complexity (Goldman LE, Chu PW, Tran
H, Romano MJ, Stafford RS; 2. American Journal of Preventive Medicine 2012 Aug;
43(2):142-9).
 Rural counties with a community health center site had 33 percent fewer uninsured
emergency department (ED) visits per 10,000 uninsured populations than those rural
counties without a health center site. Rural health center counties also had fewer ED
visits for ambulatory care sensitive visits – those visits that could have been avoided
through timely treatment in a primary care setting. (Rust George, et al. “Presence of a
Community Health Center and Uninsured Emergency Department Visit Rates in Rural
Counties.” Journal of Rural Health, Winter 2009 25(1):8-16.)
 Health centers providing enabling services that were linguistically appropriate helped
patients obtain health care (Weir R, et al. Use of Enabling Services by Asian American,
Native Hawaiian, and Other Pacific Islander Patients at 4 Community Health Centers.
Am J Public Health 2010 Nov; 100(11): 2199 – 2205).
 ED visits are higher in counties with limited access to primary care (Hossain MM,
Laditka JN. Using hospitalization for ambulatory care sensitive conditions to measure
access to primary health care: an application of spatial structural equation modeling. Int J
Health Geogr. 2009 Aug 28; 8:51).
58
Federal Tort Claims Act (FTCA) Program: The Health Center Program administers the FTCA
Program, under which participating health centers, their employees and eligible contractors may
be deemed to be Federal employees qualified for medical malpractice liability protection under
the FTCA. As Federal employees, they are immune from suit for medical malpractice claims
while acting within the scope of their employment. The Federal Government assumes
responsibility for such claims. In addition, the FTCA Program supports risk mitigation activities,
including reviews of risk management plans and sites visits as well as risk management technical
assistance and resources to support health centers. The enactment of the 21st Century Cures Act
in December of 2016 extended liability protections for volunteers at deemed health centers under
the FTCA Program. In accordance with the statute, HRSA implemented FTCA coverage for
volunteers in FY 2017. In FY 2014, 103 claims were paid totaling $72.2 million, in FY 2015,
111 claims were paid totaling $93.8 million, and in FY 2016, 134 claims were paid totaling
$92.4 million. Currently, there are 868 FTCA Program claims outstanding. It is projected that
the number of claims paid will continue to increase in FY 2019.
Funding History
FY Amount
FY 2015 $1,491,422,000
FY 2015 Mandatory Funding18 $3,509,111,000
FY 2016 $1,491,422,000
FY 2016 Mandatory Funding $3,600,000,000
FY 2017 $1,481,929,000
FY 2017 Mandatory Funding $3,510,661,000
FY 2018 (annualized CR level) $1,481,393,000
FY 2018 Current Law $550,000,000
Mandatory Funding
FY 2018 Proposed Law $3,050,000,000
Mandatory Funding
FY 2019 $4,990,629,000
Budget Request
The FY 2019 Budget requests $5.1 billion in discretionary resources, an increase of $10.1
million over the FY 2018 Annualized CR level. The Budget proposes a shift from mandatory
resources to discretionary resources for this program. In FY 2019, the Health Center Program
will provide care for approximately 26 million patients. This request will also support quality
improvement and performance management activities at existing health center organizations, and
ensure that current health centers can continue to provide essential primary health care services
to their patient populations, including substance abuse services focusing on the treatment,
prevention, and/or awareness of opioid abuse. The FY 2019 Request also supports $99.9 million
for the FTCA Program, which is an increase of $678,000 over FY 2018 Annualized CR level.
18
FY 2015 and 2017 reflect the post-sequestered amount.
59
The request also includes costs associated with the grant review and award process, operational
site visits, information technology, and other program support costs.
To provide support for the improvement and expansion of health center facilities, the request
includes a proposal to increase the loan limitation for the Health Center Loan Guarantee
Program, allowing the use existing carryover Health Center Loan Guarantee Program funding to
guarantee an addition $139 million in loans. This change will expand the capacity of health
centers to provide quality health care to more patients.
Health centers continue to be a critical element of the health system, largely because they can
provide an accessible and dependable source of primary health care services in underserved
communities. In particular, health centers emphasize coordinated primary and preventive
services that promote reductions in health disparities for low‐income individuals, racial and
ethnic minorities, rural communities and other underserved populations. Health centers place
emphasis on the coordination and comprehensiveness of care, the ability to manage patients with
multiple health care needs, and the use of key quality improvement practices, including HIT.
The health center model also overcomes geographic, cultural, linguistic and other barriers
through a team‐based approach to care that includes physicians, nurse practitioners, physician
assistants, nurses, dental providers, midwives, behavioral health care providers, social workers,
health educators, and many others. Health centers also reduce costs to health systems; the health
center model of care has been shown to reduce the use of costlier providers of care, such as EDs
and hospitals.
The FY 2019 Request supports the Health Center Program’s achievement of its performance
targets and continues to enable the provision of access to primary health care services and the
improvement of the quality of care in the health care safety net. The Health Center Program has
established ambitious targets for FY 2019 and beyond. For low birth weight, the Program seeks
to be at least 5 percent below the national rate. This is ambitious because health centers continue
to serve a higher risk prenatal population than represented nationally in terms of socio-economic,
health status and other factors that predispose health center patients to greater risk for LBW and
adverse birth outcomes. The FY 2019 target for the program’s hypertension measure is that 63
percent of adult patients with diagnosed hypertension will have blood pressure under adequate
control. The FY 2019 target for the program’s diabetes management measure is 69 percent of
adult patients with type 1 or 2 diabetes with most recent hemoglobin A1c (HbA1c) under control
(less than or equal to 9 percent).
The Health Center Program will also continue to promote efficiency and aims to keep the
percentage increase in cost per patient below the average annual national growth rate in health
care costs, as noted in the Center for Medicare & Medicaid Services’ (CMS) National Health
Expenditure Amounts and Projections. By benchmarking the health center efficiency to national
per capita health care cost growth rate, the measure takes into account changes in the healthcare
marketplace while demonstrating the Program’s continued ability to deliver services at a more
cost-effective rate. The FY 2019 target is to keep the program’s cost per patient increase below
the 2019 national health care cost growth rate. By restraining increases in the cost per individual
served at health centers, the Health Center Program is able to demonstrate that it delivers its
high-quality services at a more cost-effective rate.
60
The FY 2019 Request also supports efforts to improve quality and program integrity in all
HRSA-funded programs that deliver direct health care. Health centers annually report on a core
set of clinical performance measures that are consistent with Healthy People 2020, and include:
immunizations; prenatal care; cancer screenings; cardiovascular disease/hypertension; diabetes;
weight assessment and counseling for children and adolescents; adult weight screening and
follow up; tobacco use assessment and counseling; depression screening and follow-up; dental
sealants; asthma treatment; coronary artery disease/cholesterol; ischemic vascular disease/aspirin
use; and colorectal cancer screening. In addition to tracking core clinical indicators, health
centers report on health outcome measures (low birth weight, diabetes, and hypertension) by
race/ethnicity in order to demonstrate progress towards eliminating health disparities in health
outcomes.
To support quality improvement, the Program will continue to facilitate national and State-level
technical assistance and training programs that promote quality improvements in health center
data and quality reporting, clinical and quality improvement, and implementation of innovative
quality activities. The Program continues to promote the integration of HIT into health centers to
assure that key safety-net providers are able to advance with technology.
HRSA’s efforts to strengthen evidence-building capacity in the Health Center Program include
enhancements to the Uniform Data System (UDS). Beginning with 2013 UDS data, patients are
reported by both zip code and primary medical insurance status within four insurance categories:
Medicare; Medicaid/S-CHIP/and Other Public Insurance; Private insurance; and Uninsured.
This data enhancement supports HRSA’s efforts to better identify medically underserved
populations. Comparing geocoded health center patient insurance information with the general
U.S. population by insurance status (via the U.S. Census) facilitates identifying unmet medical
need and geographical areas that would see improved healthcare access if there were health
center presence. All UDS data continues to be aggregated at the health center/organizational
level.
Funding would allow continued coordination and collaboration with related Federal, State, local,
and private programs in order to further leverage and promote efforts to expand and improve
health centers. The Health Center Program will continue to work with the CMS and the Office
of the National Coordinator for Health Information Technology on HIT, and the Centers for
Disease Control and Prevention to address HIV prevention and public health initiatives, and the
National Institutes of Health on clinical practice issues, among others. In addition, the Health
Center Program will continue to coordinate with CMS to jointly review section 1115 Medicaid
Demonstration Waivers. The Program will continue to work closely with the Department of
Justice on the FTCA Program. Additionally, the proposed Budget supports coordination with
programs in the Departments of Housing and Urban Development, Education, and Justice.
The FY 2019 Budget also allocates new resources to the Health Center program to combat the
opioid epidemic. Additional details can be found under the Opioid tab.
61
Outcomes and Outputs Tables
Year and Most

Recent Result /
Target for Recent
Result / FY 2019
(Summary of FY 2018 FY 2019 +/-
Measure Result) Target Target FY 2018
FY 2016: 25.9M
1.I.A.1: Number of patients served by Target: 25.5M
26.0M 26.0M Maintain
health centers (Output) (Target
Exceeded)
1.I.A.2.b: Percentage of grantees that FY 2016: 91%
provide the following services either Target: 89%
90% 90% Maintain
on-site or by paid referral: (b) (Target
Preventive Dental Care (Output) Exceeded)
1.I.A.2.c: Percentage of grantees that FY 2016: 88%
provide the following services either Target: 75%
86% 86% Maintain
on-site or by paid referral: (c) Mental (Target
Health/Substance Abuse (Output) Exceeded)
FY 2016: 7.9%
1.E: Percentage increase in cost per Target: below
Below
patient served at health centers national rate Below
national Maintain
compared to the national rate (4.3%) national rate
rate
(Efficiency) (Target not met)
1.II.B.2: Rate of births less than 2500 FY 2016: 7.8%,

grams (low birth weight) to prenatal Target: 5% 5% below
5% below
Health Center patients compared to below national national Maintain
national rate
the national low birth weight rate rate (not yet rate
(Outcome) known)
1.II.B.3: Percentage of adult health
FY 2016: 62%
center patients with diagnosed
Target: 63%
hypertension whose blood pressure is 63% 63% Maintain
(Target Virtually
under adequate control (less than
Met)
140/90) (Outcome)
1.II.B.4: Percentage of adult health
center patients with type 1 or 2 FY 2016: 68%
diabetes with most recent Target: 69%
69% 69% Maintain
hemoglobin A1c (HbA1c) under (Target Virtually
control (less than or equal to 9 Met)
percent) (Outcome)
1.II.B.1: Percentage of pregnant FY 2016: 74%
health center patients beginning Target: 67%
70% 70% Maintain
prenatal care in the first trimester (Target
(Output) Exceeded)
62
Year and Most
Recent Result /
Target for Recent
Result / FY 2019
FY 2016: 92%
1.II.A.1: Percentage of Health Center
Target: 91%
patients who are at or below 200 91% 91% Maintain
(Target
percent of poverty (Output)
Exceeded)
1.I.A.3: Percentage of health centers FY 2016: 66%
with at least one site recognized as a Target: 65%
65% 65% Maintain
patient centered medical home (Target
(Outcome) Exceeded)
Grants Awards Table
FY 2017 FY 2018 FY 2019

Final Annualized CR President’s Budget
Number of Awards 1,376 1,376 1,376
Average Award $3.4 million $3.4 million $3.4 million
$400,000 – $22.5 $400,000 – $22.5 $400,000 – $22.5

Range of Awards
million million million
63
Free Clinics Medical Malpractice
FY 2019 FY 2019
FY 2017 FY 2018 President’s +/-
Final Annualized CR Budget FY 2018
BA $1,000,000 $993,000 $1,000,000 +$7,000
FTE --- --- --- ---
111-148, Section 10608
FY 2019 Authorization ...................................................................................................... Indefinite
Allocation Method ................................................................................................................... Other
The Free Clinics Medical Malpractice Program encourages health care providers to volunteer
their time at qualified free clinics by providing medical malpractice protection at sponsoring
health clinics, thus expanding the capacity of the health care safety net. In many communities,
free clinics assist in meeting the health care needs of the uninsured and underserved. They
provide a venue for providers to volunteer their services. Most free clinics are small
organizations with annual budgets of less than $250,000.
In FY 2004, Congress provided first-time funding for payments of free clinic provider’s claims
under the Federal Tort Claims Act (FTCA). The appropriation established the Free Clinics
Medical Malpractice Judgment Fund and extended FTCA coverage to medical professional
volunteers in free clinics in order to expand access to health care services for low-income
individuals in medically underserved areas.
Allocation Method: Qualifying free clinics submit applications to the Department of Health and
Human Services to deem providers that they sponsor. Qualifying free clinics (or health care
facilities operated by nonprofit private entities) must be licensed or certified in accordance with
applicable law regarding the provision of health services. To qualify under the Free Clinics
Medical Malpractice Program, the clinic cannot: accept reimbursements from any third-party
payor (including reimbursement under any insurance policy or health plan, or under any Federal
or State health benefits program including Medicare or Medicaid); or impose charges on the
individuals to whom the services are provided; or impose charges according to the ability of the
individual involved to pay the charge.
Increasing Access: In FY 2016, 11,517 health care providers received Federal malpractice
insurance through the Free Clinics Medical Malpractice Program, exceeding the Program target.
In FY 2014, 232 clinics operated with FTCA deemed clinicians; in FY 2015, 237 clinics
64
participated; and in FY 2016, 243 clinics participated. The Free Clinics Medical Malpractice
Program also examines the quality of services annually by monitoring the percentage of free
clinic health professionals meeting licensing and certification requirements. Performance
continues to meet the target with 100 percent of FTCA deemed clinicians meeting appropriate
licensing and credentialing requirements.
Promoting Efficiency: The Free Clinics Medical Malpractice Program is committed to

improving overall efficiency by controlling the Federal administrative costs necessary to deem
each provider. By restraining these annual administrative costs, the Program is able to provide
an increasing number of clinicians with malpractice coverage, thus building the free clinic
workforce capacity nationwide and increasing access to care for the target populations served by
these clinics. In FY 2014 the cost was $61 per provider; in FY 2015 the cost was $45 per
provider; and in FY 2016 the cost was $50 per provider. In each year, the Program performance
target has been exceeded.
To date, there have been no paid claims under the Free Clinics Medical Malpractice Program.
There are 2 claims currently outstanding, and the Program Fund has a current balance of
approximately $1,200,000.
Funding History
FY Amount
FY 2015 $100,000
FY 2016 $100,000
FY 2017 $1,000,000
FY 2018 $993,000
FY 2019 $1,000,000
Budget Request
The FY 2019 Budget requests $1.0 million for the Free Clinics Medical Malpractice Program,
which is an increase of $7,000 over the FY 2018 Annualized CR level. The request will support
the Program’s continued achievement of its performance targets addressing its goal of
maintaining access and capacity in the health care safety net.
Targets for FY 2019 focus on maintaining FY 2018 target levels for the number of volunteer free
clinic health care providers deemed eligible for FTCA malpractice coverage at 11,500 while also
maintaining the number of free clinics operating with FTCA deemed volunteer clinicians at 220.
The Program will also continue to promote efficiency by restraining growth in the annual Federal
administrative costs necessary to deem each provider, with a target of $75 administrative cost per
provider in FY 2019.
The FY 2019 request will also support the Program’s continued coordination and collaboration
with related Federal programs in order to further leverage and promote efforts to increase the
capacity of the health care safety net. Areas of collaboration include coordination with the
Health Center FTCA Program, also administered by HRSA, to share program expertise. In
65
addition, the two programs control costs by sharing a contract to process future claims, and by
providing technical support and outreach. The Program will coordinate with non-profit free
clinic-related umbrella groups on issues related to program information dissemination and
outreach and will continue to collaborate with the Department of Justice (DOJ) and the HHS
Office of General Counsel (HHS/OGC) to assist in drafting items including deeming applications
and related policies. The Program continues to work with the HHS/OGC to answer legal
technical assistance issues raised by free clinics in the Program and clinics interested in joining
the Program.
Year and Most

Recent Result /
Target for Recent
Result / FY 2019
2.I.A.1: Number of free clinic health
FY 2016: 11,517
care providers deemed eligible for
Target: 7,800 11,500 11,500 Maintain
FTCA malpractice coverage
(Target Exceeded)
(Outcome)
2.1: Patient visits provided by free FY 2016: 533,423
clinics sponsoring FTCA deemed Target: 500,000 475,000 475,000 Maintain
clinicians (Outcome) (Target Exceeded)
2.I.A.2: Number of free clinics FY 2016: 243
operating with FTCA deemed Target: 240 220 220 Maintain
clinicians (Output) (Target Exceeded)
2.E: Administrative costs of the FY 2016: $50
program per FTCA covered provider Target: $89 $75 $75 Maintain
(Efficiency) (Target Exceeded)
66
Health Workforce
TAB
67
HEALTH WORKFORCE
National Health Service Corps (NHSC)

FY 2019 FY 2019
BA --- --- $310,000,000 +$310,000,000
Current Law
$288,610,000 $65,000,000 --- -$65,000,000
Mandatory
Proposed
Law --- $245,000,000 --- -$245,000,000
Mandatory
Total $288,610,000 $310,000,000 $310,000,000 ---
FTE 225 225 225 ---
Authorizing Legislation: Public Health Service Act, Sections 331-338H, as amended by Public
Law 114-10
FY 2019 Authorization ............................................. Expires at the end of second quarter FY 2018
Allocation Method ...................................................... Other (Competitive Awards to Individuals)
Program Description and Accomplishments:
Since its inception in 1972, the National Health Service Corps (NHSC) has worked to support
qualified health care providers dedicated to working underserved communities. Across the
nation, NHSC clinicians serve patients in Health Professional Shortage Areas (HPSAs) –
communities with limited access to health care. As of September 30, 2017, there were more than
72 million people living in primary care HPSAs, more than 54 million people living in dental
HPSAs, and more than 111 million people living in mental health HPSAs.
The NHSC seeks clinicians who demonstrate a commitment to serve the Nation’s medically
underserved populations at NHSC-approved sites located in HPSAs. NHSC-approved sites
provide care to individuals regardless of ability to pay; currently, there are over 16,000 NHSC-
approved sites. Eligible sites include Federally Qualified Health Centers (FQHC) and FQHC
Look-Alikes, American Indian and Native Alaska health clinics, rural health clinics, critical
access hospitals and hospitals managed or owned by the Indian Health Service (IHS), school-
based clinics, mobile units, free clinics, community mental health centers, state or local health
departments, community outpatient facilities, federal facilities such as the Bureau of Prisons,
U.S. Immigration and Customs Enforcement, IHS, and private practices.
68
In particular, the NHSC has partnered closely with HRSA-supported FQHCs to help meet their
staffing needs. Over 60 percent of NHSC clinicians serve in Health Centers around the nation,
and 15 percent of clinical staff at FQHCs are NHSC clinicians. The NHSC also places clinicians
in other community-based systems of care that serve underserved populations, targeting HPSAs
of greatest need.
As of September 30, 2017, there are 10,179 primary care medical, dental, and mental and
behavioral health practitioners were providing service nationwide in the following programs 19:
NHSC Scholarship Program (SP): The NHSC SP provides financial support through
scholarships, including tuition, other reasonable education expenses, and a monthly living
stipend to health professions students committed to providing primary care in underserved
communities of greatest need. Awards are targeted to individuals who demonstrate
characteristics that are indicative of success in a career in primary care in underserved
communities. The NHSC SP provides a supply of clinicians who will be available over the next
one to eight years, depending on the length of their education and training programs. Upon
completion of training, NHSC scholars become salaried employees of NHSC-approved sites in
underserved communities.
NHSC Loan Repayment Program (LRP): The NHSC LRP offers fully trained primary care
clinicians the opportunity to receive assistance to pay off qualifying educational loans in
exchange for service in a HPSA. In exchange for an initial two years of service, loan repayers
receive up to $50,000 in loan repayment assistance. The NHSC LRP recruits clinicians as they
complete training and are immediately available for service, as well as seasoned professionals
seeking an opportunity to serve in the nation’s underserved communities.
NHSC Students to Service (S2S) Loan Repayment Program (LRP): The NHSC S2S LRP
provides loan repayment assistance of up to $120,000 to allopathic and osteopathic medical
students and dental students in their last year of school in return for a commitment to provide
primary health care in rural and urban HPSAs of greatest need for three years. This program was
established with the goal to double the number of physicians in the NHSC pipeline and was
expanded to dentists in FY 2017.
State Loan Repayment Program (SLRP): The SLRP is a federal-state partnership grant program
that requires a dollar-for-dollar match from the state that enters into loan repayment contracts
with clinicians who practice in a HPSA in that state. The program serves as a complement to the
NHSC and provides flexibility to states to help meet their unique primary care workforce needs.
States have the discretion to focus on one, some, or all of the eligible primary care disciplines
eligible within the NHSC and may also include pharmacists and registered nurses. The program
supported 37 states in FY 2017. In FY 2018, HRSA is opening a new SLRP competition,
expanding approved disciplines to include substance use disorder counselors, and is considering
opportunities to allow SLRP to expand to include different disciplines based on state needs or
emergent health crises.
19
NHSC field strength data include awards made from the FY 2017 Zika Supplemental, which supported providers
in U.S. territories.
69
The combination of these programs serves the immediate needs (through loan repayers) of
underserved communities and supports the development of a pipeline (through Scholars and
Students to Service awardees) poised to meet the needs of these communities upon completion of
their training. The tables below show the students in the NHSC pipeline that are training to serve
the underserved and the number and type of primary care providers currently serving in the
NHSC and providing care in underserved areas.
NHSC Student Pipeline by Program as of 09/30/2017

Programs Students
Scholarship Program 1,049
Students to Service Program 387
Total 1,436
NHSC Student Pipeline by Discipline as of 09/30/2017

Disciplines Students
Allopathic/Osteopathic Physicians 1,014
Dentists 226
Nurse Practitioners 57
Physician Assistants 123
Certified Nurse Midwives 16
Total 1,436
NHSC Field Strength20 by Program as of 09/30/2017

Programs Clinicians
Scholarship Program Clinicians 405
Loan Repayment Program Clinicians 8,362
State Loan Repayment Program Clinicians 1,233
Student to Service Loan Repayment Program 179
Total 10,179
NHSC Field Strength by Discipline as of 09/30/2017

Disciplines Clinicians
Allopathic/Osteopathic Physicians21 2,058
Dentists 1,298
Dental Hygienists 311
Nurse Practitioners 2,150
Physician Assistants 1,111
Nurse Midwives 183
Mental and Behavioral Health Professionals 3,002
Other State Loan Repayment Program Clinicians 66
Total 10,179
20
in U.S. territories.
21
Includes psychiatrists.
70
Average NHSC Award by Program as of 09/30/2017
Program Average Award Amount
Scholarship Program $210,069
Students to Service Loan Repayment Program $118,518
Loan Repayment Program $30,902
NHSC is committed to continuous performance improvement. Based on the most recent

Participant Satisfaction Survey results, the short-term retention rate among respondents who
completed their NHSC service commitment in the past 2 years is 93 percent.22 Applying the
NHSC alumni retention rate among survey respondents to the 5,024 clinicians who successfully
completed service in that period, NHSC estimates that more than 4,400 retained clinicians
continue to provide primary care services to underserved communities within 2 years after
completing their service commitment.
The experiences that NHSC providers have at their sites while completing their service
obligations significantly influences retention among NHSC providers. The most common
reasons given by participants for not remaining at their NHSC-approved site following their
service commitment were financial considerations and site operations.
Eligible Entities: Eligible participants for the NHSC SP are U.S. citizens (either U.S. born or
naturalized) or U.S. nationals enrolled or accepted for enrollment as a full-time student pursuing
a degree in a NHSC-eligible discipline at an accredited health professions school or program
located in a State, the District of Columbia, or a U.S. territory.
Eligible participants for the NHSC LRP are U.S. citizens (either U.S. born or naturalized) or U.S.
nationals practicing in a NHSC-eligible discipline, maintaining a current, full, unencumbered,
unrestricted health professional license, certificate, or registration to practice in the discipline and
State in which the loan repayer is applying to serve, and currently working in a NHSC approved
site in a HPSA.
Eligible participants for the NHSC Students to Service LRP are U.S. citizens (either U.S. born or
naturalized) or U.S. nationals enrolled as a full-time student in the final year at a fully accredited
medical school located in an eligible allopathic or osteopathic degree program or school of
dentistry. Medical students must be planning to complete an accredited primary medical care
residence in a NHSC-approved specialty.
22
The 2016 National Health Service Corps Participant Satisfaction Survey found that 88 percent of those NHSC
clinicians who had fulfilled their obligation within the past 2 years (957 of 1,089 survey respondents) and responded
to this voluntary survey, met the program’s definition of being retained; i.e., they were continuing to practice at their
assigned site, were practicing at another NHSC site, or were practicing in a designated shortage area. HRSA uses
survey information due to the efficiency of this method as well as a lack of authority to require individuals out of
service to provide their current place of employment.
71
Eligible entities for the State Loan Repayment Program are the 50 states, the District of
Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa,
Palau, the Marshall Islands and the Commonwealth of the Northern Mariana Islands.
Funding History
FY Amount
FY 2015 $287,370,000
FY 2016 $310,000,000
FY 2017 $288,610,000
FY 2018 Current $65,000,000
Law Mandatory
FY 2018 Proposed $245,000,000
Law Mandatory
FY 2019 $310,000,000
Budget Request
The FY 2019 Budget requests $310.0 million in discretionary resources for the NHSC program.
The Budget proposes a shift from mandatory resources to discretionary resources for this
program. The FY 2019 request will fund 2,527 new and 1,754 continuation Loan Repayment
awards, 132 new and 11 continuation Scholarship awards, 625 State Loan Repayment awards,
and 167 Students to Service Loan Repayment awards. The funding request also includes
operational costs in the form of required Federal Insurance Contributions Act tax contributions
on stipend payments for the NHSC SP, staffing, and acquisition contracts.
In FY 2019, the Department also is looking for opportunities to enhance the ability of the NHSC
to address the opioid epidemic. The NHSC will award enhanced loan repayment to physicians,
nurse practitioners and physician assistants (with a specialty in psychiatry) who have DATA
2000 waivers. As of September 2017, only two of the over 10,000 NHSC clinicians have DATA
2000 waivers. While enhanced awards would decrease the total number of NHSC new awards,
HRSA anticipates the incentive awards would:
 Encourage behavioral health clinicians to obtain a DATA 2000 waiver;

 Increase participation in NHSC LRP by DATA 2000 waiver clinicians who can be placed
in at-risk communities, and give NHSC-approved sites an added incentive to support their
recruitment of behavioral health clinicians who are well-positioned to address the need
for medication-assisted treatment. The Department is also assessing other changes in
NHSC that can help address the opioid epidemic.
The FY 2019 Budget also provides additional loan payment awards to combat the opioid
epidemic. Additional details can be found under the Opioid tab.
72
Outcomes and Outputs Table
Year and Most

FY 2018
Recent Result
Target
/Target for FY 2018 FY 2019
Measure +/-
Recent Result / Target Target
FY 2019
(Summary of
Target
Result)
FY 2017: 10.7
Million
4.I.C.1: Number of
Target: 9.7 9.1 million 9.2 million + 0.1 million
individuals served by
Million
NHSC clinicians (Outcome)
(Target
Exceeded)
4.I.C.2: Support field FY 2017:
strength of the NHSC 10,17923
through scholarship and Target: 9,219 8,705 8,810 +105
loan repayment agreements. (Target
(Outcome) Exceeded)
4.I.C.4: Percent of NHSC
clinicians retained in
FY 2016: 93%
service to the underserved
Target: 80%
for at least one year beyond 80% 80% Maintain
(Target
the completion of their
Exceeded)
NHSC service commitment.
(Outcome)
4.E.1: Default rate of NHSC
FY 2017: 1.0 %
Scholarship and Loan
Repayment Program
Target: <2.0% ≤ 2.0% ≤ 2.0% Maintain
(Target
participants. (Efficiency)
Exceeded)
(Baseline: FY 2007 = 0.8%)
FY 2017:
16,568
4.I.C.6: Number of NHSC 14,000 14,000 Maintain
Target: 14,000
sites (Outcome)
(Target
Exceeded)
23
in the U.S. territories.
73
Loan Repayments/Scholarships Awards Table
FY 2018 FY 2019
FY 2017
(whole dollars) Annualized President’s
Final
CR Budget
Loan Repayments $167,675,000 $167,000,000 $167,000,000
State Loan Repayments $14,959,000 $15,000,000 $15,000,000
Scholarships $48,849,000 $38,000,000 $38,000,000
Students to Service Loan Repayment $15,146,000 $20,000,000 $20,000,000
NHSC Awards Table24
Program 2012 2013 2014 2015 2016 2017 2018 2019

Scholarships 212 180 190 196 205 181 139 132
Scholarship
10 16 7 11 8 7 10 11
Continuation
Loan Repayment 2,342 2,106 2,775 2,934 3,079 2,554 2,384 2,527
Loan Repayment
1,925 2,399 2,105 1,841 2,111 2,259 2,111 1,754
Continuations
State Loan Repayment 281 447 464 620 634 535 625 625
Students to Service
69 78 79 96 92 175 167 167
Loan Repayment
Total Awards 4,839 5,226 5,620 5,698 6,129 5,711 5,436 5,216
24
NHSC awards include those made from the FY 2017 Zika Supplemental.
74
NHSC Field Strength Table as of 9/30/2017
Program: 2012 2013 2014 2015 2016 2017 2018 2019

Scholars 502 493 459 458 437 405 513 538
Loan Repayment 8,634 7,547 7,648 8,062 8,593 8,362 6,707 6,769
Students to Service
625 753 1,135 1,136 1,378 179 226 253
Loan Repayment
State Loan Repayment 130 106 - 27 85 1,233 1,259 1,250
USPHS Commissioned
Corps Ready 17 - - - - - - -
Responders
Total Field Strength 9,908 8,899 9,242 9,683 10,493 10,179 8,705 8,810
75
Faculty Loan Repayment Program
FY 2019 FY 2019
BA $1,187,000 $1,182,000 --- -$1,182,000
FTE --- --- --- ---
Authorizing Legislation: Public Health Service Act, Sections 738 and 740
FY 2019 Authorization ................................................................... Expired at the end of FY 2014
Allocation Method ..................................................... Other (Competitive Awards to Individuals)
The Faculty Loan Repayment Program provides loan repayment to health profession graduates
from disadvantaged backgrounds who serve as faculty at eligible health professions colleges or
universities for a minimum of two years. In return, the federal government agrees to pay up to
$20,000 of the outstanding principal and interest on the individual’s health professions education
loans for each year of service. The employing institution must also make payments to the faculty
member that match the amount paid by HRSA. In FY 2017, the Faculty Loan Repayment
Program made 20 new loan repayment awards.
Funding History
FY Amount
FY 2015 $1,190,000
FY 2016 $1,190,000
FY 2017 $1,187,000
FY 2018 $1,182,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Faculty Loan Repayment Program, which is $1.2
million below the FY 2018 Annualized CR level. At the annualized CR level, the program
supports 22 individuals from disadvantaged backgrounds per year. At this level of funding, the
program does not have a board impact on the health professions workforce. The Request
prioritizes funding for health workforce activities that provide scholarships and loan repayment
to clinicians in exchange for their service in areas of the United States where there is a shortage
of health professionals.
76
Loans Table
FY 2017 FY 2018 FY 2019

Number of Awards 20 22 ---
77
Health Professions Training for Diversity
Centers of Excellence
FY 2019 FY 2019
BA $21,659,000 $21,564,000 --- -$21,564,000
FTE 1 1 --- -1
Authorizing Legislation: Public Health Service Act, Section 736
FY 2019 Authorization .............................................................................. Such Sums as Necessary
Allocation Method ...............................................................................................Competitive Grant
The Centers of Excellence (COE) Program provides grants to health professions schools and
other public and nonprofit health or educational entities to serve as innovative resource and
education centers for the recruitment, training and retention of underrepresented minority (URM)
students and faculty.
In Academic Year 2016-2017, the COE Program supported 164 different training programs and
activities designed to prepare individuals either to apply to a health professions training program
or to maintain enrollment in such programs during the academic year. These programs supported
956 trainees across the country with stipend support. Over 93 percent of the trainees were
considered underrepresented minorities (URMs) in the health professions. In addition, 74
percent of the trainees were from financially and/or educationally disadvantaged backgrounds.
Despite an overall decrease in the number of students trained in Academic Year 2016-2017,
COE Program outcomes related to retention and post-completion intentions remained relatively
stable. Additional students participated in COE Programs throughout the academic year
increasing total participation to 6,871 students of whom 2,798 completed their programs.
Grantees partnered with 185 health care delivery sites, to provide 3,379 clinical training
experiences to health professions trainees. Nearly 46 percent of training sites used by COE
grantees were primary care settings and 55 percent were in medically underserved communities.
Eligible Entities: Health professions schools and other public and nonprofit health or
educational entities that operate programs of excellence for URM individuals and meet the
required general conditions requirements in section 736(c)(1)(B)of the Public Health Service
Act, including Historically Black Colleges and Universities; Hispanic COEs; Native American
COEs; and other COEs.
78
Designated Health Targeted Grantee Activities
Professions Educational Levels
 Allopathic medicine  Undergraduate  Increase outreach to URM students to enlarge
 Dentistry  Graduate the competitive applicant pool.
 Graduate programs in  Faculty  Develop academic enhancement programs for
mental health development URM students and train, recruit, and retain
 Osteopathic medicine URM faculty.
 Pharmacy  Improve information resources, clinical
education, cultural competency, and curricula
as they relate to minority health issues.
Funding History
FY Amount
FY 2015 $21,711,000
FY 2016 $21,711,000
FY 2017 $21,659,000
FY 2018 $21,564,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Center of Excellence Program, which is $21.6 million
below the FY 2018 Annualized CR level. The request prioritizes funding for health workforce
activities that provide scholarships and loan repayment to clinicians in exchange for their service
in areas of the United States where there is a shortage of health professionals.
Year and
Most Recent
Result /Target FY 2019
FY 2018 FY 2019
for Recent +/-
Measure Target Target
Result / FY 2018
(Summary of
Result) 25
6.I.C.20: Percent of program participants
FY 2016: 22%
who completed pre-health professions
Target: 22% 22% N/A N/A
preparation training and intend to apply to
(Target Met)
a health professions degree program
6.I.C.21: Percent of program participants FY 2016: 41%
who received academic retention support Target: 43%
43% N/A N/A
and maintained enrollment in a health (Target Not
professions degree program Met)
25
Most recent results are for Academic Year 2016-2017 and funded in FY 2016.
79
Program Activity Data
Year and
Most FY 2017 FY 2018 FY 2019
COE Program Outputs Target
Recent Target Target
Result
Number of health professions
FY 2016:
students participating in research on 600 600 ---
695
minority health-related issues
Number of faculty members
FY 2016:
participating in research on minority 500 500 ---
568
health-related issues
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $1,203,780 $1,203,780 ---
$564,723- $564,723-
Range of Awards ---
$3,499,317 $3,499,317
80
Health Professions Training
Scholarships for Disadvantaged Students

FY 2019 FY 2019
BA $45,859,000 $45,658,000 --- -$45,658,000
FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Sections 737 and 740
FY 2019 Authorization ..................................................................... Expired at the end of FY 2014
The Scholarships for Disadvantaged Students (SDS) Program authorized in 1989, provides
grants to eligible health professions and nursing schools for use in awarding scholarships to
students from disadvantaged backgrounds who have financial need, many of whom are
underrepresented minorities (URMs). The program also connects students to retention services
and activities that support their progression through the health professions educational program.
In Academic Year 2016-2017, the SDS Program provided scholarships to 2,811 students from
disadvantaged backgrounds, missing the FY 2016 target count by approximately 5 percent. This
was due in large part to fewer grants being awarded in FY 2016 as well as a significant increase
in the scholarship limit per student (increased from $15,000 to $30,000) resulting in more
substantial investments in fewer individuals. The adjustment to the scholarship cap was made to
reflect the increasing costs of health professions education programs. The majority of students
were female (80 percent), and 64 percent of students were considered under-represented
minorities (URMs) in their prospective professions.
Additionally, 621 students who received SDS-funded scholarships successfully graduated from
their degree programs by the end of Academic Year 2016-2017. Upon graduation, 59 percent
intended to work or pursue additional training in medically underserved communities, and 59
percent intended to work or pursue additional training in primary care settings.
Eligible Entities: Eligible entities are accredited schools of medicine, osteopathic medicine,
dentistry, nursing, pharmacy, podiatric medicine, optometry, veterinary medicine, public health,
chiropractic, allied health, and a school offering a graduate program in behavioral and mental
health practice or an entity providing programs for the training of physician assistants.
81
Targeted
Designated Health Professions Grantee Activities
Educational Levels
 Allied health  Undergraduate  Provide scholarships to eligible
 Behavioral and mental health  Graduate full-time students.
 Chiropractic  Retain students from
 Dentistry disadvantaged backgrounds
 Allopathic medicine including students who are
 Nursing members of racial and ethnic
 Optometry minority groups.
 Osteopathic medicine
 Pharmacy
 Physical Therapy
 Physician assistants
 Podiatric medicine
 Public health
 Veterinary medicine
Funding History
FY Amount
FY 2015 $45,970,000
FY 2016 $45,970,000
FY 2017 $45,859,000
FY 2018 $45,658,000
FY 2019 ---
Budget Request
FY 2019 Budget requests $0 for the Scholarships for Disadvantaged Students Program, which is
$45.7 million below the FY 2018 Annualized CR level. The request prioritizes funding for
health workforce activities that provide scholarships and loan repayment to clinicians in
exchange for their service in areas of the United States where there is a shortage of health
professionals. While the SDS Program exposes students from disadvantaged backgrounds who
have financial need to careers in the health professions, there are private scholarships and other
Federal loan programs that can support student education.
82
Year and Most

FY 2018
Recent Result
Target
Measure +/-
Recent Result Target Target
FY 2019
(Summary of
Target
Result)26
6.I.C.22: Number of FY 2016: 2,811
disadvantaged students with Target: 2,940
2,900 N/A N/A
scholarships (Target Not
Met)
Year and
FY 2017 FY 2018 FY 2019
SDS Program Outputs Most Recent
Target Target Target
Result
Number of URM students with FY 2016:
2,000 1,800 ---
scholarships 1,794
Percent of students who are FY 2016:
62% 62% ---
URMs 64%
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $545,828 $542,828 ---
Range of Awards $26,615-$617,837 $26,615-$617,837 ---
26
83
Health Professions Training for Diversity
Health Careers Opportunity Program

FY 2019 FY 2019
BA $14,155,000 $14,093,000 --- -$14,093,000
FTE 2 2 --- -2
Authorizing Legislation: Public Health Service Act, Sections 739 and 740(c)
The Health Careers Opportunity Program (HCOP) provides individuals from economically and
educationally disadvantaged backgrounds an opportunity to develop the skills needed to
successfully compete for, enter, and graduate from schools of health professions or allied health
professions. The HCOP is comprised of two cohorts:
HCOP: In Academic Year 2016-2017, HCOP supported 169 different training programs and
activities to promote interest in the health professions among prospective, disadvantaged
students. In total, HCOP grantees reached 2,442 disadvantaged trainees across the country
through structured programs. In AY 2016-2017, the program failed to reach its target of 3,500
disadvantaged students; however, the percentage of participants from disadvantaged
backgrounds remained stable around 90 percent (as has been the case since FY 2013). HCOP
grantees partnered with 110 sites to provide 2,736 clinical training experiences for HCOP student
trainees (e.g., academic institutions, community-based organizations, and hospitals).
Approximately 70 percent of these training sites were located in medically underserved
communities and/or rural settings. Additional students participated in HCOP activities and
programs as well bringing 5,044 total students into the health professions pipeline of whom
2,997 completed their training.
HCOP for Skills Training and Health Workforce Development of Paraprofessionals Program:
In Academic Year 2016-2017, the Program provided stipend support for 862 certificate students,
most commonly training to become nursing aids/assistants, medical assistants, and community
health workers. Analyses of data showed that approximately 95 percent of students were from
financially or educationally disadvantaged backgrounds and 77 percent were considered URMs
in their prospective professions. By the end of the Academic Year, 696 of funded students
graduated from these certificate-bearing programs in addition to other students who participated
in the Program but were not funded. In total, 1,843 students participated of whom 975 graduated
and earned certificates.
84
Eligible Entities: Accredited health professions schools and other public or private nonprofit
health or educational institutions.
Funding History
FY Amount
FY 2015 $14,189,000
FY 2016 $14,189,000
FY 2017 $14,155,000
FY 2018 $14,093,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Health Careers Opportunity Program, which is $14.1
million below the FY 2018 Annualized CR level. The request prioritizes funding for health
workforce activities that provide scholarships and loan repayment to clinicians in exchange for
their service in areas of the United States where there is a shortage of health professionals.
Year and Most

FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)27
6.I.C.23: Total number of FY 2016: 2,442
disadvantaged students in Target: 3,500 2,000 N/A N/A
structured programs (Target Not Met)
Year and
FY 2017 FY 2018 FY 2019
HCOP Outputs Most Recent
Result
Total number of students
FY 2016:
participating in all HCOP 9,000 5,000 ---
5,044
programs
Total number of URM students
FY 2016:
participating in all HCOP 4,000 2,700 ---
2,799
programs
27 Most recent results are for Academic Year 2016-2017 and funded in FY 2016.
85
Year and
FY 2017 FY 2018 FY 2019
HCOP Outputs Most Recent
Result
Total number of URM students in
FY 2016:
all HCOP-Skills Training 1,000 N/A28 ---
1,449
programs
Total number of students
graduating from HCOP-Skills FY 2016: 975 800 N/A ---
Training programs
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $752,607 $752,607 ---
Range of Awards $629,989-$797,450 $629,989-$797,450 ---
28
HCOP-Skills Training programs completed activities during FY 2017. Performance results will be available in the
FY 2020 Congressional Justification.
86
Health Care Workforce Assessment
The National Center for Health Workforce Analysis

FY 2019 FY 2019
BA $4,652,000 $4,631,000 $4,663,000 +$32,000
FTE 6 6 6 ---
Authorizing Legislation: Public Health Service Act, Sections 761, 792, and 806(f)
FY 2019 Authorization ................................................................................. Expired as of FY 2014
Allocation Method ................................................................................ Competitive Grant/Contract
The United States spends billions of dollars in both public and private funds each year on
education and training of the health workforce. Since the nation’s health care system is
constantly changing and preparing new providers requires long lead times, it is critical to have
high quality projections to ensure a workforce of sufficient size and skills capable of meeting the
nation’s health care needs. Policymakers and other decision makers need high quality
information about the health workforce that incorporates up-to-date research, modeling, and
trends. This information can help inform how the nation spends billions of dollars each year on
the education and training of the health workforce.
The National Center for Health Workforce Analysis (NCHWA) collects and analyzes health
workforce data and information in order to provide national and state policy makers, researchers,
and the public with information on health workforce supply and demand. NCHWA also
evaluates the effectiveness of HRSA’s workforce investments. NCHWA focuses on:
 Providing timely reports and data on the current state and trends of the U.S. health
workforce;
 Building national capacity for health workforce data collection by working with federal
agencies, professional associations, and others to develop and promote guidelines for data
collection and analysis;
 Improving tools for data management, analysis, modeling and projection to support
research, policy analysis, and decision making, as well as evaluation of the effectiveness
of workforce programs and policies;
 Responding to information and data needs by translating data and findings to inform
policies and programs; and
 Analyzing grantee performance data and evaluating Bureau of Health Workforce’s
programs.
87
NCHWA continues to model supply and demand of health professionals across a range of health
occupations, and makes health workforce information available through reports and online
databases. Several publications were released during Calendar Year 2017:
 Supply and Demand Projections of the Nursing Workforce: 2014-2030;
 National and Regional Projections of Supply and Demand for Geriatricians: 2013-2025
 Health Workforce Projections: General Pediatricians
 Health Workforce Projections: Neurology Physicians and Physician Assistants
 Health Workforce Projections: Physical Medicine and Rehabilitation Physicians and
Physician Assistants
 Health Workforce Projections: Physicians and Physician Assistants in Emergency
Medicine
NCHWA also annually updates county-, state-, and national-level data and works to improve the
availability of online comparison and mapping tools for analyzing data. In addition, NCHWA
oversees seven Health Workforce Research Centers that perform and disseminate research and
data analysis on health workforce issues of national importance, and provide technical assistance
to regional and local entities on workforce data collection, analysis, and reporting. Through an
interagency agreement with the Substance Abuse and Mental Health Association (SAMHSA),
NCHWA also funds a Behavioral Health Workforce Research Center, whose work is jointly
overseen by both entities.
Funding History
FY Amount
FY 2015 $4,663,000
FY 2016 $4,663,000
FY 2017 $4,652,000
FY 2018 $4,631,000
FY 2019 $4,663,000
Budget Request
The FY 2019 Budget requests $4.6 million for the National Center for Health Workforce
Analysis, which is $0.03 million above the FY 2018 Annualized CR level. In FY 2019,
NCHWA will continue to develop a projection model that allows a more sophisticated analysis
and projection of health workforce supply and demand, taking into account changing national
demographics, the demand for health care services, and the impact those changes have on the
delivery of health care. In addition, the National Center is poised to comply with Section 10 of
Executive Order 13801 to support efforts to evaluate and identify the most effective workforce
training investments. The funding request also includes costs associated with the grant review
and award process, follow up performance reviews, and information technology and other
program support costs.
88
Grants Awards Table
FY 2017 FY 2018 FY 2019

Number of Awards 7 7 7
Average Award $469,108 $469,108 $469,108
Range of Awards $134,000-$660,000 $134,000-$660,000 $134,000-$660,000
89
Primary Care Training and Enhancement Program
FY 2019 FY 2019
BA $38,830,000 $38,660,000 --- -$38,660,000
FTE 6 6 --- -6
Allocation Method. ....................................... Competitive Grant/Cooperative Agreement/Contract
The Primary Care Training and Enhancement (PCTE) Program aims to strengthen the primary
care workforce by supporting enhanced training for future primary care clinicians, teachers, and
researchers and promoting primary care practice, particularly in rural and underserved areas.
The focus is to produce primary care providers who will be well prepared to practice in, teach,
and lead transforming health care systems aimed at improving access, quality of care, and cost
effectiveness.
FY 2017 FY 2018 FY 2019

Program Final Annualized CR President’s Budget
Primary Care Training and
Enhancement29 $33,913,267 $33,774,806 ---
Academic Units for Primary

Care Training and $4,919,775 $4,898,236 ---
Enhancement
The PCTE Program includes three cohorts:
PCTE: The PCTE Program is designed to strengthen the primary care workforce by supporting
enhanced training for future primary care clinicians, teachers, and researchers. The PCTE
Program is focused on training for transforming health care systems, particularly enhancing the
clinical training experience of trainees. This Program also supports the Primary Care Medicine
and Dentistry Clinician Educator Career Development Awards, which support the development
of future clinician educator faculty and leaders in primary care medicine and dentistry while also
supporting innovative projects that involve the transformation of health care delivery systems.
29
The PCTE Program includes the Primary Care Medicine and Dentistry Clinician Educator Career Development
Awards, which are jointly funded by PCTE and Oral Health Programs. The total is approximately $3.43 million,
$2.17 million from PCTE and $1.26 million from Oral Health Programs.
90
Academic Units for Primary Care Training and Enhancement (AU-PCTE): The AU-PCTE
Program establishes, maintains, or improves academic units or programs that improve clinical
teaching and research in the fields of family medicine, general internal medicine, or general
pediatrics in order to strengthen the primary care workforce. The Program established academic
units to conduct systems-level research to inform primary care training; disseminate best
practices and resources; and develop a community of practice to promote the widespread
enhancement of primary care training to produce a high quality primary care workforce.
In Academic Year 2016-201730, PCTE grantees trained 2,098 primary care residents and fellows,
3,109 medical students, 1,138 students in physician assistant programs, 38 primary care medicine
faculty, and 961 students from collaborating interprofessional disciplines (including pharmacy
students, psychology students, dental and dental hygiene students, and nursing students) for a
total of 7,344 trainees, 1,647 of whom completed their programs at the end of the academic year.
PCTE grantees partnered with 707 health care delivery sites (e.g., physician’s offices, hospitals,
and ambulatory practice sites) to provide clinical training experiences to trainees. Approximately
64 percent of these sites were located in medically underserved communities, 30 percent were
located in rural areas, and 62 percent were primary care settings.
With regard to the continuing education of the current workforce, PCTE grantees delivered 100
unique continuing education courses that focused on emerging issues in the field of primary care
to 2,295 faculty members and current practicing providers. In addition, PCTE grantees
developed or enhanced and implemented 592 different curricular activities, most of which were
new academic courses, clinical rotations, and workshops for health professions students,
residents and fellows that reached 16,138 trainees. PCTE grantees also supported 245 different
faculty-focused training programs and activities during the academic year, reaching 4,217
faculty-level trainees.
Eligible Entities: Accredited public or nonprofit private hospitals, schools of allopathic or

osteopathic medicine, academically affiliated physician assistant training programs, or public or
private nonprofit entities determined eligible by the Secretary.
30
This performance includes the PCTE program grantees. The other grantees will report performance in the FY
2020 Congressional Justification based on FY 2017 activities.
91
Designated Health Targeted Educational
Grantee Activities
Professions Levels
 Physicians, including  Medical school  Support innovations in primary care
family medicine,  Graduate physician curriculum development, education,
general internal assistant education and practice for physicians and
medicine, general  Physician residency physician assistants.
pediatrics, and training  Community-based training in
combinations of these  Academic and medical schools, physician assistant
specialties community faculty education, and residencies.
 Physician assistants development  Primary care academic and
community faculty development.
 Improve clinical teaching and
research in primary care.
Funding History
FY Amount
FY 2015 $38,924,000
FY 2016 $38,924,000
FY 2017 $38,830,000
FY 2018 $38,660,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the PCTE Program, which is $38.7 million below the FY
2018 Annualized CR level. The request prioritizes funding for health workforce activities that
provide scholarships and loan repayment to clinicians in exchange for their service in areas of
the United States where there is a shortage of health professionals.
92
Outcomes and Outputs Table31
Year and FY
Most Recent 2018
Result FY Target
FY 2018
Measure /Target for 2019 +/-
Target
Recent Result Target FY
(Summary of 2019
Result)32 Target
FY 2016: 555
6.I.C.24: Number of physicians completing
Target: 400
a Bureau of Health Workforce-funded 480 N/A N/A
(Target
residency or fellowship
Exceeded)
6.I.C.25: Number of physicians graduating
FY 2016: 518
from a Bureau of Health Workforce- 400 N/A N/A
(Baseline)
funded medical school
FY 2016: 357
6.I.C.26: Number of physician assistants
Target: 120
graduating from a Bureau of Health 200 N/A N/A
(Target
Workforce-funded program
Exceeded)
Year and
Most FY 2017 FY 2018 FY 2019
PCTE Program Outputs
Recent Target Target Target
Result
Percent of physician and
physician assistant trainees
FY 2016:
receiving at least a portion of 50% 50% ---
53%
their clinical training in an
underserved area
physician assistant graduates who FY 2016:
38% 38% ---
practice in medically underserved 50%
areas
31
The PCTE Program supports primary care workforce growth and diversification, curricular innovations, and
development of academic infrastructure. The current outcome measures reflect these objectives. Awards
emphasize new and evidence-based education strategies such as interprofessional education and care, community
based practice experience, and education responsive to learners’ and patients’ needs, the evaluation and outcome
measures are adjusted accordingly.
32
93
Year and
Most FY 2017 FY 2018 FY 2019
PCTE Program Outputs
Result
physician assistant graduates and
FY 2016:
program completers who are 24% 30% ---
49%
minority and/or from
disadvantaged backgrounds
Number of physicians training in
FY 2016:
a Bureau of Health Workforce- 1,200 1,650 ---
2,098
funded residency or fellowship
Number of medical students
training in a Bureau of Health FY 2016:
800 2,000 ---
Workforce-funded medical 3,109
school
Number of physician assistant
students training in a Bureau of FY 2016:
600 700 ---
Health Workforce-funded 1,138
program
Grant Awards Table33
FY 2017 FY 2018 FY 2019

Average Award $392,747 $392,747 ---
Range of Awards $194,813-$818,490 $194,813-$818,490 ---
33
This table includes the PCTE portion of the 20 awards for the Primary Care Medicine and Dentistry Clinician
Educator Career Development Program, which is co-funded by the Oral Health Programs. The award amount is
approximately $3.43 million, $2.17 million from PCTE and $1.26 million from Oral Health Programs. This table
includes the $2.17 million in PCTE funds; the Oral Health Program funds are accounted for in the Grants Award
Table below.
94
Oral Health Training Programs
FY 2019 FY 2019
BA $36,587,000 $36,424,000 --- -$36,424,000
FTE 6 6 --- -6
Authorizing Legislation: Public Health Service Act, Sections 748 and 340G
FY 2019 Authorizations:......................................................................... Expired at the end of 2016
Allocation Method: ............................................................................... Competitive Grant/Contract
The Oral Health Training Programs increase access to high-quality dental health services in rural
and other underserved communities by increasing the number of oral health care providers
working in underserved areas and improving training programs for these providers.
FY 2017 FY 2018 FY 2019

Program Final Annualized CR President’s Budget
Training in General, Pediatric,
and Public Health Dentistry and $21,147,273 $21,058,672 ---
Dental Hygiene34
Dental Loan Repayment $3,212,149 $3,197,839 ---
State Oral Health Workforce
$12,124,363 $12,070,347 ---
Improvement Grant
Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene Program:
The Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene Program
aims to increase the number of dental students, residents, practicing dentists, dental faculty,
dental hygienists, or other approved primary care dental trainees qualified to practice in general,
pediatric and dental public health fields and thus increase access to oral health care. This
Program also supports the Primary Care Medicine and Dentistry Clinician Educator Career
Development Awards, which support the development of future clinician educator faculty and
leaders in primary care medicine and dentistry while also supporting innovative projects that
involve the transformation of health care delivery systems.
34
The Primary Care Medicine and Dentistry Clinician Educator Career Development Awards are jointly funded by
PCTE and Oral Health Programs. The total funding is approximately $3.43 million, $2.17 million from PCTE and
$1.26 million from Oral Health Programs.
95
In Academic Year 2016-2017, grantees of the Training in General, Pediatric, and Public Health
Dentistry and Dental Hygiene Program trained 5,291 dental and dental hygiene students in pre-
doctoral training degree programs; 460 dental residents and fellows in advanced primary care
dental residency and fellowship training programs; and 1180 dental faculty members in faculty
development activities.
Eligible Entities: Schools of dentistry and dental hygiene, public or non-profit private hospitals,
and public or nonprofit private entities that have approved residency or advanced education
programs.
Designated Health Targeted Educational Grantee Activities

Professions Levels
 General dentists  Dental Hygiene  Funds to plan, develop, operate or
 Pediatric dentists Training Programs participate in approved dental training
 Public health  Undergraduate programs in the fields of general,
dentists  Graduate School pediatric or public health dentistry.
 Dental hygienists (dental schools)  Provide financial assistance to dental
 Other approved  Predoctoral Dental students, residents, dental hygiene
primary care dental Programs students, and practicing dentists and
trainees  Dental Residency dental hygienists who are in need and are
Programs participants in any such program and who
plan to work in the practice of general,
pediatric, or public health dentistry or
dental hygiene.
 Provide traineeships and fellowships to
dentists who plan to teach or are teaching
in general, pediatric or public health
dentistry.
 Partner with schools of public health to
permit the education of dental students,
residents, and dental hygiene students for
a master’s year in public health at a
school of public health.
Dental Faculty Loan Repayment Program: The purpose of this program is to increase the
number of dental and dental hygiene faculty in the workforce by assisting dental and dental
hygiene training programs attract and retain dental and dental hygiene faculty through loan
repayment and help fund development program to provide continuing education opportunities.
In Academic Year 2016-2017, the Dental Faculty Loan Repayment Program provided a median
loan repayment of $12,526 to 14 dentists serving as teaching faculty. Females comprised 71
percent of supported faculty. Disciplines of dental faculty receiving loan repayments were
General Dentistry (57 percent), Dental Hygiene (21 percent), Pediatric Dentistry (14 percent),
and Public Health Dentistry (7 percent). With regard to background, 50 percent of teaching
faculty members were from financially or educationally disadvantaged backgrounds and about
96
36 percent were underrepresented minorities. A total of 24 faculty members participated in
structured faculty development programs through the academic year.
Faculty funded through the Dental Faculty Loan Repayment Program delivered 26 academic
courses during the year to a total of 1,904 students and advanced trainees including general
dentistry residents (70 percent), pediatric dentistry residents (16 percent), and public health
dentistry residents (4 percent).
Eligible Entities: Schools of dentistry and dental hygiene, and public or nonprofit private
entities that have approved residency or advanced education programs.

Professions Levels
 General dentists  Dental Hygiene  Provide loan repayment to dentistry
 Pediatric dentists Training Programs faculty supervising residents at
 Public health  Graduate School dental training institutions providing
dentists (dental schools) clinical services in dental clinics
 Dental hygienists  Predoctoral Dental located in dental schools, hospitals,
 Other approved Programs or community based affiliated sites.
primary care dental  Dental Residency
trainees Programs
State Oral Health Workforce Improvement Grant Program: The State Oral Health Workforce
Improvement Grant Program aims to enhance dental workforce planning and development,
through the support of innovative programs, to meet the individual needs of each state. The
program focuses on supporting innovative projects including integrating oral and primary care
medical delivery systems and supporting oral health providers who practice in advanced roles
specifically designed to improve oral health access.
In Academic Year 2016-2017, the State Oral Health Workforce Improvement Grant Program
continued carrying out a number of community-based prevention activities authorized under
statute. Grantees established 6 new oral health facilities for children with unmet needs in dental
HPSAs, and expanded 24 oral health facilities in dental HPSAs to provide education, prevention,
and restoration services to 99,581 patients. Grantees also supported four tele-dentistry facilities;
replaced 26 water fluoridation systems to provide optimally fluoridated water to 2,691,366
individuals; provided dental sealants to 31,273 children; provided topical fluoride to 85,383
individuals; provided diagnostic or preventive dental services to 85,764 persons; and oral health
education to 170,931 persons.
The program provided direct financial support to 127 dental students and 7 residents. Of these
134 students and residents, approximately 31 percent of students and residents reported coming
from a rural background, 18 percent reported coming from a disadvantaged background, and 19
percent comprised an underrepresented minority group. The program also provided loan
repayment to 4 practicing dentists, all of whom were enrolled in the Medicaid program and had
2,592 Medicaid/CHIP patient encounters during the year.
97
Eligible Entities: Eligible applicants include Governor-appointed, state governmental entities.
A 40 percent match by the state is required for this program.

Professions Levels
 Oral Health  Primary and Secondary  Integration of oral and primary care
Service Providers Education medical delivery systems.
 Pre- and Postdoctoral  Supporting oral health providers practicing
Programs in advanced roles.
 Residency Programs  Teledentistry.
 Continuing Education  Expand or establish oral health services and
facilities in Dental HPSAs.
 Partnerships with dental training
institutions.
 Expand a state dental office.
Funding History
FY Amount
FY 2015 $33,928,000
FY 2016 $35,873,000
FY 2017 $36,587,000
FY 2018 $36,424,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Oral Health Programs, which is $36.4 million under the
FY 2018 Annualized CR level. The request prioritizes funding for health workforce activities
that provide scholarships and loan repayment to clinicians in exchange for their service in areas
of the United States where there is a shortage of health professionals.
98
Year and Most

FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)35
FY 2016: 5,291
6.I.C.27: Number of dental
Target: 1,600
students trained 5,300 N/A N/A
(Target
Exceeded)
FY 2016: 460
6.I.C.28: Number of dental Target: 311
350 N/A N/A
residents trained (Target
Exceeded)
FY 2016: 1,180
6.I.C.29: Number of faculty Target: 1,200
30036 N/A N/A
trained (Target Not
Met)
Oral Health Training and

Year and Most FY 2017 FY 2018 FY 2019
Workforce Program
Recent Result Target Target Target
Outputs
Percent of students and
residents trained who are FY 2016: 17% 17% 17% ---
URMs
Number of dentists
completing a Bureau of
Health Workforce-funded FY 2016: 259 270 250 ---
dental residency or fellowship
Number of dentists
graduating from a Bureau of
FY 2016: 1,366 900 1,300 ---
Health Workforce-funded
dental school
35
36
In FY 2016, HRSA discontinued the Faculty Development in General, Pediatric, and Public Health Dentistry and
Dental Hygiene Program, which accounted for the large number of faculty trained. In FY 2016, HRSA instead
made awards to support the Dental Faculty Loan Repayment Program, which is a more modest investment with
fewer faculty supported.
99
Grant Awards Table – Training in General, Pediatric, and Public Health Dentistry and
Dental Hygiene37
FY 2017 FY 2018 FY 2019

Average Award $316,798 $316,798 ---
Range of Awards $10,461-$747,949 $10,461-$747,949 ---
Grant Awards Table – Dental Loan Repayment Programs
FY 2017 FY 2018 FY 2019

Average Award $156,260 $156,260 ---
Range of Awards $54,000-$250,000 $54,000-$250,000 ---
Grant Awards Table – State Oral Health Workforce Improvement Grant Program
FY 2017 FY 2018 FY 2019

Average Award $415,051 $415,051 ---
Range of Awards $198,132-$500,000 $198,132-$500,000 ---
37
The Primary Care Medicine and Dentistry Clinician Educator Career Development Awards are jointly funded by
PCTE and Oral Health Programs. The total funding is approximately $3.43 million, $2.17 million from PCTE and
$1.26 million from Oral Health Programs. This awards table accounts for the $1.26 million in Oral Health Program
funds only.
100
Interdisciplinary, Community-Based Linkages
Area Health Education Centers Program

FY 2019 FY 2019
BA $30,177,000 $30,045,000 --- -$30,045,000
FTE 4 4 --- -4
Allocation Method ....................................................... Competitive Grant/Cooperative Agreement
The purpose of the Area Health Education Centers (AHEC) Program is to develop and enhance
education and training networks within communities, academic institutions, and community-
based organizations. In turn, these networks develop the health care workforce, broaden the
distribution of the health workforce, enhance health care quality, and improve health care
delivery to rural and underserved areas and populations.
In Academic Year 2016-2017, the AHEC Program supported various types of pre-pipeline,
pipeline, and continuing education training activities for thousands of trainees across the country.
AHEC grantees implemented 3,307 unique continuing education courses that were delivered to
214,789 practicing professionals nationwide, 88,731 of whom were concurrently employed in
medically underserved communities.
AHEC grantees partnered with 6,574 sites to provide 40,688 clinical training experiences to
student trainees (e.g., ambulatory practice sites, physician offices, and hospitals). Approximately
63 percent of these training sites were primary care settings; 63 percent were located in
medically underserved communities; and 42 percent were in rural areas.
In the past, AHEC Program awardees addressed the immediate needs of their service areas,
which allowed for a high degree of individuality; however, the variation among programs made
it challenging to measure the collective impact of the program nationally. In FY 2017, HRSA
made new AHEC awards aligning investments around defined evidence-based practices
established through previous AHEC awards aimed at achieving a more measurable, long-term
impact on the communities and populations served.
Eligible Entities: Public or private non-profit accredited schools of allopathic and osteopathic
medicine. Accredited schools of nursing are eligible applicants in states and territories in which
no AHEC Program is in operation.
101
Designated Health Targeted Educational Levels Grantee Activities
Professions
 Allied health All education levels are  Health professions
 Behavioral/Mental health targeted to provide primary recruitment, education,
 Community health workers care workforce development training and placement.
 Dentists for the following trainees:  Clinical/community-based
 Nurse midwives  Medical residents practice
 Nurse practitioners  Medical students  Interprofessional education
 Optometrists  Health professions students  Strengthening partnerships
 Pharmacists  Continuing education (CE)  Evaluation
 Physicians for primary care providers in
 Physician assistants underserved areas
 Psychologists
 Public health
 Other health professions
Funding History
FY Amount
FY 2015 $30,250,000
FY 2016 $30,250,000
FY 2017 $30,177,000
FY 2018 $30,045,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Area Health Education Centers Program, which is $30
million below the FY 2018 Annualized CR level. The request prioritizes funding for health
workforce activities that provide scholarships and loan repayment to clinicians in exchange for
their service in areas of the United States where there is a shortage of health professionals. It is
anticipated that the AHEC Program awardees can find other sources of funding to continue these
activities.
102
Year and Most

FY 2018
Recent Result
Target
/Target for Recent FY 2018 FY 2019
Measure +/-
Result Target Target
FY 2019
(Summary of
Target
Result)38
6.I.C.30: Percent of CE trainees
FY 2016: 41%
who report being currently
employed in medically
(Target Exceeded)
underserved areas
6.I.C.31: Number of trainees
FY 2016: 402,045
receiving health career guidance
Target: 325,000 275,00039 N/A N/A
and information from the AHEC
(Target Exceeded)
Programs
Year and
FY 2017 FY 2018 FY 2019
AHEC Program Outputs Most Recent
Result
Number of medical students who
FY 2016:
participated in community-based 18,000 17,000 ---
17,879
clinical training
Number of other health
professions trainees who FY 2016:
18,000 17,000 ---
participated in community-based 17,343
clinical training
Number of trainees who received
CE on topics including cultural
FY 2016:
competence, women’s health, 200,000 175,000 ---
214,789
diabetes, hypertension, obesity,
and health disparities
38
39
In the past, AHEC Program awardees addressed the immediate needs of their service areas, which allowed for a
high degree of individuality; however, the variation among programs made it challenging to measure the collective
impact of the program nationally. In FY 2017, HRSA made new AHEC awards aligning investments around
defined evidence-based practices that increase the level of support for individual trainees. This program will
decrease the overall number of individuals served in FY 2018.
103
Grant Awards Table
FY 2019
FY 2017 FY 2018 President’s
Average Award $580,922 $580,922 ---
Range of Awards $105,739 - $1,411,968 $105,739 - $1,411,968 ---
104
Geriatrics Program
FY 2019 FY 2019
BA $38,644,000 $38,474,000 --- -$38,474,000
FTE 6 6 --- -6
Authorizing Legislation: Public Health Service Act, Sections 750, 753 and 865
FY 2019 Authorizations:................................................................... Expired at the end of FY 2014
Allocation Method ...................................................................................... Cooperative Agreement
The Geriatrics Workforce Enhancement Program (GWEP) improves health care for older people
by fostering clinical training environments that integrate geriatrics and primary care delivery
systems and by maximizing patient and family engagement in health care decisions. The
Program provides training across the provider continuum (students, faculty, providers, direct
service workers, patients, families, and lay and family caregivers) focusing on training in
interprofessional and team-based care and on academic-community partnerships to address gaps
in health care for older adults.
In Academic Year 2016-2017, GWEP grantees provided training for 30,082 students and fellows
participating in a variety of geriatrics-focused degree programs, field placements, and
fellowships. Of these trainees, 20,114 graduated or completed their training during the current
academic year. GWEP grantees partnered with 265 health care delivery sites (e.g., hospitals,
long-term care facilities, and academic institutions) to provide clinical training experiences to
trainees. Approximately 49 percent of these sites were located in medically underserved
communities, and 42 percent were situated in primary care settings.
With regard to the continuing education of the current workforce, 173,078 faculty and practicing
professionals participated in 1,578 unique continuing education courses offered by GWEP
grantees, 467 of which were specifically focused on Alzheimer’s disease and related dementia.
We expect grantees to meet the target for next year. In addition, GWEP grantees developed or
enhanced and implemented 2,543 different curricular activities. Most of these were new
continuing education courses, academic courses, and workshops which together reached 131,293
people. Finally, with regard to faculty development, results showed that GWEP grantees
supported 307 different faculty-focused training programs and activities during the academic
year, reaching 6,688 faculty-level trainees.
Eligible Entities: Accredited schools representing various health disciplines, healthcare

facilities, and programs leading to certification as a certified nursing assistant.
105
Targeted Educational
Designated Health Professions Program Activities
Levels
 Allied health  Undergraduate  Interprofessional geriatrics

 Allopathic medicine  Graduate education and training to
 Behavioral and mental  Post-graduate students, faculty, practitioners,
health  Practicing health care and caregivers.
 Chiropractic providers  Curricula development
 Clinical psychology  Faculty relating to the treatment of the
 Clinical social work  Direct service health problems of elderly
 Dentistry workers individuals.
 Health administration  Lay and family  Faculty development in
 Marriage and family caregivers geriatrics.
therapy  Continuing education for
 Nursing health professionals who
provide geriatric care.
 Optometry
 Clinical training for students
 Osteopathic medicine
in geriatrics in nursing homes,
 Pharmacy
chronic and acute disease
 Physician assistant hospitals, ambulatory care
 Podiatric medicine centers, and senior centers.
 Professional counseling
 Public health
Funding History
FY Amount
FY 2015 $34,237,000
FY 2016 $38,737,000
FY 2017 $38,644,000
FY 2018 $38,474,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Geriatrics Program, which is $38.5 million below the
FY 2018 Annualized CR level. The request prioritizes funding for health workforce activities
that provide scholarships and loan repayment to clinicians in exchange for their service in areas
of the United States where there is a shortage of health professionals.
106
Year and Most
FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)40
6.I.C.12: Number of Bureau of
Health Workforce-sponsored FY 2016: 467
interprofessional Target: 600 500 N/A N/A
continuing education sessions (Target Not Met)
provided on Alzheimer’s disease
FY 2016: 55,640
participating in interprofessional
Target: 51,000 51,000 N/A N/A
continuing education on
(Target Exceeded)
Alzheimer's disease
6.I.C.32: Number of continuing FY 2016: 173,078
education trainees in geriatrics Target: 100,000 125,000 N/A N/A
programs (Target Exceeded)
6.I.C.33: Number of students who
received geriatric-focused training
FY 2016: 29,444
in geriatric nursing homes, chronic
Target: 17,000 23,000 N/A N/A
and acute disease hospitals,
(Target Exceeded)
ambulatory care centers, and senior
centers
Year and
Most FY 2017 FY 2018 FY 2019
Geriatrics Program Outputs
Result
Number of continuing education FY 2016:
1,000 1,300 ---
offerings delivered by grantees 1,579
Number of faculty members
FY 2016:
participating in geriatrics trainings 6,000 6,000 ---
6,688
offered by grantees
Number of individuals trained in new
or enhanced curricula relating to the FY 2016:
50,000 100,000 ---
treatment of health problems of elderly 131,293
individuals
40
107
Year and
Most FY 2017 FY 2018 FY 2019
Geriatrics Program Outputs
Result
Number of individuals enrolled in FY 2016:
800 700 ---
geriatrics fellowships 638
Number of advanced education nursing
FY 2016:
students enrolled in advanced practice 65 75 ---
136
adult-gerontology nursing programs
Grant Awards Table
FY 2017 FY 2018 FY 2019 President’s

Average Award $816,000 $816,000 ---
Range of Awards $557,791 - $850,000 $557,791 - $850,000 ---
108
Behavioral Health Workforce Education and Training

FY 2019 FY 2019
BA $50,000,000 $49,660,000 --- -$49,660,000
FTE 6 6 --- -6
Authorizing Legislation: Public Health Service Act, Section 755 and 756
FY 2019 Authorization ............................................................................................... $50,000,00041
The purpose of the Behavioral Health Workforce Education and Training (BHWET) Program is
to develop and expand the behavioral health workforce serving populations across the lifespan,
including in rural and medically underserved areas. The Program places special emphasis on
establishing or expanding internships or field placement programs in behavioral health that
include interdisciplinary training for students/interns, faculty, and field supervisors to provide
quality behavioral health services to communities in need.
The Program increases the behavioral health workforce including: psychiatrists, psychologists
(to include doctoral internships and post-doctoral residency programs), psychiatric nurse
practitioners, social workers, substance use disorder prevention and treatment counselors,
marriage and family therapists, occupational therapists, and professional counselors, as well as
behavioral health-related paraprofessionals.
In Academic Year 2016-2017, the BHWET Program supported training for 3,876 individuals,
missing the target for number of students trained. Due to timing of awards, many of the grantees
were unable to recruit for the academic year; however, targets should be met for the next
academic year (5,600 students in training; 3,600 graduates) as all awardees will have their
programs established. Of the total students supported, 2,385 graduate-level social workers,
psychologists, school and clinical counselors, psychiatric nurse practitioners, and marriage and
family therapists were trained as well as 1,491 students training to become behavioral health
paraprofessionals (such as community health workers, outreach workers, social services aides,
mental health workers, substance abuse/addictions workers, youth workers, and peer
paraprofessionals). By the end of the Academic Year, 2,947 students graduated from these
degree and certificate-bearing programs and entered the behavioral health workforce. Upon
41
The 21st Century Cures Act (P.L. 114-255) authorized $50 million in appropriations through FY 2022 for Section
756 of the Public Health Service Act, which authorizes the BHWET Program, the Graduate Psychology Education
Program, and Leadership in Public Health and Social Work Education Program.
109
program completion, 62 percent of students intended to pursue training and/or employment to
serve at-risk children, adolescents, and transitional-aged youth.
BHWET grantees partnered with 2,348 training sites to provide 5,431 clinical training
experiences for BHWET student trainees (e.g., hospitals, ambulatory practice sites, and academic
institutions). Over 76 percent of these training sites were located in rural and/or medically
underserved communities where trainees provided over 1 million hours of behavioral health
services to patients and clients. Training at partnered sites incorporated interdisciplinary team-
based approaches, where 7,723 students, residents and/or fellows from a variety of professions
and disciplines were trained on teams with BHWET students. Finally, BHWET grantees used
grant funds to develop, enhance, and implement 900 behavioral health-related courses and
training activities, reaching over 25,000 students and advanced trainees (i.e., psychology interns
and fellows and psychiatry residents).
Eligible Entities:
Professionals: Accredited institutions of higher education or accredited behavioral health
professional training programs in psychiatry, behavioral pediatrics, social work, school social
work, substance use disorder prevention and treatment, marriage and family therapy,
occupational therapy, school counseling, or professional counseling. Accredited schools of
masters or doctoral level training in psychiatric nursing programs. American Psychological
Association (APA)-accredited doctoral level schools and programs of health service psychology
or school psychology.
Paraprofessionals: Behavioral paraprofessional certificate training programs and peer

paraprofessional certificate training programs offered by States, political subdivisions of states,
Indian tribes and tribal organizations, public or nonprofit private health professions schools,
academic health centers, State or local governments, or other appropriate public or private
nonprofit entities as determined appropriate by the Secretary.
Designated
Health Grantee Activities
Levels
Professions
Professionals  Graduate (doctoral)  Develop and support training programs
Paraprofessionals  Graduate (masters)  Support internships and field placement
 Undergraduate
 Certificate
Funding History
FY Amount
FY 2015 $35,000,000
FY 2016 $50,000,000
FY 2017 $50,000,000
FY 2018 $49,660,000
FY 2019 ---
110
Budget Request
The FY 2019 Budget requests $0 for the Behavioral Health Workforce Education and Training
Program, which is $49.7 million below the FY 2018 Annualized CR level. The request
FY 2018
Year and Most
Target
Recent Result FY 2018 FY 2019
Measure +/-
/Target for Target Target
FY 2019
Recent Result42
Target
6.I.C.34: Number of students FY 2016: 3,876
currently receiving training in Target: 5,000
4,500 N/A N/A
behavioral health degree and (Target Not
certificate programs Met)
6.I.C.35: Number of graduates FY 2016: 2,947
completing behavioral health Target: 3,000
3,000 N/A N/A
programs and entering the (Target Not
behavioral health workforce Met)
Grant Award Table
FY 2017 FY 2018 FY 2019

Average Award $344,072 $344,072 ---
Range of Awards $83,320 - $480,000 $83,320 - $480,000 ---
42
111
Mental and Behavioral Health Education and Training Programs

FY 2019 FY 2019
BA $9,892,000 $9,849,000 --- -$9,849,000
FTE 2 2 --- -2
Authorizing Legislation: Public Health Service Act, Sections 750, 756 and 791
FY 2019 Authorization ............................................................................................... $50,000,00043
The Mental and Behavioral Health Education and Training Programs work to close the gap in
access to behavioral health services by increasing the number and distribution of adequately
trained behavioral health professionals in integrated care settings, particularly within
underserved and/or rural communities.
Graduate Psychology Education (GPE) Program: In Academic Year 2016-2017, the GPE
Program provided stipend support to 189 students participating in practica or pre-degree
internships in psychology. The majority of students who received a stipend were trained in
medically underserved communities (96 percent) and/or a primary care setting (91 percent). Of
the 89 students who completed GPE-supported programs, 84 percent intended to become
employed or pursue further training in medically underserved communities and 56 percent
intended to become employed or pursue further training in primary care settings. GPE grantees
partnered with 139 sites to provide 428 clinical training experiences for psychology graduate
students (e.g., hospitals, ambulatory practice sites, and academic institutions) as well as 2,642
interprofessional team-based care trainees who participated in clinical training along with the
psychology graduate students. Approximately 87 percent of these training sites were located in
medically underserved communities and 74 percent were primary care settings.
Leadership in Public Health Social Work Education (LPHSWE) Program: In Academic Year
2016-2017, the LPHSWE Program supported 20 graduate-level public health social work
students most of whom were enrolled in dual degree Masters of Social Work and Masters of
Public Health programs. By the end of the academic year, 17 students graduated from their dual
degree programs, 76 percent of whom intended to pursue employment or further training in a
43
The 21st Century Cures Act (P.L. 114-255) authorized $50 million in appropriations through FY 2022 for Section
756 of the Public Health Service Act under which LPHSWE, GPE, and the Behavioral Health Workforce Education
Training Programs are all authorized.
112
medically underserved community and/or rural setting. LPHSWE grantees also partnered with
15 sites to provide clinical training experiences for supported students (e.g., community-based
organizations, hospitals, and academic institutions). Approximately 67 percent of these training
sites were located in medically underserved communities. HRSA awarded the final year of the
LPHSWE awards in FY 2017; the LPSWE Program activities will be completed in June 2018.
Eligible Entities: Accredited doctoral level schools and programs of health service psychology,
doctoral internships in professional psychology, and post-doctoral residency programs in practice
psychology.
Designated
Health Grantee Activities
Levels
Professions
 Psychologists  Graduate (doctoral)  Develop and support training programs.
 Faculty development.
 Model demonstration programs.
 Provide stipends for fellowship trainees.
Funding History
FY Amount
FY 2015 $8,916,000
FY 2016 $9,916,000
FY 2017 $9,892,000
FY 2018 $9,849,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Mental and Behavioral Health Education and Training
Program, which is $9.8 million below the FY 2018 Annualized CR level. The request prioritizes
funding for health workforce activities that provide scholarships and loan repayment to clinicians
in exchange for their service in areas of the United States where there is a shortage of health
professionals.
113
Year and FY 2018

Most Recent Target
FY 2018 FY 2019
Measure Result /Target +/-
Target Target
for Recent FY 2019
Result44 Target
FY 2016: 189
6.I.C.36: Number of graduate-level
Target: 170
psychology students supported in 170 N/A N/A
GPE program (Target
Exceeded)
FY 2016:
6.I.C.37: Number of 2,642
interprofessional students trained in Target: 1,900 1,900 N/A N/A
GPE program (Target
Exceeded)
Year and
Program Outputs Most FY 2017 FY 2018 FY 2019
Result
Number of GPE clinical training
experiences that incorporated FY 2016:
500 425 ---
interprofessional team-based care 428
training
Grant Award Table – Mental and Behavioral Health Education and Training
FY 2017 FY 2018 FY 2019

Final Annualized CR45 President’s Budget
Average Award $253,459 $265,000 ---
Range of Awards $47,213 - 350,000 $47,213 - 350,000 ---
44
45
The decreased awards reflect the discontinuation of the Leadership in Public Health Social Work Education
Program. Grantees received the final year of funding in FY 2017.
114
Public Health Workforce Development
Public Health and Preventive Medicine Training Grant Programs

FY 2019 FY 2019
BA $16,949,000 $16,885,000 --- -$16,885,000
FTE 4 4 --- -4
Authorizing Legislation: Public Health Service Act, Sections 765-768 and 770
FY 2019 Authorization .................................................................... Expired at the end of FY 2015
Funding Allocation ...................................................... Competitive Grant/Cooperative Agreement
The Preventive Medicine and Public Health Training Grant Programs train the current and future
workforce through the development of new training content and delivery and through the
coordination of student placements and collaborative projects. The programs aim to improve the
health of communities by increasing the number and quality of public health and preventive
medicine personnel who can address public health needs and advance preventive medicine
practices.
FY 2019
Program FY 2017 FY 2018 President’s
---
Public Health Training Centers $9,887,030 $9,849,696
Program
---
Preventive Medicine Residency $7,061,970 $7,035,304
Program
Public Health Training Centers (PHTC) Program: The PHTC Program, established in 1999
funds schools and programs of public health to expand and enhance training opportunities
focused on the technical, scientific, managerial and leadership competencies and capabilities of
the current and future public health workforce, including regional centers. The PHTC Program
aims to strengthen the public health workforce through the provision of education, training and
consultation to state, local, and tribal health departments to improve the capacity and quality of a
broad range of public health personnel to carry out core public health functions by providing
education, training and consultation to these public health personnel. The primary target for
education and training through the PHTC Program are frontline public health workers, middle
managers, and staff in other parts of the public health system. Beginning in Academic Year
2017-2018, the National Coordinating Center was discontinued.
115
In Academic Year 2016-2017, Regional PHTCs partnered with 170 sites to provide more than
208 clinical training experiences to student trainees (e.g., local health departments, academic
institutions, and community-based organizations). Approximately 67 percent of these training
sites were located in medically underserved communities and 28 percent were located in rural
areas. With regard to the continuing education (CE) of the current workforce, PHTC grantees
delivered 2,573 unique CE courses to 226,635 trainees during the academic year, approximately
25 percent of whom were practicing professionals concurrently employed in medically
underserved communities. Due to timing of award allocation and changes in accreditation of
continuing education the number of instructional hours for continuing education was 6,597 and
missed the target of 9,320.
Eligible Entities: Health professions schools, including accredited schools or programs of public
health, health administration, preventive medicine, or dental public health or schools providing
health management programs; academic health centers; State or local governments; or any other
appropriate public or private nonprofit entity that prepares and submits an application at such
time, in such manner, and containing such information as the Secretary may require.

Grantee Activities
Professions Levels
 Public health, health administration,  Public health  Planning, developing, or
preventive medicine, dental public students (graduate operating demonstration
health, health management. and undergraduate) training programs.
 Primary Target Audience: Frontline  Existing public  Faculty development.
and Middle Managers in state, local, health professionals  Trainee support.
and tribal health departments at all levels in the  Technical assistance.
 Public health workforce and staff in workforce
other parts of the public health
system
Preventive Medicine Residency (PMR) Program: The PMR Program provides support for
residents in medical training in preventive medicine, including stipends for residents to defray
the costs associated with living expenses, tuition, and fees. In FY 2018, PMR applicants are
encouraged to address Department of Health and Human Services (HHS) clinical priorities of opioid
abuse, mental health, and childhood obesity.
In Academic Year 2016-2017, the PMR Program supported 130 residents, the majority of which
received clinical or experiential training in a primary care setting (88 percent) and/or a medically
underserved community (82 percent). Of the 63 residents who completed their residency training
programs during the academic year, 32 percent intended to pursue employment or further
training in primary care. PMR grantees partnered with 232 sites to provide 671 clinical training
experiences for PMR residents (e.g., academic institutions, ambulatory care sites, and hospitals).
Approximately 44 percent of these training sites were located in medically underserved
communities and 32 percent were primary care settings.
In Academic Year 2015-2016, the national center of excellence for integrative medicine in
primary care continued to develop and disseminate guidelines and patient education for
integrative health care in primary care, particularly for underserved communities, completed the
116
pilot period of the Foundations in Integrative Healthcare online course, and launched the revised
online course. As of January 2017, 66 health professions education and training programs and
eight community health centers had enrolled in the pilot online course.
Eligible Entities: Accredited schools of public health, allopathic or osteopathic medicine;

accredited public or private non-profit hospitals; state, local or tribal health departments or a
consortium of two or more of the above entities.
Targeted
Designated Health
Educational Grantee Activities
Professions
Levels
 Preventive  Residency  Plan and develop new residency training
medicine training programs.
physicians  Maintain or improve existing residency programs.
 Provide financial support to residency trainees.
 Plan, develop, operate, and/or participate in an
accredited residency program.
 Establish, maintain or improve academic
administrative units in preventive medicine and
public health, or programs that improve clinical
teaching in preventive medicine and public health.
Funding History
FY Amount
FY 2015 $21,000,000
FY 2016 $21,000,000
FY 2017 $16,949,000
FY 2018 $16,885,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Preventive Medicine and Public Health Training Grant
Programs, which is $16.9 million below the FY 2018 Annualized CR level. The request
117
Year and Most

FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)46
6.I.C.9: Number of trainees FY 2016: 226,635
participating in continuing education Target: 23,000 150,000 N/A N/A
sessions delivered by PHTCs (Target Exceeded)
FY 2016: 6,597
6.I.C.18: Number of instructional
Target: 9,320 6,000 N/A N/A
hours offered by PHTCs
(Target Not Met)
6.I.C.19: Number of PHTC-
sponsored public health students that FY 2016: 144
completed field placement Target: 150 140 N/A N/A
practicums in State, Local, and Tribal (Target Not Met)
Health Departments
Year and
Most FY 2017 FY 2018 FY 2019
PMR Program Outputs
Result
Number of preventive medicine FY 2016:
7547 75 ---
residents participating in residencies 130
Number of preventive medicine
residents completing training FY 2016: 63 40 40 ---
Percent of program completers who FY 2016:

20% 20% ---
are URMs 32%
Percent of preventive medicine
resident program completers who FY 2016:
60% 60% ---
intend to practice in primary care 32%
settings
46
47
The PMR targets for number of residents decreased significantly in FY 2017 due to a $4 million decrease in
funding for Integrative Medicine residencies.
118
Grant Awards Table – Public Health Training Centers Program
FY 2017 FY 2018 FY 2019

Average Award $824,261 $910,000 ---
Range of Awards $701,112- $780,000- ---
$1,005,000 $1,105,000
Grant Awards Table – Preventive Medicine Residency Program
FY 2017 FY 2018 FY 2019

Average Award $258,788 $257,810 ---
Range of Awards $120,484-500,847 $120,484-500,847 ---
119
Advanced Nursing Education Programs

FY 2019 FY 2019
BA $64,425,000 $64,142,000 --- -$64,142,000
FTE 8 8 --- -8
Allocation Method ...................................................................... Formula Grant/Competitive Grant
The Advanced Nursing Education Programs increase the number of qualified nurses in the
primary care workforce by improving advanced nursing education through traineeships as well
as curriculum and faculty development. The programs include a preference for supporting rural
and underserved communities.
Advanced Nursing Education Workforce (ANEW) Program: In FY 2017, HRSA established

the ANEW Program, which supports innovative academic-practice partnerships to prepare
primary care advanced practice registered nursing students to practice in rural and underserved
settings through academic and clinical training. The partnerships support traineeships as well as
academic-practice program infrastructure funds to schools of nursing and their practice partners
who deliver longitudinal primary care clinical training experiences with rural and/or underserved
populations for selected students in primary care nurse practitioners (NP), primary care clinical
nurse specialists (CNS), and/or nurse-midwives programs and facilitate program graduates’
employment in those settings.
Advanced Nursing Education (ANE) Program: In Academic Year 2016-2017, grantees of the
ANE Program trained 5,942 nursing students and produced 1,541 graduates. Although the
number of students trained was lower than the projected target, this was primarily related to
increased programmatic emphasis on faculty development and continuing education. Awardees
offered 20 percent more faculty development activities and 36 percent more continuing
education courses than the prior year, thereby training more than 5,400 individuals on topics in
nursing and public health. The majority of ANE students were female (88 percent) and were
most commonly between the ages of 30 and 39 (39 percent). Further analysis showed that ANE
grantees partnered with 2,304 health care delivery sites to provide clinical and experiential
training. Approximately 40 percent of sites used by ANE grantees were located in a medically
underserved community, and 59 percent were primary care settings.
120
Nurse Anesthetist Traineeships (NAT) Program: In Academic Year 2016-2017, grantees of the
NAT Program provided direct financial support to 2,429 nurse anesthetist students. Students
received clinical training in medically underserved communities (75 percent) and/or primary care
settings (46 percent) during the academic year. More than 1,000 of the supported students
graduated from their degree programs and entered the workforce. At the time of graduation, 53
percent of graduates intended to pursue employment or further training in medically underserved
communities, and 27 percent planned to pursue employment or further training in a primary care
setting.
Advanced Education Nursing Traineeship (AENT) Program: In Academic Year 2016-2017,

grantees of the AENT program provided direct financial support to 2,166 advanced nursing
students. These individuals received training in primary care settings (80 percent), medically
underserved communities (61 percent), and/or rural settings (41 percent) during the academic
year. More than 1,200 supported students graduated from their degree programs and entered the
workforce. At the time of graduation, graduates intended to pursue employment or further
training in primary care settings (74 percent), medically underserved communities (50 percent),
and/or rural settings (28 percent).
Eligible Entities: Schools of nursing, nursing centers, academic health centers, State or local
governments, and other public or private, non-profit entities determined appropriate by the
Secretary.

Professions Levels Grantee Activities
 Nurse Practitioners  Graduate (master’s and  Enhance advanced nursing
 Nurse Midwives doctoral) education and practice
 Nurse Anesthetists  Provide traineeships to
 Nurse Educators students in advanced nursing
education programs
Funding History
FY Amount
FY 2015 $63,581,000
FY 2016 $64,581,000
FY 2017 $64,425,000
FY 2018 $64,142,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Advanced Nursing Education program, which is $64.1
million below the FY 2018 Annualized CR level. HRSA’s nursing projections generally indicate
that the supply of nurses will outpace demand at a national level in 2025. However, the distribution
of nurses is estimated to be uneven with some areas of the country having an inadequate supply to
meet the needs of their region, which is addressed by the NHSC, the NURSE Corps or other HRSA
121
investments. The Request prioritizes funding for health workforce activities that provide
scholarships and loan repayment to clinicians in exchange for their service in areas of the United
States where there is a shortage of health professionals.
Year and Most

FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)48
6.I.C.38: Number of students FY 2016: 5,942
trained in advanced nursing Target: 6,255 35049 N/A N/A
degree programs (Target Not Met)
6.I.C.39: Percent of students FY 2016: 32%
trained who are URMs and/or Target: 24%
24% N/A N/A
from disadvantaged (Target
backgrounds Exceeded)
FY 2016: 1,541
6.I.C.40: Number of
Target: 1,485
graduates from advanced 7550 N/A N/A
(Target
nursing degree programs
Exceeded)
Year and
ANE Program Outputs Most FY 2017 FY 2018 FY 2019
Result
Number of students supported in AENT FY 2016:
--- --- ---
program51 2,166
Number of graduates from AENT FY 2016:
--- --- ---
program 1,287
Number of students supported in NAT FY 2016:
3,000 2,200 ---
program 2,429
Number of graduates from NAT FY 2016:
1,500 1,000 ---
program 1,098
48
49
Targets are adjusted as the ANE program grantees complete work in FY 2017 and shift to the ANEW program.
50
Targets are adjusted as the ANE program grantees complete work in FY 2017 and shift to the ANEW program.
51
Output measures for AENT were discontinued in FY 2017 as the AENT program was no longer active.
122
Year and
ANE Program Outputs Most FY 2017 FY 2018 FY 2019
Result
Percent of NAT graduates who are
FY 2016:
minority and/or from disadvantaged 30% 30% ---
32%
backgrounds
Percent of graduates from NAT FY 2016:
40% 40% ---
programs employed in underserved areas 53%
Percent of AENT graduates who are
FY 2016:
minority and/or from disadvantaged --- --- ---
42%
backgrounds
Percent of graduates from AENT FY 2016:
--- --- ---
programs employed in underserved areas 56%
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $338,406 $338,406 ---
Range of Awards $12,406-$700,000 $12,406-$700,000 ---
123
Nursing Workforce Diversity

FY 2019 FY 2019
BA $15,306,000 $15,239,000 --- -$15,239,000
FTE --- --- --- ---
Authorizing Legislation: Public Health Service Act, Sections 821
FY 2019 Authorization ........................................................................... Expired at end of FY 2016
The Nursing Workforce Diversity (NWD) Program increases nursing education opportunities for
individuals from disadvantaged backgrounds, including racial and ethnic minorities who are
underrepresented among registered nurses. The program supports disadvantaged students
through student stipends and scholarships, and a variety of pre-entry preparation, advanced
education preparation, and retention activities.
In Academic Year 2016-2017, the NWD Program supported 57 college-level degree programs as
well as 38 training programs and activities designed to recruit and retain health professions
students. These programs trained 4,416 students including 2,637 students who graduated or
completed their programs. As project periods ended for the outgoing cohort of awardees, there
was a shift in programmatic emphasis from recruitment of new students to graduation of existing
trainees, resulting in an overall decrease in volume of trainees participating in academic support
programs as well as nursing degree programs, causing targets to be missed. With a new cohort
of awardees beginning in Academic Year 17-18, enrollment counts are expected to rebound to
target levels.
In addition to providing support to students, NWD grantees partnered with 571 training sites
during the academic year to provide 7,800 clinical training experiences to trainees across all
programs. Approximately 49 percent of training sites were located in medically underserved
communities and 37 percent were in primary care settings.
Eligible Entities: Accredited schools of nursing, nursing centers, academic health centers, state
or local governments, and other private or public entities, including faith-based and community
based organizations, tribes and tribal organizations.
124
Designated Health
Targeted Educational Levels Program Activities
Professions
 Baccalaureate-  RNs who matriculate into  Increase the recruitment,

prepared accredited bridge or degree enrollment, retention, and
Registered Nurses completion program graduation of students from
(RNs)  Baccalaureate degree disadvantaged backgrounds in
 Advanced nursing education schools of nursing.
preparation  Provide student scholarships or
 PhD degree RNs stipends.
 Prepare diploma or associate degree
RNs to become baccalaureate-
prepared RNs.
Funding History
FY Amount
FY 2015 $15,343,000
FY 2016 $15,343,000
FY 2017 $15,306,000
FY 2018 $15,239,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Nursing Workforce Diversity Program, which is $15.2
million below the FY 2018 Annualized CR level. HRSA’s nursing projections generally indicate
that the supply of nurses will outpace demand at a national level in 2025. However, the distribution
of nurses is estimated to be uneven with some areas of the country having an inadequate supply to
meet the needs of their region, which is addressed by the NHSC, the NURSE Corps or other HRSA
investments. The Request prioritizes funding for health workforce activities that provide
125
Year and Most

FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)52
6.I.C.41: Percent of program
FY 2016: 100%
participants who are URMs and/or from
Target: 95%
disadvantaged backgrounds 95% N/A N/A
(Target
Exceeded)
6.I.C.42: Number of program
FY 2016: 1,878
participants who participated in
Target: 2,900 2,000 N/A N/A
academic support programs during the
(Target Not Met)
academic year
6.I.C.43: Number of program FY 2016: 2,538
participants who are enrolled in a Target: 4,000 2,500 N/A N/A
nursing degree program (Target Not Met)
Year and
Most FY 2017 FY 2018 FY 2019
NWD Program Outputs
Result
FY 2016:
Percent of URM students 45% 45% ---
46%
Number of nursing students FY 2016:
1,000 500 ---
graduating from nursing programs 1,145
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $447,016 $447,016 ---
Range of Awards $195,574-$500,000 $195,574-$500,000 ---
52
126
Nurse Education, Practice, Quality and Retention Programs

FY 2019 FY 2019
BA $39,817,000 39,642,000 --- -39,642,000
FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Sections 831 and 831A
FY 2019 Authorizations .................................................................... Expired at the end of FY 2016
The Nurse Education, Practice, Quality and Retention (NEPQR) Programs address national
nursing needs and strengthen the capacity for basic nurse education and practice under three
priority areas: Education, Practice and Retention. The Programs support academic, service and
continuing education projects to enhance nursing education, improve the quality of patient care,
increase nurse retention, and strengthen the nursing workforce. The NEPQR Programs have a
variety of legislative goals and purposes that support the development, distribution and retention
of a diverse, culturally competent health workforce that can adapt to the population’s changing
health care needs and provide the highest quality of care for all. Woven throughout the
Programs is the aim to increase the number of Bachelor of Science in Nursing (BSN) students
exposed to enhanced curriculum and with meaningful clinical experience and training in
medically underserved and rural communities, who will then be more likely to choose to work in
these settings upon graduation.
Interprofessional Collaborative Practice (IPCP) Program: The IPCP Program was designed to
create or expand practice environments comprised of nursing and other professional disciplines
that are engaged in collaborative practice innovations. In Academic Year 2016-2017, IPCP
grantees trained more than 6,430 individuals. In addition, IPCP grantees partnered with 148
clinical sites to provide interprofessional team-based training to 6,216 individuals, 19 percent of
whom were nursing students and 763 trainees from other health care disciplines including
medical, dental, and behavioral health students. Approximately 71 percent of the clinical
training sites were located in medically underserved communities and 51 percent were in
primary care settings.
BSN Practicums in Community-based Settings (BPCS) Program: The BPCS Program

increases experiential training opportunities for senior-level BSN students in primary care
community-based settings. In Academic Year 2016-2017, 11 BPCS awardees trained 681
students, 26 percent of whom reported coming from rural backgrounds. BPCS awardees
partnered with 57 clinical sites to provide training experiences to students. Approximately 75
127
percent of sites were located in medically underserved communities, 65 percent were in primary
care settings, and 44 percent were in rural areas. In addition, awardees offered 12 continuing
education programs to 229 practicing professionals.
Veterans’ Bachelor of Science in Nursing (VBSN) Program: The VBSN Program was
designed to increase enrollment, progression, and graduation of veterans from BSN degree
programs. In Academic Year 2016-2017, 953 veterans were enrolled in BSN degree programs,
and 265 graduated with BSN degrees. Approximately 44 percent of veterans received clinical
training in a primary care setting, and 57 percent received training in a medically underserved
community during the academic year. Grantees also implemented 23 structured faculty
development programs and 82 faculty development activities including conferences and
workshops designed to enhance the teaching of veterans; 1,312 faculty were trained as a result.
HRSA awarded the final year of the VBSN awards in FY 2017; the VBSN Program activities
will be completed in June 2018.
Eligible Entities: Accredited schools of nursing, healthcare facilities, and partnerships of a

nursing school and healthcare facility.

Grantee Activities
Professions Levels
 Registered  Baccalaureate  Expand enrollment in
nurses education baccalaureate nursing programs.
 Advanced  Advanced nursing  Provide education in new
practice education technologies including simulation
registered nurses  Continuing learning and distance learning
professional training methodologies.
 Establish or expand nursing
practice arrangements in non-
institutional settings.
 Provide care for underserved
populations and other high-risk
groups.
 Provide coordinated care, and
other skills needed to practice in
existing and emerging organized
health care systems.
 Develop career ladder programs to
promote career mobility in
nursing.
 Promote career advancement for
nursing personnel.
 Improve the retention of nurses
and enhance patient care.
 Develop internships and residency
programs.
128
Funding History
FY Amount
FY 2015 $39,913,000
FY 2016 $39,913,000
FY 2017 $39,817,000
FY 2018 $39,642,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Nurse Education, Practice, Quality and Retention
Program, which is $39.6 million below the FY 2018 Annualized CR level. HRSA’s nursing
projections generally indicate that the supply of nurses will outpace demand at a national level in
2025. However, the distribution of nurses is estimated to be uneven with some areas of the country
having an inadequate supply to meet the needs of their region, which is addressed by the NHSC, the
NURSE Corps or other HRSA investments. The Request prioritizes funding for health workforce
activities that provide scholarships and loan repayment to clinicians in exchange for their service
Year and Most

FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)53
FY 2016: 1,938
participating in
Target: 1,700 N/A54 N/A N/A
interprofessional team-based
(Target Exceeded)
care
6.I.C.45: Number of nurses
FY 2016: 3,869
and nursing students trained
Target: 3,000 N/A N/A N/A
in interprofessional team-
(Target Exceeded)
based care
53
54
Measures for the IPCP program will be discontinued in FY 2018 as grantees complete work, and the program will
not be recompeted.
129
Year and
Most FY 2017 FY 2018 FY 2019
NEPQR Program Outputs
Result
Total number of trainees and
FY 2016:
professionals participating in 7,000 N/A55 ---
6,216
interprofessional team-based care
Number of veterans enrolled in FY 2016:
350 N/A56 ---
baccalaureate (BSN) nursing programs 953
Number of veterans who graduate from FY 2016:
150 N/A ---
baccalaureate (BSN) nursing programs 265
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $410,588 $420,250 ---
Range of Awards $90,000-$557,500 $90,000-$557,5000 ---
55
Outputs for the IPCP and VBSN programs are discontinued in FY 2018 as these programs will complete work in
FY 2017.
56
This measure was discontinued in FY 2018 as the Veterans’ Bachelor of Science in Nursing Program completed
its activities.
130
Nurse Faculty Loan Program

FY 2019 FY 2019
BA $26,436,000 $26,320,000 --- -$26,320,000
FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Section 846A and 847(f)
FY 2019 Authorization ......................................................................... Expired at the end of FY 16
Allocation Method ..................................................................................................... Formula Grant
The Nurse Faculty Loan Program (NFLP), which began in 2004, seeks to increase the number of
qualified nurse faculty by awarding funds to schools of nursing who in turn provide student loans
to graduate-level nursing students who are interested to serve as faculty. Upon graduation,
student borrowers are eligible to receive partial loan cancellation (up to 85 percent of the loan
principal and interest over four years) in exchange for serving as full-time faculty at an
accredited school of nursing.
In Academic Year 2016-2017, 84 schools received new NFLP grant awards and supported 1,998
nursing students pursuing graduate level degrees as nurse faculty. This outcome is slightly
below the FY16 target of 2,200 students, primarily as a result of fewer awards being made and
more stringent criteria being used to ensure that loan support was provided to individuals with an
expressed intent to pursue nursing faculty positions. The majority of students (83 percent) who
received loans during the academic year were pursuing doctoral-level nursing degrees (e.g., PhD,
DNP, DNSc/DNS, or EdD). By the end of the Academic Year, 568 trainees graduated; 92
percent of whom intend to teach nursing.
Eligible Entity: Accredited schools of nursing that offer advanced nursing education degree
program(s) that prepare graduate students for roles as nurse educators.
131
Designated Targeted Grantee Activities
Health Educational
Professions Levels
Nursing Graduate (masters • Provide funding to nursing schools to establish and
and doctoral) operate revolving loan fund.
• Match of at least 1/9 of the federal contribution to
the loan fund.
• Provide low interest rate loans to nursing students
that may be used to pay costs of tuition, fees,
books, laboratory expenses, and other education
expenses.
• Provides up to 85 percent loan cancellation upon
completion of four years of service.
Funding History
FY Amount
FY 2015 $26,500,000
FY 2016 $26,500,000
FY 2017 $26,436,000
FY 2018 $26,320,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Nurse Faculty Loan Program, which is $26.3 million
below the FY 2018 Annualized CR level. HRSA’s nursing projections generally indicate that the
supply of nurses will outpace demand at a national level in 2025. However, the distribution of nurses
is estimated to be uneven with some areas of the country having an inadequate supply to meet the
needs of their region, which is addressed by the NHSC, the NURSE Corps or other HRSA
investments. The request prioritizes funding for health workforce activities that provide
FY 2018
Year and Most Recent
Target
Result /Target for FY 2018 FY 2019
Measure +/-
FY 2019
(Summary of Result)57
Target
6.I.C.46: Number of graduate- FY 2016: 1,998
level nursing students who Target: 2,200 1,900 N/A N/A
received a loan (Target Not Met)
57
132
FY 2018
Year and Most Recent
Target
Result /Target for FY 2018 FY 2019
Measure +/-
FY 2019
(Summary of Result)57
Target
6.I.C.47: Number of loan
FY 2016: 568
recipients who graduated from
Target: 400 350 N/A N/A
an advanced nursing degree
(Target Exceeded)
program
Grant Awards Table
FY 2019
Average Award $308,942 $308,942 ---
Range of Awards $14,842-
$14,842-$2,351,957 ---
$2,351,957
133
NURSE Corps
FY 2019 FY 2019
BA $82,935,000 $82,570,000 $83,135,000 +$565,000
FTE 32 32 32 ---
FY 2019 Authorization ................................................................... Expired at the end of FY 2007
Allocation Method ...................................................... Other (Competitive Awards to Individuals)
HRSA’s nursing and primary care projections generally indicate that the supply of nurses will
outpace demand at a national level in 2025 and 2020, respectively. However, maldistribution of
nurses is projected to be a continued problem. In addition, projections at the national-level mask
a distributional imbalance of Registered Nurses (RN) at the state-level. Specifically, sixteen
states are projected to experience a shortage of RNs by 2025.58
The NURSE Corps helps to improve the distribution of nurses by supporting nurses and nursing
students committed to working in communities with inadequate access to care. In exchange for
scholarships or educational loan repayment, NURSE Corps members fulfill their service
obligation by working in Critical Shortage Facilities (CSFs) located in health professional
shortage areas and medically underserved communities around the nation, which include rural
communities and other identified geographic areas with populations that lack access to primary
care services. The NURSE Corps Program includes:
NURSE Corps Loan Repayment Program (LRP): NURSE Corps LRP which began in 1988,
aims to assist in the recruitment and retention of professional RNs, including advanced practice
RNs, (i.e., nurse practitioners, certified registered nurse anesthetists, certified nurse midwives,
clinical nurse specialists) who are dedicated to working in CSFs or as faculty in schools of
nursing. The NURSE Corps LRP decreases the economic barriers associated with pursuing
careers in CSFs or in academic nursing by repaying 60 percent of the principal and interest on
nursing education loans in exchange for two years of full-time service at a CSF or in academic
nursing.
The NURSE Corps Scholarship Program (SP): NURSE Corps SP which began in 2002, awards
scholarships to individuals who are enrolled or accepted for enrollment in an accredited school of
58
DHHS (US), Health Resources and Services Administration, National Center for Health Workforce Analysis.
(2017) Supply and Demand Projections of Nursing Workforce: 2014-2030.
134
nursing in exchange for a service commitment of at least two years in a CSF after graduation.
The NURSE Corps SP awards reduce the financial barrier to nursing education for all levels of
professional nursing students and increase the pipeline of nurses who will serve in CSFs.
The NURSE Corps performance measures gauge these programs’ contribution towards
improving access to health care and improving the health care systems through the recruitment
and retention of nurses working in CSFs. In FY 2016, 55 percent of NURSE Corps LRP
participants extended their service commitment for an additional year, exceeding the 52 percent
target; and in FY 2016, 86 percent of NURSE Corps participants were retained in service at a
CSF for up to two years beyond the completion of their NURSE Corps service commitment. In
addition, in FY 2016, 95 percent of NURSE Corps SP awardees are pursuing their baccalaureate
degree or advanced practice degree.
In FY 2017, HRSA began collecting National Provider Identifier (NPI) for NURSE Corps
applicants. This process will support the Administration’s efforts to evaluate and identify the
most effective workforce training investments.59 This will allow HRSA to conduct longitudinal
tracking for NURSE Corps participants, thereby improving the quality and breadth of the data to
drive HRSA policies and investments.
Eligible Entities: Eligible participants for the NURSE Corps LRP are U.S. citizens (either U.S.
born or naturalized), U.S. Nationals or Lawful Permanent Residents with a current license to
practice as a registered nurse who are employed full time (at least 32 hours per week) at a public
or private nonprofit CSF or at an accredited, public or private non-profit school of nursing.
Eligible participants for the NURSE Corps SP are U.S. citizens (either U.S. born or naturalized),
U.S. Nationals or Lawful Permanent Residents enrolled or accepted for enrollment in an
accredited diploma, associate or collegiate (bachelors, master’s, doctoral) school of nursing
program.
Funding History
FY Amount
FY 2015 $81,785,000
FY 2016 $83,135,000
FY 2017 $82,935,000
FY 2018 $82,570,000
FY 2019 $83,135,000
Budget Request
The FY 2019 Budget requests $83.1 million for the NURSE Corps Program, which is an increase
of $0.56 million above the FY 2018 Annualized CR level. This request will fund an estimated
202 scholarship (new and continuation) and 1,015 loan repayment (new and continuation)
awards. This request will allow the program to maintain its efforts to address the anticipated
demand for nurses in CSF. In FY 2019, NURSE Corps will assess options to direct a higher
59
See Section 10 of Executive Order 13801.
135
proportion of awards to community-based CSFs located in rural and underserved communities.
The funding request also includes operational costs in the form of required Federal Insurance
Contributions Act tax contributions, staffing, and acquisition contracts.
Year and Most

FY 2018
Recent Result
Target
+/-
Measure Recent Result / Target Target
FY 2019
(Summary of
Target
Result)
5.I.C.4: Proportion of NURSE Corps
LRP participants who extend their FY 2017: 58%
service contracts to commit to work at Target: 52% 52% 52% Maintain
a critical shortage facility for an (Target Exceeded)
additional year. (Outcome)
LRP/SP participants retained in
FY 2016: 86%
service at a critical shortage facility for
Target: 80% 80% 80% Maintain
at least one year beyond the
(Target Exceeded)
completion of their NURSE Corps
LRP/SP commitment.
FY 2017: 98%
SP awardees obtaining their
baccalaureate degree or advanced
(Target Exceeded)
practice degree in nursing. (Outcome)
FY 2017:
LRP: 2.7%
Target: 3%
5.E.1: Default rate of NURSE Corps LRP: 3% LRP: 3%
(Target Exceeded) Maintain
LRP and SP participants. (Efficiency) SP: 15% SP: 15%
SP: 8.5%
Target: 15%
(Target Exceeded)
NURSE Corps Loans/Scholarships Awards Table
FY 2018 FY 2019
FY 2017 Annualized President’s
Final CR Budget
Loans $48,110,375 $48,452,829 $48,452,829
Scholarships $23,696,155 $23,864,826 $23,864,826
136
NURSE Corps Awards
2012 2013 2014 2015 2016 2017 2018 2019

Scholarships
New Awards 233 239 242 257 230 198 203 183
Continuation Awards 31 21 13 12 12 14 22 19
Loan Repayment
New Awards 720 580 667 590 518 501 671 645
Continuation Awards 732 606 412 319 365 340 326 370
Total 1,716 1,446 1,334 1,178 1,125 1,053 1,222 1,217
NURSE Corps Field Strength
2012 2013 2014 2015 2016 2017 2018 2019

Scholarship 475 558 465 396 476 362 361 321
Loan Repayment 2,125 1,634 1,420 1,313 1,219 1,181 1,333 1,348
Loan Repayment
467 367 318 321 321 331 340 340
Nurse Faculty
Total 3,067 2,559 2,203 2,030 2,016 1,874 2,034 2,009
137
Children’s Hospitals Graduate Medical Education Payment Program
FY 2019
FY 2019
BA $299,289,000 $297,963,000 ---60 - $297,963,000
FTE 17 17 --- -17
Authorizing Legislation: Public Health Service Act, Section 340E
Allocation Method ..................................................................................... Formula Based Payment
The Children’s Hospitals Graduate Medical Education (CHGME) Payment Program was first
established in 1999 and it supports graduate medical education in freestanding children’s
teaching hospitals. CHGME helps eligible hospitals maintain GME programs to provide
graduate training for physicians to provide quality care to children and enhance their ability to
care for low-income patients. It supports the training of residents to care for the pediatric
population and enhances the supply of primary care and pediatric medical and surgical
subspecialties.
In FY 2017, 58 children’s hospitals received CHGME funding. During Academic Year 2016-
2017, the most recent year for which FTE information was reported, the CHGME hospitals
trained 7,164 resident full-time equivalents (FTEs).61 Among these FTEs, 41 percent were
pediatric residents, 33 percent were pediatric subspecialty residents, and 26 percent were
residents training in other primary disciplines such as family medicine.
During Academic Year 2015-2016, the most recent year for which performance information is
available, CHGME-funded hospitals served as sponsoring institutions for 32 residency programs
and 251 fellowship programs. In addition, they served as major participating rotation sites for
598 additional residency and fellowship programs. CHGME supported the training of 5,017
pediatric residents that included general pediatrics residents, as well as residents from five types
of combined pediatrics programs (e.g., internal medicine/ pediatrics). Additionally, 2,713
pediatric medical subspecialty residents, 285 pediatric surgical subspecialty residents, and 365
pediatric dentistry residents were trained. CHGME funding was also responsible for the training
of 3,120 adult medical and surgical specialty residents such as family medicine residents who
rotate through children’s hospitals for pediatrics training. During their training, these medical
residents and fellows provided care during more than 2 million patient encounters in primary
60
Discretionary funding for CHGME is discontinued in FY 2019. The Budget proposes to consolidate Federal
graduate medical education spending from Medicare, Medicaid, and the Children's Hospitals Graduate Medical
Education program into a single grant program for teaching hospitals.
61
Each of the children’s hospitals report the number of full-time equivalent residents trained during the latest filed
(completed) Medicare Cost Report period.
138
care settings in addition to providing 4.7 million patient contact hours in medically underserved
communities. Of the full-time residents and fellows who completed their training during this
Academic Year, approximately 62 percent of these CHGME-funded physicians chose to remain
and practice in the state where they completed their residency training.
Eligible Entities: Freestanding children’s teaching hospitals.
Targeted
Designated Educational
Health Professions Levels Grantee Activities
 Pediatric  Graduate  Operate accredited graduate
 Pediatric medical subspecialties medical medical education programs for
 Pediatric surgical Subspecialties education residents and fellows.
 Other primary care, medical, and  Submit an annual report on the
surgical specialties status and expansion of GME in
their institutions.
Funding History
FY Amount
FY 2015 $265,000,000
FY 2016 $295,000,000
FY 2017 $299,289,000
FY 2018 $297,963,000
FY 2019 ---
Budget Request
The FY 2019 Budget request discontinues the discretionary CHGME program, which is $297.96
million below the FY 2018 Annualized CR level. The Budget proposes to consolidate Federal
graduate medical education spending from Medicare, Medicaid, and the Children's Hospitals
Graduate Medical Education program into a single grant program for teaching hospitals equal to
the sum of Medicare and Medicaid's 2016 payments for graduate medical education, plus 2016
spending on children's hospitals graduate medical education, adjusted for inflation. This amount
would then grow with inflation minus 1 percentage point each year. HRSA and the Centers for
Medicare & Medicaid Services (CMS) would jointly determine program requirements and the
formula for distribution. Payments would be distributed to hospitals based on the number of
residents at a hospital (up to its existing cap) and the portion of the hospital's inpatient days
accounted for by Medicare and Medicaid patients. The Secretary would have authority to modify
the amounts distributed based on the proportion of residents training in priority specialties or
programs and based on other criteria identified by the Secretary, including addressing health
care professional shortages and educational priorities. This grant program would be funded out
of the general fund of the Treasury.
139
Year and Most

Recent Result
FY 2018 Target
+/-
Measure Result / Target Target
FY 2019 Target
(Summary of
Result)62
7.I.A.1: Maintain the
number of FTE FY 2016: 7,164
residents training in Target: 6,300 6,300 N/A N/A
eligible children’s (Target Exceeded)
teaching hospitals
7.VII.C.1: Percent of
FY 2016: 100%
hospitals with verified
FTE residents counts
(Target Met)
and caps
7.E: Percent of FY 2016: 100%
payments made on Target: 100% 100% N/A N/A
time (Target Met)
Awards Table
FY 2017 FY 2018 FY 2019 President’s

Average Award $4,838,475 $4,838,475 ---
Range of Awards $31,808-$21,117,097 $31,808-$21,117,097 ---
62
140
Teaching Health Center Graduate Medical Education Program
FY 2018 FY 2019 FY 2019
BA --- --- $60,000,000 +$60,000,000
Current Law
$55,860,000 $30,000,000 --- -$30,000,000
Mandatory
Proposed Law
--- $30,000,000 --- -$30,000,000
Mandatory
TOTAL $55,860,000 $60,000,000 $60,000,000 ---
FTE 8 8 8 ---
Authorizing Legislation: Section 340H of the Public Health Service Act
FY 2019 Authorization ................................................. Expires end of the second quarter FY 2018
Allocation Method ..................................................................................... Formula Based Payment
Primary care physician shortages persist, particularly in rural and other underserved
communities.63 Access to high quality primary care is associated with improved health outcomes
and lower costs.64, 65 The Teaching Health Center Graduate Medical Education (THCGME)
Program, established in 2010, increases the number of primary care physician and dental
residents, increasing the overall number of these primary care providers. There is also evidence
that physicians who receive training in community and underserved settings are more likely to
practice in similar settings, such as health centers.66, 67 Unlike most Federal funding for GME,
payments support training based in community-based ambulatory care settings, as opposed to in-
patient care settings in hospitals.
63
U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015.
“National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. November
2016. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-
national-projections2013-2025.pdf.
64
Starfield B, Shi L, Macinko J. Contribution of Primary Care to Health Systems and Health. Milbank Quarterly.
2005; 83(3):457-502.
65
Chang CH, O'Malley AJ, Goodman DC. Association between Temporal Changes in Primary Care Workforce and
Patient Outcomes. Health Services Research 2017; 52:634–55.
66
Phillips, RL; Petterson,S; Bazemore, A. Do Residents Who Train in Safety Net Settings Return for Practice?
Academic Medicine: 2013; 88(12): 1934–1940.
67
Goodfellow A, Ulloa J, Dowling P, Talamantes E, Chheda Somil, Bone C, Moreno G. Predictors of Primary Care
Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature
Review. 2016, Academic Medicine.
141
Although health centers receive federal funding to improve access to care, they often have
difficulty recruiting and retaining primary care professionals.68 The THCGME Program is
uniquely positioned to meet these recruitment and retention needs by providing funding to
support residents training in underserved communities. As community health centers are
generally smaller organizations than teaching hospitals with smaller operating margins, these
organizations are unable to offset the additional costs of GME training without significantly
affecting the patient and community services provided. Without THCGME funding, these
additional residency positions will cease to exist and the additional primary care physicians and
dentists will not be available to rural and underserved communities.
In addition to increasing the number of primary care residents training in these community-based
patient care settings, the THCGME Program seeks to increase health care quality and improve
overall access to care. Program funds support the educational costs incurred by new and
expanded residency programs. In addition to supporting the salaries and benefits of residents
and faculty, THCGME funds are used to foster innovation and support curriculum concepts
aimed at improving patient care, such as the Patient-Centered Medical Home model, Electronic
Health Record utilization, population health, telemedicine, and healthcare leadership. These
activities ensure residents receive high quality training and are well prepared to practice in
community-based setting after graduation.
In Academic Year 2016-2017, the THCGME Program awarded 742 resident FTE slots that
provided funding to 771 primary care medical and dental residents. Nearly all residents (over 99
percent) received training in a primary care setting, providing care during more than half a
million patient encounters and accruing nearly 600,000 contact hours with these primary care
patients. Additionally, most THCGME residents (83 percent) spent part of their training in
medically underserved and/or rural communities, providing over 795,000 hours of patient care.
Approximately 20 percent of residents reported coming from a financially or educationally
disadvantaged background, and 23 percent reported coming from a rural background.
In addition to supporting training of individual residents, THCGME recipients also used funding
to develop or enhance curricula on topics related to primary care. Programs developed or
enhanced and implemented 1,157 courses and training activities during the academic year,
impacting over 8,800 healthcare trainees. More than 12,000 students, residents, and other health
care professionals from a variety of professions and disciplines trained alongside THCGME
residents while participating in interprofessional team-based care.
Of the 248 residents who completed the program in Academic Year 2016-2017, approximately
61 percent reported intentions to practice in a primary care setting, while 51 percent intended to
practice in a medically underserved and/or rural area. Employment status will be assessed for
these individuals one year after program completion (during Academic Year 2017-2018). Of the
172 program completers from the prior academic year for whom employment data was available,
most currently practice in a primary care setting (68 percent) and/or in a medically underserved
community (30 percent).
68
National Association of Community Health Centers. Staffing the Safety Net: Building the Primary Care
Workforce at America’s Health Centers.2016: http://www.nachc.org/wp-
content/uploads/2015/10/NACHC_Workforce_Report_2016.pdf.
142
Since the THCGME Program began, 632 new primary care physicians and dentists have
graduated and entered the workforce. As the national average of physicians practicing primary
care is approximately 33 percent, 69 the THCGME Program has evidenced much stronger results.
Cumulative follow-up data indicates that 69 percent of graduates are currently practicing in a
primary setting and approximately 55 percent of the graduating physicians and dentists are
currently practicing in a medically underserved community and/or rural setting.
Eligible Entities: Community-based ambulatory patient care centers identified in statute.

Professions Levels Grantee Activities
 Family medicine  Post graduate  Operate an accredited residency
 General dentistry medical and dental program.
 Geriatrics education  Medical and dental residents
 Internal medicine will provide patient care
 Internal medicine-pediatrics services during their training
 Obstetrics and gynecology under supervision of program
 Pediatrics faculty.
 Psychiatry
 Pediatric dentistry
Funding History
FY Amount
FY 2015 ---
FY 2016 $60,000,000
FY 2017 $55,860,000
FY 2018 Current
Law Mandatory $30,000,000
FY 2018 Proposed
law Mandatory $30,000,000
FY 2019 $60,000,000
Budget Request
The FY 2019 Budget requests $60 million in discretionary resources for the THCGME Program.
The Budget proposes a shift from mandatory resources to discretionary resources for this
program. With this funding, HRSA will support the existing 57 THC recipients at their approved
FTE level for Academic Year 2018-2019.
69
Agency for Healthcare Research and Quality. Primary care workforce facts and stats no. 1. AHRQ Pub. No. 12-
P001-2-EF. Rockville, MD. 2011.
143
Year and Most
FY 2018
Recent Result
Target
Measure +/-
FY 2019
(Summary of
Target
Result)70
6.I.C.5: Number of resident
FY 2016: 742
positions supported by
Target: 660 800 800 Maintain
Teaching Health Centers
(Target Exceeded)
(Cumulative)71
6.I.C.48: Percent of
THCGME-supported residents FY 2016: 83%
80% 80% Maintain
training in rural and/or (Baseline)
underserved communities
Year and
THCGME Program Outputs Most Recent
Result
Number of primary care
FY 2016:
residents funded by THCGME
771
residencies72
Number of primary care FY 2016:
residents completing training 248
Percent of residents who are
FY 2016:
from a disadvantaged and/or
35%
rural background
Percent of primary care resident
program completers who intend FY 2016:
to practice in primary care 61%
settings
70
71
Measure captures the number FTEs resident slots supported and not the number of individuals receiving direct
financial support through the program. Awardees may use 1 FTE slot to fund two residents at 50 percent time, thus
the FTE slot is not a one to one correspondence with number of individuals trained. Number of residents also does
not equal the number of graduates as primary care residency programs require one year (Dental and Geriatrics),
three years (Family Medicine, Internal Medicine, and Pediatrics), or four years (Ob-Gyn and Psychiatry) of training.
72
Measure captures the number of individual residents supported, which is different than the FTE slots.
144
Awards Table
FY 2017 FY 2018 FY 2019

Final Annualized Level President’s Budget
Average Award $993,789 $1,028,658 $1,028,658
Range of Awards $48,285-$4,210,799 $48,285-$4,210,799 $48,285-$4,210,799
145
National Practitioner Data Bank
FY 2019 FY 2019
Discretionary
$18,814,000 $18,000,000 $18,814,000 +$814,000
Collections
FTE 35 35 35 ---
Authorizing Legislation: Section 6403 of the Patient Protection and Affordable Care Act (P.L.
111-148); Title IV of the Health Care Quality Improvement Act of 1986 (P.L. 99-660); Section
1921 of the Social Security Act (Section 5(b) of P.L. 100-93, the Medicare and Medicaid Patient
and Program Protection Act of 1987, as amended); and Section 1128E of the Social Security Act
(P.L. 104-191, the Health Insurance Portability and Accountability Act of 1996).
Allocation Method ............................................................................................... User Fee Program
The National Practitioner Data Bank (NPDB) is a workforce tool that improves health care
quality, promotes patient safety, and deters fraud and abuse in the health care system by
providing information about past adverse actions of practitioners, providers, and suppliers to
authorized health care entities and agencies. With approximately 1.3 million reports, the NPDB
helps reduce health care fraud and abuse by collecting and disclosing information to authorized
entities on health care-related civil judgments and criminal convictions, adverse licensure and
certification actions, exclusions from health care programs, and other adjudicated actions taken
against health care providers, suppliers, and practitioners. Authorized health care entities then
use this information to make informed hiring, credentialing, and privileging decisions to
ultimately determine whether, or under what conditions, it is appropriate for health care
practitioners, providers, and suppliers to provide health care services.
Prior to NPDB’s inception, health care providers who lost their licenses or had serious
unprofessional conduct moved from state to state with impunity, making it difficult for
employers and licensing boards to learn about their prior acts. Through the use of the NPDB,
employers and other authorized health care entities are able to receive reliable information on
health care practitioners, providers, and suppliers.
 In FY 2017, the NPDB facilitated over 7 million queries from the NPDB to authorized
health care providers.
 In FY 2017, the program implemented more user self-service features than ever before
(most notably for Self-Query). While NPDB customer transactions increase by 60 percent,
there was no appreciable increase in calls to the NPDB call center. In June 2017, the
146
transaction-to-call center case ratio of was 81 NPDB transactions to 1 Customer Service
Center case; one year later, it was 130 to 1.
 In August 2017, the program launched attestation for HRSA’s community health centers.
Health center attestation marks the beginning of a multi-year compliance initiative to reach
health centers, hospitals, medical malpractice payers, and health plans.
Funding History
The table below shows the user fees (revenue) collected (or expected to be collected):
FY Amount
FY 2015 $20,159,152
FY 2016 $22,436,863
FY 2017 $18,814,000
FY 2018 $18,000,000
FY 2019 $18,814,000
Budget Request
The FY 2019 Budget requests $18.8 million for the National Practitioner Databank in user fees,
which is an increase of $0.8 million above the FY 2018 Annualized CR level. This is based on
HRSA’s projections of 8.5 million queries on practitioners and organizations, and 250,000 self-
queries, which yields estimated FY 2019 revenue projections similar to the level in FYs 2017
and 2018.
As mandated by the Health Care Quality Improvement Act, the NPDB does not receive
appropriated funds and is financed by the collection of user fees. Annual Appropriations Act
language since FY 1993 requires that user fee collections cover the full cost of NPDB
operations; therefore, there is no request for appropriation for operating the NPDB. User fees are
established at a level to cover all program costs to allow the NPDB to meet annual and long term
program performance goals. Fees are established based on forecasts of query volume to result in
adequate, but not excessive, revenues to pay all program costs to meet program performance
goals.
147
Year and Most

FY 2018
Recent Result
Target
+/-
Measure Recent Result / Target Target
FY 2019
(Summary of
Target
Result)73
FY 2017:
8.III.B.5: Increase the number of 2,778,496
practitioners enrolled in Continuous Enrolled
Query (which is a subscription Practitioners
service for Data Bank queries that Target: 2,155,000 2,928,500 3,078,500 +150,000
notifies them of new information on Enrolled
enrolled practitioners within one Practitioners
business day) (Target
Exceeded)
FY 2017:
1,730,116
8.III.B.7: Increase annually the Disclosures
number of reports disclosed to Target: 1,750,000 1,770,000 +20,000
health care organizations 1,265,000
(Target
Exceeded)
73
The NPDB modified the calculation method for continuous query disclosures in order to make it more consistent
with the calculation method for one-time disclosures. As a result, the targets have been updated to reflect this
change.
148
Health Workforce Cross-Cutting Performance Measures
The Bureau of Health Workforce (BHW) has tracked and reported on four cross-cutting
measures for 33 of its programs that reported performance data during Academic Year 2016-
2017. The cross-cutting measures focus specifically on the diversity of individuals completing
specific types of health professions training programs;74 the rate in which individuals
participating in specific types of health professions training programs are trained in medically
underserved communities;75 the rate in which individuals who complete specific types of health
professions training programs report being employed in a medically underserved community;
and the rate in which clinical training sites provide interprofessional team-based care to patients.
These measures do not currently include data from the Faculty Loan Repayment Program or the
National Practitioner Data Bank.76
During Academic Year 2016-2017, results showed that 49 percent of graduates and program
completers participating in BHW-supported health professions training and loan programs were
underrepresented minorities (URMs) in the health professions and/or from disadvantaged
backgrounds.77
With regard to the types of settings used to provide training, results showed that 56 percent of
individuals participating in BHW-supported health professions training programs received at
least a portion of their training in a medically underserved community just surpassing the
performance target of 55 percent. Generally across all programs, more health professions
trainees are being exposed to training and patient care in medically underserved communities
than in prior years as a result of the Bureau’s programmatic changes aimed at increasing service
and training in rural and underserved areas.
Results showed that 46 percent of individuals who graduated from or completed specific types of
BHW-supported training programs by June 30, 201678, reported working in medically
underserved communities across the nation one year after graduation/completion.
74
BHW currently funds more than 35 health professions training and loan programs that have varying types of data
reporting requirements based on the program's authorizing legislation. For the purposes of the cross-cutting
measures, only programs that are required to report individual-level data are included in the calculation, as this
ensures a higher level of accuracy and data quality, as well as consistency in the types of programs that are included
in the calculation. Currently, 33 of the BHW-funded programs are required to report individual-level data and are
included in these calculations. These programs are representative of the health professions and include oral health
programs, behavioral health programs, medicine programs, nursing programs, geriatrics programs, and physician
assistant programs, among others.
75
A medically underserved community is a geographic location or population of individuals that is eligible for
designation by a state and/or the federal government as a medically underserved area, a health professions shortage
area, and/or medically underserved population.
76
Nearly all grant programs are reporting performance data that is utilized in the cross-cutting measures. Only two
programs do not currently report data as they have specific reporting requirements unique to their legislation.
77
This measure includes individuals who graduated from or completed a specific type of HRSA-supported health
professions training or loan program and identified as Hispanic (all races); Non-Hispanic Black or African
American; Non-Hispanic American Indian or Alaska Native; Non-Hispanic Native Hawaiian or Other Pacific
Islander; and/or identified as coming from a financially and/or educationally disadvantaged background (regardless
of race).
78
Measure based on data reported about graduates and program completers from Academic Year 2015-2016.
149
Lastly, the percent of clinical training sites that provide interprofessional training to individuals
enrolled in a primary care training program was 30 percent, exceeding the target of 19 percent.
This result is 9 percentage points higher than last year’s result due to the programmatic emphasis
of interprofessional training across programs in the Bureau.
Year and Most

FY 2018
Recent Result
FY FY Target
/Target for Recent
2018 2019 +/-
Measure Result /
Target Target FY 2019
(Summary of
Target
Result) 79
6.I.B.1. Percentage of graduates and
program completers of Bureau of
Health Workforce-supported health FY 2016: 49%
professions training programs who Target: 46% 46% TBD TBD
are underrepresented minorities (Target Exceeded)
and/or from disadvantaged
backgrounds.
6.I.C.1. Percentage of trainees in

Bureau of Health Workforce- FY 2016: 56%
supported health professions training Target: 55% 55% TBD TBD
programs who receive training in (Target Exceeded)
medically underserved communities.
6.I.C.2. Percentage of individuals

supported by the Bureau of Health
Workforce who completed a primary FY 2016: 46%
Target: 34% 40% TBD TBD
care training program and are
currently employed in underserved (Target Exceeded)
areas.80
6.I.1. Percent of clinical training sites

that provide interprofessional training FY 2016: 30%
Target: 19% 24% TBD TBD
to individuals enrolled in a primary
care training program. (Target Exceeded)
79
80
Service location data are collected on students who have been out of the HRSA program for one year. The results
are from programs that have the ability to produce clinicians with one-year post program graduation. Results are
from Academic Year 2016-2017 based on graduates from Academic Year 2015-2016.
150
Maternal and Child
Health
TAB
151
MATERNAL AND CHILD HEALTH
Maternal and Child Health Block Grant

FY 2019 FY 2019
BA $640,163,000 $637,342,000 $627,700,000 -$9,642,000
FTE 42 42 42 ---
Authorizing Legislation - Social Security Act, Title V
FY 2019 Authorization ................................................................................................$638,200,000
Allocation Methods:
 Direct federal/intramural
 Contract
 Formula grant/cooperative agreement
 Competitive grant/cooperative agreement
The Maternal and Child Health (MCH) Block Grant program, authorized under Title V of the
Social Security Act, seeks to improve the health of all mothers, children, and their families. The
activities authorized as part of the MCH Block Grant program include:
 The State MCH Block Grant program, which awards formula grants to 59 states and
jurisdictions to address the health needs of mothers, infants, and children, as well as
children with special health care needs (CSHCN) in their state or jurisdiction;
 Special Projects of Regional and National Significance (SPRANS) that address
national or regional needs, priorities, or emerging issues (such as opioids and Zika)and
demonstrate methods for improving care and outcomes for mothers and children; and
 Community Integrated Service Systems (CISS) grants, which help increase local
service delivery capacity and form state and local comprehensive care systems for
mothers and children, including children with special health care needs.
The MCH Block Grant program funding, combined with state investments, provides a significant
funding source to improve access to and the quality of health care for mothers, children, and their
families in all 50 states, the District of Columbia and the territories. The MCH Block Grant
program enables each state to:
 Assure mothers and children access to quality maternal and child health services,
especially for those with low-incomes or limited availability of care;
152
 Reduce infant mortality;
 Provide access to prenatal, delivery, and postnatal care to women (especially low-income
and at risk pregnant women);
 Increase the number of low-income children who receive regular health assessments and,
follow-up diagnostic and treatment services;
 Provide access to preventive and primary care services for low income children as well as
rehabilitative services for children with special health needs;
 Implement family-centered, community-based, systems of coordinated care for CSHCN;
and
 Provide toll-free hotlines and assistance with applying for services to pregnant women
with infants and children who are eligible for Title XIX (Medicaid).
State MCH Block Grant Program
The State MCH Block Grant Program awards formula grants to improve care and outcomes for
mothers, children, and families in all 50 states, the District of Columbia and the territories. A
federal-state partnership, the State MCH Block Grant program gives states control and flexibility
in meeting the unique health needs of their children and families, while HRSA assures
accountability and impact through performance measurement and technical assistance.
In part, HRSA distributes funding based on a legislative funding formula tied to a state’s level of
child poverty compared to the overall level of child poverty in the United States. States report
progress annually on key MCH performance/outcome measures and indicators. To assist states
in improving their performance, HRSA provides technical assistance to states on request, as
specified in Section 509(a)(4) of the Social Security Act. Each state conducts a comprehensive
Needs Assessment, as mandated by law, every five years. This assessment helps each state to
determine its highest MCH priorities, target funds to address them, and report annually on its
progress. Federal funds, combined with statutorily required state matching investments, support
activities that address individual state MCH needs.
The State MCH Block Grant continues to play an important role as payer of last resort to address
gaps in coverage and services not reimbursed by Medicaid/CHIP and other third-party payers. In
addition to gap-filling direct and enabling services, state MCH programs promote the access and
quality of comprehensive public health services and systems of care, including quality
improvement initiatives, workforce training, program outreach and population-based disease
prevention and health promotion education campaigns.
Consistent with the block grant structure and driven by a commitment to improving the health
and well-being of the nation’s mothers, infants, children and families, HRSA continues to
implement efforts to:
 Reduce state burden by streamlining the narrative reporting structure of the Five-Year
Needs Assessment and Application/Annual Report, by reducing duplication in narrative
reporting across multiple sections of the Application/Annual Report, and by pre-
populating performance and outcome measure data, as available, using national data
sources.
153
 Maintain state flexibility through a comprehensive needs assessment process where
state needs and priorities drive the selection of national performance measures and state-
specific performance measures and inform the development of a state action plan that
responds to individual state MCH needs. The action plan includes evidence-
based/informed strategy measures that assess the outputs of State Title V strategies and
activities that drive improvement in performance measures.
 Improve accountability through a performance measurement framework that enables
the states to describe their program efforts and demonstrate the impact of Title V on the
health of mothers, children, and families, at both state and national levels.
MCHB works in partnership with the State MCH Block Grant programs to provide technical
support, as requested by the state, for addressing their MCH priority needs as well as other
performance and programmatic requirements of the MCH Block Grant program. HRSA makes
key financial, program, performance, and health indicator data, as reported by states, available to
the public at https://mchb.tvisdata.hrsa.gov/.
As a longstanding source of funding for MCH populations, the State MCH Block Grant supports
a wide range of services for millions of women and children, including low-income children and
children with special health care needs. Program achievements include:
 Over 76 million individuals benefitted from a service supported by the State MCH Block
Grant in FY 2016. More than 3 million pregnant women and 57 million infants, children
and children with special health care needs were served.
 Access to health services for mothers has improved with support of the State Block Grant
program. The percentage of women who received early prenatal care in the first trimester
of pregnancy increased from 71 percent in 2007 to 77 percent in 2016. Recognizing that
improving maternal and child health in the United States will require, first of all,
improving women’s health before pregnancy, a total of 50 states and jurisdictions are
now working to improve access to preventive and primary care for all women of
childbearing age.
 The infant mortality rate is a widely used indicator of the nation’s health. The State Block
Grant program has played a lead role in the 18 percent decline in U.S. infant mortality
from 7.2 infant deaths per 1,000 live births in 1997 to 5.9 infant deaths per 1,000 in 2016.
Efforts to reduce the overall infant mortality rate and its contributing factors continue.
 States are also working to reduce maternal mortality, which has been rising over the past
two decades, through a range of approaches. For example, many State Title V programs
support comprehensive maternal mortality reviews to identify contributing factors,
monitor trends, and initiate appropriate action to reduce such events in the future. In
Kentucky, for example, the maternal mortality review team’s findings led to the
development of a patient “safety bundle” for obstetrical hemorrhage that provides
standardized treatment protocols. California’s MCH Block Grant program supported the
development and implementation of several maternal safety bundles to improve the
quality and safety of maternity care in birthing hospitals, which resulted in a 60 percent
reduction in maternal deaths in California between 2006 and 2012. New York is focusing
on the “pre-hospital” antecedents of maternal mortality, which include promotion of
women’s health and wellness across the reproductive life course and early identification
and coordinated management of high-risk pregnancies.
154
 State MCH Block Grant programs work to achieve improved health outcomes among
their individual MCH populations by removing barriers to receiving comprehensive,
timely, and appropriate health care.
Below, selected National Outcome and National Performance Measures in effect from 1997 to
2015 illustrate the program’s successes.
National Outcome Measures Percent Improvement

(1997 – 2015)
Source: National Vital
Statistics System
Infant Mortality Rate per 1,000 live births 18%
Neonatal mortality rate per 1,000 live births 19%
Post neonatal mortality rate per 1,000 live births 20%
Perinatal mortality rate per 1,000 live births plus fetal deaths 18%
Child mortality rate, ages 1 through 9 per 100,000 32%
National Performance Measures Percent Source

Change
(1997 – 2015
unless
otherwise
noted)
Percent of 19-35 month olds who have received full 63% increase National
schedule of age appropriate immunizations against (2009-2015) Immunization Survey
Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, (NIS)
Pertussis, Haemophilus Influenza, & Hepatitis B
The rate of birth (per 1000) for teenagers age 15-17 68% decrease National Vital
years Statistics System
(NVSS)
Percent of third grade children who have received 47% increase National Health and
protective sealants on at least one permanent molar (2000-2012) Nutrition
tooth Examination Survey
The rate of deaths to children aged 14 years and 58% decrease NVSS
younger caused by motor vehicle crashes per 100,000
children
The percent of mothers who breastfeed their infants at 50% increase NIS
6 months of age (2000-2013)
Percentage of newborns who have been screened for 31% increase Early Hearing
hearing before hospital discharge (2005-2014) Detection and
Intervention (EHDI)
Percent of children without health insurance 68% decrease National Health
Interview Survey
155
National Performance Measures Percent Source
Change
(1997 – 2015
unless
otherwise
noted)
Percent of children, ages 2-5 years, receiving WIC 7% decrease Supplemental
services with a Body Mass Index (BMI) at or above the (2008-2012) Nutrition Program for
85th percentile Women, Infants, and
Children (WIC)
Percentage of women who smoke in the last 3 months 25% decrease Pregnancy Risk
of pregnancy (2000-2013) Assessment
Monitoring System
Percent of very low birth weight infants delivered at 12% increase Title V Information
facilities for high-risk deliveries and neonates (1997-2013) System
Percent of infants born to pregnant women receiving 8% increase NVSS
prenatal care beginning in the first trimester (2007-2015)
Special Projects of Regional and National Significance (SPRANS)
HRSA awards SPRANS grants to 1) respond to legislative set-asides and directives, 2) address
critical and emerging issues of regional and national significance in maternal and child health,
and 3) support collaborative and innovative learning across states so programs can utilize
existing best-practices and evidence. Of the $80 million for SPRANS in FY 2017, Congress set
aside approximately 15 percent to address four specific priorities: oral health, epilepsy, sickle
cell disease, and Fetal Alcohol Syndrome. In addition, approximately 55 percent of the total
SPRANS budget supports specific directives highlighted in the authorizing language, including
genetics, hemophilia, training, and research. The remaining approximately 30 percent addresses
critical and emerging issues in maternal and child health such as maternal mortality, child
obesity, adolescent mental health, and opioid abuse prevention, and supports collaborative
learning across states.
Legislative Set-Asides
In FY 2017 Congressional appropriations directed approximately $12.4 million of SPRANS
funding to four areas:
Oral health—to improve perinatal and infant oral health;
Epilepsy—to improve access to quality services for children and youth with epilepsy in
underserved areas;
Sickle cell disease—to improve care coordination for children and families affected by sickle
cell disease; and
Fetal Alcohol Syndrome—to decrease the prevalence of alcohol use during pregnancy
through provider and consumer education.
Legislative Directives
Topics outlined in the authorizing legislation for SPRANS include.
156
 Genetics—projects to improve access to genetic counseling and services for those at-risk
of having a genetic condition and their families;
 Hemophilia—projects to improve the quality of care in 135 hemophilia treatment centers
serving 33,000 patients with hemophilia and related blood disorders per year;
 Training—projects to support targeted interdisciplinary professional training in areas
such as behavioral health, nutrition, public health, and adolescent health. In FY 2015,
SPRANS projects trained 17,171 individuals across the country and provided continuing
education to 77,297 practicing MCH professionals to improve care and outcomes for
MCH populations, including state and local MCH professionals such as Title V leaders
and staff, school nurses, and childcare providers;
 Research and Data— projects to support 1) translational research to advance MCH
science and practice; 2) capacity-building in state Title V MCH programs to use data to
drive improvements in programs and outcomes; and 3) a national survey (the National
Survey of Children’s Health). The survey is the only data source for annual national and
state-by-state data on how our children and families are doing. As such, it is the only data
source for many Title V outcome and performance measures to track how state MCH
programs are performing (and allows them to learn from each other and improve their
services in real time), as well as for 15 Healthy People Objectives.
Critical and Emerging Issues in Maternal and Child Health

SPRANS also supports projects that address critical and emerging issues in maternal and child
health. For example:
 Maternal mortality - SPRANS supports the Alliance for Innovation in Maternal Health
(AIM) to reduce maternal mortality in the United States. Building on the early successes
in California, AIM is now working with 13 states and has implemented maternal safety
bundles in more than 667 birthing hospitals across the country reaching 1,780,000 annual
births or 45 percent of all annual births in the United States.
 Opioids – SPRANS supports a pilot project working with two states (Kentucky and West
Virginia) to prevent HIV and Hepatitis C infections from injectable opioid abuse.
SPRANS also supported AIM to develop a safety bundle on the prevention and treatment
of opioid abuse during pregnancy as well as neonatal abstinence syndrome.
Collaborative Learning across the States

SPRANS improves the efficiency and effectiveness of the state MCH Block Grant program by
supporting collaborative learning across the states. For example, SPRANS supported a
collaborative improvement and innovation network (CoIIN) of 13 southern states to address
infant mortality. The CoIIN:
 Provided a platform for the 13 states to share best practices and lessons learned with each
other, and to learn from national content, methods, and data experts serving as
improvement coaches for the states.
 Provided a virtual shared workspace for the states, as well as a data dashboard that
provided real-time data to drive real-time improvements.
 Contributed, between 2011 and 2014, to a 30 percent reduction in early elective delivery
across the 13 states, averting more than 85,000 early elective deliveries and saving state
Medicaid programs hundreds of millions of dollars in unnecessary neonatal intensive care
157
unit (NICU) stays; and a 12 percent reduction in smoking during pregnancy, translating
to approximately 18,000 fewer pregnant women smoking across the South.
Building on the successes of this CoIIN, SPRANS now supports several other CoIINs in areas
such as child safety and pediatric obesity to accelerate collaborative improvement and innovation
across the states.
Community Integrated Service Systems (CISS)
CISS grants are awarded on a competitive basis and support states and communities in building
comprehensive, integrated system of care to improve care and outcomes for all children,
including children with special healthcare needs. For example, CISS funding supports Early
Childhood Comprehensive Systems (ECCS) to establish CoIIN partnerships at the community
level that work together to enhance early childhood systems building and demonstrate improved
outcomes in population-based children’s developmental health and family well-being indicators.
ECCS works with 12 states and 27 communities to improve care coordination and systems
integration so that more children are healthy at birth, thriving at age three, and school ready by
age five.
Table 1. MCH Block Grant Activities ($ in thousands)
FY 2019
MCH Activities Final Annualized CR Budget
State MCH Block Grant Awards

$549,511 $547,090 $550,831
SPRANS
$80,400 $80,046 $66,593
CISS
$10,252 $10,206 $10,276
Total
$640,163 $637,342 $627,700
Table 2. MCH Block Grant SPRANS Set-Aside Grants ($ in thousands)
FY 2019
FY 2018 President’s
MCH SPRANS Set-Aside Programs FY 2017 Final Annualized CR Budget
SPRANS - Other
$68,061 $67,761 $63,593
SPRANS - Oral Health
$5,237 $5,214 ---
SPRANS - Epilepsy
$3,633 $3,617 ---
158
FY 2019
FY 2018 President’s
MCH SPRANS Set-Aside Programs FY 2017 Final Annualized CR Budget
SPRANS - Sickle Cell

$2,993 $2,980 $3,000
SPRANS - Fetal Alcohol Syndrome
Demo
$476 $474 ---
Total SPRANS
$80,400 $80,046 $66,593
CISS
$10,252 $10,206 $10,276
Funding History
FY Amount
FY 2015 $637,000,000
FY 2016 $638,200,000
FY 2017 $640,163,000
FY 2018 $637,342,000
FY 2019 $627,700,000
Budget Request
The FY 2019 Budget requests $627.7 million for the MCH Block Grant program, which is a
decrease of $9.6 million from the FY 2018 Annualized CR. The request prioritizes support for
State MCH Block Grant formula awards, CISS projects, and SPRANS continuation awards.
HRSA will not fund new SPRANS grants or re-compete SPRANS awards that are due for
renewal in FY 2019. This will affect SPRANS activities in some areas including, oral health,
epilepsy, fetal alcohol syndrome, and maternal and child health workforce development.
HRSA will continue to:

 Partner with states through the State MCH Block Grant program to improve the health of
all mothers, adolescents, and children, particularly under-served and at-risk populations
such as CYSHCN and low-income mothers and families, through a broad array of public
health and community-based programs.
 Provide gap-filling services to assure access to quality health care services for all MCH
populations
 Provide technical assistance to states as they address emerging issues, such as opioid
abuse and Zika virus infection, as needed.
 Fund continuations of existing SPRANS awards to respond to emerging issues of
regional and national significance and support collaborative learning across the states.
 Support CISS grants to improve care and outcomes for all children, including children
with special healthcare needs, through service coordination and systems integration.
The funding request also includes costs associated with the grant review and award process,
follow-up performance reviews, and information technology and other program support costs.
159
Year and Most

Recent Result /
Target for Recent
Result FY FY FY 2019
(Summary of 2018 2019 +/- FY
Measure Result) Target Target 2018
10.I.A.1: The number of children FY 2016:82 50.7M
served by the Maternal and Child Target: 34M 48M 51M +3M
Health Block Grant81 (Output) (Target Exceeded)
10.I.A.2: The number of children
FY 2016:84 5.6M85
receiving Maternal and Child Health
Target:
Block Grant services who are 5.6M86 5.6M Maintain
15M (Target Not
enrolled in and have Medicaid and
Met)
CHIP coverage83 (Output)
10.IV.B.1: Decrease the ratio of the FY 2016: 2.2
Black infant mortality rate to the to 187,88
2.0 to 1 2.0 to 1 Maintain
White infant mortality rate (Output) Target: 2.0 to 1
(Target Not Met)
81
The definition of “children” includes those with special healthcare needs. The definition of “served” is receiving
direct, enabling, and population based services.
82
Source: State FY 2018 MCH Block Grant Applications/FY 2016 Annual Reports, Title V Information System,
HRSA/MCHB
83
The definition of “children” includes those with special healthcare needs. The methodology for reporting this
measure changed in FY 2014 to include only direct and enabling services. Prior to that time states reported on
children receiving population based services as well as children receiving direct and enabling services. This change
in methodology resulted in states reporting a smaller number of children served relative to the target that had been
set before the methodology changed. This is because population based services reach a larger number of children
per dollar spent than do individually delivered services.
84
Source: State FY 2018 MCH Block Grant Applications/FY 2016 Annual Reports, Title V Information System,
HRSA/MCHB
85
FY 2016 results may appear low because of the changes in reporting direct and enabling services. The above table
reflects the target for FY 2016 that was established prior to the change in reporting methodology.
86
The target for FY 2018 was revised to reflect the change in methodology for reporting direct and enabling
services.
87
Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File
1999-2016 on CDC WONDER Online Database, released December 2016. Data are from the Compressed Mortality
File 1999-2016 Series 20 No. 2U, 2016, as compiled from data provided by the 57 vital statistics jurisdictions
through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/cmf-icd10.html
88
National Center for Health Statistics. Natality Public Use File, 2016, as compiled from data provided by the 57
vital statistics jurisdictions through the Vital Statistics Cooperative Program.
160
Year and Most
Recent Result /
Target for Recent
Result FY FY FY 2019
(Summary of 2018 2019 +/- FY
FY 2016: 5.9 per
1,00087
10.III.A.1: Reduce the infant 5.5 per 5.5 per
Target: 5.8 per Maintain
mortality rate (Outcome) 1,000 1,000
1,000
(Target Not Met)
FY 2016:
10.III.A.2: Reduce the incidence of
8.2%88
low birth weight births (Outcome) 7.8% 7.8% Maintain
Target: 7.8%
(Target Not Met)
10.III.A.3: Increase percent of
pregnant women who received FY 2016: 77%88
prenatal care in the first trimester Target: 76% 79% 79% Maintain
(Outcome) (Target Exceeded)
FY 2014: 22.2 per

10.3: Reduce the maternal mortality 100,000
rate. (deaths/100,000 live births) (baseline)90 21.6 N/A91 N/A
(Outcome)89 (Target Not in
Place)
Grant Awards Table – Maternal and Child Health Block Grant
FY 2017 FY 2018 FY 2019

Average Award $9,131,524 $9,080,694 $ 9,151,082
$145,466- $144,656 - $145,777 -

Range of Awards
$39,113,905 $38,541,369 $38,857,412
89
This is a long-term measure with no annual targets. The most recent target was set for FY2018 and will be
updated every 5 years.
90
A revised baseline was established based for FY2014 using the Centers for Disease Control and Prevention,
National Center for Health Statistics Compressed Mortality File 2014;including 45 states and the District of
Columbia that had implemented the 2003 revision of the U.S. Standard Certificate of death or a comparable
pregnancy checkbox as of January 1, 2014. File may be accessed at http://wonder.cdc.gov/cmf-icd10.html
91
This is a long-term measure with no annual targets. The most recent target was set for FY2018 and will be
updated every 5 years.
161
Grant Awards Table – SPRANS
FY 2017 FY 2018 FY 2019

Final Annualized CR President's Budget

Average Award $272,508 $272,508 $261,584
Range of Awards $14,952 - $3,500,000 $14,952 - $3,500,000 $14,952 - $3,500,000
Grant Awards Table – CISS
FY 2017 FY 2018 FY 2019

Final Annualized CR President's Budget
Number of
14 14 14
Awards
Average Award $676,084 $676,084 $676,084
$404,843 - $404,843 - $404,843 -
Range of Awards
$2,700,000 $2,700,000 $2,700,000
State Table
CFDA NUMBER/PROGRAM NAME: 93.994/Maternal and Child Health Block

Grant
FY 201893 FY 201994 FY 2019
FY 201792
Annualized President’s +/- FY
Final
CR Budget 2018
Alabama 11,264,929 11,237,479 11,328,587 91,108
Alaska 1,057,450 1,063,094 1,087,333 24,239
Arizona 7,242,332 7,168,853 7,296,839 127,986
Arkansas 6,883,968 6,860,682 6,876,413 15,731
California 39,113,905 38,541,369 38,857,412 316,043
92
MCH Block Grant allocations are determined by a formula, as cited in Section 502 (c) (2) of Title V of the Social
Security Act, in which each state receive a base amount established from 1983 funding levels with any excess
funding distributed according to each state’s share of all U.S. children living in poverty. The poverty-based
allocation for FY17 uses 3-year poverty data calculated from the American Community Survey, 2012-2014.
93
The poverty-based allocation for FY18 uses 3-year poverty data from the American Community Survey, 2013-
2015
94
The poverty-based allocation for FY19 uses 3-year poverty data from the American Community Survey, 2014-
2016
162
Grant
FY 201893 FY 201994 FY 2019
FY 201792
Final
CR Budget 2018
Colorado 7,382,930 7,290,807 7,299,734 8,927
Connecticut 4,620,209 4,605,962 4,627,137 21,175
Delaware 1,961,971 1,972,412 1,990,992 18,580
District of Columbia 6,890,080 6,893,366 6,912,601 19,235
Florida 19,186,417 19,047,608 19,316,689 269,081
Georgia 16,928,422 16,783,140 16,933,460 150,320

Hawaii 2,153,135 2,135,954 2,135,802 -152
Idaho 3,252,956 3,229,388 3,263,675 34,287
Illinois 21,035,682 20,896,819 20,972,361 75,542
Indiana 12,140,583 12,085,479 12,166,755 81,276
Iowa 6,458,264 6,444,459 6,482,111 37,652

Kansas 4,729,794 4,703,220 4,692,491 -10,729
Kentucky 10,963,089 10,951,165 11,089,913 138,748
Louisiana 12,054,384 12,067,905 12,270,038 202,133
Maine 3,310,719 3,286,771 3,306,933 20,162
Maryland 11,673,326 11,659,029 11,731,502 72,473

Massachusetts 11,038,348 11,018,409 11,042,121 23,712
Michigan 18,725,742 18,578,367 18,669,724 91,357
Minnesota 9,039,369 9,000,707 9,062,034 61,327
Mississippi 9,170,542 9,102,262 9,145,227 42,965
Missouri 12,107,084 12,033,376 12,091,607 58,231

Montana 2,277,159 2,276,100 2,268,237 -7,863
Nebraska 3,986,203 3,981,428 3,988,735 7,307
Nevada 2,083,713 2,042,348 2,072,033 29,685
New Hampshire 1,989,264 1,956,175 1,955,635 -540
New Jersey 11,460,935 11,463,882 11,526,613 62,731

New Mexico 4,060,131 4,044,153 4,100,787 56,634
New York 37,781,882 37,690,629 37,968,161 277,532
North Carolina 17,222,472 17,103,681 17,226,213 122,532
North Dakota 1,725,639 1,727,233 1,744,875 17,642
163
Grant
FY 201893 FY 201994 FY 2019
FY 201792
Final
CR Budget 2018
Ohio 21,917,021 21,765,846 21,930,711 164,865
Oklahoma 6,956,304 6,931,897 7,038,872 106,975
Oregon 6,217,387 6,164,584 6,171,771 7,187
Pennsylvania 23,480,555 23,447,566 23,667,534 219,968
Rhode Island 1,624,486 1,622,998 1,622,569 -429
South Carolina 11,408,634 11,341,765 11,393,105 51,340

South Dakota 2,147,032 2,153,398 2,169,188 15,790
Tennessee 11,714,889 11,667,474 11,744,454 76,980
Texas 33,822,318 33,537,482 34,211,850 674,368
Utah 6,127,189 6,092,917 6,088,271 -4,646
Vermont 1,646,665 1,639,272 1,645,587 6,315

Virginia 12,128,653 12,121,239 12,218,466 97,227
Washington 8,834,688 8,742,953 8,709,035 -33,918
West Virginia 6,055,641 6,061,535 6,086,827 25,292
Wisconsin 10,851,318 10,791,346 10,825,111 33,765
Wyoming 1,194,729 1,185,070 1,188,247 3,177
SUBTOTAL 519,100,537 516,211,053 520,212,378 4,001,325
American Samoa95 484,884 482,185 485,922 3,737

Guam 748,877 744,708 750,481 5,773
Marshalls 226,278 225,018 226,763 1,745
Micronesia 511,823 508,974 512,919 3,945

Northern Marianas 457,947 455,397 458,927 3,530
Palau 145,466 144,656 145,777 1,121
Puerto Rico 15,613,262 15,526,353 15,646,703 120,350
Virgin Islands96 1,470,815 1,462,628 1,473,965 11,337
SUBTOTAL 19,659,352 19,549,919 19,701,457 151,538
TOTAL Resources 538,759,889 535,760,972 539,913,835 4,152,863
95
Funds provided in the Zika Supplemental are not included in this table
96
Funds provided in the Zika Supplemental are not included in this table
164
Autism and Other Developmental Disabilities
FY 2018 FY 2019 FY 2019

FY 2017 Final Annualized CR President’s +/-
Budget FY 2018
BA $46,985,000 $46,779,000 --- -$46,779,000
FTE 6 6 --- -6
Authorizing Legislation - Public Health Service Act, Section 399BB, reauthorized by Public Law
113-157, Section 4
FY 2019 Authorization ............................................................................................... Not Specified
Allocation Methods:
 Contract
 Other
The Autism and Other Developmental Disabilities program improves care and outcomes for
children and adolescents with autism spectrum disorder (ASD) and other developmental
disabilities (DDs) through training, advancing best practices, and service. The Autism and Other
Developmental Disabilities program began in 2008 as authorized by the Combating Autism Act
of 2006. The Autism Collaboration, Accountability, Research, Education and Support, or Autism
CARES Act reauthorized the program in 2014. The program supports training programs,
research, and state systems grants to:
 Improve access to early screening, diagnosis and intervention for children with ASD
or other DDs;
 Increase the number of professionals able to diagnose ASD and other DDs;
 Promote the use of evidence-based interventions for individuals at higher risk for
ASD and other DDs as early as possible;
 Increase the number of professionals able to provide evidence-based interventions for
individuals diagnosed with ASD or other DDs;
 Provide information and education on ASD and other DDs to increase public
awareness;
 Promote research and information distribution on the development and validation of
reliable screening tools and interventions for ASD and other DDs; and
 Promote early screening of individuals at higher risk for ASD and other DDs.
Training Programs: The program has two main training components, the Leadership Education
in Neurodevelopmental and Other Related Disabilities (LEND) program and the Developmental-
165
Behavioral Pediatrics (DBP) Training program. LEND programs provide interdisciplinary
training to enhance the clinical expertise and leadership skills of professionals dedicated to
caring for children with neurodevelopmental and other related disabilities including autism. DBP
trains the next generation of leaders in developmental-behavioral pediatrics and provides
pediatric practitioners, residents, and medical students with essential biopsychosocial knowledge
and clinical expertise. For the most recent evaluation period, FY 2011-2014, the LEND and
DBP programs collectively:
 Provided diagnostic evaluations for ASD and other DDs to more than 224,000
children.
 Provided training to nearly 16,000 pediatricians, developmental-behavioral pediatrics
specialists, and other health professionals.
 Provided more than 3,000 continuing education events on early screening, diagnosis,
and intervention that reached over 214,000 pediatricians and other health
professionals.
Research: To improve the health and well-being of children with ASD, HRSA supports five
research networks and investigator-initiated autism intervention research projects. HRSA
supports research and development of reliable screening tools for ASD and other developmental
disabilities and research to advance the evidence base on the effectiveness of interventions to
improve the physical and behavioral health of individuals with ASD and other DDs, develop
guidelines for those interventions, and disseminate information regarding these research findings,
tools, and guidelines. These research investments address the Interagency Autism Coordinating
Committee Strategic Plan research questions around improving early identification and
advancing effectiveness of interventions and services for children with ASD and other
developmental disabilities. Recent accomplishments include:
 From 2011-2014, the research programs funded 57 studies on physical and behavioral
health issues related to ASD and other DDs, screening and diagnostic measures, early
intervention, and transition to adulthood.
 Collectively, the research programs developed 42 new measures and tools, including
diagnostic and screening tools and outcome measures that are helping to guide
provider practice.
 From 2011-2014, research grantees prepared 209 publications for peer reviewed
journals, of which 105 were published, and the remainder were in progress. HRSA
autism research helps underserved populations overcome barriers to diagnosis and
access needed services.
State Systems grants: The Autism and Other Developmental Disabilities program supports state
systems grants to improve access to comprehensive, coordinated health care and related services
for children and youth with ASD and other DDs.
166
Funding History
FY Amount
FY 2015 $47,099,000
FY 2016 $47,099,000
FY 2017 $46,985,000
FY 2018 $46,779,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0, which is a decrease of $46.8 million from the FY 2018
Annualized CR. The Budget prioritizes programs that support direct health care services and give
states and communities the flexibility to meet local needs. States may continue to support these
activities with their Maternal and Child Health Block Grant awards.
Year and Most

Recent Result /
Target for FY 2018
Recent Result Target +/-
(Summary of FY 2018 FY 2019 FY 2019
Measure Result) Target Target Target
50.I.A.1 Percent of long-term FY 201597:

Maintain
trainees (LEND, DBP) working LEND 75.3%
FY 2017 N/A N/A
with underserved populations, 5 DBP 85.7%
Result98
years post-training. (baseline
Target: NA)
50.I.A.2 Percent of LEND long-
FY 2015 Result:
term trainees who at 1, 5, and 10
1 year = 78 % Maintain
years post-training, work in an
5 years = 80.6% FY 2017 N/A N/A
interdisciplinary manner to serve
(baseline Result99
the MCH population
Target: NA)
97
The data source for this measure is the Discretionary Grants Information System.
98
The FY2017 target for this measure is set at a 0.5 percentage point increase in the prior year. A continued increase
is not anticipated in in FY 2018 and therefore the target has been set to maintain the results that will be reported in
FY2017.
99
The FY2017 target for this measure is set at a 0.25 percentage point increase in the prior year. A continued
increase is not anticipated in in FY 2018 and therefore the target has been set to maintain the results that will be
reported in FY2017.
167
Year and Most
Recent Result /
Target for FY 2018
50.I.A.3 Percent of MCHB Autism Baseline data
research programs supporting the for FY 2017
N/A N/A N/A
production of scientific will be available
publications (Developmental) in 2019
Grant Awards Table
FY 2017 FY 2018 FY 2019

LEND $31,655,250 $31,892,453 ---
DBP $1,848,853 $1,906,150 ---
Research $7,123,654 $7,124,950 ---
State Systems $1,680,000 $1,680,000 ---
Resource Centers $1,076,000 $1,076,000 ---
Average Award $570,839 $574,731 ---
168
Sickle Cell Disease Treatment Demonstration Program
FY 2018 FY 2019 FY 2019

President’s +/-
FY 2017 Final Annualized CR
Budget FY 2018
BA $4,444,000 $4,425,000 --- -$4,425,000
FTE 2 2 --- -2
Authorizing Legislation - American Jobs Creation Act of 2004, Public Law 108-357, Section
712(c)
FY 2019 Authorization ......................................................................................................... Expired
Allocation Methods:
 Competitive cooperative agreement
 Contract
The Sickle Cell Disease Treatment Demonstration Program (SCDTDP) improves access to care
and health outcomes for individuals with sickle cell disease, a genetic condition that results in
abnormal red blood cells that can block blood flow to organs and tissues, causing anemia,
periodic pain episodes, damage to tissues and vital organs, and increased susceptibility to
infections and early death. While life expectancy of individuals with sickle cell disease has
increased, affected populations have not benefitted equally from therapies. Specifically, until
July 2017 hydroxyurea was the only FDA approved therapy for sickle cell disease; however
many patients who could benefit from hydroxyurea do not have access to it. Barriers to access
include a lack of knowledge of the benefits and a limited number of providers prescribing
hydroxyurea. SCDTDP grantees work to address these barriers and improve the prevention and
treatment of the complications of sickle cell disease by:
 Coordinating service delivery;
 Assessing patient need for genetic counseling and testing, and providing referral as
appropriate;
 Providing guidance and technical assistance;
 Training health professionals on evidence-based treatment of sickle cell disease, such as
hydroxyurea; and
 Expanding and coordinating patient education, treatment, and care continuity.
In FY 2014-2016, the four SCDTDP grantees developed regional clinical networks, covering 25
states, Washington, DC, and 2 territories, to improve the delivery of care for patients with sickle
cell disease, primarily by training health professionals and supporting regional coordination for
service delivery through telementoring, and improve data collection to inform the delivery of
169
care. As a result, almost 11,000 patients with sickle cell disease received care through the four
regional clinical networks. In FY 2017, the program was recompeted and five organizations
received grants to develop Regional Coordinating Centers that cover the United States. The
program aims to support at least 25 states where about 50% of the 100,000 individuals live with
sickle cell disease in the United States.
Efforts have improved sickle cell disease patients’ access to appropriate sickle cell care. Each
Sickle Cell Regional Coordinating Center grantee collects data to monitor the progress of these
activities and evaluate program outcomes. Grantee performance will be demonstrated by the
number of patients served and the number of patients on hydroxyurea.
Funding History
FY Amount
FY 2015 $4,455,000
FY 2016 $4,455,000
FY 2017 $4,444,000
FY 2018 $4,425,000
FY 2019 ---
Budget Request
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $691,404 $691,404 ---

Range of Awards $345,703-$1,037,105 $345,703-$1,037,105 ---
170
James T. Walsh Universal Newborn Hearing Screening
FY 2018 FY 2019 FY 2019

President’s +/-
FY 2017 Final Annualized CR
Budget FY 2018
BA $17,775,000 $17,697,000 --- -$17,697,000
FTE 4 4 --- -4
Authorizing Legislation - Public Health Service Act, Section 399M, as amended by Public Law
111-337, Section 2, and Public Law 115-71, Section 2
FY 2019 Authorization ..................................................................................................$18,173,800
Allocation Methods:
 Competitive grant
 Cooperative agreement
The James T. Walsh Universal Newborn Hearing Screening Program (UNHS Program) enables
states and territories to develop statewide comprehensive and coordinated systems of care to
ensure that newborns/infants receive hearing screenings and those who are diagnosed as deaf or
hard of hearing receive appropriate and timely services. The Children’s Health Act of 2000 (P.L.
106-310) authorized the UNHS Program in FY 2000. The Early Hearing Detection and
Intervention Act of 2017 (P.L. 115-71) recently amended and reauthorized the program. The
UNHS Program supports state and territorial efforts to:
 Develop statewide early hearing detection and intervention (EHDI) programs and
systems;
 Recruit, retain, educate, and train qualified personnel and health care providers; and
 Establish and foster family-to-family support mechanisms after a child is identified with
hearing loss.
The UNHS Program funds 59 competitive grants to states and territories to develop
comprehensive and coordinated statewide EHDI systems of care as well as two technical
resource centers that support these efforts in addition to empowering families to serve as leaders
in the EHDI system. Funding also supports supplemental awards to 12 Leadership Education in
Neurodevelopmental and Related Disabilities training programs supported by the Autism and
Developmental Disabilities program to train future leaders in pediatric audiology. Since the
program’s inception, states and territories have had significant success in identifying newborns
and infants with permanent hearing loss. In 2015, 98.2 percent of infants were screened for
hearing loss and 60.7 percent were diagnosed appropriately, compared to 97.9 percent and 57.6
percent respectively in FY 2014. Additionally, the UNHS program continues to work with states
to meet the Healthy People 2020 objectives of screening no later than one month of age,
171
conducting audiologic evaluations no later than 3 months of age, and enrollment in early
intervention services no later than 6 months of age (1-3-6 objectives). A lack of comprehensive
data reporting requirements for service providers and variability across states in timely access to
such providers, among other factors, continues to be a challenge.
The UNHS program continues to focus on supporting early screening and diagnosis as
recommended by Healthy People 2020. Although the program did not meet the ambitious targets
set for the 1-3-6 objectives for FY 2015, overall system improvements have led to more infants
being screened and identified as deaf or hard of hearing and fewer infants being lost to follow-up
(when an infant does not receive the recommended follow‐up services) or lost to documentation
(when an infant has received services, but results have not been reported to the EHDI program
and, therefore, cannot be documented). In addition, the UNHS Program encourages grantees to
develop an integrated EHDI health information system that allows communication and protected
data sharing among health care providers to ensure that newborns and infants receive pertinent
screenings and follow-up services.
Funding History
FY Amount
FY 2015 $17,818,000
FY 2016 $17,818,000
FY 2017 $17,775,000
FY 2018 $17,697,000
FY 2019 ---
Budget Request
172
Year and Most

Recent Result / FY 2018
Target for Target
Recent Result +/- FY
(Summary of FY 2018 FY 2019 2019
13.2: Increase the percentage of infants FY 2015: 65.3%
100, 101
with hearing loss enrolled in early
72% N/A N/A
intervention before six months of age. Target: 72%
(Output) (Target Not Met)
13.III.A.1: Percentage of infants FY 2015:
suspected of having a hearing loss with 58.7%100
77% N/A N/A
a confirmed diagnosis by three months Target: 77%
of age. (Output) (Target Not Met)
FY 2015: 95.5%
13.III.A.3: Percentage of infants 100
screened for hearing loss prior to one 95% N/A N/A
Target 98%
month of age. (Output)
(Target Not Met)
13.III.A.4 Percentage of families with
deaf or hard of hearing newborns and Baseline data for
infants that are active participants and FY 2018 will be
N/A N/A N/A
leaders within their state/territory available in 2019
UNHS program and policy activities.
(Developmental)
100
2015 CDC EHDI Hearing Screening & Follow-up Survey (HSFS);
((https://www.cdc.gov/ncbddd/hearingloss/2015-data/01-2015-HSFS-Data-Summary-508.pdf). The CDC has been
collecting data annually since 2005. Baseline updated to reflect annual data collection. Previously, data was
collected by the National Center for Hearing Assessment and Management.
101
This measure is to be tracked annually in light of new Part C of the Individuals with Disabilities Act (IDEA)
regulations that mandate collaboration with Title V programs and newborn hearing screening programs.
173
FY 2017 FY 2018 FY 2019

Number of
59 59 ---
Awards
Average Award $225,787 $225,787 ---
Range of Awards
$68,740-$250,000 $68,740-$250,000 ---
102
Does not include $1.2 million for Universal Newborn Hearing & Screening cooperative agreement, ~$940,000
for LEND supplements, $500,000 for Family Leadership in Language and Learning, $200,000 for medical home
capacity building (FY 2017), and approximately $150,000 each for Advancing Systems of Services for Children and
Youth with Special Health Care Needs: medical home capacity building and technical assistance to LEND
Audiology grantees (FY 2018).
174
Emergency Medical Services for Children
FY 2019 FY 2019
BA $20,113,000 $20,025,000 --- -$20,025,000
FTE 5 5 --- -5
Authorizing Legislation – Public Health Service Act, Section 1910, as amended by Public Law
113-180, Section 2
FY 2019 Authorization ..................................................................................................$20,213,000
Allocation Method
 Contract
The Emergency Medical Services for Children (EMSC) program is the only federal grant
program specifically focused on addressing the distinct needs of pediatric patients in emergency
medical services. The EMSC program, authorized under the EMSC Reauthorization Act of 2014,
works to ensure that seriously sick or injured children have access to the same high-quality
pediatric emergency care, no matter where they live in the United States. Children make up 25
percent of hospital emergency department visits and 10 percent of emergency transports.
Critically needed pediatric skills are often not available when needed in emergency care settings.
It is also difficult to ensure that practitioners in these settings remain current on issues affecting
children.
Additionally, EMS agencies and hospital emergency departments often do not have the
necessary equipment to treat children adequately. The EMSC program works to ensure that
ambulances and emergency rooms are equipped to deal with pediatric medical emergencies and
trauma; emergency medical services personnel receive the appropriate training for pediatric
emergencies; and guidelines and agreements are in place, which ensure the safe and effective
transfer of children from one hospital to another as necessary.
In tribal and rural areas, EMSC State Partnership Regionalization of Care grantees are testing
innovative models to address challenges such as fewer pediatric specialists and greater distances
to critical care. Improvements in technology and care coordination help to reduce costs by
175
minimizing transports and expanding pediatric access to specialty care through virtual
services.103
In recent years, the EMSC program has invested in activities that have improved the pediatric
readiness of prehospital services (EMS agencies) and emergency departments as demonstrated
through the data below:
 By 2013, greater than 95 percent of EMS agencies carried at least 75 percent of
recommended equipment, 90 percent of EMS agencies had access to medical
consultation, and 85 percent of EMS agencies had protocols for pediatric patients.
 Between 2003 and 2013, the national median pediatric readiness score improved from 55
(out of 100) to 69.104 This score represents the degree to which an emergency department
has implemented the essential components for pediatric readiness.
The EMSC program also supports the Pediatric Emergency Care Applied Research Network
(PECARN), a research network that has advanced EMSC science and clinical practice, and
Targeted Issue grants to EMS practitioners to research ways to improve emergency pediatric
care. A specific example of how PECARN research has improved pediatric emergency care is
the enrollment of 42,000 children to study the appropriate use of radiographic studies (CT scans)
in children with traumatic brain injury, resulting in a clinical decision rule that has reduced
children’s exposure to unnecessary radiation and medical cost savings.105
Funding History
FY Amount
FY 2015 $20,162,000
FY 2016 $20,162,000
FY 2017 $20,113,000
FY 2018 $20,025,000
FY 2019 ---
Budget Request
103
Yang, N. H., Dharmar, M., Yoo, B. K., Leigh, J. P., Kuppermann, N., Romano, P. S., ... & Marcin, J. P. (2015).
Economic evaluation of pediatric telemedicine consultations to rural emergency departments. Medical Decision
Making, 35(6), 773-783.
104
https://emscimprovement.center/projects/pediatricreadiness/results-and-findings The response rate for the 2003
survey was 29% (N=1,489) while the response rate for the 2013 was 82% (N=4,164).
105
Kuppermann, N., Holmes, J. F., Dayan, P. S., Hoyle, J. D., Atabaki, S. M., Holubkov, R., ... & Badawy, M. K.
(2009). Identification of children at very low risk of clinically-important brain injuries after head trauma: a
prospective cohort study. The Lancet, 374(9696), 1160-1170.
176
Year and Most

Recent Result /
Target for FY 2018
CY 2014106:
9.7% decrease
14.1.A: Percent reduction in
Target: 0.5
mortality rate for children with an
percentage point
injury severity score greater than N/A107 N/A N/A
reduction from
15. (Outcome)
prior year
(Target Met)
14.V.B.4A: Number of awardees
that have made progress in FY 2016109
implementing a pediatric Result: 25
27 N/A N/A
recognition system for hospitals Target: 26
capable of dealing with pediatric (Target Not
medical emergencies.108 (Output) Met)
14.V.B.4B: Number of awardees
that have made progress in FY 2016
implementing a pediatric Result: 43
recognition system for hospitals Target: 46 44 N/A N/A
capable of dealing with pediatric (Target Not
traumatic emergencies.110 Met)
(Output)
106
The 2014 result has been retained because this metric is no longer calculable as of CY 2015 due to changes in the
data source elements. The data source for this measure is the National Emergency Department Sample, using the
most currently available pediatric mortality data. Source: Healthcare Cost and Utilization Project, Agency for
Healthcare Research and Quality.
107
A FY 2018 target cannot be established for this measure because this metric is no longer calculable as of CY
2015 due to changes in the data source elements. .
108
An organized, coordinated system that recognizes the readiness and capability of a hospital and its staff to triage
and provide care appropriately, based upon the severity of illness/injury of the child. The system designates/verifies
hospitals as providers of a certain level of emergency care within a specified geographic area (e.g., region).
109
Twenty-five grantees made significant progress in implementing a pediatric medical recognition system, with a
subset of 11 grantees having fully developed tiered system.
110
An organized, coordinated trauma system that recognizes the readiness and capability of a hospital and its staff to
triage and provide care appropriately, based upon the severity of injury of the child. The system designates/verifies
hospitals as providers of a certain level of trauma care within a specified geographic area (e.g., region).
177
Year and Most
Recent Result /
Target for FY 2018
14.V.B.5: The percentage of EMS
Baseline
agencies in the state/territory that
data for FY
have a designated individual who
2017 will be N/A N/A N/A
coordinates pediatric emergency
available in
care.
2018
(Developmental)
14.V.B.6 The number of
awardees that monitor EMS Baseline data
provider skill retention and for FY 2017 will
N/A N/A N/A
performance in the use of be available in
pediatric equipment. 2018111
(Developmental)
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $235,053 $238,761 ---
Range of Awards $130,000-$3,000,000 $130,000-$3,000,000 ---
111
This is a new performance measure that launched on March 1, 2017. Baseline data collection is underway during
the EMSC grant year (3/1/2017 to 2/28/2018). A baseline will be established in 2018 following data collection and
analysis.
178
Healthy Start
FY 2019 FY 2019
BA $118,251,000112 $102,797,000 $103,500,000 +$703,000
FTE 15 15 15 ---
Authorizing Legislation - Public Health Service Act, Section 330H, as amended by Public Law
110-339, Section 2
Allocation Method ........................................................ Competitive grant/cooperative agreement
Program Description
HRSA’s Healthy Start program provides grants to support community-based strategies to reduce
disparities in infant mortality and improve perinatal outcomes for women and children in high-
risk communities throughout the nation. Major and persistent racial and ethnic disparities exist
for infant mortality, maternal mortality, and other adverse outcomes such as preterm birth and
low birth weight. In 2015, the preterm birth rate for non-Hispanic White infants was 8.9 percent
compared to 13.4 percent for non-Hispanic Black infants.113 Similarly, in 2013 the preterm-
related infant mortality rate for non-Hispanic Black infants was three times higher than for non-
Hispanic White infants.114 Healthy Start aims to reduce these disparities by empowering high-
risk women and their families to identify and access needed services to improve the health of
mothers and children before, during, and after pregnancy. The program began in 1991 as an
initiative and was authorized and expanded under the Children’s Health Act of 2000 (P.L. 106-
310). Healthy Start was reauthorized under the Healthy Start Reauthorization Act of 2007 (P. L.
110-339).
Healthy Start funds 100 competitive grants that reach 127 counties in 37 States and the District
of Columbia. Healthy Start targets communities with infant mortality rates that are at least 1½
times the U.S. national average and/or with high indicators of poor perinatal outcomes,
particularly among non-Hispanic Black and other disproportionately affected populations.
112
Includes one-time funding of $15 million provided for lead poisoning prevention services in Flint, Michigan.
114
Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2015. NCHS data brief, no 258.
Hyattsville, MD: National Center for Health Statistics. 2016.
114
Mathews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant
death data set. National vital statistics reports; vol 64 no 9. Hyattsville, MD: National Center for Health Statistics.
2015.
179
Grantees use five approaches to reduce infant mortality through individual services and
community support to women, infants, and families:
1) Improve women’s health before, during, and between pregnancies;
2) Promote quality services;
3) Strengthen family resilience;
4) Achieve collective impact, as a result of organizations from different sectors agreeing to
solve a specific social problem using a common agenda, alignment of efforts, and use of
common measures of success115; and
5) Increase accountability through ongoing quality improvement, performance monitoring,
and evaluation.
Healthy Start implements community-based interventions and ensures a well-prepared quality

workforce; establishes an information system for client services coordination; and supports
ongoing evaluation and quality improvement at the local and national levels. The Healthy Start
service delivery model engages the entire family, working with women and their families before,
during, and after pregnancy, and through the baby’s second birthday. Service provision begins
with direct outreach by Healthy Start community health workers to high-risk women. Each
enrolled Healthy Start family receives a standardized, comprehensive assessment that considers
physical and behavioral health, employment, housing, domestic violence risks, and more. Case
managers link women and families to appropriate services and a medical home. Healthy Start
delivers services using a range of approaches, including on-site provider/program locations,
home visits, and community locations/events. Services incorporate:
 Referrals and ongoing health care coordination for well-woman, prenatal, postpartum,
and well-child care;
 Case management and linkage to social services;
 Alcohol, tobacco, and other drug use counseling;
 Nutritional counseling and breastfeeding support;
 Perinatal depression screening and linkage to behavioral health services;
 Inter-conception education and reproductive life planning; and
 Child development education and parenting support.
Healthy Start works with individual communities to build upon their existing resources to
improve the quality of, and access to, healthcare for women and infants. Every Healthy Start
project has a Community Action Network (CAN) composed of neighborhood residents, key
community leaders, perinatal care clients or consumers, medical and social service providers, as
well as faith-based and business community representatives. Together they identify and address
barriers in their community, including fragmented service delivery, lack of culturally appropriate
health and social services, and barriers to accessing care. The CAN also coordinates care and
helps ensure the maximum and non-duplicated use of resources and services.
Healthy Start projects collaborate with federal, state, and local programs, including but not
limited to, the Maternal, Infant, and Early Childhood Home Visiting Program; Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC); Early Head Start;
115
Kania J and Kramer M. Collective Impact. Stanford Social Innovation Review. 2011; 60.
http://www.ssireview.org/articles/entry/collective_impact
180
Title V Maternal and Child Health Block Grant; Medicaid; Children’s Health Insurance
Program; and local perinatal systems such as those in community health centers. These
collaborations strengthen the services provided and help reduce risk factors, such as substance
abuse during pregnancy, while promoting healthy behaviors that can lead to improved outcomes
for women and their families. Healthy Start may also provide home visiting services, but in
communities where there is a home visiting program, programs are expected to collaborate in
order to maximize coordination and minimize duplication.
Regular collection of program data using the Healthy Start Monitoring and Evaluation Data
System enables HRSA and grantees to monitor and evaluate ongoing activities, as well as to
identify technical assistance needs. HRSA supports ongoing technical assistance, training, and
education for grantees through the Healthy Start EPIC Center (www.healthystartepic.org). EPIC
Center services include strengthening staff skills to implement evidence-based practices in
maternal and child health; facilitating grantee-to-grantee sharing of expertise and lessons from
the field; and sharing resources for effective program delivery. Additionally, Healthy Start
supports the Healthy Start Collaborative Improvement and Innovation Network (HS CoIIN), a
collaborative learning partnership of 20 experienced grantees. This initiative strengthens the
program by providing feedback to HRSA on how to effectively support Healthy Start grantees.
In FY 2017, the Water Infrastructure Improvements for the Nation Act (P.L. 114-322) authorized
$15,000,000 for Healthy Start, and the Further Continuing and Security Assistance
Appropriations Act of 2017 (P.L. 114-254) provided this one-time funding to address lead
exposure in Genesee County, Michigan. These funds will assure that children with increased risk
to lead poisoning due to the Flint water crisis receive all recommended services to minimize
developmental delays.
Program Accomplishments
 HRSA transformed Healthy Start in 2014 to apply lessons from emerging research, act on
national recommendations, and improve accountability. In 2016, grantees reported an
overall infant mortality of 5.35 deaths per 1,000 live births, below the national average
despite serving communities that historically had very high rates of infant mortality.
 An important risk factor for infant mortality is the adequacy of prenatal care. Healthy
Start facilitates access to prenatal care for disadvantaged and high-risk women. In 2016,
89 percent of Healthy Start participants initiated prenatal care during the first trimester, a
notable increase from 68.3 percent in 2015.
 Low birth weight, or birth weight less than 2,500 grams, is a major contributor to infant
mortality and has been reduced among Healthy Start participants. In 2016, 9.9 percent of
infants born to Healthy Start participants were low birth weight, compared to 10.4
percent of births to Healthy Start participants in 2015.
Consistent with the commitment to data-driven and evidence-based decision-making, in 2017 the
Healthy Start program initiated a rigorous impact evaluation plan to determine the effect of the
program on changes in participant-level characteristics, including behaviors, service use, and
health outcomes. By collaborating with the Centers for Disease Control and Prevention (CDC)
and state vital records offices, the evaluation includes non-participant comparison groups
181
through linked Vital Statistics and CDC Pregnancy Risk Assessment Monitoring System
(PRAMS) data that will allow for rigorous assessments of program impact. Final results are
expected in the Fall of 2019.
Funding History
FY Amount
FY 2015 $102,000,000
FY 2016 $103,500,000
FY 2017 $118,251,000116
FY 2018 $102,797,000
FY 2019 $103,500,000
Budget Request
The FY 2019 Budget requests $103.5 million for the Healthy Start program, which is an increase
of $703,000 above the FY 2018 Annualized CR. In FY 2019, the program will be recompeted
and will serve women and families across the Nation through approximately 100 new grants.
Healthy Start expects to serve at least 69,000 participants in FY 2019 with case managed
services. Recognizing that improving birth outcomes begins with improving women’s health
before, during, and between pregnancies, funding will continue to strengthen services and
supports to improve women’s health.
The Healthy Start program will continue to support the HS CoIIN to support collaborative
learning among grantees. HRSA will continue to collect program data through the Healthy Start
Monitoring and Evaluation Data System in order to strengthen performance monitoring and
program evaluation.
Funding also includes costs associated with the grant review and award process, follow-up
performance reviews, and other program support costs.
116
Includes one-time funding of $15 million provided for lead poisoning prevention services in Flint, Michigan.
182
Outcomes and Outputs Tables117
Year and Most

Recent Result / FY 2018
Target for Recent Target
Result +/- FY
12.1: The infant mortality rate (IMR)
per 1,000 live births among Healthy FY 2013: 5.48 per
Start Program clients.118 1,000 live births N/A N/A N/A
(Outcome)
12. III.A.1: The percentage of women

FY 2016: 89%119
participating in Healthy Start who have +5%
Target: 75% 75% 80%
a prenatal care visit in the first points
(Target Exceeded)
trimester. (Outcome)
12.III.A.2. Percent of singleton births FY 2016: 9.9%120
weighing less than 2,500 grams (low Target: 9.6% 9.6% 9.6% Maintain
birth weight) (Outcome) (Target not Met)
12.E.2 The number of persons case
FY 2015: 60,000
managed in the Healthy Start Program
(baseline) 69,000122 69,000 Maintain
with a (relatively) constant level of
funding.121 (Efficiency)
117
There are limitations that should be considered when interpreting the estimates, such as these data are obtained
by self-report and may be underreported or over reported.
118
This is a long term measure with no annual targets. The last target was set in FY 2013. The next long term target
will be set for 2020 and every 5 years thereafter.
119
Note that the FY2016 result was reported as 80% in the FY2018 Congressional Justification. HRSA has updated
this result to 89% based on more recent data.
120
Note that the FY2016 result was reported as 10% in the FY2018 Congressional Justification. HRSA has updated
this result to 9.9% to be more precise.
121
This measure does not include clients served through Addressing and Preventing Lead Exposure through Healthy
Start, the program to address lead exposure in Flint, MI.
122
Target adjusted from 74,000 as set in the FY 2018 Congressional Justification to reflect FY 2018 Annualized CR
funding levels.
183
FY 2017 FY 2018 FY 2019

Final124 Annualized CR President’s Budget
Number of Awards 100 / 1 100 100
Average Award $920,737 /

$920,737 $920,737
$14,975,000
Range of Awards $372,768-1,814,000 /
$372,768-$1,814,000 $372,768-$1,814,000
$14,975,000
123
Does not include grant offsets. Does not include amounts awarded for two technical assistance awards that are
both approximately $2 million, the HS CoIIN and Supporting Healthy Start Performance Project. .
124
Column represents Healthy Start grants/Healthy Start Addressing and Preventing Lead Exposure through Healthy
Start grant. FY 2017 Final does not include the $15 million provided for lead poisoning prevention services in Flint,
Michigan.
184
Heritable Disorders in Newborns and Children
FY 2019 FY 2019
BA $13,850,000 $13,789,000 --- -$13,789,000
FTE 3 3 --- -3
Authorizing Legislation – Public Health Service Act, Section 1109-1112 and 1114, as amended
by Public Law 113-240, Section 10
FY 2019 Authorization………………………………………………………………$11,900,000
Allocation Methods:
 Contract
The Heritable Disorders in Newborns and Children program focuses on reducing the morbidity
and mortality caused by heritable disorders in newborns and children by supporting state and
local public health agencies’ ability to provide screening, counseling, and health care services.
Four million newborns each year are screened for at least 29 of the 34 conditions on the
Recommended Uniform Screening Panel (RUSP), a list of conditions recommended by the
Secretary of HHS for state newborn screening programs. Babies testing positive for one of these
conditions receive early intervention and treatment to prevent serious problems such as brain
damage, organ damage, and even death. Newborn screening saves or improves the lives of more
than 12,000 babies in the United States each year. The Heritable Disorders in Newborns and
Children program was authorized in 2000 and was reauthorized by the Newborn Screening Saves
Lives Reauthorization Act of 2014.
The program is composed of six different projects.

 The Newborn Screening Data Repository and Technical Assistance Center (the
Center) seeks to enhance, improve and expand the newborn screening system by
supporting state public health newborn screening programs, public health professionals,
and primary and specialty care providers. The Center also tracks and estimates the
incidence of screened conditions. These data help the Center assist states and territories to
implement quality improvement activities, evaluate newborn screening program impact,
and address gaps in newborn screening follow-up. In addition, the Center supports states
with implementing conditions recently added to the RUSP.
185
 The Quality Improvement in Newborn Screening Program supports states to improve
the outcomes of newborns with conditions identified through newborn screening by
improving: the amount of time it takes to identify infants at high risk for having one of
these conditions; the processes used for detecting out-of-range results; improving the
procedures for reporting out-of-range results to providers; and the methods state newborn
screening programs use to confirm diagnoses. In addition, the program addresses
emerging issues, or any other NBS process or procedure that could negatively affect the
quality, accuracy, or timeliness of NBS. The program supports 30 states to use quality
improvement methodology to improve the newborn screening system.
 The Newborn Screening Family Education Program seeks to increase awareness,
knowledge, and understanding of newborn screening for parents, families, patient
advocacy and support groups, as well as the public at large.
 The Regional Genetics Networks address the challenges of enhancing, improving, or
expanding access to screening, counseling, and health care services for newborns and
children having or at risk for genetic disorders. The networks link patients to genetic
services and provide resources to genetic service providers, public health officials and
families.
 Severe Combined Immunodeficiency (SCID) Implementation Program: SCID is a
primary immune deficiency characterized by the lack of a functioning immune system
that, if untreated, leads to death in infancy. The program works to increase awareness and
knowledge about SCID and newborn screening for SCID among parents, families, health
care providers, public health professionals, and the public; provide education, training,
and support for newborn screening programs; link children with SCID and their families
to clinical services; and improve clinical care through education and training for
providers caring for individuals with SCID.
 Since 2009, the Clearinghouse of Newborn Screening Information serves as a central
source of current educational and family support information, materials, resources,
research, and data on newborn screening. The Clearinghouse is interactive and contains
links to various resources including government-sponsored, non-profit organizations,
laboratories, and other organizations with expertise in newborn screening; research-based
information on newborn screening tests currently available throughout the United States;
and information about newborn conditions and screening services available in each state.
The Heritable Disorders in Newborns and Children program also supports the Secretary’s
Advisory Committee on Heritable Disorders in Newborns and Children (the Committee),
which was re-chartered in FY 2015 as part of the Newborn Screening Saves Lives
Reauthorization Act of 2014. The Committee advises the Secretary on reducing mortality or
morbidity from heritable disorders, conducts evidence-based reviews of conditions to
recommend updates to the RUSP, and considers ways to ensure state and territory capacity to
screen for RUSP conditions.
186
Funding History
FY Amount
FY 2015 $13,883,000
FY 2016 $13,883,000
FY 2017 $13,850,000
FY 2018 $13,789,000
FY 2019 ---
Budget Request
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $972,917 $1,072,727 ---
Range of Awards $599,999-2,000,000 $599,999-2,000,000 ---
187
Family-To-Family Health Information Centers
FY 2019 FY 2019
BA --- --- $5,000,000 +$5,000,000
Current
Law
$4,655,000 --- --- ---
Mandatory
Funding
Proposed
Law
--- $5,000,000 --- -$5,000,000
Mandatory
Funding
Total $4,655,000 $5,000,000 $5,000,000 ---
FTE 1 1 1 ---
Authorizing Legislation - Social Security Act, Section 501(c)(1)(A) as amended by Public Law
114-10, Section 216
FY 2019 Authorization………………………………………………………………Expired
Allocation Method ........................................................................................... Competitive grants
The Family-to-Family Health Information Centers (F2F HICs) Program assists families of
children and youth with special health care needs (CYSHCN) to be partners in health care
decision making. Staffed by family members who have first-hand experience using health care
services and programs for CYSHCN, F2F HICs promote cost-effective, quality health care by
providing patient-centered information, education, technical assistance, and peer support to
families of CYSHCN and health professionals. Authorized by the Deficit Reduction Act of 2005,
the program funds one health information center in each of the 50 states and the District of
Columbia. It was most recently reauthorized through the Medicare Access and Children’s Health
Insurance Program Reauthorization Act of 2015.
The 51 F2F HICs empower families of CYSHCN to be partners in health care decision making
by:
 Helping families gain the knowledge and skills to make informed health care choices that
promote good treatment decisions, cost effectiveness, and improved health outcomes;
188
 Developing models for building working relationships between families and health
professionals to assist in providing appropriate services and information;
 Providing training and guidance to health professionals on the care of CYSHCN;
 Conducting outreach activities to families, health professionals, schools, and other
appropriate entities to increase their knowledge of F2F HICs and the resources available
for CYSHCN and their families; and
 Enlisting families of CYSHCN and health professionals to staff these efforts.
Research supports the effectiveness of the F2F HIC strategy.125 Evidence shows CYSHCN
experience improved health outcomes and cost-savings when families are empowered to make
informed choices about their care and partner with health professionals.126 Documented
outcomes include:
 Improved transition from pediatric to adult health care systems;
 Fewer unmet health needs, better community-based systems;
 Fewer problems with specialty referrals;
 Lowered out-of-pocket costs;
 Improved physical and behavioral functions; and
 Increased access to preventive health care in a medical home.
In FY 2017 F2F HICs provided services to approximately 184,000 families, which exceeded the
target of 166,000 families. In addition, in FY 2017, F2F HICs trained and provided information,
resources, and referrals to approximately 85,500 health professionals who serve CYSHCN and
their families within community and state public health agencies, managed care and insurance
organizations, medical practices, children’s hospitals, universities, Federally Qualified Health
Centers, and more.
FY 2018 data will be collected and reported in the fall of 2018.
Funding History
FY Amount
FY 2015 $5,000,000
FY 2016 $5,000,000
FY 2017 $4,655,000127
FY 2018 Current Law ---
Mandatory Funding
FY 2018 Proposed law $5,000,000
Mandatory Funding
FY 2019 $5,000,000
125
Perrin JM, Romm D, Bloom SR, Homer CJ, Kuhlthau KA, Cooley C, Duncan P, Roberts R, Sloyer P, Wells N,
Newacheck P. A Family-Centered, Community-Based System of Services for Children and Youth With Special
Health Care Needs. Arch Pediatr Adolesc Med. 2007;161(10):933-936. doi:10.1001/archpedi.161.10.933
126
Smalley, L.P., Kenney, M.K., Denboba, D.D., & Strickland, B. (2013). Family perceptions of shared decision-
making with health care providers: Results of the National Survey of Children with Special Health Care Needs,
2009-2010. Maternal and Child Health Journal.
127
FY 2017 reflects the post-sequestration funding amount.
189
Budget Request
The FY 2019 Budget requests $5.0 million for the Family-to-Family Health Information Centers
(F2F HICs). FY 2019 funding will support 51 F2F HIC grants to enable families of CYSHCN to
partner in health care decision making at all levels to improve health outcomes for CYSHCN and
achieve cost-savings for families. The FY 2019 funding will help ensure continued delivery of
patient-centered information, education, technical assistance, and peer support to families of
CYSHCN. These family-staffed centers will provide other enabling support to families and
health professionals serving them including training and guidance to health professionals on the
care of CYSHCN and building joint working relationships between families and health
professionals to improve delivery of appropriate care.
performance reviews, and other program support costs.
Year and
Most Recent
Result / FY 2018
Target for Target
Recent Result +/- FY
15.III.C.1: Number of families with FY 2017:
CSHCN who have been provided 184,002
information, education and/or training Target:
174,300 174,300 Maintain
from Family-to-Family Health 166,000
Information Centers (Output). (Target
Exceeded)
Grant Awards Table 128
FY 2017 FY 2018 FY 2019

Average Award $89,643 $91,845 $91,845

Range of Awards $76,987-$90,030 $91,845 $91,845
128
Does not include carryover funding.
190
Maternal, Infant, and Early Childhood Home Visiting Program
FY 2019 FY 2019
BA --- --- $400,000,000 +$400,000,000
Current
Law
$372,400,000 --- --- ---
Mandatory
Funding
Proposed
Law
--- $400,000,000 --- -$400,000,000
Mandatory
Funding
Total $372,400,000 $400,000,000 $400,000,000 ---
FTE 43 43 43 ---
Authorizing Legislation - Social Security Act, Section 511(j), as amended by Public Law 114-10,
Section 218
Allocation Methods:
 Contract
 Formula grant/cooperative agreement
Program Description
The Maternal, Infant, and Early Childhood Home Visiting Program, (MIECHV), supports
voluntary, evidence-based home visiting services during pregnancy and to parents with young
children up to kindergarten entry. The MIECHV Program builds upon decades of scientific
research showing that home visits by a nurse, social worker, or early childhood educator during
pregnancy and in the first years of life have the potential to improve the lives of children and
families by:
 Helping to prevent child abuse and neglect;
 Encouraging positive parenting;
 Improving maternal and child health; and
 Promoting child development and school readiness.
191
By providing necessary resources and supports, home visiting empowers families. As
research129,130 shows, home visiting services provide a positive return on investment to society
through savings in public expenditures such as emergency room visits, public benefits, and child
protective services, as well as increased tax revenues from working parents.
States, territories, and tribal entities participating in MIECHV direct their home visiting efforts to
at-risk communities. The statute defines at-risk communities as those with concentrations of:
 Premature birth, low-birth weight infants, and infant mortality, including infant death due
to neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health;
 Poverty;
 Crime;
 Domestic violence;
 High rates of high school drop-outs;
 Substance abuse;
 Unemployment; or
 Child maltreatment.131
Grantees deliver services by implementing one or more of 18 evidence-based home visiting

models, selected by the grantee, which meet established evidence of effectiveness criteria, as
required by statute. Administered by the Administration for Children and Families (ACF), the
Home Visiting Evidence of Effectiveness review (HomVEE) assesses the research literature to
determine which home visiting models meet the HHS criteria for evidence of effectiveness.
While there is some variation across the 18 evidence-based home visiting models from which
grantees may select (e.g., some programs serve expectant mothers as well as parents with young
children, while others only serve families after the birth of a child), all models share some
common characteristics. In these voluntary programs, trained professionals meet regularly with
expectant parents or families with young children in their homes, building strong, positive
relationships with families who want and need support. Home visitors work with families to
determine their specific needs and provide services tailored to those needs, such as:
 Teaching parenting skills and modeling effective parenting techniques;
 Promoting early learning in the home with an emphasis on positive interactions between
parents and children and the creation of a language-rich environment that stimulates early
language development;
 Providing information and guidance on a wide range of topics including breastfeeding,
safe sleep position, injury prevention, and nutrition;
 Conducting screenings and providing referrals to address caregiver depression, substance
abuse, and family violence;
 Screening children for developmental delays and facilitating early diagnosis and
intervention for autism and other developmental disabilities; and
 Connecting families to other services and resources as appropriate.
129
Karoly, L, et al. (2005). Early Childhood Interventions: Proven Results, Future Promise. RAND Corporation.
Santa Monica, California. Available at: http://www.rand.org/pubs/monographs/MG341.html
130
Washington State Institute of Public Policy. Benefit-Cost Results. Available at:
http://www.wsipp.wa.gov/BenefitCost
131
42 U.S.C. § 711(b)(1)(A).
192
MIECHV grantees have the flexibility to tailor the program to serve the specific needs of their
states and at-risk communities. In order to meet those needs, grantees conduct needs assessments
to identify eligible at-risk communities, determine priority populations, and choose which
approved evidence-based models or promising approaches for home visiting will be used.
Grantees work with local implementing agencies to:
 Build infrastructure for implementation of home visiting programs;
 Train a high-quality home visiting workforce;
 Provide home visiting services to eligible families;
 Establish data reporting, performance measurement, continuous quality improvement,
and financial accountability systems; and
 Develop referral networks to enroll families and facilitate service coordination in local
communities.
MIECHV distributes funds for delivery of services under early childhood home visiting
programs through three types of awards:
1) Formula Grants to states, territories, and nonprofit organizations
2) Competitive Cooperative Agreements to Indian tribes (or a consortium of Indian tribes),
tribal organizations, and urban Indian organizations, as defined in section 4 of the Indian
Health Care Improvement Act.
3) Competitive Innovation Awards to states, territories, and nonprofit organizations
Additionally, three percent is set aside for research, evaluation, and corrective action technical
assistance to grantees.
Formula grants to states and territories

In FY 2017, HRSA awarded $342 million in MIECHV formula grants to 56 states, territories,
and nonprofit organizations. Grants are generally administered by the lead state agency for home
visiting designated by the Governor or can be competitively awarded to a nonprofit organization
in those states or territories that opted not to participate in the grant program.
By law, state and territory grantees must spend the majority of their MIECHV funds to
implement evidence-based home visiting models, with up to 25 percent of funding available to
implement promising approaches for home visiting that undergo rigorous evaluation. In
FY 2017, three states implemented and evaluated three promising approaches to better address
the needs of their communities.
Cooperative agreements to Indian tribes, tribal organizations, and urban Indian organizations
Three percent of funding is set aside for five-year competitive awards available to tribal entities.
As of FY 2017, 29 tribal entities had received funding through the Tribal Home Visiting
program, administered by ACF. There are currently 25 Tribal Home Visiting program grantees.
The Tribal Home Visiting Program is designed to:
 Develop and strengthen tribal capacity to support and promote the health and well-being
of American Indian and Alaska Native families through home visiting programs;
 Expand the evidence base around home visiting in tribal communities; and
193
 Support and strengthen cooperation and linkages between programs that serve Native
children and their families.
Grantees may choose to implement either Family Spirit, the one evidence-based home visiting
model with evidence of effectiveness in tribal communities, or a promising approach for home
visiting (which includes any model that meets the evidence of effectiveness criteria for the
formula grants but does not have specific evidence of effectiveness in American Indian and
Alaska Native populations).
The Tribal Home Visiting Program also supports the Tribal Early Learning Initiative, a
partnership between ACF and tribal communities that have Tribal Home Visiting, AI/AN Head
Start, and Tribal Child Care and Development Fund programs. The eight tribal communities
participating in the Tribal Early Learning Initiative work to strengthen early childhood systems
by coordinating and collaborating across the three programs, breaking down traditional silos to
improve program efficiency and outcomes for young children and their families. Grantee
accomplishments include developing a single enrollment form across programs, agreeing on
common assessment tools to be used by all tribal early learning and development programs,
investing in a data system to allow for better coordination and sharing of relevant data across
programs, and implementing joint professional development and training activities for all early
childhood staff.
Competitive Innovation Awards

Beginning in FY 2016, HRSA revised the approach for distributing competitive funds to states.
Under the new approach, HRSA awarded competitive grants in FY 2017 to support innovations
that strengthen and improve the delivery of voluntary early childhood home visiting services to
eligible families, specifically related to four areas:
1. Recruitment, engagement, and retention of eligible families;
2. Development and retention of a trained, highly skilled home visiting workforce;
3. Coordination of MIECHV-funded home visiting programs with community resources
and supports, including high-quality, comprehensive statewide and/or local early
childhood systems, such as child health, behavioral health, and human services
systems; and
4. Implementation of effective continuous quality improvement processes.
MIECHV state and territory grantees provided nearly 4.2 million visits from FY 2012 through
FY 2017. In FY 2017 states reported serving more than 156,000 parents and children in 893
counties across all 50 states, the District of Columbia, and five territories.132 This is a 350
percent increase in the number of participants served since FY 2012 (see Tables 1 and 2 below).
The program exceeded the FY 2017 targets for the number of participants and home visits. There
was a slight decrease in participants and home visits from FY 2016. This reduction may be due,
in part, to a change in the reporting definitions as well as not receiving data from Puerto Rico
and the U.S. Virgin Islands following reporting delays due to Hurricane Maria and Irma. In
132
FY 2017 data does not include figures for Puerto Rico and the U.S. Virgin Islands due to reporting delays related
to the impact of Hurricanes Maria and Irma.
194
addition, data from grantees indicate reductions in staffing over the past year. Staffing reductions
in turn reduce the number of participants home visiting programs are able to serve. Tribal
grantees provided over 72,000 home visits from FY 2012 to FY 2017 and served over 3,500
parents and children in FY 2017.
Table 1: Number of State/Territory Participants (FY 2012 – FY 2017)133
Fiscal Year Number of Participants

2012 34,180
2013 75,970
2014 115,545
2015 145,561
2016 160,374
2017134,135 156,297
Table 2: Number of Home Visits by State/Territory Grantees (FY 2012 – FY 2017)
Fiscal Year Number of Home Visits

2012 174,257
2013 489,363
2014 746,303
2015 894,347
2016 979,521
2017136,137 942,676
MIECHV currently serves 42 percent of the highest risk counties in the country as defined by the
following indicators: low birth weight, teen birth rate, percent living in poverty and infant
mortality rates.
MIECHV serves many low-income families. In FY 2017:

 72 percent of participating families had household incomes at or below 100 percent of
the federal poverty guidelines ($24,300 for a family of four), and 42 percent were at or
below 50 percent of those guidelines;
 28 percent of adult program participants had less than a high school education, and 38
percent had only a high school degree or equivalent; and
133
Data in Tables 1 and 2 represent the number of participants and home visits provided by state and territory
grantees (does not include tribal data).
134
Reflects changes HRSA made to reporting definitions beginning in FY 2017clarifying that only participants
whose services were directly supported with federal funds should be included in MIECHV reports.
135
Does not include data from Puerto Rico and the U.S. Virgin Islands due to reporting delays caused by Hurricanes
Maria and Irma.
136
Reflects changes HRSA made to reporting definitions beginning in FY 2017 clarifying that only participants
whose services were directly supported with federal funds should be included in MIECHV reports.
137
Does not include data from Puerto Rico and the U.S. Virgin Islands due to reporting delays caused by Hurricanes
Maria and Irma.
195
 15 percent of households included pregnant teens; 22 percent of households reported a
history of child abuse and maltreatment; and 12 percent of households reported
substance abuse.
Performance data from state, territory, and non-profit grantees shows that 98 percent
demonstrated improvement in at least four of the six benchmark areas for demonstrating program
improvements as outlined in the legislation: improving maternal and newborn health; preventing
child injuries, maltreatment, and emergency department visits; improving school readiness and
achievement; reducing crime or domestic violence; improving family economic self-sufficiency;
and improving service coordination and referrals for other community resources and supports. In
FY 2018, state and territory grantees will report for the first time on 19 standardized performance
indicators and systems outcome measures. The new performance measures will allow grantees to
more effectively monitor and understand program performance, and implement continuous
quality improvements in home visiting.
The statute requires an evaluation of the MIECHV Program. To fulfill this requirement, the
Mother and Infant Home Visiting Program Evaluation (MIHOPE) was initiated in 2011. In
February 2015, HHS delivered a Report to Congress that presented the first findings from the
study, including an analysis of the states’ needs assessments and baseline characteristics of
families, staff, local programs, and models participating in the study. MIHOPE found that
women enrolled in the evaluation face multiple risk factors that can lead to adverse outcomes for
themselves and their children. The study also found that local programs’ infrastructure aligns
with MIECHV Program expectations and supports quality service delivery for these families.
Final reports on program implementation, impacts, and cost effectiveness will be available in
2018.
Funding History
FY Amount
FY 2015 $400,000,000
FY 2016 $400,000,000
FY 2017 $372,400,000138
FY 2018 Current Law ---
Mandatory Funding
FY 2018 Proposed $400,000,000
Mandatory Funding
FY 2019 $400,000,000
Budget Request
The FY 2019 Budget requests $400.0 million for the Maternal, Infant, and Early Childhood
Home Visiting Program. FY 2019 funding will support the state, territory, and tribal
administration of locally run voluntary, evidence-based home visiting services for at-risk
138
FY 2017 reflects the post-sequestration funding amount.
196
families that have been proven to prevent child abuse and neglect, encourage positive parenting,
and promote child development and school readiness. This level of funding will provide:
 Awards to 53 state and territory grantees and three non-profit organizations;
 25 awards to tribal entities; and
 Support for research, evaluation, and technical assistance for both corrective action and
program improvement for state, territory, and tribal MIECHV grantees.
Early childhood systems-building supplements have been provided to some tribal grantees since
2012 (under the Tribal Early Learning Initiative) and may continue in FY 2019.
Funds will continue to support the statutory directive for an ongoing portfolio of research and
evaluation on home visiting, which includes the MIHOPE Long-Term Follow-Up evaluation, the
Home Visiting Research and Development Platform, the Home Visiting Collaborative
Improvement and Innovation Network, a study of the home visiting workforce, and a tribal early
childhood research center.
Technical assistance to grantees is of vital importance to ensure that home visiting services are
provided with quality and fidelity to evidence-based and promising approach home visiting
service delivery models. The funding will support contracts for technical assistance to state,
territory, and tribal grantees for performance measurement, implementation, data systems,
quality improvement, and research and evaluation to help grantees enhance the efficiency and
effectiveness of their home visiting programs.

Year and Most
Recent Result /
Target for FY 2018
State/
Territory/
37.1: Number of home
Tribal: State/ State/
visits to families receiving
FY 2017: Territory/ Territory/
services under the Maintain
960,180 Tribal: Tribal:
MIECHV Program.139
Target: 912,000 960,000140 960,000
(Output)
(Target
Exceeded)
139
A home visit is the service provided by qualified professionals, delivered over time within the home to build
relationships with the enrolled caregiver and the index child to achieve improved child and family outcomes. The
number of “home visits” demonstrates the level of effort and service utilization for all enrollees and index
children participating in the MIECHV Program.
140
FY2018 target adjusted to reflect trends in recent data
197
Year and Most
Recent Result /
Target for FY 2018
State/Territory:
FY 2016: 55
(98%)
Target: 53 (95%)
37.2: Number and percent State/ State/Territory:
(Target State/Territory:
of grantees that meet Territory: +2 (+3%
Exceeded) 55 (98%)
benchmark area data 53 (95%) points)
requirements for
Tribal: Tribal: 22
demonstrating Tribal: 20 Tribal: +2
FY 2016: 22 (88%)
improvement. (Outcome) (80%) (+8% points)
(88%)
Target: 20 (80%)
(Target
Exceeded)
State/
Territory/Tribal:
37.3: Number of State/ State/
FY 2017:
participants served by the Territory/ Territory/
159,844 Maintain
MIECHV Program Tribal: Tribal:
Target: 145,000
(Output) 160,000140 160,000
(Target
Exceeded)
Grant Awards Tables141
FY 2017 FY 2018 FY 2019

Average Award $4,228,467 $4,407,407 $4,407,407

Range of Awards $300,000-$22,024,005 $300,000-$23,000,000 $300,000-$23,000,000
141
Does not include carryover funding.
198
Ryan White
HIV/AIDS
TAB
199
RYAN WHITE HIV/AIDS
Ryan White HIV/AIDS Overview

The Ryan White HIV/AIDS Program (RWHAP) supports direct health care and support services
for over half a million people living with HIV (PLWH)142 – more than 50 percent of all people
living with diagnosed HIV in the United States.143 RWHAP has a history of creating effective
patient-centered services that support strong provider and patient relationships. Nearly two-thirds
of clients (patients) live at or below 100 percent of the Federal poverty level. Approximately
three-quarters of RWHAP clients are racial/ethnic minorities. Viral suppression outcome
measures demonstrate the success of the RWHAP as 85 percent of patients receiving medical
care are virally suppressed144 - this creates a major public health benefit by also reducing new
infections.
Administered by HRSA’s HIV/AIDS Bureau (HAB), the RWHAP funds and coordinates with
cities, states, and local clinics/community-based organizations to deliver efficient and effective
HIV care, treatment, and support to low-income PLWH. The RWHAP statute indicates that the
program is the “payor of last resort” which means that RWHAP funds can only be used for
services not covered by other Federal or state programs, or private insurance.
During the past 27 years, RWHAP has developed a comprehensive system of safety net
providers who deliver high quality direct health care and support services. This system is the
foundation for reaching the public health goal of ending the HIV epidemic in the United States.
The RWHAP is critical to ensuring that individuals with HIV are linked and retained in care, are
able to adhere to medication regimens, and ultimately, remain virally suppressed. These steps
are not only crucial to ensuring the health outcomes of PLWH but to preventing further
transmission of the virus and, ultimately, ending the HIV epidemic.145
Research studies demonstrate a 96 percent reduction of HIV transmission to others among

PLWH on antiretroviral medications who achieve viral suppression.146 According to a Clinical
Infectious Diseases study, clients receiving care and support at RWHAP-funded facilities are
142
Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data
Report 2015. http://hab.hrsa.gov/data/data-reports. Published December 2016. Accessed December 9, 2016.
143
Table 18a. Persons living with diagnosed HIV infection, by year and selected characteristics, 2010–2013 - United
States. CDC HIV Surveillance Report, 2014; vol. 26. http://www.cdc.gov/hiv/library/reports/surveillance/.
Published November 2015.
144
HIV viral suppression was based on data for RWHAP clients who had at least 1 outpatient ambulatory medical
care visit during the measurement year and one viral load measurement and whose most recent viral load test result
was <200 copies/mL.
145
The goal of HIV treatment is to decrease viral load in PLWH, ideally to an undetectable level, known as viral
suppression. When viral suppression is achieved and maintained, the risk of transmitting HIV is reduced.
146
National Institute of Allergy and Infectious Disease (NIAID). Preventing Sexual Transmission of HIV with Anti-
HIV Drugs. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016
Mar 29]. Available from: http://clinicaltrials.gov/show/ NCT00074581 NLM Identifier: NCT00074581.
200
associated with improved outcomes (such as viral suppression), compared to others.147 Eighty-
five (85) percent of RWHAP patients are virally suppressed compared to the 58 percent of all
people living with diagnosed HIV in the United States who may be in or out of care.148,149
Furthermore, RWHAP patients are more likely to reach viral suppression regardless of other
health care coverage (e.g., uninsured, Medicaid, Medicare, or private insurance). Improved viral
suppression rates reduce the transmission of HIV and result in significant cost-savings to the
health care system.150
According to recent data, the RWHAP has made tremendous progress toward ending the HIV
epidemic in the United States. From 2010 to 2016, HIV viral suppression among RWHAP
patients has increased from 70 percent to 85 percent, and racial/ethnic, age-based, and regional
disparities have decreased.151 These improved outcomes mean more PLWH in the United States
will live near normal lifespans and have a reduced risk of transmitting HIV to others. Even with
these positive outcomes, fully addressing the HIV epidemic domestically continues to be a
challenge. The CDC estimates that more than 1.1 million people in the United States are living
with HIV infection, and almost 1 in 6 (15 percent) of those are unaware of their HIV infection.152
In addition, approximately 40,000 new HIV infections occur each year.153
Through targeted funding, the RWHAP provides opportunities for innovations to improve HIV
services to low-income PLWH within the context of their health care coverage status. At local
and state levels, RWHAP recipients assess unmet need and then structure their program to fill the
most critical gaps to provide a comprehensive system of HIV care in their jurisdiction.
To ensure effective use of resources and a coordinated and focused public health response,
HRSA works closely with the CDC and other Federal partners to provide effective services that
address underlying medical, public health, and social service needs, with the ultimate goal of
ending the HIV epidemic in the United States. In FY 2019, the RWHAP will continue to
coordinate and collaborate with other Federal, State, and local entities as well as national AIDS
organizations in order to further leverage and promote efforts to address the unmet care and
treatment needs of PLWH who are uninsured and underserved. HAB’s work in collaboration
with other programs has bolstered the success of the RWHAP’s efforts through the alignment of
147
Bradley H, Viall AH, Wortley PM, Dempsey A, Hauck H, Skarbinski J. Ryan White HIV/AIDS Program
Assistance and HIV Treatment Outcomes. Clin Infect Dis. (2016) 62 (1): 90-98.
148
Table 5a. Viral suppression during 2014 among persons aged >=13 years. Centers for Disease Control and
Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—
United States and 6 dependent areas, 2015. HIV Surveillance Supplemental Report 2017;22(No. 2).
http://www.cdc.gov/hiv/library/reports/hivsurveillance.html. Published July 2017. Accessed December 29, 2017.
149
Based on data reported by 32 States and the District of Columbia.
150
The lifetime cost of medical care and medications for a PLWH is $380,000. Schackman et al. The lifetime cost of
current human immunodeficiency virus care in the United States. Med Care 2006; 44(11):990-997.
151
Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data
Report 2015. http://hab.hrsa.gov/data/data-reports. Published December 2016. Accessed December 9, 2016.
152
Table 9a. Est. HIV prevalence among persons aged >= 13 years and percentages of persons living with
undiagnosed HIV infection, 2014. CDC HIV Surveillance Supplemental Report 2017; Volume 22, No. 2. Available
at http://www.cdc.gov/hiv/library/reports/ surveillance/. Published July 2017. Accessed December 29, 2017.
153
Table 1a. Diagnoses of HIV infection by year of diagnosis and selected characteristics, 2011 – 2016 – United
States. CDC HIV Surveillance Report 2017; Volume 28. Available at http://www.cdc.gov/hiv/library/reports/
surveillance/. Published November 2017. Accessed December 29, 2017.
201
the priorities, policies, and activities of the multi-faceted and comprehensive Federal response to
the HIV epidemic. Federal partners include the Office of the Assistant Secretary for Health
(OASH), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and
Mental Health Services Administration (SAMHSA), the Centers for Medicare and Medicaid
Services (CMS), the Indian Health Service (IHS), the National Institutes of Health (NIH), the
Agency for Healthcare Research and Quality (AHRQ), the Department of Housing and Urban
Development (HUD), the Department of Veterans Affairs (VA), and the Department of Justice
(DOJ) as well as other HRSA-funded programs, such as the Health Center Program.
The Administration looks forward to working with Congress to reauthorize the RWHAP to
ensure that Federal funds are allocated to address the changing landscape of HIV across the
United States.
The Budget request proposes statutory changes through Ryan White HIV/AIDS Program
authorization to the RWHAP Part A and B funding methodologies. These changes would allow
HRSA to utilize a data driven framework to distribute RWHAP Part A and B funding to ensure
that funds are allocated to populations experiencing high or increasing levels of HIV
infections/diagnoses, such as minority populations, while continuing to support Americans that
are already living with HIV across the nation. This approach would reduce burden for recipients
and increase HHS’s ability to effectively focus resources for HIV care, treatment, and support
needs in funded cities and states based on need, geography, data quality, and performance.
The Budget request also proposes statutory changes to the Ryan White authorization intended to
simplify, modernize and standardize certain statutory requirements and definitions to be
consistent across the RWHAP Parts and to reduce burden when an organization receives funding
from multiple RWHAP Parts. These changes would align and consolidate the slightly differing
provisions and eliminate those provisions that are no longer current.
202
RWHAP Part A - Emergency Relief Grants
FY 2019
FY 2017 FY 2018 President’s FY 2019 +/- FY
Final Annualized CR Budget 2018
BA $654,296,000 $651,422,000 $655,876,000 +$4,454,000
MAI (non add) $54,105,000 $54,105,000 $54,105,000 ---
Total Funding $654,296,000 $651,422,000 $655,876,000 +$4,454,000

FTE 44 44 44 ---
111-87
FY 2019 Authorization……………………………………………….……………..…….Expired
Allocation Method:
 Formula Grants
 Competitive Grants/Cooperative Agreements
 Contracts
Ryan White HIV/AIDS Program (RWHAP) Part A provides grants to cities with a population of
at least 50,000, which are severely affected by the HIV epidemic. These jurisdictions are funded
as either an Eligible Metropolitan Area (EMA) or a Transitional Grant Area (TGA), depending
on the severity of the epidemic in their jurisdiction. Formula and supplemental grants assist
eligible areas in developing and enhancing access to a comprehensive continuum of high quality,
community-based care for low-income people living with HIV (PLWH). The RWHAP requires
EMAs and TGAs to develop coordinated systems of HIV care in order to improve health
outcomes for low-income PLWH, thereby reducing transmission of HIV. Seventy-two percent
of all people living with diagnosed HIV reside in a RWHAP Part A EMA or TGA. 154,155
RWHAP Part A prioritizes primary medical care, access to antiretroviral treatment, and other
core medical and supportive services in order to engage and retain PLWH in care. The grants
fund systems of care to provide services for PLWH in 24 EMAs, which are jurisdictions with
154
Table 20a. Persons living with diagnosed HIV infection, by year and selected characteristics, 2011–2015 - United
States. CDC HIV Surveillance Report, 2016; vol. 28. http://www.cdc.gov/hiv/library/reports/surveillance/.
Published November 2017.
155
Centers for Disease Control and Prevention. HIV/AIDS data through December 2015 provided for the Ryan
White HIV/AIDS Program, for fiscal year 2017. HIV Surveillance Supplemental Report 2017;22(No. 5).
http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2017.
203
2,000 or more AIDS cases over the last five years, and 28 TGAs, which are jurisdictions with at
least 1,000 but fewer than 2,000 AIDS cases over the last five years as reported to the Centers for
Disease Control and Prevention. Two-thirds of the funds available for EMAs and TGAs are
awarded according to a formula, based on the number of living cases of HIV in the EMAs and
TGAs. The remaining funds are awarded as discretionary supplemental grants based on the
demonstration of additional need by the eligible EMAs and TGAs, and as Minority AIDS
Initiative (MAI) grants. The MAI funds are a statutory set-aside funding component for Parts A
– D, and Part F AIDS Education and Training Center programs to evaluate and address the
disproportionate impact of HIV/AIDS on, and the disparities in access, treatment, care, and
outcomes for, racial and ethnic minorities. MAI funds are also awarded based on a formula
utilizing the number of minorities living with HIV and AIDS in a jurisdiction and support HIV
care, treatment, and support services to racial/ethnic minorities.
The RWHAP Part A funds are awarded to the Chief Elected Official who is required to establish
a local Planning Council/Body that determines the allocation of RWHAP resources based on
local needs assessments. Eligible sub-recipients are community health centers, health
departments, ambulatory care facilities, and other non-profit organizations providing services for
PLWH.
In 2016, 77 percent of RWHAP Part A clients were racial/ethnic minorities and 26 percent were
women. In 2016, RWHAP Part A funded sites provided 3.6million core medical service visits
for health-related care utilizing a combination of Parts A, B, C, and D funding. The number of
visits for health-related services demonstrates the scope of Part A in delivering primary care and
related services for PLWH by increasing the availability and accessibility of care.
RWHAP Part A Funding History

FY Amount
FY 2010 $678,074,000
FY 2011 $672,529,000
FY 2012 $666,071,000
FY 2013 $624,262,000
FY 2014 $649,373,000
FY 2015 $655,220,000
FY 2016 $655,876,000
FY 2017 $654,296,000
FY 2018 $651,422,000
FY 2019 $655,876,000
Budget Request
The FY 2019 Budget requests $655.9 million for the Ryan White HIV/AIDS Program (RWHAP)
Part A, which is $4.5 million above the FY 2018 Annualized CR level. The request will fund
RWHAP activities and services for PLWH in the 24 EMAs and 28 TGAs. The FY 2019 Request
proposes statutory changes through Ryan White HIV/AIDS Program authorization to the
RWHAP Part A funding methodology. These changes would allow HRSA to utilize a data
driven framework to distribute RWHAP Part A funding to ensure that funds are allocated to
204
populations experiencing high or increasing levels of HIV infections/diagnoses, such as minority
populations, while continuing to support Americans that are already living with HIV across the
nation. This approach would reduce burden for recipients and increase HHS’s ability to
effectively focus resources for HIV care, treatment, and support needs in funded cities based on
need, geography, data quality, and performance.
Nearly 68 percent of all clients served by the RWHAP in 2016 were served in one of the 52
metropolitan areas funded under the RWHAP Part A. Approximately 72 percent of all PLWH
reside within these metropolitan areas. The RWHAP serves populations that are increasingly
diverse and challenging in terms of service delivery (e.g., PLWH at or below 100 percent Federal
Poverty Level and/or those who are homeless). The clinical paradigm has changed significantly
such that ongoing and effective treatment can not only enhance the quality and length of life but
also can suppress the virus and reduce new infections. Thus, the RWHAP Part A has a
significant public health impact on HIV incidence. These factors outline the context and role of
the RWHAP Part A Program, which focuses on areas with concentrated cases of HIV, which
must further develop and sustain a comprehensive system of HIV care to improve health
outcomes and address the HIV epidemic.
In FY 2019, Part A grant recipients will continue to provide services not covered by private or
public health care plans but which are essential to:
1. Providing quality comprehensive HIV care, such as intensive case management and care
coordination services, and
2. Linking individuals living with HIV into care in a timely manner, initiating antiretroviral
treatment as early as possible, and retaining them in ongoing care.
Supporting interventions that get people linked into care and on medications is critical to prevent
the spread of the epidemic as studies have found that treatment reduces HIV transmission by
more than 96 percent. RWHAP Part A jurisdictions are experienced in data-driven, community-
based needs assessment, responsive procurement of a variety of direct medical and supportive
services, working with a set of providers to weave together a constellation of services, serving
diverse populations and continuing to make improvements that positively affect the HIV care
continuum.
follow-up performance reviews, information technology, and other program support costs.
Measuring Ryan White HIV/AIDS Program Performance

Direct Service Provision: The FY 2019 performance target for the service utilization measure is
that RWHAP Part A will provide 3.6 million core medical service visits for health-related care.
RWHAP Part A funding will contribute to achieving the FY 2019 targets for the RWHAP’s
over-arching performance measures including: percentage of racial/ethnic minorities and women
served, percentage of clients who achieved viral suppression, and percentage of HIV-positive
pregnant women in Ryan White HIV/AIDS Programs who receive antiretroviral medications (in
Part B Section).
205
Improving Access to Health Care: The RWHAP works to improve access to health care by
addressing the disparities in access, treatment, and care for populations disproportionately
affected by HIV, including low-income racial/ethnic minorities. Through targeted investments,
the RWHAP has consistently provided HIV care and treatment services to a significantly higher
proportion of HIV-positive racial/ethnic minorities than their representation in the epidemic
nationally. According to the most recent CDC data (2015), 70 percent of PLWH in the United
States are racial/ethnic minorities, while 73 percent of RWHAP clients are racial/ethnic
minorities.156
The RWHAP also serves a higher proportion of women living with HIV relative to the number
of HIV cases reported nationally by the CDC and has maintained this higher percentage for the
past five years. In 2015, 27 percent of RWHAP clients living with HIV were women, compared
to 24 percent of CDC-reported women living with diagnosed HIV infection in the United States.
Improving Health Outcomes: The RWHAP works to improve health outcomes by preventing
transmission or slowing disease progression for disproportionately impacted communities. One
way RWHAP accomplishes this is through the provision of medications that help patients reach
HIV viral suppression. From 2010 to 2016, HIV viral suppression among RWHAP clients has
increased from 70 percent to 85 percent, and racial/ethnic, age-based, and regional disparities
have decreased.
PLWH who are on the appropriate medications and virally suppressed are less infectious,
reducing the risk of transmitting HIV to others. The importance of helping PLWH reach viral
suppression through antiretroviral medications and other medical and support services has been
highlighted by studies which show antiretroviral treatment reduces HIV transmission by more
than 96 percent. The RWHAP will continue to support activities that help low-income PLWH
reach viral suppression until the goal of an AIDS-free generation is achieved. Two targets have
been set for FY 2019 to measure progress related to antiretroviral treatment and viral suppression
across the RWHAP Parts A – D:
 At least 90 percent of pregnant women living with HIV will receive antiretroviral
medications through the RWHAP (in Part B section)
 At least 83 percent of all patients receiving HIV medical care and at least one viral load
test will be virally suppressed.
HRSA will continue to set goals for those disproportionately impacted by HIV. At some point in
their lifetimes, 1 in 16 black men will be diagnosed with HIV infection, as will 1 in 32 black
women. The estimated rate of newly diagnosed HIV infections for black women was more than
156
Table 20b. Persons living with diagnosed HIV infection, by year and selected characteristics, 2011-2015 – United
States and 6 dependent areas. Centers for Disease Control and Prevention. HIV Surveillance Report, 2016; vol. 28.
http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2017. Accessed December 29,
2017.
206
15 times that of white women and almost 5 times that of Hispanic/Latina women.157 Black and
Hispanic/Latina women accounted for 78 percent of the estimated total of all women diagnosed
with HIV infection.158 Youth (ages 13-24) make up an estimated 22 percent of all new HIV
diagnoses in the United States in 2016.159 Two performance targets have been set for FY 2019 to
measure progress related to HIV care, treatment, and support of racial/ethnic minorities and
women:
 The RWHAP will serve racial/ethnic minorities at a proportion that is not lower than 3
percentage points of national HIV prevalence data as reported by CDC.
 The RWHAP will serve women at a proportion that is not lower than 3 percentage points
of national HIV prevalence data as reported by CDC.
Year and Most

Recent Result /
Target for Recent FY 2018
Result / FY 2018 FY 2019 +/-
Measure (Summary of Result) Target Target FY 2019
17.I.A.2: Number of 2016: 3.6M
RWHAP Part A visits for (Target not in place)
3.7M 3.6M -.1M
health-related care.160
(Output) 2015 Baseline: 3.7 M
2016: 73.2%
16.I.A.1: Percentage of Target: Within 3

Not lower Not lower
people living with HIV percentage points of
than 3 than 3
served by the Ryan White CDC data (CDC data
percentage percentage Maintain
HIV/AIDS Program who not available)
points of CDC points of
are racial/ethnic
data CDC data
minorities.161 (Outcome) 2015: 73.1%
Target: Within 3
percentage points of
157
Table 3a. Diagnoses of HIV infection by race/ethnicity and selected characteristics, 2016 – United States. CDC
HIV Surveillance Supplemental Report 2017; Volume 28. http://www.cdc.gov/hiv/library/reports/ surveillance/.
Published November 2017. Accessed December 29, 2017.
158
Table 22a. Persons living with diagnosed HIV infection by race/ethnicity and selected characteristics, year-end
2015 – United States. Centers for Disease Control and Prevention. HIV Surveillance Report, 2016; vol. 28.
2017.
159
Table 1a. Diagnoses of HIV infection by year of diagnosis and selected characteristics, 2011 – 2016 – United
States. Centers for Disease Control and Prevention. HIV Surveillance Report, 2016; vol. 28.
2017.
160
This measure reports on core medical services. It replaces measure 17.I.A.1 that reported on only a subset of
core medical services.
161
A RWHAP overarching performance measure that applies to Parts A, B, C, and D and is not Part A specific.
207
Year and Most
Recent Result /
Target for Recent FY 2018
Result / FY 2018 FY 2019 +/-
Measure (Summary of Result) Target Target FY 2019
CDC data or 69.8%
(Target Met)
2016: 26.95%
Target: Within 3
CDC data (CDC data
16.I.A.2: Percentage of Not lower Not lower
not available)
people living with HIV than 3 than 3
served by the Ryan White percentage percentage Maintain
2015: 27.0%
HIV/AIDS Program who points of CDC points of
Target: Within 3
are women.162 (Outcome) data CDC data
CDC data or 24%
(Target Met)
16.III.A.4: Percentage of
Ryan White HIV/AIDS
2016: 85%
Program clients receiving
(Target not in place)
HIV medical care and at 83% 83% Maintain
least one viral load test
2015 Baseline: 83%
who are virally
suppressed.163
Grant Awards Table

FY 2017 Final Annualized CR Budget
Average Award $12,109,576 $12,109,576 $12,195,230
Range of Awards $2,841,355 - $2,841,355 - $2,841,355 -

$98,869,770 $98,869,770 $98,869,770
162
A RWHAP overarching performance measure that applies to Parts A, B, C, and D and is not Part A specific. The
first target is set for 2018.
163
This is a RWHAP overarching performance measure that applies to Parts A, B, C, and D and is not Part A
specific.
208
RWHAP Part A – FY 2017 Formula, Supplemental & MAI Grants164
Table 1. Eligible Metropolitan Areas
EMAs Formula165 Supplemental MAI Total

Atlanta, GA $15,388,141 $7,765,662 $2,376,116 $25,529,919
Baltimore, MD 9,836,906 5,540,990 1,631,100 17,008,996
Boston, MA 9,102,632 4,782,459 1,000,465 14,885,556
Chicago, IL 16,607,645 8,472,441 2,370,449 27,450,535
Dallas, TX 10,641,875 5,370,448 1,353,909 17,366,232
Detroit, MI 5,633,713 3,279,350 814,056 9,727,119
Ft. Lauderdale, FL 9,740,502 4,824,699 1,266,527 15,831,728
Houston, TX 14,088,300 6,567,876 2,117,885 22,774,061
Los Angeles, CA 26,409,738 13,626,878 3,509,303 43,545,919
Miami, FL 15,528,997 8,457,806 2,644,652 26,631,455
Nassau-Suffolk, NY 3,356,448 1,811,951 446,803 5,615,202
New Haven, CT 3,342,523 1,898,644 456,593 5,697,760
New Orleans, LA 4,618,263 2,658,091 632,594 7,908,948
New York, NY 57,774,082 31,888,924 9,206,764 98,869,770
Newark, NJ 7,385,043 4,175,063 1,265,600 12,825,706
Orlando, FL 6,090,559 2,834,567 779,948 9,705,074
Philadelphia, PA 13,405,442 7,479,766 1,994,128 22,879,336
Phoenix, AZ 5,802,955 2,870,083 542,120 9,215,158
San Diego, CA 7,109,758 3,584,211 707,817 11,401,786
San Francisco, CA 9,579,294 5,463,505 768,201 15,811,000
San Juan, PR 6,495,989 3,561,222 1,249,112 11,306,323
Tampa-St. Petersburg, FL 6,258,729 3,371,799 663,301 10,293,829
Washington, DC-MD-VA-WV 18,878,483 10,681,106 2,957,703 32,517,292
West Palm Beach, FL 4,462,946 2,512,504 662,683 7,638,133
Subtotal EMAs $287,538,963 $153,480,045 $41,417,829 $482,436,837
164
Awards to EMAs and TGAs include prior year unobligated balances.
165
Hold Harmless expired in FY 2014.
209
Table 2. Transitional Grant Areas
TGAs Formula Supplemental MAI Total

Austin, TX $3,034,191 $1,468,780 $328,199 $4,831,170
Baton Rouge, LA 2,765,539 1,394,005 443,918 4,603,462
Bergen-Passaic, NJ 2,485,988 1,291,393 349,323 4,126,704
Charlotte-Gastonia, NC-SC 3,831,974 1,842,270 559,741 6,233,985
Cleveland, OH 2,886,514 1,424,794 365,398 4,676,706
Columbus, OH 2,937,738 1,320,479 276,161 4,534,378
Denver, CO 4,976,335 2,480,300 369,107 7,825,742
Fort Worth, TX 2,808,044 1,332,555 343,346 4,483,945
Hartford, CT 1,991,188 993,222 266,371 3,250,781
Indianapolis, IN 2,706,686 1,380,177 274,203 4,361,066
Jacksonville, FL 3,662,500 1,867,559 503,478 6,033,537
Jersey City, NJ 3,045,635 1,659,069 465,661 5,170,365
Kansas City, MO 2,691,428 1,363,059 264,105 4,318,592
Las Vegas, NV 3,871,754 1,857,385 408,677 6,137,816
Memphis, TN 4,203,619 1,904,279 688,650 6,796,548
Middlesex-Somerset-Hunterdon, NJ 1,690,384 919,326 231,645 2,841,355
Minneapolis-St. Paul, MN 3,684,842 1,865,596 352,620 5,903,058
Nashville, TN 2,878,340 1,401,384 306,147 4,585,871
Norfolk, VA 3,635,253 1,767,646 532,228 5,935,127
Oakland, CA 4,398,705 2,218,135 548,509 7,165,349
Orange County, CA 3,955,129 1,952,880 419,187 6,327,196
Portland, OR 2,612,957 1,320,071 131,692 4,064,720
Riverside-San Bernardino, CA 4,896,230 2,408,938 486,167 7,791,335
Sacramento, CA 2,110,528 1,072,691 182,802 3,366,021
Saint Louis, MO 3,913,714 1,903,048 459,066 6,275,828
San Antonio, TX 3,251,075 1,582,354 481,736 5,315,165
San Jose, CA 1,927,431 988,811 219,383 3,135,625
Seattle, WA 4,546,382 2,305,080 318,203 7,169,665
Subtotal TGAs $91,400,103 $45,285,286 $10,575,723 $147,261,112
Subtotal EMAs/TGAs $378,939,066 $198,765,331 $51,993,552 $629,697,949
210
RWHAP Part B - HIV Care Grants to States
FY 2019 FY 2019
BA $1,311,837,000 $1,306,075,000 $1,315,005,000 +$8,930,000
MAI (non add) $10,145,000 $10,145,000 $10,145,000 ---

ADAP (non
add) $900,313,000 $894,199,000 $900,313,000 +$6,114,000
Total Funding $1,311,837,000 $1,306,075,000 $1,315,005,000 +$8,930,000

FTE 63 63 63 ---
111-87
FY 2019 Authorization……………………………………………………………………Expired
Allocation Method:
 Formula Grants
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part B is the largest RWHAP Part providing
grants to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and
five Associated Jurisdictions to provide services for people living with HIV (PLWH). RWHAP
Part B grants support outpatient ambulatory medical care, HIV-related prescription medications,
case management, oral health care, health insurance premium and cost-sharing assistance, mental
health and substance abuse services, and support services.
Seventy-five percent of RWHAP Part B funds must be used to support core medical services.
RWHAP Part B funds are distributed through base and supplemental grants, AIDS Drug
Assistance Program (ADAP) base and ADAP supplemental grants, Emerging Communities
(ECs) grants, and Minority AIDS Initiative (MAI) grants. The base awards are distributed by a
formula based on a state or territory’s living HIV/AIDS cases weighted for cases outside of the
jurisdictions that receive RWHAP Part A funding. The ECs are metropolitan areas that do not
qualify as RWHAP Part A EMAs or TGAs but have 500-999 cumulative reported AIDS cases
over the last five years. States apply on behalf of the ECs for funding through the Part B base
grant application. RWHAP Part B Supplemental grants are available through a competitive
process to eligible states with demonstrated need.
211
A portion of the RWHAP Part B appropriation supports ADAP, which supports the provision of
HIV medications and related services, including health insurance premium and cost-sharing
assistance. These funds are distributed by a formula based on living HIV/AIDS cases. In
addition, ADAP supplemental funds are a five percent set aside for states with severe need.
ADAP provides FDA-approved prescription medications for PLWH who cannot afford HIV
medications. ADAP is instrumental in efforts to end the HIV epidemic across the nation. ADAP
provides the access to medications and insurance necessary for PWLH to achieve optimal health
outcomes and viral suppression. . Individual ADAPs operate in all 50 states, the District of
Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of
the Northern Mariana Islands, the Federated States of Micronesia, the Republic of Palau, and the
Republic of the Marshall Islands.
The MAI funds are a statutory set-aside funding component for RWHAP Parts A – D, and Part F
AIDS Education and Training Center programs to evaluate and address the disproportionate
impact of HIV/AIDS on, and the disparities in access, treatment, care, and outcomes for, racial
and ethnic minorities. The RWHAP Part B MAI funding is statutorily required to specifically
support education and outreach services to increase the number of eligible racial/ethnic
minorities who have access to the RWHAP ADAP.
Over half of diagnosed PLWH in the United States who are in regular care receive antiretroviral
medications or medication assistance through RWHAP ADAPs. According to the RWHAP
ADAP Data Report, the demand for ADAP services has increased over the last six years from
208,809 clients in 2010, to 259,531 clients in 2015, a growth of 24 percent. In FY 2015, 67
percent of the clients served by ADAPs were racial/ethnic minorities. Nationally, more than 78
percent of ADAP clients had incomes at or below 200 percent of the Federal poverty level.
Increased demand for RWHAP Part B services in recent years has led a number of States to
implement cost-containment measures for their Part B ADAPs. Cost-containment measures
include reducing ADAP formularies, capping enrollment, lowering financial eligibility levels,
and implementing waiting lists for people to enroll in their ADAP. In addition, states
implemented cost-savings strategies such as recovering costs when another payor was primary,
coordinating benefits with Medicare Part D, and improving drug-purchasing models. In
particular, State ADAPs reported savings by participating in manufacturer rebate programs and
recovering costs through insurance reimbursement of $1.17 billion in 2015.
Since FY 2010, HHS has taken several actions to stabilize the RWHAP ADAP:
 In FY 2010, HHS used emergency authority to redistribute and transfer $25 million to
provide direct assistance to help State ADAPs eliminate their waiting lists and to address
cost containment measures;
 The FY 2011 appropriation provided an increase of $50 million for State ADAPs,
including $40 million in emergency relief funding;
212
 In FY 2012, $75 million in emergency funding was provided for ADAPs, including $35
million in redirected funding and $40 million in continuation emergency funding first
appropriated in FY 2011;
 In FY 2013, HHS redirected an additional $35 million above the FY 2013 appropriations
for State ADAPs, bringing the total for ADAP emergency relief funding to $75 million;
 In FY 2014, HRSA leveraged $73 million from the ADAP appropriation to support
emergency relief efforts to help State ADAPs eliminate their waiting lists and to address
cost containment measures;
 In FY 2015 and FY 2016, HRSA leveraged $75 million from the ADAP appropriation to
support emergency relief efforts to help State ADAP eliminate their waiting lists and to
address cost containment measures; and
 In FY 2017, HRSA leveraged $65 million from the ADAP appropriation to support
emergency relief efforts to help State ADAP maintain elimination of their waiting lists
and to address cost containment measures.
Because of investments in RWHAP ADAP and the increased technical assistance activities for
cost-containment measures, the program was able to serve 146,106 clients with HIV-related
medications or medication assistance in FY 2015. ADAP waiting lists decreased from a peak of
9,310 in September 2011, to zero in August 2015 because of these directed efforts. In FY 2018
and FY 2019, HRSA will continue the use of ADAP Emergency Relief Funds (ERF) through
“311 authority” in order to maintain infrastructure in the states and territories that had previously
imposed waiting lists and to ensure that no new waiting lists are established. This funding is also
required to address the gaps in access created by ongoing cost-containment measures in many
state ADAPs such as HIV medication formulary reductions, lower client financial eligibility
levels, and capped enrollment. However, with no individuals on the RWHAP ADAP waiting
lists in FY 2017, HRSA distributed $47.3 million in ERF funding, $18 million less than it had
planned for FY 2017 and allocated these remaining funds to the RWHAP ADAP Base Award.
These funds are required to be used for RWHAP ADAP services, including the purchase of
medications, insurance premium assistance, and medication copay assistance. States that
developed need through unforeseen events had the ability to request Part B supplemental funds
to assist in meeting shortfalls.
The RWHAP Part B has been successful in helping to ensure that PLWH have access to the care
and treatment services they need to live longer, healthier lives. Recent studies have
demonstrated that individuals with HIV on antiretroviral medications who achieve viral
suppression are not at risk to transmit HIV to others. The RWHAP provides the care and
treatment services that support the achievement of viral suppression and therefore, has a
significant public health impact on HIV incidence as well. These efforts demonstrate the central
role of the RWHAP in ending the HIV epidemic by ensuring that PLWH have access to regular
care, are started on, and adhere to, their antiretroviral medications.
In 2016, 70 percent of RWHAP Part B clients were racial/ethnic minorities, and 27 percent were
women. The number of visits for health-related services demonstrates the scope of Part B in
delivering primary care and related services for PLWH by increasing the availability and
213
accessibility of care. In 2016, Part B funded sites provided 3.4 million core medical service
visits for health-related care utilizing Parts A, B, C, and D funding.
Funding History
FY Amount ADAP (Non-Add)

FY 2010 $1,276,791,000 ($858,000,000)
FY 2011 $1,308,141,000 ($885,000,000)
FY 2012 $1,360,827,000 ($933,299,000)
FY 2013 $1,287,535,000 ($886,313,000)
FY 2014 $1,314,446,000 ($900,313,000)
FY 2015 $1,315,005,000 ($900,313,000)
FY 2016 $1,315,005,000 ($900,313,000)
FY 2017 $1,311,837,000 ($900,313,000)
FY 2018 $1,306,075,000 ($894,199,000)
FY 2019 $1,315,005,000 ($900,313,000)
Budget Request
The FY 2019 Budget requests $1.3 billion for the Ryan White HIV/AIDS Program (RWHAP)
Part B, which is $8.9 million above the FY 2018 Annualized CR level. The request includes
$900.3 million for ADAPs to provide access to life saving HIV related medications and direct
health care services to people living with HIV (PLWH) in all 50 States, the District of Columbia,
Puerto Rico, the Virgin Islands, Guam and five Pacific jurisdictions. The 311 authority will be
utilized to implement the Emergency Relief Fund to minimize RWHAP ADAP waiting lists.
The FY 2019 Request proposes statutory changes through Ryan White HIV/AIDS Program
authorization to the RWHAP Part B funding methodology. These changes would allow HRSA to
utilize a data driven framework developed by the Secretary to distribute RWHAP Part B funding
to ensure that funds are allocated to populations experiencing high or increasing levels of HIV
infections/diagnoses, such as minority populations, while continuing to support Americans that
are already living with HIV across the nation. This approach would reduce burden for recipients
and increase HHS’s ability to effectively focus resources for HIV care, treatment, and support
needs based on need, geography, data quality, and performance.
In FY 2019, the RWHAP ADAP will continue to serve more than 259,000 clients. An important
contributing factor to the demand for services for ADAP continues to be access to HIV
medications and high cost-sharing requirements for these medications. The RWHAP will
continue to provide access to life-saving medications and related services for PLWH.
In FY 2019, RWHAP Part B/ADAP grant recipients will continue to work directly with
uninsured PLWH to ensure access to health care coverage and will continue to support HIV
medications not on health plan formularies and the cost sharing required by health coverage
plans. RWHAP ADAP resources will also support:
214
 The continued increase in RWHAP clients as more PLWH are diagnosed, linked to care,
and retained in care;
 The continued increase in RWHAP growth as more people enter the health care system
with coverage who require assistance with insurance premiums and cost-sharing; and,
 The continued need for ADAP for clients who remain uninsured.

that RWHAP Part B will provide 3.4 million core medical service visits for health-related care.
According to the RWHAP ADAP Report, State ADAP Programs continue to provide robust
formularies of antiretroviral medications to treat HIV infection, prevent and treat opportunistic
infections, manage side effects, and treat co-morbidities. From 2010 through 2014, State
ADAPs served 59,827 additional clients, an increase of 28.7 percent. In 2015, State ADAP
programs served 268,636 clients, exceeding the FY 2015 performance target by 32,406 clients.
Cost Containment: Across the RWHAP, grant recipients are encouraged to maximize resources
and leverage efficiencies. One example of this is within RWHAP Part B, where State ADAPs
use a variety of strategies to maximize resources, which result in effective funds management,
enabling ADAPs to serve more people. Cost-containment approaches used by ADAPs include
using drug-purchasing strategies such as cost recovery through drug rebates and third party
billing; directly negotiating pharmaceutical pricing; reducing ADAP formularies; capping
enrollment; and lowering financial eligibility levels. In 2015, State ADAPs participating in cost-
savings strategies on medications saved $1.12 billion, exceeding the FY 2015 performance target
by $60.2 million. Over the last 5 years, ADAPs participating in medication cost-savings
strategies saved $4.7 billion.
RWHAP will continue to provide access to life-saving medications and related services for low-
income PLWH. While the number of RWHAP ADAP clients is projected to remain constant in
future years with anticipated steady funding, health care coverage and costs related to co-pays,
co-insurance, premiums, etc., are difficult to anticipate. The increased demand for ADAP
services in recent years has required many states to recover costs when possible by coordinating
benefits with Medicare Part D or exhausting all coverage options, participating in rebate
programs, and improving drug-purchasing models. Two performance targets have been set for
FY 2019 to measure RWHAP ADAP performance:
 The RWHAP ADAP will continue to be able to serve 259,531 clients in 2019. This
target is based on anticipated steady funding and not demand.
 The RWHAP ADAP will maintain prior year results of State ADAP’s participation in
cost-savings strategies on medications.
RWHAP Part B/ADAP funding will contribute to achieving the FY 2019 targets for the
RWHAP’s over-arching performance measures including: percentage of racial/ethnic minorities
215
and women served (in Part A section), percentage of clients who achieved viral suppression (in
Part A Section), and percentage of HIV-positive pregnant women in Ryan White HIV/AIDS
Programs who receive antiretroviral medications
Antiretroviral Therapy to Pregnant Women: Mother-to-child transmission in the United States

has decreased dramatically since its peak in 1992 due to 1) the implementation of opt-out testing
for HIV for all pregnant women; and 2) the use of antiretroviral therapy, which significantly
reduces the risk of HIV transmission from the mother to her baby. In 2016, 96 percent of HIV-
positive pregnant women served by the RWHAP were prescribed antiretroviral therapy to
prevent maternal-to-child transmission of HIV, exceeding the FY 2016 performance target of 90
percent. In 2019, HRSA and the Centers for Disease Control and Prevention will collaborate to
accelerate the elimination of perinatal HIV transmission in the United States.
Year and
Most Recent
Result /
Target for
Recent Result
/ FY 2018
2016: 3.4M
(Target not in
18.I.A.2: Number of RWHAP Part B
place)
visits for health-related care.166 3.6M 3.4M -.2M
(Output)
2015 Baseline:
3.6M
2015: 259,531
16.II.A.1: Number of AIDS Drug
Target:
Assistance Program (ADAP) clients
212,107 259,531 259,531 Maintain
served through State ADAPs annually.
(Target
(Output)
Exceeded)
16.E: Amount of savings by State 2015: $1.12B
Sustain Sustain
ADAPs’ participation in cost-savings Target: $1.02B
Prior Year Prior Year Maintain
strategies on medications. (Containing (Target
Results Results
Costs) Exceeded)
16.II.A.3: Percentage of HIV-positive 2016: 96%
pregnant women in Ryan White Target: 90%
90% 96% +6%
HIV/AIDS Programs who receive (Target
antiretroviral medications.167 (Output) Exceeded)
166
This measure reports on core medical services. It replaces measure 18.I.A.1 that reported on only a subset of
core medical services. The first target is set for 2018.
167
This RWHAP overarching performance measure applies to Parts A, B, C, and D and is not Part B specific.
216
Grant Awards Table
FY 2018 Annualized FY 2019 President’s

FY 2017 Final CR Budget
Average Award $23,856,579 $23,856,579 $24,007,935
Range of Awards $50,000 - $50,000 - $50,000 -

$181,550,889 $181,550,889 $181,550,889
RWHAP Part B – FY 2017 State Table168

State/ Emerging
Territory Base Base Suppl. ADAP Total Communities MAI Grand Total
Alabama $7,891,622 $4,000,000 $10,081,565 $309,234 $154,750 $22,437,171
Alaska 500,000 152,453 567,987 0 0 1,220,440
American 23,877
23,734 0 143 0 0
Samoa
Arizona 4,079,902 0 11,586,446 0 120,556 15,786,904
Arkansas 3,324,876 0 4,368,380 0 51,239 7,744,495
California 33,146,827 35,000,000 111,954,339 164,048 1,285,675 181,550,889
Colorado 3,402,181 0 9,644,402 0 79,499 13,126,082
Connecticut 2,794,701 0 8,848,895 0 0 11,643,596
Delaware 2,055,117 0 2,625,416 196,874 40,128 4,917,535
District of 16,963,586
3,828,733 0 12,905,249 0 229,604
Columbia
F. States 50,000
50,000 0 0 0 0
Micronesia
Florida 30,743,307 0 88,224,056 481,611 1,342,005 120,790,979
Georgia 13,448,517 700,000 49,467,718 167,886 599,252 64,383,373
Guam 200,000 0 60,943 0 0 260,943
Hawaii 1,628,955 0 2,080,994 0 22,360 3,732,309
Idaho 573,728 1,809,207 1,740,507 0 0 4,123,442
Illinois 9,567,609 0 32,275,155 0 448,304 42,291,068
Indiana 3,609,959 26,365,550 11,126,249 0 0 41,101,758
Iowa 1,404,425 12,286,473 1,794,156 0 0 15,485,054
Kansas 1,104,957 0 2,490,529 0 0 3,595,486
Kentucky 4,072,706 0 5,202,891 270,120 47,644 9,593,361
168
Awards include prior year unobligated balances.
217
State/ Emerging
Louisiana 6,402,181 0 16,799,088 0 266,998 23,468,267
Maine 796,350 1,776,038 1,017,339 0 0 3,589,727
Marshall 48,436
47,623 0 813 0 0
Islands
Maryland 7,965,275 0 25,998,201 0 475,222 34,438,698
Massachusetts 4,989,140 0 14,460,547 0 0 19,449,687
Michigan 4,994,196 0 13,040,135 0 185,847 18,220,178
Minnesota 2,040,110 900,000 6,262,483 0 66,668 9,269,261
Mississippi 5,904,190 6,375,000 10,278,657 280,981 133,301 22,972,129
Missouri 3,508,508 8,700,000 10,064,501 0 0 22,273,009
Montana 500,000 1,087,718 1,272,607 0 0 2,860,325
N. Marianas 50,000 42,576 1,625 0 0 94,201
Nebraska 1,268,944 3,416,000 1,621,079 0 0 6,306,023
Nevada 2,147,677 1,902,971 6,541,195 0 0 10,591,843
New 1,463,709
Hampshire 500,000 0 963,709 0 0
New Jersey 10,286,108 1,097,877 30,213,006 0 511,067 42,108,058

New Mexico 1,876,383 0 2,397,084 0 0 4,273,467
New York 35,252,036 35,000,000 107,486,859 616,508 1,824,537 180,179,940
North Carolina 11,497,540 7,300,000 26,192,394 301,803 371,591 45,663,328
North Dakota 500,000 0 213,706 0 0 713,706
Ohio 5,555,550 0 16,796,650 323,524 0 22,675,724
Oklahoma 3,630,642 0 4,638,154 227,985 0 8,496,781
Oregon 1,728,496 0 4,749,476 0 0 6,477,972
Pennsylvania 10,822,830 0 27,850,050 273,060 411,857 39,357,797
Puerto Rico 5,972,511 18,214,030 28,392,459 0 326,114 52,905,114
Republic of 53,250
50,000 0 3,250 0 0
Palau
Rhode Island 1,496,654 2,460,384 1,911,979 188,137 22,188 6,079,342
South Carolina 10,208,283 0 13,282,281 558,531 216,120 24,265,215
South Dakota 500,000 0 415,224 0 0 915,224
Tennessee 5,215,284 0 23,135,481 0 193,536 28,544,301
Texas 23,234,672 2,800,000 87,441,727 0 1,007,480 114,483,879
Utah 1,718,640 2,710,676 3,686,275 0 15,859 8,131,450
Vermont 500,000 0 407,098 0 0 907,098
Virgin Islands 500,000 946,025 498,918 0 9,735 1,954,678
Virginia 7,180,931 0 27,410,415 381,500 275,942 35,248,788
218
State/ Emerging
Washington 3,617,896 0 9,936,928 0 76,799 13,631,623
West Virginia 1,037,285 0 1,443,938 0 0 2,481,223
Wisconsin 3,610,212 2,824,500 4,636,529 258,198 54,886 11,384,325
Wyoming 500,000 0 238,083 0 0 738,083
Total $315,058,003 $177,867,478 $898,745,963 $5,000,000 $10,866,763 $1,407,538,207
219
RWHAP Part C - Early Intervention Services
FY 2019 FY 2019
BA $200,585,000 $199,713,000 $201,079,000 +$1,366,000
MAI (non add) $71,012,000 $71,012,000 $71,012,000 ---
Total Funding $200,585,000 $199,713,000 $201,079,000 +$1,366,000

FTE 54 54 56 +2
111-87
FY 2019 Authorization………………………………………………..……..……….…...Expired
Allocation Method:
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part C provides grants directly to community
and faith-based organizations, community health centers, health departments, and university or
hospital-based clinics in 49 states, the District of Columbia, Puerto Rico, and the U.S. Virgin
Islands. RWHAP Part C supports comprehensive primary health care and support services in an
outpatient setting for low-income, uninsured, and underserved people living with HIV (PLWH).
The MAI funds are a statutory set-aside funding component for Parts A – D, and Part F AIDS
Education and Training Center programs to evaluate and address the disproportionate impact of
HIV/AIDS on, and the disparities in access, treatment, care, and outcomes for, racial and ethnic
minorities. Part C Minority AIDS Initiative funding supports HIV care, treatment, and support
services to racial/ethnic minorities. Part C is also authorized to fund capacity development
grants that strengthen organizational development and infrastructure, resulting in a more
effective delivery of HIV care and services.
The RWHAP Part C provides services for PLWH who are disproportionately affected by the
HIV epidemic and have poor health outcomes, including ethnic and minority populations and
youth. In 2016, Part C funded sites served over 300,000 clients utilizing a combination of Parts
A, B, C, and D funding. Of the total clients served, 72 percent were racial/ethnic minorities and
27 percent were female. Part C providers have the clinical expertise and cultural competency to
provide quality care and treatment to low-income, diverse people living with HIV. In 2016,
RWHAP Part C funded sites provided 3.5 million core medical service visits for health-related
care utilizing a combination of Parts A, B, C, and D funding. The number of visits for health-
220
related services demonstrates the scope of Part C in delivering primary care and related services
for PLWH by increasing the availability and accessibility of care.
Funding History
FY Amount
FY 2010 $206,383,000
FY 2011 $205,564,000
FY 2012169 $215,086,000
FY 2013 $194,444,000
FY 2014 $205,544,000
FY 2015 $204,179,000
FY 2016 $205,079,000
FY 2017 $200,585,000
FY 2018 $199,713,000
FY 2019 $201,079,000
Budget Request
Part C, which is $1.4 million above the FY 2018 Annualized CR level. In FY 2019, RWHAP
Part C grant recipients’ clients will continue to achieve improved health outcomes resulting from
the comprehensive array of direct medical and supports services that are essential in addressing
the HIV epidemic. Part C supports direct health care services for low income PLWH who may
not be fully covered by public or private health care plans. These services are considered
essential to improving health outcomes and are a crucial part of the care network that links and
retains PLWH into health care. Such critical health care services include intensive case
management and care coordination services, linking and retaining PLWH into care and getting
them on antiretroviral medications as early as possible.

that RWHAP Part C will provide 3.5 million visits for health-related care.
RWHAP Part C funding will contribute to achieving the FY 2019 targets for the RWHAP’s
served (in Part A section), percentage of clients who achieved viral suppression (in Part A
Section), and percentage of HIV-positive pregnant women in Ryan White HIV/AIDS Programs
who receive antiretroviral medications (in Part B Section).
169
Reflects Ryan White Budget Authority only (does not include $5.089 million in Health Center Program Budget
Authority for Part C grant recipients in FY 2012).
221
Improving the Quality of Health Care: A major focus of the RWHAP is improving the quality
of care that participating clients receive. Grant recipients are required to develop, implement,
and monitor clinical quality management programs to ensure that service providers adhere to
established HIV clinical practices and implement quality improvement strategies. The statute
also requires that demographic, clinical, and health care utilization information be used to
monitor trends in the spectrum of HIV-related illnesses. The RWHAP will continue to assist
grant recipients in developing or maintaining a clinical quality management program.

Year and Most
Recent Result /
Target for Recent
Result / FY 2018
2016: 3.5M
19.II.A.3: Number of (Target not in place)
RWHAP Part C visits for 3.8M 3.5M -.3M
health-related care.170 2015 Baseline:
(Output) 3.8M
Grant Awards Table

Average Award $528,334 $525,382 $525,382
Range of Awards $92,720 - $1,540,565 $94,676 - $1,534,196 $94,676 - $1,534,196
170
This measure reports on core medical services. It replaces measure 19.II.A.2 that reported on only a subset of
core medical services. The first target is set for 2018.
222
RWHAP Part D - Women, Infants, Children and Youth
FY 2019 FY 2019
BA $74,907,000 $74,578,000 $75,088,000 +$510,000
MAI (non add) $23,671,000 $23,671,000 $23,671,000 ---
Total Funding $74,907,000 $74,578,000 $75,088,000 +$510,000

FTE 10 10 10 ---
111-87
FY 2019 Authorization………………………………………………….…………………Expired
Allocation Method:
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part D provides grants directly to public or
private community-based organizations, hospitals, and State and local governments. Currently,
there are 116 Part D grant recipients located in 40 states, the District of Columbia, and Puerto
Rico. The RWHAP Part D focuses on providing access to coordinated, comprehensive,
culturally and linguistically competent, family-centered HIV primary medical care and support
services. RWHAP services focus on low-income, uninsured, and underserved HIV-positive
women, infants, children, and youth living with HIV and their affected171 family members. Part
D also funds essential support services, such as case management and transportation that help
clients’ access medical care and stay in care. The MAI funds are a statutory set-aside funding
component for Parts A – D, and Part F AIDS Education and Training Center programs to
evaluate and address the disproportionate impact of HIV/AIDS on, and the disparities in access,
treatment, care, and outcomes for, racial and ethnic minorities. Part D Minority AIDS Initiative
funding supports HIV care, treatment, and support services to racial/ethnic minorities. In 2016,
Part D funded sites provided over 220,000 visits for health-related care and support services
utilizing a combination of Parts A, B, C, and D funding.
The RWHAP Part D serves women, infant, children, and youth – populations disproportionately
affected by HIV epidemic that have poor health outcomes. In 2016, RWHAP Part D funded sites
served 217,665 clients utilizing a combination of Parts A, B, C, and D funding. Of the total
171
Support services are available for family members not living with HIV. Some examples are family-centered case
management, childcare services during medical appointment attendance, and psychosocial support services that
focus on equipping affected family members, and caregivers, to manage the stress associated with HIV.
223
clients served, 75 percent were racial/ethnic minorities and 29 percent were female. Part D
providers have the clinical expertise and cultural competency to provide quality care and
treatment to low-income, diverse women, infant, children, and youth living with HIV.
Funding History
FY Amount
FY 2009 $76,845,000
FY 2010 $77,621,000
FY 2011 $77,313,000
FY 2012 $77,167,000
FY 2013 $72,361,000
FY 2014 $72,395,000
FY 2015 $73,008,000
FY 2016 $75,088,000
FY 2017 $74,907,000
FY 2018 $74,578,000
FY 2019 $75,088,000
Budget Request
Part D, which is $0.5 million above the FY 2018 Annualized CR level. In FY 2019, RWHAP
Part D grant recipients’ clients will continue to achieve improved health outcomes resulting from
the comprehensive array of medical and supports services that are essential in addressing the
HIV epidemic. Part D supports health care services for low income PLWH who may not be fully
covered by public or private health care plans. These services are considered essential to
improving health outcomes and are a crucial part of the care network that links and retains
PLWH into health care, especially for women, infants and children and youth. Such critical
health care services include intensive case management and care coordination services, linking
and retaining PLWH into care and getting them on antiretroviral medications as early as
possible.

that RWHAP Part D will provide 221,737 health-related care and support service visits.
RWHAP Part D funding will contribute to achieving the FY 2019 targets for the RWHAP’s
served (in Part A section), percentage of clients who achieved viral suppression (in Part A
Section), and percentage of HIV-positive pregnant women in Ryan White HIV/AIDS Programs
who receive antiretroviral medications (in Part B Section).
224
To achieve the elimination of mother-to-child (perinatal) HIV transmission goal, the Centers for
Disease Control and Prevention (CDC) and the Health Resources and Services Administration
(HRSA) will accelerate efforts by continuing to invest in eliminating mother-to-child HIV
transmission efforts (EMCT), primarily through o-going collaborations with health departments
and the Ryan White HIV/AIDS Program Part D programs.

Year and Most
Recent Result / FY
Target for Recent 2018
Result / +/-
(Summary of FY 2018 FY 2019 FY
2016: 221,737
(Target not in
place)
220,713 221,737 +1,024
20.II.A.2 Number of RWHAP Part D
visits for health-related care and 2015 Baseline:
support services 220,713
Grant Awards Table

Average Award $580,068 $580,068 $580,068
Range of Awards $113,823 - $2,185,691 $113,823 - $2,185,691 $113,823 - $2,185,691
225
RWHAP Part F - AIDS Education and Training Programs
FY 2019 FY 2019
BA $33,530,000 $33,383,000 --- -$33,383,000
MAI (non add) $10,144,000 $10,144,000 --- -$10,144,000
Total Funding $33,530,000 $33,383,000 --- -$33,383,000

FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Sec. 2692(a), as amended by Public Law
111-87.
FY 2019 Authorization………………………………………………………………...….Expired
Allocation Method:
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part F AIDS Education and Training Center
(AETC) Program supports a network of regional centers and two national centers that conduct
targeted, multidisciplinary education and training programs for health care providers serving
people living with HIV (PLWH) in all states, DC, Puerto Rico, the U.S. Virgin Islands, and the
Associated Jurisdictions. The RWHAP AETC improves the quality of life of persons living with
or at-risk of HIV through the provision of specialized professional education and training. The
program uses a strategy of implementation of multidisciplinary education and training programs
for health care providers in the prevention and treatment of HIV.
RWHAP AETC-trained providers are more experienced with regard to HIV clinical care and
treat more PLWH patients than other primary care providers.172 The RWHAP AETCs target
training to health care providers who serve minority populations, the homeless, rural
communities, incarcerated persons, federally qualified community and migrant health centers,
and RWHAP sites. In addition, nearly half the providers themselves are racial/ethnic minorities.
In 2015-2016, the proportion of racial/ethnic minority health care providers participating in
AETC training intervention programs was 47 percent, exceeding the FY 2016 performance target
by 4 percent.
172
Devin McBrayer. “Treatment Cascade” presentation, July 7, 2014. https://prezi.com/p6biexvknarb/addressing-
hiv-stigma-in-health-care-workers/
226
AETCs currently train providers through a variety of training modalities, including didactics,
clinical preceptorships, self-study, clinical consultation, communities of practice and distance-
based technologies. A variety of educational formats are used such as including skills building
workshops, hands-on preceptorships and mini-residencies, on-site training, tele-education, and
technical assistance. Clinical faculty also provides timely clinical consultation in person or via
the telephone or internet.
Funding History
FY Amount
FY 2010 $34,745,000
FY 2011 $34,607,000
FY 2012 $34,542,000
FY 2013 $32,390,000
FY 2014 $33,275,000
FY 2015 $33,349,000
FY 2016 $33,611,000
FY 2017 $33,530,000
FY 2018 $33,383,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Ryan White HIV/AIDS Program (RWHAP) Part F-
AETC, which is $33.4 million below the FY 2018 Annualized CR level. The Budget prioritizes
programs that provide direct healthcare services.

Year and Most
Recent Result /
Target for Recent
Result / FY 2018
21.V.B.1: Proportion of
RWHAP AETC training FY 2015: 47%
intervention participants Target: 43% 43% N/A N/A
that are racial/ethnic (Target Exceeded)
minorities. (Output)
227
Grant Awards Table

Average Award $2,029,605 $2,547,385 ---
Range of Awards $175,460 - $4,278,600 $750,000 - $4,278,600 ---
228
RWHAP Part F - Dental Programs
FY 2019 FY 2019
BA $13,090,000 $13,033,000 $13,122,000 +$89,000

FTE 1 1 1 ---
Authorizing Legislation: Public Health Service Act, Section 2692(b) as amended by Public Law
111-87
FY 2019 Authorization………………………………………………………….…….…..Expired
Allocation Method:
 Competitive Grants
 Formula Grants
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part F funding supports two dental programs: 1)
HIV/AIDS Dental Reimbursement Program (DRP); and 2) Community-Based Dental
Partnership Program (CBDPP).
The RWHAP DRP ensures access to oral health care for low-income people living with HIV
(PLWH) by reimbursing dental education programs for the non-reimbursed costs they incur
providing such care. By offsetting the costs of non-reimbursed HIV care in accredited dental
education institutions, the DRP improves access to oral health care for low-income, PLWH and
ensures quality services by dental students, dental hygiene students, and dental residents for
providing oral health care services to PLWH. The care provided through the program includes a
full range of diagnostic, preventive, and treatment services, including oral surgery, as well as oral
health education and health promotion. Dental schools, post-doctoral dental education programs,
and dental hygiene education programs accredited by the Commission on Dental Accreditation
that have documented non-reimbursed costs for providing oral health care to PLWH are eligible
to apply for reimbursement. Funds are then distributed to eligible organizations taking into
account the number of people served and the cost of providing care.
In FY 2016, the RWHAP DRP awards were able to provide 27 percent of the total non-
reimbursed costs requested by 52 participating institutions in support of oral health care. These
institutions reported providing care to 36,232 HIV-positive individuals, 18,644 for whom no
other funded source was available, missing the FY 2016 performance target by 3,578 individuals
or 10 percent. In FY 2016, the demographic characteristics of patients who were cared for by
institutions participating in the DRP were 54 percent minority and 31 percent women.
229
The RWHAP CBDPP supports collaborations between dental education programs and
community-based partners to deliver oral health services in community settings while supporting
students and residents enrolled in accredited dental educations programs. In FY 2016, CBDPP
funded 11 partnership grants to support collaboration and coordination between the dental
education programs and the community-based partners in the delivery of oral health services.
Programs FY 2017 FY 2018 FY 2019

Dental Reimbursement
Program $8,721,326 $9,042,411 $9,042,411
Community-Based
Dental Partnership
Program $3,189,991 $3,489,991 $3,489,991
Funding History
FY Amount
FY 2010 $13,565,000
FY 2011 $13,511,000
FY 2012 $13,485,000
FY 2013 $12,646,000
FY 2014 $12,991,000
FY 2015 $13,020,000
FY 2016 $13,122,000
FY 2017 $13,090,000
FY 2018 $13,033,000
FY 2019 $13,122,000
Budget Request
The FY 2019 Budget requests $13.1 million for the Ryan White HIV/AIDS (RWHAP) Part F
Dental Programs, which is $89,000 above the FY 2018 Annualized CR level. The request will
support oral health care for PLWH. This Request supports the reimbursement of applicant
institutions through the RWHAP DRP and funding of the RWHAP CBDPP.

Direct Service Provision: The FY 2019 target for the dental health care measure is that
institutions will be reimbursed for a portion of their unreimbursed oral health costs for provision
of uncompensated care to 36,232 people.
230
Year and Most
Recent Result /
Target for Recent
Result / FY 2018
22. I.D.1: Number of
persons for whom a
2016: 36,232
portion/percentage of their
Target: 39,810 38,436 36,232 -2,204
unreimbursed oral health
(Target Not Met)
costs were reimbursed.
(Output)
Grant Awards Table

Average Award $177,781 $184,300 $184,300
Range of Awards $1,901 - $1,134,333 $1,901 - $1,134,333 $1,901 - $1,134,333
231
RWHAP Part F - Special Projects of National Significance
FY 2019 FY 2019
BA $24,940,000 $24,830,000 --- -$24,830,000

FTE 2 2 --- -2
111-87
FY 2019 Authorization………………………………………………………….…….…..Expired
Allocation Method:
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance
(SPNS) supports the development, evaluation, and dissemination of innovative models of HIV
care to improve the retention and health outcomes of RWHAP clients. The RWHAP SPNS
evaluates the effectiveness of the models’ design, implementation, utilization, cost, and health
related outcomes, while promoting the dissemination and replication of successful models.
Through these special projects, SPNS grant recipients implement a variety of promising
interventions gathering evidence-informed practices and lessons learned to improve treatment
outcomes and avert new HIV infections. SPNS initiatives address the emerging needs of the
most disproportionately impacted populations living with HIV.
The RWHAP SPNS program provides opportunities for the development, implementation, and
assessment of system, community, and individual-level innovations designed to meet RWHAP
goals as well as the demands of changing health care delivery systems. Through its
demonstration projects, SPNS models contribute to the advancement of public health knowledge
and help move toward the elimination of HIV in the United States by promoting models that
focus on expanding linkage to HIV medical care, improving lifelong retention in HIV medical
care, the delivery of ART, and ultimately achieving HIV viral suppression among people living
with HIV.
Of the 64 currently funded FY 2016 RWHAP SPNS grant recipients: 15 percent are community-
based organizations/AIDS service organizations, 22 percent are state/county/local departments of
health, 36 percent are community health centers, 10 percent are academic-based clinics, and 11
percent are evaluation and technical assistance centers.
232
Funding History
FY Amount
FY 2008 $25,000,000
FY 2009 $25,000,000
FY 2010 $25,000,000
FY 2011 $25,000,000
FY 2012 $25,000,000
FY 2013 $25,000,000
FY 2014 $25,000,000
FY 2015 $25,000,000
FY 2016 $25,000,000
FY 2017 $24,940,000
FY 2018 $24,830,000
FY 2019 ---
Budget Request
The FY 2019 Budget requests $0 for the Ryan White HIV/AIDS Program (RWHAP) Part F
Special Projects of National Significance (SPNS), which is $24.8 million below the FY 2018
Annualized CR level. The Budget prioritizes programs that provide direct healthcare services.
Grant Awards Table

Average Award $420,468 $602,596 ---
Range of Awards $200,000 - $5,324,429 $200,000 - $5,469,458 ---
233
Healthcare Systems
TAB
234
HEALTHCARE SYSTEMS
Organ Transplantation
FY 2019 FY 2019
BA $23,492,000 $23,389,000 $23,549,000 +$160,000
FTE 2 2 2 ---
Authorizing Legislation: Public Health Service Act, Sections 371-378, as amended by Public
Law 113-51
FY 2019 Authorization……………………….….….….….….…...….….….….….…..... Expired
Allocation Method:
 Contracts
 Competitive Grants/Co-operative Agreements
 Other (Interagency Support)
The National Organ Transplant Act of 1984 (NOTA), as amended, provides the authorities for
the Organ Transplantation Program (Program). The primary purpose of the Program is to extend
and enhance the lives of individuals with end-stage organ failure for whom an organ transplant is
the most appropriate therapeutic treatment. The Program oversees a national system, the Organ
Procurement and Transplantation Network (OPTN), to allocate and distribute donor organs to
individuals waiting for an organ transplant. Organ allocation is guided by OPTN policies
informed by analytic support from the Scientific Registry of Transplant Recipients (SRTR),
which is also supported by the Program. In addition to the efficient and effective allocation of
donor organs through OPTN, the Program also supports public education and outreach efforts to
increase the supply of deceased donor organs made available for transplant and other efforts to
ensure the safety of living organ donation.
Program Activities
 Organ Procurement and Transplantation Network — OPTN is a critical system that

facilitates matching donor organs to individuals needing an organ transplant. Given the
great demand for and limited supply of organs, OPTN policies are under continual review
and refinement to achieve the best outcomes for patients, to attain the maximum benefit
for the maximum number of waitlist candidates, to make the best use of donor organs,
and to align with policy development requirements of the OPTN final rule (42 CFR 121).
235
OPTN operating costs are covered by appropriated funds and revenues generated by
registration fees paid by transplant centers for each transplant candidate placed on the
waiting list and collected by the contractor under authority of 42 CFR 121.5(c).
 Scientific Registry of Transplant Recipients — SRTR provides analytic support to OPTN

in the development of organ allocation policies and program performance evaluations.
Additionally, the SRTR provides analytic support to HHS, including the Advisory
Committee on Organ Transplantation (described below). SRTR makes information about
the performance of transplant programs and organ procurement organizations more
widely available to the public. It publishes online transplant program risk-adjusted patient
and graft outcomes data as well as organ procurement organization risk-adjusted organs
transplanted per donor figures. SRTR also publishes online a comprehensive Annual
Data Report that includes the most current ten years of data on waitlist, transplant, and
deceased donor organ donation.
 Advisory Committee on Organ Transplantation (ACOT) and Interagency Activities to

Support Donation and Transplantation — The OPTN final rule (42 CFR §121.12)
established the Advisory Committee on Organ Transplantation to provide
recommendations to the Secretary on issues related to organ donation and transplantation.
The Program supports ACOT activities including logistics for periodic meetings and
analytic requirements. These funds also support interagency activities in support of the
Program’s mission.
 Public and Professional Education Activities — The Program, independently and in

collaboration with the organ donation and transplantation community and other
stakeholders, supports a variety of public and professional education and outreach efforts
designed to increase organ donation. The Program supports public education and
outreach initiatives to (1) increase donor registrations, (2) enhance public awareness of
the need for organs, (3) encourage family discussion about organ donation, and (4)
improve public trust in the organ transplantation system. Communication channels
include downloadable print, radio, television, Internet (organdonor.gov and
donaciondeorganos.gov), print media, and social media platforms. The Program also
collaborates and partners with stakeholders including hospitals, faith leaders, and post-
secondary institutions.
 Grants to Support Projects to Increase Organ Donation — Through a competitive

process, the Program awards grants to public and non-profit private entities: (1) to test
new and replicate effective approaches for increasing registration in donor registries and
(2) to promote public awareness of the need for deceased organ donation and the
opportunities, risks, and benefits of living donation.
 Cooperative Agreement to Provide Support for Reimbursement of Travel and Subsistence

Expenses toward Living Organ Donation — This cooperative agreement provides
reimbursement of travel and subsistence expenses to living organ donors who are not able
to receive such support: (1) under any state compensation program, insurance policy, or
236
under any Federal or state health benefits program; (2) by an entity that provides health
services on a prepaid basis; or (3) by organ recipient.
Funding History
FY Amount
FY 2015 $23,549,000
FY 2016 $23,549,000
FY 2017 $23,492,000
FY 2018 $23,389,000
FY 2019 $23,549,000
Budget Request
The FY 2019 Budget requests $23.5 million for the Organ Transplantation Program, which is
$160,000 above the FY 2018 Annualized CR level. The request provides $14.6 million for
contracts to operate OPTN and SRTR and to support public and professional education. The
funding level will support $6.6 million for grants and cooperative agreements to fund efforts to
increase organ donation, to provide reimbursement of travel and subsistence expenses to living
organ donors who do not qualify for other means of support, and to explore the feasibility of
further reducing financial disincentives to living organ donation. The Budget request also
provides $2.3 million for activities related to the Advisory Committee, interagency agreements,
and other internal support and Program-related activities.
follow-up performance reviews, information technology and other program support costs.
Additionally, the request covers IT investment costs to support the strategic and performance
outcomes of the Program and to provide a mechanism for sharing data and conducting business
in a more efficient manner.
Performance Measures
The first of three Program goals is to increase the annual number of deceased donor organs
transplanted. In 2016, the number of deceased donor organs transplanted was 29,497, which is a
7.11 percent increase over the 2015 total of 27,539 and a 44.65 percent increase over the 2003
baseline of 20,392 deceased organs transplanted.
The second Program goal is to increase the number of expected “life-years” gained by kidney
and kidney/pancreas transplant recipients as a result of receiving the transplants. This measure
compares the life-years gained by these recipients in the first five years following the transplants
against anticipated “life-years” had these transplant recipients remained on the waiting list.
237
Table 1. Life-Years Gained in First Five Years after Kidney/Pancreas Transplant
Avg. No. Life- Total Life-Years Target Life-Years

Fiscal Year
Years Gained Gained Gained
2014 .28 3,466 4,433
2015 .34 3,801 4,502
2016 .32 4,510 4,572
The increase in total life-years gained in Table 1 reflects the record-breaking number of
transplants in 2015 and 2016. Prior to 2015, there was a continuing decrease in the average and
total “life-years” gained by transplant recipients. The decrease was attributable to increasing
“life-years” gained by patients while on the transplant waiting list prior to receiving the
transplant, due to improvements in dialysis management and clinical care of waitlist patients.
Even with these increases in “life-years” gained by candidates pre-transplant, the number of
“life-years” gained as a result of transplantation is still greater.
The third Program goal, increasing the organ donor conversion rate, is a measure of the rate at
which potential organ donors become actual organ donors after death. The conversion rate has
been a key performance metric for the organ transplantation program since 2003. Improving
national performance in this metric was a primary focus during a series of Breakthrough
Collaboratives sponsored by the Program from 2003 to 2008. Through concerted efforts of HHS
and the transplant community to promote best practices, the conversion rate increased from a
baseline of 52 percent in 2003 to 75 percent during this period. The conversion rate, however,
has remained steady at approximately 72 percent since 2010, indicating a possible natural peak
in this measure. The Program will continue to monitor conversion rates and assess potential next
steps.
The conversion rate is dependent on a denominator of potential "eligible deaths," which by

definition includes only those potential donors aged 75 or below who are legally declared dead
by neurologic criteria (brain death) and not excluded for other reasons related to the potential
donor’s risk factors, including positive results on tests indicating the presence of several
potentially transmissible infectious diseases. Number of “eligible deaths” does not include: (1)
donors declared dead by circulatory determination of death (cardiac death) rather than neurologic
criteria and (2) donors whose organs were transplanted despite donor ages or other risk factors
that may have excluded them from being counted as "eligible deaths."
The total number of transplantable organs has increased in part due to an increase in the number
of reported "eligible deaths." The slight conversion rate changes recorded in 2015 and 2016
reflect increased numbers of “eligible deaths” reported in those years (Table 2). Since 2013, the
annual number of “eligible deaths” has been increasing, perhaps linked to increases in motor
vehicle fatalities.
238
Table 2. Eligible Deaths 2008-2016
Change in
Number of Number of Conversion Eligible Deaths
Year Donors Eligible Deaths Rate (%) (%)
2008 6,574 9,845 66.8% Baseline Year
2009 6,551 9,420 69.5% -4.3%
2010 6,503 9,061 71.8% -3.8%
2011 6,540 8,946 73.1% -1.3%
2012 6,503 8,947 72.7% 0.0%
2013 6,530 9,173 71.2% 2.5%
2014 6,821 9,259 73.7% 0.9%
2015 7,053 9,781 72.1% 5.6%
2016 7,753 10,706 72.4% 9.5%
Outputs and Outcomes Tables
Year and Most

Recent Result
/Target for
Recent Result FY 2019
23.II.A.1: Increase the annual FY 2016: 29,497
number of deceased donor organs Target: 25,796 26,378 26,555 +177
transplanted. (Target
Exceeded)
23.II.A.7: Increase the total number
of expected life-years gained in the
first 5 years after the transplant for FY 2016: 4,510
all deceased kidney and Target: 4,572 4,675 4,706 +31
kidney/pancreas transplant (Target Not Met)
recipients compared to what would
be expected for these patients had
they remained on the waiting list.
23.II.A.8: Increase the annual FY 2016:
conversion rate of eligible donors. 72.20% +0.25%
74.25% 74.50%
Target: 73.75% points
(Target Not Met)
239
Grants Awards Table
FY 2017 FY 2018 FY 2019

Average Award $629,906 $646,665 $824,812
Range of Awards $184,192-$2,790,204 $250,000-$3,500,000 $250,000-$3,500,000
240
National Cord Blood Inventory
FY 2018 FY 2019 FY 2019

BA $12,239,000 $12,183,000 $12,266,000 +$83,000
FTE 4 4 4 ---
111-264
FY 2019 Authorization………………………………………………………..............$23,000,000
Allocation Method…………………….…………………………………..................……Contract
Program Description
The National Cord Blood Inventory (NCBI) Program, established through the Stem Cell
Therapeutic and Research Act of 2005 and reauthorized by the Stem Cell Therapeutic and
Research Reauthorization Act of 2015, is charged with building a genetically and ethnically
diverse inventory of at least 150,000 new units of high-quality umbilical cord blood for
transplantation. These cord blood units (CBUs), as well as other units in the inventories of
participating cord blood banks, are made available to physicians, working on behalf of patients,
for blood stem cell transplants through the C.W. Bill Young Cell Transplantation Program,
which is authorized by the same law. Cord blood banks participating in the NCBI Program also
make cord blood units available for preclinical and clinical research focusing on cord blood stem
cell biology and the use of cord blood stem cells for human transplantation and cellular therapies.
Blood stem cell transplantation is potentially a curative therapy for many individuals with
leukemia and other life-threatening blood and genetic disorders. Each year, nearly 18,000 people
in the U.S. are diagnosed with illnesses for which blood stem cell transplantation from a matched
donor is their best treatment option. Often, the first-choice donor is a sibling, but only 30 percent
of people have a fully tissue-matched brother or sister. For the other 70 percent, or
approximately 12,600 people, they often search for a matched, unrelated adult donor or a
matched umbilical cord blood unit.
The tissue types of blood stem cell donors must closely match their recipients for the transplant
to be successful. Since tissue types are inherited, patients are more likely to find a closely
matched donor within their racial and ethnic group. Due to the high rate of diversity in tissue
types of racial and ethnic minorities, especially African-Americans, racial and ethnic minorities
are less likely to find a suitably matched adult marrow donor on the Program Registry. Because
umbilical cord blood can be used with a less than perfect match in tissue type between donor and
recipient than is the case for adult marrow donors, umbilical cord blood offers a chance of
survival for patients who lack a suitably tissue-matched relative and who cannot find an
241
adequately matched unrelated adult donor through the Program. Patients from racially and
ethnically diverse populations, especially African-American patients, are particularly likely to
benefit from additional CBUs. For these reasons, HRSA’s NCBI policy continues to emphasize
increasing the number of CBUs collected from diverse populations.
The NCBI provides funds through competitive contracts for the collection and storage of
qualified CBUs by a network of cord blood banks in the U.S. The NCBI program selects cord
blood banks based on assessment of technical merit, overall quality, ability to collect from
diverse populations, geographic dispersion of storage sites, evaluation of past performance, and
evaluation of proposed costs. Additionally, HRSA prioritizes demonstrated ability of cord blood
banks to collect and bank significant numbers of CBUs from racially and ethnically diverse
populations.
Currently, thirteen cord blood banks hold NCBI contracts. As of September 30, 2017, the
cumulative number of NCBI CBUs available through the Program was 92,546 (Table 1). HRSA
estimates that approximately 5,000 additional units will be collected with FY 2019 funds.
Table 1. Cord Blood Collections
Number of Units Cumulative Units

Fiscal Year
Contracted Made Available173
2007174 23,049 2,017
2008 8,938 11,870
2009 10,207 22,920
2010 9,900 34,744
2011 10,571 43,340
2012 9,162 53,609
2013 7,900 63,960
2014 7,469 74,650
2015 6,469 79,276
2016 5,840 85,443
2017 6,369 92,546
The availability of umbilical cord blood has significantly increased access to blood stem cell
transplantation, particularly for patients who would not otherwise have a well-matched adult
donor. Additionally, cord blood has accounted for growth in blood stem cell transplants over the
173
Due to the lag between when cord blood units are collected and when they have been fully tested and qualified
for listing on the public registry, all of the units collected with funds from a given fiscal year will not be made
available on the registry during that same fiscal year.
174
Units contracted during FY 2007 used funds from no-year appropriations in FY 2004 – FY 2006 and from FY
2007 annual appropriations. The lag from time of collection of contracted units to when they were made available
was significant during the early years of the program (2004-2007).
242
life of the NCBI Program (Table 2). The NCBI further increases access to transplantation
compared to non-NCBI CBUs, because NCBI CBUs are more genetically diverse and contain
higher cell counts. Higher cell counts reflect more blood stem cells available for infusion into a
transplant patient, which can benefit larger patients and assist with improving outcomes. NCBI
units released for transplantation have cell counts well above the levels generally available prior
to implementation of the NCBI Program.
Table 2. Cord Blood Units Released for Transplantation
Total Cord Blood Units (NCBI and

Non-NCBI) released for
NCBI Units Released for
Fiscal Year Transplantation through the C.W.
Transplantation
Bill Young Cell Transplantation
Program
2007 4 648
2008 104 898
2009 458 1,056
2010 530 1,153
2011 690 1,180
2012 714 1,191
2013 714 1,102
2014 544 1,359
2015 609 1,393
2016 529 1,154
2017 494 1,050
Total 5,390 12,184
The number of NCBI cord blood units released for transplants fell below the FY 2016 target set
due to the increasing use of alternative therapies. In particular, haploidentical transplants, use of
blood stem cells from a donor who is biologically related to the recipient-patient, are on the rise.
Despite this recent trend, NCBI units remain key in servicing a diverse population. As the
NCBI’s diverse inventory of cord blood units grows, it will continue to serve an increasing
number of patients. Racial and ethnic minorities represent over 60 percent of the cord blood units
collected with funds awarded from FY 2007 to FY 2016. HRSA will continue to monitor and
assess trends in cord blood transplantation and will adjust collection targets accordingly.
In addition to directly growing the NCBI inventory, the support provided to NCBI-contracted
banks has played an important role in stimulating the collection and banking of many other non-
NCBI units. These CBUs may not meet the minimum cell content threshold established for the
NCBI, but may be a suitable source of blood stem cells for smaller patients where an acceptable
cell dose can still be achieved using smaller units. Additionally, NCBI banks have provided
researchers more than 53,025 non-NCBI units for a wide variety of research purposes.
243
Funding History
FY Amount
FY 2015 $11,266,000
FY 2016 $11,266,000
FY 2017 $12,239,000
FY 2018 $12,183,000
FY 2019 $12,266,000
Budget Request
The FY 2019 Budget requests $12.3 million for the National Cord Blood Inventory program,
which is $83,000 above the FY 2018 Annualized CR level. This funding supports continued
progress toward the statutory goal of building a genetically diverse inventory of at least 150,000
new units of high-quality cord blood for transplantation. This request will also increase the
number of patients in all population groups who are able to obtain life-saving transplants. Cell
dose and degree of match between patient and cord blood unit are both strongly associated with
positive transplant outcomes. Therefore, a larger inventory of publicly available CBUs will
contribute to improved patient survival after transplant because a growing inventory of high cell
count CBUs will allow better tissue matches between patients and CBUs.
The FY 2019 Budget request supports collecting and banking approximately 5,000 additional
CBUs, assuming an average price to HRSA of $2,000 per cord blood unit, which includes an
anticipated price increase of $400 per cord blood unit. HRSA anticipates the NCBI CBUs price
increase since cord blood banks are no longer financially positioned to offer the government
significant discounts as provided previously. However, HRSA will continue to seek substantial
discounts for each cord blood unit through competitive contracting.
The funding request also includes costs associated with the contract review and award process,
244
Year and Most

Recent Result FY
/Target for 2019
Recent Result +/-
(Summary of FY 2018 FY 2019 FY
40.II.A.1: The cumulative number of
minority cord blood units available FY 2016: 135,287
through the C.W. Bill Young Cell Target: 86,720 80,809 83,809 +3,000
Transplantation Program (NCBI & non- (Target Exceeded)
NCBI)175
40.II.A.2: The size of the National Cord
Blood Inventory (cumulative # of units FY 2016: 85,443
banked and available through the C.W. Target: 76,000
91,000 96,000 +5,000
Bill Young Cell Transplantation (Target Exceeded)
Program)
40.II.A.3: The annual number of NCBI FY 2016: 529
cord blood units released for Target: 700 535 500 -35
transplant176 (Target Not Met)
Contracts Awards Table
FY 2017 FY 2018 FY 2019

Number of Contracts 5 6 6
Average Contract $2,265,827 $1,718,833 $1,718,833

Range of Contracts $498,700-5,290,755 $500,000-5,000,000 $500,000-$5,000,000
175
Data shows there are close to 19,000 cord blood units designated as “unknown race/ethnicity” as not every cord
blood bank require donors to provide the information. Inability to properly categorize these units subsequently
impacts tracked data.
176
Due to advances in the field, the number of unrelated blood stem cell transplants using cord blood has been on
the decline, which may impact established targets.
245
C.W Bill Young Cell Transplantation Program
FY 2019 FY 2019
BA $22,056,000 $21,959,000 $22,109,000 +$150,000
FTE 7 7 7 ---
Authorizing Legislation: Public Health Service Act, Sections 379-379B, as amended by Public
Law 114-104
FY 2019 Authorization……………………………………………………………….$30,000,000
Allocation Method…………………………………………………………..……….……Contract
Program Description
The primary goal of the C.W. Bill Young Cell Transplantation Program (Program) is to increase
the number of transplants for recipients suitably matched to biologically unrelated bone
marrow177 and umbilical cord blood donors. The Program achieves this goal by: (1) providing a
national system for recruiting potential bone marrow donors; (2) tissue typing potential donors;
(3) coordinating the procurement of bone marrow and umbilical cord blood units for
transplantation; (4) offering patient and donor advocacy services; (5) providing public and
professional education; and (6) collecting, analyzing, and reporting data on transplant outcomes.
Blood stem cell transplantation, which includes bone marrow and cord blood, is a potentially
curative therapy for many individuals with leukemia and other life-threatening blood and genetic
disorders. Each year nearly 18,000 people in the U.S. are diagnosed with life-
threatening illnesses where blood stem cell transplantation from a matched donor is the best
treatment option. Often, the ideal donor is a suitably matched family member, but only 30
percent of people have a fully matched relative. The other 70 percent, or approximately 12,600
people, often search for a matched unrelated adult donor or umbilical cord blood unit.
The C.W. Bill Young Cell Transplantation Program is the successor to the National Bone
Marrow Donor Registry. While the current scope of the program is similar to that of its
predecessor, the Program has expanded responsibility for collecting, analyzing, and reporting
data on transplant outcomes, to include all allogeneic (from a genetically similar, but not
identical, donor) blood stem cell transplants as well as other therapeutic uses of blood stem cells.
The Program operates through four major contracts that require close coordination and oversight.
177
Public Health Service Act, Sections 379-379B, as amended by P.L. 114-104 states that the term ‘bone marrow’
means the cells found in the adult bone marrow and peripheral blood.
246
The authorizing legislation also requires the establishment of an Advisory Council to provide
recommendations to the HHS Secretary and to HRSA on activities related to the Program.
The major components of the Program are:
 The combined Single Point of Access – Coordinating Center (SPA-CC) maintains a

system for health care professionals and physicians, searching on behalf of patients, to
search electronically for cells derived from adult marrow donors and cord blood units
through a single point of access and supports coordination activities for bone marrow and
cord blood.
 The Office of Patient Advocacy (OPA) maintains a system for patient advocacy, which
serves the patient by directly providing to the patient (or family members, physicians, or
other individuals acting on behalf of the patient) individualized services with respect to
efficiently utilizing the system to conduct an ongoing search for a bone marrow donor or
cord blood unit and assists with information regarding treatment options and third party
payer matters.
 The Stem Cell Therapeutic Outcomes Database (SCTOD) provides an electronic

outcomes blood stem cell transplantation database for use by researchers and health care
professionals. The SCTOD also provides a repository that stores donor and recipient
samples for research and the collection and analysis of data on the clinical outcomes of
blood stem cell transplants.
Performance measures are incorporated into contracts and monitored quarterly to ensure the
Program meets its long-term goals in terms of: (1) number of blood stem cell transplants
facilitated annually; (2) number of transplants facilitated annually for minority patients; (3)
number of domestic transplants facilitated annually; and (4) one-year post-transplant patient
survival. The Program also relies on two annual performance measures: (1) number of adult
volunteer potential donors of minority race and ethnicity on the Program’s registry; and (2) per
unit cost for human leukocyte antigen (HLA) tissue typing needed to match patients and donors.
Additional performance standards are developed and monitored under each contract.
The Program continues to serve a diverse patient population, with umbilical cord blood playing a
vital role in expanding access to transplants for minority patients. Increasing the number of blood
stem cell transplants facilitated for patients from racially and ethnically diverse backgrounds
addresses the statutory aim of ensuring comparable access to transplantation for patients from all
populations. Adding to the pool of potential adult volunteer blood stem cell donors also helps
achieve this aim. As of the end of FY 2016, more than 14.8 million potential adult volunteer
donors were listed on the Program’s registry. More than 3.5 million, or 24 percent, self-identify
as belonging to a racial/ethnic minority group, meeting the Program goal of 3.49 million.
Program expects the registry will list 4.08 million adult donors who self-identify as belonging to
a racial or ethnic minority population in FY 2019.
247
The cost of tissue typing per donor strongly influences the number of potential volunteer donors
recruited for the Program’s registry. The FY 2019 cost for each donor’s tissue typing will remain
at $58.00, the same cost as in FY 2016. The cost of tissue typing increased from $40.81 in FY
2014 to $58.00 in FY 2016 due to advances in typing technology: from an allele-based, high-
resolution method to a DNA-based sequencing platform. In addition, newer techniques identify
more genetic markers to assist physicians in conducting donor searches on behalf of patients.
These advances in tissue typing technology will facilitate more efficient matching between
potential donors and searching patients and allow patients to more rapidly move toward
transplantation.
Funding History
FY Amount
FY 2015 $22,109,000
FY 2016 $22,109,000
FY 2017 $22,056,000
FY 2018 $21,959,000
FY 2019 $22,109,000
Budget Request
The FY 2019 Budget requests $22.1 million for the C.W Bill Young Cell Transplantation
program, which is $150,000 above the FY 2018 Annualized CR level. This request supports the
Program’s performance target of 4,080,000 adult volunteer donors from racially/ethnically
diverse minority population groups listed on the Program’s registry and funds the major Program
components.
The majority of funds will be used to recruit and tissue-type new donors. The Program will also
continue: (1) collecting comprehensive outcomes data on both related and unrelated-donor blood
stem cell transplants; (2) assessing quality of life for transplant recipients; (3) working with
foreign transplant centers to obtain data on U.S. stem cell products provided to them for
transplant; and (4) collecting data on emerging therapies using cells derived from bone marrow
and umbilical cord blood. Additionally, the FY 2019 Budget request allows the Program to
continue critical planning in collaboration with HHS on a response to a national radiation or
chemical emergency that could leave casualties with temporary or permanent marrow failure and
to facilitate emergency transplants for those casualties who would not otherwise recover marrow
function.
The funding request also includes costs associated with information technology and other
program support costs.
248
Measure Year and Most Recent FY 2018 FY 2019 FY 2019

Result /Target for Target Target +/-
(Summary of Result)
24.II.A.2: The number of adult
FY 2016: 3.5M
volunteer potential donors of blood
Target: 3.49M 3.94M 4.08M +0.14M
stem cells from minority race and
(Target Met)
ethnic groups (Outcomes)
24.1: The number of blood stem FY 2013: 6,283
cell transplants facilitated by the Target: 5,513 N/A N/A N/A
Program 178 (Outcome) (Target Exceeded)
24.2: The number of blood stem
FY 2013: 992
cell transplants facilitated for
Target: 845 N/A N/A N/A
minority patients by the Program 179
(Target Exceeded)
(Outcome)
24.3: The rate of patient survival at FY 2013: 71%
one year, post- transplant 180 Target: 69% N/A N/A N/A
(Outcome) (Target Exceeded)
24.4: The number of blood stem
FY 2013: 3,918
cell transplants facilitated for
(Baseline) N/A N/A N/A
domestic patients by the
(Target Not in Place)
Program 181 (Outcome)
24.E: The unit cost of human FY 2016: $58.00
leukocyte antigen (HLA) typing of Target: $58.00 $58.00 $58.00 Maintain
potential donors (Efficiency) (Target Met)
FY 2017 FY 2018 FY 2019

Average Award $6,585,737 $4,939,303 $4,939,303
Range of Awards $800,000-$14,801,102 $800,000-$14,700,000 $800,000-$14,700,000
178
“This is a long-term measure. The 2017 target for this measure, set at 6,960, will be compared to actuals once
available. There is no set schedule for establishing new long-term measures.”
179
“This is a long-term measure. The 2017 target for this measure, set at 845, will be compared to actuals once
180
“This is a long-term measure. The 2017 target for this measure, set at 69%, will be compared to actuals once
181
“This is a new long-term measure. The 2017 target for this measure, set at 5,135, will be compared to actuals
once available. There is no set schedule for establishing new long-term measures.”
249
Poison Control Program
FY 2019 FY 2019
BA $18,801,000 $18,718,000 $18,846,000 +$128,000
FTE 2 2 2 ---
Authorizing Legislation: Public Health Service Act, Sections 1271-1274, as amended by Public
Law 113-77
FY 2019 Authorization ....................................................... National Toll-Free Number - $700,000
FY 2019 Authorization .................................................... Nationwide Media Campaign - $800,000
FY 2019 Authorization ................................. Poison Control Center Grant Program – $28,600,000
Allocation Method:
 Contracts
 Competitive Grants/Co-operative Agreements
The Poison Control Program (PCP) is authorized through Public Law 113-77, the Poison Center
Network Act. The Program is legislatively mandated to fund poison centers; establish and
maintain a single, national toll-free number (800-222-1222) to ensure universal access to poison
center services and connect callers to the poison centers serving their areas; and implement a
nationwide media campaign to educate the public and health care providers about poison
prevention, poison center services, and the 800 number.
The grant program supports poison control centers’ (PCCs) efforts to: 1) prevent and provide
treatment recommendations for poisonings; 2) comply with operational requirements needed to
sustain accreditation and or achieve accreditation; and 3) improve and enhance communications
and response capability and capacity. Funds may also be used to improve the quality of data
uploaded from poison centers to the National Poison Data System (NPDS) in support of national
toxic surveillance activities conducted by the Centers for Disease Control and Prevention (CDC).
The Poison Help Line was established in 2001 to ensure universal access to PCC services.
Individuals can call from anywhere in the United States (U.S.) and will be connected to the
poison center that serves their respective areas. The PCP maintains the number, provides
translation services in over 150 languages, and offers services for the hearing impaired.
250
For over 50 years, PCCs have been our Nation’s primary defense against injury and death from
poisonings. Today, a network of 55 PCCs provides cost effective, quality health care advice to
the general public and health care providers across the entire U.S. including American Samoa,
the District of Columbia, the Federated States of Micronesia, Guam, Puerto Rico, and the U.S.
Virgin Islands. Twenty-four hours a day, seven days a week, health care providers and other
specially trained poison experts provide poisoning triage and treatment recommendations at no
cost to the caller. A hallmark of poison center case management is the use of follow up calls to
monitor case progress and medical outcomes. Poison centers are not only consulted when
children get into household products, but also when seniors and people of all ages take too much
medicine or when workers are exposed to harmful substances on the job. Emergency 911
operators refer poison-related calls to PCCs, and health care professionals regularly consult
PCCs for expert advice on complex cases. PCCs are a critical resource for emergency
preparedness and response as well as for other public health emergencies.
According to the American Association of Poison Control Centers (AAPCC), poison centers
managed 2.7 million calls in 2016, an average of 7,446 calls per day. Of the approximate 2.1
million human exposure poisonings reported in FY 2016, PCCs managed 66.6 percent at the site
of exposure, avoiding unnecessary visits to emergency departments and reducing health care
costs. Health care facilities represented less than one percent of exposures but made
approximately 23 percent of poison control calls.182
Multiple studies have demonstrated that accurate assessment and triage of poison exposures by
poison centers save dollars by reducing severity of illness and death, and eliminating or reducing
the expense of unnecessary trips to an emergency department. Poison center consultations also
significantly decrease patients’ lengths of stay in hospitals and decrease hospital
costs.183,184,185,186 Health care facilities’ utilization of poison centers continues to increase,
indicating an increase in severity of poisonings and the need for toxicological expertise in
clinical settings.187 Every dollar invested in the poison center system is estimated to save $13.39
in medical costs and lost productivity, for a total savings of more than $1.8 billion every year. Of
the $1.8 billion saved, the Federal Government saves approximately $662.8 million in medical
care costs and lost productivity.188
182
David D. Gummin, James B. Mowry, Daniel A. Spyker, Daniel E. Brooks, Michael O. Fraser & William Banner:
2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System
(NPDS): 34th Annual Report, Clinical Toxicology.
183
Vassilev ZP, Marcus SM. Impact of a Poison Control Center on the Length of Hospital Stay for patients with
Poisoning. J Toxicol Environ Health Part A. 2007; 70(2): 107-110
184
Zaloshnja, E., Miller, T.R., Jones, P., Litovitz, T.; Coben, J.; Steiner, C.; Sheppard, M. (2006). The potential
impact of poison control centers on rural hospitalization rates for poisonings. Pediatrics. 118(5), 2094-2100.
185
Healthcare Cost and Utilization Project [HCUP] (2007). 2005 National Inpatient Sample. Rockville, MD:
Agency for Healthcare Research and Quality, Department of Health and Human Services.
186
Zaloshnja, E., Miller, T.R., Jones, P., Litovitz, T.; Coben, J.; Steiner, C.; Sheppard, M. The impact of poison
control cents on poisoning-related visits to emergency departments, U.S. 2003. Am J Emerg Med. 2008.
187
Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2011 annual report of the American Association of Poison
Control Centers' National Poison Data System (NPDS): 29th annual report. Clin Toxicol (Phila). 2012;50:911-
1164.
188
Value of the Poison Center System: Lewin Group Report for the American Association of Poison Control
Centers. 2011.
251
Through the nationwide Poison Help media campaign, the PCP has been educating the public
about the toll-free number and increasing awareness of poison center services. In FY 2017, the
Poison Help media campaign included an initial investment of $320,442. Based on over 300
million media impressions through television, radio, and social media, the PCP was able to
leverage an advertising return on investment of nearly $5 million.
In addition to providing the public and health care providers with treatment advice on
poisonings, a second critical function of the PCCs is the collection of poison exposure and
surveillance data. Multiple Federal agencies, including the CDC, Consumer Product Safety
Commission, Environmental Protection Agency, Food and Drug Administration, and Substance
Abuse and Mental Health Services Administration, use these data for public health surveillance,
including timely identification, characterization, or ongoing tracking of outbreaks and other
public health threats. In addition, many state health departments collaborate directly with poison
centers within their jurisdictions. For example, states and Federal agencies use data from PCCs
to monitor exposures to e-cigarette devices and liquid nicotine, synthetic cathinones and
cannabinoids, opioids, and laundry detergent packets.
According to the CDC, in 2015, the most recent year for which data are available, unintentional
poisoning continues to be the leading cause of unintentional injury deaths. Prescription drugs,
primarily opioid analgesics, were responsible for 91 percent of unintentional poisonings. The rate
of drug poisoning deaths involving opioid analgesics nearly quadrupled over a 14-year period.
PCCs play a critical role in combatting opioid drug-related abuse and misuse, from helping to
define and trace the problem within a local and national context to responding to calls from
health care providers seeking treatment advice for substance abuse patients.
PCCs also provide public and health care provider education and actively seek to change
behaviors to reduce poisonings and promote awareness and utilization of poison center services.
Education efforts include: partnering with health departments, education departments, and other
state agencies; promoting safe prescription medication use and storage; messaging at health fairs
and community events; and collaborating to develop media campaigns focused on preventing
injuries. Additionally, PCCs participate in National Prescription Drug Take Back events
sponsored by the Drug Enforcement Agency to provide a safe, convenient, and responsible
means of prescription drug disposal, while also educating the public about potential medication
abuses.
Funding History
FY Amount
FY 2015 $18,846,000
FY 2016 $18,846,000
FY 2017 $18,801,000
FY 2018 $18,718,000
FY 2019 $18,846,000
252
Budget Request
The FY 2019 Budget requests $18.8 million for the Poison Control Program, which is an
increase of $128,000 above the FY 2018 Annualized CR level. This request will support the
PCCs’ infrastructure and core triage and treatment services. PCCs predominantly rely on state
and local funding, as Federal funding accounts for approximately 13 percent of total PCC
funding. While PCCs have innovatively secured funding from a variety of local sources,
including philanthropic organizations, their financial stability is tenuous. Federal funding helps
reinforce the nationwide PCC infrastructure, enabling PCCs to sustain their public health and
toxicosurveillance efforts.
The FY 2019 Request will also support the following activities:
National Toll-Free Hotline Services and Promotion of Number and Services will ensure access to
PCCs through the national toll-free Poison Help hotline, 24 hours a day, every day of the year
and will also support translation services for non-English speaking callers.
Nationwide Media Campaign will continue to educate the public and health care providers about
the national toll-free number and to build upon the existing national public awareness campaign,
to highlight the role of PCCs in the public health system with a focus on Medicare and Medicaid
beneficiaries. In FY 2019, the PCP will continue to build upon the existing national public
awareness campaign, Poison Help. The goals of the campaign include, increasing public
awareness of the national Poison Help toll-free number; educating Medicare and Medicaid
beneficiaries about poisoning risk and prevention; and showcasing the role of the national
network of PCCs and the services they provide. The PCP will also continue to promote the
hotline to the public and health care providers as well as engage other Federal partners including
community health centers, 340B Drug Pricing Program participants, geriatric education centers,
rural health associations, Ryan White Program providers, and Head Start programs.
Outputs and Outcomes
Year and Most

Recent Result/
Target for Recent
Result/ FY FY FY 2019
(Summary of 2018 2019 +/-
FY 2017: 85.5%
25.III.D.3: Percent of inbound volume Target: 83.0%
83% 83% Maintain
on the toll-free number. (Output) (Target Exceeded)
253
Year and Most
Recent Result/
Target for Recent
Result/ FY FY FY 2019
(Summary of 2018 2019 +/-
25. III.D.4: Percent of national survey
respondents who are aware that calls FY 2012: 25%
to poison control centers are handled (Target Expected 25% N/A N/A
by health care professionals. in FY2018)
(Outcome)189
25. III.D.5: Percent of human poison
FY 2016: 66.6%
exposure calls made to PCCs that were
managed by poison centers outside of
(Target Not Met)
a healthcare facility. (Output)
Grants Awards Table
FY 2017 FY 2018 FY 2019

Number of Awards190 52 52 52
Average Awards $323,762 $327,275 $329,635
Range of Award $12,466-$1,974,902 $12,466-$2,006,384 $12,466-$2,013,447
Range of Contracts $10,168-$320,443 $10,168-$320,443 $10,168-$320,443
189
This is a long-term measure based on periodic survey data, reported about every 5 years.
190
There are 55 PCCs across the Nation. Fifty-two awards were made in FY 2017 and are anticipated in FY 2018
and FY 2019 under the Poison Center Network Grant Program, representing all of the poison centers. For grant
purposes, HRSA counts the California Poison Control System as a single entity, while it encompasses four
California poison centers.
254
Office of Pharmacy Affairs/340B Drug Pricing Program
FY 2019 FY 2019
BA $10,213,000 $10,168,000 $10,238,000 +$70,000
User Fees --- --- $16,000,000 +$16,000,000
TOTAL $10,213,000 $10,168,000 $26,238,000 +$16,070,000
FTE 22 22 22 ---
Authorizing Legislation: Public Health Service Act, Section 340B, as amended by Public Law
111-309, Section 204
FY 2019 Authorization……………………………….……………….……….………….....SSAN
Allocation Method…………………………………………...………………….……..….Contract
Section 602 of Public Law 102-585, the “Veterans Health Care Act of 1992,” enacted section
340B of the Public Health Service Act (PHSA), “Limitation on Prices of Drugs Purchased by
Covered Entities.” Administered by HRSA’s Office of Pharmacy Affairs, the 340B Program
requires drug manufacturers to provide discounts on outpatient prescription drugs to certain
safety net health care providers specified in statute, known as covered entities. This includes
Federally Qualified Health Centers, AIDS Drug Assistance Programs, and certain
disproportionate share hospitals. The 340B Program can help these designated hospitals and
clinics provide more care to additional patients. A 2011 Government Accountability Office
(GAO) study found that entities participating in the 340B Program are able to expand the type
and volume of care they provide to target patient populations as a result of access to these lower
cost medications.
The 340B ceiling price – the maximum amount a drug manufacturer can charge a covered entity
for a given drug – is equal to the Average Manufacturer Price (AMP) minus the Unit Rebate
Amount, both set by the Centers for Medicare & Medicaid Services (CMS). Covered entities
purchase 340B drugs that are at least 23.1 percent below AMP for brand name drugs; 13 percent
below AMP for generic drugs; and 17.1 percent below AMP for clotting factor and pediatric
drugs. In 2016, total sales in the 340B Program were approximately $16 billion. Covered entities
saved between 25 to 50 percent on what they would have otherwise paid for covered outpatient
drugs. HRSA estimates 340B sales are approximately 3.6 percent of the total U.S. drug market.
255
HRSA places a high priority on the integrity of the 340B Program and continually works to
improve its oversight of the Program. HRSA conducts the following activities to ensure both
covered entities and manufacturers are in compliance with program requirements:
 Performs initial eligibility checks of all entities seeking to register with the Program.
 Recertifies covered entities annually including an attestation to compliance with all
Program requirements.
 Performs audits of covered entities to assure compliance within the Program. Since FY
2012 HRSA has completed 814 covered entity audits which included review of 11,057
offsite outpatient facilities and 18,063 contract pharmacies. Final audit results, including
statuses of corrective actions, are available on HRSA’s website. As of July 1, 2017,
HRSA has closed out and finalized 642 of the 814 audits conducted with 48 percent of
findings related to diversion and 28 percent related to duplicate discount.
 Reviews every non-compliance allegation received through targeted communication and,
if necessary, on-site audits.
 Performs audits of manufacturers.
 Provides assistance to covered entities that self-disclose compliance issues, including
developing corrective action plans and working with affected manufacturers.
 Supports an integrated system of compliance tracking for covered entities and
manufacturers, enabling enhanced communication across the Office of Pharmacy Affairs
to ensure that all covered entities and manufacturers are in compliance with 340B
program requirements.
HRSA uses the results of these program integrity efforts to develop and refine a proactive
strategy to promote best practices for complying with Program requirements.
Section 340B(a)(8) of the Public Health Service Act required the establishment of a 340B Prime
Vendor Program (PVP). The purpose of PVP is to develop, maintain, and coordinate a program
capable of facilitating distribution in support of the 340B Program. By the end of 2017, PVP had
nearly 7,800 products available to participating entities below the 340B ceiling price, including
3,760 covered outpatient drugs with an estimated average savings of 10 percent below 340B
ceiling price. From 2009 to 2017, the PVP contracts provided over $723 million in additional
sub-ceiling savings for covered entities.
HRSA continues to strengthen the program, including implementation of recommendations made

by the Office of the Inspector General (OIG) and GAO. For example, OIG recommended that
HRSA provide covered entities access to ceiling price information and improve oversight of
340B pricing. The following activities are priorities in FY 2018:
o Price Verification – Compute the 340B ceiling prices using data that manufacturers
supplied to CMS, based on an agreement with HRSA.
o Refunds and Credits – Facilitate the process for refunds and credits to entities who were
overcharged by participating manufacturers.
o Pricing System – Continue to develop a system whereby covered entities can access
340B ceiling price information via a secure website. The system will allow manufacturers
256
to submit 340B price information, allowing regular spot checks of prices and any
necessary follow up on pricing errors.
Funding History
Budget
FY User Fees
Authority
FY 2015 $10,238,000 ---
FY 2016 $10,238,000 ---
FY 2017 $10,213,000 ---
FY 2018 $10,168,000 ---
FY 2019 $10,238,000 $16,000,000
Budget Request
The FY 2019 Budget requests $10.2 million in budget authority for the 340B Program, which is
$70,000 above the FY 2018 Annualized CR level, and $16.0 million from user fees, as a new
revenue source. In FY 2019, HRSA will begin the development of a multi-functional web-based
user fee system that will calculate user fees based on required manufacturer and covered entity
sales data, collect user fees from covered entities, and verify payments. HRSA bases revenue
projections on collecting a 0.1 percent (or one dollar for every thousand dollars) of the total
340B drug purchases paid by participating covered entities. Funding from both sources will
support implementation of 340B Program statutory obligations, oversight of participating
manufacturers and covered entities, operational improvements, and increased efficiencies using
information technology.
General regulatory authority over the 340B Program would allow HHS to set clear enforceable
standards on participation on all aspects of 340B program and will help ensure compliance with
340B Program requirements. Hospitals participating in 340B are not required to report on 340B
savings or how these savings are used to benefit patient populations. The FY 2019 Request also
proposes to reform the 340B Program through a General Provision in the L/HHS Appropriations
Act that would require covered entities to report both the savings and their uses to HRSA, and
provide HRSA with general regulatory authority. In addition, the Budget includes a legislative
proposal to amend the 340B statute to improve program integrity and ensure that the program
benefits patients, especially low-income and uninsured patients. These reforms would ensure
low income and uninsured patients benefit from the Program, as intended, and strengthen
program integrity and oversight activities.
FY 2019 Budget Authority
The FY 2019 Budget request provides resources for the 340B Program to educate participating
covered entities and prospective sites on compliance with statutory requirements. For
participating covered entities, HRSA will continue to expand its oversight activities, producing a
sentinel effect of increased compliance. PVP data shows education based on oversight measures
reduces the risk of future compliance issues. Finally, HRSA will conduct audits of
manufacturers, which should not only increase compliance, but also provide greater insight into
the tools and mechanisms used by companies to comply with 340B statutory requirements and
257
guide future technical assistance. HRSA will continue to strengthen the program, including
implementation of recommendations made by the Office of the Inspector General (OIG) and
GAO. The following activities are priorities in FY 2019:
o Price Verification – Compute the 340B ceiling prices using data that manufacturers
supplied to CMS, based on an agreement with HRSA. Conduct random spot checks of
these prices with information submitted voluntarily by a small group of manufacturers.
o Price Submission – Maintain a secure system for all manufacturers to submit 340B price
information, allowing regular spot checks of prices and any necessary follow up on
pricing errors.
o Refunds and Credits – Facilitate refunds and credits to entities that are overcharged by
participating manufacturers.
o Pricing System – Continue to develop a system whereby covered entities can access
340B ceiling price information via a secure website. Implementation is expected once
the Civil Monetary Penalty and Ceiling Price calculation regulation has been finalized
and any necessary changes to the system have been implemented.
In addition, GAO recommended that HRSA clarify the definition of a patient eligible to receive
340B drugs, as well as eligibility of certain hospitals that participate as covered entities. HRSA
prioritizes developing and providing clear policies to stakeholders through regulations and
guidance.
The FY 2019 Request for budget authority includes costs associated with contract award process,
follow-up reviews, and information technology and other program support costs.
FY 2019 User Fees
In FY 2019, HRSA will began user fee implementation. Revenue collected from user fees, once
fully implemented, will support improvements to the 340B public database, program audits, and
improve the Program’s automated compliance management tool.
 Improvement of 340B Public Database – The Office of Pharmacy Affairs Information

System (OPAIS) is a multi-function web-based database system that provides
information on covered entities, contract pharmacy arrangements, and participating
manufacturers. External stakeholders use the database to verify eligible entities and their
associated sites, confirm manufacturer participation, and prevent statutorily prohibited
duplicate discounts. Integrity of the 340B database requires ongoing maintenance and
development. The user fee request would provide the additional resources needed to
improve the integrity, transparency, security, and reliability of the OPAIS and ensure that
the database continues to meet the needs of external stakeholders.
 Program Audits of Covered Entities – HRSA plans to continue random and targeted
audits of covered entities, as well as publish audit report summaries on the HRSA
website to expand the program’s compliance reach while managing program risk. The
user fee request would provide the additional funding needed to hire and train staff to
258
conduct an additional 100 on-site covered entity audits, write reports, work with entities
through the notice and hearing process, and finalize information for public dissemination.
 Program Audits of Manufacturers – HRSA plans to continue random and targeted audits
of manufacturers, as well as publish audit report summaries on the HRSA website to
expand the program’s compliance reach while managing program risk. The user fee
request would provide additional funding to hire and train staff to conduct an additional
five manufacturer audits, write reports, work with manufacturers through the notice and
hearing process, and finalize information for public dissemination.
Performance Measures
HRSA measures 340B Program performance by two key metrics. HRSA tracks participation
levels of eligible providers and ensures quality through oversight and audits of covered entities
and manufacturers.
As of January 1, 2018, there were 12,823 covered entities and 29,663 associated sites
participating in the 340B Program, for a total 42,486 registered sites. Twenty-seven percent of
the 42,486 covered entity sites have contract pharmacy arrangements that support 20,757 unique
pharmacy locations registered in the 340B database.
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Year and Most

Recent Result
/Target for
FY 2017: 200
39.I.A.1: Covered Entity
Audits Conducted
(Target Met)
FY 2017: 5
39.I.A.2: Manufacturer Audits
Conducted
(Target Met)
FY 2017 FY 2018 FY 2019

Number of Contracts 3 3 3
Average Contract $2,766,666 $3,000,000 $3,000,000
$1,500,000 - $1,000,000 - $1,000,000 -
Range of Contracts $3,900,000 $4,000,000 $4,000,000
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National Hansen’s Disease Program
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $15,169,000 $15,103,000 $11,653,000 -$3,450,000
FTE 56 56 52 -4
105-78, Section 211
Allocation Methods:
 Direct Federal/Intramural
 Contract
The National Hansen’s Disease Program (NHDP) provides medical care, education, and research
for Hansen’s disease (HD, leprosy) and related conditions as authorized since 1921. Medical care
includes providing direct patient care (diagnosis, treatment and rehabilitation), HD drug
regimens at no cost to patients, consultations, laboratory services and outpatient referral services
to any patient living in the United States (U.S.) or its territories. The Program strengthens the
safety net infrastructure for patients with this rare disease by focusing on case management,
patient compliance, and training on the diagnosis and management of Hansen’s disease, with
specific outreach efforts to health care providers who are likely to encounter and treat patients in
geographic areas most impacted by the disease. The more complicated HD cases are treated as
short-term referrals in the NHDP clinic in Baton Rouge, Louisiana.
Ninety-five percent of the human population is not susceptible to infection with M. leprae, the
bacteria that causes leprosy. Hansen's disease is also not highly transmissible, is very treatable,
and, with early diagnosis and treatment, is not disabling. Treatment with standard antibiotic
drugs is very effective, and patients become noninfectious after taking only a few doses of
medication and need not be isolated from family and friends. However, diagnosis in the U.S. is
often delayed because health care providers are unaware of Hansen's disease and its symptoms.
Early diagnosis and treatment prevents nerve involvement, the hallmark of Hansen's disease, and
the disability it causes. People with leprosy can generally continue their normal work and other
activities uninterrupted while they are under treatment, which may last several years.
Increasing Quality of Care: Increasing health care provider knowledge about Hansen’s disease
will lead to earlier diagnosis and treatment, which are key to blocking or arresting the trajectory
261
of Hansen’s disease-related disability and deformity. The Program facilitates outpatient
management of leprosy by providing additional laboratory, diagnostic, consultation, and referral
services to private sector physicians. NHDP increases U.S. health care providers’ knowledge by
serving as an education and referral center.
Improving Health Outcomes: Hansen’s disease is a life-long chronic condition, which left
untreated and unmanaged usually progresses to severe deformity. Through a focus on early
diagnosis and treatment, NHDP measures its impact on improving health outcomes for Hansen’s
disease patients in terms of reducing the percentage of patients with grades 1 or 2
disability/deformity.191 The percentage of patients presenting with disability fluctuates due to
several variables, including migration, immigration, and disease stigma. However, fluctuations in
disability are primarily attributed to delays in diagnosis
The Program has also been improving health outcomes through research. With advanced
scientific knowledge and breakthroughs in genomics and molecular biology, the Program has
been advancing the standard-of-care for leprosy with rapid assessment of drug resistance and
strain typing of leprosy bacilli to determine the origins of individual infections and the likelihood
of severe pathological reactions.
Promoting Efficiency: The NHDP outpatient care is comprehensive and includes treatment
protocols for multi-drug therapy, diagnostic studies, provider consultations, ancillary medical
services, clinical laboratory analysis, hand and foot rehabilitation, leprosy surveillance, and
patient transportation for indigent patients.
Fostering Collaboration: NHDP is the sole worldwide provider of reagent grade viable leprosy
bacilli and collaborates with researchers across the globe to further scientific investigations and
advances related to the disease. NHDP coordinates and collaborates with Federal, state, local,
and private programs to further leverage and promote efforts to improve quality of care and
health outcomes related to Hansen’s disease. Areas of collaboration include a partnership with
the Food and Drug Administration (FDA) Drug Shortage Program to distribute the drug
Clofazimine to over 500 providers nationally. The Program manages the investigational new
drug (IND) application that makes Clofazimine available in the U.S. for treatment of leprosy. .
191
Disability/deformity is measured based on the World Health Organization scale, which ranges from 0-2. Patients
graded at 0 have protective sensation and no visible deformities. Patients graded at 1 have loss of protective
sensation and no visible deformity. Patients graded at 2 have visible deformities secondary to muscle paralysis and
loss of protective sensation.
262
Funding History
FY Amount
FY 2015 $15,206,000
FY 2016 $15,206,000
FY 2017 $15,169,000
FY 2018 $15,103,000
FY 2019 $11,653,000
Budget Request
The FY 2019 Budget requests $11.7 million for the National Hansen’s Disease Program, which
is $3.5 million below the FY 2018 Annualized CR level. This request supports the Program’s
primary focus on direct patient care activities and improving health outcomes for Hansen’s
disease patients. The reduced funding level also reflects a declining inpatient beneficiary
population and improvements in health outcomes through research and health care provider
education.
NHDP continues to evaluate ways to optimize resources to provide the most effective and
efficient health care services to leprosy patients across the nation. As part of this effort, in FY
2018, NHDP expects to reduce the number of ambulatory care clinics to align resources with
levels of care. Hansen’s disease patients with severe complications, either who are advanced on
the HD spectrum or who have HD related disabilities, may be referred to the primary clinic in
Baton Rouge free of charge. The National Hansen’s Disease Program provides HD medication
free of charge to all providers upon request for the care and treatment of HD patients.
NHDP is assessing ways to reduce the overall footprint occupied by clinical and administrative
branches and the Gillis W. Long Hansen’s Disease Center, located in Carville, Louisiana.
Currently, the branches are located in separate facilities in Baton Rouge. NHDP is working with
the General Services Administration to locate a new facility, accommodate the structure to
NHDP special needs (patient rooms, pharmacy, rehab therapy, medical records, etc.) and
complete a lease agreement before January 2020.
The funding request also includes costs associated with the contract review and award process,
263
Outputs and Outcomes Table
Year and Most

Recent
Result/Target for
Recent Result/ FY 2019
FY 2016: -6.59%
3.E.: Maintain the Maintain Maintain
Target: Below
increase in the cost per below below
national medical
outpatient served below national national Maintain
inflation rate
the medical inflation rate medical medical
Target: 4.11 %
(Efficiency) inflation rate inflation rate
(Target Met)
3.II.A.4.: Number of FY 2017: 682
health care providers who Target 550
550 550 Maintain
have received training (Target Exceeded)
from NHDP (Output)
FY 2016: 42%
3.II.A.1.: Percentage of
Target: Less than or Less than or Less than or
patients at Grade 1 or 2 Maintain
equal to 50% equal to 50% equal to 50%
disability 192 (Outcome)
(Target Met)
Program Indicators
FY 2018 FY 2019
Annualized President’s
Resident Population: Inpatients 6 4 4
Baton Rouge Clinic: Outpatients 177 177 177
Baton Rouge Clinic: Outpatient Visits 20,859 20,859 20,859
Ambulatory Care Program (ACP) Clinics 16 3-8 3-8
ACP Clinic: Outpatients 3,394 2919 2919
ACP Clinic: Outpatient Visits 5,754 4948 4948
192
World Health Organization scale: Grade 0 = no disability; Grade 1 = sensory loss; Grade 2 = visible deformity
264
National Hansen’s Disease Program – Buildings and Facilities
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Enacted Annualized CR
Budget FY 2018
BA $122,000 $121,000 --- -$121,000
FTE --- --- --- ---
Authorizing Legislation: Public Health Service Act, Sections 320 and 321(a)
Allocation Method .....................................................................................................Direct Federal
This activity provides for renovation and modernization of buildings at the Gillis W. Long
Hansen’s Disease Center at Carville, Louisiana, to eliminate structural deficiencies under
applicable laws in keeping with accepted standards of safety, comfort, human dignity, efficiency,
and effectiveness. Projects assure a safe facility and functional environment for the delivery of
patient care and training activities, while meeting requirements to preserve the Carville historic
district under the National Historic Preservation Act.
Funding History
FY Amount
FY 2015 $122,000
FY 2016 $122,000
FY 2017 $122,000
FY 2018 $121,000
FY 2019 $---
Budget Request
There is no request in FY 2019 for Building and Facilities. There are sufficient funds available to
continue renovation and repair work on patient and clinic areas and to complete minor
renovation work at the Carville facilities.
265
Payment to Hawaii
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $1,853,000 $1,844,000 $1,857,000 +$13,000
FTE --- --- --- ---
Authorizing Legislation: Public Health Service Act, Section 320(d), as amended by Public Law
105-78, Section 211
Allocation Method ......................................................................................................Direct Federal
Payments are made to the State of Hawaii for the medical care and treatment of persons with
Hansen’s disease (HD) in its hospital and clinic facilities at Kalaupapa, Molokai, and Honolulu.
Expenses above the level of the Federal funds appropriated for the support of medical care are
borne by the State of Hawaii.
Funding History
FY Amount
FY 2015 $1,857,000
FY 2016 $1,857,000
FY 2017 $1,853,000
FY 2018 $1,844,000
FY 2019 $1,857,000
Budget Request
The FY 2019 Budget requests $1.9 million, which is an increase of $13,000 over the FY 2018
Annualized CR level. In addition to the payment made to the State of Hawaii for the medical
care and treatment of person with HD, the funding request also includes costs associated with the
grant review and award process, follow-up performance reviews, and information technology,
and other program support costs.
266
Rural Health Policy
TAB
267
FEDERAL OFFICE OF RURAL HEALTH POLICY
Rural Health Policy Development

FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $9,328,000 $9,287,000 $5,000,00 -$4,287,000
FTE 1 1 1 ---
Authorizing Legislation: Public Health Service Act, Section 301 and Social Security Act,
Section 711
Allocation Method ..............................................................................................Competitive Grant
The Federal Office of Rural Health Policy (FORHP) is charged with advising the HHS Secretary
on how rural health care is impacted by current policies as well as proposed statutory, regulatory,
administrative, and budgetary changes in the Medicare and Medicaid programs. The authorizing
legislation requires FORHP to advise on: (1) the financial viability of small rural hospitals; (2)
the ability of rural areas (particularly rural hospitals) to attract and retain physicians and other
health professionals; and (3) access to and quality of health care in rural areas. FORHP is also
charged with overseeing compliance, per the requirements of section 1102(b) of the Social
Security Act, related to assessing the impact of key regulations affecting a substantial number of
small rural hospitals. To support these advisory and compliance roles, FORHP maintains
clearinghouses for collecting and disseminating information on rural health care issues,
promising approaches to improving and enhancing health care delivery in rural communities, and
policy-relevant research findings addressing rural health care delivery.
Rural Health Policy Development supports a range of activities including policy analysis,
research, and information dissemination. The Rural Health Research Center and Rapid Response
Research Programs are the only Federal research programs specifically designed to provide both
short and long-term policy relevant studies on rural health issues. The Research Center program
awards seven research center grants to conduct policy-oriented health services research, while
the Rapid Response Research Program awards one grantee to conduct rapid data analyses and
short-term, issue-specific rural research studies. Rural Health Research Centers publish in policy
briefs, academic journals, research papers, and other venues, and their publications are available
268
to policy makers at both the Federal and State levels. Research Center briefs also align with
Administration priorities, such as addressing opioid abuse and other clinical priorities. For
example, the Research Centers Program is developing a number of research briefs for release in
FY 2018 that analyze rural-urban differences in opioid-affected pregnancies and births,
variations in family physicians’ prescribing of Buprenorphine, and best practices for providing
Buprenorphine Maintenance Treatment.
Rural Health Policy Development supports cooperative agreements, including the Research
Gateway, which are public clearinghouses for rural health policy research and provide general
information on HRSA’s rural health programs. In FY 2017, these clearinghouses disseminated
61 research reports, including policy briefs, full reports posted on the Rural Health Research
Gateway website, and documents published in peer-reviewed journals.
Rural Health Policy Development also supports the staffing for the National Advisory
Committee on Rural Health and Human Services (NACRHHS), which advises the HHS
Secretary on rural health and human service programs and policies, produces policy briefs, and
makes recommendations on emerging rural policy issues. In addition, HRSA continues to
monitor and track the number of rural hospitals that have closed across the country and funds a
number of grants that focus on addressing hospital closures or mitigating the loss of services due
to hospitals facing financial distress.
Funding History
FY Amount
FY 2015 $9,351,000
FY 2016 $9,351,000
FY 2017 $9,328,000
FY 2018 $9,287,000
FY 2019 $5,000,000
Budget Request
The FY 2019 Budget requests $5.0 million for Rural Health Policy Development, which is $4.3
million below the FY 2018 Annualized CR level. This request will maintain base-level support
for the following activities: Rural Health Research Centers; Rapid Response Program; Rural
Health Research Gateway; rural health information dissemination; and the National Advisory
Committee on Rural Health and Human Services. The Rural Health Research Center program
will produce 14 rural policy briefs in FY 2019.
269
Year and Most

Recent Result/
FY 2019
Target for FY 2018 FY 2019
Measure +/-
FY 2018
(Summary of
Result)
28.V.A.1: Conduct and FY 2017 : 61

disseminate policy relevant Target: 39
35 14 -21
research on rural health issues. (Target
(Outcome) Exceeded)
Grant Awards Table
FY 2018 FY 2019
FY 2017 Final
Annualized CR Annualized CR
Average Award $656,662 $639,867 $298,000
Range of Awards $120,000-$1,548,632 $120,000-$1,540,889 $100,000-$350,000
270
Rural Health Care Services Outreach, Network and Quality Improvement
Grants
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $65,347,000 $65,055,000 $50,811,000 -$14,244,000
FTE 8 8 8 ---
Authorizing Legislation: Public Health Service Act, Section 330A, as amended by Public Law
110-355, Section 4
Allocation Method ............................................ Competitive Grants and Cooperative Agreements
The Rural Health Care Services Outreach, Network and Quality Improvement Grants (Outreach
programs) improve rural community health by focusing on quality improvement, increasing
health care access, coordination of care, and integration of services.
All Outreach grant programs support collaborative models to deliver basic health care services to
rural areas and are uniquely designed to meet rural needs. The grants allow rural communities to
compete for funding against other rural communities, rather than competing against larger
metropolitan communities with greater resources. The Outreach programs are among the only
non-categorical grants within HHS, allowing grantees to determine the best ways to meet local
needs. This flexibility responds to the unique health care challenges in rural communities and
enables communities to determine the best approaches for addressing needs. Rural Health Care
Services Outreach, Network and Quality Improvement Grants Programs include:
 Rural Health Care Services Outreach Grants focus on improving access to care in rural
communities through the work of community coalitions and partnerships. These grants
often focus on disease prevention and health promotion but can also support expansion of
services such as primary care, opioid abuse treatment and prevention, mental and
behavioral health, and oral health care services. Grantees are required to submit and track
baseline data throughout their project periods and to develop their programs based on
promising practices or evidence-based models. The program expects to fund 55 awards in
FY 2019.
The Outreach Services grant funding also supports the Rural Health Opioid Program.
This program promotes rural health care services outreach by expanding the delivery of
271
opioid related health care services to rural communities through broad community
consortiums focused on treatment, care coordination practices to organize patient care
activities, and support to individuals in recovery through behavioral counselling and peer
support activities. The program brings together non-profit entities such as hospitals,
primary care practices, substance abuse treatment centers, social service organizations,
and other community groups to respond with a multifaceted approach to the opioid
epidemic in a rural community. The program expects to continue 10 awards in FY 2019.
The FY 2019 Budget also allocates new resources to HRSA to combat the opioid
epidemic. Additional details can be found under the Opioid tab.
 Rural Network Development Grants support building regional or local partnerships

among local hospitals, physician groups, long-term care facilities, and public health
agencies to improve management of scarce health care resources. The program focuses
on demonstrating the health outcomes made by the network as well as positioning
networks to be successful in the current health care landscape. Grantees under this
program are likely to focus on improving health outcomes and enhancing health care
quality. The program expects to continue 51 awards in FY 2019.
 Rural Network Development Planning Grants bring together key parts of a rural health
care delivery system (hospitals, clinics, public health, etc.) so they can work together to
address local health care challenges. The Network Planning provides an opportunity for
grantees to work on priority and emerging public health issues, such as opioid abuse. The
program plans to award 20 new grants in FY 2019.
 Small Health Care Provider Quality Improvement Grants help improve patient care and
chronic disease outcomes by assisting rural primary care providers with the
implementation of quality improvement activities. Specifically, program objectives
include developing more coordinated delivery of care, enhanced chronic disease
management, and improved health outcomes for patients. An additional program goal is
to prepare rural health care providers for quality reporting and pay-for-performance
programs. The program expects to award 15 new grants in FY 2019.
 The Delta States Network Grant Program provides network development grants to the
eight states in the Mississippi Delta for network and rural health infrastructure
development. In addition, the program supports chronic disease management, oral health
services, and recruitment and retention efforts. Unlike the programs mentioned above,
this program is geographically targeted, given the health care disparities across this eight-
state region. The program also requires all grantees to focus on diabetes, cardiovascular
disease, and obesity and to develop programs based on promising practices or evidence-
based models. The program expects to award 12 new grants in FY 2019.
In FY 2017, the Outreach program received an additional $2 million to enhance health care
delivery in the Delta region. As a result, a three-year Delta Region Community Health Systems
Development Cooperative Agreement was developed and awarded. This program will help
272
underserved rural communities identify and better address their health care needs and will help
small rural hospitals and clinics improve their financial and operational performances. These
efforts will be coordinated with the Delta Regional Authority (DRA), particularly in the selection
of the communities to receive assistance. The program expects to continue the Delta Region
Community Health Systems Development award in FY 2019.
The Outreach programs continue to conduct program evaluations and build evidence-based
models for new ways to improve health care in rural communities. Evaluations focus on
measuring program impact on the health status of rural residents with chronic conditions and
economic impact of the Federal investment in rural communities. Grantees use the Rural Health
Information (RHI) Hub’s Economic Impact Analysis193 tool to assess the economic impact of the
Federal investment. The tool translates project impacts into community-wide benefits, such as
number of jobs created, new spending, and impacts of new and expanded services.
Grantees are also required to demonstrate program impact through outcome-focused measures.
Grantees track and submit to HRSA baseline data throughout their project periods and
implement programs that are adapted from promising practices or evidence-based models. The
programs support innovative models that offer rural communities the tools and resources to
enhance health care services and ease the transition to health care models focusing on improved
quality and value.
While making the initial Federal investment in a rural area, each of the grant programs expects
the communities to continue providing the services at the conclusion of the grant funding. As
project periods end, the Outreach programs continually assess program sustainability. While
sustainability rates may vary across grantee cohorts, the majority of projects are expected to
continue after Federal funding. The most recent cohort of community-based grantees that
completed Federal funding is the Rural Health Network Development. The FY 2016 results
showed that 98 percent of the Rural Health Network Development grantees continued to sustain
either all or some of their programs, exceeding the target of 70 percent.
Across the programmatic investments made in the Outreach programs, findings and key lessons
learned from evaluations and case studies are gathered and made available on the RHI Hub’s
Community Health Gateway194 so that rural communities from across the country can benefit
from Outreach program investments and results.
Funding History
FY Amount
FY 2015 $59,000,000
FY 2016 $63,500,000
FY 2017 $65,347,000
FY 2018 $65,055,000
FY 2019 $50,811,000
193
https://www.ruralhealthinfo.org/econtool
194
https://www.ruralhealthinfo.org/community-health
273
Budget Request
The FY 2019 Budget requests $50.8 million for the Rural Health Care Services Outreach,
Network, and Quality Improvement Grants, which is $14.7 million below the FY 2018
Annualized CR level. The budget will support 87 existing grantees and 66 new grant awards that
will positively affect health care service delivery for 230,000 people.
Year and Most

Recent Result /
FY 2019
Measure +/-
FY 2018
(Summary of
Result)
29.IV.A.3. Track number
of unique individuals who
received direct services FY 2016: 993,187
through FORHP Outreach Target: 410,000 420,000 230,000 -190,000
grants, subject to (Target
availability of resources. Exceeded)
(Outcome)
29.IV.A.4: Percent of
Outreach Authority FY 2016: 98%
grantees that will continue Target: 70%
(Target 75% 75% Maintain
to offer services after the
Federal grant funding Exceeded)
ends.195 (Outcome)
195
Outreach programs have varying three-year project periods. When sustainability data is captured at the end of a
program project period, sustainability rates may vary based on the nature of the program ending.
274
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $278,758 $264,883 $285,615
Range of Awards $74,515 - $2,000,000 $100,000 - $ 2,000,000 $100,000 - $2,000,000
275
Rural Hospital Flexibility Grants
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $43,509,000 $43,313,000 --- -$43,313,000
FTE 2 2 --- -2
Authorizing Legislation: Social Security Act, Section 1820(j), as amended by Public Law 105-
33, Section 4201(a), and Public Law 108-173, Section 405 (f), as amended by Section 121,
Public Law 110-275
Allocation Method ............................................................................................. Competitive Grants
The Rural Hospital Flexibility Grants are offered through three grant programs:
 Medicare Rural Hospital Flexibility Grant (Flex) Program supports a partnership between
45 states and over 1,300 Critical Access Hospitals (CAHs) to work on quality and
performance improvement activities, as well as help eligible rural hospitals convert to
CAH status and enhance CAH-related emergency medical services. The Flex Program’s
goal is to help CAHs maintain high-quality and economically viable facilities to ensure
that rural community residents, particularly Medicare beneficiaries, have access to high-
quality health care services. States use Flex resources to address identified CAH needs
and to achieve improved and measurable outcomes in each selected program area. In FY
2017, the Flex program received an additional $2 million that was provided to 40
hospitals as supplemental awards to serve rural communities with high rates of poverty,
unemployment and substance abuse.
The Flex Program plays a key role in ensuring that CAHs are aligned with certain
Medicare Program quality initiatives. All prospective payment system hospitals (PPS) are
required to submit quality data to the Centers for Medicare & Medicaid Services (CMS)
to receive a full Medicare payment update. While not subject to this CMS requirement,
CAHs elect to submit quality data to CMS to demonstrate areas of high quality while also
identifying areas for improvement. As a result of the Flex Program’s Medicare
Beneficiary Quality Improvement Project (MBQIP), ninety-six percent196 of CAH’s are
reporting quality data to CMS.
196
Results based on the Flex Monitoring Team analysis of the 2016 CMS data.
276
 Small Rural Hospital Improvement Program (SHIP) provides support to rural hospitals
with fewer than 50 beds to enhance their administrative capabilities in meeting
information technology and reporting requirements under value-based care through
awards to 46 states with eligible hospitals, SHIP provides funding for equipment and
training to upgrade billing requirements, such as incorporating new ICD-10 standards,
and for software that captures patient satisfaction data.
 Flex Rural Veterans Health Access Program provides grants to Alaska, Missouri, and
South Carolina, states with high percentages of veterans relative to their total populations.
This program focuses on increasing the delivery of mental health services or other health
care services to meet the needs of Operation Iraqi Freedom and Operation Enduring
Freedom veterans living in rural areas. Administered in collaboration with the
Department of Veterans Affairs (VA) Office of Rural Health, this program enhances
health care for veterans living in isolated rural areas and who receive care both at their
local facilities and at more distant VA facilities. Grantees focus on investments in
telehealth and health information exchange technologies to improve veteran access to
needed services and to provide veterans greater continuity of care.
Funding History
FY Amount
FY 2015 $41,609,000
FY 2016 $41,609,000
FY 2017 $43,509,000
FY 2018 $43,313,000
FY 2019 $---
Budget Request
The FY 2019 Budget requests $0 for Rural Hospital Flexibility Grants, which is $43.3 million
below the FY 2018 Annualized CR level. The Budget prioritizes programs that provide direct
health care services.
277
Year and Most

Recent Result /
FY 2019
Target for Recent FY 2018 FY 2019
Measure +/-
FY 2018
(Summary of
Result)
30.V.B.6: Increase the percent
of Critical Access Hospitals
FY 2015: 75.8%
participating in the Hospital
Consumer Assessment of
(Target Exceeded)
Healthcare Providers and
Systems (HCAHPS) survey
30. V.B.7a: Percent of CAHs
participating in one or more
Flex-funded required quality
FY15: 65%
improvement initiatives that N/A N/A N/A
(Target Not in Place)
showed improvement in one or
more specified quality
domains.197 (Developmental)
30. V.B.7b: Percent of CAHs
participating in one or more
Flex-funded optional quality FY15: 44%
improvement initiatives that (Target Not in N/A N/A N/A
showed improvement in one or Place)
more specified quality
domains.198 (Developmental)
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $565,000 $565,000 ---
Range of Awards $18,000-$945,000 $18,000-$945,000 ---
197
FY 2015 was the first year of data for this measure. Targets will be set after two years of results.
198
The initial baseline is from FY 2015 data. Targets will be set after two years of results.
278
State Offices of Rural Health
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $9,977,000 $9,932,000 --- -$9,932,000
FTE --- --- --- ----
Authorizing Legislation: Section 338J of the Public Health Service Act, as amended by Public
Law 105-392, Section 301
This grant program provides funding to establish and maintain a State Office of Rural Health
(SORH) to strengthen each state’s rural health care delivery system, with every dollar of Federal
support matched by three state dollars. SORHs serve as focal points and clearinghouses for the
collection and dissemination of information on rural health issues, research findings, innovative
approaches, and best-practices pertaining to the delivery of health care in rural areas.
As the state’s rural institutional framework, SORHs help link rural communities with state and
Federal resources to develop long-term solutions to rural health problems. SORHs form
collaborative partnerships to better coordinate rural health activities, maximize limited resources,
and avoid duplication of effort and activities. SORHs facilitate clinical placements through
recruitment initiatives and help rural constituents meet recruitment challenges by sharing
information. SORHs identify Federal, state, and nongovernmental programs and funding
opportunities and provide technical assistance to public and nonprofit private entities regarding
participation in rural health programs. In FY 2016, SORHs provided 63,160 technical assistance
encounters directly to clients. The number of technical assistance (TA) encounters declined
compared to FY 2015 (71,868), due to programmatic changes in several states to better target
information and educational resources. FORHP continues to work with grantees, especially
engaging with new SORH program directors to provide additional support and guidance.
279
Funding History
FY Amount
FY 2015 $9,511,000
FY 2016 $9,511,000
FY 2017 $9,977,000
FY 2018 $9,932,000
FY 2019 $---
Budget Request
The FY 2019 Budget requests $0 for State Office of Rural Health, which is $9.9 million below
the FY 2018 Annualized CR level. The Budget prioritizes programs that provide direct health
care services.
Year and Most

Recent Result /
FY 2019
Measure +/-
FY 2018
(Summary of
Result)
31.V.B.3: Number of technical FY 2016: 63,160
assistance (TA) encounters Target: 68,960 63,791 N/A N/A
provided directly to clients by (Target Not Met)
SORHs. (Outcome)
31.V.B.4: Number of clients FY 2016: 22,618 N/A
(unduplicated) that received Target: 22,858 22,844 N/A
technical assistance directly from (Target Not Met)
SORHs. (Outcome)
31.V.B.5: Number of clinician FY 2015: 1,984
placements facilitated by the Target: 1,260 N/A
1,260 N/A
SORHs through their recruitment (Target
initiatives. (Outcome) Exceeded)
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $179,871 $179,871 ---
Range of Awards $165,521-$179,871 $165,521-$179,871 ---
280
Radiation Exposure Screening and Education Program
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $1,830,000 $1,822,000 $1,834,000 +$12,000
FTE 1 1 1 ---
Authorizing Legislation: Public Health Service Act, Section 417C, as amended by Public Law
109-482, Sections 103 and 104
The Radiation Exposure Screening and Education Program (RESEP) provides grants to states,
local governments, and appropriate health care organizations to support programs for cancer
screening for individuals adversely affected by the mining, transport and processing of uranium
and the testing of nuclear weapons for the Nation’s weapons arsenal. The RESEP grantees also
help clients with appropriate medical referrals, engage in public information development and
dissemination, and facilitate claims documentation to aid individuals who may wish to apply for
support under the Radiation Exposure Compensation Act. In FY 2016, the number of
individuals screened at RESEP was 1,453 and the average screening cost per individual was
$1,184.
Funding History
FY Amount
FY 2015 $1,834,000
FY 2016 $1,834,000
FY 2017 $1,830,000
FY 2018 $1,822,000
FY 2019 $1,834,000
Budget Request
The FY 2019 Budget requests $1.8 million for Radiation Exposure Screening and Education,
which is $12,000 above the FY 2018 Annualized CR level. This request will continue to support
activities such as: implementing cancer screening programs; developing education programs;
281
disseminating information on radiogenic diseases and the importance of early detection;
screening eligible individuals for cancer and other radiogenic diseases; providing appropriate
referrals for medical treatment; and facilitating documentation of Radiation Exposure
Compensation Act (RECA) claims.
performance reviews, and information technology and other program support costs.
Year and Most

Recent Result /
FY 2019
Measure +/-
FY 2018
(Summary of
Result)
32.1: Percent of RECA successful FY 2016: 21.1 %
claimants screened at RESEP Target: 8.8% 13% 13% Maintain
centers. (Outcome) (Target Exceeded)
32.2: Percent of patients screened FY 2016: 85.9%

at RESEP clinics who file RECA Target: 72% +5%
72% 77%
claims that receive RECA (Target Exceeded) points
benefits. (Outcome)
FY 2016:
32.I.A.1: Total number of 1,453
individuals screened per year. Target: 1,400 1,200 1,300 +100
(Output) (Target Exceeded)
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $244,791 $244,791 $244,791
Range of Awards $123,696-$232,776 $123,630-$300,000 $123,630-$300,000
282
Black Lung
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $7,250,000 $7,217,000 $7,266,000 +$49,000
FTE --- --- --- ---
Authorizing Legislation: Federal Mine, Health, and Safety Act of 1977, Public Law 91-173,
Section 427(a), as amended by Public Law 95-239, Section 9
Allocation Method ............................................... Competitive Grants and Cooperative Agreement
The Black Lung Clinics Program (BLCP) funds eligible public, private, and state entities that
provide medical, outreach, educational, and benefits counseling services to active, inactive,
retired, and disabled coal miners throughout the United States with the goal of reducing the
morbidity and mortality associated with occupationally related coal-mine dust lung disease. To
support the longer-term need faced by miners with severe disability due to black lung disease,
grantees may also assist coal miners and their families in preparing the detailed application for
Federal Black Lung benefits from the Department of Labor (DOL).
In FY 2016, the program served 13,122 miners, exceeding a key target program measure of
12,836. An equally important measure is the number of medical encounters BLCP awardees had
with miners with black lung disease, or coal workers’ pneumoconiosis (CWP). The program
supported 18,684 medical encounters with black lung disease patients in FY 2016, which fell
below the target of 19,880 medical encounters. Several factors may have contributed to this gap,
including HRSA’s implementation of a new approach to more effectively respond to the growing
prevalence and incidence of black lung disease across the country. This resulted in funding a new
grantee currently in the early stages of building its capacity to screen, diagnose, and treat miners
in its state’s service area. Staff turnover at black lung clinics also remains an issue, and there
continue to be shortages in the number of clinicians able to perform exams related to new DOL
standards for x-rays, pulmonary testing, and medical documentation.
Recent data highlights the continued need for black lung services. The National Institute of
Occupational Safety and Health (NIOSH) identified a cluster of 56 progressive massive fibrosis
(PMF) cases among Kentucky residents who were current and former coal miners at a single
eastern Kentucky radiology practice from January 2015 to August 2016. This figure exceeded
283
the 19 PMF cases in Kentucky detected by NIOSH’s National Coal Workers’ Health
Surveillance Program between August 2011 to July 2016.199 The current prevalence of PMF
among underground coal miners with 25 years or more of underground mining tenure in Virginia
and West Virginia, as reported by NIOSH’s Coal Workers’ Health Surveillance Program, is
around 5 percent, up from 3 percent in 2012.200
Funding History
FY Amount
FY 2015 $6,766,000
FY 2016 $6,766,000
FY 2017 $7,250,000
FY 2018 $7,217,000
FY 2019 $7,266,000
Budget Request
The FY 2019 Budget requests $7.3 million for the Black Lung Clinics Program, which is
$49,000 above the FY 2018 Annualized CR level. HRSA will continue to fund 15 Black Lung
Clinic Program awards that provide primary care and other services to coal miners and a
cooperative agreement with one Black Lung Center of Excellence (BLCE) to enhance the quality
of services provided by BLCP grantees. The BLCE cooperative agreement recipient will work
closely with HRSA to strengthen the quality of data collection and analysis.
Year and Most

Recent Result /
FY 2019
Measure +/-
FY 2018
(Summary of
Result)
FY 2016:
33.I.A.1: Number of 13,122
miners served each Target: 12,836 13,800 13,800 Maintain
year. (Output) (Target Exceeded)
199
PMF cluster in eastern KY: Blackley, et al., “Resurgence of Progressive Massive Fibrosis in Coal Miners—
Eastern Kentucky, 2016,” CDC Morbidity and Mortality Weekly Report Vol. 65, No. 49, Dec. 2016, pg. 1386.
200
Ibid., 1387.
284
Year and Most
Recent Result /
FY 2019
Measure +/-
FY 2018
(Summary of
Result)
33.I.A.2: Number of FY 2016: 18,684
medical encounters Target: 19,880 19,000 19,000 Maintain
from Black Lung each (Target Not Met)
year. (Output)
33.E.1:The number of
miners served per $1
FY 2016: 1,986 1,900 1,900 Maintain
million in HRSA Black
(Baseline)
Lung Clinics Program
funding.(Efficiency)
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $446,317 $420,716 $444,755
Range of Awards $150,000-$1,291,213 $125,000- $1,265,572 $125,000-$1,291,213
285
Telehealth
FY 2019 FY 2019
FY 2017 FY 2018
President’s +/-
Final Annualized CR
Budget FY 2018
BA $18,459,000 $18,374,000 $10,000,000 -$8,374,000
FTE 1 1 1 ---
Authorizing Legislation: Public Health Service Act, Section 330I
Allocation Method .................................................... Competitive Grants/Cooperative Agreements
The Office for the Advancement of Telehealth (OAT) promotes the use of telehealth
technologies for health care delivery, education, and health information services. OAT
administers the following grant programs listed below.
The Telehealth Network Grant Program (TNGP) supports the use of telehealth networks to
improve health care services for medically underserved populations in urban, rural, and frontier
communities. More specifically, the networks: (a) expand access to, coordinate, and improve the
quality of health care services; (b) improve and expand the training of health care providers;
and/or (c) expand and improve the quality of health information available to health care
providers, patients, and their families. For the most recent year data is available, TNGP grantees
provided 82 clinical services across 135 sites in underserved rural communities in FY 2015. Of
these 135 telehealth sites, 87 sites offered pediatric mental health services and 119 sites offered
adult mental health services. In FY 2019, FORHP will support two TNGP cohorts:
 School-Based Telehealth Network Grant focuses on providing telehealth services to rural

communities through school-based health centers. Grantees are focused on five clinical
areas, including chronic disease reduction and prevention and behavioral health. Twenty-
one grants will continue in FY 2019.
 Substance Abuse Treatment Telehealth Network Grant focuses on increasing access to

substance abuse treatment services in rural, frontier, and underserved communities.
Three grantees will continue in FY 2019.
Evidence-Based Telehealth Network Grant has a two-fold purpose of increasing access to care in
rural and frontier communities by using telehealth technologies and to conduct evaluations of
those efforts to establish an evidence-base assessing the effectiveness of telehealth care for
patients, providers, and payers. The emphasis on data collection and research to further the
286
telehealth evidence base separates this program from other Telehealth Network Grants in OAT.
OAT will continue to support six grantees in FY 2019.
Telehealth Resource Center (TRC) Program provides expert and customizable telehealth
technical assistance across the country. The TRCs provide training and support, disseminate
information and research findings, promote effective collaboration, and foster the use of
telehealth technologies to provide health care information and education for providers who serve
rural and medically underserved areas and populations. In FY 2019, OAT will continue to fund
twelve regional and two national TRCs.
Telehealth Centers of Excellence examine the efficacy of telehealth services in rural and urban
areas and serve as a national clearinghouse for telehealth research and resources. OAT
anticipates two grantees will continue in FY 2019.
Telehealth Focused Rural Health Research Center conducts policy-relevant and clinically-
informed telehealth research. OAT does not anticipate making new awards in FY 2019.
Licensure Portability Grant Program provides support to state professional licensing boards to
carry out programs under which the boards cooperate to develop and implement state policies
that will reduce statutory and regulatory barriers to telemedicine. OAT does not anticipate
making new awards in FY 2019.
Funding History
FY Amount
FY 2015 $14,900,000
FY 2016 $17,000,000
FY 2017 $18,459,000
FY 2018 $18,374,000
FY 2019 $10,000,000
Budget Request
The FY 2019 Budget requests $10 million for the Telehealth program, which is $8.4 million
below the FY 2018 Annualized CR level. This request allows a reduced level of support for the
current Telehealth Network Grants, the Telehealth Resource Centers, and the Telehealth Centers
of Excellence. It does not provide for new grant awards in FY 2019.
287
Year and
Most Recent
Result / FY 2019
FY 2018 FY 2019
Measure201 Target for +/-
Target Target
(Summary of
Result)
34.II.A.1: Increase the proportion of
diabetic patients enrolled in a FY 2015: 43%
telehealth diabetes case management Target: 30%
25% 25% Maintain
program with ideal glycemic control (Target
(defined as hemoglobin A1c at or Exceeded)
below 7%). (Outcome)
34.1: The percent of TNGP grantees

FY 2017: N/A
that continue to offer services after the
N/A N/A N/A
TNGP funding has ended. 202(Baseline
– FY 2005: 100%) (Outcome)
FY 2015:
34.III.D.2: Expand the number of 3,187
telehealth services (e.g., dermatology,
cardiology) and the number of sites Target: 2,675 2,725 2,750 +25
where services are available as a result (Target
of the TNGP program. (Outcome) Exceeded)
34.III.D.1: Increase the number of FY 2015: 488

communities that have access to
pediatric and adolescent mental health Target: 320
330 335 +5
services where access did not exist in (Target
the community prior to the TNGP Exceeded)
grant.203 (Outcome)
201
The Telehealth Network Grant Program (TNGP) is a demonstration program. Every three to four years, each
cohort of TNGP grantees completes its project period, while a new cohort of grantees commences a new cycle of
grant-supported Telehealth activities. The data is calculated as a cumulative number, and with each new cohort, the
distribution of these services is uncertain. Therefore, the targets may need to be revised if there is evidence of a
significant increase in grantees that are providing mental health services.
202
This is a long-term measure based on the end date of the current cohort of grantees. The target data for this
measure is FY 2020.
203
This is a demonstration program. Every three years to four years each cohort of TNGP grantees “graduates”
from the grant program while a new cohort of grantees commences a new multi-year cycle of grant-supported
Telehealth activities. The data is calculated as a cumulative number. However, with each new cohort, the
288
Year and
Most Recent
Result / FY 2019
FY 2018 FY 2019
Measure201 Target for +/-
Target Target
(Summary of
Result)
34.III.D.1.1: Increase the number of FY 2015: 554
communities that have access to adult
Target: 315
mental health services where access 330 340 +10
(Target
did not exist in the community prior to
Exceeded)
the TNGP grant.204 (Outcome)
34.E: Expand the number of services FY 2015: 43
and/or sites providing access to health per Million $
care as a result of the TNGP program 60 per 65 per + 5 per
per Federal program dollars Target: 105 per Million Million Million $
expended.205 (Efficiency) Million $ $ $
(Target Not
Met)
Grant Awards Table
FY 2017 FY 2018 FY 2019

Average Award $329,280 $353,061 $217,391
Range of Awards $170,424 - $900,000 $250,000 - $1,000,000 $154,799 – 634,675

-
204
This is a demonstration program. Every three years to four years each cohort of TNGP grantees “graduates”
from the grant program while a new cohort of grantees commences a new multi-year cycle of grant-supported
Telehealth activities. The data is calculated as a cumulative number. However, with each new cohort, the
205
This measure provides the number of sites and services made available to people who otherwise would not have
access to them per million dollars of program funds spent. Every three years a new cohort of grantee commences
with a new three-year cycle of grant supported activities, gradually expanding sites and services per dollar invested.
With each new cohort, there is a start-up period where services are being put in place but are not yet implemented.
289
Opioids
TAB
290
Opioids Allocation Funding
The Budget provides $10 billion in new resources across HHS to combat the opioid epidemic
and address mental health. This national crisis is a top priority at HHS. As part of this effort, the
Budget provides an initial allocation totaling $550 million in HRSA to address substance abuse,
including opioid abuse, and the overdose crisis in highest risk rural communities. This funding
will go directly to communities that are best situated to address this crisis.
Community Health Centers: To date, Community Health Centers have played a vital role in
helping millions of Americans who struggled with substance abuse and mental health issues. The
Budget allocates $400 million to community health centers to address this crisis, of which $200
million is included to provide quality improvement incentive payments to community health
centers that implement evidence-based models to address behavioral health issues, with a focus
on opioid addiction, to meet the health needs of the population served by the health center. This
funding will support and enhance the capacity of health centers to treat substance use disorders,
which includes expanding evidence-based substance abuse prevention and education programs
for patients, families, communities, and personnel to increase awareness of patient access to, and
patient retention in substance use disorder treatment programs.
Investing in Rural Communities. The request includes $150 million to address substance abuse,
including opioid abuse, and the overdose crisis in high risk rural communities. This funding will
allow communities to develop plans to address local needs. Additionally, this funding will
provide additional loan repayment awards through the National Health Service Corps to support
the recruitment and retention of health professionals needed in rural areas to provide evidence-
based substance abuse treatment and prevent overdose deaths.
The program will support multi-sector, county-level teams located in communities identified at
the highest risk for substance abuse by the Centers for Disease Control and Prevention (CDC).206
Approximately 98 percent of these communities are completely or partially rural, 61 percent are
completely rural, and 63 percent are located in counties designated as part of the Appalachian
region by the Appalachian Regional Commission. While the opioid epidemic has devastated
both urban and rural counties, the burden in rural areas is significantly higher. Rural
communities face a number of challenges in gaining access to health care in general, and
substance abuse treatment in particular. These challenges include lack of specialized health
services, health workforce shortages, and potentially greater stigma related to substance abuse
due to living in smaller communities. Research shows that rural opioid users are more likely to
have socioeconomic vulnerabilities including limited educational attainment, poor health status,
being uninsured, and low-income.207 In addition, the CDC has found that drug-related deaths are
45 percent higher in rural communities, and that rural states are more likely to have higher rates
206
Van Handel MM, Rose CE, Hallisey EJ, Kolling JL, Zibbell JE, Lewis B, et al. County-level vulnerability
assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. J
Acquir Immune Defic Syndr (2016) 73:323–31.10.1097
207
Maine Rural Health Research Center. “Rural Opioid Abuse: Prevalence and User Characteristics”. February,
2016.
291
of overdose death.208 Furthermore, 53.4 percent of U.S. counties do not have a physician who
can prescribe buprenorphine for opioid dependency treatment. Of those counties that have no
physician to prescribe buprenorphine, 82.1 percent were in rural areas.209
HRSA’s expertise in working directly with rural communities and diverse and medically
underserved population groups, including people living with HIV/AIDS, children and pregnant
women, uniquely positions HRSA to make a significant impact on the nation’s opioid crisis. To
effectively address the opioid abuse crisis, communities must be able to implement
comprehensive strategies that address prevention, treatment, and other health and community
support services. This can be achieved through the following activities:
 Recruitment of new substance abuse providers on-site at community health centers and/or
other community health services providers to increase access to services.
 Increased use of telehealth to increase access to services in rural communities.
 Training and support for existing providers to expand and enhance services.
 Implementation of new models of care, including integrated behavioral health and
primary care, and expanded team-based care, to achieve coordinated care.
 Establishment of cross-sector community partnerships that support comprehensive
systems of care and support to address the immediate treatment and recovery needs of
individuals and families. Collaborative partnerships would also actively work to reduce
the prevalence of substance misuse county-wide.
 Emphasis on the needs of special populations, including individuals with HIV/AIDS,
perinatal women and infants, children, adolescents and their families, individuals who are
homeless, and veterans, to help overcome their multiple and unique barriers to care.
208
Faul, M., et al. "Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden
of Drug Overdose in Us Rural Communities." Am J Public Health 105 Suppl 3 (2015): e26-32.
209
WWAMI Rural Health Research Center. “Geographic and Specialty Distribution of US Physicians Trained to
Treat Opioid Use Disorder.” December, 2014.
292
Program Management
TAB
293
Program Management
FY 2019 FY 2019
BA $153,629,000 $152,954,000 $151,993,000 -$961,000
FTE 789 789 789 ---
FY 2019 Authorization……………………………………………………………...……Indefinite
Allocation Method…………………………………………………………………………....Other
To achieve its mission, HRSA requires qualified staff to operate at maximum efficiency. One of
HRSA’s goals is to strengthen program management and operations by improving program
customer satisfaction, increasing employee engagement, and implementing organizational
improvements and innovative projects. Program Management is the primary means of support
for staff, business operations and processes, information technology and overhead expenses such
as rent, utilities, and miscellaneous charges, for HRSA.
Improving Processes and Business Operations

HRSA continues to improve operational planning processes to foster cross-agency collaboration.
HRSA has automated its contracting process to operate in a totally paperless environment,
including the receipt of committed funds, the obligation of funds, and the generation and storage
of contract documents. Over the past five years, HRSA has reduced travel costs and supported
telework participation by increasing the agency-wide utilization of real-time web collaboration
tools. Real-time collaboration is accomplished using automated tools that support a full range of
requirements from one-on-one for teleworkers to web-based meetings supporting as many as 500
participants. In FY 2016 HRSA used 12.7 million virtual meeting minutes, which is 2.6 million
more minutes than FY 2014.
Improving Data Transparency, Services, and Cybersecurity

Program Management supports the continued development, operations and maintenance of
enterprise functionality of the HRSA Electronic Handbooks (EHBs). The EHBs is an IT
Investment that provides the strategic and performance outcomes of the HRSA Programs and
contributes to their success by providing a mechanism for sharing data and conducting business
in a more efficient manner, while improving program integrity. The EHBs supports HRSA with
program administration, grants administration and monitoring, management reporting, and
performance measurement and analysis. In FY 2016, HRSA re-engineered the EHBs resulting in
increased 508-compliance from 52 percent to 92 percent, making the HRSA system available to
visually impaired individuals. HRSA also improved the efficiency of the system with a 50
294
percent reduction in response time and an 84 percent increase in grantee satisfaction, particularly
related to improvements in navigation, search, help videos, and screen sharing; HRSA also
supports a secure and trusted IT infrastructure. In FY 2016, HRSA patched approximately 500
servers monthly and 2,000 desktops weekly with the latest software and security updates. The
agency also investigated 222 malware detection alerts and implemented a new intrusion
detection system that blocked 18,735 intrusion events. These efforts help HRSA meet its
business needs in a safe and secure manner.
Creating a Culture of Program Integrity

Program Management also supports program integrity activities that align with performance and
strategic planning activities to reduce programmatic risk and improve performance. HRSA’s
Program Integrity Initiative includes an agency-wide workgroup that develops, monitors, and
oversees the agency’s program integrity activities; training for federal staff and grantees; and the
hiring of program integrity analysts and auditors. HRSA has established a HRSA-wide
governance structure for enterprise-wide business operations and program integrity activities to
ensure a customer-focused suite of business operation services and functions. HRSA is currently
evolving its Program Integrity Initiative to focus on Enterprise Risk Management (ERM) and the
development of a risk-aware organizational culture.
Utilizing feedback from GAO studies, OIG reports, and issues identified through members of the
HRSA Program Integrity Workgroup, HRSA has developed a series of program integrity
training, webcasts, and reference materials. For example, HRSA developed an online program
integrity toolkit that provides HRSA staff with a single source of information, resources,
templates, policies, procedures, and manuals. Additionally, HRSA collaborated with the HHS
Inspector General to provide OIG-led grant fraud training to HRSA project officers. HRSA has
also submitted its mission critical support functions—such as time and attendance, property
management, research integrity, and FOIA—to operational reviews to assess compliance with
laws and regulations, and Departmental and HRSA policies.
Funding History
FY Amount
FY 2015 $154,000,000
FY 2016 $154,000,000
FY 2017 $153,629,000
FY 2018 $152,954,000
FY 2019 $151,993,000
Budget Request
The FY 2019 Budget requests $152.0 million, which is a decrease of $961,000 below the FY
2018 Annualized CR. This funding level supports program management activities to effectively
and efficiently support HRSA’s operations.
HRSA is committed to improving quality at a lower cost and improving the effectiveness and
efficiency of government operations. HRSA continues to reduce travel costs and support
295
telework participation by increasing the agency-wide utilization of web collaboration tools,
which have led to greater business productivity.
HRSA also continues to enhance its program integrity activities by supporting analytical tools
using HRSA’s electronic grants system, program data, Office of Federal Assistance Management
data sources, HHS sources, and government-wide sources. The goal is for HRSA to identify
potential issues in the pre- and post-award processes and to address issues before they become
audit findings. HRSA plans to focus on a risk-based approach to grantee monitoring using the
information and corresponding analysis to help staff spend their time on grantees at risk of
noncompliance. HRSA will also continue to provide training for grants management and
program staff to support the alignment of program integrity initiatives with planning and
performance activities. These efforts will enhance HRSA grantees awareness and ability to
avoid potential financial integrity issues.
IT Investments
Significant progress has been made in a range of program management activities. Some
highlights include:
 Improve cybersecurity efforts through the implementation of state of the art security tools
and robust reporting. These integrated tools not only improve and secure the Information
Technology infrastructure, but will also reduce the number of physical servers as part of
the ongoing virtualization and consolidation initiative.
 Continue implementation of the Enterprise Architecture, Capital Planning and Investment

Control (CPIC) and Enterprise Performance Life Cycle (EPLC) processes.
 Support the Federal Information Technology Shared Services Strategy by consuming

more than 35 shared services offered by other HHS Operating Divisions. Shared services
enables HRSA to drive down operating costs in support and commodity areas, improve
return on investment, and eliminate waste and duplication.
 Continue development, operations and maintenance of the Electronic Handbooks

(EHBs).
 Release of a redesigned Data Warehouse site that has increased mobile and tablet device
usage by 20 percent. The Data Warehouse is the official repository for current enterprise
HRSA data and promotes maximum operating efficiency through centralization,
reconciliation, and standardization of data across HRSA’s various transactional business
systems. The Data Warehouse also promotes “Open Data” by providing HRSA and the
general public with a single source of HRSA programmatic information, related health
resources, demographic, and statistical data for analyzing and reporting on HRSA
activities with easily accessible, readily-available charts, maps, reports, data portal,
dashboards, tools, downloadable files and data feeds.
296
Year and Most

Recent Result / FY2019
Result / +/-
(Summary of FY2018
Measure Result) FY 2018 Target FY 2019 Target Target
Full participation in Full participation in

Security and Privacy Security and Privacy
FY 2017:
Awareness training Awareness training
Full participation in
35.VII.B.1.: by 100% of HRSA by 100% of HRSA
Security and Privacy
Ensure staff, specialized staff, specialized
Awareness training
Critical security training for security training for
by 100% of HRSA
Infrastructure 100% of HRSA 100% of HRSA
staff. Specialized
Protection: staff identified to staff identified to
role-based training Maintain
Security have significant have significant
for 100% of HRSA
Awareness security and privacy security and privacy
staff identified to
Training responsibilities, and responsibilities, and
have significant
(Output) participation in participation in
security and privacy
Executive Executive
responsibilities.
Awareness training Awareness training
(Target Met)
by 100% of HRSA by 100% of HRSA
executive staff executive staff
FY 2017:
100% of HRSA 100% of HRSA 100% of HRSA
information systems information systems information systems
will be assessed and will be assessed and will be assessed and
authorized to authorized to authorized to
operate (ATO). In operate (ATO). In operate (ATO). In
35.VII.B.2:
addition, all systems addition all systems addition all systems
Ensure
will go through will go through will go through
Critical
continuous continuous continuous
Infrastructure
monitoring to ensure monitoring to monitoring to ensure
Protection: Maintain
that critical patches ensure that critical that critical patches
Security
are applied, security patches are applied, are applied, security
Authorization
controls are security controls are controls are
to Operate
implemented and implemented and implemented and
(Output)
working as intended, working as working as
and risks are intended, and risks intended, and risks
managed and are managed and are managed and
mitigated in a timely mitigated in a mitigated in a timely
manner. (Target timely manner manner
Met)
297
Year and Most
Result / +/-
(Summary of FY2018
FY 2017:
Privacy - 100% of Privacy - 100% of
35.VII.B.2a: Privacy - 100% of
HRSA staff (federal HRSA staff (federal
Ensure HRSA staff (federal
and contractor) and contractor)
Critical and contractor)
accessing the HRSA accessing the HRSA
Infrastructure accessing the HRSA
network with network with Maintain
Protection: network with
Privileged accounts Privileged accounts
Security Privileged accounts
must use PIV cards must use PIV cards
HSPD-12 must use PIV cards
or other 2-factor or other 2-factor
Privilege and or other 2-factor
authentication authentication
Non-Privilege authentication
(Target Met)
FY 2017:
35.VII.B.2b:
Cyber Sprint - Cyber Sprint - Cyber Sprint -
Ensure
Remediation of Remediation of Remediation of
Critical
critical findings critical findings critical findings
Infrastructure Maintain
from cyber hygiene from cyber hygiene from cyber hygiene
Protection:
scanning within 30 scanning within 30 scanning within 30
Security
Days Days Days
Cyber Sprint
(Target Met)
35.VII.B.2c:
Ensure
Critical
Infrastructure FY 2017:
Protection: Identify 85% of
Identify 90% of Identify 90% of
Security systems that require
systems that require systems that require
Privacy a PIA or a Privacy
a PIA or a Privacy a PIA or a Privacy Maintain
Impact Threshold
Threshold Threshold
Assessment Assessment (PTA)
Assessment (PTA) Assessment (PTA)
(PIA) Or
Privacy (Target Met)
Threshold
Assessment
(PTA)
298
Year and Most
Result / +/-
(Summary of FY2018
35.VII.B.2d:
FY 2017:
Ensure
10 Phishing
Critical 6 Phishing 6 Phishing
Campaigns
Infrastructure Campaigns Campaigns Maintain
completed
Protection: completed completed
Security
(Target Met)
Phishing
FY 2017:
1) 100% of major
investments
received an IT
Dashboard Overall
Rating of “Green”, 1) Receiving
1) Receiving
which indicates an FITARA score of
FITARA score of
acceptable cost, “A” for IT
“A” for IT
schedule and Portfolio;
Portfolio;
Agency CIO Rating;
35.VII.B.3:
Capital 2) 75% of major
(Target Met) 2) 75% of major
Planning and Investment
Investment Maintain
Investment Managers will be in
2) 100% of major Managers will be in
Control compliance with the
Investment compliance with the
(Output) Federal Acquisition
Managers are in Federal Acquisition
Certification for
compliance with the Certification for
Program/Project
Federal Acquisition Program/Project
Management (FAC
Certification for Management (FAC
P/PM).
Program/Project P/PM).
Management (FAC
P/PM).
(Target Met)
299
Year and Most
Result / +/-
(Summary of FY2018
FY 2017:
Enterprise
Enterprise Enterprise
Architecture: 95%
Architecture: 90% Architecture: 90%
of IT investments
of IT investments of IT investments
35.VII.B.4: reported to OMB
reported to OMB reported to OMB
Enterprise with mapping to at Maintain
with mapping to at with mapping to at
Architecture least one HHS
least one HHS least one HHS
segment and
segment and segment and
domain.
domain. domain.
(Target Met)
FY 2017:
Began to implement
ERM efforts, Continue to Assess HRSA’s
35.VII.A.4:
including implement ERM
Implement
participation in HHS Enterprise Risk implementation
Enterprise
Risk Profile Management, efforts, including
Risk
development and including alignment with HHS
Management
integration of the developing a risk and OMB NA
(ERM)
revised OMB aware culture at Circular A-123
Circular A-123 HRSA ERM guidance
(Target Met)
300
Family Planning
TAB
301
Family Planning
FY 2019 FY 2019
BA $286,479,000 $284,534,000 $286,479,000 +$1,945,000
FTE 12210 122102 35 ---
Authorizing Legislation: ……………………………….Title X of the Public Health Service Act
FY 2017 Authorization………………………………………………………………….Indefinite
Allocation Method………………………………….Direct Federal, Contract, Competitive Grant
The Title X Family Planning Program is the only federal grant program dedicated to providing
individuals with comprehensive family planning and related health services. Enacted in 1970 as
part of the Public Health Service Act, the mission of the Title X Program is to aid individuals
and families in determining the number and spacing of children and to provide access to
voluntary family planning methods, and services (including natural family planning methods,
infertility services, and services for adolescents), and information to all who want and need them.
By law, priority is given to persons from low-income families.
The Title X Program fulfills its mission through awarding competitive grants to public and
private nonprofit organizations to support the provision of voluntary family planning services,
information, and education. According to the 2016 Family Planning Annual Report (FPAR)
data, services were provided through 91 family planning service grants that supported a
nationwide network of 3,898 community-based sites that provided clinical and educational
services to more than 4,007,500 persons. There is at least one Title X services grantee in every
state, the District of Columbia, and in each of the U.S. territories, including the six Pacific
jurisdictions. Title X family planning program regulations and authorizing legislation require
that projects provide a broad range of effective and acceptable family planning methods and
services, including natural family planning methods, infertility services and services for
adolescents.
In addition to clinical services, the Title X Family Planning program supports the US
Government response to Zika as well as three key functions aimed at assisting clinics in
responding to clients’ needs: (1) training for all levels of family planning agency personnel
through a national training program; (2) information dissemination and community-based
education and outreach activities; and (3) data collection and research to improve the delivery of
family planning services. The OPA provided support for the US response to Zika through
210
Due to coding error, FTE is reporting lower than actual 35 FTE
302
creation of a “Zika toolkit,” entitled “Providing Family Planning Care for Non-Pregnant Women
and Men of Reproductive Age in the Context of Zika,” based on Centers for Disease and Control
Prevention (CDC) guidance that addresses the educational, counseling, and testing advice for
providers serving individuals of child-bearing age, with guidance and patient education tools
specific to areas with and without local transmission of Zika. The toolkit is available in Spanish
as well as English. In addition, in 2016 OPA conducted extensive training and provided
supplemental funds to Title X recipients in Puerto Rico, the US Virgin Islands, Texas, Arizona,
Mississippi, and California to assist with Zika response. Each year the program establishes a set
of program-wide priorities that provide guidance to grantees. The 2019 priorities include
promoting the overall health of individuals by offering core family-planning services which
include a sexual health assessment and tools for family planning such as a family planning or
reproductive life plan, health screenings and information as well as education and counseling and
referral services. An important part of family planning includes supporting the overall health of
clients who may seek to become parents in the future. Therefore, each Title X project should
ensure that family planning is contextualized within a holistic conversation of health, with the
project optimally offering primary health services onsite, or having robust referral linkages to
primary health providers in close proximity to the Title X site. The FY 2019 priorities also seek
to promote positive family relationships for the purpose of healthy decision-making and optimal
health and life outcomes for every individual and couple. An additional focus has been placed on
implementing electronic health record and administrative management systems, increasing the
number and types of contracts with health insurance plans, and recovering more costs through
reimbursements and billing third-party payers to ensure the financial sustainability of service
sites.
In order to improve overall program performance, the program is increasing the emphasis on
financial and program management by providing training around billing practices, including
billing all appropriate third-party payers, and other cost recovery methods through the Title X
National Training Center. In addition, grantees are being urged to implement more efficient
administrative systems, such as health information technologies, electronic health records, and
payment management systems.
Another trend, which the program believes will improve program performance, is increased
competition and diversity in the types of grantees funded. Increased competition has led to more
diversified grantees, leading to improved cost recovery methods and different administrative
structures, which, it is anticipated, will ultimately improve quality and service delivery.
Funding History
FY Amount
FY 2015 $286,749,000
FY 2016 $286,479,000
FY 2017 $286,479,000
FY 2018 $284,534,000
FY 2019 $286,479,000
303
Budget Request
The FY 2019 Budget request of $286.5 million is $1.9 million above the FY 2018 Annualized
CR. The budget request provides funding for family planning methods and related health
services, as well as related training, information, education, counseling, and research to improve
family planning awareness and service delivery.
The FY 2019 Budget request is expected to support family planning for approximately 3,991,000
persons, with approximately 90 percent having family incomes at or below 200 percent of the
federal poverty level.
As indicated in the Program Description, OPA currently funds at least one Title X family
planning service grantee in each state throughout the U.S. as well as in the territories and most of
the Pacific Basin jurisdictions. The FY 2019 request provides funding for family planning
methods and related health services as well as related training, education, and research.
The FY 2019 request will also allow the program to continue supporting the operation of a
Family Planning National Delivery System Improvement Center. The program will likely need
to continue addressing the impact of the Zika virus or other conditions which affect non-pregnant
individuals of child-bearing age, including but not limited to the population which receives
services at Title X family planning service sites. This will include dissemination of the Zika
Toolkit, developed by OPA to incorporate CDC guidance that addresses the educational,
counseling, and testing advice for providers serving individuals of child-bearing age, with
guidance and patient education tools specific to areas with and without local transmission of
Zika.
OPA clinics and grantees were also involved in the Chlamydia screening of approximately
1,218,000 females ages 15-24, and the prevention of approximately 360 cases of invasive
cervical cancer through cervical cancer screening; they will also be involved in the prevention of
approximately 903,000 unintended pregnancies.
The targets for FY 2019 assume other sources of revenue that contribute to the family planning
program at the grantee level will continue at approximately the same levels, including Medicaid,
state and local government programs, other federal, state, and private grants, and private
insurance .
OPA’s clinical grantees will continue to include recommended chlamydia screening, screening
for undiagnosed cervical tissue abnormalities, preconception care and counseling, basic
infertility services, pregnancy testing and counseling, natural family planning methods,
contraceptives, adolescent services and related education and counseling. These services, along
with community-based education and outreach, assist individuals and families with pregnancy
leading to healthy birth outcomes and prevention of unintended pregnancy. To the extent
practicable, Title X clinics also encourage family participation when delivering such services.
OPA will also coordinate with other federal agencies, and with other data collection efforts
reflecting performance and impact. The program is anticipating that additional investment in
304
third party billing, an increase in the proportion of clients who have health insurance, and better
adoption of electronic health records and related health IT systems, will increase revenue and
allow the Title X program to reach more of the population it is intended by law to serve.
Long Term Objective: Increase awareness of voluntary family planning resources and methods
by providing Title X family planning services, education and research, with priority for services
to low-income individuals.
Measure Year and Most FY 2018 FY 2019 FY 2018

Recent Result +/-
/Target for Target Target FY 2019
Recent Result
(Summary of
Result)
FY 2016:
36.II.A.1: Total number of 4,018,000
unduplicated clients served in Title X 4,000,000 3,991,000 (9,000)
Target: 4,672,000
service sites. (Outcome)
(Target Not Met)
36.II.A.2: Maintain the proportion of

clients served who are at or below FY 2016: 88.9
200% of the Federal poverty level at 90% 90% Maintain
Target: 90%
90% of total unduplicated family (Target Not Met)
planning users. (Outcome)
36.II.A.3: Increase the number of FY 2016: 901,838
unintended pregnancies averted by
providing Title X family planning Target: 832,000 905,000 903,000 (2,000)
services, with priority for services to (Target Exceeded)
low-income individuals. (Outcome)
36.II.B.1: Reduce infertility among
women attending Title X family FY 2016: 939,224
planning clinics by identifying
Target: 1,195,000 1,195,000 1,218,000 +23,000
Chlamydia infection through
screening of females ages 15-24. (Target Not Met)
(Outcome)
36.II.C.3: Increase the proportion of FY 2016: 61.54%
females ages 15 – 24 attending Title
X family planning clinics screened Target: 64.4% 64.4% 64.4% Maintain
for Chlamydia infection. (Outcome)
(Target Not Met)
305
Efficiency Measure
Measure Year and Most FY 2018 FY 2019 FY 2018

Recent Result /Target Target Target +/-
for Recent Result FY 2017
(Summary of Result)
36.E: Maintain the actual cost per FY 2016: $325.76
Title X client below the medical Target: $301.14
care inflation rate. (Efficiency) (Target Not Met) $336.69 $345.11 +$8.43
Grant Awards Tables
FY 2017 Actual FY 2018 Annualized FY 2019

CR President’s Level
Average Award $3,079,500 $2,867,000 $2,867,000
Range of Awards $131,000 - $130,000 - $130,000 -
$20,500,000 $20,000,000 $20,000,000
306
Supplementary Tables
TAB
307
Budget Authority by Object Class
DISCRETIONARY
FY 2018 FY 2019 FY 2019
2017 Final Annualized President's +/- FY
OBJECT CLASS CR Budget 2018
Full-time permanent (11.1) 149,468 152,730 194,094 +41,364
Other than full-time permanent (11.3) 6,173 6,308 7,609 +1,301
Other personnel compensation (11.5) 3,118 3,186 3,896 +710
Military personnel (11.7) 17,251 17,647 21,688 +4,041
Special personnel services payments (11.8) 20 5 - -5
Subtotal personnel compensation 176,031 179,876 227,287 +47,411
Civilian benefits (12.1) 49,484 50,564 64,429 +13,865
Military benefits (12.2) 9,178 9,388 11,548 +2,160
Benefits to former personnel (13.1) - - - -
Total Pay Costs 234,693 239,828 303,264 +63,436
Travel and transportation of persons (21.0) 2,612 2,614 2,727 +113
Transportation of things (22.0) 163 163 146 -17
Rental payments to GSA (23.1) 14,859 14,990 18,318 +3,328
Rental payments to Others (23.2) 704 704 722 +18
Communication, utilities, and misc. charges (23.3) 7,918 7,782 8,431 +649
Commercial Reimbursement (23.6) - - - -
Network use data transmission service (23.8) - - - -
Printing and reproduction (24.0) 84 84 84 -
Other Contractual Services: 25.0 - - - -
Advisory and assistance services (25.1) 13,569 13,569 29,785 +16,216
Other services (25.2) 194,577 197,108 212,396 +15,288
Purchase of goods and services from government
accounts (25.3) 179,471 176,349 256,110 +79,761
Operation and maintenance of facilities (25.4) 944 975 854 -121
Research and Development Contracts (25.5) 16 16 16 -
Medical care (25.6) 2,964 2,964 2,964 -
Operation and maintenance of equipment (25.7) 4,927 4,801 7,077 +2,276
Subsistence and support of persons (25.8) 30 30 30 -
Discounts and Interest (25.9) - - - -
Supplies and materials (26.0) 1,187 1,182 687 -495
Subtotal Other Contractual Services 397,684 396,994 509,919 +112,925
Equipment (31.0) 9,120 9,112 7,828 -1,284
Investments and Loans (33.0) - - - -
Grants, subsidies, and contributions (41.0) 5,411,327 5,396,289 8,619,788 +3,223,499
Insurance Claims and Indemnities (42.0) 120,083 87,695 88,364 +669
Total Non-Pay Costs $ 5,964,554 $ 5,916,426 $ 9,256,327 +$3,339,901
Total Budget Authority by Object Class $ 6,199,247 $ 6,156,255 $ 9,559,591 +$3,403,336
308
PRIMARY HEALTH CARE
FY 2018 FY 2019 FY 2019
OBJECT CLASS 2017 Final Annualized President's +/- FY
CR Budget 2018
Other than full-time permanent (11.3) 1,303 1,331 1,986 +655
Other personnel compensation (11.5) 386 394 831 +437
Special personnel services payments (11.8) - - - -
Military benefits (12.2) 2,824 2,888 3,483 +595
Total Pay Costs 42,182 43,112 78,529 +35,417
Travel and transportation of persons (21.0) 842 842 887 +45
Transportation of things (22.0) 9 9 9 -
Rental payments to GSA (23.1) 2,436 2,436 3,676 +1,240
Rental payments to Others (23.2) 2 2 2 -
Communication, utilities, and misc. charges
(23.3) 1,169 1,169 1,902 +733
Printing and reproduction (24.0) - - - -
Advisory and assistance services (25.1) - - - -
Other services (25.2) 86,179 87,102 94,385 +7,283
Purchase of goods and services from
government accounts (25.3) 42,189 42,189 134,268 +92,079
Operation and maintenance of facilities (25.4) - - - -
Research and Development Contracts (25.5) - - - -
Medical care (25.6) - - - -
Operation and maintenance of equipment (25.7) 655 655 3,896 +3,241
Subsistence and support of persons (25.8) - - - -
Supplies and materials (26.0) 178 178 178 -
Equipment (31.0) 2,022 2,022 2,024 +2
Grants, subsidies, and contributions (41.0) 1,190,230 1,213,982 4,683,402 +3,469,420
Insurance Claims and Indemnities (42.0) 119,837 87,695 88,364 +669
Total Non-Pay Costs $ 1,445,748 $ 1,438,281 $ 5,012,993 +$3,574,712
Total Budget Authority by Object Class $ 1,487,929 $ 1,481,393 $ 5,091,522 +$3,610,129
309
HEALTH WORKFORCE
FY 2018 FY 2019 FY 2019
CR Budget 2018
Other than full-time permanent (11.3) 405 414 878 +464
Military benefits (12.2) 569 582 1,774 +1,192
Total Pay Costs 15,790 16,136 39,103 +22,967
Rental payments to GSA (23.1) 798 869 2,533 +1,664
Rental payments to Others (23.2) - - 18 +18
Other services (25.2) 14,902 14,902 23,635 +8,733
accounts (25.3) 26,560 26,560 18,957 -7,603
Operation and maintenance of equipment (25.7) 862 862 140 -722
Supplies and materials (26.0) - - 2 +2
Subtotal Other Contractual Services 42,324 42,324 42,734 +410
Equipment (31.0) 675 675 59 -616

Grants, subsidies, and contributions (41.0) 774,624 770,480 370,364 -400,116
Insurance Claims and Indemnities (42.0) - - - -
Total Non-Pay Costs $ 821,009 $ 816,865 $ 418,695 -$398,170
Total Budget Authority by Object Class $ 836,799 $ 833,001 $ 457,798 -$375,203
310
MATERNAL AND CHILD HEALTH
FY 2018 FY 2019 FY 2019
2017
OBJECT CLASS Annualized President's +/- FY
Final
CR Budget 2018
Military personnel (11.7) 506 518 779 +261
Civilian benefits (12.1) 2,415 2,468 3,421 +953
Military benefits (12.2) 252 258 486 +228
Total Pay Costs 11,064 11,307 15,577 +4,270
Transportation of things (22.0) 10 10 11 +1
Rental payments to GSA (23.1) 640 640 1,137 +497
Rental payments to Others (23.2) - - - -
(23.3) 580 580 367 -213
Other services (25.2) 4,525 4,525 6,242 +1,717
government accounts (25.3) 15,324 15,324 15,262 -62
Supplies and materials (26.0) 6 6 11 +5
Equipment (31.0) 440 440 387 -53
Grants, subsidies, and contributions (41.0) 819,468 800,500 1,071,576 +271,076
Total Non-Pay Costs $850,517 $831,547 $1,120,623 +$289,076
Total Budget Authority by Object Class $861,581 $842,854 $1,136,200 +$293,346
311
HIV/AIDS
FY 2018 FY 2019 FY 2019
CR Budget 2018
Full-time permanent (11.1) 15,813 16,158 16,178 +20
Other than full-time permanent (11.3) 129 132 124 -8
Other personnel compensation (11.5) 252 257 255 -2
Military personnel (11.7) 2,978 3,046 3,124 +78
Subtotal personnel compensation 19,171 19,593 19,681 +88
Total Pay Costs 25,960 26,532 26,677 +145
Travel and transportation of persons (21.0) 556 556 518 -37
Transportation of things (22.0) - - - -
Rental payments to GSA (23.1) 1,171 1,229 1,170 -59
(23.3) 1,711 1,653 1,550 -103
Commercial Reimbursement (23.6) 0 - - -
Network use data transmission service (23.8) 0 - - -
Other services (25.2) 24,989 24,989 23,899 -1,091
government accounts (25.3) 58,833 58,833 56,984 -1,849
Operation and maintenance of equipment (25.7) 1,861 1,861 1,861 -
Subtotal Other Contractual Services 85,721 85,721 82,782 -2,939
Equipment (31.0) 2,003 2,003 1,868 -135
Grants, subsidies, and contributions (41.0) 2,196,062 2,185,340 2,145,606 -39,734
Total Non-Pay Costs $ 2,287,224 $ 2,276,502 $ 2,233,493 -$43,008
Total Budget Authority by Object Class $ 2,313,185 $ 2,303,034 $ 2,260,170 -$42,864
312
HEALTHCARE SYSTEMS
FY 2018 FY 2019 FY 2019
CR Budget 2018
Total Pay Costs 11,578 11,833 11,932 +99
Travel and transportation of persons (21.0) 244 245 245 -
Rental payments to GSA (23.1) 392 392 392 -
(23.3) 1,097 1,097 1,097 -
Advisory and assistance services (25.1) 462 463 463 -
Other services (25.2) 52,791 52,510 51,710 -800
Research and Development Contracts (25.5) 16 16 16 -
Medical care (25.6) 2,964 2,964 2,964 -
Operation and maintenance of equipment (25.7) 325 329 329 +
Supplies and materials (26.0) 693 688 186 -502
Equipment (31.0) 413 406 78 -327
Grants, subsidies, and contributions (41.0) 27,217 26,808 26,277 -531
Total Non-Pay Costs $92,366 $91,652 $88,586 -$3,066
Total Budget Authority by Object Class $103,945 $103,485 $100,518 -$2,967
313
RURAL HEALTH POLICY
FY 2018 FY 2019 FY 2019
2017
Final
CR Budget 2018
Full-time permanent (11.1) $ 951 $ 972 $ 799 $-173
Other than full-time permanent (11.3) 70 71 37 -34
Other personnel compensation (11.5) 16 16 14 -2
Subtotal personnel compensation 1,106 1,130 922 -208
Civilian benefits (12.1) 321 328 259 -68
Total Pay Costs 1,467 1,499 1,224 -275
Travel and transportation of persons (21.0) 171 176 145 -31
Transportation of things (22.0) - - - -
Rental payments to GSA (23.1) 102 103 89 -15
(23.3) 207 200 42 -158
Other services (25.2) 7,427 9,316 8,760 -555
Supplies and materials (26.0) - - - -
Equipment (31.0) 21 21 21 -
Grants, subsidies, and contributions (41.0) 143,080 140,685 62,192 -78,493
Total Budget Authority by Object Class $155,700 $155,000 $74,911 -$80,089
314
PROGRAM MANAGEMENT
FY 2018 FY 2019 FY 2019
2017
Final
CR Budget 2018
Other than full-time permanent (11.3) 3,379 3,453 3,469 +16
Special personnel services payments (11.8) 9 - - -
Total Pay Costs 118,366 120,949 121,696 +746
Rental payments to GSA (23.1) 8,798 8,798 8,798 -
(23.3) 703 703 703 -
Other services (25.2) 3,713 3,713 3,713 -
accounts (25.3) 16,515 13,503 11,949 -1,554
Operation and maintenance of facilities (25.4) 735 735 735 -
Operation and maintenance of equipment (25.7) 547 547 547 -
Equipment (31.0) 3,540 3,540 3,387 -153
Grants, subsidies, and contributions (41.0) - - - -
Insurance Claims and Indemnities (42.0) 246 - - -
Total Budget Authority by Object Class $153,629 $152,954 $151,993 -$961
315
FAMILY PLANNING
FY 2018 FY 2019 FY 2019
2017
Final
CR Budget 2018
Full-time permanent (11.1) 5,242 $,357 5,382 +25
Other than full-time permanent (11.3) 64 65 65 +
Other personnel compensation (11.5) 97 99 100 +
Special personnel services payments (11.8) 6 - - -
Total Pay Costs 8,286 8,462 8,528 +66
Rental payments to GSA (23.1) 523 523 523 -
Communication, utilities, and misc. charges (23.3) 53 53 53 -
Advisory and assistance services (25.1) 4,442 4,442 4,442 -
Other services (25.2) 51 51 51 -
accounts (25.3) 12,315 12,315 12,315 -
Operation and maintenance of facilities (25.4) 50 50 50 -
Operation and maintenance of equipment (25.7) - - - -
Subtotal Other Contractual Services 16,865 16,865 16,865 -
Equipment (31.0) 4 4 4 -
Grants, subsidies, and contributions (41.0) 260,612 258,492 260,371 +1,879
Total Non-Pay Costs $278,193 $276,072 $277,952 +$1,879
Total Budget Authority by Object Class $286,479 $284,534 $286,479 +$1,945
316
MANDATORY
FY 2018 FY 2019 FY 2019
CR211 Budget 2018
Full-time permanent (11.1) 48,649 50,237 - -50,237
Other than full-time permanent (11.3) 1,559 1,605 - -1,605
Other personnel compensation (11.5) 870 898 - -898
Military personnel (11.7) 4,080 4,204 - -4,204
Subtotal personnel compensation 55,158 56,945 - -56,945
Civilian benefits (12.1) 16,210 16,738 - -16,738
Military benefits (12.2) 2,489 2,521 - -2,521
Total Pay Costs 73,857 76,205 - -76,205
Travel and transportation of persons (21.0) 403 403 - -403
Transportation of things (22.0) 24 24 - -24
Rental payments to GSA (23.1) 4,144 4,144 - -4,144
Rental payments to Others (23.2) 18 18 - -18
Communication, utilities, and misc. charges (23.3) 2,390 2,390 - -2,390
GSA Reimbursement Transaction Charge (23.5) - - - -
Advisory and assistance services (25.1) 18,903 18,903 - -18,903
Other services (25.2) 30,210 30,210 - -30,210
accounts (25.3) 111,241 111,241 - -111,241
Operation and maintenance of equipment (25.7) 3,249 3,249 - -3,249
Supplies and materials (26.0) 8 8 - -8
Subtotal Other Contractual Services 163,612 163,612 - -163,612
Equipment (31.0) 84 84 - -84
Grants, subsidies, and contributions (41.0) 3,987,654 4,128,121 - -4,128,121
Total Non-Pay Costs $4,158,329 $4,298,795 $0 -$4,298,795
Total Budget Authority by Object Class $4,232,186 $4,375,000 $0 -$4,375,000
211
317
Salaries and Expenses
DISCRETIONARY
FY 2018 FY 2019 FY 2019
CR Budget 2018
Other than full-time permanent (11.3) 6,173 6,308 7,609 +1,301
Military benefits (12.2) 9,178 9,388 11,548 +2,160
Total Pay Costs 234,693 239,829 303,265 +63,436
Travel and transportation of persons (21.0) 2,612 2,614 2,728 +114
Rental payments to Others (23.2) 704 704 722 +18
Other services (25.2) 194,577 197,108 212,396 +15,288
accounts (25.3) 179,471 176,349 256,130 +79,781
Medical care (25.6) 2,964 2,964 2,964 -
Operation and maintenance of equipment (25.7) 4,927 4,801 7,077 +2,276
Supplies and materials (26.0) 1,187 1,182 688 -494
Total Non-Pay Costs $409,149 $408,324 $522,035 +$113,711
Total Budget Authority by Object Class $643,842 $648,153 $825,299 +$177,146
318
MANDATORY
FY 2018 FY 2019 FY 2019
CR212 Budget 2018
Full-time permanent (11.1) 48,649 50,237 - -50,237
Other than full-time permanent (11.3) 1,559 1,605 - -1,605
Other personnel compensation (11.5) 870 898 - -898
Military personnel (11.7) 4,080 4,204 - -4,204
Subtotal personnel compensation 55,158 56,945 - -56,945
Civilian benefits (12.1) 16,210 16,738 - -16,738
Military benefits (12.2) 2,489 2,521 - -2,521
Total Pay Costs 73,857 76,205 - -76,205
Travel and transportation of persons (21.0) 403 403 - -403
Transportation of things (22.0) 24 24 - -24
Rental payments to Others (23.2) 18 18 - -18
Communication, utilities, and misc. charges (23.3) 2,390 2,390 - -2,390
GSA Reimbursement Transaction Charge (23.5) - - - -
Advisory and assistance services (25.1) 18,903 18,903 - -18,903
Other services (25.2) 30,210 30,210 - -30,210
accounts (25.3) 111,241 111,241 - -111,241
Operation and maintenance of equipment (25.7) 3,249 3,249 - -3,249
Discounts and Interest (25.9) - - -
Supplies and materials (26.0) 8 8 - -8
Subtotal Other Contractual Services 163,612 163,612 - -163,612
Total Non-Pay Costs $166,447 $166,447 $0 -$166,447
Total Budget Authority by Object Class $240,304 $242,651 $0 -$242,651
212
319
Detail of Full-Time Equivalent Employment
Civilian Military Total Civilian Military Estimate Civilian Military Estimate
Bureau of Primary Health Care:

Direct:
Health Centers/Tort 235 53 288 235 53 288 456 66 522
Free Clinics Medical Malpractice - - - - - - - - -
Total, Direct: 235 53 288 235 53 288 456 66 522
Mandatory:
Health Centers 212 13 225 212 13 225 - - -
School-based Health Centers- Facilities (ACA) 9 - 9 9 - 9 - - -
Total, Mandatory 221 13 234 221 13 234 - - -
Total FTE, BPHC 456 66 522 456 66 522 456 66 522
Health Workforce:
Direct:
National Health Service Corps - - - - - - 200 25 225
NURSE Corps Loan Repayment & Scholarship 28 4 32 28 4 32 28 4 32
Centers for Excellence 1 - 1 1 - 1 - - -
Scholarships for Disadvantaged Students 5 - 5 5 - 5 - - -
Health Careers Opportunity Program 1 1 2 1 1 2 - - -
Health Care Workforce Assessment 6 - 6 6 - 6 6 - 6
Primary Care Training and Enhancement 6 - 6 6 - 6 - - -
Oral Health Training 5 1 6 5 1 6 - - -
Area Health Education Centers 4 - 4 4 - 4 - - -
Geriatric Programs 5 1 6 5 1 6 - - -
Behavioral Health Workforce Education and Training 5 1 6 5 1 6 - - -
Mental and Behavioral Health 2 - 2 2 - 2 - - -
320
Public Health/Preventive Medicine 4 - 4 4 - 4 - - -

Advanced Education Nursing Program 7 1 8 7 1 8 - - -
Nurse Workforce Diversity - - - - - - - - -
Nurse Education, Practice & Retention 4 1 5 4 1 5 - - -
Nurse Faculty Loan Program 4 1 5 4 1 5 - - -
Children's Hospitals GME Program 16 1 17 16 1 17 - - -
Teaching Health Center Graduate Medical Education - - - - - - 7 1 8
Total, Direct 103 12 115 103 12 115 241 30 271
Reimbursable:
National Practitioner Data Bank 34 1 35 34 1 35 34 1 35
Total, Reimbursable: 34 1 35 34 1 35 34 1 35
Mandatory:
National Health Service Corps 200 25 225 200 25 225 - - -
Teaching Health Center Graduate Medical Education 7 1 8 7 1 8 - - -
Total, Mandatory 207 26 233 207 26 233 - - -
Total FTE, Health Workforce 344 39 383 344 39 383 275 31 306
Maternal and Child Health Bureau:
Direct:
Maternal & Child Health Block Grant 41 1 42 41 1 42 41 1 42
Autism and Other Developmental Disorders 5 1 6 5 1 6 - - -
Sickle Cell Service Demonstrations 2 - 2 2 - 2 - - -
James T. Walsh Universal Newborn Hearing Screening 4 - 4 4 - 4 - - -
Emergency Medical Services for Children 5 - 5 5 - 5 - - -
Healthy Start 12 3 15 12 3 15 12 3 15
Heritable Disorders 3 - 3 3 - 3 - - -
321
Family-to-Family Health Information Centers - - - - - - - 1 1

Maternal, Infant, and Early Childhood Home Visiting - - - - - - 40 3 43
Total, Direct: 72 5 77 72 5 77 93 8 101
Mandatory
Family-to-Family Health Information Centers - 1 1 - 1 1 - - -
Maternal, Infant, and Early Childhood Home Visiting 40 3 43 40 3 43 - - -
Total, Mandatory 40 4 44 40 4 44 - - -
Total FTE, MCHB 112 9 121 112 9 121 93 8 101
HIV/AIDS Bureau:
Direct:
Ryan White Part A 39 5 44 39 5 44 39 5 44
Ryan White Part B 54 9 63 54 9 63 54 9 63
Ryan White Part C 39 15 54 39 15 54 41 15 56
Ryan White Part D 7 3 10 7 3 10 7 3 10
Ryan White Part F 4 1 5 4 1 5 - - -
Ryan White Part F Dental 1 - 1 1 - 1 1 - 1
Special Project of National Significance (SPNS) 2 - 2 2 - 2 - - -
Total, Direct: 146 33 179 146 33 179 142 32 174
Reimbursable:
OGAC Global AIDS 20 3 23 20 3 23 20 3 23
Secretary's Minority AIDS Initiative - - - - - - - - -
Total, Reimbursable 20 3 23 20 3 23 20 3 23
Total FTE, HAB 166 36 202 166 36 202 162 35 197
322
Healthcare Systems Bureau:

Direct:
Organ Transplantation 2 - 2 2 - 2 2 - 2
National Cord Blood Inventory 3 1 4 3 1 4 3 1 4
C.W.Bill Young Cell Transplantation Program 7 - 7 7 - 7 7 - 7
Poison Control Centers 2 - 2 2 - 2 2 - 2
340B Drug Pricing Program/Office of Pharmacy Affairs 16 6 22 16 6 22 16 6 22
Hansen's Disease Center 48 5 53 48 5 53 48 5 53
Covered Countermeasures Compensation 4 2 6 4 2 6 4 2 6
Vaccine 14 6 20 14 6 20 16 6 22
Total, Direct: 96 20 116 96 20 116 98 20 118
Reimbursable:
Hansen's Disease Center 3 - 3 3 - 3 3 - 3
Total, Reimbursable 3 - 3 3 - 3 3 - 3
- - - - -
Total FTE, HSB 99 20 119 99 20 119 101 20 121
Federal Office of Rural Health Policy:

Direct:
Rural Health Policy Development 1 - 1 1 - 1 1 - 1
Rural Health Outreach Grants 7 1 8 7 1 8 7 1 8
Rural Hospital Flexibility Grants 2 - 2 2 - 2 - - -
State Offices of Rural Health - - - - - - - - -
Radiation Exposure Screening & Education Program 1 - 1 1 - 1 1 - 1
Black Lung - - - - - - - - -
Telehealth 1 1 1 - 1 1 - 1
Total FTE, FORHP 12 1 13 12 1 13 10 1 11
323
Family Planning (Direct)213 11 1 12 11 1 12 34 1 35

Program Management (Direct) 741 48 789 741 48 789 741 48 789
Subtotal Direct (non add) 1,416 173 1,589 1,416 173 1,589 1,815 206 2,021
Subtotal Reimbursable (non add) 57 4 61 57 4 61 57 4 61
Subtotal Mandatory (non add) 468 43 511 468 43 511 - - -
Total, Ceiling FTE 1,941 220 2,161 1,941 220 2,161 1,872 210 2,082
Average GS Grade
FY 2017 12.9
FY 2018 12.9
FY 2019 12.9
213
Due to coding error, FTE is reporting lower than actual 35 FTE in FY 2017 and FY 2018.
324
FTEs Funded by P.L. 111-148 and Any Supplementals
FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019
Total Total Total Total Total Total Total Total Total

Program Section FTE FTE FTE FTE FTE FTE FTE FTE FTE
Funding Funding Funding Funding Funding Funding Funding Funding Funding
Community
Health Center
Fund:
P.L. 111-148 H.R. 3590,
1,000,000 56 1,200,000 47 1,500,000 60 2,144,716 95 3,509,111 122 - - - - - - - -
Mandatory Section
Non-P.L. 111- 10503(b)(1)
- - - - - - - - - - 3,600,000 240 3,510,661 225 3,600,000 225 - -
148 Mandatory
Health Centers - H.R. 3590,

Facilities Section 1,500,000 20 - 19 - - - - - - - - - - - - - -
Construction 10503(c)
School-Based H.R. 3590,

Health Centers- Section 50,000 9 50,000 5 47,500 8 - 9 - 7 - 7 - 9 - 9 - -
Facilities 4101
National Health
Service Corps:
P.L. 111-148 H.R. 3590,
290,000 190 295,000 248 300,000 229 283,040 219 287,370 214 - - - - - - - -
Mandatory Section
Non-P.L. 111- 10503(b)(2)
- - - - - - - - - - 310,000 226 288,610 225 310,000 225 - -
148 Mandatory
GME Payments H.R. 3590,

Teaching Health Section
Centers: 5508
P.L. 111-148
230,000 4 - 4 - 6 - 5 - 4 - - - - - - - -
Mandatory
Non-P.L. 111-
- - - - - - - - - - 60,000 8 55,860 8 60,000 8 - -
148 Mandatory
Family to
Family Health
Information
Centers:
Non-P.L. 111- H.R. 3590,
148 Mandatory Section 5,000 1 5,000 1 5,000 - 5,000 1 5,000 1 5,000 1 4,655 1 5,000 1 - -
5507
Home Visiting
Program:
P.L. 111-148 H.R. 3590,
Mandatory Section 250,000 19 350,000 23 379,600 22 - - - - - - - - - - - -
2951
Non-P.L. 111-
- - - - - - 371,200 22 400,000 25 400,000 37 372,400 44 400,000 44 - -
148 Mandatory
Total 3,325,000 299 1,900,000 347 2,232,100 325 2,803,956 351 4,201,481 373 4,375,000 519 4,232,186 512 4,375,000 512 - -
325
Programs Proposed for Elimination
The following list shows the programs proposed for elimination in the FY 2019 Budget request.
Termination of these programs totals approximately $960.0 million in discretionary resources.
Following each program is a brief summary and the rationale for its elimination.
FY 2018
Program
Annualized CR
Loan Repayment/Faculty Fellowships $1.2

Centers of Excellence $21.6
Scholarships for Disadvantaged Students $45.7
Health Career Opportunity Program $14.1
Primary Care Training and Enhancement $38.7
Oral Health Training Programs $36.4
Area Health Education Centers $ 30.0
Geriatric Programs $38.5
Behavioral Health Workforce Education and Training $49.7
Mental and Behavioral Health $9.8
Public Health/Preventative Medicine $16.9
Advanced Nursing Education $64.1
Nursing Workforce Diversity $15.2
Nurse Education, Practice and Retention $39.6
Nurse Faculty Loan Program $26.3
Children’s Hospital Graduate Medical Education $298.0
Autism and Other Developmental Disorders $46.8
Sickle Cell Service Demonstrations $4.4
James T. Walsh Universal Newborn Hearing Screening $17.7
Emergency Medical Services for Children $20.0
Heritable Disorders $13.8
AIDS Education and Training Centers – Part F $33.4
HIV/AIDS Special Programs of National Significance $24.8
Rural Hospital Flexibility Grants $43.3
State Offices of Rural Health $9.9
National Hansen’s Disease – Building and Facilities $0.1
Total Programs Proposed for Elimination $ 960.0
326
Loan Repayment/Faculty Fellowships (-$1.2 million)
The Budget eliminates funding for training programs. The Budget prioritizes funding for health
workforce activities that provide scholarships and loan repayment in exchange for service in
areas of the United States where there is a shortage of health professionals.
Centers of Excellence (-$21.6 million)

Scholarships for Disadvantaged Students (-$45.7 million)

Health Career Opportunity Program (-$14.1 million)

Primary Career Training and Enhancement (-$38.7 million)

Oral Health Training Programs (-$36.4 million)

Area Health Education Centers (-$30.0 million)

Geriatric Programs (-$38.5 million)

Behavioral Health Workforce Education and Training (-$49.7 million)

327
Mental and Behavioral Health (-$9.8 million)
Public Health/Preventative Medicine (-$16.9 million)

Advanced Nursing Education (-$64.1 million)

The Budget eliminates funding for Nurse training programs. The Budget prioritizes funding for
health workforce activities that provide scholarships and loan repayment in exchange for service
Nursing Workforce Diversity (-$15.2 million)

Nurse Education, Practice and Retention (-$39.6 million)

Nurse Faculty Loan Program (-$26.3 million)

Children’s Hospital Graduate Medical Education (-$298.0 million)

Autism and Other Developmental Disorders (-$46.8 million)

No funding is requested for this program. The Budget prioritizes programs that support direct
health care services and give states and communities the flexibility to meet local needs.
Sickle Cell Service Demonstrations (-$4.4 million)

No funding is provided for this program. The Budget prioritizes programs that support direct
James T. Walsh Universal Newborn Hearing Screening (-$17.7 million)

328
Emergency Medical Services for Children (-$20.0 million)
Heritable Disorders (-$13.8 million)

AIDS Education and Training Centers – Part F (-$33.4 million)

The Budget eliminates funding for training programs, and prioritizes program that provide direct
health care services.
Special Programs of National Significance (-$24.8 million)

The Budget does not include a separate funding line for these projects. As required by Statute,
SPNS will be funded from budget authority of Ryan White HIV/AIDS Parts A-D programs.
Rural Hospital Flexibility Grants (-$43.3 million)

No funding is provided for these programs, due to a shift in program priorities that emphasize
direct health care services.
State Offices of Rural Health (-$9.9 million)

No funding is provided for this program, due to a shift in program priorities that emphasize
direct health care services.
National Hansen’s Disease – Building and Facilities (-$0.1 million)

No new funding is provided for buildings and facilities. There are sufficient funds available to
continue the renovation and repair work on patient and clinic areas, and to complete minor
renovation work on the Carville museum and cemetery.
329
Physicians’ Comparability Allowance (PCA) Worksheet
Table 1
FY2017 FY 2018* FY 2019
Estimate Request
1) Number of Physicians Receiving PCAs 37 36 36
2) Number of Physicians with One-Year PCA Agreements 1 1 1
3) Number of Physicians with Multi-Year PCA Agreements 36 35 35
4) Average Annual PCA Physician Pay (without PCA payment) $145,266 $157,524 $157,524
5) Average Annual PCA Payment $22,457 $21,692 $22,692
Category I Clinical Position 2 2 2
6) Number of Physicians Category II Research Position 1 1 1
Receiving PCAs by Category Category III Occupational Health 0 0 0
(non-add) Category IV-A Disability Evaluation 0 0 0
Category IV-B Health and Medical Admin. 34 33 33
*FY 2018 data will be approved during the FY 2019 Budget cycle.
7) If applicable, list and explain the necessity of any additional physician categories designated by your
agency (for categories other than I through IV-B). Provide the number of PCA agreements per additional
category for the PY, CY and BY.
n/a
8) Provide the maximum annual PCA amount paid to each category of physician in your agency and explain
the reasoning for these amounts by category.
For each category, the amount of PCA given is to retain highly qualified medical officers that could potentially be compensated
more in the private sector.
Category I - $28,000
Category II - $6,500
Category IV – B - $30,000
Compensation reflects physician longevity and board certification. Physicians are also selecting multi-year contracts, which also
reflect compensation for mission specific factors. Compensating at these levels has allowed HRSA to compete with the private
sector and to increase retention of HRSA physicians. Most private sector physician salaries exceed the base salary HRSA is
able to offer. Hence, PCA provides the mechanism to get close to what they are currently receiving.
9) Explain the recruitment and retention problem(s) for each category of physician in your agency (this should
demonstrate that a current need continues to persist).
PCA is used to recruit and retain highly qualified medical officers. It is difficult to compete with private industry salaries. If
HRSA did not offer PCA, HRSA would not be able to attract potential candidates or maintain current HRSA medical officers
who enhance HRSA mission and goals. In FY17, there were (2) retirements and (3) resignations. The (3) resignations were as a
result of private industry job offers.
10) Explain the degree to which recruitment and retention problems were alleviated in your agency through the
use of PCAs in the prior fiscal year.
Three vacancies were filled at the highest salary rate with PCA.
11) Provide any additional information that may be useful in planning PCA staffing levels and amounts in your
agency.
N/A
330
Significant Items
TAB
331
SIGNIFICANT ITEMS FOR INCLUSION IN L-HHS APPROPRIATIONS
COMMITTEE FY 2019 CONGRESSIONAL JUSTIFICATION
HOUSE REPORT 115-244 (July 24, 2017)
1. Update on GAO Report. — The Committee requests HRSA include an update in the
fiscal year 2019 Congressional justification on the agency’s efforts to implement the
recommendations described in GAO Report (GAO–12– 546) Health Center Program:
Improved Oversight Needed to Ensure Grantee Compliance with Requirements. (Page
20)
Action to be Taken
HRSA has completed implementation of actions in response to the recommendations
included in the GAO Report (GAO-12-546). The status of each implementation response
is acknowledged by GAO as “Closed – Implemented”.
2. Establishment of a Health Center Audit, Compliance, and Oversight Office. — The

Committee allocates not less than $15,000,000 for the establishment of a Health Center
Audit, Compliance, and Oversight Office within the Bureau of Primary Health Care. The
Committee expects the office to perform periodic audits and compliance reviews of all
health center access points, with a goal of conducting a compliance or audit review for
every access point location every five years. The office shall oversee Federally Qualified
Health Centers, Health Center Program Look-Alikes, and Health Centers receiving a
grant under section 330 of the Public Health Service Act. The office should provide
uniform guidance to health center project officers, monitor project officer adherence to
program guidance, and periodically assess whether program guidance is meeting program
objectives. The office will also conduct independent compliance reviews, ensuring all
health center access points have policies, procedures, and training to comply with
applicable Federal laws. The office shall submit quarterly reports to the Committees on
Appropriations of the House of Representatives and the Senate containing the results of
all audits and compliance reviews of health center access points and oversight of health
center project officers. The Committees directs HRSA to provide a briefing within 45
days of enactment of this Act on efforts to establish this office. (Page 21)
Action to be Taken
HRSA expects to provide the requested briefing, consistent with funding levels and
direction included in the final enacted FY 2019 appropriation.
3. Tuberculosis. — The Committee encourages HRSA to continue to implement the

recommendations of the Tuberculosis Action Plan and recommends that the agency
include an update of its progress in the fiscal year 2019 Congressional Justification.
(Page 21)
332
Action to be Taken
HRSA is collaborating with the National Association for City and County Health
Officials (NACCHO) to provide technical assistance to support coordination between
health centers and State and local TB control programs to help ensure appropriate
identification, treatment, and prevention of TB among target populations. NACCHO is
conducting an environmental scan and reaching out to stakeholders to inform their
technical assistance plan.
4. Centers of Excellence. — The Committee directs HRSA to provide continuation grants

for activities authorized under section 736 of the Public Health Service Act. (Page 22)
Action to be Taken
HRSA will follow this directive assuming funds are appropriated for these activities in
FY 2018.
5. Integration of Primary Care and Oral Health Practice. — The Committee encourages
HRSA to address the impact of medication on oral health as part of its ongoing efforts to
promote oral health and primary care integration across the patient lifespan, additional
focus would feature diabetic patients as a population of interest for primary care
integration. (Page 22)
Action to be Taken
In FY 2018, HRSA will work to address the impact of medication on oral health,
prioritizing opioids and their impact on oral health.
6. Rare Diseases. — The Committee encourages HRSA to examine programs to increase

primary care physician’s preparedness in the diagnosis of rare diseases. (Page 23)
Action to be Taken
If funds are appropriated in FY 2018, HRSA will consult with the advisory committees
supporting our physician training program including Advisory Committee on Training in
Primary Care Medicine and Dentistry and Council on Graduate Medical Education to
determine opportunities under the currently authority to increase primary care physicians’
preparedness in the diagnosis of rare diseases through technical assistance to grantees or
dissemination of curricula.
7. Oral Health Training. — The Committee directs HRSA to provide continuation funding
for pre-doctoral and postdoctoral training grants initially awarded in fiscal year 2015. The
Committee directs HRSA to provide continuation funding for grants initially awarded in
fiscal years 2016 and 2017. (Page 23)
Action to be Taken
In FY 2017, HRSA awarded non-competing continuations to the Pre-doctoral and Post-
doctoral training grants, as well as making awards to a new cohort under the Pre-doctoral
program. In FY 2017, HRSA also awarded non-competing continuations to the Dental
333
Faculty Development and Loan Repayment Program, as well as making awards to a new
cohort under the Dental Faculty Loan Repayment Program.
8. Area Health Education Centers. — The Committee is aware that some State dental
associations have already initiated programs to refer emergency room patients to dental
networks. HRSA is encouraged to work with these programs. The Committee encourages
HRSA to engage additional Federal partners, external stakeholders, including current and
former grantees of the program, to determine how the AHEC network can be used to
continually educate primary care health professionals, especially concerning infectious
diseases. (Page 23)
Action to be Taken
In FY 2018, HRSA will continue to work with our Federal partners and external
stakeholders to bolster our education efforts for health professionals around dental
networks and infectious diseases. Specifically, HRSA will offer targeted technical
assistance to support current AHEC grantees to develop partnerships with (1) State dental
associations to support dental health networks and (2) the National AHEC Association to
enhance training for health professionals concerning infectious diseases.
9. Mental and Behavioral Health. — The Committee encourages HRSA to invest in

geropsychology training programs and to help integrate health service psychology
trainees at Federally Qualified Health Centers. HRSA should build on recent efforts to
expand training to increase mental, behavioral health services for returning service
members, veterans, and their families, with an emphasis on veterans reintegrating into
rural civilian communities. (Page 23)
Action to be Taken
HRSA continues to emphasize the integration of behavioral health into primary care
settings, including Federally Qualified Health Centers. HRSA will consider other
methods to integrate geropsychology and FQHCs in future funding opportunities.
10. Behavioral Health Workforce Education and Training. — The Committee directs
HRSA to share information concerning pending grant opportunity announcements with
State licensing organizations and all the relevant professional associations. (Page 24)
Action to be Taken
HRSA shared the FY 2017 BHWET Notice of Funding Opportunity with more than
123,000 individuals, including individuals working in mental and behavioral health
organizations (i.e., American Psychiatric Association, American Academy of Pediatrics,
American Occupational Therapist Association, etc.).
11. Nursing Workforce Development. — The Committee requests HRSA include in the
fiscal year 2019 Congressional Justification information on the impact of Title VIII
programs on workforce diversity. (Page 24)
334
Action to be Taken
Of the Title VIII programs, only the Nursing Workforce Diversity (NWD) Program is
statutorily mandated to address diversity by increasing nursing education opportunities
for individuals from disadvantaged backgrounds.
A recent review of 72 peer-reviewed research studies determined that the factors most
strongly associated with primary care physicians working in underserved areas (both
urban and rural) include: (1) being a racial/ethnic underrepresented minority (URM); and
(2) growing up in inner city or rural area.
In Academic Year 2016-2017, the NWD program trained 4,416 students, 100 percent of
whom were either underrepresented minorities and/or from disadvantaged backgrounds.
In addition, 19 percent of trainees were from rural areas.
The follow up employment data shows that 45 percent of NWD graduates (from FY
2016) are currently practicing in Critical Access Hospitals and 52 percent were working
in Medically Underserved Communities.
12. Neonatal Abstinence Syndrome Effects on Maternal and Child Health. — The
Committee is alarmed by the prevalence of Neonatal Abstinence Syndrome (NAS) and
the resulting health and developmental impacts on children. The Committee requests an
update in the fiscal year 2019 Congressional Justification on efforts undertaken by HRSA
to address NAS. (Page 25)
Action to be Taken
HRSA addresses the opioid crisis, including Neonatal Abstinence Syndrome (NAS), on
several fronts, including the following:
 Grantees in programs such as the Maternal, Infant and Early Childhood Home
Visiting (MIECHV) Program and Healthy Start use evidence-based approaches to
screen, intervene, and refer perinatal women and parents of young children to
treatment and recovery support services. Front-line staff also provide health education
and guidance for parents of young children, including caring for babies born with
neonatal abstinence syndrome.
o The MIECHV Program supports voluntary, evidence-based home visiting

services for at-risk pregnant women and parents with young children up to
kindergarten entry.
o The Healthy Start program supports organizations across the country to help
reduce racial and ethnic disparities in maternal and infant health status in high-
risk communities. Healthy Start supports women before, during, and after
pregnancy through the baby’s second birthday, by providing care coordination
and linkage to comprehensive health and social services, health education,
strengthening family resilience, and engaging community partners to enhance
systems of care.
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 States and territories use Title V Maternal and Child Health (MCH) Services Block
Grant funds to support a range of activities at the state’s discretion, which may
include addressing NAS. In the MCH block grant FY 2018 Applications and FY 2016
Annual Reports, 21 of 59 states/jurisdictions reported activities to address NAS; and
five states established an NAS-related State Performance Measure including
measures to assess the rates of NAS diagnosis and early intervention for NAS-
affected infants. As one of the block grant program’s National Outcome Measures,
and in response to legislation, HRSA annually compiles and makes available to states,
national and state-level data on the proportion of infants born with NAS.
 HRSA funds the national Alliance for Innovation in Maternal Health, or AIM, that
developed a maternal safety bundle in CY 2017 for hospitals to help obstetricians and
others appropriately manage care for women with opioid dependence. In FY 2018,
the AIM National Collaborative on Maternal Opioid Use Disorder has engaged 14
states to implement the bundle and raise awareness about the need for treatment and
services for women.
13. Set-aside for Oral Health. — The Committee has included $250,000 to continue
demonstration projects to increase the implementation of integrating oral health and
primary care practice. The projects should model the core clinical oral health
competencies for non-dental providers that HRSA published and initially tested in its
2014 report, Integration of Oral Health and Primary Care Practice. The Committee
expects the Chief Dental Officer to play a key role in the design, monitoring, oversight,
and implementation of these projects. (Page 26)
Action to be Taken
In FY 2017, HRSA provided $250,000 to the National Network of Oral Health Access
(NNOHA) to support ten Health Centers in integrating oral health and primary care,
using the User’s Guide for Implementation of Interprofessional Oral Health Care Clinical
Competencies: Results of a Pilot Project. The overall goal of the program is to increase
use of dental care services by the population receiving health services at the selected
Health Centers. The Chief Dental Officer was involved in the selection of the approach
and design of the demonstration project. Plans for FY 2018 are in development, pending
the final FY 2018 appropriation.
14. Thalassemia. — HRSA has a long history of supporting thalassemia services. The
thalassemia program has been instrumental in aiding patients with this inherited blood
disorder, especially as treatments and best practices have evolved over time. The
Committee encourages HRSA to reconstitute this program in order to ensure the
continued improvement of care and treatment options for patients with this complex and
debilitating blood disorder. (Page 26)
Action to be Taken
HRSA continues to support programs that bring lifesaving medical care to individuals
with thalassemia. HRSA released a notice of funding opportunity, HRSA-18-079
Thalassemia Program, to improve the quality of care delivered to individuals with
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clinically significant thalassemia, especially those who are transfusion-dependent.
Awardees will establish collaborative regional networks that use collective impact
strategies and telehealth to (1) promote the use of expert recommended and evidence-
informed care, and (2) improve capacity of primary and subspecialty care clinicians to
manage thalassemia, particularly in remote and/or medically underserved communities.
15. Birthplace and Seamless Systems for Transfer of Care. — The Committee encourages
HRSA to work with its partners, including National organizations representing
professionals who attend home, birthing center, and hospital births, to develop a strategy
for facilitating ongoing inter-professional dialogue and cooperation and universal
adoption of the Best Practice Guidelines for Transfer from Planned Home Birth to
Hospital. The goal of this effort should be to achieve optimal mother-baby outcomes in
all settings and with all providers. The Committee requests HRSA include information on
this effort in the fiscal year 2019 Congressional Justification. (Page 27)
Action to be Taken
HRSA is aware that the rates for out of hospital births have been increasing over time.
Safe, timely transport of a woman and infant to a hospital is critical to saving lives in the
event of unanticipated complications during a home birth. Inter-professional
communication and cooperation are key components in improving quality of care and
safety during transfer from a home or birth center to a hospital. In FY 2016, HRSA
shared with all of its Healthy Start grantees “The Best Practice Guidelines for Transfer
from Planned Home Birth to Hospital.”
In addition to providing the guidelines to all Healthy Start grantees, HRSA has and will
continue to work with its technical assistance (TA) provider to use these materials in their
work with local Healthy Start programs and in the delivery of ongoing TA wherever
appropriate. HRSA notes that Healthy Start grantees do not provide delivery services.
HRSA will continue to engage with partners, including the Centers for Disease Control
and Prevention, the American Congress of Obstetricians and Gynecologists, and the
American Academy of Pediatrics, as well as other HRSA programs, such as the Title V
Maternal and Child Health Services Block Grant Program, in order to review and further
disseminate best practices for planned home births to best assure the health and safety of
the mother and infant.
16. Breastfeeding Support and Safe Sleep Promotion. — The Committee is aware that 49
jurisdictions have selected the Title V National Performance Measure 4 on Breastfeeding
and encourages HRSA to ensure incorporation and coordination of breastfeeding support
within and among the Title V Maternal and Child Health Block Grant, the Healthy Start
program, and the Maternal, Infant and Early Childhood Home Visiting Program. The
Committee further encourages the integration of breastfeeding support and safe sleep
promotion activities within these programs. (Page 27)
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Action to be Taken
HRSA encourages the integration of breastfeeding support and safe infant sleep
promotion activities through the National Action Partnership to Promote Safe Sleep
(NAPPSS) cooperative agreement program. NAPPSS is a partnership of organizations
that work to assure that safe infant sleep and breastfeeding are jointly addressed in the
delivery of health care, public health, and social services to families. The Title V
Maternal and Child Health Block Grant; Healthy Start; and Maternal, Infant and Early
Childhood Home Visiting Programs are each represented within NAPPSS, and have
helped the program develop a training module, that was released in June 2017, for how
health care and human service providers can use an individualized “conversations
approach” to help infant caregivers overcome barriers to both safe sleep and
breastfeeding. HRSA also is incorporating breastfeeding support within the Healthy Start
program through the Breastfeeding Training Initiative (Initiative) launched in June 2016.
The Initiative promotes and supports breastfeeding among the families served by Healthy
Start grantees by providing Healthy Start staff community training opportunities on how
to encourage, promote, and support breastfeeding, as well as up to 100 scholarships for
Certified Lactation Counselor training. This Initiative will continue through May 2018.
17. Recommended Uniform Screening Panel. — The Committee encourages HRSA to

expand the Heritable Disorders program to support States with the implementation,
education, and awareness of newborn screening for new conditions recently added to the
Recommended Uniform Screening Panel, including Pompe, Mucopolysaccharidosis I,
and X-linked adrenoleukodystrophy. The program will also disseminate National,
regional and State education and training resources for parents, families and providers.
(Page 28)
Action to be Taken
HRSA is committed to supporting state efforts to screen newborns for conditions on the
Recommended Uniform Screening Panel (RUSP), and developing and disseminating
education and training resources. HRSA funds the Newborn Screening Data Repository
and Technical Assistance Center to provide technical assistance on the implementation of
state-based public health newborn screening through resource development, state
education and training, policy initiatives, disorder surveillance, evidence-based data
collection, evaluation, collaborative efforts with stakeholders, and technical assistance to
state newborn screening programs to implement conditions added to the RUSP including
Pompe, Mucopolysaccharidosis I, X-linked adrenoleukodystrophy or any new condition
added to the RUSP by the Secretary. HRSA is also supporting the Newborn Screening
Family Education Program to develop and deliver educational programs at appropriate
literacy levels about newborn screening counseling, testing, follow-up, treatment, and
specialty services to parents, families, patient advocacy and support groups, and the
public. These educational programs will also include information on all conditions
including the recently added conditions on the RUSP.
18. Fetal Infant Mortality Review. — The Fetal Infant Mortality Review (FIMR) program
is an important component of many Healthy Start and local health department initiatives
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that provide evidence-based interventions crucial to improving infant health in high risk
communities. HRSA is encouraged to continue to support the FIMR program with
Healthy Start funding while educating Healthy Start Programs on the successes of the
FIMR. (Page 29)
Action to be Taken
Fetal and Infant Mortality Review (FIMR) is a community-based, action-oriented process
to review fetal and infant deaths and make recommendations to facilitate systemic
changes to prevent future similar deaths. Healthy Start grantees may use funds to support
involvement in local FIMR programs or to start their own FIMR program. In addition,
HRSA funds the National Center for Fatality Review and Prevention to train and provide
technical support to approximately 1,350 Child Death Review (CDR) and 179 FIMR
programs across the country, some of which are supported by Healthy Start programs.
Information from these reviews can be used at the local, state, and federal levels for
planning and policy development, quality improvement and health systems development,
and enhancing efforts to develop and maintain risk reduction and prevention programs for
healthy pregnancies, infants, children, and adolescents.
19. Organ Distribution Proposal. — The Committee recognizes that OPTN expects to
release for public comment an amended proposal in 2017. The Committee urges HRSA
to ensure that any proposals see a robust and transparent public debate on the merits of
the proposal. Furthermore, the Committee believes that an extended process will allow
the transplant community and its stakeholders to assess fully the use of appropriate
supply and demand metrics and the protection of programs serving rural and underserved
communities. The Committee encourages HRSA to ensure that liver redistribution
proposals go through a transparent process and receive support from the transplant
community prior to final action. (Page 30)
Action to be Taken
The development of the current liver allocation and distribution policy began in 2012
when the OPTN Board of Directors (OPTN Board) determined that geographic
disparities in liver allocation were unacceptably high. Following were several years of
policy discussion, modeling of numerous potential approaches, a series of public
meetings, and public comment on a draft policy proposal in 2016. Subsequently, HRSA
encouraged the OPTN leadership and leaders in the transplant community to consider
options to address the OPTN Final Rule requirements while taking into account the
concerns of stakeholders, including patients, liver transplant programs, and organ
procurement organizations. On December 4, 2017, the OPTN Board of Directors
approved a proposal by the OPTN Liver Committee modifying the OPTN Liver
Allocation Policy (36 in favor, 3 opposed, 1 abstention). The approved policy will be
implemented once updates to the OPTN organ matching and allocation system have been
completed for incorporation in the new policy. An implementation date has yet to be
determined.
20. Costs of Liver Distribution Proposals. — The Committee is aware that OPTN is
preparing a revised proposal for redesigning the distribution of livers for transplant in the
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United States. The Committee encourages the proposal to include the scope of financial
costs associated with the proposal, including estimates of the direct and indirect costs
imposed on the Federal government, State governments, local governments, and public
and private health insurers. (Page 30)
Action to be Taken
The development of the current liver allocation and distribution policy began in 2012
when the OPTN Board of Directors (OPTN Board) determined that geographic
disparities in liver allocation were unacceptably high. Following were several years of
policy discussion, modeling of numerous potential approaches, a series of public
meetings, and public comment on a draft policy proposal in 2016. Subsequently, HRSA
encouraged the OPTN leadership and leaders in the transplant community to consider
options to address the OPTN Final Rule requirements while taking into account the
concerns of stakeholders, including patients, liver transplant programs, and organ
procurement organizations. On December 4, 2017, the OPTN Board of Directors
approved a proposal by the OPTN Liver Committee modifying the OPTN Liver
Allocation Policy (36 in favor, 3 opposed, 1 abstention). The approved policy will be
implemented once updates to the OPTN organ matching and allocation system have been
completed for incorporation into the new policy. An implementation date has yet to be
determined.
21. Positions at Organ Procurement and Transplantation Network. — The Committee

appreciates the valuable role played by individuals in leadership positions and other
voting positions at OPTN. The Committee expects HRSA to ensure OPTN policymaking
committees and subcommittees are selected in a manner that provides equal
representation with unbiased selection. (Page 30)
Action to be Taken
The process for appointments to the OPTN Board and committees is based on the
requirements of the National Organ Transplant Act and the OPTN final rule. This well-
established process is outlined in the OPTN Bylaws. The selection process includes
guidelines to ensure inclusion of various stakeholders within the transplant community
along with balanced regional and professional representation.
22. Office of Pharmacy Affairs. — The Committee is aware that the 340B statute requires
HRSA to make 340B ceiling prices available to covered entities through a secure website
and continues to be concerned that OPA has failed to meet deadlines to complete work on
the secure website. The Committee urges OPA to complete the development of a secure
website. The Committee directs OPA to include an update on the status of the secure
website in the fiscal year 2019 Budget request. (Page 31)
Action to be Taken
The 340B statute mandates the creation of a system to allow covered entity authorized
users access to view verified 340B ceiling prices for covered outpatient drugs. HRSA
developed the 340B Pricing System to calculate and verify 340B ceiling prices. Using this
secure web-based system, drug manufacturers participating in the 340B Program will
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submit to HRSA their quarterly pricing data for their portfolio of covered outpatient
drugs, and validate their prices against HRSA-calculated 340B ceiling prices. Covered
entities will be able to use the 340B Pricing System as a mechanism to verify that they are
not paying more than the posted 340B ceiling prices for covered outpatient drugs. To this
end, HRSA has developed a new, integrated information system that focuses on three key
priorities: security, user accessibility, and data accuracy.
In the process of developing the secure pricing system, HRSA also made security updates
and enhancements to the current 340B Database used for covered entity and manufacturer
registrations to strengthen the integrity and effectiveness of all 340B stakeholder
information. It was critical to enhance the security of the registration system, as it verifies
the identity of users that would have access to the secure pricing system. The new 340B
Office of Pharmacy Affairs Information System (OPAIS) will have two separate
components – a new registration system and a new secure pricing system. The
registration component of the new 340B OPAIS was publicly launched on September 18,
2017.
The pricing component of the new 340B OPAIS has not been publicly released as HRSA
is working to align pricing policy with a methodology included in a final rule on 340B
Ceiling Prices and Civil Monetary Penalties, published in the Federal Register on January
5, 2017 (82 FR 1210, January 5, 2017). HRSA proposed delays to the effective date,
which is currently July 1, 2018, to ensure responsiveness to public comment. The pricing
component of the system was available for internal use during September 2017, allowing
HRSA to input pricing data from CMS and pricing data from a third party to calculate the
340B ceiling prices. With this information, HRSA can respond to stakeholder inquiries
about potential overcharges or participation in the 340B Program.
23. Healthcare Professional Shortages. — The Committee requests an update in the fiscal
year 2019 Congressional Justification information on the best practices and strategies to
attract healthcare practitioners to rural clinics and hospitals in areas with healthcare
professional shortages. (Page 32)
Action to be Taken
Recruitment and retention of health care providers continues to be a challenge in rural
communities. HRSA programs and resources can play a key role in helping Rural Health
Clinics (RHCs) and rural hospitals attract health care practitioners. The National Health
Service Corps (NHSC) plays an important role in supporting clinicians in underserved
rural areas through its scholarship and loan repayment programs for providers in Health
Professional Shortage Areas (HPSAs). Designed to maintain essential health care
services in rural communities, Critical Access Hospitals (CAHs) are eligible service sites
under the NHSC program. The Nurse Corps Loan Repayment program also offers
support to nurses who practice at eligible sites, including CAHs.
HRSA’s Federal Office of Rural Health Policy (FORHP) provides support to the National
Rural Recruitment and Retention Network (3RNet), a 50-state consortium of state-level
entities that link practitioners with an interest in rural practice to rural communities in
need of clinicians. In 2016, the most recent reporting period, 3RNet supported the
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placement of 1,984 clinicians in rural practice. FORHP also administers the grant-based
Rural Health Outreach programs that rural communities may utilize to focus on
addressing workforce issues.
FORHP continues to promote physician residency training in rural communities, playing

a key role in promoting the Rural Training Track Program (RTT). This program supports
family medicine residencies in which a resident serves one-year in academic health center
and two-years in a rural area. Studies have proven that physicians who practice in rural
communities are likely to stay in rural locations. There are currently 42 RTTs across the
country, and data shows that graduates from 2008 through 2014, who initially chose rural
practices, tended to remain in rural communities. One third of RTT graduates practiced in
rural areas one year post graduation. Research shows that RTT graduates are twice as
likely as non-rural residents to choose to practice in rural communities.
24. Telehealth. — The Committee encourages the Secretary to establish a Telehealth Center
of Excellence to test the efficacy of telehealth services in both urban and rural geographic
locations. (Page 32)
Action to be Taken
In FY 2017, HRSA awarded grants to two centers of excellence – the Medical University
of South Carolina and the University of Mississippi Medical Center to examine the
efficacy of telehealth in urban and rural areas. The grantees will coordinate with other
HRSA-funded telehealth entities such as the Rural Telehealth Research Center and the
Telehealth Resource Centers.
25. Chief Dental Officer. — The Committee is pleased that HRSA has restored the position
of Chief Dental Officer (CDO) and looks forward to learning how the agency has ensured
that the CDO is functioning with executive level authority with resources to oversee and
lead HRSA oral health programs and initiatives. The Committee would like an update in
the fiscal year 2019 Congressional Justification on how the CDO is serving as the agency
representative on oral health issues to international, National, State, and/or local
government agencies, universities, and oral health stakeholder organizations. (Page 32)
Action to be Taken
The CDO position at HRSA is responsible for: coordinating oral health activities across
all HRSA programs; counseling program officials throughout HRSA on the recruitment,
assignment, deployment, retention, and career development of dentists and other oral
health professionals within the agency; and advising HRSA oral health investments
throughout the various oral health programs in the agency. Over the past year, specific
activities have included: reviewing and advising on all proposed oral health-related
investments across the agency; leading a variety of cross-agency activities in recognition
of Oral Health Month; serving as featured speaker in agency-wide All-Hands meeting on
Oral Health; representing the agency at professional conferences and meetings; providing
presentations on the agency’s oral health portfolio to a variety of stakeholders; overseeing
developmental opportunities for dental residents interested in federal public health
342
careers; and serving as advisor in HRSA’s emergency response to affected areas during
and after hurricanes Harvey, Irma, and Maria.
SENATE REPORT 115-150 (September 7, 2017)
1. National Health Service Corps. — The Committee encourages HRSA to increase the
proportion of clinicians serving at health centers to improve alignment between these two
programs and to best leverage investments in Corps health professionals. The Committee
recognizes that the Secretary retains the authority to include additional disciplines in the
Corps. As such, the Committee urges the Secretary to include pharmacists and pediatric
subspecialists as eligible recipients of scholarships and loan repayments through the
program. (Page 43)
Action to be Taken
The NHSC has partnered closely with HRSA-supported Federally Qualified Health
Centers (FQHCs) to help meet their staffing needs; over 60 percent of NHSC clinicians
serve in Health Centers around the nation, and 15 percent of clinical staff at FQHCs are
NHSC clinicians.
While there is flexibility to add other health professionals, such as pharmacists, to the
NHSC, there are two considerations that the program must make before taking such
action: (1) HRSA must demonstrate that there is a need in the NHSC and the
communities it serves for the additional discipline; and (2) the discipline in question must
meet the definition of “primary health services.” It should be noted that State Loan
Repayment Program (SLRP) grantees are allowed to include pharmacists among their
eligible disciplines.
Proposals that aim to include pediatric subspecialists in the NHSC represent an expansion
of the NHSC into sub-specialty care; and therefore, would not be considered primary care
providers.
2. National Health Service Corps. — The Committee encourages HRSA to ensure that
States with fewer than ten Corps awardees in the most recent fiscal year, will receive at
least five awards in that State this fiscal year, prioritizing awards to individuals for whom
that is their home State or to those that received their education in that State. (Page 43)
Action to be Taken
The NHSC statute directs the Secretary to assign Corps members to HPSAs of greatest
shortage, without regard for equal distribution among the States. In addition, NHSC
Scholarship Program (SP) participants are not obligated to serve in the State in which
they reside or attend health professions school at the time of award; as a result, making
NHSC SP awards to individuals in each State would not guarantee that each State would
have an NHSC scholar serving there upon completion of their training. Finally, by
statute, the NHSC prioritizes both SP and Loan Repayment Program (LRP) awards based
on the training and characteristics of the individual applicant, and whether they are from
a disadvantaged background. LRP applications are also ranked based on the based on
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HPSA scores which represents the degree of health professions short. The current
statutory funding preferences do not allow the allocation of SP and LRP awards using the
proposed criteria.
3. Training in Oral Health Care. — The Committee directs HRSA to provide an update
on how the CDO is serving as the agency representative on oral health issues to
international, national, State, and local government agencies, universities, and oral health
stakeholder organizations in the fiscal year 2019 CJ. (Page 44)
Action to be Taken
The CDO position at HRSA is responsible for: coordinating oral health activities across
all HRSA programs; counseling program officials throughout HRSA on the recruitment,
assignment, deployment, retention, and career development of dentists and other oral
health professionals within the agency; and advising HRSA oral health investments
throughout the various oral health programs in the agency. Over the past year, specific
activities have included: reviewing and advising on all proposed oral health-related
investments across the agency; leading a variety of cross-agency activities in recognition
of Oral Health Month; serving as featured speaker in agency-wide All-Hands meeting on
Oral Health; representing the agency at professional conferences and meetings; providing
presentations on the agency’s oral health portfolio to a variety of stakeholders; overseeing
developmental opportunities for dental residents interested in federal public health
careers; and serving as advisor in HRSA’s emergency response to affected areas during
and after hurricanes Harvey, Irma, and Maria.
4. Training in Oral Health Care. — The Committee urges HRSA to convene a

stakeholder meeting in order to determine how best to create new entry points into the
oral health care delivery system for rural and other underserved populations, better
utilization of existing dental personnel, and exploration of new types of dental providers.
(Page 44)
Action to be Taken
HRSA has various mechanisms to ensure stakeholders are engaged around improving
access to dental care for underserved and rural populations including the Advisory
Committee on Training in Primary Care Medicine and Dentistry, quarterly calls with
grantees, and informal conversations with stakeholders. Through these conversations,
stakeholders have made clear that there are various approaches to address dental
shortages.
To that end, HRSA has afforded flexibility under the Grants to States to Support Oral
Health Workforce Activities program to support various activities that are intended to
drive innovation at the state level including:
 Exposing dental and dental hygiene students to underserved rural clinical sites;
 Targeting specific underserved populations such as those with substance use disorders
and their families;
 Leveraging dental hygienists’ expanded scopes of practice in new care models;
 Testing new models of care using new types of oral health professionals;
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 Delivering care via teledentistry or mobile care models;
 Testing new payment models; and
 Assisting dentists in establishing or taking over rural practices.
5. Training in Oral Health Care. — The agency is directed to provide continuation

funding for predoctoral and postdoctoral training grants initially awarded in fiscal year
2015, and for Section 748 Dental Faculty Loan Program grants initially awarded in fiscal
year 2016 with preference for pediatric dentistry faculty supervising dental students or
residents and providing clinical services in dental clinics located in dental schools,
hospitals, and community-based affiliated sites. (Page 44)
Action to be Taken
In FY 2017, HRSA awarded non-competing continuations to the Pre-doctoral and Post-
doctoral training grants, as well as making awards to a new cohort under the Pre-doctoral
program. In FY 2017, HRSA also awarded non-competing continuations to the Dental
Faculty Development and Loan Repayment Program, as well as making awards to a new
cohort under the Dental Faculty Loan Repayment Program. The grant periods of these
programs would extend to FY 2018, pending the final appropriation.
6. Behavioral Health Workforce Education and Training Program. — The Committee

continues to direct that eligible entities for this program shall include, but is not limited
to, accredited programs that train masters and clinical doctoral level social workers,
psychologists, counselors, marriage and family therapists, psychiatric mental health nurse
practitioners, occupational therapists; psychology interns; and behavioral health
paraprofessionals. (Page 45)
Action to be Taken
Eligible applicants for the FY 2017 BHWET competition programs included psychiatry,
behavioral pediatrics, social work, school social work, substance use disorder prevention
and treatment, marriage and family therapy, occupational therapy, school counseling, or
professional counseling, masters or doctoral level psychiatric nursing and American
Psychological Association-accredited doctoral level programs of health service
psychology or school psychology. Behavioral Health Paraprofessionals were also
included as eligible applicants.
7. Graduate Psychology Education Program. — The Committee urges HRSA to explore

evidence-based approaches to leverage workforce capacity through this program, to
invest in geropsychology training programs, and to help integrate health service
psychology trainees at Federally Qualified Health Centers. (Page 46)
Action to be Taken
HRSA continues to emphasize the integration of behavioral health into primary care
settings, including Federally Qualified Health Centers. HRSA will consider other
methods to integrate geropsychology and FQHCs in future funding opportunities.
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8. Screening and Treatment for Maternal Depression. — The Committee provides
$5,000,000 for a new Screening and Treatment for Maternal Depression program as
authorized in Section 10005 of the 21st Century Cures Act (Public Law 114-255). HRSA
is directed to make grants to States to establish, improve, or maintain programs to train
professionals to screen, assess, and treat for maternal depression in women who are
pregnant or who have given birth within the preceding 12 months. (Page 46)
Action to be Taken
If those funds are made available, HRSA will implement an initiative to focus on the
areas identified.
9. Advanced Education Nursing. — The Committee provides an increase of $5,000,000 to

award grants for the clinical training of sexual assault nurse examiners to administer
medical forensic examinations and treatments to victims of sexual assault in hospitals,
health centers, and other emergency health care service provider settings, including
Federally qualified health centers, clinics receiving funding under title X, and other
health care providers as determined appropriate by the Secretary. (Page 47)
Action to be Taken
If those funds are made available, HRSA will implement an initiative to focus on the
areas identified.
10. Children’s Hospital Graduate Medical Education. — The Committee notes the
Secretary’s use of the authority provided under the current authorization to make funding
available for hospitals previously ineligible for the program, and urges the Secretary to
continue to make such funding available in future CHGME application and funding
cycles. (Page 47)
Action to be Taken
HRSA continues to utilize the expanded eligibility for “Newly Qualified Hospitals”. The
2013 reauthorization permits the Secretary, “to make available up to 25 percent of the
total amounts in excess of $245,000,000 …but not to exceed $7,000,000” for the purpose
of making CHGME payments to these Newly Qualified Hospitals. The Notice of Funding
Opportunity, most recently for FY2018, specifies the eligible applicants for the CHGME
program as the following: There are two categories of children’s hospitals that may be
eligible for CHGME payments in FY 2018, depending on the funding appropriated to the
program – “Currently Eligible Hospitals” or “Newly Qualified Hospitals.” Hospitals that
are applying for the first time for the CHGME program may be hospitals that are eligible
as a “Newly Qualified Hospital” or hospitals that are new to the CHGME program but
qualify under the “Currently Eligible Hospitals” requirements.
Newly Qualified Hospitals: As per the Children’s Hospital GME Support Reauthorization
Act of 2013, a freestanding hospital may be eligible for CHGME payments depending on
the level of funding appropriated to the program if it meets the following criteria:
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1. Has a Medicare payment agreement and is excluded from Medicare IPPS
pursuant to section 1886(d)(1)(B) of the SSA and its accompanying regulations;
2. Its inpatients are predominantly individuals under 18 years of age;
3. Has an approved medical residency training program as defined in section
1886(h)(5)(A) of the SSA;
4. Is not otherwise qualified to receive payments under this section or section
1886(h) of the SSA.
11. Children’s Hospital Graduate Medical Education. — The Committee encourages

HRSA to continue its work with the Children’s Hospitals on the development and
collection of enhanced program performance measures. (Page 47)
Action to be Taken
The CHGME statute allows the Secretary of Health and Human Services to establish a
quality bonus system whereby the Secretary distributes bonus payments to participating
children’s hospitals that meet standards specified by the Secretary. A proposal for public
comment was published in the Federal Register on October 16, 2017, with written
comments due December 15, 2017.
12. Virtual Pediatric Trauma Center. — The Committee acknowledges the work that
HRSA has undertaken with the Uniformed Services University of the Health Sciences to
cooperatively introduce and develop the concept of a Virtual Pediatric Trauma Center.
Recognizing the value of the concept and the established conceptual framework, the
Committee requests that HRSA provide an update on the status of the Virtual Pediatric
Trauma Center model in the fiscal year 2019 CJ. (Page 48)
Action to be Taken
Currently, access to pediatric trauma care for children is limited in many regions of the
United States, particularly in rural areas. As a result, injured children receive care from
health professionals with limited experience in pediatric medicine. In 2015, the HRSA
MCHB Emergency Medical Services for Children (EMSC) Program collaborated with
the Uniformed Services University of the Health Sciences (USUHS) to develop a
conceptual framework for a Global Virtual Pediatric Trauma Center (VPTC) to address
this need. The VPTC would use telehealth/telemedicine to increase access to pediatric
trauma care for children in geographically isolated areas.
13. Children's Health and Development. — The Committee provides $3,500,000 within
the Special Projects of Regional and National Significance program for the HRSA-
funded study focused on improving child health through a statewide system of early
childhood developmental screenings and interventions. This funding shall be used to
extend the currently funded project for another year. (Page 48)
Action to be Taken
In FY 2017, HRSA awarded $3.5 million to the University of Mississippi Medical Center
to support the Early Childhood Developmental Health System Program. The project will
continue with annual funding of $3.5 million per year for three years, from September 30,
347
2017 to September 29, 2020, pending satisfactory performance and availability of future
funds. The aim of the Early Childhood Developmental Health System Program is to
improve population-level early childhood developmental health outcomes in a state with
significant risk factors for poor child health status. Through this activity, HRSA aims to
develop and promote best practices that can be applied to all states and communities, and
particularly those with the highest rates of child poverty.
14. Maternal, Infant and Early Childhood Home Visiting Program. — The Committee
encourages HRSA and the Administration for Children and Families to continue their
collaboration and partnerships to improve health and development outcomes for at-risk
pregnant women, parents, and young children through evidence-based home visiting
programs. (Page 49)
Action to be Taken
HRSA is developing plans for continuation of the Maternal, Infant and Early Childhood
Home Visiting Program in partnership with the Administration for Children and Families,
pending continued appropriations for the program.
15. Screening for Sexually Transmitted Diseases. — The Committee encourages HRSA to
continue to work with CDC’s Division of STD Prevention to establish appropriate
protocols and standards to assure that these screenings are fully integrated into grant
recipients comprehensive clinical care plan. (Page 50)
Action to be Taken
There are many mechanisms that the Health Resources and Services Administration’s
(HRSA) Ryan White HIV/AIDS Program (RWHAP) uses to address the screening and
treatment of sexually transmitted diseases (STDs). Examples include:
 HRSA is currently working collaboratively with the Centers for Disease Control and
Prevention’s Division of STD Prevention:
o To develop new activities to promote and demonstrate clinical service and
system-level interventions that support improvements in the screening and
treatment of STDs among low-income people living with HIV or at risk for
HIV who are served by HRSA’s RWHAP and/or the Health Center Program.
o To review and update performance measures for STDs (chlamydia, gonorrhea,
and syphilis screenings), which RWHAP providers utilize to assess the quality
of services provided.
 HRSA’s RWHAP Part C program specifically outlines in their notice of funding
opportunity the following programmatic expectations for recipients: Recipients must
also be able to diagnose, provide prophylaxis, and treat or refer clients co-infected
with tuberculosis, hepatitis B and C, and sexually transmitted infections.
 All Ryan White HIV/AIDS Program Parts A, B, C, and D recipients must adhere to
the legislative requirement to establish a clinical quality management program. The
HRSA RWHAP expectations for clinical quality management are outlined in Policy
Clarification Notice 15-02, Clinical Quality Management Policy Clarification Notice
348
(http://hab.hrsa.gov/manageyourgrant/clinicalqualitymanagementpcn.pdf). These
expectations state that RWHAP recipients must assess the extent to which HIV health
services provided to patients under the grant are consistent with the most recent
Public Health Service guidelines, (otherwise known as the HHS guidelines) for the
treatment of HIV disease and related opportunistic infections. Specifically, the
Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-
Infected Adults and Adolescents includes screening and treatment of STDs.
16. Office of Pharmacy Affairs. — The Committee is aware that the 340B statute requires
HRSA to make 340B ceiling prices available to covered entities through a secure Web
site and continues to be concerned that OPA has failed to meet deadlines to complete
work on the secure Web site. The Committee urges OPA to complete the development of
a transparent system to verify the accuracy of the 340B discount or ceiling prices. (Page
53)
Action to be Taken
The 340B statute mandates the creation of a system to allow covered entity authorized
users access to view verified 340B ceiling prices for covered outpatient drugs. HRSA
developed the 340B Pricing System to calculate and verify 340B ceiling prices. Using this
secure web-based system, drug manufacturers participating in the 340B Program will
submit to HRSA their quarterly pricing data for their portfolio of covered outpatient
drugs, and validate their prices against HRSA-calculated 340B ceiling prices. Covered
entities will be able to use the 340B Pricing System as a mechanism to verify that they are
not paying more than the posted 340B ceiling prices for covered outpatient drugs. To this
end, HRSA has developed a new, integrated information system that focuses on three key
priorities: security, user accessibility, and data accuracy.
In the process of developing the secure pricing system, HRSA also made security updates
and enhancements to the current 340B Database used for covered entity and manufacturer
registrations to strengthen the integrity and effectiveness of all 340B stakeholder
information. It was critical to enhance the security of the registration system, as it verifies
the identity of users that would have access to the secure pricing system. The new 340B
Office of Pharmacy Affairs Information System (OPAIS) will have two separate
components – a new registration system and a new secure pricing system. The
registration component of the new 340B OPAIS was publicly launched on September 18,
2017.
The pricing component of the new 340B OPAIS has not been publicly released, as HRSA
is working to align pricing policy with a methodology included in a final rule on 340B
Ceiling Prices and Civil Monetary Penalties, published in the Federal Register on January
5, 2017 (82 FR 1210, January 5, 2017). HRSA proposed delays to the effective date,
which is currently July 1, 2018, to ensure responsiveness to public comment. The pricing
component of the system was available for internal use during September 2017, allowing
HRSA to input pricing data from CMS and pricing data from a third party to calculate the
340B ceiling prices. With this information, HRSA can respond to stakeholder inquiries
about potential overcharges or participation in the 340B Program.
349
17. Delta States Rural Development Network Grant Program. — The Committee
encourages HRSA to continue to consult with the Delta Regional Authority [DRA] on the
awarding, implementing, administering, and monitoring grants under the Delta States
Network Grant Program in fiscal year 2018. The Committee continues to encourage
HRSA to align its awards as closely as possible with the DRA’s strategic plan and with
DRA economic and community development plans. In addition, of the funds provided,
the Committee provides $4,000,000 to support HRSA’s collaboration with the DRA to
continue DRA’s program to help underserved rural communities identify and better
address their health care needs and to help small rural hospitals improve their financial
and operational performance. Finally, the Committee encourages HRSA to participate
and collaborate on DRA’s Next Health strategic plan for the Delta Region. The
Committee believes that the information the DRA collects in the development of that
plan will be of substantial value to HRSA, and encourages HRSA to provide support to
DRA for the provision of that information. Within 90 days of enactment of this act, the
Committee directs HRSA and DRA to jointly brief the Committee on this program’s
progress. (Page 54)
Action to be Taken
HRSA continues to collaborate with the DRA on the Delta States Network Program. In
FY 2017, HRSA and DRA worked together to develop the Delta Region Community
Health Systems Program which provides technical assistance to six hospitals located in
the Delta region in the areas of financial operations, quality improvement, and telehealth.
HRSA will continue its collaboration with DRA and engage in discussions on the
development of DRA’s Next Health Strategic Plan and other activities as requested to
ensure that individuals in the Delta region receive high-quality health care.
18. Expanding Capacity for Health Outcomes. — The Committee notes there is increasing
demand for technical training on Project ECHO and encourages HRSA to support a
national resource center focused on Project ECHO technical training. (Page 54)
Action to be Taken
The Project ECHO model has proven to be a viable tool for enhancing rural patient
outcomes by expanding rural clinicians’ training. A broad range of HRSA programs use
the Project ECHO model to support clinicians in community health centers, and similar
efforts are underway to support Ryan White Care Act grantees as well as state-level
efforts supported through Title V Maternal and Child Health Funding. HRSA’s
Telehealth Resource Centers are also using the Project ECHO model to support a broad
range of clinical training in rural communities. As directed by the ECHO Act (PL 114-
270), HHS is developing a report for Congress that examines technology-enabled
collaborative learning and capacity building models used by health care providers. The
report findings will inform HHS about Project ECHO and other methods of using
technology to support clinical learning. HHS will continue to assess this model and how
it can support broader workforce goals.
350
19. Black Lung Clinics. — The Committee continues to direct the Secretary to evaluate
funding levels for applicants based on the needs of the populations those applicants will
serve and the ability of those applicants to provide health care services to miners with
respiratory illnesses, with preference given to State agency applications over other
applicants in that State, without regard to the funding tiers and overall per-applicant
funding cap established by the Secretary in fiscal year 2014. (Page 55)
Action to be Taken
The FY 2017 Black Lung Notice of Funding Opportunity removed the funding tiers and
cap on individual applicants. The State preference remains since it is directly aligned with
program regulations.
20. Telehealth Network Grant Program. — The Committee encourages HRSA to support
telestroke initiatives in the Telehealth Network Grant Program. (Page 56)
Action to be Taken
HRSA currently administers the Evidence-Based Tele-Emergency Network Grant
Program that supports the use of telehealth networks to deliver Emergency Department
consultation services via telehealth to rural communities and providers without
emergency care specialists. Several grantees in this program have developed and
implemented telestroke initiatives in their networks.
21. Telehealth Resource Centers Grant Program. — The Committee recommends that
part of OAT funding should be used to support increased outreach to providers and
communities regarding the benefits of telehealth and the availability of technical
assistance to support its further adoption. The Committee supports continued funding of
the current 12 regional centers and two National centers in fiscal year 2018. (Page 56)
Action to be Taken
HRSA continues to fund the Telehealth Resource Center Program, which was
competitive in FY 2017 and supports twelve regional and two national resource centers.
The centers are responsible for providing assistance, education and information to
organizations actively providing or interested in providing medical care in remote areas.
The most recent funding announcement increased outreach to providers and communities
regarding the benefits of telehealth and availability of technical assistance to support its
further adoption.
351
Vaccine Injury
Compensation
Program
TAB
352
Table of Contents
FY 2019 Budget
Appropriation Language ............................................................................................................. 354
Amounts Available for Obligation.............................................................................................. 355
Budget Authority by Activity ..................................................................................................... 356
Budget Authority by Object ........................................................................................................ 356
Authorizing Legislation .............................................................................................................. 357
Appropriation History Table ....................................................................................................... 358
Vaccine Injury Compensation Program ...................................................................................... 359
353
Appropriation Language
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND
For payments from the Vaccine Injury Compensation Program Trust Fund (the ‘‘Trust Fund’’),
such sums as may be necessary for claims associated with vaccine-related injury or death with
respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of
the PHS Act, to remain available until expended: Provided, That for necessary administrative
expenses, not to exceed $9,200,000 shall be available from the Trust Fund to the Secretary.
Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget
was prepared; therefore, the budget assumes this account is operating under the Continuing
Appropriations Act, 2018 (Division D of P.L. 115-56, as amended). The amounts included for
2018 reflect the annualized level provided by the continuing resolution.
354
Amounts Available for Obligation
FY 2019
Discretionary Appropriation: $ 24,260,000 $24,207,000 $27,015,000
Transfer to Other Accounts -$7,750,000
Transfer from Other Accounts $7,750,000
Subtotal, adjusted Discretionary Appropriation $ 24,260,000 $ 24,207,000 $ 27,015,000
Mandatory Appropriation $ 279,303,000 $308,000,000 $308,000,000

Transfer to Other Accounts -$282,945,000
Transfer from Other Accounts $282,945,000
Subtotal, adjusted Mandatory Appropriation $279,303,000 $308,000,000 $308,000,000
Spending Auth Offsets $ 5,549,000
Administrative Expenses 24,260,000 24,207,000 27,015,000

Total HRSA Claims 282,945,000 308,000,000 308,000,000
Total New Obligations 307,205,000 332,207,000 335,015,000
355
Budget Authority by Activity
FY 2019
Trust Fund Obligations: Post-10/1/88

$282,000,000 $308,000,000 $308,000,000
claims
Administrative Expenses: HRSA
$7,750,000 $7,697,000 $9,200,000
Direct Operations
Total Obligations $289,750,000 $315,697,000 $317,200,000
Budget Authority by Object
FY 2018 FY 2019
Annualized President’s FY 2019 +/-
CR Budget FY 2018
Insurance claims and indemnities $308,000,000 $308,000,000 ---
Salaries & Expenses/Other Services $7,697,000 $9,200,000 +$1,503,000
Total $315,697,000 $317,200,000 +$1,503,000
356
Authorizing Legislation
FY 2018 FY 2019
FY 2017 Annualized President’s
Final CR Budget
(a) PHS Act,
Title XXI, Subtitle 2,
Parts A and D:
Pre-FY 1989 Claims --- --- ---
Post-FY 1989 Claims $282,000,000 $308,000,000 $308,000,000
(b) Sec. 6601 (r)d ORBA
of 1989 (P.L. 101-239):
HRSA Operations $7,750,000 $7,697,000 $9,200,000
357
Appropriation History Table
(Pre-1988 Claims Appropriation)
Budget
Estimate House Senate
to Congress Allowance Allowance Appropriation
1996 110,000,000 110,000,000 110,000,000 110,000,000
1997 110,000,000 110,000,000 110,000,000 110,000,000
1998 --- --- --- ---
1999 --- --- 100,000,000 100,000,000
2000 --- --- --- ---
2001 --- --- --- ---
2002 --- --- --- ---
2003 --- --- --- ---
2004 --- --- --- ---
2005 --- --- --- ---
2006 --- --- --- ---
2007 --- --- --- ---
2008 --- --- --- ---
2009 --- --- --- ---
2010 --- --- --- ---
2011 --- --- --- ---
2012 --- --- --- ---
2013 --- --- --- ---
2014 --- --- --- ---
2015 --- --- --- ---
2016 --- --- --- ---
2017 --- --- --- ---
2018 --- --- --- ---
2019 --- --- --- ---
358
FY 2019 FY 2019
FY 2018 President’s +/-
FY 2017 Final Annualized CR Budget FY 2018
Claims BA $282,000,000 $308,000,000 $308,000,000 ---
Admin BA $7,750,000 $7,697,000 $9,200,000 +$1,503,000
Total BA $289,750,000 $315,697,000 $317,200,000 +$1,503,000
FTE 20 20 22 +2
Authorizing Legislation – Public Health Service Act, Title XXI, Subtitle 2, Parts A and D,
Sections 2110-19 and 2131-34, as amended by Public Law 114-255, Section 3093(c).
FY 2019 Authorization ................................................................................................... .Indefinite
Allocation Method ................................................................................................................... Other
The National Childhood Vaccine Injury Act of 1986 (the Act) established the National Vaccine
Injury Compensation Program (VICP) to compensate individuals, or families of individuals, who
have been injured by vaccines recommended by the Centers for Disease Control and Prevention
(CDC) for routine administration to children and pregnant women, and to serve as a viable
alternative to the traditional tort system. HRSA administers the VICP, and the Department of
Justice (DOJ) represents HHS in the U.S. Court of Federal Claims (Court) which ultimately
decides to provide compensation or dismiss claims.
HRSA receives claims requesting compensation for vaccine injuries or deaths, which the
petitioner has served against the HHS Secretary and filed with the Court. HRSA medical officers
with special expertise in pediatrics and adult medicine review these claims along with supporting
documentation. HRSA also contracts with health care professionals for claims review and with
other medical specialists to provide independent claim reviews and to testify in Court. HRSA
medical officers develop preliminary recommendations regarding petitioner eligibility for claim
compensation, based on medical reviews that DOJ incorporates in its Rule 4(b) report submitted
to the Court. Lastly, HRSA processes payments to petitioners and their attorneys based on
judgments entered by the Court.
HRSA also publishes notices in the Federal Register listing each claim received and promulgates
regulations to modify the Vaccine Injury Table that lists injuries and/or conditions associated
with covered vaccines. HRSA provides administrative support to the Advisory Commission on
Childhood Vaccines (ACCV), which is responsible for advising the HHS Secretary on issues
related to VICP operations. The ACCV is composed of nine voting members, including HHS
officials, health professionals, attorneys, and parents or legal representatives of children who
have suffered vaccine-related injuries or death.
359
Vaccine Injury Compensation Trust Fund
With a current balance of nearly $3.7 billion, the Vaccine Injury Compensation Trust Fund
(Trust Fund) provides funding to compensate vaccine-related injury or death claims for covered
vaccines administered on or after October 1, 1988. The Department of Treasury maintains the
Trust Fund through a $.75 excise tax on vaccines recommended by the CDC for routine
administration to children and pregnant women. The excise tax applies to each disease prevented
per vaccine dose. For example, influenza vaccine is taxed $.75 because it prevents one disease
while measles-mumps-rubella vaccine, which prevents three diseases, is taxed $2.25. The
Department of Treasury collects the excise taxes and manages Trust Fund investments.
Petitioners include individuals, parents, or legal representatives applying on behalf of others. The
number of petitioners receiving compensation nearly doubled from 375 in FY 2013 to 706 in FY
2017. The data in Table 1 reveals a steady rise in the number of petitioners and Court-ordered
compensation since FY 2014.
Table 1. Growth in Families and Individuals Receiving Compensation
No. of Compensation
Fiscal Year
Petitioners ($ in millions)
2013 375 $277
2014 365 $214
2015 508 $226
2016 689 $253
2017 706 $282
VICP Administration
The number of claims filed has more than doubled from 504 claims filed in FY 2013 to 1,243
claims filed in FY 2017, primarily due to the increase in the number of seasonal influenza
vaccine claims filed. With the CDC recommending an annual influenza vaccine for adults in
addition to children, many more people receive influenza vaccines each year. This vaccine now
accounts for approximately 60 percent of claims filed annually.
HRSA anticipates 1,720 claims filed in FY 2019, a 25% increase over the FY 2018 level of
1,380 claims filed. The Final Rule modifying the Vaccine Injury Table (Table) was published on
March 21, 2017, and petitioners have two years from the effective date of Table changes to file
claims for injuries or deaths that occurred up to eight years preceding the Table modification
date. The FY 2019 claims filed increase is based on a projected bolus of claims filed by March
21, 2019, the deadline for filing claims related to specific changes to the Vaccine Injury Table.
Becoming law in December 2016, the 21st Century Cures Act (Cures Act) requires the Secretary
to revise the Vaccine Injury Table to include vaccines recommended by the CDC for routine
administration in pregnant women (and subject to an excise tax by Federal law). It also permits
both a woman who received a covered vaccine while pregnant and any live-born child who was
in utero at the time such woman received the vaccine to be considered persons to whom the
360
covered vaccine was administered. The Cures Act also mandates that a covered vaccine
administered to a pregnant woman constitutes more than one vaccine administration—one to the
mother and one to each live-born child who was in utero at the time the woman received the
vaccine.
While the number of claims filed has more than doubled over the last five years, administrative
funding has increased by only 19 percent from $6.5 million to $7.75 million from FY 2013 to
FY 2017, as shown in Table 2. In FY 2017, the VICP initiated a backlog of claims because the
increased number of claims filed exceeded the level of funding available to conduct medical
reviews in FY 2017. This backlog results in delays in compensating petitioners since claims
remain in backlog status for more than six months awaiting review.
Table 2. Five-Year Trend in Number of Claims Filed versus Administrative Costs
Administrative
No. of Claims
Fiscal Year (FY) Funding
Filed
($ in millions)
2013 504 $6.48
2014 633 $6.46
2015 803 $7.50
2016 1,120 $7.50
2017 1,243 $7.75
Funding History – VICP Claims Compensation
FY Amount
FY 2015 $225,908,764
FY 2016 $252,884,049
FY 2017 $282,945,120
FY 2018 $308,000,000
FY 2019 $308,000,000
Funding History – VICP Administration
FY Amount
FY 2015 $7,500,000
FY 2016 $7,500,000
FY 2017 $7,750,000
FY 2018 $7,697,000
FY 2019 $9,200,000
361
Budget Request
VICP Claims Compensation - The FY 2019 Budget request for VICP claims compensation of
$308.0 million is the same as the FY 2018 Annualized CR level.
The FY 2019 Budget request will ensure adequate funds are available to compensate petitioners
and pay their attorneys’ fees and costs. These funds will also allow the VICP to continue to meet
its zero percent target for the percentage of eligible claimants who opt to reject awards and elect
to pursue civil action. Prior to the existence of the VICP, civil actions against vaccine
manufacturers threatened to cause vaccine shortages and reduce vaccination rates.
VICP Administration - The FY 2019 Budget request for VICP administration of $9.2 million is
$1.5 million above the FY 2018 Annualized CR level. This funding level will support
administrative expenses to process FY 2019 claims filed, including costs associated with medical
expert reviews and expert testimony to the Court. The increase in funds is needed to process the
continued growth in claims filed annually. The backlog of claims awaiting review, which was
394 claims at the end of FY 2017, will continue to grow.
In addition, the VICP will continue to provide professional and administrative support to the
ACCV, meet specific administrative requirements of the Act, process compensation awards,
maintain necessary records securely, and inform the public of the availability of the VICP. The
funding request also covers costs associated with the claims award process, follow-up
Year and
Most Recent
Result/
Target for
26.II.A.1: Percentage of cases
in which judgment awarding FY 2017:
compensation is rejected and 0%
0% 0% Maintain
an election to pursue a civil Target: 0%
action is filed. (Target Met)
(Outcome)
26.II.A.4: Average time FY 2017:3.9
settlements are approved from days
the date of receipt of the DOJ Target: 10
10 days 10 days Maintain
settlement proposal. days
(Outcome) (Target
Exceeded)
362
Year and
Most Recent
Result/
Target for
26.II.A.5: Average time that FY 2017:
lump sum only awards are 2.4days
paid from the receipt of all Target: 7 days 7 days 7 days Maintain
required documentation to (Target
make a payment. (Outcome) Exceeded)
26.II.A.6: Percentage of cases
FY 2017:
in which court-ordered
100%
annuities are funded within
(Baseline) 98% 98% Maintain
the carrier’s established
(Target
underwriting deadline.
Exceeded)
(Outcome)
26.II.A.7: Percentage of
FY 2017: 90%
medical reports that are
(Baseline)
completed within 90 days of 90% 90% Maintain
(Results Not
receipt of complete medical
Available)
records. (Outcome)
363

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DEPARTMENT

George Sigounas, MS, Ph.D.

Executive Summary ...................................................................................................................... 8

Budget Exhibits ........................................................................................................................... 21

PRIMARY HEALTH CARE ..................................................................................................... 53

HEALTH WORKFORCE ......................................................................................................... 68

MATERNAL AND CHILD HEALTH ................................................................................... 152

RYAN WHITE HIV/AIDS ....................................................................................................... 200

HEALTHCARE SYSTEMS .................................................................................................... 235

FEDERAL OFFICE OF RURAL HEALTH POLICY ......................................................... 268

Opioids ....................................................................................................................................... 291

Supplementary Tables .............................................................................................................. 307

Significant Items........................................................................................................................ 331

HRSA supports programs and services that target, for example:

Highlights of the major programs are listed below:

Health Workforce: -$744.4 million; total $476.6 million

 Children’s Hospital Graduate Medical Education (GME) Program: -$298 million;

Highlights of Performance Results and Targets

HRSA Goal: Strengthen the health workforce

Performance management is central to the agency’s overall management approach and

These aspects of HRSA’s performance management system promote accountability and

FY 2017 FY 2018 FY 2019 FY 2019

PROGRAM MANAGEMENT 153,629 152,954 151,993 -961

Appropriation Table Match 6,199,247 6,156,255 9,559,591 +3,403,336

Funds Appropriated to Other HRSA Accounts:

FY 2017 FY 2018 FY 2019

Offsetting Collections +16,902,000 +19,000,000 +35,000,000

Unobligated balance, start of year +519,437,000 +322,598,000 +223,000,000

2018 Continuing Resolution $6,156,255,000

2019 Estimate $9,559,591,000

2018 Mandatory6 $4,375,000,000

Net Change -$971,664,000

Total Program Increases 563 4,298,046,000 1,099 8,702,434,000 + 536 +4,404,388,000

Total Program Decreases 1,511 6,233,209,000 894 857,157,000 -617 -5,376,052,000

Net Change Discretionary 1,563 6,156,255,000 1,993 9,559,591,000 +430 +3,403,336,000

FY 2017 FY 2018 FY 2019

National Health Service Corps (NHSC):

Public Health Workforce Development:

3. MATERNAL & CHILD HEALTH:

Maternal and Child Health Block Grant 640,163 637,342 627,700

MIECHV Proposed Mandatory - 400,000 -

Emergency Relief - Part A 654,296 651,422 655,876

Organ Transplantation 23,492 23,389 23,549

Rural Health Policy Development 9,328 9,287 5,000

Telehealth 18,459 18,374 10,000

7. PROGRAM MANAGEMENT 153,629 152,954 151,993

Total, Discretionary Budget Authority 6,199,247 6,156,255 9,559,591

Federal Tort Claims Act Coverage for Free $10,000,000 per

BUREAU OF HEALTH WORKFORCE:

NHSC (Mandatory): Expiring

Subsection (a)(1) 21st Century

Advanced Education Nursing: Expired 64,142,000 Expired --

Nurse Faculty Loan Program:

Comprehensive Geriatric Education:

NURSE Corps (formerly Nursing Education

Children's Hospitals Graduate Medical Direct GME:

Teaching Health Centers Graduate Medical

National Practitioner Data Bank: (User