Budget Justification Fy2021

DEPARTMENT
of HEALTH
and HUMAN
SERVICES
Fiscal Year
2021
Health Resources and
Services Administration
Justification of
Estimates for
Appropriations Committees
Health Resources and Services
DEPARTMENT OF HEALTH & HUMAN SERVICES Administration
Rockville, MD 20857
MESSAGE FROM THE ADMINISTRATOR
As the Administrator of the Health Resources and Services Administration (HRSA), I present the
fiscal year (FY) 2021 Budget for 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 2021 Budget provides $11.2 billion to invest in programs that support direct
heath care services to individuals who are medically underserved or face barriers to health care,
and makes strategic investments in important health issues facing our country.
The FY 2021 Budget request:
 Accelerates efforts in the second year of the HHS wide initiative to end the HIV
Epidemic, expanding funding to approximately 500 health centers. It is estimated that a
total of 43,000 people with HIV will be served in the first two years of this 10-year
initiative
 Supports the Improving Maternal Health in America Initiative by implementing

evidence-based interventions to address critical gaps in maternity care service delivery
and improve maternal health outcomes
 Maintains critical resources to help communities combat the opioid crisis and substance
use disorders through funding for Health Centers and the National Health Service Corps,
and investments in rural communities
 Expands financial support to living organ donors and increases awareness about living
organ donation
 Extends mandatory funding for Health Centers, National Health Service Corps, and
Teaching Health Centers Graduate Medical Education
These investments will protect the health and well-being of the American people, while
addressing the opioid crisis, reducing the number of new HIV infections, promoting value-based
care, and focusing on programs that provide direct health care. HRSA is committed to
maximizing its funding to support critical health issues.
/Thomas J. Engels/
Thomas J. Engels
Administrator
Organizational Chart
2
Table of Contents
Organizational Chart.................................................................................................................... 2
Executive Summary ...................................................................................................................... 7

Introduction and Mission ................................................................................................................ 8
Overview of Budget Request .......................................................................................................... 9
Overview of Performance ............................................................................................................. 13
All-Purpose Table ......................................................................................................................... 17
Budget Exhibits ........................................................................................................................... 21

Appropriations Language.............................................................................................................. 22
Language Analysis ........................................................................................................................ 29
Amounts Available for Obligation................................................................................................ 33
Authorizing Legislation ................................................................................................................ 34
Summary of Changes .................................................................................................................... 49
Budget Authority by Activity ....................................................................................................... 52
Appropriations History Table ....................................................................................................... 56
Appropriations Not Authorized by Law ....................................................................................... 59
PRIMARY HEALTH CARE ..................................................................................................... 63

Health Centers ........................................................................................................................... 63
Free Clinics Medical Malpractice ............................................................................................. 76
HEALTH WORKFORCE ......................................................................................................... 80

National Health Service Corps (NHSC).................................................................................... 80
Faculty Loan Repayment Program ............................................................................................ 89
Health Professions Training for Diversity ................................................................................ 91
Centers of Excellence ............................................................................................................ 91
Scholarships for Disadvantaged Students ................................................................................. 94
Health Careers Opportunity Program ........................................................................................ 97
Health Care Workforce Assessment ....................................................................................... 100
3
Primary Care Training and Enhancement Program ................................................................ 103
Oral Health Training Programs ............................................................................................... 109
Medical Student Education Program....................................................................................... 115
Interdisciplinary, Community-Based Linkages....................................................................... 118
Area Health Education Centers Program ............................................................................. 118
Geriatrics Program ............................................................................................................... 122
Behavioral Health Workforce Development Programs .......................................................... 128
Public Health Workforce Development .................................................................................. 136
Public Health and Preventive Medicine Training Grant Programs ..................................... 136
Nursing Workforce Development ........................................................................................... 141
Advanced Nursing Education Programs.............................................................................. 141
Nursing Workforce Diversity .............................................................................................. 146
Nurse Education, Practice, Quality and Retention Programs .............................................. 149
Nurse Faculty Loan Program ............................................................................................... 154
Nurse Corps ......................................................................................................................... 157
Children’s Hospitals Graduate Medical Education Payment Program ................................... 162
Teaching Health Center Graduate Medical Education Program ............................................. 166
National Practitioner Data Bank ............................................................................................. 172
Health Workforce Cross-Cutting Performance Measures ....................................................... 175
MATERNAL AND CHILD HEALTH ................................................................................... 178

Maternal and Child Health Block Grant ................................................................................. 178
Autism and Other Developmental Disabilities........................................................................ 191
Sickle Cell Disease Treatment Demonstration Program ......................................................... 195
Early Hearing Detection and Intervention/1 ........................................................................... 198
Emergency Medical Services for Children ............................................................................. 202
Healthy Start ............................................................................................................................ 206
Heritable Disorders in Newborns and Children ...................................................................... 212
Pediatric Mental Health Care Access ...................................................................................... 215
Screening and Treatment for Maternal Depression and Related Behavioral Disorders ......... 219
Family-To-Family Health Information Centers ...................................................................... 221
Maternal, Infant, and Early Childhood Home Visiting Program ............................................ 225
4
RYAN WHITE HIV/AIDS ....................................................................................................... 235
Program Description and Accomplishments ........................................................................... 235
RWHAP Part A - Emergency Relief Grants ........................................................................... 241
RWHAP Part B - HIV Care Grants to States .......................................................................... 247
RWHAP Part C - Early Intervention Services ........................................................................ 255
RWHAP Part D - Women, Infants, Children and Youth ........................................................ 258
RWHAP Part F - AIDS Education and Training Programs .................................................... 261
RWHAP Part F - Dental Programs ......................................................................................... 264
RWHAP Part F - Special Projects of National Significance ................................................... 267
RWHAP – Ending the HIV Epidemic Initiative (EHE) .......................................................... 270
HEALTHCARE SYSTEMS .................................................................................................... 275

Organ Transplantation ............................................................................................................. 275
National Cord Blood Inventory ............................................................................................... 280
C.W Bill Young Cell Transplantation Program ...................................................................... 285
Poison Control Program .......................................................................................................... 289
Office of Pharmacy Affairs/340B Drug Pricing Program ....................................................... 294
National Hansen’s Disease Program ....................................................................................... 298
National Hansen’s Disease Program – Buildings and Facilities ............................................. 302
Payment to Hawaii .................................................................................................................. 303
FEDERAL OFFICE OF RURAL HEALTH POLICY ......................................................... 305

Rural Health Policy Development........................................................................................... 305
Rural Health Care Services Outreach, Network and Quality Improvement Grants................ 308
Rural Hospital Flexibility Grants ............................................................................................ 313
State Offices of Rural Health .................................................................................................. 317
Radiation Exposure Screening and Education Program ......................................................... 319
Black Lung .............................................................................................................................. 321
Telehealth ................................................................................................................................ 324
Rural Residency Planning and Development .......................................................................... 329
Rural Communities Opioid Response ..................................................................................... 331
Program Management .............................................................................................................. 335

Family Planning ........................................................................................................................ 343
5
Nonrecurring Expenses Fund .................................................................................................. 350
Supplementary Tables .............................................................................................................. 351

Object Class Tables..................................................................................................................... 352
Salaries and Expenses ................................................................................................................. 362
Detail of Full-Time Equivalent Employment ............................................................................. 364
FTEs Funded by P.L. 111-148 and Any Supplementals ............................................................. 368
Good Accounting Obligation in Government Act (GAO-IG Act) Report ................................. 370
Programs Proposed for Elimination ............................................................................................ 380
Physicians’ Comparability Allowance (PCA) Worksheet .......................................................... 384
Drug Control Budget................................................................................................................... 385
Significant Items........................................................................................................................ 390
Vaccine Injury Compensation Program ................................................................................. 407
6
Executive Summary
TAB
7
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;1,2
 The more than 1.1 million people living with HIV infection;3
 Persons affected by the growing national problem of opioid abuse and overdose; and
 The more than 113,000 individuals who are waiting for an organ transplant.4
By focusing on these and other underserved and at-risk groups, HRSA’s leadership and programs
promote the improvements in healthcare access and quality that are essential for a healthy nation.
1
Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death
1999-2017 on CDC WONDER Online Database, released December, 2018.Data are from the Multiple Cause of
Death Files, 1999-2017,as compiled from data provided by the 57 vital statistics jurisdictions through the Vital
Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html
2
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final data for 2017. National Vital
Statistics Reports; vol 67 no 8. Hyattsville, MD: National Center for Health Statistics. 2018.
3
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–
2015. HIV Surveillance Supplemental Report 2018;23 (No. 1). http://www.cdc.gov/
hiv/library/reports/hivsurveillance.html. Published March 2018. Accessed November 18, 2018.
4
Organ Procurement and Transplantation Network http://optn.transplant.hrsa.gov
8
Overview of Budget Request
The FY 2021 President’s program level request is $11.2 billion for the Health Resources and
Services Administration (HRSA). This level is $7055 million below the FY 2020 enacted level,
and provides investments to protect the health and well-being of the American people, while
accelerating efforts in the second year of the HHS-wide initiative to end the HIV Epidemic,
improving maternal health, transforming rural health in America, and reforming the organ
transplantation system. The Budget also extends mandatory funding for three critical programs.
Highlights of the major changes to programs are listed below:
Health Centers and Free Clinics: +$102.06 million; total program $5.7 billion – The Budget
provides resources for Health Centers to serve approximately 28.6 million patients in FY 2021.
The Budget includes $137 million for approximately 500 health centers in the Phase 1 targeted
areas to provide prevention and treatment services to people at high risk for HIV transmission,
including Pre-Exposure Prophylaxis (PrEP)-related services, outreach, and care coordination.
This will expand the initiative to all health centers in the Phase 1 targeted areas. The Budget also
includes an additional $15 million to provide health care services to the unsheltered homeless
and $4 billion in mandatory funding in FY 2021.
HIV/AIDS: +$95.0 million; total program $2.5 billion –The Budget provides a comprehensive
system of HIV primary medical care, medications, and essential support services for low-income
people living with HIV. The request includes $165 million for the second year of the Ending
HIV Epidemic Initiative. The additional resources will support HIV care and treatment services
in the identified jurisdictions. Funding will also support evidence informed practices to link,
engage, and retain people with HIV in care. The Budget provides funding for capacity building,
technical assistance, and resources for program implementation and oversight. HRSA estimates
43,000 clients will be served by this initiative through FY 2021.
Health Workforce: -$8247 million; total program $826 million
 Behavioral Health Training Programs: total program level $138.9 million

The Budget prioritizes investments in the behavioral health workforce to expand integrated
behavioral health care and treatment services in underserved communities. The request
includes $29.5 million to support the Addiction Medicine Fellowship Program. This
program seeks to increase the number of board certified addiction medicine and addiction
psychiatry specialists trained in providing interprofessional behavioral health services,
including substance use disorder prevention, treatment, and recovery services, in
underserved, community-based settings.
5
Total includes FY 2020 annualized funding amount for Health Centers, National Health Service Corps, and
Teaching Health Center Graduate Medical Education mandatory programs.
6
Total includes FY 2020 annualized funding amount for Health Centers mandatory program.
7
Total includes FY 2020 annualized funding amount for National Health Service Corps and Teaching Health Center
Graduate Medical Education mandatory programs.
9
 National Health Service Corps (NHSC): total program $430 million
The Budget supports scholarships and loan repayment to improve access to quality primary
care, dental, and behavioral health in underserved urban, rural, and tribal areas. The Budget
includes $120 million specifically for loan repayment for clinicians to provide opioid and
substance use disorder treatment. The Budget also proposes to extend mandatory funding at
$310 million in FY 2021.
 NURSE Corps: -$5.5 million; total program $83.1 million

The Budget addresses the anticipated demand for nurses in Critical Shortage Facilities. The
Budget includes a legislative proposal to expand tax-exempt status to include all components
of the NURSE Corps Scholarship Program, Native Hawaiian Health Scholarship Program,
and NURSE Corps Loan Repayment Program.
 Teaching Health Centers Graduate Medical Education Program: total program $126.5
million
The Budget includes $126.5 million in mandatory resources for residency training in primary
care medicine and dentistry in community-based, ambulatory settings. In FY 2021, the
program expects to support expects to support a maximum resident FTE cap of up to 801
resident FTE.
 Children’s Hospital Graduate Medical Education (GME) Program: -$340 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
2017 payments for graduate medical education, plus 2017 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.
 Workforce Training Programs: -$478.6 million; total program $47.2 million

The Budget invests $4.7 million in the Health Care Workforce Assessment program to
analyze health workforce data. HRSA is the primary Federal entity responsible for
monitoring and analyzing the nation’s health care workforce. The Budget also includes $18.8
million for the National Practitioner Data Bank (NPDB), 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. The request includes $23.7 million
for the Centers of Excellence program to prepare health professions students provide quality
health care to diverse populations. The Budget prioritizes funding for health workforce
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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.
Maternal and Child Health (MCH): -$24.8 million; total program $1.3 billion – The Budget
provides $760.7 million for the MCH Block Grant program, an increase of $73 million from the
FY 2020 enacted level. The Block Grant serves an estimated 55 million people, including 91
percent of pregnant women, 99 percent of infants, and 54 percent of children nationwide. In FY
2021, HRSA will provide $68 million through Special Projects of Regional and National
Significance for the HHS-wide Improving Maternal Health in America Initiative. FY 2021
resources will fund an additional State Maternal Health Innovation Grants and support the
implementation and expansion of evidence-based models of maternity care, including the
maternal safety bundles implemented through the Alliance for Innovation on Maternal Health to
community based care settings including Health Centers and IHS and Tribal health care
facilities. The Budget prioritizes programs that support direct health care services and give states
and communities the flexibility to meet local needs.
Rural Health: -$71.5 million; total programs $246.8 million – As part of the HHS-wide
Improving Maternal Health in America Initiative, the Budget requests $12 million for the Rural
Maternity and Obstetrics Management Strategies (RMOMS) program to support maternal health
needs in rural communities. FY 2021 resources will support new awards to develop and test
models that improve access to and continuity of maternal obstetrics care in rural communities.
This program focuses on Healthy Pregnancies and Births by improving the quality of obstetrics
care in rural areas.
The Budget provides $110 million for the Rural Communities Opioid Response Program to
strengthen infrastructure and capacity within rural communities at high risk for substance abuse
disorders. These funds will also support activities that combat methamphetamine, stimulant,
alcohol, and other substance misuse in rural communities. The Budget prioritizes funding for
Telehealth, the Radiation Exposure Screening Program, Black Lung Clinics, and Rural Health
Outreach Services. The request 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.
Healthcare Systems: +$15.8 million; total programs $139.4 million – In support of the
Administration’s Advancing American Kidney Health Initiative, the Budget includes an increase
of $3 million to expand HRSA’s financial support to living organ donors and increase awareness
about living organ donation. With these resources, HRSA will reimburse for donor support
travel reimbursement, lost wages, child care, elder care, and subsistence expenses to reduce
financial barriers to living organ donation. In FY 2020, HRSA proposed a new rule to expand the
scope of reimbursable expenses for living donors to include child care and elder care expenses,
to remove financial disincentives to living organ donation. HRSA also will propose to increase
the income threshold for living donors eligible for reimbursements. The Budget also includes
resources and broad regulatory authority to support the 340B Drug Pricing Program, which
requires drug manufacturers to provide discounts on outpatient prescription drugs to certain
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safety net providers. In addition, the Budget includes a new user fee on covered entities for the
340B program.
Program Management: -$3.3 million; total program $152.0 million –The Budget supports
program management activities that effectively and efficiently support HRSA’s operations,
including investments in information technology and cybersecurity. These investments are
aligned with the President’s Management Agenda.
Vaccine Injury Compensation Program: +$6 million; total program $16.2 million – The Budget
requests additional administrative funding to address the significant rise in the number of claims
filed largely due to increased claims for injuries from the influenza vaccine. The funding will
support the additional costs of medical reviewers dedicated to evaluating the increased claims
and reduce the current backlog of 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, foster a health workforce able to address current and emerging needs, enhance
population health and address health disparities though community partnerships, maximize the
value and impact of HRSA programs, and optimize HRSA operations to enhance efficiency,
effectiveness, innovation, and accountability. The anticipated performance in FY 2021 of key
HRSA programs is highlighted below, categorized by goal to indicate the close alignment of
specific programmatic activities with broader HRSA priorities. In collaboration with states,
communities, and organizations, the highlighted examples illustrate ways HRSA will continue to
improve health outcomes and address disparities through access to quality services, a skilled
health workforce, and innovative, high-value programs for millions of Americans who are
geographically isolated and economically or medically vulnerable.
Highlights
HRSA Goals: Improve access to quality health care and services
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 FY 2021, the Health Center Program expects to support health centers’ provision of
affordable, accessible, quality, and cost efficient care to 28.6 million patients.
 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 2021, 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 58 percent of children through the Maternal and Child
Health (MCH) Block Grant program in FY 2021, 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 5.8 per 1,000 in 2017 to 5.5 per 1,000 in 2021 by supporting
state MCH activities to improve the health of mothers, children, and families, particularly
among low-income mothers and families or those with limited availability of care.
 Grantees of the Maternal, Infant, and Early Childhood Home Visiting Program are
expected to make 1,033,000 home visits to at-risk families in FY 2021, using evidence-
based models of care to address children’s health, development, and well-being.
 In FY 2021, HRSA expects to serve 43,000 new clients under the Ending the HIV
Epidemic: A Plan for America initiative.
13
 By supporting the provision of HIV medications and related services to more than
285,000 persons in FY 2021 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.
 In FY 2021, 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 3.0
million visits for health-related care.
 In FY 2021, 83% of Ryan White HIV/AIDS Program clients receiving HIV medical care
and at least one viral load test are expected to be virally suppressed.
 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 nearly 4.08
million adults on the donor registry in FY 2021 who self-identify as belonging to an
underrepresented racial or ethnic group.
 The Organ Transplantation program projects that it will facilitate the transplantation of
more than 32,600 deceased donor organs in FY 2021.
HRSA Goal: Foster a Health Care Workforce Able to Address Current and Emerging Needs
HRSA works to improve the health care system by bolstering the healthcare workforce through
provider placement, retention, and training activities.
 In FY 2021, more than 14,600 primary care and other health practitioners will provide
services in health professional shortage areas in rural, urban, and frontier communities in
return for National Health Service Corps (NHSC) loan repayment or scholarship support.
 In FY 2021, 11,000 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.
HRSA Goal: Enhance Population Health and Address Health Disparities through Community
Partnerships
HRSA efforts will include activities such as leveraging advisory councils to better understand
community requirements, integrating public health and primary care services, using evidence-
based research to address health disparities, and promoting illness prevention and healthy
behaviors.
 In FY 2021, 200,000 unique individuals will receive direct services through Federal
Office of Rural Health Policy (FORHP) Outreach grants, which improve rural health
through community coalitions and evidence-based models by focusing on quality
14
improvement, increasing health care access, coordination of care, and integration of
services.
 The Graduate Psychology Education Program (GPE) will train 200 students in FY 2021
through innovative doctoral-level health psychology programs that foster an integrated
and interprofessional approach to addressing access of behavioral health and substance
use prevention and treatment services in high need areas through academic and
community partnerships. The GPE Program is focused on providing specialized training
to doctoral health psychology students, interns, and post-doctoral residents in the
provision of Opioid Use Disorder and other Substance Use Disorder prevention and
treatment services.
 In FY 2021, HRSA expects to have 148,721 cord blood units from underrepresented
racial and ethnic minorities available through the C.W. Young Cell Transplantation
Program, increasing the likelihood of finding suitably matched donors among these
populations with a high rate of diversity in tissue types.
 Recognizing that the adequacy of prenatal care is an important risk factor for infant
mortality, HRSA projects that 80% of women participating in Healthy Start will have a
prenatal care visit in the first trimester.
 The MCH Block Grant program expects to decrease the ratio of the Black infant
mortality rate to 2.0 to 1 in FY 2021.
In the ways highlighted above and others, HRSA will continue to help strengthen the health care
safety net, improve health outcomes, and increase access to quality services for millions of
Americans.
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. HRSA’s Strategic Plan includes three goals
focused on health access, the health workforce, and population health, each of which gives
direction to HRSA as it administers its external programs (described above). HRSA’s Strategic
Plan also includes two goals focused on internal HRSA performance management that drives
improved used of data and evidence to support decision-making.
As the key element of the performance management process, HRSA Senior Staff establish
annual fiscal year performance plans, including metrics and indicators of success, directly linked
to implementation of the HRSA Strategic Plan and additional priorities, as appropriate.
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,
15
mid-year and year-end Senior Staff performance reviews, and ad hoc meetings to address
emerging issues. 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. Ultimately, HRSA holds itself to high
standards by ensuring all programs maximize the investments and contribute to improved health
outcomes.
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All-Purpose Table
Health Resources and Services Administration
(Dollars in Thousands)
FY 2019 FY 2020 FY 2021

FY 2021
President's PB +/- FY
Final8 Enacted9
Budget 2020
Enacted
PRIMARY CARE:
Health Centers:
Health Centers 1,496,720 1,505,522 1,607,522 +102,000
Health Centers Mandatory 4,000,000 2,575,342 - -2,575,342
Health Centers Proposed Mandatory - 1,424,658 4,000,000 +2,575,342
Health Center Tort Claims 120,000 120,000 120,000 -
Subtotal, Health Centers 5,616,720 5,625,522 5,727,522 +102,000
Free Clinics Medical Malpractice 1,000 1,000 1,000 -
Subtotal, Bureau of Primary Health Care (BPHC) 5,617,720 5,626,522 5,728,522 +102,000
Subtotal, Mandatory BPHC (non-add) 4,000,000 4,000,000 4,000,000 -
Subtotal, Discretionary BPHC (non-add) 1,617,720 1,626,522 1,728,522 +102,000
HEALTH WORKFORCE:
National Health Service Corps (NHSC):
NHSC 120,000 120,000 120,000 -
NHSC Mandatory 310,000 199,589 - -199,589
NHSC Proposed Mandatory - 110,411 310,000 +199,589
Subtotal, NHSC 430,000 430,000 430,000 -
Loan Repayment/Faculty Fellowships 1,184 1,190 -1,190
Health Professions Training for Diversity:
Centers of Excellence 23,593 23,711 23,711 -
Scholarships for Disadvantaged Students 48,726 51,470 - -51,470
Health Careers Opportunity Program 14,118 15,000 - -15,000
Subtotal, Health Professions Training for Diversity 86,437 90,181 23,711 -66,470
Health Care Workforce Assessment 5,635 5,663 4,663 -1,000
Primary Care Training and Enhancement 48,680 48,924 - -48,924
Oral Health Training Programs 40,471 40,673 - -40,673
8
Funding levels displayed may not add to totals due to rounding.
9
The Further Consolidated Appropriations Act of FY 2020, P.L. 116-94, provides mandatory funding for Health
Centers, National Health Service Corps, and Teaching Health Centers through May 22, 2020. The amount
appropriated is displayed with an adjustment so that it may be compared to the President’s Budget. This adjustment
displays the annualized amount for this program if extended by Congress through the end of the fiscal year.
17
FY 2019 FY 2020 FY 2021
FY 2021
Final8 Enacted9
Budget 2020
Enacted
Medical Student Education 25,000 50,000 - -50,000
Interdisciplinary, Community-Based Linkages:
Area Health Education Centers 39,055 41,250 - -41,250
Geriatric Programs 40,534 40,737 - -40,737
Behavioral Health Workforce Development Programs 111,916 138,916 138,916 -
Subtotal, Interdisciplinary, Community-Based
Linkages 191,505 220,903 138,916 -81,987
Public Health Workforce Development:
Public Health/Preventive Medicine 16,915 17,000 - -17,000
Nursing Workforce Development:
Advanced Nursing Education 74,210 80,581 - -80,581
Nursing Workforce Diversity 17,257 18,343 - -18,343
Nurse Education, Practice and Retention 41,704 43,913 - -43,913
Nurse Faculty Loan Program 13,433 28,500 - -28,500
NURSE Corps Scholarship and Loan Repayment
Program 86,701 88,635 83,135 -5,500
Subtotal, Nursing Workforce Development 233,305 259,972 83,135 -176,837
Children's Hospital Graduate Medical Education 323,382 340,000 - -340,000
Teaching Health Center Graduate Medical Education
(THCGME):
THCGME Mandatory 126,500 81,445 - -81,145
THCGME Mandatory Proposed - 45,055 126,500 +81,445
Subtotal, THCGME 126,500 126,500 126,500 -
National Practitioner Data Bank (User Fees) 18,814 18,814 18,814 -
Subtotal, Bureau of Health Workforce (BHW) 1,547,828 1,649,820 825,739 -824,081
Subtotal, User Fees BHW (non-add) 18,814 18,814 18,814 -
Subtotal, Discretionary BHW (non-add) 1,092,514 1,194,506 370,425 -824,081
Subtotal, Mandatory BHW (non-add) 436,500 436,500 436,500 -
MATERNAL & CHILD HEALTH:

Maternal and Child Health Block Grant 674,723 687,700 760,700 +73,000
Autism and Other Developmental Disorders 50,377 52,344 - -52,344
Sickle Cell Service Demonstrations 4,435 5,205 - -5,205
Early Hearing Detection and Intervention 17,740 17,818 17,818 -
Emergency Medical Services for Children 22,236 22,334 - -22,334
Healthy Start 121,962 125,500 125,500 -
Heritable Disorders 16,311 17,883 - -17,883
Pediatric Mental Health Care Access Grants 9,956 10,000 10,000 -
Screening and Treatment for Maternal Depression 4,978 5,000 5,000 -
18
FY 2019 FY 2020 FY 2021
FY 2021
Final8 Enacted9
Budget 2020
Enacted
Family-to-Family Health Information Centers Mandatory 6,000 6,000 6,000 -
Maternal, Infant and Early Childhood Home Visiting
Program Mandatory 400,000 400,000 400,000 -
Subtotal, Maternal and Child Health Bureau
(MCHB) 1,328,717 1,349,784 1,325,018 -24,766
Subtotal, Discretionary MCHB (non-add) 922,717 943,784 919,018 -24,766
Subtotal, Mandatory MCHB (non-add) 406,000 406,000 406,000 -
HIV/AIDS:
Emergency Relief - Part A 655,876 655,876 655,876 -
Comprehensive Care - Part B 1,315,005 1,315,005 1,315,005 -
AIDS Drug Assistance Program (non-add) 900,313 900,313 900,313 -
Early Intervention - Part C 201,079 201,079 201,079 -
Children, Youth, Women & Families - Part D 75,088 75,088 75,088 -
AIDS Education and Training Centers - Part F 33,611 33,611 33,611 -
Dental Reimbursement Program Part F 13,122 13,122 13,122 -
Special Projects of National Significance (SPNS) 25,000 25,000 25,000 -
Ending HIV/AIDS Epidemic Initiative - 70,000 165,000 +95,000
Subtotal, HIV/AIDS Bureau 2,318,781 2,388,781 2,483,781 +95,000
HEALTHCARE SYSTEMS:
Organ Transplantation 25,437 27,549 30,549 +3,000
Discretionary (non-add) 25,437 27,549 17,164 -10,385
PHS Evaluation Funds (non-add) - - 13,385 +13,385
National Cord Blood Inventory 16,195 17,266 8,266 -9,000
C.W. Bill Young Cell Transplantation Program 24,501 30,009 30,009 -
Poison Control Centers 22,746 22,846 22,846 -
340B Drug Pricing Program/Office of Pharmacy Affairs 10,193 10,238 10,238 -
340B Drug Pricing Program User Fees - - 24,000 +24,000
Hansen's Disease Center 13,646 13,706 11,653 -2,053
Payment to Hawaii 1,849 1,857 1,857 -
National Hansen's Disease Program - Buildings and
Facilities 122 122 - -122
Subtotal, Healthcare Systems Bureau (HSB) 114,689 123,593 139,418 15,825
Subtotal, Discretionary HSB (non-add) 114,689 123,593 102,033 -21,560
Subtotal, User Fees HSB (non-add) - - 24,000 +24,000
Subtotal, Evaluation HSB (non-add) 13,385 +13,385
19
FY 2019 FY 2020 FY 2021
FY 2021
Final8 Enacted9
Budget 2020
Enacted
RURAL HEALTH:
Rural Health Policy Development 9,284 10,351 5,000 -5,351
Rural Health Outreach Grants 76,942 79,500 89,500 +10,000
Rural Hospital Flexibility Grants 53,223 53,609 - -53,609
State Offices of Rural Health 9,928 12,500 - -12,500
Radiation Exposure Screening and Education Program 1,821 1,834 1,834 -
Black Lung 10,921 11,500 11,500 -
Telehealth 24,324 29,000 29,000 -
Rural Communities Opioid Response 120,000 110,000 110,000 -
Rural Residency Planning and Development 9,956 10,000 - -10,000
Subtotal, Federal Office of Rural Health Policy 316,399 318,294 246,834 -71,460
PROGRAM MANAGEMENT 154,568 155,300 151,993 -3,307

FAMILY PLANNING 285,220 286,479 286,479 -
Appropriation Table Match 6,822,606 7,037,259 6,289,085 -748,174
Funds Appropriated to Other HRSA Accounts:

Vaccine Injury Compensation:
Vaccine Injury Compensation Trust Fund (HRSA
Claims) 225,900 260,400 265,600 +5,200
VICTF Direct Operations - HRSA 9,200 10,200 16,200 +6,000
Subtotal, Vaccine Injury Compensation 235,100 270,600 281,800 +11,200
Discretionary Program Level:

HRSA 6,841,420 7,056,073 6,345,284 -710,789
Vaccine Direct Operations Budget Authority 9,200 10,200 16,200 +6,000
Total, HRSA Discretionary Program Level 6,850,620 7,066,273 6,361,484 -704,789
Mandatory Programs: 4,842,500 4,842,500 4,842,500 -
Total, HRSA Program Level 11,693,120 11,908,773 11,203,984 -704,789
Less Programs Funded from Other Sources:
Evaluation Funds - - -13,385 -13,385
User Fees -18,814 -18,814 -42,814 -24,000
Mandatory Programs -4,842,500 -4,842,500 -4,842,500 -
Total, HRSA Discretionary Budget Authority 6,831,806 7,047,459 6,305,285 -742,174
Nonrecurring Expense Fund (notification amount) 13,000 - - -
20
Budget Exhibits
TAB
21
Appropriations Language
PRIMARY HEALTH CARE
For carrying out titles II and III of the Public Health Service Act (referred to in this Act as
the "PHS Act") with respect to primary health care and the Native Hawaiian Health Care Act of
1988, [$1,626,522,000] $1,728,522,000: Provided, That no more than $1,000,000 shall be
available until expended for carrying out the provisions of section 224(o) of the PHS Act:
Provided further, That no more than $120,000,000 shall be available until expended for carrying
out subsections (g) through (n) and (q) of section 224 of the PHS Act, and for expenses incurred
by the Department of Health and Human Services (referred to in this Act as "HHS") pertaining to
administrative claims made under such law.
HEALTH WORKFORCE
For carrying out titles III, VII, and VIII of the PHS Act with respect to the health
workforce, sections 1128E and 1921 of the Social Security Act, and the Health Care Quality
Improvement Act of 1986, [$1,194,506,000, of which $138,916,000 shall remain available
through September 30, 2021 to carry out sections 750, 755, 756, 760, 781, and 791 of the PHS
Act]$370,425,000: Provided, That sections 751[(j)(2)] and 762(k) of the PHS Act and the
proportional funding amounts in paragraphs (1) through (4) of section 756(f) of the PHS Act
shall not apply to funds made available under this heading[:Provided further, That for any
program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary
of Health and Human Services (referred to in this title as the ‘‘Secretary’’) may hereafter waive
any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the
full project period of a grant under such section: Provided further, That no funds shall be
available for section 340G–1 of the PHS Act:] Provided further, That fees collected for the
22
disclosure of information under section 427(b) of the Health Care Quality Improvement Act of
1986 and sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover
the full costs of operating the programs authorized by such sections and shall remain available
until expended for the National Practitioner Data Bank: Provided further, That funds transferred
to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may be
used to make prior year adjustments to awards made under such section and subpart: Provided
further, That $120,000,000 shall remain available until expended for the purposes of providing
primary health services, assigning National Health Service Corps (‘‘NHSC’’) members to
expand the delivery of substance use disorder treatment services, notwithstanding the assignment
priorities and limitations under sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of the PHS
Act, and making payments under the NHSC Loan Repayment Program under section 338B of
such Act: [Provided further, That, within the amount made available in the previous proviso,
$15,000,000 shall remain available until expended for the purposes of making payments under
the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals
participating in such program who provide primary health services in Indian Health Service
facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs (as those
terms are defined by the Secretary), notwithstanding the assignment priorities and limitations
under section 333(b) of such Act[: Provided further, That for purposes of the previous [two
provisos] proviso, section 331(a)(3)(D) of the PHS Act shall be applied as if the term ‘‘primary
health services’’ includes clinical substance use disorder treatment services, including those
provided by masters level, licensed substance use disorder treatment counselors[:Provided
further, That of the funds made available under this heading, $5,000,000 shall be available to
make grants to establish or expand optional community-based nurse practitioner fellowship
23
programs that are accredited or in the accreditation process, with a preference for those in
Federally Qualified Health Centers, for practicing postgraduate nurse practitioners in primary
care or behavioral health].
[Of the funds made available under this heading, $50,000,000 shall remain available until
expended for grants to public institutions of higher education to expand or support graduate
education for physicians provided by such institutions: Provided, That, in awarding such grants,
the Secretary shall give priority to public institutions of higher education located in States with a
projected primary care provider shortage in 2025, as determined by the Secretary: Provided
further, That grants so awarded are limited to such public institutions of higher education in
States in the top quintile of States with a projected primary care provider shortage in 2025, as
determined by the Secretary: Provided further, That the minimum amount of a grant so awarded
to such an institution shall be not less than $1,000,000 per year: Provided further, That such a
grant may be awarded for a period not to exceed 5 years: Provided further, That such a grant
awarded with respect to a year to such an institution shall be subject to a matching requirement
of non-Federal funds in an amount that is not less than 10 percent of the total amount of Federal
funds provided in the grant to such institution with respect to such year.]
MATERNAL AND CHILD HEALTH
For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and
child health and title V of the Social Security Act, [$943,784,000]$919,018,000: Provided, That
notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than
[$119,116,000]$132,593,000 shall be available for carrying out special projects of regional and
national significance pursuant to section 501(a)(2) of such Act and $10,276,000 shall be
24
available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such
Act.
RYAN WHITE HIV/AIDS PROGRAM
For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS
program, [$2,388,781,000]$2,483,781,000, of which $1,970,881,000 shall remain available to
the Secretary through September 30, [2022] 2023, for parts A and B of title XXVI of the PHS
Act, and of which not less than $900,313,000 shall be for State AIDS Drug Assistance Programs
under the authority of section 2616 or 311(c)of such Act; and of which
[$70,000,000]$165,000,000, to remain available until expended, shall be available to the
Secretary for carrying out a program of grants and contracts under title XXVI or section 311(c)
of such Act focused on ending the nationwide HIV/AIDS epidemic, with any grants issued under
such section 311(c) administered in conjunction with title XXVI of the PHS Act, including the
limitation on administrative expenses.
HEALTH CARE SYSTEMS
For carrying out titles III and XII of the PHS Act with respect to health care systems, and
the Stem Cell Therapeutic and Research Act of 2005, [$123,593,000, of which $122,000 shall be
available until expended for facilities renovations at the Gillis W. Long Hansen’s Disease
Center]$102,033,000: Provided, That in addition to amounts provided herein, $13,385,000 shall
be from funds available under section 241 of the PHS Act to supplement funding for organ
transplantation activities; Provided further, That the Secretary may collect a fee of 0.1 percent of
each purchase of 340B drugs from entities participating in the Drug Pricing Program pursuant
to section 340B of the PHS Act to pay for the operating costs of such program: Provided further,
That fees pursuant to the 340B Drug Pricing Program shall be collected by the Secretary based
25
on sales data that shall be submitted by drug manufacturers and shall be credited to this account
to remain available until expended.
RURAL HEALTH
For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a)
of the Federal Coal Mine Health and Safety Act of 1969, and sections 711 and 1820 of the Social
Security Act, [$318,294,000 of which $53,609,000 from general revenues, notwithstanding
section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural
hospital flexibility grants program: Provided, That of the funds made available under this
heading for Medicare rural hospital flexibility grants, $19,942,000 shall be available for the
Small Rural Hospital Improvement Grant Program for quality improvement and adoption of
health information technology and up to $1,000,000 shall be to carryout section 1820(g)(6) of the
Social Security Act, with funds provided for grants under section 1820(g)(6) available for the
purchase and implementation of telehealth services, including pilots and demonstrations on the
use of electronic health records to coordinate rural veterans care between rural providers and the
Department of Veterans Affairs electronic health record system: Provided further, That
notwithstanding section 338J(k) of the PHS Act, $12,500,000 shall be available for State Offices
of Rural Health: Provided further, That $10,000,000 shall remain available through September
30, 2022, to support the Rural Residency Development Program: Provided further, That
$110,000,000 shall be for the Rural Communities Opioids Response Program]$246,834,000.
FAMILY PLANNING
For carrying out the program under title X of the PHS Act to provide for voluntary family
planning projects, $286,479,000: Provided, That amounts provided to said projects under such
title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and
26
that such amounts shall not be expended for any activity (including the publication or
distribution of literature) that in any way tends to promote public support or opposition to any
legislative proposal or candidate for public office.
PROGRAM MANAGEMENT
For program support in the Health Resources and Services Administration,
[$155,300,000]$151,993,000: Provided, That funds made available under this heading may be
used to supplement program support funding provided under the headings "Primary Health
Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program",
"Health Care Systems", and "Rural Health".
GENERAL PROVISIONS
Sec. 228 Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended—
(a) in subsection (a)(5)(C)—
(1) by striking "A covered entity shall permit" and inserting "(i) DUPLICATE
DISCOUNTS AND DRUG RESALE.—A covered entity shall permit"; and
(2) by inserting at the end the following:
"(ii) USE OF SAVINGS.—A covered entity shall permit the Secretary to audit, at the
Secretary's expense, the records of the entity to determine how net income from purchases under
this section are used by the covered entity.
"(iii) RECORDS RETENTION.—Covered entities shall retain such records and provide
such records and reports as deemed necessary by the Secretary for carrying out this
subparagraph.".
27
(b) by adding at the end the following new subsection: "(f) REGULATIONS.—The
Secretary may promulgate such regulations as the Secretary determines to carry out the
provisions of this section.".
28
Language Analysis
LANGUAGE PROVISION EXPLANATION
Provided, That sections 751[(j)(2)] and Language and citation regarding the Area
762(k) of the PHS Act and the proportional Health Education Centers is removed because
funding amounts in paragraphs (1) through funding is not requested for this program.
(4) of section 756(f) of the PHS Act shall not
apply to funds made available under this
heading:[Provided further, That for any
program operating under section 751 of the
PHS Act on or before January 1, 2009, the
Secretary of Health and Human Services
(referred to in this title as the "Secretary")
may hereafter waive any of the requirements
contained in sections 751(d)(2)(A) and
751(d)(2)(B) of such Act for the full project
period of a grant under such section: Provided
further, That no funds shall be available for
section 340G-1 of the PHS Act]:
[of which $138,916,000 shall remain Language specific to FY 2020 removed.

available through September 30, 2021 to carry
out sections 750, 755, 756, 760, 781, and 791
of the PHS Act]:
[Provided further, That, in addition to Specific set-aside language not necessary.

amounts otherwise made available in the
previous proviso, $15,000,000 shall remain
available until expended for the purposes of
making payments under the NHSC Loan
Repayment Program under section 338B of
the PHS Act to individuals participating in
such program who provide primary health
services in Indian Health Service facilities,
Tribally-Operated 638 Health Programs, and
Urban Indian Health Programs (as those terms
are defined by the Secretary), notwithstanding
the assignment priorities and limitations under
section 333(b) of such Act]:
Provided further, That for purposes of the Language amended to reflect removal of
previous [two provisos] proviso, section previous proviso.
331(a)(3)(D) of the PHS Act shall be applied
as if the term "primary health services"
29
includes clinical substance use disorder

treatment services, including those provided
by masters level, licensed substance use
disorder treatment counselors.
[Provided further, That of the funds made Language specific to FY 2020 removed.
available under this heading, $5,000,000 shall
be available to make grants to establish or
expand optional community-based nurse
practitioner fellowship programs that are
accredited or in the accreditation process,
with a preference for those in Federally
Qualified Health Centers, for practicing
postgraduate nurse practitioners in primary
care or behavioral health].
[Of the funds made available under this Language regarding the Graduate Medical
heading, $50,000,000 shall remain available Education for Health Care Professionals
until expended for grants to public institutions program removed because funding is not
of higher education to expand or support requested for this program.
graduate education for physicians provided by
such institutions: Provided, That, in awarding
such grants, the Secretary shall give priority
to public institutions of higher education
located in States with a projected primary care
provider shortage in 2025, as determined by
the Secretary: Provided further, That grants so
awarded are limited to such public institutions
of higher education in States in the top
quintile of States with a projected primary
care provider shortage in 2025, as determined
by the Secretary: Provided further, That the
minimum amount of a grant so awarded to
such an institution shall be not less than
$1,000,000 per year: Provided further, That
such a grant may be awarded for a period not
to exceed 5 years: Provided further, That such
a grant awarded with respect to a year to such
an institution shall be subject to a matching
requirement of non-Federal funds in an
amount that is not less than 10 percent of the
total amount of Federal funds provided in the
grant to such institution with respect to such
year.]
30
[of which $122,000 shall be available until Language removed because funding is not
expended for facilities renovations at the requested for this program.
Gillis W. Long Hansen's Disease Center]
Provided, That in addition to amounts Provision to authorize use of PHS evaluation

provided herein, $13,385,000 shall be from funding to supplement funding for organ
funds available under section 241 of the PHS transplantation activities.
Act to supplement funding for organ
transplantation activities;
Provided, That the Secretary may collect a fee Provision to authorize the Secretary to collect
of 0.1 percent of each purchase of 340B drugs and spend user fees for the 340B Drug Pricing
from entities participating in the Drug Program.
Pricing Program pursuant to section 340B of
the PHS Act to pay for the operating costs of
such program: Provided further, That fees
pursuant to the 340B Drug Pricing Program
shall be collected by the Secretary based on
sales data that shall be submitted by drug
manufacturers and shall be credited to this
appropriation and remain available until
expended.
[of which $53,609,000 from general revenues, Language removed because funding is not
notwithstanding section 1820(j) of the Social requested for these programs.
Security Act, shall be available for carrying
out the Medicare rural hospital flexibility
grants program: Provided, That of the funds
made available under this heading for
Medicare rural hospital flexibility grants,
$19,942,000 shall be available for the Small
Rural Hospital Improvement Grant Program
for quality improvement and adoption of
health information technology and up to
$1,000,000 shall be to carryout section
1820(g)(6) of the Social Security Act, with
funds provided for grants under section
1820(g)(6) available for the purchase and
implementation of telehealth services,
including pilots and demonstrations on the
use of electronic health records to coordinate
rural veterans care between rural providers
and the Department of Veterans Affairs
electronic health record system: Provided
31
further, That notwithstanding section 338J(k)

of the PHS Act, $12,500,000 shall be
available for State Offices of Rural Health:
Provided further, That $10,000,000 shall
remain available through September 30, 2022,
to support the Rural Residency Development
Program]
[Provided further, That $110,000,000 shall be Language regarding the Rural Communities
for the Rural Communities Opioids Response Opioids Response Program is removed
Program.] because a separate funding proviso is
unnecessary and duplicative.
Sec. 228 Section 340B of the Public Provision to permit the Secretary to issue
Health Service Act (42 U.S.C. 256b) is regulations on all aspects of the 340B
amended— Program and to require covered entities to
(a) in subsection (a)(5)(C)— report on the use of savings to ensure that net
(1) by striking "A covered entity shall income from purchases under the 340B Drug
permit" and inserting "(i) DUPLICATE Pricing Program benefit low-income and
DISCOUNTS AND DRUG RESALE.—A uninsured patients of the covered entities.
covered entity shall permit;" and
(2) by inserting at the end the
following:
"(ii) USE OF SAVINGS.—A covered
entity shall permit the Secretary to audit, at
the Secretary's expense, the records of the
entity to determine how net income from
purchases under this section are used by the
covered entity.
"(iii) RECORDS RETENTION.—
Covered entities shall retain such records and
provide such records and reports as deemed
necessary by the Secretary for carrying out
this subparagraph.".
(b) by adding at the end the following
new subsection: "(f) REGULATIONS.—The
Secretary may promulgate such regulations
as the Secretary determines necessary or
appropriate to carry out the provisions of this
section.".
32
Amounts Available for Obligation 10
FY 2021
FY 2020 President's
FY 2019 Final Enacted Budget
General Fund Discretionary Appropriation:

Appropriation 6,843,503,000 7,037,259,000 6,289,085,000
Real transfer to the Administration for Children -20,897,000 - -
and Families
Health Center Supplemental +80,000,000 - -
Subtotal, adjusted general fund discretionary $6,902,606,000 $7,037,259,000 $6,289,085,000
appropriation
Mandatory Appropriation: 11
Family to Family Health Information Centers +6,000,000 +6,000,000 +6,000,000
Primary Health Care Access:
Community Health Center Fund +4,000,000,000 +4,000,000,000 +4,000,000,000
National Health Service Corps +310,000,000 +310,000,000 +310,000,000
Subtotal Primary Health Care Access +4,310,000,000 +4,310,000,000 +4,310,000,000
Early Childhood Visitation +400,000,000 +400,000,000 +400,000,000
Teaching Health Centers Graduate Medical +126,500,000 +126,500,000 +126,500,000
Education
Subtotal, adjusted mandatory appropriation 4,842,500,000 4,842,500,00012 4,842,500,000
Subtotal, adjusted appropriation $11,745,106,000 $11,879,759,000 $11,131,585,000
Offsetting Collections +18,814,000 +18,814,000 +42,814,000

Subtotal Spending Authority from offsetting +18,814,000 +18,814,000 +42,814,000
collections
Unobligated balance, start of year +473,568,000 + 484,401,000 + 228,000,000

Unobligated balanced end of year -484,401,000 -228,000,000 -198,000,000
Recoveries from prior year unpaid obligations -80,098,000 - -
Unobligated balance, lapsing -2,359,000 - -
Total obligations $11,670,630,000 $12,154,974,000 $11,204,399,000
10
Excludes the following amounts for reimbursable activities carried out by this account: FY 2019 - 12,088,000 and
18 FTE; FY 2020 - $12,088,000 and 18 FTE; FY 2020 $25,474,000 and 18 FTE.
11
FY 2020 and FY 2021 level includes proposed mandatory funding for Community Health Center Fund, National
Health Service Corps, and Teaching Health Centers Graduate Medical Education.
12
Total includes FY 2020 annualized funding amount for Health Centers, National Health Service Corps, and
Teaching Health Center Graduate Medical Education mandatory programs.
33
Authorizing Legislation
FY 2020 FY 2020 FY 2021

FY 2021 Amount
Amount Amount President’s
Authorized
Authorized Appropriated Budget
PRIMARY HEALTH CARE:
Authorized for FY Authorized for FY
2020 (and each 2021 (and each
subsequent year), an subsequent year), an
Health Centers (Discretionary): amount equal to the amount equal to the
Public Health Service (PHS) Act, previous year’s previous year’s
$1,505,522,000 $1,607,522,000
Section 330, as amended by P.L. 111- funding adjusted for funding adjusted for
148, Section 5601; any increase in the any increase in the
number of patients number of patients
served and the per- served and the per-
patient costs patient costs
Health Centers (Mandatory) (CHC
Fund):
P.L. 111-148, Section 10503 (b)(1)(F);
as amended by P.L 111-152, Section
2303; as amended by P.L. 114-10, (FY 2020 through
Section 221 P.L. 115-96, Sec. 3101(a); 5/22/2020):
P.L. 115-123, Section 50901, and P.L. $2,575,342,466 $4,000,000,00013 Expired $4,000,000,000
116-59, Division B, Title I, Section
1101, as amended by P.L. 116-69,
Division B, Title I, Section 1101, as
amended by P.L. 116-94, Division N,
Title I, Subtitle D, Section 401 (see 42
U.S.C. 254b-2)
$10,000,000 per $10,000,000 per
fiscal year is fiscal year is
authorized under authorized under
Federal Tort Claims Act Coverage for Section 224; funding Section 224; funding
Health Centers: comes from the comes from the
PHS Act, Section 224, as added by P.L. Health Center line. Health Center line.
102-501; as amended by P.L. 103-183; Note: This program $120,000,000 Note: This program $120,000,000
P.L. 104-73; P.L. 108-163; and the 21st is funded through is funded through
Century Cures Act, P.L. 114-255, annual appropriations annual appropriations
Section 9025 that are typically that are typically
made “available until made “available until
expended” (i.e., no- expended” (i.e., no-
year) appropriations. year) appropriations.
13
Total includes FY 2020 annualized funding amount for Health Centers mandatory program.
34
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
$10,000,000 per $10,000,000 per
fiscal year is fiscal year is
Federal Tort Claims Act Coverage for authorized. authorized.
Free Clinics: Note: This program Note: This program
PHS Act, Section 224, as added to the is funded through is funded through
$1,000,000 $1,000,000
PHS Act by P.L. 104-191, Section 194; annual appropriations annual appropriations
as amended by P.L. 111-148, Section that are typically that are typically
10608 made “available until made “available until
expended” (i.e., no- expended” (i.e., no-
year) appropriations. year) appropriations.
BUREAU OF HEALTH
WORKFORCE:
NHSC: Authorized for FY Authorized for FY
PHS Act, Sections 331-338, and 338C-H 2020 (and each 2021 (and each
as amended by the Health Care Safety subsequent year), subsequent year),
Net Act of 2008, P.L. 110-355, Section based on previous $120,000,000 based on previous $120,000,000
3(a)(1) and 3(c)-(d); as amended by P.L. year’s funding, year’s funding,
111-148, 10501(n)(1)-(3) and (5) subject to adjustment subject to adjustment
formula formula
NHSC (Mandatory):
P.L. 111-148, Section 10503(b)(2), as
amended by P.L. 114-10, Section 221
[see 42 USC 254b-2 stand-alone
provision—not in PHS Act] , as
amended by P.L. 115-96, Sec. (FY 2020 through
3101(b)(3)(F); as amended by P.L. 115- 5/22/2020):
$310,000,00014 Expired $310,000,000
123, Section 50901, as amended by P.L. $199,589,041
Division B, Title I, Section 1101, as
amended by P.L. 116-94, Division N,
Title I, Subtitle D, Section 401 (see 42
U.S.C. 254b-2)
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
14
Total includes FY 2020 annualized funding amount for National Health Service Corps mandatory program.
35
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
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
State Loan Repayment Program
(SLRP): Expired Expired
PHS Act, Section 338I(a)-(i), as (Note: The (Note: The
amended CHC/NHSC Fund CHC/NHSC Fund
--- ---
by P.L. 107-251, Section 315; as further (extended by (extended by
amended by the Health Care Safety Net MACRA) is used to MACRA) is used to
Act of 2008, P.L. 110-355, Section make SLRP grants) make SLRP grants)
3(a)(2)
Loan Repayments and Fellowships
Regarding Faculty Positions (Faculty
Loan Repayment): PHS Act, Section Expired $1,190,000 Expired ---
738(a) and 740(b), as amended by P.L.
111-148, Sections 5402 and 10501(d)
Centers of Excellence:
Section 736, PHS Act, as amended by SSAN $23,711,000 SSAN $23,711,000
P.L. 111-148, Section 5401
Scholarships for Disadvantaged
Students:
PHS Act, Section 737, as amended by
Expired $51,470,000 Expired ---
P.L. 111-148, Section 5402(b),
authorization of appropriations in
Section 740(a)
Health Careers Opportunity Program:
P.L. 111-148, Section 5402, Expired $15,000,000 Expired ---
authorization of appropriation in Section
740(c)
National Center for Workforce Analysis:
PHS Act, Section 761(b), as amended by Expired $5,663,000 Expired $4,663,000
P.L. 111-148, Section 5103
Primary Care Training and

Enhancement:
P.L. 111-148, Section 5301
36
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Oral Health Training Programs
Expired (with Expired (with
(Training in General, Pediatric, and
provision for provision for
Public Health Dentistry): $40,673,000 ---
carryover funds for carryover funds for
PHS Act, Section 748, as added by P.L.
no more than 3 years) no more than 3 years)
111-148, Section 5303
Graduate Medical Education for
$25,000,000 (until $25,000,000 (until
Physicians: $50,000,000 ---
expended) expended)
as added by P.L. 115-245, Title II
Interdisciplinary, Community-Based
Linkages:
Expired (with Expired (with
provision for provision for
Area Health Education Centers: $41,250,000 ---
carryover funds for carryover funds for
no more than 3 years) no more than 3 years)
P.L. 111-148, Section 5403; as amended
by P.L. 113-128, Section 512(z)(2)
Behavioral Health Workforce Education
and Training (BHWET): PHS Act,
Sections 755 and 756; as amended by $50,000,000 for each $50,000,000 for each
the 21st Century Cures Act, P.L. 114- of fiscal years 2020 $102,000,000 of fiscal years 2021 $102,000,000
255, section 9021 and the SUPPORT for through 2023 through 2023
Patients and Communities Act P.L. 115-
271, section 7073
Education and Training Related to
Geriatrics:
P.L. 111-148, Section 5305
Geriatric Academic Career Awards
PHS Act, Section 753(c), as amended by Not Specified --- Not Specified ---
P.L. 111-148, Section 5305(b)
SUPPORT Act
21st Century CURES
(through FY 2023):
Act, Section 9021
(through FY 2022):
Mental and Behavioral Health Education Subsection (a)(1)--
Subsection (a)(1)
and Training Grants (MBHET): $15,000,000
grants: $15,000,000
PHS Act, Section 756, as added by P.L.
111-148, Section 5306; as amended by Subsection (a)(2)
Subsection (a)(2) $36,916,000 $36,916,000
the 21st Century Cures Act, P.L. 114- $15,000,000;
grants: $15,000,000
255, Section 9021 and the SUPPORT
for Patients and Communities Act P.L.
Subsection (a)(3)
115-271, section 7073 Subsection (a)(3):
grants: $10,000,000
$10,000,000;
Subsection (a)(4)
Subsection (a)(4):
grants: $10,000,000
$10,000,000
37
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Public Health /Preventive Medicine:
PHS Act, Sections 765-768, as amended
by P.L. 111-148, Section 10501.
Note: PHS Act Section 770 provides the Expired $17,000,000 Expired ---
authorization of appropriations for
subpart 2 of Part E of Title VII, which
includes sections 765-768
Advanced Education Nursing: Expired $75,581,000 Expired ---

P.L. 111-148, Section 5308
Nursing Workforce Diversity
PHS Act, Section 821, as amended by Expired $18,343,000 Expired ----
P.L. 111-148, Sec. 5404
Nurse Education, Practice, Quality and
Retention :
PHS Act, Section 831 and 831A, as
Nurse Faculty Loan Program:
PHS Act, Section 846A, as amended by Expired $28,500,000 Expired ---
P.L. 111-148, Section 5311
NURSE Corps (formerly Nursing
Education Loan Repayment and
Scholarship Programs):
Expired $88,635,000 Expired $83,135,000
P.L. 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

Education Program:
Direct GME: Direct GME:
PHS Act, Section 340E, as amended by
$105,000,000 $105,000,000
P.L. 106-129, section 4; as amended by
Indirect Medical $340,000,000 Indirect Medical ---
P.L. 106-310, section 2001; as amended
Education: Education:
by P.L. 108-490; as amended by P.L.
$220,000,000 $220,000,000
109-307; as amended by P.L. 113-98, as
amended by P.L. 115-241, section 2
38
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Teaching Health Centers Graduate

Medical Education Program:
PHS Act, Section 340H, as added by
by P.L. 114-10, Section 221; as
amended by P.L. 115-63, Section 301(a)
by the Disaster Tax Relief and Airport (FY 2020 through
and Airway Extension Act of 2017 5/22/2020):
$126,500,00015 Expired $126,5000,000
(included 3-month THCGME funding), $81,445,205
as amended by P.L. 115-96 Sec.
3101(c)(2); as amended by P.L. 115-
123, Section 50901, as amended by P.L.
Division N, Title I, Subtitle D, Section
401
National Practitioner Data Bank: (User

Fees)
Title IV, P.L. 99-660, SSA, Section 1921;
P.L. 100-508, SSA, Section 1128E Not Specified $18,814,000 Not Specified $18,814,000
(also includes: Health Care Integrity
and Protection Data Bank (HIPDB),
SSA, Section 1128E)
Health Professional Shortage Areas
PHS Act Section 332 as amended by the

Improving Access to Maternity Care
---- --- ---- ---
Act, Public Law 115-320, section 2—
added a new subsection (k) authority for
“Maternity Care Health Professional
Target Areas”
Grants for Innovative Programs

FY 2019-2023 FY 2019-2023
PHS Act Section 340G, as amended by --- ---
$13,903,000 $13,903,000
the Action for Dental Health Act of
2018 P.L. 115-302, section 3
MATERNAL & CHILD

HEALTH:
Maternal and Child Health Block Grant: Indefinite at Indefinite at
$687,700,000 $760,700,000
Social Security Act, Title V $850,000,000 $850,000,000
15
Total includes FY 2020 annualized funding amount for Teaching Health Center Graduate Medical Education
mandatory program.
39
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Autism Education, Early Detection and
Intervention:
PHS Act, Section 399BB, as added by
$50,599,000 $50,599,000
P.L. 109-416, Section 3; reauthorized: $52,344,000 ---
(through FY 2024) (through FY 2024)
P.L. 112-32, Section 2; reauthorized:
P.L. 113-157, Section 4; reauthorized by
P.L. 116-60, Section 3
Sickle Cell Service Demonstration
Grants: American Jobs Creation Act of
2004, P.L. 108-357, Section 712(c ), as
amended by the Sickle Cell Disease and
Other Heritable Blood Disorders $4,455,000 (each of $4,455,000 (each of
Research, Surveillance, Prevention, and FY 2020 through FY $5,205,000 FY 2021 through FY ---
Other Treatment Act of 2018, P.L. 115- 2023) 2023)
327, section 3(b) (which transferred
section 712(c) of Pub. L. 108–
357 section and redesignated it as 42
U.S.C. 300b-5)
Universal Newborn Hearing Screening:
PHS Act, Section 399M, as amended by
Expired $17,818,000 Expired $17,818,000
by P.L. 111-337, Section 2
Emergency Medical Services for
Children:
by P.L. 111-148, Section 5603(1); as $22,334,000 (through 334,000 (through FY
$22,334,000 ---
amended by P.L. 113-180, Section 2; as FY 2024) 2024)
amended by the Emergency Medical
Services for Children Program
Reauthorization Act of 2019, P.L. 116-
49, Section 2
Healthy Start:
PHS Act, Section 330H, as added by
Expired $125,500,000 Expired $125,500,000
Heritable Disorders:
PHS Act, Section 1109-1112 and 1114,
as amended by P.L. 106-310, Section
2601; as amended by P.L. 110-204,
Section 2; as amended by P.L. 110-237,
Section 1; as amended by P.L. 113-240,
Section 10 (see PHS Act, Section 1117-
relating to authorization of
appropriations for fiscal years 2015
through 2019)
Pediatric Mental Health Care Access
$9,000,000 $9,000,000
Grants:
(each of FY 2020 $10,000,000 (each of FY 2021 $10,000,000
PHS Act, Section 330M, as added by
through FY 2022) through FY 2022)
P.L. 114-255, Section 10002
40
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Screening and Treatment for Maternal
$5,000,000 $5,000,000
Depression:
(each of FY 2020 $5,000,000 (each of FY 2021 $5,000,000
PHS Act, Section 317L-1, as added by
through FY 2022) through FY 2022)
P.L. 114-255, Section 10005
Family to Family Health Information
Centers: Social Security Act, Section
501(c)(1)(A), as added by P.L. 109-171,
Section 6064; reauthorized by P.L. 111-
148, Section 5507(b), as amended by
$6,000,000 (each of $6,000,000 (each of
fiscal years 2020 $6,000,000 fiscal years 2021 $6,000,000
by P.L. 113-67, Section 1203; as
through 2024) through 2024)
amended by P.L. 113-93, Section 207;
216; as amended by P.L. 115-123,
Section 50501; as amended by P.L. 116-
39, Section 5
$400,000,000
(each of FY 2020
through FY 2022)
Maternal, Infant and Early Childhood
Visiting Program:
[Note: P.L. 115-123,
Social Security Act, Section 511, as
Section 50606, adds
added by P.L. 111-148, Section 2951; as
subsection (h)(5) $400,000,000
amended by P.L. 113-93, Section 209;
language on “data $400,000,000 (each of FY 2021 $400,000,000
exchange standards through FY 2022)
218; as amended by the Bipartisan
for improved
Budget Act of 2018, P.L. 115-123,
interoperability” at
Section 50601-50607(see 42 U.S.C.
the end of Social
711)
Security Act, Section
511(h)(4)—effective
on 02/09/2020.]
HIV/AIDS:16
Emergency Relief - Part A
Expired $655,876,000 Expired $655,876,000
by P.L. 106-345; as amended by P.L.
109-415; as amended by P.L. 111-87
Comprehensive Care - Part B:
Expired $1,315,005,000 Expired $1,315,005,000
by P.L. 106-345, as amended by P.L.
109-415, as amended by P.L. 111-87
AIDS Drug Assistance Program (Non-
Add)
PHS Act, Sections 2611-31 and 2616, as
Expired $900,313,000 Expired $900,313,000
amended by P.L. 106-345, as amended
111-87
16 The Ryan White Program was authorized through September 30, 2013. The Ryan White HIV/AIDS Treatment
Extension Act of 2009 (P.L. 111-87, enacted 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.
41
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Early Intervention Services – Part C:
Expired $201,079,000 Expired $201,079,000
109-415, as amended by P.L. 111-87
Coordinated Services and Access to

Research for Women, Infants, Children
and Youth - Part D:
Expired $75,088,000 Expired $75,088,000
P.L. 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 Expired $33,611,000 Expired $33,611,000
109-415, as amended by P.L. 111-87
Dental Reimbursement Program - Part

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

- Part F:
PHS Act, Section 2691, as amended by Expired $25,000,000 Expired $25,000,000
P.L. 104-146, as amended by P.L. 109-
415, as amended by P.L. 111-87
Ending HIV Epidemic Initiative: Section
311 of the Public Health Service Act and
Expired $70,000,000 Expired $165,000,000
Title XXVI of the Public Health Service
Act
HEALTHCARE SYSTEMS:
Organ Transplantation:
42 U.S.C. 273-274g, PHS Act, Sections
371-378, as amended by P.L. 108-216, Expired $27,549,000 Expired $30,549,000
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
$23,000,000 (through
P.L. 109-129, Section 3; as amended by $17,266,000 Expired $8,266,000
FY 2020)
P.L. 111-264; as amended by P.L. 114-
104, Section 3
42
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
C.W. Bill Young Cell Transplantation
Program:
PHS Act, Sections 379-379B, as $30,000,000 (through
$30,009,000 Expired $30,009,000
amended by P.L. 109-129, Section 3; as FY 2020)
amended by P.L. 111-264; as amended
Toll-free number:
Toll-free number:
$700,000
$700,000
Media campaign:
Poison Control: Media campaign:
$800,000
PHS Act, Sections 1271-1274, as $800,000
amended by P.L. 108-194; as amended
by P.L. 110-377; as amended by P.L. Grant program: $22,846,000 $22,846,000
Grant program:
113-77, as amended by P.L. 116-94, $28,600,000
$28,600,000
Division N, Title I, Subtitle D, Section
403 Note: The amounts
Note: The amounts
are authorized
are authorized
through fiscal year
through fiscal year
2024
2024
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 amended by P.L. 111- SSAN indefinitely $10,238,000 SSAN indefinitely $10,238,000
148, Sections 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 $13,706,000 Not Specified $11,653,000
Payment to Hawaii:
PHS Act, Section 320(d), as amended by Not Specified $1,857,000 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, Not Specified --- Not Specified ---
as amended by P.L. 113-5 (to Section
319F-3)
RURAL HEALTH:
43
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Rural Health Policy Development:
Social Security Act, Section 711, and Indefinite $10,351,000 Indefinite $5,000,000
Rural Health Outreach Network

Development and Small Health Care
Provider Quality Improvement:
Expired $79,500,000 Expired $89,500,000
PHS Act, Section 330A, as amended by
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, Expired $53,609,000 Expired ---
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 $12,500,000 (each of $12,500,000 (each of
P.L. 105-392, Section 301, and the State fiscal years 2020 $12,500,000 fiscal years 2021 ---
Offices of Rural Health Reauthorization through 2022) through 2022)
Act of 2018, P.L. 115-408, Section 2
Radiogenic Diseases (Radiation

Exposure Screening and Education
Program):
PHS Act, Section 417C, as amended by
P.L. 106-245, Section 4, as amended by
P.L. 109-482, Sections 103, 104
Black Lung:
Federal Mine Safety and Health Act Not Specified $11,500,000 Not Specified $11,500,000
1977, 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- Expired $29,000,000 Expired $29,000,000
163; as amended by P.L. 113-55,
Section 103
Rural Communities Opioid Response:

SSA Section 711, as added by P.L. 100-
203, Section 4401; as amended by P.L.
100-360, Section 411(m)(1); as amended
by P.L. 101-239, Section 6213(g); as
44
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Rural Residency:
SSA Section 711(b)(5), as added by P.L.
100-203, Section 4401; as amended by
P.L. 100-360, Section 411(m)(1); as Not Specified $10,000,000 Not Specified ---
amended by P.L. 101-239, Section
6213(g); as amended by P.L. 108-173,
Section 432
Rural Emergency Medical Services

Training and Equipment Assistance SSAN (each of fiscal
SSAN (each of fiscal
Program: years 2021 through
years 2020 through --- ---
PHS Act Section 330J as amended by 2023)
2023)
the Agriculture Improvement Act of
2018, P.L. 115-334, Section 12608
OTHER PROGRAMS:
Family Planning:
Expired $286,479,000 Expired $286,479,000
Grants: PHS Act Title X
Program Management Indefinite $155,300,000 Indefinite $151,993,000
Vaccine Injury Compensation Program
(VICP) (funded through the VICP Trust
Fund):
Indefinite $270,600,000 Indefinite $281,800,000
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 FY Expired (through FY

School Based Health Centers - Facilities
2013 and amounts 2013 and amounts
Construction --- ---
remain available until remain available until
P.L. 111-148, Section 4101(a)
expended) expended)
School Based Health Centers -

Operations
Expired --- Expired ---
PHS Act, Section 399Z-1, as added by
P.L. 111-148, Section 4101(b)
Health Information Technology
Innovation Initiative
PHS Act, Section 330(e)(1)(C), (Grants SSAN --- SSAN ---
for 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
45
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
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, Section 10221 (incorporating
Section 202(a) of title II of Senate
Indian Affairs Committee-reported S.
1790)
Health Professions Education in Health
Disparities and Cultural Competency
P.L. 111-148, Section 5307
Training Opportunities for Direct Care
Workers
PHS Act, Section 747A, as added by
P.L. 111-148, Section 5302
Comprehensive Geriatric Education:
PHS Act, Section 865, as re-designated
by
P.L. 111-148, Section 5310(b)
Continuing Education Support for
Health Professionals Serving in
Underserved Communities SSAN --- SSAN ---
P.L. 111-148, Section 5403
Geriatric Career Incentive Awards
PHS Act, Section 753(e), as amended by Expired --- Expired ---
P.L. 111-148, Section 5305(a)
Rural Interdisciplinary Training
(Burdick) Not Specified --- Not Specified ---
Grants for Pain Care Education &
Expired (through FY
Training, PHS Act, Section 759, as
2012 and amounts
added by P.L.111-148, Section 4305 and
appropriated remain --- SSAN 2019-2023 ---
the SUPPORT for Patients and
available until
Communities Act P.L. 115-271, section
expended)
7073
Advisory Council on Graduate Medical
Education
P.L. 111-148, Section 5103
Health Professions Education in Health
Disparities and Cultural Competency
P.L. 111-148, Section 5307
46
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Minority Faculty Fellowship Program
PHS Act, Section 738 (authorized
appropriation in PHS Act Section Expired --- Expired ---
740(b)), as amended by P.L.111-148,
Sections 5402, 10501
State Health Care Workforce
Development Grants and
Implementation Grants
SSAN --- SSAN ---
[stand-alone 42 U.S.C. 294r (not as part
of PHS Act)], as added by P.L. 111-148,
Section 5102
Allied Health and Other Disciplines
Not Specified --- Not Specified ---
Nurse Managed Health Clinics ,
PHS Act, Section 330A-1, as added by Expired --- Expired ---
P.L. 111-148, Section 5208
Patient Navigator
P.L. 109-18, Section 2; as amended by
P.L. 111-148, Section 3510
Teaching Health Centers Development
Grants,
SSAN --- SSAN ---
P.L. 111-148, Section 5508
Evaluation of Long Term Effects of
Living Organ Donation,
P.L. 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. Expired --- Expired ---
111-148, 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:
PHS Act, Section 760, as added by P.L. $10,000,000 (each of $10,000,000 (each of
--- ---
114-255, the 21st Century Cures Act, FY 2020-FY 2022) FY 2021-FY 2022)
Section 9022
Liability Protections for Health
Professional Volunteers at Community
47
FY 2020 FY 2020 FY 2021
FY 2021 Amount
Authorized
Health Centers: PHS Act, Section
224(q), as added by P.L. 114-255, the
21st Century Cures Act, Section 9025
48
Summary of Changes
2020 Enacted $7,037,259,000

(Obligations) ($7,037,259,000)
2021 Estimate $6,289,085,000

(Obligations) ($6,289,085,000)
2020 Mandatory $4,842,500,000

(Obligations) ($4,842,500,000)
2021 Mandatory $4,842,500,000

(Obligations) ($4,842,500,000)
Net Change -$748,174,000
FY 2021 President's
FY 2020 Enacted FY 20201+/- FY 2020
Budget
Budget
FTE Budget Authority Budget Authority FTE
Authority
2,090 -85
$338,504,686 $330,618,222 -$7,886,464
Increases:
A. Built in:
1. January 2021 Civilian Pay Raise +6,734,553 +2,168,902 -4,565,651
2. January 2021 Military Pay Raise +730,383 +708,262 -22,121
3. Civilian Annualization of Jan. 2020 +1,382,486 +2,242,962 +860,476
4. Military Annualization of Jan. 2020 +204,193 +243,957 +39,764
Subtotal, built-in increases +9,051,615 +5,364,083 -3,687,532
B. Program:
Discretionary Increases
Health Centers 319 1,505,522,000 1,607,522,000 - +102,000,000
National Health Service Corps 5 120,000,000 120,000,000 +1 -
49
FY 2021 President's
FY 2020 Enacted FY 20201+/- FY 2020
Budget
Maternal and Child Health Block Grant 44 687,700,000 760,700,000 - +73,000,000
Ending HIV/AIDS Epidemic Initiative 30 70,000,000 165,000,000 - +95,000,000
Rural Communities Opioid Response 7 110,000,000 110,000,000 +5 -
Rural Health Outreach Grants 9 79,500,000 89,500,000 - +10,000,000
Subtotal Discretionary Program Increases 414 2,572,722,000 2,852,722,000 +6 +280,000,000
Mandatory Increases
Subtotal Mandatory Program Increases - - - - -
414 2,572,722,000 2,852,722,000 +6 +280,000,000
Total Program Increases
Decreases:
A. Built in:
1. Pay Costs 2,090 338,504,686 330,618,222 -85 -7,886,464
B. Program:
Discretionary Decreases
Loan Repayment/Faculty Fellowships - 1,190,000 - - -1,190,000
Scholarships for Disadvantaged Students 5 51,470,000 - -5 -51,470,000
Health Careers Opportunity Program 2 15,000,000 - -2 -15,000,000
Health Care Workforce Assessment 6 5,663,000 4,663,000 - -1,000,000
Primary Care Training and Enhancement 7 48,924,000 - -7 -48,924,000
Oral Health Training Programs 6 40,673,000 - -6 -40,673,000
Graduate Medical Education for Health Care Professionals - 50,000,000 - - -50,000,000
Area Health Education Centers 4 41,250,000 - -4 -41,250,000
Geriatric Programs 5 40,737,000 - -5 -40,737,000
Public Health/Preventive Medicine 5 17,000,000 - -5 -17,000,000
Advanced Nursing Education 9 75,581,000 - -9 -75,581,000
Nursing Workforce Diversity 3 18,343,000 - -3 -18,343,000
Nurse Education, Practice and Retention 4 43,913,000 - -4 -43,913,000
Nurse Faculty Loan Program 3 28,500,000 - -3 -28,500,000
NURSE Corps Scholarship and Loan Repayment Program 30 88,635,000 83,135,000 +2 -5,500,000
Nurse Practitioner Residency Program - 5,000,000 -5,000,000
Children's Hospital Graduate Medical Education 20 340,000,000 - -20 -340,000,000
Autism and Other Developmental Disorders 7 52,344,000 - -7 -52,344,000
Sickle Cell Service Demonstrations 2 5,205,000 - -2 -5,205,000
Emergency Medical Services for Children 5 22,334,000 - -5 -22,334,000
Heritable Disorders 3 17,883,000 - -3 -17,883,000
50
FY 2021 President's
FY 2020 Enacted FY 20201+/- FY 2020
Budget
Organ Transplantation 4 27,549,000 17,164,000 - -10,385,000
National Cord Blood Inventory 4 17,266,000 8,266,000 - -9,000,000
Hansen's Disease Center 49 13,706,000 11,653,000 - -2,053,000
National Hansen's Disease Program - Buildings and Facilities - 122,000 - - -122,000
Rural Health Policy Development 3 10,351,000 5,000,000 - -5,351,000
Rural Hospital Flexibility Grants 2 53,609,000 - -2 -53,609,000
State Offices of Rural Health - 12,500,000 - - -12,500,000
Rural Residency 1 10,000,000 - -1 -10,000,000
Program Management 770 155,300,000 151,993,000 - -3,307,000
Subtotal Discretionary Program Decreases 959 1,310,048,000 281,874,000 -91 -1,028,174,000
Mandatory Decreases
Subtotal Mandatory Program Decreases - - - -
Total Program Decreases 959 $1,310,048,000 $281,874,000 -91 -$1,028,174,000
Net Change Discretionary 1,373 $3,882,770,000 $3,134,596,000 -85 -$748,174,000

Net Change Mandatory - - - - -
Net Change Discretionary and Mandatory 1,373 $3,882,770,000 $3,134,596,000 -85 -$748,174,000
51
Budget Authority by Activity
FY 2019 FY 2020 FY 2021
President's
Final17 Enacted18
Budget
1. PRIMARY CARE:
Health Centers:
Health Centers 1,496,720 1,505,522 1,607,522
Health Centers Mandatory 4,000,000 2,575,342 -
Health Centers Proposed Mandatory - 1,424,658 4,000,000
Health Center Tort Claims 120,000 120,000 120,000
Subtotal, Health Centers 5,616,720 5,625,522 5,727,522
Free Clinics Medical Malpractice 1,000 1,000 1,000
Subtotal, Bureau of Primary Health Care 5,617,720 5,626,522 5,728,522
2. HEALTH WORKFORCE:
NHSC 120,000 120,000 120,000
NHSC Mandatory 310,000 199,589 -
NHSC Proposed Mandatory - 110,411 310,000
Subtotal, NHSC 430,000 430,000 430,000
Loan Repayment/Faculty Fellowships 1,184 1,190
Health Professions Training for Diversity: - -
Centers of Excellence 23,593 23,711 23,711
Scholarships for Disadvantaged Students 48,726 51,470 -
Health Careers Opportunity Program 14,118 15,000 -
Subtotal, Health Professions Training for Diversity 86,437 90,181 23,711
Health Care Workforce Assessment 5,635 5,663 4,663
Primary Care Training and Enhancement 48,680 48,924 -
Oral Health Training Programs 40,471 40,673 -
Medical Student Education 25,000 50,000 -
17
Funding levels displayed may not add to totals due to rounding
18
The Further Consolidated Appropriations Act of FY 2020, P.L. 116-94, provides mandatory funding for Health
Centers, National Health Service Corps, and Teaching Health Centers through May 22, 2020 at a pro-rated level.
The amount appropriated is displayed with an adjustment so that it may be compared to the President’s Budget. This
adjustment displays the annualized amount for this program if extended by Congress through the end of the fiscal
year.
52
FY 2019 FY 2020 FY 2021
President's
Final17 Enacted18
Budget
Interdisciplinary, Community-Based Linkages:

Area Health Education Centers 39,055 41,250 -
Geriatric Programs 40,534 40,737 -
Behavioral Health Workforce Development Programs 111,916 138,916 138,916
Subtotal, Interdisciplinary, Community-Based Linkages 191,505 220,903 138,916
Public Health Workforce Development:
Public Health/Preventive Medicine 16,915 17,000 -
Advanced Nursing Education 74,210 75,581 -
Nursing Workforce Diversity 17,257 18,343 -
Nurse Education, Practice and Retention 41,704 43,913 -
Nurse Faculty Loan Program 13,433 28,500 -
NURSE Corps Scholarship and Loan Repayment Program 86,701 88,635 83,135
Nurse Practitioner Residency Program - 5,000 -
Subtotal, Nursing Workforce Development 233,305 259,972 83,135
Children's Hospital Graduate Medical Education 323,382 340,000 -
Teaching Health Center Graduate Medical Education:
THCGME Mandatory 126,500 81,445 -
THCGME Mandatory Proposed - 45,055 126,500
Subtotal, THCGME 126,500 126,500 126,500
National Practitioner Data Bank (User Fees) 18,814 18,814 18,814
Subtotal, Bureau of Health Workforce 1,547,828 1,649,820 825,739
3. MATERNAL & CHILD HEALTH:

Maternal and Child Health Block Grant 674,723 687,700 760,700
Autism and Other Developmental Disorders 50,377 52,344 -
Sickle Cell Service Demonstrations 4,435 5,205 -
Early Hearing Detection and Intervention 17,740 17,818 17,818
Emergency Medical Services for Children 22,236 22,334 -
Healthy Start 121,962 125,500 125,500
Heritable Disorders 16,311 17,883 -
Pediatric Mental Health Care Access Grants 9,956 10,000 10,000
Screening and Treatment for Maternal Depression 4,978 5,000 5,000
Family-to-Family Health Information Centers Mandatory 6,000 6,000 6,000
Maternal, Infant and Early Childhood Home Visiting Program
Mandatory 400,000 400,000 400,000
Subtotal, Maternal and Child Health Bureau 1,328,717 1,349,784 1,325,018
53
FY 2019 FY 2020 FY 2021
President's
Final17 Enacted18
Budget
4. HIV/AIDS:
Emergency Relief - Part A 655,876 655,876 655,876
Comprehensive Care - Part B 1,315,005 1,315,005 1,315,005
AIDS Drug Assistance Program (non-add) 900,313 900,313 900,313
Early Intervention - Part C 201,079 201,079 201,079
Children, Youth, Women & Families - Part D 75,088 75,088 75,088
AIDS Education and Training Centers - Part F 33,611 33,611 33,611
Dental Reimbursement Program Part F 13,122 13,122 13,122
Special Projects of National Significance (SPNS) 25,000 25,000 25,000
Ending HIV/AIDS Epidemic Initiative - 70,000 165,000
Subtotal, HIV/AIDS Bureau 2,318,781 2,388,781 2,483,781
5. HEALTHCARE SYSTEMS:
Organ Transplantation 25,437 27,549 30,549
Discretionary (non-add) 25,437 27,549 17,164
PHS Evaluation Funds (non-add) - - 13,385
National Cord Blood Inventory 16,195 17,266 8,266
C.W. Bill Young Cell Transplantation Program 24,501 30,009 30,009
Poison Control Centers 22,746 22,846 22,846
340B Drug Pricing Program/Office of Pharmacy Affairs 10,193 10,238 10,238
340B Drug Pricing Program User Fees - - 24,000
Hansen's Disease Center 13,646 13,706 11,653
Payment to Hawaii 1,849 1,857 1,857
National Hansen's Disease Program - Buildings and Facilities 122 122 -
Subtotal, Healthcare Systems Bureau 114,689 123,593 139,418
6. RURAL HEALTH:
Rural Health Policy Development 9,284 10,351 5,000
Rural Health Outreach Grants 76,942 79,500 89,500
Rural Hospital Flexibility Grants 53,223 53,609 -
State Offices of Rural Health 9,928 12,500 -
Radiation Exposure Screening and Education Program 1,821 1,834 1,834
Black Lung 10,921 11,500 11,500
Telehealth 24,324 29,000 29,000
Rural Communities Opioid Response 120,000 110,000 110,000
Rural Residency Planning and Development 9,956 10,000 -
Subtotal, Federal Office of Rural Health Policy 316,399 318,294 246,834
54
FY 2019 FY 2020 FY 2021
President's
Final17 Enacted18
Budget
7. PROGRAM MANAGEMENT 154,568 155,300 151,993

8. FAMILY PLANNING 285,220 286,479 286,479
Total, HRSA Discretionary Budget Authority 6,822,606 7,037,259 6,289,085

FTE (excludes Vaccine) 2,095 2,152 2,083
55
Appropriations History Table
Budget
Estimate to House Senate
Congress Allowance Allowance Appropriation
FY 2012
General Fund Appropriation:

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
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
56
Budget
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
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 6,736,753,000
Advance
Supplemental
Rescissions
Subtotal 5,538,834,000 5,815,727,000 6,217,794,000 6,720,897,000
FY 2019

Base 9,559,591,000 6,540,385,000 6,816,753,000 6,843,503,000
Advance
Supplemental 60,000,000
Rescissions
Subtotal 9,559,591,000 6,540,385,000 6,816,753,000 6,882,605,973
57
Budget
FY 2020

Base 5,841,352,000 7,326,109,000 6,928,714,000 7,037,259,000
Advance
Supplemental
Rescissions
Transfers
Subtotal 5,841,352,000 7,326,109,000 6,928,714,000 7,037,259,000
FY 2021

Base 6,289,085,000
Advance
Supplemental
Rescissions
Transfers
Subtotal 6,289,085,000
58
Appropriations Not Authorized by Law19
Appropriations
Last Year of Last Authorization in Last Year of Appropriations
HRSA Program Authorization Level Authorization in FY 2020
School-Based Health Centers (Facilities
Construction) –P.L. 111-148, Section 4101(a)
School Based Health Centers - Operations 2013 50,000,000 47,450,000 ---
PHS Act, Section 399Z-1, as added by P.L.
111-148, Section 4101(b)
NHSC – PHS Act, Sections 331-338
Authorization of appropriations (“Field”): 2012 --- --- ---
Section 338(a)
NURSE Corps (formerly Nursing Education
Loan Repayment and Scholarship Programs)
PHS Act, Section 846, as amended by P.L.
107-205, Section 103; and for NURSE Corps
Loan Repayment only, as amended by P.L. 2007 SSAN 31,055,000 88,635,000
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 1,190,000
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 51,470,000
740(a), as amended by P.L. 111-148, Section
5402(b)
Health Careers Opportunity Program –
PHS Act, program authorized by Section 739,
authorization of appropriation in Section 2014 SSAN 14,153,000 15,000,000
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 5,663,000
appropriation in Section 761(e)(1)(A), as
Primary Care Training and Enhancement --
PHS Act, Section 747, as amended by P.L. 2014 SSAN 36,831,000 48,924,000
111-148, Section 5301
Area Health Education Centers
PHS Act, Section 751, as amended by P.L.
2014 125,000,000 30,250,000 41,250,000
111-148, Section 5403; as amended by P.L.
113-128, Section 512(z)(2)
19
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.
59
Appropriations
Education and Training Relating to Geriatrics
– PHS Act, Section 753, as amended by P.L.
111-256, Section 2(f)(5)
 Geriatric Workforce Development
(authorization of appropriation in Section
2014 10,800,000
753(d) (9)) 33,237,000 40,737,000
2013 10,000,000
 Geriatric Career Incentive Awards
(authorization of appropriation in Section
753(e)(4))
 Geriatric Academic Career Awards PHS
Act, Section 753(c), as amended by P.L.
111-148, Section 5305(b)
Nursing Workforce Development
 Nurse Retention Grants – PHS Act,
2012 SSAN --- ---
Section 831A; as amended by P.L. 111-
148, Section 5309(a)
 Nurse Education, Practice, and Quality
2016 SSAN 37,913,000 43,913,000
grants – PHS Act, Section 831; as
amended by P.L. 111-148, Section 5311(a)
 Nurse Faculty Loan Program – PHS Act,
2014 SSAN 24,500,000 28,500,000
Section 846A; as amended by P.L. 111-
148, Sections 5305(c), 5310(b)(10)(A)
 Comprehensive Geriatric Education – PHS 2014 SSAN 4,350,000 ---
Act, Section 865
Healthy Start –
Amount authorized
PHS Act, Section 330H, as added by P.L.
2013 for the preceding FY 100,746,000 125,500,000
increased by formula
110-339, Section 2
Emergency Relief - Part A –
PHS Act, Sections 2601-10, as amended by
2013 789,471,000 649,373,000 655,876,000
P.L. 106-345; as amended by P.L. 109-415; as
amended by P.L. 111-87
Comprehensive Care - Part B –
2013 1,562,169,000 1,314,446,000 1,315,005,000
P.L. 106-345, as amended by P.L. 109-415, as
Early Intervention Services – Part C –
2013 285,766,000 205,544,000 201,079,000
Coordinated Services and Access to Research
for Women, Infants, Children and Youth -
Part D –
PHS Act, Section 2671, as amended by P.L. 2013 87,273,000 72,395,000 75,088,000
106-345, as amended by P.L. 109-415, as
60
Appropriations
Special Projects of National Significance -
Part F –
PHS Act, Section 2691, as amended by P.L. 2013 25,000,000 25,000,000 25,000,000
104-146, as amended by P.L. 109-415, as
AIDS Education and Training Centers - Part F
– PHS Act, Section 2692(a), as amended by
2013 42,178,000 33,275,000 33,611,000
Dental Reimbursement Program - Part F –
PHS Act, Section 2692(b), as amended by
2013 15,802,000 12,991,000 13,122,000
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 27,549,000
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 –
2012 45,000,000 55,553,000 79,500,000
PHS Act, Section 330A, as amended by P.L.
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),,
2012 SSAN 41,040,000 53,609,000
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)
Telehealth –
PHS Act, Section 330I, as amended by P.L.
2006 SSAN 6,814,000 29,000,000
107-251, as amended by P.L. 108-163; as
further amended by P.L. 113-55, Section 103
Family Planning Grants –
PHS Act, Title X 1985 158,400,000 142,500,000 286,479,000
61
Primary Health Care
TAB
62
PRIMARY HEALTH CARE
Health Centers
FY 2021 FY 2021
FY 2019 FY 2020 President’s +/-
Final Enacted Budget FY 2020
BA $1,496,720,000 $1,505,522,000 $1,607,522,000 +$102,000,000

Current Law
Mandatory $4,000,000,000 $2,575,342,000 --- -$2,575,342,000
Funding
Proposed Law
Mandatory --- $1,424,658,000 $4,000,000,000 +$2,575,342,000
Funding
FTCA Program $120,000,000 $120,000,000 $120,000,000 ---
Total $5,616,720,000 $5,625,522,000 $5,727,522,000 +$102,000,000
FTE 504 504 504 ---
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 2021 Authorization: FY 2020 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 2021 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 for millions of people across the country.
Health centers advance a model of coordinated, comprehensive, and patient-centered primary
health care, integrating a wide range of medical, dental, mental health, substance use disorder,
and patient services. Today, approximately 1,400 health centers operate over 12,000 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 2018, health centers served 28.4 million patients, one in every twelve people living in the
United States, providing approximately 116 million patient visits, at an average cost of $990 per
63
patient (including Federal and non-Federal sources of funding). In 2018, nearly half of all health
centers served rural areas providing care to 8.9 million patients, one in 5 people living in rural
areas. Patient services are supported through Federal Health Center grants, Medicaid, 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 value-based care by using key quality improvement
practices, including health information technology. More than 77 percent of health centers are
currently 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 2018 including Healthy People 2020 goals for hypertension control
and dental sealant services. Overall, 93 percent of health centers met or exceeded Healthy People
2020 goals for at least one clinical measure in 2018, and 99% of health centers improved in one
or more clinical quality measures. 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 hospitals20.
Populations served: Health centers serve a diverse patient population. In 2018:
 People of all ages: Approximately 31 percent of patients were children (age 17 and
younger); over 9 percent were 65 or older. Health centers provided primary care services
for one in nine children nationwide.
 People in poverty: Over 91 percent of health center patients are individuals or families
living at or below 200 percent of the Federal Poverty Guidelines as compared to
approximately 33 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 1.4 million individuals experiencing
homelessness, nearly 1 million agricultural workers and their families, 4.4 million people
living in or near public housing and nearly 13,000 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 2017 Annual Homeless
Assessment Report to Congress, over 1.4 million people experienced sheltered
20
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
64
homelessness. In 2018, HRSA-funded health centers provided primary care
services for nearly 1.4 million persons in supportive housing and/or 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.
o Migrant Health Center Program: HRSA-funded health centers provided primary

care services for nearly 1 million 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 4.4 million
people living in or near 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 13,000 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
65
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 2018 was 28.4 million; an increase of 11.3 million, or 66 percent,
above the 17.1 million patients served in 2008. Of the 28.4 million patients served and for those
for whom income status is known, over 91 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 91
percent of health centers provide preventive dental services either directly or via contract. In
2018, health centers provided oral health services to over 6.4 million patients, an increase of 86
percent since 2010. In 2018, nearly 2.5 million people received behavioral health services at
health centers, an increase of 83 percent from 2014 to 2018 due to significant Health Center
Program investments in behavioral health services beginning in 2014.
From FY 2016 through FY 2019, HRSA has invested $545 million in targeted, ongoing annual
grant funding for the expansion of substance use disorder (SUD) and mental health (MH)
services in health centers. An additional $300 million has been invested in one-time health
center infrastructure costs that support the expansion of services. These investments support
health centers in implementing and advancing evidence-based strategies to expand access to
quality integrated SUD prevention and treatment services, including those addressing opioid use
disorder (OUD) and other emerging SUD issues, to best meet the health needs of the population
served by each health center; and/or to expand access to quality integrated mental health
services, with a focus on conditions that increase risk for, or co-occur with SUD, including
OUD. Screening for substance use disorders has increased 53 percent since 2016 with the
number of patients receiving screening, brief intervention, referral and treatment (SBIRT)
increasing from 716,677 in 2016 to 1,099,001 in 2018. From 2016–2018, the number of health
center providers eligible to prescribe MAT increased nearly 190 percent (from 1,700 in 2016 to
4,897 in 2018) and the number of patients receiving MAT increased 142 percent (from 39,075 in
2016 to 94,528 in 2018).
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.
66
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 2018, exceeding the target of
70.0 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 28 percent of the total health center patient
population served in 2018. In 2018, the health center rate was 8.0 percent, lower than the 2018
national rate of 8.3 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 2018, 63 percent of adult health center patients
with diagnosed hypertension had blood pressure under adequate control (less than 140/90)
compared to 57 percent nationally. Additionally in 2018, 67 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 60 percent nationally.
HRSA recognizes that there are many opportunities to maintain and improve the quality, value,
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 2019, more than three-fourths 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 99 percent of all health centers reported having an EHR in 2018.
67
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 patient visits provided per dollar as well as keeping medical cost per medical visit below
average annual national health care medical cost per medical visit while maintaining access to
the full complement of high quality services (e.g., medical, dental, mental health, substance use
disorder, pharmacy and patient support services) that make health centers a “health care home”.
In 2015, the medical cost per medical visit at health centers was $177, compared to the national
cost of $187. In 2016, the medical cost per medical visit at health centers was $185, compared to
the national figure of $187. In 2017, the medical cost per medical visit at health centers was
$192, and in 2018 it was $200.
By keeping the cost per medical visit at health centers below comparable national costs, 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
increase access to care, promote quality and cost-effective care, and improve patient outcomes,
especially for traditionally underserved populations.
 Health centers’ support for ambulatory care accreditation improve quality of care and
reduce health disparities in underserved communities across the United States. (Nair S,
Chen J; “Improving Quality of Care in Federally Qualified Health Centers Through
Ambulatory Care Accreditation” Journal of Healthcare Quality 2018 Oct; 40(5):301-
309).
 The availability of health centers’ services is positively associated with having a usual
source of care among those with no insurance coverage. (Kirby JB, Sharma R. “The
Availability of Community Health Center Services and Access to Medical Care”
Healthcare, 2017 December; 5(4): 174-182).
 Health centers with longer periods of PCMH recognition were more likely to have
improved their clinical quality on 9 of 11 measures, than health centers with fewer years
of PCMH recognition. (Ruwei Hu, Leiyu Shi, Alek Sripipatana, Hailun Liang, Ravi
Sharma, Suma Nair, Michelle Chung, De-Chih Lee; “The Association of Patient-
Centered Medical Home Designation with Quality of Care of HRSA-Funded Health
Centers: A Longitudinal Analysis of 2012 - 2015” Medical Care, 2018 Feb; 56(2): 130-
138).
 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
68
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 demonstrate lower total costs for Medicare beneficiaries. Total median
annual costs (at $2,370) for health center Medicare patients were lower by 10 percent
compared to patients in physician offices ($2,667) and by 30 percent compared to
patients in outpatient clinics ($3,580). (Dana B. Mukamel, Laura M. White, Robert S.
Nocon, Elbert S. Huang, Ravi Sharma, Leiyu Shi and Quyen Ngo-Metzger; "Comparing
the Cost of Caring for Medicare Beneficiaries in Federally Funded Health Centers to
Other Care Settings" Health Services Research, Volume 51, No. 2, April 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).
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 2018. More than 220 volunteers were covered under the FTCA Program in
FY 2018. Overall, in FY 2017, 127 claims were paid totaling $119.7 million, in FY 2018, 110
claims were paid totaling $109.3 million, and in FY 2019, 150 claims were paid totaling $135
million. Currently, there are over 840 FTCA Program claims outstanding. As the number of
69
health center patients continues to grow, it is projected that the amount of annual claims paid will
continue to increase through FY 2021.
Funding History
FY Amount
FY 2017 $1,481,929,000
FY 2017 Mandatory21 $3,510,661,000
FY 2018 $1,621,709,000
FY 2018 Mandatory $3,825,000,000
FY 2019 $1,616,720,000
FY 2019 Mandatory $4,000,000,000
FY 2020 $1,625,522,000
FY 2020 Mandatory $4,000,000,00022
FY 2021 $1,727,522,000
FY 2021 Mandatory $4,000,000,000
Budget Request
The FY 2021 Budget Request for the Health Center Program is $1.7 billion in discretionary
resources and includes $4 billion in mandatory funding, for a total request of $5.7 billion, which
is an increase of $102 million over the FY 2020 Enacted level. In FY 2021, the Health Center
Program will provide care for approximately 28.6 million patients. This request will also support
quality improvement and value-based 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 use disorder
services focusing on the treatment, prevention, and/or awareness of opioid abuse. The request
also supports costs associated with the grant review and award process, operational site visits,
information technology, and other program support costs. The FY 2021 Request also supports
$120 million for the FTCA Program, which is equal to the FY 2020 Enacted level. In addition,
HHS is seeking to establish statutory confidentiality and privilege protections for medical quality
assurance and peer review activities conducted by and on behalf of HHS components and HHS
grantees and contractors that are applying for or acting within the scope of deemed Public Health
Service (PHS) employment.
The Budget also supports a strategic initiative of the Administration to address the unsheltered
homelessness in the United States. Specifically, the Budget would support a Commissioned
Corps led public health efforts that could include health assessments, treatment of acute and
chronic illness, and medical stabilization for transitioning to long term health care services – all
of which would be coordinated with a larger program of human services such as housing and
training. Included in the Budget Request level is an additional $15 million for health centers to
provide primary care services to individuals experiencing homelessness in geographic areas with
21
FY 2017 reflects the post-sequestered amount.
22
Includes FY 2020 annualized funding amount for Health Centers mandatory program.
70
large numbers of unsheltered homeless individuals as part of the Administration’s FY 2021
efforts in this area.
In February 2019, the Administration announced a new initiative, Ending the HIV Epidemic: A
Plan for America. This ten-year initiative beginning in FY 2020 seeks to achieve the important
goal of reducing new HIV infections in the United States to less than 3,000 per year by 2030.
The first phase of the Ending the HIV Epidemic (EHE) initiative will focus on 48 counties,
Washington, D.C., San Juan (PR), and seven states that have a substantial rural HIV burden. By
focusing on these jurisdictions in the first phase of the EHE initiative, HHS plans to reduce new
HIV infections by 75% within five years.
The HRSA Health Center Program will provide HIV testing and prevention services, HIV care
and treatment where appropriate, and also assist with responding quickly to HIV cluster
detection efforts. The HRSA Health Center Programs’ primary focus in the Ending the HIV
Epidemic initiative will be on expanding outreach, care coordination, and access to Pre-Exposure
Prophylaxis (PrEP)-related services to people at high risk for HIV transmission through selected
health centers in the identified jurisdictions. In FY 2020, the first year of the Initiative, HRSA
will target resources to nearly 200 health centers that receive Health Center/Ryan White Program
funding and/or are located in close proximity to a Ryan White Program where no jointly funded
health center currently exists in the target jurisdiction.
In FY 2021, the second year of the EHE initiative, the Budget Request level includes $137
million which will support the participation of approximately 500 health centers in the phase I
targeted Initiative areas. This will add all health centers located in the targeted areas to the
Imitative. The Health Centers Program will continue to provide prevention and treatment
services to people at high risk for HIV transmission, including Pre-Exposure Prophylaxis (PrEP)-
related services, outreach, and care coordination through new grant awards in targeted areas
currently served by health centers. The Health Center program will continue to provide
resources to support the expansion of patient access and adherence to PrEP, with an increased
emphasis on outreach and care coordination.
Health centers continue to be a critical element of the health system, largely because they can
provide an accessible and dependable source of value-based 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, and health educators.
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. In 2016, a study
published in the American Journal of Public Health evaluated the total annual health care use and
total health care spending of Medicaid (fee-for-service) patients seen at health centers versus
71
those seen at non-health center settings.23 This study found that patients seen at a health center
had lower health care utilization and spending across all services when compared to non-health
center patients. This included 33% lower spending on specialty care, 25% fewer inpatient
admissions, and 24% lower total spending overall. Specifically, Medicaid FFS patients seen at a
health center saved nearly $2,400 in total health care spending per year when compared to those
seen in a non-health center setting. Health centers serve 4.4 million Medicaid FFS patients.
The FY 2021 Request supports the Health Center Program’s achievement of its performance
targets, including goals on access to affordable, accessible, quality, and cost-effective primary
health care services, and the improvement of health outcomes and quality of care. The Health
Center Program has established ambitious targets for FY 2021 and beyond. For low birth
weight, the Program seeks to be 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 2021 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 2021 target for the program’s diabetes management measure is
67 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 efficient, value-based care, and aims to
keep the medical cost per medical visit below the average annual national medical visit costs.
By benchmarking the health center efficiency to national per capita medical visit costs, 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 2021 target
is to keep the program’s medical cost per medical visit below the 2021 national cost figure. By
restraining increases in the medical cost per medical visit at health centers, the Health Center
Program is able to demonstrate that it delivers its high-quality services at a more cost-effective
rate.
The FY 2021 Request also supports efforts to improve the value, 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
23
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
72
data and quality reporting, clinical and quality improvement, and implementation of innovative
value-based, quality activities. The Program continues to promote the integration of HIT into
health centers through the Health Center Controlled Network Program to assure that key safety-
net providers are able to advance their operations through enhanced technology and tele-health
systems.
HRSA also utilizes a variety of methods to oversee the Health Center Program and to monitor
Health Center Program grantees to identify potential issues, including non-compliance with
program requirements and areas where technical assistance might be beneficial. HRSA
accomplishes this monitoring through a variety of available resources, including the review of
health center data reports, independent annual financial audits reports, routine conference calls,
and site visits.
HRSA’s efforts to strengthen evidence-building capacity in the Health Center Program include
recent enhancements and modernization to the Uniform Data System (UDS). Patient visits are
now reported for both in-person and virtual visits. This data enhancement supports HRSA’s
efforts to better identify medically underserved population service needs and utilize new
technology to improve access to care in medically underserved communities nationwide.
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 and precision medicine, 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.
Outcomes and Outputs Tables
Year and
Most Recent
FY 2021
Result
Target
/Target for FY 2020 FY 2021
Measure +/-
Recent Result Target Target
FY 2020
/
Target
(Summary of
Result)
FY 2018:
1.I.A.1: Number of 28.4M
patients served by health Target: 26.0M 28.6M 28.6M Maintain
centers (Output) (Target
Exceeded)
73
Year and
Most Recent
FY 2021
Result
Target
Measure +/-
FY 2020
/
Target
(Summary of
Result)
1.I.A.2.b: Percentage of
grantees that provide the FY 2018: 91%
following services either Target: 90% 90% 90% Maintain
on-site or by paid referral: (Target
(b) Preventive Dental Care Exceeded)
(Output)
1.I.A.2.c: Percentage of
grantees that provide the
FY 2018: 93%
following services either
Target: 86% 88% 88% Maintain
on-site or by paid
(Target
referral: (c) Mental
Exceeded)
Health/Substance Abuse
(Output)
FY 2018:
2.4M
1.I.A.2.d: Number of HIV 2.8M 3.2M +0.4M
Target: 2.0M
tests conducted (Output)
(Target
Exceeded)
FY 2018:
1.E.1: Medical cost per $200
medical visit at health Target: below Below Below
Maintain
centers compared to the national cost national cost national cost
national cost (Efficiency) (not yet
known)
1.II.B.2: Rate of births less FY 2018:
than 2500 grams (low 8.0%,
birth weight) to prenatal Target: 5% 5% below 5% below
Health Center patients below national Maintain
national rate national rate
compared to the national rate of 8.3%
low birth weight rate (Target
(Outcome) Virtually Met)
1.II.B.3: Percentage of
adult health center patients
with diagnosed FY 2018: 63%
hypertension whose blood Target: 63% 63% 63% Maintain
pressure is under adequate (Target Met)
control (less than 140/90)
(Outcome)
74
Year and
Most Recent
FY 2021
Result
Target
Measure +/-
FY 2020
/
Target
(Summary of
Result)
adult health center patients
with type 1 or 2 diabetes FY 2018: 67%
with most recent Target: 69% 67% 67% Maintain
hemoglobin A1c (HbA1c) (Target Not
under control (less than or Met)
equal to 9 percent)
(Outcome)
FY 2018: 74%
pregnant health center
patients beginning prenatal
(Target
care in the first trimester
Exceeded)
(Output)
1.II.A.1: Percentage of
Health Center patients FY 2018: 91%
who are at or below 200 Target: 91% 91% 91% Maintain
percent of poverty (Target Met)
(Output)
1.I.A.3: Percentage of
FY 2018: 75%
health centers with at least
one site recognized as a
(Target
patient centered medical
Exceeded)
home (Output)
Grants Awards Table
FY 2019 FY 2020 FY 2021

Final Enacted President’s Budget
Number of Awards 1,395 1,395 1,395
Average Award $3.7 million $3.7 million $3.7 million
Range of Awards $400,000 – $23 million $400,000 – $23 million $400,000 – $23 million
75
Free Clinics Medical Malpractice
FY 2021 FY 2021
BA $1,000,000 $1,000,000 $1,000,000 ---
FTE --- --- --- ---
111-148, Section 10608
FY 2021 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 2018, 11,338 health care providers received Federal malpractice
insurance through the Free Clinics Medical Malpractice Program, slightly less than the Program
target. In FY 2016, 243 clinics operated with FTCA deemed clinicians; in FY 2017, 237 clinics
participated, and in FY 2018, 239 clinics participated, exceeding the program target in each year.
76
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 2016 the cost was $50 per provider, and in FY 2017 the cost was $7 per
provider, which was unusually low due to no need to support system enhancement costs in FY
2017. Costs in FY 2018 were $38 per provider and are expected to remain similar through FY
2021. In each year, the Program performance target has been exceeded.
To date, there has been 1 paid claim under the Free Clinics Medical Malpractice Program. There
is 1 claim currently outstanding, and the Program Fund has a current balance of approximately
$2.46 million.
Funding History
FY Amount
FY 2017 $1,000,000
FY 2018 $1,000,000
FY 2019 $1,000,000
FY 2020 $1,000,000
FY 2021 $1,000,000
Budget Request
The FY 2021 Budget request for the Free Clinics Medical Malpractice Program is $1 million,
which is equal to the FY 2020 Enacted 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. The funding request also includes costs associated with information
technology and other program support costs.
Targets for FY 2021 focus on maintaining FY 2020 target levels for the number of volunteer free
clinic health care providers deemed eligible for FTCA malpractice coverage at 11,000, 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 2021.
The FY 2021 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
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
77
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 FY 2021
Recent Result / Target +/-
(Summary of FY 2020 FY 2021 FY 2020
Measure Result) Target Target Target
FY 2018:
2.I.A.1: Number of free clinic health 11,338
care providers deemed eligible for Target: 11,500 11,000 11,000 Maintain
FTCA malpractice coverage (Output) (Target Not
Met)
FY 2017:
474,701
2.1: Patient visits provided by free
Target:
clinics sponsoring FTCA deemed 475,000 475,000 Maintain
475,000
clinicians (Output)
(Target
Virtually Met)
FY 2018: 239
2.I.A.2: Number of free clinics
Target: 220
operating with FTCA deemed 220 220 Maintain
(Target
clinicians (Output)
Exceeded)
FY 2018: $85
2.E: Administrative costs of the
Target: $75
program per FTCA covered provider $75 $75 Maintain
(Target Not
(Efficiency)
Met)
78
Health Workforce
TAB
79
HEALTH WORKFORCE
National Health Service Corps (NHSC)
FY 2021 FY 2021
$120,000,000 $120,000,000 $120,000,000 ---

BA
Current Law
$310,000,000 $199,589,000 --- -$199,589,000
Mandatory Funding
Proposed Law
--- $110,411,000 $310,000,000 +$199,589,000
Mandatory Funding
Total $430,000,000 $430,000,000 $430,000,000 ---
FTE 214 214 215 +1
Authorizing Legislation: Public Health Service Act, Sections 331-338H, as amended by Public
Law 114-10
FY 2021 Authorization .......................................................................................... Expires FY 2019
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 in underserved communities in urban, rural,
and tribal areas. Across the nation, NHSC clinicians serve patients in Health Professional
Shortage Areas (HPSAs) – communities with limited access to health care. As of September 30,
2019, there were 7,578 primary care HPSAs, 6,782 dental HPSAs, and 6,069 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 17,740 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.
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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, 2019, there are 13,053 primary care medical, dental, and mental and
behavioral health practitioners providing service nationwide in the following programs24:
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. In FY 2018, the
NHSC LRP added flexibility for NHSC clinicians to better utilize telemedicine. Currently, less
than 10 percent of NHSC applicants indicate that their site uses telemedicine.
In addition, the NHSC and Primary Care Training and Enhancement (PCTE) are coordinating to
increase the number of PCTE graduates serving in HPSAs through the PCTE: Training Primary
Care Champions program. The purpose of this program is to strengthen primary care and the
workforce by establishing fellowship programs to train community-based practicing primary care
physicians and/or physician assistant champions to lead health care transformation and enhance
teaching in community–based settings. HRSA made awards in FY 2018 to support the PCTE:
Training Primary Care Champions program to give PCTE fellows experience and competency in
areas that make them more likely to serve in underserved areas. Physicians and physician
assistants who have completed PCTE fellowships will be afforded priority status when applying
for NHSC LRP awards and continuation awards in FY 2020.
NHSC Substance Use Disorder (SUD) Workforce LRP: The Consolidated Appropriations Act
of 2018 and the Department of Defense and Labor, Health and Human Services, and Education
Appropriations Act, 2019 and Further Consolidated Appropriations Act, 2020 appropriated
funding to the NHSC for the express purpose of expanding and improving access to quality
opioid and SUD treatment in rural and underserved areas nationwide. The primary purpose of
24
NHSC field strength data include awards made from the FY 2017 Zika Supplemental, which supported providers
in U.S. territories.
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this dedicated funding is to expand the availability of substance use disorder (SUD) treatment
providers to include the SUD workforce and categories for outpatient services, including Opioid
Treatment Programs, Office-based Opioid Treatment Facilities and Non-opioid Outpatient SUD
facilities. The funding supports the recruitment and retention of health professionals needed in
underserved areas to provide evidence-based SUD treatment and prevent overdose deaths.
Providers receive loan repayment assistance to reduce their educational financial debt in
exchange for service at SUD Treatment Facilities.
SUD Providers include:

• MDs/DOs, NPs, PAs with Drug Addiction Treatment Act 2000 Waivers
• Licensed or certified Health professionals providing SUD services; and
• Licensed primary care and mental & behavioral health professionals.
NHSC Rural Community LRP: A portion of the FY 2018 and FY 2019 appropriations provided
funding for the NHSC Rural Community LRP, a new program for providers working to combat
the opioid epidemic in the nation’s rural communities. The NHSC Rural Community LRP will
make FY 2020 loan repayment awards in coordination with the Rural Communities Opioid
Response Program (RCORP) initiative within the Federal Office of Rural Health Policy
(FORHP) to provide evidence-based substance use treatment, assist in recovery, and to prevent
overdose deaths across the nation.
NHSC and the Indian Health Service (IHS:) The FY 2020 appropriation directed funding to
support loan repayment awards to both fully trained medical, nursing, dental and
behavioral/mental health clinicians, and SUD providers, to deliver health care services in Indian
Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health
Programs. Federal Indian Health Service Clinics, Tribal Health Clinics, Urban Indian Health
Clinics, and dually-funded Tribal Health Clinics/Community Health Centers are automatically
designated as HPSAs. Without directed funding, these entities are still eligible to receive
providers that are supported through NHSC scholarship and loan repayment activities.
NHSC Students to Service (S2S) 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 increase
the number of physicians and dentists in the NHSC pipeline.
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. In FY 2018,
HRSA opened a new SLRP competition, expanding approved disciplines to include substance
use disorder counselors, an additional 5 states and one territory received awards, for a total of 43
grantees.
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The combination of these programs serve 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. States receiving funding from this opportunity
are encouraged to allow health professionals to practice to the full extent of their license.
NHSC Student Pipeline by Program as of 09/30/2019

Programs Students
Scholarship Program 1,081
Students to Service Program 398
Total 1,479
NHSC Student Pipeline by Discipline as of 09/30/2019

Disciplines Students
Allopathic/Osteopathic Physicians 971
Dentists 266
Nurse Practitioners 72
Physician Assistants 149
Certified Nurse Midwives 21
Total 1,479
NHSC Field Strength25 by Program as of 09/30/2019

Programs Clinicians
Scholarship Program Clinicians 506
Loan Repayment Program Clinicians 8,973
State Loan Repayment Program Clinicians 1,957
SUD Workforce Loan Repayment Program 1,074
Rural Community Loan Repayment Program 174
Student to Service Loan Repayment Program 369
Total 13,053
NHSC Field Strength by Discipline as of 09/30/2019

Disciplines Clinicians
Allopathic/Osteopathic Physicians26 2,418
Dentists 1,473
Dental Hygienists 363
Nurse Practitioners 3,150
Physician Assistants 1,255
25
NHSC field strength data include awards made from the FY 2017 Zika Supplemental, which supported providers
in U.S. territories.
26
Includes psychiatrists.
83
Disciplines Clinicians
Nurse Midwives 175
Mental and Behavioral Health Professionals 4,074
Other State Loan Repayment Program Clinicians 145
Total 13,053
Average NHSC Award by Program as of 09/30/2019

Program Average Award
Amount
Scholarship Program $225,393
Students to Service Loan Repayment Program $119,904
Loan Repayment Program $37,020
NHSC is committed to continuous performance improvement. The short-term retention rate

among NHSC participants who completed their service obligation in FY 2018 is 81 percent,
meaning that more than 2,000 clinicians continue to provide primary care services to
underserved communities 1-2 years after completing their service commitment. In FY 2019,
HRSA began using a newly-developed Clinician Dashboard to calculate retention rate for NHSC
providers. The Clinician Dashboard uses National Provider Identifier numbers from CMS as a
baseline in conjunction with other data sources to assist in determining the current practice
locations of providers who previously served in the National Health Service Corps. It allows
HRSA to calculate a more accurate retention rate that is not dependent on survey response rates.
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:
General Eligibility: Participants for all the NHSC programs are U.S. citizens (either U.S. born or
naturalized) or U.S. nationals.
Program Specific Eligibility: For NHSC SP, participants must be 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.
For all NHSC LRPs participants must be practicing in a NHSC-eligible discipline with qualified
student loan debt for education that led to their degree; 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 either have accepted a
position to work or are currently working in a NHSC approved site in a HPSA.
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For the NHSC SUD Workforce LRP participants must be working, or have accepted a position to
work, at an NHSC-approved SUD treatment facility. For the NHSC Rural Community LRP
participants must be working, or have accepted a position to work, at a rural NHSC-approved
SUD treatment facility.
For the NHSC Students to Service LRP participants must be 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.
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 2018 Discretionary $105,000,000
FY 2018 Current Law Mandatory $310,000,000
FY 2019 Discretionary $120,000,000
FY 2020 Enacted Discretionary $120,000,000
FY 2021 Discretionary Request $120,000,000
FY 2021 Proposed Law Mandatory $310,000,000
Budget Request
The FY 2021 Budget Request for the NHSC program of $430 million is equal to the FY 2020
Enacted level and includes $310 million in mandatory funding. This request will fund an
estimated 4,160 new and 2,350 continuation Loan Repayment awards, 149 new and 12
continuation scholarship awards, 594 State Loan Repayment awards, and 158 Students to Service
Loan Repayment awards.
The FY 2021 Discretionary Request of $120 million, combined with any carryover of
Discretionary funds from FY 2020 will enable HRSA to continue to enhance the ability of the
NHSC to combat the opioid epidemic by making as many as 2,360 new awards (of the 4,160
noted above) through the NHSC LRP, NHSC SUD Workforce LRP and the NHSC RCLRP in
this year. In coordination with both IHS and FORHP, these additional primary care and SUD-
treatment clinicians may be placed in Indian and rural NHSC-approved SUD treatment facilities
to address the needs of these communities in the face of the opioid epidemic.
The FY 2021 funding request includes operational costs in the form of Federal Insurance
Contributions Act tax contributions, staffing, and acquisition contracts and also includes costs
associated with the award process, follow-up performance reviews, and information technology
and other program support costs.
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Outcomes and Outputs Table
Year and Most

Recent Result
FY 2021
/Target for
FY 2020 FY 2021 +/-
Recent Result
Measure Target Target FY 2020
/
(Summary of
Result)
FY 2019:
13.05
4.I.C.1: Number of
Million
individuals served by
Target: 11.9 14.8 million 15.7 million +.9 million
NHSC clinicians
Million
(Outcome)
(Target
Exceeded)
FY 2019:
4.I.C.2: Support field 27
13,053
strength (participants in
Target: 11,410 14,133 14,964 +831
service) of the NHSC
(Target
(Outcome)
Exceeded)
4.I.C.4: Percent of NHSC
clinicians retained in
FY 2019: 81%
service to the underserved
Target: 80%
for at least one year beyond 80% 80% Maintain
(Target
the completion of their
Exceeded)
NHSC service
commitment28. (Outcome)
4.E.1: Default rate of FY 2019:
NHSC Scholarship and 1.3%
Loan Repayment Program
≤ 2.0% ≤ 2.0% Maintain
participants. (Efficiency) Target: <2.0%
(Baseline: FY 2007 = (Target
0.8%) Exceeded)
FY 2019:
17,744
4.I.C.6: Number of NHSC
Target: 16,000 18,000 18,000 Maintain
sites (Outcome)
(Target
Exceeded)
27
This measure reports on the number of people who received assistance through the NHSC scholarship and loan
repayment programs who are currently in the field. NHSC field strength data include awards made from the FY
2017 Zika Supplemental, which supported providers in the U.S. territories.
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Loan Repayments/Scholarships Awards Table
FY 2019 FY 2020 FY 2021

Final Enacted29 President’s
Budget30
Loan Repayments $236,821,423 $355,000,000 $311,000,000
State Loan Repayments $19,785,850 $15,000,000 $19,000,000
Scholarships $47,558,840 $38,000,000 $37,000,000
Students to Service Loan Repayment $15,277,840 $20,000,000 $19,000,000
NHSC Awards Table3132
Program 2014 2015 2016 2017 2018 2019 2020 2021
Scholarships 190 196 205 181 222 200 150 149

Scholarship
7 11 8 7 7 11 12 12
Continuation
Loan Repayment 2,775 2,934 3,079 2,554 3,262 4,012 4,899 4,160
Loan Repayment
2,105 1,841 2,111 2,259 2,384 2,385 2,350 2,350
Continuations
State Loan
464 620 634 535 625 812 625 594
Repayment
Students to Service
79 96 92 175 162 127 167 158
Loan Repayment
Total Awards 5,620 5,698 6,129 5,711 6,662 7,547 8,203 7,423
29
FY 2020 Enacted level assumes annualized mandatory funding. Loan Repayment Funding includes planned
carry-over FY 2018 and FY 2019 Discretionary funds for NHSC SUD LRP and NHSC RC LRP
30
Loan Repayment Funding includes possible carry-over of FY 2020 Discretionary funds for NHSC RC LRP
31
NHSC awards include those made from the FY 2017 Zika Supplemental.
32
NHSC LRP awards include those made from the FY 2018 and FY 2020 BA appropriations
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NHSC Field Strength Table as of 9/30/201933
Program: 2014 2015 2016 2017 2018 2019 2020 2021

Scholars 459 458 437 405 463 506 513 540
Loan Repayment 7,648 8,062 8,593 8,362 8,849 10,221 11,361 12,657
Students to Service
1,135 1,136 1,378 179 277 369 434 517
Loan Repayment
State Loan
- 27 85 1,233 1,350 1,957 1,825 1,250
Repayment
Total Field
9,242 9,683 10,493 10,179 10,939 13,053 14,133 14,964
Strength
33
Field Strength numbers for FY 2020- FY 2021 are projections.
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Faculty Loan Repayment Program
FY 2021 FY 2021
BA $1,184,000 $1,190,000 --- -$1,190,000
FTE 4 4 --- -4
Authorizing Legislation: Public Health Service Act, Sections 738 and 740
FY 2021 Authorization ................................................................... Expired at the end of FY 2014
Allocation Method ..................................................... Other (Competitive Awards to Individuals)
The Faculty Loan Repayment Program (FLRP) 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 2019, FLRP made 22 new loan
repayment awards. In FY 2020, FLRP anticipates making 21 new loan repayment awards.
Funding History
FY Amount
FY 2017 $1,187,000
FY 2018 $1,187,000
FY 2019 $1,184,000
FY 2020 $1,190,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Faculty Loan Repayment Program of $0 is $1.1 million
below the FY 2020 Enacted 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.
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Loans Table
FY 2021
FY 2019 FY 2020 President’s
Final Level Enacted Budget
Number of Awards 22 21 ---
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Health Professions Training for Diversity
Centers of Excellence
FY 2021 FY 2021
BA $23,593,000 $23,711,000 $23,711,000 ---
FTE 2 2 2 ---
Authorizing Legislation: Public Health Service Act, Section 736
FY 2021 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. These award recipients also focus on facilitating faculty and student
research on health issues particularly affecting URM groups.
In Academic Year 2018-2019, the COE Program supported 159 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. Award recipients develop
programming focused on mentorship and academic support, and faculty recruitment and
development. These programs supported 1,357 trainees across the country with stipend support
of whom 99 percent were considered underrepresented minorities (URMs) in the health
professions. In addition, 64 percent of the trainees were from financially and/or educationally
disadvantaged backgrounds. Additional students participated in COE Programs throughout the
academic year increasing total participation to 5,631 students of whom 3,107 completed their
programs.
Grantees partnered with 239 health care delivery sites, to provide 3,894 clinical training
experiences to health professions trainees. The clinical experiences are designed to help prepare
health professions students to provide quality health care to diverse populations. The training
emphasizes the importance of cultural competency and the impact of health disparities on overall
health outcomes. Nearly 42 percent of training sites used by COE grantees were primary care
settings and 56 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
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Act, including Historically Black Colleges and Universities (HBCUs); Hispanic COEs; Native
American COEs; and other COEs.
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
 Osteopathic medicine  Train, recruit, and retain URM faculty.
 Pharmacy  Improve information resources, clinical
education, cultural competency, and curricula
as they relate to minority health issues.
Funding History
FY Amount
FY 2017 $21,659,000
FY 2018 $23,652,000
FY 2019 $23,593,000
FY 2020 $23,711,000
FY 2021 $23,711,000
Budget Request
The FY 2021 Budget Request for the Centers of Excellence program of $23,711,000 is the same
as the FY 2020 Enacted level. In FY 2020 and FY 2021, the COE program anticipates making
19 awards and plans to continue supporting health workforce activities that strengthen the
national capacity to produce a high quality, diverse healthcare workforce. These funds support
HBCUs and other minority serving intuitions.
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Year and
Most Recent
Result /Target FY 2021
FY 2020 FY 2021
for Recent +/-
Measure Target Target
Result / FY 2020
(Summary of
Result) 34
6.I.C.20: Percent of program participants FY 2018: 13%
who completed pre-health professions Target: 22%
18% 18% Maintain
preparation training and intend to apply to (Target Not
a health professions degree program Met)
6.I.C.21: Percent of program participants FY 2018: 27%
who received academic retention support Target: 43%
40% 40% Maintain
and maintained enrollment in a health (Target Not
professions degree program Met)
Program Activity Data
Year and
Most FY 2019 FY 2020 FY 2021
COE Program Outputs
Recent Target Target
Result
Number of health professions
FY 2018:
students participating in research on 600 600 600
414
minority health-related issues
Number of faculty members
FY 2018:
participating in research on minority 500 500 500
359
health-related issues
Grant Awards Table
FY 2021
Final Enacted Budget
Number of Awards 19 19 19
Average Award $1,165,025 $1,170,883 ---
Range of Awards $465,860-$3,177,641 $604,971-$3,177,641 ---
34
Most recent results are for Academic Year 2018-2019 and funded in FY 2018.
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Scholarships for Disadvantaged Students
FY 2021 FY 2021
BA $48,726,000 $51,470,000 --- -$51,470,000
FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Sections 737 and 740
FY 2021 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 pipeline program.
In Academic Year 2018-2019, the SDS Program provided scholarships to 3,155 students from
disadvantaged backgrounds, slightly above the FY 2018 target. The majority of students were
considered under-represented minorities (URMs) in their prospective professions (64 percent).
Additionally, 1,392 students who received SDS-funded scholarships successfully graduated from
their degree programs by the end of Academic Year 2018-2019. Upon graduation, 69 percent
intended to work or pursue additional training in medically underserved communities, and 50
percent intended to work or pursue additional training in primary care settings. In FY 2020, SDS
will direct funds to educate midwives to address the national shortage of maternity care
providers, and specifically to address the lack of diversity in the maternity care workforce
Eligible Entities: Eligible entities are accredited schools of medicine, osteopathic medicine,
dentistry, nursing, pharmacy, physical therapy, 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.
94
Targeted
Designated Health Professions Grantee Activities
Educational Levels
 Allied health  Undergraduate  Provide scholarships to eligible
 Allopathic medicine  Graduate full-time students.
 Behavioral and mental health  Retain students from
 Chiropractic disadvantaged backgrounds
 Dentistry including students who are
 Nursing members of racial and ethnic
 Certified Nurse-Midwife minority groups.
 Optometry
 Osteopathic medicine
 Pharmacy
 Physical Therapy
 Physician assistants
 Podiatric medicine
 Public health
 Veterinary medicine
Funding History
FY Amount
FY 2016 $45,970,000
FY 2017 $45,859,000
FY 2018 $48,705,000
FY 2019 $48,726,000
FY 2020 $51,470,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Scholarships for Disadvantaged Students Program of $0 is
$51.5 million below the FY 2020 Enacted 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.
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Year and Most

Recent Result
FY 2021
Measure +/-
FY 2020
(Summary of
Result)35
6.I.C.22: Number of FY 2018: 3,155
disadvantaged students with Target: 2,930
2,930 N/A -2,930
scholarships (Target
Exceeded)
Year and
FY 2019 FY 2020
SDS Program Outputs Most Recent FY 2021
Target Target
Result
Number of URM students with FY 2018:

1,800 1,869 ---
scholarships 2,024
Percent of students who are FY 2018:
62% 62% ---
URMs 64%
Grant Awards Table
FY 2019 FY 2020 FY 2021

Level Enacted President’s Budget
Average Award $578,780 $600,000 ---
Range of Awards $28,000-$650,000 $28,000-$650,000 ---
35
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Health Careers Opportunity Program
FY 2021 FY 2021
BA $14,118,000 $15,000,000 --- -$15,000,000
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 National HCOP Academies provide a variety of academic and social supports
to individuals from disadvantaged backgrounds through formal academic and research training,
programming, and student enhancement or support services that can include tailored academic
counseling and highly-focused mentoring services, student financial assistance in the form of
scholarships and stipends, financial planning resources, and health care careers and training
information. These HCOP activities are an integral part of structured programming for students
throughout the academic year. Exemplary activities of HCOP grantees include post-
baccalaureate, summer, and other programs that provide disadvantaged students with often
previously unheard of knowledge, experiences, and opportunities to participate in individualized
and tailored academic coursework and community work in the health professions school areas.
In addition, the HCOP National Ambassador Program, a longitudinal, integrated curriculum-
based program, provides assist to students from disadvantaged backgrounds with matriculating
through the educational pipeline.
In Academic Year 2018-2019, HCOP supported 232 training programs and activities to promote
interest in the health professions among prospective, disadvantaged students. In total, HCOP
grantees reached 4,082 disadvantaged trainees across the country through structured programs.
The establishment of National HCOP Academies is aimed at increasing the numbers of students
in formal-structured programs in order to meet established targets.
HCOP grantees partnered with 168 sites to provide 3,437 clinical health profession trainings in
primary care, emphasizing experiences in rural and underserved communities for HCOP student
trainees (e.g., academic institutions, community-based organizations, and hospitals).
Approximately 65 percent of these training sites were located in medically underserved
communities and/or rural settings. Additional students participated in HCOP activities and
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programs as well bringing 5,616 total students into the health professions pipeline of whom
3,794 completed their training.
Eligible Entities: Accredited health professions schools and other public or private nonprofit
health or educational institutions.
Funding History
FY Amount
FY 2017 $14,155,000
FY 2018 $14,154,000
FY 2019 $14,118,000
FY 2020 $15,000,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Health Careers Opportunity Program of $0 is $15 million
Year and Most

Recent Result
FY 2021
Measure +/-
Recent Result / Target Target
FY 2020
(Summary of
Result)36
6.I.C.23: Total number of FY 2018: 4,082
disadvantaged students in Target: 2,000 N/A37 N/A N/A
structured programs (Target Exceeded)
6.I.C.51: Number of HCOP
trainees from disadvantaged
backgrounds participating in
---38 TBD N/A N/A
academic programming, clinical
training and/or student support
services
36 Most recent results are for Academic Year 2018-2019 and funded in FY 2018.
37
This measure will be discontinued in FY 2019 as new measures will account for programmatic changes.
38
Baseline will be set for this measure in FY 2019 and reported in the FY 2022 Congressional Justification.
98
Year and Most
Recent Result
FY 2021
Measure +/-
FY 2020
(Summary of
Result)36
6.I.C.52: Percent of HCOP health
professions program completers
---39 TBD N/A N/A
who intend to work in primary care
settings
Year and Most FY 2019 FY 2020 FY 2021

HCOP Outputs
Total number of students

participating in all HCOP FY 2018: 5,616 5,000 5,000 ---
programs
Total number of URM students
participating in all HCOP FY 2018: 3,638 2,700 3,000 ---
programs
Grant Awards Table
FY 2019 FY 2020 FY 2021

Final Level Enacted President’s Budget
Average Award $633,384 $672,003 ---
Range of Awards $583,464 – $645,101 $620,083-$683,720 ---
39
99
Health Care Workforce Assessment
The National Center for Health Workforce Analysis
FY 2021 FY 2021
BA $5,635,000 $5,663,000 $4,663,000 -$1,000,000
FTE 6 6 6 ---
Authorizing Legislation: Public Health Service Act, Sections 761, 792, and 806(f)
FY 2021 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.
100
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 have been released during Calendar Years 2018 and 2019:
 Long-Term Services and Supports: Direct Care Worker Demand Projections 2015-2030
 Long-Term Services and Supports: Nursing Workforce Demand Projections 2015-2030
 Behavioral Health Workforce Projections, 2016 – 2030
 Allied Health Workforce Projections, 2016-2030
NCHWA also oversees nine 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.40 NCHWA funded two new Health Workforce Research Centers (HWRCs) that began
work in FY 2019. Together, these two Centers examine a broad range of issues related to health
equity in health workforce education and training. Research conducted by these two HWRCs
aims to strengthen the evidence base for effective education and training programs that can
enable and empower a health workforce capable of fostering and ensuring health equity for all
populations. Examples of research areas related to this topic include:
 Looking across a range of health care professions and providers to develop a

comprehensive picture of how current health workforce education and training programs
incorporate consideration of health equity, including social needs, social determinants of
health, and related elements, into their programs.
 Developing measures to assess and track consideration of health equity and related
elements into health workforce education and training programs.
 Evaluating health workforce education and training programs to understand whether and
how a program’s incorporation of health equity considerations, including consideration of
social needs and social determinants of health, may improve health care delivery, with
respect to factors such as: increasing access to primary care; mitigating provider
shortages in underserved areas; delivering integrated primary, behavioral, and oral health
care; addressing health workforce diversity; and strengthening community/provider
partnerships.
Funding History
FY Amount
FY 2017 $4,652,000
FY 2018 $5,663,000
FY 2019 $5,635,000
FY 2020 $5,663,000
FY 2021 $4,663,000
40
In FY 2019, one Health Workforce Resource Center administered by NCHWA was funded from the Bureau of
Primary Health Care.
101
Budget Request
The FY 2021 Budget Request for NCHWA of $4.7 million is $1 million below the FY 2020
Enacted level.
In FY 2020, NCHWA continued 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 FY 2021, NCHWA will continue to deliver reports and evaluation that support the
Administration’s goal of improving access to behavioral health services, including substance use
treatment and prevention services. This includes collecting data and conducting studies on
models of behavioral health care delivery systems, the extent of their use, and the staffing ratios
required to implement those systems. This new information will soon be incorporated into
NCHWA’s projection model to enhance its capabilities with emerging models of care.
Grants Awards Table
FY 2019 FY 2020 FY 2021

Average Award $449,951 $449,951 $449,951
Range of Awards $449,795-$450,000 $449,795-$450,000 $449,795-$450,000
102
Primary Care Training and Enhancement Program
FY 2021 FY 2021
BA $48,680,000 $48,924,000 --- -$48,924,000
FTE 7 7 --- -7
Allocation Method. ....................................... Competitive Grant/Cooperative Agreement/Contract
The Primary Care Training and Enhancement 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 2019 FY 2020 FY 2021 President’s

Program Final Enacted Budget
Primary Care Training
and Enhancement41 $31,395,619 $21,201,184 ---
Training Primary Care

Champions $7,363,001 $7,513,767 ---
Academic Units for

Primary Care Training and $4,766,677 $4,467,071 ---
Enhancement
41
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 $4,063,148 million, $2,977,396
million from PCTE and $1,085,752 million from Oral Health Programs.
103
Program Final Enacted Budget
Enhancement: Integrating
Behavioral Health and $3,544,703 $3,598,770 ---
Primary Care (PCTE-
IBHPC) Program
Enhancement (PCTE) -
Physician Assistant (PA) $1,610,000 $3,081,542 ---
Program
Enhancement: Residency
Training in Primary Care --- $9,061,666 ---
(PCTE-RTPC)
The PCTE Program includes seven cohorts:
Primary Care Training and Enhancement (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.
Primary Care Medicine and Dentistry Clinician Educator Career Development Award:
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.
In Academic Year 2018-2019, the Primary Care Medicine and Dentistry Clinician Educator
Career Development Award program supported 22 faculty, including 15 individuals from the
field of medicine, 5 in dentistry, and 2 physician assistants. In addition, grantees developed or
enhanced 90 curricula activities offered to 6,153 individuals. Grantees also sponsored 2,432
faculty development activities to 824 faculty members, and grant-funded faculty taught 49
courses to 1,926 students and advanced trainees.
Primary Care Training and Enhancement (PCTE): Training Primary Care Champions
(TPCC): The PCTE-TPCC Program strengthens the primary care and the workforce by
establishing fellowship programs to train community-based practicing primary care physician
and/or physician assistant champions to lead health care transformation and enhance teaching in
community-based settings. Awardees are encouraged to partner with National Health Service
Corps-approved sites and to address the Administration’s clinical priorities of opioid abuse and
mental health through their training and fellows’ health care transformation projects.
104
In Academic Year 2018-2019, PCTE-TPCC provided fellowships to 81 physicians and 18
physician assistants, of which 26 were from an underrepresented minority background and 46
reported coming from a rural or disadvantaged background. Among the physicians, 46 were from
Family Medicine, 17 were from Internal Medicine, 15 were from Pediatrics, and the remainder
from Internal Medicine/Pediatrics. PCTE-TPCC fellows developed or enhanced and
implemented 194 different curricular activities, most of which were new academic courses,
continuing education courses, and workshops for students that reached 629 trainees. PCTE-
TPCC fellows also participated in 28 different faculty-focused training programs and activities
during the academic year. Approximately 41 percent of fellows received training in substance
use treatment, and 54 percent received specific training in medication-assisted treatment (MAT)
for opioid use leading to 14 percent receiving a DATA waiver to prescribe MAT.
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 FY
2019, HRSA provided $300,000 in supplemental funding to continue to support collaborative
activities that are intended to enable joint research, development of a common community of
practice that will assist with dissemination and application of the research into education and
practice, and develop plans for sustaining the scope of work after federal funding.
Primary Care Training and Enhancement (PCTE): Integrating Behavioral Health and
Primary Care (IBHPC) Program: In FY 2019, HRSA established the PCTE-IBHPC Program
to fund innovative training programs that integrate behavioral health care into primary care,
particularly in rural and underserved settings with a special emphasis on the treatment of opioid
use disorder.
Primary Care Training and Enhancement (PCTE) - Physician Assistant (PA) Program: In
FY 2019, HRSA established the PCTE-PA Program to increase the number of primary care
physician assistants, particularly in rural and underserved settings, and improve primary care
training in order to strengthen access to and delivery of primary care services nationally.
Primary Care Training and Enhancement (PCTE) – Residency Training in Primary Care: In
FY 2020, HRSA established the PCTE-Residency Training in Primary Care to enhance
accredited residency training programs in family medicine, general internal medicine, general
pediatrics or combined internal medicine and pediatrics (med-peds) in rural and/or underserved
areas, and encourage program graduates to choose primary care careers in these areas.
In Academic Year 2018-2019, PCTE grantees trained 2,566 primary care residents and fellows,
6,482 medical students, 1,922 students in physician assistant programs, 107 primary care
medicine faculty, and 2,017 students from collaborating interprofessional disciplines (including
pharmacy students, psychology students, dental and dental hygiene students, and nursing
students) for a total of 13,094 trainees, 3,593 of whom completed their programs at the end of the
105
academic year. PCTE grantees partnered with 997 health care delivery sites (e.g., physician’s
offices, hospitals, and ambulatory practice sites) to provide clinical training experiences to
trainees. Over a third of the sites offered substance use treatment services. Approximately 61
percent of these sites were located in medically underserved communities, 30 percent were
located in rural areas, and 63 percent were primary care settings.
With regard to the continuing education of the current workforce, PCTE grantees delivered 197
unique continuing education courses that focused on emerging issues in the field of primary care
to 7,177 faculty members and current practicing providers. In addition, PCTE grantees
developed or enhanced and implemented 1,220 different curricular activities, most of which were
new academic courses, clinical rotations, and workshops for health professions students,
residents and fellows that reached 35,086 trainees. PCTE grantees also supported 404 different
faculty-focused training programs and activities during the academic year, reaching 7,427
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.
Designated Health Targeted Educational

Grantee Activities
Professions Levels
 Physicians, including  Medical school  Support innovations in primary care
family medicine, general  Graduate physician curriculum development, education,
internal medicine, assistant education and practice for physicians and
general pediatrics, and  Physician residency physician assistants.
combinations of these training  Community-based training in medical
specialties  Academic and schools, physician assistant education,
 Physician assistants community faculty and residencies.
development  Primary care academic and
community faculty development.
 Improve clinical teaching and
research in primary care.
Funding History
FY Amount
FY 2017 $38,830,000
FY 2018 $48,802,000
FY 2019 $48,680,000
FY 2020 $48,924,000
FY 2021 ---
106
Budget Request
The FY 2021 Budget Request for the Primary Care Training and Enhancement program of $0 is
$48.9 million below the FY 2020 Enacted level. The request prioritizes funding for health
Outcomes and Outputs Table42
Year and Most

Recent Result
FY 2021
Measure +/-
FY 2020
(Summary of
Result)43
6.I.C.24: Number of physicians FY 2018: 825
completing a Bureau of Health Target: 480
700 N/A -700
Workforce-funded residency or (Target
fellowship Exceeded)
FY 2018: 1,622
6.I.C.25: Number of physicians
Target: 400
graduating from a Bureau of Health 1,000 N/A -1,000
(Target
Workforce-funded medical school
Exceeded)
FY 2018: 577
6.I.C.26: Number of physician
Target: 200
assistants graduating from a Bureau of 300 N/A -300
(Target
Health Workforce-funded program
Exceeded)
42
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.
43
107
Year and
Most FY 2019 FY 2020 FY 2021
PCTE Program Outputs
Recent Target Target Target
Result
Percent of physician and
physician assistant trainees
FY 2018:
receiving at least a portion of 50% 50% ---
37%
their clinical training in an
underserved area
Percent of physician and
physician assistant graduates and
FY 2018:
program completers who are 30% 30% ---
35%
minority and/or from
disadvantaged backgrounds
Number of physicians training in
FY 2018:
a Bureau of Health Workforce- 2,000 2,000 ---
2,566
funded residency or fellowship
Number of medical students
training in a Bureau of Health FY 2018:
4,000 4,000 ---
Workforce-funded medical 6,482
school
Number of physician assistant
students training in a Bureau of FY 2018:
1,000 1,000 ---
Health Workforce-funded 1,922
program
Grant Awards Table44
FY 2019 FY 2020 FY 2021

Average Award $389,331 $391,282 ---
Range of Awards $176,562-$799,802 $177,447-$803,811 ---
44
This table includes the PCTE portion of the 22 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 $4.4 million, $3.2 million from PCTE and $1.2 million from Oral Health Programs. This table
includes the $3.2 million in PCTE funds; the Oral Health Program funds are accounted for in the Grants Award
Table below.
108
Oral Health Training Programs
FY 2021 FY 2021
BA $40,471,000 $40,673,000 --- - $40,673,000
FTE 6 6 --- -6
Authorizing Legislation: Public Health Service Act, Sections 748 and 340G45
FY 2021 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 2021
FY 2019 FY 2020
Program President’s
Final Enacted
Budget
Training in General, Pediatric, and
Public Health Dentistry and Dental
$27,925,000 $26,675,000 ---
Hygiene46 and Dental Faculty Loan
Repayment
State Oral Health Workforce
$12,546,000 $13,998,000 ---
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.
45
Public Law No: 115-302 extended the authorization for Section 340G until FY 2023.
46
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 $4.0 million, $2.9 million from PCTE and
$1.1 million from Oral Health Programs.
109
Dentists, in particular, are in a position to meet the Administration’s goal of addressing the
opioid epidemic through better pain management, identifying substance abuse and referring
patients for treatment, and providing quality oral health care that meets the needs of this
vulnerable population.
In Academic Year 2018-2019, grantees of the Training in General, Pediatric, and Public Health
Dentistry and Dental Hygiene Program trained 10,356 dental and dental hygiene students in pre-
doctoral training degree programs; 494 dental residents and fellows in advanced primary care
dental residency and fellowship training programs; and 261 dental faculty members in faculty
development activities and programs.
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 faculty through loan repayment and help fund
development programs to provide continuing education opportunities.
In Academic Year 2018-2019, the Dental Faculty Development and Loan Repayment Program
provided financial support to 36 dental faculty and 1 dental resident with a median award of
110
$18,450 in direct financial support. Grantees developed or enhanced 77 curricula that were
offered to 2,743 individuals. In addition, grantees sponsored 38 faculty development programs to
261 dental faculty, just missing the FY 2018 target of 300 due to a programmatic change where
faculty development funding was capped, and the focus of the program was shifted to loan
repayment. Faculty funded through the Dental Faculty Development and Loan Repayment
Program offered 61 courses to 2,958 advanced trainees from general dentistry (85 percent) and
pediatric dentistry (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 students and
 Public health dentists  Graduate School residents at dental training institutions
 Dental hygienists (dental schools) providing clinical services in dental
 Other approved  Predoctoral Dental clinics located in dental schools,
primary care dental Programs hospitals, or community based
trainees  Dental Residency affiliated sites.
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 funded 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 2018-2019, the State Oral Health Workforce Improvement Grant Program
continued to carry out community-based prevention activities authorized under statute. Grantees
established 6 new oral health facilities for children with unmet needs in dental HPSAs, and
expanded 6 oral health facilities in dental HPSAs to provide education, prevention, and
restoration services to 13,834 patients.
Grantees also supported 45 tele-dentistry facilities; replaced 7 water fluoridation systems to

provide optimally fluoridated water to 1,358,663 individuals; provided dental sealants to 5,060
children; provided topical fluoride to 19,682 individuals; provided diagnostic or preventive
dental services to 7,866 persons; and oral health education to 39,674 persons. The program
provided direct financial support to 9 dental students and 1 dental resident. Of these 10 students
and resident, approximately 30 percent reported coming from a rural background, 20 percent
reported coming from a disadvantaged background, and 40 percent from an underrepresented
minority group.
Eligible Entities: Eligible applicants include Governor-appointed, state governmental entities.

A 40 percent match by the state is required for this program.
111
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.
 Placement of dental trainees.
 Partnerships with dental training
institutions.
 Expand a state dental office.
 Advancing pain management and
improving access to opioid treatment
services.
Funding History
FY Amount
FY 2016 $35,873,000
FY 2017 $36,587,000
FY 2018 $40,571,000
FY 2019 $40,471,000
FY 2020 $40,673,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Oral Health Training programs of $0 is $40.7 million
112
Year and Most

Recent Result
FY 2021
Measure +/-
FY 2020
(Summary of
Result)47
FY 2018: 10,356
6.I.C.27: Number of dental Target: 5,300
5,00048 N/A -5,000
students trained (Target
Exceeded)
FY 2018: 494
6.I.C.28: Number of dental Target: 350
65049 N/A -650
residents trained (Target
Exceeded)
FY 2018: 261
6.I.C.29: Number of faculty Target: 300
200 N/A -200
trained (Target Not
Met)
Oral Health Training and

Year and Most FY 2019 FY 2020 FY 2021
Workforce Program
Recent Result Target Target Target
Outputs
Percent of students and
residents trained who are FY 2018: 24% 20% 20% ---
URMs
Number of dentists
completing a Bureau of
FY 2018: 258 250 350 ---
Health Workforce-funded
dental residency or fellowship
Number of dentists
graduating from a Bureau of
FY 2018: 2,518 2,000 1,200 ---
Health Workforce-funded
dental school
47
48
One of two cohorts of grantees will not be funded beginning in FY 2020 resulting in a decline of dental students
trained. Instead, funding will be utilized to fund additional advanced dental residencies.
49
Additional funding for advanced dental residencies will be utilized beginning in FY 2020 resulting in an increase
in dental residents trained.
113
Grant Awards Table – Training in General, Pediatric, and Public Health Dentistry and
Dental Hygiene50
FY 2019 FY 2020 FY 2021

Average Award $414,250 $378,189 ---
Range of Awards $27,969-$812,803 $142,144-$650,000 ---
Grant Awards Table – Dental Faculty Loan Repayment Programs
FY 2019 FY 2020 FY 2021

Average Award $158,665 230,739 ---
Range of Awards $40,500-$300,000 $81,000-$350,000 ---
Grant Awards Table – State Oral Health Workforce Improvement Grant Program
FY 2019 FY 2020 FY 2021

Average Award $338,100 $375,719 ---
Range of Awards $181,698-$407,722 $209,904-$400,000 ---
50
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 $4.0 million, $2.9 million from PCTE and
$1.1 million from Oral Health Programs. This awards table accounts for the $1.1 million in Oral Health Program
funds only.
114
Medical Student Education Program
FY 2021 FY 2021
BA $25,000,000 $50,000,000 --- -$50,000,000
FTE --- --- --- ---
Authorizing Legislation: Department of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 2019 and Further Consolidated Appropriations Act,
2020(P.L. 116-69)
FY 2021 Authorization ............................................................................................. Not Specified51
Allocation Method .................................................................................................................. Grants
The purpose of the Medical Student Education (MSE) Program is to provide grants to public
institutions of higher education to expand or support graduate education for medical students
preparing to become physicians in the top quintile of states with a projected primary care
provider shortage in 202552. The program is designed to prepare and encourage medical students
who are training in the most underserved states to choose residencies and careers in primary care
that serve tribal communities, rural communities, and/or medically underserved communities
(MUCs) after they graduate. The MSE Program supports the development of medical school
curricula, clinical training site partnerships, and faculty training programs, with the goal of
educating medical students who are likely to choose career paths in primary care, especially for
tribal communities, rural communities, and/or MUCs.
In FY 2019, HRSA awarded five institutions to develop new and expand medical school
curricula and training focused on the primary care needs of rural and tribal communities. All
awardees expanded their community-based partnerships to incorporate experiential training
opportunities in rural communities. These grants were fully funded for the four-year project
period.
In FY 2020, HRSA will fund the unfunded applications from the FY 2019 MSE Notice of
Funding Opportunity. The remaining funds will be used to supplement the FY 2019 awardees.
These grants will be fully funded for the four-year project period.
51
The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and
Continuing Appropriations Act, 2019 (P.L. 115-245) authorized $25 million in appropriations, to remain available
until expended, funding for the Medical School Education Program.
52
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-state-
projections2013-2025.pdf.
115
Eligible Entities:
Eligible entities are limited to public institutions of higher education in states in the top quintile
of states with projected primary care provider shortages in 2025.
Funding History
FY Amount
FY 2017 ---
FY 2018 ---
FY 2019 $25,000,000
FY 2020 $50,000,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Medical Student Education program of $0 is $50 million
below the FY 2020 Enacted level. As FY 2019 and FY 2020 grantees are fully funded for the
four year project periods, these activities will still continue in 2021. 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
FY 2021
Measure +/-
FY 2020
(Summary of
Result)
6.I.C.59: Number of medical
students trained in ---53 TBD N/A TBD
underserved states
6.I.C.60: Number of medical
students matched to primary ---54 TBD N/A TBD
care residencies
53
Baseline for this measure will be set for the FY 2019 and reported in the FY 2022 Congressional Justification.
54
Baseline for this measure will be set for the FY 2019 and reported in the FY 2022 Congressional Justification.
116
Awards Table
FY 2019 FY 2020 FY 2021

Average Award $1,148,966 $1,695,048 ---
Range of Awards $1,101,010- $1,119,468- ---
$1,177,247 $2,257,088
117
Interdisciplinary, Community-Based Linkages
Area Health Education Centers Program
FY 2021 FY 2021
BA $39,055,000 $41,250,000 --- -$41,250,000
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. AHECs develop and maintain a diverse
health care workforce and broaden the distribution of the health workforce. The redesigned
AHEC Program invests in interprofessional networks that address social determinants of health
and incorporate field placement programs for rural and medically-underserved populations
In Academic Year 2018-2019, 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 2,238 unique continuing education courses that were delivered to
192,070 practicing professionals nationwide, 92,682 of whom (48 percent) were concurrently
employed in medically underserved communities.
AHEC grantees partnered with 5,513 training sites to provide 34,663 clinical training
experiences to student trainees (e.g., ambulatory practice sites, physician offices, and hospitals).
Approximately 60 percent of these training sites were primary care settings; 69 percent were
located in medically underserved communities; and 44 percent were in rural areas.
The new AHEC Scholars Program began in Academic Year 2018-2019 supporting 2,751 AHEC
Scholars. The AHEC Scholars Program is an interprofessional educational and training program
targeted towards health professions students and consists of a specialized curriculum focused on
six core topic areas and health care delivery within rural/underserved areas and populations. The
six core topic areas include: (a) interprofessional education, (b) social determinants of health, (c)
behavioral health integration, (d) cultural competency, (e) practice transformation, and (f) current
and emergent health issues. Approximately 36 percent of these AHEC Scholars came from a
118
rural background and nearly 45 percent came from a disadvantaged background. Over half of
AHEC scholars received training in a rural setting and 87 percent received training a medically
underserved community. Over a quarter of c Scholars received training on integrating behavioral
health in primary care and 12 percent received training in substance use treatment. Since the
AHEC Scholars program is a two-year commitment, there were no program completers during
the first year.
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.

Professions Levels
 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
 Physician assistants in underserved areas
 Psychologists
 Public health
 Other health professions
Funding History
FY Amount
FY 2016 $30,250,000
FY 2017 $30,177,000
FY 2018 $38,154,000
FY 2019 $39,055,000
FY 2020 $41,250,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Area Health Education Centers (AHEC) Program of $0 is
$41.3 million less than the FY 2020 Enacted level. The request prioritizes funding for health
119
Year and Most

Recent Result
FY 2021
/Target for Recent FY 2020 FY 2021
Measure +/-
Result Target Target
FY 2020
(Summary of
Result)55
6.I.C.30: Percent of CE trainees who FY 2018: 48%
report being currently employed in Target: 34% N/A56 N/A N/A
medically underserved areas (Target Exceeded)
6.I.C.31: Number of trainees
FY 2018: 282,408
receiving health career guidance and
Target: 275,000 N/A57 N/A N/A
information from the AHEC
(Target Exceeded)
Programs
6.I.C.49: Number of AHEC scholars
trained in medically underserved ---58 TBD N/A N/A
communities and/or rural areas.
6.I.C.50: Percent of AHEC program
completers practicing in medically
---59 TBD N/A N/A
underserved communities and/or
rural areas.
Year and
FY 2019 FY 2020
AHEC Program Outputs Most Recent FY 2021 Target
Target Target
Result
Number of medical students
FY 2018:
who participated in community- 13,000 11,500 N/A
11,739
based clinical training
Number of other health
professions trainees who FY 2018:
13,000 11,000 N/A
participated in community- 12,385
based clinical training
55
56
Measure discontinued in FY 2019 as new measures will account for programmatic changes.
57
Measure discontinued in FY 2019 as new measures will account for programmatic changes.
58
59
120
Year and
FY 2019 FY 2020
AHEC Program Outputs Most Recent FY 2021 Target
Target Target
Result
Number of trainees who
received CE on topics including
FY 2018:
cultural competence, women’s 130,000 140,000 N/A
192,070
health, diabetes, hypertension,
obesity, and health disparities
Grant Awards Table
FY 2019 FY 2020 FY 2021


Average Award $735,056 $773,009 ---
Range of Awards $255,600- $249,967- ---
$1,912,000 $1,813,760
121
Geriatrics Program
FY 2021 FY 2021
BA $40,534,000 $40,737,000 --- -$40,737,000
FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Sections 750, 753 and 865
FY 2021 Authorizations:................................................................... Expired at the end of FY 2014
Allocation Method ...................................................................................... Cooperative Agreement
The Geriatrics Workforce Enhancement Program (GWEP) improves health care for older adults
by developing a health care workforce to provide value-based care that improves health
outcomes for older adults by integrating geriatrics and primary care delivery sites/systems. .
The Program maximizes patient and family engagement in health care decisions and provides
training focusing on interprofessional and team-based care across the educational continuum
(students, faculty, providers, direct service workers, patients, families, and lay and family
caregivers).
An essential component of the program is developing academic-primary care-community-based

partnerships to address gaps in health care for older adults, and transforming clinical training
environments into integrated geriatrics and primary care sites/systems to become age-friendly
health systems and dementia-friendly communities.
FY 2019 FY 2020 FY 2021

Program Final Enacted President’s Budget
Geriatrics Workforce
Enhancement Program $38,534,000 $38,737,000 ---
Geriatrics Academic Career
Awards (GACA) Program $2,000,000 $2,000,000 ---
In Academic Year 2018-2019, GWEP grantees provided training for 39,585 students and fellows
participating in a variety of geriatrics-focused degree programs, field placements, and
fellowships. Of these trainees, 31,522 graduated or completed their training during the current
academic year. GWEP grantees partnered with 307 health care delivery sites (e.g., hospitals,
long-term care facilities, and academic institutions) to provide clinical training experiences to
122
trainees. Approximately 56 percent of these sites were located in medically underserved
communities, and 54 percent were primary care settings.
With regard to the continuing education of the current workforce, 187,955 faculty and practicing
professionals participated in 1,342 unique continuing education courses offered by GWEP
grantees, 445 of which were specifically focused on Alzheimer’s disease and related dementia,
just missing the target of 500.
The redesign of the GWEP program in FY 2019 shifts its focus to transforming clinical training
environments into integrated geriatrics and primary care systems to become age-friendly health
systems that incorporate the principles of value-based care and alternative-payment models (e.g.,
Advanced Alternative Payment Models [AAPMs], bundled payment, Comprehensive Primary
Care Plus [CPC+], etc.). The number of continuing education trainings decreased slightly (a 14
percent reduction in the number of courses offered in FY 2018), which explains the small
decrease in professionals participating in these trainings (12 percent reduction those participating
in continuing education trainings from the prior year). These targets were still exceeded,
however.
In addition, GWEP grantees developed or enhanced and implemented 4,313 different curricular
activities. Most of these were new continuing education courses, academic courses, and
workshops, which together reached 142,022 people. Finally, with regard to faculty development,
results showed that GWEP grantees supported 372 different faculty-focused training programs
and activities during the academic year, reaching 11,406 faculty-level trainees.
The National and Regional Projections of Supply and Demand for Geriatricians: 2013-2025
report by HRSA’s National Center for Health Workforce Analysis projected demand for
geriatricians will exceed supply, resulting in a national shortage of 26,980 full time equivalent
positions in 2025.60 The report states all regions of the U.S. are projected to have a 2025 shortage
of geriatricians, although the degree of shortage in each region is variable.61 The education and
training of health professionals in the area of geriatrics are hindered by a shortage of faculty,
inadequate and variable academic curricula and clinical experiences, and a lack of opportunities
for advanced training. In order to address these issues, faculty with expertise in geriatrics are
needed to train the workforce to provide specialized care to improve health outcomes for older
adults.
Consequently, in FY 2019, HRSA funded the Geriatrics Academic Career Awards (GACA)
Program to support the career development of junior faculty in geriatrics at accredited schools of
allopathic medicine, osteopathic medicine, nursing, social work, psychology, dentistry,
pharmacy, or allied health. Faculty with expertise in geriatrics are needed to train the workforce
and provide specialized care to improve health outcomes for older adults. Under the GACA
program, career development awards were made to support individual junior faculty who will
provide interprofessional clinical training and become leaders in academic geriatrics. The goals
of the program are for the GACA candidate to develop the necessary skills to lead health care
60
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center
for Health Workforce Analysis. 2017. National and Regional Projections of Supply and Demand for Geriatricians:
2013-2025. Rockville, Maryland.
61
Id.
123
transformation in a variety of settings. These settings include rural and/or medically underserved
settings, as well as age-friendly settings that provide interprofessional training in clinical
geriatrics.
GWEP Eligible Entities: Accredited schools representing various health disciplines, healthcare
facilities, and programs leading to certification as a certified nursing assistant.
Targeted Educational
Designated Health Professions Levels Program Activities
 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
GACA Eligible Entities: Accredited health professions schools of allopathic medicine,

osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy, or allied health
who apply on behalf of individuals to HRSA for a Geriatrics Academic Career Award where the
individuals have a full-time junior faculty appointment.
124
Designated Health Professions Levels Program Activities
 Allied health  Practicing health care  Develop and implement a
 Allopathic medicine providers faculty career development
 Dentistry plan to develop the necessary
 Nursing knowledge and skills as a
 Osteopathic medicine clinician educator in geriatrics
 Pharmacy to transform and lead age-
 Psychology friendly health systems
 Social Work  Meet the statutory service
requirement that 75% of time
will be devoted to provide
training in clinical geriatrics,
including the training of
interprofessional teams of
health care professionals
 Disseminate reports,
products, and/or project
outputs so project
information is provided to
key target audiences
Funding History
FY Amount
FY 2016 $38,737,000
FY 2017 $38,737,000
FY 2018 $40,635,000
FY 2019 $40,534,000
FY 2020 $40,737,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Geriatrics programs of $0 is $40.7 million less than the
FY 2020 Enacted 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.
125
Outcomes and Outputs Measures
Year and Most

Recent Result
FY 2021
Measure +/-
Result Target63 Target
FY 2020
(Summary of
Result)62
6.I.C.12: Number of Bureau of
Health Workforce-sponsored FY 2018: 445
interprofessional Target: 500 150 N/A -150
continuing education sessions (Target Not Met)
provided on Alzheimer’s disease
FY 2018: 73,115
participating in interprofessional
Target: 51,000 10,000 N/A -10,000
continuing education on
(Target Exceeded)
Alzheimer's disease
6.I.C.32: Number of continuing FY 2018: 187,955
education trainees in geriatrics Target: 125,000 50,000 N/A -50,000
programs (Target Exceeded)
6.I.C.33: Number of students who
received geriatric-focused training
FY 2018: 38,916
in geriatric nursing homes, chronic
Target: 23,000 10,000 N/A -10,000
and acute disease hospitals,
(Target Exceeded)
ambulatory care centers, and senior
centers
Year and
Most FY 2019 FY 2020 FY 2021
Geriatrics Program Outputs
Recent Target Target64 Target
Result
Number of continuing education FY 2018:
1,500 1,000 ---
offerings delivered by grantees 1,342
Number of faculty members
FY 2018:
participating in geriatrics trainings 8,000 8,000 ---
11,406
offered by grantees
62
63
Reduction in targets reflect programmatic changes and shift to new priorities. New measures will be established in
FY 2021.
64
Reduction in targets reflect programmatic changes and shift to new priorities. New measures will be established in
FY 2021.
126
Year and
Most FY 2019 FY 2020 FY 2021
Geriatrics Program Outputs
Recent Target Target64 Target
Result
Number of individuals trained in new
or enhanced curricula relating to the FY 2018:
140,000 140,000 ---
treatment of health problems of elderly 142,022
individuals
Number of individuals enrolled in FY 2018:
560 560 ---
geriatrics fellowships 669
Number of advanced education nursing
FY 2018:
students enrolled in advanced practice 80 80 ---
97
adult-gerontology nursing programs
GWEP Grant Awards Table

Average Award $740,384 $742,780 ---
Range of Awards $537,408-750,000 $537,408-750,000 ---
GACA Grant Awards Table

Average Award $75,000 $75,000 ---
Range of Awards $75,000 $75,000 ---
127
Behavioral Health Workforce Development Programs
FY 2021 FY 2021
BA1 $111,916,000 $138,916,000 $138,916,000 ---
FTE 13 13 13 ---
1/ Funding combines appropriations for Mental and Behavioral Health Workforce ($36.916 million) and Training
and Behavioral Health Workforce Education and Training ($102 million). Both appropriations support funding for
the same authorizations and have been merged to streamline and eliminate confusion.
Authorizing Legislation: Public Health Service Act, Sections 755, 756 and 760
FY 2021 Authorization ............................................................................................... $50,000,00065
Allocation Method ........................................ Competitive Grant/Cooperative Agreement/Contract
The purpose of the Behavioral Health Workforce Development Programs is to develop and
expand the behavioral health workforce serving populations across the lifespan, including in
rural and medically underserved areas. Opioid use and its resulting deaths have impacted the
lives of individuals and families, crippled communities, and depleted limited resources. The rate
of opioid-related Emergency Department visits continues to increase. Analysis of data from 52
jurisdictions in 45 states, which covers over 60 percent of ED visits in the U.S., found that from
July 2016 through September 2017:
 All five U.S. regions experienced rate increases; the largest was in the Midwest (70
percent), followed by the West (40 percent), Northeast (21 percent), Southwest (20
percent), and Southeast (14 percent).
 Every demographic group experienced substantial rate increases, including men (30
percent) and women (24 percent) and people ages 25-34 (31 percent), 35-54 (36 percent),
and 55 or older (32 percent)66.
65
The 21st Century Cures Act (P.L. 114-255) authorized $50 million through FY 2022.
66
Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital Signs: Trends in Emergency Department Visits for
Suspected Opioid Overdoses — United States, July 2016–September 2017. MMWR Morb Mortal Wkly Rep
2018;67:279–285. DOI: http://dx.doi.org/10.15585/mmwr.mm6709e1
128
From 2013 to 2017, synthetic opioid-involved overdose death rates increased 45.2% in the U.S.67
This effect is especially evident in geographical areas of the U.S. with large rural concentrations,
where nonmedical prescription opioid misuse remains a growing public problem.68
HRSA uses projections data and other information about the behavioral health workforce to
develop and adjust programs to ensure that they are responsive to the Nation’s emerging needs.
For example, HRSA’s 2018 Behavioral Health Workforce Projections Report estimated national-
level health workforce needs for several behavioral health occupations between 2016 and 2030.
The report estimated the demand for addiction counselors is expected to increase 21 percent by
2030, with demand exceeding supply and leading to a deficit of addiction counselors of
approximately 13,600 FTE.
Also, the report estimated that by 2030, the supply of psychiatrists is expected to decrease by
approximately 27 percent. The report also highlighted that under certain scenarios, there could
be an estimated shortage of 14,300 FTE psychologists by 2030.69 However, by 2025, HRSA’s
BHWET program is projected to eliminate over 40% of the projected shortfall of behavioral
health providers, and provide thousands of new paraprofessionals to enhance the nation’s health
workforce capacity in critical areas of need. Since the program began, 3,293 new
paraprofessionals have begun work as community health workers, peer paraprofessionals, and
substance use/addictions workers.
Since HRSA’s workforce projection models are based on observed trends in production of new
entrants to the workforce, HRSA’s 2018 Behavioral Health Workforce Projections assume
continued, stable discretionary appropriations levels and programmatic outputs for the BHWET
program. As a result, HRSA’s new behavioral health projections for the year 2030 demonstrate
significant reductions in (or abatement of) 2016 (baseline) health workforce shortages projected
across four BHWET-supported behavioral health professions: psychologists, social workers,
school counselors, and marriage and family therapists.70
The Behavioral Health Workforce Development budget line supports the Behavioral Health
Workforce Education and Training (BHWET) Program, the Graduate Psychology Education
(GPE) Program, the Opioid Workforce Expansion Programs (OWEP), Addiction Medicine
Fellowship (AMF) Program, a new loan repayment program for the Substance Use Disorder
67
Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States,
2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427. DOI:
http://dx.doi.org/10.15585/mmwr.mm675152e1
68Mack KA, Jones CM, Ballesteros MF. Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan
and Nonmetropolitan Areas — United States. MMWR Surveillance Summaries 2017;66(No. SS-19):1–12. DOI:
http://dx.doi.org/10.15585/mmwr.ss6619a1
69
Health Resources and Services Administration/National Center for Health Workforce Analysis; Substance Abuse
and Mental Health Services Administration/Office of Policy, Planning, and Innovation.2019.Behavioral Health
Workforce Projections, 2016-2030. Rockville, Maryland. DOI: https://bhw.hrsa.gov/health-workforce-
analysis/research/projections/behavioral-health-workforce-projections
70
Health Resources and Services Administration/National Center for Health Workforce Analysis. Behavioral Health
Workforce Education and Training Program, Academic Years 2014-2018. Rockville, Maryland. DOI:
https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/program-highlights/2018/behavioral-health-
workforce-education-training-program-2018.pdf
129
Treatment Workforce, the Opioid-Impacted Family Support Program (OIFSP) and Peer Support
Specialists program providing new training opportunities for paraprofessionals.
FY 2021
FY 2019 Final FY 2020 Enacted President’s
Budget
(Dollars in Millions) (Dollars in Millions) (Dollars in Millions)
Behavioral Health
Workforce
$93.9 $120.9 $120.9
Development
Graduate
Psychology $18.0 $18.0 $18.0
Education
Total Behavioral
Health Workforce
$111.9 $138.9 $138.9
Development
Programs1
1/ Includes appropriations from both MBHET and BWHET lines.
Behavioral Health Workforce Development: The Behavioral Health Workforce Development

programs support a number of activities to increase the behavioral workforce. In Fiscal Year
2020, Behavioral Health Workforce Development (BHWD) will support a number of activities
which are described below.
 BHWET Program: In 2020 HRSA anticipates making $51 million in continuation

awards for BHWET. This program increases the number of behavioral health providers
entering and continuing practice, with special emphasis on prevention and clinical
intervention and treatment for those at risk of developing mental and substance use
disorders, and the involvement of families in the prevention and treatment of behavioral
health conditions. In FY 2018, HRSA made an additional $8 million in awards to current
BHWET grantees for a two-year project to increase training in behavioral health and
primary care services for Opioid Use Disorder (OUD) in HRSA-supported health centers.
In Academic Year 2018-2019, the BHWET Program supported training for 6,209
individuals. Of the total students supported, 3,213 graduate-level social workers,
psychologists, school and clinical counselors, psychiatric nurse practitioners, and
marriage and family therapists were trained as well as 2,996 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).
Over fifty percent of the BHWET trainees received training in substance use treatment.
By the end of the Academic Year, 3,940 students graduated from these degree and
certificate-bearing programs and entered the behavioral health workforce. Upon program
130
completion, 28 percent of students intended to pursue training and/or employment to
serve at-risk children, adolescents, and transitional-aged youth. Further, 63 percent of
students intended to pursue training and/or employment in a medically underserved area
and/or primary care setting.
BHWET grantees partnered with 2,355 training sites (e.g., hospitals, ambulatory practice
sites, and academic institutions) to provide 7,985 clinical training experiences for
BHWET student trainees. Approximately 70 percent of these training sites were located
in medically underserved communities where trainees provided over 1.3 million hours of
behavioral health services to patients and clients. Over 20 percent of the sites offered
opioid use treatment services and 49 percent of the sites offered substance use treatment
services. Training at partnered sites incorporated interdisciplinary team-based
approaches, where 17,345 students, residents and/or fellows from a variety of professions
and disciplines were trained on teams with BHWET students. BHWET grantees used
grant funds to develop, enhance, and implement nearly 1,500 behavioral health-related
courses and training activities, reaching over 43,000 students and advanced trainees (i.e.,
psychology interns and fellows and psychiatry residents).
 Addiction Medicine Fellowship (AMF) Program: In FY 2020, HRSA anticipates

making $26.7 million in awards for the AMF program. The AMF program seeks to
increase the number of board certified addiction medicine and addiction psychiatry
specialists trained in providing interprofessional behavioral health services, including
OUD and SUD prevention, treatment, and recovery services, in underserved, community-
based settings. HRSA anticipates making $3 million in additional awards above those
made in FY 2020 to support Mental Health and Substance Use Disorder (SUD)
Workforce Training Demonstration to expand the number of fellows trained as addiction
medicine specialists and to increase the number of providers that serve in underserved,
community-based settings.
 Opioid-Impacted Family Support Program (OIFSP): In FY 2020, HRSA anticipates

making $11.5 million in awards for OIFSP. OIFSP seeks to train paraprofessionals to
support children and families impacted by OUD and other SUD in underserved areas.
The program will also provide professional development opportunities and educational
support to increase the number of paraprofessional trainees receiving a certificate upon
completion of the program. In FY 2021, HRSA anticipates supporting the FY 2020
awardees.
 Loan Repayment Program for Substance Use Disorder Treatment Workforce: In FY

2020, HRSA anticipates developing Application and Program Guidance that would make
available roughly $12 million to address shortages in the substance use disorder
workforce by providing for the repayment of education loans for individuals working in a
full-time SUD treatment job that involves direct patient care in either a Mental Health
Professional Shortage Area or a county where the overdose death rate exceeds the
national average. HRSA anticipates making awards in FY 2021.
131
The GPE Program: This program supports innovative doctoral-level health psychology
programs that foster an interprofessional approach to providing behavioral health and substance
use prevention and treatment services in high need and high demand areas through academic and
community partnerships. Through these efforts, the GPE Program transforms clinical training
environments and aligns with HRSA’s mission to improve health outcomes and address health
disparities through access to quality services, a skilled health workforce, and innovative, high-
value programs.
 In Academic Year 2018-2019, the GPE Program provided stipend support to 267 students
participating in practica, internships, or post-doctoral residency programs in psychology.
The majority of students who received a stipend were trained in medically underserved
communities (97 percent) and/or a primary care setting (87 percent). Of the 150 students
who completed GPE-supported programs, 76 percent intended to become employed or
pursue further training in medically underserved communities and 57 percent intended to
become employed or pursue further training in primary care settings.
 GPE grantees partnered with 184 sites (e.g., hospitals, ambulatory practice sites, and
academic institutions) to provide 1,003 clinical training experiences for psychology
graduate students as well as 2,631 interprofessional team-based care trainees who
participated in clinical training along with the psychology graduate students.
communities and 85 percent were primary care and/or rural settings. Approximately 48
percent of the sites offered substance use treatment services and 38 percent offered
telehealth services.
 The future targets for the GPE program take into account the timing of the psychology
internship match and GPE funding. Because the annual psychology match for the next
academic year occurs in early spring and grant funds are allocated in September, GPE
grantees would have already had interns match prior to funding; therefore, almost a one-
year delay occurs between the start of the next academic year and this program’s funding
cycle.
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: State-licensed mental health non-profit and for-profit organizations, including
but not limited to Federally Qualified Health Centers, universities, community colleges and
technical schools.
132
Designated
Health Grantee Activities
Levels
Professions
Professionals  Graduate (doctoral and  Develop and support training programs
Paraprofessionals post-doctoral)  Support internships and field placement
 Graduate (masters)  Faculty Development
 Certificate
Funding History
FY Amount
FY 2017 $ 69,784,000
FY 2018 $111,766,000
FY 2019 $111,916,000
FY 2020 $138,916,000
FY 2021 $138,916,000
Budget Request
The FY 2021 Budget Request for the Behavioral Health Workforce Development Programs
(BHWD) of $138.9 million is the same as the FY 2020 Enacted level. The request continues to
fund priorities authorized under section 760 of the PHSA including $29.5 million for the
Addiction Medicine Fellowship (AMF) program. HRSA anticipates making new awards in the
BHWET program and providing additional support to the AMF program to help ensure the
behavioral health workforce has the skills and training necessary to address our nation’s evolving
behavioral health needs. HRSA anticipates making awards for the Loan Repayment for
Substance Use Disorder Treatment Workforce program as well as continuing to support Opioid-
Impacted Family Support Program grantees. HRSA will continue to fund the Graduate
Psychology Education Program at the current levels with a slight decrease to the Behavioral
Health Workforce programs due to an increase in the Addiction Medicine Fellowship program
within BHWET.
133
Year and FY 2021

Most Recent Target
FY 2020 FY 2021
Measure Result /Target +/-
Target Target
for Recent FY 2020
Result71 Target
6.I.C.34: Number of students FY 2018: 6,209
currently receiving training in Target: 4,500
4,500 4,500 Maintain
behavioral health degree and (Target
certificate programs Exceeded)
6.I.C.35: Number of graduates FY 2018: 3,940
completing behavioral health Target: 3,000
3,000 3,000 Maintain
programs and entering the (Target
behavioral health workforce Exceeded)
6.I.C.53: Number of OWEP
trainees currently receiving
training in opioid-related ---72 TBD TBD Maintain
behavioral health degree and
certificate programs
6.I.C.54: Number of OWEP
graduates completing opioid-
related behavioral health ---73 TBD TBD Maintain
programs and entering the
behavioral health workforce
FY 2018: 267
6.I.C.36: Number of graduate-
Target: 170
level psychology students 200 200 Maintain
(Target
supported in GPE program
Exceeded)
FY 2018: 2,631
6.I.C.37: Number of
Target: 1,900
interprofessional students trained 1,900 1,900 Maintain
(Target
in GPE program
Exceeded)
6.I.C.61: Number of new
addiction medicine and addiction
---74 TBD TBD TBD
psychiatry fellowship graduates
entering workforce
6.I.C.62: Number of substance
use disorder treatment providers ---75 TBD TBD TBD
receiving loan repayment
71
72
Baseline for this measure will be set for FY 2019 and will be reported in the FY 2022 Congressional Justification.
73
Baseline for this measure will be set for FY 2019 and will be reported in the FY 2022 Congressional Justification.
74
Baseline for this measure will be set for FY 2020 and reported in the FY 2023 Congressional Justification.
75
134
Year and
Most FY 2019 FY 2020 FY 2021
Program Outputs
Result
Number of GPE clinical training
experiences that incorporated FY 2018:
500 400 400
interprofessional team-based care 1,003
training
Behavioral Health Workforce Development Programs Grant Award Table
FY 2019 FY 2020 FY 2021

Final76 Enacted President’s Budget
Average Award $606,942 $498,330 $498,330
Range of Awards $83,324- $1,350,000 $83,320- $800,000 $83,320-$800,000
Loan Repayment Program for Substance Use Disorder Treatment Workforce
FY 2019 FY 2020 FY 2021

Number of Awards --- 42 42
Average Award --- $250,000 $250,000
Range of Awards --- $75,000 – 250,000 $75,000 – 250,000
GPE Grant Award Table
FY 2019 FY 2020 FY 2021

Average Award $355,353 $355,353 $355,353
Range of Awards $112,104-$450,000 $112,104-$450,000 $112,104-$450,000
76
FY 2019 funding includes funds appropriated in FY 2018.
135
Public Health Workforce Development
Public Health and Preventive Medicine Training Grant Programs
FY 2021 FY 2021
BA $16,915,000 $17,000,000 --- -$17,000,000
FTE 5 5 --- -5
Authorizing Legislation: Public Health Service Act, Sections 765-768 and 770
FY 2021 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 2021
Program FY 2019 FY 2020 President’s
Public Health Training Centers
Program $9,651,757 $9,700,258 ---
Preventive Medicine Residency

$7,263,243 $7,299,742 ---
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
136
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.
The NCC’s purpose was to provide national coordination and technical assistance to the 10
Regional PHTCs. Instead of developing a new iteration of the NCC, HRSA redesigned the
Regional PHTC program. HRSA has funded 10 PHTCs, one for each HHS region, to ensure that
the United States and its territories and jurisdictions have access to quality public health
workforce education and training. Each Regional PHTC encompasses a designated geographic
area or medically underserved population that provides specialized technical assistance reflective
of that Region’s unique needs.
In Academic Year 2018-2019, Regional PHTCs partnered with 241 sites to provide more than
304 clinical training experiences to student trainees (e.g., local health departments, academic
institutions, and community-based organizations). Approximately 75 percent of these training
sites were located in medically underserved communities and 25 percent were located in rural
areas. With regard to the continuing education (CE) of the current workforce, PHTC grantees
delivered 2,360 unique CE courses to 169,935 trainees during the academic year, approximately
22 percent of whom were practicing professionals concurrently employed in medically
underserved communities. Nearly 6,000 instructional hours for continuing education were
offered in the current academic year, slightly missing the target.
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. The program aims to increase the
137
number and quality of preventive medicine residents and physicians to support access to preventive
medicine to improve the health of communities.
In Academic Year 2018-2019, the PMR Program financially supported 128 residents, the
majority of whom received clinical or experiential training in a primary care setting (82 percent)
and/or a medically underserved community (61 percent). Approximately 30 percent of residents
received training in substance use treatment. Of the 76 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 293 sites to provide 839 clinical
training experiences for PMR residents (e.g., academic institutions, ambulatory care sites, State
and local health departments, and hospitals).

communities and 32 percent were primary care settings. Nearly 27 percent of these training sites
offered substance use treatment services. The intent of the Preventive Medicine Residency
Program is to prepare physicians for positions in public health. Physicians completing the
residency program are prepared to work in a variety of settings including state and local health
departments, health systems, companies, and government.
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 2017 $16,949,000
FY 2018 $17,000,000
FY 2019 $16,915,000
FY 2020 $17,000,000
FY 2021 ---
138
Budget Request
The FY 2021 Budget Request for the Preventive Medicine and Public Health Training Grant
Programs of $0 is $17.0 million below the FY 2020 Enacted 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

FY 2021
Result /Target for FY 2020 FY 2021
Measure +/-
FY 2020
(Summary of Result)77
FY 2018: 169,935
participating in continuing
Target: 150,000 160,000 N/A -160,000
education sessions delivered by
(Target Exceeded)
PHTCs
6.I.C.18: Number of FY 2018: 5,972
instructional hours offered by Target: 6,000 6,000 N/A -6,000
PHTCs (Target Not Met)
6.I.C.19: Number of PHTC-
sponsored public health
FY 2018: 189
students that completed field
Target: 140 180 N/A -180
placement practicums in State,
(Target Exceeded)
Local, and Tribal Health
Departments
Year and
FY 2019 FY 2020 FY 2021
PMR Program Outputs Most Recent
Target78 Target Target
Result
Number of preventive medicine
FY 2018: 128 75 75 N/A
residents participating in residencies
Number of preventive medicine
residents completing training FY 2018: 76 40 40 N/A
Percent of program completers who FY 2018:

20% 20% N/A
are URMs 32%
77
78
Reduced targets for PMR program reflects a $4 million decrease in funding for Preventive Medicine residencies
and the completion of one program cohort that will not be re-competed.
139
Year and
FY 2019 FY 2020 FY 2021
PMR Program Outputs Most Recent
Target78 Target Target
Result
Percent of preventive medicine
resident program completers who FY 2018:
40% 30% N/A
intend to practice in primary care 32%
settings
Grant Awards Table – Public Health Training Centers Program
FY 2019 FY 2020 FY 2021

Operating Level Enacted President’s Budget
Average Award $895,381 $899,880 ---
Range of Awards $771,326- ---
$767,470-$1,087,248
$1,092,711
Grant Awards Table – Preventive Medicine Residency Program
FY 2019 FY 2020 FY 2021

Operating Level Enacted President’s Budget
Average Award $386,194 $388,135 ---
Range of Awards $347,399-$400,000 $349,145-$402,010 ---
140
Advanced Nursing Education Programs79
FY 2021 FY 2021
BA $74,210,000 $80,581,000 --- -$80,581,000
FTE 9 9 --- -9
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.
FY 2021
Program FY 2019 FY 2020 President’s
Advanced Nursing Education
Program $74,210,000 $75,581,000 ---
Nurse Optional Fellowship

-- $5,000,000 ---
Program
Advanced Nursing Education Workforce (ANEW) Program: In FY 2019, HRSA established a

new funding opportunity for the ANEW Program to continue to support 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.
79
Includes funding for Advanced Nursing Education and Nurse Practitioner Optional Fellowship Programs
141
In Academic Year 2018-2019, grantees of the ANEW Program trained 3,658 nursing students of
which more than thirty percent were underrepresented minorities and/or from disadvantaged
backgrounds. The ANEW program produced 1,256 graduates who were ready to enter the health
care workforce. Of the 1,857 students who were directly funded by ANEW, the majority trained
in rural and/or medically underserved settings and received training in substance use treatment
(51 percent) and/or opioid use treatment (49 percent).
In addition, ANEW grantees supported 65 faculty and 32 preceptors. To provide clinical training
experiences to nursing students, grantees partnered with 2,642 clinical training sites in primary
care settings (73 percent), medically underserved communities (62 percent), and/or rural areas
(32 percent). ANEW grantees offered 474 curricula, provided 168 continuing education courses
to practicing professionals, and offered 156 faculty and preceptor development programs. HRSA
anticipates $39 million in continuation awards in FY 2020.
Advanced Nursing Education Nurse Practitioner Residency (ANE-NPR) Program: In FY

2019, HRSA established the ANE-NPR program to prepare new nurse practitioners (NPs) in
primary care for transition to practice in community-based settings through clinical and academic
focused 12-month Nurse Practitioner Residency (NPR) programs with a preference for those
projects that benefit rural or underserved populations. The program seeks to increase primary
care providers in community-based settings and the program encourages eligible entities to
develop training programs supporting the placement and retention of NPs in rural and
underserved settings. HRSA anticipates $25 million in continuation awards in FY 2020.
Advanced Nursing Education-Sexual Assault Nurse Examiners (ANE-SANE) Program: In FY

2019, HRSA provided continuation funding for the ANE-SANE Program which supports
partnerships that recruit, train and retain nurses to conduct sexual assault forensic examinations
which provide better physical and mental health care for survivors, better evidence collection,
and leads to higher prosecution rates. The partnerships have an infrastructure to provide didactic
and clinical training, monitor and track experiential learning hours and SANE certificate
completion. They also provide support and resources to help improve the practice and retention
of sexual assault nurse examiners.
In Academic Year 2018-2019, Grantees from the ANE-SANE program trained 563 students and
produced 59 graduates. The majority of trainees were from a rural and/or disadvantaged
background (51 percent). The ANE-SANE grantees partnered with 95 clinical training sites in
primary care settings (18 percent), medically underserved communities (64 percent), and/or rural
areas (21 percent). HRSA anticipates $9 million in continuation awards in FY 2020.
Advanced Nursing Education (ANE): In Academic Year 2018-2019, grantees of the ANE
Program trained 2,324 nursing students and produced 642 graduates. Further analysis showed
that ANE grantees partnered with 1,193 health care delivery sites to provide clinical and
experiential training to students. Approximately 46 percent of these sites were located in
medically underserved communities, and 62 percent were in primary care settings. This is the
final year of reporting for the ANE program grants as this program was recompeted as the
ANEW program.
142
Nurse Anesthetist Traineeships (NAT) Program: In Academic Year 2018-2019, grantees of the
NAT Program provided direct financial support to 2,647 nurse anesthetist students and 1,168
students graduated. Students received clinical training in medically underserved communities
(78 percent) and/or primary care settings (39 percent) during the academic year. More than
1,100 students graduated from their degree programs and entered the workforce. At the time of
graduation, 58 percent of graduates intended to pursue employment or further training in
medically underserved communities, and 19 percent planned to pursue employment or further
training in a primary care setting. HRSA anticipates $2.3 million in new awards in FY 2020.
Advanced Nursing Education- Primary Care/ Behavioral Health Nurse Practitioner Residency
Program: In FY 2020, HRSA established the Advanced Nursing Education- Primary Care/
Behavioral Health Nurse Practitioner Residency Program with Nurse Practitioner Optional
Fellowship, (NPOF) funds to establish or expand optional community-based nurse practitioner
and nurse midwife fellowship programs that are accredited or in the accreditation process for
practicing postgraduate nurse practitioners in primary care or behavioral health. This program
gives preference to Federally Qualified Health Centers (FQHCs). HRSA anticipates $5 million in
new awards in FY 2020.
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  Advanced education  Provide traineeships to
 Nurse Educators students in advanced nursing
 Sexual Assault Nurse education programs
Examiners  Provide post graduate Nurse
 Registered Nurses Practitioner and Nurse
 Forensic Nurses Midwife transition-to-practice
 Clinical Nurse Specialists periods through residency
programs
Funding History
FY Amount
FY 2017 $64,425,000
FY 2018 $74,311,000
FY 2019 $74,210,000
FY 2020 $80,581,000
FY 2021 ---
143
Budget Request
The FY 2021 Budget Request for the Advanced Nursing Education and Nurse Optional
Fellowship programs of $0 is $80.6 million less than the FY 2020 Enacted 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
FY 2021
Measure +/-
FY 2020
(Summary of
Result)80
FY 2018: 3,658
6.I.C.38: Number of students
Target: 350
trained in advanced nursing 3,700 N/A -3,700
(Target
degree programs
Exceeded)
6.I.C.39: Percent of students FY 2018: 36%
trained who are URMs and/or Target: 24%
36% N/A -36%
from disadvantaged (Target
backgrounds Exceeded)
FY 2018: 1,256
6.I.C.40: Number of
Target: 75
graduates from advanced 1,000 N/A -1,000
(Target
nursing degree programs
Exceeded)
Year and
ANE Program Outputs Most FY 2019 FY 2020 FY 2021
Result
Number of students supported in NAT FY 2018:
2,200 2,400 ---
program 2,647
Number of graduates from NAT FY 2018:
1,000 1,050 ---
program 1,168
Percent of NAT graduates who are
FY 2018:
minority and/or from disadvantaged 30% 30% ---
29%
backgrounds
80
144
Year and
ANE Program Outputs Most FY 2019 FY 2020 FY 2021
Result
Percent of graduates from NAT
FY 2018:
programs employed in underserved 45% 45% ---
48%
areas
Grant Awards Table

Average Award $400,000 $388,510 ---
Range of Awards $10,000-$1,000,000 $4,229-$992,690 ---
ANE- Primary Care/ Behavioral Health Nurse Practitioner Residency Program
FY 2019 FY 2020 FY 2021

Number of Awards --- Up to 10 ---
Average Award --- $450,000 ---
Range of Awards --- $250,000-$500,000 ---
145
Nursing Workforce Diversity
FY 2021 FY 2021
BA $17,257,000 $18,343,000 --- -$18,343,000
FTE 3 3 --- -3
Authorizing Legislation: Public Health Service Act, Sections 821
FY 2021 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 2018-2019, the NWD Program supported 67 college-level degree programs as
well as 174 training programs and activities designed to recruit and retain health professions
students. These programs trained 11,067 students, including 5,405 students who graduated or
completed their programs. Degree programs had 5,508 enrolled students and academic support
programs had 5,559 participants this academic year.
In addition to providing support to students, NWD grantees partnered with 789 training sites
during the academic year to provide 7,371 clinical training experiences to trainees across all
programs. Approximately 46 percent of training sites were located in medically underserved
communities and 37 percent were in primary care settings.
In FY 2020, HRSA will support a new Nursing Workforce Diversity program with an emphasis
of increasing on increasing the eldercare workforce and increasing access to care in rural and
underserved areas.
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.
146
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 and Master’s degree RNs stipends.
 Prepare diploma or associate degree
RNs to become baccalaureate-
prepared RNs.
Funding History
FY Amount
FY 2016 $15,343,000
FY 2017 $15,306,000
FY 2018 $17,300,000
FY 2019 $17,257,000
FY 2020 $18,343,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Nursing Workforce Diversity program of $0 is $18.3
million below the FY 2020 Enacted 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 in areas of the United
States where there is a shortage of health professionals.
147
Year and Most

Recent Result
FY FY 2021
/Target for FY
Measure 2020 +/-
Recent Result 2021
Target FY 2020
(Summary of Target
Result)81
6.I.C.41: Percent of program
FY 2018: 100% -98
participants who are URMs and/or
Target: 95% 98% N/A percentage
from disadvantaged backgrounds
(Target Exceeded) points
6.I.C.42: Number of program
FY 2018: 5,559
participants who participated in
Target: 2,000 4,500 N/A -4,500
academic support programs during the
(Target Exceeded)
academic year
6.I.C.43: Number of program FY 2018: 5,808
participants who are enrolled in a Target: 2,500 3,000 N/A -3,000
nursing degree program (Target Exceeded)
Year and
Most FY 2019 FY 2020 FY 2021
NWD Program Outputs
Result
FY 2018:
Percent of URM students 65% 60% ---
51%
Number of nursing students FY 2018:
2,500 2,500 ---
graduating from nursing programs 1,650
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $475,458 $524,085 ---
Range of Awards $250,000-$500,000 $250,000-$1,000,000 ---
81
148
Nurse Education, Practice, Quality and Retention Programs
FY 2021 FY 2021
BA $41,704,000 $43,913,000 --- -$43,913,000
FTE 4 4 --- -4
Authorizing Legislation: Public Health Service Act, Sections 831 and 831A
FY 2021 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 statutory 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.
In FY20 HRSA will support the use of simulation to enhance nurse education and expand
experimental learning opportunities.
Interprofessional Collaborative Practice (IPCP): Behavioral Health Integration (BHI)

Program: The IPCP: BHI Program was initiated in July 2016 to address the significant unmet
need for behavioral health services in community-based primary care settings. The IPCP: BHI
program expands evidence-based practices into nurse-led primary care teams to increase access
to care, enhance care coordination and improve patient, family, and community outcomes in
rural and underserved communities.
In Academic Year 2018-2019, IPCP grantees trained 1,680 individuals. Grantees partnered with
65 clinical sites to provide interprofessional team-based training to 1,381 individuals.
149
Approximately 77 percent of the clinical training sites were located in medically underserved
communities, and 77 percent were in primary care settings. More than 56 percent of
interprofessional trainees were nurses and nursing students, while 597 were trainees from other
health care disciplines, including medical, dental, and behavioral health. HRSA anticipates
approximately $9 million in new awards in FY 2020.
Registered Nurses in Primary Care (RNPC) Training Program: The purpose of this four-year
training program is to recruit and train nursing students and current registered nurses (RNs) to
practice to the full scope of their license in community-based primary care teams to increase
access to care, with an emphasis on chronic disease prevention and control, including mental
health and substance use conditions. The program aims to achieve a sustainable primary care
nursing workforce equipped with the competencies necessary to address pressing national public
health issues, even the distribution of the nursing workforce, improve access to care and improve
population health outcomes.
In Academic Year 2018-2019, the RNPC program trained 831 individuals in primary care
nursing programs and produced 174 graduates. Over one third of nursing students received
training in substance use treatment (37 percent) and/or opioid use treatment (39 percent). RNPC
grantees partnered with 307 training sites to provide experiential training. These training sites
were located in primary care settings (70 percent), medically underserved communities (85
percent), or rural areas (44 percent). HRSA anticipates approximately $27 million in
continuation awards in FY 2020.
Veteran Registered Nurses in Primary Care (VNPC) Training Program: The purpose of this
three-year training program is to recruit and train veteran nursing students and current registered
nurses (RNs) to practice to the full scope of their license in community-based primary care teams
to increase access to care, with an emphasis on veteran care, chronic disease prevention and
control, including mental health and substance use conditions. The program aims to achieve a
sustainable primary care nursing workforce equipped with the competencies necessary to address
pressing veteran public health issues, as well as the distribution of the nursing workforce,
improve access to care and improve population health outcomes. HRSA anticipates
approximately $3.5 million in continuation awards in FY 2020.
Simulation Education Training (SET) Program: This program aims to enhance public health
nursing education and practice with the use of simulation-based technology to advance the health
of patients, families, and communities in rural and medically underserved areas experiencing
diseases and conditions that affect public health including high burden of stroke, heart disease,
behavioral and mental health, maternal mortality, HIV/AIDS and or obesity. HRSA anticipates
$2 million in new awards in FY 2020.
Eligible Entities: Accredited schools of nursing, healthcare facilities, and partnerships of a

nursing school and healthcare facility.
150
Grantee Activities
Professions Levels
 Registered  Baccalaureate  Expand enrollment in baccalaureate
nurses education nursing programs.
 Continuing  Provide education in new technologies
professional training including simulation learning and
 Advanced practice distance learning methodologies.
nursing education  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.
 Promote career advancement for nursing
personnel.
 Improve the retention of nurses and
enhance patient care.
Funding History
FY Amount
FY 2017 $39,817,000
FY 2018 $41,733,000
FY 2019 $41,704,000
FY 2020 $43,913,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Nurse Education, Practice, Quality and Retention
(NEPQR) Program of $0 is $43.9 million below the FY 2020 Enacted 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 in areas of the United States where there is a shortage of health
professionals
151
Year and Most

FY 2021
Recent Result
Target
Measure +/-
FY 2020
(Summary of
Target
Result)82
FY 2018: 368
participating in
Target: 250 N/A83 N/A N/A
interprofessional team-based
(Target Exceeded)
care
6.I.C.45: Number of nurses
FY 2018: 784
and nursing students trained
Target: 300 N/A84 N/A N/A
in interprofessional team-
(Target Exceeded)
based care
6.I.C.57: Number of
NEPQR nursing students ---85 TBD N/A N/A
trained in primary care
6.I.C.58: Number of
NEPQR trainees and
professionals participating ---86 TBD N/A N/A
in interprofessional team-
based care
Year and
Most FY 2019 FY 2020 FY 2021
NEPQR Program Outputs
Result
Total number of trainees and
FY 2018:
professionals participating in N/A87 N/A N/A
1,381
interprofessional team-based care
82
83
Measure discontinued as program was restructured.
84
85
86
87
152
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $530,665 $609,902 ---
Range of Awards $131,830-$700,000 $291,004-$700,000 ---
153
Nurse Faculty Loan Program
FY 2021 FY 2021
BA $13,433,000 $28,500,000 --- -$28,500,000
FTE 3 3 --- -3
Authorizing Legislation: Public Health Service Act, Section 846A and 847(f)
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 2018-2019, 80 schools received new NFLP awards. Awardees supported
2,277 nursing students pursuing graduate level degrees as nurse faculty. By the end of the
Academic Year, 699 trainees graduated, 65 percent of whom intended to teach nursing.
The number of schools receiving a new NFLP award does not equate to the number of schools
providing NFLP loans to graduate-level nursing students. In order to receive a new NFLP award,
schools must meet certain criteria with regard to available fund balances. However, even schools
that do not receive new awards may continue giving out loans with the accounts they have
already established.
Eligible Entity: Accredited schools of nursing that offer advanced nursing education degree
program(s) that prepare graduate students for roles as nurse educators.
154
Designated Targeted Grantee Activities
Health Educational Levels
Professions
• Nursing • Graduate • Provide funding to nursing schools to establish and
(masters and operate revolving loan fund.
doctoral) • 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 2017 $26,436,000
FY 2018 $28,500,000
FY 2019 $13,433,000
FY 2020 $28,500,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request of $0 is $28.5 million below the FY 2020 Enacted 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.
FY
2021
Result /Target for FY 2020 FY 2021
Measure +/-
FY
(Summary of Result)88
2020
6.I.C.46: Number of graduate- FY 2018: 2,277
level nursing students who Target: 1,900 1,900 N/A -1,900
received a loan (Target Exceeded)
6.I.C.47: Number of loan FY 2018: 699
recipients who graduated from an Target: 350 400 N/A -400
advanced nursing degree program (Target Exceeded)
88
155
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $159,000 $259,189 ---
Range of Awards $7,750-$1,014,000 $64,620-$1,113,268 ---
156
Nurse Corps
FY 2021 FY 2021
BA $86,701,000 $88,635,000 $83,135,000 -$5,500,000
FTE 30 30 32 +2
FY 2021 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 2030. 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, seven states are projected
to experience a shortage of RNs by 2030.89 Furthermore, as the Administration seeks to continue
to address the opioid epidemic and other substance use disorders across the nation, the Nurse
Corp program is critical to ensure access to high quality adequate behavioral health nursing
workforce.
The Nurse Corps addresses (1) the distribution of nurses by supporting nurses and nursing
students committed to working in communities with inadequate access to care; and (2) limited
access to behavioral health services by increasing funding for scholarships for behavioral health
training for Nurse Practitioners (NPs). 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 and behavioral health services. As of
September 30, 2019, over three-quarters of the Nurse Corps providers were serving in
community-based settings and 22 percent served in rural communities.
The Nurse Corps Program includes:
89
DHHS (US), Health Resources and Services Administration, National Center for Health Workforce Analysis.
(2017) Supply and Demand Projections of Nursing Workforce: 2014-2030.
157
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
(APRNs), (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
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 2019, 58 percent of Nurse Corps LRP participants extended
their service commitment for an additional year, exceeding the 52 percent target; and in FY
2019, 84 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.90 In addition, in FY
2019, 96 percent of Nurse Corps SP awardees are pursuing their baccalaureate degree or
advanced practice degree.
In FY 2021, HRSA plans to continue directing up to 20 percent of scholarship awards to NPs

specializing in Psychiatric-Mental Health with the goal of leveraging HRSA funding to address
the opioid crisis.
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.
In FY 2020, HRSA began using the “Clinician Dashboard” to calculate the retention rate. The Clinician
90
Dashboard is a data visualization tool that includes data on clinicians with NPI numbers supported by the National
Health Service Corps and Nurse Corps.
158
Funding History
FY Amount
FY 2017 $82,935,000
FY 2018 $87,107,000
FY 2019 $86,701,000
FY 2020 $88,635,000
FY 2021 $83,135,000
Budget Request
The FY 2021 Budget Request for the Nurse Corps Program of $83.1 million is $5.5 million
below the FY 2020 Enacted level. This request will fund an estimated 224 scholarship (new and
continuation) and 799 loan repayment (new and continuation) awards. This request will allow
the program to maintain its efforts to address the anticipated demand for nurses in Critical
Shortage Facilities (CSF). Additionally, the funds will help increase the number of well-trained
nurses available to provide mental/behavioral health services in communities experiencing a
shortage in nurses. In FY 2021, Nurse Corps will continue to drive funding to support the
Administration’s priorities to improve access to opioid treatment and prevention services through
the Scholarship and LRP.
In FY 2021, HRSA proposes to expand tax-exempt status under (1) 26 USC 117(c)(2) to the
Nurse Corps Scholarship Program (SP) and Native Hawaiian Health Scholarship Program
(NHHSP); and (2) 26 USC 108(f)(4) to the Nurse Corps Loan Repayment Program (LRP). The
funding request includes operational, staffing, acquisition contracts, and costs associated with the
award process, follow-up performance reviews, and information technology and other program
support costs.
Year and Most

FY 2021
Recent Result
Target
+/-
Measure Recent Result / Target Target
FY 2020
(Summary of
Target
Result)
5.I.C.4: Proportion of Nurse Corps
LRP participants who extend their FY 2019: 58%
service contracts to commit to work at Target: 52% 52% 52% Maintain
a critical shortage facility for an (Target Exceeded)
additional year. (Outcome)
159
Year and Most
FY 2021
Recent Result
Target
+/-
FY 2020
(Summary of
Target
Result)
LRP/SP participants retained in
FY 2019: 84%
service at a critical shortage facility
for at least one year beyond the
(Target Exceeded)
completion of their Nurse Corps
LRP/SP commitment.
FY 2019: 96%
SP awardees obtaining their
baccalaureate degree or advanced
(Target Exceeded)
practice degree in nursing. (Outcome)
FY 2018:
LRP: 2.8%
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: 10.3%
Target: 15%
(Target Exceeded)
Nurse Corps Loans/Scholarships Awards Table
FY 2021
Loans $52,583,040 $53,719,072 $50,377,158
Scholarships $24,295,434 $24,837,380 $23,296,166
Nurse Corps Awards
2015 2016 2017 2018 2019 2020 2021

Scholarships
New Awards 257 230 198 215 220 223 219
Continuation
12 12 14 4 6 6 5
Awards
Loan Repayment
New Awards 590 518 501 544 561 566 507
Continuation
319 365 340 279 292 293 292
Awards
Total 1,178 1,125 1,053 1,042 1,079 1,088 1,023
160
Nurse Corps Field Strength
2015 2016 2017 2018 2019 2020 2021

Scholarship 396 476 362 465 450 453 400
Loan Repayment 1,313 1,219 1,181 1,129 1,279 1,284 1,210
Loan Repayment
321 321 331 271 199 200 123
Nurse Faculty
Total 2,030 2,016 1,874 1,865 1,928 1,937 1,733
161
Children’s Hospitals Graduate Medical Education Payment Program
FY 2021 FY 2021
BA $323,382,000 $340,000,000 --- -$340,000,000
FTE 20 20 --- -20
Authorizing Legislation: Public Health Service Act, Section 340E

FY 2021 Authorization ................................................................................................$340,000.000
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. 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.
A sufficient and appropriate health workforce, efficient organization of health care teams, and
training in value-based models of care are all critical components to supporting new models of
care that drive value and quality throughout the entire system. In FY 2020, the CHGME
program implemented the second year of the Quality Bonus System (QBS), authorized by statute
to allow the Secretary of HHS to distribute bonus payments to participating CHGME hospitals
that meet quality standards specified by the Secretary. The goal of the QBS is to recognize and
incentivize CHGME Payment Program awardees with high quality training to meet the pediatric
workforce needs of the nation. The CHGME QBS is the first of its kind for any federal GME
payment program and responds to changes occurring in the larger health care arena. The
CHGME QBS is the only flexibility allowed in the legislation in the CHGME Payment Program
in how payments can be distributed.
In FY 2019, HRSA implemented the first phase of the CHGME QBS which included a pay-for-
reporting CHGME QBS payment by requesting children’s hospitals submit information on their
hospital’s initiatives, resident curriculum, and direct resident involvement in five areas: (1)
integrated care models, (2) telehealth and/or health information technology, (3) population
health, (4) social determinants of health, and (5) additional initiatives to improve access and
quality of care to rural and/or underserved communities.
162
The FY 2020 CHGME QBS payment aims to incentivize complete individual level reporting for
all residents supported by the CHGME Payment Program. In order to qualify for the QBS
payment in FY 2020, CHGME awardees must complete individual level documentation for all
residents supported by the CHGME Payment Program in the FY 2020 Annual Performance
Report (AY 2019-2020). In FY 2021, HRSA will continue to collect baseline information to
establish QBS standards in the future.
HRSA awarded an evaluation contract in FY 2019, to conduct an environmental scan of GME

quality measures, develop quality measures for GME programs in the identified priority areas,
and manage an organized stakeholder engagement process on potential QBS standards and
measures. Recommendations from the QBS contract and data collected will help support
HRSA’s plan to implement a full Pay-for-Performance QBS.
In FY 2019, 58 children’s hospitals received CHGME funding. During FY 2018 (AY 2018-
2019), the most recent year for which FTE information was reported, the CHGME hospitals
trained 7,522 resident full-time equivalents (FTEs).91 Among these FTEs, 40 percent were
pediatric residents, 34 percent were pediatric subspecialty residents, and 26 percent were
residents training in other primary disciplines such as family medicine.
During Academic Year 2018-2019, the most recent year for which performance information is
available, CHGME-funded hospitals served as sponsoring institutions for 39 residency programs
and 257 fellowship programs. In addition, they served as major participating rotation sites for
666 additional residency and fellowship programs. CHGME supported the training of 4,634
pediatric residents that included general pediatrics residents, as well as residents from seven
types of combined pediatrics programs (e.g., internal medicine/ pediatrics).
Additionally, 2,933 pediatric medical subspecialty residents, 331 pediatric surgical subspecialty
residents, and 402 adult and pediatric dentistry residents were trained. CHGME funding was also
responsible for the training of 3,349 adult medical and surgical specialty residents such as family
medicine residents who rotate through children’s hospitals for pediatrics training. The total
number of funded residents and fellows during Academic Year 2018-2019 was 11,649. During
their training, these medical residents and fellows provided care during more than 1.4 million
patient encounters in primary care settings in addition to providing over 4 million patient contact
hours in medically underserved communities. Of the full-time residents and fellows who
completed their training during this Academic Year, approximately 59 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.
91
Each of the children’s hospitals report the number of full-time equivalent residents trained during the latest filed
(completed) Medicare Cost Report period.
163
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 2016 $295,000,000
FY 2017 $299,289,000
FY 2018 $314,213,000
FY 2019 $323,382,000
FY 2020 $340,000,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Children’s Hospitals Graduate Medical Education program
of $0 is $340.0 million below the FY 2020 Enacted level.
The Request 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 2017
payments for graduate medical education, plus 2017 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.
164
Year and Most

Recent Result
FY 2021
+/-
Measure Result / Target Target
FY 2020
(Summary of
Result)92
7.I.A.1: Maintain the
number of FTE FY 2018: 7,522
residents training in Target: 6,300 7,141 N/A -7,141
eligible children’s (Target Exceeded)
teaching hospitals
7.VII.C.1: Percent of
FY 2018: 100%
hospitals with verified
Target: 100% 90%93 N/A -90%
FTE residents counts
(Target Met)
and caps
7.E: Percent of FY 2018: 100%
payments made on Target: 100% 100% N/A -100%
time (Target Met)
Awards Table
FY 2019 FY 2020 FY 2021

Average Award $5,273,460 $5,762,712 ---
Range of Awards $27,737-$22,185,631 $29,233-$23,300,699 ---
92
93
A programmatic change requiring only 90% of hospitals be audited has been implemented.
165
Teaching Health Center Graduate Medical Education Program
FY 2021 FY 2021
Current Law
$126,500,000 $81,445,000 --- -$81,445,000
Mandatory Funding
Proposed Law
--- $45,055,000 $126,500,000 +$81,445,000
Mandatory Funding
Total $126,500,000 $126,500,000 $126,500,000 ---
FTE 7 7 7 ---
Authorizing Legislation: Section 340H of the Public Health Service Act
Allocation Method ..................................................................................... Formula Based Payment
Primary care physician shortages persist, particularly in rural and other underserved
communities.94 Access to high quality primary care is associated with improved health outcomes
and lower costs.95, 96 A number of strategies are effective in incentivizing providers to choose
careers in primary care and to practice in rural and underserved areas including positive training
experiences in rural and underserved communities and rotations in community based practice
locations.97,98 There is evidence that physicians who receive training in community and
underserved settings are more likely to practice in similar settings, such as health centers.99
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
94
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.
95
Starfield B, Shi L, Macinko J. Contribution of Primary Care to Health Systems and Health. Milbank Quarterly.
2005; 83(3):457-502.
96
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.
97
Washko, M, Snyder, J, & Zangaro, G. Where do physicians train? Investigating public and private institutional
pipelines. Health Affairs. 2015; 34(5): 852-856.
98
Connelly M, et al. Variation in Predictors of Primary Care Career Choice by Year and Stage of Training. Journal
of General Internal Medicine. 2003; 18(3): 159-69.
99
Chang C, O'Malley A, Goodman D. Association between Temporal Changes in Primary Care Workforce and
Patient Outcomes. Health Services Research. 2017; 52:634–55.
166
number of these primary care providers. Teaching Health Centers (THCs) specifically have been
shown to attract residents from rural and/or disadvantaged backgrounds who are more inclined to
practice in underserved areas than those from urban and economically advantaged
backgrounds.100
Unlike most Federal funding for graduate medical education (GME), THCGME payments
support training in community-based ambulatory care settings, as opposed to in-patient care
settings in hospitals. Although health centers receive federal funding to improve access to care,
they often have difficulty recruiting and retaining primary care professionals.101 Community
health centers are also generally smaller organizations with smaller operating margins compared
to teaching hospitals. The THCGME Program is uniquely positioned to meet these recruitment
and retention needs by providing funding to support residents training in underserved
communities. 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.
A sufficient and appropriate health workforce, efficient organization of health care teams, and
training in value-based models of care are all critical components to meeting the
Administration’s priority of driving value and quality throughout the entire system. Health
professions training programs such as the THCGME are essential players in value-based
transformation of the healthcare system. In addition to increasing the number of primary care
residents training in these community-based patient care settings, the THCGME Program meets
the Administration’s priority by increasing health care quality and improving overall access to
care.
Program funds support the educational costs incurred by new and expanded residency programs.
Along with supporting the salaries and benefits of residents and faculty, THCGME funds are
used to foster innovation and support curriculum concepts aimed at improving the quality of
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
settings after graduation.
The Bipartisan Budget Act of 2018 included language which permits the Secretary to make
payments for the maintenance of filled positions at existing approved THCs; expansion of FTEs
at existing THCs, and the establishment of new THCs. The statute also outlines priorities for
awarding new approved programs including a prioritization to applicants serving a health
professional shortage area or medically underserved community, or in a rural area. HRSA issued
a new FY 2020 notice of funding opportunity in June 2019 to support residencies for Academic
Year 2020-2021. Starting in Academic Year 2020-2021, HRSA will award $120 million to 58
100
Talib, Z, Jewers, MM, Strasser, JH, Popiel, DK, Goldberg, DG, Chen, C, Kepley, H, Mullan, Regenstein, M.
Primary Care Residents in Teaching Health Centers: Their Intentions to Practice in Underserved Settings After
Residency Training. Academic Medicine. 2018; 93(1): 98-103.
101
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.
167
teaching health centers - 53 continuation awards and 5 awards to establish new teaching health
centers - increasing the maximum number of approved FTE slots to over 800. All five of the
new programs are FQHC-based and will support nearly 50 resident FTEs beginning in Academic
Year 2020-2021.
In Academic Year 2018-2019, the THCGME Program awarded 728102 resident FTE slots that
provided funding to 858 primary care medical and dental residents. While the number of FTE
slots missed the target due to the unexpected loss of two grantees, the program managed to
increase the number of residents funded by 11 over the prior academic year. 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 665,000 contact hours with these primary
care patients. Additionally, most THCGME residents (80 percent) spent a significant part of
their training in medically underserved and/or rural communities, providing over 1 million hours
of patient care. Approximately 18 percent of residents reported coming from a financially or
educationally disadvantaged background, and 26 percent of them reported 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 1,381 courses and training activities during the academic year,
impacting over 11,000 healthcare trainees. Over 10,000 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 268 residents who completed the program in Academic Year 2018-2019, approximately
56 percent reported intentions to practice in a primary care setting, while 66 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 2019-2020). Of the
228 program completers from the prior academic year for whom employment data was available,
most currently practice in a primary care setting (65 percent) and/or in a medically underserved
community (50 percent).
Since the THCGME Program began, 1,148 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, 103 the THCGME Program has evidenced much stronger
results. Cumulative follow-up data indicates that 65 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.
102
Awarded FTE slots not the maximum resident FTE cap of up to 801 resident FTEs.
103
Agency for Healthcare Research and Quality. Primary care workforce facts and stats no. 1. AHRQ Pub. No. 12-
P001-2-EF. Rockville, MD. 2011.
168
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 2017104 $55,860,000
FY 2018 $126,500,000
FY 2019 $126,500,000
FY 2020 $126,500,000
FY 2021 $126,500,000
Budget Request
The FY 2021 Budget Request of $126.5 million is equal to the FY 2020 Enacted level. In
Academic Year 2021-2022, the program expects to support around 740 FTE slots with a
maximum resident FTE cap of up to 801 resident FTEs.
The FY 2021 President’s Budget requests to remove the current capped amount of funds
available to re-obligate funds recouped through the statutorily-required annual reconciliation
process through awards to recipients. Current statutory language limits the total payments in a
fiscal year to no more than the amount appropriated for that fiscal year. The President’s Budget
proposes to remove this limitation to allow HRSA to make additional payments with funds that
may return from the annual required reconciliation (i.e., recoupment of unused funds at the end
of a prior fiscal year) which is required by statute.
Section 340H(b)(2)(A) of the PHS Act limits the amount of funds made available through
awards to the amount appropriated in a given fiscal year. Although the appropriated funds are
no-year, HRSA is limited in its ability to use recouped funds to support FTEs in a subsequent
FY due to this cap on annual spending. In order to maximize the appropriated funds, the budget
is proposing to remove this limitation. The effect of this proposal would allow HRSA to utilize
104
FY 2017 reflects the post-sequestration funding amount.
169
all available funds (including those made available after reconciliation). In the past few
academic years, the reconciliation amounts have ranged from $2.8 to $5 million.
Year and Most

Recent Result
FY 2021
Measure +/-
FY 2020
(Summary of
Result)105
6.I.C.5: Number of resident
FY 2018: 728
positions supported by
Target: 800 730 740 +10
Teaching Health Centers
(Target Not Met)
(Cumulative)106
6.I.C.48: Percent of
FY 2018: 80%
THCGME-supported residents
training in rural and/or
(Target Met)
underserved communities
THCGME Program Outputs Year and Most Recent Result

Number of primary care residents funded by THCGME
FY 2018: 858
residencies107
Number of primary care residents completing training FY 2018: 268
Percent of residents who are from a disadvantaged
FY 2018: 35%
and/or rural background
Percent of primary care resident program completers
FY 2018: 56%
who intend to practice in primary care settings
105
106
Measure captures the number FTEs resident slots awarded and not the maximum possible nor 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.
107
Measure captures the number of individual residents supported, which is different than the FTE slots.
170
Awards Table
FY 2019 FY 2020 FY 2021

Average Award $2,145,978 $639,355 $1,090,513
Range of Awards $223,813 - $8,293,868 $62,658-$6,052,986 $202,700-$5,523,575
171
National Practitioner Data Bank
FY 2021 FY 2021
BA $18,814,000 $18,814,000 $18,814,000 ---
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 more than 1.5 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 2019, the NPDB facilitated more than 9 million queries from the NPDB to
authorized health care providers.
 DPDB has launched attestation initiatives for HRSA’s community health centers, hospitals,
health plans, medical malpractice payers, and all other health care entities. To date, the
attestation completion rate for selected health centers, hospitals, health plans, medical
malpractice payers, and all other health care entities is over 90 percent.
172
Funding History
The table below shows the user fees (revenue) collected (or expected to be collected):
FY Amount
FY 2017 $15,987,575
FY 2018 $16,922,234
FY 2019 $18,814,000
FY 2020 $18,814,000
FY 2021 $18,814,000
Budget Request
The FY 2021 Budget Request for the National Practitioner Data Bank program of $18.8 million
in user fees, is the same as the FY 2020 Enacted level. This is based on HRSA’s projections of
queries on practitioners and organizations.
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.
Year and Most

Recent Result
FY 2021
+/-
FY 2020
(Summary of
Result)
FY 2019:
8.III.B.5: Increase the number of 3,854,730
practitioners enrolled in Continuous Enrolled
Query (which is a subscription Practitioners
service for Data Bank queries that Target: 3,078,500 3,900,000 4,200,000 +300,000
notifies them of new information on Enrolled
enrolled practitioners within one Practitioners
business day) (Target
Exceeded)
173
Year and Most
Recent Result
FY 2021
+/-
FY 2020
(Summary of
Result)
FY 2019:
1,958,026
8.III.B.7: Increase annually the
Disclosures
number of disclosures of NPDB 1,980,000 2,020,000 +40,000
Target: 1,850,000
reports to health care organizations
(Target
Exceeded)
174
Health Workforce Cross-Cutting Performance Measures
The Bureau of Health Workforce (BHW) has tracked and reported on four cross-cutting
measures for over 30 of its programs that reported performance data during Academic Year
2018-2019. The cross-cutting measures focus specifically on the diversity of individuals
completing specific types of health professions training programs;108 the rate in which
individuals participating in specific types of health professions training programs are trained in
medically underserved communities;109 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.110
During Academic Year 2018-2019, 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.111
With regard to the types of settings used to provide training, results showed that 65 percent of
individuals participating in BHW-supported health professions training programs received at
least a portion of their training in a medically underserved community surpassing the
performance target of 55 percent. This is an improvement over last year’s result of 60 percent
and reflects the Bureau’s continued emphasis aimed at increasing service and training in rural
and underserved areas. As a result, more health professions trainees are being exposed to
training and patient care in medically underserved communities than in prior years.
Results showed that 47 percent of individuals who graduated from or completed specific types of
BHW-supported training programs reported working in medically underserved communities
across the nation one year after graduation/completion.
108
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, 27 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.
109
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.
110
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.
111
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).
175
Lastly, the percent of clinical training sites that provide interprofessional training to individuals
enrolled in a primary care training program was 64 percent, far exceeding the target of 24
percent. This result is also an improvement over last year’s result due to a continued focus on
the programmatic emphasis of interprofessional training across programs in the Bureau.
Year and Most

Recent Result FY
FY 2021
/Target for Recent 2020 FY 2021
+/-
Measure Result / Target Target
113 FY 2020
(Summary of
Result) 112
6.I.B.1. Percentage of graduates and
program completers of Bureau of
Health Workforce-supported health FY 2018: 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 2018: 65%
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
FY 2018: 47%
Workforce who completed a primary
Target: 40% 40% TBD TBD
care training program and are
(Target Exceeded)
currently employed in underserved
areas.114
6.I.1. Percent of clinical training sites
FY 2018: 64%
that provide interprofessional training
Target: 24% 50% TBD TBD
to individuals enrolled in a primary
(Target Exceeded)
care training program.
112
113
Targets for FY 2020 are maintained on certain measures to prepare for inclusion of the CHGME program that
year.
114
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 2018-2019 based on graduates from Academic Year 2017-2018.
176
Maternal and Child
Health
TAB
177
Maternal and Child Health Block Grant

FY 2021 FY 2021
BA $674,723,000 $687,700,000 $760,700,000 +$73,000,000
FTE 44 44 44 ---
Authorizing Legislation - Social Security Act, Title V
FY 2021 Authorization ................................................................................................$850,000,000
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 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, maternal
mortality, and value-based care) 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:
178
 Assure access to quality maternal and child health care services for mothers and children,
especially for those with low-incomes or limited availability of care;
 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 children
with special health care needs; 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.
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-
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populating performance and outcome measure data, as available, using national data
sources.
 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 through the Title V Information System.115
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:
 An estimated 55 million women, infants, and children, including children with special
health care needs, benefitted from a service supported by the State MCH Block Grant in
FY 2018. Nationwide, the 59 State MCH Block Grants reached approximately 91percent
of pregnant women, 99 percent of infants, and 54 percent of children.
 Access to health services for mothers has improved with support of the State MCH Block
Grant program. The percentage of women who received early prenatal care in the first
trimester of pregnancy increased from 71.0 percent in 2007 to 77.5 percent in 2018.
Recognizing that improving maternal and child health in the United States will require,
first of all, improving women’s health before pregnancy, 46 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 MCH
Block Grant program has played a lead role in the 19 percent decline in U.S. infant
mortality from 7.2 infant deaths per 1,000 live births in 1997 to 5.8 infant deaths per
1,000 in 2017. 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, in 2018, 37 State Title V
programs provided funding to support comprehensive maternal mortality reviews to
identify contributing factors, monitor trends, and initiate appropriate action to reduce
such events in the future. An additional 14 states were in the planning process to use Title
V funds to support maternal mortality reviews. In Kentucky, for example, the maternal
mortality review team’s findings led to the development of a patient “safety bundle” for
115
https://mchb.tvisdata.hrsa.gov/
180
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 coincided with 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.
 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.
Select National Outcome and National Performance Measures in effect from 1997 to 2017
illustrate the program’s successes:
National Outcome or Performance Measures Percent Change Data Source

(1997 – 2017 unless
otherwise noted)
Infant Mortality Rate per 1,000 live births 19% decrease National Vital Statistics
System (NVSS)
Neonatal mortality rate per 1,000 live births 21% decrease NVSS
Postneonatal mortality rate per 1,000 live births 24% decrease NVSS
Perinatal mortality rate per 1,000 live births plus 19% decrease NVSS
fetal deaths
Child mortality rate, ages 1 through 9 per 33% decrease NVSS
100,000
Percent of 19-35 month olds who have received 64% increase National Immunization
full schedule of age appropriate immunizations (2009-2018) Survey (NIS)
against Measles, Mumps, Rubella, Polio,
Diphtheria, Tetanus, Pertussis, Haemophilus
Influenza, & Hepatitis B
Percentage of children without health insurance 63% decrease National Health
(1997-2018) Interview Survey
(NHIS)
Percent of very low birth weight infants 12% increase Title V Information
delivered at facilities for high-risk deliveries and (1997-2013) System
neonates
Percent of infants born to pregnant women 9% increase NVSS
receiving prenatal care beginning in the first (2007-2018)
trimester
Special Projects of Regional and National Significance (SPRANS)
HRSA awards SPRANS grants to 1) address critical and emerging issues of regional and national
significance in maternal and child health, and 2) support collaborative and innovative learning
across states so programs can utilize existing best-practices and evidence. Of the $119.1 million
181
for SPRANS in FY 2020, Congress set aside approximately 11 percent to address four specific
priorities: oral health, epilepsy, sickle cell disease, and Fetal Alcohol Syndrome. In addition,
approximately 38 percent of the total SPRANS budget supports specific directives highlighted in
the authorizing language, including genetics, hemophilia, training, and research. The remaining
approximately 51 percent addresses critical and emerging issues in maternal and child health
such as maternal mortality and opioid abuse prevention, and supports collaborative learning
across states.
Critical and Emerging Issues in Maternal and Child Health
SPRANS supports projects that address critical and emerging issues in maternal and child health,
including special projects that respond to Congressional priorities. For example:
 Maternal mortality –
o AIM – SPRANS supports the Alliance for Innovation on Maternal Health (AIM)
to reduce maternal mortality in the United States. To date, 27 states are enrolled in
AIM, with participation from approximately 1,300 hospitals. With additional
funding provided in FY 2019 and 2020, AIM is expanding to all U.S. States, the
District of Columbia, and U.S. territories, as well as tribal entities.
o FY 2019 SPRANS funding also supported three new state-focused efforts to
improve maternal health outcomes and address disparities in maternal mortality
and severe maternal morbidity.
 State Maternal Health Innovation Grants – The State Maternal Health
Innovation (STATE MHI) Program funds states working in concert with
the State Title V agency to strengthen partnerships and collaboration by:
establishing a state-focused Maternal Health Task Force, improving state-
level data surveillance on maternal mortality and severe maternal
morbidity, and promoting and executing innovation in maternal health
service delivery.
 The Supporting Maternal Health Innovation Program supports states and
other stakeholders through capacity-building assistance to State MHI
recipients and other HRSA-funded maternal health award recipients as
they implement innovative and evidence-informed strategies. This funding
supports the establishment of a national resource center to provide
guidance to HRSA award recipients, states, and key stakeholders in
improving maternal health.
 The Alliance for Innovation on Maternal Health (AIM) – Community Care
Initiative supports the development and implementation of non-hospital
focused maternal safety bundles within community-based organizations
and outpatient clinical settings across the U.S. This initiative builds upon
the foundational work of AIM by utilizing a quality improvement
framework to address mortality and morbidity among pregnant and
postpartum women outside of hospital and other birthing facility settings.
o Opioids – SPRANS supported AIM to develop a maternal safety bundle on the
prevention and treatment of opioid use disorder during pregnancy and its
associated adverse perinatal outcomes, including neonatal abstinence syndrome.
182
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.
 A study on results of this CoIIN, led by researchers from the Health Resources and
Services Administration (HRSA), showed early elective delivery decreased by 22 percent
in the Southern states versus 14 percent in other regions. Alabama and Louisiana showed
the largest reductions in the nation at more than 40 percent. Results in the South also
showed that stopping smoking during pregnancy increased by 7 percent, infant back sleep
position increased by 5 percent, and preterm birth fell by 4 percent; other regions only
showed improvements of 2 percent for each of these outcomes measured.116
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 enhance early childhood systems at the state and
community level to achieve improved outcomes in population-based children’s developmental
health and family well-being indicators. ECCS works with 12 states and 28 communities and
supports an ECCS CoIIN Coordinating Center to build early childhood systems
leadership, improve care coordination and systems integration, and improve policies and
practices across sectors so that more children are thriving at age three and school ready by age
five.
116
https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304371
183
Table 1. MCH Block Grant Activities ($ in thousands)
FY 2021
MCH Activities Final Enacted Budget
State MCH Block Grant Awards $555,380 $558,308 $617,831
SPRANS $109,112 $119,116 $132,593
CISS $10,231 $10,276 $10,276
Total $674,723 $687,700 $760,700
Table 2. MCH Block Grant SPRANS Set-Aside Grants ($ in thousands)
FY 2021
MCH SPRANS Set-Aside Programs Final Enacted Budget
SPRANS – Other
$96,798 $106,224 $124,474
SPRANS - Oral Health
$5,227 $5,250 $4,000
SPRANS – Epilepsy
$3,626 $3,642 $3,642
SPRANS - Sickle Cell
$2,986 $3,000 ---
SPRANS - Fetal Alcohol Syndrome
Demo
$475 $1,000 $477
Total SPRANS
$109,112 $119,116 $132,593
Funding History
FY Amount
FY 2017 $641,700,000
FY 2018 $650,194,233
FY 2019 $674,723,000
FY 2020 $687,700,000
FY 2021 $760,700,000
Budget Request
The FY 2021 Budget Request for the Maternal and Child Health (MCH) Block Grant program of
$760.7 million is $73.0 million above the FY 2020 Enacted level. The Request includes an
184
increase of $60.0 million in funding for formula awards to states to provide states with additional
flexibility to support activities previously funded through a number of MCH categorical grant
programs. Additionally, the Budget includes an increase of $13 million in SPRANS funding for a
total of $132.59 million, of which $68 million will support the Improving Maternal Health in
America Initiative, which focuses on a four-pillar strategy to achieve: 1) Healthy Outcomes for
All Women of Reproductive Age by improving prevention and treatment, 2) Healthy
Pregnancies and Births by prioritizing quality improvement, 3) Healthy Futures by optimizing
post-partum health, and 4) Improve Data and Bolster Research to inform future interventions.
This initiative builds on HRSA’s efforts to improve maternal health and reduce maternal
mortality and severe maternal morbidity. This funding will support:
 State Maternal Health Innovation Grants: An additional $30 million, for a total of $53
million, to expand the program to additional states. This program supports innovation
among states to improve maternal health outcomes and address disparities in maternal
health. With this funding, states collaborate with maternal health experts to implement
state-specific actions plans in order to improve access to maternal care services, identify
and address workforce needs, and support postpartum and interconception care services.
 Alliance for Innovation on Maternal Health (AIM): An additional $10 million, for a total
of $15 million, to support implementation and expansion of evidence-based models of
maternity care, including the maternal safety bundles implemented through AIM. The
additional funding in 2021 will expand AIM to community care settings including health
centers, IHS, and Tribal facilities.
The President’s Budget prioritizes SPRANS funding for addressing maternal health and reduces
funding for on-going, new and recompeting SPRANS awards to respond to emerging issues of
regional and national significance and support collaborative learning across the states. 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.
Year and Most

Recent Result /
Target for Recent FY 2021
Result Target +/-
FY 2018:
10.4: The percentage of children
Result: 56%
served by the Maternal and Child 58% 58% Maintain
Target: N/A
Health Block Grant117 (Output)
(Baseline)
117
The term “children” includes both infants and children (0-21 years of age).
185
Year and Most
Recent Result /
Result Target +/-
10.5: The percentage of pregnant FY 2018:
women served by the Maternal Result: 91% +5
87% 92%
and Child Health Block Grant Target: N/A percentage
(Output) (Baseline) points
10.IV.B.1: Decrease the ratio of
FY 2017: 2.2 to
the Black infant mortality rate to
1118,119
the White infant mortality rate 2.0 to 1 2.0 to 1 Maintain
Target: 2.0 to 1
(Outcome)
(Target Not Met)
FY 2017: 5.8 per

1,000
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 Met)
10.III.A.2: Reduce the incidence
FY 2018: 8.3%
of low birth weight births
Target: 7.8% 8.0% 8.0% Maintain
(Outcome)
(Target Not Met)
10.III.A.3: Increase percent of

pregnant women who received FY 2018: 77.5%
prenatal care in the first trimester Target: 79% 80% 80% Maintain
(Outcome) (Target Not Met)
118
Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death
1999-2017 on CDC WONDER Online Database, released December, 2018.Data are from the Multiple Cause of
Death Files, 1999-2017,as compiled from data provided by the 57 vital statistics jurisdictions through the Vital
Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html
119
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final data for 2017. National Vital
Statistics Reports; vol 67 no 8. Hyattsville, MD: National Center for Health Statistics. 2018.
186
Grant Awards Table – Maternal and Child Health Block Grant

Average Award $9,232,429 $9,231,596 $10,224,978
$147,073- $147,060- $162,885-

Range of Awards
$39,660,787 $39,082,139 $45,661,483
Grant Awards Table – SPRANS

Average Award $440,507 $433,345 $428,710
Range of Awards $11,219-$3,484,624 $11,219-$10,000,000 $11,219-$3,000,000
Grant Awards Table – CISS

Number of
14 14 13
Awards
Average Award $637,283 $673,235 $640,609
Range of Awards $208,501-$2,700,000 $410,771-$2,700,000 $410,771-$2,700,000
187
State Table
CFDA NUMBER/PROGRAM NAME: 93.994/Maternal and Child Health Block Grant
FY 2019 FY 2020 FY 2021 Difference

Final120 Estimate121 Estimate122 +/- 2020
Alabama $11,401,820 $11,436,123 $12,542,308 $1,106,185

Alaska 1,077,677 1,102,220 1,214,990 112,770
Arizona 7,394,328 7,378,658 8,773,998 1,395,340
Arkansas 6,966,533 6,932,732 7,640,428 707,696
California 39,660,787 39,082,139 45,661,483 6,579,344
Colorado 7,397,625 7,318,760 7,939,329 620,569

Connecticut 4,667,875 4,647,058 5,072,024 424,966
Delaware 1,992,794 2,021,547 2,184,026 162,479
District of Columbia 6,909,749 6,940,912 7,078,869 137,957
Florida 19,572,974 19,691,955 23,240,189 3,548,234
Georgia 17,133,550 17,029,221 19,192,425 2,163,204

Hawaii 2,159,575 2,137,424 2,268,777 131,353
Idaho 3,272,972 3,285,138 3,565,834 280,696
Illinois 21,222,869 21,085,669 23,032,783 1,947,114
Indiana 12,270,064 12,261,391 13,447,096 1,185,705
Iowa 6,505,246 6,503,109 6,925,087 421,978

Kansas 4,773,454 4,716,139 5,132,446 416,307
Kentucky 11,092,633 11,176,041 12,159,181 983,140
Louisiana 12,238,148 12,501,330 13,804,752 1,303,422
Maine 3,311,945 3,297,106 3,442,511 145,405
Maryland 11,756,544 11,821,935 12,495,623 673,688

Massachusetts 11,135,267 11,118,963 11,825,355 706,392
Michigan 18,855,463 18,817,408 20,573,013 1,755,605
Minnesota 9,098,601 9,081,270 9,742,391 661,121
120
The poverty-based allocation for FY 19 uses 3-year poverty data from the American Community Survey, 2014-
2016
121
2017
122
2018
188

Mississippi 9,228,087 9,243,441 10,066,954 823,513
Missouri 12,193,258 12,197,702 13,284,551 1,086,849

Montana 2,300,122 2,275,612 2,414,008 138,396
Nebraska 4,024,409 4,018,103 4,262,008 243,905
Nevada 2,121,400 2,119,621 2,641,158 521,537
New Hampshire 1,972,621 1,952,143 2,061,761 109,618
New Jersey 11,640,399 11,630,726 12,768,611 1,137,885

New Mexico 4,125,964 4,164,551 4,730,158 565,607
New York 38,206,443 38,261,546 41,466,617 3,205,071
North Carolina 17,406,891 17,426,938 19,409,886 1,982,948
North Dakota 1,738,945 1,745,477 1,823,876 78,399
Ohio 22,085,885 22,118,712 24,317,818 2,199,106

Oklahoma 7,049,999 7,179,799 8,116,401 936,602
Oregon 6,263,146 6,181,630 6,724,489 542,859
Pennsylvania 23,732,205 23,847,096 25,723,124 1,876,028
Rhode Island 1,646,441 1,629,925 1,778,734 148,809
South Carolina 11,496,042 11,467,943 12,572,817 1,104,874

South Dakota 2,174,073 2,188,849 2,339,984 151,135
Tennessee 11,875,637 11,816,877 13,252,157 1,435,280
Texas 34,479,260 34,875,018 41,808,444 6,933,426
Utah 6,160,252 6,112,864 6,472,054 359,190
Vermont 1,649,043 1,650,304 1,717,208 66,904

Virginia 12,278,402 12,330,317 13,457,958 1,127,641
Washington 8,893,654 8,770,997 9,661,924 890,927
West Virginia 6,114,105 6,160,550 6,553,753 393,203
Wisconsin 10,916,577 10,835,671 11,597,867 762,196
Wyoming 1,194,968 1,202,702 1,280,988 78,286
SUBTOTAL 524,836,721 524,789,362 581,260,226 56,470,864
American Samoa 490,242 490,198 542,946 52,748
189

Guam 757,152 757,084 838,551 81,467

Marshalls 228,778 228,758 253,374 24,616
Micronesia 517,478 517,432 573,111 55,679

Northern Marianas 463,007 462,965 512,783 49,818
Palau 147,073 147,060 162,885 15,825
Puerto Rico 15,785,792 15,784,367 17,482,871 1,698,504
Virgin Islands 1,487,068 1,486,934 1,646,938 160,004
SUBTOTAL 19,876,590 19,874,798 22,013,459 2,138,661
TOTAL Resources $544,713,311 $544,664,160 $603,273,685 $58,609,525
190
Autism and Other Developmental Disabilities
FY 2021 FY 2021
FY 2019 FY 2020
President’s +/-
Final Enacted
Budget FY 2020
BA $50,377,000 $52,344,000 --- -$52,344,000
FTE 7 7 --- -7
Authorizing Legislation - Section 399BB of the Public Health Service Act, reauthorized by
Public Law 113-157, Section 4 and Public Law, 116-60
FY 2021 Authorization ..................................................................................................$50,559,000
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 2019. 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.
191
Training Programs
The program has two main training components, the Leadership Education in
Neurodevelopmental and Other Related Disabilities (LEND) program and the Developmental-
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. Data from the 2018 evaluation covering FY 2014 – FY 2016 showed that
the LEND and DBP programs collectively:
 Provided diagnostic services to confirm or rule out ASD and other DDs to more than
340,000 children.
 Provided training to over 16,000 pediatricians, developmental-behavioral pediatrics
specialists, and other health professionals.
 Provided more than 11,600 continuing education events on early screening, diagnosis,
and intervention that reached nearly 600,000 pediatricians and other health
professionals.
Research
To improve the health and well-being of children with ASD and other DDs, HRSA supports
research networks, single investigator-led autism innovation projects, field-initiated research and
secondary data analyses projects. HRSA supports research and development of reliable screening
tools and guidelines for ASD and other developmental disabilities and the implementation of
interventions to improve the physical and behavioral health of individuals with ASD and other
DDs across the life course as well as research to address barriers to diagnosis and access to care
for underserved populations. 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 from the 2018 evaluation covering FY
2014-FY 2016 include:
 Conducted 84 studies on physical and behavioral health issues related to ASD and other
DDs, screening and diagnostic measures, early intervention, and transition to
adulthood.
 Developed 32 new guidelines and tools, including diagnostic and screening tools that
are helping to guide health care practice and delivery.
 Prepared 299 manuscripts for publication and delivered over 300 scientific conference
presentations.
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. State grantees:
 Promoted access to more comprehensive coordinated services for ASD by establishing
integrated teams of educators, physicians, and social service providers.
 Engaged families in program planning, community outreach, and training for providers;
192
 Implemented strategies to reduce disparities in early identification and treatment of
ASD.
The funding also includes costs associated with the grant review and award process, follow-up
performance reviews, and information technology and other program support costs.
Funding History
FY Amount
FY 2017 $46,985,000
FY 2018 $48,899,000
FY 2019 $50,377,000
FY 2020 $52,344,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Autism and Other Developmental Disabilities program of
$0 is $52.3 million below the FY 2020 Enacted level. 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. The Budget includes an increase of $60.0 million in funding for Maternal and
Child Health (MCH) Block Grant formula awards to states to provide states with additional
programs, including Autism and Other Developmental Disabilities.
Outputs and Outcomes Table
Year and Most Recent FY 2021 Target

FY 2020 FY 2021
Result /Target for +/- FY 2020
Recent Result / Target
(Summary of Result)
FY 2016123: LEND
50.I.A.1 Percent of
76% DBP 100%
long-term trainees
(Target 0.5 percentage
(LEND, DBP)
point increase from LEND: 76%
working with
prior year– LEND DBP: N/A N/A
underserved
(75.3%): Target 86.2%
populations, 5 years
exceeded; DBP
post-training.
(85.7%): Target
(Outcome)
exceeded)
123
The data source for this measure is the Discretionary Grants Information System.
193
Year and Most Recent FY 2021 Target
FY 2020 FY 2021
Result /Target for +/- FY 2020
Recent Result / Target
(Summary of Result)
50.I.A.2 Percent of FY 2016 Result124: 1
long-term trainees year = 79.2 %; 5 years
(LEND, DBP) who = 77.2%
at 2 and 5 years post- (Target 0.25 percentage
1 year =
training, have point increase from
79.2% N/A N/A
worked in an prior year – 1 year
77.2%
interdisciplinary (78%): Target
manner to serve the exceeded; 5 years
MCH population. (80.6%): Target not
(Outcome) met)
50.I.A.3 Percent of
MCHB Autism
research programs
supporting the
Baseline data for FY
production of 100% N/A N/A
2017125: 100%
scientific
publications
(Developmental)
(Output)
Grant Award Table

LEND $33,767,075 $35,485,778 ---
DBP $2,240,423 $2,284,870 ---
Research $7,516,804 $7,525,000 ---
State Systems $1,854,336 $1,854,316 ---
Resource Centers $896,000 $896,000 ---
Average Award $557,526 $532,997 ---
124
FY 2016 data are from the previously worded measure. FY 2016 data only includes LEND, whereas both LEND
and DBP will be included in the measure beginning with FY 2017 data, per the measures description.
125
The data source for this measure is the Discretionary Grants Information System.
194
Sickle Cell Disease Treatment Demonstration Program
FY 2021 FY 2021
BA $4,435,000 $5,205,000 --- -$5,205,000
FTE 2 2 --- -2
Authorizing Legislation - Sickle Cell Disease and Other Heritable Blood Disorders Research,
Surveillance, Prevention, and Treatment Act of 2018
FY 2021 Authorization ....................................................................................................$4,455,000
Allocation Methods:
 Competitive cooperative agreement
 Contract
The Sickle Cell Disease Treatment Demonstration Program 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. For example, hydroxyurea was approved
by the FDA in 1998; 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. Sickle Cell Disease Treatment Demonstration Program
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;
 Implementing telehealth strategies, such as Project ECHO, to educate health
professionals on evidence-based treatment of sickle cell disease, such as the use of
hydroxyurea; and
 Expanding and coordinating patient education, treatment, and care continuity.
In FY 2017, the program was re-competed and five organizations received grants to develop
Regional Coordinating Centers that cover the United States. The program supports at least
30 states where more than 50 percent of the 100,000 individuals with sickle cell disease live in
195
the United States. Regional grantees are working 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 care.
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 2017 $4,444,000
FY 2018 $4,455,000
FY 2019 $4,435,000
FY 2020 $5,205,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Sickle Cell Disease Treatment Demonstration Program of
$0 is $5.205 million below the FY 2020 Enacted level. 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. The Budget includes an increase of $60.0 million in funding for Maternal and
Child Health (MCH) Block Grant formula awards to states to provide states with additional
programs, including the Sickle Cell Disease Treatment Demonstration Program.
196
Year and Most

Recent Result /
Target for FY 2021
Recent Result Target +/-
Baseline data
51.1: Number of sickle cell
for FY2018 will
patients served by SCDTDP
be available N/A N/A ---
network providers in the past year
December
(Developmental) (Output)
2020126
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $704,829 $860,997 ---
Range of Awards $357,500-$1,072,500 $436,711-$1,281,994 ---
126
The data source for this measure will be collected from provider surveys via the SCDTDP National Coordinating
Center.
197
Early Hearing Detection and Intervention/1
FY 2021 FY 2021
BA $17,740,000 $17,818,000 $17,818,000 ---
FTE 4 4 4 ---
1/This program is formerly known as the James T. Walsh Universal Newborn Hearing Screening. The program
name is changed to better reflect the broader use of funds.
Authorizing Legislation – Early Hearing Detection and Intervention Act of 2017, Public Health
Service Act, Title III, Section 399M (as added by Public Law 106-310, Section 702; as amended
by Public Law 111-337 and Public Law 115-71)
Allocation Methods:
 Competitive grant
 Cooperative agreement
The Early Hearing Detection and Intervention (EHDI) program (formerly known as the James T.
Walsh Universal Newborn Hearing Screening program) supports comprehensive and coordinated
state and territory EHDI systems so families with newborns, infants, and young children up to
three years of age that are deaf or hard of hearing receive appropriate and timely services that
include hearing screening, diagnosis, and early intervention. This program focuses on:
 Increasing health professionals’ engagement in and knowledge of the EHDI system;
 Improving access to early intervention services and language acquisition; and
 Improving family engagement, partnership, and leadership.
The Children’s Health Act of 2000 (P.L. 106-310) authorized the UNHS Program in FY 2000.
The EHDI Act of 2017 (P.L. 115-71) recently amended and reauthorized the program. The EHDI
Program supports state and territorial efforts to:
 Develop statewide 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 EHDI 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
198
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 2017, 98.3 percent of infants overall were screened for hearing loss.127 In addition, 65.2
percent of infants were diagnosed in accordance with expert guidelines, compared to 60.7
percent in FY 2015.128 Additionally, the EHDI Program continues to work with states to meet the
Healthy People 2020 objectives of screening no later than one month of age, 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). In 2017, 91.1% of infants were
screened before one month of age, 75.4% were evaluated before 3 months of age, and 66.7%
were enrolled in early intervention before six months of age.129 A lack of comprehensive data
reporting requirements for service providers in states and variability across states in timely
access to such providers, among other factors, continues to be a challenge.
The EHDI Program continues to focus on supporting early screening and diagnosis as
recommended by Healthy People 2020. 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 EHDI 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 2017 $17,775,000
FY 2018 $17,818,000
FY 2019 $17,740,000
FY 2020 $17,818,000
FY 2021 $17,818,000
127
2017 CDC EHDI Hearing Screening & Follow-up Survey (HSFS);
(https://www.cdc.gov/ncbddd/hearingloss/2017-data/01-2017-HSFS-Data-Summary-h.pdf).
128
Ibid
129
Ibid
199
Budget Request
The FY 2021 Budget Request for the EHDI program of $17.8 million is the same as the FY 2020
Enacted level. The Budget Request will continue to support 59 competitive grants to states and
territories, in addition to two technical resource centers and supplemental awards to 12
Leadership Education in Neurodevelopmental and Related Disabilities training programs to train
future leaders in pediatric audiology.
Year and Most

Recent Result / FY 2020
Target for Target
Recent Result +/- FY
(Summary of FY 2020 FY 2021 2021
13.2: Increase the percentage of infants FY 2017: 66.7%
130, 131
with hearing loss enrolled in early
72% 72% Maintain
intervention before six months of age. Target: 72%
(Output) (Target Not Met)
13.III.A.1: Percentage of infants
FY 2017: 75.4 133
suspected of having a hearing loss with
a confirmed132 diagnosis by three
(Target Not Met)
months of age. (Output)
FY 2016: 97.1%
13.III.A.3: Percentage of infants 134
screened for hearing loss prior to one 98% 98% Maintain
Target 98%
month of age. (Output)
(Target Not Met)
130
2017 CDC EHDI Hearing Screening & Follow-up Survey (HSFS): 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. Data can be found at https://www.cdc.gov/ncbddd/hearingloss/2017-
data/01-data-summary.html
131
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.
132
“Confirmed” diagnosis refers to a “documented” diagnosis which is consistent with CDC reporting.
133
Ibid.
134
Ibid.
200
FY 2019 FY 2020 FY 2021

Number of
59 59 59
Awards
Average Award $226,373 $235,000 $235,000
Range of Awards
$53,491-$250,000 $235,000-$235,000 $235,000-$235,000
135
Does not include Universal Newborn Hearing & Screening cooperative agreement ($1.2M in FY 2019; $0.9M in
FY 2020), LEND supplements ($0.9M), Family Leadership in Language and Learning ($0.5M), and Advancing
Systems of Services for Children and Youth with Special Health Care Needs: medical home capacity building and
technical assistance to LEND Audiology grantees ($150K each).
201
Emergency Medical Services for Children
FY 2021 FY 2021
FY 2019 FY 2020
President’s +/-
Final Enacted
Budget FY 2020
BA $22,236,000 $22,334,000 --- -$22,334,000
FTE 5 5 --- -5
Authorizing Legislation – Public Health Service Act, Section 1910, as amended by Public Law
113-180, Section 2 and Public Law 116-49.
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, reauthorized under the EMSC Reauthorization Act of
2019, 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 for health care practitioners in these settings to remain current on issues
affecting children.
Additionally, EMS agencies and hospital emergency departments often lack 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; EMS
personnel receive appropriate training for pediatric emergencies; and guidelines and agreements
are in place to ensure the safe and effective transfer of children from one hospital to another as
necessary.
In recent years, the EMSC program has invested in activities that have improved the pediatric
readiness of prehospital services (EMS agencies) and emergency departments. Notable
accomplishments include:
 Between 2011 and 2018, the proportion of hospitals with written interfacility transfer
guidelines covering pediatric patients increased from 38% to 58%. These guidelines
standardize procedures and facilitate communication between hospitals to prevent
202
adverse events and improve the delivery of timely, effective care to children in a medical
emergency.136
 Between 2006 and 2018, the number of states that established a pediatric medical facility
recognition program more than doubled from five to 12. These 12 states established a
state or regional entity to perform on-site assessments of hospital emergency departments
to assure the presence of critical resources and protocols needed to manage pediatric
medical emergencies.137
 In 2017-2019, the EMSC program partnered with the Federal Office of Rural Health
Policy (FORHP) to organize a federal steering committee to improve the coordination of
care of children in emergency mental health crisis in rural regions, resulting in the
development of the Critical Crossroads: Pediatric Mental Health Care in the Emergency
Department Pathways Toolkit. This Pathways Toolkit aims to help hospitals identify,
manage, and ensure continuity of care for children and adolescents in mental health crisis
seeking care in an emergency department.138
The EMSC program supports the Pediatric Emergency Care Applied Research Network
(PECARN) Program, which enables rigorous clinical research using pooled samples of pediatric
patients across institutions to advance EMSC science and clinical practice. For example, the
Network examined the impact of giving fluids intravenously to children with diabetic
ketoacidosis (DKA), a clinical intervention that was often avoided for fear of causing brain
injury. The study found that fluid hydration can be safe for children with DKA, allowing
clinicians to administer the fluids on an individualized basis, which may prevent cognitive
impairment and decrease the risk of other complications in these children.139 In 2019, PECARN
released a new clinical decision rule to help guide the practice of pediatricians. This rule focused
on infants less than 2 months of age who present to the emergency department with fevers and
demonstrated how physicians can more precisely identify babies who are at low risk of serious
bacterial infections such as urinary tract infections, bacteria in the blood and bacterial meningitis.
Better identification helps avoid unneeded spinal taps, antibiotic medications and
hospitalizations, which can carry risks and can be costly. Nearly half a million febrile infants are
evaluated in U.S. emergency departments each year. 140
In addition, the EMSC program funds Targeted Issues grants, which support researchers to
expand the evidence base in pediatric emergency medicine. For example, the Pediatric Evidence-
Based Guidelines: Assessment of EMS System Utilization in States (PEGASUS) project
136
Genovesi, A.L., Olson, L.M., Telford, R., Fendya, D., Schenk, E., Morrison-Quintana, T., & Edgerton, E.A.
(2017). Transitions of Care: The Presence of Written Interfacility Transfer Guidelines and Agreements for Pediatric
Patients. Pediatric Emergency Care, doi: 10.1097/PEC.0000000000001210. (Epub ahead of print).
137
Remick, K., Kaji, A.H., Olson, L., Ely, M., Schmul, P., McGrath, N., Edgerton, E., & Gausche-Hill, M. (2016). Pediatric
Readiness and Facility Verification. Annals of Emergency Medicine. 67(3). 320-328.
138
Critical Crossroads: Pediatric Mental Health Care in the Emergency Department - https://www.hrsa.gov/critical-
crossroads.
139
Kuppermann, N., Ghetti, S., Schunk, J.E., Stoner, M.J., Rewers, A., McManemy, J.K., Myers, S.R., Nigrovic,
L.E., Garro, A., Brown, K.M., Quayle, K.S., Trainor, J.L., et al. (2018). Clinical Trial of Fluid Infusion Rates for
Pediatric Diabetic Ketoacidosis. New England Journal of Medicine, 378(24), 2275-2287.
140
Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and
Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. Published online February 18,
2019173(4):342–351.
203
developed four evidence-based guidelines to help prehospital health care providers deliver
optimal care to children during airway management, allergic reactions, spinal care, and shock.
The PEGASUS project then tested the application of these and five pre-existing guidelines in the
management of pediatric asthma, bronchiolitis, croup, seizures, and pain in several states.141
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.
Funding History
FY Amount
FY 2017 $20,113,000
FY 2018 $22,134,000
FY 2019 $22,236,000
FY 2020 $22,334,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the EMSC program of $0 is $22.3 million below the FY 2020
Enacted level. 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. The Budget includes an
increase of $60.0 million in funding for Maternal and Child Health (MCH) Block Grant formula
awards to states to provide states with additional flexibility to support activities previously
funded through a number of MCH categorical grant programs, including the EMSC program.
141
Marino, M.C., Ostermayer, D.G., Mondragon, J.A., Camp, E.A., Keating, E.M., Fornage, L.B., Brown, C.A., &
Shah, M.I. (2018). Improving Prehospital Protocol Adherence Through a Bundled Educational Intervention.
Prehospital Emergency Care, 22(3), 361-369.
204
Year and Most
Recent Result /
Target for FY 2021
Recent Result Target +/-
14.3: The percentage of
responding EMS agencies FY 2018: 23%
142
nationwide that have a designated
24% N/A ---
individual who coordinates Target: N/A
pediatric emergency care (Baseline)
(Outcome)
14.4: Percent of responding
hospitals nationwide that have
FY 2018:
written interfacility transfer
Result: 58% 143
guidelines that cover pediatric 61% N/A ---
Target: N/A
patients and that include specific
(Baseline)
components of transfer
(Outcome)
14.5: Number of children enrolled FY 2019

in Pediatric Emergency Care Result: 125,759
144 126,009 N/A ---
Applied Research Network
(PECARN) studies (Outcome) Target: N/A
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $249,362 $272,078 ---
Range of Awards $130,000-$3,000,000 $130,000-$3,000,000 ---
142
The data source for this measure is the National EMSC Data Analysis Resource Center (NEDARC). Data are
collected every 2 years.
143
Ibid.
144
The data source for this measure is the Data Coordinating Center.
205
Healthy Start
FY 2021 FY 2021
BA $121,962,000 $125,500,000 $125,500,000 ---
FTE 16 16 16 ---
Authorizing Legislation - Public Health Service Act, Section 330H, as amended by Public Law
110-339, Section 2
FY 2021 Authorization ......................................................................................................... Expired
Allocation Method:
Program Description
The 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.
Following a plateau between 2000 and 2005, the infant mortality rate declined nearly 16 percent
overall and 20 percent for non-Hispanic black infants between 2005 and 2017. However, the
non-Hispanic black infant mortality rate continues to be more than twice that for non-Hispanic
whites. The five leading causes of infant mortality include birth defects, preterm birth and low
birthweight, maternal pregnancy complications, Sudden infant death syndrome, and
injuries. There is a potential for reducing each of these causes of death, particularly among low-
income families and communities. Preterm birth (defined as birth at less than 37 completed
weeks of gestation) is a key risk factor for infant death. More than two-thirds of all infant deaths
occur among infants born preterm. After declining from 2007 to 2014, the U.S. preterm birth
rate increased nearly 4 percent from 9.57 percent in 2014 to 9.93 percent in 2017. Non-Hispanic
black women continue to be more likely to experience preterm birth than non-Hispanic white
women (13.93 and 9.05 percent, respectively, in 2017). Greater rates of preterm birth and
preterm-related infant deaths among non-Hispanic blacks account for over half of the infant
mortality gap compared to non-Hispanic whites. 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.
206
In FY 2019, Healthy Start funded 101 competitive grants in 34 States, the District of Columbia,
and Puerto Rico. 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. For
the FY 2019 competition, HRSA revised the program to a single funding level with a common
set of expectations for all grantees in order to maximize the capacity of recipients to focus on
service to pregnant women and infants. HRSA developed the single enhanced model and funding
based on performance data from the current recipients as well as recipient input gathered at
HRSA listening sessions. Recipient feedback indicated a desire to increase program capacity to
serve more pregnant women during the project period and promote healthy pregnancy outcomes.
Also for FY 2019, the program serves infants and families for the first 18 months after birth
instead of up to 2 years after birth. This change allows the program to focus resources on its key
purposes of infant mortality/women’s health/perinatal health and associated milestones (e.g.,
provision of interconception care), while still ensuring support for children through critical
milestones. This change also reflects feedback from current recipients in the field to increase
program capacity to serve more pregnant women within the project period and promote healthy
pregnancy outcomes.
Grantees use four 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) Improve family health and wellness to improve infant health and development;
3) Promote systems change to maximize opportunities for community action to address
social determinants of health; and
4) Assure impact and effectiveness to conduct ongoing HS workforce development, data
collection, 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 first 18 months after birth. 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, intimate partner 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,
in-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
207
 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;
Title V State Maternal and Child Health Services 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
use 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
supported the Healthy Start Collaborative Improvement and Innovation Network (HS CoIIN), a
collaborative learning partnership of 20 experienced grantees. This initiative strengthened the
program by providing feedback to HRSA on how to effectively support Healthy Start grantees.
In FY 2019, the Supporting Healthy Start Performance Project was awarded to a new provider to
continue the EPIC Center and provide capacity building activities such as training, technical
assistance, technology transfer, and information transfer/dissemination to Healthy Start
programs.
Starting in FY 2019, Healthy Start also supports a new initiative to reduce maternal mortality
through hiring of clinical service providers (e.g., nurse practitioners, certified nurse midwives,
physician assistants, and other maternal-child advance practice health professionals) to provide
clinical services, such as well-woman care and maternity care services, within program sites
nationwide. These activities are funded through the additional $12 million provided to HRSA in
the FY 2019 appropriation.
208
Program Accomplishments
Key program accomplishments highlighted below reflect FY 2018 outcomes among Healthy
Start program participants.
This is the final year of data reporting for the cohort of grantees initially funded in FY 2014.
Healthy Start serves high-risk women and their families in communities with elevated rates of
infant mortality and adverse perinatal outcomes. The program met or exceeded two of the three
performance measures for the program. The program did not meet its target for low birthweight
births, though performance has remained stable since 2015, potentially reflecting the program’s
focus on reaching the highest risk populations.
 An important risk factor for infant mortality is the timing of entry into prenatal care.
Healthy Start facilitates access to prenatal care for disadvantaged and high-risk
women. In 2018, 77.8 percent of Healthy Start participants initiated prenatal care during
the first trimester, exceeding the FY 2018 target of 75 percent.
 Low birth weight, or birth weight less than 2,500 grams, is a major contributor to infant
mortality. In 2018, 10.3 percent of infants born to Healthy Start participants were low
birth weight. Healthy Start did not meet the FY 2018 target of 9.6 percent. The
percentage of low birth weight births in Healthy Start has remained relatively stable
(approximately 10 percent) since 2015.
 The 2016-2018145 infant mortality rate among Healthy Start participants was 6.99 per
1,000 live births which may reflect the high risk population targeted by the program. For
comparison, the infant mortality rate in the United States for 2016-2017 was 5.83 per
1,000 live births (2018 data are not yet available from the Centers for Disease Control
and Prevention (CDC)/National Center for Health Statistics (NCHS)).
 In addition, the program is now monitoring a multi-year infant mortality rate among the
Healthy Start participants. This is the first year for which these data are being reported.
In 2018, the number of individuals receiving case managed services through the program
was 81,769. This exceeded the FY 2018 target of 69,000.
Consistent with the commitment to data-driven and evidence-based decision-making, in 2017,

the Healthy Start program initiated a national evaluation to explore associations between
program participation and participant-level characteristics, including behaviors, service use, and
health outcomes. By collaborating with the CDC and state vital records offices, the evaluation
was designed to examine the association between Healthy Start program participation and
145
A multi-year infant mortality rate (IMR) is reported for 2016-2018. This allows the Healthy Start program to
track infant mortality while taking into consideration that infant death is a rare event and when calculated within
small populations, such as the Healthy Start program population, IMRs can appear to change substantially if there is
even a small difference in the number of deaths within a single year. Such changes may be due to normal variation
and are not necessarily caused by actual change in the underlying risk. The IMRs for the single years 2016 to 2018
are as follows:
2016: Healthy Start 5.57 per 1,000 live births, United States 5.87 per 1,000 live births
2017: Healthy Start 9.47 per 1,000 live births, United States 5.79 per 1,000 live births
2018: Healthy Start 6.26 per 1,000 live births, United States (data not yet available from CDC/NCHS)
209
maternal and infant outcomes using linked vital statistics and CDC Pregnancy Risk Assessment
Monitoring System (PRAMS) data with a population-based external comparison group of non-
participants. It is anticipated that findings from this evaluation will be made publicly available by
the end of CY 2020.
Funding History
FY Amount
FY 2017 $118,251,000146
FY 2018 $110,300,000
FY 2019 $121,962,000
FY 2020 $125,500,000
FY 2021 $125,500,000
Budget Request
The FY 2021 Budget Request for the Healthy Start program of $125.5 million is the same as the
FY 2020 Enacted level. Within this total, funding is also continued at $15 million to allow
grantees to hire clinical service providers at Healthy Start sites to provide direct access to well
woman care and maternity care services. This will reduce barriers to care and better address
health disparities among high-risk and underserved women. In FY 2021, the program will
continue to serve women and families across the nation through the 101 grants awarded in the
FY 2019 funding cycle. Healthy Start expects to serve at least 75,000 participants in FY 2021
with case management 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.
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, site visits and other program support costs.
146
Includes one-time funding of $15 million provided for lead poisoning prevention services in Flint, Michigan.
210
Outcomes and Outputs Tables147
Year and Most

Recent Result /
Result Target +/-
12.III.A.1: The percentage of women
FY 2018: 77.8%
participating in Healthy Start who
have a prenatal care visit in the first
(Target Exceeded)
trimester (Output)
12.III.A.2. Percent of singleton births FY 2018: 10.3%
weighing less than 2,500 grams (low Target: 9.6% 9.6% 9.6% Maintain
birth weight) (Outcome) (Target Not Met)
FY 2018: 81,769
12.E.2 The number of persons case
Target: 69,000
managed in the Healthy Start 70,000 75,000 +5,000
(Target Exceeded)
Program (Output)
FY 2019 FY 2020 FY 2021

Final149 Enacted President’s Budget
Average Award $1,043,748 $1,122,334 $1,100,000
Range of Awards $154,262 - $1,092,899 $980,000 - $1,167,899 $1,100,000
147
Fiscal year targets reflects calendar year data. Awards are made annually in April, thus the bulk of the data
coincides with the fiscal year.
148
Does not include grant offsets. Does not include $2M for the Supporting Healthy Start Performance Project.
149
Does not include $4.9M for 13 awards, funded for 5 months, to get on cycle with remaining 87 awards in April.
Does not include $2M for the HS CoIIN.
211
Heritable Disorders in Newborns and Children
FY 2021 FY 2021
FY 2019 FY 2020
President’s +/-
Final Enacted
Budget FY 2020
BA $16,311,000 $17,883,000 --- -$17,883,000
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 2021 Authorization………………………………………………………………Expired
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 35 core 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 program is composed of six different projects.

 The Newborn Screening Data Repository and Technical Assistance Program 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 program also tracks and estimates the incidence of screened
conditions. These data help the program 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 program supports states with implementing
conditions recently added to the RUSP.
 The Quality Improvement in Newborn Screening Program supports states to improve
the outcomes of newborns with conditions identified through newborn screening by
improving:
o The amount of time it takes to identify infants at high risk for having one of these
conditions;
212
o The processes used for detecting out-of-range results; the procedures for reporting
out-of-range results to providers; and
o The methods state newborn screening programs use to confirm diagnoses.
In addition, the program addresses emerging issues, or any other newborn screening
process or procedure that could negatively affect the quality, accuracy, or timeliness of
newborn screening. 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 purpose of this program
is to develop and deliver educational programs about newborn screening, counseling,
testing, follow-up, treatment, and specialty services to parents, families, patient advocacy
and support groups.
 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.
 The Newborn Screening Interoperability portfolio includes 2 programs: the State
Newborn Screening Interoperability Planning Program and the Innovations in
Newborn Screening Interoperability. The purpose of these programs is to provide state
newborn screening programs with expertise, training, and education in informatics and to
support programs in the development and implementation of comprehensive data
interoperability plans. The aim is to ensure accurate and timely data sharing between
entities involved in the newborn screening system, including hospitals, providers,
laboratories, registries, vital records and other state programs. The overall goal is to
improve outcomes for newborns and children affected by a condition identified through
newborn screening.
Until FY 2020, the Heritable Disorders in Newborns and Children program also supported the
Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (the
Committee). The statutory authority for the Committee expired on September 30, 2019. All
official business related to the Committee is halted at this time. The Committee previously
provided national newborn screening guidance and standards as well as advised the Secretary on
reducing mortality or morbidity from heritable disorders, conducted evidence-based reviews of
conditions to recommend updates to the RUSP, and considered ways to ensure state and territory
capacity to screen for RUSP conditions.
213
Since 2009, the program also supports the Clearinghouse of Newborn Screening Information 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.
Funding History
FY Amount
FY 2017 $13,850,000
FY 2018 $15,788,085
FY 2019 $16,311,000
FY 2020 $17,883,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Heritable Disorders in Newborns and Children program of
$0 million is $17.883 million below the FY 2020 Enacted level. 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. The Budget includes an increase of $60.0 million in funding for
Maternal and Child Health (MCH) Block Grant formula awards to states to provide states with
additional flexibility to support activities previously funded through a number of MCH
categorical grant programs, including the Heritable Disorders in Newborns and Children
program.
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $763,590 $678,955 ---
Range of Awards $103,000-$3,300,000 $103,000-$3,300,000 ---
214
Pediatric Mental Health Care Access
FY 2021 FY 2021
BA $9,956,000 $10,000,000 $10,000,000 ---
FTE 2 2 2 ---
Authorizing Legislation – Public Health Service Act, § 330M (42 U.S.C. § 254c-19), as added by
the 21st Century Cures Act, Section 10002 (P.L. 114-255)
FY 2021 Authorization.………………………………………………………………...$9,000,000
Allocation Method
The Pediatric Mental Health Care Access Program promotes behavioral health integration in
pediatric primary care by supporting the development of new, or the improvement of existing,
statewide or regional pediatric mental health care telehealth access programs. These programs
provide tele-consultation, training, technical assistance, and care coordination for pediatric
primary care providers to diagnose, treat and refer children with behavioral health conditions.
This program works to address the shortages of psychiatrists, developmental-behavioral
pediatricians, and other behavioral health clinicians who can identify behavioral disorders in
children and adolescents and provide appropriate services through telehealth technologies that
support and promote long-distance clinical health care, clinical consultation, patient and
professional health-related education, public health and health administration.
A total of 13-20 percent of children living in the United States experience a mental disorder in a
given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to
be increasing.150 However, between 2010 and 2012, the percent of youth receiving any outpatient
mental health service was estimated to be 13.3 percent.151
Compounding this, 34.3 percent of the U.S. population lives in a designated Mental Health
Professional Shortage Area (population of designated MH HPSAs/U.S. population as of
September 30, 2019) and only 27.2 percent of the need for mental health care in these Mental
150
Centers for Disease Control and Prevention. Mental Health Surveillance Among Children – United States, 2005-
2011. Morbidity and Mortality Weekly Report 2013:62(02), 1-35.
151
Olfson, M, Druss, BG, Marcus, SC. Trends in Mental Health Care among Children and Adolescents. The New
England Journal of Medicine. 2015:372, 2029-2038.
215
Health Professional Shortages Areas has been met.152 Primary care physicians in these areas are
often the first to identify behavioral health disorders and provide services. These primary care
providers are able to identify severe behavioral health problems, but often have difficulty in
identifying milder cases. This under-identification and lack of access to needed services may
lead to conditions severe enough to impair child, adolescent, and family functioning, school
performance, and safety.
Telehealth strategies, like the ones supported by the Pediatric Mental Health Care Access
Program, connect primary care providers with specialty mental and behavioral health care
providers and can be an effective means of increasing access to mental and behavioral health
services for children and adolescents, especially those living in rural and other underserved
areas. Results from this program are expected to be shared with the field and scaled up as
feasible and appropriate.
performance reviews, information technology, and other program support costs.
Funding History
FY Amount
FY 2018 $10,000,000
FY 2019 $9,956,000
FY 2020 $10,000,000
FY 2021 $10,000,000
Budget Request
The FY 2021 Budget Request for the Pediatric Mental Health Care Access program of $10
million the same as the FY 2020 Enacted level. The Budget Request will continue to support
21 statewide or regional pediatric mental health care telehealth access programs providing tele-
consultation, training, technical assistance, and care coordination for pediatric primary care
providers to diagnose, treat and refer children with behavioral health conditions.
152
Health Resources and Services Administration. Bureau of Health Workforce. Designated Health Professional
Shortage Areas Statistics (September 30, 2019). Retrieved 12/2019.
https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport
216
Outputs and Outcomes Tables
FY
Year and Most
2021
Recent Result FY FY
Target
/Target for 2020 2021
Measure +/- FY
2020
(Summary of
Target
Result)
52.1: Number of primary care providers
FY 2019
enrolled in a statewide or regional pediatric
(Baseline)153: N/A N/A ---
mental health care access program.
2,091
52.2: Percentage of primary care providers
enrolled in a statewide or regional pediatric FY 2019
mental health care access program who (Baseline): N/A N/A ---
receive tele-consultation on behavioral 48.7%
health conditions (Developmental) (Output)
52.3: Number of children and adolescents,
0-21 years of age, seen by primary care
providers enrolled in a statewide or regional
pediatric mental health care access program, FY 2019
N/A N/A ---
who received at least one screening for a (Baseline): 0
behavioral health condition using a
standardized validated tool (Developmental)
(Output)
52.4: Among children and adolescents, 0-21
years of age, seen by primary care providers
mental health care access program and who
FY 2019
received at least one screening for a N/A N/A ---
(Baseline): 0
behavioral health condition using a
standardized validated tool, the percentage
who screened positive for a behavioral
health condition (Developmental) (Output)
153
FY 2019 baseline data was collected via EHB Request for Information (RFI) from 8 of 21 grantees. All grantees
will be reporting first year data in February 2020 via EHB RFI. Targets for FY 2020 and FY 2021 will be set at that
time. These measures are being incorporated into the DGIS, and data will be collected from grantees using the NCC
performance reports for future year reporting.
217
FY
Year and Most
2021
Recent Result FY FY
Target
/Target for 2020 2021
Measure +/- FY
2020
(Summary of
Target
Result)
52.5: Among children and adolescents, 0-21
years of age, seen by primary care providers
mental health care access program, who
FY 2019
screened positive for a behavioral health N/A N/A ---
(Baseline): 0
condition, the percentage who received
treatment from the primary care providers or
a referral to a behavioral clinician
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $438,828 $440,569 $440,569

Range of Awards $337,425 – $445,000 $337,425 - $445,000 $337,425 - $445,000
218
Screening and Treatment for Maternal Depression and Related Behavioral
Disorders
FY 2021 FY 2021
BA $4,978,000 $5,000,000 $5,000,000 ---
FTE 1 1 1 ---
Authorizing Legislation – Public Health Service Act, Section 317L-1, as added by the 21st
Century Cures Act, Section 10005 (P.L. 114-255)
FY 2021 Authorization ………………………………………………………...……..$5,000,000
Allocation Method
The Screening and Treatment for Maternal Depression and Related Behavioral Disorders
Program expands health care providers’ capacity to screen, assess, treat, and refer pregnant and
postpartum women for maternal depression and related behavioral health disorders by providing
training, real-time psychiatric consultation, and care coordination support to front-line health
care providers, including in rural and underserved areas.
This program improves the mental health and well-being of pregnant and postpartum women and
the social and emotional development of their infants. Experienced by one in seven women,154
depression is the most common complication of pregnancy and within the first year of
delivery.155 Additionally, substance use can co-occur with mental disorders and is at least as
common as many of the medical conditions typically screened for and managed during
pregnancy.156 These issues affect not only the mother, but can also affect the child’s cognitive
and emotional development. Intervening early and offering integrated services and support can
prevent or reverse these affects.
154
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic
review of prevalence and incidence. Obstet Gynecol 2005;106:1071–83.
155
American College of Obstetricians and Gynecologists 2015 committee opinion (Reaffirmed 2016), Screening for
Perinatal Depression. Retrieved 7/2017 https://www.acog.org/Resources-And-Publications/Committee-
Opinions/Committee-on-ObstetricPractice/Screening-for-Perinatal-Depression
156
Wright, T.E., Terplan, M., Ondersma, S.J., Boyce, C., Yonkers, K., et al. (2016). The role of screening, brief
intervention, and referral to treatment in the perinatal period. American Journal of Obstetrics & Gynecology, 215(5),
539-547.
219
Despite the importance of screening and early intervention, these services are often unavailable
due to limited access to behavioral health resources for front-line health care providers. A
nationwide shortage of psychiatrists, especially perinatal psychiatrists, compounds this issue.
Women in rural and medically underserved areas are especially vulnerable to these shortages and
experience poorer health outcomes than urban women.
The Screening and Treatment for Maternal Depression and Related Behavioral Disorders
Program addresses these gaps by employing strategies such as telehealth to provide front-line
health care providers with real-time psychiatric consultation and care coordination support, and
training on evidence-based and culturally and linguistically appropriate screening, assessment,
and treatment protocols. Project activities will increase universal screening in project areas, and
improve access to treatment and referral for maternal depression and related behavioral health
disorders, such as anxiety and substance use disorder, for pregnant and postpartum women.
Funding History
FY Amount
FY 2018 $5,000,000
FY 2019 $4,978,000
FY 2020 $5,000,000
FY 2021 $5,000,000
Budget Request
The FY 2021 Budget Request for the Screening and Treatment for Maternal Depression and
Related Behavioral Disorders program of $5 million is the same as the FY 2020 Enacted level.
The Budget Request will continue to support 7 awards to expand health care providers’ capacity
to screen, assess, treat, and refer pregnant and postpartum women for maternal depression and
related behavioral health disorders by providing training, real-time psychiatric consultation, and
care coordination support to front-line health care providers, including in rural and underserved
areas.
Grant Awards Table

Average Award $646,210 $646,379 $646,379
Range of Awards $627,525-$650,000 $627,525-$650,000 $627,525-$650,000
220
Family-To-Family Health Information Centers
FY 2021 FY 2021
FY 2019 FY 2020
President’s +/-
Final Enacted
Budget FY 2020
Mandatory Funding $6,000,000 $6,000,000 $6,000,000 ---
FTE 1 1 1 ---
Authorizing Legislation - Social Security Act, Section 501(c)(1)(A) as amended by Public Law
114-10, Section 216, Public Law 115-123, Section 50501, and Public law 116-39
FY 2021 Authorization………………………………………………………………...$6,000,000
Allocation Method:
 Competitive grant/co-operative agreement
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. Initially authorized by the Deficit Reduction Act
of 2005, the program funded one health information center in each of the 50 states and the
District of Columbia. Since then, F2F HICs have been developed in all territories and also for
Indian tribes. Most recently, the Sustaining Excellence in Medicaid Act of 2019 reauthorized the
program through FY 2024.
The 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;
 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.
221
Research supports the effectiveness of the F2F HIC strategy.157 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.158 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 2018 F2F HICs provided services to 181,938 families, which exceeded the target of
174,300 families. In addition, in FY 2018, F2F HICs trained and provided information,
resources, and referrals to 83,859 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.
Funding History
FY Amount
FY 2017159 $4,655,000
FY 2018 $6,000,000
FY 2019 $6,000,000
FY 2020 $6,000,000
FY 2021 $6,000,000
Budget Request
The Family-to-Family Health Information Centers (F2F HICs) program is funded at $6 million
for each fiscal year through FY 2024.
FY 2021 funding will support 59 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 2021 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
157
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
158
Singer, G. H., Marquis, J., Powers, L. K., Blanchard, L., Divenere, N., Santelli, B., et al. (1999). A multi-site
evaluation of parent to parent programs for parents of children with disabilities. Journal of Early
Intervention, 22(3), 217-229 and Rearick, E. M., Sullivan-Bolyai, S., Bova, C., & Knafl, K. A. (2011).
159
222
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

FY 2020 FY 2021 Target +/-
Target for
Target Target FY 2020
Recent Result
Target
(Summary of
Measure Result)
15.III.C.1: Number of families with FY 2018:
CYSHCN who have been provided 181,938 160
184,250 184,250
information, education and/or training Target: 166,000 Maintain
from Family-to-Family Health (Target
Information Centers (Output) Exceeded)
15.III.C.2: Number of professionals
who serve CYSHCN who have been
provided information, education FY 2018:
84,700 84,700 Maintain
and/or training from Family-to- 83,859 161
Family Health Information Centers
15.III.C.3: Percentage of families
with CYSHCN served who report that
the information or services received
FY 2018162:
from Family-to-Family Health
Baseline data
Information Centers helped prepare N/A N/A ---
available August
them to work with those who serve
2020
their children (Developmental)
(Outcome)
160
The data source for this measure was collected by Family Voices.
161
Ibid.
162
The data source for this measure will be collected from grantee surveys.
223
Year and Most
FY 2020 FY 2021 Target +/-
Target for
Target Target FY 2020
Recent Result
Target
(Summary of
Measure Result)
15.III.C.4: Percentage of
professionals served who reported the
information or services received from
FY 2018163:
the Family-to-Family Health
Baseline data
Information Centers helped prepare N/A N/A ---
available
them to work better with families of
August 2020
CYSHCN and/or others who serve
CYSHCN (Developmental)
(Outcome)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $96,758 $96,750 $96,750
Range of Awards $96,750-$97,200 $96,750 $96,750
163
The data source for this measure will be collected from grantee surveys.
224
Maternal, Infant, and Early Childhood Home Visiting Program
FY 2021 FY 2021
Mandatory Funding $400,000,000 $376,400,000164 $400,000,000 ---
FTE 38 38 38 ---
Authorizing Legislation - Social Security Act, Section 511(j), as amended by Public Law 115-
123, Section 50601
FY 2021 Authorization ................................................................................................$400,000,000
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.
By providing necessary resources and supports, home visiting empowers families. Evidence-
based home visiting can be cost-effective in the long term, with the largest benefits coming
through reduced spending on government programs and increased individual earnings.165
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;
164
165
Michalopoulos, C, et. al. (2017). Evidence on the Long-Term Effects of Home Visiting Programs: Laying the
Groundwork for Long-Term Follow-Up in the Mother and Infant Home Visiting Program Evaluation (MIHOPE).
OPRE Report 2017-73. Available at: https://files.eric.ed.gov/fulltext/ED579153.pdf.
225
 Crime;
 Domestic violence;
 High rates of high school drop-outs;
 Substance abuse;
 Unemployment; or
 Child maltreatment.166
Grantees deliver services by implementing one or more of 17 evidence-based home visiting

models, selected by the grantee, which meet HHS established evidence of effectiveness criteria
and MIECHV criteria for implementation. 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 17 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.
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, which will be updated by October 1, 2020, as required under the Bipartisan Budget
Act of 2018, 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.
MIECHV currently distributes funds for delivery of services under early childhood home visiting
programs through two 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.
166
42 U.S.C. § 711(b)(1)(A).
226
Additionally, three percent is set aside for research, evaluation, and corrective action technical
assistance to grantees.
Formula grants to states and territories

In FY 2019, HRSA awarded $351 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 2019, 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 ($12 million) is set aside for five-year competitive awards available to
tribal entities. As of FY 2019, 29 tribal entities had received funding through the Tribal Home
Visiting program, administered by ACF. There are currently 23 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
 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).
MIECHV state and territory grantees provided 5.2 million visits from FY 2012 through FY 2019.
In FY 2019 states reported serving more than 154,000 parents and children in 896 counties
across all 50 states, the District of Columbia, and five territories. This is a 350 percent increase in
the number of participants served since FY 2012 (see Tables 1 and 2 below). Tribal grantees
provided over 90,298 home visits from FY 2012 to FY 2018 and served over 3,751 parents and
children in FY 2018.167
167
FY 2018 is the most recently available data for Tribal grantees.
227
Table 1: Number of State/Territory Participants (FY 2012 – FY 2019)168
Fiscal Year Number of Participants

2012 34,180
2013 75,970
2014 115,545
2015 145,561
2016 160,374
2017169,170 156,297
2018171 150,291
2019 154,496
Table 2: Number of Home Visits by State/Territory Grantees (FY 2012 – FY 2018)
Fiscal Year Number of Home Visits

2012 174,257
2013 489,363
2014 746,303
2015 894,347
2016 979,521
2017172,173 942,676
2018174 930,595
2019 1,015,217
MIECHV currently serves approximately 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.
168
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).
169
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.
170
Does not include data from Puerto Rico and the U.S. Virgin Islands due to reporting delays caused by Hurricanes
Maria and Irma.
171
Does not include data from the Commonwealth of the Northern Mariana Islands due to reporting delays caused
by Super Typhoon Yutu.
172
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.
173
Does not include data from Puerto Rico and the U.S. Virgin Islands due to reporting delays caused by Hurricanes
Maria and Irma.
174
Does not include data from the Commonwealth of the Northern Mariana Islands due to reporting delays caused
by Super Typhoon Yutu.
228
MIECHV serves many at-risk families. In FY 2019:
 70 percent of participating families had household incomes at or below 100 percent of
the federal poverty guidelines ($25,750 for a family of four), and 41 percent were at or
below 50 percent of those guidelines;
 26 percent of adult program participants had less than a high school education, and 37
percent had only a high school degree or equivalent; and
 12 percent of households included pregnant teens; 20 percent of households reported a
history of child abuse and maltreatment; and 14 percent of households reported
substance abuse.
Performance data collected to fulfill the statutory requirement of a three-year assessment of
improvement175 were most recently updated in FY 2016. These data indicate that 98 percent of
states, territories, and non-profit grantees 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.
Following a redesign of the MIECHV performance measurement system, awardees began

reporting on 19 standardized performance indicators and systems outcome measures in FY 2017.
These new performance measures 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. Women enrolled in the
MIHOPE evaluation faced 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. Released in
November 2018,176 findings from the MIHOPE Implementation Report include: that the local
175
Performance data represent data submitted after three years of program implementation as required under Social
Security Act, Title V, § 511(d)(1)(B)
176
Duggan, Anne, Ximena A. Portilla, Jill H. Filene, Sarah Shea Crowne, Carolyn J. Hill, Helen Lee, and Virginia
Knox (2018). Implementation of Evidence-Based Early Childhood Home Visiting: Results from the Mother and
Infant Home Visiting Program Evaluation, OPRE Report # 2018-76A, Washington, DC: Office of Planning,
Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human
Services.
229
programs that participated in MIHOPE served eligible families in disadvantaged communities
with high levels of socioeconomic risk as intended by the program; most home visitors were well
educated, trained and experienced; local programs focused on improving parenting and child
development outcomes; and the tailoring of services to families’ needs was especially evident in
areas of substance use, mental health, and intimate partner violence. The MIHOPE Impact
Report, released in January 2019,177 presents evidence that MIECHV-funded home visiting
services had positive effects for the families that participated in services, including in the quality
of the home environment and the frequency of psychological aggression towards the child. The
study provides evidence that differences in effects among the evidence-based models are
generally consistent with the models’ focuses.
Funding History
FY Amount
FY 2017178 $372,400,000
FY 2018 $400,000,000
FY 2019 $400,000,000
FY 2020179 $376,400,000
FY 2021 $400,000,000
Budget Request
The Maternal, Infant, and Early Childhood Home Visiting Program is funded at $400 million for
each fiscal year through FY 2022.180 FY 2021 funding will support the state, territory, and tribal
administration of locally run voluntary, evidence-based home visiting services for at-risk
families that have been proven to help 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;

 Awards to 23 tribal entities; and
 Support for research, evaluation, and technical assistance for both corrective action and
program improvement for state, territory, and tribal MIECHV grantees.
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
177
Michalopoulos, Charles, Kristen Faucetta, Carolyn J. Hill, Ximena A. Portilla, Lori Burrell, Helen Lee, Anne
Duggan, and Virginia Knox. 2019. Impacts on Family Outcomes of Evidence-Based Early Childhood Home
Visiting: Results from the Mother and Infant Home Visiting Program Evaluation. OPRE Report 2019-07.
Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S.
Department of Health and Human Services.
178
179
180
FY 2020 and FY 2021 are subject to sequestration.
230
Home Visiting Research and Development Platform, the Home Visiting Collaborative
Improvement and Innovation Network, a multi-site implementation study of Tribal Home
Visiting, 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 Recent
Result FY 2021
(Summary of FY 2020 FY 2021 Target +/- FY
Measure Result) Target Target 2020 Target
37.1: Number of home State/ State/ State/ Maintain
visits to families receiving Territory/ Territory/ Territory/
services under the Tribal: Tribal: Tribal:
MIECHV Program.181 FY 2019182: 1,033,000 1,033,000
(Output) 1,033,189
Target: 960,000
(Target
Exceeded)
181
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.
182
Home Visiting Information System (HVIS). Results reflect the most recent data available, which include FY
2019 data for state and territory grants and FY 2018 data for Tribal grants.
231
Year and Most
Recent Result /
Target for Recent
Result FY 2021
(Summary of FY 2020 FY 2021 Target +/- FY
Measure Result) Target Target 2020 Target
37.2: Number and percent State/Territory: State/ State/Territory: State/Territory:
of grantees that meet FY 2016: 55 Territory: 55 (98%) Maintain
benchmark area data (98%)183 55 (98%)
requirements for Target: 53 (95%) Tribal: 22 Tribal:
demonstrating (Target Tribal: 22 (88%) Maintain
improvement. (Outcome) Exceeded) (88%)
Tribal:
FY 2017: 24
(96%)
Target: 20 (80%)
(Target
Exceeded)
37.3: Number of State/ State/ State/ Maintain
participants served by the Territory/Tribal: Territory/ Territory/
MIECHV Program FY 2019184: Tribal: Tribal:
(Output) 153,247 160,000 160,000
Target: 160,000
(Target Not Met)
37.4: Percent of children FY 2019185: 72.6% N/A N/A ---
enrolled in MIECHV who
received daily early (Baseline186):
language and literacy 65.4%
support from a family
member (Developmental)
37.5: Percent of parents FY 2019187: 80.0% N/A N/A ---
enrolled in MIECHV who
were screened for Baseline188: 76.5%
depression after enrollment
or after giving birth
(Developmental)
183
Ibid. Per statute, an initial assessment of improvement occurred after three years of program implementation.
Current statute requires the next assessment of improvement following FY 2020, and every 3 years thereafter.
184
Ibid. Results reflect the most recent data available, which includes FY 2019 data for state and territory grants and
FY 2018 data for Tribal grants.
185
Ibid. Results reflect state and territory grants only and reflect a two-year average from FY 2018 and FY 2019.
186
187
188
232
Grant Awards Tables189
FY 2019 FY 2020 FY 2021

Final Enacted190 President’s Budget
Average Award $4,589,742 $4,297,152 $4,589,742
Range of Awards $300,000-$20,813,184 $300,000-$20,813,184 $300,000-$20,813,184
189
Does not include carryover funding.
190
FY 2020 reflects post-sequestration funding
233
Ryan White
HIV/AIDS
TAB
234
RYAN WHITE HIV/AIDS

The Ryan White HIV/AIDS Program (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 people with HIV. Sixty one percent of clients (patients)
live at or below 100 percent of the Federal poverty level and approximately three-quarters of
RWHAP clients are racial/ethnic minorities. The RWHAP statute indicates that the program is
the “payor of last resort,” meaning RWHAP funds can only be used for allowable services not
covered by other Federal or state programs, or private insurance. Since 1990, RWHAP has
developed a comprehensive system of safety net providers who deliver high quality direct health
care and support services to over half a million people with HIV191 – more than 50 percent of all
people with diagnosed HIV in the United States.192 This is one of the many reasons why HRSA
is leading key components of the Ending the HIV Epidemic: A Plan for America - a 10-year
initiative beginning in FY 2020.
Working within the RWHAP statute, funding priorities are guided by stakeholders at local and
state levels, resulting in uniquely structured programs that address their jurisdictions’ critical
gaps and needs. HRSA also works in partnership with RWHAP recipients at state and local
levels to use innovative, evidence informed approaches for community engagement, needs
assessment, planning processes, policy development, service delivery, clinical quality
improvement, and workforce development activities that are needed to support a robust system
of HIV care, support and treatment.
The RWHAP provides HIV care and treatment services to a higher proportion of certain
populations with HIV than their representation in the epidemic nationally. For example,
according to the most recent Centers and Disease Control Prevention (CDC) data, 70 percent of
people with diagnosed HIV in the United States are racial/ethnic minorities, while 73 percent of
RWHAP clients are racial/ethnic minorities, meeting the target (to be within 3 points of the
national percentage) by 3 percentage points.193 Similarly, 24 percent of people with diagnosed
HIV in the United States are women, while 27 percent of RWHAP clients are women, meeting
the target (to be within 3 percentage points of the national percentage) by 3 percentage points.
The RWHAP is critical to ensuring that individuals with HIV are linked to care, retained in care,
able to adhere to medication regimens, and ultimately, achieve viral suppression. These steps are
not only crucial to ensuring the health outcomes of people with HIV but to preventing further
191
Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data
Report 2018. http://hab.hrsa.gov/data/data-reports. Published December 2019. Accessed December 2, 2019.
192
Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (Preliminary); vol. 30.
http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2019. Accessed December 3,
2019.
193
2019.
235
transmission of the virus,194 which furthers the public health goal of ending the HIV epidemic in
the United States.195 Research studies demonstrate that people with HIV who take HIV
medications daily as prescribed, and achieve and then maintain an undetectable viral load, have
effectively no risk of sexually transmitting the virus to an HIV uninfected partner.196,197 In the
RWHAP, 87.1 percent of patients receiving RWHAP medical care are virally suppressed 198
compared to the general population of people with diagnosed HIV, who have a viral suppression
rate of 62.7 percent,199200 - an outcome measure that demonstrates the success of the program and
results in major public health benefits.
According to a Clinical Infectious Diseases study, clients receiving care and support at RWHAP-
funded facilities are associated with improved outcomes (such as viral suppression), compared to
those not served by the RWHAP.201 Furthermore, RWHAP patients are more likely to reach viral
suppression regardless of other health care coverage (e.g., uninsured, Medicaid, Medicare, or
private insurance). Not only do improved viral suppression rates reduce the transmission of HIV,
they also result in significant cost-savings to the health care system.202
The RWHAP has made tremendous progress toward ending the HIV epidemic in the United
States: from 2010 to 2018, HIV viral suppression among RWHAP patients has increased from
69.5 percent to 87.1 percent, and racial/ethnic, age-based, and regional disparities have
decreased.203 However, even with these positive outcomes, fully addressing the HIV epidemic
domestically continues to be a challenge as the CDC estimates more than 1.1 million people in
194
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United
States, 2010–2016. HIV Surveillance Supplemental Report, 2019; vol. 24. http://www.cdc.gov/
hiv/library/reports/hiv-surveillance.html. Published February 2019. Accessed August 23, 2019
195
The goal of HIV treatment is to decrease viral load in people with HIV, ideally to an undetectable level, known
as viral suppression. When viral suppression is achieved and maintained, the risk of transmitting HIV is reduced.
196
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.
197
Rodger AJ et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in
serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA,
2016;316(2):1-11. DOI: 10.1001/jama.2016.5148. (12 July 2016). Full free access.
198
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.
199
Harris NS, Johnson AS, Huang YA, et al. Vital Signs: Status of Human Immunodeficiency Virus Testing, Viral
Suppression, and HIV Preexposure Prophylaxis — United States, 2013–2018. MMWR Morb Mortal Wkly Rep
2019;68:1117–1123. DOI: http://dx.doi.org/10.15585/mmwr.mm6848e1
200
Based on data reported by 41 States and the District of Columbia.
201
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.
202
The lifetime cost of medical care and medications for a person with HIV 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.
203
Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data
Report 2016. http://hab.hrsa.gov/data/data-reports. Published November 2017. Accessed July 20, 2018.
236
the United States have HIV, and almost 1 in 7 are unaware of their HIV.204 In addition,
approximately 40,000 HIV diagnoses occur every year.205
Ending the HIV Epidemic: A Plan for America
Beginning in FY 2020, the Ending the HIV Epidemic: A Plan for America (EHE) initiative aims
to reduce new HIV infections to less than 3,000 per year by 2030. The multi-year EHE initiative
will focus on 48 counties, Washington, D.C., San Juan (PR), as well as 7 states that have a
substantial rural HIV burden. The initiative will bring the additional expertise, technology, and
resources needed to end the HIV epidemic in the United States. The four Pillars of the initiative –
Diagnose, Treat, Prevent, and Respond – will be implemented across the entire U.S. over the 10
years. Without this EHE initiative, new infections will continue and could increase, costing more
lives and the U.S. government more than $200 billion in direct lifetime medical costs for HIV
prevention and medication.
HRSA cooperative agreements will be awarded to the 39 RWHAP Part A recipients and 8 Part B
recipients that encompass the 48 counties, Washington, D.C., San Juan (PR), as well as 7 states
that have a substantial rural HIV burden. Jurisdictions will utilize their existing infrastructure to
implement effective and innovative strategies, interventions, approaches, and services to reduce
new HIV infections in the United States. Strategies for implementation are:
 Implementing evidence-informed practices shown to increase linkage, engagement, and
retention in care targeted to those not yet diagnosed, those diagnosed but not in HIV care,
and those who are in HIV care but not yet virally suppressed;
 Expand re-engagement and retention efforts for people with HIV who are not currently in
care or who are not virally suppressed;
 Providing technical assistance and systems coordination to support effective strategic plans
and activities to successfully implement the new initiative; and
 Expand workforce capacity through the efforts of the AIDS Education and Training Centers
(AETCs).
The RWHAP’s comprehensive system of HIV care and support services and effective system for
medication delivery creates a very efficient and effective service delivery mechanism for this
initiative.
Additional Priorities and Collaborative Efforts

In FY 2021, the HRSA RWHAP program will continue to ensure effective use of resources and a
coordinated and focused public health response to HIV. HRSA will also continue to coordinate
and collaborate with other federal, state, and local entities as well as national HIV organizations
to further leverage and promote efforts to address the unmet care and treatment needs of people
with HIV who are uninsured and underserved. These efforts help to align priorities, policies, and
204
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–
2016. HIV Surveillance Supplemental Report 2019;24(No. 1). http://www.cdc.gov/ hiv/library/reports/hiv-
surveillance.html. Published February 2019. Accessed December 4, 2019.
205
2019.
237
activities in sustaining a multi-faceted and comprehensive Federal response to the HIV epidemic.
Federal partners include the Office of the Assistant Secretary for Health (OASH), the Center for
Disease Control (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 National HIV/AIDS Strategy (NHAS) for the United States: The NHAS provides a roadmap
for federal, state, and local governments, national and community based organization, health care
providers, people with HIV, and others. The goals are to reduce new HIV infections; increase
access to care and improve health outcomes for people with HIV; reduce HIV-related health
disparities and health inequities; and achieve a more coordinate national response to the HIV
epidemic. The RWHAP will continue to coordinate with other Federal partners, grant recipients,
and other partners to work towards achieving these four goals.
Perinatal Transmission: To achieve the Administration’s goal of elimination of mother-to-child

(perinatal) HIV transmission, the CDC and HRSA will continue efforts to invest in eliminating
mother-to-child HIV transmission efforts, primarily through ongoing collaborations with state
health departments and RWHAP providers.
Substance Use Disorder/Opioid Epidemic: In support of HHS’s efforts to lead a national

response to the opioid crisis, HRSA will continue to work collaboratively with other Federal
partners to address opioid use disorder screening, treatment, and support for people with HIV.
Modernization
The Administration looks forward to working with the Congress to reauthorize the RWHAP to
ensure that the allocation of Federal funds address the changing landscape of HIV across the
United States. The FY 2021 Budget Request includes the following statutory changes through
the RWHAP authorization which will also help support the Ending the HIV Epidemic initiative:
RWHAP Part A and B Supplemental Funding Methodologies: Reauthorization of the

RWHAP should include changes to the funding methodologies for Parts A and B
Supplemental funding to ensure that funds may be allocated to target populations
experiencing high or increasing levels of HIV infections/diagnoses, such as minority
populations, while continuing to support Americans with HIV across the nation. African
Americans, for example, account for a higher proportion of new HIV diagnoses
compared to other races/ethnicities. This data-driven approach would reduce burden for
recipients and increase HHS’s ability to effectively focus resources for HIV care,
treatment, and support needs in states and eligible metropolitan areas based on metrics of
need, geography, data quality, and performance.
Simplification and Modernization: The proposed changes would simplify, modernize and
standardize certain statutory requirements and definitions for consistency across RWHAP
238
Parts. This would reduce burden, align and consolidate the differing provisions, eliminate
those provisions in the statute that are no longer current as well as update certain
provisions to make the statute more consistent with the current state of the US epidemic,
and better direct resources to the jurisdictions where clients are currently residing. An
example is modernizing data collection for the RWHAP to include the collection and
submission of patient residential zip codes in order to better understand geographic
distribution of patient demographics, outcomes and service utilization; understand the
impact of the RWHAP by geographic location, including urban and rural differences; and
display RWHAP patient data in alignment with CDC HIV surveillance data to determine
shifts and trends. RWHAP patient level data is de-identified and encrypted prior to
submission to HRSA so appropriate privacy protections are in place to ensure patient
privacy and confidentiality.
Measuring Future Performance
Together, in FY 2021 RWHAP Parts A-D programs are anticipated to achieve the following
performance goals:
 In FY 2021, the RWHAP will serve racial/ethnic minorities at a proportion not lower
than 3 percentage points of national HIV prevalence data as reported by CDC.
 In FY 2021, 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.
 In FY 2021, at least 83 percent of all patients receiving HIV medical care and at least one
viral load test will be virally suppressed.
Additional RWHAP Part-specific performance targets are in the sections that follow.
239
Outcomes and Outputs Table for Over-Arching Performance Measures
Year and Most

Recent Result /
Result / FY 2020 FY 2021 +/-
Measure (Summary of Result) Target Target FY 2020
people with diagnosed 2018: 73% Not lower Not lower
HIV served by the Ryan Target: Within 3 than 3 than 3
White HIV/AIDS percentage points of percentage percentage Maintain
Program who are CDC data or 70% points of points of
racial/ethnic (Target Met) CDC data CDC data
minorities.(Output)
2018: 27% Not lower Not lower
people with diagnosed
Target: Within 3 than 3 than 3
HIV served by the Ryan
percentage points of percentage percentage Maintain
White HIV/AIDS
CDC data or 24% points of points of
Program who are
(Target Met) CDC data CDC data
women.(Output)
16.III.A.4: Percentage of
Ryan White HIV/AIDS
Program clients receiving 2018: 87.1%
HIV medical care and at Target: 83% 83% 83% Maintain
least one viral load test (Target Exceeded)
who are virally
suppressed. (Outcome)
240
RWHAP Part A - Emergency Relief Grants
FY 2021 FY 2021
BA $655,876,000 $655,876,000 $655,876,000 ---

MAI (non
add) $54,105,000 $54,105,000 $54,105,000 ---
Total
Funding $655,876,000 $655,876,000 $655,876,000 ---
FTE 44 44 44 ---
111-87
FY 2021 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 areas 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. Seventy-two percent of all people
with diagnosed HIV reside in a RWHAP Part A EMA or TGA. 206,207
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 with
HIV. The RWHAP requires EMAs and TGAs to utilize local needs assessments and planning
processes to develop coordinated systems of HIV care in order to improve health outcomes for
low-income people with HIV, thereby reducing transmission of HIV.
206
2019.
207
Centers for Disease Control and Prevention. HIV/AIDS data through December 2017 provided for the Ryan
White HIV/AIDS Program, for fiscal year 2019. HIV Surveillance Supplemental Report 2019;24(No. 6).
http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2019. Accessed December 3, 2019.
241
RWHAP Part A prioritizes primary medical care, access to antiretroviral treatment, and other
core medical and supportive services in order to engage and retain people with HIV in care. The
grants fund systems of care to provide services for people with HIV in 24 EMAs, which are
jurisdictions with 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 people with
diagnosed 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
RWHAP Parts A – D, and Part F AIDS Education and Training Center programs to evaluate and
address the disproportionate impact of HIV 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 with diagnosed 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. Seventy-five percent of RWHAP Part A funds must be used to support
core medical services. Eligible sub-recipients are community health centers, health departments,
ambulatory care facilities, and other non-profit organizations providing services for people with
HIV.
In 2018, 77 percent of RWHAP Part A clients were racial/ethnic minorities and 25 percent were
women. In 2018, RWHAP Part A funded sites provided 3.6 million core medical service visits
for health-related care utilizing a combination of RWHAP Parts A, B, C, and D funding. The
number of visits for health-related services demonstrates the scope of RWHAP Part A in
delivering primary care and related services for people with HIV by increasing the availability
and accessibility of care.
Ending the HIV Epidemic: RWHAP Part A Jurisdictions
Thirty nine of the RWHAP Part A jurisdictions will receive a cooperative agreement to
implement EHE initiative activities related to Pillar Two (Treat) and Pillar Four (Respond) in
2020. Jurisdictions will utilize their existing infrastructure to implement effective and innovative
strategies, interventions, approaches, and services to reduce new HIV infections in the United
States. The EHE initiative is more specifically addressed in the last section of this document.
242
RWHAP Part A Funding History
FY Amount
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 $655,876,000
FY 2019 $655,876,000
FY 2020 $655,876,000
FY 2021 $655,876,000
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part A of
$655.9 million is equal to the FY 2020 Enacted level. This request will continue to support the
provision of core medical and support services for people with HIV in the 24 EMAs and 28
TGAs.
The FY 2021 funding request proposes statutory changes through RWHAP authorization to the
RWHAP Part A Supplemental funding methodology. These changes would allow HRSA to
utilize a data driven framework developed by the Secretary to distribute RWHAP Part A
Supplemental funding. This would ensure the allocation of funds to areas experiencing high or
increasing of need while continuing to support people 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 in funded cities based on need, geography, data quality, and
performance.
In 2018, 68 percent of all RWHAP clients were served by one of the 52 metropolitan areas
funded under the RWHAP Part A. Approximately 72 percent of all people with diagnosed HIV
reside within these metropolitan areas. The RWHAP serves populations that are diverse with
multiple structural barriers to care (e.g., people with HIV at or below 100 percent Federal
Poverty Level and/or those who are homeless).
The FY 2021 funding request will support the RWHAP Part A in achieving its target of
providing 3.6 million core medical service visits for health-related care. 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 across service
providers to develop and maintain a system of services, and serving diverse populations.
RWHAP Part A funding will also contribute to achieving the FY 2021 targets for performance
goals that relate to cross-cutting activities, such as the percentage of racial/ethnic minorities and
women served, percentage of clients who achieved viral suppression, and percentage of HIV-
positive pregnant women served by RWHAP who receive antiretroviral medications.
243
follow-up performance reviews, information technology, and other program support costs.

Result /
Result / FY 2020 FY 2021 +/-
17.I.A.2: Number of 2018: 3.6M
RWHAP Part A visits for Target: 3.7M
3.6M 3.6M Maintain
health-related care.208 (Target Not Met)
(Output)
Grant Awards Table
FY 2019 FY 2021
Final FY 2020 Enacted President’s Budget
Average Award $12,083,109 $12,083,109 $12,083,109
Range of Awards $2,844,248 - $2,844,248 - $2,844,248 -
$94,232,524 $94,232,524 $94,232,524
208
This measure reports on core medical services. It replaces measure 17.I.A.1 that reported on only a subset of
core medical services.
244
RWHAP Part A – FY 2019 Formula, Supplemental & MAI Grants209
Table 1. Eligible Metropolitan Areas
EMAs Formula210 Supplemental MAI Total

Atlanta, GA $16,691,703 $8,452,077 $2,547,018 $27,690,798
Baltimore, MD $9,695,480 $5,411,707 $1,580,857 $16,688,044
Boston, MA $9,276,289 $4,630,725 $1,018,413 $14,925,427
Chicago, IL $16,680,261 $8,641,209 $2,366,011 $27,687,481
Dallas, TX $11,191,253 $5,434,406 $1,436,623 $18,062,282
Detroit, MI $5,790,139 $3,080,209 $823,800 $9,694,148
Ft. Lauderdale, FL $9,536,333 $5,144,428 $1,244,179 $15,924,940
Houston, TX $14,661,280 $7,404,298 $2,207,383 $24,272,961
Los Angeles, CA $26,722,640 $13,682,879 $3,563,360 $43,968,879
Miami, FL $15,481,459 $8,501,723 $2,613,762 $26,596,944
Nassau-Suffolk, NY $3,260,952 $1,801,337 $431,322 $5,493,611
New Haven, CT $3,260,952 $1,855,957 $446,012 $5,562,921
New Orleans, LA $4,669,870 $2,653,985 $639,145 $7,963,000
New York, NY $54,691,411 $30,924,433 $8,616,680 $94,232,524
Newark, NJ $7,237,024 $4,040,968 $1,226,433 $12,504,425
Orlando, FL $6,219,212 $3,066,489 $800,632 $10,086,333
Philadelphia, PA $13,327,254 $7,480,747 $1,967,913 $22,775,914
Phoenix, AZ $6,080,869 $3,074,432 $583,640 $9,738,941
San Diego, CA $7,166,812 $3,591,710 $736,649 $11,495,171
San Francisco, CA $9,329,858 $5,262,445 $766,126 $15,358,429
San Juan, PR $6,175,525 $3,512,228 $1,169,745 $10,857,498
Tampa-St. Petersburg, FL $6,254,578 $3,441,787 $666,355 $10,362,720
Washington, DC-MD-VA-WV $18,150,030 $10,321,593 $2,821,388 $31,293,011
West Palm Beach, FL $4,368,739 $2,361,937 $644,568 $7,375,244
Subtotal EMAs $285,919,923 $153,773,709 $40,918,014 $480,611,646
209
Awards to EMAs and TGAs include prior year unobligated balances.
210
Hold Harmless expired in FY 2014.
245
Table 2. Transitional Grant Areas
TGAs Formula Supplemental MAI Total

Austin, TX $3,163,723 $1,584,058 $351,071 $5,098,852
Baton Rouge, LA $2,737,398 $1,361,121 $441,871 $4,540,390
Bergen-Passaic, NJ $2,395,612 $1,270,028 $343,382 $4,009,022
Charlotte-Gastonia, NC-SC $3,852,999 $1,861,271 $571,317 $6,285,587
Cleveland, OH $2,923,072 $1,469,004 $377,592 $4,769,668
Columbus, OH $2,964,045 $1,475,196 $287,778 $4,727,019
Denver, CO $4,874,726 $2,494,410 $379,859 $7,748,995
Fort Worth, TX $2,899,215 $1,437,985 $365,761 $4,702,961
Hartford, CT $1,883,193 $1,057,448 $255,934 $3,196,575
Indianapolis, IN $2,767,479 $1,385,089 $293,989 $4,446,557
Jacksonville, FL $3,609,756 $1,849,173 $499,249 $5,958,178
Jersey City, NJ $2,944,855 $1,644,459 $458,138 $5,047,452
Kansas City, MO $2,675,161 $1,360,729 $269,638 $4,305,528
Las Vegas, NV $4,035,043 $2,040,343 $446,899 $6,522,285
Memphis, TN $4,009,630 $1,995,994 $666,355 $6,671,979
Middlesex-Somerset-Hunterdon, NJ $1,664,326 $947,452 $232,470 $2,844,248
Minneapolis-St. Paul, MN $3,675,623 $1,797,242 $364,578 $5,837,443
Nashville, TN $2,507,639 $1,275,778 $271,511 $4,054,928
Norfolk, VA $3,526,254 $1,742,613 $519,558 $5,788,425
Oakland, CA $4,386,683 $2,247,171 $562,345 $7,196,199
Orange County, CA $3,961,396 $1,997,575 $441,082 $6,400,053
Portland, OR $2,590,104 $1,315,992 $139,502 $4,045,598
Riverside-San Bernardino, CA $4,976,383 $2,542,054 $525,079 $8,043,516
Sacramento, CA $2,151,850 $1,094,768 $198,063 $3,444,681
Saint Louis, MO $3,899,159 $1,870,471 $470,067 $6,239,697
San Antonio, TX $3,404,373 $1,685,372 $513,051 $5,602,796
San Jose, CA $1,931,945 $990,978 $232,174 $3,155,097
Seattle, WA $4,473,815 $2,204,638 $347,818 $7,026,271
Subtotal TGAs $90,885,457 $45,998,412 $10,826,131 $147,710,000
Subtotal EMAs/TGAs $376,805,380 $199,772,121 $51,744,145 $628,321,646
246
RWHAP Part B - HIV Care Grants to States
FY 2021 FY 2021
BA $1,315,005,000 $1,315,005,000 $1,315,005,000 ---

MAI (non
add) $10,145,000 $10,145,000 $10,145,000 ---
ADAP (non
add) $900,313,000 $900,313,000 $900,313,000 ---
Total
Funding $1,315,005,000 $1,315,005,000 $1,315,005,000 ---
FTE 59 59 59 ---
111-87
FY 2021 Authorization……………………………………………………………………Expired
Allocation Method:
 Formula Grants
 Contracts
The Ryan White HIV/AIDS Program (RWHAP) Part B is the largest RWHAP Part and provides
grants to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and
five Associated Pacific Jurisdictions to provide services for people with HIV. 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.
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 prevalent HIV 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 RWHAP Part
B base grant application. RWHAP Part B Supplemental grants are available through a
competitive process to eligible states with demonstrated need.
247
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 prevalent HIV cases. In addition,
ADAP supplemental funds are a five percent set aside for states with severe need. ADAP
provides FDA-approved prescription medications for people with HIV 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 people with HIV 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 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.
In 2018, 71 percent of RWHAP Part B clients were racial/ethnic minorities, and 26 percent were
women. Seventy-five percent of RWHAP Part B funds must be used to support core medical
services and in 2018, RWHAP Part B funded sites provided 2.2 million core medical service
visits for health-related care utilizing RWHAP Parts A, B, C, and D funding. The number of
visits for health-related services demonstrates the scope of RWHAP Part B in delivering primary
care and related services for people with HIV by increasing the availability and accessibility of
care.
Ending the HIV Epidemic - States
Seven RWHAP Part B recipients and the state of Ohio (on behalf of Hamilton County, which is
currently not part of an EMA/TGA), will receive a cooperative agreement to implement EHE
initiative activities related to Pillar Two (Treat) and Pillar Four (Respond) in 2020. Jurisdictions
will utilize their existing infrastructure to implement effective and innovative strategies,
interventions, approaches, and services to reduce new HIV infections in the United States. The
EHE initiative is more specifically addressed in the last section of this document.
AIDS Drug Assistance Program
The RWHAP Part B has been successful in helping to ensure that people with HIV have access
to the care and treatment services they need to live longer, healthier lives. According to the
RWHAP ADAP Report, ADAPs, which are run by states and territories, continue to provide
robust formularies of antiretroviral medications to treat HIV infection, prevent and treat
opportunistic infections, manage side effects, and treat co-morbidities. 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
248
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 people with HIV have access
to regular care, are started on, and adhere to, their antiretroviral medications.
According to the RWHAP ADAP data, the number of people with HIV receiving ADAP services
has grown 37% over the last eight years from 208,809 clients in 2010, to 285,101 clients in 2018,
exceeding the FY 2018 target by 25,570. In FY 2018, the RWHAP ADAP provided medication
and health care coverage assistance for 28% of people diagnosed with HIV in the United States
and 69 percent of the clients served by ADAPs were racial/ethnic minorities. Nationally, 82
percent of ADAP clients had incomes at or below 250 percent of the Federal poverty level.
ADAP Cost Containment: Increased demand for RWHAP ADAP services has led States to
implement cost-containment strategies for their ADAPs. Cost-containment measures include
using drug-purchasing strategies such as cost recovery through drug rebates and third party
billing and directly negotiating pharmaceutical pricing. In addition, states have implemented
cost-savings strategies such as recovering costs when another payor was primary, coordinating
benefits with Medicare Part D, and improving drug-purchasing models. ADAPs have reported
significant savings by participating in manufacturer rebate programs and recovering costs
through insurance reimbursement.
Across the RWHAP, grant recipients are encouraged to maximize resources and leverage
efficiencies. One example of this is within RWHAP Part B, where ADAPs use a variety of the
above-mentioned strategies to maximize resources, which result in effective funds management,
enabling ADAPs to serve more people. In 2018, ADAPs participating in cost-savings strategies
on medications saved $2.1 billion, meeting the FY 2018 performance target by sustaining the
results from the prior year. Over the last 5 years, ADAPs participating in medication cost-
savings strategies saved $6.5 billion.
Elimination of ADAP Waiting Lists: Because of investments in RWHAP Part B, ADAP and the
increased technical assistance activities for cost-containment measures, ADAP waiting lists
decreased from a peak of 9,310 in September 2011, to zero in August 2015. Since FY 2010,
HHS has taken several actions to stabilize the ADAP, including using emergency authority to
target States with waiting lists or potential waiting lists, and to implement cost containment and
cost savings measures.
In FY 2021, HRSA will continue the use of RWHAP 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 is
particularly important as EHE initiative efforts diagnose more people with HIV and engage
people who are out of HIV care and treatment. This funding also addresses the gaps in access
created by ongoing cost-containment measures in many ADAPs such as HIV medication
formulary reductions, lower client financial eligibility levels, and capped enrollment. However,
with no individuals on the ADAP waiting lists, states requested and HRSA distributed $51.21
million in ERF funding in FY 2019. These funds are required to be used for 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
RWHAP Part B supplemental funds to assist in meeting shortfalls.
249
Due to availability of effective HIV medications, mother-to-child transmission in the United
States has decreased dramatically since its peak in 1992 due to 1) an increased focus on HIV
testing 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 2018, 99 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 2018 performance target by 9
percentage points. The RWHAP ADAP plays a crucial role that ensures access to HIV
medications for pregnant women.
Funding History
FY Amount ADAP (Non-Add)

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 $1,309,251,000 ($894,559,000)
FY 2019 $1,315,005,000 ($900,313,000)
FY 2020 $1,315,005,000 ($900,313,000)
FY 2021 $1,315,005,000 ($900,313,000)
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part B of $1.3
billion is equal to the FY 2020 Enacted level. This request includes $900.3 million for RWHAP
ADAPs to provide access to life saving HIV related medications and direct health care services
to people with HIV in all 50 States, the District of Columbia, Puerto Rico, the Virgin Islands,
Guam and five Associated Pacific Jurisdictions. HRSA will continue to utilize the 311 authority
to implement the Emergency Relief Fund to prevent, reduce, or eliminate ADAP waiting lists
through cost containment and/or cost savings measures.
The FY 2021 Request re-proposes statutory changes through the RWHAP authorization to the
RWHAP Part B Supplemental funding methodology. These changes would allow HRSA to
utilize a data driven framework developed by the Secretary to distribute RWHAP Part B
Supplemental funding. This would ensure the allocation of funds to areas experiencing high or
increasing of need while continuing to support people 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 services based on need, geography, data quality, and
performance.
As part of the program’s efforts to continue to provide access to life-saving medications and
related services for low-income people with HIV, the RWHAP has established a target for FY
2021 of serving at least 285,000 RWHAP ADAP clients. This target is based on anticipated
steady funding - not demand. While the number of ADAP clients is projected to remain constant
250
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.
An important contributing factor to the demand for services for RWHAP ADAP continues to be
access to HIV medications and high cost-sharing requirements for these medications. In order to
meet this demand, the number of ADAPs participating in cost-savings strategies on medications
will need to remain steady (the FY 2021 target is to maintain the previous year’s output
measure).
The FY 2021 funding request will support the RWHAP Part B in achieving its target of
providing 2.2 million core medical service visits for health-related care. RWHAP Part B grant
recipients will continue to work directly with uninsured people with HIV 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. ADAP resources will also
support the continued:
 increase in RWHAP clients as more people with HIV are diagnosed, linked to care, and
retained in care;
 increase in RWHAP growth as more people enter the health care system with coverage
who require assistance with insurance premiums and cost-sharing; and,
 need for medication and/or health care coverage assistance for clients who remain
uninsured.
HRSA and the CDC continue to collaborate to accelerate the elimination of perinatal HIV
transmission in the United States. The FY 2021 funding request will support RWHAP ADAP to
ensure that at least 96% of HIV-positive pregnant women served by the RWHAP will receive
antiretroviral medications. RWHAP Part B funding will also contribute to achieving the FY
2021 targets for performance goals that related to cross-cutting activities, such as the percentage
of racial/ethnic minorities and women served, and percentage of clients who achieved viral
suppression.
251
Year and Most

Recent Result /
Target for
(Summary of FY 2020 FY 2021 +/-
Measure Result) Target Target FY 2020
2018: 3.0M
18.I.A.2: Number of RWHAP Part
Target: 3.6M
B visits for health-related care.211 3M 3M Maintain
(Target Not
(Output)
Met)
16.II.A.1: Number of AIDS Drug 2018: 285,101
Assistance Program (ADAP) Target: 259,531
285,000 285,000 Maintain
clients served through State (Target
ADAPs annually. (Output) Exceeded)
2018: $2.1B
16.E: Amount of savings by State
Target: Sustain Sustain Sustain
ADAPs’ participation in cost-
Prior Year Prior Year Prior Year Maintain
savings strategies on medications.
Results or $2.1B Results Results
(Efficiency’s)
(Target Met)
16.II.A.3: Percentage of HIV-
2018: 98%
positive pregnant women in Ryan
Target: 90%
White HIV/AIDS Programs who 96% 96% Maintain
(Target
receive antiretroviral
Exceeded)
medications.212 (Output)
Grant Awards Table
FY 2019 FY 2021
Average Award $22,335,070 $22,335,070 $22,335,070
Range of Awards $50,000-$156,380,340 $50,000-$156,380,340 $50,000-$156,380,340
211
This measure reports on core medical services. It replaces measure 18.I.A.1 that reported on only a subset of
core medical services.
212
This RWHAP overarching performance measure applies to RWHAP Parts A, B, C, and D and is not Part B
specific.
252
RWHAP Part B – FY 2019 State Table213
State/ Base Emerging

Territory Base Suppl. ADAP Total Communities MAI Grand Total
Alabama $8,100,933 $2,010,447 $10,470,766 $316,265 $162,065 $21,060,476
Alaska $500,000 $167,158 $573,082 $0 $0 $1,240,240
American Samoa $50,000 $0 $788 $0 $0 $50,788
Arizona $4,224,934 $3,367,621 $12,077,287 $0 $0 $19,669,842
Arkansas $3,431,552 $0 $4,547,606 $0 $54,603 $8,033,761
California $33,423,848 $6,375,772 $115,062,843 $167,898 $1,349,979 $156,380,340
Colorado $3,409,873 $0 $9,680,906 $0 $83,415 $13,174,194
Connecticut $2,699,111 $0 $8,582,828 $0 $0 $11,281,939
Delaware $1,990,013 $427,043 $2,572,168 $192,153 $39,803 $5,221,180
Dist. of Columbia $3,527,427 $0 $10,408,704 $0 $214,134 $14,150,265
F States Micronesia $50,000 $0 $0 $0 $0 $50,000
Florida $30,354,143 $5,919,497 $98,590,089 $472,350 $1,355,784 $136,691,863
Georgia $14,641,185 $3,185,196 $54,479,256 $169,788 $659,283 $73,134,708
Guam $200,000 $0 $88,288 $0 $0 $288,288
Hawaii $1,613,722 $0 $2,085,797 $0 $23,459 $3,722,978
Idaho $589,137 $2,362,242 $3,751,777 $0 $0 $6,703,156
Illinois $9,549,487 $0 $35,693,840 $0 $456,274 $45,699,601
Indiana $3,661,472 $4,910,680 $8,617,512 $0 $0 $17,189,664
Iowa $1,470,402 $4,640,925 $5,807,994 $0 $0 $11,919,321
Kansas $1,106,691 $3,563,449 $2,515,412 $0 $0 $7,185,552
Kentucky $4,180,674 $0 $5,403,681 $278,150 $50,073 $9,912,578
Louisiana $6,566,114 $0 $17,205,858 $0 $276,993 $24,048,965
Maine $777,587 $766,952 $1,005,061 $0 $0 $2,549,600
Marshall Islands $50,000 $0 $788 $0 $0 $50,788
Maryland $7,823,385 $6,214,714 $25,662,560 $0 $472,434 $40,173,093
Massachusetts $5,194,169 $2,738,613 $15,745,957 $0 $197,907 $23,876,646
Michigan $5,108,493 $0 $13,401,603 $0 $192,370 $18,702,466
Minnesota $2,068,277 $2,282,268 $6,371,693 $0 $70,142 $10,792,380
Mississippi $5,876,638 $2,206,599 $10,322,134 $281,378 $135,686 $18,822,435
Missouri $3,519,801 $0 $10,157,817 $0 $0 $13,677,618
Montana $500,000 $388,101 $371,281 $0 $0 $1,259,382
N. Marianas $50,000 $8,575 $5,518 $0 $0 $64,093
Nebraska $1,259,386 $0 $1,627,805 $0 $0 $2,887,191
Nevada $2,251,175 $0 $6,914,820 $0 $82,895 $9,248,890
213
Awards include prior year unobligated balances.
253
State/ Base Emerging
Territory Base Suppl. ADAP Total Communities MAI Grand Total
New Hampshire $275,060 $0 $826,355 $0 $0 $1,101,415
New Jersey $10,066,553 $1,263,597 $29,726,948 $0 $509,250 $41,566,348
New Mexico $1,858,281 $0 $2,401,899 $0 $0 $4,260,180
New York $33,082,619 $9,985,945 $101,488,310 $587,721 $1,738,108 $146,882,703
North Carolina $11,519,837 $2,762,432 $26,429,353 $305,004 $379,387 $41,396,013
North Dakota $500,000 $108,362 $266,440 $0 $0 $874,802
Ohio $7,221,439 $0 $17,305,181 $338,316 $0 $24,864,936
Oklahoma $3,644,596 $0 $4,710,780 $230,899 $0 $8,586,275
Oregon $41,305 $0 $4,074,705 $0 $0 $4,116,010
Pennsylvania $10,726,651 $0 $27,711,308 $274,763 $413,971 $39,126,693
Puerto Rico $5,655,258 $6,685,566 $29,639,890 $0 $311,896 $42,292,610
Republic of Palau $50,000 $0 $7,095 $0 $0 $57,095
Rhode Island $1,505,774 $1,625,709 $1,946,271 $190,342 $22,855 $5,290,951
South Carolina $10,270,867 $5,946,187 $13,526,940 $564,017 $222,138 $30,530,149
South Dakota $500,000 $0 $1,519,168 $0 $0 $2,019,168
Tennessee $4,963,282 $0 $13,417,368 $0 $187,285 $18,567,935
Texas $24,201,455 $0 $84,178,158 $0 $1,079,244 $109,458,857
Utah $1,780,827 $1,027,268 $3,624,724 $0 $0 $6,432,819
Vermont $500,000 $329,891 $403,601 $0 $0 $1,233,492
Virgin Islands $342,169 $0 $368,506 $0 $9,514 $720,189
Virginia $6,965,287 $0 $17,978,375 $370,525 $273,587 $25,587,774
Washington $3,637,552 $3,691,384 $10,012,773 $0 $85,982 $17,427,691
West Virginia $1,005,628 $2,623,704 $1,407,086 $0 $0 $5,036,418
Wisconsin $3,616,794 $2,041,035 $4,698,956 $260,431 $57,221 $10,674,437
Wyoming $500,000 $0 $249,886 $0 $0 $749,886
Total $314,250,863 $89,626,932 $897,723,595 $5,000,000 $11,167,737 $1,317,769,127
254
RWHAP Part C - Early Intervention Services
FY 2021 FY 2021
BA $201,079,000 $201,079,000 $201,079,000 ---

MAI (non
add) $71,012,000 $71,012,000 $71,012,000 ---
Total
Funding $201,079,000 $201,079,000 $201,079,000 ---
FTE 52 52 52 ---
111-87
FY 2021 Authorization………………………………………………..……..……….…...Expired
Allocation Method:
 Contracts
HRSA’s Ryan White HIV/AIDS Program (RWHAP) Part C provides grants directly to
community and faith-based organizations, 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 with HIV.
Minority AIDS Initiative (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 on, racial and ethnic minorities. RWHAP Part C MAI
funding supports HIV care, treatment, and support services to racial/ethnic minorities. RWHAP
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 people with HIV disproportionately affected by the
HIV epidemic and who have poor health outcomes, including ethnic and minority populations
and youth. In 2018, RWHAP Part C funded sites served over 320,000 clients utilizing a
combination of RWHAP Parts A, B, C, and D funding. Of the total clients served, 73 percent
were racial/ethnic minorities and 26 percent were female.
The RWHAP has a history of creating effective patient-centered services that support strong
provider and patient relationships. Providers funded through RWHAP Part C have the clinical
255
expertise and cultural competency to provide quality care and treatment to low-income, diverse
people with HIV. In 2018, RWHAP Part C funded sites provided 2.2 million medical service
visits for health-related care utilizing a combination of RWHAP Parts A, B, C, and D funding.
The number of visits for health-related services demonstrates the scope of RWHAP Part C in
delivering primary care and related services for people with HIV by increasing the availability
and accessibility of care.
Expansion of Services
In 2018, HRSA expanded access to HIV care and treatment by funding 10 new RWHAP Part C
clinics to provide comprehensive medical care and support services. Six of the ten new recipients
are located in the southern United States, where there is the greatest burden of new HIV
diagnoses, HIV cases, and deaths from HIV. Expanding patient access to direct HIV care
services is a priority for HRSA.
Funding History
FY Amount
FY 2012214 $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 $201,079,000
FY 2019 $201,079,000
FY 2020 $201,079,000
FY 2021 $201,079,000
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part C of
$201.1 million is equal to the FY 2020 Enacted level. This funding will support comprehensive
medical, treatment and support services necessary to achieve improved health outcomes, such as
improved viral suppression rates, essential to ending the HIV epidemic.
RWHAP Part C supports direct health care services for low income people with HIV who are
uninsured or underserved. These services are considered essential to improving health outcomes
and are a crucial part of the care network that links and retains people with HIV into health care.
Such critical health care services include intensive case management and care coordination
services, linking and retaining people with HIV into care, and getting them on antiretroviral
medications as early as possible.
214
Reflects Ryan White Budget Authority only (does not include $5.089 million in Health Center Program Budget
Authority for RWHAP Part C grant recipients in FY 2012).
256
The funding request will support the RWHAP Part C in achieving its target of providing 2.2
million visits for health-related care in FY 2021. RWHAP Part C funding will also contribute to
achieving the FY 2021 targets for performance goals that relate to cross-cutting activities, such
as percentage of racial/ethnic minorities and women served, percentage of clients who achieved
viral suppression, and percentage of HIV-positive pregnant women served by the RWHAP who
receive antiretroviral medications.

Year and Most
Recent Result /
Target for Recent
Result / FY 2021
19.II.A.3: Number of
2018: 2.2M
RWHAP Part C visits for
Target: 3.8M 2.2M 2.2M Maintain
health-related care.215
(Target Not Met)
(Output)
Grant Awards Table
FY 2019 FY 2021
Average Award $520,831 $520,831 $520,831
Range of Awards $92,999-$1,507,775 $92,999-$1,507,775 $92,999-$1,507,775
215
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. The 2015 baseline and FY 2019 target was reported
incorrectly in the FY 2019 Congressional Justification and has been corrected.
257
RWHAP Part D - Women, Infants, Children and Youth
FY 2021 FY 2021
BA $75,088,000 $75,088,000 $75,088,000 ---

MAI (non
add) $23,671,000 $23,671,000 $23,671,000 ---
Total
Funding $75,088,000 $75,088,000 $75,088,000 ---
FTE 11 11 11 ---
111-87
FY 2021 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 115 RWHAP 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 women, infants,
children, and youth with HIV and their affected216 family members. RWHAP Part D also funds
essential support services, such as case management and transportation that help clients’ access
medical care and stay in care.
Minority AIDS Initiative Funds (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. RWHAP Part D MAI funding supports HIV
care, treatment, and support services to racial/ethnic minorities. In 2018, RWHAP Part D funded
sites provided 1.6 million visits for health-related care and support services utilizing a
combination of RWHAP Parts A, B, C, and D funding.
216
Support services are available for family members who do not have 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.
258
The RWHAP Part D serves women, infant, children, and youth – populations disproportionately
affected by HIV epidemic that have poor health outcomes. In 2018, RWHAP Part D funded sites
served 215,125 clients utilizing a combination of RWHAP Parts A, B, C, and D funding. Of the
total clients served, 75 percent were racial/ethnic minorities and 29 percent were female.
RWHAP 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 with HIV.
Funding History
FY Amount
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 $75,088,000
FY 2019 $75,088,000
FY 2020 $75,088,000
FY 2021 $75,088,000
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part D of
$75.1 million is equal to the FY 2020 Enacted level. This funding will support the
comprehensive array of medical and supports services necessary to achieve improved health
outcomes, such as improved viral suppression rates, essential to ending the HIV epidemic.
RWHAP Part D supports health care services for low income people with HIV who are
uninsured or underserved. These services are considered essential to improving health outcomes
and are a crucial part of the care network that links and retains people with HIV 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 people with
HIV into care, and getting them on antiretroviral medications as early as possible.
The funding request will support the RWHAP Part D in achieving its target of providing at least
1.6 million health-related care and support service visits in FY 2021. RWHAP Part D funding
will also contribute to achieving the FY 2021 targets for performance goals that relate to cross-
cutting activities, such as the percentage of racial/ethnic minorities and women served,
percentage of clients who achieved viral suppression, and percentage of pregnant women with
HIV served by the RWHAP who receive antiretroviral medications.
259

Result / FY FY FY 2021
Target for Recent Result / 2020 2021 +/-
20.II.A.2 Number of RWHAP
2018: 1.6M
Part D visits for health-related
care and support services
217 (Target Not Met)
(Output)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $583,894 $583,894 $583,894
Range of Awards $113,823 - $113,823 - $113,823 -
$2,185,691 $2,185,691 $2,185,691
217
The 2018 target was reported incorrectly in the FY 2019 Congressional Justification and has been corrected.
260
RWHAP Part F - AIDS Education and Training Programs
FY 2021 FY 2021
BA $33,611,000 $33,611,000 $33,611,000 ---

MAI (non
add) $10,144,000 $10,144,000 $10,144,000 ---
Total
Funding $33,611,000 $33,611,000 $33,611,000 ---
FTE 5 5 5 ---
Authorizing Legislation: Public Health Service Act, Sec. 2692(a), as amended by Public Law
111-87.
FY 2020 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 eight regional centers and two national centers that
conduct targeted, multidisciplinary education and training programs for health care providers
serving people with HIV in all states, DC, Puerto Rico, the U.S. Virgin Islands, and the
Associated Jurisdictions. The RWHAP AETC improves the quality of life of people 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.
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 2017-2018, the proportion of racial/ethnic minority health care
providers participating in RWHAP AETC training intervention programs was 49 percent,
exceeding the most recent performance target by 6 percentage points.218
RWHAP AETCs currently train providers through a variety of training modalities, including
didactics, clinical preceptorships, self-study, clinical consultation, communities of practice and
218
Due to changes in the reporting instrument, an estimated proportion of racial/ethnic minority providers was
calculated using data from the past three reporting years.
261
distance-based technologies. A variety of educational formats are used including skills building
workshops, hands-on preceptorships and mini-residencies, on-site training, tele-education, and
technical assistance. For example, the RWHAP AETC implemented an online interactive
platform that hosts an HIV care and treatment curriculum targeted to health care
professionals. Clinical faculty also provides timely clinical consultation in person or via the
telephone or internet.
Funding History
FY Amount
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 $33,611,000
FY 2019 $33,611,000
FY 2020 $33,611,000
FY 2021 $33,611,000
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part F-AETC
of $33.6 million is equal to the FY 2020 Enacted level. This funding will support targeted,
multidisciplinary education and training programs for novice and experienced health care
providers treating people with HIV in order to assure access to high quality HIV care delivered
by competent providers. The RWHAP AETC program also provides expert advice to providers
across the country on: HIV treatment; pre-exposure prophylaxis to reduce HIV transmission;
substance use disorders; viral hepatitis co-infection; post-exposure prophylaxis, and the
treatment of pregnant women with HIV and their newborns to prevent mother-to-child
transmission.
The RWHAP AETC program funds a national curriculum for medical providers on HIV care and
treatment to assure continued training of providers from medical/nursing school through in-
service training. The central focus of RWHAP AETC training is to ensure high quality care and
good patient outcomes through HIV care and treatment that is consistent with established
treatment guidelines and reflects current research. This is increasingly important as people with
HIV are living longer. In addition, the number of experienced HIV care professionals is
projected to decrease as many of those who have worked in the epidemic since its inception
reach retirement age. Training an expanded cadre of culturally competent, high quality providers
is vital to increasing access to quality HIV care and treatment and improving health outcomes for
people with HIV.
HRSA will continue to prioritize interactive training and technical assistance that result in health
system strengthening and transformation. Focus will be on training health care providers,
particularly racial/ethnic minority providers, to deliver high quality HIV care and treatment
262
services in primary care settings – settings that have typically not provided services to people
with HIV.

Result /
Result / FY 2020 FY 2021 +/-
21.V.B.1: Proportion
of RWHAP AETC
FY 2017: 49%
training intervention
participants that are
(Target Exceeded)
racial/ethnic
minorities. (Output)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $2,225,728 $2,083,555 $2,083,555
Range of Awards $ 300,000- $300,000 - $300,000 -
$4,293,630 $4,049,008 $4,049,008
263
RWHAP Part F - Dental Programs
FY 2021 FY 2021
BA $13,122,000 $13,122,000 $13,122,000 ---

FTE 1 1 1 ---
Authorizing Legislation: Public Health Service Act, Section 2692(b) as amended by Public Law
111-87
FY 2021 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 with HIV 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 RWHAP DRP improves access to oral health care for low-income, people with
HIV and ensures quality services by dental students, dental hygiene students, and dental
residents for providing oral health care services to people with HIV. 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 people with HIV 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 2018, the RWHAP DRP awards were able to provide 38 percent of the total non-
reimbursed costs requested by 51 participating institutions in support of oral health care. These
institutions reported providing care to 26,334 people with HIV, 13,404 for whom no other
funded source was available, missing the FY 2018 performance target by 12,102 individuals. In
FY 2018, the demographic characteristics of patients who were cared for by institutions
participating in the RWHAP DRP were 64 percent minority and 32 percent women.
264
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 2018, RWHAP
CBDPP funded 12 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 2019 FY 2020 FY 2021

RWHAP Dental
Reimbursement
Program $8,977,802 $8,977,802 $8,977,802
RWHAP Community-
Based Dental
Partnership Program $3,475,672 $3,475,672 $3,475,672
Funding History
FY Amount
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 $13,122,000
FY 2019 $13,122,000
FY 2020 $13,122,000
FY 2021 $13,122,000
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part F-Dental
of $13.1 million is equal to the FY 2020 Enacted level. This funding will support oral health
care for people with HIV and the reimbursement of applicant institutions through the RWHAP
DRP and funding of the RWHAP CBDPP.
The FY 2021 funding request will support RWHAP target for reimbursing at least 26,000 people
with HIV for a portion of their unreimbursed oral health costs through the RWHAP Dental
Reimbursement Program.
The FY 2021 funding request also includes costs associated with the grant review and award
process, follow-up performance reviews, information technology, and other program support
costs.
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Year and Most
Recent Result /
Target for Recent
Result / FY 2021
22. I.D.1: Number of
persons for whom a
2018: 26,334
portion/percentage of their
Target: 38,436 26,000 26,000 Maintain
unreimbursed oral health
(Target Not Met)
costs were reimbursed.
(Output)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $196,305 $196,305 $196,305
Range of Awards $6,195 - $1,545,922 $6,195 - $1,545,922 $6,195 - $1,545,922
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RWHAP Part F - Special Projects of National Significance
FY 2021 FY 2021
BA $25,000,000 $25,000,000 $25,000,000 ---

FTE 2 2 2 ---
111-87
FY 2021 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 interventions,
models and strategies for HIV care to improve the retention and health outcomes of RWHAP
clients.
As healthcare systems work under increasingly dynamic conditions, evidence-based and/or

evidence-informed strategies are essential in order to ensure that research investments maximize
healthcare value and improve public health. Implementation science plays a critical role in
supporting these efforts. RWHAP SPNS-funded projects use implementation science - the
scientific study of methods to promote the systematic uptake of research findings into routine
practice - to improve the quality and effectiveness of health services, maximize resources, and
improve health outcomes for people with HIV.
The RWHAP SPNS evaluates the effectiveness of various models, interventions, strategies,
implementation, utilization, cost, and health-related outcomes. Systematic strategies are used to
identify promising practices among RWHAP recipients and develop tool kits and other
modalities that allow for rapid dissemination. Through these special projects, RWHAP SPNS
grant recipients implement a variety of promising interventions which contribute to the
advancement of public health knowledge and the ultimate goal of ending the HIV epidemic in
the United States.
Of the 58 currently funded FY 2019 Ryan White HIV/AIDS Program SPNS grant recipients: 7
percent are community-based/AIDS services organizations; 19 percent are state/county/local
departments of health; 21 percent are community health centers; 11 percent are academic-based
clinics; and 42 percent are universities/evaluation and technical assistance providers.
267
Current SPNS initiatives include: building capacity to support innovative program model
replication among RWHAP jurisdictions; enhancing linkages of sexually transmitted infections
(STI) and HIV surveillance data in the RWHAP; strengthening systems of care for people with
HIV and opioid use disorder; gathering evidence-informed approaches to improve health
outcomes for people with HIV; implementation science projects to promote the replication of
SPNS evidence–informed interventions; implementation of evidence-informed behavioral health
models to improve HIV health outcomes for Black Men Who Have Sex With Men; improving
health outcomes through the coordination of supportive employment and housing services;
approaches to cure Hepatitis C among HIV/HCV co-infected people of color; and an initiative to
promote the use of social media to improve engagement, retention, and health outcomes..
Funding History
FY Amount
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 $25,000,000
FY 2019 $25,000,000
FY 2020 $25,000,000
FY 2021 $25,000,000
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) Part F- Special
Projects of National Significance (SPNS) of $25.0 million is equal to the FY 2020 Enacted level.
The FY 2021 funding will support the continued development of innovative models of HIV care
and treatment for populations that are significantly difficult to engage in continuous care and
achieve viral suppression.
Through its funded demonstration projects, RWHAP SPNS evaluates the design,
implementation, utilization, cost, and health-related outcomes of treatment models, interventions,
and strategies, while promoting the dissemination and replication of successful ones. RWHAP
SPNS funding also supports projects to build capacity in the health information technology
(HIT) systems of RWHAP grant recipients and provider organizations to report client-level data
and to improve health outcomes.
268
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $762,301 1,091,589 $404,241
Range of Awards $200,000 - $4,274,605 $296,596 - $5,324,435 $150,000 - $3,359,774
269
RWHAP – Ending the HIV Epidemic Initiative (EHE)
FY 2021
FY 2019 FY 2021 +/-
Final FY 2020 Enacted President’s Budget FY 2020
BA — $70,000,000 $165,000,000 +$95,000,000
FTE — 30 30 ---
Authorizing Legislation: Section 311 of the Public Health Service Act and Title XXVI of the
Public Health Service Act
FY 2021 Authorization……………………………………………….……………..…….Expired
Allocation Method:
 Contracts
Program Description
The Ending the HIV Epidemic (EHE): A Plan for America initiative is an HHS-wide effort to
reduce new infections by 75 percent in the next five years and by 90 percent in the next ten
years, with the goal of decreasing the number of new HIV infections to fewer than 3,000 per
year. HRSA will focus on linking people with HIV who are either newly diagnosed, diagnosed
but currently not in care, or diagnosed and in care but not yet virally suppressed to the essential
HIV care and treatment and support services needed to help them achieve viral suppression.
HRSA anticipates 18,000 additional people with HIV will be served by the RWHAP in the first
year of the EHE initiative (FY 2020), and an additional 25,000 people with HIV will be served in
the second year (FY 2021). Overall, a total of 43,000 people with HIV will be served through
this initiative in the first two years of this 10-year initiative.
In FY 2021, funded RWHAP Part A and Part B jurisdictions encompassing the 48 counties,
Washington, D.C., San Juan (PR), and seven states that have a substantial rural HIV burden will
continue their focus on engaging people who are newly diagnosed with HIV, or diagnosed but
currently not in care, or diagnosed and in care but not yet virally suppressed. These jurisdictions
will continue to build off of their locally-developed work plans submitted through the Notice of
Funding Opportunity in FY 2020. The jurisdictions will continue using evidence-based
strategies to engage these populations into HIV medical care, treatment, and support services that
will ensure retention and viral suppression. As patients are linked and retained in care, the
jurisdictions will support the HIV care and treatment needs of the newly identified and re-
engaged people with HIV.
The EHE funded technical assistance (TA) and systems coordination cooperative agreements
will support strategies such as: data to care efforts; using acuity tools to identify and provide care
for the most challenging patients; developing models such as low-barrier clinics to meet patients
270
where they are; rapid engagement and medication initiation protocols; and others that have been
successful in the field. As lessons are learned from the first year, HRSA and the TA entity will
work to utilize and disseminate those lessons nationally, so that as other resources are available,
additional jurisdictions are able to plan EHE efforts early in the initiative.
The HRSA funded jurisdictions will work with their respective AIDS Drug Assistance Programs
(ADAPs) to ensure necessary resources are available to provide assistance for medications and
health care coverage premiums and cost-sharing for people newly diagnosed with HIV or re-
engaged in care through the EHE initiative.
As part of the EHE initiative, the AIDS Education and Training Centers (AETCs) will work to
expand workforce capacity by providing training and technical assistance to health care
providers and paraprofessionals. This will include activities such as training health care
providers on HIV medical care and treatment and PrEP service delivery; working with clinics
and health care providers to develop culturally competent settings and approaches to the
populations reached through the EHE initiative; and providing technical assistance on practice
transformation in clinics to increase HIV testing, linkage to care, rapid ART delivery, and
improved viral suppression.
Budget Request
The FY 2021 Budget Request for the Ryan White HIV/AIDS Program (RWHAP) EHE initiative
of $165.0 million is $95.0 million above the FY 2020 Enacted level. This funding will support
HIV care and treatment for an estimated 43,000 clients in the 57 geographic locations that
currently have more than 50% of new HIV diagnoses nationally, expand evidence-informed
practices to link, engage, and retain people with HIV in care, and support capacity building,
technical assistance, program implementation, and oversight.
HRSA estimates that 43,000 clients will be served by this initiative through FY 2021.
In FY 2021, HRSA will continue to direct RWHAP funding to the 48 counties, DC, San Juan
(PR), and seven states that contain more than 50% of new HIV infections. Funding will continue
to be awarded to the current 39 RWHAP Part As that contain one or more of the counties and the
current eight RWHAP Part B states (including funding to the state of Ohio for Hamilton County
which is not a RWHAP Part A). HRSA requires coordination with the respective AIDS Drug
Assistance Program (ADAPs) to ensure necessary resources are available to provide assistance
for medications and health care coverage premiums and cost-sharing for people newly diagnosed
with HIV or re-engaged in care through the initiative. The RWHAP’s comprehensive system of
HIV care and support services and effective system for medication delivery creates a very
efficient and effective service delivery mechanism for this initiative.
Starting in FY 2020 and continuing into FY 2021, HRSA will fund the AETCs to provide
training and technical assistance to health care providers, clinics, and paraprofessionals as well
as health departments to increase HIV testing, care and treatment, the provision of PrEP services,
and retention in care.
HRSA will continue to direct funding to support technical assistance and systems coordination to
enhance the current RWHAP data collection systems to provide timely monitoring of the
initiative; to support dissemination of effective interventions to increase the number of people
271
with HIV served by the initiative; to provide additional technical assistance to jurisdictions to
implement models of care that work to identify and link and retain the key populations for the
EHE initiative.
Year and Most

Recent Result /
Target for
60.1 Number of new
clients served through the N/A 18,000 43,000 +25,000
EHE initiative (Output)
60.2 Viral suppression

among new clients
N/A TBD TBD TBD
served by the EHE
initiative ( Outcome)219
219
This is a long-term measure without annual targets. The first target will be set for FY 2024.
272
Grants Awards Table
FY 2021
Number of Jurisdiction Awards --- 47 47
Average Award --- $1,200,000 $3,100,000
Range of Awards --- N/A N/A
FY 2021
Number of Technical Assistance Awards --- 2 2
Average Award --- $2,500,000 $4,000,000
FY 2021
Number of AETC Awards --- 10 10
Average Award --- $300,000 $900,000
273
Healthcare Systems
TAB
274
HEALTHCARE SYSTEMS
Organ Transplantation
FY 2021 FY 2021
BA $25,437,000 $27,549,000 $17,164,000 -$13,385,000
PHS Evaluation Funds --- --- $13,385,000 ---
Total $25,437,000 $27,549,000 $30,549,000 +$3,000,000
FTE 4 4 4 ---
Authorizing Legislation: Public Health Service Act, Sections 371-378, as amended by Public
law 108-216, Public Law 109-129, Public Law 110-144, Public Law 110-413, and Public Law
113-51
FY 2021 Authorization……………………….….….….….….…...….….….….….…..... Expired
Allocation Method:
 Contracts
 Competitive Grants/Co-operative Agreements
 Other (Interagency Support)
Program Description
The Organ Transplantation Program extends and enhances the lives of individuals with end-stage
organ failure for whom an organ transplant is the most appropriate therapeutic treatment. HRSA
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). HRSA also invests in public education and outreach to
increase the supply of deceased donor organs available for transplant and to ensure the safety of
living organ donors.
The OPTN is a critical system that facilitates matching donor organs to individuals needing
organ transplants. 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, attain the
maximum benefit for the maximum number of waitlist candidates, make the best use of donor
organs, and align with policy development requirements of the OPTN final rule (42 CFR 121).
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. The
OPTN collects fees under the authority of 42 CFR §121.5(c).
275
The OPTN final rule (42 CFR §121.12) established the Advisory Committee on Organ
Transplantation (ACOT), which is composed of experts in the field of organ transplantation, to
provide recommendations to the Secretary on issues related to organ donation and
transplantation. HRSA provides logistics and analytic support for periodic ACOT meetings.
HRSA also engages in interagency activities that support organ donation and transplantation.
The SRTR provides analytic support to the OPTN in the development of organ allocation
policies and performance evaluation. Additionally, the SRTR provides analytic support to HHS,
including the ACOT. SRTR shares information publicly about the performance of transplant
programs and organ procurement organizations at https://www.srtr.org/. It publishes online
transplant program risk-adjusted patient and graft outcomes data as well as organ procurement
organization risk-adjusted data on organs procured per donor. 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.
HRSA collaborates with the organ donation and transplantation community on efforts to promote
awareness of the need for donated organs and to encourage public enrollment on organ donor
registries (state or national). Outreach activities include:
 Public service announcement campaigns for radio, TV stations, and publications

nationwide
 Educational web videos for reposting, download, and social media
 Radio Ad Spotlights during high traffic drive-time hours in designated markets with the
highest numbers of African Americans, Asians, Hispanics or Latinos, and people 50
years and older. Data reveals gaps between the numbers of patients waiting for an organ
and numbers of donors from these groups.
 Print ads in widely circulated publications such as major sporting event program guides
 Organ donation and transplantation related articles for newspapers and journals
 Downloadable print materials on a variety of topics for multiple audiences
 HRSA’s organ donation sites: www.organdonor.gov and https://donaciondeorganos.gov
 Social media outreach
 Grant projects to test approaches to promote public awareness of the need for organ
donation and increase registration in donor registries
President’s Executive Order on Advancing American Kidney Health
On July 10, 2019, the President issued an Executive Order on Advancing American Kidney
Health that provides increased support for living donors to further the goal of significantly
increasing the supply of transplantable kidneys. Section 8 of the Executive Order specifically
requires the Secretary of HHS to, in part, “…raise the limit on the income of donors eligible for
reimbursement under the Program, allow reimbursement for lost-wage expenses, and provide for
reimbursement of child-care and elder-care expenses.”
Pursuant to the Executive Order, HRSA published in the Federal Register on December 20, 2019
a notice of proposed rulemaking to amend the regulation implementing the National Organ
Transplant Act of 1984 (NOTA). HRSA’s proposed rule would expand the scope of
276
reimbursable expenses for living donors to include lost wages, and childcare and eldercare
expenses for those donors who lack other forms of financial support. This proposal could
increase the number of transplant recipients receiving a better quality organ in a shorter time
period from living donors.
In accordance with the Executive Order, HRSA will also release a Federal Register Notice
(FRN) requesting public comment to amend the Reimbursement of Travel and Subsistence
Expenses toward Living Organ Donation Program’s eligibility guidelines to increase the
household income eligibility threshold for the organ recipients, and the prospective living organ
donors, above the current 300 percent of the HHS Poverty Guidelines.
One of HRSA’s primary goals for the Organ Transplantation Program is to increase the annual
number of deceased donor organs transplanted. In CY 2019, the number of deceased donor
organs transplanted was 35,742, which is an 8.8 percent increase over the CY 2018 total of
32,857. HRSA has achieved record-breaking numbers of deceased donor and overall organ
transplants year over year since 2015.
Another important program goal is to increase the organ donor conversion rate, which is the rate
potential organ donors become actual organ donors after death. The conversion rate has been a
key performance metric and a priority for the Organ Transplantation Program since 2003. The
conversion rate remained steady at approximately 72 percent in CY 2015 and CY 2016, but
declined to 70 percent in CY 2017. In CY 2018, the conversion rate increased to 71 percent.
HRSA will continue to monitor conversion rates and assess potential next steps.
The organ donor conversion rate is based on potential "eligible deaths," which includes potential
donors aged 75 or below who are legally declared dead by neurologic criteria (brain death) and
not excluded for other defined reasons related to certain risk factors. The 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."
277
Table 1. Conversion Rates and Eligible Deaths 2014-2018
Change in
Number of Number of Conversion Eligible Deaths
Year Donors Eligible Deaths Rate (%) (%)
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
2017 8,104 11,653 69.5 8.8
2018 8,272 11,661 70.9 0.1
Funding History
FY Amount
FY 2017 $23,492,000
FY 2018 $25,486,000
FY 2019 $25,437,000
FY 2020 $27,549,000
FY 2021 $30,549,000
Budget Request
The FY 2021 Budget Request for the Organ Transplantation program of $30.5 million is $3.0
million above the FY 2020 Enacted level.
HRSA will target up to $9.5 million towards expanding support for living organ donors in
support of the President’s Executive Order on Advancing Kidney Health. The proposed budget
provides funding for the implementation of these new policies and initiatives designed to expand
support for living organ donation.
This work will be accomplished through HRSA’s continued funding of the Reimbursement of
Travel and Subsistence Expenses toward Living Organ Donation Program that provides
reimbursement to living organ donors who lack other forms of financial support. In FY 2021,
HRSA will continue funding a three-year demonstration project to assess the impact of
reimbursement of lost wages on individuals’ willingness to become living organ donors.
This request includes $18.5 million for the OPTN, SRTR, and public and professional education
efforts to increase public awareness about the need for organ donation. Additionally, this request
includes approximately $2.4 million for activities related to the Advisory Committee,
interagency agreements, and other internal support and Program-related activities.
The funding request includes costs associated with the grant review and award process, follow-
up performance reviews, information technology and other program support costs.
278
Year and Most

Recent Result
FY 2021
Measure +/-
FY 2020
(Summary of
Result)
FY 2019: 35,742
23.II.A.1: Annual number
Target: 26,555
of deceased donor organs 32,010 32,652 +642
(Target
transplanted.220 (Output)
Exceeded)
23.II.A.8: Annual FY 2018: 70.9%
conversion rate of eligible Target: 74.0% 74.50% 74.50% Maintain
donors. (Output) (Target Not Met)
Grants Awards Table
FY 2019 FY 2020 FY 2021

Average Award $938,529 $881,140 $1,882,084
Range of Awards $299,274-$3,250,000 $300,000-$3,250,000 $300,000-$7,300,000
220
Performance Measure 23.II.A.1 2019 data using OPTN data as of January 14, 2020.
279
National Cord Blood Inventory
FY 2021 FY 2021
BA $16,195,000 $17,266,000 $8,266,000 -$9,000,000
FTE 4 4 4 ----
114-104
FY 2021 Authorization………………………………………………………..............$23,000,000
Allocation Method…………………….…………………………………..................……Contract
Program Description
The National Cord Blood Inventory (NCBI) Program 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 cord blood units in the
inventories of participating cord blood banks, are made available to patients for blood stem cell
transplants through the C.W. Bill Young Cell Transplantation Program. Cord blood banks
participating in the NCBI program also make cord blood units not suitable for transplantation
available for preclinical and clinical research.
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 matched
donors 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. The other 70 percent, or
approximately 12,600 people, often search for a matched, unrelated adult donor or a matched
umbilical cord blood unit.
Tissue types of blood stem cell donors must closely match their recipients for transplants to be
successful. Since tissue types are inherited, patients are more likely to find closely matched
donors within their own racial and ethnic groups. Due to the high rate of diversity in tissue types
of underrepresented racial and ethnic populations, especially African-Americans,
underrepresented racial and ethnic populations are less likely to find suitably matched adult
marrow donors on the C.W. Bill Young Cell Transplantation Program Registry. Because
umbilical cord blood can be used with a less stringent match in tissue types between donor and
recipient than is the case for adult marrow donors, umbilical cord blood offers a chance of
survival for patients who lack suitably matched related or unrelated adult donors, particularly
280
those from racially and ethnically diverse populations. For this reason, 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, geographic dispersion of
collection and 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, 2018, the
cumulative number of NCBI CBUs available through the Program was 96,977(Table 1). HRSA
estimates that approximately 3,000 additional units will be collected and made available for
patient searches in FY 2021. The number of units collected varies from year to year based on
funding levels, contractor’s ability to collect and store units from diverse populations, and
contractor’s licensure status.
Table 1. Cord Blood Collections
NCBI Cord Blood

Units Collected and Cumulative
Number of Units
Fiscal Year Made Available1 Units Made
Contracted
for Patient Available221
Searches
2014 7,469 8,654 69,903
2015 6,469 9,373 79,276
2016 5,840 6,167 85,443
2017 6,369 7,103 92,546
2018 7,787 4,431 96,977
The availability of umbilical cord blood has increased access to blood stem cell transplantation,
particularly for patients who would not otherwise have well-matched adult donors. 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.
As shown in Table 2, the number of NCBI cord blood units released for transplants remained
level in FY 2018 over FY 2017, at 493 and 494 cord blood units, respectively. The NCBI units
221
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, not all of the units collected with funds from a given fiscal year will be available on
the registry during that same fiscal year.
281
released for transplantation and the total cord blood units released for transplantation through the
C.W. Bill Young Cell Transplantation Program have been decreasing since FY 2015 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 still 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 should continue to serve an increasing
number of patients. Underrepresented racial and ethnic populations account for over 60 percent
of the cord blood units collected. HRSA will continue to monitor and assess trends in cord blood
transplantation and will adjust transplant targets accordingly.
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
2014 544 1,359
2015 609 1,393
2016 529 1,154
2017 494 1,050
2018 493 949
In addition to directly growing the NCBI inventory, resources provided to NCBI-contracted

banks have played an important role in stimulating the collection and banking of many other
non-NCBI units. These CBUs may not meet minimum cell content thresholds established for the
NCBI, but may be suitable sources of blood stem cells for smaller patients where acceptable cell
doses can still be achieved using smaller units. Additionally, NCBI banks have provided
researchers more than 94,000 cord blood units that were not be suitable for clinical
transplantation but serve a wide variety of research purposes.
Funding History
FY Amount
FY 2017 $12,239,000
FY 2018 $15,236,000
FY 2019 $16,195,000
FY 2020 $17,266,000
FY 2021 $8,266,000
Budget Request
The FY 2021 Budget Request for the National Cord Blood Inventory Program of $8.3 million is
$9 million below the FY 2020 Enacted level. This Budget request supports continued progress
toward the statutory goal of building a genetically diverse inventory of at least 150,000 new units
282
of high-quality cord blood for transplantation. The request supports collecting and banking
approximately 2,400 CBUs toward the statutory goal.
This Budget request will increase the number of patients in all population groups who are able to
obtain life-saving transplants. Although the number of newly added CBUs will decrease from
previous years, the size of the inventory will increase and should contribute to improved patient
survival after transplant and allow access to higher cell doses and better tissue matches for
patients.
The funding request also includes costs associated with the contract review and award process,
follow-up performance reviews, and other program support costs.
Year and Most

Recent Result
/Target for FY 2021
FY 2020 FY 2021
Measure Recent Result +/-
Target Target
(Summary of FY 2020
Result)
40.II.A.1: The cumulative
number of cord blood units from
FY 2018: 170,398
underrepresented racial and
Target: 80,809
ethnic populations available 145,721 148,721 +3,000
(Target
through the C.W. Bill Young
Exceeded)
Cell Transplantation Program
(NCBI & non-NCBI)222(Output)
40.II.A.2: The size of the
National Cord Blood Inventory FY 2018: 96,977
(cumulative # of units banked Target: 91,000
99,000 100,800 +1,800
and available through the C.W. (Target
Bill Young Cell Transplantation Exceeded)
Program) (Output)
40.II.A.3: The annual number of FY 2018: 493
NCBI cord blood units released Target: 535 500 500 Maintain
for transplant223 (Output) (Target Not Met)
Contracts Awards Table

222
Data shows there are over 20,000 cord blood units designated as “unknown race/ethnicity” as not every cord
blood bank requires donors to provide the information. Inability to properly categorize these units subsequently
impacts tracked data. The 20,000 cord blood units are not included in this measure but are included in the total
number of cord blood units available through the CWBYCTP.
223
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.
283
FY 2019 FY 2020 FY 2021
Number of Contracts 5 6 6
Average Contract $3,038,825 $2,505,500 $1,170,833

Range of Contracts $665,000-8,400,000 $500,000-4,950,000 $315,000-$2,500,000
284
C.W Bill Young Cell Transplantation Program
FY 2021 FY 2021
BA $24,501,000 $30,009,000 $30,009,000 ---
FTE 6 6 6 ---
Authorizing Legislation: Public Health Service Act, Sections 379-379B, as amended by Public
Law 114-104
FY 2021 Authorization…………………………………………………….………….$30,000,000
Allocation Method…………………………………………………….……….………….Contract
Program Description
The primary goal of the C.W. Bill Young Cell Transplantation Program is to increase the number
of transplants for recipients suitably matched to biologically unrelated bone marrow224 and
umbilical cord blood donors. HRSA 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 matched donors 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 is similar to that of its predecessor, HRSA
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 C.W. Bill Young Cell
Transplantation Program operates through three major contracts that require close coordination
and oversight and supports an Advisory Council that provides recommendations to the HHS
224
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.
285
Secretary and 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
provides individualized patient services for ongoing searches for bone marrow donors or
cord blood units. The OPA also assists patients with information regarding treatment
options and payment 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
C.W. Bill Young Cell Transplantation Program meets its long-term goals for: (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 C.W. Bill Young Cell Transplantation Program also relies on two annual performance
measures: (1) number of adult volunteer potential donors from underrepresented racial and ethnic
populations listed 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 C.W. Bill Young Cell Transplantation Program continues to serve a diverse patient
population, with umbilical cord blood playing a vital role in expanding access to transplants for
patients from underrepresented racial and ethnic populations. 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 2018, more than 20.6 million potential adult volunteer
donors were listed on the Program’s registry. More than 3.8 million, or approximately 18
percent, self-identify as belonging to an underrepresented racial or ethnic population. HRSA
expects the registry will list 4.08 million adult donors who self-identify as belonging to an
underrepresented racial or ethnic population in FY 2021.
286
The cost of tissue typing per donor strongly influences the number of potential volunteer donors
recruited for the Program’s registry. The FY 2021 cost for each donor’s tissue typing will remain
at $58.00, the same cost as in FY 2020. Tissue typing identifies genetic markers that assist
physicians in conducting donor searches on behalf of patients. Continued advances in tissue
typing technology facilitate more efficient matching between potential donors and searching
patients and allow patients to move more rapidly toward transplantation.
Funding History
FY Amount
FY 2017 $22,056,000
FY 2018 $24,050,000
FY 2019 $24,501,000
FY 2020 $30,009,000
FY 2021 $30,009,000
Budget Request
The FY 2021 Budget Request for the C.W. Bill Young Cell Transplantation program of $30.0
million is the same as the FY 2020 Enacted level. This Budget request supports the Program’s
FY 2021 performance target of 4.08 million adult volunteer donors from underrepresented racial
and ethnic populations listed on the Program’s registry.
The Budget request prioritizes recruiting and tissue-typing new donors and continues the
following activities: (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 2021 Budget request allows the C.W.
Bill Young Cell Transplantation Program to continue critical planning in collaboration with HHS
on a response to a national radiation or chemical emergency. In such an event, casualties could
involve temporary or permanent marrow failure and may possibly require emergency transplants
for individuals unable to recover marrow function.
287
Measure Year and Most

Recent Result
/Target for Recent
Result FY 2021
Result) Target Target FY 2020
24.II.A.2: The number of adult
FY 2018: 3.78M
volunteer potential donors of
blood stem cells from minority
(Target Not Met)
race and ethnic groups (Output)
24.1: The number of blood stem FY 2017: 5,994
cell transplants facilitated by the Target: 6,960 N/A N/A N/A
Program 225 (Output) (Target Not Met)
24.2: The number of blood stem
FY 2017: 875
cell transplants facilitated for
Target: 1,150 N/A N/A N/A
minority patients by the Program
226 (Target Not Met)
(Output)
24.3: The rate of patient survival FY 2013: 71%
at one year, post- transplant 227 Target: 69% N/A N/A N/A
(Outcome) (Target Exceeded)
24.4: The number of blood stem
FY 2017: 4,835
cell transplants facilitated for
Target: 5,135 N/A N/A N/A
domestic patients by the
(Target Not Met)
Program 228 (Output)
24.E: The unit cost of human FY 2018: $58.00
leukocyte antigen (HLA) typing Target: $58.00 $58.00 $58.00 Maintain
of potential donors (Efficiency) (Target Met)
FY 2019 FY 2020 FY 2021

Average Award $5,526,799 $6,784,710 $6,784,710
Range of Awards $60,000-$16,700,000 $60,000-$21,600,000 $60,000-$21,600,000
225
This is a long-term measure. The next target will be set for FY 2022.
226
227
This is a long-term measure. The 2017 target for this measure, set at 69%, will be compared to actuals once
available. The next target will be set for FY 2022.
228
288
Poison Control Program
FY 2021
FY 2019 FY 2020 FY 2021 +/-
President’s
Final Enacted FY 2020
Budget
BA $22,746,000 $22,846,000 $22,846,000 ---
FTE 2 2 2 ---
Authorizing Legislation: Public Health Service Act, Sections 1271-1274, as amended by Public
Law 113-77
FY 2021 Authorization .........................................................................................................Expired
Allocation Method:
 Contracts
 Competitive Grants/Co-operative Agreements
The Poison Control Program (PCP) was established in 2000 and 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; 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 PCP grant program supports Poison Control Centers’ efforts to: 1) prevent and provide
treatment recommendations for poisonings; 2) comply with operational requirements 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 in support of national toxic
surveillance activities conducted by the Centers for Disease Control and Prevention (CDC).
The national toll-free Poison Help Line was established in 2001 to ensure universal access to
Poison Control Center services. Individuals can call from anywhere in the U.S. and the
territories and connect to the poison centers that serve their respective areas. The PCP maintains
the number, provides translation services in over 150 languages, and offers services for the
hearing impaired.
Today, a network of 55 Poison Control Centers, supported by 52 grant awards, provide cost-
effective, quality health care advice to the general public and health care providers across the
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
289
treatment recommendations at no cost to callers. 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 mismanage medicine or when workers are exposed to harmful substances on the job.
Emergency 911 operators refer poison-related calls to Poison Control Centers, and health care
professionals regularly consult Poison Control Centers for expert advice on complex cases.
Poison Control Centers 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, poison centers managed 2.5
million cases in 2018 a 2.96 percent decline from 2017. Of the approximate 2.0 million human
exposure poisonings reported in 2018, Poison Control Centers managed about 66 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 24 percent of poison control calls. Consistent with the previous year, the top 5
substance classes most frequently involved in all human exposures were analgesics (10.8%),
household cleaning substances (7.28%), cosmetics/personal care products (6.53%),
sedatives/hypnotics/antipsychotics (5.53%), and antidepressants (5.22%). 229 Multiple studies
have demonstrated that poison centers’ accurate assessments and triage of poison exposures save
dollars by reducing the severity of illness and death, and by eliminating or reducing the expense
of unnecessary trips to emergency departments. Poison center consultations also decrease
patients’ lengths of stay in hospitals and decrease hospital costs. Health care facilities’ use of
poison centers continues to increase, indicating an increase in severity of poisonings and the
need for toxicological expertise in clinical settings. 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, and the State and Local Government saves approximately $284.2
million in medical care costs and lost productivity.230
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 2019, the
Poison Help media campaign included an investment of $320,442. Based on over 456 million
media impressions through television, radio, and social media, the PCP was able to leverage an
advertising return on investment of over $4.9 million.
In addition to providing the public and health care providers with treatment advice on
poisonings, a second critical function of the Poison Control Centers 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
229
David D. Gummin, James B. Mowry, Daniel A. Spyker, Daniel E. Brooks, Krista O. Osterthaler & William
Banner: 2018 Annual Report of the American Association of Poison Control Centers’ National Poison Data
System (NPDS): 36th Annual Report, Clinical Toxicology.
230
Value of the Poison Center System: Lewin Group Report for the American Association of Poison Control
Centers. 2012
290
occurrences 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 Poison Control Centers to monitor exposures to e-cigarette
devices and liquid nicotine, synthetic cathinones and cannabinoids, opioids, hand sanitizer, and
laundry detergent packets. In another example, Poison Control Centers are on the frontline of the
opioid epidemic handling opioid-related calls every day, resulting in 60,997 opioid misuse and
abuse cases per year.
According to the CDC, in 2017, 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.
Poison Control Centers 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 patients.
Poison Control Centers 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 poisonings. Additionally, Poison Control Centers 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 2017 $18,846,000
FY 2018 $20,810,000
FY 2019 $22,746,000
FY 2020 $22,846,000
FY 2021 $22,846,000
Budget Request
The FY 2021 Budget Request for the Poison Control Program of $22.8 million is equal to the FY
2020 Enacted level. This request will support the Poison Control Centers’ infrastructure and core
triage and treatment services. Poison Control Centers predominantly rely on state and local
funding, as Federal funding accounts for approximately 13 percent of total Poison Control Center
funding. While Poison Control Centers have innovatively secured funding from a variety of local
sources, including philanthropic organizations, their financial stability is tenuous. Federal
funding helps reinforce the nationwide Poison Control Center infrastructure, enabling Poison
Control Centers to sustain their public health and toxic surveillance efforts.
291
In FY 2021, the PCP plans to issue grant continuation awards to 52 recipients. The National
Toll-Free Hotline Services and Promotion of Number and Services will ensure access to Poison
Control Centers 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.
The Nationwide Media Campaign will continue to educate the public and health care providers
about the national toll-free number and build upon the existing national public awareness
campaign, Poison Help, to highlight the role of Poison Control Centers in the public health
system with a focus on Medicare and Medicaid beneficiaries. The goals of the campaign include
increasing public awareness of the national Poison Help toll-free number; providing education on
poisoning risk and prevention; and showcasing the role of the national network of Poison Control
Centers 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.
follow-up performance reviews, information technology and other program support costs.
Outputs and Outcomes
Year and Most

Recent Result/
Target for Recent
Result/ FY 2021
FY 2019: 90%
25.III.D.3: Percent of inbound volume
Target: 85.0% 85% 85% Maintain
on the toll-free number. (Output)
(Target Exceeded)
25.III.D.4: Percent of national survey

FY 2017: 37%
respondents who are aware that calls to
Target: 25% N/A N/A N/A
poison control centers are handled by
(Target Exceeded)
health care professionals. (Outcome) 231
25.III.D.6: Percent of human exposure

FY 2021: 24%
calls made to Poison Control Centers
Baseline N/A 24% N/A
that came from health care facilities.
(Target: 24%)
(Output)
231
This is a long-term measure based on periodic survey data, reported about every 5 years. The next survey
findings are expected in FY 2022, with results in 2023 once a final report is approved by HRSA.
292
Grants Awards Table
FY 2019 FY 2020 FY 2021

Number of Awards 232 52 52 52
Average Awards $392,307 $392,307 $392,307
Range of Award $12,466-$2,411,364 $12,466-$2,411,364 $12,466-$2,411,364
FY 2019 FY 2020 FY 2021

Number of Contracts 2 2 2
Average Contract $260,584 $415,722 $415,722
Range of Contracts $54,871-$511,000 $500,000-$511,000 $500,000-$511,000
232
There are 55 Poison Control Centers across the Nation. Fifty-two awards were made in FY 2019 and are
anticipated in FY 2020 and FY 2021 under the Poison Control Stabilization and Enhancement 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.
293
Office of Pharmacy Affairs/340B Drug Pricing Program
FY 2021 FY 2021
BA $10,193,000 $10,238,000 $10,238,000 ---
User
--- --- $24,000,000 +$24,000,000
Fees
Total $10,193,000 $10,238,000 $34,238,000 +$24,000,000
FTE 22 22 38 +16
Authorizing Legislation: Public Health Service Act, Section 340B, as amended by Public Law
111-309, Section 204
FY 2021 Authorization……………………………….……………….……….………….....SSAN
Allocation Method…………………………………………...………………….……..….Contract
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.
These include Federally Qualified Health Centers, AIDS Drug Assistance Programs, and certain
disproportionate share hospitals. The 340B Program helps these designated hospitals and clinics
provide more care to additional patients.
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 2018, total sales in the 340B Program were approximately $24 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 5 percent of the total U.S. drug market.
HRSA places a high priority on the integrity of the 340B Program and continually works to
improve Program oversight. 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 completed 1,293 covered entity audits, which included review of 17,946
294
offsite outpatient facilities and 27,235 contract pharmacies. Final audit results, including
statuses of corrective actions, are available on HRSA’s website. As of December 6, 2019,
HRSA closed out and finalized 1,150 of the 1,293 audits conducted, with 38 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, performs 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 to ensure that all covered entities and
manufacturers are in compliance with 340B program requirements.
 Publishes quarterly in the Office of Pharmacy Affairs Information System, Pricing
Component, the verified ceiling prices of covered outpatient drugs available for purchase
under the 340B Program.
The 340B Program includes the establishment of a Prime Vendor Program (PVP) to develop,
maintain, and coordinate a program capable of facilitating distribution of covered outpatient
drugs. By the end of 2018, the PVP had nearly 4,600 products available to participating entities
below the 340B ceiling price, including 2,500 covered outpatient drugs with an estimated
average savings of 27 percent below the 340B ceiling price. From 2009 to 2018, the PVP
contracts provided over $1.3 billion in additional sub-ceiling savings for covered entities.
Funding History
Budget
FY User Fees
Authority
FY 2017 $10,213,000 ---
FY 2018 $10,210,000 ---
FY 2019 $10,193,000 ---
FY 2020 $10,238,000 ---
FY 2021 $10,238,000 $24,000,000
Budget Request
The FY 2021 Budget Request for the Office of Pharmacy Affairs/340B Drug Pricing Program of
$10.2 million is equal to the FY 2020 Enacted level. Additionally, the FY 2021 Budget Request
includes $24 million from user fees as a new revenue source. In FY 2021, 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 up to 0.1 percent (or one
dollar for every thousand dollars) of the total 340B drug purchases paid by participating covered
entities. Both appropriated resources and user fee revenue will support implementation of 340B
Program statutory obligations, oversight of participating manufacturers and covered entities,
operational improvements, and increased efficiencies using information technology.
295
The FY 2021 Budget Request also re-proposes to reform the 340B Program through a General
Provision in the Labor and Health and Human Services Appropriations Act that would require
covered entities to report both their savings and uses to HRSA, and provide HRSA with general
regulatory authority. HRSA is currently evaluating its audit process and other program integrity
efforts as they relate to HRSA’s ability to enforce and require corrective action in a Program that
is primarily administered by guidance. Guidance documents do not provide HRSA appropriate
enforcement capability, which is why HRSA has requested regulatory authority in the
President’s Budget each year since FY 2017. General regulatory authority over the 340B
Program would allow HHS to set clear enforceable standards of participation on all aspects of
340B program and will help ensure compliance with 340B Program requirements. Currently,
hospitals participating in 340B are not required to report on 340B savings or how these savings
are used to benefit patient populations. These reforms would help ensure low income and
uninsured patients benefit from the Program, as intended, and strengthen program integrity and
oversight activities.
FY 2021 Budget Authority
The FY 2021 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. 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 guide future
technical assistance.
The request supports facilitation of refunds and credits to entities that are overcharged by
participating manufacturers as well as enhancements to the pricing system whereby covered
entities access 340B ceiling price information via a secure website. System implementation
began in the first two quarters of calendar year 2019, with manufacturers reporting data during
the first quarter and prices being available to covered entities, after review and validation, on
April 1, 2019.
The FY 2021 Budget Request for budget authority includes costs associated with contract award
processes, follow-up reviews, information technology, and other program support costs.
FY 2021 User Fees
In FY 2021, HRSA will begin 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.
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
296
development. User fees 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.
HRSA plans to continue random and targeted audits of covered entities and manufacturers, as
well as publish audit report summaries on the HRSA website to expand the 340B Program’s
compliance reach while managing program risk. User fees would provide the additional funding
needed to hire and train staff to expand capacity to conduct additional covered entity audits in the
future, conduct additional manufacturer audits, write reports, work with entities and
manufacturers through the notice and hearing process, and finalize information for public
dissemination.
Performance Measures
HRSA measures 340B Program performance by two key metrics: numbers of covered entities
and manufacturers audits. As of October 1, 2019, participation levels included 12,414 covered
entities and 34,629 associated sites participating in the 340B Program, for a total of 47,043
registered sites. The 47,043 covered entity sites have contract pharmacy arrangements that
support 25,654 unique pharmacy locations registered in the 340B database.
Year and Most

Recent Result
FY 2021
+/-
Measure Recent Result Target Target
FY 2020
(Summary of
Result)
FY 2019: 200
39.I.A.1: Covered Entity
Target: 200 200 200 Maintain
Audits Conducted (Output)
(Target Met)
FY 2019: 5
39.I.A.2: Manufacturer Audits
Target: 5 5 5 Maintain
Conducted (Output)
(Target Met)
FY 2019 FY 2020 FY 2021

Number of
3 3 3
Contracts
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
297
National Hansen’s Disease Program
FY 2021 FY 2021
BA $13,646,000 $13,706,000 $11,653,000 -$2,053,000
FTE 50 50 50 ---
105-78, Section 211
FY 2021 Authorization ......................................................................................................Indefinite
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 1917. 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 clinical training on the diagnosis and management of Hansen’s disease.
The Program makes 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 Mycobacterium
leprae or Mycobacterium lepromatosis, the bacterium that cause leprosy. Hansen's disease is 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 many health care providers
are unaware of Hansen's disease and its symptoms. Early diagnosis and treatment prevent nerve
involvement 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
of Hansen’s disease-related disability and deformity. The Program facilitates outpatient
management of leprosy by providing additional laboratory, diagnostic, consultative, and referral
298
services to private sector physicians. NHDP increases U.S. health care providers’ knowledge by
serving as an education and referral center.
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 indigent patient transportation.
Improving Health Outcomes: Hansen’s disease is a life-long chronic condition that usually
progresses to severe deformity when left untreated and unmanaged. Through a focus on early
diagnosis and treatment, NHDP measures its impact on improving health outcomes for Hansen’s
disease patients by reducing the percentage of patients with grades 1 or 2 disability/deformity. 233
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 is also 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 diagnosis and treatment. Currently, lab research is
using 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.
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 the quality of care and
health outcomes related to Hansen’s disease.
Funding History
FY Amount
FY 2017 $15,169,000
FY 2018 $13,650,000
FY 2019 $13,646,000
FY 2020 $13,706,000
FY 2021 $11,653,000
Budget Request
The FY 2021 Budget Request for the National Hansen’s Disease Program of $11.7 million is
$2.1 million below the FY 2020 Enacted level. This request supports the Program’s primary
focus on direct patient care activities and improving health outcomes for Hansen’s disease
233
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 a loss of protective
sensation and no visible deformity. Patients graded at 2 have visible deformities secondary to muscle paralysis and
loss of protective sensation.
299
patients. The funding level also reflects improvements in health outcomes through research and
health care provider education.
In FY 2021, NHDP will fund eleven ambulatory care contracts with continuing efforts to align
resources with levels of care. Hansen’s disease patients with severe complications 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 also
provides free HD medication to all providers upon request for the care and treatment of HD
patients in the U.S. and its territories.
NHDP plans to invest FY 2021 resources in a new Electronic Health Record system to capture
patient care data, improve care coordination, and increase communication among staff and
providers. The investment will include implementation and staff training costs. In FY 2021, the
NHDP also plans to expand and enhance outreach and training activities to providers to improve
early diagnosis and reduce permanent disability in patients.
The FY 2021 Budget Request will also support the first full year of NHDP’s lease costs for its
new administrative and clinical facility, following the Program’s planned FY 2020 relocation to
a different site in Baton Rouge, Louisiana. In FY 2019, NHDP initiated a process with the
General Services Administration (GSA) to locate research space as the current lease for research
activities expires in FY 2022. This process will continue through FY 2021, and HRSA
anticipates future lease costs for research space to increase.
The funding request also includes costs associated with the contract review and award process,
Year and Most

Recent
Result/Target for
Recent Result FY 2021
3.II.A.4.: Number of health

FY 2019: 681
care providers who have
Target 600 650 700 +50
received training from NHDP
(Target Exceeded)
(Output)
FY 2019: 32%
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 (Outcome)
(Target Met)
300
Program Indicators
FY 2021
Resident Population: Inpatients 1 1 1
Baton Rouge Clinic: Outpatients 399 399 399
Baton Rouge Clinic: Outpatient Visits 2,261 2,261 2,261
Ambulatory Care Program (ACP) Contracts 11 11 11

ACP Clinic: Outpatients 819 819 819
ACP Clinic: Outpatient Visits 2,700 2,700 2,700
301
National Hansen’s Disease Program – Buildings and Facilities
FY 2021 FY 2021
BA $122,000 $122,000 --- -$122,000
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 while meeting
requirements to preserve the Carville historic district under the National Historic Preservation
Act.
Funding History
FY Amount
FY 2017 $122,000
FY 2018 $122,000
FY 2019 $122,000
FY 2020 $122,000
FY 2021 $---
Budget Request
There is no request in FY 2021 for Building and Facilities. HRSA has funds to complete minor
renovation work. In FY 2021, HRSA operations that remain at Carville are solely for the
Museum.
302
Payment to Hawaii
FY 2021 FY 2021
BA $1,849,000 $1,857,000 $1,857,000 ---
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 2017 $1,853,000
FY 2018 $1,852,000
FY 2019 $1,849,000
FY 2020 $1,857,000
FY 2021 $1,857,000
Budget Request
The FY 2021 Budget Request of $1.9 million is equal to the FY 2020 Enacted level. This request
supports the payment made to the State of Hawaii for the medical care and treatment of persons
with HD. It also includes costs associated with the grant review and award process, follow-up
performance reviews, and information technology, and other program support costs.
303
Rural Health Policy
TAB
304
FEDERAL OFFICE OF RURAL HEALTH POLICY
Rural Health Policy Development

FY 2021 FY 2021
BA $9,284,000 $10,351,000 $5,000,000 -$5,351,000
FTE 3 3 3 ---
Authorizing Legislation: Social Security Act, Section 711
Allocation Method ............................................................... Competitive Cooperative Agreements
The Federal Office of Rural Health Policy (FORHP) is charged with advising the HHS Secretary
on how rural health care is affected by current policies as well as proposed statutory, regulatory,
administrative, and budgetary changes in the Medicare, Medicaid and other key HHS 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. Rural Health Policy Development funds a number of programs
to carry out these advisory and compliance roles, including supporting 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.
FORHP provides funding for the only federal research programs specifically designed to provide
publically available, policy relevant studies on rural health issues. The Rural Health Research
Center (RHRC) Program funds seven research centers to conduct policy-oriented health services
research. The RHRCs produce policy briefs and peer-reviewed journal manuscripts and make
their publications available to policy makers and other rural stakeholders at both the federal and
state levels. The RHRC publications also align with Administration priorities, such as addressing
opioid abuse. The Rapid Response Rural Data Analysis and Issue Specific Rural Research
Studies Program supports one award to conduct rapid data analyses and short-term rural research
studies. The Rural Health Research Dissemination Cooperative Agreement, currently awarded
to the Rural Health Research Gateway, disseminates and promotes FORHP funded rural health
305
services research to stakeholders at the national, state, and community levels with the goal of
informing and raising awareness of key policy issues important to rural communities. In FY
2019, these programs conducted and disseminated 56 research reports, including policy briefs
posted on the Rural Health Research Gateway website and manuscripts published in peer-
reviewed journals. The National Rural Health Information Clearinghouse Program, currently
awarded to the Rural Health Information Hub, serves as a clearinghouse for information on rural
health, including HRSA’s rural health programs, for residents of rural areas in the United States
and other rural health stakeholders.
In FY 2020, FORHP will establish a new Telementoring Training Center Program to provide
training for academic medical centers and other centers of excellence to create technology-
enabled telementoring learning programs that focus on reaching regionally diverse populations
and addressing unique cultural aspects across rural areas.
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, FORHP continues to
monitor and track the number of rural hospitals that have closed across the country. From
January 1, 2010 to November 30, 2019, 119 rural hospitals have closed. FORHP has funded a
number of grants that focus on addressing hospital closures, particularly mitigating the loss of
services due to hospitals closing or facing financial distress.
Funding History
FY Amount
FY 2017 $9,351,000
FY 2018 $9,325,000
FY 2019 $9,284,000
FY 2020 $10,351,000
FY 2021 $5,000,000
Budget Request
The FY 2021 Budget Request for the Rural Health Policy Development Program of $5.0 million
is $5.4 million below the FY 2020 Enacted Level. This request will allow the following activities
to continue at a reduced level of effort: Rural Health Research Center Cooperative Agreement;
Rapid Response Rural Data Analysis and Issue Specific Rural Research Studies Program; the
Rural Health Research Gateway; the Rural Health Information Hub; National Rural Health
Policy, Community, and Collaboration Program; 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 2021.
306
Year and Most

Recent Result/
FY 2021
Target for FY 2020 FY 2021
Measure +/-
FY 2020
(Summary of
Result)
28.V.A.1: Conduct and FY 2019 : 56

disseminate policy relevant Target: 39
39 14 -25
research on rural health (Target
issues. (Output) Exceeded)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $758,041 $881,071 $458,750
Range of Awards $100,000 - $2,500,000 $100,000 - $3,000,000 $67,500 - $1,500,000
307
Rural Health Care Services Outreach, Network and Quality Improvement
Grants
FY 2021 FY 2021
BA $76,942,000 $79,500,000 $89,500,000 +$10,000,000
FTE 9 9 9 ---
Authorizing Legislation: Public Health Service Act, Section 330A, as amended by Public Law
110-355, Section 4 and Social Security Act, Section 711
FY 2021 Authorization (330A) ............................................................................................. Expired
FY 2021 Authorization (711)…………………………………………………………… Indefinite
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.
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.
 Outreach Service Grants focus on improving access to health care in rural communities
through community coalitions and evidence based and promising practice models. These
grants focus on disease prevention, health promotion, and can support the expansion of
services around primary care, opioid use disorder treatment and prevention, behavioral
health, and oral health care. Additionally, through the introduction of the Health
Improvement Special Project track, a cohort of grantees within the Outreach Program
have a specific focus on addressing cardiovascular disease risk through use of the Centers
for Disease Control and Prevention (CDC) Heart Age Calculator. 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. HRSA plans to make
88 new awards.
308
 Rural Network Development Grants support formalized partnerships among health care
providers and social and community service organizations collaborating to improve
access and enhance the quality of healthcare in rural areas. The program focuses on
demonstrating improved health outcomes resulting from network collaboration, as well as
positioning healthcare networks and their products and services to be sustainable as the
health care landscape continues to evolve. Grantees under this program are likely to focus
on improving health outcomes, enhancing health care quality, and increasing services
provided by the network. HRSA plans to make 46 continuing awards.
 Network Planning Grants assist in the development of integrated healthcare networks to

address local health care challenges. The Network Planning program provides an
opportunity for grantees to work on priority and emerging local public health issues, such
as care coordination, patient engagement, rural hospital closure/conversion, telehealth,
mental health, and substance use (particularly opioid use disorder). HRSA will make 20
new awards.
 Small Healthcare 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 increased care coordination, 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. HRSA
will continue to support 32 awards in FY 2021.
 The Delta States Rural Development Network Grant Program provides network
development grants to the eight states in the Mississippi Delta for network and rural
health infrastructure development. This program is geographically targeted, given the
health care disparities across this eight-state region. The program supports chronic
disease management, oral health services, and recruitment and retention efforts for health
professionals. The program requires grantees to focus on diabetes, cardiovascular disease,
and obesity and to develop programs based on promising practices or evidence-based
models. HRSA will make 12 continuing awards in FY 2021.
 Delta Region Community Health Systems Development Program help rural communities
address their health care needs in a targeted manner and assists small rural hospitals and
clinics improve their financial and operational performances. The program started with
one cohort of nine rural communities and their hospitals in FY 2017. The program
expanded to include a second cohort of two rural communities and their hospitals in FY
2018 and a third new cohort of ten rural communities and their hospitals in FY 2019.
HRSA will close out the first cohort and continue the new cohorts in FY 2020. HRSA
developed this program in FY 2017 in coordination with the Delta Regional Authority.
HRSA will continue to support the Delta Region Community Health Systems
Development award in FY 2021.
309
 Rural Maternity and Obstetrics Management Strategies (RMOMS) grants improve access
and continuity of maternal and obstetrics care in rural communities. RMOMS goals
include:
(1) Developing a sustainable network approach to coordinate maternal and obstetrics

care within a rural region;
(2) Increase the delivery and access of preconception, pregnancy, labor and delivery,
and postpartum services;
(3) Developing sustainable financing models for the provision of maternal and
obstetrics care; and
(4) Improving maternal and neonatal outcomes.
In FY 2019, HRSA created RMOMS in response to research by the University of

Minnesota that revealed a decreasing availability of obstetric units in rural areas.234 The
HHS Rural Health Taskforce further validated these study results. HRSA will support
continuing RMOMS grant awards in FY 2021.
Beginning in FY 2021, HRSA will launch an HHS-wide Improving Maternal Health in

America Initiative, which focuses on a four -pillar strategy to achieve: 1) Healthy
Outcomes for All Women of Reproductive Age by improving prevention and treatment,
2) Healthy Pregnancies and Births by prioritizing quality improvement, 3) Healthy
Futures by optimizing post-partum health, and 4) Improved Data and Bolster Research to
inform future interventions. HRSA plans to spend an additional $10.0 million in FY 2021
for new RMOMS awards as part of the Improving Maternal Health in America Initiative.
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 Analysis235 tool to assess the economic impact of
federal investments. 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
234
Hung P, Henning-Smith C, Casey M, Kozhimannil, K. Access to Obstetric Services in Rural Counties Still
Declining, with 9 Percent Losing Services, 2004-14. Health Affairs. 2017; 36 (9): 1663-1671.
doi:10.1377/hlthaff.2017.0338
235
https://www.ruralhealthinfo.org/econtool
310
each project periods end, the Outreach programs continually assess program sustainability.
While sustainability rates may vary across grantee cohorts, HRSA expects the majority of
projects to continue after federal funding. Across the 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 Gateway236 so that rural communities from
across the country can benefit from Outreach program investments and results.
Funding History
FY Amount
FY 2017 $65,500,000
FY 2018 $71,300,000
FY 2019 $76,942,000
FY 2020 $79,500,000
FY 2021 $89,500,000
Budget Request
The FY 2021 Budget Request for the Rural Health Care Services Outreach, Network and Quality
Improvement Grants Program of $89.5 million includes $10.0 million above the FY 2020
Enacted Level specifically to improve maternal health. This request will allow HRSA to expand
the Rural Maternity and Obstetrics Management Strategies (RMOMS) program that supports
maternal health needs in rural communities. HRSA plans to fund new FY 2021 RMOMS awards
in support of HHS’s Improving Maternal Health in America Initiative. HRSA will also support
continuing RMOMS grant awards in FY 2021, for a total of $12 million
In FY 2021, the Outreach Program will support the continuation of 94 existing grantees and 118
new competitive grants that will positively affect health care service delivery for over 420,000
people.
236
https://www.ruralhealthinfo.org/community-health
311
Year and Most

Recent Result /
FY 2021
Measure +/-
FY 2020
(Summary of
Result)
29.IV.A.3. Track number
of unique individuals who FY 2018:
received direct services 1,930,243
through FORHP Outreach 200,000 200,000 Maintain
grants, subject to Target: 420,000
availability of resources. (Target
(Output) Exceeded)
29.IV.A.4: Percent of
Outreach Authority FY 2018: 100%
grantees that will continue Target: 75%
(Target 75% 75% Maintain
to offer services after the
federal grant funding Exceeded)
ends.237 (Outcome)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Number of
219 202 212
Awards
Average
$264,541 $276,904 $302,149
Award238
Range of $88,099 - $100,000 - $100,000 -
Awards $8,000,000239 $10,000,000240 $10,000,000241
237
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.
238
Average award amount does not include the Delta Region Community Health Systems Development Cooperative
Agreement, which is $8.0 million in FY 2019 and $10.0 million in FY 2020 and FY 2021.
239
This represents one cooperative agreement worth up to $8,000,000 for the Delta Region Community Health
Systems Development Cooperative Agreement.
240
241
312
Rural Hospital Flexibility Grants
FY 2021 FY 2021
BA $53,223,000 $53,609,000 -- -$53,609,000
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
FY 2021 Authorization ......................................................................................................... Expired
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 more than 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
2018, HRSA received an increase in appropriated funds for the Flex Program and
allocated an additional $3 million across the 45 states to support ongoing efforts and
ensure the program is meeting the goal of improving the financial viability of hospitals.
With FY 2019 funds, HRSA targeted $2 million for a new three-year initiative supporting
emergency medical services (EMS) across eight states and focusing on quality and
operational improvement initiatives.
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, through this program, can elect to submit quality data to CMS to demonstrate
areas of high quality while also identifying areas for improvement. This provides an
avenue for ensuring that CAH quality efforts are aligned with broader Medicare quality
313
initiatives. As a result of the Flex Program’s Medicare Beneficiary Quality Improvement
Project (MBQIP), ninety-six percent242 of CAH’s are reporting quality data to CMS.
 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 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. 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. For
the FY 2019 competitive cycle, HRSA partnered closely with the Veteran’s Health
Administration Office of Rural Health to connect the state level grantees with VHA
knowledge and expertise.
Funding History
FY Amount
FY 2017 $43,609,000
FY 2018 $49,470,000
FY 2019 $53,223,000
FY 2020 $53,609,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Rural Hospital Flexibility Grants Program of $0 is $53.6
million below the FY 2020 Enacted Level. The Budget prioritizes programs that provide direct
health care services.
242
Results based on the Flex Monitoring Team analysis of the 2016 CMS data.
314
Year and Most

Recent Result /
FY 2021
Target for Recent FY 2020 FY 2021
Measure +/-
FY 2020
(Summary of
Result)
30.V.B.6: Increase the percent

of Critical Access Hospitals FY 2017: 84.4%
participating in the Hospital Target: 74%
Consumer Assessment of 85% N/A ---
Healthcare Providers and (Target Exceeded)
Systems (HCAHPS) survey
(Output)
30. V.B.7a: Percent of CAHs
participating in one or more
Flex-funded required quality
FY 2017: 72%
improvement initiatives that
showed improvement in one (Target Not in 70% N/A ---
or more specified quality Place)
domains. (Developmental)243
(Outcome)
30. V.B.7b: Percent of CAHs

participating in one or more
Flex-funded optional quality
FY 2017: 54%
improvement initiatives that
showed improvement in one (Target Not in 47% N/A ---
or more specified quality Place)
domains. (Developmental) 244
(Outcome)
243
FY 2015 was the first year of data for this measure. Targets were set beginning for FY 2019 Results.
244
FY 2015 was the first year of data for this measure. Targets were set beginning for FY 2019 Results.
315
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $565,000 $565,000 ---
Range of Awards $18,000-$945,000 $23,732-$945,000 ---
316
State Offices of Rural Health
FY 2021 FY 2021
BA $9,928,000 $12,500,000 -- -$12,500,000
FTE --- --- --- ---
Authorizing Legislation: State Offices of Rural Health Reauthorization Act of 2018, Section
338J of the Public Health Service Act (42 U.S.C. 254r)
FY 2021 Authorization ......................................................................................... Expires FY 2022
This grant program provides funding to establish and maintain a State Office of Rural Health
(SORH) within states to strengthen rural health care delivery systems. Every dollar of federal
support is 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.
Funding History
FY Amount
FY 2017 $10,000,000
FY 2018 $10,000,000
FY 2019 $9,928,000
FY 2020 $12,500,000
FY 2021 ---
317
Budget Request
The FY 2021 Budget Request for the State Offices of Rural Health Program of $0 is $12.5
million below the FY 2020 Enacted Level. The Budget prioritizes programs that provide direct
health care services.
Year and Most

Recent Result /
FY 2021
Measure +/-
FY 2020
(Summary of
Result)
31.V.B.3: Number of
technical assistance FY 2017: 69,303
(TA) encounters Target: 82,549 ---
67,000 N/A
provided directly to (Target Not Met)
clients by SORHs.
(Output)
31.V.B.4: Number of
clients (unduplicated) FY 2017: 22,467
that received technical Target: 26,574 23,484 N/A ---
assistance directly from (Target Not Met)
SORHs. (Output)
31.V.B.5: Number of
clinician placements FY 2017: 2,380
facilitated by the Target: 1,260 1,260 N/A ---
SORHs through their (Target Exceeded)
recruitment initiatives.
(Output)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Final Enacted245 President’s Budget
Average Award $179,108 $229,270 ---
Range of Awards $171,165 - $179,270 $229,270 – $229,270 ---
245
Average Award and Range of Awards based on 50 SORHs receiving the same amount.
318
Radiation Exposure Screening and Education Program
FY 2021 FY 2021
BA $1,821,000 $1,834,000 $1,834,000 --
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 2018, the number of individuals
screened at RESEP was 1,261.
Funding History
FY Amount
FY 2017 $1,834,000
FY 2018 $1,834,000
FY 2019 $1,821,000
FY 2020 $1,834,000
FY 2021 $1,834,000
Budget Request
The FY 2021 Budget Request for the Radiation Exposure Screening and Education Program of
$1.8 million is equal to the FY 2020 Enacted Level. This request will continue to support
activities such as: implementing cancer screening programs; developing education programs;
disseminating information on radiogenic diseases and the importance of early detection;
screening eligible individuals for cancer and other radiogenic diseases; providing appropriate
319
referrals for medical treatment; and facilitating documentation of Radiation Exposure
Compensation Act (RECA) claims.
Year and Most

Recent Result /
FY 2021
Measure +/-
FY 2020
(Summary of
Result)
32.1: Percent of RECA successful FY 2018: 19 %
claimants screened at RESEP Target: 8.8% 13% 13% Maintain
centers. (Outcome) (Target Exceeded)
32.2: Percent of patients screened FY 2018: 79%

at RESEP clinics who file RECA Target: 72% 77% 77% Maintain
claims that receive RECA (Target Exceeded)
benefits. (Outcome)
FY 2018:
32.I.A.1: Total number of 1,261
individuals screened per year. Target: 1,200 1,300 1,300 Maintain
(Output) (Target Exceeded)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $228,919 $228,919 $228,919
Range of Awards $119,461 - 281,733 $119,461 - 281,733 $119,461 - 281,733
320
Black Lung
FY 2021 FY 2021
BA $10,921,000 $11,500,000 $11,500,000 --
FTE 1 1 1 ---
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 the recent years, most
grantees have been able to use funds to upgrade equipment, enhance their workforce capacity
and increase behavioral health screenings and care integration.
HRSA also funds the Black Lung Center for Excellence Program (BLCE) in supporting and
strengthening the operations of BLCP awardees and their ability to examine and treat respiratory
and pulmonary impairments in active and inactive coal miners. BLCE supports BLCP awardees
through improved data collection, analysis and expanding the body of knowledge of the health
status and needs of coal miners nationally.
In FY 2018, HRSA piloted a new patient-level data reporting system to capture the number of
medical encounters a black lung disease patient may experience on a single trip to the clinic.
HRSA can now track each unique patient encounter within a day, rather than measuring multiple
encounters within a day as only one encounter. In FY 2018, the program supported 67,489
medical encounters with Black Lung disease patients, under the new reporting method. This
exceeds the target of 20,000 that is based on the former reporting method; the targets will be
formally changed in the near future.
321
Recent data highlights the continued need for black lung services. The National Institute of
Occupational Safety and Health (NIOSH) identified a cluster of 60 progressive massive fibrosis
(PMF) cases among current and former Appalachian coal miners at a single eastern Kentucky
radiology practice from January 2015 to August 2016. This figure exceeded the 19 PMF cases in
Kentucky detected by NIOSH’s National Coal Workers’ Health Surveillance Program between
August 2011 and July 2016.246 The current prevalence of CWP among underground coal miners
with 25 years or more of underground mining tenure in central Appalachia (Kentucky, Virginia,
and West Virginia) is 20.6 percent and the national prevalence is over 10 percent.247
Funding History
FY Amount
FY 2017 $7,250,000
FY 2018 $10,000,000
FY 2019 $10,921,000
FY 2020 $11,500,000
FY 2021 $11,500,000
Budget Request
The FY 2021 Budget Request for the Black Lung Program of $11.5 million is equal to the FY
2020 Enacted 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.
246
Blackley DJ, Crum JB, Halldin CN, Storey E, Laney AS. “Resurgence of Progressive Massive Fibrosis in Coal
Miners — Eastern Kentucky, 2016.” MMWR 2016;65:1385–1389.
DOI: http://dx.doi.org/10.15585/mmwr.mm6549a1external
247
Blackley DJ, Halldin CN, Laney AS. “Continued Increase in Prevalence of Coal Workers’ Pneumoconiosis in the
United States, 1970–2017”, American Journal of Public Health 108, no. 9 (September 1, 2018): pp. 1220-1222.
DIO: https://doi.org/10.2105/AJPH.2018.304517
322
Year and Most

Recent Result /
FY 2021
Measure +/-
FY 2020
(Summary of
Result)
33.I.A.1: Number of FY 2018: 13,099
miners served each Target: 13,800 13,800 13,800 Maintain
year (Output) (Target Not Met)
33.I.A.2: Number of
FY 2018: 67,489
medical encounters
Target: 20,000 19,000 19,000 Maintain
from Black Lung each
(Target Exceeded)
year. (Output)
33.E.1:The number of
miners served per $1 FY 2018: 1,341
million in HRSA Black Target: 1,314 1,300 1,300 Maintain
Lung Clinics Program (Target Exceeded
funding (Efficiency)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $675,359 $718,750 $718,750
Range of Awards $125,000 - $1,954,576 $125,000 - $2,081,625 $125,000 - $2,081,625
323
Telehealth
FY 2021 FY 2021
BA $24,324,000 $29,000,000 $29,000,000 ---
FTE 2 2 2 ---
Authorizing Legislation: Public Health Service Act, Section 330I and Section 330L, and Social
Security Act, Section 711.
FY 2021 Authorization (Section 330I and 330L) ................................................................. Expired
FY 2021 Authorization (Section 711)................................................................................ Indefinite
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:
 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.
This program funds different cohorts of grantees, usually with unique clinical or
population focus areas, although grantees can also provide other clinical services in their
projects. All TNGP grantee cohorts focus on using telehealth technology to expand
access to services. In addition, the program conducts project evaluations to establish an
evidence-base assessing the effectiveness of telehealth care for patients, providers, and
payers. HRSA will continue to support 29 TNGP grantees focused on improving access
to health care services, in rural and underserved communities.
 Evidence-Based Tele-Behavioral Health Network (EB THNP) Program increases access

to behavioral health care in rural and frontier communities by using telehealth
technologies, given the shortage of mental health providers in many rural and
underserved communities. The emphasis on data collection and research to further the
324
telehealth evidence base separates this program from other Telehealth Network Grants in
OAT. HRSA expects to make new awards in FY 2021.
 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
2021, HRSA expects to make new regional and national TRCs.
 Telehealth Center of Excellence (COE) program examines the efficacy of telehealth

services in rural and urban areas and serves as a national clearinghouse for telehealth
research and resources. HRSA expects to make new COE awards in FY 2021.
 Telehealth Research Centers (THRCs) conducts policy-relevant, clinically informed

telehealth research and comprehensive evaluation of nationwide telehealth investments in
rural areas and populations. As part of the research and evaluation, the Telehealth
Research Centers will also work with Telehealth Network Grant Program awardees,
helping them quantify and analyze their results and preparing summaries and publications
of TNGP’s clinical impact. HRSA anticipates making new awards in FY 2020 and will
continue support for these awards in FY 2021.
 Licensure Portability Grant (LPG) 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.
HRSA will continue to fund two awards for this program in FY 2021.
Funding History
FY Amount
FY 2017 $18,500,000
FY 2018 $23,434,000
FY 2019 $24,324,000
FY 2020 $29,000,000
FY 2021 $29,000,000
325
Budget Request
The FY 2021 Budget Request for the Telehealth Program of $29 million is equal to the FY 2020
Enacted Level. HRSA will continue to utilize telehealth to provide access to healthcare in rural
and underserved areas. In FY 2021, HRSA will make 30 new grant awards and continue 33
grants awards to strengthen the networks that provide telehealth services.
Year and Most

Recent Result /
FY 2021
Measure248 +/-
FY 2020
(Summary of
Result)
34.II.A.1: Increase the
proportion of diabetic patients FY 2017: 37%
enrolled in a telehealth diabetes Target: 25%
case management program with 25% 25% Maintain
(Target
ideal glycemic control (defined Exceeded)
as hemoglobin A1c at or below
7%). (Outcome) 249
34.1: The percent of TNGP

grantees that continue to offer FY 2017: N/A
95% N/A N/A
services after the TNGP funding
has ended. 250(Outcome)
248
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.
249
In FY 2021, HRSA anticipates replacing this measure so no grantees will be expected to participate in
telediabetes case management.
250
This is a long-term measure based on the end date of the current cohort of grantees. The target date for this
measure is FY 2020.
326
Year and Most
Recent Result /
FY 2021
Measure248 +/-
FY 2020
(Summary of
Result)
34.III.D.2: Expand the number
of telehealth services (e.g., FY 2017: 3,189
dermatology, cardiology) and
Target: 2,750 2,750 2,775 +25
the number of sites where
(Target
services are available as a result
Exceeded)
of the TNGP program.
(Output)251
34.III.D.1: Increase the number

of communities that have access FY 2017: 499
to pediatric and adolescent
Target: 335
mental health services where 335 340 +5
(Target
access did not exist in the
Exceeded)
community prior to the TNGP
grant.252 (Output)
34.III.D.1.1: Increase the FY 2017: 556

number of communities that
have access to adult mental Target: 340
340 350 +10
health services where access did (Target
not exist in the community prior Exceeded)
to the TNGP grant.253 (Output)
251
This is a demonstration program. Every three to four years, each cohort of TNGP grantees “graduates” from the
program while a new cohort of grantees begin a new multi-year cycle of grant-supported telehealth activities. This
measure is calculated as a cumulative number of total services by site. With each new cohort, the distribution of
telehealth service types and the number of sites delivering one or more services may change. Therefore, the targets
may need to be revised if there is evidence of a significant increase or decrease in the number of sites or services
that new grantees select to provide.
252
This is a demonstration program. Every three to four years, each cohort of TNGP grantees “graduates” from the
program while a new cohort of grantees begins a new multi-year cycle of grant-supported telehealth activities. This
measure is calculated as a cumulative number. With each new cohort, the distribution of telehealth service types
which grantees select to provide may change. Therefore, the targets may need to be revised if there is evidence of a
significant increase or decrease in grantees that are providing mental health services.
253
Ibid.
327
Year and Most
Recent Result /
FY 2021
Measure248 +/-
FY 2020
(Summary of
Result)
34.E: Expand the number of FY 2017: 35 per
services and/or sites providing Million $
access to health care as a result 65 per 65 per Maintain
of the TNGP program per Target: 65 per Million Million
federal program dollars Million $ $ $
expended.254 (Efficiency) (Target Not
Met)
Grant Awards Table
FY 2019 FY 2020 FY 2021

Average Award $381,579 $460,317 $460,317
Range of Awards $250,000 - $2,000,000 $250,000 - $2,000,000 $250,000 - $2,000,000
254
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 to four years a new cohort of grantee begins a
new three- or four-year cycle of grant-supported activities, with grantees gradually expanding sites and services per
dollar invested. With each new cohort, there is a start-up period where services are put in place but are not yet
necessarily implemented, which increases the cost per site or service type. OAT has refined programs to focus on
specific uses and users like school-based health clinics. The focus on innovation in the use of telehealth services
rather than volume of telehealth services has increased cost per site or service type. As OAT seeks to focus
telehealth funding on special areas, it will reexamine the target baseline for cost per site or service.
328
Rural Residency Planning and Development
FY 2021 FY 2021
BA $9,956,000 $10,000,000 --- -$10,000,000
FTE 1 1 --- -1
Allocation Method .....................................................Competitive Grants/Cooperative Agreement
The Rural Residency Planning and Development Program seeks to expand the number of rural
residency training programs and subsequently increase the number of physicians choosing to
practice in rural areas. For the purpose of this program, rural residencies are allopathic and
osteopathic physician residency training programs that primarily train in rural communities. This
includes Rural Training Tracks (RTTs), a specific model of rural residency training in which
residents receive more than 50 percent of their training in a rural location after spending their
initial year in a larger, often urban, residency setting. Research has shown that residents often
practice near where they complete their residency training. RTT graduates are twice as likely to
practice family medicine in a rural setting as compared to family medicine residents trained in an
urban program. The Federal Office of Rural Health Policy collaborates with HRSA’s Bureau of
Health Workforce (BHW) to fund two rural residency programs:
 Rural Residency Planning and Development (RRPD) creates new physician residency
training programs that support physician workforce expansion in rural areas and that are
sustainable beyond the grant performance period through public (i.e., Medicare or
Medicaid), other state or private funding. Grantees may use funds to cover planning and
development costs incurred while achieving program accreditation through the
Accreditation Council for Graduate Medical Education (ACGME).
 Rural Residency Planning and Development Technical Assistance (RRPD-TA) funds a

cooperative agreement that serves as a technical assistance center to support RRPD
awardees.
In FY 2019, HRSA fully funded 27 three-year RRPD awards across 21 states. These awards
support new rural residency programs in family medicine, internal medicine and psychiatry.
Sixteen of the 27 awardees are using the RTT model for their residency programs. The RRPD
329
Program generated significant interest from rural stakeholders, and HRSA received more
applications than anticipated.
In FY 2020, HRSA will fully fund a new cohort of RRPD awards as well as a new RRPD-TA
program to provide technical assistance to the new RRPD awardees.
Funding History
FY Amount
FY 2017 ---
FY 2018 $14,958,000
FY 2019 $9,956,000
FY 2020 $10,000,000
FY 2021 ---
Budget Request
The FY 2021 Budget Request for the Rural Residency Planning and Development Program of $0
is $10.0 million below the FY 2020 Enacted Level. HRSA’s previously funded Rural Residency
awards will remain active in FY 2021 and continue to provide assistance to rural entities seeking
to establish new rural residency programs and to develop accredited residencies.
Grant Awards Table
FY 2021
Final255 Enacted Budget
Average Award $750,000 $770,833 ---
Range of Awards $750,000 - $750,000 $750,000 - $1,000,000 ---
255
Data represents 13 RRPD awards that were fully funded at the beginning of the project period using FY 2019
multi-year funds. An additional 14 awards were made at the same time using multi-year funding appropriated in FY
2018.
330
Rural Communities Opioid Response
FY 2021 FY 2021
BA $120,000,000 $110,000,000 $110,000,000 ---
FTE 7 7 12 +5
Allocation Method .....................................................Competitive Grants/Cooperative Agreement

The Rural Communities Opioid Response Program (RCORP) initiative aims to reduce the
morbidity and mortality associated with substance use disorder (SUD), including opioid use
disorder (OUD), in high risk rural communities by providing funding and technical assistance to
multi-sector consortia to enable them to identify and address OUD prevention, treatment, and
recovery needs at the community, county, state, and/or regional levels.
RCORP is composed of three grant programs:
 RCORP-Planning provides one year of support to rural communities to strengthen their

capacity to identify OUD workforce and service delivery needs and develop plans to
address them. HRSA has awarded 265 RCORP-Planning awards since FY 2018, which
have targeted nearly 1,000 rural counties nationwide and resulted in the development of
broad and diverse consortia, with an average of 10 organizations per consortium. Over
half of the FY 2019 Implementation grant recipients were recipients of FY 2018 Planning
grants, which is a testament to the value of the one-year planning period for rural
communities and the quality of technical assistance provided to Planning grantees.
HRSA does not anticipate making new RCORP-Planning awards in FY 2021.
 RCORP-Implementation provides multi-year support to established rural consortia to

implement a set of core OUD prevention, treatment, and recovery services that align with
HHS’ Five-Point Strategy to Combat the Opioid Crisis. HRSA awarded 80
Implementation awards in FY 2019. HRSA plans to award new Implementation awards
in FY 2020 and new Implementation awards in FY 2021.
 RCORP-Medication-Assisted Treatment Expansion provides multi-year support for the

establishment and/or expansion of Medication-Assisted Treatment (MAT) in Rural
Health Clinic, Critical Access Hospital, Health Center Look-Alike, and Tribal settings to
increase the number of access points where rural residents can receive evidence-based
331
treatment for OUD. The 12 three-year grants that HRSA fully funded in FY 2019 will
remain active in FY 2021.
HRSA funds three cooperative agreements that provide information, technical assistance, and
evaluation support to RCORP grantees. In FY 2021, HRSA will continue funding three Rural
Centers of Excellence on Substance Use Disorders awards that provide multi-year support for the
dissemination of best practices related to the treatment for and prevention of substance use
disorders within rural communities, with a focus on the current opioid crisis. In FY 2021, HRSA
will also continue supporting a cooperative agreement to conduct program-wide evaluation
activities for the RCORP initiative and a cooperative agreement to provide technical assistance
to RCORP grantees.
Funding History
FY Amount
FY 2017 $---
FY 2018 $100,000,000
FY 2019 $120,000,000
FY 2020 $110,000,000
FY 2021 $110,000,000
Budget Request
The FY 2021 Budget Request for the Rural Communities Opioid Response Program of $110.0
million is equal to the FY 2020 Enacted Level. This request will enable HRSA to fund new
RCORP-Implementation grants that provide needed SUD/OUD prevention, treatment, and
recovery services to rural residents.
The request will also provide HRSA with flexibility to respond to the evolving needs of the
opioid epidemic, including the addition of psychostimulants. Recent data from the Centers for
Disease Control and Prevention (CDC) indicate that the rate of overdose deaths involving
psychostimulants with abuse potential (e.g., methamphetamine) increased by over a third in rural
counties between 2016 and 2017256. Additionally, HRSA has heard from rural stakeholders and
grantees that psychostimulants currently pose a great concern for their communities. In FY 2021,
HRSA will allocate funding to respond specifically to this increasing burden of psychostimulants
in rural communities.
HRSA will continue to engage and partner with other federal agencies to promote a coordinated
approach to combatting this devastating epidemic and identifying additional priority areas.
256
Kariisa et al (2019), “Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential—
United States, 2003-2017,” CDC Morbidity and Mortality Weekly Report,
https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6817a3-H.pdf
332
Grant Awards Table
FY 2019 FY 2020 FY 2021

Final 257 Enacted 258 President’s Budget259
Number of
188 145 98
Awards
Average $617,021 $717,241 $1,066,327
Award
Range of $200,000 -$6,666,666 $200,0000 - $3,333,333 $500,000 - $3,333,333

Awards
257
Data represents awards funded using one-year funds appropriated in FY 2019. Awards made during the FY19
project period using multi-year funds are not included.
258
259
333
Program Management
TAB
334
Program Management
FY 2021 FY 2021
BA $154,568,000 $155,300,000 $151,993,000 -$3,307,000
FTE 770 770 770 ---
FY 2021 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 several years, HRSA has 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.
Developing a 21st Century Workforce

Numerous efforts are underway to enhance efficiency and effectiveness of the agency and to
ensure the workforce is positioned to succeed in the 21st century. The hiring process has been
improved, reducing the time it takes to complete the hiring cycle from recruitment to onboarding.
HRSA is focused on intense employee engagement improvement efforts. The agency had over
an 85% participant rate in the 2019 Federal Employee Viewpoint Survey (FEVS). HRSA
performs custom analysis and consultations with organizations at all levels to inform
improvement strategies.
Maintaining a skilled workforce is a top priority. In 2018, The HRSA Learning Institute (HLI)
delivered 246 classes, including both in person and virtual. More than 1,330 HRSA employees
participated in at least one class, an increase of 10 percent compared to 2017. HLI received and
335
assisted agency staff on requests for organizational development facilitation services, and
collaborated with the Bureaus/Offices to create custom training curriculum.
Sharing Quality Services

HRSA relies on HHS-provided shared services for many of the services represented in this CAP
goal, such as human resources, financial management, grants, and procurement. HRSA actively
seeks out and deploys shared services to improve and simplify processes, and to maximize the
efficiency of shared services with other components of HHS.
Creating a Culture of Program Integrity

Program Management also supports Enterprise Risk Management (ERM) activities that align
with core principles and performance and strategic planning activities to reduce programmatic
risk and improve performance. HRSA has established a HRSA-wide governance structure for
enterprise-wide business operations and risk management activities to ensure a proactive and
customer-focused suite of business operation services and risk management functions.
HRSA is currently engaged in ERM implementation strategies aligned with the revised OMB
Circular A-123. Recent revisions to the circular’s Appendices A and C, respectively, include
prioritizing risk based assessments and a focus on fraud identification and prevention activities.
HRSA’s ERM efforts include Governance and Process support for the promotion of a risk-aware
organizational culture, the creation of a comprehensive view of risks to drive strategic decision
making and the establishment and communication of risk appetite.
Funding History
FY Amount
FY 2017 $153,629,000
FY 2018 $154,615,000
FY 2019 $154,568,000
FY 2020 $155,300,000
FY 2021 $151,993,000
Budget Request
The FY 2021 Budget Request of $152 million is $3.3 million below the FY 2020 Enacted Level.
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 support 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
336
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 by enhancing HRSA’s public-facing websites in

compliance with OMB and DHS requirements, by implementing enterprise-wide Security
Event Management using Splunk, and by initiating a successful “PhishMe” campaign to
train HRSA staff to recognize and properly report suspicious emails.
 Continue implementation of the Enterprise Architecture, Capital Planning and Investment

Control (CPIC) and Enterprise Performance Life Cycle (EPLC) processes.
 Enhance Electronic Handbooks (EHBs) by adding a team based approach to all modules,
adding auto-save, and implementing a Modern Business analytics Platform (MDAP)
using Tableau. Launched a new EHBs user interface for grantees with simpler navigation,
widgets, fly-out menus, and other shortcuts.
 Continue modernizing the Data Warehouse. Developed a series of colorful and

interactive Tableau dashboards to replace 130 legacy reports, giving HRSA staff and the
public deeper analytical insight into HRSA funding, location, and program performance.
Upgraded geocoding technology, resulting in 20 percent faster map generation and
improved accuracy of Health Center site locations. Collapsed 250 web pages into 75,
resulting in a simpler, more organized site that is easier to search and navigate.
FY 2021
Year and Most Recent Result Target +/-
/Target for Recent Result / FY 2020 FY 2021 FY 2020
Measure (Summary of Result) Target Target Target
35.VII.A.4 FY 2018: Contribute to HHS Assess Analyze N/A
Implement ERM efforts and continue to HRSA’s ERM results of risk-
Enterprise Risk engage HRSA governance boards implementation based A-123
Management in ERM, per revised OMB efforts, assessments,
(ERM) (Output) circular A-123 including
(Target Met) alignment with
337
FY 2021
revised OMB to inform
Target: Continue to implement Circular A-123 ERM strategy.
Enterprise Risk Management, and
including developing a risk aware Appendices A
culture at HRSA (reporting) and
C (improper
(Target Met) payments)
35.VII.B.1. FY 2018: Full participation in Full Full Maintain

Ensure Critical Security and Privacy Awareness participation in participation
Infrastructure training by 100% of HRSA staff. Security and in Security and
Protection: specialized security training for Privacy Privacy
Security 100% of HRSA staff identified to Awareness Awareness
Awareness have significant security and training by training by
Training (Output) privacy responsibilities, and 100% of 100% of
participation in Executive HRSA Staff, HRSA Staff,
Awareness training by 100% of specialized specialized
HRSA executive staff security security
(Target Met) training for training for
100% of 100% of
Target: Full participation in HRSA staff HRSA staff
Security and Privacy Awareness identified to identified to
training by 100% of HRSA Staff, have have
specialized security training for significant significant
100% of HRSA staff identified to security and security and
have significant security and privacy privacy
privacy responsibilities, and responsibilities responsibilities
participation in Executive and and
Awareness training by 100% of participation in participation
HRSA executive staff. Executive in Executive
(Target Met) Awareness Awareness
training by training by
100% of 100% of
HRSA HRSA
executive staff. executive
staff.
338
FY 2021
35.VII.B.2 FY 2018: 100% of HRSA 100% of 100% of Maintain
Ensure Critical information systems were be HRSA HRSA
Infrastructure assessed and Authorized to information information
Protection: Security Operate (ATO). In addition, all systems will be systems will
Authorization to systems went through continuous assessed and be assessed
Operate (Output) monitoring to ensure that critical authorized to and authorized
patches were applied, security operate (ATO). to operate
controls were implemented and In addition all (ATO). In
working as intended, and risks systems will go addition all
were managed and mitigated in a through systems will
timely manner. continuous go through
(Target Met) monitoring to continuous
ensure that monitoring to
Target: 100% of HRSA critical patches ensure that
information systems will be are applied, critical patches
assessed and Authorized to security are applied,
Operate (ATO). In addition, all controls are security
systems will go through implemented controls are
continuous monitoring to ensure and working as implemented
that critical patches are applied, intended, and and working
security controls are implemented risks are as intended,
and working as intended, and risks managed and and risks are
are managed and mitigated in a mitigated in a managed and
timely manner. timely manner mitigated in a
(Target Met) timely manner
339
FY 2021
35.VII.B.2a FY 2018: Privacy - 100% of Privacy - 95% Privacy - +5
Ensure Critical HRSA staff (federal and of HRSA staff 100% of percentage
Infrastructure contractor) accessing the HRSA (federal and HRSA staff points
Protection: Security network with Privileged contractor) (federal and
HSPD-12 Privilege accounts used PIV cards or other accessing the contractor)
and Non-Privilege 2-factor authentication HRSA network accessing the
(Output) (Target Met) with Privileged HRSA
accounts must network with
Target: Privacy - 100% of HRSA use PIV cards Privileged
staff (federal and contractor) or other 2- accounts must
accessing the HRSA network with factor use PIV cards
Privileged accounts must use PIV authentication or other 2-
cards or other 2-factor factor
authentication authentication
(Target Met)
35.VII.B.2b FY 2018: Cyber Sprint - Cyber Sprint - Cyber Sprint - Critical

Ensure Critical Remediation of critical findings Remediation of Remediation findings
Infrastructure from cyber hygiene scanning critical findings of critical within 15
Protection: Security within 30 days from cyber findings from days
Cyber Sprint (Target Met) hygiene cyber hygiene
(Output) scanning scanning: High
Target: Cyber Sprint - within 30 days Critical findings
Remediation of critical findings findings within 30
from cyber hygiene scanning within 15 days days
within 30 days High findings
(Target Met) within 30 days
35.VII.B.2c FY 2018: 90% of systems that Identify 90% of Identify 95% +5

Ensure Critical required a PIA or a Privacy systems that of systems that percentage
Infrastructure Threshold Assessment (PTA) were require a PIA require a PIA points
Protection: Security identified or a Privacy or a Privacy
Privacy Impact (Target Met) Threshold Threshold
Assessment (PIA) Assessment Assessment
or Privacy Target: Identify 90% of systems (PTA) (PTA)
Threshold that require a PIA or a Privacy
Assessment (PTA) Threshold Assessment (PTA)
(Output) (Target Met)
340
FY 2021
35.VII.B.2d FY 2018: 17 Phishing Campaigns 12 Phishing 24 Phishing +12
Ensure Critical completed Campaigns Campaigns Phishing
Infrastructure (Target Exceeded) completed completed Campaigns
Protection: Security
Phishing (Output) Target: 6 Phishing Campaigns
completed
(Target Exceeded)
35.VII.B.4 FY 2018: Enterprise Architecture: Enterprise Enterprise Maintain

Enterprise 90% of IT investments were Architecture: Architecture:
Architecture reported to OMB with mapping to 90% of IT 90% of IT
(Output) at least one HHS segment and investments investments
domain reported to reported to
(Target Met) OMB with OMB with
mapping to at mapping to at
least one HHS least one HHS
Target: Enterprise Architecture: segment and segment and
90% of IT investments reported to domain domain
OMB with mapping to at least one
HHS segment and domain.
(Target Met)
341
Family Planning
TAB
342
Family Planning
FY 2021
FY 2019 FY 2020 FY 2021 +/-
Final Enacted President’s Budget FY 2020
BA $285,220,000 $286,479,000 $286,479,000 ---
FTE 8* 35 35 ---
*Due to coding error, FTE is reporting lower than actual 35 FTE
Authorizing Legislation - Title X of the Public Health Service Act
FY 2020 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 assist individuals
and families in determining the number and spacing of children and to provide access to
voluntary family planning methods, services, and information to all who want and need them.
Title X authorizing legislation requires that projects provide a broad range of effective and
acceptable family planning methods and services, including fertility awareness-based methods,
infertility services and services for adolescents. 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. According to the 2018 Family Planning Annual Report (FPAR)
data (the most recent data available), services were provided through 99 family planning service
grants that supported a nationwide network of 3,954 community-based sites that provided
clinical and educational services to more than 3,939,749 persons. There was 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.
In 2018, OPA clinics and grantees were also involved in Chlamydia screening for over 886,000
females ages 15-24. Screening for Chlamydia is important to not only reduce the impact of
sexually transmitted infections which continues to be on the rise in the United States, but also the
impact on reducing infertility. Untreated Chlamydia infection may lead to the development of
343
pelvic inflammatory disease, which if left untreated may cause infertility. As a result of the Title
X network, this screening resulted in the prevention of at least 1,050 cases of infertility in
women ages 15-24. Additionally, the Title X program was responsible for the prevention of
approximately 861,600 unintended pregnancies through the provision of family planning
methods, counseling and education, and other clinical services. Over 1.2 million confidential
HIV tests were also administered with 2,699 diagnosed as HIV positive.
In addition to providing grants to clinical service providers, the Title X Family Planning program
supports the US Department of Health and Human Services, and the Office of the Assistant
Secretary for Health’s initiative to identify and provide solutions to reduce substance use
disorders (SUD) and the impact that they have on future health outcomes. In 2019, the Title X
program built off of an previously held expert work group focused on the identification of
interventions to better incorporate and link SUD screening, referral, and treatment with Title X
family planning centers. As a result of this, OPA is in the process of funding research program
that focus on innovate ideas to improve the delivery of Title X family planning services,
including funding program that integrate SUD screening, referral, and/or treatment with family
planning and related reproductive health services. The awards were made in the Fall of 2019.
OPA also continues to collaborate with SAMHSA’s addiction Technology Transfer Centers
(ATTCs) and other Federal and community-based programs in order to improve counseling,
screening and referral for treatment services at Title X service sites.
In FY 2019, the program completed a 3-year initiative to improve the ability of Title X family
planning projects to provide PrEP (Pre Exposure Prophylaxis) services on-site or by referral.
This initiative included the development of a comprehensive tool, guidance and technical
assistance for Title X family planning projects interested in providing PrEP services to reduce
the risk of HIV infection. While the audience of this tool is Title X family planning service
providers, it can also be used by other clinical care providers, including but not limited to STD
clinics and other service sites which provide family planning and related preventive health
services.
The Title X program will play a key role in helping to develop the STI Federal Action Plan.
Emphasis will be directed to underserved populations or communities where high rates of STIs
impact the ability of individuals to achieve healthy pregnancies. Though the response will be
directed by the epidemiology of the specific infections, the program will build upon its expertise
in providing training for all levels of family planning personnel to disseminate information,
collect data and research improved delivery mechanisms for family planning services. Title X
will work with other HHS OPDIVs to update clinical guidance and recommendations to ensure
that high-quality counseling, education and family planning services are available to clients and
providers.
Each year, the program provides guidance to grantees by identifying key issues which highlight
areas of significance for Title X projects. The program will continue to emphasize the
importance of making the broad range of family planning methods and services available at Title
X family planning centers, including increased use of fertility awareness-based methods.
Supporting the overall health of clients will continue to be an important focus of the program.
Therefore, each Title X project should ensure that access to primary health care services, either
344
onsite or by referral is encouraged and, at a minimum, supported through robust referral
linkages.
On March 4, 2019, the Final Rule, Compliance with Statutory Program Integrity Requirements –
84 FR 7714, pps. 7714-7791, to revise 42 CFR 59, was published in the Federal Register. The
program regulations are currently in effect and the Title X Program is working with Grantees to
assist with implementing the changes within the new set of regulations. The Title X program has
modified its monitoring tools, guidance, and training to support Title X projects as well as ensure
compliance with the rule and that program resources are used for their intended purposes.
In addition, 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. Grantees are urged to implement more efficient administrative
systems, such as health information technologies, electronic health records, and payment
management systems. Focusing on these areas will also assist in better data collection and
increase the ability to report on the outputs and outcomes of Title X projects and the program.
Another trend, which the program believes will improve program performance, is increasing
competition and the diversity in the types of grantees funded. Increased competition has led to
more diversified grantees, improved cost recovery methods and different administrative
structures, which, it is anticipated, will ultimately improve quality and service delivery.
Funding History
FY Amount
FY 2017 $286,479,000
FY 2018 $286,479,000
FY 2019 $285,220,000
FY 2020 $286,479,000
FY 2021 $286,479,000
Budget Request
The FY 2021 President’s Budget for Family Planning is $286.5 million, which is flat with the FY
2020 Enacted. The FY 2021 Budget request is expected to support family planning services for
approximately 3,890,000 persons, with approximately 90 percent having family incomes at or
below 200 percent of the federal poverty level. The FY 2021 request provides funding for
family planning methods and related preventive health services, as well as related training,
information, education and research to improve family planning service delivery.
The FY 2021 request will also allow the program to continue supporting the operation of Family
Planning National Training Centers. These training centers focus on improving grantee capacity
and skills of clinical providers in Title X service grant projects service providers in order to
increase access and the quality of services for all individuals seeking Title X family planning
services.
345
The targets for FY 2021 assume other sources of revenue that contribute to the family planning
program at the grantee level will remain at current levels, including Medicaid, state and local
government programs, other federal, state, and private grants, and private insurance.
OPA is increasing its focus on improving Chlamydia screening rates within the Title X projects.
While OPA has always stressed the importance of screening for Chlamydia infection, following
CDC’s clinical recommendations, the continued increase in sexually transmitted infections over
the past decade stresses the added importance of identifying and treating this preventable
infection as early as possible. In addition, OPA is continuing to stress the importance of
vaccination against HPV, screening for undiagnosed cervical tissue abnormalities, providing
preconception care and counseling and basic infertility services, providing pregnancy testing and
counseling, increasing access to fertility awareness-based methods (FABM), which includes
natural family planning methods, hormonal and non-hormonal contraceptives methods,
adolescent services and related education and counseling. These services, along with
community-based education and outreach, assist individuals and families with effective family
planning services, whether it be to prevent or achieve 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
third party billing training, 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 to serve,
and based on the FPAR, billing revenue has continued to increase over the past decade. In
addition, the program is assessing traditional and innovative ways to increase access to family
planning and related preventive health services, specifically in rural and hard to reach areas.
In FY 2020 and continuing into FY 2021, the Title X family planning program will continue to
develop and recommend additional performance measures for the program. These measures will
include: (1) Increasing the number of unduplicated clients that receive the HPV (human
papillomavirus) vaccine at Title X family planning centers; (2) Increasing the number of clients
screened for substance use disorders; and (3) re-emphasizing the importance of screening for
Chlamydia infection in females ages 15 – 24. It is anticipated that the new data collection
system, FPAR 2.0 will begin collecting encounter-level data from Title X projects beginning
January 1, 2021 which will increase the number of data elements collected, the accuracy and
precision of the data, and better allow for OPA to use these data to direct program resources to
improve performance.
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.
346
Year and Most FY 2021
Measure Recent Result Target
FY 2020 FY 2021
/Target for Recent Target Target +/- FY
Result / 2020
(Summary of Target
Result)
FY 2018:
36.II.A.1: Total number of
3,939,749
unduplicated clients served in Title X 3,965,000 3,890,000 -75,000
Target: 4,018,000
service sites. (Outcome)
(Target Not Met)
36.II.A.2: Maintain the proportion of
clients served who are at or below FY 2018: 89%
200% of the Federal poverty level at Target: 90% 90% 90% Maintain
90% of total unduplicated family (Target Not Met)
planning users. (Outcome)
36.II.A.3: Increase the number of
unintended pregnancies averted by FY 2018: 861,626
providing Title X family planning Target: 905,000 912,000 880,000 -32,000
services, with priority for services to (Target Not Met)
low-income individuals. (Outcome)
36.II.B.1: Reduce infertility among
women attending Title X family
FY 2018: 886,101
planning clinics by identifying
Target: 1,195,000 1,030,000 943,000 -87,000
Chlamydia infection through
(Target Not Met)
screening of females ages 15-24.
(Outcome)
36.II.C.3: Increase the proportion of
FY 2018: 62.13%
females’ ages 15 – 24 attending Title
Target: 64.4% 85.0% 85% Maintain
X family planning clinics screened
(Target Not Met)
for Chlamydia infection. (Outcome)
Efficiency Measure
Year and Most FY 2021

Measure Recent Result FY 2020 FY 2021 Target +/-
/Target for Recent Target Target FY 2020
Result / Target
(Summary of
Result)
36.E: Maintain the actual cost per FY 2017: $335.36
Title X client below the medical care Target: $336.69 $364.21 $367.70 +$3.49
inflation rate. (Efficiency) (Target Exceeded)
347
Grant Awards Tables
FY 2019 FY 2020 FY 2021

Average Award $2,866,666 $2,866,666 $2,866,666
Range of Awards $150,000 - $150,000 - $150,000 -
$21,000,000 $21,000,000 $21,000,000
348
Nonrecurring Expense
Fund
TAB
349
Nonrecurring Expenses Fund
Budget Summary
Notification260 FY 2019 FY 2020261 FY 2021262
HRSA Investments $13,000 TBD TBD
Authorizing Legislation:
Authorization………….Section 223 of Division G of the Consolidated Appropriations Act, 2008
Allocation Method…………………………………………..Direct Federal, Competitive Contract

The Nonrecurring Expenses Fund (NEF) permits HHS to transfer unobligated balances of
expired discretionary funds from FY 2008 and subsequent years into the NEF account. Congress
authorized use of the funds for capital acquisitions necessary for the operation of the
Department, specifically information technology (IT) and facilities infrastructure acquisitions.
Budget Allocation
In FY 2019, HRSA received $13.0 million to support five NEF projects that will improve HRSA
operations, strengthen the security of HRSA’s data, and support the President’s Management
Agenda. HRSA is expanding Electronic Handbooks (EHBs) modernization efforts, enhancing
EHBs security features, and supporting cloud migration activities. HRSA is also investing in
security operations upgrades that identify and mitigate open source security risks across
application portfolios and that resolve minor cybersecurity events through tool automation and
orchestration. A final project focuses on developing dashboards that leverage internal and
external health workforce data sets to enable HRSA to prioritize funding strategies to target
specific areas of workforce need.
260
Pursuant to Section 223 of Division G of the Consolidated Appropriation Act, 2008, notification is required of
planned use. Notification submitted to the Committees on Appropriations in the House of Representatives and the
Senate on December 4, 2018.
261
HHS has not yet notified for FY 2020.
262
HHS has not yet notified for FY 2021.
350
Supplementary Tables
TAB
351
Object Class Tables
(dollars in thousands)
DISCRETIONARY
FY 2021 FY 2021
FY 2019 FY 2020
OBJECT CLASS President's +/-
Actual Enacted
Budget FY 2020
Full-time permanent (11.1) 157,906 168,718 161,247 -7,471
Other than full-time permanent (11.3) 6,014 6,182 6,018 -164
Other personnel compensation (11.5) 4,259 4,379 4,244 -135
Military personnel (11.7) 14,465 14,895 14,404 -491
Special personnel services payments (11.8) 85 88 89 +1
Subtotal personnel compensation 182,729 194,262 186,002 -8,260
Civilian benefits (12.1) 51,730 54,304 51,851 -2,453
Military benefits (12.2) 8,008 8,247 8,014 -233
Benefits to former personnel (13.1) 1,747 1,796 1,810 +14
Total Pay Costs 244,214 258,609 247,677 -10,932
Travel and transportation of persons (21.0) 3,505 3,505 3,291 -214
Transportation of things (22.0) 186 186 186 -
Rental payments to GSA (23.1) 16,405 16,405 15,752 -653
Rental payments to Others (23.2) 703 703 703 -
Communication, utilities, and misc. charges (23.3) 2,490 2,490 2,416 -74
Commercial Reimbursement (23.6) - - - -
Network use data transmission service (23.8) - - - -
Printing and reproduction (24.0) 109 109 - -109
Other Contractual Services: 25.0 - - 93 +93
Advisory and assistance services (25.1) 11,707 11,707 9,149 -2,558
Other services (25.2) 223,765 230,435 209,786 -20,649
Purchase of goods and services from government
accounts (25.3) 180,108 177,488 145,700 -31,788
Operation and maintenance of facilities (25.4) 723 723 723 -
Research and Development Contracts (25.5) - - - -
Medical care (25.6) 2,265 2,265 1,014 -1,251
Operation and maintenance of equipment (25.7) 4,154 4,154 3,586 -568
Subsistence and support of persons (25.8) 20 20 20 -
Discounts and Interest (25.9) - - - -
Supplies and materials (26.0) 698 698 698 -
Subtotal Other Contractual Services 423,440 427,490 370,769 -56,721
Equipment (31.0) 5,445 5,445 4,566 -879
Land and Structures (32) 3,757 3,757 3,757 -
Investments and Loans (33.0) - - - -
Grants, subsidies, and contributions (41.0) 5,995,934 6,210,205 5,531,631 -678,574
Insurance Claims and Indemnities (42.0) 135,097 108,355 108,337 -18
Total Non-Pay Costs 6,587,071 6,778,650 6,041,408 -737,242
Total Budget Authority by Object Class 6,831,285 7,037,259 6,289,085 -748,174
352
PRIMARY HEALTH CARE
FY 2021 FY 2021
FY 2019 FY 2020
Actual Enacted
Budget FY 2020
Full-time permanent (11.1) 26,125 26,835 27,043 +208
Other than full-time permanent (11.3) 599 616 621 +5
Other personnel compensation (11.5) 450 463 466 +3
Military personnel (11.7) 2,979 3,067 3,160 +93
Special personnel services payments (11.8) - - - -
Subtotal personnel compensation 30,153 30,981 31,290 +309
Civilian benefits (12.1) 8,622 8,863 8,932 +69
Military benefits (12.2) 1,571 1,617 1,666 +49
Benefits to former personnel (13.1) - - - -
Total Pay Costs 40,346 41,461 41,888 +427
Travel and transportation of persons (21.0) 1,285 1,285 1,285 -
Rental payments to GSA (23.1) 1,555 1,555 1,555 -
Communication, utilities, and misc. charges (23.3) 215 215 215 -
Printing and reproduction (24.0) - - - -
Other Contractual Services: 25.0 - - - -
Advisory and assistance services (25.1) - - - -
Other services (25.2) 89,773 89,931 89,931 -
accounts (25.3) 44,701 44,661 44,661 -
Medical care (25.6) - - - -
Operation and maintenance of equipment (25.7) 532 532 532 -
Subsistence and support of persons (25.8) - - - -
Subtotal Other Contractual Services 135,383 135,501 135,501 -
Equipment (31.0) 1,532 1,532 1,532 -
Grants, subsidies, and contributions (41.0) 1,328,918 1,336,628 1,438,219 +101,591
Insurance Claims and Indemnities (42.0) 135,048 108,306 108,288 -18
Total Non-Pay Costs 1,603,975 1,585,061 1,686,634 +101,573
Total Budget Authority by Object Class 1,644,321 1,626,522 1,728,522 +102,000
353
HEALTH WORKFORCE
FY 2021 FY 2021
FY 2019 FY 2020
Actual Enacted
Budget FY 2020
Other than full-time permanent (11.3) 172 177 26 -151
Other personnel compensation (11.5) 173 178 55 -123
Military personnel (11.7) 1,318 1,358 564 -794
Military benefits (12.2) 651 670 275 -395
Total Pay Costs 18,940 19,475 8,848 -10,627
Travel and transportation of persons (21.0) 160 160 41 -119
Transportation of things (22.0) - - - -
Rental payments to GSA (23.1) 656 656 169 -487
Rental payments to Others (23.2) - - - -
Communication, utilities, and misc. charges (23.3) 988 988 928 -60
Printing and reproduction (24.0) 17 17 1 -16
Other services (25.2) 23,655 23,655 13,783 -9,872
accounts (25.3) 32,780 32,780 10,007 -22,773
Operation and maintenance of facilities (25.4) - - - -
Operation and maintenance of equipment (25.7) 749 749 476 -273
Supplies and materials (26.0) - - - -
Equipment (31.0) 1,249 1,249 610 -639
Grants, subsidies, and contributions (41.0) 985,466 1,114,777 335,562 -779,215
Insurance Claims and Indemnities (42.0) - - - -
Total Non-Pay Costs 1,045,720 1,175,031 361,577 -813,454
Total Budget Authority by Object Class 1,064,660 1,194,506 370,425 -824,081
354
FY 2021
FY 2021
FY 2019 FY 2020 +/-
OBJECT CLASS President's
Actual Enacted FY 2020
Budget
Military personnel (11.7) 320 329 236 -93
Civilian benefits (12.1) 2,779 2,857 2,257 -600
Military benefits (12.2) 170 175 114 -61
Total Pay Costs 12,060 12,398 9,757 -2,641
Other services (25.2) 8,429 8,429 7,683 -746
accounts (25.3) 15,095 15,095 11,711 -3,384
Equipment (31.0) 327 327 181 -146
Grants, subsidies, and contributions (41.0) 877,283 898,251 883,342 -14,909
Total Non-Pay Costs 910,418 931,386 909,261 -22,125
Total Budget Authority by Object Class 922,478 943,784 919,018 -24,766
355
HIV/AIDS
FY 2021
FY 2021
FY 2019 FY 2020 +/-
OBJECT CLASS President's
Actual Enacted FY 2020
Budget
Total Pay Costs 28,884 34,202 34,574 +372
Travel and transportation of persons (21.0) 388 388 388 -
Other services (25.2) 28,130 28,130 28,130 -
accounts (25.3) 59,848 59,848 59,848 -
Operation and maintenance of equipment (25.7) 2,047 2,047 2,047 -
Equipment (31.0) 1,219 1,219 1,219 -
Grants, subsidies, and contributions (41.0) 2,208,829 2,260,424 2,355,052 +94,628
Total Non-Pay Costs 2,302,984 2,354,579 2,449,207 +94,628
Total Budget Authority by Object Class 2,331,868 2,388,781 2,483,781 +95,000
356
HEALTHCARE SYSTEMS
FY 2021 FY 2021
OBJECT CLASS FY 2019 FY 2020
President's +/-
Actual Enacted
Budget FY 2020
Military benefits (12.2) 625 644 663 +19
Total Pay Costs 11,828 12,163 12,301 +138
Advisory and assistance services (25.1) 837 837 837 -
Other services (25.2) 59,322 65,834 56,790 -9,044
accounts (25.3) 4,387 4,459 3,682 -777
Medical care (25.6) 2,265 2,265 1,014 -1,251
Equipment (31.0) 288 288 288 -
357
RURAL HEALTH POLICY
FY 2021 FY 2021
FY 2019 FY 2020
Actual Enacted
Budget FY 2020
Military personnel (11.7) 79 81 81 -
Civilian benefits (12.1) 892 917 966 +49
Total Pay Costs 3,908 4,018 4,166 +148
Transportation of things (22.0) - - - -
Other services (25.2) 7,737 7,737 6,752 -985
accounts (25.3) 3,999 3,999 3,616 -383
Supplies and materials (26.0) - - - -
Equipment (31.0) 310 310 215 -95
358
PROGRAM MANAGEMENT
FY 2021 FY 2021
FY 2019 FY 2020
Actual Enacted
Budget FY 2020
Other than full-time permanent (11.3) 4,151 4,267 4,300 +33
Other personnel compensation (11.5) 2,818 2,897 2,920 +23
Total Pay Costs 122,003 125,434 126,594 +1,160
Printing and reproduction (24.0) 93 93 93 -
Other services (25.2) 6,704 6,704 6,704 -
accounts (25.3) 11,174 8,523 4,050 -4,473
Equipment (31.0) 521 521 521 -
Grants, subsidies, and contributions (41.0) 515 516 522 +6
Insurance Claims and Indemnities (42.0) 20 20 20 -
359
FAMILY PLANNING
FY 2021 FY 2021
OBJECT CLASS FY 2019 FY 2020
President's +/-
Actual Enacted
Budget FY 2020
Other than full-time permanent (11.3) 67 69 69 -
Military personnel (11.7) 532 548 564 +16
Total Pay Costs 6,245 9,459 9,551 +92
Rental payments to GSA (23.1) 341 341 341 -
Communication, utilities, and misc. charges
(23.3) 22 22 22 -
Advisory and assistance services (25.1) 2,975 2,975 2,975 -
Other services (25.2) 14 14 14 -
accounts (25.3) 8,124 8,124 8,124 -
Equipment (31.0) - - - -
Grants, subsidies, and contributions (41.0) 266,767 265,173 265,081 -92
Insurance Claims and Indemnities (42.0) 29 29 29 -
Total Non-Pay Costs 278,614 277,020 276,928 -92
Total Budget Authority by Object Class 284,859 286,479 286,479 -
360
MANDATORY
FY 2021 FY 2021
FY 2019 FY 2020
President's +/- FY
Actual Enacted
OBJECT CLASS Budget 2020
Special personnel services payments (11.8) - 123 124 +1
Benefits to former personnel (13.1) 60 62 63 +1
Total Pay Costs 77,577 79,888 80,765 +877
(23.3) 1,714 1,714 1,714 -
GSA Reimbursement Transaction Charge
(23.5) - - - -
Other services (25.2) 44,097 44,097 44,097 -
Purchase of goods and services from
government accounts (25.3) 126,655 126,655 126,655 -
Operation and maintenance of facilities
(25.4) 41 41 41 -
Operation and maintenance of equipment
(25.7) 635 635 635 -
Equipment (31.0) 2,914 2,914 2,914 -
Grants, subsidies, and contributions (41.0) 4,599,998 4,559,267 4,558,390 -877

Total Non-Pay Costs 4,803,343 4,762,612 4,761,735 -877
Total Budget Authority by Object Class 4,880,920 4,842,500 4,842,500 -
361
Salaries and Expenses
(dollars in thousands)
DISCRETIONARY
FY 2021 FY 2021
FY 2019 FY 2020
Actual Enacted
Budget FY 2020
Other than full-time permanent (11.3) 6,014 6,182 6,018 -164
Other personnel compensation (11.5) 4,259 4,379 4,244 -135
Military personnel (11.7) 14,465 14,895 14,404 -491
Military benefits (12.2) 8,008 8,247 8,014 -233
Total Pay Costs 244,214 258,609 247,677 -10,932
Travel and transportation of persons (21.0) 3,505 3,505 3,291 -214
Communication, utilities, and misc. charges (23.3) 2,490 2,490 2,416 -74
Printing and reproduction (24.0) 109 109 - -109
Other Contractual Services: 25.0 - - 93 +93
Other services (25.2) 223,765 230,435 209,786 -20,649
accounts (25.3) 180,108 177,488 145,700 -31,788
Medical care (25.6) 2,265 2,265 1,014 -1,251
Operation and maintenance of equipment (25.7) 4,154 4,154 3,586 -568
362
MANDATORY
FY 2021 FY 2021
FY 2019 FY 2020
President's +/- FY
Actual Enacted
OBJECT CLASS Budget 2020
Special personnel services payments (11.8) - 123 124 +1
Benefits to former personnel (13.1) 60 62 63 +1
Total Pay Costs 77,577 79,888 80,765 +877
(23.3) 1,714 1,714 1,714 -
GSA Reimbursement Transaction Charge
(23.5) - - - -
Other services (25.2) 44,097 44,097 44,097 -
Purchase of goods and services from
government accounts (25.3) 126,655 126,655 126,655 -
Operation and maintenance of facilities
(25.4) 41 41 41 -
Operation and maintenance of equipment
(25.7) 635 635 635 -
Total Non-Pay Costs 196,482 196,482 196,482 -
Total Budget Authority by Object Class 274,059 276,370 277,247 +877
363
Detail of Full-Time Equivalent Employment
Programs 2019 Actual 2020 Estimate 2021 Estimate

Civilian Military Total Civilian Military Total Civilian Military Total
Bureau of Primary Health Care:

Direct:
Health Centers/Tort 272 47 319 272 47 319 272 47 319
Free Clinics Medical Malpractice - - - - - - -
Total, Direct: 272 47 319 272 47 319 272 47 319
Mandatory:
Health Centers 166 11 177 170 11 181 170 11 181
School-based Health Centers- Facilities (ACA) 8 - 8 4 - 4 4 - 4
Total, Mandatory 174 11 185 174 11 185 174 11 185
Total FTE, BPHC 446 58 504 446 58 504 446 58 504
Health Workforce:
Direct:
National Health Service Corps 5 - 5 5 - 5 6 - 6
NURSE Corps Loan Repayment & Scholarship 26 4 30 26 4 30 28 4 32
Centers for Excellence 2 - 2 2 - 2 2 - 2
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 1 7 6 1 7 - - -
Oral Health Training 5 1 6 5 1 6 - - -
Area Health Education Centers 4 - 4 4 - 4 - - -
Geriatric Programs 3 2 5 3 2 5 - - -
Behavioral Health Workforce Development Programs 11 2 13 11 2 13 11 2 13
Public Health/Preventive Medicine 4 1 5 4 1 5 - - -
Advanced Education Nursing Program 9 - 9 9 - 9 - - -
Nurse Workforce Diversity 2 1 3 2 1 3 - - -
Nurse Education, Practice & Retention 3 1 4 3 1 4 - - -
Nurse Faculty Loan Program 2 1 3 2 1 3 - - -
Children's Hospitals GME Program 19 1 20 19 1 20 - - -
364
Medical Student Education - - - - - - - - -
Total, Direct 113 16 129 113 16 129 53 6 59
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 185 24 209 185 24 209 185 24 209
Teaching Health Center Graduate Medical Education 6 1 7 6 1 7 6 1 7
Total, Mandatory 191 25 216 191 25 216 191 25 216
Total FTE, Health Workforce 338 42 380 338 42 380 278 32 310
Maternal and Child Health Bureau:
Direct:
Maternal & Child Health Block Grant 44 - 44 44 - 44 44 - 44
Autism and Other Developmental Disorders 6 1 7 6 1 7 - - -
Sickle Cell Service Demonstrations 2 - 2 2 - 2 - - -
James T. Walsh Universal Newborn Hearing
Screening 3 1 4 3 1 4 3 1 4
Emergency Medical Services for Children 5 - 5 5 - 5 - - -
Healthy Start 12 4 16 12 4 16 12 4 16
Heritable Disorders 3 - 3 3 - 3 - - -
Pediatric Mental Health Care Access Grants 2 - 2 2 - 2 2 - 2
Screening and Treatment for Maternal Depression 1 - 1 1 - 1 1 - 1
Total, Direct: 78 6 84 78 6 84 62 5 67
Mandatory
Family to Family Health Info Centers 1 - 1 1 - 1 1 - 1
Home Visiting 36 2 38 36 2 38 36 2 38
Total, Mandatory 37 2 39 37 2 39 37 2 39
Total FTE, MCHB 115 8 123 115 8 123 99 7 106
365
HIV/AIDS Bureau:
Direct:
Ryan White Part A 38 6 44 38 6 44 38 6 44
Ryan White Part B 53 6 59 53 6 59 53 6 59
Ryan White Part C 39 13 52 39 13 52 39 13 52
Ryan White Part D 8 3 11 8 3 11 8 3 11
Ryan White Part F 4 1 5 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 2 - 2
Ending HIV/AIDS - - - 30 - 30 30 - 30
Total, Direct: 145 29 174 175 29 204 175 29 204
Reimbursable:
OGAC Global AIDS 17 - 17 17 - 17 17 - 17
Secretary's Minority AIDS Initiative - - - - - - - - -
Total, Reimbursable 17 - 17 17 - 17 17 - 17
Total FTE, HAB 162 29 191 192 29 221 192 29 221
Healthcare Systems Bureau:

Direct:
Organ Transplantation 4 - 4 4 - 4 4 - 4
National Cord Blood Inventory 3 1 4 3 1 4 3 1 4
C.W.Bill Young Cell Transplantation Program 6 - 6 6 - 6 6 - 6
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 44 5 49 44 5 49 44 5 49
Covered Countermeasures Compensation 3 2 5 3 2 5 3 2 5
Vaccine 14 5 19 16 5 21 23 5 28
Total, Direct: 92 19 111 94 19 113 101 19 120
Reimbursable:
Hansen's Disease Center 1 - 1 1 - 1 1 - 1
340B - - - - - - 16 - 16
Total, Reimbursable 1 - 1 1 - 1 17 - 17
366
Total FTE, HSB 93 19 112 95 19 114 118 19 137
Federal Office of Rural Health Policy:

Direct:
Rural Health Policy Development 3 - 3 3 - 3 3 - 3
Rural Health Outreach Grants 8 1 9 8 1 9 8 1 9
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 1 - 1 1 - 1 1 - 1
Telehealth 2 - 2 2 - 2 2 - 2
Rural Communities Opioid Response 7 - 7 7 - 7 12 - 12
Rural Residency 1 - 1 1 - 1 - - -
Total FTE, FORHP 25 1 26 25 1 26 27 1 28
Family Planning (Direct)263 7 1 8 34 1 35 34 1 35

Program Management (Direct) 727 43 770 727 43 770 727 43 770
Subtotal Direct (non add) 1,459 162 1,621 1,518 162 1,680 1,451 151 1,602
Subtotal Reimbursable (non add) 52 1 53 52 1 53 68 1 69
Subtotal Mandatory (non add) 402 38 440 402 38 440 402 38 440
Total, Ceiling FTE 1,913 201 2,114 1,972 201 2,173 1,921 190 2,111
263
Due to coding error, FTE is reporting lower than actual 35 FTE
367
FTEs Funded by P.L. 111-148 and Any Supplementals
FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015
Total Total Total Total Total Total

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

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

- - 50,000 9 50,000 5 47,500 8 - 9 - 7
Facilities Section 4101
National Health Service Corps:

P.L. 111-148 Mandatory H.R. 3590, - - 290,000 190 295,000 248 300,000 229 283,040 219 287,370 214
Section
Non-P.L. 111-148 Mandatory 10503(b)(2) - - - - - - - - - - - -
GME Payments Teaching Health H.R. 3590,

Centers: Section 5508
P.L. 111-148 Mandatory - - 230,000 4 - 4 - 6 - 5 - 4
Non-P.L. 111-148 Mandatory - - - - - - - - - - - -
Family to Family Health

Information Centers:
H.R. 3590,
Non-P.L. 111-148 Mandatory - - 5,000 1 5,000 1 5,000 - 5,000 1 5,000 1
Section 5507
Home Visiting Program:

H.R. 3590,
P.L. 111-148 Mandatory - - 250,000 19 350,000 23 379,600 22 - - - -
Section 2951
Non-P.L. 111-148 Mandatory - - - - - - - - 371,200 22 400,000 25
Total - - 3,325,000 299 1,900,000 347 2,232,100 325 2,803,956 351 4,201,481 373
368
FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021
Total Total Total Total Total Total

FTE FTE FTE FTE FTE FTE
Program Section Funding Funding Funding Funding Funding Funding
Community Health Center

Fund:
P.L. 111-148 Mandatory H.R. 3590, - - - - - - - - - - - -
Section
Non-P.L. 111-148 Mandatory 10503(b)(1) 3,600,000 240 3,510,661 225 3,800,000 174 4,000,000 177 4,000,000 181 4,000,000 181
H.R. 3590,
Health Centers - Facilities
Section
Construction
10503(c) - - - - - - - - - - - -
School-Based Health Centers- H.R. 3590,

Facilities Section 4101 - 7 - 9 - 9 - 8 - 4 - 4
National Health Service Corps:

P.L. 111-148 Mandatory H.R. 3590, - - - - - - - - - - - -
Section
Non-P.L. 111-148 Mandatory 10503(b)(2) 310,000 226 288,610 225 310,000 206 310,000 209 310,000 209 310,000 209
GME Payments Teaching H.R. 3590,

Health Centers: Section 5508
P.L. 111-148 Mandatory - - - - - - - - - - - -
Non-P.L. 111-148 Mandatory 60,000 8 55,860 8 126,500 10 126,500 7 126,500 7 126,500 7
Family to Family Health

Information Centers:
H.R. 3590,
Non-P.L. 111-148 Mandatory
Section 5507 5,000 1 4,655 1 6,000 1 6,000 1 6,000 1 6,000 1
Home Visiting Program:

H.R. 3590,
P.L. 111-148 Mandatory
Section 2951 - - - - - - - - - - - -
Non-P.L. 111-148 Mandatory 400,000 37 372,400 44 400,000 42 400,000 39 400,000 39 400,000 39
Total 4,375,000 519 4,232,186 512 4,642,500 442 4,842,500 441 4,842,500 441 4,842,500 441
369
Good Accounting Obligation in Government Act (GAO-IG Act) Report
The information below addresses the requirements of the Good Accounting Obligation in
Government Act (GAO-IG Act; Public Law 115-414) to provide a report identifying each public
recommendation issued by the Government Accountability Office (GAO) and federal Offices of
Inspectors General (OIG) which remains unimplemented for one year or more from the annual
budget justification submission date. The recommendations below apply specifically to this
division of HHS. Please refer to the General Departmental Management budget justification for
more information on the Department’s overall progress in implementing GAO and OIG
recommendations.
Appendix 1: OIG-GAO Open Recommendations
Report Report Title Report Recommendation Concur Implementation Implementation Implementation Updates
Number Date Text / Non- Timeline Status and Constraints
Concur
GAO- Foreign 11/30/2006 To better account Concur 2020 In Progress The Department of
07-52 Physicians: for physicians Homeland Security (DHS)
Data on Use practicing in Citizenship and Immigration
of J-1 Visa underserved areas Services issues J-1 Visa
Waivers through the use of waivers to physicians. DHS
Needed to J-1 visa waivers, does not report data on
Better the Secretary of physicians granted J-1 Visa
Address Health and waivers to HHS. Because
Physician Human Services HHS does not have legal or
Shortages should collect and regulatory authority to
maintain data on collect detailed data on J-1
waiver Visa-waivered physicians,
physicians-- HRSA is not in a position to
including maintain a complete and
information on accurate list of physicians
their numbers, granted J-1 Visa waivers.
practice locations, However, HRSA has taken
and practice steps to better understand the
specialties--and distribution of J-1 Visa-
use this waivered physicians,
information when including by working with
identifying areas states’ Primary Care Offices
experiencing that report data on physicians
physician with J-1 Visa waivers when
shortages and submitting information to
placing physicians HRSA for shortage
in these areas. designation purposes. As
Conrad 30 J-1 Visa-waivered
physicians are cumulatively
the greatest bulk of
placements nationally, this
370
Concur
accounting provides
substantial data for the
purposes of shortage
designation. HRSA will work
with HHS and GAO to close
this recommendation.
GAO- Drug 9/23/2011 PPACA contained Concur NA In Progress HRSA is currently evaluating
11-836 Pricing: several important its audit process and overall
Manufacturer program integrity program integrity efforts.
Discounts in provisions for the This evaluation is centered
the 340B 340B program, on HRSA’s ability to enforce
Program and additional program guidance that is not
Offer steps can also tied to the statute or
Benefits, but ensure appropriate regulations. Existing
Federal use of the guidance does not provide
Oversight program. HRSA appropriate
Needs Therefore, the enforcement capability.
Improvement Secretary of HHS Binding and enforceable
should instruct the regulations for all aspects of
administrator of the 340B Program would
HRSA to finalize provide HRSA the ability to
new, more more clearly define and
specific guidance enforce policy and would
on the definition significantly strengthen
of a 340B patient. HRSA’s oversight of the
Program. The FY 2021
President’s Budget includes a
proposal to provide HRSA
comprehensive regulatory
authority. If this proposal
were enacted, HRSA could
regulate on patient definition.
371
Concur
GAO- Drug 9/23/2011 PPACA contained Concur NA In Progress HRSA is currently evaluating
11-836 Pricing: several important its audit process and overall
Manufacturer program integrity program integrity efforts.
Discounts in provisions for the This evaluation is centered
the 340B 340B program, on HRSA’s ability to enforce
Program and additional program guidance that is not
Offer steps can also tied to the statute or
Benefits, but ensure appropriate regulations. Existing
Federal use of the guidance does not provide
Oversight program. HRSA appropriate
Needs Therefore, the enforcement capability.
Improvement Secretary of HHS Binding and enforceable
should instruct the regulations for all aspects of
administrator of the 340B Program would
HRSA to issue provide HRSA the ability to
guidance to more clearly define and
further specify the enforce policy and would
criteria that significantly strengthen
hospitals that are HRSA’s oversight of the
not publicly Program. The FY 2021
owned or operated President’s Budget includes a
must meet to be proposal to provide HRSA
eligible for the comprehensive regulatory
340B program. authority. If this proposal
were enacted, HRSA could
further define hospital
eligibility criteria in
regulations.
GAO- Drug 6/28/2018 The Administrator Non- NA Awaiting HRSA’s current process is
18-480 Discount of HRSA should Concur Disposition responsive to GAO’s
Program: require covered recommendation for covered
Federal entities to register entity types other than
Oversight of contract hospitals and health centers.
Compliance pharmacies for Because HRSA recognizes
at 340B each site of the relationships of hospitals and
Contract entity for which a health centers in a different
Pharmacies contract exists. manner (parent and child),
Needs and for administrative burden
Improvement reasons, HRSA only requires
that a contract pharmacy
register with the parent
covered entity,
372
Concur
notwithstanding that child

sites can still utilize that
pharmacy. HRSA does
require all covered entity
sites and contract pharmacy
sites to be listed on the
written contract, and this
information is audited by
HRSA. In addition, for the
FY 2019 audit cycle, HRSA
strengthened its risk-based
audit strategy by including an
assumption that all contract
pharmacies registered with
the parent entity would also
be used by the child sites,
prior to randomly selecting
covered entities for audit.
GAO- Drug 6/28/2018 The Administrator Concur 2021 In Progress HRSA has requested
18-480 Discount of HRSA should regulatory authority in every
Program: issue guidance to President’s Budget since FY
Federal covered entities 2017 and has again requested
Oversight of on the prevention this in the FY 2021
Compliance of duplicate President’s Budget. HRSA
at 340B discounts under is currently evaluating its
Contract Medicaid audit process and overall
Pharmacies managed care, program integrity efforts.
Needs working with This evaluation is centered
Improvement CMS as HRSA on HRSA’s ability to enforce
deems necessary program
to coordinate with requirements/guidance
guidance provided outside of the statue or
to state Medicaid regulations. Existing
programs. guidance does not provide
HRSA appropriate
enforcement capability.
Binding and enforceable
regulations for all aspects of
the 340B Program would
provide HRSA the ability to
more clearly define and
enforce policy and would
373
Concur
significantly strengthen
HRSA’s oversight of the
Program.
GAO- Drug 6/28/2018 The Administrator Concur 2021 In Progress HRSA updated its audit
18-480 Discount of HRSA should policy in April 2018 by
Program: incorporate an adding an area for
Federal assessment of improvement (AFI) when
Oversight of covered entities' Medicaid managed care
Compliance compliance with claims were identified in
at 340B the prohibition on audits where the covered
Contract duplicate entity was at risk for non-
Pharmacies discounts, as it compliance. HRSA has
Needs relates to requested regulatory
Improvement Medicaid authority in every President’s
managed care Budget since FY 2017 and
claims, into its has again requested this in
audit process after the FY 2021 President’s
guidance has been Budget. HRSA notes that
issued and ensure guidance does not provide
that identified HRSA appropriate
violations are enforcement capability.
rectified by the Binding and enforceable
entities. regulations for all aspects of
the 340B Program would
provide HRSA the ability to
more clearly define and
enforce policy and would
Program.
GAO- Drug 6/28/2018 The Administrator Concur 2021 In Progress HRSA is currently evaluating
18-480 Discount of HRSA should its audit process and overall
Program: issue guidance on program integrity efforts.
Federal the length of time This evaluation is centered
Oversight of covered entities on HRSA’s ability to enforce
Compliance must look back program guidance that is not
at 340B following an audit tied to the statute or
Contract to identify the full regulations. Existing
Pharmacies scope of guidance does not provide
374
Concur
Needs noncompliance HRSA appropriate

Improvement identified during enforcement capability.
the audit. HRSA has requested
regulatory authority in every
President’s Budget since FY
2017 and has again requested
this in the FY 2021
President’s Budget. Binding
and enforceable regulations
for all aspects of the 340B
Program would provide
HRSA the ability to more
clearly define and enforce
policy and would
Program.
GAO- Drug 6/28/2018 The Non- NA Awaiting Beginning April 1, 2018,

18-480 Discount Administrator of Concur Disposition HRSA requires entities that
Program: HRSA should are subject to target audits
Federal require all covered and re-audits to specify their
Oversight of entities to specify methodology for identifying
Compliance their methodology the full scope of
at 340B for identifying the noncompliance identified
Contract full scope of during the audit as part of
Pharmacies noncompliance their corrective action plans
Needs identified during and to incorporate reviews of
Improvement the audit as part of the methodology into their
their corrective audit process to ensure that
action plans, and entities are adequately
incorporate assessing the full scope of
reviews of the non-compliance. If
methodology into implemented, GAO’s
their audit process recommendation could create
to ensure that a significant burden for all
entities are covered entities requiring
adequately them to produce additional
assessing the full documentation. HRSA has an
scope of efficient audit process to
noncompliance. ensure that if there is a
compliance issue, covered
entities are able to resolve
375
Concur
the issue quickly and work in

good faith with the
manufacturer to determine if
repayments may be owed.
GAO- Drug 6/28/2018 The Administrator Non- NA Awaiting Beginning April 1, 2018,
18-480 Discount of HRSA should Concur Disposition HRSA requires entities that
Program: require all covered are subject to target audits
Federal entities to provide and re-audits to specify their
Oversight of evidence that their methodology for identifying
Compliance corrective action the full scope of
at 340B plans have been noncompliance identified
Contract successfully during the audit as part of
Pharmacies implemented prior their corrective action plans
Needs to closing audits, and to incorporate reviews of
Improvement including the methodology into their
documentation of audit process to ensure that
the results of the entities are adequately
entities' assessing the full scope of
assessments of the non-compliance. Requiring
full scope of all entities to provide
noncompliance evidence and documentation
identified during could create a significant
each audit. burden for covered entities to
comply with the additional
documentation needed as
part of the audit. HRSA has
an efficient audit process to
ensure that if there is a
compliance issue, covered
entities are able to resolve
the issue quickly and work in
good faith with the
manufacturer to determine if
repayments may be owed.
376
Concur
GAO- Drug 6/28/2018 The Administrator Concur 2021 In Progress HRSA is currently evaluating
18-480 Discount of HRSA should its audit process and overall
Program: provide more program integrity efforts.
Federal specific guidance This evaluation is centered
Oversight of to covered entities on HRSA’s ability to enforce
Compliance regarding contract program guidance that is not
at 340B pharmacy tied to the statute or
Contract oversight, regulations. Existing
Pharmacies including the guidance does not provide
Needs scope and HRSA appropriate
Improvement frequency of such enforcement capability.
oversight. HRSA has requested
this in the FY 2021
President’s Budget. Binding
and enforceable regulations
for all aspects of the 340B
Program would provide
HRSA the ability to more
clearly define and enforce
policy and would
Program.
OEI-05- Status of the 8/1/2005 HRSA should Concur 2020 In Progress Health Professional Shortage
03- Rural Health publish Areas (HPSAs) are
00170 Clinic regulations to statutorily required to be
Program revise its reviewed annually and
shortage- updated as necessary. HRSA
designation has no statutory or other
criteria. authority to mandate updates
to Medically Underserved
Areas or Medically
Underserved Populations
once they are designated.
CMS, which certifies Rural
Health Clinics, has not put
forward a regulation
outlining a process to
decertify Rural Health
377
Concur
Clinics once they have been

certified. As a result, as
shortage designations are
reviewed and de-designated
for no longer meeting the
criteria, a number of Rural
Health Clinics will continue
to exist outside of Health
Professional Shortage Areas
or Medically Underserved
Areas, regardless of any
updates to shortage
designation process. HRSA
will continue to work with
HHS and OIG to close this
recommendation.
OEI-05- State 6/14/2011 HRSA should Concur 2021 In Progress HRSA continues to work
09- Medicaid share 340B ceiling with CMS to determine
00321 Policies and prices with States whether the 340B ceiling
Oversight price data can be released to
Activities states.
Related to
340B-
Purchased
Drugs
OEI-05- State Efforts 6/6/2016 HRSA should Concur 2021 In Progress HRSA is internally
14- to Exclude clarify its discussing the issue of MCO
00430 340B Drugs guidance on drugs in the 340B Program
from preventing and continues to work with
Medicaid duplicate CMS on effective ways to
Managed discounts for address the issue for both the
Care Rebates MCO drugs Medicaid and 340B Program.
Existing guidance does not
provide HRSA appropriate
enforcement capability.
HRSA has requested
378
Concur
this in the FY 2021

President’s Budget.
OEI-12- HHS 10/11/2005 HRSA should Concur 2021 In Progress HHS continues to comply
04- Agencies' implement a with Federal law and the
00310 Compliance corrective action Health Care Quality
with the process that would Improvement Act of 1986,
National address which created the NPDB.
Practitioner unreported cases. Through its Medical Claims
Data Bank Review Panel (MCRP)
Malpractice chartered by the Secretary,
Reporting HHS reviews claims for
Policy damage, injury, or death filed
under the Federal Tort
Claims Act (FTCA) against
an HHS facility or health
care practitioner covered
under the FTCA.
379
Programs Proposed for Elimination
The following list shows the programs proposed for elimination in the FY 2021 Budget Request.
Termination of these programs totals approximately $991.5 million in discretionary resources.
Following each program is a brief summary and the rationale for its elimination.
(dollars in millions)
FY 2020
Program
Enacted
Loan Repayment/Faculty Fellowships264 $1.2

Scholarships for Disadvantaged Students265 $51.5
Health Career Opportunity Program264 $15.0
Primary Care Training and Enhancement264 $48.9
Oral Health Training Programs264 $40.7
Medical Student Education3 $50.0
Area Health Education Centers2 $41.3
Geriatric Programs264 $40.7
Public Health/Preventative Medicine264 $17.0
Advanced Nursing Education264 $75.6
Nursing Workforce Diversity264 $18.3
Nurse Education, Practice and Retention264 $43.9
Nurse Faculty Loan Program264 $28.5
Nurse Practitioner Residency Program $5.0
Children’s Hospital Graduate Medical Education266 $340.0
Autism and Other Developmental Disabilities264 $52.3
Sickle Cell Disease Treatment Demonstrations264 $5.2
Emergency Medical Services for Children264 $22.3
Heritable Disorders in Newborns and Children 264 $17.9
National Hansen’s Disease – Building and Facilities264 $0.1
Rural Hospital Flexibility Grants264 $53.6
State Offices of Rural Health264 $12.5
Rural Residency3 $10.0
Total Programs Proposed for Elimination $ 991.5
264
Proposed for elimination in the FY 2018, FY 2019 and FY 2020 budgets.
265
Proposed for elimination in the FY 2017, FY 2018, FY 2019, and FY 2020 budgets.
266
Proposed for elimination in the FY 2020 budget.
380
Loan Repayment/Faculty Fellowships (-$1.2 million)
The Budget eliminates funding for this training program. 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.
Scholarships for Disadvantaged Students (-$51.5 million)

Health Career Opportunity Program (-$15.0 million)

Primary Career Training and Enhancement (-$48.9 million)

Oral Health Training Programs (-$40.7 million)

Medical Student Education (-$50.0 million)

Area Health Education Centers (-$41.3 million)

Geriatric Programs (-$40.7 million)

Public Health/Preventative Medicine (-$17.0 million)

The Budget eliminates this funding for training program. The Budget prioritizes funding for
381
Advanced Nursing Education (-$75.6 million)
The Budget eliminates funding for this Nurse training program. 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.
Nursing Workforce Diversity (-$18.3 million)

Nurse Education, Practice and Retention (-$43.9 million)

Nurse Faculty Loan Program (-$28.5 million)

Nurse Practitioner Residency Program (-$5.0 million)

Children’s Hospital Graduate Medical Education (-$340.0 million)

Autism and Other Developmental Disabilities (-$52.3 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. States
may continue to support these activities with their Maternal and Child Health Block Grant
awards. The Budget includes an increase of $60.0 million in funding for Maternal and Child
Health (MCH) Block Grant formula awards to states to provide states with additional flexibility
to support activities previously funded through a number of MCH categorical grant programs,
including Autism and Other Developmental Disabilities.
Sickle Cell Disease Treatment Demonstrations (-$5.2 million)

No funding is provided for this program. The Budget prioritizes programs that support direct
382
including Sickle Cell Service Demonstrations.
Emergency Medical Services for Children (-$22.3 million)

including Emergency Medical Services for Children.
Heritable Disorders in Newborns and Children (-$17.9 million)

including Heritable Disorders.
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.
Rural Hospital Flexibility Grants (-$53.6 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 (-$12.5 million)

No funding is provided for this program, due to a shift in program priorities that emphasize
Rural Residency (-$10.0 million)

No funding is provided for this program, due to a shift in program priorities that emphasize
383
Physicians’ Comparability Allowance (PCA) Worksheet
1) Department and component:
Department of Health and Human Services, Health Resources and Services Administration
2) Explain the recruitment and retention problem(s) justifying the need for the PCA pay
authority.
(Please include any staffing data to support your explanation, such as number and duration of unfilled
positions and number of accessions and separations per fiscal year.)
FY19 included (4) Separations of which (2) resigned (1) reassigned and (1) retired. Their average length
of service was 9.5 years.
In FY19, (1) vacancy announcement has been posted. Quality applicants have been limited. For
example, 7 applications were received for this vacancy, however, only (4) applicants were considered
highly qualified for the position.
To date there have been (2) Accessions.
3-4) Please complete the table below with details of the PCA agreement for the following years:
PY 2019 CY 2020 BY* 2021

(Actual) (Estimates) (Estimates)
3a) Number of Physicians Receiving PCAs 31 37 37
3b) Number of Physicians with One-Year PCA Agreements 4 0 0
3c) Number of Physicians with Multi-Year PCA Agreements 27 37 37
4a) Average Annual PCA Physician Pay (without PCA payment) $165,748 $165,586 $165,586
4b) Average Annual PCA Payment $21,650 $21,658 $21,658
*BY data will be approved during the BY Budget cycle. Please ensure each column is completed.
5) Explain the degree to which recruitment and retention problems were alleviated in your agency
through the use of PCAs in the prior fiscal year.
(Please include any staffing data to support your explanation, such as number and duration of unfilled
positions and number of accessions and separations per fiscal year.)
In FY18 there were (3) resignations and (1) accessions. PCA in addition to their base salary was needed
to meet their current salary or salary expectations.
6) Provide any additional information that may be useful in planning PCA staffing levels and
amounts in your agency.
n/a
384
Drug Control Budget
Resource Summary
Budget Authority (in millions)
FY 2021
FY 2019 FY 2020
President’s
Enacted Enacted
Budget
Drug Resources by Function
Prevention $114.500 $109.500 $94.100
Treatment $550.500 $545.500 $560.900
Total Drug Resources by Function $665.000 $655.000 $655.000
Drug Resources by Decision Unit
Bureau of Primary Health Care $545.000 $545.000 $545.000
Federal Office of Rural Health Policy $120.000 $110.000 $110.000
Total Drug Resources by Decision Unit $665.000 $655.000 $655.000
Drug Resources Personnel Summary

Total FTEs (direct only) -- -- --
Drug Resources as a percent of Budget

Total Agency Budget (in Billions) $11.7 $11.9 $11.2
Drug Resources percentage 5.7% 5.5% 5.8%
Program Summary
MISSION
The Health Resources and Services Administration (HRSA) is the primary Federal agency for
improving access to health care for people who are geographically isolated, and economically or
medically challenged.
BPHC
The Health Resources and Services Administration (HRSA) is the principal Federal agency
charged with increasing access to primary health care for those who are medically underserved.
For more than 50 years, HRSA-funded 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 for millions of
people across the country. Health centers advance a model of coordinated, comprehensive, and
patient-centered primary health care, integrating a wide range of medical, dental, mental health,
substance use disorder (SUD), and patient services. Today, nearly 1,400 health centers operate
approximately 12,000 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.
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Health centers providing SUD services play an essential role in addressing the Nation’s opioid
epidemic. They offer a range of integrated services, including but not limited to Screening, Brief
Intervention, and Referral to Treatment (SBIRT), counseling and psychiatry, 24-hour crisis
intervention, detoxification, Medication-Assisted Treatment (MAT), and recovery support.
FORHP
The Federal Office of Rural Health Policy (FORHP) is responsible for advising on rural policy
issues, conducting and overseeing policy relevant research on rural health issues, and
administering grant programs that focus on supporting and enhancing health care delivery in
rural communities. FORHP is statutorily charged with coordinating the activities within the
Department that relate to rural health care and providing information to the Secretary and others
in the Department with respect to the activities of other Federal departments and agencies that
relate to rural health care. In addition to its policy roles, FORHP also administers a range of
grant programs focusing on capacity building and enhancing health care delivery at the
community and state levels as well as programs aimed at leveraging the use of health
information technology and telehealth to enhance access to and the quality of health care services
in rural and underserved areas.
FORHP launched the Rural Communities Opioid Response Program (RCORP) in FY 2018 to
support treatment and prevention of substance use disorder, including opioid abuse, in rural
communities at the highest risk for substance use disorder. The program goal is to reduce the
morbidity and mortality associated with opioid overdoses in rural communities through the
strengthening of the organizational and infrastructural capacity of multi-sector consortiums.
These consortiums address prevention, treatment, and recovery focus areas at the community,
county, state, and/or regional levels. This initiative reflects the high level of interest in and
continued need for rural-focused funding to build robust opioid prevention, treatment, and
recovery infrastructure and capacity in rural communities. HRSA has newly developed OMB-
approved performance measures to support this new large-scale initiative.
METHODOLOGY
BPHC
Starting in FY 2016, the Health Center Program has been awarding targeted supplemental
funding to support substance use disorder service expansion. For each of fiscal years 2016 –
2019, HRSA has provided new annual funding toward this effort that remains in Health Center
Program base continuation funding in subsequent fiscal years. All of this targeted supplemental
funding is scored as drug control funding.
FORHP
The allocation of funds for the Rural Community Opioid Response Program (RCORP) is through
competitive grants and cooperative agreements. The entirety of these programs is scored as drug
control funding.
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BUDGET SUMMARY
The drug control budget for the Health Resources and Services Administration at the FY 2021
President’s Budget Request is $655.0 million, the same level as FY 2020 Enacted.
Bureau of Primary Health Care
FY 2021 President’s Budget Request: $545 million

(level with FY 2020 Enacted)
In FY 2021, the Health Center program plans to support nearly 1,400 grantees and provide
primary health care services to nearly 29 million patients, including access to ongoing SUD
services. Health centers will continue to provide SUD services for all age groups.
In FY 2018, the Health Center Program awarded approximately $350 million in an additional
targeted supplemental funding opportunity for the expansion of SUD/MH in existing health
centers. Approximately $200 million of the FY 2018 SUD/MH expansion awards were provided
as one-time funding, and an additional $150 million was awarded as ongoing annual funding, to
be included in health centers’ base continuation funding in subsequent fiscal years, contingent
upon sufficient Health Center Program appropriations.
In FY 2019, the Health Center Program awarded $201 million in new SUD/MH ongoing annual
awards, and the FY 2020 President’s Budget includes no additional drug resources. As a result,
the reported amount of drug resources for FY 2018, and those projected for FY 2019 and FY
2020, reflect the ongoing annual SUD/MH awards initiated in FY 2016 through FY 2019 and
projections in FY 2020 and FY 2021.
Federal Office of Rural Health Policy
FY 2021 President’s Budget Request: $110 million

(level with FY 2020 Enacted)
In FY 2021, the Federal Office of Rural Health Policy will continue to invest in initiatives and
support evidence-based strategies that address the specific substance use disorder issues and
mental health services needs in rural communities. The FY 2021 President’s Budget Request will
fund new and continuing grants and cooperative agreements for RCORP to strengthen the
infrastructure and capacity within rural communities at high risk for substance abuse disorders
and provide needed prevention, treatment, and recovery services to rural residents.
The RCORP initiative is currently composed of three competitive grant programs and three
cooperative agreements that provide technical assistance coordination, program evaluation, and
dissemination of evidence-based programs and best practices.
 RCORP-Planning provides one year of support to rural communities to identify opioid

use disorder issues in their communities and develop plans to resolve these issues. The
one-year planning grant provides sufficient time and resources for communities to form
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partnerships with other entities, conduct needs assessments, and plan ways to address
specific issues being faced by the communities. HRSA does not anticipate making new
RCORP-Planning awards in FY 2021.
 RCORP-Implementation provides multi-year support to rural communities to yield

large-scale organizational and infrastructural improvements at the regional and state
levels to address opioid use disorder, with a particular focus on treatment and recovery.
HRSA plans to make new Implementation awards in FY 2021.
 RCORP-Medication-Assisted Treatment (MAT) Expansion provides multi-year

support to eligible hospitals, health clinics, or tribal organizations to establish and/or
expand MAT and increase the number of access points for individuals living in rural
communities. HRSA will support the continuation of awards in FY 2021.
In FY 2021, HRSA will continue funding three Rural Centers of Excellence on Substance Use
Disorders that support the dissemination of best practices related to the treatment for and
prevention of substance use disorders within rural communities, with a focus on the current
opioid crisis. Additionally, HRSA will continue supporting a cooperative agreement to conduct
program-wide evaluation activities for the RCORP Initiative and another cooperative agreement
to provide technical assistance to RCORP grantees.
Finally, in FY 2021, HRSA will allocate funding for new awards to respond specifically
to the increasing burden of psychostimulants in rural communities. HRSA will continue
to engage and partner with other federal agencies to promote a coordinated approach to
combatting this devastating epidemic and identifying additional priority areas.
PERFORMANCE
Information regarding HRSA’s Health Center Program’s performance is based on the UDS. The
table and accompanying text represent highlights of their achievements for the latest year for
which data are available.

FY 2018 FY 2018
Selected Measures of Performance
Target Achieved
» Number of Health Center Program grantees providing SBIRT 580 665
services
» Number of Health Center Program grantees providing substance 515 688
abuse counseling and treatment services
HRSA is taking several approaches to improve access to high quality substance use disorder
(SUD) services for medically underserved communities through the Health Center Program.
General approaches include developing the infrastructure for high quality care through the
adoption of health information technology (HIT) and the transformation of health centers to
patient-centered medical homes (PCMH). PCMH and the meaningful use of HIT will enable
enhanced access to care, better care coordination, and improved patient engagement.
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Transformed health centers are better positioned to partner with other addiction-related services
in the community including inpatient and outpatient SUD services.
To further improve access and raise the quality of SUD services, the availability of services on-
site is essential. This is to be achieved by training health center clinicians to provide high quality
and expanded services for those with addiction disorders. Screening, Brief Intervention, and
Referral to Treatment (SBIRT) is an evidence-based process used by primary care providers in
health centers to detect and treat addiction effectively. Because many communities served by
health centers have a high burden of addiction disorders, many health centers have chosen to co-
locate and integrate SUD specialty services reflecting efficient and effective approaches in
meeting patient needs. The integration of SUD services may include the provision of enhanced
services, such as medication-assisted treatment (MAT), by primary care clinicians. In addition,
HRSA provides guidance to health centers on collaboration with State agencies to ensure that
appropriate standards of care are implemented and that referrals are coordinated.
Screening for substance use disorders has increased 53 percent since 2016 with the number of
patients receiving screening, brief intervention, referral and treatment (SBIRT) increasing from
716,677 in 2016 to 1,099,001 in 2018. From 2016–2018, the number of health center providers
eligible to prescribe MAT increased nearly 190 percent (from 1,700 in 2016 to 4,897 in 2018)
and the number of patients receiving MAT increased 142 percent (from 39,075 in 2016 to 94,528
in 2018).
In 2018, 688 health centers provided SUD counseling and treatment services, exceeding the
program 2018 target. Also in 2018, 665 health centers provided SBIRT services, exceeding the
program FY 2018 target.
The Rural Communities Opioid Response program goal is to reduce the morbidity and mortality
associated with opioid overdoses in rural communities through the strengthening of the
organizational and infrastructural capacity of multi-sector consortiums. HRSA has developed
OMB-approved performance measures to support this large-scale initiative, and data collection
will begin in Spring 2020.
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Significant Items
TAB
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SIGNIFICANT ITEMS FOR INCLUSION IN L-HHS APPROPRIATIONS
COMMITTEE FY 2021 CONGRESSIONAL JUSTIFICATION
FURTHER CONSOLIDATED APPROPRIATIONS ACT, 2020 (December 20, 2019)
1. Area Health Education Centers. — The agreement encourages HRSA to invest in

interprofessional networks that address social determinates of health and incorporate field
placement programs for rural and medically-underserved populations. (Page 16)
Action to be Taken
The AHEC Scholars Program is a longitudinal program targeted to health professions
students and allied health professions students developed in FY 2017. As a supplement
to the student’s current curriculum, the AHEC Scholars Program consists of an
interdisciplinary curricula (e.g., 2-year program) with a defined set of clinical, didactic,
and community-based training activities focused on rural/underserved settings and
populations. Each AHEC Scholars Program curriculum focuses on 6 core topic areas: (a)
interprofessional education; (b) behavioral health integration; (c) social determinants of
health; (d) cultural competency; (e) practice transformation; and (f) current/emerging
health issues (e.g., Ebola or community-relevant).
The AHEC Scholars Program has increased academic-community partnerships among

the AHEC grantees in which more specialized team-based interdisciplinary training
experiences in rural/underserved areas are available to health professions students of a
variety of disciplines. Many of these training experiences occur within federally
qualified health centers (FQHCs), acute care settings, primary care practices, and
outpatient clinical settings. The AHEC Scholars Program has increased capacity to better
track health professionals within rural/underserved areas through a 1-year follow up upon
completion of the program. In FY 2020, HRSA will continue to support AHEC awards
to maintain interdisciplinary community-based linkages to facilitate team-based
interdisciplinary experiential training experiences in rural/underserved areas and
populations.
2. Nurse Education, Practice, Quality, and Retention. — HRSA is directed to ensure that
these grants include as an allowable use the purchase of simulation training equipment.
HRSA shall give priority to grantees located in a medically-underserved area in a State
with an age-adjusted high burden of stroke, heart disease, and obesity, and HRSA is
encouraged to prioritize submissions that support high poverty rate communities. (Page
16)
Action to be Taken
HRSA is currently working on the NOFO to support the use of simulation to enhance
nurse education and expand experimental learning opportunities. HRSA plans to release
a competitive NOFO in 2020.
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3. Veterans’ Bachelor of Science Degree in Nursing. — HRSA is encouraged to consider
the successful past practice of entities that have received funding from this nursing
program in making new awards that support veterans and expand the nursing workforce.
(Page 17)
Action to be Taken
In FY 2020, HRSA will continue to support the Veteran Nurses in Primary Care
(NEPQR-VNPC) Training Program. Seven VNPC cooperative agreements were awarded
in FY 2019. The VNPC program works to recruit and train Veteran nursing students and
current RNs to practice at the full scope of their license in community-based primary care
teams to increase access to care, with an emphasis on chronic disease prevention and control,
including mental health and substance use conditions. The VNPC program provides
professional development and primary care skillset training that addresses Veterans
unique needs to faculty members, preceptors, and practicing primary care RNs.
4. Nursing Workforce Diversity. — HRSA shall give priority to eligible entities with
training programs that serve one or more communities that have: (1) a poverty rate
exceeding 32 percent and a median household income below $34,000 a year as reported
by the Census Bureau’s Small Area Income and Poverty Estimates program for 2017; and
(2) are located in a State with an elderly population that exceeds 15 percent of the total
State’s population as reported by the Census Bureau for 2018. (Page 17)
Action to be Taken
In FY 2020, HRSA plans to re-compete a version of the Nursing Workforce Diversity
program with an emphasis of increasing on increasing the eldercare workforce and
increasing access to care in rural and underserved areas. Priority will be given to eligible
entities in communities with a poverty rate exceeding 32 percent, and a median
household income below $34,000 a year as reported by the Census Bureau's Small Area
Income and Poverty Estimates program for 2017; and are located in a State with an
elderly population that exceeds 15 percent of the total State's population as reported by
the Census Bureau for 2018. All the previous grantees, which are institutions that have a
program in place to support increasing the diversity in the nursing workforce, are eligible
in addition to new applicants. Special consideration will be given to Historically Black
Colleges and Universities, and other Minority Serving Institutions.
5. Nursing Workforce Diversity. — HRSA is directed to give priority to established and

reputable nursing programs in historically black colleges and universities that can
demonstrate increased educational opportunities for individuals from disadvantaged
backgrounds. (Page 17)
Action to be Taken
HRSA is actively planning a Notice of Funding Opportunity. As a funding factor within
the NOFO, HRSA will give priority to any applicant that has demonstrated an increase in
educational opportunities for individuals from disadvantaged backgrounds within the last
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four years. HRSA will also give priority to Historically Black Colleges and Universities
(HBCUs) and other Minority Serving Institutions (MSIs).
6. Medical Student Education. — The agreement provides up to $35,000,000 to fund

additional applications received in FY 2019. Of the remaining amount, the agreement
directs HRSA to make supplementary grant awards to entities funded in FY 2019. (Page
18)
Action to be Taken
In FY 2020, HRSA will fund the five unfunded applications from the FY 2019 Notice of
Funding Opportunity. The remaining funds will be provided as supplemental funding to
the FY 2019 awardees.
7. Organ Allocation Policy. — HRSA and the Organ Procurement and Transplantation
Network are encouraged to ensure the process for changing organ allocation policies is
transparent, thorough, and accommodates the recommendations of transplantation and
organ donation professionals. (Page 20)
Action to be Taken
HRSA and the Organ Procurement and Transplantation Network (OPTN), which is
comprised of organ transplantation and donation professionals as well as representatives
of donor and recipient families, are committed to an open and deliberative process for
OPTN policy development including organ allocation policies. HRSA will continue to
ensure that these processes are thorough and transparent with opportunity for the public
to comment on all proposed OPTN policy changes.
8. Rural Hospital Flexibility Grants. — The agreement recommends HRSA give

preference in grant awards to Critical Access Hospitals, as described in Senate Report
115-289. (Page 21)
Action to be Taken
The Medicare Rural Hospital Flexibility Grants (Title XVIII, §1820(g)(1) and (2) of the
Social Security Act) authorizes HRSA to provide grants to states to fund activities to
meet the needs of Critical Access Hospitals in the areas of quality and performance
improvement and in rural Emergency Medical Services. The Program’s FY 2019 Notice
of Funding Opportunity included specific recommendations for states to include activities
that improve population health, such as chronic disease management. These activities
will continue throughout the five-year performance period that ends in FY 2024.
9. Telehealth Centers of Excellence. — The agreement provides $6,000,000 for the

Telehealth Centers of Excellence (Centers) awardees. The Centers are encouraged to
develop best practices for treating HIV through telehealth that can be replicated across
rural America and accelerate progress toward the goal of eliminating HIV transmission.
(Page 21)
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Action to be Taken
HRSA will work with the Telehealth Centers of Excellence awardees to include the
development of best practices for treating HIV through telehealth services among their
grant activities.
HOUSE REPORT 116-62 (May 15, 2019)
1. Rural Health Workforce. — The Committee encourages HRSA to explore

opportunities for collaboration and partnership with schools and programs that offer rural
residencies, rural health certificates, or otherwise recognized rural curriculum in order to
increase the placement of health care providers and professionals with rural health
training in HRSA Health Workforce Programs. (Page 38)
Action to be Taken
In FY 2019, HRSA supported the rural health professions workforce through innovative
training grant programs focused on expanding community-based residency training and
incentivizing clinicians to work in rural and underserved communities. In Academic
Year (AY) 2018-2019, HRSA funded programs utilized 5,811 training sites located in
rural areas to provide customized academic training to better serve rural communities.
More than 160,000 students and trainees from rural backgrounds participated in these
programs (excluding National Health Service Corps and Nurse Corps). In FY 2019, one
in three National Health Service Corps clinicians serve in rural areas and one in five
Nurse Corps clinicians serve in rural areas.
In FY 2020, HRSA will continue to support the rural health professions workforce
through the:
 Teaching Health Center Graduate Medical Education Program: In AY 2020-
2021, HRSA will award $120 million to 58 teaching health centers - 53
continuation awards and 5 awards to establish new teaching health centers -
increasing the maximum number of approved FTEs to over 800. Starting in AY
2020-2021, THCGME funding will support a total of 11 residency programs in
rural areas.
 National Health Service Corps Rural Community Loan Repayment Program: In
FY 2020, HRSA will continue to support providers working in rural communities
who use evidence-based treatment models to treat substance use disorders and
opioid use disorders.
2. Shortage Designation Modernization Project. — The Committee is concerned that

HRSA is implementing the Shortage Designation Management System without a
thorough understanding of the potential impact of the revised Health Professional
Shortage Area scores on States. The Committee requests a briefing from HRSA within 60
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days of enactment of this Act on the revised methodology and implications for addressing
health care workforce shortages in States. (Page 38)
Action to be Taken
HRSA plans to brief the Committee as requested on the Shortage Designation
Management Project. The first phase of this project, which began in 2013, created the
Shortage Designation Management System, the online system through which HPSAs are
designated and scored. The latest phase of the project, which was completed in August
2019, implemented improvements to the data collection processes used to score HPSAs
automatically designated by statute or regulation. The methodologies for designating and
scoring HPSAs have not been changed during the Shortage Designation Management
Project.
To determine the data sources that would be used for the August 2019 update, HRSA
convened a working group with representatives of all site types that would be affected by
the updates. These include Federally Qualified Health Centers and Look A-likes, CMS-
certified Rural Health Clinics, Indian Health Service, Tribally-run clinics, and Urban
Indian Organizations, and national stakeholder groups representing these entities. HRSA
incorporated the working group’s recommendations into the Auto-HPSA update.
Throughout this process, HRSA has provided outreach to all affected stakeholders in a
variety of ways, including workgroups, presentations, conferences, and technical
assistance sessions. Additionally, in October 2018, HRSA began distributing a series of
nine Auto-HPSA update previews to stakeholders. The purpose of these previews was to
prepare stakeholders for the update that would happen in August 2019, and to show the
projected impact of the update on states and organizations at single points in time.
3. Trafficking Awareness for Health Professionals. — The Committee encourages HRSA

to identify best practices for accredited schools of medicine or nursing to train students in
identifying and responding to human trafficking victims and to respond appropriately to
such individuals. Best practices should be developed in consultation with law
enforcement personnel, social service providers, and other experts in the field of human
trafficking. (Page 38)
Action to be Taken
In FY 2020, HRSA will consult with law enforcement personnel, social service
providers, and other experts in the field of human trafficking to look into the possibility
of supplementing webinar training for grantees that are medical and/or nursing schools.
4. National Health Service Corps Loan Repayment Program. — The Committee

encourages HRSA to conduct a review of the National Health Service Corps Loan
Repayment Program with a specific focus on the qualifications for the program and
whether those qualifications, including designation as an HPSA, alone capture candidates
that effectively address the health care needs of the community. (Page 39)
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Action to be Taken
The National Health Service Corps continues to expand to address the health care needs
of underserved communities. Through continued efforts to capture individuals with the
desired qualifications to effectively address the health care needs of the community,
HRSA plans to apply a funding priority to applicants who have completed HRSA
education and training programs specifically dedicated to providing care to rural and
underserved populations in need. Physicians and physician assistants who have
completed HRSA’s Primary Care Training Enhancement program will be afforded
priority status when applying for NHSC LRP awards in FY 2020. Physicians and
psychiatrists who have completed HRSA’s Addiction Medicine Fellowship program will
be afforded priority status when applying for NHSC LRP awards in FY 2021.
Following are three recent examples of HRSA’s focusing on specific clinician

qualifications to effectively respond to the community’s need for opioid / substance use
disorder treatment.
 HRSA launched the National Health Service Corps Substance Use Disorder
(SUD) Workforce Loan Repayment Program in December 2018 to expand
and improve access to quality opioid use disorder (OUD) and other SUD
treatment in rural and underserved areas nationwide. This opportunity
expanded the scope of SUD treatment providers and sites that are eligible for
participation in the National Health Service Corps Loan Repayment Program;
these include opioid treatment programs, office-based opioid treatment
practices, and non-opioid outpatient SUD sites. HRSA initiated this program
in FY 2019, making 1,074 awards to SUD clinicians, and will continue to
administer this program in FY 2020.
 HRSA launched the NHSC Rural Community Loan Repayment Program in

May 2019 to expand and improve access to quality OUD and other SUD
treatment in underserved areas nationwide. Given the disproportionate impact
of the opioid epidemic on rural areas, the NHSC Rural Community LRP is
making loan repayment awards to rural OUD and SUD treatment providers.
o The Rural Community Loan Repayment Program expands the scope of
SUD treatment providers and sites that are eligible for participation in
the National Health Service Corps Loan Repayment Program,
including opioid treatment programs, office-based opioid treatment
facilities, and non-opioid outpatient SUD treatment facilities.
Providers receive loan repayment to reduce their educational financial
debt in exchange for a service obligation to work at a rural National
Health Service Corps-approved SUD treatment facility. HRSA made
174 Rural Community Loan Repayment Program awards in FY 2019,
and will continue the program in FY 2020.
 In FY 2019 HRSA offered $5,000 incentive awards to current National Health

Service Corps participants who obtained a DATA 2000 Waiver and capable of
providing medication-assisted treatment (MAT). MAT is an evidenced based
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treatment that combines medications, counseling and behavioral therapies,
which is effective in the treatment of OUD and can assist in sustaining
recovery. This increased funding was offered in conjunction with
continuation awards to eligible National Health Service Corps participants. In
addition, it recognized current National Health Service Corps providers that
offer MAT while serving rural and underserved communities. HRSA made
192 of these supplemental awards and will continue the DATA waiver
repayment bonus opportunity in FY 2020.
5. Centers of Excellence. — The Committee commends the Bureau of Health Workforce

(BHW) on the continued implementation of COE and notes that partnerships with HRSA
have allowed minority health professions institutions to address the need for diverse and
culturally competent health professionals that contribute to the healthcare needs of
underrepresented populations. The Committee asks that HRSA report within 120 days of
enactment of this Act on the achievements and challenges of COE and the contribution
COE makes to workforce development. (Page 39)
Action to be Taken
HRSA plans to submit a Report to Congress as requested.
6. Health Careers Opportunity Program. — The Committee encourages BHW to

continue its improvement of the diversity and distribution of needed health care
professionals through National Health Career Opportunity Program Academies
(NHCOPA) and report back to Congress within 120 days of enactment of this Act on the
progress of the NHCOPA pipeline. (Page 39)
Action to be Taken
HRSA plans to submit a Report to Congress as requested.
7. Oral Health Training. — The Committee directs HRSA to provide continuation funding
for predoctoral and postdoctoral training grants initially awarded in fiscal year 2015, and
for section 748 Dental Faculty Loan Program (DFLRP) grants initially awarded in fiscal
years 2016, 2017, 2018 and 2019. (Page 40)
Action to be Taken
Continuation funding for predoctoral and postdoctoral training grants initially awarded in
fiscal year 2015 is not possible as these grants will be concluding their statutorily
mandated five-year project periods in fiscal year 2020. HRSA opened a new competition
for the postdoctoral training program in fiscal year 2020 and plans to provide
continuation funding for the predoctoral training grants initially awarded in fiscal year
2017.
HRSA is planning to provide continuation funding for section 748 Dental Faculty Loan
Program (DFLRP) grants initially awarded in fiscal years 2016, 2017 and 2018. Due to
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increasing continuation commitments last year, HRSA did not make any new awards in
fiscal year 2019 for DFLRP.
8. Area Health Education Centers. — The Committee encourages HRSA to support

AHEC oral health projects that establish primary points of service and address the need to
help patients find treatment outside of hospital emergency rooms. The Committee
encourages HRSA to work with programs that have already been initiated by some State
dental associations to refer emergency room patients to dental networks. (Page 41)
Action to be Taken
Multiple Area Health Education Centers (AHEC) will continue to support oral health
activities through strategic academic-community partnerships with a variety of
organizations including, state dental associations, state departments of health, primary
care offices, and offices of rural health. Such partnerships have led to oral health
initiatives in North Carolina, Hawaii, and Pennsylvania.
The North Carolina AHEC offers programs for dental professionals throughout the state
based on the needs expressed by the North Carolina Dental Society, the State Board of
Dental Examiners, and the North Carolina Dental Hygienists Association. Most recently,
the North Carolina AHEC partnered with the North Carolina Department of Health and
Human Services to provide training to general practice dentists to prepare them to treat
individuals with developmental disabilities. The training highlighted the importance of
increasing various access points for dental care and included a clinical experience with
volunteers from this vulnerable population.
In partnership with the Office of Primary Care and Rural Health, the Hawaii AHEC
collaborated in the planning of the rural health and oral health track of the annual Hawaii
Health Workforce Summit. The Pennsylvania AHEC oral health activities include an
annual Oral Health Conference providing technical assistance to multiple stakeholders
across the state to address unmet oral health needs. In addition, the Colorado AHEC is an
active partner with its state Oral Health Coalition. HRSA will continue to support the
Area Health Education Centers awards to expand access to oral health care, continuing
education opportunities for practicing health care professionals regarding oral health
topics, and increase rural/underserved interprofessional experiential clinical training
experiences.
9. Nurse Practitioner Optional Fellowship Program. — The Committee includes an

increase of $20,000,000 to make grants to establish or expand optional community-based
nurse practitioner fellowship programs that are accredited or in the accreditation process
for practicing postgraduate nurse practitioners (NPs) in primary care or behavioral health.
The Committee directs HRSA to give preference to Federally Qualified Health Centers
(FQHCs), as defined by section 1861(aa)(4) of the Social Security Act. (Page 43)
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Action to be Taken
For FY 2020 HRSA will develop a Notice of Funding Opportunity (NOFO) for an
Advanced Nursing Education - Nurse Practitioner Optional Fellowship (ANE-NPOF)
Program. This program will provide support to academic clinical practice partnerships
between/among one or more each of academic institutions providing advanced nursing
education, and community based clinical organizations providing primary care to rural
and underserved populations.
Successful applicants will be community-based nurse practitioner fellowship programs

that are accredited or in the accreditation process for practicing postgraduate nurse
practitioners (NPs) in primary care or behavioral health. This NOFO will give preference
to Federally Qualified Health Centers (FQHCs), as defined by section 1861(aa)(4) of the
Social Security Act.
10. Medical Student Education. — The Committee includes $40,000,000 to expand support
to colleges of medicine at public universities located in the top quintile of States
projected to have a primary care provider shortage. This is $15,000,000 above the fiscal
year 2019 enacted level and $40,000,000 above the fiscal year 2020 budget request. The
Committee directs HRSA to maintain existing eligibility criteria for the second year of
grants for this program. (Page 44)
Action to be Taken
In FY 2020, HRSA will fund the five unfunded applications from the FY 2019 Notice of
Funding Opportunity. The remaining funds will be provided as supplemental funding to
the FY 2019 awardees.
11. Adverse Childhood Experiences. — The Committee encourages the Maternal and Child
Health Bureau (MCHB) to develop protocols to train professionals to screen, diagnose,
and provide evidence-based interventions to individuals suffering from adverse childhood
experiences such as child abuse and neglect, witnessing interpersonal violence, family
substance abuse, family separation, parental divorce, parental loss, and mental illness, to
promote developmental resiliency. (Page 45)
Action to be Taken
Currently, HRSA addresses ACEs through a variety of programs, including the Title V
State Maternal and Child Health Block Grant program, Maternal, Infant, and Early
Childhood Home Visiting Program, the Healthy Start program, as well as a number of
workforce development and training programs, that improve maternal and child health
across the lifespan. For example:
 Bright Futures, a HRSA-supported initiative led by the American Academy of
Pediatrics (AAP), provides health care professionals and maternal and child
health programs updated recommendations for pediatric health promotion, health
supervision, and anticipatory guidance for well-child visits. These guidelines
provide entry points for discussing adverse experiences with families.
399
 The AAP has created a companion resource to Bright Futures, the HRSA-funded
Trauma Toolbox for Primary Care, for providers. This 6-part series provides
guidance to primary care practitioners that may not be familiar with ACEs or how
to care for families suffering from exposure to ACEs or other traumatic events.
12. Breastfeeding Services and Supplies. — The Committee urges HRSA, during the next
review of the Women’s Preventive Services Guidelines for breastfeeding services and
supplies, to incorporate into the clinical and implementation considerations section of the
guideline: evidence of the critical timeframe for breastfeeding initiation following
delivery; and recommendations for assessing risk factors, initiating milk production and
ensuring that women are able to build supply and sustain breastfeeding in the early post-
partum period (as well as during the antenatal, perinatal, and the postpartum period) in
both pre-term and term infants. (Page 45)
Action to be Taken
Currently, Women’s Preventive Services Guidelines recommends comprehensive
lactation support services (including counseling, education, and breastfeeding equipment
and supplies) during the antenatal, perinatal, and postpartum periods to ensure successful
initiation and maintenance of breastfeeding. In FY 2021, the Women’s Preventive
Services Initiative (WPSI) will undergo an open competition which will include a review
of updated evidence for breastfeeding services and supplies.
13. Infant-Toddler Court Teams. — The Committee expects this increase of $7,000,000
above the fiscal year 2019 enacted level to: (1) build upon the work of sites established
through the Quality Improvement Center for Research-based Infant Toddler Court
Teams, including by providing training and technical assistance in support of such court
teams’ efforts across the country, and (2) support additional outreach sites to start a court
team. (Page 46)
Action to be Taken
In FY 2020, HRSA will increase funding for the Infant Toddler Court Program (ITCP) by
$7 million, for a total of $10 million, consistent with the FY 2020 appropriation. The
ITCP works to address gaps in evidence-based practice and systems coordination for very
young children and families involved in, or at risk for involvement in, the child welfare
system. HRSA currently supports 50 outreach sites through sub-award funding and/or
training and technical assistance. With the additional funding provided in FY 2020,
HRSA will expand the provision of training and technical assistance in support of Infant
Toddler Court teams’ efforts across the country and will expand the number of outreach
sites to start a court team.
14. Maternal Mortality Disparities. — The Committee encourages HRSA to work with
States to collect comprehensive data associated with all pregnancy-associated and
pregnancy-related deaths, regardless of the outcome of the pregnancy. (Page 46)
400
Action to be Taken
In FY 2020, HRSA will continue to support the State Maternal Health Innovation (State
MHI) program, which supports state-led demonstrations to implement evidence-based
interventions to address critical gaps in maternity care service delivery and reduce
maternal mortality. The State MHI program includes activities to support surveillance,
analysis and reporting of maternal health outcome data, including data on racial/ethnic
and geographic disparities. In addition, HRSA’s Title V Maternal and Child Health Block
Grant program supports state data collection and analysis related to maternal health,
maternal mortality and severe maternal morbidity. For example, in FY 2018, of the 39
States that reported having a maternal mortality review process in place, 38 States were
using Title V funds to provide sole or partial support. Fourteen additional States were in
the planning stages for initiating a maternal mortality review process, with Title V
providing sole or partial support in 13 States.
15. Set-aside for Oral Health. — The Committee includes $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 continue to direct the design, monitoring, oversight,
and implementation of these projects. (Page 46)
Action to be Taken
In FY 2019, with consultation/direction from HRSA’s Chief Dental Officer, HRSA
awarded $250,000 to the National Maternal and Child Center for Oral Health Systems
Integration and Improvement program (COHSII) for the Partnership for Integrating Oral
Health Care into Primary Care (PIOHCPC) project. This funding will support the
continued provision of technical assistance, training, and other support for five PIOHCPC
state team projects working to successfully and demonstrably implement the Inter-
professional Oral Health Care Clinical Competencies (IPOHCCC) outlined in the 2014
report Integration of Oral Health and Primary Care Practice.
16. National Living Donor Assistance Center Program. — The Committee urges HRSA to
consider the expansion of NLDAC to reimburse a comprehensive range of living donor
expenses for the greatest possible number of donors, including lost wages, childcare,
eldercare, and similar expenses for donor caretakers and expansion of income eligibility
for the program to allow as many donors as possible to qualify. (Page 50)
Action to be Taken
On July 10, 2019, the President issued an Executive Order on Advancing American
Kidney Health. The Executive Order outlines providing increased support for living
donors to further the goal of significantly increasing the supply of transplantable kidneys
(https://www.whitehouse.gov/presidential-actions/executive-order-advancing-american-
kidney-health/). Section 8 of the Executive Order specifically requires the Secretary of
401
HHS to, in part, “…raise the limit on the income of donors eligible for reimbursement
under the Program….”
In furtherance of that directive in the Executive Order, HRSA plans to amend the
Reimbursement of Travel and Subsistence Expenses toward Living Organ Donation
Program’s eligibility guidelines through the Federal Register Notice toincrease the
household income eligibility threshold for organ recipients, and prospective living organ
donors, from the current 300 percent of the HHS Poverty Guidelines, to a higher
threshold.
On December 20, 2019, HRSA published in the Federal Register a notice of proposed
rulemaking to amend the regulation implementing the National Organ Transplant Act of
1984 (NOTA) to remove financial barriers to organ donation by expanding the scope of
reimbursable expenses incurred by living organ donors to include lost wages, along with
child-care and elder care expenses incurred by a primary care giver.
17. Regenerative Cell Therapy Pilot Registry. — The Committee looks forward to
reviewing the state of the science report required by P.L. 114–104 on using adult stem
cells and birthing tissues to develop new types of therapies for patients, for the purpose of
considering the potential inclusion of such new types of therapies in the C.W. Bill Young
Cell Transplantation Program. (Page 50)
Action to be Taken
In August 2019, the Secretary of Health and Human Services, in consultation with the
Director of the National Institutes of Health, the Commissioner of the Food and Drug
Administration, and the Administrator of the Health Resources and Services
Administration, submitted a report to the Committee on Health, Education, Labor, and
Pensions of the Senate and the Committee on Energy and Commerce of the House of
Representatives outlying recommendations on the appropriateness of new types of
therapies for inclusion in the C.W. Bill Young Transplantation Program (CWBYCTP).
In summary, the report noted that based on considerations from the respective agencies,
members of the Advisory Council on Blood Stem Cell Transplantation, and the
evolution of the field of stem cell-based therapies, the following were recommended
criteria for inclusion of new cellular therapies in the CWBYCTP:
 Should include only those adult stem cell and birthing tissue products, including
those with new uses outside of hematologic or immunologic reconstitution, that:
o Are utilized as treatments for serious or life-threatening conditions, that
require donor matching if appropriate, and,
o Have been demonstrated to be safe and effective as evidenced by FDA
approval, or if FDA approval is not required, through adoption as a standard
of care.
The report further noted that based on the criteria above, the inclusion in the CWBYCTP
of adult stem cells and birthing tissues for uses other than hematologic and immunologic
402
reconstitution is not recommended at this time. The report further stated that as the
science advances and new classes of cell-based products are developed, that meet
regulatory approval standards for safety and efficacy, it may be appropriate to include
such products in the CWBYCTP. Therefore, re-evaluation by HRSA, NIH, and FDA (in
conjunction with appropriate expert consultation) of the status of adult stem cells and
birthing tissues for potential inclusion in the CWBYCTP is recommended on a periodic
basis (every two to three years or as needed), with issuance of a report on the outcomes of
such therapies). A copy of the full report can be found at
https://bloodstemcell.hrsa.gov/sites/default/files/bloodstemcell/about/legislation/2019cwb
illyoungreporttocongress.pdf
18. Attracting Health Care Providers to Rural Communities. — The Committee requests
an update in the fiscal year 2021 Congressional Justification on the best practices and
strategies to attract healthcare practitioners to rural clinics and hospitals in areas with
healthcare professional shortages. (Page 51)
Action to be Taken
Studies show that health care providers who train in rural areas are more likely to practice
in rural areas. In FY 2019, HRSA funded the Rural Residency Planning and
Development (RRPD) program and made 27 awards to organizations across 21 states to
develop newly accredited, sustainable rural residency programs in family medicine,
internal medicine, and psychiatry. HRSA also continues to support the Rural Recruitment
and Retention Network (3RNet), which places health care providers in rural and
underserved practices. In FY 2019, the 3RNet program placed 2,380 clinicians in rural
communities.
19. Coordinating with USDA. — The Committee encourages HRSA, namely the Federal
Office of Rural Health Policy, to coordinate with USDA and, when established, the Rural
Health Liaison to ensure communities have access to the full suite of federal resources
and those resources are used effectively to improve health outcomes. (Page 51)
Action to be Taken
HRSA regularly promotes USDA rural development programs to ensure rural audiences
are aware of these important resources. HRSA also continues to collaborate with USDA
on the establishment of the Rural Health Liaison; HRSA plans to assist USDA with the
development of essential resources, such as a listing of rural health programs and contacts
within HHS, non-HHS rural organizations, and other external stakeholders. Once the
Rural Health Liaison is established, HRSA will continue to work with USDA through the
Liaison to ensure that communities have access to the full suite of federal resources to
effectively improve health outcomes.
20. Telementoring Training Center. — The Committee directs HRSA to give preference to
models of professional education and support that are adaptable to culturally and
regionally diverse populations. (Page 52)
403
Action to be Taken
HRSA will develop a funding announcement for a Telementoring Training Center that
will focus on reaching regionally diverse populations and addressing unique cultural
aspects across rural areas.
21. Telehealth. — The Committee directs HRSA to conduct additional evaluations in
conjunction with an academic medical center not previously funded through the
Telehealth Centers of Excellence program that has experience providing telemedicine
services across the care continuum in medically underserved areas in both rural and urban
settings. (Page 53)
Action to be Taken
HRSA will assess how best to expand telehealth evaluation efforts within the
Telehealth Research Center program.
22. Telehealth Solutions and Virtual Models of Care. — The Committee encourages the
Secretary to consider pilot programs on a variety of telehealth solutions with the goal of
finding an effective, scalable solution to treating substance use disorder in rural
communities where access to care is limited. (Page 53)
Action to be Taken
HRSA will consider ways to leverage its telehealth program resources to focus on
effective telehealth methods for treating substance use disorder in rural communities
within its Evidence-Based Tele-Behavioral Health Network Program that is competitive
in FY 2021.
23. 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 at an executive level authority with resources to oversee and
lead HRSA oral health programs and initiatives. The Committee requests an update in the
fiscal year 2021 Congressional Budget Justification request on how the CDO is serving
as the agency representative on oral health issues to international, national, State or local
government agencies, universities, and oral health stakeholder organizations. (Page 54)
Action to be Taken
The CDO position at HRSA is responsible for: coordinating oral health activities across
all HRSA programs 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 all proposed oral health-related investments across the agency;
leading a variety of cross-agency activities to advance oral health; serving as a featured
speaker at HRSA stakeholder leadership meeting; representing the agency at professional
conferences and meetings with domestic and international audiences; providing
presentations on the agency’s oral health portfolio to a variety of stakeholders; and
overseeing and directing developmental opportunities to increase the oral health
404
professional pipeline including an annual symposium for dental students and residents
interested in federal public health careers.
24. Oral Health Literacy. — The Committee includes $500,000 to continue the
development of an oral health awareness and education campaign across relevant HRSA
divisions, including the Health Centers Program, Oral Health Workforce, Maternal and
Child Health, Ryan White HIV/AIDS Program, and Rural Health. The Committee directs
HRSA to identify oral health literacy strategies that are evidence-based and focused on
oral healthcare prevention and education, including prevention of oral disease such as
early childhood and other caries, periodontal disease, and oral cancer. The Committee
expects the Chief Dental Officer to play a key role in the design, monitoring, oversight,
and implementation of this project. (Page 55)
Action to be Taken
HRSA will collaborate across relevant agency components/programs to develop
evidence-based oral health literacy approaches around early detection, disease
prevention, and oral health promotion. The Chief Dental Officer will be involved in the
design, planning, development, and monitoring of an oral health education campaign for
health center patients, people living with HIV/AIDS, pregnant women and children, and
rural or underserved populations.
405
Vaccine Injury
Compensation
Program
TAB
406
Table of Contents
FY 2021 Budget
Vaccine Injury Compensation Program ........................................................................... 407
Appropriation Language .................................................................................................. 408
Amounts Available for Obligation................................................................................... 409
Budget Authority by Activity .......................................................................................... 410
Budget Authority by Object ............................................................................................. 410
Authorizing Legislation ................................................................................................... 411
Appropriation History Table ............................................................................................ 412
Vaccine Injury Compensation Program ........................................................................... 413
407
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 [$10,200,000] $16,200,000 shall be available from the Trust Fund to the
Secretary.
408
Amounts Available for Obligation
FY 2021
Discretionary Appropriation: $27,675,000 $32,270,000 $44,900,000
Transfer to Other Accounts -$9,200,000
Transfer from Other Accounts $9,200,000
Subtotal, adjusted Discretionary Appropriation $27,675,000 $32,270,000 $44,900,000
Mandatory Appropriation $225,921,000 $260,400,000 $265,600,000

Transfer to Other Accounts -$225,921,000
Transfer from Other Accounts $225,921,000
Subtotal, adjusted Mandatory Appropriation $225,921,000 $260,400,000 $265,600,000
Spending Auth Offsets ---
Administrative Expenses 27,675,000 32,270,000 44,900,000

Total HRSA Claims 225,921,000 260,400,000 265,600,000
Total New Obligations 253,596,000 292,670,000 310,500,000
409
Budget Authority by Activity
FY 2021
Trust Fund Obligations: Post-10/1/88

$225,921,000 $260,400,000 $265,600,000
claims
Administrative Expenses: HRSA
$9,200,000 $10,200,000 $16,200,000
Direct Operations
Total Obligations $235,121,000 $270,600,000 $281,800,000
Budget Authority by Object
FY 2021
FY 2020 President’s FY 2021 +/-
Enacted Budget FY 2020
Insurance claims and indemnities $260,400,000 $265,600,000 +$5,200,000
Salaries & Expenses/Other Services $10,200,000 $16,200,000 +$6,000,000
Total $270,600,000 $281,800,000 +$11,200,000
410
Authorizing Legislation
FY 2021
(a) PHS Act,
Title XXI, Subtitle 2,
Parts A and D:
Pre-FY 1989 Claims --- --- ---
Post-FY 1989 Claims $225,921,000 $260,400,000 $265,600,000
(b) Sec. 6601 (r)d ORBA
of 1989 (P.L. 101-239):
HRSA Operations $9,200,000 $10,200,000 $16,200,000
411
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 --- --- --- ---
2020 --- --- --- ---
2021 --- --- --- ---
412
FY 2021 FY 2021
FY 2020 President’s +/-
FY 2019 Final Enacted Budget FY 2020
Claims BA $225,900,000 $260,400,000 $265,600,000 +$5,200,000
Admin BA $9,200,000 $10,200,000 $16,200,000 +$6,000,000
Total BA $235,100,000 $270,600,000 $281,800,000 +$11,200,000
FTE 19 21 28 +7
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 2021 Authorization ............................................................................................ …....Indefinite
Allocation Method ................................................................................................................... Other
Serving as an alternative to the traditional tort system, the National Vaccine Injury
Compensation Program (VICP) compensates 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 or pregnant women. 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 claim reviews 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
compensation, and DOJ incorporates these recommendations in Rule 4(b) reports 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, healthcare professionals, attorneys, and parents or legal representatives of children who
have suffered vaccine-related injuries or death.
413
Vaccine Injury Compensation Trust Fund
With a current balance of over $3.8 billion, the Vaccine Injury Compensation Trust Fund (Trust
Fund) provides funding for VICP administration and for compensating 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 $0.75 excise tax on vaccines recommended by the
CDC for routine administration to children or pregnant women. The excise tax applies to each
disease prevented per vaccine dose. For example, influenza vaccine is taxed $0.75 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.

Table 1 shows number of petitioners and vaccine injury compensation provided over the last five
years.
Table 1. Growth in Families and Individuals Receiving Compensation
No. of Compensation
Fiscal Year
Petitioners ($ in millions)
2015 508 $226
2016 689 $253
2017 706 $282
2018 522 $227
2019 653 $226
VICP Administration
The number of claims filed has risen 60 percent from 803 claims filed in FY 2015 to 1,282
claims filed in FY 2019, primarily due to the increase in the number of seasonal influenza
vaccine claims filed. During the same period, administrative funding has increased by only 23
percent from $7.5 million to $9.2 million, as shown in Table 2.
In FY 2017, HRSA began a backlog of vaccine injury claims awaiting medical review since the
volume of claims exceeded resources available to conduct medical reviews. This backlog results
in delays in compensating petitioners since claims remain in backlog status for more than ten
months awaiting review. The cumulative claims backlog was 880 claims at the end of FY 2019,
and HRSA anticipates the backlog to grow to 1,060 claims by the end of FY 2020.
414
Table 2. Five-Year Trend in Number of Claims Filed and Administrative Costs
Administrative
No. of Claims
Fiscal Year (FY) Funding
Filed
($ in millions)
2015 803 $7.50
2016 1,120 $7.50
2017 1,243 $7.75
2018 1,238 $9.20
2019 1,282 $9.20
Funding History – VICP Claims Compensation
FY Amount
FY 2017 $282,945,120
FY 2018 $227,082,600
FY 2019 $225,900,000
FY 2020 $260,400,000
FY 2021 $265,600,000
Funding History – VICP Administration
FY Amount
FY 2017 $7,750,000
FY 2018 $9,200,000
FY 2019 $9,200,000
FY 2020 $10,200,000
FY 2021 $16,200,000
Budget Request
VICP Claims Compensation - The FY 2021 Budget Request for VICP claims compensation of
$265.6 million is $5.2 million above the FY 2020 Enacted level. This 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 2021 Budget Request for VICP Administration of $16.2 million
is $6.0 million above the FY 2020 Enacted level. This request will support administrative
expenses to process approximately 1,280 claims filed in FY 2021, including costs associated
with medical expert reviews and expert testimony to the Court. This request will also allow
HRSA to begin a multi-year effort to eliminate the claims backlog.
In FY 2021, HRSA will hire and train additional contractors who will conduct initial medical
reviews of the claims, including the claims in backlog. HRSA will hire and train five physicians
415
to review the contractor’s work, and HRSA will also hire two administrative staff to support
claims processing.
Decreasing the size of the backlog over time depends on the rate of hiring and training of new
staff and contractors. HRSA estimates that it could take multiple years to reduce the backlog. .
In addition, the VICP will continue to provide professional and administrative support to the
ACCV, 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 performance reviews, and information technology and other
program support costs.
Year and
Most Recent
Result/
Target for
26.II.A.1: Percentage of cases
in which judgment awarding
FY 2019: 0%
compensation is rejected and
an election to pursue a civil
(Target Met)
action is filed.
(Outcome)
26.II.A.4: Average time FY 2019: 5
settlements are approved days
from the date of receipt of the Target: 10
10 days 10 days Maintain
DOJ settlement proposal. days
(Efficiency) (Target
Exceeded)
26.II.A.5: Average time that FY 2019: 1.3
lump sum only awards are days
paid from the receipt of all Target: 7 days 4 days 4 days Maintain
required documentation to (Target
make a payment. (Efficiency) Exceeded)
26.II.A.6: Percentage of cases
in which court-ordered FY 2019: 92%
annuities are funded within Target: 98%
98% 98% Maintain
the carrier’s established (Target Not
underwriting deadline. Met)
(Outcome)
416
Year and
Most Recent
Result/
Target for
26.II.A.7: Percentage of
FY 2019:
medical reports that are
75%
completed within 90 days of 75% 75% Maintain
Target: 75%
receipt of any medical
(Target Met)
records. (Efficiency)
26.II.A.8 Percentage of FY
2017 and subsequently filed FY 2019:
claims with any medical 27%
records assigned for medical Target: 65% 65% 65% Maintain
review within 4 months of (Target Not
receipt from the Court. Met)
(Outcome)
417

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DEPARTMENT

MESSAGE FROM THE ADMINISTRATOR

The FY 2021 Budget request:

 Supports the Improving Maternal Health in America Initiative by implementing

Executive Summary ...................................................................................................................... 7

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

PRIMARY HEALTH CARE ..................................................................................................... 63

HEALTH WORKFORCE ......................................................................................................... 80

MATERNAL AND CHILD HEALTH ................................................................................... 178

HEALTHCARE SYSTEMS .................................................................................................... 275

FEDERAL OFFICE OF RURAL HEALTH POLICY ......................................................... 305

Program Management .............................................................................................................. 335

Supplementary Tables .............................................................................................................. 351

Significant Items........................................................................................................................ 390

Vaccine Injury Compensation Program ................................................................................. 407

HRSA supports programs and services that target, for example:

 Behavioral Health Training Programs: total program level $138.9 million

 NURSE Corps: -$5.5 million; total program $83.1 million

 Workforce Training Programs: -$478.6 million; total program $47.2 million

HRSA Goals: Improve access to quality health care and services

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

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

FY 2019 FY 2020 FY 2021

MATERNAL & CHILD HEALTH:

PROGRAM MANAGEMENT 154,568 155,300 151,993 -3,307

Appropriation Table Match 6,822,606 7,037,259 6,289,085 -748,174

Funds Appropriated to Other HRSA Accounts:

Discretionary Program Level:

PRIMARY HEALTH CARE

1988, [$1,626,522,000] $1,728,522,000: Provided, That no more than $1,000,000 shall be

administrative claims made under such law.

Improvement Act of 1986, [$1,194,506,000, of which $138,916,000 shall remain available

provided by masters level, licensed substance use disorder treatment counselors[:Provided

make grants to establish or expand optional community-based nurse practitioner fellowship

care or behavioral health].

MATERNAL AND CHILD HEALTH

RYAN WHITE HIV/AIDS PROGRAM

program, [$2,388,781,000]$2,483,781,000, of which $1,970,881,000 shall remain available to

[$70,000,000]$165,000,000, to remain available until expended, shall be available to the

limitation on administrative expenses.

HEALTH CARE SYSTEMS

Center]$102,033,000: Provided, That in addition to amounts provided herein, $13,385,000 shall

to remain available until expended.

Security Act, [$318,294,000 of which $53,609,000 from general revenues, notwithstanding

$110,000,000 shall be for the Rural Communities Opioids Response Program]$246,834,000.

legislative proposal or candidate for public office.

For program support in the Health Resources and Services Administration,

"Health Care Systems", and "Rural Health".

(a) in subsection (a)(5)(C)—

DISCOUNTS AND DRUG RESALE.—A covered entity shall permit"; and

(2) by inserting at the end the following:

this section are used by the covered entity.

provisions of this section.".

LANGUAGE PROVISION EXPLANATION

[of which $138,916,000 shall remain Language specific to FY 2020 removed.

[Provided further, That, in addition to Specific set-aside language not necessary.

includes clinical substance use disorder

Provided, That in addition to amounts Provision to authorize use of PHS evaluation

further, That notwithstanding section 338J(k)