(FY) 2020 Budget Proposal
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DEPARTMENT OF HEALTH AND HUMAN SERVICES 200 INDEPENDENCE AVENUE S.W., WASHINGTON, D.C. 20201 THIS DOCUMENT IS ALSO AVAILABLE AT HTTP://WWW.HHS.GOV/BUDGET TABLE OF CONTENTS Overview ...................................................................................................................................................1 Lowering the Cost of Prescription Drugs ..................................................................................................12 Food and Drug Administration .................................................................................................................21 Health Resources and Services Administration ........................................................................................29 Indian Health Service ................................................................................................................................36 Centers for Disease Control and Prevention ............................................................................................43 National Institutes of Health ....................................................................................................................52 Substance Abuse and Mental Health Services Administration ................................................................60 Centers for Medicare & Medicaid Services ..............................................................................................65 Empowering States and Consumers to Reform Health Care .............................................................68 Medicare ............................................................................................................................................74 Program Integrity ...............................................................................................................................89 Medicaid .............................................................................................................................................98 Children’s Health Insurance Program ................................................................................................108 State Grants and Demonstrations ......................................................................................................112 Center for Medicare and Medicaid Innovation ..................................................................................114 Program Management .......................................................................................................................118 Administration for Children and Families.................................................................................................122 Discretionary Programs ......................................................................................................................123 Mandatory Programs .........................................................................................................................127 Administration for Community Living ......................................................................................................136 Office of the Secretary ..............................................................................................................................140 General Departmental Management .................................................................................................140 Office of Medicare Hearings and Appeals ..........................................................................................142 Office of the National Coordinator for Health Information Technology ...........................................144 Office for Civil Rights ..........................................................................................................................147 Office of Inspector General ......................................................................................................................149 Public Health and Social Services Emergency Fund .................................................................................152 Abbreviations and Acronyms ...................................................................................................................157 PUTTING AMERICA’S HEALTH FIRST FY 2020 President’s Budget for HHS dollars in millions 2018 2019/1 2020 Budget Authority /2 1,176,503 1,274,242 1,292,523 Total Outlays 1,120,647 1,230,614 1,286,434 1/ The FY 2019 funding level reflects FY 2019 Enacted for all of HHS except for FDA, IHS, and small components of CDC and NIH, which reflect the FY 2019 Annualized CR, including any funding anomalies and directed or permissive transfers (where applicable). 2/ The Budget Authority levels presented here are based on the Appendix, and potentially differ from the levels displayed in the individual Operating or Staff Division Chapters. General Notes Numbers in this document may not add to the totals due to rounding. Budget data in this book are presented “comparably” to the FY 2020 Budget, since the location of programs may have changed in prior years or be proposed for change in FY 2020. This approach allows increases and decreases in this book to reflect true funding changes. The FY 2019 and FY 2020 mandatory figures reflect current law and mandatory proposals reflected in the Budget. 1 PUTTING AMERICA’S HEALTH FIRST The mission of the U.S. Department of Health and Human Services (HHS) is to enhance and protect the health and well-being of all Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. The President’s Fiscal Year (FY) 2020 Budget supports costs, improve transparency, and end foreign free- HHS’s mission by prioritizing key investments that work riding. Congress has already taken bipartisan action to towards fulfilling the Administration’s commitments to end pharmacy gag clauses, so patients can work with improve American health care, address the opioid pharmacists to lower their out-of-pocket costs. The crisis, lower the cost of drugs, and streamline federal Budget proposes to: programs. The Budget reforms the Department’s Stop regulatory tactics used by brand programs to better serve and safeguard the American manufacturers to impede generic competition; people, while prioritizing key investments within them. Ensure federal and state programs get their fair share of rebates, and enact inflation The Budget proposes $87.1 billion in discretionary penalties to prevent the growth of prescription budget authority and $1.2 trillion in mandatory funding drug prices beyond inflation; for HHS. It reflects HHS’s commitment to making the Improve the Medicare Part D program to lower federal government more efficient and effective by seniors’ out-of-pocket costs, create an focusing spending in areas with the highest impact. out-of-pocket cap for the first time, and end the incentives that reward list price increases; REFORM, STRENGTHEN, AND MODERNIZE THE Improve transparency and accuracy of NATION’S HEALTH CARE SYSTEM payments under Medicare Part B, including imposing payment penalties to discourage pay- Reforming the Individual Market for Insurance for-delay agreements; and The Budget proposes bold reforms to build a stronger Build on America’s successful generic market health care system and fix the damage done by with a robust biosimilars agenda, by improving Obamacare. These reforms return the management of the efficient approval of safe and effective health care to the states, which are more capable of biosimilars, ending anti-competitive practices tailoring programs to their unique markets, increasing that delay or restrict biosimilar market entry, options for patients and providers, and promoting and harnessing payment and cost-sharing financial stability and responsibility, while protecting incentives to increase biosimilar adoption. people with pre-existing conditions and high health care costs. Reforming Medicare and Medicaid Millions of Americans rely on Medicare and Medicaid The Budget includes proposals to make it easier to for their health care. The Budget supports reforms to open and use Health Savings Accounts and reform the make these programs work better for the people they medical liability system to allow providers to focus on serve and reduce unnecessary spending. The FY 2020 patients instead of lawsuits. Medicare budget aligns incentives within the Part D program to lower drug costs, continues to drive Lowering the Cost of Prescription Drugs Medicare toward a value-based payment system, and Putting America’s health first includes improving access combats the opioid crisis. The FY 2020 Medicaid to safe, effective, and affordable prescription drugs. budget provides additional flexibility to states, puts The Budget proposes to expand the Administration’s Medicaid on a path to fiscal stability by restructuring its work to lower prescription drug prices and reduce financing and reducing waste, and refocuses on the beneficiary out-of-pocket costs. The Administration low-income populations Medicaid was originally has proposed and, in many cases, made significant intended to serve: the elderly, people with disabilities, strides to implement bold regulatory reforms to children, and pregnant women. increase competition, improve negotiation, create incentives to lower list prices, reduce out-of-pocket 2 Paying for Value In FY 2020, the Health Resources and Services The Administration is focused on ensuring federal