FY19 Labor, Health and Human Services, and Education Appropriations Bill

FY19 Labor, Health and Human Services, and Education Appropriations Bill ASTHO Summary and Analysis Sept. 14, 2018 Last night, Congress released the bipartisan conference report for the FY19 Defense and Labor, Health and Human Services and Education (LHHS) appropriations bill to provide funding for health agencies for the entire FY19, which begins on Oct. 1. Important public health provisions in the bill include: CDC: $7.9 billion and, after accounting for one-time facilities funding in, the legislation provides an increase of $126 million from for CDC on a comparable funding level. The bill also includes $805 million in transfers from the Prevention and Public Health Fund. The bill creates a $50 million infectious disease rapid response fund, where funds only become available for use in the event of a public health emergency. In addition to these provisions, the bill includes $10 million to continue efforts to track children and families affected by the Zika virus and $5 million to address infectious diseases related to the opioid crisis. HRSA: $6.8 billion, a $107 million increase from. This funding includes $678 million, a $26 million increase for the Title V Maternal and Child Health block grant and $122.5 million, an increase of $12 million for the Healthy Start program. SAMHSA: $5.7 billion, a $584 million increase from. The legislation maintains a prohibition on federal funds for the purchase of syringes or sterile needles, but allows communities with rapid increases in cases of HIV and hepatitis to access federal funds for other activities, including substance use counseling and treatment referrals. This funding also includes $1.5 billion for the state opioid response grants. Read the bill s text here, the committee report here, and a summary here. ASTHO s detailed summary and analysis can be found below. Regarding the proposed move of the strategic national stockpile (SNS) from CDC to ASPR, the conference report does not shift the funding from CDC to ASPR and Congress included the report language below. ASTHO received confirmation that keeping the funding at CDC will not impact the transfer of SNS to ASPR, but Congress will be monitoring these developments closely. Report Language on the Strategic National Stockpile (SNS). The conferees direct the Secretary to ensure that the administrative transition of the SNS from CDC to ASPR covers any programmatic or funding gaps that would hinder CDC's ability to continue their ongoing activities related to the SNS or any other ongoing activity. The conferees reiterate that the Secretary is directed to maintain a strong and central role for CDC in the medical countermeasures enterprise. Outlook: The Senate is expected to consider the bill next week and ASTHO anticipates it will be approved by a bipartisan vote. The legislation then moves to the House where it faces a less certain

future. We expect this legislation will need to garner both democrat and republican votes to move the bill to the President s desk for his signature. If you have any questions or concerns, please contact Carolyn Mullen, ASTHO s chief of government affairs and public relations. Centers for Disease Control and Prevention Final FY19/ Immunization and Respiratory Diseases 798,405 798,405 0 Section 317 Immunization Program 610,847 610,847 0 Influenza Planning and Response 187,558 187,558 0 HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention 1,127,278 1,132,278 5,000 Domestic HIV/AIDS Prevention and Research 788,712 788,712 0 Viral Hepatitis 39,000 39,000 0 Sexually Transmitted Infections 157,310 157,310 0 Tuberculosis 142,256 142,256 0 Infectious Disease and Opioids 5,000 5,000 Emerging and Zoonotic Infectious Diseases 614,572 620,372 5,800 Core Infectious Diseases 422,000 424,800 2,800 Antibiotic Resistance Initiative 168,000 168,000 0 Lab Safety and Quality 8,000 8,000 0 Vector borne Diseases 38,603 38,603 0 Lyme Disease 10,700 12,000 1,300 Prion Disease 6,000 6,000 0 Chronic Fatigue Syndrome 5,400 5,400 0 Emerging Infectious Diseases 155,457 156,957 1,500 All Other Infectious Diseases 29,840 29,840 0 Food Safety 58,000 60,000 2,000 National HealthCare Safety Network 21,000 21,000 0 Advanced Molecular Detection 30,000 30,000 0 Epidemiology and Lab Capacity Program 40,000 40,000 0 Healthcare Associated Infections 12,000 12,000 0 Chronic Disease Prevention and Health Promotion 1,162,896 1,187,771 24,875 Tobacco 210,000 210,000 0 Nutrition, Physical Activity and Obesity 54,920 56,920 2,000 School Health 15,400 15,400 0 Health Promotion 18,000 19,000 1,000 Prevention Research Centers 25,461 25,461 0 Heart Disease and Stroke 140,062 140,062 0 2

Diabetes 148,129 148,129 0 National Diabetes Prevention Program 25,300 25,300 0 Cancer Prevention and Control 367,674 371,549 3,875 Oral Health 19,000 19,000 0 Safe Motherhood/Infant Health 46,000 58,000 12,000 Arthritis and Other Chronic Disease 26,000 27,000 1,000 Racial and Ethnic Approach to Community Health 50,950 55,950 5,000 Million Hearts 4,000 4,000 0 National Early Child Care Collaboratives 4,000 4,000 0 Hospitals Promoting Breastfeeding 8,000 8,000 0 Birth Defects, Developmental Disabilities, Disabilities and Health 140,560 155,560 15,000 Child Health and Development 65,800 65,800 0 Health and Development with Disabilities 59,660 62,660 3,000 Public Health Approach to Blood Disorders 4,400 4,400 0 Hemophilia CDC Activities 3,500 3,500 0 Hemophilia Treatment Centers 5,100 5,100 0 Thalassemia 2,100 2,100 0 Surveillance for Emerging Threats to Mothers and Babies 10,000 10,000 Public Health Scientific Services 490,397 496,397 6,000 Environmental Health 205,750 209,350 3,600 Environmental Health Laboratory 63,150 65,750 2,600 Environmental Health Activities 44,600 44,600 0 Climate Change 10,000 10,000 0 Environmental and Health Outcome Tracking Network 34,000 34,000 0 Asthma 29,000 29,000 0 Childhood Lead Poisoning 35,000 35,000 0 Injury Prevention and Control 648,559 648,559 0 Intentional Injury 102,730 102,730 0 National Violent Death Reporting System 23,500 23,500 0 Unintentional Injury 8,800 8,800 0 Injury Prevention Activities 28,950 28,950 0 Opioid Overdose Prevention and Surveillance 475,579 475,579 0 Injury Control Research Centers 9,000 9,000 0 National Institute for Occupational Safety and Health 335,200 336,300 1,100 Global Health 488,621 488,621 0 Public Health Preparedness and Response 1,450,000 1,465,200 15,200 Public Health Emergency Preparedness Cooperative Agreement 670,000 675,000 5,000 Strategic National Stockpile 610,000 610,000 0 3

Preventive Health and Health Services Block Grant 160,000 160,000 0 Infectious Disease Rapid Response Reserve Fund 50,000 50,000 Buildings and Facilities 510,000 30,000-480,000 Total, CDC * 8,301,166 7,947,741-353,425 * After accounting for one-time facilities funding in, the legislation provides an increase of $126 million from for CDC on a comparable funding level. Select Report Language: Infectious Diseases and the Opioid Epidemic. The conferees include $5,000,000 for a new initiative targeting infectious disease consequences of the opioid epidemic. The conferees direct CDC to focus efforts on improving surveillance, treatment, and education efforts around hepatitis B, hepatitis C, and HIV infections as it relates to the opioid epidemic. CDC is directed to prioritize 14 funding for those areas most at risk for outbreaks of HIV and hepatitis due to injection drug use. Harmful Algal Blooms. The conferees provide $1,000,000 to enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months. Farm to School. The conferees include $2,000,000 within Nutrition, Physical Activity, and Obesity for research and education activities related to farm to school programs that result in promoting healthy eating habits for students. High Obesity Counties. The conferees provide $15,000,000 to address obesity in counties as described in Senate Report 115-289. Maternal Mortality Review Committees. The conferees provide $12,000,000 for Maternal Mortality Review Committees as described in Senate Report 115-289. Neonatal Abstinence Syndrome. The conferees provide $2,000,000 for activities related to neonatal abstinence syndrome as directed in section 246 of division B of H.R. 6157 as passed by the Senate on August 23, 2018. Surveillance for Emerging Threats to Mothers and Babies. The conferees include $10,000,000 to support CDC's continued collaboration with State, tribal, territorial, and local health departments to monitor mothers and babies impacted by the Zika virus during pregnancy in the highest risk jurisdictions. This funding will allow CDC to pilot the Zika surveillance/registry system in additional jurisdictions to capture data on other emerging public health threats to mothers and babies, such as opioid use during pregnancy, natural disasters, and pandemic influenza. Opioid Prescription Drug Overdose (PDO) Prevention Activity. The conferees include $475,579,000 for the CDC's PDO activities, the same as the fiscal year 2018 funding level. CDC 4

shall continue to use the provided funds to advance the understanding of the opioid overdose epidemic and scale up prevention activities across all 50 states, Washington, D.C., territories, and Tribes, as well as extend eligibility to local health departments. In addition, CDC shall use $10,000,000 of the funds provided to conduct a nationwide opioid awareness and education campaign. The conferees direct CDC to adhere to guidance included in House report 115-862 and Senate report 115-289 relating to the CDC's PDQ activities. Assistant Secretary for Preparedness and Response Final FY19/ Preparedness and Emergency Operations 24,654 24,654 0 National Disaster Medical System 57,404 57,404 0 Hospital Preparedness Cooperative Formula Grants 264,555 264,555 0 Total 1,639,128 1,689,128 50,000 Health Resources and Services Administration Final FY19/ Bureau of Primary Health Care 1,626,522 1,626,522 0 Health Workforce 1,060,695 1,096,695 36,000 National Health Service Corps 105,000 105,000 0 Maternal and Child Health Bureau 886,789 926,789 40,000 Maternal and Child Health Block Grant 651,700 677,700 26,000 Maternal Mortality 23,000 23,000 Ryan White HIV/AIDS Program 2,318,781 2,318,781 0 Health Care Systems 111,693 115,193 3,500 Rural Health 290,794 317,794 27,000 Family Planning 286,479 286,479 0 Total HRSA 6,736,753 6,843,503 106,750 Select Report Language: Behavioral Health Workforce Education and Training. Funding is included to support the mental health and substance abuse workforce and eligible entities under the Behavioral Health Workforce Education and Training program, including Master's level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health nurse practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals. HRSA should continue to encourage all eligible health professions to apply when applicable and ensure funding for eligible entities, including social work. HRSA should maintain the integrity of this program through an open competition for all eligible entities. 5

National Health Service Corps. The conferees include $105,000,000 for the National Health Service Corps to expand and improve access to quality health care and substance use disorder treatment in rural and other underserved areas nationwide. The conferees continue eligibility for loan repayment awards through the National Health Service Corps for substance use disorder counselors. Of the amount provided, the conferees include $15,000,000 for the Rural Communities 7 Opioid Response within the Office of Rural Health and $15,000,000 for placement at health care facilities within the Indian Health Service. Maternal Mortality. The conferees include $23,000,000 within SPRANS for State Maternal Health Innovation Grants to establish demonstrations to implement evidence-based interventions to address critical gaps in maternity care service delivery and reduce maternal mortality, as described under this heading in Senate Report 115-289. Within this amount, the conferees include up to $1,000,000 for awarding grants for the purchase and implementation of telehealth services. Such amount may include pilots and demonstrations for the use of electronic health records or other necessary technology and equipment (including ultrasound machines or other technology and equipment that may be useful for the care of pregnant women) and may support efforts to coordinate obstetric care between pregnant women living in rural areas and their providers. In addition to this $23,000,000, the conferees include $3,000,000 within SPRANS to expand implementation of the Alliance for Innovation in Maternal Health Initiative's maternal safety bundles to all U.S. States, the District of Columbia, and U.S. territories, as well as tribal entities. Rural Communities Opioids Response. The conferees include $120,000,000 to continue the Rural Communities Opioids Response program. The conferees 10 provide funds to support treatment for and prevention of substance use disorder, focusing on rural communities with the highest risk for substance use disorders. Funds should support activities as described in Senate Report 115-289. In addition to funds provided under this heading, the conferees direct that up to $15,000,000 of the amount provided to the National Health Service Corps be used as part of the Rural Communities Opioids Response program. Within the funding provided, the conferees include an increase of $20,000,000 for the establishment of three Rural Centers of Excellence (Centers) on substance use disorders as directed by Senate Report 115-289. The Centers should provide scientific and technical assistance to county and State health departments and other entities as identified seeking guidance on how to address the substance use disorder challenges in their community. HRSA is directed to establish one such Center at an academic university, in a rural State where the U.S. Census Bureau defines over 60 percent of the population as rural. In addition, the university should be connected to an associated medical school that is already utilizing a collaborative approach to behavioral health care, with partnerships between the university and medical school, and the State has an effective, systems-wide approach to addiction treatment, such as the hub and spoke model. In addition, one Center shall be a publicprivate partnership between a nonprofit and an academic university to provide technical assistance and best practices on the development of recovery housing programs for substance use disorder intervention. This Center shall serve multiple States and be based on an intervention model with a demonstrated track record, including multi-year outcomes data conducted by an academic research institution. Furthermore, the Center shall focus on best practices for successful substance use disorder intervention for low income, high-risk individuals, including those who have been involved with the criminal justice system. Finally, one Center shall be at an academic university located in a State included in the Delta Regional 6

Authority or Appalachian Regional Commission with an overdose death rate for synthetic opioids as determined by the Centers for Disease Control and Prevention higher than a 150 percent change between 2015 and 2016. Substance Abuse and Mental Health Services Administration Final FY19/ Mental Health 1,487,011 1,558,013 71,002 Programs of Regional and National Significance 438,659 395,774-42,885 Community Mental Health Services Block Grant 722,571 722,571 0 Center for Substance Abuse Treatment 3,263,506 3,818,756 555,250 Programs of Regional and National Significance 405,427 460,677 55,250 Substance Abuse Prevention and Treatment Block Grant 1,858,079 1,858,079 0 State Opioid Response Grants* 1,000,000 1,500,000 500,000 Substance Abuse Prevention Programs of Regional and National Significance 248,219 205,469-42,750 Total SAMHSA 5,158,994 5,742,496 583,502 *Note: ASTHO believes this funding is level when compared to. We believe this is due to CURES funding shifting from mandatory to a discretionary program. Select Report Language: SAMHSA. The conferees strongly encourage SAMHSA to include as eligible applicants in new funding opportunity announcements, States, political subdivisions of States, Indian tribes or tribal organizations, health facilities, or programs operated by or in accordance with a contract or grant with the Indian Health Service, or other public or private nonprofit organizations. The conferees strongly encourage SAMHSA to exercise maximum flexibility when developing funding opportunity announcements to ensure that all eligible applicants may apply. National Child Traumatic Stress Initiative. The conferees include an increase of $10,000,000 for the National Child Traumatic Stress Initiative. This increase is for the following activities, which are subject to the first proviso under this heading in the accompanying bill language: (1) $4,000,000 for mental health services for unaccompanied alien children, with a special focus on children who were separated from a parent or family unit and subsequently classified as unaccompanied alien children, (2) $3,000,000 for mental health services for children in Puerto Rico, (3) $1,000,000 to expand access to tribal populations, and (4) $2,000,000 for activities authorized under section 582(d) and (e) of the Public Health Service Act. In order to award funds not later than December 1, 2018, the conferees direct SAMHSA to take administrative action that would provide supplemental awards to existing grantees in the National Child Traumatic Stress Network who have already received Federal funding through a competitive process. 7

Suicide Lifeline. The conferees include $12,000,000 for the National Suicide Prevention Lifeline, an increase of $4,802,000. The conferees support efforts to expand and enhance access to the suicide lifeline nationwide. State Opioid Response Grants. The conferees include $1,500,000,000 for grants to States to address the opioid crisis. Bill language provides $50,000,000 for grants to Indian tribes or tribal organizations. In addition, bill language includes a 15 percent set-aside for States with the highest age-adjusted mortality rate related to opioid use disorders. The conferees direct SAMHSA to adhere to the directives under this heading in Senate Report 115-289. Grants to Prevent Prescription Drug/Opioid Overdose and First Responder Training. The conferees encourage SAMHSA to ensure grantees incorporate robust evidence-based intervention training and facilitate linkage to treatment and recovery services. Medication-Assisted Treatment for Prescription Drug and Opioid Addiction. The conferees include $89,000,000 for the Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program. Within this amount, the conferees include $10,000,000 for grants to Indian tribes, tribal organizations, or consortia. Office of the Secretary Final FY19/ Teen Pregnancy Prevention Community Grants 101,000 101,000 0 Sexual Risk Avoidance 25,000 35,000 10,000 8