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Thursday, February 28, 2013

The Maternal and Child Health Services Block Grant: Background and Funding



Amalia K. Corby-Edwards
Analyst in Public Health and Epidemiology

The Maternal and Child Health (MCH) Services Block Grant program, authorized under Title V of the Social Security Act, is a flexible source of funds that states use to support maternal and child health programs. The program provides grants to states and territories to enable them to coordinate programs, develop systems, and provide a broad range of direct health services. In addition to block grants to states, the MCH Services Block Grant includes a set-aside for Special Projects of Regional and National Significance (SPRANS), and another set-aside for the Community Integrated Service Systems (CISS) program. The Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) administers the block grant. The Maternal and Child Health Bureau of HRSA also receives funding for other maternal and child health programs authorized under both Title V of the Social Security Act and the Public Health Service Act, including maternal and infant home visiting and autism services.

The MCH Services Block Grant received an appropriation of $639 million in FY2012. Of that amount, an estimated $550 million was for block grants to states (86%), $79 million was for SPRANS (12%), and $10 million was for CISS (2%). The President’s budget requested $640 million for the program in FY2013. Funding for the MCH Services Block Grant is discretionary and subject to the annual appropriations process. Full-year appropriations for FY2013 have yet to be enacted and may be subject to sequestration if and when that should take effect. However, a six-month government-wide continuing resolution (CR) was signed into law on September 28, 2012 (P.L. 112-175), which generally maintained funding for discretionary programs at the FY2012 levels, increased by 0.612%.

Title V programs, including the MCH Services Block Grant, serve women and children who are covered by public and private insurance, as well as those who have no insurance coverage. MCH Services Block Grant funds are distributed for the purpose of funding core public health services provided by maternal and child health agencies. These core services are often divided into four categories: infrastructure-building, population-based, enabling, and direct health care. A wide array of programs is supported in each of these categories, including newborn screening, health services for children with special health care needs, and immunization programs. Another main objective of the MCH Services Block Grant is to increase pediatric workforce capacity, and to link low-income children and families to other services and programs, such as Medicaid.

To receive MCH Services Block Grant funds, states are required to (1) conduct a needs assessment every five years; (2) provide an annual report, including program participation data, state maternal and child health measures, and state pediatric and family workforce measures; and (3) ensure that an independent audit is performed every two years. HRSA, in turn, must report to Congress on the activities carried out under the SPRANS and CISS programs, in addition to providing a summary of state reports on block grant activities.

This report provides MCH Services Block Grant background and funding information. It also includes selected program participation data. Selected maternal and child health indicators are presented to provide readers with context on issues that Congress has sought to address through MCH Services Block Grant funding. Although improvement in these measures is an objective of Title V funding, it is important to note that Title V funding is only one component affecting these measures. Other federal and state health and social services and policies, as well as complex societal issues, substantially affect these measures and maternal and child health in general.



Date of Report: January 17, 2013
Number of Pages: 37
Order Number: R42428
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Wednesday, February 27, 2013

Title X (Public Health Service Act) Family Planning Program



Angela Napili
Information Research Specialist

The federal government provides grants for voluntary family planning services through the Family Planning Program, Title X of the Public Health Service Act (42 U.S.C. §§300 to 300a-6). Enacted in 1970, it is the only domestic federal program devoted solely to family planning and related preventive health services. In 2011, Title X-funded clinics served more than 5 million clients.

Title X is administered through the Office of Population Affairs (OPA) in the Department of Health and Human Services (HHS). Although the authorization of appropriations for Title X ended with FY1985, funding for the program has continued through appropriations bills for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor- HHS-Education).

FY2012 funding for Title X was $294 million, 2% less than the FY2011 funding level of $299 million. The Consolidated Appropriations Act, 2012 (P.L. 112-74) continued previous years’ requirements that Title X funds not be spent on abortions, that all pregnancy counseling be nondirective, and that funds not be spent on promoting or opposing any legislative proposal or candidate for public office. Grantees continued to be required to certify that they encourage “family participation” when minors seek family planning services, and certify that they counsel minors on how to resist attempted coercion into sexual activity. The law also clarified that family planning providers are not exempt from state notification and reporting laws on child abuse, child molestation, sexual abuse, rape, or incest.

The President’s FY2013 Budget requests $297 million for Title X, 1% more than the FY2012 funding level. The Senate-reported FY2013 Labor-HHS-Education Appropriations bill would provide $294 million. The draft appropriations bill approved by the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies would provide zero funding for Title X in FY2013. Continuing Appropriations Resolution, 2013 (P.L. 112-175) funds Title X through March 27, 2013, under the same authority and conditions as in FY2012, at an annualized level of $297 million (though the amount may change depending on various factors, such as potential sequestration).

The law (42 U.S.C. §300a-6) prohibits the use of Title X funds in programs where abortion is a method of family planning. According to OPA, family planning projects that receive Title X funds are closely monitored to ensure that federal funds are used appropriately and that funds are not used for prohibited activities such as abortion. The prohibition on abortion does not apply to all the activities of a Title X grantee, but only to activities that are part of the Title X project. A grantee’s abortion activities must be “separate and distinct” from the Title X project activities.

Two bills addressing Title X have been introduced in the 113
th Congress. H.R. 61 and H.R. 217 would prohibit Title X grants to entities that perform abortions, with exceptions for rape, incest, and certain physician-certified cases where the woman is “in danger of death unless an abortion is performed.”


Date of Report: January 23, 2013
Number of Pages: 28
Order Number: RL33644
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Tuesday, February 26, 2013

Drugs, Biologics, and Medical Devices: A Compendium



This Compendium includes a wealth of reports on drugs, biologics and medical devices. The reports included consist of the authority to regulate drug compounding; the law and intellectual property rights of biologics; federal drug discovery and pricing; the FDA’s Safety and Innovation ACT (P.L. 112-114); effects on pharmaceutical innovation and effects of generic brands; infringement and experimental use under the Hatch-Waxman Act. Furthermore, the reauthorization of the Prescription Drug User Fee Act (PDUFA); and how the FDA approves drugs and regulates their safety and effectiveness.

Updated 4-Feb-2013


Date of Report: February 4, 2013
Number of Pages: 313
Order Number: C12010
Price: $79.95

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Health Benefits for Members of Congress



Ada S. Cornell
Information Research Specialist

Members of Congress and retired Members are eligible for private insurance coverage under the same system as other federal employees, the Federal Employees Health Benefits Program (FEHBP). FEHBP is the largest employer-sponsored health plan in the United States, covering more than 8 million federal employees, retirees, and their families.

Retired federal employees, including retired Members, who meet the minimum enrollment period requirements and who are eligible for an immediate annuity may continue to participate in FEHBP in retirement. Current federal employees, including Members of Congress, may also participate in the Federal Flexible Spending Account Program (FSAFEDS) to set up tax-exempt flexible spending accounts for reimbursement of health care, child care, and elder care expenses not otherwise reimbursed or covered by insurance. Current and retired federal employees, including Members of Congress, may enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP) for supplemental dental and vision insurance coverage. They may also apply for long-term care coverage under the Federal Long Term Care Insurance Program (FLTCIP).

All federal employees, including Members of Congress, pay the same payroll taxes as other workers for Medicare Part A coverage, and they are eligible to enroll in Medicare Part B, Part C, and Part D. Current Members, unlike other federal employees, are also eligible to receive health care services from the Office of the Attending Physician in the U.S. Capitol and at military hospitals.

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148) requires health insurance exchanges to be established in every state by January 1, 2014. The ACA requires that the only health plans the federal government may make available to Members of Congress and certain congressional staff as a benefit of their federal employment are health plans created under the ACA or offered through health insurance exchanges established under the ACA. The Director of OPM has resolved a lack of clarity in the law as to the effective date of this provision by concluding that this provision will not be effective until the health insurance exchanges become operational. Therefore, this provision does not currently affect Members of Congress or their staffs’ participation in FEHBP. Regulations providing interpretive guidance have not yet been promulgated as of the date of this report.

This report covers health benefits made available to Members of Congress through federal government employment, including FEHBP, dental and vision insurance, flexible spending accounts, long-term care insurance, services at the Office of the Attending Physician and military hospitals, and Medicare. It also offers a comparison of FEHBP to health benefits offered by the private sector and state and local governments and a discussion of the effect of the ACA on Members’ health benefits.



Date of Report: February 12, 2013
Number of Pages: 10
Order Number: RS21982
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Federal Employees Health Benefits Program (FEHBP): Available Health Insurance Options



Annie L. Mach
Analyst in Health Care Financing

FEHBP is generally available to employees, annuitants, and their dependents. Eligible individuals may elect coverage in an approved health benefits plan for either individual or family coverage. For the 2013 plan year, there are about 230 different plan choices, including all regionally available options. As a practical matter, an individual’s choice of plans is often limited to 10 to 15 different plans, depending on where the individual resides. While enrollees have a range of choices, they typically decide which options best match their needs, the amount of their wages they will contribute to health insurance, and how risk-averse they are to potential out-of-pocket costs.

While most federal employees or annuitants reaching age 65 are automatically entitled to Medicare Part A, Medicare-eligible employees may also voluntarily choose to enroll in Medicare Part B and Part D. For individuals covered under a FEHBP plan as an annuitant, Medicare is the primary payer and FEHBP is the secondary payer. As a secondary payer, FEHBP could cover a share of Medicare deductibles and coinsurance for any services that are covered by both plans, and FEHBP would continue to reimburse for its covered services that are not covered by Medicare.

FEHBP is administered by the Office of Personnel Management (OPM), which is statutorily given the authority to contract with qualified carriers offering plans and to prescribe regulations necessary to carry out the statute, among other duties. Some of OPM’s additional duties include coordinating the administration of FEHBP with employing offices, managing contingency reserve funds for the plans, and applying sanctions to health care providers according to the prescribed regulations.



Date of Report: February 13, 2013
Number of Pages: 27
Order Number: RS21974
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