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Executive Summary

AIDS-related activities at the National Institutes of Health would be funded with $800 mil. in fiscal 1991, a $57 mil. or 6.9% increase from FY 1990, under the Bush Administration's budget proposal. The overall Public Health Service HIV/AIDS budget totals $1.7 bil., a 6.8% increase. Among the larger agencies, FDA would receive $63 mil., the Centers for Disease Control would receive$509 mil., the Alcohol, Drug Abuse and Mental Health Administration $230 mil., and the Health Resources and Services Administration$73 mil. A total of 2,862 FTE's (full-time equivalent staff slots) are provided for HIV/AIDS activities. The 6.9% increase for NIH AIDS activities compares to the proposed 4.7% overall budget increase for NIH and a 4.2% inflation rate the Administration projects for 1991. The National Institutes of Health's total budget would be$7.9 bil. in fiscal 1991, under the budget plan. This would provide for 20,439 research project grants, an increase of 123 from 1990. Of the over 20,000 grants, 5,095 would be new and competing awards, up by 492 from the year before. About $4.5 mil. of NIH's budget package is earmarked for basic research. In addition, NIH would receive $108 mil. for the human genome mapping project, a $48 mil. increase over the previous year. The Energy Department would receive another $47.9 mil. for its share of the genome initiative. HHS is highlighting the request of $88.6 mil. for renovation of NIH research facilities, a $28 mil. increase over the previous year. The funds would be used for "crucial infrastructure improvements, the clinical center modernization/safety program, rehabilitation of older laboratory buildings, renovations to NIH animal facilities and several HIV/AIDS research construction projects," according to HHS. The budget also would allow the NIH director to transfer up to 1% of NIH appropriations to "take advantage of emerging research opportunities." In addition, NIH is to create 10 endowed chairs "to foster integration of academic and federal scientists." Elsewhere within PHS, the newly-created Agency for Health Care Policy and Research would receive $39 mil. in direct appropriations plus $71 mil. from other sources such as transfers from the Medicare trust funds. Established by Congress last year, the agency replaces the National Center for Health Services Research -- which was budgeted at a total of $99 mil. in 1990. The agency will continue NCHSR's duties of evaluating new medical technologies for Medicare coverage recommendations. In addition, the agency is housing the department's research program on the outcomes and utilization of specific medical procedures in clinical practice and on developing guidelines for physicians on when to choose specific treatments ("The Pink Sheet" Jan. 22, p. 12). The outcomes research/practice guidelines project is budgeted at $49 mil. in fiscal 1991. At the Health Care Financing Administration, the budget contains several proposals aimed to further Medicare and Medicaid's move into managed care. In one project, dubbed "Medicare Plus," Medicare would contract with preferred provider organizations to administer coverage that integrates Medicare and a beneficiary's private supplemental "Medigap" insurance policy. The Administration also proposes to lower Medicare premiums for beneficiaries who enroll in health maintenance organizations. In Medicaid, the Administration proposes to pay a higher portion of a state's Medicaid costs in states that "promote the use of managed care over traditional fee-for-service arrangements," and relax requirements that states obtain a waiver of federal rules before implementing managed care strategies.

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