FY20 Appropriations

On Wednesday morning, September 18, the Senate released a draft of their Fiscal Year (FY)2020 Labor, Health and Human Services (LHHS) appropriations bill. The bill funds LHHS programs at $178.3 billion, a 1 percent increase over FY19 funding levels. The bill’s report language can be found here, and an additional summary can be found here. An updated funding chart for CDC and other important public health programs can be found here.

In May of this year, the House gave STD prevention a $10 million increase for FY20. Unfortunately, the Senate Appropriations Committee did not mirror this increase, and level funded STD prevention. Differences between the House and Senate bills funding levels will be resolved in conference, the process where the Senate and House come to an agreement on their different FY20 appropriations numbers. It is unlikely negotiations will be completed by the end of the fiscal year (Sept. 30), therefore a continuing resolution (CR) will be put in place to keep the government open until all appropriations bills are completed.

While the draft bill fell short in providing a much needed funding increase for STD Prevention, it did contain the below Report Language, detailing how the appropriated money should be spent:

• “The Committee is concerned with recent data showing that CS cases are at the highest level since 1997. The Committee encourages CDC to support prenatal outreach programs in high burden States, for patients, including those with a drug addiction, who are at a high-risk for contracting syphilis. The Committee further encourages CDC to increase awareness of CS through community organizations and inform STD and drug addiction clinics of the importance of multi-testing throughout pregnancy.”
• “The Committee is concerned about the continuing rise in STI rates and recognizes that STIs are associated with increased risk of HIV transmission. Direct funding to States and local health departments is critical in order to reverse this trend. The Committee recommends that CDC continue to provide State and local funding at or near the current percentage of total STI prevention funding to the extent possible given evolving public health needs. The Committee further encourages CDC to continue support for STI training centers.”
• STI Research at NIH: “The Committee continues to be concerned about the prevalence of STIs, especially with the increase in their resistance to multiple classes of antibiotics. The Committee commends NIAID for its efforts in developing new antibiotics specifically to treat gonorrhea and encourages NIAID to continue its work in this area for new treatments, and cures. Further, the Committee encourages NIAID to continue to accelerate the development of screening tests, vaccines, and new treatment options for syphilis, for both adults and newborns.”
• STIs at CMS: “It has been brought to the Committee’s attention that many States are limiting reimbursement for STIs testing to only once a year. This is counter to CDC guidelines, which recommend testing every 3–6 months for those at high risk of the disease and those who are on PrEP. Given that STI rates are at the highest level ever recorded, to prevent, treat, and stop the spread of STIs, the Committee encourages CMS to work with States to achieve consistency with CDC screening and treatment guidelines.”
• STI Action Plan: “The Committee is aware the recent statistics regarding the rise in STIs across the nation and is pleased that the Assistant Secretary for Health is creating a National STD Action Plan to address increasing rates in these diseases. Further, the Committee requests that the Action Plan is responsive to findings included in the National Academy of Public Administration report on ‘‘The Impact of Sexually Transmitted Diseases in the United States: Still Hidden, Getting Worse, Can be Controlled’’. The Committee requests an update in the fiscal year 2021 [budget proposal].”

Continuing Resolution

On the evening of Thursday, September 19, the House passed a CR in order to avoid a government shutdown while the FY20 appropriations process is finalized. The resolution would keep programs funded at FY19 levels, and states there would be no new program starts if they were not funded in the prior year. The CR would begin at the start of the new fiscal year (Oct. 1) through November 21. A quick Senate passage for the CR is expected next week.