	Introduction to the PHS Agencies

The Department of Health and Human Services (HHS) has designated 8 of its 11 operating divisions (agencies) as components of the U.S. Public Health Service (PHS). The PHS agencies are (1) the Agency for Healthcare Research and Quality (AHRQ), (2) the Agency for Toxic Substances and Disease Registry (ATSDR), (3) the Centers for Disease Control and Prevention (CDC), (4) the Food and Drug Administration (FDA), (5) the Health Resources and Services Administration (HRSA), (6) the Indian Health Service (IHS), (7) the National Institutes of Health (NIH), and (8) the Substance Abuse and Mental Health Services Administration (SAMHSA). NIH conducts and supports basic, clinical, and translational medical research. AHRQ conducts and supports research on the quality and effectiveness of health care services and systems. IHS supports a health care delivery system for American Indians and Alaska Natives. SAMHSA funds community-based mental health and substance abuse prevention and treatment services. ATSDR, which is headed by the CDC director and included in the CDC section of this report, is tasked with identifying potential public health effects from exposure to hazardous substances. In FY2013, for example, NIH was the primary source of transfers both to CMS for ACA implementation and to CDC and SAMHSA to help offset a loss of funding for those two agencies from the ACA's Prevention and Public Health Fund (PPHF, discussed below). Mandatory Funding, User Fees, and Collections

Although the bulk of PHS agency funding is provided through annual discretionary appropriations, agencies also receive mandatory funding, user fees, and third-party collections. Prevention and Public Health Fund (PPHF) . A table showing the allocation of annual PPHF funding by agency since FY2010 is provided in Appendix C . Patient-Centered Outcomes Research Trust Fund (PCORTF) . FDA's user fee programs now support the agency's regulation of prescription drugs, animal drugs, medical devices, tobacco products, and some foods, among other activities. In FY2017, user fees account for 41% of the agency's funding. Almost all of the CDC accounts, for example, are funded with discretionary appropriations plus amounts from other sources (see Table 5 ). From FY2003 through FY2014, AHRQ did not receive its own annual discretionary appropriation. In FY2015, AHRQ received its own discretionary appropriation for the first time in more than a decade in lieu of any set-aside funding. This trend continued in FY2016 and FY2017, with the agency receiving its own discretionary appropriation and no set-aside funds. Most of CDC's spending is extramural. In FDA's annual appropriation, Congress sets both the total amount of appropriated funds and the amount of user fees that the agency is authorized to collect and obligate for that fiscal year. Recent Trends in Agency Funding

HRSA funding increased from $8.1 billion in FY2010 to $10.7 billion in FY2017; this increase occurred despite a reduction in the agency's discretionary appropriation during that time (see Table 7 ). Recent Trends in Agency Funding

IHS's funding, which includes discretionary appropriations and collections from third-party payers of health care, increased between FY2010 and FY2017 from $5.1 billion to $6.3 billion (see Table 8 ). National Institutes of Health (NIH)75

		Agency Overview

NIH is the primary agency of the federal government charged with performing and supporting biomedical and behavioral research. 244 ; P.L. Recent Trends in Agency Funding

SAMHSA's program-level funding increased by 13% from FY2016 ($3.8 billion) to FY2017 ($4.3 billion). As discussed earlier in this report, the FY2016 CHCF funding was not subject to sequestration.
Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS). The PHS agencies are funded primarily with annual discretionary appropriations. They also receive significant amounts of funding from other sources, including mandatory funds from the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), user fees, and third-party reimbursements (collections).
The Agency for Healthcare Research and Quality (AHRQ) funds research on improving the quality and delivery of health care. For more than a decade prior to FY2015, AHRQ did not receive its own annual appropriation. Instead, it relied on redistributed ("set-aside") discretionary funds from other PHS agencies for most of its funding, with supplemental amounts from the ACA's mandatory Patient-Centered Outcomes Research Trust Fund (PCORTF). Since FY2015, AHRQ has received an annual appropriation in lieu of any set-aside funds. The agency's FY2017 funding level of $417 million was $11 million less than the FY2016 level of $428 million. The Centers for Disease Control and Prevention (CDC) is the federal government's lead public health agency. CDC obtains its funding from multiple sources besides discretionary appropriations. The Agency for Toxic Substances and Disease Registry (ATSDR) investigates the public health impact of exposure to hazardous substances. ATSDR is headed by the CDC director and included in the discussion of CDC in this report. The CDC/ATSDR funding level decreased from $12.2 billion in FY2016 to $12.1 billion in FY2017. The Food and Drug Administration (FDA) regulates drugs, medical devices, food, and tobacco products, among other consumer products. The agency is funded with annual discretionary appropriations and industry user fees. The agency's funding levels for FY2016 and FY2017 remained constant at about $4.7 billion, with user fees accounting for 41% of FDA's total FY2017 funding. The Health Resources and Services Administration (HRSA) funds programs and systems that provide health care services to the uninsured and medically underserved. HRSA, like CDC, relies on funding from several different sources. The agency's funding decreased from $10.8 billion in FY2016 to $10.7 billion in FY2017. The Indian Health Service (IHS) supports a health care delivery system for Native Americans. IHS's funding, which includes discretionary appropriations and collections from third-party payers of health care, increased between FY2016 and FY2017 from $6.2 billion to $6.4 billion. Appropriations increased during that period, while collections stayed the same in both fiscal years. The National Institutes of Health (NIH) funds basic, clinical, and translational biomedical and behavioral research. NIH gets more than 99% of its funding from discretionary appropriations. Recent increases in NIH's annual appropriations have boosted its funding level to a new high of $34.1 billion in FY2017, compared with $32.3 billion in FY2016. The Substance Abuse and Mental Health Services Administration (SAMHSA) funds mental health and substance abuse prevention and treatment services. SAMHSA's funding, about 95% of which comes from discretionary appropriations, was approximately $3.8 billion in FY2016 and $4.3 billion in FY2017.
This report supersedes two earlier products, both of which remain available: CRS Report R43304, Public Health Service Agencies: Overview and Funding (FY2010-FY2016), and CRS Report R44505, Public Health Service Agencies: Overview and Funding (FY2015-FY2017).