What Is Government’s Role in Comparing Medical Treatments?

The personalized medicine initiative that President Barack Obama announced on Friday was previewed in the State of the Union address and is scheduled for inclusion in the budget to be released Monday. But in devoting federal funds to this, the administration may have made an argument against another type of medical research funded as part of Obamacare.

Section 6301 of the health-care law creates a Patient-Centered Outcomes Research Institute (PCORI), designed to study the comparative effectiveness of treatment options for diseases. Comparative effectiveness research has proven controversial for several reasons. The idea that the price of various treatments are taken into account, using cost metrics to determine coverage decisions for government health programs, raises the specter of rationed care.

But beyond the potential question of government rationing–and whether the restrictions included in Obamacare are sufficient–lies a more nuanced problem: As one administration scientist noted ahead of the president’s announcement on Friday, “Throughout history most medical treatments were designed for the average patient, meaning they can be very successful for some but not for others.” Comparative effectiveness research involves comparing the effects of treatment on average patients or average groups of patients; others may not benefit, or may even be harmed, by the average treatment or course of action.

The challenge for policymakers and medical professionals is how to respond to the growing personalization of medical treatments. In creating PCORI, Obamacare attempted to acknowledge this trend, noting that the institute should engage in “research and evidence synthesis that considers variations in patient subpopulations.” The president’s new initiative may make such research obsolete. It also raises a different question: When personalized medicine may turn patient “groups” into a subpopulation of one, what is the proper role for the federal government in comparing treatments?

This post was originally published at the Wall Street Journal Think Tank blog.

Roberts Motion to Commit on Rationing

Senator Roberts has offered a motion to commit regarding new bureaucracies that could ration Americans’ care. 
Summary
  • The motion to commit instructs the Finance Committee to report offset amendments that would repeal the Patient-Centered Outcomes Research Institute, the Center for Medicare and Medicaid Innovation, any new functions of the United States Preventive Services Task Force, and the Independent Payment Advisory Board.
Arguments in Favor
  • President Obama has previously made comments that there needs to be a “difficult democratic conversation” about what he views as excessive spending on end-of-life care, raising serious questions about whether or not the new bureaucracies created in the health law will be used to allow government bureaucrats to deny access to life-saving treatments.
  • Several of the President’s senior advisors have also written positively about government bureaucrats intervening in personal health decisions, stating that “waiting lines represent a trade-off between patient costs and capital costs,” and that while “delays in access to high-technology care will, in some instances, lead to worse health for particular patients,” waiting times will “on average…have minimal effects.”
  • Doctors and patients are the best individuals to determine the proper health choices for individuals, not government bureaucrats.

159 Ways H.R. 3590 Is a Government Takeover of Health Care

The Republican Policy Committee has compiled a list of all the new boards, bureaucracies, commissions, and programs created in Democrats’ government takeover of health care:

  1. Grant program for consumer assistance offices (Section 1002, p. 37)
  2. Grant program for states to monitor premium increases (Section 1003, p. 42)
  3. Committee to review administrative simplification standards (Section 1104, p. 71)
  4. Demonstration program for state wellness programs (Section 1201, p. 93)
  5. Grant program to establish state Exchanges (Section 1311(a), p. 130)
  6. State American Health Benefit Exchanges (Section 1311(b), p. 131)
  7. Exchange grants to establish consumer navigator programs (Section 1311(i), p. 150)
  8. Grant program for state cooperatives (Section 1322, p. 169)
  9. Advisory board for state cooperatives (Section 1322(b)(3), p. 173)
  10. Private purchasing council for state cooperatives (Section 1322(d), p. 177)
  11. State basic health plan programs (Section 1331, p. 201)
  12. State-based reinsurance program (Section 1341, p. 226)
  13. Program of risk corridors for individual and small group markets (Section 1342, p. 233)
  14. Program to determine eligibility for Exchange participation (Section 1411, p. 267)
  15. Program for advance determination of tax credit eligibility (Section 1412, p. 288)
  16. Grant program to implement health IT enrollment standards (Section 1561, p. 370)
  17. Federal Coordinated Health Care Office for dual eligible beneficiaries (Section 2602, p. 512)
  18. Medicaid quality measurement program (Section 2701, p. 518)
  19. Medicaid health home program for people with chronic conditions, and grants for planning same (Section 2703, p. 524)
  20. Medicaid demonstration project to evaluate bundled payments (Section 2704, p. 532)
  21. Medicaid demonstration project for global payment system (Section 2705, p. 536)
  22. Medicaid demonstration project for accountable care organizations (Section 2706, p. 538)
  23. Medicaid demonstration project for emergency psychiatric care (Section 2707, p. 540)
  24. Grant program for delivery of services to individuals with postpartum depression (Section 2952(b), p. 591)
  25. State allotments for grants to promote personal responsibility education programs (Section 2953, p. 596)
  26. Medicare value-based purchasing program (Section 3001(a), p. 613)
  27. Medicare value-based purchasing demonstration program for critical access hospitals (Section 3001(b), p. 637)
  28. Medicare value-based purchasing program for skilled nursing facilities (Section 3006(a), p. 666)
  29. Medicare value-based purchasing program for home health agencies (Section 3006(b), p. 668)
  30. Interagency Working Group on Health Care Quality (Section 3012, p. 688)
  31. Grant program to develop health care quality measures (Section 3013, p. 693)
  32. Center for Medicare and Medicaid Innovation (Section 3021, p. 712)
  33. Medicare shared savings program (Section 3022, p. 728)
  34. Medicare pilot program on payment bundling (Section 3023, p. 739)
  35. Independence at home medical practice demonstration program (Section 3024, p. 752)
  36. Program for use of patient safety organizations to reduce hospital readmission rates (Section 3025(b), p. 775)
  37. Community-based care transitions program (Section 3026, p. 776)
  38. Demonstration project for payment of complex diagnostic laboratory tests (Section 3113, p. 800)
  39. Medicare hospice concurrent care demonstration project (Section 3140, p. 850)
  40. Independent Payment Advisory Board (Section 3403, p. 982)
  41. Consumer Advisory Council for Independent Payment Advisory Board (Section 3403, p. 1027)
  42. Grant program for technical assistance to providers implementing health quality practices (Section 3501, p. 1043)
  43. Grant program to establish interdisciplinary health teams (Section 3502, p. 1048)
  44. Grant program to implement medication therapy management (Section 3503, p. 1055)
  45. Grant program to support emergency care pilot programs (Section 3504, p. 1061)
  46. Grant program to promote universal access to trauma services (Section 3505(b), p. 1081)
  47. Grant program to develop and promote shared decision-making aids (Section 3506, p. 1088)
  48. Grant program to support implementation of shared decision-making (Section 3506, p. 1091)
  49. Grant program to integrate quality improvement in clinical education (Section 3508, p. 1095)
  50. Health and Human Services Coordinating Committee on Women’s Health (Section 3509(a), p. 1098)
  51. Centers for Disease Control Office of Women’s Health (Section 3509(b), p. 1102)
  52. Agency for Healthcare Research and Quality Office of Women’s Health (Section 3509(e), p. 1105)
  53. Health Resources and Services Administration Office of Women’s Health (Section 3509(f), p. 1106)
  54. Food and Drug Administration Office of Women’s Health (Section 3509(g), p. 1109)
  55. National Prevention, Health Promotion, and Public Health Council (Section 4001, p. 1114)
  56. Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (Section 4001(f), p. 1117)
  57. Prevention and Public Health Fund (Section 4002, p. 1121)
  58. Community Preventive Services Task Force (Section 4003(b), p. 1126)
  59. Grant program to support school-based health centers (Section 4101, p. 1135)
  60. Grant program to promote research-based dental caries disease management (Section 4102, p. 1147)
  61. Grant program for States to prevent chronic disease in Medicaid beneficiaries (Section 4108, p. 1174)
  62. Community transformation grants (Section 4201, p. 1182)
  63. Grant program to provide public health interventions (Section 4202, p. 1188)
  64. Demonstration program of grants to improve child immunization rates (Section 4204(b), p. 1200)
  65. Pilot program for risk-factor assessments provided through community health centers (Section 4206, p. 1215)
  66. Grant program to increase epidemiology and laboratory capacity (Section 4304, p. 1233)
  67. Interagency Pain Research Coordinating Committee (Section 4305, p. 1238)
  68. National Health Care Workforce Commission (Section 5101, p. 1256)
  69. Grant program to plan health care workforce development activities (Section 5102(c), p. 1275)
  70. Grant program to implement health care workforce development activities (Section 5102(d), p. 1279)
  71. Pediatric specialty loan repayment program (Section 5203, p. 1295)
  72. Public Health Workforce Loan Repayment Program (Section 5204, p. 1300)
  73. Allied Health Loan Forgiveness Program (Section 5205, p. 1305)
  74. Grant program to provide mid-career training for health professionals (Section 5206, p. 1307)
  75. Grant program to fund nurse-managed health clinics (Section 5208, p. 1310)
  76. Grant program to support primary care training programs (Section 5301, p. 1315)
  77. Grant program to fund training for direct care workers (Section 5302, p. 1322)
  78. Grant program to develop dental training programs (Section 5303, p. 1325)
  79. Demonstration program to increase access to dental health care in underserved communities (Section 5304, p. 1331)
  80. Grant program to promote geriatric education centers (Section 5305, p. 1334)
  81. Grant program to promote health professionals entering geriatrics (Section 5305, p. 1339)
  82. Grant program to promote training in mental and behavioral health (Section 5306, p. 1344)
  83. Grant program to promote nurse retention programs (Section 5309, p. 1354)
  84. Student loan forgiveness for nursing school faculty (Section 5311(b), p. 1360)
  85. Grant program to promote positive health behaviors and outcomes (Section 5313, p. 1364)
  86. Public Health Sciences Track for medical students (Section 5315, p. 1372)
  87. Primary Care Extension Program to educate providers (Section 5405, p. 1404)
  88. Grant program for demonstration projects to address health workforce shortage needs (Section 5507, p. 1442)
  89. Grant program for demonstration projects to develop training programs for home health aides (Section 5507, p. 1447)
  90. Grant program to establish new primary care residency programs (Section 5508(a), p. 1458)
  91. Program of payments to teaching health centers that sponsor medical residency training (Section 5508(c), p. 1462)
  92. Graduate nurse education demonstration program (Section 5509, p. 1472)
  93. Grant program to establish demonstration projects for community-based mental health settings (Section 5604, p. 1486)
  94. Commission on Key National Indicators (Section 5605, p. 1489)
  95. Quality assurance and performance improvement program for skilled nursing facilities (Section 6102, p. 1554)
  96. Special focus facility program for skilled nursing facilities (Section 6103(a)(3), p. 1561)
  97. Special focus facility program for nursing facilities (Section 6103(b)(3), p. 1568)
  98. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 6112, p. 1589)
  99. Demonstration projects for nursing facilities involved in the culture change movement (Section 6114, p. 1597)
  100. Patient-Centered Outcomes Research Institute (Section 6301, p. 1619)
  101. Standing methodology committee for Patient-Centered Outcomes Research Institute (Section 6301, p. 1629)
  102. Board of Governors for Patient-Centered Outcomes Research Institute (Section 6301, p. 1638)
  103. Patient-Centered Outcomes Research Trust Fund (Section 6301(e), p. 1656)
  104. Elder Justice Coordinating Council (Section 6703, p. 1773)
  105. Advisory Board on Elder Abuse, Neglect, and Exploitation (Section 6703, p. 1776)
  106. Grant program to create elder abuse forensic centers (Section 6703, p. 1783)
  107. Grant program to promote continuing education for long-term care staffers (Section 6703, p. 1787)
  108. Grant program to improve management practices and training (Section 6703, p. 1788)
  109. Grant program to subsidize costs of electronic health records (Section 6703, p. 1791)
  110. Grant program to promote adult protective services (Section 6703, p. 1796)
  111. Grant program to conduct elder abuse detection and prevention (Section 6703, p. 1798)
  112. Grant program to support long-term care ombudsmen (Section 6703, p. 1800)
  113. National Training Institute for long-term care surveyors (Section 6703, p. 1806)
  114. Grant program to fund State surveys of long-term care residences (Section 6703, p. 1809)
  115. CLASS Independence Fund (Section 8002, p. 1926)
  116. CLASS Independence Fund Board of Trustees (Section 8002, p. 1927)
  117. CLASS Independence Advisory Council (Section 8002, p. 1931)
  118. Personal Care Attendants Workforce Advisory Panel (Section 8002(c), p. 1938)
  119. Multi-state health plans offered by Office of Personnel Management (Section 10104(p), p. 2086)
  120. Advisory board for multi-state health plans (Section 10104(p), p. 2094)
  121. Pregnancy Assistance Fund (Section 10212, p. 2164)
  122. Value-based purchasing program for ambulatory surgical centers (Section 10301, p. 2176)
  123. Demonstration project for payment adjustments to home health services (Section 10315, p. 2200)
  124. Pilot program for care of individuals in environmental emergency declaration areas (Section 10323, p. 2223)
  125. Grant program to screen at-risk individuals for environmental health conditions (Section 10323(b), p. 2231)
  126. Pilot programs to implement value-based purchasing (Section 10326, p. 2242)
  127. Grant program to support community-based collaborative care networks (Section 10333, p. 2265)
  128. Centers for Disease Control Office of Minority Health (Section 10334, p. 2272)
  129. Health Resources and Services Administration Office of Minority Health (Section 10334, p. 2272)
  130. Substance Abuse and Mental Health Services Administration Office of Minority Health (Section 10334, p. 2272)
  131. Agency for Healthcare Research and Quality Office of Minority Health (Section 10334, p. 2272)
  132. Food and Drug Administration Office of Minority Health (Section 10334, p. 2272)
  133. Centers for Medicare and Medicaid Services Office of Minority Health (Section 10334, p. 2272)
  134. Grant program to promote small business wellness programs (Section 10408, p. 2285)
  135. Cures Acceleration Network (Section 10409, p. 2289)
  136. Cures Acceleration Network Review Board (Section 10409, p. 2291)
  137. Grant program for Cures Acceleration Network (Section 10409, p. 2297)
  138. Grant program to promote centers of excellence for depression (Section 10410, p. 2304)
  139. Advisory committee for young women’s breast health awareness education campaign (Section 10413, p. 2322)
  140. Grant program to provide assistance to provide information to young women with breast cancer (Section 10413, p. 2326)
  141. Interagency Access to Health Care in Alaska Task Force (Section 10501, p. 2329)
  142. Grant program to train nurse practitioners as primary care providers (Section 10501(e), p. 2332)
  143. Grant program for community-based diabetes prevention (Section 10501(g), p. 2337)
  144. Grant program for providers who treat a high percentage of medically underserved populations (Section 10501(k), p. 2343)
  145. Grant program to recruit students to practice in underserved communities (Section 10501(l), p. 2344)
  146. Community Health Center Fund (Section 10503, p. 2355)
  147. Demonstration project to provide access to health care for the uninsured at reduced fees (Section 10504, p. 2357)
  148. Demonstration program to explore alternatives to tort litigation (Section 10607, p. 2369)
  149. Indian Health demonstration program for chronic shortages of health professionals (S. 1790, Section 112, p. 24)*
  150. Office of Indian Men’s Health (S. 1790, Section 136, p. 71)*
  151. Indian Country modular component facilities demonstration program (S. 1790, Section 146, p. 108)*
  152. Indian mobile health stations demonstration program (S. 1790, Section 147, p. 111)*
  153. Office of Direct Service Tribes (S. 1790, Section 172, p. 151)*
  154. Indian Health Service mental health technician training program (S. 1790, Section 181, p. 173)*
  155. Indian Health Service program for treatment of child sexual abuse victims (S. 1790, Section 181, p. 192)*
  156. Indian Health Service program for treatment of domestic violence and sexual abuse (S. 1790, Section 181, p. 194)*
  157. Indian youth telemental health demonstration project (S. 1790, Section 181, p. 204)*
  158. Indian youth life skills demonstration project (S. 1790, Section 181, p. 220)*
  159. Indian Health Service Director of HIV/AIDS Prevention and Treatment (S. 1790, Section 199B, p. 258)*

 

*Section 10221, page 2173 of H.R. 3590 deems that S. 1790 shall be deemed as passed with certain amendments.

New Federal Bureaucracies Created in the Pelosi Health Care Bill

The House Republican Conference has compiled a list of all the 120 new boards, bureaucracies, commissions, and programs created in H.R. 3962, Speaker Pelosi’s government takeover of health care:

  1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
  2. Grant program for wellness programs to small employers (Section 112, p. 62)
  3. Grant program for State health access programs (Section 114, p. 72)
  4. Program of administrative simplification (Section 115, p. 76)
  5. Health Benefits Advisory Committee (Section 223, p. 111)
  6. Health Choices Administration (Section 241, p. 131)
  7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
  8. Health Insurance Exchange (Section 201, p. 155)
  9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
  10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
  11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
  12. State-based Health Insurance Exchanges (Section 308, p. 197)
  13. Grant program for health insurance cooperatives (Section 310, p. 206)
  14. “Public Health Insurance Option” (Section 321, p. 211)
  15. Ombudsman for “Public Health Insurance Option” (Section 321(d), p. 213)
  16. Account for receipts and disbursements for “Public Health Insurance Option” (Section 322(b), p. 215)
  17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
  18. Demonstration program providing reimbursement for “culturally and linguistically appropriate services” (Section 1222, p. 617)
  19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
  20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
  21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
  22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
  23. Independence at home demonstration program (Section 1312, p. 718)
  24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
  25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
  26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
  27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
  28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
  29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
  30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
  31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
  32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
  33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
  34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
  35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
  36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
  37. Nursing facility supplemental payment program (Section 1745, p. 1106)
  38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
  39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
  40. “Identifiable office or program” within CMS to “provide for improved coordination between Medicare and Medicaid in the case of dual eligibles” (Section 1905, p. 1191)
  41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
  42. Public Health Investment Fund (Section 2002, p. 1214)
  43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)
  44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
  45. Grant program for training in dentistry programs (Section 2215, p. 1240)
  46. Public Health Workforce Corps (Section 2231, p. 1253)
  47. Public health workforce scholarship program (Section 2231, p. 1254)
  48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
  49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
  50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
  51. Prevention and Wellness Trust (Section 2301, p. 1286)
  52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
  53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
  54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
  55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
  56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
  57. Grant program for public health infrastructure (Section 2301, p. 1313)
  58. Center for Quality Improvement (Section 2401, p. 1322)
  59. Assistant Secretary for Health Information (Section 2402, p. 1330)
  60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
  61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
  62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
  63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
  64. “No Child Left Unimmunized Against Influenza” demonstration grant program (Section 2524, p. 1391)
  65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
  66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
  67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
  68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
  69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
  70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
  71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
  72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
  73. Grant program for community-based collaborative care (Section 2534, p. 1440)
  74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
  75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
  76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
  77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
  78. Council for Emergency Care (Section 2552, p 1479)
  79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
  80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
  81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
  82. National Medical Device Registry (Section 2571, p. 1501)
  83. CLASS Independence Fund (Section 2581, p. 1597)
  84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
  85. CLASS Independence Advisory Council (Section 2581, p. 1602)
  86. Health and Human Services Coordinating Committee on Women’s Health (Section 2588, p. 1610)
  87. National Women’s Health Information Center (Section 2588, p. 1611)
  88. Centers for Disease Control Office of Women’s Health (Section 2588, p. 1614)
  89. Agency for Healthcare Research and Quality Office of Women’s Health and Gender-Based Research (Section 2588, p. 1617)
  90. Health Resources and Services Administration Office of Women’s Health (Section 2588, p. 1618)
  91. Food and Drug Administration Office of Women’s Health (Section 2588, p. 1621)
  92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
  93. Grant program for national health workforce online training (Section 2591, p. 1629)
  94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
  95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
  96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)
  97. Program of Indian community education on mental illness (Section 3101, p. 1722)
  98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
  99. Office of Indian Men’s Health (Section 3101, p. 1765)
  100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
  101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
  102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
  103. Urban youth treatment center demonstration project (Section 3101, p. 1873)
  104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
  105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
  106. Mental health technician training program (Section 3101, p. 1898)
  107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
  108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
  109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
  110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
  111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)
  112. Grant program for mental health and substance abuse screening (Manager’s Amendment, p. 31)
  113. Centers for Disease Control Office of Minority Health (Manager’s Amendment, p. 35)
  114. Substance Abuse and Mental Health Services Administration Office of Minority Health (Manager’s Amendment, p. 35)
  115. Agency for Healthcare Research and Quality Office of Minority Health (Manager’s Amendment, p. 36)
  116. Health Resources and Services Administration Office of Minority Health (Manager’s Amendment, p. 36)
  117. Food and Drug Administration Office of Minority Health (Manager’s Amendment, p. 36)
  118. Outreach program to increase awareness of diabetes screening benefits (Manager’s Amendment, p. 39)
  119. Grant program to develop medical schools in shortage areas (Manager’s Amendment modification, p. 2)
  120. Demonstration program of incentive payments for National Health Service Corps (Manager’s Amendment modification, p. 4)