HHS Policy on the Use of Federal Funds Michele S. Walsh, M.Ed., CHES Associate Director for Policy and Communication Division of Population Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention NOPREN Webinar, August 10, 2015 National Center for Chronic Disease Prevention and Health Promotion Division of Population Health

OVERVIEW  Introduction and Background  Policy and Public Health  Overview of Federal Restrictions  Tips for Reporting  Questions and Closing

DISCLAIMERS  The contents of this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.  These materials are for training and instructional use only and are not intended as a substitute for professional legal or other advice.  These slides and discussion are only meant as general guidance. As each situation is unique, please do not rely on this as legal advice on any particular set of facts.  Organizations should consult appropriate legal counsel to ensure compliance with all rules, regulations, and restriction of any funding sources.

TRUE OR FALSE? Educating the public on personal health behaviors and choices is an activity CDC is allowed to do through use of federal funds. Note: Whether an activity is allowable or not will be determined by the facts of a specific situation. CDC advises caution regarding the use of federal funds for certain activities, and recommends awardees contact appropriate CDC officials BEFORE engaging in those activities. True. This is an allowable activity.

TRUE OR FALSE? State and local government grantees can work with their own state or local government’s legislative body on policy approaches to health issues, as part of normal executive- legislative relationships. Note: Whether an activity is allowable or not will be determined by the facts of a specific situation. CDC advises caution regarding the use of federal funds for certain activities, and recommends awardees contact appropriate CDC officials BEFORE engaging in those activities. True. This is an allowable activity.

TRUE OR FALSE? State university grantees can work with their own state government’s legislative body on policy approaches to health issues, as part of normal executive-legislative relationships. Note: Whether an activity is allowable or not will be determined by the facts of a specific situation. CDC advises caution regarding the use of federal funds for certain activities, and recommends awardees contact appropriate CDC officials BEFORE engaging in those activities. False. This is an unallowable activity.

TRUE OR FALSE? Non-government organization (NGO) grantees can present materials to elected officials relating to public policies that may require legislative or executive action that do not include an objective or balanced presentation of evidence. Note: Whether an activity is allowable or not will be determined by the facts of a specific situation. CDC advises caution regarding the use of federal funds for certain activities, and recommends awardees contact appropriate CDC officials BEFORE engaging in those activities. False. This is an unallowable activity.

GOVERNMENT’S ROLE? “Government has a responsibility to implement effective public health measures that increase the information available to the public and decision makers, protect people from harm, promote health, and create environments that support healthy behaviors.” – Thomas Frieden, N Engl J Med 2013

FACTORS THAT AFFECT HEALTH Socioeconomic factors Changing the context To make individuals’ default decisions healthier Long-lasting protective interventions Clinical interventions Counseling & education Largest Impact Smallest Impact Examples Poverty, education, housing, inequality Fluoridation, 0g trans fat, iodization, smoke-free laws Immunizations, brief intervention, cessation of treatment, colonoscopy Medication for high blood pressure, high cholesterol, diabetes Eat healthy, be physically active

POLICY AND PUBLIC HEALTH  Vehicle safety  Water fluoridation  Tobacco control

EVIDENCE-BASED STRATEGIES  Policy development is a core function of public health  Conduct rigorous analyses  Identify and report on strategies and policies  Educate the public and stakeholders  Policy development and education are not lobbying  Federal law prohibits the use of federal funds to lobby at the federal, state or local level

SO, WHAT IS “POLICY”? CDC defines “Policy” as a:  Law,  Regulation, procedure, administrative action,  Incentive, or  Voluntary practice of governments and other institutions.

POLICY DEVELOPMENT FRAMEWORK Proceed with caution!

RECENT INTEREST  Congress  Government Accountability Office (GAO)  Office of Inspector General (OIG)  Other

KEY DOCUMENTS ON LOBBYING RESTRICTIONS WITH CDC AWARD DOLLARS AR-12 Anti-Lobbying Restrictions for CDC Grantees Section 503, Appropriations Act OMB Circulars

FY 2014 APPROPRIATIONS ACT Section 503 (a) and (b)  Prohibits lobbying  city councils  county commissions  other local legislative bodies  Includes regulations and administrative actions by state and local executive orders

FY 2014 APPROPRIATIONS ACT Section 503(c) “The prohibitions…include any activity to advocate or promote any … tax increase, or … requirement or restriction on any legal consumer product, including its sale or marketing ….”

FEDERAL ANTI-LOBBYING PROVISIONS UNDER SECTION 503 Even when operating within legal limits, there is a need for continuing attention to:  Policy positions  Congressional intent regarding the use of appropriations  Appropriateness of grantee activities

Direct lobbying by grantees: Grantees are restricted from using federal funds to attempt to influence deliberations or actions by Federal, state, or local legislative or executive branches SNAPSHOT IN GENERAL: WHAT IS PROHIBITED?

Grassroots lobbying: No appropriated Federal funds can be used by CDC awardees for grassroots lobbying SNAPSHOT IN GENERAL: WHAT IS PROHIBITED?

 Non-government entities (NGOs) and public and private Institutions of Higher Education (IHEs), funded by CDC may engage in a range of policy- related activities  But the allowable activities for NGOs and public and private IHEs are more constrained than state and local government grantees according to regulations. WHAT IS ALLOWED FOR NGO S ?

AN EXAMPLE OF WHAT IS ALLOWED?  Compiling and communicating results of research on health issues and policy approaches  Conducting educational campaigns

AN EXAMPLE OF WHAT IS ALLOWED? Balanced Widely disseminated Avoid call to action

Upon formal, written request, providing public officials with technical advice (TA) or assistance concerning evidence of program or policy effectiveness. Under previous and new OMB regulations, all IHEs and NGOs need a formal documented request from the legislative body asking for the TA. EXAMPLE OF WHAT IS ALLOWED?

Presenting materials relating to public policies that may require legislative or executive action that:  Do not include an objective, balanced presentation of evidence, OR  That are only made available to allies or a narrow or selective audience. EXAMPLE OF WHAT IS PROHIBITED?

 Determined by the facts of a specific situation  CDC advises caution and recommends awardees contact appropriate CDC officials BEFORE engaging in those activities. DO NOT ASSUME YOUR ACTIVITIES ARE ALLOWABLE BASED ON THE EXAMPLES

 Are you using CDC funds or other federal funds for this activity?  Do you have a written invitation from the public official?  What is the purpose of meeting with the official?  Time:  When are activities planned/conducted?  Adoption? Implementation?  Are CDC funded communications balanced, objective and widely disseminated? CLARIFYING QUESTIONS

 Ensure that progress reported reflects activities that were completed with federal resources (e.g. your PRC funds).  Attribution: Clarify “We” statements  Ensure language in report clearly describes the role, nature, and purpose of funded activities.  Where possible, focus progress report information on the impact or outcome of grantee activities.  Provide clarifying explanations to information that could be misunderstood.  Refer to the AR-12 and CDC Guidance documents for information on Anti-Lobbying restrictions and guidance on allowable and restricted activities. REPORTING TIPS

Questions? Michele S. Walsh, M.Ed., CHES Associate Director for Policy and Communication Phone: National Center for Chronic Disease Prevention and Health Promotion Division of Population Health