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DEPARTMENT OF HEALTH 8< HUMAN SERVICES
Office of the Assistant Secretary for Legislation
Washington, D.C. 20201
JU" 1 a 2012
The Honorable Susan Collins Ranking Member Committee on Homeland Security and Governmental Affairs United States Senate Washington, D.C. 20515 Dear Senator Collins: Secretary Sebelius has asked me to thank you for your letter regarding the Centers for Disease Control and Prevention's (CDC) programs and its proper use of federal funds, and asked me to respond on her behalf. We appreciate your support for wellness and prevention efforts and your commitment to ensuring that federal funds are being used appropriately. The Department of Health and Human Services (HHS) and CDC share your commitment to these principles. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability, accounting for 70 percent of all deaths in the United States. These diseases cause major limitations in daily living for about one out often Americans. Chronic diseases are also costly, accounting for approximately 75 percent of the $2.5 trillion our Nation spends annually on health care, yet chronic diseases are also among the most preventable. Lack of physical activity and poor nutrition-two modifiable risk factors for obesity-and tobacco use are responsible for much of the illness, suffering, and death related to chronic diseases. The Communities Putting Prevention to Work (CPPW) program, funded in FY 2009 through the Recovery Act, is nearing conclusion, with most grantee activity having been completed. Through the program, CDC has worked with award recipients in all 50 states, the District of Columbia, Puerto Rico, and six Pacific Island territories to address chronic disease risk factors, including obesity and tobacco use. These efforts are leading to broad, high-impact, sustainable health outcomes for communities and states across the Nation. CPPW grants are locally-driven initiatives. Awardees proposed and have carried out activities that best met the needs of their citizens and addressed chronic disease burden in their respective communities. CDC provided resources to support awardees' efforts to create healthy environments for their residents. Among the activities awardees could choose to pursue toward these ends, it was permissible to include interaction with policy makers and the public only to the extent the interaction was consistent with applicable lobbying restrictions. Federal law allows many activities that are not considered lobbying and that community awardees may decide to pursue. For example, awardees could use funds to disseminate information about public health problems and sciencebased solutions and to implement specific programs, such as evidence-based educational materials and media on the health effects of increasing physical activity or decreasing exposure
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to secondhand smoke. Engagement in these kinds of activities under CPPW grants is consistent with applicable grant conditions that prohibited use of CDC funds for lobbying activities, discussed below. In creating the CPPW program, Congress recognized the importance of evidence-based" programs designed to reduce chronic diseases. One of CDC's objectives was to provide guidance to potential grantees on the range of effective interventions on tobacco, nutrition, and physical activity that would be responsive to Congressional intent. In the "MAPPS (Media, Access, Point of Decision Information, Price, and Social Support & Services) Interventions for Communities Putting Prevention to Work", CDC provided an extensive menu of interventions that had been reviewed in the literature, as well as expert syntheses from The Community Guide and other peer-reviewed sources, for grantees to use in designing strategies that addressed communityidentified needs. Some of the MAPPS interventions related to nutrition and physical activity are discussed in more detail in another document, "Nutrition and Physical Activity Information for American Recovery and Reinvestment Act (Recovery Act) Communities Putting Prevention to Work". These documents, referenced in your letter, were unique to the CPPW program guidance and have not been used in other CDC grant guidance. There are many effective interventions in the literature and MAPPS that involve a range of activities; however, it is important to note that in designing specific implementation strategies and work plans, grantees were subject to multiple conditions on the appropriate use of CPPW funding, as rioted below. Use of CDC funds for lobbying activities by CPPW grantees and their sub-awardees was prohibited under the CDC grant award. HHS is committed to ensuring the proper use of appropriated funds, and to ensuring awardees' compliance with all applicable regulations and statutes related to lobbying activities, such as Office of Management and Budget (OMB) Circular A;-122: Cost Principles for Non-Profit Organizations; OMB Circular A-87: Cost Principles for State, Local, and Indian Tribal Governments; and our own policy regarding lobbying activities. CDC's policy prohibits lobbying at the federal, state, and local levels. These restrictions apply to all CDC grants, including the CPPW program. All CDC awardees are informed at multiple junctures about the federal laws relating to use of federal funds, including applicable antilobbying provisions. CDC's Additional Requirement 12, "Lobbying Restrictions" (AR-12) (enclosed) states CDC's policy prohibiting awardees from using any appropriated federal funds for "any activity designed to influence action in regard to a particular piece of pending legislation." This lobbying prohibition was included within the respective funding opportunity announcements for the CPPW Communities, States and Territories programs and was also included within the terms and conditions to which each awardee agreed prior to receiving federal "funds. CDC's policy on lobbying by grantees, as expressed in the enclosed AR-12, has been in place for over a decade.
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In addition to making these restrictions part of grant awards, to ensure grantees understood the limits on use of the awards, including limits on application of the MAPPS strategies, CDC staff has provided numerous reminders and conducted trainings for CPPW awardees on these prohibitions, including the following: • Funded CPPW communities were explicitly reminded of the prohibition on using federal funds for lobbying activity during an all-hands teleconference prior to acceptance of their awards on February 17,2010; HHS' s Office of General Counsel reiterated the prohibitions against lobbying and emphasized the restrictions imposed by AR-12 at the CPPW Communities kick-off meeting in April 2010;
• . CPPW State and Territory awardees were reminded of the prohibition on using federal funds for lobbying activity at training sessions in March 2010 and June 2010 as well as at the awardees' Fall Institute 2010 and at a March 2011 training session; and • All CPPW Community awardees were reminded of the prohibition during the CPPW Annual Training held in March 2011. A mandatory meeting for all program managers and principal investigators was held in which the prohibitions outlined in the AR-12 were discussed.
In addition to educating awardees, CDC regularly monitors grantee performance in order to ensure that federal funds are used effectively and appropriately. CDC staff interact with awardees every month to ensure that they are implementing the activities and strategies set forth in the awardee's work plan and that awardees are adhering to administrative requirements, including provisions relating to lobbying. In addition, CDC staff monitors the use of federal funds by awardees using tools such as onsite review and risk mitigation plans. You asked about instances in which we have identified CDC awardees that have used federal funds to pay for lobbying activities. CDC has determined that one CPPW awardee's actions were not in full compliance with the restrictions in AR-12. Specifically, CDC determined that staff funded by a CPPW grant to the South Carolina Department of Health had taken actions including sending email messages and scheduling a press event for the purpose of gaining the support of city council members for a proposed smoke-free ordinance. In response, CDC directed the awardee to cease all current and future prohibited activity, disallowed the costs the awardee incurred in conducting such activities ($248), and required each of the awardee's employees and contractors to attend additional training on AR-12. As noted above, CDC regularly reviews the activities of this and all other grantees and takes action where appropriate.
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In addition to CDC's own direct work with awardees, CDC reviews each instance where a potential violation is brought to our attention, and we are reviewing the three Recovery Actfunded examples cited in your letter. Thus far, CDC has not found among the grantees referenced in your letter any instance in which the anti-lobbying prohibitions have been violated. Many that have been brought to the agency's attention have included excerpts from descriptions of activities that took place before the state or community received federal funds. In other cases, the statements were reporting on activities that were performed by outside organizations not using federal funds. Other excerpts are missing essential context that shows the statements actually describe permissible activities, such as providing evidence-based education on chronic disease prevention interventions. At HHS and CDC we are committed to fulfilling the mandates from Congress to empower communities to pursue high-quality, science-based programs that make a real difference in the health of Americans. CDC's community and state awardees are working hard to reduce the impact of chronic diseases on our population and health system. We are committed to enabling their success and to ensuring that federal funds are used efficiently and appropriately. With this work in prevention we can save lives, better manage our health-care costs, and help Americans be more productive. We appreciate your interest in the CPPW program and we look forward to continuing to work with you to improve our Nation's health.
Jim R. Esquea Assistant Secretary for Legislation
CDC AR-12: Lobbying Restrictions
Applicants should be aware of restrictions on the use of HHS funds for lobbying of Federal or State legislative bodies. 'Under the provisions of 31 U.S.C. Section 1352, recipients (and their sub-tier contractors) are prohibited from using appropriated Federal funds (other than profits from a Federal contract) for lobbying congress or any Federal agency in connection with the award of a particular contract, grant, cooperative agreement, or loan. This includes grants/cooperative agreements that, In whole or in part, involve conferences for which Federal funds cannot be used directly or indirectly to encourage participants to lobby or to instruct participants on how to lobby. In addition no part of CDC appropriated funds, shall be used, other than for normal and recognized executive-legislative relationships, for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio, television, or video presentation designed to support or defeat legislation pending before the Congress or any State or local legislature, except in presentation to the Congress or any State or local legislature itself. No part of the appropriated funds shall be used to pay the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence legislation or appropriations pending before the Congress or any State or local legislature. Any activity designed to influence action in regard to a particular piece of pending legislation would be considered "lobbying." That is lobbying for or against pending legislation, as well as indirect or "grass roots" lobbying efforts by award recipients that are directed at inducing members of the public to contact their elected representatives at the Federal or State levels to urge support of, or opposition to, pending legislative proposals is prohibited. As a matter of policy, CDC extends the prohibitions to lobbying with respect to local legislation and local legislative bodies. The provisions are not intended to prohibit all interaction with the legislative branch, or to prohibit educational efforts pertaining to public health. Clearly there are circumstances when it is advisable and permissible to provide information to the legislative branch in order to foster implementation of prevention strategies to promote public health. However, it would not be permissible to influence, directly or indirectly, a specific piece of pending legislation It remains permissible to use CDC funds to engage in activity to enhance prevention; collect and analyze data; publish and disseminate results of research and surveillance data; implement prevention strategies; conduct community outreach services; provide leadership and training, and foster safe and healthful environments. Recipients of CDC grants and cooperative agreements need to be careful to prevent CDC funds from being used to influence or promote pending legislation. With respect to conferences, public events, publications, and "grassroots" activities that relate to specific legislation, recipients of CDC funds should give close attention to isolating and separating the appropriate use of CDC funds from non-CDC funds. CDC also cautions recipients of CDC funds to be careful not to give the appearance that CDC funds are being used to carry out activities in a manner that is prohibited under Federal law.
Last Updated: December 2011
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